NRS-241 Unit 3a
The Child with
GI/GU Dysfunction
Unit Objectives
1.
Describe the characteristics of infants that affect their ability to adapt to fluid loss or gain.
2.
Describe the types of dehydration inherent to children and identify appropriate management plans to correct fluid
and electrolyte imbalances.
3.
Formulate a plan of care for the child with one or more of the following motility disorders: diarrhea, constipation,
vomiting, Hirschsprung’s Disease, gastroesophageal reflux
4.
Formulate a plan of care for the child with an obstructive gastrointestinal disorder: pyloric stenosis, intussusception
5.
Formulate a plan of care for the child with biliary atresia
6.
Formulate a plan for teaching parents preoperative and postoperative care of the child with a cleft lip or palate.
7.
Describe the various factors that contribute to urinary tract infections in infants and children.
8.
Outline a nursing care plan for a child with nephrosis or acute glomerulonephritis
9.
Define the major implications of hemolytic uremic syndrome in children
Gastrointestinal Disorders
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• To review:
Clinical Manifestations
 General principles of nursing care
Emesis
o Gastrointestinal assessment
Feeding patterns
 Manifestations of gastrointestinal
dysfunction
Stool pattern
 Pediatric considerations related to daily
fluid requirements and increased risk of
dehydration
Abdominal assessment
Skin changes
Pain/ Fever
Bleeding
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
Isotonic
Hypotonic
Hypertonic
Types of Dehydration
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
Isotonic
Hypotonic
Hypertonic
Types of Dehydration
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• No fluid shifting
 Sodium WNL
• Potential complication
 Hypovolemic shock
• Management

Fluid resuscitation with boluses of isotonic
fluid (0.9% NS or LR)
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
Isotonic
Hypotonic
Hypertonic
Types of Dehydration
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Fluid shift from ECF to ICF
 Hyponatremia
• Potential complication
 Hypovolemic shock
• Management

Fluid resuscitation with boluses of isotonic
fluid (0.9% NS or LR)
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
Isotonic
Hypotonic
Hypertonic
Types of Dehydration
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Fluid shift from ICF to ECF
 Hypernatremia
• Potential complication
 Neurological damage, seizures
 Can occur without warning
• Management

Slow fluid replacement
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Manifestations of Dehydration
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Hypovolemic Shock
 When losses exceed the body’s ability to sustain blood volume and blood pressure,
circulation is compromised, leading to tissue hypoxia
 Manifestations
o Tachycardia
o O2 saturations < 94%
o Hypotension
o Anuria / oliguria
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Management of Fluid
and Electrolyte
Imbalances
 Correct fluid balance
o Oral
o Parenteral
 Identify and treat the
underlying cause
 Monitor for fluid
overload
Gastrointestinal Disorders
Disorders of Motility
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Diarrhea
 A symptom of “disorders involving digestive, absorptive, and secretory function”
 Acute versus Chronic
o Acute infectious diarrhea
• Increased intestinal motility leading to decreased absorption, loss of fluid and
electrolytes in the stool, and inflammation of the stomach in and intestine
• Etiology
Viruses
Bacteria
Parasites
• Diagnosis
• Management
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Constipation
 Secondary to organic disorders versus functional or idiopathic dysfunction
 Age-specific considerations
o Newborn
o Infancy
o Childhood
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Vomiting
 Causes
 Complications
 Management
o Nursing priorities
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Hirschsprung's Disease
 Epidemiology
o Congenital anomaly
 Manifestations
 Diagnosis
 Treatment
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Gastroesophageal
Reflux (GER)
 Epidemiology
 Manifestations
 Diagnosis
 Treatment
o Nursing
priorities
Gastrointestinal Disorders
Structural Defects
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Esophageal atresia with tracheoesophageal fistula
 Epidemiology
 Manifestations
 Diagnosis

Treatment
o Nursing priorities
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Cleft lip and palate
 Epidemiology
 Manifestations
 Diagnosis
 Complications
 Treatment
o Nursing priorties
Gastrointestinal Disorders
Obstructive Disorders
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Hypertrophic Pyloric
Stenosis
 Epidemiology
 Manifestations
 Diagnosis
 Treatment
o Nursing
priorities
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Intussusception
 Epidemiology
 Manifestations
 Diagnosis
 Treatment
o Nursing priorities
Gastrointestinal Disorders
Hepatic Disorders
Unit 3a The Child with GI/GU Dysfunction
Gastrointestinal Dysfunction
• Biliary Atresia
 Epidemiology
 Manifestations
 Diagnosis
 Treatment
o Nursing
priorities
Genitourinary Disorders
Unit 3a The Child with GI/GU Dysfunction
Genitourinary Dysfunction
• To review:
 General principles of
nursing care
 Manifestations of
genitourinary
dysfunction
 Diagnostic testing
o Voiding
cystourethrogram
o Ultrasound
o Intravenous
pyelography
o DMSA
Unit 3a The Child with GI/GU Dysfunction
Genitourinary Dysfunction
• Urinary Tract Infections
 Etiology
 Manifestations
 Diagnosis
 Treatment
o Nursing
priorities
Unit 3a The Child with GI/GU Dysfunction
Genitourinary Dysfunction
• Urinary Tract Infections
Urethritis
Cystis
Infections
Pylenoprhitis
Urosepsis
Genitourinary Disorders
Glomerular Disease
Unit 3a The Child with GI/GU Dysfunction
Genitourinary Dysfunction
• Nephrotic Syndrome
 Includes massive proteinuria,
hypoalbuminemia, hyperlipidemia and
edema
 Manifestations
 Diagnosis
 Treatment
o Nursing priorities
Unit 3a The Child with GI/GU Dysfunction
Genitourinary Dysfunction
Unit 3a The Child with GI/GU Dysfunction
Genitourinary Dysfunction
• Acute glomerulonephritis
 Etiology
 Manifestations
 Diagnosis
 Treatment
o Nursing priorities
Genitourinary Disorders
Misc. Renal Disorders
Unit 3a The Child with GI/GU Dysfunction
Genitourinary Dysfunction
• Hemolytic Uremic Syndrome
 Etiology
 Manifestations
 Diagnosis
 Treatment
o Nursing priorities
 Prognosis