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Pediatric Gastrointestinal Development and Disorders Nursing Care

This guide covers pediatric gastrointestinal development, congenital anomalies, and nursing care for conditions such as cleft lip, esophageal atresia, pyloric stenosis, and Hirschsprung's disease. Detailed assessment, diagnostic studies, and post-operative care are discussed.

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Pediatric Gastrointestinal Development and Disorders Nursing Care

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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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