GASTROSTOMY
Nursing interventions
Pre Op
a.  position: upright; 30 degree
head elevation
b. Provide suction
c. Keep on NPO
d. Admin IV fluids as ordered.
e. Gastrostomy tube: place &
left open so air can escape
f. Administer antibiotics: for
Aspiration pneumonia
feeding,
drooling, regurgitation
undigested food (signs of RD
and constricted esophagus)
Post OP
a. Provide nutrition
- gastrostomy feeding
- SFF
- monitor I &O, weight
B. monitor anastomotic
leaks.
(purulent chest drainage,
increased temp & WBC)
c. instruct parents to
identify: poor
dysphagia,
of
d. If gastrostomy tube is present, it is attached to gravity
drainage until infant can tolerate feedings (5th-7th day
post opertively).
e. BARIUM SWALLOW – to verify the integrity of
esophageal anastomosis (performed before oral
feedings & chest tube is removed).
UGIT study: examination of UGIT using “fluoroscopy”.
Pre procedure: NPO after midnight before day of test
Post procedure:
1.  May prescribed a laxative.
2.  Increase OFI – pass barium
3.  Monitor stools for passage of barium (chalky white) –
bowel obstruction
Celiac disease
III. Celiac disease
-  Aka “ Gluten enteropathy or tropical sprue”.
-  Intolerance to gluten (protein component of BROW)
-  Results in accumulation of amino acid “glutamine”
(toxic to intestinal mucosal cells)
-  Intestinal villi atrophy, affecting absorption of
ingested nutrients.
-  Reduced absorptive surface causes marked
malabsorption of fats.
-  Symptoms occur: ages 1 and 5 years
-  Cause: unkown –”inborn error of metabolism or
immunologic disorder.
-  Assessment:
a.  Acute or insidious diarrhea; stools (watery, pale w/
offensive odor) - steatorrhea
b.  Anorexia, abdominal pain & distention
c.  Muscle wasting in buttocks & extremities
d. Vomiting
e. Anemia
f. Irritability
g. Failure to thrive

Celiac crisis: precipitated by infection, fasting, and gluten

ingestion.
-  Can lead to electrolyte imbalance, rapid dehydration
-  Causes: profuse watery diarrhea & vomiting
Nursing interventions:
1.  Must have a Gluten Free Diet.
-  Substitute corn, rice & millet (grain source) instead of
BROW!!!!
2. Lifelong elimination of gluten.
3. Mineral & vitamin supplements: ADEK
4. Teach parents about gluten free diet & read food labels.
Foods allowed Foods prohibited
- meat: pork, beef -commercially prepared
- Poultry; fish; ice cream, malted milk
- Eggs; milk, vegetables Breads, rolls,
- Grains, rice, corn, corn
cookies,cakes
meal Crackers, cereals,
spaghetti, macaroni
noodles, beer
IV. Hirschsprung’s disease
- Aka “ aganglionic megacolon”; congenital aganglionosis

-  occur: result of an absence of ganglion cells in the

rectum & upward in the colon.
- Results in mechanical obstruction from inadequate

motility in intestinal segment

- Usually diagnosed in infancy

- Familial disease; more common in BOYS, associated with

Down’s syndrome.
- “RECTAL BIOPSY”: histologic evidence of absence of

ganglionic cells
- Most serious complication: :”Enterocolitis” (fever,
severe prostation, GIT bleeding, explosive watery
diarrhea)
Hirschsprung’s disease:
What happens?
- When stool enters the affected part of the colon è

lack of peristalsis causes it to remain there until

additional stool pushes through è colon dilates due to
impacted stool.
- Treatment for mild or moderate disease:

(relieve chronic constipation)

- stool softeners; rectal irrigations, mostly: surgery!

Treatment for moderate to severe disease:

- 2 step surgical procedure.

1st step (neonatal period):

- “temporary colostomy” – relieve obstruction & allow
normally innervated, dilated bowel to return to its
normal size.
2nd step: complete surgical repair is performed.
- when? Child weighs 9 kg (20 pounds)

- What? ABDOMINAL- PERINEAL PULL THROUGH

PROCEDURE ( bowel containing ganglia is pulled down &
anastomosed to the rectum - excise portion of the bowel –
colostomy is closed).

Assessment
NB infants Older infant/children
a. Failure to pass meconium a. failure to gain weight &
stool w/in 24-48 hours after delayed growth
Birth. b. watery stools & diarrhea
b. Refusal to suck c. FTT
c. Abdominal distention d. abdominal distention
d. Bile stained vomitus e. RIBBON LIKE & FOUL
SMELLING STOOLS
 Colostomy:
Pre op Post op:
- Low residue diet - petroleum jelly
- Intestinal antibiotics/antiseptics gauze to stoma then
(decrease bacterial content of colon dry sterile dressing
& reduce risk of infection) if pouch system isn’t
- Admin laxatives & enema. use.
-  - monitor stoma (size,
unusual bleeding, color changes).
-  - Normal color stoma
- ( red or pink – high vascularity) & moist

-  - Stoma: pale pink

- ( low hemoglobin & hematocrit levels)

-  - Stoma: purple-
black (compromised circulation – report to AP).
Colostomy
Stool consistency:
-  Liquid stool – post op but becomes solid depending on the
area of colostomy.
-  Liquid stool ( ascending colon)
-  Loose to semi formed stool (transverse colon)
-  Close to normal stool (descending colon)

-  - Empty pouch when 1/3 full

-  Avoid foods that cause excessive gas & odor formation.

-  DIAGNOSTICS:
a.  Rectal biopsy (confirms presence of aganglionic cells)
b.  Barium enema
Interventions:
1.  Administer enema as ordered.
-  use: Mineral oil or isotonic saline
-  Do not use: Soap suds or tap water: water intoxication
( more diluent than solute).
2. Use volume appropriate to weight of child.
-  infants: 150-200 ml
-  Children: 250-500 ml
3. Do not treat the child for loose stools – constipated.
4. Low residue diet.
5. Administer TPN as ordered.
 Intussusception:
- Telescoping of 1 portion of the bowel into another

usually at ileocecal valve.

 Results in edema, obstruction to the passage of
- 
intestinal contents and necrosis of the bowel.
-  Most common cause of intestinal obstruction in
children ages 3 months to 3 years.
-  Occur often: BOYS than in girls
-  Incidence increase in CF or CD.

Assessment:
1.  “colicky abdominal pain” – child to scream & draw to
knees to the abdomen.
2.  Vomiting of gastric contents.
3.  Bile stained emesis
4.  “Currant jelly stools”: blood & mucus
5.  Hypo or hyperactive bowel sounds
6.  Tender distended abdomen
7.  Palpable “Sausage shaped mass” – RUQ.
Treatment:
1.  Barium enema to reduce telescoping & confirms the
problem.
-  Associated with increased risk of peritonitis if
there is perforation.
-  Barium enema (LGIT study)
( a fluoroscopic & radiographic examination of the LI &
performed after rectal instillation of barium
sulfate).
Interventions:
1.  Careful assessment of client’s physical & behavioral
symptoms.
2.  Maintain NPO and assess electrolyte imbalance.
3.  Monitor all stools.
- normal stool passage: indicates reduction
4. Barium enema is contraindicated if there is:
-  Air in abdomen
-  High fever
-  Vomiting
-  Signs of peritonitis
5. Prepare the child for barium enema as though
surgery will follow: NPO status, NGT, IV fluids.
 Pyloric stenosis
- Obstruction of pyloric sphincter by “hypertrophy of the

circular muscles of the pylorus” è causing the narrowing of

the pyloric canal between the stomach & duodenum.
- More common in Caucasian, first born, full term boys.
Pyloric stenosis Stenosis – develop in 1st
few weeks of life.
Forceful, projectile vomiting
develop at 4-6 weeks of
age, dehydration, FTT.

Assessment:
1. Projectile vomiting
2. Olive shaped mass in
the epigastrium just right
of the umbilicus.
3. Vomitus: milk formula,
mucus, but NO BILE.
4. The child exhibits hunger & irritability.
5. Peristaltic waves are visible from left to right across
the epigastrium during or immediately following a
feeding. (“ rolling balls under abdominal wall”).
6. Dehydration (sunken fontanels, poor skin turgor,
decreased urinary output) & malnutrition occur.
7. Electrolyte imbalance occur.
8. FTT

Diagnostics:
1.  UGI series reveals narrowing of pylorus diameter.
2.  Sodium, potassium, chloride decreased.
Medical Management:
1.  Non invasive: thickened feedings
2.  Surgery: “PYLOROMYOTOMY” (Fredet- Ramstedt
procedure)

Preop interventions:
1.  Monitor hydration status: I&O, daily weight, urine for
S.G.
2.  Prevent vomiting.
-  Give thickened feedings
-  HF position
-  Place on right side after feedings
-  Minimize handling
-  Observe for symptoms of aspiration of vomitus
3. Frequent burping during feeding to prevent gastric
distention.
Post operative:
1.  Monitor I&O.
2.  Feedings are initiated early.
-  Bottle fed may begin with clear liquids è then diluted
formula.
3. Begin small, frequent feedings of glucose, water, or
electrolyte solution 4-6 hours post op.
4. FEED the infant “slowly” – burping frequently – handle the
infant minimally after feedings.
5. Monitor for abdominal distention.