Week 14: Alteration in Ntrition and G.I, Metabolsm & Ndocrne

• Functions of GI System

  • Digestion and absorption of nutrients 
  • Perform excretory system
  • Provide detoxification 
  • Participate in maintaining fluid and electrolyte balance
  • Serve a lymphoid function by providing a barrier for pathogens 
• CLEFT LIP - results from incomplete fusion of the embryonic structures surrounding the primitive oral cavity
• CLEFT PALATE - Occurs when the primary and secondary plates fail to fuse during embryonic development
• ETIOLOGY OF CLEFT LIP & PALATE

  • Teratogens
  • Inheritance
  • Drugs (phenytoin, valproic acid, thalidomide, pesticide dioxin)
  • Folic acid deficiency
  • Maternal smoking and alcohol ingestion
• THERAPEUTIC MANAGEMENT (CLEFT LIP & PALATE)

  a.Surgery

  • Cleft lip (cheiloplasty)
  • Cleft palate (palatoplasty; maximize speech production and growth of midface)
• DIAGNOSIS OF CLEFT LIP AND PALATE

  • Newborn Screening
  • Transabdominal ultrasound can be performed as early as 13 to 14 weeks’ gestation
  • The upper lip, alveolar arches, nostrils, and primary and secondary palates is inspected and palpated.
• NURSING MANAGEMENT OF CLEFT LIP AND PALATE

  a.Feeding

  • Best accomplished with the infants head in an upright position
  • Special bottles for feeding (Haberman Bottle)

  b. POST-OP

  • Cleft lip: avoid prone position
  • Cleft palate: prone position
  • Elbow restraints (remove at intervals)
  • Avoid use of suction, tongue depressor, thermometers, spoons, and straws
• Hirschsprung Disease is also known as congenital aganglionic megacolon
• Hirschsprung Disease - congenital anomaly in which inadequate motility causes mechanical obstruction of the intestine (failure of the bowel to relax)
• Ganglion cell - responsible for relaxing the colon
• THERAPEUTIC MANAGEMENT OF H.S DISEASE

  a.Surgery ( Two Stages)

  • 1st: Creation of temporary ostomy site to relieve obstruction
  • 2nd: Complete corrective surgery or Soave endorectal pull-through (remove the segment of the colon that has no ganglion cell)

  b. Anorectal myomectomy (very short-segment disease)
• Clinical manifestations of Hirschsprung disease

  • Abdominal distention
  • Feeding intolerance
  • Bilious vomiting
  • Failure to pass meconium within the first 24 to 48 hours after birth.
  • Constipation
  • Ribbon-like and foul smelling stool
• Diagnosis of Hirschsprung Disease

  • History and Physical examination
  • Rectal biopsy for presence or absence of ganglion cells.
  • Barium Enema ( injection of Barium Sulfate via enema)
  • Anorectal manometry (measures the capacity of the rectum to pass the stool)
• NURSING CONSIDERATION OF H.S DISEASE

  • Observe the passage of meconium (if the baby was able to excrete meconium within 24 hrs)
  • Helping parents to adjust to the congenital disorder
  • Preparing the parents for the medical-surgical procedure
  • Detect abdominal distention
• Intussuception - Telescoping or invagination of the proximal segment to a more distal segment that results in lymphatic and venous obstruction
• CLINICAL MANIFESTATION OF INTUSSUCEPTION

  • Sudden onset of abdominal pain

  • Inconsolable crying

  • Drawing up of knees on the chest

  • Bilous vomiting

  • Palpable sausage-shaped mass in the abdomen

  • Currant Jelly-like stool
• DX OF INTUSSUCEPTION

  • Subjective findings

  • Barium enema

  • Abdominal radiography

  • Rectal exam (mucus and blood)
• NURSING MANAGEMENT OF INTUSSUCEPTION

  • Assist in establishing DX
  • Explain the basic defect to the parents and how it is corrected
• TREATMENT OF INTUSSUCEPTION

  • radiologist-guided pneumo-enema (air enema); not recommended if there are signs of perforation
  • Intravenous fluids
  • NG decompression
  • antibiotic therapy
  • surgical intervention
• Appendicitis - inflammation of the vermiform appendix, the small sac near the end of the cecum, and is the most common cause of emergency surgery in children.
• ETIOLOGY OF APPENDICITIS

  • a fecalith (hard fecal mass)
  • parasitic infestations
  • stenosis
  • hyperplasia of lymphoid tissue
  • a tumor
• CX MANIFESTATIONS OF APPENDICITIS

  • Colicky
  • Pain in the periumbical area
  • Blumberg sign (pain upon removal of palpation (pressure) rather than application of pressure)
  • Rovsing sign (palpating other quadrants but the pain was felt on RLQ)
  • Psoas sign (px in supine position; apply your hand (pressure) on the right knee and ask the px to lift it. px will feel pain on RLQ)
  • Obturator sign (px in supine position; bend and lift the right knee, then rotate it. px will feel pain on RLQ)
• Diagnosis of appendicitis

  • Elevated white blood cell count (above 10,000/mm3 )
  • Abdominal ultrasound
  • CT scans
• NURSING MANAGEMENT OF APPENDICITIS

  a.Assist in establishing diagnosis

  b. Instruct the child to pint a finger on the painful region

  c. Light palpation induced pain

  d. PRE-OP CARE

  • Don’t administer pain relievers (paracetamol); it can mask the rupture appendicitis that causes relief of pain
  • PX is NPO
  • Administer IV fluids and antibiotics

  e. POST-OP CARE

  • Dressing covering the incision
  • Antibiotics
  • If px has perforated appendix, remain NPO until bowel function return
  • Give Morphine for pain reliever
• Hypertrophic pyloric stenosis (HPS) - circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel.
• CLINICAL MANIFESTATION OF HPS

  • projectile vomiting
  • fails to gain weight
  • dehydration
  • olive-sized mass in the right upper quadrant may be evident
• DIAGNOSIS OF HPS

  • History and Physical examination
  • Ultrasonography (determine the diameter and length of the pyloric muscle)
  • Blood test (determine if the child is dehydrated or has electrolyte or acid–base imbalance)
  • Upper GI radiography
• NURSING MANAGEMENT OF HPS

  • Careful regulation of fluid therapy

  • Minimizing weight loss

  • Promote rest and comfort

  • Preventing infection

  • Reestablishment of normal feeding patterns

  • Encourage the parents to become involved in caring for the child
• Laparoscopic pyloromyotomy is the preferred surgical method to correct pyloric stenosis
• Celiac disease is a sensitivity or abnormal immunologic response to protein, particularly the gluten factor of protein found in grains—wheat, rye, oats, and barley.
• CLINICAL MANIFESTATION OF CELIAC DISEASE

  • impaired growth
  • chronic diarrhea
  • abdominal distention
  • muscle wasting with hypotonia
  • poor appetite
  • lack of energy
• DIAGNOSIS OF CELIAC DISEASE

  • Presence of antigliadin and antiendomysial immunoglobulin and their disappearance when gluten is removed from the diet
  • Villous atrophy and hyperplasia in children who eat a diet with gluten
  • Remission of symptoms upon gluten withdrawal
• THERAPEUTIC MANAGEMENT OF CELIAC DISEASE

  a.Dietary Management (gluten-free diet); avoid BROW

  • Barley
  • Rye
  • 0at
  • Wheat

  b. Substitute: Rice and Corn

  c. Helping children adhere to dietary regimen

  d. Advise parents the necessity of reading all label ingredients

  e. Hidden sources of gluten:

  • bread, cake, cookies, crackers, donuts, pizza, hotdog, luncheon meat, hamburger
• NURSING MANAGEMENT OF CELIAC DISEASE

  a.Due to inflamed bowel the child must avoid high fiber foods

  • nuts, raisins, raw vegetable, raw fruits with skin, until inflammation subsides
• NURSING CONSIDERATION OF CELIAC DISEASE

  • helping the child adhere to the dietary regimen.
  • explaining the disease process to the child and parents,
  • the specific role of gluten in aggravating the disorder, and the foods that must be restricted.
• Hypopituitarism (dwarfism) - diminished or deficient secretion of pituitary hormones
• 2 CATEGORIES OF DWARFISM

  a.Disproportionate Dwarfism

  • The body size is disproportionate, and some parts of the body are small while others are of average size or above average size

  b. Proportionate Dwarfism

  • The body is proportionately small; all parts of the body are small to the same degree
• CLINICAL MANIFESTATION OF DWARFISM

  • An average-size trunk
  • Short arms and legs
  • Short fingers
  • Limited mobility at the elbow
  • A disproportionate large head
  • Progressive development of bowed legs
  • Progressive development of lower back
  • An adult height around 4 feet (122 cm)
• NURSING CONSIDERATION OF DWARFISM

  • identifying children with growth problems
  • special emotional adjustments for these children
  • key person in helping to establish a diagnosis
  • observed carefully for signs of hypoglycemia; generated by tests with insulin
• PITUITARY HYPERFUNCTION (GIGANTISM) - Excess GH before closure of the epiphyseal shafts results in proportional overgrowth of the long bones until the individual reaches a height of 2.4 m (8 ft) or more.