1. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 10

2. 2 Gastrointestinal System Many GI issues require surgical intervention Nursing interventions will often include general pre and post-op care Bilious vomiting is a sign of GI obstruction and requires immediate intervention Assess stools! Assess hydration status

3. 3 Gastrointestinal System Pediatric Variances Mechanical functions of digestion are immature at birth Infants have decreased saliva Peristalsis is faster in infants Digestive processes are mature as a toddler Gastric acidity is low at birth

4. 4 The Gastrointestinal System  Altered Connections 3 Esophageal Atresia/Tracheoesophageal Fistula 3 Cleft Lip and Palate  Gastrointestinal Disorders 3 Gastroesophageal Reflux 3 Pyloric Stenosis  Acquired Gastrointestinal Disorders 3 Appendicitis

5. 5 ESOPHAGEAL ATRESIA & TRACHEOESOPHAGEAL FISTULA Congenital defects of esophagus EA is an incomplete formation of esophagus TEF is a fistula between the trachea and esophagus Classic 3 “C’s” - coughing,choking,cyanosis

6. 6 ESOPHAGEAL ATRESIA & TRACHEOESOPHAGEAL FISTULA TREATMENT Surgery: either a one- or two-stage repair Pre-op care focuses on preventing aspiration and hydration Post-op care focus is a patent airway, prevent incisional trauma

7. 7 Cleft Lip/Palate  May present as single defect or combined  Non-union of tissue and bone of upper lip and hard/soft palate during fetal development  Cleft interferes with normal anatomic structure of lips, nose, palate, muscles – depending on severity and placement  Open communication between mouth and nose with cleft palate  Nutrition is a challenge in infancy  Risk for aspiration  Respiratory distress

8. 8 Cleft Lip/Palate Operative Care  Monitor for infection  Clean Cleft Lip incision  Pain Management

9. 9 GASTROESOPHAGEAL REFLUX  Regurgitation of gastric contents back into esophagus  GER may predispose patient to aspiration and pneumonia  Apnea has been associated with GER   chance of GER after 12-18 mo old related to growth due to elongation of esophagus

10. 10 GASTROESOPHAGEAL REFLUX SIGNS/SYMPTOMS Vomiting Gagging during feedings Irritability Anemia Bloody stools DIAGNOSTIC EVAL History of feedings/PE Upper GI endoscopy to visualize esophageal mucosa

11. 11 GASTROESOPHAGEAL REFLUX: Therapeutic Management Positioning Prone HOB  30° Right side Dietary modifications Small, frequent feedings Possibly thicken formula Avoid fatty, spicy foods caffeine, & citrus Teach Medications Prokinetic agents Histamine H-2 Proton Pump Inhibitors Mucosal Protectants Surgery: fundoplication Fundoplication (anti-reflux surgery): A surgical technique that strengthens the barrier to acid reflux when the lower esophageal sphincter does not work normally and there is gastro-esophageal reflux.

12. 12 PYLORIC STENOSIS  Hypertrophy of pyloric sphincter, causing a narrowing/ obstruction  Infant presents “always hungry”  Weight loss

13. 13 PYLORIC STENOSIS DIAGNOSTIC EVAL History/PE Abdominal Ultrasound TREATMENT Surgical Intervention: Pyloromyotomy INTERVENTIONS Pre-op: NPO, NGT to hydration, I/O, monitor electrolytes Post-op: Start feedings in 4-6 hrs. Progressive feeding schedule

14. 14 APPENDICITIS Inflammation and infection of vermiform appendix, usually related to an obstruction Cause may be bacteria, virus, trauma S/S: periumbilical pain, fever, vomiting, diarrhea, irritability,  WBC’s Surgery is necessary Pre-op Care: NPO, pain management, hydration, consent Post-op Care: routine post-op care, IVF/antibiotics, NPO  ambulation, positioning, pain management, wound care, possible drains.

15. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 11

16. 16 Respiratory System Pediatric Variances  The airway is smaller and more flexible.  The larynx is more flexible and more susceptible to spasm.  The tongue is large.  Chest muscles are not well developed  Irregular breathing pattern and brief periods of apnea (10 - 15 secs) are common  Abdominal muscles are used for inhalation until age 5-6 yrs.  Respiratory rate is higher

17. 17 The Respiratory System Upper Airway Disorders Tonsillitis Croup Epiglottis Foreign Body Aspiration Lower Airway Disorders Bronchiolitis Asthma Cystic Fibrosis

18. 18 Tonsillitis CLINICAL MANIFESTATIONS  Sore throat  Mouth breathing  Sleep Apnea  Difficulty swallowing  Fever IMPLEMENTATIONS  Provide Comfort Warm saline gargles Reduce Fever  Promote Hydration  Administer Antibiotics  Provide Rest  Patient Teaching  Tonsillectomy may be necessary

19. 19 Tonsillectomy Pre-operative Nursing Care Monitor Labs (CBC, PT, PTT) Age-appropriate Preparation/Teaching Surgical Consent Post-operative Nursing Care Frequent site assessment Monitor for S/S of Complications Pain Management Diet Patient Teaching

20. 20 Croup/Epiglottitis Infection and swelling of larynx, trachea, epiglottis, bronchi Causative agent: Viral Characterized by hoarseness, barky cough, inspiratory stridor, and respiratory distress Most common ages 6 mo-3 yrs LIFE-THREATENING EMERGENCY Most common in ages 2-5 years Often the child is intubated

21. 21 Croup/Epiglottitis Nursing Interventions  Maintain Patent Airway  Assess and Monitor  Promote Hydration  Reduce Fever  Calm Environment  Promote Rest Nursing Interventions  Administer Meds  Corticosteroids  Nebulizer treatment  Antibiotic for epiglottitis

22. 22 Foreign Body Aspiration Occurs most often in small children Choking, coughing, wheezing, respiratory difficulty Often it is round food, such as grapes, nuts, popcorn Bronchoscopy often needed for removal Age-appropriate preparation needed for procedure Prevention and parent education is very important

23. 23 Bronchiolitis Acute viral infection of the bronchioles causing an inflammatory/obstructive process to occur CXR shows hyperinflation and consolidation if atelectasis present Primarily seen in children under 2 years of age Most common in winter and early spring

24. 24 Bronchiolitis CLINICAL MANIFESTATIONS  Nasal Congestion  Cough  Crackles, Wheezes  Increased RR & SOB  Respiratory Distress  Fever  Poor Feeding IMPLEMENTATIONS  Suction – priority  Bronchodilator  CPT  Promote fluids  Monitor VS, SaO2, lung sounds & respiratory effort  Supplemental oxygen  Reduce fever  Promote rest

25. 25 Asthma Asthma is a common chronic inflammatory disease of the airways CLINICAL MANIFESTATIONS  Tachypnea  SaO2 below 95%  Wheezes, crackles  Retractions, nasal flaring  Non-productive cough  Restlessness, fatigue  Abdominal pain

26. 26 Asthma INTERVENTIONS  Monitor VS (HR, RR)  Monitor SaO2  Auscultate lung sounds  Monitor respiratory effort  Humified oxygen  Calm environment  Promote hydration  Promote rest  Monitor labs/x-rays  Patient teaching Administer Medications  Bronchodilator  Corticosteroid IV or PO  Antibiotic if precipitated from a respiratory infection

27. 27 Otitis Media  Most common childhood illness  Inflammation of middle ear  Acute otitis media (AOM)  Infectious process by pathogen  S/S: pain, fever, irritability, vomiting, diarrhea, ear drainage, full/bulging tympanic membrane  Otitis media with effusion (OME)  Inflammation of middle ear with fluid behind tympanic membrane-no infection  Chronic otitis media  Inflammation of middle ear  Can lead to hearing loss/delayed speech

28. 28 Otitis Media TREATMENT  Antibiotics INTERVENTIONS  Teaching  Feeding techniques  Medication regimen PAIN MANAGEMENT  Fever management  Surgery prep if needed