Gastro Intestinal Flashcards
Review the structure, function, and development of the gastrointestinal system of an infant and young child.
The primary functions of the GI system are the digestion and absorption of nutrients and water, elimination of waste products, and secretion of various substances required for digestion. 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.
Discuss the process of performing a gastrointestinal assessment of a child.
Look for skin, eye, and lip color as pallor may be a sign of anemia. Hydration status - decreased turgor tenting indicate dehydration. Abdominal size and shape. - laying spring.
Immediately report hypoactive or absent bowel sounds to physical or nurse practitioner
Therapeutic Management: Cleft Lip/ Palate
plastic surgeon or craniofacial specialist, dentist or orthodontist. Many children offer these services in one location, such as a craniofacial specialty.
Lip: 2-3 months surgery
Palate- 6-9 months surgery
Early repair restores a normal appearance to child’s face and may improve parent-infant bonding.
Risk factors: Cleft Lip/Palate
maternal smoking
prenatal infection
advanced maternal age
use of anticonvulsants, steroids or other medications
Nursing Management: Cleft Lip/Palate
Preventing Injury to suture line
Promoting Adequate Nutrition
Encourage Infant-Parent bonding
Emotional support
Preventing Injury to suture line
Don not allow infant to rub suture line ; to prevent- position infant in a supine or side-lying position
- may need restraints
h. Clean the suture line as ordered by the surgeon. Possible care options include using petroleum jelly on the facial suture line or a lip-protective device such as a Logan bow (curved thin metal apparatus) or a butterfly adhesive, both of which protect and maintain the suture line. Protect the palate operative site. Avoid putting items in the mouth that might disrupt the sutures (e.g., suction catheter, spoon, straw, pacifier, or plastic syringe). Prevent vigorous or sustained crying in the infant, because this may cause tension on either suture line. Ways to prevent crying include administering medications as needed for pain and providing other comfort or distraction measures, such as cuddling, rocking, and anticipation of needs.
Promoting Adequate Nutrition
cleft lip may demonstrate enhanced growth patterns if breastfed. The contour and softness of the breast against the lip may allow for a better seal to be maintained for adequate sucking in some infants
he infant with unrepaired cleft palate is at risk for aspiration with oral feeding. In some instances, a prosthodontic device may be created to form a false palate covering. This device may prevent breast milk or formula from being aspirated. Breastfeeding may be effective in the infant with cleft palate due to the pliability of the breast and the fact that soft breast tissue may cover the opening in the palate. Postoperatively, some surgeons allow breastfeeding to be resumed almost immediately
Encourage Infant-Parent Bonding
he appearance of a cleft lip is appalling. Encourage parents to hold the medically stable infant immediately after delivery to encourage bonding. Acknowledge normal feelings of guilt, anger, and sadness. Support the parents in providing care for the infant, particularly feeding, which is viewed as a significant nurturing function. Provide education about the anticipated surgical procedure and eventual normal appearance of the infant’s lip.
Esophageal Atresia and Tracheoesophageal Fistula
GI anomalies in which the esophagus and trachea do not separate normally during embryonic development. Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Tracheoesophageal fistula is an abnormal communication between the trachea and esophagus. When associated with esophageal atresia, the fistula most commonly occurs in the distal esophageal segment (Smith & Grover, 2014). Both defects are thought to be the result of incomplete separation of the lung bed from the foregut during early fetal development. A large percentage of newborns with either of these defects also have other congenital anomalie
Nursing Assessment
maternal history for polyhydramnios. Often this is the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation (Smith & Grover, 2014). Soon after birth, the newborn may exhibit copious, frothy bubbles of mucus in the mouth and nose, accompanied by drooling. Note abdominal distention as air builds up in the stomach. In esophageal atresia, a gastric tube cannot be inserted beyond a certain point because the esophagus ends in a blind pouch. The newborn may have rattling respirations, excessive salivation and drooling, and “the three C’s” (coughing, choking, and cyanosis) if feeding is attempted. The presence of a fistula increases the risk of respiratory complications such as pneumonitis and atelectasis due to aspiration of food and secretions. Diagnosis is made by radiograph showing either an inserted gastric tube appearing coiled in the upper esophageal pouch (indicating esophageal atresia) or air in the GI tract (indicating the presence of a fistula between the trachea and esophagus
Preoperative Care:
Initiate nothing by mouth (NPO) status. Elevate the head of the bed 30 to 45 degrees to prevent reflux and aspiration. Monitor hydration status and fluid and electrolyte balance; administer and monitor parenteral intravenous (IV) fluid infusions. Assess and maintain the patency of the orogastric tube; monitor the functioning of the tube, which is attached to low continuous suction; and avoid irrigation of the tube to prevent aspiration. Have oxygen and suctioning equipment readily available should the newborn experience respiratory distress. Assist with diagnostic studies to rule out other anomalies. Use comfort measures to minimize crying and prevent respiratory distress; provide nonnutritive sucking. Inform the parents about the rationales for the aspiration prevention measures. Document frequent observations of the newborn’s condition.
Post Operative Care:
Surgery consists of closing the fistula and joining the two esophageal segments. Postoperative care involves closely observing all of the newborn’s body systems to identify any complications. Expect to administer total parenteral nutrition (TPN) and antibiotics until the esophageal anastomosis is proven intact and patent. Then begin oral feedings, usually within a week after surgery. Keep the parents informed of their newborn’s condition and progress. Closely assess the newborn during feeding and report any difficulty with swallowing. Provide parent teaching. Demonstrate and reinforce all teaching prior to discharge.
Hypertrophic Pyloric Stenosis
ypertrophic pyloric stenosis, the circular muscle of the pylorus becomes hypertrophied, causing thickness in the luminal side of the pyloric canal (Fig. 20.12). This thickness creates a gastric outlet obstruction, causing nonbilious vomiting that presents between weeks 3 and 6 of life. The vomiting becomes more frequent and forceful as time goes on and is often projectile. The incidence is 2 to 3.5 per 1,000 live births, and it occurs more in males than females (4:1), with 30% to 40% of all cases being in first-born infants (Olivé & Endom, 2018). The cause of pyloric stenosis is probably multifactorial.Pyloric stenosis requires surgical intervention. A pyloromyotomy is performed to cut the muscle of the pylorus and relieve the gastric outlet obstruction (Fig. 20.12). Postoperative complications are rare.
Nursing Assessment: Pyloric Stenosis
forceful, non bilious vomiting, unrelated to feeding position
hunger soon due to vomiting
weight loss
progressive dehydration w/ lethargy
possible family history
-palpable hard, moveable olive in the right upper quadrant If an easily palpable mass is felt, no further testing is necessary, and a surgical consult is called. If no mass is identified, a pyloric ultrasound may be ordered to identify a thickened hypoechoic ring in the region of the pylorus. Assess laboratory values to determine if the infant has metabolic
Nursing alert: Pyloric Stenosis
It may be difficult to examine the infant’s abdomen when pyloric stenosis is suspected because of the infant’s extreme irritability. A pacifier or nipple dipped in glucose water may soothe the infant long enough to perform the abdominal examination.
