The Child with Gastrointestinal Dysfunction Flashcards
Pediatric Differences in Anatomy and Physiology
- Larger extracellular fluid volume
- Greater body surface area
- Larger insensible loss
- Children <2 years have immature kidneys- unable to conserve and excrete water and solutes.
- Increased illnesses and diseases that cause dehydration
DISTRIBUTION OF BODY WATER
Types of Dehydration
- Isotonic: water and sodium loss is in the same proportion as it exists in the body
— Loss from sweating, diarrhea, vomiting - Hypertonic: water losses exceed sodium losses Loss due to insufficient fluid intake
- Hypotonic: sodium loss exceeds water loss
— Loss of sodium from diuretics and excessive sweating
Mild dehydration s/s:
- Percent of body weight lost: up to 5%
- Level of consciousness: alert, restless, thirsty
- Blood pressure: normal
- Pulse: normal
- Skin turgor: normal
- Mucous membranes: moist
- Urine: may appear normal
- Thirst: slightly increased
- Fontanelle: normal
- Extremities: warm; normal capillary refill
- Respirations: normal
- Eyes: normal
Moderate dehydration s/s:
- Percent of body weight lost: 6–9%
- Level of consciousness: irritable or lethargic (infants and very young children); alert, thirsty, restless (older children and adolescents)
- Blood pressure: normal or low; postural hypotension (older children, and adolescents)
- Pulse: rapid
- Skin turgor: poor
- Mucous membranes: dry
- Urine: decreased output (<1 mL/kg/hr); dark color; increased specific gravity
- Thirst: moderately increased
- Fontanelle: sunken
- Extremities: delayed capillary refill (>2 sec)
- Respirations: normal or rapid
- Eyes: slightly sunken, decreased tears
Severe dehydration s/s:
- Percent of body weight lost: 10% or more (100mL/kg)
- Level of consciousness: lethargic to comatose (infants, and young children); often conscious, apprehensive (older children and adolescents)
- Blood pressure: low to undetectable
- Pulse: rapid, weak to nonpalpable
- Skin turgor: very poor
- Mucous membranes: parched
- Urine: very decreased or absent output
- Thirst: greatly increased unless lethargic
- Fontanelle: sunken
- Extremities: cool, discolored; delayed capillary refill (>3-4)
- Respirations: changing rate and pattern
- Eyes: deeply sunken, absent tears
Calculation of percentage of weight loss
To calculate percent of weight loss:
- Subtract the child present weight from the original wait to find the loss
- Divide the loss by the child’s original weight
— Example: in the opening scenario, Vernon weighed 12 kg (26 lb) at the clinic last week. However, when he is weighed today, the scale reads only 11 kg (24.5 lb). In this case, subtracting 11 kg from 12 kg yields 1 kg of weight loss. Dividing 1 kg by his original weight of 12 kg reveals that he has lost approximately 8% of his body weight, which indicates moderate dehydration.
Calculation of intravenous fluid needs
Step: Calculate the maintenance fluid needs of the child, using guidelines
- Calculation:
— Usual weight maintenance amount
— Up to 10 kg: 100 mL/kilograms/24 hours
— 11–20 kg: 1000 mL + (50 mL/kilograms for weight above 10 kg)/ 24 hours
— > 20 kg: 1500 mL + (20 mL/kg for weight above 20 kg)/ 24 hours
Step: calculate replacement, fluid for that loss, using formula to obtain mL/kg/24 hr:
- Calculation:
— Percentage of body weight loss X 10 X normal weight = mL/kg/24 hour required
Step: calculate, continued losses; add them to total of maintenance and replacement needs
Cleft Lip and Palate
A: notch in vermilion border
B: unilateral, cleft lip, and cleft palate
C: bilateral cleft lip, and cleft palate
D: cleft palate
Cleft lip and cleft palate
Etiology & Pathophysiology
- Cleft lip occurs in 14 out of 10,000 live births
- Cleft palate occurs in 4 out of 10,000 live births.
- Maxillary process fails to fuse by week 8. failure of tongue to move downward prevents fusion of palate between 5-12 weeks.
- Cause-genetic and environmental- Folic Acid deficiency
Cleft palate and cleft lip
Diagnostic Evaluation
- How much tissue is involved
- The severity of the CP has an impact on feeding problems
- The infant is unable to generate negative pressure and create suction in the oral cavity.
Problems & Interventions Associated With Cleft Lip/Palate
- Respiratory
- Feeding
- Breastfeeding
- Hearing & Dental
- Speech
- Child’s Self Concept
- Orthodontics and prosthodontics are usually needed to correct problems of malposition of the teeth and maxillary arches
- Increased risk of otitis media
Cleft Lip Surgery
Time for surgery is usually done in first few weeks of life. Try by 3 months of age
Cleft Palate Surgery
Try to do by 18 months of age
Post Op Care
- Restraints
- Supine or Side Lying
- Clean Suture site after feedings
Hirschsprung Disease ‘Aganglionic Megacolon”
- Absence of Ganglionic intervention of the bowel muscle- prevents peristalsis
- Chronic constipation
Hirschsprung Disease ‘Aganglionic Megacolon”
Newborn
Failure to pass meconium & increase abdominal distention
Hirschsprung Disease ‘Aganglionic Megacolon”
Infant & Older Child
- Constipation history with intermittent diarrhea
- Ribbon like stools
- Vomiting
- Failure to gain weight & delayed growth
Gastroesophageal Reflux
- Caused by relaxation of lower esophageal sphincter
Regurgitation of feedings - Diagnosis: Upper GI series, Ph probe study.
- Treatment: thicken feedings, small frequent meals, medications, positioning- elevated and prone while awake.
Esophageal Atresia & Tracheoesophegeal Fistula
- Failure of esophagus to develop properly by 5th week gestation.
- Symptoms: drooling, cyanosis, choking, coughing.
- NGT placement attempted
- Surgery performed asap.
Pyloric Stenosis
- Cause unknown
- White males more commonly effected
- 1-3 in 1000 births
- Usually 1st born children
- More common term than premature infants
Pyloric Stenosis
Pathophysiology
- Starts in the second or third week of life
- *Projectile Vomiting; Emesis contains milk or formula and is not bile stained
- May be hungry- even after emesis and irritable; Lethargic, dehydrated, and malnourished
- *Gastric peristalsis may be visible
Pyloric Stenosis
Treatment=
Pyloromyotomy
Pyloric Stenosis surgery
Postoperative Nursing Care
- High Fowler’s or Right side- to facilitate gastric emptying and promote drainage to the duodenum. Also decreases risk of aspiration
- NG in place until BS return. Leave in until tolerating feeds.
- Feeding Schedule
- Incision Care
Intussusception
Intestine telescopes into itself
Most common site is ileocecal valve
Vomiting, currant jelly stool, palpable mass in upper abdomen.
Treatment-Enema or surgery
Celiac Disease
- Gluten sensitivity. Immunologic Disorder. Chronic Malabsorption syndrome 1 in 140 people have it
- Inability to digest glutenin and glaidin results in the accumulation of amino acid glutamine- which is toxic to intestinal mucosa.
- Intolerance for wheat, barley, rye, and oats
Celiac Disease Manifestations
- Symptoms between 6 mo to 2 yrs
- Diarrhea- watery pale, foul smelling, steatorrhea
- Anorexia & vomiting
- Irritable
- Abdominal pain & distention
- Muscle wasting- buttocks and extremities
- Anemia, constipation
- Lactose intolerance
Celiac Disease Nursing Care
The major role of the nurse in the management of celiac disease is helping the parents and child adhere to diet therapy- Corn, rice and millet, quinoa
Omphalocele
- Intra-abdominal Contents herniate through the umbilical cord.
- Associated with other congenital abnormalities
- Surgical Repair is necessary
Gastroschisis
- Herniation in abdominal Wall with protrusion of Small intestines and colon.
- No membrane covers the organs
Gastroschisis Nursing Management
- Sterile gauze with normal saline
- Maintain temperature- warmer or isolette
- NPO until after surgery
- Educate and support family
