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Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management

A study on pediatric gastrointestinal disorders and nursing interventions.

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    Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management Discuss the pathophysiology, clinical manifestations, and treatment options for at least two gastrointestinal conditions in pediatric patients, such as cleft lip and palate, pyloric stenosis, or necrotizing enterocolitis (NEC). Additionally, explain the nursing management and patient education for each condition, focusing on preoperative and postoperative care where applicable. (Word count: 500 - 600 words) GI • GI stomach capacity o Gastric stomach capacity of the neonate is 30 to 60 ml, which gradually increases to 200 to 350 ml by age 12 months and to 1,500ml as an adolescent. • Cleft lip & palate: pt teaching, surgical implications and procedure, feeding, and nursing management pre & post - op o Cleft lip and Palate ▪ Bone and tissue of the maxillary processes and palate fail to fuse completely at the midline between 5 and 12 weeks gestation ▪ Failure of the tongue to move down at the correct time prevents the palatine processes from fusing ▪ MULTIFACTORIAL CAUSES - not fully known • Genetics? • Environment? • Teratogens? • Folic acid? ▪ Clinical Manifestations • Abdominal distention from swallowed air • Difficulty swallowing • Cleft lip: can range from a simple notch on the upper lip to a complete cleft from the lip edge to the floor of the nostril, on either side of the midline but rarely along the midline itself • Cleft palate: partial or complete ▪ Complications/Nursing Diagnosis • Feeding problems (Imbalanced Nutrition) • Risk for aspiration/Impaired swallowing

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    • Frequent otitis media (Risk for infection) • Dental and orthodontic problems (Impaired dentition) • Speech delays • Infant/parental bonding issues (Risk of impaired parenting) ▪ Pre op • Feed slowly and in an upright position • Burp frequently • Give small, frequent feedings • Use ESSR (Enlarged nipple, Stimulate suck with lower lip, Swallow, full Rest) • Clean mouth with water to remove residue ▪ Treatment/ Surgical Correction • Closure of lip defect precedes correction of the palate • “Rule of 10” = 10 weeks/10 pounds • Lip: 3 – 6 months, Palate: 6 – 24 months • Z - plasty to minimize retraction of scar • Protect suture line with Logan bow • Cheiloplasty: Birth to 3 months of age • Staphylorrhaphy: 18 months ▪ Post operative (Lip) • Observe for cyanosis • Restrain hands/arms • Prevent crying • Use syringe with tubing to feed at side of mouth • Place on right side • Clean suture line after each feeding ▪ Post operative (Palate) • Assess for signs of decreased oxygenation • Use elbow restraints • Position on abdomen or side • Keep hard or pointed objects away from mouth • Use a cup to feed (no nipples or pacifiers) • Rinse the suture line after each feed • Distract or hold toddler • Post operative palate repair (PPRSA)

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    o Prone for recovery in immediate post - op period o Packing o Respiratory difficulties o Soft diet o Avoid straws, spoons to protect suture line • • EA & TEF: pathology, clinical manifestations, labs, treatments, nursing care and family teaching. Know how they are identifies and long - term complications o Esophageal Atresia with Tracheoesophageal Fistula ▪ Rare malformations that result when the foregut fails to lengthen, separate, and fuse into two parallel tubes (esophagus and trachea) at 4 to 5 weeks’ gestation ▪ Pathophysiology: • Proximal segment of esophagus ends in blind pouch • Distal segment is connected to the trachea or primary bronchus ▪ Etiology: Unknown ▪ Clinical Manifestations: • THREE C’s of TEF: o Coughing o Choking o Cyanosis ▪ Treatment • Surgical Repair – (at birth or after 2 to 4 months) • NPO • Gastrostomy tube (PEG) insertion and feedings • Antibiotics - aspiration pneumonia ▪ Nursing Diagnosis: • Risk for aspiration

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    • Impaired swallowing • Imbalanced nutrition ▪ Nursing Management: • Pre - op o HOB elevated 30 degrees(may need reflux harness) o Frequent suctioning • Post - Op o Maintain chest tube and respiratory support o Suction as needed o Make sure the NG tube is secure and handle with extreme caution o Administer antibiotics o Administer total parenteral nutrition (TPN) ▪ • Pyloric stenosis: pathology, clinical manifestations, labs, treatments, nursing care and family teaching. Surgical treatment o Pyloric Stenosis: (infantile hypertrophic pyloric stenosis) ▪ Pathophysiology: • Hypertrophy of the muscles that surround the pylorus causing obstruction of the gastric outlet • Gastric distention, dilation and hypertrophy ▪ Cause: Unknown ▪ Clinical Manifestations: • Progressive, projectile, non - bilious vomiting

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    • Palpable olive - sized bulge right below the right costal margin • Hunger, irritability, desire to eat voraciously • Dehydration and malnutrition despite apparent adequate intake ▪ Therapeutic Management /Treatment : • Surgery – pyloromyotomy ▪ Nursing Management: • NPO before surgery • Assessing hydration status • IVFs until taking PO well and to correct fluid and electrolyte imbalances • Start PO feeding soon after surgery • Possible NG, kept open and elevated for gastric decompression • Position on right side post - op • GERD: Manifestations, treatments, nursing management and teaching o Backflow of gastric or duodenal contents or both into the esophagus and past the lower esophageal sphincter (LES) ▪ Clinical Manifestations: • Pain after eating, cries when lying down • Arching of back - stiffening • Refuses to eat – failure to thrive • Frequent vomiting, possibly hematemesis • Regurgitation and re - swallowing • Frequent crying and fussiness • Choking or gagging with feeding • Frequent or persistent cough ▪ Treatments: • Positional therapy • Medications: o Histamine - 2 - receptor antagonists (Zantac, Pepcid) o Proton - pump inhibitor (Nexium) o Anti - gas agents (Mylicon) • Surgery for severe GERD – Nissan fundoplication ▪ Nursing Management and teaching: • Change feeding habits – thicken, rice, avoid fatty foods and citrus and caffeine, burp often • Closely monitor respiratory status d/t risk of aspiration

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