Children with Gastrointestinal Dysfunction
Child
ren
with
Gastrointestinal
Dysfunction
Dr
.
Reda Elfeshawy
Assistant
professor
of pediatric nursing
•
Definition
•
Signs
and
symptoms
•
Causes
•
Complication
•
Assessment
and
diagnostic
evaluation
•
Therapeutic
management
•
Nursing
diagnosis
•
Nursing
care
management
Anatomy
And
Physiology
•
The
gastrointestinal
(GI)
system
involves
the
area
from
the
mouth
to
the
anus
and
includes
the
organs
responsible
for
digestion
and
elimination
.
The
organs
in
this
system
include:
■
Mouth
■
pharynx
■
Esophagus
■
Stomach
■
Small
and
large
intestines
■
Liver,
gallbladder,
and
associated
bile
ducts
Pancreas
(
Accessory digestive organs )
Gastrointestinal
Dysfunction
•
Disorders
that
impair
the
functional
integrity
of
the
GI
system
have
the
potential
for
causing
serious
alterations
in
fluid
and
electrolyte
balance.
•
Disorders
that
involve
GI
losses
of
large
amounts
of
fluid,
absorption
disorders,
inflammatory
disorders,
and
decreased
or
excessive
water
intake
have
the potential
for causing
fluid
and
electrolyte
imbalance
in infants
and
children.
•
Disorder
involve
the
stomach
and
intestines
(
gastroenteritis
),
the
small
intestine
(enteritis),
the
colon
(colitis),
or
the
colon
and
intestines
(enterocolitis).
G
ASTROENTERITIS
G
A
S
T
R
O
E
N
T
E
R
I
T
I
S
Is the inflammation of the lining of the stomach and small
and large intestines. The most common cause of this
disease is infection obtained from consuming food or
water. A variety of bacteria, viruses, and parasites are
associated with gastroenteritis.
Gastroenteritis is a very common condition that causes
diarrhea and vomiting.
Signs
and
symptoms
of
gastroenteritis
■
Watery
diarrhea
■
Abdominal
cramping
■
Vomiting
■
Headache
■
May
have
fever
and
chills
■
Signs
of
dehydration
—
depressed
fontanels,
lack
of
tears,
poor
skin
turgor, lethargy
■
Symptoms
last
from
1
to
2
days
up
to
10
days
Diarrhea
•
Diarrhea
is
a
symptom
that
results
from
disorders
involving
digestive,
absorptive,
and
secretory
functions
of
GIT.
Diarrhea
is
classified
as
acute
or
chronic
.
•
Etiology
most pathogens
that
cause
diarrhea
are
spread
by
the
fecal–oral
route
through
contaminated
food
or
water
or
are
spread
from
person
to
person
where
there
is
close
contact
(e.g.,
daycare
centers).
Lack
of
clean
water,
crowding,
poor
hygiene,
nutritional
deficiency,
and
poor
sanitation
are
major
risk
factors,
especially
for
bacterial
or
parasitic
pathogens.
•
Worldwide,
there
are
an
estimated
1.3
billion
episodes
of
diarrhea
each
year.
Approximately
24%
of
all
deaths
in
children
living
in
developing
countries
are
related
to
diarrhea
and
dehydration.
T
h
e
r
a
p
e
u
t
i
c
M
a
n
a
g
e
m
e
n
t
The
major
goals
in
the
management
of
gastroenteritis
or
acute
diarrhea
include
(1)
assessment
of
fluid
and
electrolyte
imbalance
(2)
rehydration
therapy
(every
1
/
2
hour—ORS)
(3)
maintenance
fluid
therapy
(4)
reintroduction
of
an
adequate
diet.
■
If
severe
diarrhea
or
vomiting,
may
institute
IV
therapy
■
Antibiotics
may
be
administered
if
stool
culture
is
positive.
■
If
patient
is
not
dehydrated
,
care
may
be
given
at
home.
■
Moisturize
lips
with
Vaseline.
■
Keep
perineal
area
clean
and
dry
between
diarrhea
episodes.
FORMULA
FOR
FLUID
MAINTENANCE
•
100
mL/kg
for
first
10
kg
•
50
mL/kg
for
next
10
kg
•
20
mL/kg
for
remaining
kg
•
Add
together
for
total
mL
needed
per
24-
hour
period.
•
Divide
by
24
for
mL/hour
fluid
requirement.
Ex.
Thus,
for
a
23-
kg
child:
•
100
×
10
=
1,000
•
50
×
10
=
500
•
20
×
3
=
60
•
1,000
+
500
+
60
=
1,560
ml
/day
1,560/24
=
65
mL/hour
Nursing Interventions
Fluid Volume Deficit:
1.
Monitor vital signs, intake, and output closely to assess fluid balance.
2.
Encourage oral rehydration with clear fluids or oral rehydration
solutions (ORS) to replace fluids and electrolytes lost through vomiting
and diarrhea.
3.
Administer intravenous fluids as prescribed to correct dehydration
and maintain adequate hydration.
4.
Assess for signs of severe dehydration, such as tachycardia,
hypotension, or altered mental status, and promptly report to the
healthcare team.
Imbalanced Nutrition: Less than Body Requirements:
1.
Assess the patient’s nutritional status, dietary intake, and weight
changes.
2.
Offer small, frequent meals of easily digestible foods, such as rice,
toast, bananas, and yogurt, to provide nutrients and promote gradual
refeeding.
3.
Encourage the patient to consume clear liquids or easily digestible
during the acute phase of gastroenteritis.
4.
Provide education on the gradual reintroduction of regular foods,
avoiding spicy or fatty foods that may exacerbate symptoms.
Risk for Infection:
1.
Practice strict hand hygiene and adhere to infection prevention
protocols.
2.
Implement isolation precautions as indicated, particularly for patients
with highly contagious or infectious gastroenteritis.
3.
Educate the patient and caregivers about proper hand hygiene,
including thorough handwashing with soap and water, to prevent the
spread of infection.
Cleft
Lip
and
Palate
C
l
e
f
t
L
i
p
a
n
d
P
a
l
a
t
e
•
Cleft
lip
(CL)
and
palate
(CP)
is
the
most
common
congenital
craniofacial
anomaly,
they
may
appear
separately
or,
more
often,
together.
It
occurs
frequently
in
association
with
other
anomalies.
•
CL
results
from
failure
of
the
maxillary
and
median
nasal
processes
to
fuse;
•
CP
is
a
midline
fissure
of
the
palate
that
results
from
failure
of
the
two
palatal
processes
to
fuse.
The
incidence
:
occurring
once
in
every
700
births
worldwide.
Cleft lip is a condition where there is a gap or split in the upper lip,
often extending upward toward the nose. This gap can be small or
extensive and may occur on one or both sides of the lip.
Cleft palate, on the other hand, is a condition where there is an opening or gap
in the roof of the mouth (palate). This gap may extend from the front of the
mouth toward the back, and it can vary in size and severity.
Clinical
Manifestations
•
The
infant
with
cleft
lip
may
have
•
D
ifficulty
suction
for
feeding
and
may
also
experience
•
E
xcessive
air
intake.
•
Gagging,
choking,
and
nasal
regurgitation
of
milk
may
occur
in
babies
with
cleft
palate
.
•
Excessive
feeding
time,
inadequate
intake,
and
fatigue
contribute
to
insufficient
growth.
Complications
of
cleft
lip
and
palate
include
•
feeding
difficulties
•
altered
dentition
•
delayed
or
altered
speech
development,
and
•
otitis
media.
T
h
e
r
a
p
e
u
t
i
c
M
a
n
a
g
e
m
e
n
t
•
T
r
e
a
t
m
e
n
t
o
f
t
h
e
c
h
i
l
d
w
i
t
h
C
L
a
n
d
C
P
i
n
v
o
l
v
e
s
t
h
e
c
o
o
p
e
r
a
t
i
v
e
e
f
f
o
r
t
s
o
f
a
m
u
l
t
i
d
i
s
c
i
p
l
i
n
a
r
y
h
e
a
l
t
h
c
a
r
e
t
e
a
m
.
c
l
e
f
t
l
i
p
s
h
o
u
l
d
b
e
r
e
p
a
i
r
s
u
r
g
i
c
a
l
l
y
a
r
o
u
n
d
t
h
e
a
g
e
o
f
2
t
o
3
m
o
n
t
h
s
a
n
d
c
l
e
f
t
p
a
l
a
t
e
a
t
9
t
o
1
8
m
o
n
t
h
s
.
•
Management
is
directed
toward
closure
of
the
cleft(s),
prevention
of
complications,
and
facilitation
of
normal
growth
and
development.
Nursing
diagnosis
•
Altered
Nutrition:
Less
Than
Body
Requirements
related
to
deficient
oral
intake
and
inability
to
suck
effectively
(preoperative
CL/CP)
or difficulty
eating
after
surgical
procedure
(postoperatively)
•
Risk
for
Altered
Parenting
related
to
infant
with
a
highly
visible
physical
defect
•
Pain
related
to
tissue
trauma
•
Risk
for
Trauma
of
the
surgical
site
related
to
infant’s
hand-to-mouth
activity
•
Altered
Family
Processes
related
to
child’s
hospitalization
and
surgical
correction
of
phy
sical
defect
N
u
r
s
i
n
g
C
a
r
e
M
a
n
a
g
e
m
e
n
t
•
T
h
e
i
m
m
e
d
i
a
t
e
n
u
r
s
i
n
g
c
a
r
e
f
o
r
a
n
i
n
f
a
n
t
w
i
t
h
C
L
/
P
d
e
f
o
r
m
i
t
i
e
s
a
r
e
r
e
l
a
t
e
d
t
o
f
e
e
d
i
n
g
.
I
n
a
d
d
i
t
i
o
n
t
o
•
Promoting
Adequate
Nutrition
(preoperatively)
•
Preventing
Injury
to
the
Suture
Line
(Postoperatively
)
•
Encouraging
Infant–Parent
Bonding
•
Providing
Emotional
Support
Maintain adequate nutrition
. Breastfeeding may be
successful because the breast tissue may mold to close the
gap; if the newborn cannot be breastfed, the mother’s
breast milk may be expressed and used instead of
formula; a soft nipple with a cross-cut made to promote
easy flow of milk may work well.
Positioning
. If the cleft lip is unilateral, the nipple should
be aimed at the unaffected side; the infant should be kept
in an upright position during feeding.
Tools for feeding
. Cross-cut nipple, Lamb’s nipples (extra long,
soft nipples
or several extra holes.
) and special cleft palate nipples
molded to fit into the open palate area to close the gap may be
used.
Promote family coping
. Encourage the family to verbalize
their feelings regarding the defect and their
disappointment; serve as a model for the family
caregiver’s attitudes toward the child.
Reduce family anxiety
. Give the family information about
cleft repairs; encourage them to ask questions and reassure
them that any question is valid.
Provide family teaching
. Explain the usual routine of
preoperative, intraoperative, and post-operative care;
written information is helpful, but be certain the parents
understand the information.
Thank you
Gastrointestinal dysfunction in children can lead to serious fluid and electrolyte imbalances, impacting their health. Learn about the anatomy, causes, and symptoms of GI disorders, including gastroenteritis. Discover more about the signs, symptoms, and management of conditions like diarrhea. Explore insights for assessing and diagnosing pediatric gastrointestinal issues to provide optimal nursing care.
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Presentation Transcript
Children with Gastrointestinal Dysfunction Dr . Reda Elfeshawy Assistant professor of pediatric nursing
Outline Definition Signs and symptoms Causes Complication Assessment and diagnostic evaluation Therapeutic management Nursing diagnosis Nursing care management
Anatomy And Physiology The gastrointestinal (GI) system involves the area from the mouth to the anus and includes the organs responsible for digestion and elimination. The organs in this system include: Mouth pharynx Esophagus Stomach Small and large intestines Liver, gallbladder, and associated bile ducts Pancreas (Accessory digestive organs )
Gastrointestinal Dysfunction Disorders that impair the functional integrity of the GI system have the potential for causing serious alterations in fluid and electrolyte balance. Disorders that involve GI losses of large amounts of fluid, absorption disorders, inflammatory disorders, and decreased or excessive water intake have the potential for causing fluid and electrolyte imbalance in infants and children. Disorder involve the stomach and intestines (gastroenteritis), the small intestine (enteritis), the colon (colitis), or the colon and intestines (enterocolitis).
G GASTROENTERITIS ASTROENTERITIS
GASTROENTERITIS Is the inflammation of the lining of the stomach and small and large intestines. The most common cause of this disease is infection obtained from consuming food or water. A variety of bacteria, viruses, and parasites are associated with gastroenteritis. Gastroenteritis is a very common condition that causes diarrhea and vomiting.
Signs and symptoms of gastroenteritis Waterydiarrhea Abdominal cramping Vomiting Headache May have fever and chills Signs of dehydration depressed fontanels, lack of tears, poor skin turgor, lethargy Symptoms last from 1 to 2 days up to 10 days
Diarrhea Diarrhea is a symptom that results from disorders involving digestive, absorptive, and secretory functions of GIT. Diarrhea is classified as acute or chronic. Etiology most pathogens that cause diarrhea are spread by the fecal oral route through contaminated food or water or are spread from person to person where there is close contact (e.g., daycare centers). Lack of clean water, crowding, poor hygiene, nutritional deficiency, and poor sanitation are major risk factors, especially for bacterial or parasitic pathogens. Worldwide, there are an estimated 1.3 billion episodes of diarrhea each year. Approximately 24% of all deaths in children living in developing countries are related to diarrhea and dehydration.
Therapeutic Management The major goals in the management of gastroenteritis or acute diarrhea include (1) assessment of fluid and electrolyte imbalance (2) rehydration therapy (every 1/2 hour ORS) (3) maintenance fluid therapy (4) reintroduction of an adequate diet. If severe diarrhea or vomiting, may institute IV therapy Antibiotics may be administered if stool culture is positive. If patient is not dehydrated, care may be given at home. Moisturize lips with Vaseline. Keep perineal area clean and dry between diarrhea episodes.
FORMULA FOR FLUID MAINTENANCE 100 mL/kg for first 10 kg 50 mL/kg for next 10 kg 20 mL/kg for remaining kg Add together for total mL needed per 24-hour period. Divide by 24 for mL/hour fluid requirement. Ex. Thus, for a 23-kg child: 100 10 = 1,000 50 10 = 500 20 3 = 60 1,000 + 500 + 60 = 1,560 ml /day 1,560/24 = 65 mL/hour
Nursing Interventions Fluid Volume Deficit: 1.Monitor vital signs, intake, and output closely to assess fluid balance. 2.Encourage oral rehydration with clear fluids or oral rehydration solutions (ORS) to replace fluids and electrolytes lost through vomiting and diarrhea. 3.Administer intravenous fluids as prescribed to correct dehydration and maintain adequate hydration. 4.Assess for signs of severe dehydration, such as tachycardia, hypotension, or altered mental status, and promptly report to the healthcare team.
Imbalanced Nutrition: Less than Body Requirements: 1.Assess the patient s nutritional status, dietary intake, and weight changes. 2.Offer small, frequent meals of easily digestible foods, such as rice, toast, bananas, and yogurt, to provide nutrients and promote gradual refeeding. 3.Encourage the patient to consume clear liquids or easily digestible during the acute phase of gastroenteritis. 4.Provide education on the gradual reintroduction of regular foods, avoiding spicy or fatty foods that may exacerbate symptoms.
Risk for Infection: 1.Practice strict hand hygiene and adhere to infection prevention protocols. 2.Implement isolation precautions as indicated, particularly for patients with highly contagious or infectious gastroenteritis. 3.Educate the patient and caregivers about proper hand hygiene, including thorough handwashing with soap and water, to prevent the spread of infection.
Cleft Lip and Palate Cleft lip (CL) and palate (CP) is the most common congenital craniofacial anomaly, they may appear separately or, more often, together. It occurs frequently in association with other anomalies. CL results from failure of the maxillary and median nasal processes to fuse; CP is a midline fissure of the palate that results from failure of the two palatal processes to fuse. The incidence : occurring once in every 700births worldwide.
Cleft lip is a condition where there is a gap or split in the upper lip, often extending upward toward the nose. This gap can be small or extensive and may occur on one or both sides of the lip.
Cleft palate, on the other hand, is a condition where there is an opening or gap in the roof of the mouth (palate). This gap may extend from the front of the mouth toward the back, and it can vary in size and severity.
Clinical Manifestations The infant with cleft lip may have Difficulty suction for feeding and may also experience Excessive air intake. Gagging, choking, and nasal regurgitation of milk may occur in babies with cleft palate. Excessive feeding time, inadequate intake, and fatigue contribute to insufficient growth.
Complications of cleft lip and palate include feedingdifficulties altereddentition delayedor alteredspeech development, and otitismedia.
Therapeutic Management Treatment of the child with CL and CP involves the cooperative efforts of a multidisciplinary health care team. cleft lip should be repair surgically around the age of 2 to 3 months and cleft palate at 9 to 18 months. Management is directed toward closure of the cleft(s), prevention of complications, and facilitation of normal growth and development.
Nursing diagnosis Altered Nutrition: Less Than Body Requirements related to deficient oral intake and inability to suck effectively (preoperative CL/CP) or difficulty eating after surgical procedure (postoperatively) Risk for Altered Parenting related to infant with a highly visible physical defect Pain related to tissue trauma Risk for Trauma of the surgical site related to infant s hand-to-mouth activity Altered Family Processes related to child s hospitalization and surgical correction of phy sical defect
Nursing Care Management The immediate nursing care for an infant with CL/P deformities are related to feeding. In addition to Promoting Adequate Nutrition (preoperatively) Preventing Injury to the Suture Line (Postoperatively ) Encouraging Infant Parent Bonding Providing Emotional Support
Maintain adequate nutrition. Breastfeeding may be successful because the breast tissue may mold to close the gap; if the newborn cannot be breastfed, the mother s breast milk may be expressed and used instead of formula; a soft nipple with a cross-cut made to promote easy flow of milk may work well. Positioning. If the cleft lip is unilateral, the nipple should be aimed at the unaffected side; the infant should be kept in an upright position during feeding.
Tools for feeding. Cross-cut nipple, Lambs nipples (extra long, soft nipples or several extra holes.) and special cleft palate nipples molded to fit into the open palate area to close the gap may be used.
Promote family coping. Encourage the family to verbalize their feelings regarding the defect and their disappointment; serve as a model for the family caregiver s attitudes toward the child. Reduce family anxiety. Give the family information about cleft repairs; encourage them to ask questions and reassure them that any question is valid. Provide family teaching. Explain the usual routine of preoperative, intraoperative, and post-operative care; written information is helpful, but be certain the parents understand the information.
