Oral cavity. Esophagus. Lower esophageal sphincter Liver Stomach Pancreas Large & lower intestine...

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By The Name Of Allah Presentation about : Gastrointestinal system assessment . Students name -: Galia Baraka

Transcript of Oral cavity. Esophagus. Lower esophageal sphincter Liver Stomach Pancreas Large & lower intestine...

By The Name Of Allah

Presentation about:

Gastrointestinal system assessment.

Students name-:Galia Baraka

Component of GI system

• Oral cavity.• Esophagus.• Lower esophageal sphincter• Liver• Stomach• Pancreas• Large & lower intestine• Gallbladder• Cecum• Appendix• rectum

Assessment of GI system• The newborn's stomach capacity is only 10 to 20 ml• It expands rapidly to 200 ml by one month of age and reaches

adult capacity of 2000-3000 ml by late adolescence.• Enzymes that aid in digestion(amylase,lipase,trypsin)Infants are deficient in these enzymes until around 4-6 month,

therefore abdominal distention from gas is common.• GI system immature at birth– Process of absorption and secretion do not take place until

after birth– Sucking primitive reflex– Voluntary swallow (at 6 weeks)– Newborn’s stomach capacity is small at birth

Cont.…• Liver function immature at birth and next few weeks• During first year of life

– Gluconeogenesis (formation of glycogen from noncarbs)– Plasma protein– Ketone formation– Vitamin storage.

• The stomach lying horizontally, is round until approximately 2 year of age.

• Lower esophageal sphincter has a poor development of mucous membrane and muscular layer, its tone is decreased or relaxed.

• Pyloric sphincter is developed well.• Gastroesophageal reflux and regurgitation is frequent in infants.

Cont……• The infant's first stool is meconium– sticky and greenish black. – composed of intrauterine debris, such as bile pigments, epithelial

cells, fatty acids, mucus, blood, and amniotic fluid. – Passage of meconium should occur within the first 24 hours.

• transitional stools:– appear by the third day after the initiation of feedings. – greenish brown to yellowish brown in color, less sticky than

meconium, and may contain some milk curds. • typical milk stool:– is passed by the fourth day. – In breast-fed infants the stools are yellow to golden in color and

pasty in consistency, with odor, similar to that of sour milk. – In infants fed cow's milk formula, the stools are pale yellow to

light brown, are firmer in consistency, and have a more offensive odor.

Cont.… meconium

transitional stools

milk stool

GI Assessment Techniques• Subjective data;

– Lifestyle and family factors• Include family history.

– Diet• Gaining weight• feeding pattern

– Elimination patterns• Intake & output.

• Objective– Observe

• Abdominal distension.• Symmetry, bumps, bulges or masses.• Umbilicus.• Peristaltic waves.

Cont.…• Objective (con’t)–Auscultation• Hyper/hypo bowel sounds

–Percussion• Tympany vs dullness

–Palpation• Light vs deep • Rebound tenderness…peritoneal

inflammation

diarrheaDefinition:

It is defined as "An increase in the fluidity, volume and number of stools relative to the usual habits of

each individual ."Causes of diarrhea: Enteropahtogenic (infectious diarrhea)Dietary .Some parenteral infectionsMalabsorption

Dietary cause

Weaning food problems:• Introduction of food,

which is not suitable for the age.

• Unripe fruits.• Introduction of new

food.• Improperly cooked diet.• Malnutrition .

A-Formula feeding problemms

• Contaminated feeding bottles.

• Overfeeding. • Over concentrated formula.• Excess sugar or fat in

formula.

Cont.…Note***• Teething is not a cause of diarrhea. Diarrhea that occurs

during teething is usually caused by an intestinal infection and should be treated properly.

Dehydration: It is one of the consequences of watery diarrhea. It is

caused by the loss of water and electrolytes in liquid or loose stools and vomitus

Therapy of dehydration

Oral rehydration:• The rehydrauon therapy in the form of ORS is

considered an effective treatment of dehydration, It is a mixture of water, glucose, and electrolytes and is used to correct or prevent dehydration. Glucose is added (2%) to promote sodium absorption. Increasing the concentration of glucose by 2% increase the osmolarity of the solution and may cause osmotic diarrhea.

Component of ORS

Amount G/L Components g/1

3.5 G/L Sodium chloride.

2.9 G/L Trisodium citrate.

1.5 G/L potassium chloride

20.0 G/L Glucose

N.B. The use of citrate increases the shelf life of ORS and therefore lowers its cost. Tape water(200 ml) is used to dissolve the mixture

and needs no boiling .

CONT.…• It is given by cup and spoon, but :It can be given by nasogastric tube in the

following conditions :• When the patient is unable to drink but not in

shock, or has severe dehydration .• When the patient has severe repeated

vomiting, or if dehydration is not improving when ORS is given slowly by cup and spoon.

Nursing management of diarrhea

Nursing Assessment:• It includes taking the patient's history, measuring weight and temperature

and Assessing the degree of dehydration.1- History:

Personal characteristics (age and sex) and socioeconomic background (home environment, income, education, occupation, beliefs .... etc).Duration of the episode. Presence or absence of mucus, pus or blood in stool.Patient's ability to drink and or presence of thirst.Presence of vomiting, fever or other problems (cough, otitis media).Last time urine passed.Feeding practices before and during illness.Treatment during this episode (ORS, drugs).Vaccination taken especially measles vaccine.Frequency and consistency of stool.

Cont.…2- Assessment of the degree of dehydration:• Assessment of the degree of dehydration is

based on 4 signs which are the most important to be detected:

CONT.…Nursing intervention:

The aim of nursing intervention is:

To hydrate the infant.

To feed the infant.

To deal with associated problems.

•Guidance during intervention.

Mothers should be taught how to give ORS (one teaspoonful every 1-2 minutes and the child should be in a semi-sitting position).

Give ORS as much as the desires.

If vomiting occurs, wait 10 minutes. then continue giving ORS solution but more slowly (one teaspoonful every 2-3 minutes).

Watch for puffy eyes as a sign of over hydration. If this occurs, stop ORS solution and give breast feeding and plain water. When puffiness is gone, the child is considered fully dehydrated . Further treatment should follow treatment plan A.

Feeding during and after the episode:

– During diarrhea give the child as much food as he wants.

– Offer food every 3-4 hours.

– Small frequent feeding are better tolerated than less frequent and large feedings.

– Children will anorexia have to be gently encouraged to eat.

– After stoppage diarrhea, give one extra meal per day for 2 weeks in normal child and longer period in malnourished one .

– As mentioned earlier, breastfed children must continue to be breastfed.

*It is a well-known fact that artificially-fed children are more prone to diarrhea. But if a child wants milk, do not hesitate to give it to him.

*If the child is not keen, stopping milk ‘for about 12 hours may be preferable. The milk may be diluted for a day or two. But after that, give undiluted milk even if the loose motions continue

Advantage of continued feeding during diarrhea.(important point)

Preserves body weight and sustains growth, thus maintaining strength and health avoiding lowered resistance.The contact of foodstuffs with the gut mucosa protects its absorptive capacity and stimulates the production of digestive enzymes. Easily digestible foods may enhance intestinal salt and water absorption by providing organic molecules, which facilities their absorption. Studies have shown that continued feeding actually hastens recovery from a diarrheal episode.

Prevention of diarrhea:

1- Promotion of breast-feeding2- Improved weaning practices3- Proper use of water for hygiene and

drinking:4- Personal hygiene 5- Use of latrines 6- Safe disposal of stools of young children 7- Measles vaccination

constipation•Definition = Difficult, incomplete, or infrequent evacuation

of dry hardened feces from the bowels •Prevelance up to 30% children

Idiopathic:– Stool holding– Emotional problems/phobia.

Due to underlying disease– Neurological conditions – Cystic Fibrosis– Hirsprungs or abnormal bowel development– Side effects of medications

Stuctural defect

Cleft lip & cleft palate

• Complication Associated with Cleft Lip or Cleft Palate :– Feeding problems– Speech development–Otologic–Dental and orthodontic–Developmental

Cleft lip..oOpening between the nose and lipoApparent at birtho Should be documented during newborn

assessmentoAssess child’s ability to suck and swallowoCleft lip repair is performed during first

month of lifeo Special feeding techniques if surgery is

delayed

CONT.…• Feeding a Child before Cleft Lip Repair• Bottle with special nipple – longer and

narrower• Hold infant in upright position• Large cross-cut hole in nipple to allow the

child to get food into back of throat without strong sucking

• Stimulate sucking by rubbing nipple on infant’s lower lip

• Allow child to swallow and burp frequently• ESSR method – Enlarge nipple, Stimulate

sucking, Swallow, Rest

Cont…Pre-Op Care of the Child and ParentsExplain pre-op procedures to parentsProvide support and informationKeep accurate record of child’s growth

and feeding scheduleInfant:

NPO X 4-6 hours pre-opIvs fluid

Cont…Post-Op Care of Child and FamilyEncourage rooming-inIncision care: clean sutures with sterile cotton swab and ½ strength H2O2 followed by saline to prevent crusting (esp. after feeding). May apply antibiotic ointment to suture lineDO NOT DISPLACE LOGAN BARSpecial feeder – syringe with rubber tubing into side of mouth, Breck feederDiet advance from clear to diet for age over 48 hoursElbow restraints

Repair of unilateral cleft lip

Repair of Bilateral cleft lip

Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families

©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

B

CLEFT PALATE..…

• Repaired surgically between 6 months to 2 years prior to talking• Parents will care for child at home

until surgical repair• Altered diatition and speech

dysfunction may also occur• Frequent episodes of otitis media –(due to opening into nasopharynx)

CP treatment• Post-op: sutures in child’s mouth• Keep straws, pacifiers, spoons away from

child’s mouth for 7-10 days post-op• Elbow restraints and mittens• Feeding – soft foods: baby food. Short

nipples may be used• All feeding followed by rinsing mouth

with water to clean suture line• No brushing teeth X 1-2 weeks

Repair of cleft palate

COLOSTOMYColostomy refers to a surgical procedure where a portion of the large intestine is brought through the abdominal wall to carry stool out of the body.

**It may be permanent or temporary.A colostomy is created as a means to treat various disorders of the large intestine:

-cancer -obstruction -inflammatory bowel disease IschemiaIn a baby or child

it may be due to an imperforate anus which is the absence of an anal opening.

It also may be due to Hirschsprung’s Disease , or it may be due to other malformations that are present at birth

Care of ostomy wash your hands. remove the old appliance carefully from the

top down and avoid dragging the skin. wash the stoma and surrounding skin,

gently removing all waste. place prepared appliance over stoma. spend a few minutes moulding flang to

skin. do not forget to attach the clip (drainable

bag) place the empty old appliance in the

disposal bag wash your hands.

Cont.…

Feeding tubes**Nasogastric tube

• Tubes are used in infants & children for feeding when the child comatose , semiconscious , or unable to consume sufficient food orally.

Purpose for use (NG): Gavag lavag Decompression

Orogastric tube• Tube is most commonly

used in place of the nasogastric tube for newborns &young infant who obligate nose breathers.

• Use in older children if they are intubated,unconscious,or unresponsive.

Cont…Note**

The differences between NG tube & OG tube that's NG tube passed through nose & OG tube passed through mouth.• The principle of insertion & care of both tube

are the same.

Equipment for tube NG insertion

Washing hands. Prepare a trolley including :

Clean gloves.Ky jelly.60ml syringe.Kidney tray. Sticky tap. Bag to collect secretions. Placing a glass of drinking water nearby .Stethoscope.

NG tube insertionProcedure:

Prepare all equipment.Wash hands ,wear clean gloves(to reduce transmission of microorganism&protect froe contact with body fluid).Prepare child & family,enhance cooperation & participation.Position the child supine at a 30-45 angle if possible allow efficient passing of tube.

Cont.…Assess patency of nares, to determine if tube can easily passed.Measure the length of tube to be inserted and mark with apiece of tape.Lubricate 1 to 3 inches of the tube with ky gel to enhance passing tube.Insert the tube back & up into nostril by using gentel pressure .

Note***if resistance is met ,withdraw the tube & try to the other nostril.

Cont.…If the child is able , ask child to swallow .

Note ***Remove the tube immediately if there is vomiting or sings of

respiratory distress.(cynosis,tachypnea,nasal flaring,prolong coughing).

Who we can sure that the NG tube in place:Withdraw of gastric content.Checking contents withdrawn PH and other characteristics.Inserting end of tube in water & watching for bubbles.Listening by the stethoscope.X-ray ,to be sure tube is in the stomach.Fix the tube well.

NG TUBE & OG TUBE

Video about caring of child stoma

The EndWe have a right to be free from diseases

EVALUATIONA 9 month old infant is admitted with diarrhea and dehydration. The nurse plans to assess the child's vital signs frequently. Which other action should provide the most important assessment information?

a. measuring the infant's weightb. obtaining a stool specimen for analysisc. obtaining a urine specimen for analysisd. inspecting the infant's posterior fontanel

Cont..…The postoperative care plan for an infant with

surgical repair of a cleft lip includes:

a. A clear liquid diet for 72 hoursb. Nasogastric feedings until the sutures are removedc. Elbow restraints to keep the infant's fingers away from the mouthd. Rinsing the mouth after every feeding

Cont…Therapeutic management of the child with acute

diarrhea and dehydration usually begins with:

a. Clear liquids

b. Adsorbents, such as kaolin and pectin

c. Oral rehydration solution (ORS)

d. Antidiarrheal medications such as paregoric

Cont.…The nurse is preparing for the discharge of a neonate with a cleft lip and palate. One of the nurse's major concerns is to:

 a. institute prescribed antibiotic therapyb. administer supplemental vitaminsc. apply a sterile dressing to the lipd. establish an adequate feeding pattern

CONT.…What is the best response by the nurse to a mother asking about the

cause of her infant's bilateral cleft lip?

a. "Did you use alcohol during your pregnancy?"

b. "Do you know of anyone in your family or the baby's father's

family who was born with cleft lip or palate problems?"

c. "This defect is associated with intrauterine infection during the

second trimester."

d. "The prevalent of cleft lip is higher in Caucasians"