GI Alterations Student 4312 2024 PDF

The Child with Gastrointestinal Alterations Review of the digestive system Age-related differences in the GI system Infants have minimal saliva Swallowing has voluntary control at 6 wk Infants and children have less stomach capacity Small stomach with horizo...

The Child with Gastrointestinal Alterations Review of the digestive system Age-related differences in the GI system Infants have minimal saliva Swallowing has voluntary control at 6 wk Infants and children have less stomach capacity Small stomach with horizontal positioning Shorter large intestine Unable to reabsorb water from stool (stools are looser) Peristaltic waves are faster and can reverse in infants. Regurgitation/vomiting Immature neonatal liver Less vitamin/mineral breakdown (McKinney et al, Box p. 960) Disorders of GI development Cleft lip and palate Esophageal atresia Tracheoesophageal fistula Congenital diaphragmatic hernia Oomphalocele & Gastroschesis Imperforate Anus Disorders of Development (prenatal GI) Primitive gut is formed first 4 weeks of embryologic development Most rapid and extensive development 3rd trimester Children with GI alterations often have many special requirements Can began at birth Can be life threatening Some parents may have to accept child’s altered appearance Some require long term management and treatment Unexpected surgeries Affects many systems (skin, respiratory, grow & development) Consider mental health Consider family functioning Photo from Fairview Health Services  Cleft lip or palate Multiple genetic and environmental factors Failure of closures: Lip (6-8 weeks), palate (7-12 weeks) 1/1600 births occur in combination 1/2800 births occur independently May be associated with a syndrome Treatment: staged surgery, Prognosis: EXCELLENT, with treatments. Photos from Ellen Morrison.  Cleft lip or palate; Nursing considerations Caregiver support Coordination of services Feeding consult (speech, OT) Education Feeding, skin care, aspiration risk Preparation for next steps Surgery Photos from Ellen Morrison. Esophageal atresia (EA) and Tracheoesophageal fistula (TEF) 1 /3500 live births May be associated with a genetic syndrome May be seen with polyhdraminos Failure to differentiate the foregut into trachea and esophagus Watch for the 3 C’s Esophagus terminates before it reaches the stomach - Coughing Oral intake can enter lungs, extra air can enter - Choking with feedings Photos from UVA GI stomach Radiology (severe and abdominal distention - Cyanosis McKinney. 8 EA and TEF; Nursing Considerations Cannot be fed orally, NPO Will need IV access NG to suction HOB elevated Constant respiratory evaluation Removal of oral secretions Surgical intervention as neonate/Emergency Requires PICU/NICU stay Parent support/education Congenital Diaphragmatic Hernia Excepted course Incidence 1 in 3600 births Results in GI issues/obstruction Respiratory impairment Requires urgent surgical repair Signs and symptoms Fetal ultrasonography Absent/dim breath sounds Bowel sounds in chest Cardiac sounds on right side of the heart Respiratory distress soon after birth Scaphoid abdomen Nursing Considerations: Requires mechanical ventilation Underdeveloped lungs Abdominal contents herniate into the Chronic issues thoracic cavity during prenatal Parental support development at 6-10 weeks gestation  Oomphalocele & Gastroschesis Oomphalocele Placental abnormality at or near the umbilicus 1/4200 births Baby is born with some abdominal contents outside their body Oomphalocele- through the “belly button” in a sac Requires surgery (primary or staged) May need a silo Large oomphalocele often need tissue expanders Gatroschisis During fetal development an opening forms in the baby’s abdominal wall. (right of umbilicus) Baby’s bowel pushes through the hole (1-2 1/10,000 births inches). Many have underlaying genetic disorer Bowel then develops outside body in-utero Oomphalocele & Gastroschesis Nursing considerations : Nutrition; NG, parenteral & may need decompression Infection risk (Immediately cover with warm, moist, sterile gauze and wrap with plastic) Fluids; increased loss/prevent dehydration Antibiotics Respiratory support Caregiver support Educating Caregivers At the delivery hospital, a neonatologist (a doctor who specializes in treating newborns) will manage the care of your baby. The neonatologist will assess your baby’s breathing and heart rate, and examine the baby for other problems. Your baby will receive care in the delivery hospital’s neonatal intensive care unit (NICU). A breathing tube will be placed if your baby is having difficulty breathing. The omphalocele sac will be covered with a warm, moist sterile dressing. A tube will be put through your baby’s nose (nasogastric, NG) or mouth (orogastric, OG) down into the stomach. This tube helps to keep the stomach and intestines empty and decompressed. An intravenous line (IV) will be started in your baby’s arm, hand, foot or scalp. The IV provides fluids and antibiotics to prevent dehydration and infection. Your baby will be transferred to the main children’s hospital NICU for further care. Silo specially made piece of plastic placed over the bowels to protect before surgery few hours - several days while we wait for the intestines to shrink enough to fit back into the abdomen. The silo can usually be easily placed at your baby’s bedside Surgery ideally 2-3 days after birth Imperforate 1/5,000 births Anus Nursing considerations: Opening may be completely missing or Parenteral nutrition and misplaced decompression Requires surgery Fluid losses May result in chronic genitourinary Constipation issues Bowel and bladder function Rectal atresia- Parental support Rectal stenosis- Imperforate ansus- Motility Disorders GERD Encopresis/constipation  GER vs GERD Gastroesophageal reflux (GER)- gastric contents reflux back up into the esophagus, making esophageal mucosa vulnerable to injury. Usually peaks at 4 months and resolves by 1 year Most common cause, relaxation of the (lower esophageal sphincter) LES As infant grows, LES matures and reflux stops Physiologic Gastroesophageal reflux disease (GERD)- symptoms or tissue damage from GER Pathologic Tissue damage Normal GER Failure to thrive Respiratory problems Dysphagia Common symptoms & complications by age of GER Symptoms in infants Spitting up, regurgitation, recurrent vomiting Excessive crying, irritability, arching of the back, stiffening Poor weight gain Respiratory problems (cough, wheeze, stridor, gagging, choking with feeds) Feeding refusal Those at risk Symptoms in children Premature infants Heartburn Infants with Abdominal pain bronchopulmonary Chronic cough, hoarse voice dysplasia Dysphagia Had tracheoesophageal or Asthma esophageal atresia repairs Complications Neurologic disorders Esophagitis Esophageal stricture Scoliosis Laryngitis Asthma Recurrent pneumonia Cystic fibrosis Anemia Cerebral palsy Barrett esophagus GER; Nursing considerations Diet Infant/child Thickened formula Breast feeder Avoiding certain foods Smaller/frequent meals Positioning Prone (not while sleeping) Medications Zantac – H2-receptor antagonist Prilosec – proton pump inhibitor Babies typically outgrow by 12 months  GERD; Nursing considerations Diagnosis History and physical examination- usually sufficient Upper GI study to detect GI structural abnormalities 24 hour intra-esophageal pH probe study Endoscopy w/ biopsy to detect severity esophagitis and strictures Diet Infant/child Breastfeeding person (if breastfeeding) NG (with severe reflux) Positioning Medications Watch for respiratory complication- pneumonia Surgery Severe GER/GERD, aspiration pneumonia, apnea, severe esophagitis, failure to thrive, not responding to medications Nissen fundoplication Wrap the fundus of the stomach around the distal esophagus reinforces the lower esophageal sphincter Constipation/Encopresis Constipation: Decrease in bowel movement frequency or trouble defecating for > 2 weeks Passing