Transcript Lecture 10+11

Clinical Aspect of Maternal and Child Nursing
NUR 363
Lecture 10
Gastrointestinal System
• Many GI issues require surgical
intervention
• Nursing interventions will often
include general pre and post-op
care
• Bilious vomiting is a sign of GI
obstruction and requires
immediate intervention
• Assess stools!
• Assess hydration status
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Gastrointestinal System
Pediatric Variances
•Mechanical functions of digestion are
immature at birth
•Infants have decreased saliva
•Peristalsis is faster in infants
•Digestive processes are mature as a toddler
•Gastric acidity is low at birth
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The Gastrointestinal System
8 Altered Connections
3 Esophageal Atresia/Tracheoesophageal Fistula
3 Cleft Lip and Palate
8 Gastrointestinal Disorders
3 Gastroesophageal Reflux
3 Pyloric Stenosis
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Acquired Gastrointestinal Disorders
3 Appendicitis
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ESOPHAGEAL ATRESIA &
TRACHEOESOPHAGEAL FISTULA
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Congenital defects of esophagus
EA is an incomplete formation of esophagus
TEF is a fistula between the trachea and esophagus
Classic 3 “C’s” - coughing,choking,cyanosis
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ESOPHAGEAL ATRESIA &
TRACHEOESOPHAGEAL FISTULA
TREATMENT
• Surgery: either a one- or two-stage repair
• Pre-op care focuses on preventing aspiration and
hydration
• Post-op care focus is a patent airway, prevent incisional
trauma
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Cleft Lip/Palate
 May present as single defect or combined
 Non-union of tissue and bone of upper lip and
hard/soft palate during fetal development
 Cleft interferes with normal anatomic structure of
lips, nose, palate, muscles – depending on severity
and placement
 Open communication between mouth and nose with
cleft palate
Nutrition is a challenge in infancy
Risk for aspiration
Respiratory distress
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Cleft Lip/Palate
Operative Care
 Monitor for infection
 Clean Cleft Lip incision
 Pain Management
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GASTROESOPHAGEAL REFLUX
 Regurgitation of gastric
contents back into esophagus
 GER may predispose patient
to aspiration and pneumonia
 Apnea has been associated
with GER
  chance of GER after 12-18
mo old related to growth due
to elongation of esophagus
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GASTROESOPHAGEAL REFLUX
SIGNS/SYMPTOMS
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Vomiting
Gagging during feedings
Irritability
Anemia
Bloody stools
DIAGNOSTIC EVAL
• History of feedings/PE
• Upper GI endoscopy to
visualize esophageal
mucosa
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GASTROESOPHAGEAL REFLUX:
Therapeutic Management
• Positioning
• Prone HOB  30°
• Right side
• Dietary modifications
• Medications
• Prokinetic agents
• Histamine H-2
• Small, frequent
• Proton Pump Inhibitors
feedings
• Possibly thicken
• Mucosal Protectants
formula
• Avoid fatty, spicy foods
caffeine, & citrus
• Surgery: fundoplication
• Teach
Fundoplication (anti-reflux surgery): A surgical technique that strengthens the barrier to
acid reflux when the lower esophageal sphincter does not work normally and there is
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gastro-esophageal reflux.
PYLORIC STENOSIS
 Hypertrophy of pyloric sphincter, causing a narrowing/ obstruction
 Infant presents “always hungry”
 Weight loss
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PYLORIC STENOSIS
DIAGNOSTIC EVAL
• History/PE
• Abdominal Ultrasound
INTERVENTIONS
• Pre-op: NPO, NGT to
hydration, I/O, monitor
electrolytes
TREATMENT
• Surgical Intervention:
Pyloromyotomy
• Post-op: Start feedings
in 4-6 hrs. Progressive
feeding schedule
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APPENDICITIS
• Inflammation and infection
of vermiform appendix,
usually related to an
obstruction
• Surgery is necessary
• Cause may be bacteria,
virus, trauma
• Post-op Care: routine
post-op care,
IVF/antibiotics,
NPO ambulation,
positioning, pain
management, wound
care, possible drains.
• S/S: periumbilical pain,
fever, vomiting, diarrhea,
irritability,  WBC’s
• Pre-op Care: NPO, pain
management,
hydration, consent
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Clinical Aspect of Maternal and Child Nursing
NUR 363
Lecture 11
Respiratory System
Pediatric Variances
 The airway is smaller and more flexible.
 The larynx is more flexible and more susceptible to spasm.
 The tongue is large.
 Chest muscles are not well developed
 Irregular breathing pattern and brief periods of apnea (10 -
15 secs) are common
 Abdominal muscles are used for inhalation until age 5-6 yrs.
 Respiratory rate is higher
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The Respiratory System
Upper Airway Disorders
Tonsillitis
Croup
Epiglottis
Foreign Body Aspiration
Lower Airway Disorders
Bronchiolitis
Asthma
Cystic Fibrosis
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Tonsillitis
CLINICAL MANIFESTATIONS
 Sore throat
 Mouth breathing
 Sleep Apnea
 Difficulty swallowing
 Fever
IMPLEMENTATIONS
Provide Comfort
Warm saline gargles
Reduce Fever
 Promote Hydration
 Administer Antibiotics
 Provide Rest
 Patient Teaching
 Tonsillectomy may be
necessary
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Tonsillectomy
Pre-operative Nursing Care
Monitor Labs (CBC, PT, PTT)
Age-appropriate Preparation/Teaching
Surgical Consent
Post-operative Nursing Care
Frequent site assessment
Monitor for S/S of Complications
Pain Management
Diet
Patient Teaching
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Croup/Epiglottitis
• Infection and swelling of larynx,
trachea, epiglottis, bronchi
• Causative agent: Viral
• Characterized by hoarseness,
barky cough, inspiratory stridor,
and respiratory distress
• Most common ages 6 mo-3 yrs
• LIFE-THREATENING
EMERGENCY
• Most common in ages 2-5 years
• Often the child is intubated
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Croup/Epiglottitis
Nursing Interventions
 Maintain Patent Airway
 Assess and Monitor
Nursing Interventions
 Administer Meds
 Corticosteroids
 Promote Hydration
 Reduce Fever
 Calm Environment
 Promote Rest
 Nebulizer treatment
 Antibiotic for epiglottitis
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Foreign Body Aspiration
• Occurs most often in small children
• Choking, coughing, wheezing, respiratory difficulty
• Often it is round food, such as grapes, nuts,
popcorn
• Bronchoscopy often needed for removal
• Age-appropriate preparation needed for procedure
• Prevention and parent education is very important
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Bronchiolitis
• Acute viral infection of the bronchioles
causing an inflammatory/obstructive
process to occur
• CXR shows hyperinflation and consolidation
if atelectasis present
• Primarily seen in children under 2 years of
age
• Most common in winter and early spring
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Bronchiolitis
CLINICAL MANIFESTATIONS
 Nasal Congestion
 Cough
 Crackles, Wheezes
 Increased RR & SOB
 Respiratory Distress
 Fever
 Poor Feeding
IMPLEMENTATIONS
 Suction – priority
 Bronchodilator
 CPT
 Promote fluids
 Monitor VS , SaO2, lung
sounds & respiratory effort
 Supplemental oxygen
 Reduce fever
 Promote rest
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Asthma
Asthma is a common chronic inflammatory disease
of the airways
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CLINICAL MANIFESTATIONS
Tachypnea
SaO2 below 95%
Wheezes, crackles
Retractions, nasal flaring
Non-productive cough
Restlessness, fatigue
Abdominal pain
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Asthma
INTERVENTIONS
 Monitor VS (HR, RR)
 Monitor SaO2
 Auscultate lung sounds
 Monitor respiratory effort
 Humified oxygen
 Calm environment
 Promote hydration
 Promote rest
 Monitor labs/x-rays
 Patient teaching
Administer Medications
 Bronchodilator
 Corticosteroid IV or PO
 Antibiotic if precipitated from a respiratory infection
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Otitis Media
 Most common childhood illness
 Inflammation of middle ear
 Acute otitis media (AOM)
 Infectious process by pathogen
 S/S: pain, fever, irritability, vomiting, diarrhea, ear
drainage, full/bulging tympanic membrane
 Otitis media with effusion (OME)
 Inflammation of middle ear with fluid behind tympanic
membrane-no infection
 Chronic otitis media
 Inflammation of middle ear
 Can lead to hearing loss/delayed speech
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Otitis Media
TREATMENT
 Antibiotics
INTERVENTIONS
 Teaching
 Feeding techniques
 Medication regimen
PAIN MANAGEMENT
 Fever management
 Surgery prep if needed
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