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Pediatric GI

Pediatric GI. Sheila Gentry,MSN,RN. Development. Begins 3rd week of gestation Mouth to Anus Includes the liver, gallbladder and pancreas Mouth Esophagus Stomach Small intestines Large intestines Rectum. Function.

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Pediatric GI

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  1. Pediatric GI Sheila Gentry,MSN,RN

  2. Development • Begins 3rd week of gestation • Mouth to Anus • Includes the liver, gallbladder and pancreas • Mouth • Esophagus • Stomach • Small intestines • Large intestines • Rectum

  3. Function • Digestion and absorption of nutrients and water, secretion of substances and elimination of waste products • Digestion: circular muscles churn and mix food. Longitudinal muscles propel the food bolus. And sphincter muscles control passage of food • Enzymatic activity: aids in breakdown of foods

  4. General Assessment • Assess pain(seven variables) • Normal bowel habit • Assess for changes in appetite • Identify thirst level • Food intolerance • Belching, vomiting, heartburn, flatulence • Identify routine eating habits • Ask about PMH related to GI

  5. Height/Weight • Hydration status • I, A, P, P of abdomen

  6. Common Diagnostic Studies • Blood chemistries, liver profile, sed rate, C-reactive protein, thyroid function • Stool exams for ova and parasites, blood, WBC’s, pH, cultures, fecal fat collection(72 hr test to r/o fat malabsorption) • Bowel studies: UGI, BE, biopsy, rectosigmoidoscopy, Abd. Xrays. US of abdomen and pelvis

  7. Congenital GI Anomalies • Cleft lip/palate • Esophageal atresia • Tracheoesophageal fistula • Omphalocele • Gastroschisis • Pyloric stenosis • Imperforate anus • Celiac disease • Hirshsprung’s disease • Intussusception • Hernia’s

  8. Cleft Lip • Affects 1 in 800. More common in boys • Etiology: hereditary, environmental, teratogenic factors. Occurs around 7 weeks gestation • Readily apparent • Degree affected may vary. Small notch to complete separation • Surgical closure 1-2 months or Rule of 10

  9. Cleft Palate • 1-2800 affected. More girls affect • Occurs at about 9 weeks gestation • May involve soft palate alone to hard palate /more severe maxilla • Surgical repair between 6-18mo. • Will have long-term care with HCP • Plastic surgeon, ENT, Nutritionist, Speech Therapy, Orthodontist, Pediatrician

  10. Major Nursing Diagnoses • Ineffective airway clearance • Alt. Nutrition-LBR • Potential for Alt. in parenting • Risk for infection • Pain

  11. Management /Nursing CarePre-op • Assess degree of cleft • Assess Respiratory status • Assess ability to suck(will see difficulty with sucking and swallowing) • Assist with feeding: head upright/special nipples/ESSR • Continuous monitoring during feeding • Remove oral secretions carefully

  12. Reaction of parents-guilt, disappointment, grief, sense of loss, anger. Encourage verbalization of fears/concerns • Encourage bonding/touching • Inform parents of successful surgical intervention

  13. Nursing Care Post-Op • Maintain patent airway. Lung assessment before/after feeding • Cleft lip proper positioning • Upright, or on unaffected side. Never prone • Cleft palate-side or abdomen • Liquids from side of cup or spoon • NO ORAL TEMPS • No straws, pacifiers, spoons, or fingers around mouth for 7-10 days • Encourage family participation in care

  14. PROTECT SURGICAL SITE!!! • Elbow restraints • Minimize crying • Maintain Logan Bow if applied • No toothbrushes 1-2 weeks • Monitor site for infection • Assess pain • Resume feedings as ordered • Care of site after feeding

  15. Esophageal Atresia with Tracheoesophageal Fistula • Congenital anomalies rare • Clinical and Surgical Emergency • Assessment • Three C’s of TEF • Choking, coughing, cyanosis • Plain water at birth • Management/Nursing Care • Surgical correction(thoracotomy) • Monitor Resp. status • Monitor/Remove excessive secretions

  16. Elevate infant into anti-reflux position 30 degree incline • Provide O2 • NPO(non-nutritive sucking ok) • IVF’s • Provide gastrostomy care/feedings • Education/Family involved in care

  17. Pyloric Stenosis • Assessment • Characteristic projectile vomiting(bile free) • Hungry, fretful, irritable,dehydration • Weight loss/failure to gain weight • Metabolic alkalosis • Palpable olive-shaped mass in RUQ • Diagnosis: US/UGI delayed emptying and elongated pyloric canal

  18. May require surgical intervention: Pyloromyotomy • Nursing Care • Monitor respiratory status • Hydration status • IVF’s, electrolytes, NG tube care, Daily WT, I/O hrly , small frequent meals(clears)NPO prior to surgery. • 4-6hrs. After surgery may begin small frequent feeding with lytes solution or glucose

  19. Place on R side/Semi-Fowler’s after feeding • Burp frequently

  20. Congenital/AganglionicMegacolon • Also called Hirshsprung’s Disease • Congenital 1 in 500 • Absence of parasympathetic ganglion cells in distal portion of colon and rectum • Lack of peristalsis • Fecal contents accumulate • Mechanical obstruction

  21. Management/Nursing Care • Correction- series of surgical intervention(Temporary colostomy with reanastamosis and closure later) • Pre-op care • Post-op care • Same as for any abdominal surgery • NPO • Routine ABC’s (axillary temps) • Monitor colostomy..note stoma color

  22. Monitor bowel function, abdominal circumference • Teach family ostomy care • Toilet-training after age 2

  23. Intussusception • Telescoping of a portion of bowel into another(usually ileum to colon) • Partial or complete bowel obstruction. May require Emergency Surgery • Assessment • Usually infant under 1 yr. • Parent may relay acute, intermittent abdominal pain • Child may present screaming with legs drawn up

  24. Management/Nursing Care • Vomiting • “Currant Jelly” stools • Sausage shaped mass in RUQ while RLQ is empty(Dance sign) • Management/Nursing Care • Medical treatment: Barium enema • Monitor VS • Monitor for shock or bowel perforation • IVF’s, I/O, prepare child for barium enema…monitor stools pre/post BE

  25. Anorectal Malformations • Congenital • Surgical repair based on extent • Imperforate Anus • Will see unusual anal dimpling • No passage of meconium • Meconium appearing from perianal fistula or in urine

  26. Suspicion in newborn for failure to pass meconium in 24 hrs • Or if emesis is bile stained • Abdominal assessment • Chronic constipation in toddlers • May alt. With diarrhea • “Ribbon-like” stools. Foul-smelling

  27. Management/Nursing Care • Requires surgical correction • Discovered with newborn 1st temp rectally • Assess passage of meconium • Assist family to cope with dx • Will usually see other high-level defect

  28. Celiac Disease • Genetic: Inability to tolerate foods with gluten(wheat, barley, rye, oats) • Life-long dietary modification • Diagnosis: Biopsy • Celiac crisis • Assessment • symptoms appear 3-6mo. After introduction of gluten(grains) • frequent bulky, greasy, malodorous stools with frothy appearance (Steatorrhea) 72 hr.fecal fat study

  29. Management/Nursing Care • Gluten free diet • Read labels

  30. Hernias • Protrusion of an organ through abnormal opening • Results in organ constriction and impaired blood flow • Diaphragmatic • Hiatal • Abdominal

  31. Diaphragmatic Hernia • Congenital • Abdominal content protrude into thoracic cavity through an opening in the diaphragm • Findings depend on severity • diminished/absent breath sounds • bowel sound may be heard over chest • Cardiac sounds may be heard on right side of chest • Dyspnea, cyanosis, nasal flaring, retractions, sunken abdomen and barrel chest

  32. Management/Nursing Care • Surgical correction • Medical emergency • Chest tubes • Maintain airway(ventilator)ECMO • HOB^ Position on affected side • NG tube • IVF • Post-op • Monitor for infection, respiratory distress • Activities to promote lung function

  33. Hiatal • Sliding • Protrusion of abdominal structure(stomach) through the esophageal hiatus

  34. Management/Nursing Care • Depends on severity • Diagnosis: Fluoroscopy • Assessment • See dysphagia, Failure to thrive, vomiting, GER • Nursing care: • HOB elevated • Small frequent feedings • Manage GER symptoms • Monitor respiratory status pre/post feedings

  35. Umbilical Hernia • Soft, skin covered protrusion of intestine around umbilicus • See in premature infants and African American infants more often • Spontaneous closure 3-4 (most by 1yr.)

  36. Management/Nursing Care • Surgical repair if >1.5-2cm or if not spontaneously closed by age 2 • May be reduced with a finger • Nursing Care: • Monitor for change in size or for incarceration(hyperactive bowel sounds or inability to reduce) • Education • Binding not effective • Discourage home remedies

  37. Omphalocele and Gastroschisis • Omphalocele: • abdominal contents herniate through the umbilical cord • Covered with translucent sac • Gastroschisis: • bowel herniates through defect in abdominal wall. Usually to the right of the umbilicus • No covering of on exposed bowel • Degree is varied in both

  38. Management/Nursing Care • Surgical Repair necessary • Nursing Care: • Will be obvious @ delivery • Caution not to rupture sac • Place in warmer immediately • Sterile treatment • Immediately cover with sterile gauze saturated with warm saline and wrap with plastic • Minimize movement of the infant and handling of sac

  39. Continuous temperature monitoring • ABC’s • NG tube • Wt, I/O, IVF’s, TPN as ordered • Monitor for signs of ileus… • Assess parents coping, encourage grieving, and parental participation in care, refer to support group

  40. Biliary Atresia • Unknown cause • Intrahepatic and extrahepatic bile duct obstruction • Liver becomes fibrotic, cirrhosis and portal HTN develops..Leads to Liver Failure and death without treatment • Surgical(Kasai procedure) temporary measure • Liver Transplant

  41. Healthy @ birth • Jaundice --2 weeks to 2 month • Acholic stools • ^Bilirubin • Abdominal distention • Hepatomegaly • ^bruising ^ PT • Intense itching • Tea-colored urine

  42. Infections • Thrush • Acute Gastroenteritis • Appendicitis • Pinworms

  43. Thrush • Monilial (yeast) infection of mouth • May or may not have symptoms • White coating in oral cavity • Fussy and gassy • Treatment: • If breast fed: treat mother and baby • Anti-fungal cream to nipples after feeding • Nystatin orally x 7 days • Careful hand washing to prevent spread

  44. Gastroenteritis Vomiting/Diarrhea • Common in childhood, usually self-limiting • No specific treatment

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