Month: June 2016

MAL-ABSORPTION SYNDROME
It is a group of disorders marked by subnormal absorption on dietary constituent & excessive loss of nutrition in stool
CAUSES—
• Gall bladder & pancreatic diseases
• Lymphatic obstruction
• Vascular impairment
• Bowel resection
• Stool with mucus
• Infection
• CLINICAL FEATURES—
• Chronic diarrhea
• Abdominal distension
• Failure to thrive
• Flatulence
• Anorexia
• Fatigue
• Loss of weight
• Mall nutrition
• Growth failure
• Stool loose & bulky in severe disease
• Pasty & yellowish in exocrine pancreatic in sufficiency
There are mainly 3 categories—
1) IMPAIRED DIGESTION—
Impaired digestion due to exocrine pancreatic insufficiency also result in chronic diarrhea & malabsorption.
It also occurs due to cystic fibrosis, lipase deficiency, bile-duct atresia &crohn’s disease
Massive steatorrhea occurs most frequently in exocrine pancreatic insufficiency
2) INTESTINAL MAL ABSORPTION—
Due to celiac disease & bacterial over growth
These patient have steatorrhea abnormal D-xylose test & abnormal intestinal histology
3) CARBOHYDRATE MALABSORPTION—
Due to congenital deficiency of mucosal enzyme
It is presented with liquid acidic loose stools which is usually passed with flatus.
DIAGNOSTIC EVALUATION—
• Repeated routine stood examination
• Fecal fat studies
• Intestinal biopsy
• Pancreatic function test
• Radiology like barium meal studies
• NURSING MANAGEMENT—
• Nursing care focouses on the supporting the parents in the maintain glutting free diet for the child
• Help parents to understand that this disease may requires lifelong dietary modification
• Discoution of diet plan for the child at risk of growth retardation
• Nutritional assessment & continuous teaching of diet plan to parent should be maintain
• The child also avoid processed food that content glutain or a filler
• Empharis the needs of complication while entering the child developments needs
NURSING DIAGNOSIS–
• Maintenance of normal diet pattern
• Fluid volume deficit
• Knowledge deficit related to diet plan

Hypertrophic phloric stenosis is a marked and progressive over growth or enlargement of clcular muscles fibers of pylorus by which partical or total obstruction of the stomach due to narrowing of the lumen.
ETIOLOGY—
Exicat etiology is unknown
• Congenital problem
• Maternal stress
• Elevated prostaglandins level
• Deficiency of nitric acid and immature pyloric ganglion cells with abnormal muscle innervations.
*PATHOPHYSIOLOGY—
Due to any etiological factors
↓
Circular musculature of the pylorus is thickened & increased in size & shape
↓
Muscles become enlarged
↓
Narrowing of the lumen occur
↓ (obstruction partial or total)
Stomach become dilated due to gastric content accumulation
*SIGN & SYMPTOMS—
* regurgitation
* projective vomiting forcefully with in 30 minute of feeding
* constant hunger
*irritability
*failure to thrive
* constipation
* decrease the quantity of stool & urine control
* dehydration
*abdominal pain
DIAGNOSTIC EVALUATION—
* History illness
* X-ray
• USG
• Blood & urine examination
MANAGEMENT—
• Monitor vital signs
• Ramstedts pylomyotomy- surgery done at the age 4-5 weeks
• After surgery (8-12hours) of few liquid content to child
• Monitor input, output chart of the baby
• Monitor for signs of dehydration & electrolyte imbalance
• COMPLICATION—
• Fluid and electrolyte imbalance
• Alkalosis & dehydration may occurs
• Haemptemasis, jaundice
• Intermediate muscle spasm in arma & leg
* NURSING MANAGEMENT—
• PREOPERATIVE CARE—
• Emphasis on maintaince of fluid or electrolyte balance
• Maintain nutrition intake by breast feeding if not contraindicated
• Provide relief or parental anxiety & routine care
• Small frequent liquid to be given
• Measures to be taken for prevention of hospital acquired infection
• Continuous monitoring of infants conditions is very important
• POST OPERATIVE NURSING CARE—
• Special attention to be provided on oral feeding
• Usually after 8-12 hours surgery small frequent feeds with expressed milk
• Initially feeding can be started with 1 or 2 tea spoon
• After feeding baby should be placed with elevating the head for 45-60 minute & on the right side of the baby
• Provide worm wound care, medication
• Provide emotional support to the parents health education should be provide related to child’s conditions

• It refers to an abrupt or sudden deterioration in renal function resulting in retention of nitrogenous waste & other bio-chemical substance.
• It is a common life threatening situation process adquate treatment are crucid.
ETIOLOGY—
• Renal failure occurs due to-
• Burn, nephritic syndrome, fluid electrolytic, disturbance blood clots, developmental anomalies, acute tubular necrosis is damage to glomeruli
• Post streptococcal glomerulo nephritis, hemolytic uremic syndrome or ischemia
• Wilm’s tumour (nephro blastomy)
• CLINICAL FEATURES—
• Oliguria, anuria is uncommon excapt in obstructive disorders
• Metabolic acidosis
• Electrolytic disturbance
• Non specific features-
• Nausea, vomiting, drowsiness, edema & hypertension
• DIAGNOSTIC EVALUTION—
• Urine examination – blood urea nitrogen
• RBCs, protein & tubular cells may be present urine
• Radiological studies- USG. CT-scan, X-ray
• Laboratory data such as- hyperkalemia, metabolic acidosis, hypocalcemia, hyponatremia
MANAGEMENT—
• There should be treatment of renal failure done by the underline cause such as-maintain electrolytic & acid base balance
• There should be treated with complication such as- hyperkalemia is treated by administration of 75% solution of sodium bicarbonate in a done of 1.2 mi/kg over 15-30minute may reduce serum potassium level
• Hypertensive encephalopathy (BP) is reduced by 1/3 of total desired reduction of during first 6-8 hours a further 1/3 over next 12-24 hours and final 1/3 over the following 2-3 days
• Infusion of nitropruside should be 0.5-8 mg/kg /minute is as predicatble reduction cause in blood pressure
• Metabolic acidosis is treated by administration of sodium bicarbonate till serum bicarbonate lead 15-17 milliq/litter is reached
NURSING MANAGEMENT—
• Nutrition level impairment related to disease condition
• Fluid electrolyte imbalance
• Improper rest & uncomfortable position due to disease condition
• Self care deficit
• Knowledge deficit of the family members