What is celiac disease?
Known also as gluten enteropathy or celiac sprue.
Intolerance to gluten.
Results in the accumulation of the amino acid glutamine, which is toxic to intestinal mucosal cells.
What is gluten?
the protein component of wheat, barley, rye, and oats.
Assessment for celiac disease?
acute or insidious diarrhea
abdominal pain and distention
muscle wasting particularly in the buttocks and extremities
What is celiac crisis?
precipitated by infection, fasting, or ingestion of gluten.
causes profuse watery diarrhea and vomiting
can lead to electrolyte imbalance, rapid dehydration, and severe acidosis.
Interventions for Celiac Disease?
Maintain a glueten free diet.
(Substituting corn, rice, and millet as grain sources.
instruct the parents and child about life long elimination of gluten sources such as wheat, rye, oats, and barley.
administer mineral and vitamin supplements
teach the child and parents about gluten free diet and about reading food labels carefully for hidden sources of gluten.
instruct the parents in measures to prevent celiac crisis.
inform the parents about the celiac spruse association.
what sources of food have gluten in them?
What are good suplements for gluten foods?
What does strict dietary avoidance of gluten minimize the risk for?
developing malignant lymphoma of the small intestine and other gastrointestinal malignancies.
How long does it take to develop symptoms of Celiac disease?
It usually takes 3-6 months between the introduction of gluten in the diet and the onset of the symptoms.
When is celiac disease usually diagnosed?
What is Hirschsprung's disease?
What results from Hirschspring's disease?
mechanical obstruction results because of the inadequate motility in an intestinal segment.
What causes Hirschsprung's disease?
may be a familial congenital defect or may be associated with other anomalies, such as down syndrome and genitourinary abnormalities.
aHow do you diagnose Hirschisprung's disease?
What is the most serious complication of Hirschsprung's disease?
what are the entercolitis sings and symptoms?
treatment for mild to moderate disease:
based on relieving the chronic constipation with stool softeners and rectal irrigations.
*many children require surgery.
*Treatment for moderate to severe disease:
Assessment of newborn infants:
Assessment of children:
failure to gain weight and delayed growth
constipation alternating with diarrhea
ribbon like and foul smelling stools
Interventions: medical management:
Surgical management: Preoperative interventions:
Surgical management: post Op interventions:
monitor vitals, avoiding rectal temp
measure abdominal girth daily and prn.
assess the surgical site for reddness, swelling, and drainage
assess th stoma if present for bleeding or skin breakdown.
(STOMA SHOULD BE RED AND MOIST)
assess the anal area for the presence of stool redness or discharge
maintain NPO status until bowel sounds return or flatus is passed (48-72 hours)
maintain NG tube to allow intermittent suction until peristalsis returns.
maintain iv fluids until the child tolerates appropriate oral intake, advancing the diet from clear liquids to regular as tolerated and as prescribed
assess for dehydration and fluid overload
monitor strict I&O
obtain dialy weight
assess for pain and provide comfort measures as required
provide the parents with instructions regarding colostomy care and skin care
teach the parents about the appropriate diet and the need for adequate fluid intake.
what is intussusception?
Telescoping of one portion of the bowel into another portion
The condition results in obstruction to the passage of intestinal contents.
What does Intussusception look like?
colicky abdominal pain that causes the child to scream and draw the knees to the abdomen, similar to the fetal position
vomiting of gastric contents
bile stained fecal emesis
currant jelly like stools containing blood and mucus
hypoactive or hyperactive bowel sounds
Interventions for intussusception:
monitor for signs of perforation and shock AEB fever, increased heart rate, changes in LOC, or blood pressure, respiratory distress, and report immediately
antibiotics, iv fluids, and decompression via ng tube that may be prescribved
monitor for the passage of normal brown stool which indicates that the intussusception has reduced itself
prepare for hydrostatic reduction as prescribed, if no signs of perforation or shock occur
monitor for the return of normal bowel sounds for the passage of barium and the characteristics of stool.
administer clear fluids and advance the diet gradually as prescribed.
What is Volvulus?
the intestine twisting around itself
What does Volvulus look like?
intermittent bilious vomiting
recurrent abdominal pain
lower GI bleeding
What is complete volvulus called and why is it serious?
malrotation. it is most serious because intestine undergoes complete volvulus where the intestine twist completely around itself.
How do I diagnose Volvulus?
it is important that it is diagnosed promptly and surgical treatment instituted quickly.
What is therapeutic management for Volvulus?
surgery is indicated to remove the affected area.
Because of the extensive nature of some lesions, short gut syndrome is a post op complication.
Nursing care for Volvulus: pre op.
preop the nursing care is the same as that provided to an infant or child with intestinal obstruction.
Nursing care: post op:
the nursing care is similar to that provided tothe infant or child who has undergone abdominal surgery.