Chapter 42 Nursing Care of the Child with an Alteration in Bowel Elimination/Gastrointestinal Disorder Flashcards
Bowel Elimination
Refers to the secretion and excretion of body waste through the intestinal system
Primary Functions of GI System
Digestion and absorption of nutrients and water, elimination of waste products, and secretion of various substances required for digestion
Infant GI System
Babies are born with immature GI tracts that are not fully mature until age 2
Due to this immaturity, there are many differences between the digestive tract of the young child and that of the older child or adult
Variations in Anatomy & Physiology in Children: Mouth
Mouth is highly vascular, making it a common entry point for infectious invaders.
In addition, infants and young children repeatedly bring objects to their mouths and explore them in that fashion
- Increases the infant’s and young child’s risk for contracting infectious agents via the mouth
Variations in Anatomy & Physiology in Children: Esophagus
Esophagus: Provides passageway from mouth to stomach for food
The muscle tone of the LES is not fully developed until age 1 month, so infants younger than 1 month of age frequently regurgitate after feedings
Many children younger than 1 year of age continue to regurgitate for several months, but this usually disappears with age.
If edema or narrowing of the esophagus occurs in a child with undeveloped esophageal muscle tone, dysphagia may occur
Function of Lower Esophageal Sphincter (LES)
Prevents regurgitation of stomach contents up into the esophagus and/or oral cavity
Regurgitation
Backflow
Dysphagia
Difficult or painful swallowing
Variations in Anatomy & Physiology in Children: Stomach
Newborns have a stomach capacity of only 10 to 20 mL.
- At 2 months of age an infant has the capacity to hold up to 200 mL, though most young infants cannot tolerate 200-mL feedings
By age 16, the stomach capacity is 1,500 mL; by adulthood it is 2,000 to 3,000 mL.
Hydrochloric acid, which is found in gastric contents to aid in digestion, reaches the adult level by the time the child is 6 months old
Variations in Anatomy & Physiology in Children: Intestines
Not functionally mature at birth
A full-term infant has approximately 250 cm of small intestine; an adult has up to 600 cm
Infants who have small bowel loss during early infancy have more problems with absorption and diarrhea than adults who have the same amount of small bowel loss.
Variations in Anatomy & Physiology in Children: Biliary System
The liver is relatively large at birth, as much as 2 cm below the costal margin
- Allow for the smooth edge of the liver to be easily palpated in infancy
The pancreatic enzymes continue to develop postnatally, reaching adult levels around 2 years of age
Variations in Anatomy & Physiology in Children: Body Fluid Balance
Infants and children have a proportionately greater amount of body water than do adults
- Infants and young children require a larger relative fluid intake than adults and excrete a relatively greater amount of fluid.
Increased risk for fluid loss with illness compared to adults.
Until age 2 years, the extracellular fluid, with its larger proportion of sodium and chloride, makes up about half of the child’s total body water
- Therefore, when potential fluid-loss states occur, water loss occurs more rapidly and in larger amounts than in adults
Variations in Anatomy & Physiology in Children: Insensible Fluid Losses
Fever increases fluid loss at a rate of about 7 mL/kg/24-hour period for every sustained 1°C rise in temperature
Since children become febrile with illness more readily and their fevers are higher than those of adults, infants and young children are more apt than adults to experience insensible fluid loss with fever when ill.
Fluid loss via the skin accounts for about two thirds of insensible fluid loss.
- Infants have a relatively larger body surface area (BSA) relative to their body mass as compared to older children and adults.
- The newborn’s BSA ratio to body mass is about two or three times greater than the adult’s, and the preterm infant’s is about five times greater than the adult’s.
- This places infants, especially young infants, at increased risk of insensible fluid loss as compared to older children and adults.
The basal metabolic rate in infants and children is higher than that of adults to support growth.
- This higher metabolic rate, even in states of wellness, accounts for increased insensible fluid losses and increased need for water for excretory functions.
The young infant’s renal immaturity does not allow the kidneys to concentrate urine as well as in older children and adults. This puts infants at risk for dehydration or overhydration, depending on the circumstances
