structural and inflammatory disorders Flashcards
structural
- Cleft lip and palate
- Gastroesophageal reflux disease
- Hypertrophic pyloric stenosis
- Hirschsprung’s disease, and intussusception.
inflammatory disorders
Appendicitis
Meckel’s diverticulum.
cleft lip and palate
- Results from the incomplete fusion of the oral cavity during intrauterine life.
Although a CL and CP can occur together, either defect can appear alone.
- The defects can be unilateral (one-sided) or bilateral (two-sided).
cleft lip repair
- Repair is typically done between 2 to 3 months of age.
- Revisions are usually required in severe defects.
cleft palate repair
- Repair is typically done between 6 to 12 months of age.
- Most require a second surgery.
therapeutic procedures for isolated cleft lip
- Encourage breast feeding.
- Use a wide-based nipple for bottle feeding.
- Squeeze the infant’s cheeks together during feeding to decrease the gap.
for cleft palate or cleft lip and palate
- Position the infant upright while cradling the head during feeding.
- Use a specialized bottle with a one-way valve and a specially cut nipple.
- Syringe feeding can be necessary for the infant who is unsuccessful with other methods.
cleft complications
ear infections
speech and lanaguage impairment
dental probelms
ear infections and hearing loss
- Feed the infant in an upright position.
- Monitor temperature.
- Insertion of tubes to facilitate fluid drainage
GIRD infants
- Spitting up or forceful vomiting, irritability, excessive crying, blood in vomitus, arching of back, stiffening
- Respiratory problems
- Failure to thrive
- Apnea
gird children
Heartburn, abdominal pain, difficulty swallowing, chronic cough, noncardiac chest pain
nursing care for gird
- Offer small, frequent meals.
- Thicken infants formula with rice cereal
- Avoid foods that cause reflux (caffeine, citrus, peppermint, spicy or fried foods).
- Assist with weight control.
- Position the child with the head elevated after meals.
- Position prone with extreme caution; supine is still the recommended position
gird medicine
Initiate a proton pump inhibitor such as
Omeprazole
Esomeprazole
Pantoprazole and rabeprazole
H2-receptor antagonist
Ranitidine
Cimetidine
Famotidine.
nissen fundoplication
- Laparoscopic surgical procedure that wraps the fundus of the stomach around the distal esophagus to decrease reflux.
- Used for clients who have severe cases of GERD
hypertrophic pyloric stenosis
- spinictor blocked
- projectile vomit
- Thickening of the pyloric sphincter, which creates an obstruction.
Hypertrophic pyloric stenosis clinical findings
- Vomiting that often occurs following a feeding, but can occur up to several hours following a feeding and becomes projectile as obstruction worsens
- Constant hunger
- Olive-shaped mass in the right upper quadrant of the abdomen and possible peristaltic wave that moves from left to right when lying supine
- Failure to gain weight and signs of dehydration
pylortomy
for the hps
- widden the spinctor
- Performed by laparoscope
- IV fluids for correction of dehydration and electrolyte imbalances
- Nasogastric (NG) tube for decompression
- NPO
- I&O
- Daily weights
Hirschsprung’s disease
confirmed by
Congenital disorder resulting in decreased motility and mechanical obstruction.
Confirmed by rectal biopsy
newborn symptoms of Hirschsprung’s disease
- Failure to pass meconium within 24 to 48 hr after birth
- Episodes of vomiting bile
- Refusal to eat
- Abdominal distention
Hirschsprung’s disease infant
Failure to thrive
Constipation
Episodes of diarrhea and vomiting
Hirschsprung’s disease child
- Undernourished, anemic appearance
- Abdominal distention
- Visible peristalsis
- Palpable fecal mass
- Constipation
- Foul-smelling, ribbonlike stool
therapeutic procedue for hirschsprung disease
- Surgical removal of the aganglionic section of the bowel.
- Temporary colostomy can be required.
- Teach the family ostomy care if indicated.
- Teach the family incisional care and to monitor for infection.
- Teach the family manifestations of dehydration.
Enterocolitis
inflammation of the bowel
complications of Hirschsprung’s disease
- Enterocolitis (inflammation of the bowel)
- Measure girth
- Monitor for signs of sepsis, peritonitis, or shock caused by enterocolitis.
- Monitor and manage fluid, electrolyte, and blood product replacement.
- Administer antibiotics as prescribed.
- Anal stricture and incontinence
intussuseption
common age
- Proximal segment of the bowel telescopes resulting in lymphatic and venous obstruction causing edema in the area.
- With progression, ischemia and increased mucus into the intestine will occur.
- Common in children ages 3-6.
clinical findings of intussusception
- Sudden episodic abdominal pain
- Screaming with drawing knees to chest during episodes of pain
- Abdominal mass (sausage-shaped)
- Stools mixed with blood and mucus that resemble the consistency of red currant jelly
- Vomiting
- Fever
- Tender, distended abdomen
nursing care for intussuscuption
- Stabilize the child prior to procedures.
- IV fluids to correct and prevent dehydration
- Nasogastric (NG) tube for decompression
Air enema
- With or without contrast
- Performed by a radiologist
Surgery is required for reoccurring cases.
Appendicitis
Inflammation caused from an obstruction
Average client age is 10 years.
clinical findings of appendicitis
- Abdominal pain in the right lower quadrant
- Rigid abdomen
- Decreased or absent bowel sounds
- Fever
- Diarrhea or constipation
- Lethargy
- Tachycardia
- Rapid, shallow breathing
- Anorexia
- Possible vomiting
nursing interventions/ assessment appendicitis
- Found on CT
- Prepare the child and family for removal of the appendix- done laparoscopiclly
- Avoid applying heat to the abdomen.
- Avoid enemas or laxatives.
- Administer analgesics for pain as prescribed.
- Assess surgical site for bleeding or any other abnormalities.
- Assess bowel sounds and bowel function.
appendicitis prior to sugery interventions
Place NG tube for decompression-put on low continuous suction Administer IV antibiotics. Administer IV fluids and antibiotics Maintain NPO status. Assess for peritonitis.
peritonitis s/s
Fever, tachycardia Sudden increase in pain Irritability Rigid abdomen with distention Abdominal distention Pallor, Chills
appendicitis complication
- Peritonitis (inflammation in the peritoneal cavity)
Pain
- Provide pain management.
- Assess for pain using a developmentally appropriate tool.
- Administer analgesics as prescribed.
Meckel’s diverticulum
Failure of the omphalomesenteric duct to fuse during embryonic development.
Meckel’s diverticulum clinical findings
Rectal bleeding, usually painless
Abdominal pain
Bloody, mucus stools
RADIONUCLEOTIDE SCAN:
Meckel’s scan is the most effective diagnostic test
Meckel’s diverticulum interventions
Prepare the child and family for surgery
Surgical removal of the diverticulum
Provide blood transfusions to correct hypovolemia.
Administer IV fluid and electrolyte replacement as prescribed.
Closely monitor blood loss in stools.
Meckel’s diverticulum post op
- Assess respiratory status and maintain airway.
- Administer analgesics for pain as prescribed.
- Assess surgical site for bleeding or any other abnormalities.
- Assess bowel sounds and bowel function.
- Administer IV fluids and antibiotics as prescribed.
- Maintain NPO status.
- Maintain NG tube to low continuous suction.
- Teach the family manifestations of infection.
Meckel’s diverticulum complications
- GI hemorrhage
- Bowel obstruction
for untreated Meckel’s diverticulum
