The Child with GI Dysfunction

§ Acute or insidious diarrhea, anorexia, anemia § Abdominal pain and distention, muscle wasting, vomiting § Irritability steatorrhea (fatty, foul frothy, bulky stools) § Secondary vitamin deficiencies (Fe, B12, Vitamin D)

Characteristics of celiac disease

-an increase in frequency and change of consistency of stools for > than 14 days -caused by chronic conditions (malabsorption syndrome, food allergies, inflammatory bowel disease) -idiopathic

Chronic diarrhea

-Maintaining adequate nutritional status -special feeding method and strategies to maximize growth pre-surgery -encourage breast feeding or wide based nipple for bottle feeding -squeeze infants cheeks together during feeding to decrease gap -repair is typically done between 2-3 months of age.

Cleft lip

-notched vermilion border -dental abnormalities-absent teeth, extra teeth, supernumerary teeth -variably sized clefts involving alveolar ridge

Cleft lip manifestations

-opening in roof of mouth -nasal distortions and exposed nasal cavities -breathing difficulties; mouth breathing -recurrent ear and throat infections -speech & language impairments -feeding difficulties; can lead to anemia, malnutrition, FTT -Incoordination of breathing and feeding, leading to inadequate nutrition

Cleft palate manifestations

-repair typically done between 6-12 months of age, 2nd surgery required -position infant upright while cradling head during feeding -specialized bottle with a 1-way valve & specially cut nipple -burp infant frequently -syringe feeding might be necessary, if other feeding methods do not work

Cleft palate or cleft lip & palate

Client Teaching: diet/food choices, ostomy care if indicated, incisional care and signs of infection, s/s of dehydration Complications: Enterocolitis, Anal stricture and incontinence

Client teaching and possible complications of Hirschsprung disease

§ Importance of oral rehydration therapy, hand hygiene, preventive measures (immunization for rotavirus), skin care. § Increase oral fluids. § Resume normal diet ASAP. § Monitor how many times the child voids.

Client teaching for GI disorders

· Increase abdominal girth, decreased or absent bowels , bowel loop distinction, · vomiting, bile-stained emesis, abdominals tenderness, occult blood in stool · poor feeding and gastric residual, bloody stools, apnea (new or worsen status) · hypotension, lethargy, decreased urine output o CBC w/differential, ABGs, coagulation studies, blood culture and sensitivity o Abdominal x-rays will show distention, sausage-shaped dilation of intestine

Clinical manifestations and diagnostics for NEC

Newborn: failure to pass meconium within 24-48 hrs of birth, bile colored vomiting, refusal to eat, abdominal distention Infant: FTT, constipation, vomiting, episodes of diarrhea and vomiting Children: Accumulation of stool with abdominal distention, visible peristalsis, palpable fecal mass, constipation, foul smelling ribbon-like stool

Clinical manifestations of Hirschsprung disease

-abdominal pain, cramping w/o distention -palpable movable fecal masses -normal or decreased bowel sounds -malaise, HA -anorexia, N/V

Clinical manifestations of constipation

-fatigue, malaise, abdominal pain -change in behavior -change in stool pattern -poor appetite, weight loss --assess for s/s of dehydration

Clinical manifestations of diarrhea

*Diarrhea of varying amount and consistency *nausea and vomiting *abdominal pain, tenesmus (cramping rectal pain), fever *dehydration a severe consequence of gastroenteritis and occurs mainly in children <2 yoa

Clinical manifestations of gastroenteritis

o Jaundice: skin, sclera, mucous membranes, elevated serum bilirubin levels, enlarged liver o poor muscle tone, lethargy, poor sucking reflex o poor feeding, hypotonic, high pitched cry o hypoxia, temperature instability, hypoglycemia, metabolic acidosis · ABO incompatibility with positive direct Coombs test (antibody) · Hematoma/bruising, preterm birth, sibling with jaundice · hemolytic disease, Asian descent ^serum bilirubin (https://bilitool.rog/); blood typing, H&H, direct Coombs test, electrolytes

Clinical manifestations, risk factors and diagnostic evaluation of hyperbilirubinemia

*An alteration in the frequency, consistency, or ease of passage of stool *a symptom rather than a disease *idiopathic (functional) constipation-no known cause *May be 2ndary to other disorders -chronic constipation: environmental or psychosocial factors *In newborn period: -1st meconium should be w/in 24-36 hour of life -if not, assess for Hirschsprung disease, hypothyroidism, Meconium plug or Meconium ileus (CF?) *In infancy: -often related to diet; formula-fed infants may develop constipation more often than breastfed infants -constipation in exclusively breastfed infants uncommon -might occur from the undigested breast milk *In childhood: -might result from stress, environmental changes or control over bodily functions -Encopresis: inappropriate passages of feces, often with soiling

Constipation

-acute or chronic inflammation of the liver, caused by a virus, medication reaction, or another disease process -can damage and destroy liver cells *lasts 5-7 days, absence of jaundice, n/v *anorexia, malaise, lethargy, fatigability *epigastric or RUQ abdominal pain, ^history and physical examination; serologic markers

Definition and diagnostic evaluation of hepatitis

-telescoping or invagination of 1 portion of intestine into another part of intestine -medical emergency -common in infants and children 3 moa-6 yoa *classic triad of symptoms: *sudden episodic abdominal pain *screaming with knees crawn to chest *abdominal mass "sausage shaped" in RUQ *Stool mixed with bloody and mucus-"currant jelly-like stools" from leaking blood and mucus into the intestinal lumen *fever; tender distended abdomen

Definition and expected findings of intussusception

§ A genetic disorder (autosomal recessive disorder) that result in CNS damage from toxic levels of phenylalanine (essential amino acid) in the blood. o lack of enzyme phenylalanine hydroxide § Characterized by blood phenylalanine levels > 20mg/dl; normal levels are 0-2 mg/dl. § All 50 states require routine screening of all newborns for PKU. ü Identifying mother with PKU, advise mother to follow strict dietary guidelines for three months prior to conception and during her pregnancy. ü Newborn metabolic screening for PKU by blood spot analysis; Guthrie test for confirmation of diagnosis

Definition and prevention of PKU

Inadequate growth resulting from inability to obtain or use of calories required for growth Risk factors: IUGR, dysfunctional parenting, poverty, family stress, insufficient breastfeeding ØOrganic causes: CP, CHF, CF, down syndrome, premature birth, GERD

Definition and risk factors related to Failure to Thrive (FTT)

o Also known as gluten enteropathy or celiac sprue o Intolerance to gluten, the protein component of wheat, barley, Rye, and oats. o Results in the accumulation of amino acid glutamine, which is toxic to intestinal mucosal cells o Intestinal villous atrophy occurs, which affects absorption of ingested nutrients. o Occur most often between ages of 1 and 5 yoa o Between the introduction of gluten and the onset of symptoms is normally an interval of three to six months o Strict dietary avoidance of gluten minimizes risk of developing bowling and lymphoma of the small intestine and other GI malignancy.

Definition of Celiac Disease

Chronic inflammatory condition of the small or large intestine. -Two major forms: S/S varies based on types *Ulcerative colitis (UC): affects only the colon and involves both the mucosal and submucosal layers of the intestine. *Crohn's disease (CD): occur anywhere in the GI tract, involving all layers of the intestine.

Definition of Inflammatory Bowel Disease (IBD)

-inflammation of perforated appendix/inflammation in the peritoneal cavity -increased fever -progressive abdominal distention, rigid guarding of the abdomen -fever, chills, pallor -tachycardia, rapid/shallow breathing -irritability, sudden increase in pain

Definition of Peritonitis and clinical manifestations of peritonitis

-inflammation of the vermiform appendix caused from obstruction of the lumen of the appendix -average client is 10 yoa, adolescents

Definition of appendicitis

*A complication resulting from failure of the omphalomesenteric duct (outpouching or bulge in the lower part of the small intestine) to fuse during embryonic development. · Rectal bleeding (usually painless) · Abdominal pain, intestinal obstruction · currant-jelly like/tarry stools *CBC, metabolic panel, Meckel's scan (most effective diagnostic test)

Definition, clinical manifestations and lab test for Meckel Diverticulum

o Elevated serum bilirubin level: Elevation is indicated when serum levels are > 12 mg/dl in a term newborn. o Normal levels of unconjugated bilirubin: 0.2-14 mg/dL o Therapy is aimed at preventing kernicterus (a type of brain damage from high levels of bilirubin in the baby's blood). o physiologic jaundice: benign, due to breakdown of fetal RBCS and liver immaturity, shows symptoms after 24 hours of life o pathologic jaundice: AKA hemolytic disease, normally appears before 24 hours of age, caused by ABO/Rh incompatibility or isoimmunization

Definition, physiologic and pathologic jaundice regarding hyperbilirubinemia

-USG-ultrasonography (prenatal) and physical examination -observation of neonates and infants

Diagnosis of cleft lip and palate

-Serum electrolytes, CBC ØX-ray, barium enema, Anorectal exam, Confirm diagnosis with rectal biopsy

Diagnostic evaluation of Hirschsprung disease

^serological testing, upper GI endoscopy, biopsy of small intestine *dietary management of eliminating gluten -assist with assessment and diagnosis -education and support of child and family -instruct child and parents about lifelong elimination of gluten sources -instruct parents about measures for prevention of a celiac crisis

Diagnostic evaluation, therapeutic management and nursing considerations of celiac disease

-can be mild to severe -can be acute or severe -higher mortality and morbidity among infants and children < 5 yoa -higher incidence in low-income homes and communities worldwide

Diarrhea

-abdominal pain in RLQ at McBurney's point (diagnosis is made at this point) -Rigid abdomen, rebound tenderness, guarding -decreased or absent bowel sounds -fever, tachycardia, tachypnea -diarrhea/constipation, anorexia, N/V -CBC, UA -CT (enlarged diameter of the appendix, thickening of the appendiceal wall)

Expected findings, labs, diagnostic procedures for acute appendicitis

Ø Avoid overfeeding Ø Thickening feedings (1 tsp/1 tbsp:1 oz formula) Ø Upright positioning to promote gastric emptying Ø Frequent burping during feeds -Offer small, frequent meals

Feeding alterations for infants with GER

A nurse is assessing a child who has a rotavirus infection. Which of the following are expected findings? SATA A. Fever B. Vomiting C. Watery stools D. Bloody stools E. Confusion

Fever; Vomiting; Watery stools

-gastric contents back up into the esophagus, esophageal mucosa vulnerable to injury from gastric acid -can occur with Gastroesophageal reflux disease (GERD) -self-limiting, resolution by 1 year of age

Gastrointestinal reflux disease (GER)

-Cleft lip and cleft palate -gastroesophageal reflux disease -hypertrophic pyloric stenosis -Hirschsprung's disease -intussusception

Gastrointestinal structural disorders

-fecal oral contamination -highest incidence occurs among preschool or school-age children < 125 yoa -mild n/v, diarrhea

Hep A

-Perinatally acquired most often -newborns at risk if mother is infected, or mother was a carrier of HBV during pregnancy -transmission include: leakage of virus across placenta late in pregnancy or during labor, ingestion of amniotic fluid or maternal blood, breast-feeding, especially if mother has cracked nipples

Hep B

-parenteral exposure to virus -most common chronic liver disease

Hep C

occurs in individuals who have already acquired HV

Hep D

-contaminated water or fecal-oral -worse in pregnant women

Hep E

AKA congenital aganglionic megacolon Structural abnormality of GI tract caused by lack or absence of ganglionic cells in colon Ømechanical obstruction from inadequate motility of intestine Incidence: 1 in 5000 live births; more common in males and in Down syndrome, risk is high if positive family Hx. >80% of cases affects the internal sphincter, rectum, and sigmoid colon

Hirschsprung disease

-the thickening of the pyloric sphincter, creating an obstruction -occurs 1st few weeks of life -risk factors: genetic predisposition -vomiting following a feeding, nonbilious projectile vomiting, can be blood-tinged -constant hunger, but can be FTT -Olive-shaped mass in RUQ, visible peristalsis -Failure to gain weight and manifestations of dehydration (pallor, cool lips, dry skin & mucus membranes, decreased skin turgor, diminished urination, concentrated urine, thirst, rapid pulse, sunken eyes)

Hypertrophic Pyloric Stenosis

^Lab test: blood electrolytes ^Diagnostic procedure: USG ^Nursing care: prepare child for surgery ^Therapeutic management: laparoscopic surgery (pyloromyotomy) ^Nursing considerations: · IV fluid correct dehydration and electrolyte imbalance prior to surgery. · Preoperative nursing actions: daily weight, I&O, NPO, NG tube decompression · Postoperative nursing actions: VS, provide IV fluids, monitor I&O and daily weight, analgesics, assess for manifestations of infection, start patient on clear liquid's 4-6 hours after surgery, document tolerance to feedings. · Support of infant and family.

Hypertrophic Pyloric Stenosis

o DISCONTINUE ALL FEEDINGS, IV fluids to correct fluid, electrolyte , and acid-base imbalances, TPN to provide rest to gastrointestinal tract, IV antibiotics o abdominals decompression, NG tube decompression o routine assessment, vital signs o surgical intervention is indicated, temporary colostomy and removal of necrotizing portion of the bowel. o Withhold feedings for 24 to 48 hours four infants believed to have suffered birth asphyxia. o Breastfeeding preferred nutrient for NEC

Nursing management and prevention of NEC

Ø If PKU is diagnosed, implement the following: •formula low on phenylalanine, and monitor its level (goal: 2-8mg/dl) •20-30 mg phenylalanine/kg body weight in 24 hrs is recommended •Exclusive breastfeeding may be not possible due to phenylalanine level Ø Dietician consult, referral to support groups Ø Parental support and teaching

Nursing management of PKU

§ Oral rehydration is attempted first for mild and moderate cases of dehydration. § Mild: 50 ml/kg rehydration fluid within 4 hours. § Moderate: 100 ml/Kg rehydration fluid within 4 hours § Given small amounts frequently (tsp, cup, syringe, or via NGT) § Continue use of breast milk § If vomiting: 5-10 ml every 2-5 minutes. § Assess capillary refill, vital signs. § Monitor weight and maintain accurate I&O.

ORS guidelines for rehydration

*Life can be very difficult for adolescents that have IBD. They are often embarrassed by the symptoms of the disease and are trying to fit in with their peers so may stop taking their medication. *Encourage these individuals to join a support group of others who are their age and have IBD. *Social media provides a great way for them to find and participate in a support group.

Patient teaching for Adolescents with IBD

A nurse is caring for a child who is suspected to have pinworms. Which of the following action should the nurse take? A. Perform a tape test. B. Collect stool specimen for culture. C. Test the stool for occult blood. D. Initiate IV fluids.

Perform a tape test.

o Antimicrobials may be prescribed to prevent or treat secondary infections o 5-Aminosalicylates decrease gastrointestinal inflammation, side and adverse effects include nausea, rash, arthralgia, hematological disorders. o Corticosteroids: act as an inflammatory to decrease gastrointestinal inflammation. o Immunomodulators: monoclonal antibodies modulate the immune system to induce and maintain remission.

Pharmacological management for IBD

-ear infections and hearing loss (recurrent OM) -speech and language impairment -dental problems

Possible complications from cleft lips and cleft palate.

ØCognitive impairment (may become severe) ØHyperactive and erratic behavior ØHead banging, disorientation ØSpasticity and seizures

Possible complications of PKU

-monitor VS, redness or drainage at site, I&O, and hydration status -assess for wound infection -advance diet as tolerated per child -administer analgesics as prescribed

Postoperative interventions for umbilical hernia

*Surgical removal of diverticulum is standard treatment *Prepare the child in family for surgery *Pre operative care: · Administer IV fluid and electrolyte replacement, IV antibiotics · Blood transfusions if indicated, bed rest, oxygen therapy *Postoperative care: · Assess respiratory status and maintain airway, surgical site for bleeding or other abnormalities, bowel sounds and bowel functions. · Provide supplemental oxygen · Obtain vital signs, · Maintain NPO status, NG tube to load continuous suction

Therapeutic management and nursing care management of Meckel Diverticulum

ØType of surgery depends on extent/location of aganglionic bowel ØLess extensive: single surgery without colostomy ØTwo stages: Temporary colostomy (first), "pull-through" procedure (2nd stage) ØClosely monitor and record the child's bowel elimination pattern ØProvide High-protein, high-calorie diet prior to surgery ØTotal parenteral nutrition as indicated ØProvide preoperative and postoperative care ØMake appropriate referrals

Therapeutic management and nursing interventions for Hirschsprung disease

-No antibiotics for: *C. botulinum *E. coli *Salmonella

Therapeutic management for Bacterial infections

-removal of nonruptured appendix -laparoscopic surgery: -preoperative nursing actions: -sudden cessation of pain with prescription -IV fluid replacement as prescribed -IV antibiotic -NPO -postoperative nursing actions: -assess respiratory status, surgical site for bleeding or other abnormalities, bowel sounds and bowel functions -provide supplemental oxygen as needed, drain care if needed -obtain vital signs -administer analgesics -monitor for bleeding/infection

Therapeutic management for acute appendicitis

Ø Early detection Ø Support and monitoring of disease Ø Prevention of spread of disease Ø Nutritional support to promote growth and development -Based on severity of disease and medical treatment -Education and prevention -Well-balanced diet and rest -Standard precautions ^Hep A and Hep B vaccines have decreased the # of incidences in the United States ^No vaccines against the other types

Therapeutic management, nursing care management and prevention of Hepatitis

*USG *1st attempt should be conservative treatment (nonsurgical) such as air enema with or w/o contrast *attempt unsuccessful, surgery is required -assessment pre-and post-procedure -IV fluids to correct and prevent dehydration -NG tube for decompression PRIOR to surgery -postoperative care as indicated ^intestinal obstruction, perforation ^necrosis, death ^shock and dehydration can occur

Therapeutic management, nursing care, and possible complications from Intussusception

-most common outpatient infectious diseases of children -viral, bacterial, helminthic infection (S/S differ based on causative organisms) *Viral: Rotavirus, Norwalk-like virus *Bacterial: Yersinia enterocolitis, E. coli, Salmonella, C. Difficile, Clostridium botulinum, Staphylococcus, Shigella *Helminthic: Enterobius (Pinworm) *Parasitic pathogen: Giardia lamblia

Types of infections gastroenteritis

-a protrusion of the bowel through an abnormal opening in the abdominal wall *(from separation in abdominal muscles) -most common in the newborn period -typically resolves in 1st year of life -more common in females and African Americans -surgical: repair in 1-2 years of life if < 2 cm -belly bands, taping do not help

Umbilical hernia

-frequency & persistency may make it abnormal -infants: spitting up or forceful vomiting, irritability, excessive crying, blood in vomitus, arching of back, stiffening, respiratory problems, apnea, poor weight gain -Pathological: FTT, bleeding, dysphagia (swallowing) -children: Heartburn, abdominal pain, difficulty swallowing, chronic cough, noncardiac chest pain

What are the clinical manifestations?

-Upper GI endoscopy detects GI structural abnormalities -24-hour intraesophageal pH study to measure amount of gastric acid reflux into the esophagus -endoscopy w/biopsy detection of esophagitis and strictures -Scintigraphy [pictures (scans) of structures inside the body] for identification of gastric content aspiration

What are the different diagnostic procedures for GER?

-History of travel and exposure -CBC with differential, H&H, BUN, Creatinine, blood -stool test (presence of WBCs) and blood in stool supports definitive diagnosis -Urinalysis if dehydration is suspected -H&H, BUN, creatinine, urine specific levels elevated with dehydration -tape test (enterobius vermicularis) pinworm

What are the laboratory test for gastroenteritis?

-child is crying but is otherwise a healthy infant *sick or hungry, cries for more than 3 hours a day, more than 3 days a week, for more than 3 weeks. -S/S: difficult to comfort, grimacing/frowning, excessive crying, high pitched-piercing sound, clenched fists, red faced, knees drawn to chest, excessive gas *worse in afternoon/evening but can happen at anytime -episodes starts around 2 weeks, peaks at 6 weeks and ends by 4 moa -incidence is 12-20% of the time (80% of parents report child was colicky) -afebrile and normal physical examination -screen child for weight loss -give parental support

What is Colic?

-monitor integrity of the postoperative protective device -position infant on back and upright, or on side during immediate postoperative period to maintain integrity of the repair -apply elbow restraints to keep infant from injuring the repair site. -Use water or dilated hydrogen peroxide to clean incision site. -Aspirate secretions from mouth and nasopharynx for prevention of respiratory complications

What is the postoperative nursing actions for a cleft lip?

-Change infant's position frequently for drainage and breathing. -Maintain IV fluids until infant is able to eat and drink -NPO for 4 hours then liquids for the 1st 3-4 days, progress to soft diet -avoid placing straws, tongue depressor, hard pacifier, rigid utensils, hard-tipped sippy cups, suction catheters in infant's mouth, due to possible damage. -elbow restraints used to prevent injury to repair -close observation for airway obstruction, hemorrhage, laryngeal spasm -use of face mask for oxygen delivery

What is the postoperative nursing care for cleft palate?

-dietary management is treatment of choice -remove constipating foods such as bananas, rice, cheese -increase fluids and fiber-rich foods such as whole grains, fruits, veggies -increase hydration, exercise activities, bowel regimen -caution parents to avoid use of laxatives, sugar and/or milk products, stool softeners, or enemas

What is the therapeutic management of constipation?

-history of bowel patterns, medications -educate parents and child on dietary modifications -incorporation of high-fiber foods, fluids -avoid excessive cows milk

What the nursing management for constipation?

Incomplete fusion of the lip or palate, most common congenital craniofacial deformity. Øresults from incomplete fusion of oral cavity (Cleft lip) Øresults from incomplete fusion of palates (Cleft palate) ØCan appear together or alone, and unilateral/bilateral

cleft lip and palate

*Fruit juices, carbonated sodas, gelatin, caffeine, chicken or beef broth. *BRAT diet - bananas, rice, applesauce, and toast (low nutritious value)

foods to avoid while for GI disorders

-Administer antibiotics: C.difficlie and G. Lamblia *Metronidazole/tindazole -Administer antibiotics: pinworm *Mebendazoe, albendazole, pyantel pamoate *assessment of fluid and electrolyte imbalance *rehydration and maintenance fluid therapy: -Initial replacement: ORS 75-90 mEq of Na/L at 40-50mL/kg over 4 hours. -Maintenance: ORS 40-60 mEq of Na/L and limit to 150 mL/kg/day -Replace ongoing stool loss 1:1 with ORS 10 mL/kg each stool -reintroduce diet, and continue breastfeeding and/or formula

therapeutic management of GI disorders

-recurrent pneumonia -weight loss -FTT

what are the possible complications that happen with GER?

Ø Administer IV fluids, analgesics, and IV antibiotics Ø Maintain NG tube to low continuous suction Ø Pre- and post op care Ø Provide surgical wound care, wound irrigation and dressings as indicated Ø Psychological support to child and family -pre and post-op care, NPO, pain medication, early ambulation, S/S of infection, wound care

Therapeutic management and client teaching for peritonitis

-sudden increase in frequency and change in consistency of stool -secondary to an infectious agent in the UTI, URI, GI tract, antibiotic use, or laxative use -self-resolution occurs in less than 14 days if dehydration does not occur -Caused by viral, bacterial, parasitic pathogens

Acute diarrhea

*Primary: Recurrent or chronic diarrhea *Weight loss, dehydration, anorexia, growth failure, vitamin deficiencies, and anemia are common.

Assessment findings of IBD

**Bread and grains: whole-grain bread or rolls, whole-grain cereals, bran, pancakes, waffles, muffins with fruit or bran, unrefined (brown) rice **Vegetables: raw veggies-broccoli, cabbage, carrots, cauliflower, celery, lettuce, spinach, asparagus, beans, Brussel sprouts, corn, potatoes, rhubarb, squash, string beans, turnips **fruits: prunes, raisins, raw fruits with skins or seeds, other than ripe banana or avocado **Miscellaneous: legumes (beans), popcorn, nuts, seeds, high fiber snack bars

Incorporation of high fiber foods

-appendicitis -Meckel's diverticulum

Inflammatory disorders

A nurse is caring for a child who had watery diarrhea for the past three days. Which of the following is an action for the nurse to take? A. Offer chicken broth. B. Initiate oral rehydration therapy. C. Start hypertonic IV solution. D. Keep NPO until the diarrhea subsides.

Initiate oral rehydration therapy. (to replace lost electrolytes for children with diarrhea)

A nurse is teaching a group of parents about Salmonella. Which of the following information should the nurse include in the teaching? SATA A. Incubation period is nonspecific. B. It is a bacterial infection. C. Bloody diarrhea is common. D. Transmission can be from house pets. E. Antibiotics are used for treatment.

It is a bacterial infection. Bloody diarrhea is common. Transmission can be from house pets.

-pain, followed by N/V -if appendix is perforated, patient will experience relief of pain, other S/S will worsen with high fever and signs of dehydration -SUDDEN CESSATION OF PAIN W/O PAIN TREATMENT CAN INDICATE RUPTURE OF APPENDIX, THIS IS EMERGENT. -nurse should monitor child for changes in behavior, know signs of rupture.

Key points of acute appendicitis

ØWeight loss: <5th %tile on growth chart ØMalnourished appearance, developmental delays ØPoor feeding, minimal smiling, withdrawn ØNo fear of strangers, body stiffness *if organic (based on cause) *Assessment: nutritional hx., baseline Ht., Wt., dehydration *Assess Parent-child interactions and bonding *Establish routines for feeding: breastfeeding, 24 cal. formula *Medications: Multivitamin as prescribed *Provide developmental stimulation *Parent teaching: feeding, eye contact, burping, consistent care, NEVER force to eat.

Manifestations and management of FTT

· Acute inflammatory disease of the gastrointestinal tract; occurs 4 to 10 days after birth and is most frequently seen a preterm newborn. Caused by ischemia or hypoxia. · Ischemia--death of mucosal cells-the chronic patches from improper digestion · Prematurity, RDS, IURG, shock, asphyxia, enteral feedings, pre-existing infections

Necrotizing Enterocolitis (NEC) definition and risk factors

-a minimally invasive procedure ^Five small incisions are made in the abdomen where a camera and working surgical instruments are placed. ^The esophagus is mobilized and the opening in the diaphragm (crural opening) is identified. ^The crural opening is then closed. ^The fundus (upper part of the stomach) is then wrapped around the lower portion of the esophagus. ^The fundoplication is formed by suturing the stomach around the esophagus. https://www.memorialhermann.org/services/treatments/laparoscopic-nissen-fundoplication

Nissen fundoplication procedure

§ Obtain baseline height and weight. Obtain child's weight at the same time each day. § Avoid taking rectal temperature, avoid antibiotics, avoid antimotility agents. § Assess and monitor I&O (urine and stool). § Administer antibiotic as prescribed (shigella, C. Difficile, and G. Lamblia). § Assessment and re assessment and reassessment !!!! § Identify and initiate appropriate treatment for mild, moderate, or severe dehydration.

Nursing care for GI disorders

-prepare child and family for surgery -avoid applying HEAT to abdomen -AVOID ENEMAS or LAXATIVES

Nursing care of acute appendicitis

-support and encourage parents in general care of child -promotion of parent-infant bonding -promotion of healthy self-esteem throughout child development -Interprofessional care: plastic surgeon, orthodontist, otolaryngologist, speech-language pathologist, pediatrician, nursing, audiologist, social worker, psychologist

Nursing care of cleft lip and palate

^Family history such as a sibling or parent due to autosomal recessive trait v Digestive problems and vomiting , seizures, musty urine odor, v Growth failure, irritability, microcephaly, v CHD, blue eyes, fair skin, and blonde hair

Risk factors and clinical manifestations of PKU

-prematurity, Bronchopulmonary dysplasia -neurologic impairments, asthma -CF, CP, scoliosis -50% of infants < than 2 moa reported to have "physiological" GER

Risk factors of GER

-occur as a result of embryonic developmental failures related to multiple genetic and environmental factors. -Family history of cleft lip or palate -folate deficiency in pregnancy -Prenatal exposure to alcohol, smoking, and anticonvulsants, retinoid and steroids

Risk factors of cleft lip and palate

-lack of clean water -poor hygiene -crowded living environments -poor sanitation -nutritional deficiency

Risk factors of diarrhea

A nurse is teaching a group of caregivers about E coli. Which of the following information should the nurse include in the teaching? SATA A. Severe abdominal cramping occurs. B. Watery diarrhea is present for more than five days. C. It can lead to hemolytic uremic syndrome. D. It is a foodborne pathogen. E. Antibiotics are for treatment.

Severe abdominal cramping occurs. It is a foodborne pathogen. It can lead to hemolytic uremic syndrome.

-Prevent aspiration -Maintain patent airway without signs of respiratory distress/periods of apnea -Medications: Proton Pump Inhibitors (omeprazole, pantoprazole) or H2-receptor antagonist (ranitidine, famotidine) -Surgical intervention: Nissen Fundoplication for severe cases of GERD -Avoid offending foods: Caffeine, citrus and spicy/fried foods

Therapeutic and Nursing Management of GER

ØNutritional support: low-fiber, low-residue, low-fat, milk-free, elemental diet ØPharmacologic therapy: anti-inflammatory, antibacterial, antibiotic, and immunosuppressive agents. ØEmotional support, Preparing for exacerbations ØSurgical treatment: Colectomy, Ileostomy

Therapeutic and nursing management for IBD

*Phototherapy primary treatment (double/single/bili blanket); if bilirubin is in high-risk zone on hour specific nomogram *Eye mask to protect cornea and retina *Undressed but keep diaper on *No lotion or ointments on skin *Check Lamp energy per facility protocol *Monitor for s/s of dehydration and elimination patterns (stools and urine) *Monitor VS, skin color, wt., eyes (for injury/inflammation), and bilirubin level *Frequent feedings, continue breastfeeding and supplemental formula as needed *Parental support and teaching

Therapeutic and nursing management of hyperbilrubinemia