N211: Health Differences Across the Lifespan I Pyloric stenosis is seen in infants, with symptoms occurring about three weeks after birth. The infant seems healthy or regurgitates occasionally after eating. The parents may describe the child as a “good eater” who vomits occasionally. This disorder is most common in male Caucasian infants. Nursing Assessment Includes progressive, projectile vomiting, movable, palpable, firm, olive shaped mass in the right upper quadrant; visible deep peristaltic waves from LUQ to RUQ immediately before vomiting. Client will be irritable, hungry and cry. Sunken fontanels, poor skin turgor, dry mucous membranes, decreased urine output, constipation, jaundice and metabolic alkalosis. Diagnostics Include ultrasonography and upper GI series may reveal delayed gastric emptying and an elongated pyloric canal. Laboratory findings reveal possible increased pH and bicarbonate level (metabolic alkalosis), decreased serum chloride, sodium, and potassium levels, and increased hematocrit and hemoglobin. Nursing Diagnosis • Altered nutrition: less than body requirements related to vomiting • Fluid volume deficit related to vomiting • Anxiety and knowledge deficit of parents related to infant’s illness, hospitalization, and surgery Nursing Interventions Includes monitoring skin turgor, mucous membranes, and fontanels at least every shift and monitor urine specific gravity; weight client daily. Maintain NPO status prior to surgery, monitor I&O hourly, administer IV fluid and electrolytes as ordered. Maintain NG tube patency and monitor NG output. Keep the infant warm and client. Initiate small, frequent feedings of clear liquids within 4-6 hours after surgery; follow strict diet regimen of gradual advancement of feedings until normal formula feedings have been resumed. Continue IV hydration until age and weight or appropriate amounts of formula are tolerated. Monitor incision for redness, swelling and drainage; immediately report signs of infection. Monitor vital signs every four hours. Encourage parental involvement and rooming in. Assess parents understanding of diagnosis and plan of care. Assist to minimize feelings of guilt. Prepare parents for surgery of child by explaining procedures and expected sequence of the surgical experience to include pre-op, intra-op and post-op. Evaluation of outcomes includes minimal to complete cessation of vomiting; stools are of normal amount and consistency of infant; demonstrates appropriate growth by maintaining and gaining weight. Client is free of signs of dehydration. Abdomen in soft and of normal appearance for an infant. Vital signs and lab studies are within normal range for infant. Infant tolerates ordered nutrition. Parents demonstrate decreased anxiety, increased understanding, and ability to cope with situation.
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