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Nursing Care of the Child with Gastrointestinal Disorders

Nursing Care of the Child with Gastrointestinal Disorders. Ann Hearn RNC, MSN Fall 2009. Cleft Lip and Cleft Palate. Unilateral, bilateral, midline. photos. Treatment. Surgical repair done ASAP Rule of 10 > 10#, 10 weeks, 10 HGB Multidisciplinary team. Pre-op Goals.

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Nursing Care of the Child with Gastrointestinal Disorders

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  1. Nursing Care of the Child with Gastrointestinal Disorders Ann Hearn RNC, MSN Fall 2009

  2. Cleft Lip and Cleft Palate • Unilateral, bilateral, midline

  3. photos

  4. Treatment • Surgical repair done ASAP • Rule of 10 > 10#, 10 weeks, 10 HGB • Multidisciplinary team

  5. Pre-op Goals

  6. Prevent Aspiration / Maintain Nutrition • Breast feed – small cleft lip • Bottle feed – special feeding devises • Special nipples • Enlarge cross cut hole • Bubble frequently • Hold upright • ESSR

  7. Provide Emotional Support • Assist with accepting of defect • Teach proper feeding • Point out positive attributes • Encourage participation in care • Explain surgical procedure

  8. Pre-op Teaching • Remind parents that defect is operable- show photographs of corrected clefts • Introduce cup, spoon feeding devices • Explain elbow restraints • Explain Logan Bow

  9. Post-Op • Prevent trauma to suture line • Reduce pain & infection • Cleanse suture lines as ordered • Facilitate breathing • Maintain nutrition • Referral to appropriate team members

  10. Esophageal Atresia

  11. Assessment Findings • Respiratory difficulties • Drooling • Coughing, choking, cyanosis • Gastric distention - if fistula present • Hx of ??? during pregnancy? • Polyhydramnios • gastrointestinal obstruction • fetus unable to swallow

  12. Management • Early diagnosis • Ultrasound • Radiopaque catheter inserted in the esophagus to illuminate defect on X-ray • Surgical repair • Thoracotomy and anastomosis

  13. Pre-Op Nursing Priority • Maintain airway • Prevent aspiration pneumonia • Keep NPO- administer IV fluids • Elevate HOB 30 degrees • Suction PRN • Prophylactic antibiotics

  14. Post-Op • Maintain nutrition • TPN • Gastrostomy • Maintain airway • Prevent aspiration • Monitor weigh, growth and development achievements • Complications • GERS • Stricture formation

  15. Teaching Plan: Gastrostomy Tube • Equipment • Procedure • Psychosocial needs • Medication administration • Stoma care • Problem solving

  16. Gastroesophagial Reflux Disease(GERD)

  17. Assessment findings: Infant • Regurgitation almost immediately after each feeding when the infant is laid down • Excessive crying, irritability • Failure to thrive (FTH) • Complications: • aspiration pneumonia • apnea

  18. Assessment findings: Child • Heartburn • Abdominal pain • Cough, recurrent pneumonia • Dysphagia

  19. Diagnosis

  20. Management & Nursing Care • Nutritional needs • Small frequent feedings • Frequent burping • Positioning • Prone flat or head elevated after feedings (not for sleep) • Medications • CPR instruction for parents/caregivers

  21. Surgery Nissenfundoplication

  22. Post Op Nursing Care • Feedings • Burping (bubbling) • Positioning • Airway • Medications

  23. Medications • H2 Histamine receptor antagonists – suppress gastric acid secretions • Zantac and Pepcid • Proton-pump inhibitors – reduce gastric acid production • Prevacid and Prilosec • Gastric emptying - increases • Reglan • Antacids – neutralize gastric acidity • Gaviscon **be sure to study nursing implications and side effects

  24. Pyloric Stenosis • Incidence: 3 in 1000 births • Possible genetic predisposition

  25. Pyloric Stenosis Narrowing of the pyloric spincter Delayed emptying of the stomach

  26. Assessment • Vomiting - projectile • Constant hunger and fussiness • Distended upper abdomen • Hypertrophied pylorus – olive shaped mass • Visible peristaltic waves

  27. Diagnosis • History and Physical • Laboratory values • X-ray or Ultrasound

  28. Surgery FredRamstedt procedure- Pyloromyotomy via laparoscopy • Pre-op • Hydration and electrolyte balance • Weigh daily & I and O • NG tube • Support of parents

  29. Management and Nursing Care: Post-Op • NPO until bowel function • Progressive feeds: 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 for infection - Antibiotics • Analgesia • Patient teaching

  30. Critical 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? a. Begin an intravenous infusion b. Measure abdominal circumference c. Orient family to unit d. Weigh infant

  31. Gastroschisis&Omphalocele

  32. Gastroschisis

  33. Treatment and Nursing Care Pre-operatively – focus is on protection of the contents / sac. Cover with warm, sterile, saline-soaked dressings over the defect. 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.  

  34. Gastroschisis • Assessment- noted on ultrasound and obvious at birth • Treatment - surgical repair in stages • Nursing care: • monitor thermoregulation and loss of fluids • assess for ileus • maintain parenteral feeding • provide support to the parents

  35. Omphalocele

  36. Omphalocele • Assessment- ultrasound and at birth • Treatment - surgical repair in stages • Nursing care- same as for Gastroschisis

  37. Intussuception • Results in inflamed bowel & bleeding • Leading to necrosis & perforation

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

  39. Intussuception: Clinical Manifestations • Intermittent then constant pain • Vomiting • Abdominal distention • Currant jelly-like stools • Diarrhea • Dehydration Serious complications: Ischemia, perforation & shock

  40. Volvulus

  41. Clinical Manifestations and Assessment • Pain • Vomiting (fecal material) • Abdominal distention • Stools • Dehydration • Serious complication: shock

  42. Diagnosis • X-ray • Abdominal ultrasound

  43. Therapeutic Intervention • Hydrostatic reduction • Laparoscopic Surgery

  44. Post-op Nursing Care: • NPO- NG tube, IV • Assess – V/S, pain • Monitor stools • Re-introduce food

  45. Appendicitis

  46. Clinical Manifestations • Abdominal pain – McBurney’s point • Silent Abdomen • Anorexia & nausea • Diarrhea • Elevated temperature • IF PERFORATED: • Sudden pain relief • Fever • Dehydration

  47. Diagnosis • History and Physical • Ultrasound • X-Ray • Laboratory values • increased WBC 15,000 – 20,000

  48. Management and Nursing Care: Pre-Op • NPO • IV • Comfort measures • Antibiotics • Thermal therapy • Elimination • Patient education

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

  50. Hirschsprung’s Disease

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