Chapter 45: Nursing Care of A Family When A Child Has A Gastrointestinal Disorder

Chapter 45: Nursing Care of a family When a
Child Has a Gastrointestinal Disorder

A. Anatomy and Physiology of Gastrointestinal System
B. Fluid, Electrolyte, and Acid-Base Imbalances
 Because the GI system is the main route by which substances are taken into
the body, it can be a major source of fluid and electrolyte loss if vomiting or
diarrhea occur.
 In adults, body water accounts for approximately 60% of total weight. In
infants, it accounts for as much as 75% to 80% of total weight; in children,
it averages approximately 65% to 70%.
 Fluid is distributed in three body compartments: (a) intracellular (within
cells), 35% to 40% of body weight; (b) interstitial (surrounding cells), 20%
of body weight; and (c) intravascular (blood plasma), 5% of body weight.
 Together, the interstitial and the intravascular fluid are often referred to as
extracellular fluid (ECF), totaling 25% of body weight. In young children,
this amount is 30%; in adolescents, it is 25%.
 Infants do not concentrate urine as well as adults because their kidneys are
immature. As a result, they have a proportionally greater loss of fluid in
their urine
1. Fluid Imbalances
Isotonic dehydration- water and salt are lost in proportion to each
other. Occurs when a child’s body loses more water than it absorbs (as
with diarrhea) or absorbs less fluid than it excretes (as with nausea and
vomiting).
Hypertonic dehydration- water is lost out of proportion to salt, and
water depletion. Occur in a child with nausea (thus preventing fluid
intake) and fever (which increases fluid loss through perspiration);
profuse diarrhea, where there is a greater loss of fluid than salt; or
renal disease associated with polyuria such as nephrosis with diuresis.
Hypotonic dehydration- electrolytes are lost out of proportion to water.
This could result from excessive loss of electrolytes by vomiting, from
an increased loss of salt from diuresis, or from diseases such as
adrenocortical insufficiency or diabetic acidosis.
Overhydration- or excessive body fluid intake, can be as serious as
dehydration. It generally occurs in children who are receiving IV fluid
and can lead to cardiovascular and cardiac failure.
2. Acid Imbalances
Metabolic Acidosis- results from diarrhea because a great deal of
sodium is lost with stool. This excessive loss of Na + causes the body
to conserve H+ ions in an attempt to keep the total number of positive
and negative ions in serum balanced. With metabolic acidosis, an
arterial blood gas analysis will reveal a decreased pH (under 7.35) and
a low HCO3 value (near or below 22 mEq/L).
Metabolic Alkalosis- with metabolic alkalosis, therefore, the serum

HCO3 will invariably be high. The higher the value, presumably the
more Cl − ions have been lost or the more extensive the vomiting has
been. The child will breathe slowly and shallowly; pH will be elevated
(near or above 7.45), and HCO3 level will be near or above 28 mEq/L.
C. Common Gastrointestinal Symptoms of Illness in Children
1. Vomiting
Assessment:
Treatment Management:
 Give small amounts of fluid frequently as soon as tolerated to prevent
dehydration and electrolyte imbalance.
 Clear liquids such as ginger ale, tea, and sports drinks can be used to
maintain hydration, but they are not suitable for rehydration.
 Oral rehydration solutions (ORS) such as Pedialyte should be used for
infants and younger children as well as older children with
dehydration.
 Children with intractable vomiting or severe dehydration will require
IV fluids.
2. Diarrhea
a) Mild Diarrhea
Assessment: Children usually are anorectic, irritable, and appear unwell; a
fever of 101° to 102°F (38.4° to 39.0°C) may be present. The episodes of
diarrhea consist of 2 to 10 loose, watery bowel movements per day. The
mucous membrane of the mouth appears dry and the skin feels warm,
although skin turgor will not yet be decreased. The pulse may be rapid and
out of proportion to the low-grade fever. Urine output is usually normal.
b) Severe Diarrhea
Infants with severe diarrhea appear obviously ill. Rectal temperature is
often as high as 103° to 104°F (39.5° to 40.0°C). Both pulse and
respirations are weak and rapid, and the skin is pale and cool. Infants may
be apprehensive, listless, and lethargic. Obvious signs of dehydration such
as a depressed fontanelle, sunken eyes, and poor skin turgor are usually
present. The episodes of diarrhea usually consist of a movement of liquid
green stool perhaps mixed with mucus and blood, passed with explosive
force every few minutes. Urine output will be scanty and concentrated.
Laboratory findings will show elevated hematocrit, hemoglobin, and serum
protein levels because of the dehydration. Electrolyte determinations will
indicate a metabolic acidosis
3. Bacterial Infectious Diseases That Cause Diarrhea and Vomiting

a. Salmonellosis
• Causative agent: one of the Salmonella bacteria
• Incubation period: 6 to 72 hours for intraluminal type; 7 to 14 days for
extraluminal type
• Period of communicability: as long as organisms are being excreted (may
be as long as 3 months)
• Mode of transmission: ingestion of contaminated food, especially chicken
and raw egg
b. Listeriosis
• Causative agent: Listeria monocytogenes
• Incubation period: variable, ranging from 1 day to more than 3 weeks •
Mode of transmission: ingestion of unpasteurized milk or cheeses or
vegetables grown in contaminated soil. The infection is particularly
important to avoid during pregnancy because infections during pregnancy
can lead to miscarriage or stillbirth, prematurity, or infection of the
newborn.
c. Shigellosis (Dysentery)
• Causative agent: organisms of the genus Shigella
• Incubation period: 1 to 7 days
• Period of communicability: approximately 1 to 4 weeks
• Mode of transmission: contaminated food, water, or milk products
d. Staphylococcal Food Poisoning
• Causative agent: staphylococcal enterotoxin produced by some strains of
Staphylococcus aureus
• Incubation period: 1 to 7 hours
• Period of communicability: Carriers may contaminate food as long as they
harbor the organism.
• Mode of transmission: ingestion of contaminated food such as poultry,
creamed foods (e.g., potato salad), and inadequate cooking
4. Protozoan or Viral Diarrhea
D. Common Disorders of the Stomach and Duodenum

1. Gastroesophageal Reflux
- is the regurgitation of stomach secretions into the esophagus through the
lower esophageal (cardiac) sphincter. It is a normal physiologic process that
occurs throughout the day in infants, children, and adults.
- Gastroesophageal reflux in infants occurs due to the immaturity of the lower
esophageal sphincter, which allows easy regurgitation of gastric contents
into the esophagus. It is very common during infancy, with about 70% of
infants affected, and it usually requires no treatment.
2. Pyloric Stenosis
- is the opening between the lower portion of the stomach and the beginning
portion of the intestine (the duodenum). If hypertrophy or hyperplasia of the
muscle surrounding the sphincter occurs, it is difficult for the stomach to
empty, a condition called pyloric stenosis
3. Peptic Ulcer Disease

- Peptic ulcer is a shallow excavation formed in the mucosal wall of the
stomach, the pylorus, or the duodenum. They are rare occurring in only 1%
to 2% of children and more frequently in males than females.
- Peptic ulcer disease includes gastritis (irritation of the lining of the stomach
or duodenum) and is more commonly seen in childhood. In infants, ulcers
tend to occur in the stomach; in adolescents, they are usually duodenal.
- Such ulcers occur in a primary form caused by infection with H. pylori
bacteria and a secondary form that follows severe stress such as burns or
chronic ingestion of medications such as aspirin, nonsteroidal anti-
inflammatory drugs (NSAIDs), alcohol, caffeine, and smoking cigarettes
E. Hepatic Disorders
1. Hepatitis
- Hepatitis (inflammation and infection of the liver) is caused by invasion of
the hepatitis A, B, C, D, or E virus
a. Hepatitis A
• Causative agent: a picornavirus, hepatitis A virus (HAV)
• Incubation period: 25 days on average
• Period of communicability: highest during 2 weeks preceding onset
of symptoms
• Mode of transmission: in children, ingestion of fecally contaminated
water or shellfish; day care center spread from contaminated changing
tables
• Immunity: Natural immunity: one episode induces immunity for the
specific type of virus. Active artificial immunity: HAV vaccine
(recommended for all children 12 to 23 months of age, workers in day
care centers, and certain international travelers) Passive artificial
immunity: immune globulin
b. Hepatitis B
• Causative agent: a hepadnavirus; hepatitis B virus (HBV)
• Incubation period: 120 days on average

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Chapter 45: Nursing Care of A Family When A Child Has A Gastrointestinal Disorder

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Chapter 45: Nursing Care of a family When a

Child Has a Gastrointestinal Disorder

Metabolic Alkalosis- with metabolic alkalosis, therefore, the serum

3. Bacterial Infectious Diseases That Cause Diarrhea and Vomiting

4. Protozoan or Viral Diarrhea

D. Common Disorders of the Stomach and Duodenum

3. Peptic Ulcer Disease

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