Transcript Management/Nursing Care

Pediatric GI
Development
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Begins 3rd week of gestation
Mouth to Anus
 Includes
the liver, gallbladder and
pancreas
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Mouth
Esophagus
Stomach
Small intestines
Large intestines
Rectum
Function
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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
General Assessment
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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
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Height/Weight
Hydration status
I, A, P, P of abdomen
Common Diagnostic
Studies
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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
Congenital GI
Anomalies
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Cleft lip/palate
Esophageal atresia
Tracheoesophageal fistula
Omphalocele
Gastroschisis
Pyloric stenosis
Imperforate anus
Celiac disease
Hirshsprung’s disease
Intussusception
Hernia’s
Anorectal Malformations
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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
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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
Management/Nursing
Care
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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
Biliary Atresia
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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 temporary measure
Liver Transplant
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Healthy @ birth
Jaundice --2 weeks to 2 month
Acholic stools
^Bilirubin
Abdominal distention
Hepatomegaly
^bruising ^ PT
Intense itching
Infections
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Thrush
Acute Gastroenteritis
Appendicitis
Pinworms
Thrush
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Monilial (yeast) infection of mouth
May or may not have symptoms
White coating in oral cavity
 Fussy
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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
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Gastroenteritis
Vomiting/Diarrhea
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Common in childhood, usually selflimiting
No specific treatment
Management/Nursing
Care
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Prevent dehydration
Assessment
 Note onset/ ALWAYS inquire about
associated signs/symptoms
 Color
Green-think bile obstruction
 Curded, stomach contents several hrs.
after eating-think delayed gastric emptying
 Coffee ground- think GI bleeding
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Nursing Care
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Monitor hydration status/ IVF’s
Vital signs/ no rectal temps
Daily wts, I/O, weigh diapers,
Diet: NPO, Pedialyte 1-3 tsp q 1015 minutes, clear to bland, milk
free. Progress to diet
No juices, carbonated drinks, or
caffeine
Standard precautions
Appendicitis
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Most common reason for surgery in
childhood
Diagnosis: US show incompressible
appendix
CBC..^ WBC’s and left shift/symptoms
Treatment: Surgical removal
Assessment Findings:
Abdominal pain/rebound tenderness/
peri-umbilical pain
 N/V, fever, chills, anorexia, diarrhea or
acute constipation
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Management/Nursing
Care
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Pre-op care
NPO, IVF’s,Permit
 Semi-Fowler’s or right side lying
 Do nothing to stimulate peristalsis
 No heat application
 Sudden relief of pain…BAD
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Post-op care
VS
 Monitor for abdominal distention, wound
care, ambulation within 6-8h
 Pain assessment
 education
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Pinworms
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Enterobiasis
 Caused
by a nematode
 It is the most common helminthic
infection
 Eggs ingested or
inhaled..hatch/mature in upper
intestine..then migrate through the
intestine to mate and lay eggs at
the anal opening
Management/Nursing
Care
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Symptoms
 Intense
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Diagnosis:
 Tape
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anal pruritis
test early AM
DOC:
 Vermox
if >2yrs of age
 Treat entire family
Hepatitis
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Same as in adult
A,B,C,D,E
Anicteric phase 5-7 days
Icteric phase last up to 4 weeks
Hep A Control spread(standard
precaution)
Hep B prevent with vaccine
Failure to Thrive
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IBW falls below 5th percentile on
growth charts
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Organic:
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Non-organic
Gastroesophageal Reflux
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Typically self-limiting by 1 yr
Severe may require surgery
 Assessment
 frequent
vomiting, melena,
hematemesis, hiccuping, heartburn
and abdominal pain
Management/Nursing
Care
 keep
upright, rice cereal added to
formula, no fatty foods or citrus
juices
 Asses breath sounds before and
after feeding
 Suction @ bedside
 Prone head elevated after feeding
 avoid placing in infant seat
 administer meds: Antiacids, H2
blockers,
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Assess hydration
I/O, Monitor IVF’s, Daily weights
Small frequent feedings
Solids first then liquids
Burp often
Monitor for dumping syndrome 30
minutes after feeding (if post-op)
Constipation/Encopresis
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Three or more days without BM
Painful BM’s
Encopresis is fecal soiling or
incontinence
Can be secondary to GI disorder,
certain medications or
psychosocial factors
Management/Nursing
Care
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Investigate cause
Promote regular bowel movement
Increase fiber and fluid in diet
Stool softeners
Provide a non-threatening
environment
Do not push child during training
Fluid and Electrolyte
Imbalance
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Infants and younger children have
greater need for water and are
more vulnerable to alterations
Greater BSA(body surface area)
Increased BMR(basal metabolic
rate)
Decreased kidney function
(immaturity)
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Fluid requirements depend of
hydration status, size of
infant/child,environmental factors
and underlying disease
Management/Nursing
Care
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Daily maintenance based on
weight in kilograms
ml/kg for 1st 10 kg
 50 ml/kg for 2nd 10 kg
 20 ml/kg remaining of kg
 100
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Then divide total amount by 24 hrs
This will be the rate in ml/hr
Nursing Care:
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Be alert to potential problems
Accurate I&O’s are vital
Daily weights
Weigh diapers
Assess mucous membranes,
fontanels
Poisoning/Foreign
Bodies
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Major health concern
Most occur in children less than 6
90% occur in the home
Most commonly ingested poisons
 Cosmetic
products
 Cleaning products
 Plants
 Foreign body ( toys, batteries)
 Gasoline
Management/Nursing
Care
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Emergency treatment may or may
not be necessary
Assess victim
Terminate exposure
Identify poison
Call poison control
Remove poison/Prevent absorption
 Syrup
of Ipecac
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Do not induce vomiting if patient
has absent gag reflex
Or if poison is corrosive
Place child in side-lying, sitting or
kneeling position
Administer activated charcoal with
cathartic usual dose 1gm/kg
Education: PREVENTION is key…
Colic
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Persistent abdominal pain
characterized by loud crying,
drawing up legs to abdomen
lasting greater than 3 hrs.
Common in infants less than 3
months
Possible causes
 Too
rapid feeding, excessive air
 Overeating, milk allergy
 Parental tension, or smoking
Management/Nursing
Care
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Try to identify causative agent
Medications: Atarax and
Simethicone
Obtain detailed diet history of baby
and mother if breast baby
Try to identify relationships to
crying episodes
Parental coping