(1) This document discusses nursing care for children with altered gastrointestinal function. It covers assessment, clinical manifestations of GI problems, diagnostic studies, and nursing care approaches. (2) Assessment involves obtaining a health history and physical exam including prenatal history, signs of dehydration, liver exam, bowel sounds, and abdominal/rectal assessment. (3) Common GI issues discussed are regurgitation, vomiting, abdominal distention, pain, and diarrhea. Laboratory tests covered include CBC, liver enzymes, stool tests.

1. rsin ursin ursin
.nur
sin
w.n w.n ww
ww ww w
s.com s.c om s.c om
ture ture ture tur es.c
c -lec -lec -lec
g -l e Nursing care ofnchildren with altered gastrointestinal function
si g sing sing
rsin .nur .nur .nur
w w w
ww
Assessment ww ww
s.c om Health history and physicalsfunction
(1) om om
ture e .c es.c es.c
lec  Prenatal historyg-le
ctur age and birth wt) -le ctur -le ctur
g- (gestational
sing associated with a change of ursing
rsin sin
 Neonatalur infancy GI problems (whether the problem
.n and .nur
ww water intake. ww w.n
w
food or w ww
 Life-style and family factors (family history and if the same problem with siblings)
 Socioeconomic status and living condition, hygiene and health practices.
s.c om Well-being within a family. s.co
m om
ture

r e es.c es.c
lec 
-le -le c r
Changes in a child’s lifeu starting school, new sibling death. tu
ct e.g -le ctur
g- Assess digestiveg sing sing
rsin 
.nur
sin function in a 24hr
.nur .nur
 ww
Nutritional history. ww ww
w w w
(2) Physical Exam
s.c om om om
ture  tur es.c infection.
Mouth: cleft, dental problems, tur es.c tur es.c
c -lec -lec -lec
g- l e 
ing
S&S of dehydration: dry mucous.
sing sing
rsin  skin colorurs jaundice).
.n (pale .nur .nur
w w w
 ww
Liver. ww ww
 Peristalsis (visible in pyloric stenosis)
 Bowel sounds (increased with diarrhea).
s.c om om om
ture
 Tender abdomen (appendicits).
tur es.c tur es.c tures.c
c 
g-le -lec
Displaced heart (diaphragmatic hernia).
-lec -lec
rsin  sing
Distended abdomen ( Hirschsprug’s disease). sing sin g
 .nur pigment or brittle (decreased protein intake).
Hair:w of
loss w .nur w.n
ur

ww
Wt below 10th percentile. ww ww
 Abdominal and rectal assessment
om om om
tur es.c (3) Clinical manifestation of res.c
tu GI problems. tur es.c tur es.c
g -l e c -lec -lec -lec
rsin 1- Regurgitationur
sing sing sing
w .n (spitting up): normal until a round.nur
w 8 months of age. .nur
ww ww w ww
2- Vomiting (assess for onset, frequency, severity, quantity, degree of forcefulness &
presence of bile):
m m m
re s.co s.co s.co es.c
ectu ure
1) Mechanical: secondary tot obstructive lesions.
ure tur
-l lec lect -lec
rsin
g s ing- urs ing- sin g
.nur w.n
wdue to GIT stimuli (infection or allergy). w.n
ur
ww
2) Reflexive: ww ww
3) Central: either CNS involvement (meningitis) or others such as sepsis, abnormal
om om om
es.c es.c s.c es.c
metabolites.
tu r ctur ture tur
g -lec -le ing-
lec -lec
rsin sing s sin g
.nur .nur .nur
w ww ww
w
w ww
s.c om om om
ture es.c ture
s.c es.c
-lec -le ctur -lec -le ctur

2. rsin ursin ur sin
.nur
sin
w.n w.n ww
ww ww w
s.c om s.c om s.c om
ture ture ture tur es.c
c 3- Abdominal distentionlec to accumulation of fluid or gasesec both in the abdomen, or -lec
g -l e sing
- due g -l or
sing
rsin as a result of congenital malformations, constipation,ursin GIT perforation, or
.nur .n hernia, .nur
cirrhosis. ww
w ww
w
ww
w
4- Abdominal pain.
om om om
r es.c es.c es.c
5- Diarrhea: an increase lincturfrequency and fluidity of the bowel movement and it may
es.c
lec tu
-e
the
-le ctur -le ctur
rsin g - be (1) acute due tosing
ur sing
infection, stress or reaction to drug,r(2) chronic due to chronic sing
infection, ww.n .nu .nur
w w ww
obstructive inflammatory bowel disease or malabsorption.
w ww
(4) Laboratory and Diagnostic studies
om om om
tur es.c 4) CBC: infection, anemia, hemorrhage
tur es.c es.c es.c
-lec -lec ctur -lec
tur
g sing g-le g
rsin .nur .nur
sin
ur sin
5) ESR: inflammation.
w w w.n
ww ww ww
6) Serum Na, Cl , K: electrolyte balance.
om om om
es.c 7) Liver enzymes: (1) ALT (Alanine aminotransferase) & AST (Aspartate
es.c es.c es.c
-le ctur aminotransferase) assessle ctur
- liver cells integrity, (2) Alkalineng-le ctur hepatic obstruction,
phosphate: -le ctur
rsing sing with hemolysis or liver damage, (4) Serum ammonia: impaired ursing
si
.nur
(3) Bilirubin: increased
.nur w.n
ww ww
hepatic detoxification of protein, (5) serum amylase: pancreatic enzyme
w w ww
8) Absorption tests
om om om
r es.c tur es.c es.c es.c
-lec
tu 9) Stool tests: c ctur -lec
tur
g g-le g-le g
rsin sin sin
.nurturns acid with malabsorption of.sugars.
nur ur sin
1. Stool pH:w
stool w w.n
ww ww ww
2. Stool fat, trypsin.
om om om
tur es.c 3. Stool culture, ova & parasites,soccult blood.
tur e .c tur es.c tur es.c
g -l e c -lec -lec -lec
rsin Nursing Carenur
sing sing sing
w . w .nur .nur
ww ww w ww
A. Monitoring and measurement:
om om om
tur es.c v Caloric count. ture
s.c r es.c tur es.c
g-le
c
g-le
c -lectu -lec
rsin v Intake & output. sin sing sin g
.nur .nur w.n
ur
w ww ww
w
ww
v Daily weight.
s.c om om om
es.c s.c es.c
v USG.
c ture ctur lec ture tur
g-l e v Abdominal girth. ing
-le ing- g-lec
rsin .nur
s
.nur
s
.nur
sin
w ww ww
w
www
s.c om om om
ture es.c ture
s.c es.c
-lec -le ctur -lec -le ctur

3. rsin ursin ur sin
.nur
sin
w.n w.n ww
ww ww w
s.c om s.c om s.c om
ture ture ture tur es.c
c c c -lec
g -l e v Stool chart. g-le g-le g
rsin ur sin ur sin
.nur
sin
w.n
B. Providing altered means for nutrition and ww w.n ww
ww elimination (NG tube, enema). w
Impact of GI Alteration on the Child and the Family
om om om
r es.c es.c of adjustment. es.c es.c
lec tu c ur
A- Chronic alteration needs ta lifetime
-le -le ctur -le ctur
rsin g - ur sing sing sing
B- Familyww.n .nur
will experience negative feeding experiences leading to disturbance in ww.n
ur
ww
family’swfeeling and achievement. w w
om GI problems interferes with infant’s/child’s oral gratification and availability of
C- om om
es.c energy for mobility. es.c es.c es.c
-le ctur -le ctur -le ctur -le ctur
rsing sing be encouraged by early involvement in the child’s care.
sing sing
.nur
D- Family adaptation can .nur .nur
w ww w ww w ww
om om om
tur es.c GI Alterations es.c ture
s.c es.c
c ctur c -lec
tur
g- l e sing
-l e g-le sing
rsin I- Anomalies and r
.nu Obstructions. .nur
sin
.nur
w ww w ww ww
w
 Cleft lip & Cleft palate
 Pyloric stenosis
s.c om  Intussusception om om
ture Hirschsprung’s diseaseur es.c es.c es.c
c  ct ctur -lec
tur
g-le sing
-le g-le g
rsin .nur .nur
sin ur sin
II- Alterations associated with an inflammatory bowel disease
w w w.n
ww ww ww
 Inflammatory bowel diseases: Ulcerative colitis and Crohn disease.
om om om
tur es.c III- Malabsorption Alterationsres.c
tu ture
s.c
tur es.c
g -l e c -lec g-le
c -lec
rsin sing sin sing
.nur
 Celiac disease.
w w .nur .nur
ww ww w ww
IV- Gastroesophegeal Reflux (Chalasia)
om om om
tur es.c Anomalies and Obstructionsrofsthe Digestive Tract
tu e .c tur es.c tur es.c
g -lec g -lec -lec -lec
rsin 1) Cleft lip (CL) rsin cleft palate (CP) sing sin g
.nur ur
and
w .nu w w.n
ww ww ww
- Most common of all facial anomalies
s.c om
-Incidence rate of cleft lip is 1:7800.om om
ture ur es.c tur es.c tur es.c
g-l e
c
- Incidence rate of sing
lect
-palate alone is 1:2000 -lec -lec
rsin cleft sing sin g
w .nur w .nur .nur
ww ww www
s.c om om om
ture es.c ture
s.c es.c
-lec -le ctur -lec -le ctur

4. rsin ursin ur sin
.nur
sin
w.n w.n ww
ww ww w
s.c om s.c om s.c om
ture ture ture tur es.c
c - CL with or without CPlisc -lec -lec
g -l e sing
- e more common in males, and CPgalone is more common in
sing
rsin females
.nur .nur
sin
.nur
w w w
ww ww ww
- Genetic basis is present and the role of non-hereditary factors is not clear
om Cleft lip results from incompleteom of the embryonic structures surrounding the
om
es.c primitive oral cavity. The cleftres.cbe unilateral or bilateral and tis res.c associated with es.c
(1) fusion
-l e ctur -le ctu may -le c u often -le ctur
rsing sing sing
abnormal development of the external nose, nasal cartilages, nasal septum, and maxillary rsing
.nur .nur
alveolar ridges. It may or may not be associated with CP. Cleft lip can be slightly ww.n
u
ww ww
w
indentation (incomplete) or a widely opened w (complete). w
om Cleft palate occurs when the s om and secondary palatine plates .failm fuse during
(2) primary o to
es.c embryonic development. CPs may.c es c
e involve only the uvula (incomplete) or extend to both es.c
-le ctur le ctur le ctur -le ctur
the soft palate and hard -palate (complete cleft). Wide central-palatal clefts may be
rsing accompanied byur
sing or complete absence of nasal ursingdevelopment, resulting in sing
.n partial .n septal .nur
w ww between the nasal and oral cavities.
communication w ww w ww
(3) Cleft palate associated with cleft lip
es .com es.c
om s.c om
es.c
tur tur ture tur
g -lec -lec g-le
c -lec
rsin sing sin sing
w .nur .nur .nur
ww w ww ww
w
Selected Nsg Dx
om om om
r es.c than r
es.crequirements RT physical defect, s.c
eor difficulty eating es.c
lec tu 1- Altered nutrition: less ectubody
l -le ctur -le ctur
rsing- following surgical sing-
procedure. sing sing
.nur .nur .nur
ww ww ww
2- Risk w trauma of the surgical site RT surgical procedure, dysfunctional swallowing.
for w w
s.c omPain RT surgical procedure. s.com
3-
s.c om
ture ure ture tur es.c
g-l e
c lect g-le
c -lec
rsin ng-
4- Altered family processes.
sin sing
ursi .nur .nur
w.n w ww
ww
5- Potential for aspiration ww w
3- Potential for infection (otitis media).
es .com es.c
om
es.c
om
es.c
tur ur
4- Potential for impairedlect communication tur tur
g -lec - verbal -lec -lec
rsin sing sing sin g
w .nur w .nur w.n
ur
ww ww ww
Complications
om com om
r es.c• Due to the irregular shape turthe
es.c
es.palate it can cause speech difficulties. Sounds can be es.c
lec tu le c of -le ctur -lectur
rs in g - inner -
hard to hear with rsingear problems creating speech problems.
sing sing
.nu .nur .nur
w ww w ww w ww
s.c om om om
ture es.c ture
s.c es.c
-lec -le ctur -lec -le ctur

5. rsin ursin ur sin
.nur
sin
w.n w.n ww
ww ww w
s.c om s.c om s.c om
ture ture ture tures.c
c lec
• Can affect the development of teeth and jaws. lec -lec
g -l e ing- ing- g
rsin urs urs .nur
sin
w.nbite of a patient.
• Can affect the w.n ww
ww ww w
• Can lead to orthodontics, oral surgeries, or Prosthodontics in patients with Clefts.
om om om
r es.c es.c with the eustachian tube. tures.c bacteria gets es.c
lec tu e c ur
• The ear and soft palate laretconnected
-le cIf food or -le ctur
rsin g - ur ing-
into this area it canscreate infection. Thus children with sing tend to have more frequent rsing
Cleft
ear problems. .n .nur .nu
w ww w ww w ww
• Cleft reduces pressure buildup in the mouth making sucking weaker.
om om om
tur es.c • Increase in chance of Infection s.c
tur e es.c es.c
-lec -lec ctur -lec
tur
g sing g-le g
rsin .nur .nur
sin
ur sin
w w w.n
ww ww ww
Therapeutic Management
om om om
tur es.c (1) Surgical repair for cleft liprduring the first weeks of life (Z-plasty). .c
tu es.c tur es tur es.c
g -lec g -lec -lec -lec
rsin sing
(2) Initial surgicalrsin for cleft palate done during the 4-6 months of age. sing
w .nu repair w .nur w.nur
ww ww ww
• Surgical correction:cleft lip (1 to 2 months). cleft palate (6 to 18 months)
om om om
tur es.c Preoperative Nursing Careures.c
t tur es.c tur es.c
g -lec -lec and touch the baby in the earliestlhours or days
- Encourage parentsinghold
- ec -lec
rsin s to sing sin g
w .nur w .nur w.n
ur
ww ww
- Financial concerns must be discussed with parents ww
om
- Providing adequate nutrition and com om
preventing aspiration: use large, soft nipple with large
es.c holes, or long, soft nipples &uupright position during feeding. tures.c
es. es.c
-l e ctur -le ct r -le c -le ctur
rsing - Protected fromur
sing sing sing
.n otitis media .nur .nur
w ww w ww w ww
- feed upright; assess resp. status during feedings; feed slowly; burp frequently.
om om om
es.c Postoperative Nursing Care res.c es.c es.c
-le ctur -le ctu -le ctur -le ctur
rsing 1- Preventing the r sing sing sing
after r
.nu disturbance of the surgical site w.nuthe operation: restrains may be .nur
w ww
used. No straws, pacifiers, etc.; no tooth brushing; monitor site; remove restraints www
w w every
two hours.
s.c omPreventing aspiration om om
es.c s.c es.c
2-
c ture ctur lec ture tur
g-l e -le ing- -lec
rsin sing
3- Preventing infection s sin g
.nur .nur .nur
w ww ww
w
w ww
s.c om om om
ture es.c ture
s.c es.c
-lec -le ctur -lec -le ctur

6. rsin ursin ur sin
.nur
sin
w.n w.n ww
ww ww w
s.c om s.c om s.c om
ture ture ture tur es.c
c lec c -lec
g -l e 4- Providing optimal comfort
ing- g-le g
rsin urs ursin
.nur
sin
w.n w.n ww
ww
Follow-Up ww w
1- Plot height and weight to assess adequacy of nutritional intake
om om om
r es.c2- Discuss with parent anyctur
es.c es.c es.c
lec tu
-le
feeding concerns
-le ctur -le ctur
rsin g - sing sing sing
.nur . ur
3-Assess respiratory status for evidence of infectionnrelated to aspiration of milk or ww.n
ur
w ww w ww w
secretions
s.c omAssess the middle ear
4-
s.c om om
ture ture es.c es.c
c lec ctur -lec
tur
g-le ing-
5- Assess speech and teeth g-le g
rsin .nur
s
.nur
sin ur sin
w w w.n
ww
2) Hypertrophic Pyloric Stenosis (HPS) ww ww
- An overgrowth of the circular muscle of the pylorus, results in obstruction/ partially /
.com
es narrowing of the pyloric sphincter.c
es.
om
es.c
om
es.c
-le ctur -lectur -le ctur -le ctur
rsing sing sing sing
.nur .nur
- Cause is unknown, however there is a hereditary component.
.nur
w ww w ww w ww
- This condition usually develops in the first few weeks of life, causing projectile
vomiting, dehydration, metabolic alkalosis, and failure to thrive.
om om om
es.c - The stomach contractions increase in frequency and force to empty the stomach content.
es.c es.c es.c
-le ctur -le ctur -le ctur -le ctur
rsing sing sing sing
.nur .nur .nur
w ww w ww w ww
s.c om s.c om s.c om
ture ture ture tur es.c
c c c -lec
g-l e g-le g-le g
rsin ur sin
.nur
sin
.nur
sin
w.n w ww
ww ww w
s.c om s.com om
ture ture r es.c tur es.c
g-le
c
g-le
c -lectu -lec
rsin ursi
n sing sin g
w.n w .nur w.n
ur
CM: ww ww ww
1- Regurgitate small amounts of milk m
immediately after feeding
om o om
r es.c es.c ture
s.c es.c
-lec
tu
-le ctur
2- Vomiting become projectile lec -lec
tur
rsin
g sing s ing- sin g
.nur .nur .nur
w ww ww
w
www
s.c om om om
ture es.c ture
s.c es.c
-lec -le ctur -lec -le ctur

7. rsin ur sin ursin
.nur
sin
w.n w.n ww
ww ww w
s.com s.c om s.c om
ture ture ture tur es.c
c lec
3- Vomiting may occur -during feeding or shortly after feedingec even after hours of -lec
g -l e sing sing
-l or
sing
rsin feeding
.nur .nur .nur
w w w
ww ww ww
4- Vomitus contain no bile
s.c om om om
es.c es.c es.c
5-Gastritis may occur due to prolonged stay of stomach content
c ture tur tur tur
g -l e 6- Wt lose, FTT. rsing
-lec -lec -lec
rsin sing sin g
.nu .nur .nur
ww ww
w ww
7- Signsw dehydration
of w
s.c om assessment
Dx
s.c om om
ture ture es.c es.c
lec c ctur ctur
g- le
1- in 90% of the infants-with pyloric stenosis, the mass cang-le -le
sing of the liver (olivelike mass)sin sing
be palpated in the right
rsin epigastriumw.nur the edge
under .nur .nur
w w w ww w ww
2- peristaltic waves can be noted after feeding moving from left to right
om om om
es.c 3- Radiograph and ultrasonography
es.c es.c es.c
-le ctur -lectur -le ctur -le ctur
rsing sing (pyloromyotomy: longitudinalngsi incision through the circular ursing
.nur
Tx Management: surgery
.nur w.n
w ww
muscle fibers of the pylorus down to submucosa)w
w w ww
Nursing Care
om om om
tu r es.c and r
es.c
1- Rehydration the infantectusupporting the parents tur es.c tures.c
g -lec -l -lec -lec
rsin sing sing sin g
2- Preventww .nur
postoperative fluid volume deficit ww .nur w.n
ur
w w ww
3- Providing optimal comfort: using pharmacological and non-pharmacological strategies
om om om
tur es.c 4- Teaching to facilitate careures.c
t at home ture
s.c
tur es.c
g -l e c -lec g-le
c -lec
rsin sing sin sing
Follow-up w.nur w .nur .nur
ww ww w ww
1- plot wt and Ht
om om om
tur es.c 2- infants' Temp and inspecttures.c
the surgical site
tur es.c tur es.c
g -lec -lec -lec -lec
rsin sing s g
3- ask the parentuabout fluid intake/ episodes of vomitingin sin g
w .n r w .nur w.n
ur
ww ww ww
4- encourage parent to express their concerns
om om om
tur es.c 3) Intussusception es.c ture
s.c es.c
c ctur lec -lec
tur
g-l e sing
-le ing- g
rsin .nur .nur
s
.nur
sin
w ww ww
w
www
s.c om om om
ture es.c ture
s.c es.c
-lec -le ctur -lec -le ctur

8. rsin ursin ur sin
.nur
sin
w.n w.n ww
ww ww w
s.com s.c om s.c om
ture ture ture tur es.c
c Is an invagination of partec the intestine into an adjacent distal c -lec
g -l e sing
-l of ing -le portion of the intestine. It g
rsin occurs in healthy,rmale infants around 6 -months ofnursand rarely occur before 3-months ursin
.nu . age .n
ww
w
or after 3-years of age. The cause is unknown. ww most common type is near the www
wThe
ileocecal valve pushing into the cecum and onto the colon. The involved intestine become
inflamed and edematous with bleeding from the mucosa. Untreated intussusception can
om to intestinal gangrene, peritonitism death
s.c lead s.co and s.co
m
tur e tur e tur e tures.c
g -l e c g -lec -lec -lec
rsin si n sing sin g
w .nur w .nur .nur
ww ww w ww
s.c om s.com om
ture ture es.c es.c
c c ctur -lec
tur
g-le g-le g-le g
rsin .nur
sin
.nur
si n
ur sin
ww w w.n
w ww ww
s.c om om om
ture es.c ture
s.c es.c
c ctur c -lec
tur
g- l e sing
-le g-le sing
rsin .nur .nur
sin
.nur
w ww w
ww w ww
s.c om om om
ture tur es.c es.c es.c
c c ctur -lec
tur
g-le g-le g-le g
rsin sin sin
.nur compressed and angled, resulting ur lymphatic and venous
.n in ursin
• The mesentery is
w w w.n
ww
obstruction.
ww ww
om the edema from the obstructionom
• As of m
increases, pressure within the area.cointussusception
es.c increases. es.c es es.c
-l e ctur -le ctur -le ctur -le ctur
rsing sing sing sing
.nur .nur
• When the pressure equals the arterial pressure, arterial blood flow stops, resulting inw.nu
r
w wwthe pouring of mucus into the intestine
ischemia and w ww w w
• Venous engorgement also leads to leaking of blood and mucus into the intestinal lumen
om om om
es.c forming the classic currant-jelly s.c
estools es.c es.c
-le ctur -le ctur -le ctur -le ctur
rsing sing the Dx ( initially an abdominalng
si radiograph is obtained to detect ursing
.nur
A barium enema confirms .nur .n
w ww w ww
intraperitoneal air from a bowel perforation, which contraindicate a barium enema) ww
w
s.c om c om s.c om
ture res. ture tur es.c
c Clinical Manifestations: ctu lec
g-l e -le ing- -lec
rsin sing s sin g
.nur .nur .nur
w ww ww
w
www
s.c om om om
ture es.c ture
s.c es.c
-lec -le ctur -lec -le ctur