Nursing Care of the Child with a Gastrointestinal Disorder

Normal Gastrointestinal Normal Gastrointestinal SystemSystem

Disorders of

Development

Cleft Lip and Cleft PalateCleft Lip and Cleft Palate

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

Remember the psycho-social implications for these children and families

AssessmentAssessment

Unilateral, bilateral, midline

TreatmentTreatment

Surgical repair between 3 and 6 months Multidisciplinary team Reconstruction begins in infancy and can continue

through adulthood. Homecare by the family prior to surgery

Pre-op Nursing CarePre-op Nursing Care

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

Before After

Pre-op Nursing CarePre-op Nursing Care

Latham DeviceLatham Device

Post-OpPost-Op Prevent trauma to suture line

Protect site Advance diet as tolerated Maintain upper arm restraints Position supine No hard objects in mouth 7-10 days

Reduce Pain Prevent Infection

Cleanse suture lines as ordered – rinse with water after each feeding.

Call Doctor for any swelling or redness Referral to appropriate team members

Esophageal Atresia

Malformation from failure of esophagus to Malformation from failure of esophagus to develop as a continuous tubedevelop as a continuous tube

Upper Esophagus

Trachea

Lower Esophagus

Signs and SymptomsSigns and Symptoms

Excessive amounts of salivation / mucus, frothy bubbles Three “C’s”: Coughing, choking, and cyanosis when fed Food may be expelled through the nose immediately

following the feeding Rattling respirations and frequent respiratory problems

such as aspiration pneumonia Gastric distention, if fistula

Diagnosis and ManagementDiagnosis and Management

Early diagnosis Ultrasound Radiopaque catheter inserted in the esophagus to

illuminate defect on X-ray

Surgical repair Thoracotomy and anastomosis

Pre-OpPre-Op

Post-OpPost-Op

Maintain airway

Maintain nutrition Gastrostomy tube feedings

Prevent trauma

Monitor for potential complications

Monitor weight, growth and developmental achievements

Imperforate Anus

Incomplete development or absence of anus in its normal

position in perineum.

AssessmentAssessment

Most commonly diagnosed upon Newborn Assessment

Symptoms Absence of anorectal canal Failure to pass meconium Presence of anal membrane

TreatmentTreatment

Anal stenosis is treated with repeated anal dilation

Surgery

Omphalocele

Gastroschisis

OmphaloceleOmphalocele

Herniation of abdominal contents through the umbilical cord. Contents are covered by a translucent sac.

Gastroschisisherniation of abdominal viscera outside the abdominal cavity through a defect in the abdominal wall to the side of the umbilicus. Not covered.

DiagnosisDiagnosis

Alpha-fetaoprotein

Provide an early diagnosis Ultrasound

Treatment and Nursing CareTreatment and Nursing Care

Pre-operatively – provide protection of the contents/sac. Cover with warm, sterile, saline-soaked dressings Maintain temperature – esp. with gastroschisis

May choose to replace the gut to the abdomen gradually over several weeks.

May place silo or silastic material

over gut until it returns to the

abdomen. Surgery used to close defect.  

Post-op CarePost-op Care

Assess for ileus

Maintain parenteral feedings

Provide support to the parents.

Gastroesophageal Reflux Disease(GERD)

The cardiac sphincter and lower portion of the esophagus are weak, allowing

regurgitation of gastric contents back into the esophagus.

Assessment: InfantAssessment: Infant

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

Excessive crying, irritability

Failure to Thrive

Life Threatening Risk / Complications: aspiration pneumonia apnea

Assessment: ChildAssessment: Child

Heartburn Abdominal pain Cough, recurrent pneumonia Dysphagia

DiagnosisDiagnosis

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

Also diagnosed using Barium Swallow and visualization of esophageal abnormalities

Management & Nursing CareManagement & Nursing Care

Small frequent feedings of predigested formula or thicken the formula

Frequent burping Positioning --prone position- flat prone or head elevated prone. Use

reflux board to keep head elevated.

Avoid excessive handling after feedings. Nissen Fundoplication

Reflux board

MedicationsMedications H2 Histamine receptor antagonists – reduce gastric acidity

Zantac and Pepcid Proton-pump inhibitors

Prevacid Prilosec

Gastric emptying Reglan

Antacids Gaviscon

Diarrhea

Infectious Gastroenteritis

Diarrhea/GastroenteritisDiarrhea/GastroenteritisSevereSevere

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

Most infectious diarrheas in this country are caused by Rotovirus but can be C. Difficele

Clinical ManifestationsClinical Manifestations

Increase in peristalsis Large volume stools Increase in frequency of stools Nausea, vomiting, cramps Increased heart & resp. rate, decreased tearing and

fever

DiagnosisDiagnosis

ComplicatioComplicationsns

DehydrationDehydration

Metabolic AcidosisMetabolic Acidosis

The newborn and infant have a high percentage of body weight comprised of water, especially extracellular fluid, which is lost from the body easily. Note the small stomach size which limits ability to rehydrate quickly.

Treatment & Nursing CareTreatment & Nursing Care

Treat cause Fluid and electrolyte balance Weigh daily Monitor I&O Assess for dehydration Isolate Skin care

Appendicitis

Inflammation of the lumen of the appendix which becomes quickly obstructed causing

edema, necrosis and pain.

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

NPO IV Comfort measures – semi-fowlers or R side lying Antibiotics Elimination Patient education

**Narcotic pain medications are used minimally so as not mask the signs of appendicitis.

AppendicitisAppendicitis

What is the most common symptom indicating that the appendix may have ruptured?

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

NPO Antibiotics Analgesia Patient teaching

Pyloric Stenosis

The pylorus muscle which is at the distal end of the stomach becomes thickened causing

constriction of the pyloric canal between the stomach and the duodenum and obstruction of

the gastric outlet of the stomach.

Pyloric StenosisPyloric Stenosis

Narrowing of the pyloric spincter

Delayed emptying of the stomach

AssessmentAssessment

Treatment and Nursing CareTreatment and Nursing Care

Treatment: Surgery Pyloromyotomy

Post Operative Care: I & O Feeding

Feeding begins with clear liquids containing glucose and electrolytes. Regime example: 8 hours NPO, 10cc sterile water feed X 2. Increase to 15cc X 2, progressing to ½ strength formula, then full strength formula. Observe and record the infant’s response to feeding.

Position with head elevated Assess Surgical site to prevent infection Patient teaching

Critical ThinkingCritical Thinking

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

Intussuception

Volvulus

Both are forms of bowel obstruction

IntussuceptionIntussuception

Most commonly seen in infants 3-12 months Bowel “telescopes” within itself

VolvulusVolvulus

A twisting of the bowel that leads to a bowel obstruction.

 

AssessmentAssessment

Pain Vomiting Stools – resemble currant jelly Dehydration Serious complications

Therapeutic Intervention Therapeutic Intervention

IntussuceptionHydrostatic ReductionSurgery

VolvulusSurgery

Hirschsprung's Disease

Hirschsprung’s DiseaseHirschsprung’s Disease

Congenital disorder of nerve cells in lower colon

AssessmentAssessment

Diagnosis & ManagementDiagnosis & Management

Diagnosis History & Physical Barium enema (X-ray) Rectal biopsy- absence of ganglionic cells in bowel

mucosa

Management Surgical intervention

Colostomy Resection Colostomy takedown

Nursing CareNursing Care Pre-op

Cleanse bowel Patient/parent teaching

Post-op NPO Vital Signs – never take a rectal temperature Assessment Patient/parent teaching

Colostomy care Skin care Nutrition

Lactose Intolerance

Inability to tolerate the sugar found in dairy products as a result of an absence or deficiency of lactase.

Celiac Disease

inability to digest gliadin which is a

by-product of gluten breakdown.

Signs and Symptoms Signs and Symptoms

The child with celiac disease commonly demonstrates

failure to grow and wasting of extremities. The abdomen can appear large due to intestinal distension and malnutrition

Complications: Hypocalcemia, osteomalacia, osteoporosis, depression.  

Treatment and Nursing CareTreatment and Nursing CareTeach parents DIETARY REGULATIONS:

Gluten Free Diet

NO !