GI disorder in children

  1. Structural anomalies: cleft lip and palate
    • def: cleft lip fissures or openning in the upper lip due to failure of maxillary and median nasal processes to fuse normally
    • cleft palate- opening of the palate due to failure of hard palate to fuse at the midline
    • 5-6 weeks when lip fuses
    • incre in girls for palate
    • together it is boys
    • cleft happens 1/;1000 births
    • cause: isolate birth defect, part of chromosomal abnormality, prenatal exposure to teratogens, hereditary, predispostion possibly environmental factors
  2. Cleft lip and palate assessment
    • prenatal u/s
    • inspect the lip and palate for defect
    • inspect abdomen for distension from swallowed air bc you take in more air
    • monitor feeding for difficulty, swallowing or latching on difficulties
    • assess for other congenital anomalies
    • make sure good latch, look for other problems
  3. cleft lip and palate thera management and nx dx
    • Thera management:
    • surgical repair in utero or after birth
    • cheloplasty of cleft lip surgery unites the lip and gum edges 2-3 months of age
    • palate 9-18 months to prepare
    • good prognosis
    • Nx Dx:
    • risk for imbalance nutrition
    • risk for ineffective airway
    • impaired tissue integrity
    • risk for infection
    • pain
    • family bonding
  4. Cleft lip and palate interventions
    • offer pacifer
    • haberman feeder (dev by a mom) or other commercial feeding apparatus (large soft nipple with large holes)
    • feed in an upright position
    • encourage breast milk by pumping or manuel expression
    • pre-op: pacifer
    • post op not
    • burp well after meals
    • encourage bonding
    • offer small sips fluid between feedings (keep mouth moist)
    • breast fed after surgery
    • side lying position
    • assess Respiration distress
    • swelling
    • asses suture lineĀ  or logan bar (wire bow tie tape to cheeks) or band aide after feeding
    • pain meds
    • clean suture line w/sterile water, NS or 50% hydrogen peroxide as ordered by surgeon
    • offer parental support to promote bonding. refer to genetic counseling
  5. Cleft lip palate complication
    • speech difficulties
    • failure to thrive due to inadequate PO intake/feeding difficulty
    • dentition problems- teeth
    • nasal defects
    • ear infections and hearing loss (bc of eustation tube)
    • appearance
    • incr risk for aspiration/URI
    • risk for dec parent child bonding
  6. Tracheoesophageal fistula and atresia
    • def: serious congenital of neonate, incre incidence or prematurity, polyhydraminos in mom
    • transesophaheal fistula: abnormal connection of the trachea and the esophaus
    • esophageal atresia: esophagus closed off at some point and food can't go into stomach
    • cause: failure of the embryonic esophagus and trachea ti develop and separate correctly
    • medical emergency could cause aspiration
    • 1:4000 births
  7. Tracheoesophageal fistula and atresia
    surgical emergency
    • assessment: frothy saliva, drooling, increased amt of choking coughy observed. feedings coming out of nose and mouth, apnea, cyanosis
    • three C choking, coughing, cyanosis
    • surgical emerg: correct to prevent aspiration
    • dx: bronchscopy, chest x-ray, radiopaque cather to see how far it goes
    • complicatin: stictures-tightness/blockage, leakage at surgical site, feeding problems, tracheomalacia (weak tracheal walls)
  8. TEFA
    different types
    • Atresia: goes down esophagus but blocked and it comes back up. anything from the stomach comes up too
    • atresia w/out fistula: ends up in a blind pouch not connected
    • both upper and lower communicate w/trachea: stomach contents and food like acid can go into trachea
    • atresia and fistula into trachea- didn't connect stomach not receiving food
    • trachea connects to lower and upper segment of goes into trachea rare
  9. TEFA therapeutic management
    • preop: prevent dehydration w/IVF OR TPN
    • emerge to prevent aspiration
    • post op: monitor chest tube, monitor for respiratory distress, suction shallowly PRN to prevent disruption of suture line in esophagus
    • turn frequently to prevent secretion from pooling in lungs
  10. TEFA management
    • humidy O2
    • keep larygoscope and endotracheal tube at bedside
    • observe for surgical complication in 7-10 days when suture dissolve, may leak fluid and air in chest cavity and could results in pneumothorax
  11. Gastroesophageal reflux (GER)
    • return of gastric or duodenal contents into the esophagus from incompetent or poorly developed esophageal spinchter
    • cause: premature, long term NG intubation, hiatal hernia w/incompetent sphincter
    • path: lower esopheal sphincter preverts gastic contents from backing up into the esophagus
    • - norm: LES creates pressure and closing of the lower end of esophagus but relaxes after each swallow to allow food to get into stomach
    • - problem: occurs when LES pressure is decient or when pressure in the stomach exceeds LES pressure
  12. GEr complication, assessment
    • complication: nocturnal wheeze, bronchitis, asthma, FTT, aspiration pnuemonia, esophagitis
    • assessment: vomiting after feed, fussy, appears hungry, esophagitis- blood in vomit or stool, weight loss, FTT aspiration of feeds, recurrent pneumonia, life threaten apnea
  13. GER dx, medical manage, nx intervention
    • dx: ph probe study, endoscopy, biopsy
    • medical manage: conservative, usually self limiting positional therapy
    • - meds: H2 blocker (famotodine, rantidine, PPI (omeprazole or prilosec) both used to decre acid production
    • - surgery- to tighten sphincter if necessary
    • Nursing intervention: provide reassurance
    • - educate about causes and how to prevent
    • - small/frequent food, use nipple that controls flow well, burp frequently, keep upright for 30mins, eleva HOB to 30
    • - ** thicken formula with rice cereal: 1 tsp-1TSB cereal to 1oz of formula or breast milk. enlarge nipple hole
    • prep for surgery
  14. pyloric stenosis
    • def: increased size and mass of circular muscle at the pylorus which narrows the pyloric canal= gastric outlet obstruction
    • common in males 1-6 months
    • cause: unknown, not inherited, possible association with malrotation,esophageal atresia, anorectal abnormalities'
    • path: narrowing of the passageway between the stomach and duodenum. swelling and inflammation can cause obstruction which prevent your stomach from emptying
    • complication: nutrition, dehydration
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GI disorder in children