Nursing Care of Pediatric Gastrointestinal Disorders

NURSING CARE OF A FAMILY WHEN A CHILD HAS § GI system § Major source of fluid and electrolyte loss if vomiting or diarrhea occurs. § 3 Body Compartments: § Intracellular (35% to 40% of body weight) § Interstitial (20% of the body weight) § Intravascular (5% of body weight) § In in...

NURSING CARE OF A FAMILY WHEN A CHILD HAS § GI system § Major source of fluid and electrolyte loss if vomiting or diarrhea occurs. § 3 Body Compartments: § Intracellular (35% to 40% of body weight) § Interstitial (20% of the body weight) § Intravascular (5% of body weight) § In infants, the ECF is much greater. § ISOTONIC DHN § Water and salt are lost in proportion § Occurs when more water is lost than it absorbs (diarrhea) or absorbs less fluid than it excretes (N/V) § HYPERTONIC DHN § Water is lost out of proportion to salt § Nausea, fever, profuse diarrhea, renal disease such as nephrosis § Increase sodium, chloride, and bicarbonate in the blood § Increase RBC count and hematocrit because blood is more concentrated. § HYPOTONIC DHN § Electrolytes are lost out of proportion to water. § Excessive loss of electrolytes from vomiting, increased lost of salt from diuresis § Excessive body fluid intake = occurs in children receiving IV fluids § Can lead to cardiovascular and cardiac failure § Large quantities of tap water are ingested or given by enema = water transfers from EC space into the IC space = intracellular edema (S/SX: headache, N/V, dimness and blurring of vision, cramps, muscle twitching, seizures) § Vomiting and diarrhea = metabolic acidosis and metabolic alkalosis § Metabolic acidosis = results from diarrhea since a great amount of Na is lost with stool § Metabolic alkalosis = from vomiting (HCl loss) § VOMITING § Can be from mild gastroenteritis due to viral or bacterial organism § Other causes: obstruction, increased ICP, metabolic disease § Give small amount of fluid frequently as soon as tolerated § Clear liquids can be used to maintain hydration = ginger ale, tea, sports drinks § ORS such as Pedialyte for infants and younger children § DIARRHEA § Acute = infection § Chronic = malabsorptive or inflammatory cause § Giardia lamblia § Rotaviruses and adenoviruses § Campylobacter jejuni, Salmonella, Clostridium difficile, Escherichia coli § MILD DIARRHEA § Mucous membrane of the mouth appears dry, skin feels warm, pulse may be rapid, low grade fever, urine output is normal § SEVERE DIARRHEA § Depressed fontanelle, sunken eyes, poor skin turgor § Liquid green stool (explosive force) § Scanty and concentrated urine output § Elevated hematocrit, hemoglobin, serum protein § 2.5% to 5 % body weight loss = mild DHN § 5% to 15% body weight loss = severe DHN § 10% or more body weight loss = needs immediate treatment § Treatment focuses on regulating electrolyte and fluid balance by initiating oral or IV rehydration therapy and on discovering the organism responsible for diarrhea § Severe diarrhea or diarrhea that persists longer than 24 hours = stool culture § Most effective way to replace fluid = offering oral rehydration therapy (if child can drink) § IV solution PNSS, D5 0.9 NaCl = for child who is unable to drink § Salmonella bacteria § Incubation: 6 to 72 hours for intraluminal type; 7 to 14 days for extraluminal type § Period of Communicability: as long as organisms are being excreted (may be as long as 3 months) § MOT: ingestion of contaminated food (chicken and raw eggs) § Listeria monocytogenes § Incubation: variable, ranging from 1 day to more than 3 weeks § MOT: ingestion of unpasteurized milk or cheese or vegetables grown in contaminated soil. § Should be avoided during PREGNANCY = can lead to miscarriage, stillbirth, prematurity, infection of the newborn § Shigella § Incubation: 1 to 7 days § Period of Communicability: 1 to 4 weeks § MOT: contaminated food, water, or milk products § Staphylococcal enterotoxin (S.aureus) § Incubation: 1 to 7 hours § Period of Communicability: carriers may contaminate food as long as they harbor the organism § MOT: ingestion of contaminated food such as poultry, creamed foods (potato salad), and inadequate cooking § Results in loose, watery stools § Chief therapy = ORS § G.lamblia = metronidazole § Due to the immaturity of the cardiac sphincter / LES § Emesis occurs after eating § Feed infants small frequent feedings of formula thickened with rice cereal (1 tbsp of cereal per 1 oz. of breast or formula milk) § Infant should be held in an upright position for 30minutes after feedings if possible § Tight clothing and diapers should be avoided § Cigarette smoke should be avoided § Breastfeeding mother to eliminate dairy from her diet or trial of hypoallergenic formula for 2 weeks § Self-limiting for infants § At 4 to 6 weeks of age, infants typically begin to vomit almost immediately after each feeding. § The vomiting grows increasingly forceful until it is projectile, possibly projecting as much as 3 to 4 feet. § Occurs less frequently in breastfed infants than in formula fed infants. § Vomitus usually smells sour. § Usually hungry after vomiting § Surgical or laparoscopic correction - pyloromyotomy § Peptic ulcer is a shallow excavation in the mucosal wall of the stomach, pylorus, duodenum. § Include gastritis and is commonly seen in childhood. § Infants = ulcers in the stomach § Adolescents = ulcers in the duodenum § Pain, blood in the stool, vomiting (with blood) § If untreated can lead to bowel or stomach perforation. § Ulcer in neonate § Hematemesis or melena § Usually superficial and heal rapidly § Toddler § First symptom = anorexia or vomiting § Preschool or early school-age § May report pain as mild, severe, colicky, or continuous § Poorly localized; pain may be in the epigastric or RLQ § School age and adolescents § Gnawing or aching pain in the epigastric area before meals that is relieved by eating § Epigastric tenderness § If due to H.pylori infection: § 2 antibiotics = amoxicillin and clarithromycin § PPI = omeprazole § Bismuth salicylate (Pepto-Bismol) § The invagination of one portion of the intestine into another. § Most frequently occurs in the second half of the first year of life. § Point of invagination is generally at the juncture of the distal ileum and proximal colon. § Children usually draw up their legs and cry as if they are in severe pain; may also vomit. § Stool is described as having a “red currant jelly” appearance due to the blood and mucus it contains. § Abdomen becomes distended as the bowel above the intussusception distends § If necrosis occurs = elevated temperature, peritoneal irritation (abdomen feels tender and they may “guard” it by tightening their abdominal muscles), increased WBC, rapid pulse. § Episodes of crying for a short time but repeat every 15 to 20 minutes § The stomach feels full and vomitus and diarrhea with blood may occur. § Confirmed by X-ray or UTZ § Surgical emergency § Twisting of the intestine leading to obstruction of the passage of the feces and compromising blood supply to the loop of intestine involved. § Symptoms occur during the first 6 months of life and are those of intestinal obstruction such as intense crying and pain, pulling up the legs, abdominal distention, vomiting § Pain and vomiting are unrelated to feeding. § Confirmed by UTZ and lower barium X-ray § Surgery is emergency § Necrotic areas develop in the bowel that interfere with digestion and can lead to paralytic ileus, perforation, peritonitis. § Highest in immature infants, those who have suffered anoxia or shock, those fed by enteral feedings. § Signs usually occur in the first week of life § Abdomen becomes distended and tense § Positive occult blood § Abdominal girth measurements made just above the umbilicus every 4 to 8 hours will show a gradual increase. § Abdominal X-ray films will show a characteristic picture of air invading the intestinal wall § If perforation has occurred, there will be air in the abdominal cavity. § Breast feedings or formula feedings are discontinued once diagnosis is made. § IV or TPN to rest the GI tract except for additional supplements of enteral probiotics. § Antibiotic may be given to limit secondary infections. § Handle the infant’s abdomen gently to lessen possibility of bowel perforation.