• Nursing Care of a family when a child has a Gastrointestinal Disorder
• Heather M. Fowler, PhD, RN, CNE
• Module I
Section 6
Chapter 45
• 2030 National Health Goals-Related to GI
• Increase the contribution of fruits and vegetables to the diets of 2 and older
• Increase the number of states with nutrition standards for food and drink for preschool
• Increase proportion of schools that do not sell or offer soda
• Increase number or districts that require schools to make fruits and vegetables available with food service
• Food handling goals to reduce food borne illnesses- washing hands/surfaces when preparing foods, separate
cutting boards, safe temperatures, refrigeration,
• Reduce Norovirus outbreaks, and increase safe preparation/handling of deli foods
• Reduce Hepatitis A, Reduce acute Hepatitis B rates
• Increase vaccines for Hep A and Hep B
•
• Nursing care for gastrointestinal disorders
• Assessment
• Signs of fluid loss
• Poor skin turgor
• Dry mucus membranes
• Lack of tearing
• Ask parents EXACT amount of “spitting up” or “little vomit”
• Voiding times in 24hrs
• Less than usual?
• Compare weight to last visit
• X-ray with contrast medium barium
• Endoscopic examination
• Ultrasound
• MRI
• Laboratory testing
• Electrolyte imbalance
• Urinalysis
• Diagnosis
• Impaired parenting r/t interference with establishing the parent -infant bond
• Interrupted family process r/t chronic illness
• Risk for deficient fluid volume r/t chronic illness
• Imbalanced nutrition r/t malabsorption of necessary nutrients
• Situational low self-esteem r/t feelings of being different resulting from special dietary restrictions
• Outcome/Planning
• Include person who prepares or supervises child nutrition
• Contact school/meal exceptions or supervise nutritional intake
• MyPlate nutrition guide
• Support family following restrictions for child
• Parent comfortable feeding through nasogastric tube
• Implementation
• Support parents with restrictions
• Parenteral feeding
• Enteric feeding
• Gastrostomy feeding
• Colostomy needs
• Give clear, simple explanations
• Praise parent & child when demonstrated correctly
• Therapeutic paly for children before and after
• Outcome/Evaluation
, • Record child’s height and weight
• Make certain children learn gradually about nutritional measures
• Eventually become responsible for own intake
• Parents will eventually feel comfortable to let them stay overnight elsewhere
• Childs Self-esteem evaluated periodically
• Child lists examples of gluten free foods
• Parents list steps to take to seek medical care if child has diarrhea
• Family members state adjustments caring for child
• Anatomy and Physiology Review
• Occurs in same way as adults
• Newborns sphincter is immature
• Gastroesophageal reflux
• Some infant’s pyloric sphincter becomes narrowed (stenosed)
• Prevents food from flowing out of the stomach freely (pyloric stenosis)
• Stomach is not sterile
• Diagnostic/
Therapeutic Techniques
Endoscopy
Enteroscopy (capsule endoscopy)
Colonoscopy
Radiology studies
Conscious sedation
Clear and simple explanation of what will happen in procedure
Parent can stay by side until they fall asleep
Therapy may involve alternative ways of feeding to let the GI tract rest
Colostomy may be used to let GI rest
Ileostomy may be used to let GI rest
• Health Promotion/
Risk Management
Can NOT be prevented
o Appendicitis cannot be prevented
o Celiac disease genetic aspects cannot be changed
o Crohn’s disease & ulcerative colitis associated with autoimmune response
Can be prevented
o Vomiting
o Diarrhea
o Hepatitis A/B (through hand washing or immunization)
o Vitamin and protein deficiencies
o Rotavirus
Help families adapt to new lifestyle
Encourage at least one meal together “touch base”
Urge child to table for social time (gastrostomy/parenteral feeding)
Educate parents about normal nutrition and to distinguish illness from something normal
Early interventions prevent child from dehydration or serious illness
• Fluid Imbalances
• Infants = 70%
• Children = 65%
• Adolescents/adults = 60%
• Fluid is distributed by 3 body compartments:
1. Intracellular (within cells) 35-40%
2. Interstitial (surrounding cells) 20% ECF extracellular fluid
3. Intravascular (blood plasma) 5% infants =45% adults/adolescents = 25% children =30%
• Fluid obtained by oral ingestion & breakdown of food
• Primarily lost by urine & feces
• Minor losses (insensible losses) evaporation from skin, lungs, and saliva
1. Only important in children w/ tracheostomy & nasopharyngeal suction
• Infants DON’T concentrate urine well
1. Lose greater amounts of fluid in their urine as a result
• Heather M. Fowler, PhD, RN, CNE
• Module I
Section 6
Chapter 45
• 2030 National Health Goals-Related to GI
• Increase the contribution of fruits and vegetables to the diets of 2 and older
• Increase the number of states with nutrition standards for food and drink for preschool
• Increase proportion of schools that do not sell or offer soda
• Increase number or districts that require schools to make fruits and vegetables available with food service
• Food handling goals to reduce food borne illnesses- washing hands/surfaces when preparing foods, separate
cutting boards, safe temperatures, refrigeration,
• Reduce Norovirus outbreaks, and increase safe preparation/handling of deli foods
• Reduce Hepatitis A, Reduce acute Hepatitis B rates
• Increase vaccines for Hep A and Hep B
•
• Nursing care for gastrointestinal disorders
• Assessment
• Signs of fluid loss
• Poor skin turgor
• Dry mucus membranes
• Lack of tearing
• Ask parents EXACT amount of “spitting up” or “little vomit”
• Voiding times in 24hrs
• Less than usual?
• Compare weight to last visit
• X-ray with contrast medium barium
• Endoscopic examination
• Ultrasound
• MRI
• Laboratory testing
• Electrolyte imbalance
• Urinalysis
• Diagnosis
• Impaired parenting r/t interference with establishing the parent -infant bond
• Interrupted family process r/t chronic illness
• Risk for deficient fluid volume r/t chronic illness
• Imbalanced nutrition r/t malabsorption of necessary nutrients
• Situational low self-esteem r/t feelings of being different resulting from special dietary restrictions
• Outcome/Planning
• Include person who prepares or supervises child nutrition
• Contact school/meal exceptions or supervise nutritional intake
• MyPlate nutrition guide
• Support family following restrictions for child
• Parent comfortable feeding through nasogastric tube
• Implementation
• Support parents with restrictions
• Parenteral feeding
• Enteric feeding
• Gastrostomy feeding
• Colostomy needs
• Give clear, simple explanations
• Praise parent & child when demonstrated correctly
• Therapeutic paly for children before and after
• Outcome/Evaluation
, • Record child’s height and weight
• Make certain children learn gradually about nutritional measures
• Eventually become responsible for own intake
• Parents will eventually feel comfortable to let them stay overnight elsewhere
• Childs Self-esteem evaluated periodically
• Child lists examples of gluten free foods
• Parents list steps to take to seek medical care if child has diarrhea
• Family members state adjustments caring for child
• Anatomy and Physiology Review
• Occurs in same way as adults
• Newborns sphincter is immature
• Gastroesophageal reflux
• Some infant’s pyloric sphincter becomes narrowed (stenosed)
• Prevents food from flowing out of the stomach freely (pyloric stenosis)
• Stomach is not sterile
• Diagnostic/
Therapeutic Techniques
Endoscopy
Enteroscopy (capsule endoscopy)
Colonoscopy
Radiology studies
Conscious sedation
Clear and simple explanation of what will happen in procedure
Parent can stay by side until they fall asleep
Therapy may involve alternative ways of feeding to let the GI tract rest
Colostomy may be used to let GI rest
Ileostomy may be used to let GI rest
• Health Promotion/
Risk Management
Can NOT be prevented
o Appendicitis cannot be prevented
o Celiac disease genetic aspects cannot be changed
o Crohn’s disease & ulcerative colitis associated with autoimmune response
Can be prevented
o Vomiting
o Diarrhea
o Hepatitis A/B (through hand washing or immunization)
o Vitamin and protein deficiencies
o Rotavirus
Help families adapt to new lifestyle
Encourage at least one meal together “touch base”
Urge child to table for social time (gastrostomy/parenteral feeding)
Educate parents about normal nutrition and to distinguish illness from something normal
Early interventions prevent child from dehydration or serious illness
• Fluid Imbalances
• Infants = 70%
• Children = 65%
• Adolescents/adults = 60%
• Fluid is distributed by 3 body compartments:
1. Intracellular (within cells) 35-40%
2. Interstitial (surrounding cells) 20% ECF extracellular fluid
3. Intravascular (blood plasma) 5% infants =45% adults/adolescents = 25% children =30%
• Fluid obtained by oral ingestion & breakdown of food
• Primarily lost by urine & feces
• Minor losses (insensible losses) evaporation from skin, lungs, and saliva
1. Only important in children w/ tracheostomy & nasopharyngeal suction
• Infants DON’T concentrate urine well
1. Lose greater amounts of fluid in their urine as a result
