Patient scenario Chapter 45 Nursing care of a family when a child has a gastrointestinal disorder

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Pos Terkait

Table of Contents

• Pos Terkait
• Why is this page out of focus?
• Why is this page out of focus?
• Why is this page out of focus?
• Why is this page out of focus?
• What occurs in the gastrointestinal system of the child with Hirschsprung disease?
• Which of the following is the nurse's priority in the plan of care for a child admitted with pyloric stenosis?
• Which activities should the home health nurse suggest to an elderly patient to avoid constipation?
• Which procedure would the nurse anticipate to confirm the diagnosis of Hirschsprung disease congenital Aganglionic Megacolon in a 1 month old infant?

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CHAPTER 45 NURSING CARE OF A FAMILY WHEN A CHILD HAS A GI DISORDER

- Dehydration: occurs whenever total output of fluid exceeds intake, regardless of

what the cause actually is. UNDER NORMAL CONDITIONS, WE ALL LOSE SOME BODY

WATER EVERY DAY IN OUR SWEAT, TEARS, URINE, AND STOOL. WATER ALSO

EVAPORATES FROM SKIN AND LEAVES THE BODY AS VAPOR WHEN WE BREATHE. WE

USUALLY REPLACE THIS BODY FLUID AND THE SALTS IT CONTAINS WITH THE WATER

AND SALTS IN OUR REGULAR DIET.

SOMETIMES, HOWEVER, KIDS LOSE LARGE AMOUNTS OF WATER AND SALTS

THROUGH FEVER (MORE WATER EVAPORATES FROM THE BODY WHEN BODY

TEMPERATURE IS INCREASED), DIARRHEA, VOMITING, OR LONG PERIODS OF

EXERCISE WITH EXCESSIVE SWEATING. SOME ILLNESSES MIGHT ALSO

PREVENT THEM FROM TAKING FLUIDS BY MOUTH. IF THEY'RE UNABLE TO

ADEQUATELY REPLACE THE FLUID THAT'S BEEN LOST, KIDS CAN BECOME

DEHYDRATED. Also they become dehydrated faster than adults.

ORS is the first treatment for acute diarrhea.

Types of dehydration:

⬤Isotonic

➢Water and salt are lost in equal amounts

➢Primary form of dehydration in children

⬤When proportionally the same amount of water and sodium is lost from

the body, the sodium concentration of the extracellular fluid and hence its

tonicity will not change — this is isotonic dehydration. Statistically, in most

cases (~ 80%) dehydration is isotonic

⬤Hypotonic

➢Electrolyte deficit exceeds water deficit

⬤When proportionally more sodium than water is lost, the sodium

concentration of the extracellular fluids falls, which therefore becomes

hypotonic in comparison to intracellular fluid, so water moves from the

extracellular fluid into the cells. This causes cell swelling.

⬤Hypertonic

➢Water loss in excess of electrolyte loss (the most dangerous type of

dehydration. It is caused by feeding children fluids with high amounts of

solute)

⬤When proportionally more water than sodium is lost from the body, the

extracellular fluid has increased concentration of sodium and becomes

hypertonic regarding the intracellular fluid and therefore attracts water

from the cells. This results in the cell shrinkage.

-Daily maintenance fluid requirements:

⬤Calculate child’s weight in kg

➢Allow 100 ml/kg for first 10 kg body wt

➢Allow 50 ml/kg for second 10 kg body wt

➢Allow 20 ml/kg for remaining body wt

➢Ex: 16 kg -> 10*100=1000, 6*50=350, add it together and this is the total

per day of fluid this particular child needs.

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What occurs in the gastrointestinal system of the child with Hirschsprung disease?

In children with Hirschsprung's disease, nerves fail to form in all or part of the large intestine (colon). Waste from digestion cannot pass through the part of the colon lacking nerve tissue. The normal colon swells with blocked stool.

Which of the following is the nurse's priority in the plan of care for a child admitted with pyloric stenosis?

The major nursing care planning goals for a child with pyloric stenosis are: Improving nutrition and hydration. Maintaining mouth and skin integrity.

Which activities should the home health nurse suggest to an elderly patient to avoid constipation?

Lifestyle changes to consider include avoiding mild dehydration, eating fiber-rich foods, getting enough physical activity, and encouraging a regular toilet routine (e.g. sitting on the toilet after meals).

Which procedure would the nurse anticipate to confirm the diagnosis of Hirschsprung disease congenital Aganglionic Megacolon in a 1 month old infant?

Diagnosis is confirmed through rectal biopsy.

What occurs in the gastrointestinal system of the child with Hirschsprung disease?

Which of the following is the nurse's priority in the plan of care for a child admitted with pyloric stenosis?

Which activities should the home health nurse suggest to an elderly patient to avoid constipation?

Which procedure would the nurse anticipate to confirm the diagnosis of Hirschsprung disease congenital Aganglionic Megacolon in a 1 month old infant?