Hypertrophic Pyloric Stenosis, GERD, and Ileocolic Intussusception and Hirschsprung Disease Flashcards
Hypertrophic Pyloric Stenosis
Obstruction of circular muscle of pyloric canal
Initially good feeder with occasional vomiting; Becomes projectile; always hungry, irritable, fails to gain weight, fewer & smaller stools
Most common in 1st born children
Surgically corrected; good prognosis
Assessment of HPS (4)
visible peristaltic waves, hyperactive bowel sounds; olive-shaped mass in upper quadrant when palpated, projectile vomiting (hydration status; monitor vomiting)
Nursing Management (7)
Meet fluid needs (NPO, IV, accurate I&O)
Minimize weight loss (daily weight; small, frequent feedings 4-6 hrs post-op)
Promote rest & comfort (pre-op: swaddling, cuddling, pacifier. Pre-op: pain management)
Prevent infection (incision clean & dry, temperature)
Supportive care (explanations for parents)
Discharge teaching (sign of infection of incision; fold diaper away from incision, occasional vomiting may occur first 24-48 hours post-op)
Gastroesophageal Reflux (GER)
transfer of gastric contents into esophagus
Most common cause is transient relaxation of LES
Children prone to develop GER: BPD, TEF or EA repairs, neurological disorders, CF, CP, preterm
Differentiate between GER and GERD
difference is severity and it is a progression
GER: normal and very common and doesn’t require medical intervention. Peaks at 4 months and resolves at 1 year.
Manifestations of GER
Hungry & irritable, weight loss, history of vomiting & upper respiratory infections, hematemesis, apnea, gagging or choking after feeding
- most common is passive regurgitation or emesis
Diagnosis of GER
history, upper GI series, 24-hour pH probe monitoring, endoscopy with biopsy
Treatment of GER
Depends on severity of condition
Mild: modify feeding habits (thicken feeds, avoid foods that aggravate); medications (h2 receptor antagonists, proton pump inhibitors); upright positioning after feeds
Severe: surgery (Nissen fundoplication) with G-tube for 6 weeks)
Nursing care of GER
Daily weight; signs of respiratory distress
Adequate nutrition: small, frequent feedings, raise upper body 30 degrees after feeds; G-tube
Ileocolic Intussusception
invagination or telescoping of one portion of intestine into another
Results in obstruction -> inflammation, edema, decreased blood flow -> ischemia, perforation, peritonitis & shock
Medical emergency! potentially life-threatening
Manifestations of II
Sudden onset of crampy abdominal pain, inconsolable crying, & drawing up of knees; may develop bilious emesis & lethargy; red, currant jelly stools; tender & distended abdomen; palpable sausage-shaped mass in RUQ
Hirschsprung Disease (Congenial Aganglionic Megacolon)
watch for the meconium. Need to see that because it indicates a bowel that is working.
ABSENCE OF AUTONOMIC PARASYMPATHETIC GANGLION CELLS IN ONE OR MORE SEGMENTS OF COLON
Lack of innervation produces absence of peristalsis which causes accumulation of intestinal contents & bowel distension proximal to defect (megacolon)
Results in mechanical obstruction from inadequate motility of part of intestine
Manifestations of Hirschsprung Disease
Failure to pass meconium within 24-48 hrs, bilious vomiting, abdominal distension, FTT, constipation, visible peristalsis, palpable fecal mass
