Pediatric Nursing
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Transcript Pediatric Nursing
Pediatric
Nursing
Module 3
Caring for Children with
Alterations in
Nutrition/Elimination
Assessment of GI System
History
gathering base line data
infant - formula type and tolerance
children - diet, appetite, preferences meal
schedule
any prior GI problems
elimination patterns
stools, characteristic, number per day, toilet habits
general nutritional appearance
height and weight
Physical Assessment
Inspection
oral cavity
ability to suck, swallow, chew
any ulcers, sores, bleeding, thrush, dental
caries,congenital anomalies (cleft lip and palate)
sore throat
Abdomen
distention, turgor, contour, pain, girth
Physical Assessment
Stool
number, consistency, presence of blood
Vomitus
color, amount, blood, projectile
Urine
specific gravity, frequency amount
Tears
Fontanels
Pf closes at 2-3 months, Af closes 9-18 months
Assessment - dehydration
Children are more susceptible
to dehydration due to greater
% or portion of their body
weight being water
Signs and Symptoms
poor skin turgor
sunken fontanel
decreased urine out-put
(1-2ml/uo/kg/hr)
decreased body weight
dry mucous membranes, lips
no tears
Physical Assessment
Auscultation
Abdominal
peristalsis
presence/absent
hypo or hyper
visible - possible pyloric stenosis
Adjunct Assessment
Weight
Temperature
Labs
stool culture, ova & parasite, guiac, roto virus
electrolytes - Na, K, Cl, HCO3
CBC - wbc’s
I&O
X-ray
barium swallow, barium enema
What questions do you have for
the parent, for the child?
Signs and Symptoms of
Dehydration
Neurological
Cardiac
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Integumentary
Disorders of Motility
Gastroenteritis
Acute Diarrhea
bacterial vs viral
isolation - good handwashing
bloody stools, mucous, cramping
change in the number and consistency of
stool, increase in the water margin, usually
green in color
Gastroenteritis
Acute vomiting
Differentiate between
vomiting vs spitting up
projectile - pyloric stenosis
reflux - may lead to
respiratory problems
A 6 month old is admitted with
dehydration. Effectiveness of therapy
is evaluated by which assessment
measures? Choose all that apply
Analysis question, first
recall assessment
findings for dehydrated
child
assess fontanel
measure and document abdominal girth
document mucous membrane moisture
record and analyze I & O
daily wt., same scale, time, no clothes
Hirschsprung’s Disease
Congenital absence of
the parasympathetic
nerve ganglion cells in
the mesenteric plexus of
the distal bowel
area proximal to the
aganglionic portion
becomes hypertrophied
and greatly dilated
Hirschsprung’s Disease
Signs/Symptoms
abdominal distention
intermittent
progressively increasing
anorexia
malnutrition
obstruction with diarrhea
dehydration and electrolyte imbalance
Hirschsprung’s Disease
Treatment
temporary colostomy
Pre-op
clear liquids
bowel prep
enemas/laxatives
antibiotic therapy - decrease normal bowel flora
Hirschsprung’s Disease
Post-op Care
pain control
hydration
assessing stoma
bowel elimination
teaching
Gastric Reflux
Gastroesophageal Reflux
(GER)
backward flowing of
gastric contents into the
esophagus
incompetent lower
esophageal sphincter
increase intra abdominal
pressure
Gastric Reflux
Signs and Symptoms
Infant
spitting up, regurgitation, vomiting
crying, irritable
wt. loss, FTT
Children
heartburn, chest pain, abd. pain
dysphasia, burping,
regurgitation, cough, pneumonia
Gastric Reflux
Treatment
small frequent thicken feedings
hypoallergenic formula
positioning
medications
H 2 antagonist
pepcid, tagament, zantac
surgical
Nissen fundoplication
Inflammatory Disorders
Appendicitis
Inflammation of the
appendix resulting from
bacterial infection or
obstruction
Rupture = peritonitis
abscess
Appendicitis
Signs and Symptoms
G.I.
n/v/a and d/c, rigid abdomen
Pain
peri-umbilical - localizing RLQ
re-bound tenderness
progressive
Other
fever, stooped posture, lethargy
Treatment
appendectomy
Structural Defects
Craniofacial Abnormalities
Cleft orLip
& Palate
May occur separately
together
Unilateral or bilateral
Associated problems
feeding difficulties
URTI
otitis media
speech
dental formation
self-image
Cleft Lip
Interference with bonding
Disfigurement
Feeding Techniques
more upright to avoid aspiration
frequent burping
lamb’s nipple
asepto syringe with tubing if infant unable
to create closure and suction
Cleft Lip
Surgical repair
2-4 months old
Post-op care
prevent strain on suture line
keep infant off their stomach
keep suture line clean
Q-tip, NS, antibiotic oint.
Cleft Palate
Feeding
same as cleft lip
solids as soon as possible
thicken liquids
aspiration may be a problem
frequent URTI and ear problems
Cleft Palate
Surgical Repair
usually 9 - 18 months
perform closure prior to speech
after weaned to cup
Post-op Care
keep on abdomen till fully awake
semi-liquid, puree diet
no sucking
elbow restraints
keep suture line clean after feeding with water
Cleft Palate
Long term care
speech
socialization
dental problems
psychosocial
You are caring for a newborn with a cleft lip
and palate. You are aware the infant and
family have multiple needs. Which is your
priority nursing diagnosis?
HR for impaired parent/infant attachment R/T
newborn structural defect
Ineffective feeding pattern R/T newborn
structural defect
HR for aspiration R/T newborn structural
defect
HR for imbalanced nutrition less than body
requirements R/T abnormal feeding patterns
and structural defect.
Obstructive Disorders
Intussusception
Telescoping or a portion of the
small intestine or colon into a
more distal segment
Signs/Symptoms
vomiting
pain - paroxysmal colicky
abdominal
“current jelly” stools - brown,
bloody, mucous mixed
Intussusception
Treatment
barium enema to reduce it or surgery
Post-op
gastric decompression
IV therapy
Obstructive Disorders
Pyloric Stenosis
Narrowing of the pyloric valve
hypertrophic muscle
Signs/Symptoms
projectile vomiting
left to right peristalsis
olive sized mass palpated in
upper right quadrant
cries with hunger
readily accepts 2nd feeding
after vomiting
Pyloric Stenosis
Adjunct Problems
dehydration
electrolyte imbalance
alkalosis
malnutrition
Diagnosis
confirmed with barium x-ray
Pyloric Stenosis
Surgery
Pyloromyotomy
Post-op Feeding
post-pyloromyotomy feeding schedule
sterile water, small amount, gradually
increasing in substance and quantity
Nursing Care - Nutrition and
Fluid Balance Needs
Nursing Care and Concerns
Fluid Volume and Electrolyte Imbalance
daily wt.
I & O
assess for s/s of dehydration
maintain IV therapy
oral care if NPO
monitor labs - electrolytes
Nursing Care
When introducing fluids
small frequent feedings
clear liquids
pedialyte
may dilute formula
monitor for
vomiting
diarrhea
abdominal distention
Nursing Care/Concerns
Nutrition
check for vomiting
assess tolerance of feedings
weight and graph
thickened feedings
feed slowly
check suck
small amounts
calorie count
upright - infant seat
Nursing Care/Concerns
High Risk for Infection
Cleft Lip/Palate
URTI or OM
diarrhea
spread of infection
pyloric stenosis
body may be debilitated
appendicitis
peritonitis
Nursing Care/Concerns
Local infection - superficial
redness, heat, swelling
tenderness, pain
Systemic infection - internal
abdominal pain, increasing
abdominal girth
guarding
temperature
Nursing Care/Concerns
Knowledge Deficit
assessing parents understanding
of child’s needs and the problem
assess parent’s ability to learn
teach simply, clearly, allowing time
for questions and return
demonstration
support group
referrals
Case Study
Jesus 5-year old boy, weights 40.3Kg wakes up at 2am with a “stomach
ache”, he has a fever of 100.2F and vomiting. Parents administer Tylenol
120mg which he vomits 5 minutes later.
In the morning he is still sick, so parent take him to the ER. Vital signs
are Ax Temp 100.4, HR 125, RR 35, B/P 119/79. RLQ guarding, crying.
IV started then MS 2mg IVP given. Abdominal US is ordered, CBC shows
WBC’s are 17,500.
Discuss your impressions of the situation.
Questions
The US confirms appendicitis.
Discuss the following orders.
NPO
B/R
D5 1/2 with 10 KCL at 70ml/hr
Gentamycin 45mg IV on call to OR
MS 1-2mg IVP q2hrs prn pain
K-pad to abdomen
Prepare for OR - lap appendectomy
Questions
Just prior to OR, Jesus experiences a relief from his pain.
What is happening now? What is your nursing action?
What are your nursing priorities in the PACU?
What are the pros and cons of letting parents into the
PACU?
Post-op orders are as follows:
routine post op vitals
foley catheter to straight drainage
D5 1/2 NS with 20KCL 75ml/hr
Gentamycin 45mg IVP q8hr
Unasyn 900mg IV q 6hr
MS PCA
Tylenol 240mg q4rhs per N/G tube prn T>100.4
NGT to continuous drainage
NPO except for meds
IS 10 times each hour while awake