Peds Final Review - Gastrointestinal Disorders Flashcards Preview

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Flashcards in Peds Final Review - Gastrointestinal Disorders Deck (35)
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1

CLEFT LIP AND PALATE

Description: Malformations of the face and oral cavity that seem to be multifactorial in hereditary origin.

Cleft lip is readily apparent.

Cleft palate may not be identified until the infant has difficulty with feeding.

Initial closure of cleft lip is performed when infant weighs approximately 10 pounds, is at least 10 weeks, and has an Hgb of 10.

Closure of palate is performed between 6 and 12 months to minimize speech impairment.

2

CLEFT LIP AND PALATE

Nursing Assessment:

Failure of fusion of the lip, palate, or both

Difficulty sucking and swallowing

Parent reaction to facial defect

3

CLEFT LIP AND PALATE

Nursing Diagnosis:

Imbalanced nutrition: less than body requirements R/T

Impaired parenting R/T

4

CLEFT LIP AND PALATE

Nursing Interventions:

--Promote family bonding and grieving during newborn period

--Inform family that successful corrective surgery is available.

--In newborn period, assist with feeding.
a. Feed in upright position
b. Feed slowly, with
frequent burping
c. Use soft, large nipples;
Haberman feeder, etc.
d. Support mother’s breast-
feeding and/or pumping

5

CLEFT LIP AND PALATE

Nursing Interventions:

Provide postoperative care:

--Maintain patent airway and proper positioning.
-Cleft lip: Client upright
in infant seat

- Cleft palate: Place
client on side or
abdomen

-Remove oral secretions
carefully with bulb syringe

Protect surgical site:
1. Apply elbow restraints

2. Minimize crying to prevent strain on lip suture

3. Maintain Logan bow to lip if applied

Provide care for restrained child.
1. Remove one restraint at a time, and perform ROM exercises.
2. Provide age-appropriate stimulation.

Resume feeding as prescribed. Cleanse suture site with sterile water after feeding; formula remaining on suture line may impede healing and lead to infection.


Encourage family participation in care and feeding:
1.Fluids are taken by a cup or an oral feeding syringe with a rubber tip

2.The diet progresses from a clear to a full liquid diet

3.The child may go home on a soft diet – nothing harder than mashed potatoes.

6

CLEFT LIP AND PALATE

Usually for cleft palate: Coordinate long-term care with other team members: plastic surgeon, ENT specialist, nutritionist, speech therapist, orthodontist, pediatrician, nurse.

7

CLEFT LIP AND PALATE

NCLEX HINT: Typical parent and family reactions to a child with an obvious malformation such as cleft lip or palate are guilt, disappointment, grief, sense of loss, and anger.

8

ACUTE APPENDICITIS

Nursing Assessment:

Pain precedes vomiting

Periumbilical pain, right lower quadrant pain (McBurney point), vomiting with fever

The absence of fever does not exclude appendicitis

Rebound tenderness is not a reliable sign of appendicitis

Ruptured appendix:
--Relief of pain, then child becomes seriously ill

--Rigid guarding of abdomen

--Fever, tachycardia, abdominal distention

--Rapid shallow breathing

9

ACUTE APPENDICITIS

Nursing diagnosis:

Risk of Infection R/T ruptured appendix

Risk of Fluid Imbalance R/T NPO status, IV fluid infusions, NG tube to intermittent low wall suction

10

ACUTE APPENDICITIS

Nursing Interventions Post-op:

Monitor vital signs
Monitor and manage IV fluid infusion

NG tube in place for decompression to intermittent low-wall suction

Pain relief – PCA pump

Monitor intake and output closely

Auscultation of bowel sounds
Post-op drains – JP, Penrose

Early initiation of enteral nutrition to minimize the degree of mucosal atrophy

11

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL
FISTULA

Description: congenital anomaly in which the esophagus does not fully develop.

Most common: upper esophagus ends in a blind pouch, and the lower part of the esophagus is connected to the trachea.

This condition is a clinical and surgical emergency.

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ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA

Nursing Assessment:

Three C’s of TEF in the newborn:
--Choking
--Coughing
--Cyanosis

Excess salivation
Respiratory distress
Aspiration pneumonia

13

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA

Nursing Diagnosis:

Risk for aspiration R/T

Imbalanced nutrition: less than body requirements R/T

14

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA


Nursing Interventions:

Provide preoperative care

Monitor respiratory status

Remove excess secretions – suctions is usually continuous to blind pouch

Elevate infant 30 degrees

Provide oxygen as prescribed

Maintain NPO

Administer IV fluids as prescribed

15

ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA

Provide postoperative care.

Maintain NPO

Administer IV fluids as prescribed

Monitor I&O

Provide gastrostomy tube care and feedings as prescribed

Provide pacifier to meet developmental needs

Monitor child for postoperative stricture of the esophagus
--Poor feeding
--Dysphagia
--Drooling
--Regurgitating undigested
food

Promote parent-infant bonding for high-risk infant

16

PYLORIC STENOSIS

Description: Narrowing of the pyloric canal; the sphincter (circular muscle of the pylorus) hypertrophies to twice the normal size.

17

PYLORIC STENOSIS

Nursing Assessment:

Usually occurs in first-born males

Vomiting (free of bile) usually begins after 14 days of life and becomes projectile.

Hungry, fretful infant

Weight loss, failure to gain weight

Dehydration with decreased sodium and potassium

Metabolic alkalosis (decreased serum chloride, increased pH and bicarbonate or CO2 content)

Palpable olive-shaped mass in upper right quadrant of the abdomen
Visible peristaltic waves

18

PYLORIC STENOSIS

Nursing Diagnosis:

Imbalanced nutrition: less than body requirements R/T

Deficient fluid volume R/T

19

PYLORIC STENOSIS

Nursing Interventions:

Preoperative care

Assess for dehydration

Administer IV fluids and electrolytes as prescribed

Weigh daily; monitor I&O

Provide small, frequent feedings if prescribed

Prepare family for surgery by teaching that:
---Hypertrophied muscle will be split
---Prognosis is excellent

20

PYLORIC STENOSIS

Postoperative care
--Continue IV fluids as prescribed

--Provide small oral feedings with electrolyte solutions or glucose (usually 4 – 6 hours post-operative).

--Position on right side in semi-Fowler position after feeding

--Burp frequently to avoid stomach becoming distended and putting pressure on surgical site

--Weigh daily; monitor I&O

21

INTUSSUSCEPTION

Description: Telescoping of one part of the intestine into another part of the intestine, usually the ileum into the colon (called ileocolic)

Partial to complete bowel obstruction occurs

Blood vessels become trapped in the telescoping bowel, causing necrosis

22

INTUSSUSCEPTION

Nursing Assessment:

Child under 1 year of age

Acute, intermittent abdominal pain

Screaming, with legs drawn up to abdomen

Vomiting
“Current jelly” stools (mixed with blood and mucus)

Sausage-shaped mass in upper right quadrant while lower right quadrant is empty

23

INTUSSUSCEPTION

Nursing Diagnosis:

Ineffective tissue perfusion R/T

Risk for deficient fluid volume R/T

24

INTUSSUSCEPTION

Nursing Interventions:

Monitor carefully for shock and bowel perforation

Administer IV fluids as prescribed

Monitor I&O

Prepare family for emergency intervention

Prepare child for barium enema (which provides hydrostatic reduction). Two of three cases respond to this treatment; if not, surgery is necessary.

Notify health provider is child passes normal stool

Provide postoperative care for infants who require abdominal surgery

25

HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )

Description: congenital absence of autonomic parasympathetic ganglion cells in a distal portion of the colon and rectum.

There is a lack of peristalsis in the area of the colon where the ganglion cells are absent

Fecal contents accumulate above the aganglionic area of the bowel.

Correction usually involves a series of surgical procedures:

---A temporary colostomy

--Later a reanastomosis and
closure of the colostomy

26

HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )

Nursing Assessment:

Suspicion in newborn who fails to pass meconium within 24 hours

Distended abdomen, chronic constipation alternating with diarrhea

Nutritionally deficient child

Ribbon-like stools in the older child

27

HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )

Nursing Diagnoses:

Constipation R/T

Diarrhea R/T

Imbalanced nutrition: less than body requirements R/T

28

HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )

Nursing Interventions:

Provide preoperative care

Begin preparation for abdominal surgery

Provide bowel-cleansing program as prescribed

Insert rectal tube if prescribed

Observe for symptoms of bowel perforation:
---Abdominal distention (Measure abdominal girth)
Vomiting

---Increased abdominal tenderness
Irritability

---Dyspnea and cyanosis

Initiate preoperative teaching regarding colostomy

29

HIRSCHSPRUNG DISEASE (CONGENITAL AGANGLIONIC MEGACOLON )

Nursing Interventions:

Provide postoperative care

Check vital signs, axillary temperature

Administer IV fluids as prescribed

Monitor I& O

Care for nasogastric tube with connection to intermittent suction

Check abdominal and perineal dressings

Assess bowel sounds

Prepare family for home care:
---Teach care of temporary colostomy
---Teach skin care
---Refer famiy to enterostomal therapist and social services

Prepare child and family for closure of temporary colostomy

After closure, encourage family to be patient with child when toileting

Teach family to begin toilet training after age 2.

30

ANORECTAL MALFORMATION

Congenital malformation of the anorectal section of the GI tract (imperforate anus)

It is often associated with a fistula

It may be also associated with urinary tract anomalies

Type and level of rectal anomaly determine surgical procedure and degree of bowel control possible