Nutritional and GI dysfunction Flashcards
Meconium
thick, sticky, tarry green-black stool shortly after birth
Digestional differences in kids
- immature digestion at birth
- swallow is automatic relex until 6W but can control swallow around 6M
- small stomach
- emptying time of stomach is faster in infants
- less saliva until 2Y
- stomach acid not present until 6M
- more relaxed esophageal sphincter
- stomach pain can be from anxiety/other causes (psychosomatic)
Failure to thrive
inadequate growth from inability to obtain and/or use calories required for growth
- no universal definition but wt/ht is below 5th percentile or wt/ht does not follow growth curve as expected
Common vitamin/mineral deficiencies
Iron (12-36M), Vit A, C, Bs
Organic failure to thrive
From underlying medical condition like cardiac prob, CF
Non-organic failure to thrive
Can’t find anything attributing to them not growing, often psychosocial factors like parents can’t provide
idiopathic failure to thrive
unknown
Clinical features of failure to thrive
- ht/wt below 5th percentile for age
- persistent deviation from an est growth pattern
Clinical features of non-organic FTT
- developmental delays like social, motor, adaptive, lang
- apathy
- inadequate hygiene
- feeding or eating dx
- no stranger anxiety
- avoidance of eye contact
- stiff and unyielding, flaccid and unresponsive
Factors contribute to NFTT
- caregiver frustration and anger at infant poor response to feeding or prob assessing infant’s needs
- poverty
- health beliefs
- inadequate nutritional knowledge
- family stress or crisis
- feeding resistance
- insufficient breast milk
Therapeutic management (NFTT)
- catch up growth
- multidisciplinary team approach to therapy
- correct nutritional deficiencies
- treat underlying cause
- educate parents or caregivers
Nursing interventions for FTT
- feeding is a priority
- give consistent staff
- quiet, calm atmosphere
- calm, even temperament
- talk to child and instruct about eating
- be persistent
- face-to-face posture
- introduce new foods slowly
- follow child’s rhythm of feeding
- follow structured routine
- accurate I&O
- daily weight
- support parents and build confidence
Cleft lip/palate
Abnormal opening in the lip and/or palate that occurs during embyonic development caused by teratogens, maternal smoking, genetics and environmental
Palate examination
Done to all infants at birth
Clinical findings with CL/CP
- difficulty feeding
- mouth breathing causing more air to be swallowed with distended abdomen and pressure on diaphragm, dry mucus membrane, inc risk of infx esp aspiration pneumonia
Therapeutic management with CL/CP
- surgical correction of lip in first weeks of life; Z-plasty–minimize notching and lengthen lip
- cleft palate surgery - close between 12-18M, obturators, try to fix before child can speak
- multidisciplinary care
Preop NC for CL/CP
- promote bonding btwn child and parent–show pics of the finished procedure
- reassure parents it is fixable
- love and hold
CL/CP NC for feeding probs
- breast feeding usually not feasible
- upright position
- special nipples–CL/CP feeder, Haberman feeder, pigeon feeder
- stimulate suck reflex
- swallows fluid appropriately
- rest
- burp frequently
Postop NC (CL/CP)
- protect airway (positioning on belly right after birth for cleft palate)
- position on back for cleft lip
- hypothermia–give warm blanket
- prevent infection
- protect suture line and clean well, antibiotic ointment
- pain management
- elbow restraints “no-nos” so can’t pick at face
Postop NC (CL/CP)
- long term consequences like altered speech, dentition, and hearing prob
- discharge teaching like good oral care, watch ears, promote speech dev
Esophageal atresia (EA) and Tracheoesophageal fistula (TEF)
- failure of esophagus to dev as a continuous passage and/or failure of the trachea and esophagus to separate
EA and TEF diagnosis
Passage of radioplaque catheter until obstruction is encountered
- DON’T feed if suspected
EA and TEF CM
frothy saliva in mouth and nose, choking and coughing, feedings return thru nose and mouth, may become cyanotic and apnic (3 Cs of TEF are choking, coughing, cyanosis)
EA and TEF NC
Preoperatively–early detection, maintenance of airway, prevention of pneumonia, gastric or blind pouch decompression, antibiotics, prepare for surgical correction, use G tube to keep using the gut
Postop NC (EA/TEF)
- careful suctioning
- positioning
- provide for non-nutritive sucking
- N/G to low suction (irrigate frequently)
- high humidity environment
- prevent pneumonia
- care for chest tubes
- maintain nutrition
- provide comfort and physical contact
- D/C teach–s/s of resp distress, tracheomalacia, GERD, constriction of the esophagus
