GASTRO INTESTINAL SYSTEM
Define/explain intestinal obstruction.
Intestinal obstruction is a condition in which the intestine is partially or completely blocked due to mechanical impairment/obstruction, due to which the normal flow of intestinal contents is impaired. This condition can also occur in the small intestine and large intestine. Content cannot be properly passed out.
Intestinal obstruction is partial obstruction and complete obstruction.
••••>
Partial obstruction
Partial obstruction can be treated without any surgical intervention.
Complete obstruction
Complete obstruction, if left untreated, can lead to shock and vascular collapse and even death.
Complete obstruction requires surgical intervention.
Explain the types of intestinal obstruction. (State the type of intestinal obstruction).
There are total three types of intestinal obstruction.
1) Simple intestinal obstruction,
2)Structulated intestinal obstruction,
3) Closed loop intestinal obstruction
••••>
1) Simple intestinal obstruction,
Simple intestinal obstruction is a type of mechanical obstruction in which normal flow to pass intestinal contents is impaired.
Simple intestinal obstruction is mainly in the small intestine or large intestine.
May be a mother.
2)Structulated intestinal obstruction,
A strangulated obstruction is a type of obstruction in which the blood supply to the obstructed section is impeded/cut off. Impaired blood supply in strangulated intestinal obstruction occurs mainly when the obstruction is very tight.
Stratified intestinal obstruction is primarily an emergency condition that requires immediate intervention.
3) Closed loop intestinal obstruction)
In closed loop intestinal obstruction, both ends of the intestine are obstructed.
Due to the obstructed parts of the intestine on both sides, the blood supply to that place is impaired.
Due to this, conditions of ischemia (lake of blood supply) and necrosis (tissue death) arise.
Explain the Etiology/cause of the intestinal obstruction.
1) Adhesion
After any abdominal surgery, the formation of scar tissue occurs due to which the walls of the intestines stick together and create an obstruction.
2) Hernia
An obstruction is created when a part of the intestine protrudes through a gap in the abdominal wall.
3) Tumor
When a tumor occurs on the wall of the intestine, a mass-like structure is formed and obstructs the intestine.
4) Impacted bodies
Intestine obstruction also occurs when hard stool accumulates in the large intestine.
5) Volvulus
When the intestine gets twisted in itself, obstruction occurs.
This occurs primarily in the colon and creates intestinal obstruction.
6) Inflammatory Bowel Disease)
Inflammatory bowel diseases such as Crohn’s disease, ulcerative colitis cause inflammation in the intestine which is responsible for obstructing the intestine.
7) Stricture
Intestinal obstruction is also seen mainly due to narrowing of the intestine.
8) Paralytic ileus
Explain the clinical manifestation/sign and symptoms of the child with the intestinal obstruction.
Abdominal pain.
Vomiting.
Abdominal distension.
Constipation.
Diarrhea.
Inability to pass stool
Getting a fever.
Tenderness.
Explain the diagnostic evaluation of the child with the intestinal obstruction.
(Write the diagnostic evaluation of a child with intestinal obstruction).
history taking and physical examination.
Blood test.
Urine test.
Electrolyte test.
Abdominal ultra sound.
Abdominal X Ray
Abdominal CT scan.
Abdominal MRI. Barium contrast study.
Colonoscopy.
Endoscopy.
Barium enema.
Explain the management of the children with the intestinal obstruction.
medical management
Providing intra-venous fluid to the child.
Inserting a nasogastric tube to evacuate stomach contents and air to reduce abdominal swelling.
Maintaining Child No Intake Output Chart.
Colonoscopy of child.
Provide antiemetic medicine to the child.
Providing analgesic medicine to relieve the child’s pain.
Providing child anticholinergic drug.
Explain the surgical management of children with the intestinal obstruction (Write the surgical management of a child with intestinal obstruction).
Exploratory laparotomy
This is an open abdominal surgery in which the abdomen and intestines are opened
can be visualized directly.
In this, the abdomen is opened and the cause of bowel obstruction is identified.
Adhesiolysis
In adhesiolysis, the scar tissue that forms an obstruction in the wall of the intestine.
Nu formation is separated.
Bowel resection
In this mainly the damaged part of the intestine is removed.
This is mainly done when there is any necrosis, tumor and irreversible condition in the intestine.
After resection of the affected part, anastomosis is done with its healthy part.
Hernia repair
This mainly involves correcting the hernia that is responsible for the obstruction.
This mainly involves placing the herniated tissue in its normal place.
Stricture plasty
Structure plasty involves widening of the narrowed intestine without removing any segment of the intestine which is mainly narrowing.
This is mainly used when there is inflammatory bowel disease.
Bypass surgery
Bypass surgery mainly involves bypassing the part of the intestine that is strictured so that the contents of the intestine can flow freely.
Colestomy or ileostomy
When there is a condition of serious intestinal obstruction, mainly a stoma (opening at the abdominal wall) is formed and the normal flow of stool is diverted.
Explain the nursing management of children with intestinal obstruction.
(Write nursing management of child with intestinal obstruction
Nursing assessment
To assess the child’s vital signs properly.
Ask the child about abdominal pain, abdominal distension, vomiting and any other signs and symptoms.
Auscultation of child’s bowel movements and sounds.
Monitor the child’s abdominal movements.
Monitor child’s fluid and electrolyte balance.
To monitor child’s blood pressure, temperature, pulse and respiratory status.
Nursing Diagnosis
1) Pain related to surgical incision.
2) fluid and electrolyte imbalance related to vomiting.
3) Impaired skin integrity related to fluid volume deficit.
4) Imbalance nutritional status less than body requirement related to avoidance of food.
5) Risk for infection related to surgery.
Nursing interventions
Provide child prescribed analgesic medicine.
Provide the child with prescribed intravenous fluids to maintain the child’s hydration status.
Provide food to the child through nasogastric tube.
Maintaining Child No Intake Output Chart.
Assess the child’s urinary output regularly.
Provide a position that makes the child comfortable.
Collaborate with the physician and other health care personnel regarding the child’s condition to improve the child’s condition.
To provide education to the child and his family members about the child’s disease condition, its causes, its signs and symptoms, and its treatment.
Providing emotional support to the child and his family members.
Provide him with proper psychological support.
Advising the parents to provide proper medication to the child.
Advising parents of child to take regular follow up.
Appendix := The appendix is a small finger-like structure near the beginning of the large interstyle)
Appendicitis is also called “appetiflites”.
Appendicitis means infection and inflammation in the vermiform appendix is called appendicitis.
Appendicitis is called an emergency condition.
Conditions of appendicitis require immediate abdominal surgery.
It causes abdominal pain,
vomiting,
discomfort,
nozia,
Signs and symptoms like fever are seen.
Explain the Etiology/cause of the children with the Appendicitis.
(State the causes of appendicitis.)
Due to obstruction in appendix lumen.
Due to bacterial infection.
Due to parasitic infection.
Due to inflammatory bowel disease.
Due to Crohn’s disease.
Ulcerative colitis
Due to trauma to the abdomen.
Due to fungal infection.
Due to environmental factors.
Due to genetic factor.
Due to trauma.
Explain the clinical manifestation/sign and symptoms of the children with the appendicitis. (State the symptoms and signs of a child with appendicitis).
Right lower quadrant abdominal pain.
Pain in the periumbilical region.
Getting a low grade fever.
Severe abdominal pain.
Decreased appetite.
Nozia
Vomiting
Pain at McBurney’s point.
Local tenderness.
Having rebound tenderness present.
Swelling of abdominals.
Filling pain while passing urine.
Explain the early signs of Appendicitis.
Guarding sign
Tensing and tightening of the abdominal muscles occurs when health care personnel palpate the lower abdominal area.
Rebound tenderness
When the health care personnel palpates the abdominal area with a hand and then releases the hand, the child still experiences abdominal pain and tenderness, this is called rebound tenderness.
Rowsing sign
Rovsing’s sign indicates Rovsing’s sign is present when health care personnel palpate the child’s left lower abdominal side with the hand and when the hand releases pressure and the child feels pain in the right lower abdominal site.
sauce sign
The sous muscles are located in the pelvic cavity near the appendix. These sous muscles create abdominal pain when there is infection and inflammation in the appendix.
In Sous sign, the child is asked to do the left side lining position, then the child’s right foot or hip is extended to the right hand side, when the child is in pain, it indicates Sous sign.
Obturator sign
In this test, the child is made to lie down in the supine position.
Then internal rotation of the right hip joint is done. And if the child
Pain over the right iliac fossa indicates an obturator sign.
Aaron’s sign
Pain filled epigastrium region when firm pressure is applied on continuous Mc Burney’s point in Aaron’s sign is chronic appendicitis.
indicates the condition of
The Bloomberg sign
In Blumbag’s sign, slowly pressure is applied to the abdominal wall.
The pressure is then rapidly released and if the patient feels pain while releasing the pressure, it indicates a positive Blumbag sign.
Explain the diagnostic evaluation of children with appendicitis.
(Write diagnostic evaluation of a child with appendicitis).
history taking and physical examination.
Laboratory test.
Blood test.
Complete blood count test (CBC).
Urine Analysis.
Abdominal ultrasound.
Abdominal X Ray
Abdominal CT scan.
Laparoscopy
Explain the management of children with appendicitis.
(State the management of a child with appendicitis).
Medical management
Provide antibiotic medicine to the child.
Provide intravenous fluid to the child.
Maintain child’s fluid and electrolyte balance.
Provide analgesic medicine to the child.
Administer antipyretic medicine to the child.
Provide antiemetic drug to the child.
Advise the child to take proper bed rest.
Surgical management
Appendectomy
An appendectomy involves surgically removing an infected appendix.
Mainly two methods are used in it.
Older method laparotomy
Newer laparoscopic surgery
•••>
In laparotomy surgery, the infectious appendix is removed by making a single incision on the lower right area of the abdomen.
In laparoscopic surgery, the infectious appendix is removed by making a small incision in the lower right abdominal area using a special surgical instrument.
Nursing management
Nursing assessment
Assess the child for any signs and symptoms of abdominal tenderness, anorexia, nosia, vomiting, temperature increase.
Assessing whether the child has rebound tenderness sign or not.
Assessing whether the child is presenting with rousing signs.
Assessing whether the child has any other complications.
Nursing diagnosis
1) Acute pain related to disease condition.
2) Imbalance nutritional status less than body requirement related to nausea and vomiting.,
3) Impaired skin integrity related to fluid and electrolyte imbalance.,
4) Risk for fluid volume deficit related to excessive amount of fluid loss from the body.,
5) Risk for infection related to the disease condition.
Nursing interventions
1) Relieving pain of the patient.,
2) maintain nutritional status of the patient.,
3) maintain skin integrity of the patient.,
4) preventing fluid volume deficit.,
5) Reduce the risk of infection.
Pre-operative and post-operative nursing management
Preoperative nursing management
Consent of child and family member before surgery
to take
Keeping the child oral on nil do not provide him with anything by mouth.
Maintain the patient’s hydration status by intravenous fluids to the child.
Antibiotic medicine to prevent the child from infection.
To monitor child’s bowel sounds.
Assessing the child’s pain level.
Provide analgesic medicine to relieve the child’s pain.
To carry out proper laboratory investigation of the child viz.
Blood Investigation,
Complete blood count,
Abdominal ultrasonography,
urinalysis,
abdominal x ray,
To do tests like abdominal ct scan etc.
To prepare the surgery side area properly.
Maintain child’s fluid and electrolyte balance.
Postoperative nursing management
To receive the child comfortably in the recovery room.
To monitor the child’s vital signs properly.
Properly monitor the child’s operative site.
Assess the child for any bleeding and suture gaping on the operative side.
Monitor child’s intake output chart.
Advise the child on deep breathing techniques.
To perform bowel sound auscultation of the child.
Provide analgesic medicine to the child.
Provide antibiotic medicine to the child.
Provide antiemetic medicine to the child.
Providing intravenous fluids to the child
Postoperatively, provide the child with a side-lying position to prevent secretions from being aspirated.
Keeping the child oral on the nipple after the operation.
Providing feeding to the child through nasogastric tube.
Provide oxygen to the child until the effect of anesthesia.
Dressing the operative side of the child by proper sterile technique.
Providing child skin care.
Advise the child to do moderate walking.
Assess the child for any signs and symptoms of infection.
Involving the child in daily routine activities.
Advising the child to maintain personal hygiene.
Providing psychological support to the child.
Advise the child to take medication regularly.
Advising the child’s parents to follow up regularly.
explain/define Diverticulitis. (Define diverticulitis).
Diverticulum :=
A diverticulum is mainly due to a defect in the muscles of the intestine, a sack-like pouch forms due to the stretching of the lining of the intestine, it is called a diverticulum.
If this sac-like structure is one, it is called a diverticulum.
If it is multiple pouches it is called diverticula.
Diverticulitis is mainly when any food, bacteria, or microorganism is retained in the diverticulum structure and if it is retained for a prolonged time, it creates infection and inflammation in the diverticulum, it is called diverticulitis.
Explain the etiology/cause of the children with the diverticulitis.
(Give reasons for diverticulitis).
Due to low fiber food intake.
Hereditary.
Due to congenital anamylosis.
Because of obesity.
Due to gallbladder disorder.
In a child who has a high intake of processed food
Ex:=
white rice,
white bread,
Cereals,
Crackers, etc.
Due to constipation. Due to genetic factors. Due to less physical activity.
Due to disorder of connective tissues.
Explain the clinical manifestation/sign and symptoms of the children with the diverticulitis. (State the symptoms and signs of children with diverticulitis).
Abdominal bloating.
Abdominal cramping.
Abdominal tenderness.
Bowel irregularity.
Diarrhea.
Nozia.
Vomiting.
Cramping abdominal pain.
Constipation.
Getting a low grade fever.
Chills.
Loss of appetite.
Hematochezia
Burning and pain during urination.
Bleeding from the rectum.
Weakness.
feeling tired
Explain the diagnostic evaluation of the children with the diverticulitis.
(Type Diverticulitis Diagnostic Evaluation).
history taking and physical examination.
Blood test.
Stool test.
Colonoscopy.
Abdominal ultrasound.
x-rays.
ct scan.
In Barium Annie.
Explain the management of children with diverticulitis.
(Write management of child with diverticulitis).
Medical management
Advising the child on nutritional diet.
Advise child to take high fiber diet, low fat diet.
Providing fiber supplements to relieve child’s constipation.
Provide antibiotic medicine to the child.
Ex:=
•>Ciprofloxacone (cipro),
Metronidazole (flagyl),
•>Cephalexin (keflex),
•>Doxycycline (vibramycin) etc.
If the child has abdominal pain, provide antispasmodic medicine to the child.
Ex:=
•>Dicyclomine
(Bentyl),
•>Chlordiazepoxine
(librax),
•>Phenobarb
(Donnatal),
•>Hyoscyamine
(levsin),
Atropine,
•>Scopalamine.etc.
Providing laxatives to the child.
If the child is immunosuppressant and has, then the child should be hospitalized immediately.
Provide evacuation suppository to the child.
Surgical management
1) Primary Bowel Resection
In this procedure, the surgeon mainly removes the dissected part of the intestine and reconnects (anastomoses) it with the healthy segment of the colon.
2) Bowel resection with colostomy
This procedure is mainly done when there is a lot of inflammation in the colon.
In a colostomy procedure, the surgeon makes an opening (stoma) in the abdominal wall, and then the unaffected part of the colon is connected to the stoma, allowing waste to pass through the stoma into a bag.
Explain the Nursing management of the Children with the Diverticulitis.
Advise the child to take low fat, high protein diet, fibrous food, and green leafy vegetables.
Giving advice to avoid irritating food like coffee, tea, hot food, spicy food.
Giving advice to the child to avoid cigarettes and smoking.
Advise the child to intake adequate amount of fluid.
Advise the child to avoid roughage food.
Advise the child to take fresh juice like and fruits like apple, papaya, orange.
Advising the child to do regular physical activity and exercise.
Giving advice to the child to do yoga and meditation.
Provide antispasmodic medicine to the child.
Providing laxative medicine to the child.
Advise the child to take adequate bed rest.
Provide analgesic medicine if the child is in pain.
If the child is constipated, provide a tool softener such as lactulose (Regulose).
To provide work and comfortable environment to the child.
Providing education to the child’s parents to take medication regularly.
Advising the parents to follow up the child regularly.
Ulcerative colitis is a chronic inflammatory bowel disease.
Ulcerative colitis primarily affects the lining of the large intestine (colon) and rectum.
Ulcerative colitis mainly creates ulcers and inflammation in the digestive tract.
In ulcerative colitis, superficial inflammation of the large intestine occurs due to ulceration and build-up.
Ulceration causes inflammation in the lining of the colon and the cells of the colon are killed and inflamed, leading to bleeding, and production of pus.
Due to inflammation, the colon frequently empties and due to this the condition of diarrhea arises.
When ulcerative colitis occurs in the lower part of the rectum and colon, it is called ulcerative proctitis.
If the entire colon is affected, it is called pancolitis.
If only the left side of the colon is affected, it is called limited or distal colitis.
Explain the Etiology/cause of ulcerative colitis.
Exit cause is unknown
Hereditary
Due to infection.
Due to immunological factors.
Due to taking stress.
Due to consumption of certain types of food.
Due to environmental factors.
Due to allergic reaction.
Due to autoimmune response.
Due to psychological factor.
Explain the clinical manifestation/sign and symptoms of the children with the ulcerative colitis.
Bleeding occurs due to ulceration.
Loss of appetite.
Diarrhea.
Weight loss.
Rectal bleeding
Nozia.
Abdominal cramping.
Malnutrition
Weakness.
Electrolyte imbalance.
Bloody stool
Low red blood cell count
Nozia
Nutritional deficiency.
Weight loss.
Eye pain and redness.
Mouth ulcers.
Skinresis occurs.
Liver disease.
Rectal pain.
Inability to pass stool.
Severe abdominal pain.
Blood in vomiting.
Gastrointestinal bleeding.
Loss of appetite.
Dehydration.
Hypocalcemia.
Having rebound tenderness present.
To see skin licenses.
Explain the diagnostic evaluation of children with ulcerative colitis.
(Write the diagnostic evaluation of a child with ulcerative colitis.)
history taking and physical examination.
Stool test.
Hemoglobin level test.
Sigmoidoscopy.
Barium enema.
Endoscopy.
Leukoside count assessment.
Erythrocyte Sedimentation Rate (ESR) Assessment.
Colonoscopy.
Flexible sigmoidoscopy.
Explain the management of children with ulcerative colitis.
(State the management of a child with ulcerative colitis.)
Provide oral fluids to the child.
Provide high protein diet to the child.
Provide high calorie diet to the child.
Provide iron replacement to the child.
Providing proper nutrition therapy to the child.
Avoiding foods that are responsible for causing diarrhoea.
Providing total parenteral nutrition to the child.
Provide sedative medicine to the child.
Provide antidiarrheal medicine to the child.
Providing an immunosuppressive agent to the child.
Providing an anti-inflammatory agent to the child.
Provide antibiotic medicine to the child.
Providing corticosteroid medicine to the child.
surgical management
Total colectomy, (removal of the entire colon).
Segmental colectomy.
ileostomy
Resection of the affected area.
Nursing management of children with ulcerative colitis
(Write nursing management of a child with ulcerative colitis.)
Providing citrus fruits to the child.
Advising the child to take fresh fruit.
Advise the child to rinse the mouth properly.
Advise the child to maintain proper hand hygiene.
Advise the child to take liquid diet.
Advise the child for clear liquid and bland diet.
To give the child a high fiber diet like fruits and vegetables
giving advice
Advise the child to take vitamin C rich diet.
Advise the child to drink lemon water.
Advise to avoid irritating foods like tea, coffee, soft drinks, foods that are responsible for causing irritation.
Giving advice to the child to avoid anxiety, stress, tension, aggressive behavior.
Advise the child to maintain fluid volume.
Advise child to maintain intake output chart.
Advise the child to intake fluid in adequate amount and advise the child to take coconut water, oral rehydration solution.
Giving advice to the child to take proper rest and sleep.
Giving advice to the child to reduce anxiety.
Provide the child with prescribed medicines such as corticosteroids, proton pump inhibitors, antibiotic medicines.
Carry out daily weight assessment of the child.
To provide psychological support to the child and his family members.
Helminthic infestation is a common health problem in children. It is also called worm infestation. In helminthic infestation, parasitic worms known as helminths enter the body.
These worms infect various organs including the intestines, lungs, liver and blood. In common types of helminths
Round worms (nematodes),
Tapeworms (Cestodes),
Includes threadworms, hookworms and flukes (trematodes).
Helminthic infestations often enter the body through the ingestion of contaminated food or contaminated water, or by the larvae penetrating the skin.
Explain the Etiology/cause of the Helminthic infestation
The etiology of helminthic infestation in children is usually due to exposure to an environment contaminated with helminth eggs or larvae. This exposure can occur through various routes:
Infection:
Children due to ingestion of eggs or larvae of helminths in contaminated food or water, especially in poor sanitation and
In areas with unhygienic conditions.
Contact:
Direct contact with contaminated soil, such as playing with bare feet in areas where infected individuals have defecated, can cause helminth larvae, particularly hookworm larvae, to enter the skin.
Poor hygiene:
Inadequate hand washing practices,
Lack of proper hand washing, especially after using the toilet or before eating, can increase the risk of helminthic infestation as children may inadvertently come into contact with helminth eggs or larvae.
Contact with animals:
Humans can acquire helminthic infestations through contact with some helminth-infected animals or by consuming undercooked food or raw meat containing helminth larvae, such as certain tapeworms.
Environmental Factors:
Environments such as warm and humid climates play an important role in the survival and transmission of helminth eggs and larvae, and children living in such areas are more likely to have helminthic infestations.
other reasons
Due to not properly disposing of human excreta.
Due to not maintaining personal hygiene.
Explain the clinical manifestation / sign and symptoms of the Helminthic infestation.
Gasterinterestine:– Abdominal pain,
Nausea and vomiting, diarrhoea,
conception,
flatulence,
loss of appetite,
weight loss,
bloody stool,
Itching in the anal area.
Fatigue and weakness:
Chronic helminthic infestation causes fatigue and weakness due to nutritional deficiency and anemia.
Anemia:
Some helminths, such as hookworms and whipworms, can cause chronic blood loss from the intestines, causing anemia that can cause pallor, weakness, dizziness, and shortness of breath.
Skin:
itching,
rashes,
Skin ulcers and lesions.
Respiratory Symptoms:
Infection Cough, wheezing, chest pain, shortness of breath
Allergic reaction:
Symptoms such as itching, hives, swelling (angioedema) and anaphylaxis may occur.
Neurological symptoms:
Neurocysticercosis, seizures, headaches
Other Symptoms:
Getting a low grade fever,
Irritability,
becoming restless,
weight loss,
feel tired,
growth failure,
Not sleeping properly,
vulvovaginitis in females,
loss of appetite,
Races can be seen in the body,
itching,
Explain the Diagnostic evaluation of the Helminthic infestation
History taking and physical examination,
Stool examination,
blood examination,
imaging studies,
Abdominal Ultra Sound,
chest x-ray,
CT scan,
serological test,
sputum examination,
Identifying helminthic species.
Provide antihelminthic medication to the child.
Ex:=
Albendazole,
Mebendazole.
Prazequantel meditation should be provided to the child if he has helminthic infestation by tapeworm and fluke.
If the child has stationed helminthic infestation by roundworm and threadworm then provide vermectin medicine.
If the child has anemic condition then provide ferrous sulphate medication.
Advise the side’s parents to provide proper medication to the child.
Giving advice to the child’s parents or taking regular follow up.
Proper assessment of the child.
Assessing the child’s vital signs and nutritional status.
Assess the child for anemia dehydration and any allergic reactions.
Regularly assess the child’s stool.
Giving advice to parents of child to maintain proper hygienic condition of child.
To provide education to the child that after toilet and before meals and proper hand washing.
Advise the child to drink clean water.
Provide adequate nutritious diet to the child.
If the child has anemic condition, then providing the child with proper iron supplement.
Provide proper antihelminthic medication to the child.
To provide proper comfort measures to relieve the child’s symptoms like pain, fever, fatigue, nausea.
Providing proper psychological support to the child.
Advise the parents of the child to provide properly cooked food to the child.
Advising parents to provide properly protective shoes to the child when the child goes out to play.
Advising the parents to provide the child with properly clean toys to play with.
Advise the parents to provide the child with properly heated water i.e. clean water to drink.
Advise parents to wash raw vegetables properly after consuming them.
Advising parents to keep their child’s nails short.
Advising parents to maintain cleanliness while preparing food.
Advising the parents of the child to maintain proper environmental sanitation.
Advise the child to intake high protein, low carbohydrate and fibrous food.
Advising parents to provide food in properly small and frequent amounts to the child.
To provide properly green leafy vegetables to prevent the child from anemia condition.
To provide education to the child’s parents to provide proper meditation.
Advising parents of child to take regular follow up.
Roundworms are also known as “Ascaris lumbricoides/nematodes”.
They are a group of cylindrical worms that belong to the phylum Nematoda. They are found in a variety of habitats around the world, including soil, water, and as parasites of plants and animals.
Ascaris lumbricoides is one of the most common infestations in children. In children, it mainly affects the small intestine, the adult female roundworms are 20 to 40 centimeters. And mail worms are 12 to 30 centimeters.
These roundworm infections are mainly found in tropical and subtropical climates where environmental sanitation and hygienic conditions are poor.
A female roundworm produces 2,40,000 eggs a day.
These roundworms in the child include the intestine, liver, lungs, trachea, alveoli,
Affects bronchioles etc.
Roundworms mature in 60 to 80 days. And its life span is between 6 to 12 months and maximum life span is 1.5 to 2 years. Infestation of roundworms is mainly transmitted through phyco-oral route i.e. in areas where sanitary facilities are scarce. It is caused by ingestion of contaminated fruits, vegetables and food.
Several factors are involved in the etiology of roundworm infestation:
Transmission:
Roundworms can be transmitted through different routes, including
Ingestion of contaminated food and contaminated water,
Due to direct contact with infected soil,
Bite of an infected insect or animal,
Due to poor sanitation,
over crowding,
Due to compromised immune system,
Due to environmental conditions,
Due to inadequate hygiene practices,
Due to coming into close contact with infected animals,
Due to children ingesting mud while playing outside,
Due to malnutrition,
Due to food not being cooked properly.
Explain the clinical manifestation/ sign and symptoms of the child with the round worms
Symptoms and signs of roundworms include:
Abdominal pain,
Abdominal distension,
Nausea and vomiting
Diarrhea and constipation,
Malnutrition,
feel tired,
weakness,
Visible worms in the stool,
Coughing, wheezing and other respiratory symptoms,
Loeffler syndrome such as fever,
dyspnoea, cough,
Vision, Urticaria
Irritability,
abdominal discomfort,
nutritional deficiency,
poor growth,
to see anemia,
peritonitis,
Pancreatitis,
Explain the diagnostic evaluation of the child with the round worms.
History taking and physical examination,
stool examination,
sputum examination,
Vomit Examination,
Serological test,
imaging test,
ultrasound,
Abdominal x-ray,
blood eosinophilia test,
A contrast study of the gastroenteric tract.
Explain the medical management of the child with the round worms.
Provide proper antiparasitic medication to the child.
Ex:=
Albendazole (15mg/ kg) 400 mg or
Mebendazole 100 mg twice a day for three days.
Levamisole 2.5 mg/ kg single dose.
Pyrantel pamoate 10mg/kg single dose.
The ideal drug for eradication of roundworm infestation is Piperazine citrate 100 to 150 mg/kg provided in the form of syrup, tablets, and granules at night time before sleep for one or two days. This drug paralyzes the worms so the child passes stool within 12 hours after ingesting the peperazine medicine.
If the child has any gastrointestinal symptoms such as abdominal pain, diarrhoea, constipation, nosia, vomiting, treat it properly by providing medication.
If the child has a condition of nutritional deficiency and malnutrition due to roundworms infestation, provide adequate nutritious diet to the child.
Advising the child’s parents to properly maintain the child’s hygienic condition.
Advise the child and his parents that after going to the toilet, wash hands properly with soap and water.
Advise the child not to ingest any contaminated food and water.
Advise parents of child to maintain proper sanitation like proper disposal of human and animal waste.
Advise the parents to provide properly clean and safe water to the child to drink.
Advising the child’s parents to provide proper medication to the child.
Advising parents to take regular follow up.
Explain the nursing management of the child with the round worms
To provide properly comprehensive care and support to the child.
Proper assessment of the child.
Provide complete education to the child and his parents about roundworm infestation, its causes, symptoms and signs, and its treatment.
Properly administer antiparasitic medication to the child and properly assess whether it has any kind of side effect or not.
If the child has any other type of gastrointestinal system related and other symptoms, it should be properly managed.
Provide properly nutritional food and properly cooked food to the child.
Advising the child and his parents to maintain proper good hygienic practices.
Giving advice to the child and his parents for proper hand hygiene.
Giving advice to the child and parents for proper hand washing before and after eating.
Advising parents not to provide their child with any contaminated food and drinking contaminated water.
Advise the parent to provide clean drinking water to the child and maintain proper hygienic condition and provide prepared food to the child.
To provide proper emotional support to the child and his family members.
Advising parents to avoid open defecation.
Advise parents to wash any raw vegetables and fruits properly with water.
Advise parents to keep their child’s nails short.
Infestations of Enterobius vermicularis (Oxyuris vermicularis) are commonly known as pinworms or threadworms.
Pinworm or threadworm is a very common parasitic infection of infants and young children.
Pinworms and threadworms have separate sexes. Females are larger than males. It’s body is covered by a highly resistant coating called the cuticle.
Females are 8 to 13 millimeters in length and males are 2 to 5 millimeters in length.
Pinworms and threadworms mainly affect the appendix, cecum, ileum, and the ascending colon of the intestine.
Pin worms are mainly tiny, narrow and white colored worms. Pinworms and threadworms are mainly transmitted in the perianal region by scratching with nails.
Explain the Etiology/cause of the pinworm or threadworm infestation in child
Due to contaminated food,
Due to coming in contact with any contaminated surface and object like toys, towels, clothing, bedding,
Due to contact with contaminated water and soil.
Direct person-to-person transmission,
Due to environmental factors,
Due to poor hygienic practices,
Due to inadequate personal hygiene,
Due to poor environmental sanitation,
Explain the Clinical manifestation/ sign and symptoms of the pinworm or threadworm infestation in child
Itching in the anal area (pruritus ani),
Child has restlessness and irritability especially at night time,
Redness and inflammation of the skin due to scratching in the peripheral area,
Impaired sleep,
Abdominal pain,
weight loss,
loss of appetite,
Nausea and vomiting,
condition of diarrhea,
weight loss,
Area itching in female child,
Explain the Diagnostic evaluation of the child with the pinworm or threadworm
History taking and physical examination,
Early morning perianal swab,
To detect eggs of pinworms
Cellophane tape assessment (in this test cellophane tape is applied around the perianal region and then the tape is examined under a microscope to detect the presence of any pinworm eggs).
Scratch tap test assessment,
Explain the management of the child with the pinworm infestation or thread worm infestation.
Provide proper antiparasitic meditation to the child.
Ex:=
Albendazole,
Mebendazole,
Piperazine citrate,
Pyruvinium etc.
Provide proper anti-parasitic medicine to all the family members of the child who has pin worms infestation.
Advise the child’s family members to keep the child’s nails properly short.
Advising on hand washing by proper shop and water.
Dry the infected cloth properly in sunlight.
If the child is experiencing itching and irritation in the perianal region, then application of anti-pruritic cream in the perianal region.
Advising the parents of the child to maintain proper environmental sanitation.
Advising on proper hand washing before and after food intake.
Advising on proper disposal of human and animal excreta.
Advise the parents to wash the garments using proper antiseptic solution and then keep them dry in sun light.
Giving advice to parents about drinking clean and safe water.
Advise parents to keep their nails short.
Advising the parents to bathe the child daily.
Advise to keep the perianal area properly clean.
Provide proper antihelminthic medication to the child.
Hookworm is a roundworm infestation of the nematodes group. Hookworm infection, also known as “Ancylostoma-duodenali (ancylosto-miasis)” or nectoriasis, is a parasitic disease caused by hookworm larvae that affects the intestines of children. Hookworms infection is mainly found in rural areas, slum areas and sub tropical areas.
Hookworm is mainly transmitted through contaminated soil and direct skin contact with a contaminated object. And due to injecting any contaminated fruits and vegetables through oral route, hookworm infestation also occurs and it affects the small intestine mainly jejunum and also affects the longs bronchi and trachea in the body.
Male hookworm is 6 to 12 mm long and female hookworm is 10 to 14 mm long.
In hookworm the female hookworm is curved anteriorly dorsally. Hookworms are commonly found in agricultural areas where moist, sandy soils with deciduous vegetation are suitable for larval survival.
Iron deficiency ania is mainly seen in children due to worms infestation.
Explain the Etiology/cause of the child with the Hook worms
Due to contaminated soil and food,
Due to skin penetration,
Due to poor sanitation,
Due to inadequate sanitation,
Due to poor hygiene practices,
Due to intake of contaminated food and water,
Due to intake of contaminated food and fruits.
Explain the Clinical manifestations / Sign and symptoms of the child with the Hookworms
Finding iron deficiency anemia in children.
Loss of appetite.
Epigastric pain and cramping.
Paika.
Passing black color stool.
Diarrhea and constipation.
Irritant papulo-vesicular lesions and itching.
Child Malnutrition.
Growth retardation in the child.
Hypoproteinemia occurs.
Found in heels in the body.
nozia,
vomiting,
diarrhea,
Restlessness,
Cuffing, sneezing, wheezing and chest discomfort.
Impaired cognitive development of the child.
feeling tired
Explain the Diagnostic evaluation of the Hook worms
History taking and physical examination,
stool examination,
blood examination,
serological test,
imaging studies,
Abdominal ultrasound,
Abdominal X Ray
Explain the management of the child with hookworm infestation
Give the child proper antiparasitic medication.
Ex:=
Albendazole.
Mebendazole.
Pyrantel pamoate,
Bephenium hydroxynaphthoate,
Levamisole
Provide iron supplement if the child has anemic condition. And provide iron rich food to the child.
Providing proper nutritional support to the child. And providing it with nutritious diet.
Advising the parents of the child to maintain proper hygienic condition of the child.
Advising the child’s parents to provide the child to wear properly protective shoes when playing outdoor games.
Advise the child to do regular handwashing.
Advising parents of child to maintain environmental sanitation.
Advise parents of children to prepare food in a properly clean and hygienic condition and provide clean water to the child to drink.
Advising child’s parents to wash hands properly with soap and water before and after food intake.
Advise child’s parents on proper disposal of excreta.
Advise the child’s parents to provide properly cooked food for the child’s intake.
Provide daily bathing to the child.
Advising Chinese parents to keep child’s nails short.
Providing education to parents to wash all child’s garments properly in antiseptic solution and dry them in sunlight.
Advise the parents to provide regular medication of the child.
Advising parents to take regular follow up.
Tapeworms are a type of parasitic flatworm of the class “Cestoda”. Which is mainly seen in children. They are long, ribbon-like worms.
Tapeworms are separated by the structure of their segmented bodies, with each segment called a proglottid.
Tapeworms are mostly “Taenia solium” and “Taenia saginata”, pork tapeworms are Taeniasolium and beef tapeworm is Taenia saginata.
Taenia solium tapeworm has suckers, hooks and scolex but Taenia saginata does not have hooks.
These sugar hooks allow tapeworms to attach to children’s intestines.
Taenia saginata is 5 to 12 meters in length and Taeniasolium is 2 to 6 meters in length.
Tapeworms are primarily transmitted by ingesting water contaminated by improperly cooked meat and infected pork and beef, by improperly washed vegetables, food, and fruits, by eggs.
Tapeworms are swallowed orally by animals and then invade the striated muscles of the animal’s intestine where they develop into cysticerci. These cysticerci remain in the animal for several years and are then ingested by humans through raw and undercooked infected meat. Humans are infected due to ingestion.
Explain the Etiology / cause of the Tapeworm in child.
through contaminated food,
Due to ingestion of undercut and romit that is contaminated by tapeworms,
Due to poor hygienic conditions,
Due to exposure to contaminated environment,
Due to non-proper handling of food materials,
Due to contaminated water and soil,
Due to lack of proper hand hygiene,
Explain the Clinical manifestation/ sign and symptoms of the child with the Tapeworms.
Abdominal discomfort,
Abdominal pain and cramping,
Abdominal distension,
Nausea and vomiting
Changes in bowel habit,
Diarrhea and constipation,
weight loss,
Visible worms in stool,
Itching and irritation,
Deficiency of vitamin B12 and iron will be observed.
Fatigue, weakness, pale skin,
pale skin,
Shortness of breath,
Certain types of allergy creations such as AD, difficulty in bridging and skin rashes,
Proglottids of tapeworms can be found in schools,
Child having headache,
Explain the Diagnostic evaluation of the child with the Tape worm.
History taking and physical examination,
Stool examination,
ultrasound,
CT scan,
like this. RI
CSF Examination,
serological test,
endoscopy test,
Explain the management of the child with the tape worm
Providing proper antiparasitic meditation to the child.
Ex :=
Albendazole,
Mebendazole.
Provide Prazequantel and Niclosamide medication to the child.
Providing Mepacrine, Niclosamide meditation to the child.
Advise the child’s parents to provide properly cooked food and clean food to the child.
Giving advice to the child’s parents to maintain the child’s hygienic condition.
Advise the parents of the child to provide properly clean drinking water to the child.
Advise the parents or provide education to the child for proper hand washing before and after eating.
To provide complete information to the child’s parents about the child’s disease, its causes, its symptoms and signs and its treatment.
Advise the child’s parents for proper disposal of excreta.
Giving advice to parents or providing education to their child or washing hands properly with soap and water after going to the bathroom.
Advise parents to wash all vegetables and fruits with proper water.
Advise parents to consume raw fruits vegetables and meat.
Advise parents to provide their child with properly clean/boiled water intake.
Explain/Define schistoma Haematobium (Flukes).
Schistoma haematobium is a worm infection in children caused by flukes (trematodes).
Schistoma haematobium, also known as bladder fluke or blood fluke, can infect children just as it infects adults. Symptoms such as blood in the urine (hematuria), pain during urination (dysuria), etc. can be experienced.
In children, if not given immediate attention, infection can lead to stunted growth, cognitive impairment and other developmental problems.
After malaria and intestinal helminthiasis, schistosomiasis is the third most devastating tropical disease in the world.
Schistoma haematobium affects organs like skin, brain, muscles, adrenal gland, ice, bladder, urinary tract, kidney etc. Schistoma haematobium is caused by contact with fresh water contaminated by parasitic larval cercaraie (cercariae).
These larvae are released from infected fresh water snails, can penetrate the skin of children exposed to contaminated water during activities such as swimming, bathing or washing. Therefore, contact with contaminated water rather than fresh water is the primary source of transmission of Schistoma haematobium in children and adults.
Schistoma haematobium is more common in South America and Africa.
Explain the Etiology/cause of the Schistoma Hematobiun in child.
Contaminated water:
Infected individuals pass out the eggs of Schistoma haematobium through their urine into fresh water bodies like lakes, rivers.
Once in the water, Schistoma haematobium is released from the eggs, which release larvae called miracidia. The miracidia then infect specific freshwater snails, where they undergo development and multiplication. Inside the snail, the larvae develop into free-swimming cercariae. Dewop occurs, which is released into the water. When children come into contact with contaminated water while playing, swimming, or bathing, the cercariae penetrate their skin, entering their bloodstream. Inside the body, cercariae migrate into the blood vessels around the bladder and reproductive organs, where they develop into adult worms. and schistoma haematobium develops.
Explain the clinical manifestation / sign and symptoms of the child with the Schistoma Hematobiun. (Explain the symptoms and signs of a child with schistoma haematobium.)
Passing blood in the urine (hematuria),
Pain during urination,
(dysuria),
Increased urinary frequency,
Urinary tract infection,
Abdominal pain,
feel tired,
weakness,
Delay in child’s growth and development,
fever,
expectoration,
muscle contraction,
Abdominal pain,
diarrhea,
hepatosplenomegaly,
eosinophilia,
passing blood in the stool,
Finding anemia in a child,
Child malnourishment,
Recesses in the skin and itching in the skin,
Acute dermatitis,
Nausea and vomiting.
Explain the Diagnostic evaluation of the child with the Schistoma Hematobiun
History taking and physical examination,
Stool examination,
Urine Examination,
serological test,
imaging studies,
ultrasound,
computed tomography,
biopsy,
Explain the management of the child with the Schistoma Hematobium
Complete assessment of the child.
Provide antiparasitic medication to the child.
Ex:= Prazequantel .
Proper symptomatic management of the child.
If the child has condition of abdominal pain and dysuria then provide painkiller medication.
Ex:= Acetaminophen,
Non-steroidal anti-inflammatory drug (NSAID).
Properly monitoring whether the child’s treatment is effective or not.
Advising the parents of the child to prevent the child from coming into contact with contaminated water.
Advise the parents to provide the child with boiled clean water intake.
Advise parents or provide education to their child about hand hygiene.
Advise parents to provide their child to wear properly protective shoes.
To provide complete education to the child’s parents about their child’s disease condition, its causes, symptoms and signs, and its treatment.
To provide proper psychological support to the child’s parents and the child.
Giving advice to the child’s parents to maintain the child’s personal hygiene.
Advise the child’s parents to provide medical treatment to the child immediately.
To provide proper education to the parents to take proper care of the child.
Advising the parents to follow up the child regularly.
Hirschsprung’s disease is also called “megacolon” and “congenital aganglionic megacolon”. Hirschsprung’s disease usually results in extreme dilatation of the colon due to congenitally absent parasympathetic ganglionic nerves in both the mucosal and submucosal regions of the distal colon and rectum.
Hirschsprung’s disease varies in length and sometimes involves involvement of the colon wall. Rectosigmoid colon is mainly involved in this disease.
Explain the Etiology/cause of the Hirschsprung’s Disease. (State the cause of Hirschsprung’s disease.)
Due to ganglionic nerve cell damage in part of the colon.
Due to chronic constipation.
Due to narrowing of the rectum.
Because parasympathetic ganglionic nerves are absent in the rectum and colon.
Explain the clinical manifestation / sign and symptoms of the Hirschsprung’s Disease. (State the symptoms and signs of Hirschsprung’s disease.)
Delayed passing of miconium (stool).
Vomiting (with bile or fecal matter).
Diarrhea.
Dehydration.
Failure to Thrive.
Abdominal distension.
Chronic constipation.
Anorexia.
Visible peristalsis on the abdominal wall.
Superficial vein visible.
Abdominal discomfort and irritability.
Child passing ribbon like, fluid like stool.
Gross Malnutrition and Failure to Grow.
Malnutrition.
Anemia.
Explain the Diagnostic evaluation of the Hirschsprung’s Disease. (State the diagnostic evaluation of Hirschsprung’s disease.)
Malabsorption syndromes are a group of disorders in which interstitium cannot adequately absorb nutrients into the bloodstream. Because of this, essential nutrients cannot be adequately absorbed.
Nutrients such as protein, carbohydrates, fats, vitamins and minerals cannot be adequately absorbed. Due to which symptoms like weight loss, diarrhea, fatigue are seen.
Explain the Etiology / cause of Malabsorption syndrome
Due to enzyme deficiency,
Due to structural deficit,
Due to mucosal abnormalities,
Due to infectious agents,
Due to gallbladder and pancreatic diseases,
Due to lymphatic obstruction.
Due to vascular impairment.
Because of bowel resection.
Due to ion deficiency.
Due to celiac disease.
Due to cystic fibrosis.
Due to celiac disease.
Topical sprue.
Explain the clinical manifestation/ sign and symptoms of Malabsorption syndrome.
diarrhea,
weight loss,
Abdominal discomfort,
fatigue,
steatorrhea,
anemia,
Due to bone abnormality,
muscle wasting,
chronic fever,
Joint pain.
Explain the Diagnostic evaluation of Malabsorption syndrome.
History taking and physical examination,
stool test,
blood test,
Complete blood count test (CBC test),
bowel biopsy,
Biopsy.
Explain the management of Malabsorption syndrome.
Management of malabsorption syndrome depends on the underlying cause.
If there is a condition of malabsorption syndrome due to celiac disease, provide gluten free diet to the child.
If the child has the condition of cystic fibrosis, provide the child with easily digestible food gradually and in small amounts.
Provide protein and sugar rich food items to the child.
If the child has any infectious condition, provide proper antibiotic medicine.
Advise the child to do breathing exercises to prevent pulmonary complications.
Explain the Nursing management of Malabsorption syndrome.
To properly assess the child.
Daily monitoring of child’s intake output chart.
Daily weight monitor of child.
To properly assess the child’s vital signs.
Properly assess the child’s serum electrolyte level.
Improving the nutritional status of the child by providing appropriate nutritional diet and nutritional supplementation to the child.
Maintain child’s fluid and electrolyte levels by providing proper oral fluid and parenteral fluid to the child.
Monitoring the child properly and continuously.
Provide proper analgesic medicine if the child is in pain.
Provide a properly comfortable position to the child.
Provide proper antidiarrheal medication to the child.
Provide proper skin care to the child.
To provide complete education to the child and his family members about the causes, symptoms and signs of the child’s condition and its treatment.
To provide proper reassurance to the parents of the child.
Advising parents of child to take proper follow up.