Gastrointestinal Gastrointestinal Disorders in Pediatric Disorders in Pediatric

PatientsPatientsMarlene Meador RN, MSNMarlene Meador RN, MSN

Fall 2006Fall 2006

Cleft Lip and Cleft PalateCleft Lip and Cleft Palate

Etiology- Failure of maxillary and Etiology- Failure of maxillary and median nasal processes to fuse median nasal processes to fuse during embryonic developmentduring embryonic development

Remember the psycho-social Remember the psycho-social implications for these children and implications for these children and

families families

pphhoottooss

AssessmentAssessment

Unilateral, bilateral, midlineUnilateral, bilateral, midline

TreatmentTreatment

Surgical repair done ASAPSurgical repair done ASAP Rule of 10 > 10#, 10 weeks, 10 HGBRule of 10 > 10#, 10 weeks, 10 HGB Multidisciplinary teamMultidisciplinary team

Management Pre-opManagement Pre-op

Maintain nutrition Maintain nutrition

Prevent aspirationPrevent aspiration

Pre-op TeachingPre-op Teaching

Remind parents that defect is Remind parents that defect is operable- show photographs of operable- show photographs of corrected cleftscorrected clefts

Introduce cup, spoon feeding devices Introduce cup, spoon feeding devices (see page 1114 for feeding tips) (see page 1114 for feeding tips)

Explain restraints Explain restraints Explain Logan BowExplain Logan Bow

Post-OpPost-Op

Prevent trauma to suture linePrevent trauma to suture line Facilitate breathingFacilitate breathing Maintain nutritionMaintain nutrition Cleanse suture lines as orderedCleanse suture lines as ordered Referral to appropriate team Referral to appropriate team

membersmembers

Esophageal AtresiaEsophageal Atresia

Failure of the esophagus to totally Failure of the esophagus to totally differentiate during uterine differentiate during uterine development.development.

AssessmentAssessment

Respiratory difficultiesRespiratory difficulties Drooling Drooling Coughing, chokingCoughing, choking Gastric distention Gastric distention Hx of ??? during pregnancy?Hx of ??? during pregnancy?

Management Management

Early diagnosisEarly diagnosisUltra soundUltra sound

Radiopaque catheter inserted in the Radiopaque catheter inserted in the esophagus to illuminate defect on X-rayesophagus to illuminate defect on X-ray

Surgical repair- thoracotomy and Surgical repair- thoracotomy and anastomosisanastomosis

Pre-OpPre-Op

Maintain airway Maintain airway Keep NPO- administer IV fluidsKeep NPO- administer IV fluids Elevate HOB 30 degreesElevate HOB 30 degrees Suction PRNSuction PRN Prophylactic antibioticsProphylactic antibiotics

Post-OpPost-Op

Maintain airwayMaintain airway

Maintain nutritionMaintain nutrition

Prevent trauma Prevent trauma

Gastroesophagial Reflux Gastroesophagial Reflux (GER)(GER)

The cardiac sphincter and lower The cardiac sphincter and lower portion of the esophagus are weak, portion of the esophagus are weak, allowing regurgitation of gastric allowing regurgitation of gastric contents back into the esophagus.contents back into the esophagus.

Assessment: InfantAssessment: Infant

Regurgitation almost immediately Regurgitation almost immediately after each feeding when the infant is after each feeding when the infant is laid downlaid down

Excessive crying, irritability Excessive crying, irritability FTHFTH Complications of aspiration Complications of aspiration

pneumonia, apneapneumonia, apnea

Assessment: ChildAssessment: Child

HeartburnHeartburn Abdominal painAbdominal pain Cough, recurrent pneumoniaCough, recurrent pneumonia DysphagiaDysphagia

DiagnosisDiagnosis

Assess Ph of secretions in esophagus Assess Ph of secretions in esophagus if <7.0 indicates presence of acidif <7.0 indicates presence of acid

Also diagnosed using Barium Swallow Also diagnosed using Barium Swallow and visualization of esophageal and visualization of esophageal abnormalities abnormalities

Management & Nursing Management & Nursing CareCare

Nutritional needsNutritional needs PositioningPositioning Medications Medications CPR instruction for CPR instruction for

parents/caregiversparents/caregivers Surgery Surgery

Diarrhea/GastroenteritisDiarrhea/GastroenteritisSevereSevere

A disturbance of the intestinal tract A disturbance of the intestinal tract that alters motility and absorption that alters motility and absorption and accelerates the excretion of and accelerates the excretion of intestinal contents.intestinal contents.

Most infectious diarrheas in this Most infectious diarrheas in this country are caused by Rotoviruscountry are caused by Rotovirus

Critical ThinkingCritical Thinking

Why is there an increase in incidence Why is there an increase in incidence of diarrhea in lower socio-economic of diarrhea in lower socio-economic groups?groups?

Why is there and increase in young Why is there and increase in young children?children?

Clinical ManifestationsClinical Manifestations

Increase in peristalsisIncrease in peristalsis Large volume stoolsLarge volume stools Increase in frequency of stoolsIncrease in frequency of stools Nausea, vomiting, crampsNausea, vomiting, cramps Increased heart & resp. rate, Increased heart & resp. rate,

decreased tearing and fever decreased tearing and fever

ComplicationsComplications

DehydrationDehydration

Metabolic AcidosisMetabolic Acidosis

DiagnosisDiagnosis

Stool cultureStool culture

O&PO&P

Diagnose Metabolic AcidosisDiagnose Metabolic Acidosis

Treatment & Nursing CareTreatment & Nursing Care

Treat causeTreat cause Fluid and electrolyte balanceFluid and electrolyte balance Weigh dailyWeigh daily Monitor I&OMonitor I&O Assess for dehydrationAssess for dehydration IsolateIsolate Skin careSkin care

AppendicitisAppendicitis

Inflammation of the lumen of the Inflammation of the lumen of the appendix which becomes quickly appendix which becomes quickly obstructed causing edema, necrosis obstructed causing edema, necrosis and pain. and pain.

Clinical ManifestationsClinical Manifestations

Abdominal painAbdominal pain Silent abdomenSilent abdomen Anorexia and nauseaAnorexia and nausea DiarrheaDiarrhea Elevated temperatureElevated temperature Sudden reliefSudden relief

DiagnosisDiagnosis

History and PhysicalHistory and Physical Laboratory valuesLaboratory values X-ray or UltrasoundX-ray or Ultrasound

Management and Nursing Management and Nursing Care: Pre-OpCare: Pre-Op

NPONPO IVIV Comfort measuresComfort measures AntibioticsAntibiotics Thermal therapyThermal therapy EliminationElimination Patient educationPatient education

Management and Nursing Management and Nursing Care: Post-OpCare: Post-Op

NPONPO AntibioticsAntibiotics AnalgesiaAnalgesia Patient teachingPatient teaching

Pyloric StenosisPyloric Stenosis

Pyloric sphincterPyloric sphincter IncidenceIncidence Possible genetic predispositionPossible genetic predisposition

AssessmentAssessment

VomitingVomiting Constant hunger and fussinessConstant hunger and fussiness Distended upper abdomenDistended upper abdomen Hypertrophied pylorusHypertrophied pylorus Visible peristaltic wavesVisible peristaltic waves

DiagnosisDiagnosis

History and PhysicalHistory and Physical UltrasoundUltrasound Laboratory valuesLaboratory values

Management and Management and Nursing CareNursing Care

FredFred Ramstedt procedure- Ramstedt procedure- Pylorotomy via laproscopyPylorotomy via laproscopy

Pre-OpPre-Op

Hydration and electrolyte balanceHydration and electrolyte balance Weigh daily & I and OWeigh daily & I and O Support of parentsSupport of parents

Post- Op:Post- Op:

I & OI & O FeedingFeeding PositionPosition Surgical siteSurgical site Patient teachingPatient teaching

Critical ThinkingCritical Thinking

A 4 week old infant with a history of A 4 week old infant with a history of vomiting after feeding has been vomiting after feeding has been hospitalized with a tentative diagnosis of hospitalized with a tentative diagnosis of pyloric stenosis. Which of these actions is pyloric stenosis. Which of these actions is priority for the nurse?priority for the nurse?– Begin an intravenous infusionBegin an intravenous infusion– Measure abdominal circumferenceMeasure abdominal circumference– Orient family to unit Orient family to unit – Weigh infantWeigh infant

IntussuceptionIntussuception

Most commonly seen in infants 3-12 Most commonly seen in infants 3-12 monthsmonths

Typically follows what type of illness?Typically follows what type of illness?

AssessmentAssessment

PainPain VomitingVomiting StoolsStools DehydrationDehydration Serious complicationsSerious complications

DiagnosisDiagnosis

X-rayX-ray

Abdominal ultrasoundAbdominal ultrasound

Therapeutic InterventionTherapeutic Intervention

Hydrostatic reductionHydrostatic reduction

Surgery Surgery

Nursing Care:Nursing Care:

NPO- NGNPO- NG

AssessAssess

Monitor stoolsMonitor stools

Re-introduce foodRe-introduce food

Hirschsprung’s DiseaseHirschsprung’s Disease

Congenital disorder of nerve cells in lower Congenital disorder of nerve cells in lower coloncolon

AssessmentAssessment Failure to pass meconiumFailure to pass meconium VomitingVomiting

Bowel assessmentBowel assessment

BreathBreath

Older childOlder child

DiagnosisDiagnosis

History & PhysicalHistory & Physical

Barium enema (X-ray)Barium enema (X-ray)

Rectal biopsy- absence of ganglionic Rectal biopsy- absence of ganglionic cells in bowel mucosacells in bowel mucosa

Management Management

Surgical intervention Surgical intervention –ColostomyColostomy–ResectionResection

Nursing Care:Nursing Care:

Pre-opPre-op– Cleanse bowel Cleanse bowel – Patient/parent teachingPatient/parent teaching

Post-opPost-op– NPONPO– VSVS– AssessmentAssessment– Patient/parent teachingPatient/parent teaching

Volvulus & MalrotationVolvulus & Malrotation

Assessment- pain, bilious vomiting, S Assessment- pain, bilious vomiting, S & S & S bowel obstructionbowel obstruction

Treatment- surgery to prevent Treatment- surgery to prevent ischemiaischemia

Nursing Care- same as Intussuception Nursing Care- same as Intussuception and and Hirschsprung’sHirschsprung’s

GastroschisisGastroschisis

Assessment- noted on ultrasound Assessment- noted on ultrasound and and obvious at birthobvious at birth

Treatment- surgical repair in stagesTreatment- surgical repair in stages

Nursing care- support parents loss of Nursing care- support parents loss of “Perfect Child”“Perfect Child”

OmphaloceleOmphalocele

Assessment- ultrasound and at birthAssessment- ultrasound and at birth

Treatment- surgical repair in stagesTreatment- surgical repair in stages

Nursing care- same as for Nursing care- same as for GastroschisisGastroschisis

Imperforate AnusImperforate Anus

Assessment- note failure to pass Assessment- note failure to pass meconium, Ultrasound & CTmeconium, Ultrasound & CT

Treatment- repeated dilation or surgical Treatment- repeated dilation or surgical intervention dependent on intervention dependent on

extentextent

Nursing Care- note skin dimples or stool Nursing Care- note skin dimples or stool in in urine or vaginaurine or vagina

Umbilical HerniaUmbilical Hernia

Assessment- abdominal muscle of NB Assessment- abdominal muscle of NB does does not meet around umbilical not meet around umbilical ringring

Treatment- resolve by age 1 yr. Surgical Treatment- resolve by age 1 yr. Surgical if if not resolved by 5 years or not resolved by 5 years or

becomes strangulated or enlargesbecomes strangulated or enlarges Nursing care- Binding not effective. Nursing care- Binding not effective.

Monitor for obstruction or Monitor for obstruction or strangulationstrangulation

Failure to Thrive (FTH)Failure to Thrive (FTH)

Assessment- low growth for age, Assessment- low growth for age, developmental delays, developmental delays,

apathyapathy Diagnosis- History to determine Diagnosis- History to determine

organic-organic- vs- non-organic vs- non-organic Nursing Care- Teaching on nutrition Nursing Care- Teaching on nutrition

feeding techniques, feeding techniques, feeding feeding cues, cues, praisepraise

Community resourcesCommunity resources

Helminths/Parasitic Helminths/Parasitic DisordersDisorders

Assessment- parasites identified in Assessment- parasites identified in stoolstool

Treatment- oral medications specific Treatment- oral medications specific to to helminthhelminth

Nursing care- Nursing care- preventionprevention education, education,

Celiac DiseaseCeliac Disease

Assessment- Growth pattern, GI patternAssessment- Growth pattern, GI pattern

Treatment- Treatment- Dietary restrictions Dietary restrictions Nursing Care- monitor for dehydration, Nursing Care- monitor for dehydration,

encourage compliance with encourage compliance with dietary restrictions, provide dietary restrictions, provide support groups for patient and support groups for patient and

caregivercaregiver

Please contact me with any questions Please contact me with any questions or concerns regarding my lecturesor concerns regarding my lectures

Marlene Meador RN, MSNMarlene Meador RN, MSN

mmeador@austincc.edummeador@austincc.edu