TLO 2.3 Nutrition and Fluid Balance - Child Flashcards
Cleft Lip/Cleft Palate
Structural defect?
Causes?
Structure:
Facial malformations that occur during embryonic development
Most common of congenital deformities of the head and neck
Most often have both deformities
Causes:
Interaction of multiple genetic and environment factors
-exposure to alcohol, smoking, anticonvulsants, steroids (10x increase with phenytoin)
Cleft Lip/Cleft Palate
First sign?
Occurs during 7-12th week of embryonic development
US during pregnancy can reveal deformity
Cleft lip obvious at birth
Cleft palate is discovered with exam
Cleft Lip/Cleft Palate
Problems?
Inability to suck -imbalance nutrition -imbalanced fluid/electrolytes -breast/bottle feeding difficulties -growth and development -liquids escape through nose Risk for aspiration Risk for chronic otitis media and hearing loss Parental anxiety and fears Maternal-child bonding -emphasize positive physical features -emphasize post op outcomes -do not focus on defect
Cleft Lip/Cleft Palate
Feeding
ESSR method of feeding: enlarged, stimulate, swallow, rest feeding
- special bottle systems with enlarged nipples
- hold infant in semi upright seated position
- try to limit feeding to 30 min
Cleft Lip Palate
Post op care
Cleft lip repair: 3-6 mo old, revision by 5 yr Focus on protecting operative site -prevent crying -elbow restraints -keep on back/side position or infant seat Analgesia for pain Clear liquids when awake Suture line meticulously cleaned Antibiotic ointment Gentle aspiration of mouth/nose prn
Cleft palate repair
Post op care
Cleft palate repair: 6-24 mo, <1 yr recommended 4-6 weeks healing May position on abdomen No suction or other objects in mouth No hard foods Parental support access information
Esophageal atresia
Suspected?
Any infant with unexplained frothy saliva in the mouth and unexplained episodes of cyanosis should be suspected in having esophageal atresia
Esophageal atresia with a tracheoesophageal fistula
what is it?
Esophagus terminated before it reaches the stomach and a fistula occurs that represents an unnatural connection with the trachea
Results in aspiration, respiratory distress and dehydration
Surgical repair needed
Esophageal atresia with a tracheoesophageal fistula
clinical signs and diagnosis
Clinical signs: 3 "C's" chocking, coughing, cyanosis with feeding Excessive oral secretions Vomiting Unable to pass an NG tube at birth Abdominal distention
Diagnosis:
X-ray, proximal esophagus dilated with air (atresia) or abdominal distention (fistula)
Bronchoscopy and endoscopy to assess fistulas
Esophageal atresia with a tracheoesophageal fistula
Surgical emergency
Repair to ligate fistula and anastomose esophagus Priority: prevent aspiration -NPO until repaired -frequent suctioning oral -NG w/ aspiration q 5-10 min (pouch empty) -infant in warmer/humidified O2 -IV fluids -HOB elevated to 30 -monitor VS, pulse ox, I/O
Esophageal atresia with a tracheoesophageal fistula
Post op nursing
Monitor respiratory status Support fluid balance and nutrition Maintain temperature, pain relief monitor for infection Promote bonding with parents chest tube patency maintained Assess lung sounds, suction prn Accurate I/O, gastric tubes for feeding
Esophageal atresia with a tracheoesophageal fistula
Evaluation
Infant tolerating oral feedings with 3 “C’s”?
Infant gaining weight?
Surgical site without signs of infection?
Skin intact around G tube, chest tube, incision?
Esophageal atresia with a tracheoesophageal fistula
Parent care
Parents anxiety levels with care responsibilities
Demonstrate G tube feeding and care (tube bath in 1-2 wks)
Report drainage, leakage of formula, s/s of infection
Demonstrate skin care of wounds
CPR trained
Home care resources
Gastroesophageal Reflux and Disease: GER and GERD
What is it?
Causes?
Gastroesophageal Reflux: GER
Regurgitation of gastric contents back into the esophagus: 50% of infants <2 mo have GER, physiologic usually resolves by 1 yr
Gastroesophageal Reflux Disease: GERD (pathologic)
Represents resulting symptoms or tissue damage
Becomes a disease when complication occur
-growth failure
-bleeding
-dysphagia develops
-GERD is associated with: apnea, bronchospasm, laryngospasm and pneumonia
Causes: inappropriate transient relaxation of the lower esophageal sphincter (LES)
GERD s/s
Symptoms: vomiting or spitting up after meals hiccupping apnea, coughing, choking recurrent otitis media weight loss/failure to thrive irritable, discomfort, ad pain severe cases: hematemesis or melena and anemia
GERD diagnosis
H/P
UGI series/barium swallow study
24 hr intraesophageal pH monitoring study- gold standard
endoscopy with biopsy, US, CT
GERD nursing interventions
Monitor airway CPR education Provide education on nutrition/fluids Position upright after feeding, 1hr Small frequent feeding (rice cereal) Teach signs of dehydration and when to seek help Observe for GI bleeding
GERD evaluation
Patent airway Swallowing without respiratory distress Retaining feeding with regurgitation of <10ml Gaining weight Balanced I/O
GER/GERD colaborative care and medications
Care:
No therapy if thriving and no resp complications
15% require surgery
Medications:
H2-receptor antagonists: Pepcid (famotidine), Zantac (ranitidine)
Proton pump inhibitors: Prilosec (omeprazole), Protonix (pantoprazole)
Gastroenteritis causes
Infectious agent in GI tract
Viral, bacterial and parasitic pathogens
Spread by fecal-oral route
-contaminated food or water
-spread person to person in close contact
**Giardia is the most common pathogen in daycare
**Rotavirus is the most common viral cause of diarrhea (29% of deaths <5 yr)
Most severe in 3 mo to 24 mo
Gastroenteritis NI
Obtain accurate history, length of symptoms, frequency and consistency of stools blood/mucus
Assess for poor hydration
Maintain fluid balance: I/O, weight, electrolytes, K+, NA+
Maintain isolation: teach prevention of spread
No antidiarrheal
Report worsening symptoms: bloody stool, ab distention/pain, persistent elevated temp
Pyloric Stenosis
what is it?
Circular area of muscle around pylorus hypertrophies and obstructs gastric emptying
Most common symptom is progressive projectile vomiting (no bile)
Dehydration is most serious outcome
NI aimed at preventing dehydration
Hypertrophic Pyloric Stenosis
what is it?
Pyloric sphincter is thickened causing narrowing
-outlet obstruction and dilation, hypertrophy and hyperperistalsis of the stomach
Develops at 2-5 wk
