GI Disorders Final

Assessment:
GI disorders among

children can lead to
dehydration especially if
vomiting & diarrhea are the
presenting symptoms
Assess for poor skin turgor,
dry mucous membranes &
lack of tearing
Alert: All children with
diarrhea must be seen by a
health care provider
because of rapid change in
fluids & electrolyte levels
Greater percentage of
fluid held extracellularly
rather than intracellularly
Vomiting
forcible ejection of stomach

contents through the mouth
Etiology:
Infections
Obstructions
Motion sickness
Metabolic alterations
Psychological alterations
Allergic reactions
Side effects of medications
(chemotherapy)
Toxic effects of medications
Eating disorders
Manifestations:
Sour milk curds without

green or brown color
Undigested food (stomach)
Diagnostic Evaluation:
CBC
Electrolyte studies
Blood Urea Nitrogen (BUN)
Glucose levels
Urine tests
Radiographic studies
Blood cultures
Arterial blood gas analysis
Assessment:
Major concern:
Dehydration
Fluid & electrolyte
imbalance
Accurate monitoring of
intake & output
Assess weight
Fontanels in infants
Skin turgor
Eyes/skin
Heart/respiratory rates
Determine/describe type &
force of vomiting
(regurgitation, projectile
vomiting)
Assess amount, color,
consistency, time (ACCT)
Nursing diagnoses:
Fluid volume deficit

Imbalanced Nutrition: Less
than Body Requirements
Interventions:
Position child upright or

side lying
Educate family regarding
appropriate feeding
techniques (eg. Burping)
Educate family (avoiding
certain foods) fatty foods
Minimize stimuli ( stress,
anxiety)
Avoid unfavorable smelling
food
Therapeutic Management:
Oral Rehydration
Treatment (ORT)
IV therapy (prolonged
vomiting neonates/infants)
Anti-emetics
Dehydration
Fluid loss in excess of fluid

intake
Can cause fluid &
electrolyte deficiencies
Classification:
Isonatremic dehydration –
most common type of
dehydration in children
Water & electrolytes are lost
the same proportion they
exist in the body
Normal serum Na level
(135-145 mEq./L)
Hyponatremic dehydration –
electrolyte loss greater than
water loss
Serum Na less than 130
mEq./L
Hypernatremic dehydration
– water loss is greater than
the electrolyte loss
Serum Na concentration
above 150 mEq./L
Etiology:
GI tract- vomiting,

diarrhea, malabsorption
Endocrine system: - fever,
DM,
Skin – burns
Lungs – tachypnea
Kidneys - Renal failure
Heart - CHF
Neonates/infants –
vulnerable to the effects of
dehydration
Mild dehydration – 4-5%
loss of body weight; fluid
volume loss less than
50ml/kg
Moderate dehydration – 6-
10% loss of body weight;
fluid volume loss 50-100
ml/kg.
Severe dehydration – 10%
or more loss of body weight;
fluid volume loss of 100
ml/kg or more
Signs & symptoms of Dehydration:
Fewer wet diapers (6-8

hours)
No tears when crying (if
older than 2-4 months)
Sticky/dry mouth
Irritability/high pitched
cry
Difficulty in awakening
Increased RR/DOB
Sunken fontanels/sunken
eyes with dark circles
Abnormal skin color,
temperature or dryness
Signs of impending shock:
Changes in heart rate
Changes in sensorium
Urine output
Skin qualities
Fontanels (infants)
Pathophysiology:
Reduced fluid intake

Increased fluid loss
Vomiting, diarrhea,
fever,
hyperventilation/burns
Trauma, hemorrhage,
DM
Rapid ECF loss
Electrolyte
imbalance
ICF Loss
Cellular
dysfunction
Hypovolemi
c shock
Death
Management:
Directed toward correcting

the fluid & electrolyte
imbalance & then treating
the causative factors
Oral rehydration therapy
(Rehydralyte, Pedialyte,
Infalyte)
Rehydralyte (WHO’s solution)
– best source of oral
rehydration
Children (mild to moderate
dehydration)
50-100 ml/kg of ORT over
4 hours
Parenteral fluid &
electrolyte therapy
Lactated Ringer’s
solution/0.9% NaCl
Assessment Parameters:
Intake & output

Urine output & Specific
gravity
Output < 2-3 ml./kg./hr –
infants & toddlers
1-2 ml/kg/hr – preschoolers &
young school- age children
0.5 ml./kg/hr in school-age
children or adolescents
Specific gravity above 1.020
Weight crucial indicator of
fluid status
Stools/vomitus
Sweating
Skin, Mucous membranes &
presence of tears
Anterior fontanel
Vital signs/behavior
Nursing diagnosis
Fluid volume deficit

Diarrhea
One of the most common

disorders in childhood
Increased in the frequency,
fluidity & volume of stools
Gastroenteritis – diarrhea
caused by infection
Acute diarrhea can lead to
dehydration, electrolyte
imbalance & hypovolemic
shock
Most common viral pathogens -
rotavirus & adenovirus
Bacterial pathogens include –
Campylobacter jejuni, Salmonella,
Giardia lamblia & Clostridium difficile
Mild Diarrhea
Fever, anorectic, irritable
& appear unwell
2-10 loose, watery stools
per day
Dry mucous membranes,
rapid pulse, warm skin
Normal skin turgor,
normal urine output
Management:
Rest the GI tract; 1 hour
after offer OHT
Ask parents to wash hands
after changing diapers
Continue breastfeeding
Notify healthcare provider
if condition worsens
Severe diarrhea
Rectal temperature is high
(103-104⁰) F
Pulse/RR weak & rapid
Skin pale/cool
Depressed fontanelle, sunken
eyes, poor skin turgor
Bowel movement every few
minutes
Liquid green stool, mixed with
mucus & blood
Urine output is scanty &
concentrated
Elevated hemoglobin,
hematocrit & serum protein
levels
Treatment:
Focus is centered in regulating
electrolyte & fluid balance
Oral or IV rehydration therapy
Rest the GI tract
Identifying the responsible
organism
All children with severe
diarrhea must have a stool
culture taken
IV fluids – NSS or 5%
glucose in NS
Nursing diagnosis:
Fluid volume deficit
Gastrointestinal Disorders
III. Cleft Lip & Cleft Palate

Failure of soft tissue or bony
structure to fuse during embryonic
development
Abnormal openings in the lip or
palate that may occur unilaterally or
bilaterally
Causes include genetic, environmental
factors; exposure to radiation or rubella
virus; chromosome abnormalities; &
teratogenic factors
Closure of cleft lip defect precedes that
of the palate & is formed usually during
the first wks of life
Cleft lip
o failure of median & maxillary nasal
process to fuse by 5 - 8 weeks of
pregnancy
common to boys
unilateral
Cleft Palate
Failure of the palatine shelves to fuse
by 9 – 12 weeks of pregnancy
 common to girls
 unilateral or bilateral

Cleft palate repair is performed
sometime between 12 to 18 months of
age ; a cleft palate is closed before the
child develops faulty speech habits
Implementation
Assess fluid & calorie intake daily &
monitor weight
Modify feeding techniques; plan to
use specialized feeding techniques,
obturators, & special nipples &
feeders
Hold the child in an upright position &
direct the formula to the side & back of
the mouth to prevent aspiration; feed
small amounts gradually (every 3-5
minutes) & burp frequently (2x in the
middle & at the end of feeding)
Implementation
Position on side after feeding
Keep suction equipment & bulb
syringe at bedside
Encourage breastfeeding if
appropriate
Teach the parents special feeding or
suctioning techniques
Teach the parents the ESSR (enlarge,
stimulate sucking, swallow, rest)
method of feeding
Implementation
Teach the parents the ESSR
(enlarge, stimulate sucking, swallow,
rest) method of feeding
Encourage the parents to describe
their feelings related to the
deformity
Implementation
Postoperatively
Cleft lip repair
A lip protector device may be taped
securely to the cheeks
Position the child on the side or on the
back; avoid the prone position to
prevent rubbing of the surgical site on
the mattress
Implementation Postoperatively
Cleft lip repair
 After feeding, cleanse the suture line
of formula or serosanguinous
drainage
w/ a cotton-tipped swab dipped in
saline; apply antibiotic ointment if
prescribed
Implementation
Postoperatively
Cleft palate repair
Childis allowed to lie on the
abdomen
Feedings are resumed by bottle,
breast, or cup
Oral packing may be secured to the
palate (removed in 2 to 3 days)
Cleft palate repair
 Do not allow the child to brush his or
her teeth
Avoid offering hard food items to the
child, such as toast or cookies
Implementation
Postoperatively
Soft elbow or jacket restraints may
be used; remove restraints at least
every 2 hours to assess skin integrity
& allow for exercising the arms
Avoid the use of oral suction or
placing objects in the mouth such as
tongue depressor thermometer,
straws, spoons, forks, or pacifiers
Monitor for signs of infection at the
surgical site, such as redness, swelling, or
drainage
Initiate appropriate referrals for speech
impairment or language-based learning
difficulties
IV. Esophageal Atresia &

Tracheoesophageal Fistula
The esophagus terminates before it
reaches the stomach &/or a fistula is
present that forms an unnatural
connection w/ the trachea
An obstruction of the esophagus
A fistula occurs between the closed
esophagus & trachea
Five usual types of esophageal atresia:
Esophagus ends in a blind pouch-TEF
between the distal part of the
esophagus & trachea
Esophagus ends in a blind pouch-there
is no connection in the trachea
Fistula present between a normal
esophagus & trachea
Esophagus ends in a blind pouch-
fistula connects the blind pouch of the
proximal esophagus to the trachea
Blind end portion of the esophagus-
fistulas present between both widely
spaced segments of the trachea &
esophagus
A fistula can allow milk to enter the
trachea causing an aspiration
Must be ruled out in any infant born to
a woman with hydramnios
Diagnosis:
Barium swallow
Bronchial endoscopy exam
Treatment: Surgery-closing the fistula &

& anastomosing the esophageal
segments
Causes oral intake to enter the
lungs or a large amount of air to
enter the stomach
IV. Esophageal Atresia &

Tracheoesophageal Fistula
Aspiration pneumonia & severe
respiratory distress will develop, &
death will occur w/out surgical
intervention
Assessment
Frothy saliva in the mouth & nose, &
drooling
Coughing & choking during feedings
Unexplained cyanosis
Regurgitation & vomiting
Abdominal distention
Inability to pass a small-gauge (no. 5
French) orogastric feeding tube via
the mouth into the stomach
Implementation
 Suction accumulated secretions from the
mouth & pharynx
 A double-lumen catheter is placed into the
upper esophageal pouch & attached to
intermittent or continuous low suction to
keep the pouch empty secretions
 Maintain in an upright position to
facilitate drainage
Implementation
A gastrostomy tube may be placed
& is left open so that air entering the
stomach through the fistula can
escape, minimizing the danger of
regurgitation
Implementation
postoperatively
Monitor respiratory status
Inspect surgical site
Provide care to the chest tube if in

place
Assess for signs of pain
Monitor for anastomotic leaks as
evidenced by purulent chest drainage,
increased temperature, & an increased
white blood cell count
Implementation
postoperatively
Ifa gastrostomy tube is present, it is
attached to gravity drainage until the
infant can tolerate feedings (usually
the 5th to 7th day postoperatively)
Before oral feedings & removal of the
chest tube, a barium swallow is
performed
Implementation
postoperatively
Prior to feeding, the gastrostomy
tube is elevated to allow gastric
secretions to pass to the duodenum
& swallowed air to escape through
the open gastrostomy tube
The gastrostomy tube may be removed
prior to discharge or may be
maintained for supplemental feedings
at home
Implementation
postoperatively
Assess cervical esophagostomy site
for redness, breakdown, or exudate;
remove drainage frequently & apply
a protective ointment
If the infant is awaiting esophageal
replacement, nonnutritive sucking is
provided by a pacifier; may have
difficulty eating by mouth after surgery
& develop oral hypersensitivity & food
aversion
Implementation
postoperatively
Instruct parents to identify
behaviors that indicate the need of
suctioning, signs of respiratory
distress, & signs of a constricted
esophagus (poor feeding, dysphagia,
drooling, or regurgitated undigested
food)
V. Gastroesophageal Reflux
Disease (GERD)
Backflow of gastric contents into the
esophagus as a result of relaxation or
incompetence of the lower esophageal
or cardiac sphincter
Complications include esophagitis,
esophageal strictures, aspiration of
gastric contents, & aspiration
pneumonia
V. Gastroesophageal Reflux (GER)
Assessment
Passiveregurgitation or emesis
Hematemesis & melena
Heartburn (in older children)
Anemia from blood loss

Implementation
Assess amount & characteristics of
emesis
Assess the relation of vomiting to the
times of feedings & infant activity
Monitor breath sounds before & after
feedings
Place suction equipment at the
bedside
Positioning
Place in either the flat prone position
or the head-elevated prone position
following feedings & at night
Diet
Provide small frequent feedings
For infants, thicken formula by
adding 1 tablespoon of rice cereal per
6 ounces of formula & crosscut the
nipple
Breastfeeding may continue, & the
mother may provide more frequent
feeding times or express milk for
thickening w/ rice cereal
Diet
Burp the infant frequently when
feeding & handle the infant
minimally after feedings
For toddlers, feed solids first,
followed by liquids
Avoid feeding the child fatty foods,
chocolate, tomato products
carbonated liquids, fruit juices, citrus
products, & spicy foods
Avoid vigorous play after feeding &
avoid feeding just before bedtime
Medications
Antacids & histamine receptor
antagonists as prescribed
Surgery
Ifsurgery is prescribed, it will
require a procedure known as
fundoplication
A gastrostomy may be performed at
the same time as the fundoplication
Fundoplication may be combined w/
pyloroplasty in children w/ GER who
also have delayed gastric emptying
Surgery
 fundoplication
X. Hirschsprung’s Disease
A congenital anomaly also known as
congenital aganglionosis or megacolon
Congenital Aganglionic Megacolon
Absence of ganglion cells in the rectum
& upward in the colon
Results in mechanical obstruction
May be associated w/ other anomalies,
such as Downs syndrome & genital
urinary diarrhea
A rectal biopsy demonstrates histologic
evidence
The most serious complication is
enterocolitis; signs include fever, GI
bleeding & explosive watery diarrhea
Initially, in the neonatal period, the
obstruction is relieved by a temporary
colostomy to relieve obstruction &
allow the normally innervated, dilated
bowel to return to its normal size
A complete surgical repair is
performed, when the child weighs
approximately 9 kg (20 lbs), via a pull-
through procedure
Assessment
1. Newborn infants
Failure to pass meconium stool
Refusal to suck
Bile-stained vomitus
Assessment
2. Children
 Abdominal distention
 Vomiting
 Constipation alternating w/ diarrhea

 Ribbon-like & foul-smelling stools
Implementation: Medical
management
Dietary management
Daily rectal irrigations w/ normal
saline to promote adequate
elimination
Surgical management:
preoperative implementation
MaintainNPO status
Measure abdominal girth
Avoid rectal temperatures
Monitor for respiratory distress
associated w/ abdominal distention
Implementation
postoperatively
Monitor vital signs, avoiding rectal
temperatures
Assess surgical site for redness,
swelling, & drainage
Assess the stoma for bleeding or skin
breakdown
Maintain the NG tube to allow
intermittent suction until peristalsis
returns
Implementation postoperatively
Maintain the IV until the child tolerates
appropriate oral intake; begin the diet w/ clear
liquids, advancing to regular as tolerated & as
prescribed
Provide the parents w/ instructions
regarding colostomy care & skin care
XI. Intussusception
Telescoping of one portion of the
bowel into another portion
Results in an obstruction
XI. Intussusception
Assessment
Colicky abdominal pain that causes
the child to scream & draw the knees
to the abdomen
Currant jelly-like stools containing
blood & mucus
Tender distended abdomen, possibly
w/ a palpable sausage-shaped mass in
the upper right quadrant
Implementation
Monitor for signs of perforation &
shock as evidenced by fever, increased
heart rate
Prepare for hydrostatic reduction if
prescribed (not performed if signs of
perforation of shock occur
Monitor for the passage of normal
brown stool, w/c indicates that the
intussusception has reduced itself
Implementation
Afterhydrostatic reduction
Monitor for the return of normal
bowel sounds, for the passage of
barium, & the characteristics of stool
XIII. Umbilical hernia, Inguinal hernia, or

Hydrocele
A hernia is a protrusion of the bowel through
an abnormal opening in the abdominal wall
In children, a hernia most commonly occurs
at the umbilicus & through the inguinal canal
Omphalocele – protrusion of abdominal contents
through the abdominal wall at the point of the
junction of the umbilical cord & abdomen
Incidence: 1 in 5000 live births
Diagnosis:
Prenatally through a sonogram
Inspection after birth
Management:
Immediate surgery to replace the bowel back
If large apply silver sulfadiazine to prevent infection;
followed by delay surgical exposure
XIII. Umbilical hernia, Inguinal hernia, or Hydrocele
XIII. Umbilical hernia, Inguinal

hernia, or Hydrocele
A hydrocele is the presence of
abdominal fluid in the scrotal sac
Diagnosis:
Prenatal sonogram
At birth, scrotum of newborn appears enlarged
If uncomplicated, fluid will be gradually reabsorbed
in the body; no treatment necessary
Assessment
1.Umbilical hernia
Soft swelling or protrusion around
the umbilicus that is usually
reducible w/ the finger
2.Inguinal hernia
Painless inguinal swelling that is
reducible
Swelling may disappear during
periods of rest
Assessment
3.Incarcerated hernia
When the descended portion of
bowel becomes tightly caught in the
hernial sac compromising blood
supply
Irritability
Tenderness at site
May lead to complete intestinal

obstruction & gangrene
XVIII. Ingestion of poisons

A. Lead Poisoning
Causes
The pathway for exposure may be
food, air, or water
Dust & soil contaminated w/ lead
Poisoning occurs commonly in 2-3
years old age group; all
socioeconomic groups
Poisoning can occur from:
OTC drugs (vitamins, aspirin, iron compounds or
prescription drugs; antidepressants)
The most common route is ingestion
either from hand to mouth behavior
from contaminated objects or from
eating loose paint chips
It affects the erythrocytes, bones, &
teeth, & organs & tissues, including
the brain & nervous system
Universal screening
Recommended in high-risk areas at
the age of 1 to 2 yrs
Any child between the ages 3 & 6 yrs
who has not been screened
Common in toddlers. (falls- common
to infant)
Blood lead level (BLL) test

BLL less than 10 ug/dl: Reassess or
rescreen in 1 year
BLL 10 to 14 ug/dl.: Provide family
lead education, follow-up testing, &
social service referral
BLL 15 to 19 ug/dL or greater: Provide
family lead education, follow-up
testing, & social service referral
Blood lead level (BLL) test
BLL 70 ug/dL or greater: medical
treatment is immediately provided
BLL 20 to 44 ug/dL: A BLL greater
than 20 ug/dL is considered acute;
clinical management, including
treatment, environmental
investigation, & lead-hazard control
Principles:
Determine substance taken, assess LOC
Unless poison is corrosive, caustic
(strong alkali such as LYE) or a
hydrocarbon, vomiting is the most
effective way to remove poison.
Give syrup of Ipecac to induce
vomiting
Ipecac – oral emetic
Dose:
* 15 ml – adolescent, school age & pre
school
* 10 ml to infant
Vomiting will occur within 20 minutes after giving
Ipecac
If vomiting did not occur within 20-30 minutes;
another dose maybe given
UNIVERSAL ANTIDOTE- activated
charcoal either (orally or via
NGT),stools appear black, milk of
magnesia & burned toast
Never administer charcoal before
ipecac
For caustic poisoning ( muriatic acid )
neutralize acid by giving vinegar .
Don’t vomit instead prepare
tracheostomy set
Gas - mineral oil will coat intestine
Gastrointestinal
Disorders
XVIII. Ingestion of poisons

B. Acetaminophen (Tylenol)
Description
- Seriousness of ingestion is
determined by the amount ingested
& the length of time before
intervention
- Toxic dose is 150 mg/kg or greater
in children
Assessment
GI effects: nausea, vomiting & thirst
from dehydration
CNS effects: hyperpnea, confusion,
tinnitus, convulsions, coma
Hematopoietic effects: bleeding
tendencies
Implementation
Induce vomiting w/ syrup of ipecac or
perform gastric lavage
Administer activated charcoal to
decrease absorption of salicylate
Antidote for Acetaminophen poisoning
– Acetylcystine ( Mucomyst)
Kwashiorkor
Diseased caused by CHON
insufficiency
Occurs in children 1-3 years old
Growth failure – major symptom
Edema
Muscle wasting
Irritable & disinterested in
environment
Lag in motor development compared
to other children at same age group
Zebra sign – hair shafts develop a
striped appearance
Diarrhea
Anemia
Hepatomegaly
Treatment: Diet high in CHON
Fatal if not treated
Even if corrected children fail to reach their
full potential (cognitive,psychological)
Marasmus
Deficiency of all food groups
Children affected –younger than 1 year
old
Symptoms:
Growth failure
Muscle wasting
Irritability
Iron-deficiency anemia
diarrhea
Starving – will suck on anything
offered to them
Treatment:
Supply with diet rich in all nutrients

GI Disorders Final

Caricato da

Informazioni sul documento

Descrizione originale:

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

GI Disorders Final

Caricato da

Copyright:

Formati disponibili

Assessment:

GI disorders among

forcible ejection of stomach

Sour milk curds without

Fluid volume deficit

Position child upright or

Fluid loss in excess of fluid

GI tract- vomiting,

Fewer wet diapers (6-8

Reduced fluid intake

Directed toward correcting

Intake & output

Fluid volume deficit

One of the most common

III. Cleft Lip & Cleft Palate

III. Cleft Lip & Cleft Palate

IV. Esophageal Atresia &

Treatment: Surgery-closing the fistula &

IV. Esophageal Atresia &

Provide care to the chest tube if in

Heartburn (in older children)

Anemia from blood loss

 Constipation alternating w/ diarrhea

XIII. Umbilical hernia, Inguinal hernia, or

XIII. Umbilical hernia, Inguinal

May lead to complete intestinal

XVIII. Ingestion of poisons

Blood lead level (BLL) test

XVIII. Ingestion of poisons

Potrebbero piacerti anche