Transcript By The Name Of Allah

By The Name Of Allah
Presentation about:
Gastrointestinal system assessment.
Students name:Galia Baraka
Component of GI system
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Oral cavity.
Esophagus.
Lower esophageal sphincter
Liver
Stomach
Pancreas
Large & lower intestine
Gallbladder
Cecum
Appendix
rectum
Assessment of GI system
• The newborn's stomach capacity is only 10 to 20 ml
• It expands rapidly to 200 ml by one month of age and reaches
adult capacity of 2000-3000 ml by late adolescence.
• Enzymes that aid in digestion(amylase,lipase,trypsin)
Infants are deficient in these enzymes until around 4-6 month,
therefore abdominal distention from gas is common.
• GI system immature at birth
– Process of absorption and secretion do not take place until
after birth
– Sucking primitive reflex
– Voluntary swallow (at 6 weeks)
– Newborn’s stomach capacity is small at birth
Cont….
• Liver function immature at birth and next few weeks
• During first year of life
– Gluconeogenesis (formation of glycogen from noncarbs)
– Plasma protein
– Ketone formation
– Vitamin storage.
• The stomach lying horizontally, is round until approximately 2
year of age.
• Lower esophageal sphincter has a poor development of
mucous membrane and muscular layer, its tone is decreased
or relaxed.
• Pyloric sphincter is developed well.
• Gastroesophageal reflux and regurgitation is frequent in
infants.
Cont……
• The infant's first stool is meconium
– sticky and greenish black.
– composed of intrauterine debris, such as bile pigments, epithelial
cells, fatty acids, mucus, blood, and amniotic fluid.
– Passage of meconium should occur within the first 24 hours.
• transitional stools:
– appear by the third day after the initiation of feedings.
– greenish brown to yellowish brown in color, less sticky than
meconium, and may contain some milk curds.
• typical milk stool:
– is passed by the fourth day.
– In breast-fed infants the stools are yellow to golden in color and
pasty in consistency, with odor, similar to that of sour milk.
– In infants fed cow's milk formula, the stools are pale yellow to
light brown, are firmer in consistency, and have a more offensive
Cont….
meconium
transitional stools
milk stool
GI Assessment Techniques
• Subjective data;
– Lifestyle and family factors
• Include family history.
– Diet
• Gaining weight
• feeding pattern
– Elimination patterns
• Intake & output.
• Objective
– Observe
• Abdominal distension.
• Symmetry, bumps, bulges or masses.
• Umbilicus.
• Peristaltic waves.
Cont….
• Objective (con’t)
– Auscultation
• Hyper/hypo bowel sounds
– Percussion
• Tympany vs dullness
– Palpation
• Light vs deep
• Rebound tenderness…peritoneal
inflammation
It is defined as "An increase in the fluidity,
volume and number of stools relative to the
usual habits of each individual".
 Enteropahtogenic (infectious diarrhea)
Dietary .
Some parenteral infections
Malabsorption
• Contaminated feeding
bottles.
• Overfeeding.
• Over concentrated formula.
• Excess sugar or fat in
formula.
• Introduction of food,
which is not suitable for
the age.
• Unripe fruits.
• Introduction of new
food.
• Improperly cooked diet.
• Malnutrition .
Cont….
• Teething is not a cause of diarrhea. Diarrhea that occurs
during teething is usually caused by an intestinal infection
and should be treated properly.
It is one of the consequences of watery diarrhea. It is
caused by the loss of water and electrolytes in liquid
or loose stools and vomitus
Oral rehydration:
• The rehydrauon therapy in the form of ORS is
considered an effective treatment of dehydration,
It is a mixture of water, glucose, and electrolytes
and is used to correct or prevent dehydration.
Glucose is added (2%) to promote sodium
absorption. Increasing the concentration of
glucose by 2% increase the osmolarity of the
solution and may cause osmotic diarrhea.
Component of ORS
Components g/1
Amount G/L
Sodium chloride.
Trisodium citrate.
3.5 G/L
2.9 G/L
potassium chloride
Glucose
1.5 G/L
20.0 G/L
N.B. The use of citrate increases the shelf life of
ORS and therefore lowers its cost. Tape
water(200 ml) is used to dissolve the mixture
and needs no boiling.
• It is given by cup and spoon, but :
It can be given by nasogastric tube in the
following conditions :
• When the patient is unable to drink but not in
shock, or has severe dehydration .
• When the patient has severe repeated
vomiting, or if dehydration is not improving
when ORS is given slowly by cup and spoon.
Nursing Assessment:
• It includes taking the patient's history, measuring weight and temperature
and Assessing the degree of dehydration.
1- History:
Personal characteristics (age and sex) and socioeconomic background
(home environment, income, education, occupation, beliefs .... etc).
Duration of the episode. Presence or absence of mucus, pus or blood in
stool.
Patient's ability to drink and or presence of thirst.
Presence of vomiting, fever or other problems (cough, otitis media).
Last time urine passed.
Feeding practices before and during illness.
Treatment during this episode (ORS, drugs).
Vaccination taken especially measles vaccine.
Frequency and consistency of stool.
2- Assessment of the degree of dehydration:
• Assessment of the degree of dehydration is
based on 4 signs which are the most
important to be detected:
Nursing intervention:
The aim of nursing intervention is:
To hydrate the infant.
To feed the infant.
To deal with associated problems.
Guidance during intervention. •
Mothers should be taught how to give ORS (one teaspoonful every 1-2 minutes
and the child should be in a semi-sitting position).
Give ORS as much as the desires.
If vomiting occurs, wait 10 minutes. then continue giving ORS solution but more
slowly (one teaspoonful every 2-3 minutes).
Watch for puffy eyes as a sign of over hydration. If this occurs, stop ORS solution
and give breast feeding and plain water. When puffiness is gone, the child is
considered fully dehydrated . Further treatment should follow treatment plan A.
– During diarrhea give the child as much food as he wants.
– Offer food every 3-4 hours.
– Small frequent feeding are better tolerated than less frequent and large
feedings.
– Children will anorexia have to be gently encouraged to eat.
– After stoppage diarrhea, give one extra meal per day for 2 weeks in normal
child and longer period in malnourished one .
– As mentioned earlier, breastfed children must continue to be breastfed.
*It is a well-known fact that artificially-fed children are more prone to
diarrhea. But if a child wants milk, do not hesitate to give it to him.
*If the child is not keen, stopping milk ‘for about 12 hours may be preferable.
The milk may be diluted for a day or two. But after that, give undiluted milk
even if the loose motions continue
Preserves body weight and sustains growth, thus
maintaining strength and health avoiding lowered
resistance.
The contact of foodstuffs with the gut mucosa
protects its absorptive capacity and stimulates the
production of digestive enzymes.
Easily digestible foods may enhance intestinal salt
and water absorption by providing organic
molecules, which facilities their absorption.
Studies have shown that continued feeding
actually hastens recovery from a diarrheal episode.
1- Promotion of breast-feeding
2- Improved weaning practices
3- Proper use of water for hygiene and
drinking:
4- Personal hygiene
5- Use of latrines
6- Safe disposal of stools of young children
7- Measles vaccination
Definition = Difficult, incomplete, or infrequent •
evacuation of dry hardened feces from the bowels
Prevelance up to 30% children •
– Stool holding
– Emotional problems/phobia.
– Neurological conditions
– Cystic Fibrosis
– Hirsprungs or abnormal bowel development
– Side effects of medications
Stuctural defect
• Complication Associated with Cleft Lip or Cleft
Palate :
– Feeding problems
– Speech development
– Otologic
– Dental and orthodontic
– Developmental
o Opening between the nose and lip
o Apparent at birth
o Should be documented during newborn
assessment
o Assess child’s ability to suck and swallow
o Cleft lip repair is performed during first
month of life
o Special feeding techniques if surgery is
delayed
• Feeding a Child before Cleft Lip Repair
• Bottle with special nipple – longer and
narrower
• Hold infant in upright position
• Large cross-cut hole in nipple to allow the
child to get food into back of throat without
strong sucking
• Stimulate sucking by rubbing nipple on
infant’s lower lip
• Allow child to swallow and burp frequently
method – Enlarge nipple, Stimulate
sucking, Swallow, Rest
Pre-Op Care of the Child and Parents
Explain pre-op procedures to parents
Provide support and information
Keep accurate record of child’s growth
and feeding schedule
Infant:
NPO X 4-6 hours pre-op
Ivs fluid
Post-Op Care of Child and Family
Encourage rooming-in
Incision care: clean sutures with sterile cotton
swab and ½ strength H2O2 followed by saline
to prevent crusting (esp. after feeding). May
apply antibiotic ointment to suture line
DO NOT DISPLACE LOGAN BAR
Special feeder – syringe with rubber tubing
into side of mouth, Breck feeder
Diet advance from clear to diet for age over 48
hours
Elbow restraints
B
Jane W. Ball and Ruth C. Bindler
Child Health Nursing: Partnering with Children & Families
© 2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
• Repaired surgically between 6
months to 2 years prior to talking
• Parents will care for child at home
until surgical repair
• Altered diatition and speech
dysfunction may also occur
• Frequent episodes of otitis media
–(due to opening into nasopharynx)
• Post-op: sutures in child’s mouth
• Keep straws, pacifiers, spoons away from
child’s mouth for 7-10 days post-op
• Elbow restraints and mittens
• Feeding – soft foods: baby food. Short
nipples may be used
• All feeding followed by rinsing mouth
with water to clean suture line
• No brushing teeth X 1-2 weeks
Colostomy refers to a surgical procedure where a portion of the large
through the abdominal wall to carry stool out intestine is brought
of the body.
**It may be permanent or temporary.
A colostomy is created as a means to treat
various disorders of the large intestine:
-cancer -obstruction -inflammatory bowel disease
Ischemia
In a baby or child
it may be due to an imperforate anus which is the absence of an anal
opening.
It also may be due to Hirschsprung’s Disease,
or it may be due to other malformations that are present at birth
 wash your hands.
 remove the old appliance carefully from the
top down and avoid dragging the skin.
 wash the stoma and surrounding skin,
gently removing all waste.
 place prepared appliance over stoma.
 spend a few minutes moulding flang to skin.
 do not forget to attach the clip (drainable
bag)
 place the empty old appliance in the
disposal bag
 wash your hands.
Nasogastric tube
• Tubes are used in infants &
children for feeding when
the child comatose ,
semiconscious , or unable to
consume sufficient food
orally.
Purpose for use (NG):
 Gavag
 lavag
 Decompression
Orogastric tube
•
Tube is most commonly
used in place of the
nasogastric tube for
newborns &young infant
who obligate nose
breathers.
• Use in older children if they
are
intubated,unconscious,or
unresponsive.
The differences between NG tube & OG tube
that's NG tube passed through nose & OG
tube passed through mouth.
• The principle of insertion & care of both tube
are the same.
Washing hands.
Prepare a trolley including :
Clean gloves.
Ky jelly.
60ml syringe.
Kidney tray.
Sticky tap.
Bag to collect secretions.
Placing a glass of drinking water nearby .
Stethoscope.
NG tube insertion
Procedure:
Prepare all equipment.
Wash hands ,wear clean gloves(to reduce
transmission of microorganism&protect froe
contact with body fluid).
Prepare child & family,enhance cooperation &
participation.
Position the child supine at a 30-45 angle if
possible allow efficient passing of tube.
Assess patency of nares, to determine if tube can easily
passed.
Measure the length of tube to be inserted and mark
with apiece of tape.
Lubricate 1 to 3 inches of the tube with ky gel to
enhance passing tube.
Insert the tube back & up into nostril by using gentel
pressure .
if resistance is met ,withdraw the tube & try to the other
nostril.
If the child is able , ask child to swallow .
Remove the tube immediately if there is vomiting or sings of
respiratory distress.(cynosis,tachypnea,nasal
flaring,prolong coughing).
Who we can sure that the NG tube in place:
Withdraw of gastric content.
Checking contents withdrawn PH and other
characteristics.
Inserting end of tube in water & watching for bubbles.
Listening by the stethoscope.
X-ray ,to be sure tube is in the stomach.
Fix the tube well.
We have a right to be
free from diseases
A 9 month old infant is admitted with diarrhea and
dehydration. The nurse plans to assess the child's
vital signs frequently. Which other action should
provide the most important assessment information?
a. measuring the infant's weight
b. obtaining a stool specimen for analysis
c. obtaining a urine specimen for analysis
d. inspecting the infant's posterior fontanel
The postoperative care plan for an infant with
surgical repair of a cleft lip includes:
a. A clear liquid diet for 72 hours
b. Nasogastric feedings until the sutures are
removed
c. Elbow restraints to keep the infant's fingers
away from the mouth
d. Rinsing the mouth after every feeding
Therapeutic management of the child with acute
diarrhea and dehydration usually begins with:
a. Clear liquids
b. Adsorbents, such as kaolin and pectin
c. Oral rehydration solution (ORS)
d. Antidiarrheal medications such as paregoric
The nurse is preparing for the discharge of a
neonate with a cleft lip and palate. One of
the nurse's major concerns is to:
a. institute prescribed antibiotic therapy
b. administer supplemental vitamins
c. apply a sterile dressing to the lip
d. establish an adequate feeding pattern
What is the best response by the nurse to a mother asking about the
cause of her infant's bilateral cleft lip?
a. "Did you use alcohol during your pregnancy?"
b. "Do you know of anyone in your family or the baby's father's
family who was born with cleft lip or palate problems?"
c. "This defect is associated with intrauterine infection during the
second trimester."
d. "The prevalent of cleft lip is higher in Caucasians"