Pediatric Nursing9(Gastrointestinal Disorder)

8/4/2019 Pediatric Nursing9(Gastrointestinal Disorder)

1/52

teret

Pediatric NursingGastrointestinal


2/52

teret

Function

1. Assists in maintaining F&E and acid1. Assists in maintaining F&E and acid--base balancebase balance

2. Processes and absorbs nutrients to2. Processes and absorbs nutrients tomaintain metabolism and supportmaintain metabolism and supportgrowth and developmentgrowth and development

3.Ex

crete waste products from3.Ex

crete waste products fromdigestive processdigestive process


3/52

teret

Recommended DailyAllowance

Calories: 120 cal/Kbw/day; 360Calories: 120 cal/Kbw/day; 360--380 cal380 caldailydaily

ProteinProtein 2.2 g/Kbw/day2.2 g/Kbw/day FluidsFluids 1616--20 cc/kg/day20 cc/kg/day


4/52

teret

Supplementary Feeding

Supplementary feedingSupplementary feeding 44--6 months6 months

Never wean an infant if inNever wean an infant if in

1.Solid foods in order:1.Solid foods in order: -- cerealscereals rich in ironrich in iron

-- fruitsfruits

-- vegetablesvegetables

-- meatmeat


5/52

teret

2. begin in small quantities2. begin in small quantities

3.Finger foods3.Finger foods offered at 6 monthsoffered at 6 months

4.Soft table foods4.Soft table foods 1 year1 year 5. Dilute fruit juices5. Dilute fruit juices 6 months; 1 is to6 months; 1 is to

4 ounces of water4 ounces of water

6. Never give half cooked eggs6. Never give half cooked eggs salmonelliosis/gastroenteritissalmonelliosis/gastroenteritis

7. Dont give honey7. Dont give honey infant botulisminfant botulism


6/52

teret

8. Offer food one at a time8. Offer food one at a time interval ofinterval of44--7 days7 days

Total body fluidsTotal body fluids 6565--85% of body85% of bodyweightweight

Greater in extracellularGreater in extracellular dehydrationdehydration


7/52

teret

Acid-Base Balance

1.Chemical buffers1.Chemical buffers

2.Renal and respiratory system2.Renal and respiratory system

3. Dilution of strong acids and bases in blood3. Dilution of strong acids and bases in blood Respiratory acidosisRespiratory acidosis carbonic acid excesscarbonic acid excess

-- hypoventilationhypoventilation

-- RDSRDS

-- COPDCOPD

-- LaryngotracheobronchitisLaryngotracheobronchitis


8/52

teret

Respiratory alkalosisRespiratory alkalosis carbonic acidcarbonic aciddeficitdeficit

-- hyperventilationhyperventilation -- feverfever

-- encephalopathyencephalopathy


9/52

teret

etabolic acidosisMetabolic acidosis base HCO3 deficitbase HCO3 deficit

-- diarrheadiarrhea

-- severe dehydrationsevere dehydration -- malnutritionmalnutrition

-- ciliac crisisciliac crisis


10/52

teret

Metabolic alkalosisMetabolic alkalosis case HCO3 excesscase HCO3 excess

-- uncontrolled vomitinguncontrolled vomiting

-- NGT insertionNGT insertion -- gastric lavagegastric lavage


11/52

teret

Problems Leading to F&EImbalance

1. Vomiting1. Vomiting forceful expulsion offorceful expulsion ofstomach contentsstomach contents

Sx:Sx: NauseaNausea

DizzinessDizziness

Facial flushingFacial flushingAbdominal crampingAbdominal cramping


12/52

teret

Assess:Assess:

AmountAmount

FrequencyFrequency ForceForce projectileprojectile

Mgt:Mgt:

BRAT dietBRAT diet banana, rice, apply sauce,banana, rice, apply sauce,toasttoast


13/52

teret

Diarrhea

Exaggerated excretion of intestinalExaggerated excretion of intestinalcontentscontents

Types:Types: 1. Acute1. Acute related to gastroenteritis,related to gastroenteritis,

salmonellasissalmonellasis

-- dietary indescretiondietary indescretion -- antibiotic use (Ampicillin, tetracycline)antibiotic use (Ampicillin, tetracycline)


14/52

teret

2.Chronic non2.Chronic non--specificspecific

Cause:Cause:

1. food intolerance1. food intolerance 2.Excessive fluid intake2.Excessive fluid intake

3. carbohydrate and protein3. carbohydrate and proteinmalabsorptionmalabsorption

Assess:Assess:

Frequency, consistency, appearanceFrequency, consistency, appearance

Best criteria: consistencyBest criteria: consistency


15/52

teret

Complication:Complication:

DehydrationDehydration

MildMild 5% wt loss5% wt loss ModerateModerate 10% wt loss10% wt loss

SeverSever 15% wt loss15% wt loss


16/52

teret

Early signs and symptoms:Early signs and symptoms:

Tachycardia, tachypnea, hypotensionTachycardia, tachypnea, hypotension

Increase temp, sunken fontanel andIncrease temp, sunken fontanel andeyeballs, absence of tearseyeballs, absence of tears

Weight loss, scanty urine, dry skinWeight loss, scanty urine, dry skin

Severe dehydration: marked oliguria,Severe dehydration: marked oliguria,prolonged capillary refillprolonged capillary refill


17/52

teret

Mgt:Mgt:

Acute:Acute:

-- NPONPO -- IV therapyIV therapy

-- prone to hypokalemiaprone to hypokalemia

DrugDrug NaHCO3NaHCO3


18/52

teret

Chronic:Chronic:

-- thickened feeding with baby cerealsthickened feeding with baby cereals

-- feed slowly, burp often (every 1feed slowly, burp often (every 1ounce)ounce)


19/52

teret

Hirschprungss Disease

Congenital aganglionic megacolonCongenital aganglionic megacolon

Earliest sign:Earliest sign:

1. failure to pass meconium after 241. failure to pass meconium after 24hourshours

2. abdominal distention2. abdominal distention

3. vomitus of fecal material3. vomitus of fecal material 4. foul smelling breath4. foul smelling breath

Early childhoodEarly childhood ribbonribbon--like stoollike stool


20/52

teret


21/52

teret

Diagnosis

1. Barium enema1. Barium enema reveals narrowedreveals narrowedportion of bowelportion of bowel

2.Rectal biopsy2.Rectal biopsy reveals absence ofreveals absence ofaganglionic cellsaganglionic cells

3. Abdominal X3. Abdominal X--rayray reveals dilatedreveals dilated

loops on intestineloops on intestine 4.Rectal manometry4.Rectal manometry reveals failurereveals failure

of intestine sphincter to relaxof intestine sphincter to relax


22/52

teret

Management

1. NGT feeding1. NGT feeding

2.Surgery2.Surgery

-- Temporary colostomyTemporary colostomy -- anastomosis and pull throughanastomosis and pull through

porcedureporcedure

DietDiet increase protein, increaseincrease protein, increasecalories, decrease residuecalories, decrease residue pastapasta


23/52

teret

Gastroesophageal Reflux Disease

AchalasiaAchalasia

Regurgitation of stomach contents intoRegurgitation of stomach contents into

the esophagusthe esophagus ComplicationComplication esophagitis; aspirationesophagitis; aspiration

pneumoniapneumonia


24/52

teret


25/52

teret

Management

AnticholinergicAnticholinergic

1. Betanicol (Urecholine)1. Betanicol (Urecholine) increaseincrease

esophageal tone and peristaltic activityesophageal tone and peristaltic activity 2. Metachlorpromide (Reglam)2. Metachlorpromide (Reglam)

decrease esophageal pressure bydecrease esophageal pressure by

relaxing pyloric duodenal segmentsrelaxing pyloric duodenal segments

-- increase peristalsis withoutincrease peristalsis withoutstimulating secretionsstimulating secretions


26/52

teret

3. H2 Receptor Antagonist3. H2 Receptor Antagonist decreasedecreasegastric acidity and pepsin secretiongastric acidity and pepsin secretion

-- Ranitidine (Zantac)Ranitidine (Zantac)AntacidAntacid neutralizes gastric acidneutralizes gastric acid

between feedingsbetween feedings

-- MaaloxMaalox SurgerySurgery Nissen funduplicationNissen funduplication


27/52

teret

Esophageal Cancer

Assessment:Assessment:

1.Chronic vomiting1.Chronic vomiting

2.Failure to thrive syndrome2.Failure to thrive syndrome 4. Melena or hematemesis4. Melena or hematemesis


28/52

teret

Diagnosis

1.Esophagoscopy1.Esophagoscopy

2.Esophageal manometry2.Esophageal manometry relvealsrelveals

lower esophageal sphincter pressurelower esophageal sphincter pressure 3. Intra esophageal pH content3. Intra esophageal pH content

reveals pH of distal esophagusreveals pH of distal esophagus


29/52

teret

Pyloric Stenosis

Hypertrophy of muscles of pylorusHypertrophy of muscles of pyloruscausing narrowing and obstructioncausing narrowing and obstruction

Outstanding signOutstanding sign projectile vomitingprojectile vomiting -- vomitingvomiting initial sign of upper GIinitial sign of upper GI

obstructionobstruction

-- vomitus of upper GIvomitus of upper GI blood tingedblood tinged -- vomitus of lower GIvomitus of lower GI bile streaked;bile streaked;

bilousbilous


30/52

teret


31/52

teret

-- abdominal distentionabdominal distention major sign ofmajor sign oflower GI obstructionlower GI obstruction

Metabolic alkalosisMetabolic alkalosis Failure to gain weightFailure to gain weight

Olive shaped massOlive shaped mass


32/52

teret

Diagnosis

Increase Na and K, decrease ClIncrease Na and K, decrease Cl

UltrasoundUltrasound

XX--ray with barium swallowray with barium swallowABGABG


33/52

teret

Management

1. Pyloromyotomy1. Pyloromyotomy incision of pyloricincision of pyloricmusclemuscle

2.Fredt2.Fredt--Ramstedt procedureRamstedt procedure separation of hyperthrophied muscleseparation of hyperthrophied musclewithout incisionwithout incision


34/52

teret

Intussusception

Invagination or telescoping of positionInvagination or telescoping of positionof bowel to anotherof bowel to another

Common site: distal ileum and proximalCommon site: distal ileum and proximalcoloncolon

Prone: eats fastProne: eats fast

ComplicationComplication -- peritonitisperitonitis


35/52

teret


36/52

teret

Sn/Sx:Sn/Sx:

1. persistent paroxysmal abdominal1. persistent paroxysmal abdominal

painpain severesevere FrequencyFrequency 1515--20 minutes20 minutes

2. vomiting2. vomiting contains bilecontains bile

3. currant jelly stool3. currant jelly stool after 12 hoursafter 12 hours 4. sausage4. sausage--shaped massshaped mass


37/52

teret

Management

Hydrostatic reduction with bariumHydrostatic reduction with bariumenemaenema

Pneumatic insufflationPneumatic insufflation airair SurgerySurgery anastomosis and pull throughanastomosis and pull through


38/52

teret

Inborn Errors of Metabolism

Phenylketonuria (PKU)Phenylketonuria (PKU)

Deficiency of liver enzymeDeficiency of liver enzyme

phenylalanine hydroxylasephenylalanine hydroxylase Prevents conversion of phenylalanine toPrevents conversion of phenylalanine to

tyrosinetyrosine

TyrosineTyrosine epinephrine, thyroxine,epinephrine, thyroxine,melaninmelanin


39/52

teret

Signs and Symptoms

1. Urine has musty or mousy odor1. Urine has musty or mousy odor phenylpyruvic acidphenylpyruvic acid

2. Atopic dermatitis2. Atopic dermatitis 3.Seizures3.Seizures

4. Growth retardation4. Growth retardation -- thyroxinethyroxine


40/52

teret

Diagnosis

Guthrie testGuthrie test bacterial inhibitionbacterial inhibition

Pheric chloridePheric chloride green spots in thegreen spots in the

diaper as sign of PKUdiaper as sign of PKU


41/52

teret

Diet

Low phenylalanine dietLow phenylalanine diet contraindicatecontraindicatehigh protein foodshigh protein foods

LofenalacLofenalac extremelyextremely--lowlowphenylalanine formulaphenylalanine formula


42/52

teret


43/52

teret


44/52

teret


45/52

teret

Galactosemia

Carbohydrate metabolism disorderCarbohydrate metabolism disorder

Deficient: galactose 1Deficient: galactose 1--phosphatephosphate

uridyltransferaseuridyltransferase May die at 3 days of ageMay die at 3 days of age

Symptoms:Symptoms:

GalactosemiaGalactosemia GalactosuriaGalactosuria


46/52

teret


47/52

teret

Diagnosis

Beutler testBeutler test screening test; uses cordscreening test; uses cordbloodblood


48/52

teret

Management

DietDiet galactosegalactose--freefree

NutramigenNutramigen milk substitute formulamilk substitute formula


49/52

teret

Celiac Disease

GlutenGluten--induced Enteropathyinduced Enteropathy

Intolerance to:Intolerance to:

BB barleybarley RR ryerye

OO oatoat

WW wheatwheat Inability to absorb fatInability to absorb fat


50/52

teret

Early sign:Early sign:

1. Diarrhea1. Diarrhea

2.Constipation2.Constipation 3. Vomiting3. Vomiting

Late sign:Late sign:

1. Abdominal pain1. Abdominal pain protuberantprotuberantabdomenabdomen

2.Steatorrhea2.Steatorrhea


51/52

teret

Diagnosis

1. history and clinical symptoms1. history and clinical symptoms

2.Serum analysis2.Serum analysis IgA antigliadinIgA antigliadin

antibodiesantibodies


52/52

teret

Management

GlutenGluten--free dietfree diet lifetimelifetime

Rice and cornRice and corn OKOK

Vitamin supplementsVitamin supplements Mineral supplementsMineral supplements

Documents

Pediatric Nursing9(Gastrointestinal Disorder)