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Attachment to
Parent
-Involve parent in
procedure if desired
-Keep parent in
infants line of vision
-if parent is unable to
be there, place
familiar object such
as a stuffed toy.
Strange anxiety
-Make advances
slowly and in a
nonthreatening
manner
-Limit # of strangers
in room
Sensorimotor phase
of learning
-Use sensory
soothing measures
-Use analgesics
-cuddle and hug
infant after stressful
procedure
Increased muscle
control
-Restrain adequately
-Keep harmful objects
out of reach
Imitation of
gestures
-Model desire
behavior
Egocentric though
-Explain to child in
relation to what child
will see, hear, taste,
smell, and feel
-Emphasize aspects
of procedure that
require cooperation
Negative behavior
-Expect tx to be
resisted; child might
try to run away
-use firm, direct
approach
-ignore temper
tantrums
-use distraction
techniques
-restrain adequately
Animism
-Keep frightening
objects out of view
Limited language
skills
-communicate using
gestures or
demonstrations
-give child 1 direction
at a time
-Use small replicas of
equipment & let child
handle them
-Use play; use a doll
to demonstrate but
avoid favorite doll
Limited concept of
time
-Prepare child shortly
or immediately before
procedure
-keep teaching short
-have preparations
completing before
involving child in it
Striving for
Independence
-Allow choices when
possible
-allow to participate in
care
Egocentric
-Same as toddler plus,
-demonstrate equipment
-allow child to play with doll or equipment
-Use neutral words
Animism
-Keep equipment out of view until used
Increased language
skills; interest in
acquiring
knowledge
-Explain procedure
using scientific and
medical term
-explain procedure
using pictures
-Discuss why its
being done
-explain function and
operation of
equipment
Improved concept
of time
-Plan for longer
teaching
-prepare up to 1 day
in advance of
procedure
Increased selfcontrol
-Gain childs
cooperation
-Tell child what is
expected
-encourage active
participation
Developing
relationships with
peers
-prepare 2+ children
for same procedure
or encourage to help
each other
-privacy from peers
Adolescent- developing identity and abstract thought
Increasing abstract
thought and
reasoning
-Discuss why its
being done
-Explain long-term
consequences of
procedures
-Realize they might
fear death, disability,
risks
-encourage
questioning
Consciousness and
appearance
-Provide privacy
-Discuss how
procedure may affect
appearance
-Emphasize physical
benefits of procedure
Striving for
independence
-involve in decision
making and planning
-explore coping
strategies
-have difficulty
accepting new
authority figures
Developing peer
relationships and
group identity
-same as school
aged child
6.
Fever
During febrile, shivering and vasoconstriction generate and conserve heat during the chill
phase of fever, raising central temperatures
Fever has physiologic benefits which include increased in wbc activity, interferon
production and effectiveness, and antibody production and enhancement of some
antibiotic effects
Important terms
Set point- Temp. around which body temp is regulated by a thermpstat-like
mechanism in the hypothalamus
Fever (hyperpyrexia)- an elevation in set point. Above 38 C
Hyperthermia- body tempt exceeding the set point
Therapeutic management
To relieve discomfort
Fever
Acetaminophen is the preferred drug
Aspirin should not be used
Ibuprofen should be 5mg/kg of body wt for temp less than 39.2C or 10mg/kg for
greater than 39.2C
Acetaminophen dosage should never be exceeded
Cooling measures such as wearing minimal clothing, exposing skin to air, reducing
room temp, increasing air circulation, and applying cool moist compresses to the
skin
Sponging or tepid baths are ineffective
Hyperthermia
Antipyretics are no value bc the set point is already normal
Cooling measures are used such as applications to the skin
Cooling devices and cooling blankets can reduce body temp
Tepid baths are effective to reduce body temp. Water should be 1C less than childs
body temp and left in there for 15-20 mins while water is gently squeezed from
washcloth over the back and chest of body
9.
Safety
Responsibility of everyone who comes into contact with small children to maintain
protective measures throughout their hospital stay
Each age level and how each child is operating is important in guiding a safety plan
Identification bands are important for children
Infants and unconscious parties are unable to respond to their names
Can be used for family in varying structures and stage of the life
cycle
Limitations
Difficult to determine cause and effect relationships due to
circular causality
Applications
Mate selection, courtship processes, family communication, power
and control within family, parent-child relationships, teenage
pregnancy and parenthood
Family Stress
Explains how families react to stressful events and suggests factors that
promote adaptation to stress
Family encounters both normative (parenthood) and unexpected ( illness,
unemployment, etc.) stressors throughout the life cycle
Too many stressors in a short time (1 year) can overwhelm the family and
its ability to cope causing breakdown or additional stressors that can lead
to a family crisis
Strengths and Limitations
Strengths
Explain and predict how a family will react to stressors and
develop into effective interventions to promote family
adaptations
Focuses on positive coping, resources, and social support
Limitations
Not yet known if there are certain resources and coping
strategies are applicable to all stressful events
Applications
Transition to parenthood hood, single parent families, families with
work related issues, acute or chronic childhood
illnesses/disabilities, infertility, death of child, divorce, teenage
pregnancy and parenthood
Developmental
Addresses family change over time using Duvalls eight developmental
tasks of the family based on predictable changes in the familys structure,
function, and roles with the age of the oldest child as the marker for stage
transition
Each family member must achieve individual developmental tasks as part
of each family life cycle stage within the family and broader society
Family role performance at one stage of the family life cycle influences
familys behavioral options at the next stage
Family is in a stage of equilibrium when entering a new life cycle stage
and strives towards homeostasis within stages
Strengths and Limitations
Strengths
2.
3.
Family roles
Each individual has a position in each family structure with a culturally and socially
defined interactions and roles in the family
Conflicts arise when members do not fulfill their roles according to other family members
expectations or because they choose not to fulfill them
Parental Roles
Socially recognized mother and father with socially sanctioned roles that
define the sexual behavior and childrearing responsibilities in a family
structureall based upon parents social experience
Roles have evolved immensely with changing times fathers are more active in
child rearing and household tasks
More conflicts arise in families due to cultural lag and persisting of
traditional role definitions
Siblings
Narrower the spacing between siblings, the more the children influence one
another
Wider spacing between siblings, the greater the influence from parents
Siblings exert power, exchange services, and express feelings in a reciprocal
way
Family Size
Small families emphasize individual development of the children
Children have a say in the family
Adolescents indentify more strongly with their parents and rely on them
for advice
Large Families emphasis on the group and less than the individuals
All members learn to cooperate
Dominant member either the parent or an older sibling emerges
Children adopt specialized roles to gain recognition in the family
Older children administer discipline and assumes responsibility for the
security of the other children when a parent is either ill or dies
Ordinal Position/Birth Order
Affects personalities and how parents treat their children as well as how sibling
interact with one another
Firstborn
Achievement oriented, dominant, self discipline
Identify with parents more than peer group
Begin to speak earlier in life
Plan better and experience fewer frustrations
Subject to greater parental expectations
Middle children
More demands made on them to help with the household
Praised less often and receive less of parents attention
Good at compromising and adapting to new situations
Difficult to characterize due to variety of positions it assumes in the family
Youngest
Less dependent and less intense than the firstborn
Identify more with peer group than parentspopular among classmates
4.
Transition to parenting
No amount of preparation can fully prepare prospective parents for an infants constant
and immediate needs
Factors affecting transition
Parental age
Physiological standpoint best age for childbearing 18-35 years old
Childbearing age increased to 30-44 years old
Father involvement
Fathers with little initial contact with newborns will become involved with
them over the next few months
Fathers engage in more physically stimulating activities, successful at
soothing infants
Secure attachment to the father can help offset the consequences of an
insecure attachment to the mother
Parenting education
Programs are designed to take place near the time of birth or soon after
can be more helpful in easing transitional stress than earlier programs
Nurses offer suggestions and education in helping become a better
parent
Support systems
Need to have at least two types of family resources
Internal Resources
Adaptability: learning to be patient, becoming better
organized, and becoming more flexible
Integration: couples attempt to continue some activities
they engaged in before they becoming parents
Time away from the child is essential
Coping Strategies
Use of social support systems and community resources
Interpersonal supportrelationship with family, friends, and
the community
Provides opportunities to be away from the child
Brings reassurance that others experience the
same fears of parenthood as you
5. Discipline and limits
Discipline: the action taken to enforce the rules of noncompliance
Types of Discipline
Reasoning
Explaining why an act is wrong
Appropriate for older children especially with moral issues
Does not work well for children because of egocentrism or they cannot
see the other side
Used by children to gain attention
Scolding
Often combined with reasoning
A form of shame or criticism
Believe that they are bad not necessarily that their action is bad
Behavior Modification
Consistency and timing are essential
Positive and negative reinforcement
Rewarded for positive behavior to minimize the tendency to want to
misbehave
Older Children use a token system
Certain number of stars or points add up to a special reward
Parents need to plan and explain expected behavior to the child and
establish a reward system that is reinforcing
Verbal approval should accompany extrinsic rewards
Ignoring
Extinguish or minimize the act
6.
7.
Discussion should include the reason for the divorce and reassurance that the
divorce is not the fault of the children a
Acknowledge feelings of fear and abandonment
Need love and reassurance that their lives will try and remain as consistent and
orderly as possible
Physically comfort the children can help provide them with warmth and
reassurance
Custody and Parenting Partnerships
Past belief is mother gets custody with visitation agreements for the father
Current belief is neither mother nor father should be awarded custody
automaticallyshould be awarded to the parent who is best able to provide for the
childrens welfare
Grandparents on the side of the parent with custody are increasingly involved in
the care of young children of divorced parents
Non custodial grandparents are kept away from their grandchildren
Divided/Split Custody
Each parent is awarded custody of one or more of the childrenseparated
siblings
Sons live with the father and daughters with the mother
Joint Physical Custody
Parents alternate the physical care and control of the children on an
agreed on basis while maintain shared parenting responsibilities legally
Works well with families who live close to each other and whose
occupations permit an active role in the care and rearing the children
Joint Legal Custody
The children reside with one parent but both parents are the childrens
legal guardians and both participate in childrearing
Co parenting allows children to be close to both parents and life with each parent
can be more normal
For a successful co parenting relationship, parents have to be committed
to providing normal parenting and to separate their marital conflicts from
their parenting roles
Primary consideration is welfare of the children
8.
9.
Minimize Separation
Rooming In: parents/family stays with child
Telephone: communication with family
Nursing Presence: play with patient
Parent Education
How to leave*: leave without saying goodbye is difficult; encourage
parents to have discussion with child (I may leave when you fall asleep,
the nurses can call me at home)
Explaining time: frequent short visit are good- quality*
Limit Physical Restriction/Changed Routines
Help parent maintain routine
Take out of room: noisy room
Provide visual, auditory, tactile diversion: games, videos, books, cards
Maintain certain routines: e.g. pray before bed
Familiar food
Promote self-care if appropriate: wagon instead of wheelchair
Help child understand
Carefully consider how much information: little tube in your hand to give your
body medicine
Timing of information varies: 3 yo will normally be combative regarding a Foley
tell them a new min before
Prevent Fear of Bodily Injury
Pre-procedure preparation
Parental presence: encourage pts to be present for most things even
anesthesia in OR; can be relief to parents who think its worse than it is
Clear communication: IV stick (not a stick like found in woods), CAT-SCAN
(cat? big camera thats taking a lot of pictures its going to get loud but it will be
ok; headphones), Stretcher (bed on wheels), Flush (explain not bathroom)
Explain wording!
Infection control: e.g. soft, plush toy becomes pts permanently (cant
wash for another kid)
10. Dealing with Isolated patients
Isolated: isolating both child and family; PPE can frighten/intimidate patients; so
encourage pt and family to put on isolation gown and experience it, understand it a little
better to decrease anxiety
Communication and Physical Assessment- Chapter 6
1. Concentrate on content pp 99-131
2. Appropriate ways to obtain vitals (equipment, size, method)
Order is important!
Look, listen, than feel*
Look: RR (chest, nasal flare) can count, color
Listen: apical heart rate, lung sounds for FULL minute
Lung sounds are loud can overbear heart rate
Feel: BP, thermometer, cap refill
Vary by age: ranges via table*
Temperature:
Birth to 2 years: axillary, rectal
2-5 Years: axillary, tympanic, oral, rectal
5+ years: oral, axillary, tympanic
Pulse:
Radially: 2+ years old
Apical impulse: under 2; heard with stethoscope; count for full minute
Grading: 0 not palpable; +1 difficult to palpate, thready, weak; +2
difficult to palpate, may ne obliterated with pressure; +3 easy to palpate,
normal; +4 strong, bounding, not obliterated with pressure
Compare with femoral pulse at least once during infancy to detect presence
of circulatory impairment e.g. aorta coarctation
Respiration:
Count like you would for adult
Observe* abdominal movements since they are primarily diaphragmatic
Movements are irregular so count for a full minute
Breath Sounds: R/T low fat and because it is such a small area and most you
dont even need a stethoscope for (wheezing, stridor can be loud)
Can hear referred sounds (bowel, heart)
Almost always uncooperative: do before child get active/upset, while
parents hold
Can us. hear when patients cry
Blood Pressure
Annually in children 3+ years of age with sx of HTN, in the ER or ICU, and highrisk infants
Compare in upper and lower extremities to detect abnormalities
Use appropriately sized cuff OR a larger one if appropriate size if not available:
cuff bladder should be about 40% of circumference of arm measured at a point
midway between olecranon and acromion (shoulder, elbow); cuff bladder should
cover 80-100% of arm circumference; measure at the level of the heart with arm
supported; stethoscope bell placed over brachial artery pulse
3.
Order of assessment
Do full exam: patient may not be able verbalize problems and some dont want to tell
Prior to exam, look at general appearance: appear well, sick, or very sick?
Observation: kids associate nurses with shots
First thing to do*: once touch child, assessment may change e.g. crying
increases RR; start with least invasive assessment first
General appearance
Assessment order: usually cannot go in order go as body part becomes available
Listen when child is calmest: hate BP (do at end)
Toe to head
Infant: listen to heart, lungs, and abdomen if quiet; palpate and percuss the
areas; head to toe direction; traumatic procedures last e.g. ears, eyes, mouth
(while crying); elicit reflexes as body part is examined; elicit moro last
Toddler: use play to inspect areas (tickle toes); minimum physical contact
initially; introduce equipment slowly; auscultate, percuss, palpare whenever
quiet; perform traumatic procedures last
Pre-school child and up: if cooperative, head-to-toe fashion and genitalia last
Assessment Tips
Play with kids
Lighting
Inspect the entire body
Parent assist: good!
Listen to history
DO NOT ASSUME ANYTHING
4.
5. Steps in general assessment of various systems (i.e capillary refill time, apical pulse)
Go from toe to head
General appearance- if a significant finding sticks out, it may direct how assessment is
done
Facial expressions, posture, position, body movements, hygiene, behavior
Growth measurements
Length- fully extend the body of the infant, children can stand upright
Weight
Skin fold thickness and/or arm circumference may be used to distinguish
between fat and muscle
Head circumference-up to 36 months or if childs head size is questionable
Vitals
Apical pulse-listen for 1 minute
RR-count for 1 minute
Blood Pressure (mean averages)- Newborn-> 65/41, 1month-2years -> 95/58, 25years-> 101/57
Temperature- for children a value of 37-37.5 C (97.7-99.7 F), for neonates 36.537.6 C (97.7-99.7 F)
Skin-texture, color, hair distribution, nail quality
Lymph nodes-palpate for enlargement and/or tenderness
Head and neck-shape, symmetry, head control, palpate skull for patent sutures,
depressed fontanels, fractures, and swelling
Eyes-PERRLA, inspect conjunctiva, vision testing
Ears- inspect external structures and see if ears are level with eyes, inspect internal ear
with otoscope, auditory testing
Nose/throat/mouth-inspect mucous membranes, internal and external structures
Chest-inspect for barrel or pigeon chest
Lungs- note breathing mechanism (nose breather?), assess
rate/rhythm/depth/quality/breath sounds
Heart- S1 and S2 present, S3 may be normal in some children but S4 is abnormal
Abdomen- inspect contour (distension, respiratory involvement), umbilicus for
abnormalities, check for hernias (umbilical, inguinal, femoral), auscultate for BS, palpate
for abnormal masses, tenderness, muscle tone, internal organs
Genitalia
Boys-note the external appearance of the glans and shaft of the penis, inspect
urethral meatus, note location and size of scrotum and identify two testes
Girls- limited to inspection and palpation of external structures (prepuce, clitoris,
labias, urethral meatus, vaginal orifice)
Anus-inspect skin, gluteal folds, anal reflex (assess tone of anal sphincter)
Back and Extremities- Curvature of spine, assess mobility, shape of bones (Bowleg
(knees outward) or Knock knee (knees inward)), pigeon toe, plantar/grasp reflex,
babinski reflex, assess range of motion, tone/strength of muscles
Neuro- assess cranial nerves, reflexes, cerebellar function (balance and coordination)
3.
4.
5.
6.
Vegetarian diets
Lacto-ovo-vegetarian: exclude meat from diet but consume dairy products and rarely fish
Lactovegetarian: exclude meat and eggs but drink milk
Pure vegetarians (vegans): eliminate all foods of animal origin, including milk and eggs
Macrobiotics: allowing only a few types of fruits, vegetables, and legumes (more strict
than vegans)
Semi vegetarians: consume lacto-ovo-vegetarian diet with some fish and poultry
The major deficiencies that may occur are inadequate protein for growth, inadequate
calories, poor digestibility of many of the bulky natural, unprocessed foods (especially for
infants), and deficiencies in vitamins and minerals
May need supplementation of vitamins and minerals
Achieving a nutritionally adequate vegetarian diet is not difficult but requires careful
planning and knowledge of nutrient sources (especially to ensure sufficient protein in the
diet)
7.
Malnutrition
Primary cause is not always lack of food
Diarrhea is a major factor
Additional factors are bottle feeding in poor sanitary conditions, inadequate knowledge,
economic and political factors
Poverty is leading cause of malnutrition
Most extreme form of malnutrition is protein-energy malnutrition (PEM)
Causes of PEM in U.S. are cystic fibrosis, renal dialysis, cancer, and GI malabsorption
Treatment of PEM includes providing a diet with high-quality proteins, carbohydrates,
vitamins, and minerals
If malnutrition is due to underlying disease and/or infection, must treat that as well
8.
9.
11. What is a high risk newborn what are major nursing concerns-temp, infection,
nutrition, feeding methods
A high risk newborn is a newborn who has a greater-than-average chance of morbidity
or mortality. A newborn can be considered high-risk regardless of their gestational age
or weight.
Primary objective for high-risk newborns is to establish and maintain respiration.
Thermoregulation is important to control in newborns. It is important to make sure that
they stay warm. In healthy term infants, axillary temps should be 36.5-37.5.
A fever in a newborn warrants immediate attention.
Less than 3 months old, a fever is 100.4 (38)
3-36 months, fever is 102 (38.9)
For children of any age, immediate attention for anything over 104
Watch BEHAVIOR though. (Restlessness and refusal to feed are two red
flags)
2. Motility disorders
- Diarrhea:
Caused by abnormal intestinal water and electrolyte transport
Involves digestive, absorptive, and secretory functions
Involves stomach and intestines, small intestine, colon, colon and intestines
Classified as acute or chronic
Acute: leading cause of illness in children younger than 5
Sudden increase in frequency and change in consistency of stools, often
caused by infectious agent in GI
May be associated with upper respiratory, antibiotic therapy or laxative use
Self limiting (<14 days)
Acute Infectious Diarrhea: caused by viral, bacterial and parasitic pathogens
Chronic: increase in stool frequency and increased water content with a duration of
more than 14 days.
Often caused by chronic conditions (IBD, malabsorption syndrome, food
allergy, etc.)
Intractable diarrhea of infancy: first few months of life, longer than 2 weeks
Difficult to treat
Chronic nonspecific diarrhea: irritable colon of childhood
Children 6-54 months
Loose stool, undigested food particles, diarrhea lasting longer than 2 weeks
Children grow normally and have no evidence of malnutrition, no blood in stool, no
infection
Excessive intake of sugar substances, sweeteners could be a factor
Etiology
Fecal-oral through contaminated food/water or person to person
Rotavirus is most important cause of serious gastroenteritis
Most severe in 3-24 months
Salmonella, shigella, and campylobacter are top causes of bacterial diarrhea
Giardia and shigella have highest incidence among toddlers
Nursing Care
Identifying children with symptoms
Educate parents regarding home care
Care for children undergoing surgery
Supine positioning for feeding
Avoid vigorous play after feeding
PPIs are most effective when administered 30 minutes before breakfast
- Acute Appendicitis Inflammation of the vermiform appendix
Symptoms:
Periumbilical pain followed by nausea, right lower quadrant pain, and later vomiting with
fever
Perforation of appendix can occur within 48 hours
Phlegmon: acute supportive inflammation of subcutaneous connective tissue that
spreads
Cause: obstruction of the lumen of the appendix
Diagnosis
Fever, vomiting, abdominal pain, and elevated WBC counts (greater than 10,000)
Lower right quadrant
McBurney point
Referred pain, elicited by light percussion
CBC, urinalysis (to rule out UTI)
Peritonitis: sudden relief from pain after perforation, subsequent increase in pain, progressive
abdominal distention, tachy, rapid shallow breathing, pallor, chills, and irritability
Management
Rehydration, antibiotics, surgical removal of appendix (laparoscopic normally)
Postoperative
IV fluids, NPO, NG tube
Listen for bowel sounds
Meticulous skin care
Ruptured: preoperative IV administration of fluid and electrolytes, continued administration of
antibiotics, NG abdominal, Penrose drain post op
Nursing Care
If appendicitis suspected avoid laxatives or exams and applying heat to the site
Meckel Diverticulum Remnant of the fetal omphalomesenteric duct
Failure of obliteration may result in an omphalomesenteric fistula
Complication: bleeding (due to peptic ulceration), obstruction or inflammation
Diagnosis
History, physical exam, radiographic studies, often hard to diagnose
Painless rectal bleeding in children, abdominal pain, signs of intestinal obstruction, dark
red or jelly stool
Management
Surgical removal of diverticulum
Antibiotics
Reverse electrolyte imbalances and prevent abdominal distention
Nursing Care
Frequent monitoring of vital signs including BP
Keeping the child on bed rest
Recording the approximate amount of blood lost in stools
- Cirrhosis
End stage of many chronic liver diseases
Irreversibly damaged
Jaundice, poor growth, anorexia, muscle weakness, and lethargy, ascites, edema, GI bleed,
anemia, and abdominal pain
Management
Monitoring liver function
Combination of immunosuppressive medication
Nutritional support: supplements of fat-soluble vitamins
Sodium restriction and diuretics for ascites
Drugs to reduce ammonia formation (neomycin and lactulose)
- Biliary Atresia Progressive inflammatory process that causes both intrahepatic and
extrahepatic bile duct fibrosis
If untreated usually leads to cirrhosis, liver failure and death if first 2 years of life
Acquired late in gestation or in perinatal period and is manifested a few weeks after birth
Jaundice, manifesting with yellow discoloration of skin and sclera, pale stool, dark urine
Direct bilirubin greater than 1 ml/dl with total bilirubin less than 5 mg/dl
Early diagnosis is key (surgery within first 60 days)
Management
Hepatic portoenterostomy: segment of intestine is anastomosed
Progressive cirrhosis still occurs in many children
Support is important
Supplication of fat soluble vitamins
Aggressive nutritional support
- Cleft Lip and Cleft Palate
Occur during embryonic development and most common congenital deformities
CL: failure of maxillary and median nasal processes to fuse
Can be unilateral or bilateral
CP: midline fissure of palate that results from failure of the two palatal processes to fuse
CL/P and CP are distinct from isolated CP
Multifactorial inheritance, exposure to tetragons, foliate deficiency and show up between
4th and 10th week of embryonic development
Impact on the feeding is biggest complication
Surgical correction
Cleft Lip
Definition: Decreased intestinal surface area for absorption of fluid, electrolytes, and
nutrients
A need for PN (feeding)
Management
Preserve as much length of bowel as possible during surgery
Maintain optimum nutritional status, growth, and development while intestinal
adaptation occurs
Stimulate intestinal adaptation with enteral feeding
Minimize complications related to disease process and therapy
Nutritional support is long term focus
Initial phase: PN as primary source
Secondary phase: introduction of enteral feeding (after surgery)
Decrease PN solution in terms of calories, amount, and total hours infused per
day
Final phase: sustained exclusively by enteral feedings
Risk for nutritional deficiency secondary to malabsorption of fat soluble vitamins
(A, D, E, K) and trace minerals
Use of H2 blockers, PPIs
Bacterial overgrowth is often a problem: altering cycles of broad spectrum antibiotics
Also watch for metabolic acidosis and gastric hyper secretion
Surgical interventions: intestinal valves, tapering enteroplasty, intestinal lengthening
Nursing Care
Most important: monitoring and administration of nutritional therapy
Avoid infection, occlusions, dislodgement or accidental removal of lines
Routine ostomy care
5. Abdominal trauma
- Gastroschisis Protrusion of intra abdominal contents through defect in abdominal wall
lateral to umbilical ring; there is no peritoneal sac covering the exposed bowel
Symptoms: defect obvious at delivery if not detected prenatally by ultrasonography
Nursing Management
Surgical repair of defect
Use of Siloh pouch
Preoperative
Keep sac covered with bowel bag
BG decompression
Maintain thermoregulation
Monitor electrolyte status
IV fluids
Antibiotics
Observe exposed bowel for necrosis
Postoperative
Monitor vitals, especially BP
Bowel decompression with NG tube
IV fluids
Pain management
Monitor surgical closure site
Monitor lower extremities for pulses
Monitor for return of bowel function
- Omphalocele Protrusion of intraadbominal viscera into base of umbilical cord; sac covered
with peritoneum without skin
Symptoms: obvious on inspection
However might look like hematoma in umbilical cord
Nursing Management
Surgical repair
Preoperative
Protect defect from trauma
Keep sac or viscera moist with saline soaked dressings
Maintain thermoregulation
Carry out routine IV fluid infusion
Prophylactic antibiotics
Keep patient NPO
Assess for associated birth defects (CL or CP)
Postoperative
Monitor vital signs and BP
Pain management
Bowel decompression with NG tube
Iv fluids
Monitor return of bowel function
- Hernias Protrusion of an organ or organs through an abnormal opening
Danger when circulation is impaired
Congenital Diaphragmatic
Abdominal organs through opening in the diaphragm, commonly left side
Severe respiratory compromise and inability to adequately expand lungs
Seen within a few hours after birth, tachy, cyanosis, dyspnea, impaired cardiac
output
Management
Avoid bag and mask ventilation because fill stomach with air
Provide supportive treatment
Administration of inhaled nitric oxide
Preoperative
Monitor respiratory status, provide oxygen supplementation
Monitor cardiovascular status, reduce stimulation
Maintain NG suction, oxygen, and IV fluids
Medication: sedation, muscular paralysis, inotropes
Postoperative
Ondansetron
selective receptor antagonist, antiemetic
Indications
Chemotherapy induced emesis: PO, IV
Prevention of post op nausea/vomiting: IV
Nursing Consideration
Assess degree of nausea and vomiting
Assess for dehydration
Provide emotional support
Monitor patient in environment
Assess bowel sounds
Provide supportive measures
Assess mental status
Monitor daily patterns of bowel activity and stool consistency
Record time of evacuation
Relief occurs shortly after drug administration
Avoid alcohol and barbiturates
Avoid tasks that require alertness
Imodium
antidiarrheal
Indications
Acute or chronic diarrhea: PO
Nursing Considerations
Do not administer in presence of bloody diarrhea or temperature greater than 101
Encourage adequate fluid intake
Assess bowel sounds
Monitor daily patterns of bowel activity and stool consistency
Withhold drug and notify physician for abdominal pain, distention, and fever
Do not exceed prescribed dose
May cause dry mouth
Avoid alcohol