Gastrointestinal Disorders in Pediatric Patients

1. Gastrointestinal Disorders in Pediatric Patients Marlene Meador RN, MSN Fall 2006

2. Cleft Lip and Cleft Palate • Etiology- Failure of maxillary and median nasal processes to fuse during embryonic development Remember the psycho-social implications for these children and families

3. photos

4. Assessment • Unilateral, bilateral, midline

5. Treatment • Surgical repair done ASAP • Rule of 10 > 10#, 10 weeks, 10 HGB • Multidisciplinary team

6. Management Pre-op • Maintain nutrition • Prevent aspiration

7. Pre-op Teaching • Remind parents that defect is operable- show photographs of corrected clefts • Introduce cup, spoon feeding devices (see page 1114 for feeding tips) • Explain restraints • Explain Logan Bow

8. Post-Op • Prevent trauma to suture line • Facilitate breathing • Maintain nutrition • Cleanse suture lines as ordered • Referral to appropriate team members

9. Esophageal Atresia Failure of the esophagus to totally differentiate during uterine development.

10. Assessment • Respiratory difficulties • Drooling • Coughing, choking • Gastric distention • Hx of ??? during pregnancy?

11. Management Early diagnosis Ultra sound Radiopaque catheter inserted in the esophagus to illuminate defect on X-ray Surgical repair- thoracotomy and anastomosis

12. Pre-Op • Maintain airway • Keep NPO- administer IV fluids • Elevate HOB 30 degrees • Suction PRN • Prophylactic antibiotics

13. Post-Op • Maintain airway • Maintain nutrition • Prevent trauma

14. Gastroesophagial Reflux (GER) The cardiac sphincter and lower portion of the esophagus are weak, allowing regurgitation of gastric contents back into the esophagus.

15. Assessment: Infant • Regurgitation almost immediately after each feeding when the infant is laid down • Excessive crying, irritability • FTH • Complications of aspiration pneumonia, apnea

16. Assessment: Child • Heartburn • Abdominal pain • Cough, recurrent pneumonia • Dysphagia

17. Diagnosis • Assess Ph of secretions in esophagus if <7.0 indicates presence of acid • Also diagnosed using Barium Swallow and visualization of esophageal abnormalities

18. Management & Nursing Care • Nutritional needs • Positioning • Medications • CPR instruction for parents/caregivers • Surgery

19. Diarrhea/GastroenteritisSevere • A disturbance of the intestinal tract that alters motility and absorption and accelerates the excretion of intestinal contents. • Most infectious diarrheas in this country are caused by Rotovirus

20. Critical Thinking • Why is there an increase in incidence of diarrhea in lower socio-economic groups? • Why is there and increase in young children?

21. Clinical Manifestations • Increase in peristalsis • Large volume stools • Increase in frequency of stools • Nausea, vomiting, cramps • Increased heart & resp. rate, decreased tearing and fever

22. Complications • Dehydration • Metabolic Acidosis

23. Diagnosis • Stool culture • O&P • Diagnose Metabolic Acidosis

24. Treatment & Nursing Care • Treat cause • Fluid and electrolyte balance • Weigh daily • Monitor I&O • Assess for dehydration • Isolate • Skin care

25. Appendicitis • Inflammation of the lumen of the appendix which becomes quickly obstructed causing edema, necrosis and pain.

26. Clinical Manifestations • Abdominal pain • Silent abdomen • Anorexia and nausea • Diarrhea • Elevated temperature • Sudden relief

27. Diagnosis • History and Physical • Laboratory values • X-ray or Ultrasound

28. Management and Nursing Care: Pre-Op • NPO • IV • Comfort measures • Antibiotics • Thermal therapy • Elimination • Patient education

29. Management and Nursing Care: Post-Op • NPO • Antibiotics • Analgesia • Patient teaching

30. Pyloric Stenosis • Pyloric sphincter • Incidence • Possible genetic predisposition

31. Assessment • Vomiting • Constant hunger and fussiness • Distended upper abdomen • Hypertrophied pylorus • Visible peristaltic waves

32. Diagnosis • History and Physical • Ultrasound • Laboratory values

33. Management and Nursing Care FredRamstedt procedure- Pylorotomy via laproscopy

34. Pre-Op • Hydration and electrolyte balance • Weigh daily & I and O • Support of parents

35. Post- Op: • I & O • Feeding • Position • Surgical site • Patient teaching

36. Critical Thinking • A 4 week old infant with a history of vomiting after feeding has been hospitalized with a tentative diagnosis of pyloric stenosis. Which of these actions is priority for the nurse? • Begin an intravenous infusion • Measure abdominal circumference • Orient family to unit • Weigh infant

37. Intussuception • Most commonly seen in infants 3-12 months • Typically follows what type of illness?

38. Assessment • Pain • Vomiting • Stools • Dehydration • Serious complications

39. Diagnosis • X-ray • Abdominal ultrasound

40. Therapeutic Intervention • Hydrostatic reduction • Surgery

41. Nursing Care: • NPO- NG • Assess • Monitor stools • Re-introduce food

42. Hirschsprung’s Disease Congenital disorder of nerve cells in lower colon

43. Assessment • Failure to pass meconium • Vomiting • Bowel assessment • Breath • Older child

44. Diagnosis • History & Physical • Barium enema (X-ray) • Rectal biopsy- absence of ganglionic cells in bowel mucosa

45. Management • Surgical intervention • Colostomy • Resection

46. Nursing Care: • Pre-op • Cleanse bowel • Patient/parent teaching • Post-op • NPO • VS • Assessment • Patient/parent teaching

47. Volvulus & Malrotation • Assessment- pain, bilious vomiting, S & S bowel obstruction • Treatment- surgery to prevent ischemia • Nursing Care- same as Intussuception and Hirschsprung’s

48. Gastroschisis • Assessment- noted on ultrasound and obvious at birth • Treatment- surgical repair in stages • Nursing care- support parents loss of “Perfect Child”

49. Omphalocele • Assessment- ultrasound and at birth • Treatment- surgical repair in stages • Nursing care- same as for Gastroschisis

50. Imperforate Anus • Assessment- note failure to pass meconium, Ultrasound & CT • Treatment- repeated dilation or surgical intervention dependent on extent • Nursing Care- note skin dimples or stool in urine or vagina