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Alteration in Metabolism
Alteration in Metabolism
Nursing interventions
Pre Op Post OP
a. position: upright; 30 degree a. Provide nutrition
head elevation - gastrostomy feeding
b. Provide suction - SFF
c. Keep on NPO - monitor I &O, weight
d. Admin IV fluids as ordered. B. monitor anastomotic
e. Gastrostomy tube: place & leaks.
left open so air can escape (purulent chest drainage,
f. Administer antibiotics: for increased temp & WBC)
Aspiration pneumonia c. instruct parents to
identify: poor
feeding, dysphagia,
drooling, regurgitation of
undigested food (signs of RD
and constricted esophagus)
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
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
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: 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)
- 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
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
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.