GASTROINTESTINAL SYSTEM



GASTROINTESTINAL SYSTEM

The primary function of the alimentary tract is to provide the body with a continual supply of nutrients, fluids and electrolytes for tissue nourishment. This system has three components: a tract for ingestion and movement of food and fluids; secretion of digestive juices for breaking down the nutrients; and absorption mechanisms for the utilization of foods, water, and electrolytes for continued growth and repair of body tissues.

System Implementation

A. Evaluate vital signs.

1. Increased temperature and pulse are signs of infection.

2. If significant dehydration has occurred, respirations will be rapid.

B. Maintain hydration status.

C. Isolate child until the causative organisms is identified.

D. Maintain nutritional status.

1. Compare child’s growth with standardized growth chart.

2. Evaluate food intake and meal pattern; vomiting pattern.

3. Record stooling pattern and reaction to feedings. (If fatty, bulky stools, assess for malabsorption problem.)

4. Evaluate laboratory results of stool culture.

5. Determine child’s likes and dislikes and orient diet accordingly.

6. Allow bottle if child regresses and is comforted by sucking.

7. Allow between-meal snacks that are both nutritious and fun (popsicles, fruit bars).

E. Provide meticulous skin care, especially if diapered.

POISONING

Definition: Ingestion of toxic substances which may result in death of severe illness.

Characteristics

A. Interventions for poisoning.

1. Identify the toxic substance and retrieve the poison.

2. Call local poison control telephone number and inform them of the toxic substance.

3. Reverse the effect of the poison.

a. Induce vomiting with syrup of ipecac or apomorphine.

1) Families of small children should keep this substance in the house in case of accidental poisoning.

2) Dose is 15 mL for children and 30 mL for young adults; follow with 8 ounces of tap water.

3) Child should vomit within 30 minutes—important to bring up the syrup of ipecac to avoid cardiac complications.

b. Activated charcoal may be used to bind and carry toxic substance out of the body.

4. Vomiting is contraindicated with some substances.

a. If child or person is in a coma, in shock, convulsing, or exhibits no gag reflex.

b. If person has ingested low viscosity hydrocarbons or corrosive substances (acid or alkaloid).

PYLORIC STENOSIS

Definition: The pyloric canal, which is at the distal end of the stomach and connects with the duodenum, is greatly narrowed. This narrowing is believed to be caused by a combination of muscular hypertrophy, spasms, and edema of the mucous membrane.

Implementation

A. Monitor infant for metabolic alkalosis from vomiting.

B. Provide preoperative care.

1. Ensure accurate regulation of IV to prevent dehydration.

2. Accurately record intake and output.

3. observe feeding behavior for definitive diagnosis.

4. Support mother and infant.

C. Maintain proper insertion and observation of gastric tube for gastric decompression.

1. Measure length of tube externally on infant from bridge of nose to ear to stomach.

2. Check position of the tube. Infant should show no sign of respiratory difficulty with external end of tube occluded.

3. Aspirate gastric contents. Check pH of gastric contents. If acidic (below 3), tube is in stomach.

4. No gagging, redness, or coughing should be observed.

INTUSSUSCEPTION

Definition: A segment of the bowel telescopes into the portion of bowel immediately distal to it. Probably results from hyperactive peristalsis in the proximal portion of the bowel, with inactive peristalsis in the distal segment. Usually occurs at the junction of the ileum with the colon. Common in children with cystic fibrosis and celiac disease.

Implementation

A. Prepare child for barium enema x=ray, which frequently reduces the bowel.

B. observe and monitor for recurrence of symptoms. Surgery may need to be performed for bowel reduction.

C. Observe and maintain IV fluid and electrolyte replacement.

D. Perform nasogastric suction to deflate the stomach to prevent vomiting.

E. Gradually reintroduce fluids and foods.

F. Maintain care of operative site following surgery.

DIARRHEA (SEVERE)

Definition: Diarrhea is seen when there is a disturbance of the intestinal tract that alters motility and absorption and accelerates the excretion of intestinal contents (3 to 30 stools per day). Fluids and electrolytes that are normally absorbed are excreted, causing electrolyte imbalances. Most infectious diarrheas in this country are caused by a virus. Diarrhea can be a separate disease, or it may be a symptom of another disease.

Implementation

A. Provide small, frequent offerings of oral rehydration solutions (ORS) throughout the course, unless vomiting is severe.

B. Breastfeeding should be continued throughout the disease and ORS given to replace on-going losses.

C. Early reintroduction of the normal diet is becoming common and beneficial in reducing the number of stools and decreasing weight loss. Discourage the administration of juices, broth, gelatins, or BRAT diet.

D. Maintain isolation until causal organism or other factors are determined.

1. Encourage careful handwashing at hom.

2. Dispose of stools and diapers in proper containers.

E. Maintain careful ongoing assessment of dehydration level and acidosis.

F. Complete accurate recording of the number and consistency of stools.

G. Prevent dehydration and electrolyte imbalance.

H. Maintain excellent skin care to prevent excoriation caused by alkaline stools; apply appropriate skin protectants (such as zinc oxide).

DEHYDRATION

Definition: Loss of water with resulting sodium excess. (Fluid volume deficit is when water and sodium losses are proportional.)

Implementation

A. Maintain strict recording of intake and output.

B. supervise IV therapy if ordered.

C. Monitor electrolyte laboratory results and urine specific gravity.

D. Maintain skin care.

INFLAMMATORY BOWEL DISEASE (ENCOMPASSES ULCERATIVE COLITIS AND CROHN’S DISEASE

Definition: An inflammatory disease of the colon and the rectum in which the mucous membrane becomes hyperemic, bleends easily, and tends to ulcerate. The etiology is unknown; however, the incidence is highest in young adults and middle-age groups.

Implementation

A. Control inflammation.

1. Supervise medication regimen.

2. Provide adequate hydration with intravenous therapy and oral fluids as indicated.

B. Provide rest to intestinal tract.

1. Observe for amount of bowel activity and symptoms of bleeding and hyperactive peristalsis.

2. Administer tranquilizers, and observe for side effects.

C. Monitor diet therapy.

1. Provide a high-fiber, bland, high-protein diet.

2. Institute vitamin therapy.

3. Avoid cold foods because they increase gastric motility.

4. Arrange for attractive environment with opportunities for socialization at mealtime.

5. Avoid sharp cheeses, highly spiced foods, smoked or salted meats, fried foods, raw fruits, and vegetables.

D. Provide counseling activities.

1. Educate child about diet, medication, and symptoms of bleeding.

2. Observe for signs of psychological problems; initiate referral if necessary.

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