Nursing Care of the Child With a Gastrointestinal Disorder 1531

VARIATIONS IN PEDIATRIC ANATOMY AND PHYSIOLOGY

Some GU conditions directly involve the kidney from the outset, while others involve other parts of the urinary tract and can have a long-term effect on the kidneys and renal function, especially if left untreated or inadequately treated. Treatment of acute or common pediatric GU conditions may be provided in the outpatient setting of the pediatric or general practice setting, while specialists such as pediatric nephrologists or urologists usually treat chronic or involved GU conditions.

COMMON MEDICAL TREATMENTS

Nurses must be knowledgeable about pediatric GU conditions in order to provide prompt recognition, nursing care, education, and support to children and their families. Although some disorders are acute and resolve quickly, many have a long-term effect on quality of life and will require more intense, extended support.

Assessment

NURSING PROCESS OVERVIEW FOR THE CHILD WITH A

GENITOURINARY DISORDER

The urine sample must be sent to the laboratory immediately at the end of the 24-hour period. If the dye infiltrates at the intravenous site, hyaluronidase (Wydase) can be used to speed up the absorption of the iodine.

Nursing Diagnoses and Related Interventions

Nursing goals, interventions, and assessment for a child with GU disorder are based on nursing diagnoses. NURSING DIAGNOSIS: Disturbed body image related to anatomical differences, short stature, or the effects of long-term corticosteroid use, as evidenced by verbalization of dissatisfaction with the child's or adolescent's appearance.

URINARY TRACT AND RENAL DISORDERS

Teach the child and parents appropriate perineal hygiene and toilet hygiene to prevent recurrence of UTI. It is important for the child to understand that he or she is not alone.

FIGURE 43.1 The abdominal stoma allows for urinary continence and requires catheterization.

Consider This

Observe the child for pallor, toxic appearance, edema, oliguria (reduced urine production) or anuria (absence of urine production). Introduce the child to other children with ESRD (this often happens at the hemodialysis center anyway).

FIGURE 43.5 Some children and fami- fami-lies ind great success with the use of an enuresis alarm

Thinking About Development

Encourage the child with a kidney transplant to wear a medical alert necklace or bracelet, and encourage the parents to inform community emergency services about the child's transplant status. The transplanted kidney must match the child's blood type and the child's human leukocyte antigens (HLAs).

REPRODUCTIVE ORGAN DISORDERS

Before the procedure, assess the normal placement of the urinary meatus in the glans penis (in boys with hypospadias, circumcision should be postponed until evaluation by a pediatric urologist). A boy with a varicocele will have a lump on one or both sides of the scrotum and a bluish spot.

FIGURE 43.12 Paraphimosis: note the swollen prepuce.

NEUROMUSCULAR DISORDER

Some of the conditions result from a neurological injury, such as trauma or hypoxia of the brain or spinal cord. Laboratory or non-nursing personnel perform some tests, while the nurse may perform others.

Nursing Diagnoses, Goals, Interventions, and Evaluations

Auscultate the child's lungs; random sounds are often present when respiratory muscle function is impaired. NURSING DIAGNOSIS: Chronic sadness associated with the presence of a chronic disability, as evidenced by the child's or family's expression of sadness, anger, frustration, or feeling overwhelmed.

CONGENITAL NEUROMUSCULAR DISORDERS

SMA (Werdnig- Hoffman Disease,

SMA (Intermediate SMA)

The use of therapeutic modalities such as physiotherapy, occupational therapy and speech therapy will be essential to promote mobility and development in the child with cerebral palsy. Once inserted, the delivery of the drug can be individualized to meet the child's unique needs. These tests will also be important in evaluating the severity of the child's physical disability.

FIGURE 44.7 Note the very nar- nar-row chest, beginning xiphoid depression, and relatively enlarged appearance of the abdomen in this infant with type 1 spinal muscular atrophy (SMA).

ACQUIRED NEUROMUSCULAR DISORDERS

The early intervention coordinator's office can then refer the health care professional to the local or district early intervention office. Nursing care will be similar to the management of adults with a spinal cord injury and will focus on optimizing mobility, promoting bladder and bowel control, promoting adequate nutritional status, preventing complications associated with extreme immobility such as contractures and muscle atrophy, respiratory complications, pain management and support and education for the child and the family. Rehabilitation must focus on the child's ever-changing developmental needs as they grow.

BOTULISM

Assessment of range of motion and muscle tone is critical in the child with a neuromuscular disorder. Based on the case in the above question, develop a nursing care plan for the child with myelomeningocele. Identify the role of the registered nurse in the multidisciplinary care of the child with a debilitating neuromuscular disorder.

VARIATIONS IN PEDIATRIC ANATOMY AND PHYSIOLOGY

The lower limbs of the baby are usually bowed, which is attributed to the position in the womb. In genu valgum, when the knees touch, the ankles are widely separated and the lower legs are turned outward (Fig. 45.3). The hard nature of the cast keeps the bone aligned so faster healing can occur.

FIGURE 45.1 Anatomic areas of growing bone.

MUSCULOSKELETAL DISORDER

Nursing goals, interventions, and assessment for the child with musculoskeletal dysfunction are based on nursing diagnoses (see Nursing Care Plan 45.1). Nursing Care Plan 45.1 can be used as a guide in planning nursing care for the child with a musculoskeletal disorder. In the injured child or the child in a cast or splint, fully assess the neurovascular status of the affected extremities.

Nursing Diagnoses, Goals, Interventions, and Evaluation

Instruct the child and family to keep the cast still, and place it with pillows as needed. Provide instruction at an appropriate level for the child and family (depends on age of child, physical condition, memory) to ensure understanding. Continuous, careful neurovascular assessments are critical in the child with a cast or in skeletal traction.

FIGURE 45.5 Assist with cast application by distracting or comforting the child.

CONGENITAL AND

The Ilizarov ixator uses wires that are thinner than regular pins, so showering is usually enough to clean the pin to keep the pin site clean.

DEVELOPMENTAL DISORDERS

Elicit the medical history, noting progression of the defect and effects on the child's cardiopulmonary function. Accompanying hip dysplasia can be seen; therefore, careful examination of the hips is warranted (Wells & Sehgal, 2011). Calcium is deposited primarily in the bones of the fetus in the third trimester.

FIGURE 45.10 Pectus excavatum: note the depression in the chest wall at the xiphoid process

ACQUIRED DISORDERS

Administer antipyretics as prescribed if the child is febrile in the initial stage of the illness. Transient synovitis of the hip (also called toxic synovitis) is the most common cause of hip pain and lameness in children in the United States (Polousky & Eilert, 2009). With the child bending forward, arms hanging freely, note asymmetry of the back (pronounced hump on one side).

FIGURE 45.19 In osteomyelitis, bacterial invasion leads to infection within the bone

INJURIES

Wearing a cotton T-shirt under the brace can reduce some of the discomfort associated with wearing a brace. The growth plate is the most vulnerable part of the child's leg and is often the site of injury. Perform the physical examination of the child with a potential fracture carefully, so as not to cause further pain or trauma.

FIGURE 45.24 (A) External ixation is required for compli- compli-cated fractures. (B) The Ilizarov ixator is a circular apparatus usually used for complicated lower extremity fractures

NURSING PROCESS

Look at the skin in general, noting the distribution of any obvious rash or lesions. Some of the tests are administered by laboratory or non-nursing personnel, while others may be obtained by the nurse. In both cases, the nurse must be familiar with how the tests are obtained, what they are used for, and normal versus abnormal results.

OVERVIEW FOR THE CHILD WITH AN INTEGUMENTARY

If a rash or lesions are present, note their location and give a detailed description of them. The tests can help the doctor or nurse practitioner diagnose the disease or can be used as guidelines to determine ongoing treatment. This knowledge will also be needed when providing child and family education regarding the testing.

INFECTIOUS DISORDERS

Determine the child's and family's skin care practices to determine the need for skin care education. Place the child on the opposite side of the skin injury to avoid further skin breakdown. Inform the child with tinea versicolor that the return to normal skin pigmentation may take several months.

FIGURE 46.2 Note honey-colored crusting with impetigo.

INFLAMMATORY SKIN CONDITIONS

Note the medications used to treat the rash, as well as other medications the child may be taking. Using diversion, imagination, and play can help distract the child from itching. Nursing management of the child with atopic dermatitis focuses on promoting skin hydration, maintaining skin integrity, and preventing infection.

FIGURE 46.11 Atopic dermatitis rash is red, dry, and scaly.

ACNE

Inspect the child for other traumatic injuries (children who have jumped or fallen from a house may suffer cervical spine injuries or internal injuries). Thus, the child's pain management needs are of paramount importance (see pain management section below). Check the child's ABCs (airway, breathing and circulation) and perform cardiopulmonary resuscitation (CPR) if necessary.

FIGURE 46.18 Supericial burn— painful but without blisters.

HEMATOLOGIC DISORDER

Mean corpuscular hemoglobin (MCH): a calculated value of the oxygen-carrying capacity of Hgb in RBCs. When assessing the CBC, the nurse should consider the child's clinical appearance. Laboratory or non-nursing personnel take some of the tests, while the child nurse with a hematologic disorder includes the inspection.

ANEMIA

Note history of immunizations, including pneumococcal, lu. Children with sickle cell anemia have an increased inci-. Medical care of a child with sickle cell anemia focuses on preventing vaso-occlusive crises, providing education for the family and the child, managing episodes of pain and. Various interventions are needed to prevent a serious infection in a child with sickle cell anemia.

FIGURE 47.2 Note the concave shape of nails

CLOTTING DISORDERS

Triggers that can result in oxidative stress and hemolysis include bacterial or viral illness or exposure to certain substances such as medications (eg, sulfonamides, sulfones, antimalarial drugs [such as quinine] or methylene blue [for treating urinary tract infections] ), naphthalene (an agent in moth balls) or fava beans. Once the trigger is removed or the child recovers from an illness, the child will get better. Educate the child and family about triggers and advise them that the child should avoid contact with these agents.