Alterations in GI Function in Children Assessment of GI Function History o The Great American Obsession vomiting diarrhea constipation and our many definitions o GI function is a measure of health and it is key to how someone feels that day Nursing Assessment o Differentiate what parents tell you from your observations lab values assessment of skin abdomen behaviors of child o Listening to parent but looking at child o Lab values dehydrated sodium levels rise Assessing You are caring for a 5 day old who is immediately post op a cord hernia repair The orders state advance diet as tolerated How do you assess the return of bowel function and toleration of diet advancement Look at the belly touch feel o Is baby rebounding Feel the belly Bowel sounds o Do not feed is there are no bowel sounds regardless of age o General anesthesia lose bowel sounds Stools flatus Toleration of PO o Tolerating ice chips Give only a few o Gagging swallowing keeping it down NG producing drainage shut off suction and listen for bowel sounds Subjective info hunger pain distention AB girth weight o Typically 6mo or General Nursing Care Issues Hydration status o Assessments Skin gums Weight daily very same time with out anything but a gown on Compare to I O I O Fontanel baby tears any child VS Lab studies sodium levels electrolyte balances o Interventions Oral hydration done by kgs how much fluid they need in 24 hours IV fluids typically not bolus 2x the maintaince fluids physician ordered but as the nurse look at the hydration status electrolytes Nutrition o Assessments Weight gain Want them to get enough protein o Stabilized blood pressure Growth taller Development I O Lab studies Liver profiles o Interventions Feeding evaluation Maybe from speech therapist Swallow study to see if they are refluxing Nutritional supplements alternate products Watch sodium levels If they fall they will have trouble gaining weight CF kids may need calorie supplements Button G tube additional nutrition run at night nocturnal feed Alternate routes Which of the following assessments would cause you to more closely assess a child s hydration status A A specific gravity of 1 010 normal B A supple skin turgor good C A weight gain of 0 2 kg not quite enough info given D A history of frequent emesis the younger the child the more important it is to look at hydration status newborn 80 85 free water dehydrate rapidly Common GI Nursing Interventions Slow advancement of feedings Watch to see how they handle advancement NG tube for feedings or decompression postop Gastrostomy PEG tube placement for additional fluids or calories at night or kids with gag reflex Total Parenteral Nutrition delivers proteins carbs and fats Metabolized in LIVER Liver problems or damage can result from long term use of TPN Medications Teaching geared towards family rather then the child Ingestion Conditions vs Development Conditions Ingestion Vomiting Usually caused by a GI disorder admitted as hypovolemia or dehydrated Nursing Assessment differentiate carefully look at all systems what is causing the vomiting Infectious food related psych related monitor fluid electrolyte balance very carefully Nursing Interventions NPO for 4 6 hours to rest stomach small sips of pedialyte or flat cola oral care mouth tastes yucky Gastroesophageal Reflux GERD Gastric contents return to esophagus Nursing Assessment Watch while sleeping assess for apnea examine history look at time line of feeding irritability colic assess growth failure to thrive plot of growth chart Diagnosis gastric pH gastric probe nasaly pneumogram check if desating barium swallow xray to watch barium go down and see if it goes back up if barium comes back up at risk for aspiration pneumonia Identify 5 key organic changes clinical manifestations diagnostic procedures treatment options sitting up in carseat need wedge so heat of bed is up nursing considerations watch airway make sure they are not aspirating while asleep Intervention Options Small frequent feedings frequent burping thickened liquids baby oatmeal or rice cereal positioning HOB up Environmental concerns decrease stress sitting up after feeds Research findings Lay a child on stomach pushed stomach forward and closes open valve Medication options Reglan metoclopramide promotes gastric emptying gets food out faster not getting nutrients out of the food that they are eating Zantac ranitidine neutralizes gastric acid used in adult population no acid burn doesn t change the fact that the reflux is happening Nissen fundoplication as last option G tube take muscle and wrap it around the sphincter so that they cannot reflux purpose is to prevent complications of GERD Nursing Diagnosis for GERD Altered nutrition less than body requirements Risk for aspiration Altered growth development Also parental anxiety knowledge deficit risk for infection Diarrhea and Gastroenteritis Inflammation of stomach intestines peristalsis with water in bowel can be malabsorption allergies bug or food poisoning Nursing Assessment Stool studies assess fluid electrolyte status monitor for pain Nursing Interventions Bowel rest skin care particularly butt I O slow dietary advances meds as ordered did I mention stool studies Look at stools for blood may be positive for blood due to diaper rash Look for sugar in stool sugar tells us of malabsportion Care for child Significant issue in many settings Infective do not cross contaminate between kids family Teach prevention assessment and management Dumping Syndrome Rapid gastric emptying occurs when the undigested contents of the stomach are transported or dumped into the small intestine too rapidly Symptoms include cramps and nausea across age spectrum Impacts pediatric growth development Many times formula or food allergy or celiac disease Intussusception Typically 2 6mo 3 years More likely boys can reoccur Organic Changes Telescoping of the bowel into another portion of the intestine Primary not related to any other type of disease process Secondary CF Invagination bowel collapses on top of eachother obstruction edema inflammation bloody Jelly comes out ischemia perforation peritonitis might die Clinical Manifestations Acute abdominal pain come to ER knees to chest makes it feel better episodes of pain and periods of relief vomiting palpable abdominal mass but be very careful current jelly stool severely ill hemorrhage peritonitis infection Diagnosis signs symptoms barium enema w X ray barium fills bowel back up makes sure bowel is