Lecture 6 Part Two 1 Omphalocele the bowel protrudes outside of the body through a defect in the umbilical cord A membrane covers the bowel and protects it from damage and germs Omphalocele occurs early in the babys development ID: 926586
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Slide1
Alteration in Gastrointestinal Function
Lecture 6
Part Two
1
Slide2Omphalocele
the bowel protrudes outside of the body through a defect in the umbilical cord. A membrane covers the bowel and protects it from damage and germs. Omphalocele occurs early in the baby’s development. It may be detected on an ultrasound before the baby is born.
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Slide3Omphalocele
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Slide4omphalocele
Prevalence of omphalocele is 2.5 in 10000 births.May associated with other congenital anomaliesTreatment involves:Protecting the site from injury.Providing fluids and warmth.Surgical repair to replace the abdominal content
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Slide5Gastroschisis
The bowel comes out of the abdomen through a defect (abnormal opening) in the abdominal wall. There is no membrane covering to protect these organs. So, they’re more likely to become damaged or infected. If doctor sees gastroschisis on an ulstrasound, he or she will probably deliver your baby by
cesarean section. This helps lessen damage to the bowel.5
Slide6Abdominal organs may include small intestine and ascending colon.1: 10000 births Survival rate: 92%
Gastroschisis
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Slide7Gastroschisis
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Slide8Collaborative care:
Elevated Maternal serum alpha fetoprotien MSAFP and ultrasonography lead to early diagnosis .Intensive care is needed to manage fluid status and Temperature regulation and infection control.Surgical care.
Prosthetic silo around a gastroschisis.8
Slide9Treatment
Vital signIV is placed and a naso-gastric (NG) tube (a tube is placed to decompress the intestine. Repair of gastroschisis involves returning the extra-abdominal contents back into the abdominal cavity, followed by abdominal wall closureThis can either be performed with an immediate primary gastroschisis
repair or, more commonly, a repair done in a series of steps (staged), depending upon postnatal assessment9
Slide10Nursing Management
Following the physician protocol:Sterile guaze soaked in warm normal saline.Monitor vital sign especially temprature.The child
sould be in warmer.Inspect of infectionNPO.10
Slide11Post operative
Control pain.Prevent infectionFluid and electrolyte balance.first feedings are provided through an intravenous (IV) line. Once intestinal function returns, oral feedings or feedings via an NG tube are slowly started while IV feeds continue.Parants care.
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Slide12Intussusception
Intussusception is a serious disorder in which part of the intestine slides into an adjacent part of the intestine. This "telescoping" often blocks food or fluid from passing through. Intussusceptions also cuts off the blood supply to the part of the intestine that's affected. Intussusception
can lead to a tear in the bowel (perforation), infection and death of bowel tissue. 12
Slide13Symptoms
Stool mixed with blood and mucusVomiting A lump in the abdomen Lethargy Diarrhea Fever Constipation
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Slide14Etiology
Idiopathic cause Viral infectionUse of medication.The body inflammatory mediators The most common site of intussusception is iliosecal
valve14
Slide15Diagnosis
Radiograph UltrasoundContrast enema can be diagnostic and therapeutic Surgical intervention
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Slide16Nursing management
Fluid & electrolytes, monitoring, NG to suction , pain meds, antibiotics, barium/air enemaVital sign Check abdominal distention.Listen bowel movement q 4 hrs.Feeding are advanced to milk if tolerated.
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Slide17Hyperbilirubinemia
The term refers to an excessive level of accumulated bilirubin in the blood.Characterized by jaundice, or icterus, a yellowish discoloration of the skin, sclera, and nails.It is a common finding in the newborn.
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Slide18Pathophysiology
Normally the body is able to maintain a balance between the destruction of RBC and the use or excretion of productsDestruction of RBC= heme+
globin.Globin (protein) portion is used by the body.Heme portion is converted to unconjugated bilirubin: an insoluble substance bound to albumin.In the liver: the unconjugated bilirubin with the presence of the enzyme glucuronyl
transferase
is conjugated
produce
a highly soluble substance,
conjugated bilirubin
. Which is then excreted into the bile.
In the intestine , bacterial action reduces the conjugated bilirubin to
urobilinogen
, the pigment that gives stool its characteristic color.
Most of reduced bilirubin is excreted through the feces; a small amount is eliminated in the urine
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Slide19Causes of Hyperbilirubinemia in the newborns
Physiologic factors (prematurity).Excess production of bilirubin (hemolytic disease, bruises).
Disturbed capacity of the liver to secrete conjugated bilirubin (enzyme deficiency, bile duct obstruction).Combined overproduction and under secretion (sepsis).Some disease states (hypothyroidism)19
Slide20Hyperbilirubinemia
Types of Unconjugated Hyperbilirubinemia:Physiological jaundice.
Breast-feeding associated jaundice (early onset).Breast milk jaundice( late onset).Hemolytic disease.20
Slide21Diagnostic evaluation
The degree of jaundice is determined by serum bilirubin measurements. (invasive method)Normal values of unconjugated bilirubin are 0.2 to 1.4 mg/dl.
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Slide22Complication
Bilirubin encephalopathy: Kernicterus
a syndrome of sever brain damage resulting from the deposition of unconjugated bilirubin in brain cells called: Factors that enhance the development of bilirubin encephalopathy include:Metabolic acidosis.
Lowered serum albumin levels.
Intracranial infection as meningitis.
Increase in blood pressure
.
Signs:
CNS depression. or excitation .decrease activity, lethargy; irritability,
hypotonia
, and seizures.
Later signs
: cerebral palsy, mental retardation, deafness.
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Slide23Therapeutic management
The main form of treatment involves:1. the use of
phototherapy.2. Pharmacologic management with Phenobarbital has centered primarily on the infant with hemolytic disease. 23
Slide24Nursing consideration
Nursing diagnoses:Body temperature, risk for imbalanced related to use of phototherapy.Fluid volume, risk for deficient related to phototherapy.Family processes, interrupted, related to situational crisis, prolonged hospitalization of infant, or
rehospitalization for therapy injury, risk for, related for phototherapy.24
Slide25Nursing consideration
Planning: the goals:Infant will receive appropriate therapy needed to reduce serum bilirubin levels.Infant will experience no complications from therapy.
Family will receive emotional support.Family will be prepared for home phototherapy (if prescribed).25
Slide26Nursing consideration
Implementation:Nursing care for infant under Phototherapy:
Repositioned frequently to expose all body surface areas to the light.Frequent serum bilirubin levels every 4-12 hours are necessary.The infant's eyes are shieldedThe infant's eyelids are closedOn each nursing shift the eyes are checked
Eye shield are removed during feeding.
Temperature is closely monitored
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Slide27Nursing consideration
Accurate charting is important nursing responsibility and includes:Times that phototherapy is started and stopped.
Proper shielding of the eyes.Distance between surface of lamps and infant (should be no less than 18 inches.Use of phototherapy in combination with an incubator or open bassinet.Oily lubricant or lotions are not used on the skin in order to prevent increased heatAdditional fluid volume needed.
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Slide28Hirschsprung
Disease“Megacolon”, aganglionic cells in parts of the bowel
M>F, associated with congenital heart defectsAt birth, fail to pass meconium, anorexia, abdominal distension and emesis Diagnosed: clinical hx, bowel patterns, lower GI series, rectal biopsy> birth (<5cm affected), ribbon-like, foul-smelling stools; intestinal obstruction, abd discomfort/distension, bloating, distention, constipation, (fever, GI bleeding & diarrhea =
enterocolitis
, life-threatening)
Fluids & electrolytes, monitoring, NG to
sux
, pain meds, antibiotics, barium/air enema, rectal irrigation (bowel prep), surgery
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Slide29Hernias
A hernia is an opening or weakness in the wall of a muscle, tissue, or membrane that normally holds an organ in place.29
Slide30Hernias
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Slide31Umbilical Hernias
Umbilical hernias are common in newborns and infants younger than 6 months. They occur when part of the intestines bulge through the abdominal wall next to the belly button. In babies with umbilical hernias, parents may see bulging around area when the baby cries.Unlike other types of hernias, umbilical hernias may heal on their own, usually by the time a baby is 1 year old. If not, surgery can repair the hernia.
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Slide32Appendicitis
Infected, inflamed appendix (teens – young adults)Abdominal pain, but this may be vague and poorly localized in the periumbilical area. The pain gradually migrates to the RLQ.
Anorexia and nausea with or without vomiting may occur but usually begin after the abdominal pain. Constipation or diarrhea may be present, and the child’s temperature may be normal or slightly elevated.Emesis, low-grade fever, inc WBC, rebound tenderness LR quad (McBurney’s point), rigid abd, dec/absent bowel sounds
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Slide33Appendicitis
Immediate bowel rest, then appendectomy (24-48 hrs of first symptoms)Rupture – fever rises sharply, peritonitis, sudden pain relief (diffuse pain), inc abd distention, tachycardia, shallow tachypneaIV antibiotics, fluids, electrolytes
Appendicitis is difficult in children because the clinical manifestations are atypical. This increases the incidence of perforation. 33
Slide34Diverticulum
Out-pouching of ileum that secretes acid – irritation and ulceration1-3% of general population Symptoms appear by 2 yo
, M>FPainless rectal bleeding, abdominal pain rare, severe case will perforate &/or cause peritonitis (many may be asymptomatic)Surgery – very good prognosis34
Slide35Inflammatory Bowel Disease
Crohn’s Chronic, inflammation of random segments of GI tract, and move around – through the wall involvementOften develop enteric fistulas between loops of bowel &/or nearby organs
Often develops between 15-25 years of ageSubtle onset, crampy abd pain, diarrhea, fever, anorexia, wt loss, malaise, joint pain, greatly inc rate of cancerAnemia common, inc ESR, hypoalbuminemia35
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Slide37Inflammatory Bowel Disease
Ulcerative colitisChronic, recurrent disease of colon & rectal mucosaInflammation, ulceration, hemorrhage, edema – localized in a portion of the GI tract (may be removed)
Peak onset at 12 years of ageDiarrhea, lower abd pain with passage of stool and gas, blood & mucous in stool, anorexia, weight lossTreatment same for both Crohn’s and UCAntibiotics, anti-inflammatory, immunosuppressive, antidiarrheal, nutrition counseling (high protein/carb with low fiber diet), surgery
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Slide38Ulcerative colitis
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Slide39Celiac Disease
Genetic disorder – inability to digest gluten9-12 mo, diarrhea, abd distention, emesis, anemia, malnutrition, steatorrhea, pale, watery and foul smelling stools; muscle wasting, edema, low serum albumin, wt loss, anorexia
Fluids & electrolytes, monitoring, pain & antiemetic meds, dietary instructionswhich is primarily found in bread, pasta, cookies, pizza crust and many other foods containing wheat, or rye. 39
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Slide41Teaching plan for child with celiac disease and the child’s family.
Important to a teaching plan for the child with celiac disease and the child’s family is to provide dietary education and adequate supervision of the dietary treatment.
It is important for the nurse to explain the disease process, the signs and symptoms, and the rationale for the gluten-free diet. 41
Slide42Lactose Intolerance
Inability to digest lactose (insufficiency of lactase)>3 yo, watery diarrhea, bloating, flatulence, crampy abdominal pain after ingestion of lactose
Fluid/elec replacement, monitoring, pain meds, dietary instructions42
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