Congenital Anomalies GI, GU and Skeletal
Congenital Anomalies GI, GU and Skeletal NUR 349
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This 4 page Class Notes was uploaded by Nicole Raynor on Thursday August 25, 2016. The Class Notes belongs to NUR 349 at Molloy College taught by Paraszczuk in Fall 2016. Since its upload, it has received 7 views. For similar materials see HumanistChldFam in Nursing and Health Sciences at Molloy College.
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Date Created: 08/25/16
Congenital Anomalies: GI, GU, and Skeletal Pediatric Differences o Newborns have a small stomach capacity need to eat frequently (approx. 1 tsp at a time) o Have more intestinal surface area greater risk for fluid and electrolyte loss Clinical Manifestations o Growth failure, regurgitation, N/V, diarrhea, constipation, abdominal pain, distention GI Dysfunction o Distention to perforation can progress more rapidly o Fluid losses due to vomiting, diarrhea, or NG drainage Frequently need to address the losses and replace them because they can become dehydrated very quickly Even though they are already on fluid maintenance – this can still happen Clef Lip/Clef Palate o Occurs during embryonic development o Can happen together or separately o Has a familial tendency o Decrease in incidences since women have been taking folic acid o Children have feeding problems! – Aspiration precuations!! Surgical Correction: If lip and palate need to be repaired at the same time – palate is done first (otherwise lip is usually done first) Protect the sure line, limit crying, encourage feeding Elbow restrains are used to keep the infant’s hands away from the mouth Children may need braces Can have recurrent ear infections – which can effect hearing Feeding: Problem until fixed Breast fed babies – need their palate to do this If it is just a clef lip – they can usually be breast fed o Parents can have a strange reaction Discharge teaching: Bilateral clef lip: Feed in an upright position Burp child frequently Apply antibiotic ointment to lip as prescribed Tracheoesophageal Fistual (TEF) and Esophageal Atresia o Failure of the esophagus to develop as a continuous passage o Aspiration precautions! Clinical Manifestations: Excessive salivation/drooling (because can’t swallow secretions) Coughing Choking Cyanosis Respiratory distress Nursing Considerations: If suspected: elevate the head but give nothing by mouth Associated with tracheomalacia – weakening of the wall of the trachea – as the baby breathes in the trachea may collapse on itself Oral aversion suctioning frequently – hard to feed them later on because they associate something going into their mouth with something negative Alternative feeding – PEG tube or gastrostomy Esophageal atresia is suspected if NG tube fails to pass at birth Omphalocele (membrane sac) o Herniation of abdominal viscera into the base of the umbilical cord Gastrochisis (no membrane) o Protrusion of intraabdominal contents through a defect in the abdominal wall lateral to the umbilical ring. There is no peritoneal sac o Abdominal wall defects – viscera protrudes o Surgery – repair in stages Management: Thermoregulation – heat/fluid can be lost because of great surface area IV fluids with antibiotics Hernias o A abdominal content protrude through an abnormal opening – no opening in the skin o Umbilical – preterm infants o Inguinal – abdominal contents protrude through inguinal canal into scrotum for guys and groin for females In males – scrotum is enlarged Crying causes an increase in pressure in abdominal wall o Strangulation If intestine gets trapped there can be impairment of blood supply Short Bowel Syndrome o Some part of the bowel is removed – now there is not enough remaining bowel to absorb properly o Malabsorption disorder – decrease mucosa surface Management: Maintain nutrition, stimulate adaptation by feeding TPN is often used If patient is discharged – teach family signs of central venous catheter infections Minimize complications – TPN can lead to sepsis because of bacterial overgrowth Imperforate anus o opening may or may not be present – stenosis or fistula Management: Surgery (ostomy) Teach parents to notify doctor if baby starts vomiting Ostomy care Nursing Considerations: Check for rectal patency in newborns – need ot check where meconium/ 1 bowel is coming from If there is no opening they will become distended very quickly Hirschsprung Disease o Mega colon o Absence of ganglion cells in colon – apart of the nervous system Movement and peristalsis are not going to happen as it should Clinical Manifestations: Abdominal distention caused by stool accumulation Empty rectum No meconium passage or constipation Passage of foulsmelling ribbon like stools o Confirm diagnosis with rectal biopsy to see if there are ganglion cells Management: Surgical removal of the affected section of the bowel Temporary ostomy Second stage – pull through procedure After 6 months of ostomy being placed – bowel will go back to normal size and can proceed with 2 surgery to reconnect Nursing considerations: Pre Op Monitor distention and bowel prep (NPO, IV antibiotics and fluids) Post Op – monitor ostomy for: infection, good color, skin breakdown No rectal temperatures Assess stools Keep npo until bowel sounds return Maintain IV fluids Discharge – ostomy teaching Ostomies o Skin care Cryptorchidism o Undescended testes (scrotal sac is empty) o Wait to see if they will descend on their own o When assessing – warm the room o Orchioplexy is done by 1 year of age – it is done at this age because you want the testes to function normally Toddlers are aware of their genitals Done before they become aware Hypospadias o Abnormal location of meatus – positioned somewhere other than the head of the penis / along the ventral surface of the penis o Potential impact on body image for ages 36 (Toddlers) o Repaired early by 12 months, – and before toilet training o Post Op urinary stent is placed, pain and spasms can occur Congenital Club Foot o Abnormality of the bones – so that the foot is not in usual position o Look to see if we can put the foot though normal range of motion Nursing Considerations: Cast care – need time for muscles to readjust to new position Cast is removable not worn frequently Need to be changed often – monitor circulation! Dysplasia of the Hip (DDH) o Shallow acetabulum – socket head of the femur goes in can bounce in and out o Subluxation: incomplete dislocation o Dislocations: femur head not in contact with acetabulum Clinical Manifestations: Infant Part of the newborn exam is to check Affected leg shorter than the other – hard to see because they are usually flexed Unequal gluteal folds when infant is prone (on stomach) ** Restricted abduction of affected hip (+Ortolani and Barlow test) – if it is poping out of socket you will hear a click Child Not usually diagnosed this late o Importance of early intervention o Newborn to age 6 months: pavlik harness for abduction of hip o Spica cast used for ages 618 months
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