Anatomy and Physiology of the Gastrointestinal System of Children Mouth highly vascular entry point of infection Esophagus LES not fully developed until age 1 causing regurgitation Newborn stomach capacity only 10 to 20 mL ID: 998913
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1. Chapter 42: Nursing Care of the Child With an Alteration in Bowel Elimination/Gastrointestinal Disorder
2. Anatomy and Physiology of the Gastrointestinal System of ChildrenMouth: highly vascular; entry point of infectionEsophagus: LES not fully developed until age 1, causing regurgitationNewborn stomach capacity only 10 to 20 mL Intestines: small intestine not mature at birthBiliary system: liver relatively large at birth; pancreatic enzymes develop postnatally until around 2 years old Fluid balance and losses: low fluid volume maintained
3. Medical TreatmentMost common result of GI illness is dehydration, requiring fluid therapy at home or, in more extreme cases, in the hospital
4. Laboratory and Diagnostic TestsMonitoring the blood count, electrolyte levels, and liver function tests is necessary in many pediatric GI disorders.
5. Laboratory and Diagnostic Tests for AppendicitisAbdominal computed tomography (CT) scan: performed to visualize the appendix for further evaluationLaboratory testing: may reveal an elevated white blood cell countC-reactive protein: may be elevated
6. Medication Therapy Oral CandidiasisAppropriate administration of oral antifungal agents by administering Mycostatin suspension four times per day following feeding to allow the medication to remain in contact with the lesions.
7. Medications to Manage Short Bowel SyndromeAntibiotics to control bacterial overgrowthVitamin and mineral supplementation to replace lost vitaminsAntidiarrheal agents such as loperamide and gastric acid–suppressive medications to decrease stool outputTPN for extended periods for adequate growthProgression to enteral feeding may occur extremely slowly
8. Anomalies and Complications Associated With Cleft Lip and PalateAnomaliesHeart defectsEar malformationsSkeletal deformitiesGenitourinary abnormalityComplicationsFeeding difficultiesAltered dentitionDelayed or altered speech developmentOtitis media
9. Risk Factors for DehydrationDiarrheaVomitingDecreased oral intakeSustained high feverDiabetic ketoacidosisExtensive burns
10. Risk Factors for Oral CandidiasisYoung ageImmune suppressionAntibiotic useUse of corticosteroid inhalersFungal infection in the mother
11. Risk Factors for IntussusceptionMale gender (higher incidence)Meckel diverticulumDuplication cystsPolyps, hemangiomas, tumorsAppendixCystic fibrosisCeliac diseaseCrohn disease
12. Acute GI DisordersDehydration, vomiting, and diarrheaOral candidiasis and oral lesionsHypertrophic pyloric stenosisNecrotizing enterocolitisIntussusception, malrotation, and volvulus Appendicitis
13. Structural Anomalies of the GI TractCleft lip and palateOmphalocele and gastroschisisHernias (inguinal and umbilical)Anorectal malformations
14. Question Is the following statement True or False? The nurse is caring for a child with diarrhea related to infectious enteritis. The nurse accurately informs the parents that most cases of diarrhea are bacterial in nature and therapeutic management is usually supportive in nature.
15. Answer False. Most cases of diarrhea are viral in nature and therapeutic management is usually supportive in nature. Since most cases of diarrhea are acute and viral in nature, therapeutic management of diarrhea is usually supportive (maintaining fluid balance and nutrition). Probiotic supplementation may decrease the length and extent of diarrhea. Bacterial and parasitic causes of diarrhea may be treated with antibiotics or antiparasitic medications, respectively.
16. Chronic GI DisordersGastroesophageal reflux, peptic ulcer diseaseConstipation/encopresisHirschsprung diseaseShort bowel syndromeInflammatory bowel diseaseCeliac diseaseRecurrent abdominal painFailure to thrive and chronic feeding problems
17. Esophageal AtresiaCongenitally interrupted esophagus where the proximal and distal ends do not communicateUpper esophageal segment ends in a blind pouchLower segment ends a variable distance above the diaphragm
18. Common Gastrointestinal IllnessesImperforate anus: congenital malformation of the anorectal opening Pyloric stenosis and point out that hypertrophic pyloric stenosis is one of the most common conditions requiring surgery in the first 2 months of life. Note that a pyloromyotomy is performed to cut the muscle of the pylorus and relieve the gastric outlet obstruction Intussusception is a process that occurs when a proximal segment of bowel “telescopes” into a more distal segment, causing edema, vascular compromise, and, ultimately, partial or total bowel obstruction
19. Common Gastrointestinal Illnesses (cont.)Appendicitis is the most common cause of emergent abdominal surgery in childrenHirschsprung disease is the most common cause of neonatal intestinal obstruction and is characterized by constipation in newborns
20. Signs and Symptoms of Crohn Disease and Ulcerative ColitisAbdominal crampingNighttime symptoms, including waking due to abdominal pain or urge to defecateFeverWeight lossPoor growthDelayed sexual development
21. Recurrent Abdominal PainFunctional abdominal painNonulcer dyspepsiaIrritable bowel syndrome
22. Hepatobiliary DisordersPancreatitisGallbladder diseaseJaundiceBiliary atresiaHepatitisCirrhosis and portal hypertension Liver transplantation
23. PancreatitisAbdominal traumaDrugs and alcoholMultisystem diseaseInfectionsCongenital anomaliesObstructionMetabolic disorders
24. CholelithiasisPresence of stones in the gallbladderAssociated withHyperlipidemiaObesityPregnancyBirth control pill useCystic fibrosis
25. Stool DiversionCreation of an ostomyIleostomyColostomy
26. Nursing InterventionsAssess infants and children with an inguinal hernia for the presence of a bulging mass in the lower abdomen or groin areaTherapeutic management of vomiting most often involves slow oral rehydration and at times may require administration of antiemeticsCeliac disease is a strict gluten-free diet, which will cause the villi of the intestines to heal and function normally, with subsequent improvement of symptoms
27. Data Collected in the Physical AssessmentAuscultationHyperactive or hypoactive bowel soundsPercussionDullness, flatness, tympanyPalpationReserve for last in sequence; palpable kidneys may indicate tumor or hydronephrosis; right lower quadrant pain may warn of appendicitis
28. Question The nurse is auscultating the bowel sounds of a 4-year-old child and documents hypoactive bowel sounds. What might this finding indicate? a. obstruction b. gastroenteritis c. diarrhea d. infection
29. Answer a. obstruction Hypoactive bowel sounds indicate obstruction. Hypoactive or absent bowel sounds may indicate an obstructive process. Hyperactive bowel sounds may be noted in children with diarrhea or gastroenteritis. Fever is an indicator of infection.
30. Nursing Management of a Newborn With Meckel DiverticulumSigns and symptomsBleeding, anemia, severe colicky abdominal painAbdominal distention, hypoactive bowel sounds, guarding, abdominal mass, rebound tendernessManagementAdminister ordered blood products and IV fluidsMaintain NPO statusPerform postoperative care and family education
31. Teaching PlanChild and family education related to the treatment of GI disorders is key to preventing the illness from progressing to an emergency situationDehydration need to restore fluid volume and prevent progression to hypovolemiaVomiting to focus on promotion of fluid and electrolyte balanceNurses should teach parents that to facilitate daily bowel evacuation, the child should sit on the toilet twice a day (after breakfast and dinner) for 5 to 15 minutes
32. Psychosocial ImpactConstipation can be a very stressful process for both the child and family and behavior modification is necessary for manShort bowel syndrome considered to be medically fragile for a lengthy period, causing much anxiety related to the initial bowel resection that resulted in short bowel childrenLong-term hospitalization is required for GI disorders, causing parents to miss work and cutting down on the time they have to spend with other children