Nursing Care of the child with a GI disorder

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  1. variations in Ped A&P
    • Gi not fully mature until 2
    • mouth: highly vascular organ, incre risk of infection (handwashing)
    • esophagus: edema or narrowing, decre tone, lax/les regurgitation
    • Stomach: NB capacity 10-20ml, adolescent 1,500ml 12m 200-250ml. Narrow pyloric sphincter= stenosis
    • Intestines: not functionally mature at birth
    • billary system: liver large= 5% infant body weight. Pancreatic enzymes at adult levels by 2 yrs.
  2. Variation in Pediatric A&P
    fluid balance, insensible fluid loss
    • fluid balance and fluid loss:
    • Body fluid balance (infants and children)
    • - body water incre compared to adults
    • - required incre fluid intake
    • - at increase risk for fluid loos with illness (fever, loss thru vapor and skin)
    • Insensible fluid loss (losing water everywhere) (infant and children)
    • - fever: severe fluid loss
    • - skin: larger body surface area
    • - basal metabolic rate: increased to support growth which incr need for water. kidneys immature (comes out more faster)
    • 7ml/kg loss of water w/fever 1.8 degree above normal for 24hrs
  3. Nursing assessment
    collect hx
    Physical exam
    • chief concerns- v/n/d constipation, abd pain, distention, decre weight, lethargy, paleness
    • pregnancy hx- hydraminos- oligiohydraminos
    • PMH hx of V/D. abd pain
    • Fhx family member with a similar disorder
    • stress at school and home
    • how many times in the last 24 hrs for vomiting and diarrehea
  4. Common medical treatment
    • cleansing enema- children with encoprisis (holding on to stool)
    • bowel prep- surgery, c-scope, cleanse colon
    • IV therapy- fluid to help with dehydration
    • Ostomy- diversion of bowel to be outside
    • oral rehydration therapy
    • probiotics- give back normal flora
    • total parenteral nutrition- IV complete nutrition. special formula that goes thru the vessels
  5. Common medical treatments: ostomy
    • stool diversion: ileostomy or colostomy
    • - portion of the small or large intestine to abdominal surface=stoma
    • Ostomy care: pg 1339 ricci stoma
    • - set up equipment
    • - warm wash cloths or paper towels
    • - clean pouch and clamp
    • - skin barrier: power paste sealant
    • - pencil or pen
    • - scissors
    • - pattern to measure stoma size
    • - take of pouch, adhesive remover
    • - observe the stoma and skin. clean stoma and skin as needed. allow to dry throughly
    • - measure stoma, mark the new pouch backing and cut new backing to size
    • apply pouch
  6. commons nursing dx
    • imbalance nutrition, less body requirement- celiac disease malabsorption
    • pain- acute, surgery
    • risk for infection
    • fluid volume excess
    • fluid volume deficient
    • constipation
  7. Dehydration extra Kim
    • vomiting: hold PO feed for 1-2hr after vomiting. give 0.5-2oz q 15. advance as tolerated (50-100 ml/kg)
    • home ORT (pedialyte):
    • - oral rehydration therapy
    • - mild to moderate dehydration
    • - 1 quart of water
    • - 8 tsp of sugar
    • - 1 tsp of salt
    • Nausea: ginger ale. the real ginger canada dry
  8. Dehydration
    • occurs when water loss exceeds water intake over a period of time and the body is in a negative fluid balance
    • dehydration is a common sequel of prolonged bouts of diarrhea or vomiting, profused sweating, water deprivation, hemorrhage, burns
    • early signs: sticky oral mucous, thrist, dry, flushed skin, decre urine output (oliguria)
    • hypovolemic shock: occurs due to incr water lost from the ECF compartment, once lost there is not enough blood volume to maintain normal circulation
    • - if left uncheck
  9. Types of dehydration
    p 1345
    • mild dehydration: alert, fontanels soft and flat, eye normal pink moist mucous membrane, normal HR and BP, elastic turgor, brisk cap refill, slight decr urine output
    • Moderate dehydration: alert to listless (lethargic), sunken fontanels, pale, slightly dry mucous membrane, decre turgor, HR incre, bp normal, delayed cap refill, urine output decre
    • Severe dehydration: alert to comatose, sunken fontanels, deeply sunken eye, dry oral mucosa and tenting, HR incre to bradycardia, BP normal to hypotension, cool mottle skin, delayed cap refill, urine decre to < 1ml/kg/hr
    • normal urine 1ml/kg/hr for children (up to 6-8)
    • adults 30 ml/hr
  10. Nursing management dehydration
    • Goal is to restore fluid volume and prevent hypovolemia
    • provide oral rehydration therapy
    • mild to moderate dehydration
    • - give 50-100 ml/kg of ors over 4 hrs
    • severe dehydration:
    • - IV fluids, Initially 20ml/kg of NS or LR bolus
    • ex: child weigh 20kg you would give 400ml
    • - once balance restored we use a maintenance rate
    • -- 100ml/kg for the first 10 kg
    • -- 50ml/kg for the next 10kg
    • -- 20ml/kg for remaining kg
    • ex: child weighs 12kg how much 1040ml (remember 2kg remaining so use the 20 to calculate then divide by 24 hrs) 43.3ml/hr
    • ex
  11. Vomiting
    • def: also called emesis, forceful emptying of the stomach contents thru the mouth
    • cause: mild gastroenteritis (infection) either viral and bacteria (e.coli, shigella), head injury, pnemonia
    • pathophysiology: areas in the medulla control vomiting reflex, chemoreceptors in the 4th ventricle stimulate vomiting. maybe a learned behavior in response to stress, wet burp, spitting up fyi
    • complications: metabolic alkalnosis, stomach acid loss, dehydration malnutrition, apiration, mallory weiss syndrome (tear in the mucosa¬† in lower esophagus)
    • billous bc of bile obstruction yellow/green color (not normal)
    • bloody vomiting not good
  12. vomiting assessment, dx
    • assessment:
    • non or projectile vomiting
    • asso symptoms- fever, nausea, HA, abd pain, constipation or diarrhea, blood in vomit, bile, undigested or digested food, determine amt and force of vomit
    • dx:
    • UA for blood or protein
    • basic metabolic panel for lytes
    • abd x-ray or u/s for abd abnormalities
    • endoscopy]CBC
  13. Vomiting management and intervention
    • Medical management goal: prevent further episode:
    • zofran (not for babies) ondansetron antiemetic
    • drugs to stimulate upper GI peristalsis metoclopromide (reglan), Phergan (promethezine)
    • Nursing intervention:
    • evaluate feeding methods, position side lying, maintain patent airway, suction as needed, hold foods/fluids to rest stomach for 4-6 hr
    • for severe vomiting : IVF, PO clear liquids (pedialyte, popsicle)
    • for older children: antiemetic, hemoccult emesis, describe type and amount, HOB up, skin and mouth care, monitor hydration, monitor bowel sounds
  14. diarrhea and gastroenteritis
    • def: diarrhea: increase frequency, amount, and decr consistency of stool
    • def: gastro: inflammation of the lining of the stomach and intestines. classified as mild to severe
    • Causes:
    • - virus (rotavirus and adenovirus, norovirus)
    • - bacteria (c. diff, staph, samanella, shigella, e.coli)
    • - other: amoebea, parasites, ingestion of toxins, drug reactions, enzymes deficiencies, food allergens
  15. Diarrhea and Gastroen (path, complication, assessments, dx)
    • Path:
    • virus cause injury to the intestinal mucosa. water in bowel incr from the osomotic pull w/electrolytes imbalance. peristalsis incre
    • complication: metabolic acidosis, dehydration (serious in infants bc they need water)
    • assessment finding: loose, watery stools, abd discomfort, nausea, vomiting, fever
    • dx: stool culture and sentivity, blood cultures (identify causative pathogen)
  16. diarrhea/gastro management/intervention
    • medical management: bedrest, nutritional support, incre fluid intake PO or IVF, electrolyte replacement
    • Nursing intervention:
    • depends on severity
    • mild diarrhea care for child at hoe. hold foods and fluid to rest abdomen for a short time 1 hr. then offer ORS ie pedialyte in small amounts. avoid high sodium food
    • correct dehydration
    • begin fluid with ORT
    • skin care with protective ointments
    • monitor i&o and v/s axillary temp
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Nursing Care of the child with a GI disorder
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