Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder

Vomiting immediately after feeding

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described?

pink and moist. If the stoma is dry or pale, the mother must notify the health care provider immediately because it could indicate compromised circulation

A healthy stoma is

esophageal atresia (EA)

A maternal history of polyhydramnios is usually present in one-third of cases of __________ _________

1 to 2 days

After surgery for Hypertrophic Pyloric Stenosis, infants usually resume oral feedings after

Strict enforcement of standard precautions

An adolescent has hepatitis B. What would be the most important nursing action

Acute inflammation of the appendix median age in the pediatric population is 4 to 15

Appendicitis

The absence of some or all of the major biliary ducts resulting in obstruction of bile flow Stools will appear chalky and white due to the lack of bile pigment Jaundice of the skin and sclera Liver will feel enlarged and harden Splenomegaly

Biliary Atresia

Immunological disorder in which gluten causes damage to the small intestines The villi of the small intestines are damaged due to the bodies immunological response to the digestion of gluten.Damage to the villi results in malnutrition

Celiac disease

Children at risk include those with immune disorders, those using steroid inhalers,and those receiving therapy that suppresses the immune system

Children at risk for Oral Candidiasis (Thrush)

congenital craniofacial anomaly

Cleft Lip and Palate

ultrasound Barium swallow ERCP Hemoccult HIDA scan Liver Function tests (LFTs: AST, ALT, GCT) Colonoscopy and endoscopy Amylase and lipase

Common Lab & Diagnostic Tests

diarrhea, vomiting, decreased oral intake, sustained highfever, DKA and excessive burns

Common causes of dehydration

bleeding, anemia and intestinal obstruction such as a volvulus and intussusception which usually occur within the first two years of life

Complications of Meckel Diverticulum

feeding difficulties, altered dentition, delayed or altered speech development and otitis media

Complications of cleft lip and palate include

7ml/kg per 24 hour period for every sustained 1 degree rise in temperature

Fever increases fluid loss at a rate o what?

2/3 of insensible fluid loss

Fluid loss from the skin accounts for about how much fluid loss?

100 ml/kg for first 10kg 50 ml/kg for next 10 kg 20 ml/kg for remaining Add together the total ml needed per 24 hour period Divide by 24 for ml/hr fluid requirements

Formula for Fluid Maintenance

Autonomic nervous system which controls the body's response to emotions and stress and intestinal motility are the two mechanisms Diagnosis of functional abdominal pain is made on a symptom-based approach

Functional Abdominal Pain

Passage of gastric contents into the esophagus

Gastroesophageal Reflux

the sphincter in the lower portion of the esophagus, which leads into the stomach, is relaxed and allows gastric contents to be regurgitated back into the esophagus

Gastroesophageal reflux (GER) occurs when

Disorder of the intestinal tract resulting in obstruction. Failure to pass a stool(meconium) within the first 24 hours of life this is due to lack of ganglion cells inthe bowel which causes inadequate motility in part of the intestines

Hirschsprung Disease (Cogenital Aganglionic Megacolon)

circular muscle of the pylorus becomes hypertrophied causing thickness in the luminal side of the pyloric canal

Hypertrophic Pyloric Stenosis

Intussusception

In children under 2 what is the most common cause of bowel obstruction

he abdominal or pelvic viscera travels through the intestinalinguinal ring into the inguinal canal. Boys are more likely to develop than girls. Surgical repair is done when the child is several weeks old

Inguinal hernia

A proximal segment of the bowel telescopes into a moredistal segment causing edema, vascular compromise andultimately partial or total bowel obstruction

Intussusception

painless rectal bleeding

Meckel diverticulum

appropriate positioning such as elevating the head of the bed and keeping the infant or child upright for 30 minutes after feeding Smaller more frequent meals Medications to decrease acid production and stabilize the pH of the gastric contents Nissen fundoplication the gastric fundus is wrapped around the lower 2 to 3 cm of the esophagus

Medical management of Gastroesophageal Reflux

Hypertrophic Pyloric Stenosis

Palpation of a hard movable "olive" in the right upper quadrant shows what

Acute pancreatitis is an acute inflammatory process that occurs within the pancreas, most common causes include abdominal trauma, drugs, multi system disease, congenital anomalies, obstruction or metabolic disorders Chronic pancreatitis is based on the structural and or functional permanent changes that occur in the pancreas

Pancreatitis

7 to 14 days of intravenous antibiotic therapy

The child with a perforated appendix requires how many days of antibiotics

abdominal distention absence of stool in the rectum enterocolitis bilious vomiting

The nurse examines the newborn and finds which symptoms that are indicative of Hirschsprung disease

Check for gastric residual before starting feeding. done by gently aspirating from the tube with a syringe or positioning the tube below the level of the stomach with only the barrel of the syringe attached

The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube?

The nurse assesses the color of the newborn's abdominal organs. The nurse places the newborn in a radiant warmer to maintain the newborn's temperature. The nurse closely monitors the hydration status of the newborn for signs of dehydration.

The nurse is caring for a newborn following delivery who has been diagnosed with gastroschisis. Which action(s) by the nurse indicates knowledge of appropriate care for this disorder? Select all that apply.

Hirschsprung disease

The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.

commonly in preterm infants and much more frequentlyin African-Americans. Caused by an incomplete closure of the umbilical ring allowing intestinal contents to herniate through the opening.

Umbilical hernia

abnormally attached and the mesentery narrows twisting on itself (volvulus)

When malrotation occurs the intestine is

right lower quadrant

With appendicitis, percussion reveals irritation and pain in which quadrant

the first surgery establishes a colostomy and the second surgery comes at around 18-months for bowel repair. The child will be able to resume breastfeeding or other fluids after about 24 hours and the resumption of bowel sounds and passing flatus, and then slowly re-introduce solids.

describe the two-step surgery for Hirschsprung disease

Vomiting is forceful and often projectile

describe vomiting from Hypertrophic Pyloric Stenosis

an air or barium enema

diagnosis of Intussusception

fungal infection of the oral mucosa most common in newborns and infants

hat is Oral Candidiasis (Thrush)

Opening in the cleft palate contributes to buildup of fluid in the middle ear which can lead to acute infections

how does cleft lip/palate lead to ear infections?

treatment of mom and baby

if Oral Candidiasis (Thrush) occurs in a breastfeeding baby what needs to happen

its higher so they require more calories to grow

in pediatrics what is the difference in metabolic rate

Kidneys are not able to concentrate urine as well as an older children putting theinfant at risk for dehydration or overhydration depending on the situation

kidney function in younger patients?

steatorrhea

large amounts of bulky stools and what looks like fat in the stools is known as

Bilious vomiting other manifestations: abdominal pain, shock symptoms, abdominal distention, tachycardia and bloody stools

main manifestation of Malrotation

Sudden onset of intermittent crampy abdominal pain Vomiting and diarrhea Currant-jelly stools, gross blood or a hemoccult positive stools Symptoms flare and then regress Sausage shaped mass in the upper mid abdomen

manifestations of Intussusception

illness

pediatrics are at risk of fluid loss with what?

Preventing injury to the suture line-do not allow the child to rub the facial sutureline. Position the infant in a supine or side laying position it may be necessary touse arm restraints

post op for cleft lip/plate

hard, moveable "olive-like mass" in the upper right quadrant

the nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

vitamin and caloric support. Administer vitamins A, D, E, and K. Special formulas because of significant fat malabsorption

treatment of Biliary Atresia

Surgical resection of the aganglionic about an attachment of the remaining intestines. An ostomy is placed to allow the bowel to heal. Once healed the ostomy is reversed

treatment of Hirschsprung Disease

Require surgical intervention

treatment of Hypertrophic Pyloric Stenosis

attempting to reduce the hernia by pushing it back through the external inguinal ring. Reduction is only a temporary method of management they must be corrected surgically.

treatment of Inguinal hernia

IV fluids and antibiotics

treatment of Intussusception

Administer IV fluids and antibiotics NGT to decompress the stomach

treatment of Malrotation and Volvulus

Surgical repair is necessary

treatment of Meckel Diverticulum

Most are notcorrected surgically. Most spontaneously close by four years of age. Teach thefamily how to reduce the hernia

treatment of Umbilical hernia

Surgical repair around the age of 2 to 3 months for a cleft lip and cleft palate at 6 to 9 months

treatment of cleft lip

Initially administer 20 ml/kg of normal saline or LR and then reassess thehydration status

treatment of dehydration?

Tap water, milk, undiluted fruit juice, soup and broth

what are NOT appropriate for oral rehydration

Gagging, choking and nasal regurgitation of milk frequently occur

what frequently occurs in pediatric patients with cleft lip and palate

eads to shock, so early recognition and treatment is critical to prevent progression to hypovolemic shock.

what happens when Dehydration is left untreated

an immunologic disorder in which gluten, a product most commonly found in grains, causes damage to the small intestine. It is total gluten intolerance,

what is Celiac disease

A fibrous band connects the small intestines to the umbilicus. The most common congenital anomaly of the G.I. tract

what is Meckel Diverticulum

high-carbohydrate fluids such as Kool-Aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time

why avoid high-carbohydrate fluids such as Kool-Aid and fruit juice when dehydrating a fluid volume deficit patient?