Caring for children with gastrointestinal dysfunction

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Caring for children with gastrointestinal
dysfunction Chap 17

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• (LGI?UGI? ?)

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•  Intestinal obstruction
• Intussusception
• Inflammatory disorders
• Appendicitis
• Disorders of motility
• Gastroenteritis(Acute diarrhea)
• Dehydration ---Chap 10
• Constipation
• Feeding disorders
• Colic
• Disorders of malabsorption
• Celiac disease
• Lactose Intolerance
• Short bowel syndrome

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Intussusception P602

• Etiology and pathophysiology ?1?
• One portion of the intestine prolapses and then
  invaginates(??) or telescopes (???) into
  another.?1?
• One of the most frequent causes of intestinal
  obstruction during infant
• Between the age of 3 months and 6 years
• Siteileocecal valve ?2?
• Telescoping of the Intestine obstructs the
  passage of stool.
• The walls of intestine rub together
• ? inflammation?edema?decreased blood flow
• ? necrosis?perforation?hemorrhage? peritonitis
• In infant, intussusception is commonly associated
  with measles, viral disease, and gastroenteritis
  syndromes. P603 Fig17-7

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Clinical manifestations P603?2?

• Onset is abrupt
• Acute abdominal pain(periods of comfort between
  acute episodes of pain)
• Vomiting
• Passage of brown stool?become red and resemble
  currant jelly
• A palpable mass may be present in the upper right
  quadrant or mid-upper abdomen
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Diagnosis P603?2?

• History
• Radiographs and ultrasound of the abdomen
• Barium enema

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Treatment P603?3?

• Hydrostatic pressure???Barium enema
• Oxygen(air)?saline?aqueous contrast material
• Surgery
• Supportive care
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Nursing management

• Maintain fluid and electrolyte balance

• Post OP
• Monitoring for early signs of infection
• Pain management
• Maintain NG tube patency
• Assess vital signs?Abdominal distention?
• Listen for bowel sounds every 4 hours
• After normal bowel function
• Clear liquid feeding? half- strength milk and
  other foods

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Appendicitis P609

• Is an inflammation of the vermiform appendix.
• Most often in adolescent boys(10-19 y/o)rarely
  seen before 2 years of age

• Etiology and pathophysiology
• Result from an obstruction in the appendiceal
  lumen
• Caused by a fecalith,parasitic infestations,stenos
  is,hyperplasia of lymphoid tissue,or a tumor
• Obstruction?continued secretion of
  mucus?pressure? ?ischemia,cellular death,and
  ulceration
• Complicationperforation or rupture ? peritonitis
  ? small bowel obstruction,electrolyte
  imbalances,septicemia,and hypovolemic shock

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Clinical manifestations

• Pain
• Fever, vomiting, diarrhea, constipation P610?2?
• Motionless, side-lying position with knees flexed

Caution

• Some children
• Appendix is in a different location P609??1?
• Differentiation P609???2?
• Ovulation
• Ruptured ectopic pregnancy
• Pelvic inflammatory

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Pain

• Periumbilical cramps,abdominal tenderness?1? ?
  pain in the right lower abdomen become
  constant?4?
• Most intense halfway between the anterior
  superior iliac crest and umbilicus ? rigidity and
  rebound tenderness P610?2? ? if sudden relief of
  pain(ruptured)

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Signs and symptoms of a ruptured appendix
include

P609??

• Fever
• Sudden relief from abdominal pain
• Guarding
• Abdominal distention
• Rapid shallow breathing
• Pallor
• Chills
• Irritability or restlessness

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Diagnosis evaluation over several hours P610

• WBC?(teenagers)?2?
• Abdominal pain
• X-ray
• Abdominal ultrasound
• Focused appendiceal computerized tomography(FACT)

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Treatment ?3?

• Preoperatively
• NPO NG decompression
• IV fluids electrolytes
• Antibiotics
• Appendectomy
• Postoperatively
• Antibiotics
• If ruptured
• Penrose drain
• Wound irrigations

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Nursing management

• Promote comfort
• Maintain hydration
• Provide emotional support
• Recognize symptoms of infection
• Support respiratory function
• Discharge planning and home care teaching

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Disorders of motility

• Diarrhea
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Gastroenteritis(Acute diarrhea)P617

• Is an inflammation of the stomach and intestines
  ?1?
• Vomiting and diarrhea
• Infants and small children with gastroenteritis
  or
• diarrhea can quickly become dehydrated and
  are
• at risk for hypovolemic shock .

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Etiology and pathophysiology (P617?2?)

• Decrease in the absorptive capacity?decrease in
  surface area for absorption?alteration of
  parasympathetic innervation
• High risk-day-care centers?improper sanitation
  (?56?)
• Causes(Table 17-2)

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Clinical manifestations P617

• Mild
• -Slightly increased in number and more liquid
• Moderate
• -Several loose or watery stools
• -Irritability?anorexia?nausea?vomiting
• -Self-limiting
• Severe
• -Continuous watery stools
• -Fluid and electrolyte imbalance
• -Cramp?extremely irritable?difficult to console

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Diagnosis clinical therapy??1?

• History
• Physical examination
• Laboratory finding-S/R?S/C ?urine sp.gr
• Presence of ova, parasite, infectious organisms,
  viruses, fat, and undigested sugars.

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Treatment P618?2?

• Depends on the severity of the diarrhea and fluid
  and
• electrolyte imbalances.
• Goalcorrect the fluid and electrolyte

• Mild to moderate
• -Oral rehydration therapy ( Contain water,
  carbohydrate, sodium, potassium, chloride and
  lactate P315 )
• -Carbonated beverages and those containing high
  amounts of sugar should NOT be given
• Severe
• -IV(N/S with glucose?one half or one quarter
  normal
• saline? or L/R)?3?
• -NPO
• -Antiemetics and antidiarrheals should generally
  not be used in
• infants and young children. P618??
• Lactose-free milk, breast milk, half-strength
  milk. P315???4?

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Nursing assessment P618

• Frequency, color, amount and consistency of
  stools?4?
• The amount and type of vomitus
• Observing dehydration
• Urine output and specific gravity
• Weight
• Vital signs ( Febrile )
• Skin integrity

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Nursing diagnosis management P619

• Anxiety
• Provide Emotional support
• Sleep pattern disturbance
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• Promote rest and comfort
• Altered nutrition
• Ensure adequate nutrition
• CRAM (Complex carbohydrates, Rice and Milk )
  P619??
• Diarrhea related to infectious process P620 care
  plan
• Fluid volume deficit P620
• Risk for impaired skin integrityP621

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Dehydration Chap 10 --P313

• There is not enough fluid in the extracellular
  compartment.
• The state of body water deficit is called
  dehydration.
• Sodium is generally lost along with water ?
  hyponatremia

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Etiology and pathophysiology

• Causes P313 ?1??2?
• Loss of fluid containing sodium are
  vomiting?diarrhea?nasogastric suction?hemorrhage
  and burns
• Radiant warmers ?2??2?
• Adrenal insufficiency and overuse of diuretics
• Bulimic adolescents

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• Blood urea nitrogengt25mg/dL
  clinical therapy?1??3?
• Serum bicarbonategt17mEq/L

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Medical management P315
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• Oral rehydration therapy-mild and moderate
  dehydration
• Contain water, carbohydrate, sodium, potassium,
  chloride and lactate
• Lactose-free milk, breast milk, half-strength
  milk ???4?
• IV-severely P316?1?
• L/R, one half or one quarter normal saline

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Nursing assessment

• Weight
• I/O
• Urine specific gravity
• Consciousness
• Pulse rate and quality
• Skin turgor and mucous membrane moisture
• Respiration
• Blood pressure

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Nursing management

• Provide oral rehydration therapy guidelines
• Teach parents oral rehydration methods
• Monitor intravenous fluid administration
• Discharge planning and home care teaching

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Disorders of malabsorption P627

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  Disease)??????????????,?short bowel
  syndrome,??????????????,??????

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Lactose Intolerance P628

• Etiology and pathophysiology
• Inability to digest lactose(a disaccharide)?1?
• A congenital or acquired deficiency of the enzyme
  lactase
• Congenital
• Rare ?3?
• Acquired
• Highest(?100)among Asian and Native American
  ?5?

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• Clinical manifestations ?4?
• Abdominal pain
• Flatulence
• Diarrhea

Diagnosis ?2? History Hydrogen breath
test Lactose-free diet for confirming the
diagnosis
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Treatment ?2? ?4?

• Diet
• Infant-soy-based formula
• Older children-eliminating lactose-containing
  foods
• Enzyme tablets

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Nursing management

• Support
• Explain dietary modifications and discuss
  alternate sources of calcium P337??
• Discuss the need for supplementation of calcium
  and vitamin D
• Read food labels

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Short bowel syndrome(SBS)P628

•   Etiology and pathophysiology ?1?
• It is a decreased ability to digest and absorb a
  regular diet because of a shortened intestine.
• Causesnecrotizing enterocolitis(NEC)?inflammatory
  disorders?congenital bowel anomaly
• The extent and location of the involved bowel
  determine the severityof the disorder. ?2?
• Adaptation periodincreases its absorptive
  surface area ?5?

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• Clinical manifestations?2?
• Watery diarrhea ?4?

• Treatment ?2?
• Nutritional support ?6?
• TPN?elemental formula?MCT
• Enteral feeding
• High-fat, low-carbohydrate diet
• Nucleotide, glutamine, polyamine, and fatty acid
• Surgical(?)

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Complication(?)

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• ????TPN????,?sepsis or TPN-cholestasis

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Nursing management

• Meeting the childs nutritional and fluid needs
• Oral and enteral feedings are instituted
  gradually
• Feeding pump
• Feeding tube
• Emotional support
• Arrange home visits to monitor the childs growth
  and development and observed side effects (fluid
  and electrolyte imbalance and diarrhea)