The Child withGastrointestinalDysfunctionChapter 24             Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Clinical Manifestationsof GI Dysfunction• Failure to thrive• Regurgitation• Nausea, vomiting, diarrhea, constipation• Abdo...
Daily Maintenance FluidRequirements• Calculate child’s wt in kg• Allow 100 mL/kg for first 10 kg body wt• Allow 50 mL/kg f...
Example #1 of Daily FluidCalculation• Child weighs 32 kg• 100 x 10 for 1st 10 kg of body weight =  1000• 50 x 10 for 2nd 1...
Example #2 of Daily FluidCalculation• Child weighs 8.5 kg• 100 x 8.5 for 1st 10 kg of body weight =  850• No further calcu...
Example #3 of Daily FluidCalculation• Child weighs 14 kg• 100 x 10 for 1st 10 kg of body weight =  1000• 50 x 4 for 2nd 10...
Diarrhea• Description: the major concerns when a child is  having diarrhea are the risk of dehydration, the loss  of fluid...
Diarrhea (Interventions)1. Monitor vital signs2. Monitor the character, amount, &   frequency diarrhea3. Monitor skin inte...
Diarrhea (Interventions)6. For mild to moderate dehydration,   provide oral rehydration therapy.7. For severe dehydration,...
Prevention of Diarrhea• (Most diarrhea is spread by the fecal-oral  route)• Teach personal hygiene• Clean water supply/pro...
Vomiting• Descriptions: 1. The major concerns when a child is vomiting are the risk of dehydration, the loss of fluid & el...
Vomiting• Assessment: 1. Signs of aspiration 2. Character of vomitus 3. Pain & abdominal cramping 4. Dehydration 5. Fluid ...
Vomiting• Interventions: 1. Maintain a patent airway 2. Position the child on side to prevent aspiration 3. Monitor vital ...
Gastroesophageal Reflux(GER)• Defined as transfer of gastric contents into the esophagus  as a result of relaxation of the...
GER (cont’d)•   Interventions:1. Assess amount & ch-ch of emesis2. Monitor breath sounds before &after   feeding3. Place s...
GER (cont’d)•    Treatment:a)   Positioning: prone position after feedings & at nightb)   Diet:1.   Provide small, frequen...
GER (cont’d)c) Medications:1. Administer antacids to reduce the amount of    acid present in gastric secretions, & to prev...
Cleft Lip and/or Cleft Palate               (Description)• Cleft lip or cleft is a congenital anomaly that occur  as a res...
Cleft Lip and/or Cleft Palate             (Assessment)• Cleft lip can range from a slight notch to a  complete separation ...
Cleft Lip and/or Cleft Palate             (Interventions)• Assess the ability to suck, swallow, handle  normal secretions,...
Cleft Lip and/or Cleft Palate    (Interventions postoperatively)1. Cleft lip repair:a) A lip protector device may be taped...
Cleft Lip and/or Cleft Palate    (Interventions postoperatively)2. Cleft palate repair:a) Child is allowed to lie on the a...
Cleft Lip and/or Cleft Palate    (Interventions postoperatively)3. Soft elbow or jacket restraints may be used     (check ...
Image 322: Stages in palatine development.                                             Mosby items and derived items © 200...
Image 323: Variations in clefts of lip and palate at birth. A, Notch in vermilionborder. B, Unilateral cleft lip and cleft...
Image 324: Infant with Logan bow in place to prevent trauma to the suture line.Note elbow restraints.                     ...
Image 325: Some devices used to feed an infant with a cleft lip and palate.                                              M...
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Ch 24 ppt

  1. 1. The Child withGastrointestinalDysfunctionChapter 24 Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  2. 2. Clinical Manifestationsof GI Dysfunction• Failure to thrive• Regurgitation• Nausea, vomiting, diarrhea, constipation• Abdominal pain, distention, GI bleeding• Jaundice• Dysphagia• Hypoactive, hyperactive, or absent bowel sounds Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  3. 3. Daily Maintenance FluidRequirements• Calculate child’s wt in kg• Allow 100 mL/kg for first 10 kg body wt• Allow 50 mL/kg for second 10 kg body wt• Allow 20 mL/kg for remaining body wt Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  4. 4. Example #1 of Daily FluidCalculation• Child weighs 32 kg• 100 x 10 for 1st 10 kg of body weight = 1000• 50 x 10 for 2nd 10 kg of body weight = 500• 20 x 12 for remaining body weight = 240• 1000 + 500 + 240 = 1740 mL/24 hrs Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  5. 5. Example #2 of Daily FluidCalculation• Child weighs 8.5 kg• 100 x 8.5 for 1st 10 kg of body weight = 850• No further calculations• 850 mL/24 hrs Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  6. 6. Example #3 of Daily FluidCalculation• Child weighs 14 kg• 100 x 10 for 1st 10 kg of body weight = 1000• 50 x 4 for 2nd 10 kg of body weight = 200• No further calculations• 1000 + 200 = 1200 mL/24 hrs Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  7. 7. Diarrhea• Description: the major concerns when a child is having diarrhea are the risk of dehydration, the loss of fluid & electrolytes, & the development of metabolic acidosis.• Assessment:1. Character of stools2. Pain & abdominal cramping3. Dehydration4. Fluid & electrolyte imbalances5. Metabolic acidosis Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  8. 8. Diarrhea (Interventions)1. Monitor vital signs2. Monitor the character, amount, & frequency diarrhea3. Monitor skin integrity4. Monitor intake & output & signs of dehydration5. Monitor electrolyte levels Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  9. 9. Diarrhea (Interventions)6. For mild to moderate dehydration, provide oral rehydration therapy.7. For severe dehydration, maintain NPO status & provide fluid & electrolyte replacement by the IV route8. Reintroduce a normal diet once rehydration is achieved9. Provide enteric isolation is required10. Instruct the parents in good hand- washing technique Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  10. 10. Prevention of Diarrhea• (Most diarrhea is spread by the fecal-oral route)• Teach personal hygiene• Clean water supply/protect from contamination• Careful food preparation• Handwashing Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  11. 11. Vomiting• Descriptions: 1. The major concerns when a child is vomiting are the risk of dehydration, the loss of fluid & electrolytes, & the development of metabolic alkalosis 2. Additional concerns include aspiration, atelactasis, and the development of pneumonia Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  12. 12. Vomiting• Assessment: 1. Signs of aspiration 2. Character of vomitus 3. Pain & abdominal cramping 4. Dehydration 5. Fluid & electrolyte imbalances 6. Metabolic alkalosis Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  13. 13. Vomiting• Interventions: 1. Maintain a patent airway 2. Position the child on side to prevent aspiration 3. Monitor vital signs 4. Monitor the character, amount, & frequency of vomiting 5. Assess the force of vomiting, for projectile vomiting indicates pyloric stenosis or increased intracranial pressure 6. Monitor intake & output & signs of dehydration 7. Monitor electrolyte levels 8. Provide oral rehydration therapy 9. Assess for diarrhea or abdominal pain10. Advise the parents to inform the physician when signs of dehydration, blood in vomitus, forceful vomiting, or abdominal pain is present Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  14. 14. Gastroesophageal Reflux(GER)• Defined as transfer of gastric contents into the esophagus as a result of relaxation of the lower esophageal or cardiac sphincter.• Complications include esophageal strictures, aspiration of gastric contents, & aspiration pneumonia.• Assessment:1.Passive regurgitation or emesis2.Poor weight gain3.Hematemesis4.Heartburn (in older children)5.Anemia from blood loss Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  15. 15. GER (cont’d)• Interventions:1. Assess amount & ch-ch of emesis2. Monitor breath sounds before &after feeding3. Place suction equipment at the bedside4. Monitor intake & output5. Monitor for signs & symptoms of dehydration Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  16. 16. GER (cont’d)• Treatment:a) Positioning: prone position after feedings & at nightb) Diet:1. Provide small, frequent feedings to decrease the amount of regurgitation, nasogastric tube feedings are indicated if severe regurgitation & poor growth are present.2. For infants, thicken formula by adding rice cereal.3. Burp the infant frequently when feeding & handle the infant minimally after feedings4. Instruct the parents to avoid feeding the child fatty foods, chocolate, fruit juices, & spicy foods5. Avoid feeding just before bedtime6. Avoid vigorous play after feedingitems and derived items © 2005, 2001 by Mosby, Inc. Mosby
  17. 17. GER (cont’d)c) Medications:1. Administer antacids to reduce the amount of acid present in gastric secretions, & to prevent esophagitis2. Administer prokinetic agents to accelerate gastric emptying & decrease reflux3. Administer acetaminophen to relieve reflux paind) Surgery:1. Procedure known as fundoplication to restore the competence of lower esophageal sphincter2. A gastrostomy may be performed at the same time for decompression of the stomach Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  18. 18. Cleft Lip and/or Cleft Palate (Description)• Cleft lip or cleft is a congenital anomaly that occur as a result of failure of soft tissue or bony structure to fuse during embryonic development.• The defects involve abnormal openings in the lip or palate that may occur unilaterally or bilaterally• Causes include genetic, hereditary, & environmental factors, exposure to radiation or rubella virus, chromosome abnormalities, & teratogenic factors.• Closure of cleft lip defect precedes that of the palate? & is performed usually during the 1st weeks of life.• Cleft palate is repair is performed between 12 & 18 months of age Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  19. 19. Cleft Lip and/or Cleft Palate (Assessment)• Cleft lip can range from a slight notch to a complete separation from the floor of the nose.• Cleft palate can include nasal distortion, midline or bilateral cleft, & variable extension from the uvula & soft & hard palate. Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  20. 20. Cleft Lip and/or Cleft Palate (Interventions)• Assess the ability to suck, swallow, handle normal secretions, & breathe without distress• Assess fluid & calorie intake daily & monitor weight• Modify feeding techniques• Hold the child in an upright position, and feed small amounts gradually & burp frequently• Position on side after feeding• Teach the parents ESSR (enlarge, stimulate, sucking, swallow, rest) method of feeding. Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  21. 21. Cleft Lip and/or Cleft Palate (Interventions postoperatively)1. Cleft lip repair:a) A lip protector device may be taped securely to the cheeks to prevent trauma to the suture lineb) Position the child on the side lateral to the repair or on the back, avoid the prone position to prevent rubbing of the surgical site on the mattressc) After feeding, cleanse the suture line of formula or drainage with a cotton tipped swab dipped in saline, apply antibiotic ointment if prescribed Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  22. 22. Cleft Lip and/or Cleft Palate (Interventions postoperatively)2. Cleft palate repair:a) Child is allowed to lie on the abdomenb) Feedings are resumed by bottle, breast, or cupc) Do not allow the child to brush his or her teethd) Instruct the parents to avoid offering hard food items to the child Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  23. 23. Cleft Lip and/or Cleft Palate (Interventions postoperatively)3. Soft elbow or jacket restraints may be used (check agency policy)4. Avoid the use of oral suction or placing objects in the mouth as a tongue depressor, thermometer, straws, spoons, forks, or pacifiers5. Provide analgesics for pain6. Instruct the parents to monitor for signs of infection at the surgical site7. Encourage the parents to hold the child8. Initiate appropriate referrals for speech impairment or language-based learning difficulties Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  24. 24. Image 322: Stages in palatine development. Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  25. 25. Image 323: Variations in clefts of lip and palate at birth. A, Notch in vermilionborder. B, Unilateral cleft lip and cleft palate. C, Bilateral cleft lip and cleftpalate. D, Cleft palate. Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  26. 26. Image 324: Infant with Logan bow in place to prevent trauma to the suture line.Note elbow restraints. Mosby items and derived items © 2005, 2001 by Mosby, Inc.
  27. 27. Image 325: Some devices used to feed an infant with a cleft lip and palate. Mosby items and derived items © 2005, 2001 by Mosby, Inc.
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