Peds Final Review - Gastrointestinal Disorders Flashcards
CLEFT LIP AND PALATE
Description: Malformations of the face and oral cavity that seem to be multifactorial in hereditary origin.
Cleft lip is readily apparent.
Cleft palate may not be identified until the infant has difficulty with feeding.
Initial closure of cleft lip is performed when infant weighs approximately 10 pounds, is at least 10 weeks, and has an Hgb of 10.
Closure of palate is performed between 6 and 12 months to minimize speech impairment.
CLEFT LIP AND PALATE
Nursing Assessment:
Failure of fusion of the lip, palate, or both
Difficulty sucking and swallowing
Parent reaction to facial defect
CLEFT LIP AND PALATE
Nursing Diagnosis:
Imbalanced nutrition: less than body requirements R/T
Impaired parenting R/T
CLEFT LIP AND PALATE
Nursing Interventions:
–Promote family bonding and grieving during newborn period
–Inform family that successful corrective surgery is available.
–In newborn period, assist with feeding.
a. Feed in upright position
b. Feed slowly, with
frequent burping
c. Use soft, large nipples;
Haberman feeder, etc.
d. Support mother’s breast-
feeding and/or pumping
CLEFT LIP AND PALATE
Nursing Interventions:
Provide postoperative care:
–Maintain patent airway and proper positioning.
-Cleft lip: Client upright
in infant seat
- Cleft palate: Place
client on side or
abdomen
-Remove oral secretions
carefully with bulb syringe
Protect surgical site:
1. Apply elbow restraints
- Minimize crying to prevent strain on lip suture
- Maintain Logan bow to lip if applied
Provide care for restrained child.
- Remove one restraint at a time, and perform ROM exercises.
- Provide age-appropriate stimulation.
Resume feeding as prescribed. Cleanse suture site with sterile water after feeding; formula remaining on suture line may impede healing and lead to infection.
Encourage family participation in care and feeding:
1.Fluids are taken by a cup or an oral feeding syringe with a rubber tip
- The diet progresses from a clear to a full liquid diet
- The child may go home on a soft diet – nothing harder than mashed potatoes.
CLEFT LIP AND PALATE
Usually for cleft palate: Coordinate long-term care with other team members: plastic surgeon, ENT specialist, nutritionist, speech therapist, orthodontist, pediatrician, nurse.
CLEFT LIP AND PALATE
NCLEX HINT: Typical parent and family reactions to a child with an obvious malformation such as cleft lip or palate are guilt, disappointment, grief, sense of loss, and anger.
ACUTE APPENDICITIS
Nursing Assessment:
Pain precedes vomiting
Periumbilical pain, right lower quadrant pain (McBurney point), vomiting with fever
The absence of fever does not exclude appendicitis
Rebound tenderness is not a reliable sign of appendicitis
Ruptured appendix:
–Relief of pain, then child becomes seriously ill
–Rigid guarding of abdomen
–Fever, tachycardia, abdominal distention
–Rapid shallow breathing
ACUTE APPENDICITIS
Nursing diagnosis:
Risk of Infection R/T ruptured appendix
Risk of Fluid Imbalance R/T NPO status, IV fluid infusions, NG tube to intermittent low wall suction
ACUTE APPENDICITIS
Nursing Interventions Post-op:
Monitor vital signs
Monitor and manage IV fluid infusion
NG tube in place for decompression to intermittent low-wall suction
Pain relief – PCA pump
Monitor intake and output closely
Auscultation of bowel sounds
Post-op drains – JP, Penrose
Early initiation of enteral nutrition to minimize the degree of mucosal atrophy
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL
FISTULA
Description: congenital anomaly in which the esophagus does not fully develop.
Most common: upper esophagus ends in a blind pouch, and the lower part of the esophagus is connected to the trachea.
This condition is a clinical and surgical emergency.
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA
Nursing Assessment:
Three C’s of TEF in the newborn:
- -Choking
- -Coughing
- -Cyanosis
Excess salivation
Respiratory distress
Aspiration pneumonia
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA
Nursing Diagnosis:
Risk for aspiration R/T
Imbalanced nutrition: less than body requirements R/T
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA
Nursing Interventions:
Provide preoperative care
Monitor respiratory status
Remove excess secretions – suctions is usually continuous to blind pouch
Elevate infant 30 degrees
Provide oxygen as prescribed
Maintain NPO
Administer IV fluids as prescribed
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA
Provide postoperative care.
Maintain NPO
Administer IV fluids as prescribed
Monitor I&O
Provide gastrostomy tube care and feedings as prescribed
Provide pacifier to meet developmental needs
Monitor child for postoperative stricture of the esophagus --Poor feeding --Dysphagia --Drooling --Regurgitating undigested food
Promote parent-infant bonding for high-risk infant
PYLORIC STENOSIS
Description: Narrowing of the pyloric canal; the sphincter (circular muscle of the pylorus) hypertrophies to twice the normal size.
PYLORIC STENOSIS
Nursing Assessment:
Usually occurs in first-born males
Vomiting (free of bile) usually begins after 14 days of life and becomes projectile.
Hungry, fretful infant
Weight loss, failure to gain weight
Dehydration with decreased sodium and potassium
Metabolic alkalosis (decreased serum chloride, increased pH and bicarbonate or CO2 content)
Palpable olive-shaped mass in upper right quadrant of the abdomen
Visible peristaltic waves
PYLORIC STENOSIS
Nursing Diagnosis:
Imbalanced nutrition: less than body requirements R/T
Deficient fluid volume R/T
PYLORIC STENOSIS
Nursing Interventions:
Preoperative care
Assess for dehydration
Administer IV fluids and electrolytes as prescribed
Weigh daily; monitor I&O
Provide small, frequent feedings if prescribed
Prepare family for surgery by teaching that:
- –Hypertrophied muscle will be split
- –Prognosis is excellent
PYLORIC STENOSIS
Postoperative care
–Continue IV fluids as prescribed
–Provide small oral feedings with electrolyte solutions or glucose (usually 4 – 6 hours post-operative).
–Position on right side in semi-Fowler position after feeding
–Burp frequently to avoid stomach becoming distended and putting pressure on surgical site
–Weigh daily; monitor I&O
INTUSSUSCEPTION
Description: Telescoping of one part of the intestine into another part of the intestine, usually the ileum into the colon (called ileocolic)
Partial to complete bowel obstruction occurs
Blood vessels become trapped in the telescoping bowel, causing necrosis
INTUSSUSCEPTION
Nursing Assessment:
Child under 1 year of age
Acute, intermittent abdominal pain
Screaming, with legs drawn up to abdomen
Vomiting
“Current jelly” stools (mixed with blood and mucus)
Sausage-shaped mass in upper right quadrant while lower right quadrant is empty
INTUSSUSCEPTION
Nursing Diagnosis:
Ineffective tissue perfusion R/T
Risk for deficient fluid volume R/T
INTUSSUSCEPTION
Nursing Interventions:
Monitor carefully for shock and bowel perforation
Administer IV fluids as prescribed
Monitor I&O
Prepare family for emergency intervention
Prepare child for barium enema (which provides hydrostatic reduction). Two of three cases respond to this treatment; if not, surgery is necessary.
Notify health provider is child passes normal stool
Provide postoperative care for infants who require abdominal surgery
HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )
Description: congenital absence of autonomic parasympathetic ganglion cells in a distal portion of the colon and rectum.
There is a lack of peristalsis in the area of the colon where the ganglion cells are absent
Fecal contents accumulate above the aganglionic area of the bowel.
Correction usually involves a series of surgical procedures:
—A temporary colostomy
–Later a reanastomosis and
closure of the colostomy
HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )
Nursing Assessment:
Suspicion in newborn who fails to pass meconium within 24 hours
Distended abdomen, chronic constipation alternating with diarrhea
Nutritionally deficient child
Ribbon-like stools in the older child
HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )
Nursing Diagnoses:
Constipation R/T
Diarrhea R/T
Imbalanced nutrition: less than body requirements R/T
HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )
Nursing Interventions:
Provide preoperative care
Begin preparation for abdominal surgery
Provide bowel-cleansing program as prescribed
Insert rectal tube if prescribed
Observe for symptoms of bowel perforation:
—Abdominal distention (Measure abdominal girth)
Vomiting
—Increased abdominal tenderness
Irritability
—Dyspnea and cyanosis
Initiate preoperative teaching regarding colostomy
HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )
Nursing Interventions:
Provide postoperative care
Check vital signs, axillary temperature
Administer IV fluids as prescribed
Monitor I& O
Care for nasogastric tube with connection to intermittent suction
Check abdominal and perineal dressings
Assess bowel sounds
Prepare family for home care:
- –Teach care of temporary colostomy
- –Teach skin care
- –Refer famiy to enterostomal therapist and social services
Prepare child and family for closure of temporary colostomy
After closure, encourage family to be patient with child when toileting
Teach family to begin toilet training after age 2.
ANORECTAL MALFORMATION
Congenital malformation of the anorectal section of the GI tract (imperforate anus)
It is often associated with a fistula
It may be also associated with urinary tract anomalies
Type and level of rectal anomaly determine surgical procedure and degree of bowel control possible
ANORECTAL MALFORMATION
Nursing Assessment
An unusual-appearing anal dimple
Newborn who does not pass meconium stool within 24 hours
Meconium appearing from perineal fistula or in urine
ANORECTAL MALFORMATION
Nursing Diagnosis
Bowel incontinence related to….
Deficient knowledge related to…..
ANORECTAL MALFORMATION
Nursing Interventions
–Determine newborn’s first temperature, typically using a rectal thermometer, to assess for imperforate anus
–Assess newborn for passage of meconium
–Assist family’s ability to cope with diagnosis
Provide preoperative care to infant
Assess vital signs
Administer IV fluids and keep
NPO
Monitor I&O
Provide postoperative care for anal reconstruction:
–Keep perineal site clean
–Position infant in side-lying prone position with hips elevated. This decreases pressure on perineal sutures
–Provide colostomy care if needed
Teach home care:
–Teach home care of colostomy if necessary
–Teach that with high level defects, long-term follow-up is required
–Teach that toilet training is delayed and full continence may not be achieved
Ulcerative Colitis Vs. Crohn Disease – Inflammatory Bowel disease
Ulcerative Colitis:
***Rectal bleeding common Bloody diarrhea Diarrhea often severe Less frequent pain Mild to moderate anorexia Moderate weight loss Mild Growth retardation Rare anal lesions Rare fistulas
Ulcerative Colitis Vs. Crohn Disease – Inflammatory Bowel disease
Crohn Disease:
Rare rectal bleeding Moderate to severe diarrhea Pain very common Severe anorexia Severe Wt loss Severe growth retardation **Common anal lesions **Common fistulas
