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Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management - Document preview page 1

Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management - Page 1

Document preview content for Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management

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

A study on pediatric gastrointestinal disorders and nursing interventions.

Claire Mitchell
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Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management - Page 1 preview imagePediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, andNursing ManagementDiscuss the pathophysiology, clinical manifestations, and treatment options for at least twogastrointestinal conditions inpediatric patients, such as cleft lip and palate, pyloric stenosis, ornecrotizing enterocolitis (NEC). Additionally, explain the nursing management and patient education foreach condition, focusing on preoperative and postoperative care where applicable. (Word count: 500-600 words)GIGI stomach capacityoGastric stomach capacity of the neonate is 30 to 60 ml, which gradually increases to 200to 350 ml by age 12 months and to 1,500ml as an adolescent.Cleft lip & palate: pt teaching, surgicalimplications and procedure, feeding, and nursingmanagement pre & post-opoCleft lip and PalateBone and tissue of the maxillary processes and palate fail to fuse completely atthe midline between 5 and 12 weeks gestationFailure of the tongue to move down at the correct time prevents the palatineprocesses from fusingMULTIFACTORIAL CAUSES-not fully knownGenetics?Environment?Teratogens?Folic acid?Clinical ManifestationsAbdominal distention from swallowed airDifficulty swallowingCleft lip: canrange from a simple notch on the upper lip to a completecleft from the lip edge to the floor of the nostril, on either side of themidline but rarely along the midline itselfCleft palate: partial or completeComplications/Nursing DiagnosisFeeding problems (Imbalanced Nutrition)Risk for aspiration/Impaired swallowing
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Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management - Page 2 preview image
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Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management - Page 3 preview imageFrequent otitis media (Risk for infection)Dental and orthodontic problems (Impaired dentition)Speech delaysInfant/parental bonding issues (Risk of impaired parenting)Pre opFeedslowly and in an upright positionBurp frequentlyGive small, frequent feedingsUse ESSR (Enlarged nipple, Stimulate suck with lower lip, Swallow, fullRest)Clean mouth with water to remove residueTreatment/ Surgical CorrectionClosure of lipdefect precedes correction of the palate“Rule of 10” = 10 weeks/10 poundsLip: 36 months, Palate: 624 monthsZ-plasty to minimize retraction of scarProtect suture line with Logan bowCheiloplasty: Birth to 3 months of ageStaphylorrhaphy: 18 monthsPost operative (Lip)Observe for cyanosisRestrain hands/armsPrevent cryingUse syringe with tubing to feed at side of mouthPlace on right sideClean suture line after each feedingPost operative (Palate)Assess for signs of decreasedoxygenationUse elbow restraintsPosition on abdomen or sideKeep hard or pointed objects away from mouthUse a cup to feed (no nipples or pacifiers)Rinse the suture line after each feedDistract or hold toddlerPost operative palate repair (PPRSA)
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Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management - Page 4 preview imageoProne for recovery in immediate post-op periodoPackingoRespiratory difficultiesoSoft dietoAvoid straws, spoons to protect suture lineEA & TEF: pathology, clinical manifestations, labs, treatments, nursing care and family teaching.Know how they areidentifies and long-term complicationsoEsophageal Atresia with Tracheoesophageal FistulaRare malformations that result when the foregut fails to lengthen, separate, andfuse into two parallel tubes (esophagus and trachea) at 4 to 5 weeks’ gestationPathophysiology:Proximal segment of esophagus ends in blind pouchDistal segment is connected to the trachea orprimary bronchusEtiology:UnknownClinical Manifestations:THREE C’s of TEF:oCoughingoChokingoCyanosisTreatmentSurgical Repair(at birth orafter 2 to 4 months)NPOGastrostomy tube (PEG) insertion and feedingsAntibiotics-aspiration pneumoniaNursing Diagnosis:Risk for aspiration
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Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management - Page 5 preview imageImpaired swallowingImbalanced nutritionNursing Management:Pre-opoHOB elevated 30 degrees(may needreflux harness)oFrequent suctioningPost-OpoMaintain chest tube and respiratory supportoSuction as neededoMake sure the NG tube is secure and handle with extremecautionoAdminister antibioticsoAdminister total parenteral nutrition (TPN)Pyloricstenosis: pathology, clinical manifestations, labs, treatments, nursing care and familyteaching. Surgical treatmentoPyloric Stenosis:(infantile hypertrophic pyloric stenosis)Pathophysiology:Hypertrophyof the musclesthat surround the pyloruscausingobstruction of the gastric outletGastric distention, dilation and hypertrophyCause:UnknownClinical Manifestations:Progressive, projectile, non-bilious vomiting
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Pediatric Gastrointestinal Disorders: Pathophysiology, Clinical Manifestations, Treatments, and Nursing Management - Page 6 preview imagePalpable olive-sized bulge right below the right costal marginHunger, irritability, desire to eat voraciouslyDehydration and malnutrition despite apparent adequate intakeTherapeutic Management/Treatment:SurgerypyloromyotomyNursing Management:NPO before surgeryAssessing hydration statusIVFs until taking PO well and to correct fluid and electrolyte imbalancesStart PO feeding soon after surgeryPossible NG, kept open and elevated for gastric decompressionPosition on right side post-opGERD: Manifestations, treatments, nursing management and teachingoBackflow of gastric orduodenal contents or both into the esophagus and past the loweresophageal sphincter (LES)Clinical Manifestations:Pain after eating, cries when lying downArching of back-stiffeningRefuses to eatfailure to thriveFrequent vomiting,possibly hematemesisRegurgitation and re-swallowingFrequent crying and fussinessChoking or gagging with feedingFrequent or persistent coughTreatments:Positional therapyMedications:oHistamine-2-receptor antagonists (Zantac, Pepcid)oProton-pump inhibitor (Nexium)oAnti-gas agents (Mylicon)Surgery for severe GERDNissan fundoplicationNursing Management and teaching:Change feeding habitsthicken, rice, avoid fatty foods and citrus andcaffeine, burp oftenClosely monitor respiratory status d/t risk of aspiration
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