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2. Gastroenteritis
• Inflammation of stomach and intestines
– Fluid, electrolyte loss
– Dehydration
• May be acute or chronic
• Nausea, vomiting, diarrhea

3. Dehydration
• Occurs more readily in infants and young children than it
does in adults.
• The risk is increased in infants and young children because
they have an increased extracellular fluid percentage and a
relative increase in body water compared to adults.
• Increased basal metabolic rate, increased body surface area,
immature renal function & increased insensible fluid loss
through temperature elevation also contribute to the increased
risk for dehydration in infants & young children as compared
to adults.

4. Dehydration
• Dehydration left unchecked leads to shock, so early
recognition and treatment of dehydration is critical to
prevent progression to hypovolemic shock.
• The goals of therapeutic management of dehydration
are to restore appropriate fluid balance and to prevent
complications
Dehydration

6. Nursing goals for the infant or child with dehydration are aimed at
restoring fluid volume & preventing progression to hypovolemia.
1. Provide oral rehydration to children for mild to moderate states
of dehydration.
2. Children with severe dehydration should receive intravenous
fluids.
3. Initially, administer 20 mL/kg of normal saline or lactated
Ringer, and then reassess the hydration status.
4. Once initial fluid balance is restored, the physician or nurse
practitioner may order intravenous fluids at the maintenance rate
or as much as 1.5 times maintenance.
Dehydration- Nursing
Management

7. Dehydration- Nursing
Management

8. Dehydration- Nursing
Management

9. Calculate Deficit
– Mild Dehydration: 3-5% deficit (50 ml/kg deficit, 30
ml/kg if >10 kg)
– Moderate Dehydration: 6-10% deficit (100 ml/kg
deficit, 60 ml/kg if >10 kg)
– Severe Dehydration: >10% deficit (120 ml/kg deficit)
Replacement over 24 hours
•First 8 hours: 50% Deficit + Maintenance
•Next 16 hours: 50% Deficit + Maintenance

10. Ongoing Fluid
• Ongoing fluid losses= 0.9% Sodium
Chloride +/- potassium chloride to replace
ongoing losses.

11. Vomiting
• Vomiting is the forceful expulsion of gastric
contents through the mouth.
• Vomiting in infants and children has many
different causes and is considered to be a
symptom of some other condition.
• Therapeutic management of vomiting most often
involves slow oral rehydration and at times may
require administration of antiemetics

12. • Nursing management focuses on promoting fluid and
electrolyte balance.
• Oral rehydration is accomplished successfully in most
outpatient cases of simple vomiting.
• Teach the primary caregiver about oral rehydration
• In the child with mild to moderate dehydration resulting
from vomiting, withhold oral feeding for 1 to 2 hours after
emesis, after which time oral rehydration can begin.
• Give the infant or child 0.5 to 2 ounces of oral rehydration
solution Q 15 minutes, depending on the child’s age & size.
(ounce= 2 table spoon)
Vomiting- Nursing Management

13. Nursing Management
• Most infants and children can retain this small amount of fluid if
fed the restricted amount every 15 minutes.
• As the child improves, larger amounts will be tolerated
• If oral rehydration is not possible due to continued nausea and
vomiting, intravenous fluids will likely be ordered.
• In some cases, antiemetics may be used to help control the
vomiting. Some antiemetics can cause drowsiness or other side
effects and should not be used until a definitive diagnosis is made
or severe pathologic processes can be excluded.
• Educate the family regarding the prevention of vomiting and use
of antiemetic therapy
Vomiting- Nursing Management

14. Diarrhea
• Is either an increase in the frequency or a
decrease in the consistency of stool. Diarrhea in
children can either be acute or chronic.
• Acute infectious diarrhea (gastroenteritis) remains
the leading cause of death for children worldwide.

15. Pathophysiology
• Acute diarrhea in children is most commonly caused by
viruses, but it may also be related to bacterial or parasitic
enteropathogens.
• Acute diarrhea may be bloody or nonbloody.
• Diarrhea may also occur in relation to antibiotic use.
• Though most cases of diarrhea in children are of acute
origin, diarrhea may also occur chronically.
• Chronic diarrhea is diarrhea that lasts for more than 2
weeks.
• This type of diarrhea is not usually caused by serious illnesses.
Diarrhea- Pathophysiology

16. • Tissue damage and inflammation lead to the release of
exotoxins that cause a secretion of electrolytes and water
into the intestine; as a result, diarrhea & fluid loss occur.
• Medications such as antibiotics, laxatives
• Toxic agents: Ingestion of metals "lead, mercury“
• Functional causes: Irritable bowel syndrome
• Associated with: URTI., UTI, OM
• Enzymes deficiencies
Diarrhea- Etiology

17. Risk factors
•Include recent ingestion of undercooked meats,
foreign travel, day care attendance & well water use
Dietary causes
• Over feeding
• Introduction of new foods
• Reinstituting milk too soon after diarrheal episodes
• Osmotic diarrhea from excess sugar in formula
• Excessive ingestion of sorbitol or fructose
Diarrhea- Risk Factors

18. • Diarrhea, mild to severe
• Anorexia, N&V
• Excessive vomiting may lead to metabolic alkalosis due
to loss of hydrochloric acid from the stomach
• Malaise
• Abdominal distention, pain, cramps
• Electrolyte imbalances such as hypokalemia,
hyponatremia
• Fever
• Headache
Diarrhea- Signs & Symptoms

19. • Stool culture: may indicate presence of bacteria
• Stool for ova and parasites (O&P): may indicate the
presence of parasites
• Stool viral panel or culture: to determine presence of
rotavirus or other viruses
• Stool for occult blood: may be positive if inflammation
or ulceration is present in the GI tract (hardened
immobile bulk of stool); air–fluid levels may indicate
intestinal obstruction
Diarrhea- Laboratory & Diagnostic Tests

20. Laboratory and Diagnostic Tests
• Stool for leukocytes: may be positive in cases of
inflammation or infection
• Stool pH/reducing substances: to see if the diarrhea is
caused by carbohydrate intolerance
• Electrolyte panel: may indicate dehydration
• Abdominal radiographs (KUB): presence of stool in
colon may indicate constipation or fecal impaction
Diarrhea- Laboratory & Diagnostic
Tests

21. • Acute gastroenteritis resolves quickly; if client is
severely ill, medications are prescribed, antibiotics are
used if cause is bacterial (obtain a stool culture first),
• Occasionally antidiarrheals used to increase comfort and
decrease fluid loss or cathartics may be used to remove
toxins from the bowel
• Antiemetics for severe vomiting
• Supportive measures as bed rest, nutritional supplements,
increasing fluids & a bland diet; electrolytes are
replaced; IV fluids are administered if necessary, as
glucose in normal saline or lactated ringers solution
Diarrhea- Treatment

22. • Restoring Fluid and Electrolyte Balance
Continue the child’s regular diet if the child is not
dehydrated.
Initial nursing management of the dehydrated child
with diarrhea is focused on fluid and electrolyte
balance restoration.
Diarrhea- Nursing Management

23.  Teach the parents the importance of oral rehydration therapy
 The physician may order medication therapy.
 In such instances, teach the importance of finishing all prescribed
antibiotic therapy.
 After the cause of the diarrhea is known, teach the child and
family how to prevent further occurrences.
 As most cases of acute diarrhea are infectious, provide education
about proper hand-washing techniques and transmission route.
 Chronic diarrhea is often a result of excessive intake of formula,
water, fruit juice, so teach the parents about appropriate fluid
intake.
Diarrhea- Providing Family Education

24. Appendicitis
• Function of appendix: The entire digestive tract helps with our immune
system, may be a place for our body to store certain healthy types of gut bacteria
that otherwise could be altered or changed during an intestinal illness or with
overuse of antibiotics
• Inflammation of vermiform appendix
• Occurs most often in adolescent boys – can occur in any age
• Pathophysiology: Obstruction of appendiceal lumen –
may perforate or rupture as pressure increases
• Obstruction of the lumen of the appendix by hardened
fecal materials, foreign bodies, microorganisms or
parasite, lymphoid hyperplasia, fibrous stenosis from
earlier inflammation & tumor

25. Pyloric Stenosis
• Pyloric stenosis is spasms of the pylorus muscle
in the pyloric sphincter that connects the stomach
to the duodenum, causing the pyloric sphincter to
become inflamed and swell, thus preventing the
stomach from emptying into the duodenum.
• The cause is unknown and is seen in children
between 1 and 6 months of age.

26. • Hypertrophic obstruction of the pyloric sphincter
• Occurs in boys more than girls (4:1 ratio)
• Hypertrophy of pyloric sphincter results in
– Obstruction of sphincter
– Inability to move food from stomach to duodenum
– Vomiting and dehydration
Pyloric Stenosis

27. Pyloric Stenosis- Pathophysiology
It develops within the first few weeks of life projectile
vomiting, dehydration, metabolic alkalosis, & failure to thrive

28. • Projectile nonbilious vomiting caused by reverse
peristaltic & gastritis
• No nausea
• Blood-stained vomit caused by gastritis
• Olive-shaped bulge below the right costal margin
• Malnutrition
• Poor weight gain
• Normal appetite
• Eats after vomiting
Pyloric Stenosis- Signs &
Symptoms

29. • Abdominal ultrasound: Increased size of pyloric
sphincter
• Endoscopy: Increased size of pyloric sphincter
• Upper GI series: Delayed gastric emptying
• Blood chemistry: Decreased calcium, sodium,
potassium
• Blood gases: Metabolic alkalosis
Pyloric Stenosis- Lab
Results

30. • Insert NG tube to decompress the GI tract.
• Administer IV fluids and electrolytes to maintain
fluid and electrolytes balance.
• Surgery: Pyloromyotomy to repair the pyloric
sphincter.
Pyloric Stenosis-
Treatment

31. • Nothing by mouth.
• Strict intake and output to assess for dehydration.
• Daily weight.
• Assess vomitus for character and frequency.
• Monitor vital signs.
Pyloric Stenosis- Nursing
Interventions

32. • Postoperative care:
– Monitor intake and output.
– Elevate the child’s head when feeding.
– Burp frequently.
– Small frequent feedings until the pyloric
sphincter function returns to normal.
– Explain the disorder & treatment to the family.
Pyloric Stenosis- Nursing
Interventions

33. Intussusception
• One portion of the intestine prolapses and then
invaginates (or, “telescopes”) into itself
• Results in
– Obstructed blood flow
– Ischemia and necrosis
– Hemorrhage, perforation if untreated
• Frequent cause of intestinal obstruction
• Most cases occur in boys <2 years of age

34. Signs and Symptoms
• Colicky
• Knees drawn to chest
• Grunting
• Fecal material in vomit
• Sweating
• Red currant jelly-like stool
• Dehydration
• Distended abdomen
• Fever
• Shallow respiration
• Sausage-shaped abdominal mass

35. Test Results
• Abdominal radiograph: Shows mass.
• Barium enema: Shows intussusception.
• Complete blood count—elevated WBC
(leukocytosis)

36. Treatment
• Insert an NG tube to reduce vomiting and decompress
the GI tract.
• Hydrostatic reduction of bowel: The bowel is moved
back into position using a barium solution, water-soluble
contrast solution, or air pressure.
• Surgery: Pulling the intussusceptions back into position
or resectioning the bowel if other treatments fail to
resolve the intussusceptions.

37. Nursing Intervention
• Monitor vital signs.
• Insert the NG tube as ordered and measure output.
• Administer the enema as ordered.
• Strict intake and output.
• Postoperative care:
Administer antibiotics
Monitor signs of infection
Monitor bowel sounds
Explain the disorder and treatment to the family.

38. Cleft Lip and Palate
• A cleft palate and cleft lip is a birth defect caused
by chromosomal abnormalities “chromosome
8” or exposure to alcohol, anticonvulsant
medication, and other teratogens resulting in the
upper jaw and palate bone and tissue not fusing
together properly in the second month of
pregnancy.

39. • Occur singly or in combination
• Maxillary processes fail to fuse
• Multifactorial cause suspected
– Environment
– Genetics
– Folate
Unilateral
Cleft Lip
Bilateral
Cleft Lip

40. Signs and Symptoms
• Distended abdominal due to swallowing air
• Abnormal formation of the lip
• Abnormal formation of the palate

41. Treatment
• Cheiloplasty to surgically repair the cleft lip
within the first 3 months after birth to provide
adequate sucking.
• Palatoplasty to surgically repair the cleft palate
between 12 months and 18 months of age before
the child begins speaking.

42. Nursing Intervention
Cleft lip:
• Elevate the infant when feeding.
• Use an oversized nipple.
• Stimulate the sucking reflex because this helps with speech.
• Give the infant time to swallow to prevent choking.
• Feed slowly giving the infant a rest period after swallowing.
• Burp frequently to expel swallowed air and prevent vomiting.
• Provide small, frequent feedings to prevent the infant from getting
tired.
• Give water following feedings to flush food from the mouth and
thereby preventing the growth of microorganisms

44. Nursing Intervention
• Cleft palate:
– Feed using a cleft palate nipple.
– Assess for abdominal
distention.
– Strict intake and output.
– Assess the ability to suck.
– Monitor the vital signs
Nursing Intervention

45. Nursing Intervention
• Cleft lip Postoperative care:
– Maintain airway.
– Monitor for respiratory distress.
– Restrain the infant from accessing the site.
– Clean the site after feeding.
– Place the infant on the right side after feedings
to prevent aspiration.
Nursing Intervention

46. Nursing Intervention
• Cleft palate postoperative:
• Don’t use a pacifier.
• Use a cup rather than a nipple for feeding.
• Don’t brush teeth for 2 weeks following surgery.
• Don’t use pointed objects near the infant’s mouth.
• Explain the disorder and treatment to the family.

47. Hirschsprung Disease
• Congenital aganglionic megacolon
• Congenital anomaly; genetic basis (RET
protooncogene)
• Portion of large intestine lacks parasympathetic
innervation
• Results in
– Inadequate motility
– Obstruction of the intestine

48. Signs and Symptoms
• Failure to pass meconium within the first 48 hours following birth
• Failure to pass stool within the first 48 hours following birth
• Abdominal distention
• Abdominal mass
• Ribbon-like or liquid stool
• Sunken eyes
• Pallor
• Dehydration
• Irritable
• Weight loss
• Lethargic

49. Test Results
• Abdominal radiograph: Shows distended colon
• Rectal biopsy: Absence of ganglion cells in the
colon
• Full-thickness surgical biopsy: Absence of
ganglion cells in the colon
• Suction aspiration of rectum: Absence of
ganglion cells in the colon

50. Treatment
• Surgery: After 9 months of age, the affected
portion of the colon is removed.

51. Nursing Intervention
• Preoperative care:
– Nothing by mouth.
– Administer IV fluids as ordered to prevent maintain
fluid and electrolyte balance.
– Insert an nasogastric (NG) tube to decompress the
upper GI tract.
– Administer normal saline or mineral oil enemas to
clean the bowel.
– Administer antibiotics as ordered.

52. Nursing Intervention
• Postoperative care:
– Strict input and output.
– Provide care for the colostomy or ileostomy, if necessary.
– Monitor bowel sounds.
– Begin feeding by mouth when bowel sounds are present.
– Nothing should be placed in the rectum.
– Monitor for constipation.
– Explain the disorder and treatment to the family and instruct
them on proper care for the wound and how to care for the
colostomy or ileostomy, if necessary. Tell the family to call the
health-care provider at the first signs of constipation,
dehydration, fever, vomiting, and diarrhea.

53. CELIAC DISEASE
• Celiac disease occurs when enzymes in the
intestinal mucosal cells are damaged when they
are in contact with gluten, resulting in decreased
absorption by the small intestines.
• Gluten is a protein found in wheat, rye, oats
“ ‫الشوفان‬
» ”, & barley “ »
‫الشعير‬
» . Celiac disease is
detected in infants when they are introduced to
gluten-containing foods.

54. • Diarrhea
• Fatty, foul-smelling stool
• Distention
• Vomiting
• Irritability
• Abdominal pain
CELIAC DISEASE- Signs &
Symptoms

55. • Serum: Decreased level of albumin, potassium,
cholesterol, calcium, and sodium
• Blood count: Decreased platelets, white blood
cells (WBC), and hematocrit
• Stool: High fat content
• Biopsy: Positive for celiac disease
CELIAC DISEASE- Lab Results

56. Treatment
• Diet free from wheat, rye, oats, and barley.
• Increase dietary protein, calories.
• Decrease dietary fat.
• Administer water-soluble vitamins A and D.
• Administer iron supplements.
• Administer folic acid.
• Nursing Intervention
• Teach the family about the disorder and treatment and inform them
that dietary changes are for the child’s entire life.
• If untreated, it may result in cancers such as intestinal lymphoma,
and a slightly increased risk of early death
CELIAC DISEASE- Treatment

57. Esophageal Atresia and
Tracheoesophageal Fistula (TEF)
• A tracheoesophageal fistula is a congenital anomaly in
which the trachea and the esophagus are connected.
• A child with a tracheoesophageal fistula is likely to have
an esophageal atresia where the esophagus ends in a
blind pouch preventing food from entering the stomach.
• These disorders occur approximately at 5 weeks of
gestation when the foregut normally develops into the
trachea and esophagus.

58. • Esophagus and trachea do not develop as
parallel tracts
• Esophagus ends as either
– Blind pouch
– Connected to trachea by a fistula
Esophageal Atresia and
Tracheoesophageal Fistula (TEF)

61. Signs and Symptoms
• Frothy saliva
• Coughing due to excessive secretions
• Gagging when feeding
• Feedings exiting the mouth and nose
• Aspiration
• Difficulty breathing
• Distended stomach

62. Test Results
• Radiopaque catheter radiograph: A radiograph is
taken after the radiopaque catheter is inserted into
the esophagus to identify the fistula or blind
pouch.
• Bronchoscopy: Shows the fistula.
• Chest radiograph: Shows pneumonia and air in the
esophageal pouch.

63. • Suction the contents of the blind pouch.
• Insert NG tube to decompress the stomach.
• Surgery: Repair the fistula &/or blind pouch.
Treament

64. • Nothing by mouth
• Insert the NG tube as ordered.
• Suction the contents of the blind pouch as
ordered.
• No pacifier because this increases saliva
production.
• Elevate the child’s head.
Nursing Interventions

65. • Postoperative care:
– Monitor vital signs.
– Place NG tube to low suction per order.
– Monitor output of NG tube every 4 hours.
– Provide gastrostomy feeding until esophagus returns to
normal.
– Monitor chest tube drain, if necessary.
– Use pacifier.
– Start feeding by mouth with sterile water and then advance
diet as tolerated.
– Explain the disorder and treatment to the family.
Nursing Interventions

66. Abdominal Wall Defects
• Omphalocele
– Congenital malformation
– Intra-abdominal contents
herniate through umbilical
cord
– Covered with peritoneal
membrane
– Often associated with other
anomalies

67. Abdominal Wall Defects
• Gastroschisis
– Abdominal organs herniate through abdominal
wall
– Not covered with peritoneal membrane
Abdominal Wall Defects

68. Anorectal Malformations
• Common congenital defects
• Minor to complex
• Occur in isolation or with other defects –
VACTERL “vertebral defects, anal atresia, cardiac defects,
tracheo-esophageal fistula, renal anomalies & limb abnormalities”.
• Types
– Anal stenosis
– Anal atresia
– Imperforate anus

69. • Malformation occurring during fetal development;
rectum can end and not connect to the anus or
may connect to wrong location as the vagina,
urethra, or bladder; anal agenesis in which rectal
pouch ends blindly above the perineum, can be an
anal fistula formation or anal stenosis; no
prevention is known.
Etiology

70. Predisposing factors
• Due to an abnormal congenital defect
formed during fetal development;
associated with other congenital defects
as Down’s syndrome, cardiac defects,
esophageal atresia, or renal anomalies.
Predisposing Factors

71. Signs and symptoms:
• Without an anal opening, or misplaced anal
opening
• No passage of stool 24–48 hours after birth
• Passage of meconium from vagina or urinary
meatus
• Abdominal distention

72. Diagnosis
• Made by examination of the perineum,
abdominal X-ray, ultrasound of rectal and
vaginal areas to evaluate for malformations

73. Treatment
• Prophylactic antibiotics
• Excision of membrane
• Daily anal dilation by nurse & at home by parents
• Surgical reconstruction, called an anoplasty, to
repair malformations
• Postoperative pain medications
• Temporary colostomy may be performed if
classified as high

74. Failure To Thrive (FTT)
• Failure to thrive (FTT): growth failure.
• It is the inability to utilize or obtain enough food,
resulting in poor growth patterns.
• It represents a continual deceleration on the growth curve.
• Etiology: Organic FTT caused by the presence of a major
disease, inorganic FTT caused by many psychosocial
factors. Mixed FTT may also occur

75. • Weight &/or height falls below the 5th percentile for
child’s age
• Developmental milestones are not achieved
• Slow social, lingual, and motor development
• Irregular sleep patterns
• Weakness
• Limited smiling
• Absence of appropriate stranger anxiety
Failure To Thrive (FTT)-Signs &
Symptoms

76. • Health and dietary history; physical examination
and diagnostic tests to rule out major illnesses;
developmental screening; evaluation of growth
patterns; family assessment; evidence of growth
retardation
Failure To Thrive (FTT)- Diagnosis

77. • Reversal of malnutrition
• Adequate nutrition to increase calorie intake
• Treat psychosocial problems with a
multidisciplinary team
• Multivitamins & minerals
Failure To Thrive (FTT)-
Treatment

78. • Assess parent & child behavior during feeding: how
child is held, eye-to-eye contact, sensitivity to child’s
needs
• Provide feedings by consistent nursing staff, to learn
child’s feeding behavior
• Take initial height and weight and weigh daily
• Evaluate when hungry and when hunger is met
• Record food intake
Failure To Thrive (FTT)- Nursing
Management

79. • Use a structured feeding schedule
• Provide quiet none stimulating surroundings
• Offer appropriate developmental stimulation
• Arrange home care visits, contact social agencies for
financial assistance to family
Failure To Thrive (FTT)- Nursing
Management