The Child with a Gastrointestinal Condition PDF

2/15/2024 The Child with a Gastrointestinal Condition NP03L009 ELO B · VERSION 2.0 INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING 8TH ED., C H A PTER 28 P P. , 658 - 685 1 MAIN POINTS...

2/15/2024 The Child with a Gastrointestinal Condition NP03L009 ELO B · VERSION 2.0 INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING 8TH ED., C H A PTER 28 P P. , 658 - 685 1 MAIN POINTS 1. Gastrointestinal anomalies in infants. 2. Disorders and Dysfunctions of the GI tract 3. Disorder of Motility 4. Nutritional Deficiencies. 5. Infections of the GITract. 6. Worms in the GITract 7. Poisoning 2 2 GASTROINTESTINAL (GI) TRACT Transports and metabolizes nutrients necessary for the life of the cell Nutrients are broken down by enzymes from various digestive organs. Differences between adult and Child GI Intestinal resistance is immature Higher nutritional, metabolic and energy needs Stomach is small and empties rapidly 3 3 1  2/15/2024 DISORDERS AND DYSFUNCTION OF THE GI TRACT 4 4 DIAGNOSTIC TESTS CBC Stool Cultures Erythrocyte sedimentation Ultrasonography rate Liver FunctionTest Comprehensive chemistry Liver biopsy panel SchillingTest GI Series 72hr Fecal Fat test Barium Enema 5 5 ENDOSCOPY Capsule Endoscopy Gastroscopy Sigmoidoscopy Colonoscopy 6 6 2  2/15/2024 BREATH TEST Hydrogen breath test Abnormal bacteria growth Urea breath test Prescence of h. pylori in the stomach 7 7 SYMPTOMS OF GI DISORDERS Systemic signs Failure to thrive (FTT)— Pruritus in the absence of allergy may indicate liver dysfunction. Local signs Pain Vomiting Diarrhea Constipation Rectal bleeding Hematemesis 8 8 CONGENITAL DISORDERS 9 9 3  2/15/2024 ESOPHAGEAL ATRESIA ( TRACHEOESOPHAGEAL FISTULA [TEF]) TEF is caused by a failure of the tissues of the GI tract to separate properly in prenatal life. Four types 10 10 CLINICAL MANIFESTATIONS Polyhydraminos in the mother Will vomit and choke when feeding Pooling of secretions 11 11 MEDICAL MANAGEMENT Surgical is essential for survival Nursing care Goals If symptoms are noted; NPO Suction and position to drain mucous 12 12 4  2/15/2024 IMPERFORATE ANUS 13 13 IMPERFORATE ANUS Lower GI and anus arise from two different types of tissue during fetal development. When two tissues meet perforation occurs Lower end of the GI tract and anus end in blind pouch. Four types 14 14 CLINICAL MANIFESTATIONS No anus Failure to pass meconium in the first 24 hours must be reported. Infant should not be discharged home until a meconium stool has passed. 15 15 5  2/15/2024 MEDICAL MANAGEMENT Confirmed by x-ray or MRI Infant placed NPO Initial surgery may be colostomy Subsequent surgeries to reestablish patency 16 16 PYLORIC STENOSIS 17 17 PYLORIC STENOSIS Obstruction of the lower end of the stomach caused by overgrowth Commonly classified as a congenital anomaly Most common surgical condition of GI tract in infancy Incidence is higher in boys. Occurs with hyperbilirubinemia 18 18 6  2/15/2024 CLINICAL MANIFESTATIONS Projectile vomiting Constant hunger Olive shaped mass Distended stomach and peristaltic waves in severe cases Dehydration and malnutrition will develop 19 19 MEDICAL MANAGEMENT Pyloromyotomy Infant able to resume feeds shortly after anesthesia Nursing Care IV Fluids Slow feedings Place infant on right side after feedings Chart feeding 20 20 CELIAC DISEASE 21 21 7  2/15/2024 CELIAC DISEASE Also known as gluten enteropathy and sprue Leading malabsorption problem in children Symptoms not evident until 6 months to 2yrs Wheat,barley,oats,and rye 22 22 CLINICAL MANIFESTATIONS Large,bulky,foul smelling,frothy stools Irritability Malabsorption syndrome Diagnosis confirmed by IgA,tTg, increased fecal fat content 23 23 CELIAC DISEASE Classified four ways: Classic Atypical Silent Latent 24 24 8  2/15/2024 HIRSCHSPRUNG DISEASE (AGANGLIONIC MEGACOLON) 25 25 HIRSCHSPRUNG DISEASE Absence of ganglionic innervation to a segment of bowel Lack of normal peristalsis; results in constipation Ribbon like stools May be acute or chronic 26 26 CLINICAL MANIFESTATIONS Newborns: Failure to pass meconium stools Infants:constipation,ribbonlike stools,abdominal distention,anorexia,vomiting,and FTT Young children: usually seen in clinic after parents have tried over-the-counter laxatives to treat constipation 27 27 9  2/15/2024 TREATMENT/NURSING CARE Treatment Surgery to remove impaired part of colon and an anastomosis of intestine is performed Nursing care Dependent on age of child Signs of undernutrition, abdominal distention, andpoor feedings are suspect. 28 28 INTUSSUSCEPTION 29 29 INTUSSUSCEPTION A slipping of one part of the intestine into another part just below it Edema occurs. At first, intestinal obstruction occurs, but then strangulation of the bowel occurs as peristalsis occurs. Affected portion may burst, leading to peritonitis. 30 30 10  2/15/2024 CLINICAL MANIFESTATIONS Onset is sudden Severe paroxysmal abdominal pain Vomiting Currant jelly stools Palpable abdominal mess 31 31 TREATMENT This condition is an emergency. May feel a sausage-shaped mass in right upper abdomen. USGHR replaces barium enema as treatment of choice 32 32 MECKEL DIVERTICULUM Small blind pouch formed after duct fails to disappear Most common congenital malformation of the GI tract Symptoms most often occur by 2 33 33 11  2/15/2024 MECKEL DIVERTICULUM Diagnosed by barium enema and radionuclide scintigraphy Surgical removal of the diverticulum Emotional support 34 34 HERNIAS Inguinal Umbilical Congenital or acquired Irreducible/Incarcerated Strangulated 35 35 CLINICAL MANIFESTATIONS May be free of symptoms Irritability, fretfulness,constipation,vomiting,severe abdominal pain Physical examination shows mass 36 36 12  2/15/2024 TREATMENT/NURSING CARE Herniorrhaphy Diapers left open Parents encouraged to assist in routine post-op care 37 37 38 38 DISORDERS OF MOTILITY 39 39 13  2/15/2024 GASTROENTERITIS Involves inflammation of the stomach and intestines Most common noninfectious causes of diarrhea Food intolerance Overfeeding Improper formula preparation Ingestion of high amounts of sorbitol Priority problem in diarrhea is fluid and electrolyte imbalance and FTT. 40 40 TREATMENT/NURSING CARE Treatment is focused on identifying and eradicating cause. Priority goal of care is restoring fluid and electrolyte balance. 41 41 VOMITING Results from sudden contractions of diaphragm and muscles of the stomach Persistent vomiting requires investigation Multiple causes of vomiting Improper feeding technique Systemic illness such as increased intracranial pressure or infection Child at risk for aspiration pneumonia Carefully burped and fed Food reintroduced slowly 42 42 14  2/15/2024 GASTROESOPHAGEAL REFLUX Lower esophageal sphincter is relaxed or not competent. Often seen in preterm infants Symptoms Vomiting Weight loss FTT Respiratory problems 43 43 TREATMENT/NURSING CARE History taken Diagnosis includes pH monitoring- most definitive Scintigraphy Barium swallow Treatment dependent on severity Nursing Care 44 44 DIARRHEA Sudden increase in stools from the infant’s normal pattern, with a fluid consistency and a color that is green or contains mucus or blood. Acute sudden diarrhea:inflammation,infection,or response to meds, food,or poisoning. Chronic diarrhea: lasts more than 2 weeks;may indicate malabsorption problem, long-term inflammatory disease, or allergic responses. Infectious diarrhea:viral,bacterial,or parasitic infection usually involves gastroenteritis. 45 45 15  2/15/2024 CLINICAL MANIFESTATIONS Watery, explosive,yellow-greenish stool Refusal to eat or drink Dehydration Infectious diarrhea caused: E.coli Salmonella Shigella C difficile Giardia lamblia 46 46 TREATMENT/NURSING CARE Mild diarrhea can be treated at home Reduce solids Oral rehydration BRAT diet not encouraged 47 47 CONSTIPATION Difficult or infrequent defecation with the passage of hard, dry fecal material Functional constipation Evaluate bowel and dietary habits 48 48 16  2/15/2024 ORAL FLUIDS Oral hydration preferred over IV therapy Encourage small amounts,frequently Accurate intake and output 10ml/kg per stool; 2ml/kg per emesis Simple protein and starch 49 49 PARENTERAL FLUIDS Necessary when vomiting or LOC is involved Pacifier given to infants on NPO status Encourage parents to comfort child 50 50 DEHYDRATION Causes fluid and electrolyte disturbances Evaluation of type and severity, including clinical observation and chemical analysis of the blood 51 51 17  2/15/2024 TYPES OF DEHYDRATION Isotonic Electrolytes & water deficits are present in balanced proportions Hypotonic Electrolyte deficit exceeds water deficit Hypertonic Larger loss of water or larger intake of electrolytes Requires specific therapy May cause permanent damage 52 52 TREATMENT/NURSING CARE Maintenance fluid therapy Deficit therapy IV Potassium 53 53 OVERHYDRATION Body receives more fluid than it can excrete. Manifests as edema-Anasarca Treatment Nursing Care 54 54 18  2/15/2024 FLUID AND ELECTROLYTE IMBALANCE More water is lost through the skin than through the kidneys. Metabolic rate and heat production are also 2-3x greater Increase of waste products Stimulates respirations Greater percentage of body water in children younger than 2 years is contained in extracellular compartment 55 55 NUTRITIONAL DEFICIENCIES 56 56 FAILURE TO THRIVE Failure to gain weight and often lose weight Can be caused by Organic (OFTT) Nonorganic (NFTT) Often admitted Hypotonia 57 57 19  2/15/2024 FAILURE TO THRIVE Development is delayed. Disturbance in the mother–child relationship. Pregnancy history may contribute to a lack of mother– infant bonding. 58 58 KWASHIORKOR Severe deficiency of protein in the diet. Seen most often in developing countries Ages 1-4; no longer breastfeeding 59 59 RICKETS Deficient in vit.D Classic symptoms: bow legs; knock knees; rachitic rosary improper formation of teeth Treatment 60 60 20  2/15/2024 SCURVY Insufficient fruits and vegetables that contain vitamin C Symptoms: joint pain bleeding gums loose teeth lack of energy Vitamin supplements and dietary intake such as citrus fruits and raw leafy vegetables 61 61 INFECTIONS OF THE GI TRACT 62 62 APPENDICITIS Initial pain usually in periumbilical and increases within a 4- hour period When inflammation spreads to peritoneum, pain localizes in RLQ of abdomen. Surgical intervention Nursing Care 63 63 21  2/15/2024 THRUSH (ORAL CANDIDIASIS) Infection caused by Candida Anorexia may be present. Symptoms: white patches,anorexia Local application of antifungal suspension With proper care, the condition disappears within a few days after onset. 64 64 PINWORMS (ENTEROBIASIS) Seen more in toddlers; infected by ingesting eggs Symptoms:itching,weight loss, poor appetite Scotch tape test Anthelmintic medications Treatment/ Nursing Care 65 65 ROUNDWORMS (ASCARIASIS) Asymptomatic and cause abdominal pain Eggs ingested through contaminated soil Chronic cough with fever is characteristic of this condition. 66 66 22  2/15/2024 POISONING Goals of treatment Remove the poison. Prevent further absorption. Call the poison control center. Provide supportive care; seek medical help. Poison control centers—Nationwide phone number is 800-222- 1222. 67 67 DETECTING POISON Odor of vomitus Probably content Sweet Chloroform, acetone Bitter Almond Cyanide Pear Chloral hydrate(sedative) Garlic Organophosphate (chemical fertilizer), arsenic Shoe polish Nitrobenzene Violet Turpentine Rotten egg Natural gas leak 68 68 TREATMENTS Activated charcoal Gastric Lavage Whole Bowel Irrigation 69 69 23  2/15/2024 OTC DRUG POISONING Acetaminophen Overdose results in hepatic destruction Symptoms are non specific Antidote N-acetylcysteine (Mucomyst) administered Salicylate Act rapidly but is excreted slowly Symptoms:Nausea,vomiting, tinnitus,tachycardia Vitamin K administered to control bleeding 70 70 LEAD POISONING (PLUMBISM) Child ingest materials containing lead. Symptoms gradually occur: Weakness, weight loss,vomiting Can have a lasting effect on the CNS, especially the brain Treatment aimed at reducing concentration in tissues and blood. Chelating agents administered-45mcg/dL 71 71 ANTICIPATED CARE FOR POISONING Symptoms Intervention Absorption Assist with initial treatment and activated charcoal administration CNS: restlessness, agitation, seizures, Seizure precautions, document LOC and coma response Respiratory: airway obstruction, Cardiopulmonary resuscitation, oxygen hypoventilation, hypoxia saturation monitoring, oxygen therapy, keep artificial airway handy Cardiovascular: difficulties with Monitor VS and labs electrolytes, blood urea nitrogen, creatinine, glucose Gastrointestinal: difficulty swallowing, NPO status; monitor bowel sounds and abdominal pain diarrhea Kidney problems Monitor I&Os; monitor IV lines Hypothermia or hyperthermia Sponge baths, cooling blanket, monitor body temp Child: physical response or Crisis intervention psychological trauma Counseling, teaching, referral Parents: guilt, anger, family dysfunction 72 72 24  2/15/2024 FOREIGN BODIES 80% of foreign bodies pass through the GI tract. Child cared for at home Caution parents to not use laxatives 73 73 On the second day of hospitalization for a 3‐ month‐old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment? a) Dry mucous membranes b) Decreased skin tugor c) Weight loss of 4oz d) Depressed fontanelle 74 74 Which finding in a newborn is suggestive of tracheoesophageal fistula? a) Failure to pass meconium in 24hrs b) Palpable mass in the sternal area c) Choking on the first feeding d) Visible peristalsis across abdomen 75 75 25  2/15/2024 Which is the most appropriate intervention for a 3‐month‐old infant who has gastroesophageal reflux? a) Failure to pass meconium in 24hrs b) Palpable mass in the sternal area c) Choking on the first feeding d) Visible peristalsis across abdomen 76 76 The nurse is teaching a parent about pyrvinium (Povan). What would be included in regard to potential side effects? a) diarrhea b) Skin rash c) Red stool d) Metallic taste 77 77 What instruction will the nurse give to parents about preventing the spread and reinfection of pinworms? a) Keep nails cut short, wear tight fitting underwear, wash all linen and clothes in hot water, meticulous hand hygiene 78 78 26  2/15/2024 Following surgery for pyloric stenosis, an infant awoke from anesthesia hungry and crying. What is the most appropriate nursing action? a) Offer regular formula thinned with water b) Delay feeding child for 6hrs c) Give small amounts of regular formula thickened with cereal d) Allow 1oz of glucose water at frequent intervals 79 79 Which statement made by a parent alerts the nurse to the need for additional education about poison prevention? a) “I keep the poison control center phone number easily accessible.” b) “All medication is kept out of reach in a locked cabinet.” c) “I keep a bottle of syrup of ipecac handy.” d) “Our garden is free from marigolds.” 80 80 REVIEW OF MAIN POINTS 1. Gastrointestinal anomalies in infants. 2. Disorders and Dysfunctions of the GI tract 3. Disorder of Motility 4. Nutritional Deficiencies. 5. Infections of the GITract. 6. Worms in the GITract 7. Poisoning 81 81 27