Disease/Disorder -no meconium (first stool) in first 24hrs of life HIRSCHSPRUNG DISEASE -bile stained vomitus -abdominal distention -dehydrated -feeding intolerance -mechanical obstruction from congenitally slow motility of intestine+chronically contract bowel -absence of ganglion nerves in rectum/intestine Potential Complications -radiographs -barium enema -rectal biopsy -enterocolitis -distended abdomen -fever -diarrhea -dehydration/sepsis -surgery to remove aganglionic bowel to relieve obstruction -temporary colostomy -stool softeners -oral/systemic antibiotics given preop to reduce chances of enterocolitis postop Nursing Intervention PREOP surgery -DIET: low fiber, high calorie + high protein -correct dehydration -popcorn, brown rice, and fruits with skin are high fiber foods -give enemas w/normal saline to empty bowel -measure abdominal circumference -use visual aids to show colostomy POSTOP surgery -new ostomy care -bowel retraining -pin diaper below stoma dressing Disease/Disorder 1. -periumbilical pain/cramping -fecalith (hard stool) APPENDICITIS -swollen lymphoid tissue (after virus) -nausea/vomiting -RLQ pain, Rovsing/McBurney sign -fever -inflammation/obstruction of appendix -pinworms -outflow of mucus from appendix is blocked, increasing pressure => ischemia Potential Complications -peritonitis -appendectomy surgery -antibiotics Nursing Intervention PREOP appendectomy -replace fluids and electrolytes -assess pain + allow child to position self as needed -take bowel sounds POSTOP appendectomy -give fluids -NG suction until intestinal activity returns -avoid laxatives/enemas or heat before surgery increases the chance of perforation Disease/Disorder -cyanosis during feeding ESOPHAGEAL ATRESIA -choking/coughing during feeding -foamy mouth -spitting up/drooling -difficulty breathing Potential Complications -failure of esophagus to develop as continuous passage -failure of trachea + esophagus to be separate -radiographic radiopaque catheter into esophagus -drooling from esophageal obstruction, cannot swallow saliva -polyhydramnios (2000mLs of amniotic fluid) -sedatives: midaz/fentanyl/morphine -muscle paralysis C/I -broad spectrum antibiotics Nursing Intervention -maintain patent airway -place in incubator/radiant warmer -give oxygen -NG decompression suction PREOP -ET + NG tube insertion -correct acid-base imbalances -position supine w/HOB elevated 30* -frequent/continuous suction of mouth -report any persistent respiratory difficulty after suctioning to HCP immediately -pacifier is allowed Disease/Disorder -projectile vomiting PYLORIC STENOSIS -family Hx -chronic hunger -palpable olive-shaped lump right of the umbilicus -visible peristaltic waves -dehydrated -thickened/narrowing of the pyloric sphincter (going from stomach to intestine) -ultrasound Potential Complications -metabolic alkalosis -failure to thrive -jaundice -pyloromyotomy surgery removes some of pyloric sphincter muscles to loosen tight muscle Nursing Intervention PREOP pyloromyotomy -feeding schedule comes back 48hrs after surgery -NG tube decompression -call HCP if baby is still vomiting after drinking only clear liquids -give IV fluids w/dextrose -I&O, urine specific gravity, skin turgor, mucous membranes, abdominal girth POSTOP pyloromyotomy -try feeding 4-6hrs after w/water or electrolytes => formula after 24hrs (initiate small feedings) -postop vomiting is common, accurately record it Disease/Disorder -abdominal pain INTUSSUSCEPTION -abdominal mass -red, currant jelly-like stools -bilious vomiting -lethargy -obstruction caused by the small intestine folding into the large intestine -ultrasound Potential Complications -perforation -air or barium enema to fill space and expand intestines Nursing Intervention -IV fluids -NPO status -NG decompression -antibiotic therapy -report normal, brown bowel movement postop STAT -antibiotics Disease/Disorder -steatorrhea CELIAC DISEASE -family Hx -malnutrition/impair growth -bloating -fat vitamin+iron deficiencies -abdominal pain -flatulence -autoimmune intolerance to foods with gluten or dietary wheat that inflames and damages the small intestine -tissue transglutaminase antibody (tTG-IgA) test -upper GI endoscopy w/biopsy Potential Complications -stool pH test -lactose intolerance -osteoporosis -iron-deficiency anemia -Tissue transglutaminase + -gastrointestinal cancer/lymphoma -low electrolytes -vitamin A, D, E, K, folic acid, iron -corticosteroids Nursing Intervention -administer electrolytes -eliminate wheat, rye, barley, oats -replace fluids to prevent dehydration -avoid high fiber foods like nuts, raisins, raw veggies, fruits -skin care + barrier cream for profuse diarrhea -make NPO if in Celiac Crisis -lactose free diet may be needed initially -LOW FAT DIET Disease/Disorder -bicycle injuries/sports injuries HEAD INJURY/TRAUMA -vomiting -falls -MVA -concussion: tearing of nerve fiber in brain stem; confusion lasts mins-hrs; resolves in 1-3wks -contusion/laceration: visible bruising/tearing of brain -CT/MRI Potential Complications -hematomas/hemorrhage -brain herniation -cerebral edema (subsides in 24-72hrs) -focal seizure -hydrocephalus -antiepileptics -acetaminophen -antibiotics= prophylactic tetanus toxoid Nursing Intervention -make NPO until no vomit possible -put on ICP monitor: intraventricular catheter -avoid repositioning, coughing, environmental noise -cluster care -avoid suctioning unless risk of aspiration -tepid sponges if hyperthermic -slightly elevate HOB -take temperature axillary Disease/Disorder -increased agitation/rigidity UNCONSCIOUS CHILD -increased HR, RR, BP -decreased O2 -glasgow coma scale <=8 Potential Complications -stool softeners -opioids (naloxone given to slowly reverse sedation and check altered consciousness) -osmotic diuretics to reduce cerebral edema -corticosteroids to reduce inflammation Nursing Intervention -monitor for overhydration: cerebral edema = increased ICP -weigh diapers -intermittent catheterization for long-term -ROM exercises -play music/recording of parents’ voices -NG tube long-term Disease/Disorder -chronically draining ear BACTERIAL MENINGITIS -pneumonia -fever/chills/n/v -alterations in sensorium -acute inflammation of spinal cord and CSF -seizures -lumbar puncture -CBC (for WBC) Potential Complications -blood, nose/throat culture -cephalosporins -dexamethasone (initial treatment) -antiepileptic -acetaminophen w/codeine Nursing Intervention -isolation + seizure precautions -get hearing screen 6mo after resolution of illness -hydration -if sent home with IV: parents are taught how to administer IV -manage shock -temperature control -no pillow, position side-lying -urinary output Disease/Disorder -bulging fontanels HYDROCEPHALUS -rapid head growth within 24wks -setting-sun sign -CT/MRI Potential Complications -peritonitis -paralytic ileus -shunt to provide drainage of CSF -IV phenobarbital or oral chloral hydrate to sedate before procedures -opioids Nursing Intervention -measure head daily -small, frequent feedings POSTOP -position on unoperated side, keep flat -monitor pupils and BP -NPO for first 24hrs -inspect for leakage, if leakage=>test for glucose Disease/Disorder Potential Complications Nursing Intervention