Friday, October 9, 2015

Nursing Diagnosis and Interventions for Pediatric GERD


Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid content of the stomach backs up into the esophagus.

The cause of GERD is complex and may involve multiple causes.

Like in adults with the condition, gastroesophageal reflux is the upward movement of stomach contents into the esophagus and sometimes into or out of the mouth.

According to the National Digestive Disease Information Clearinghouse, a child's immature digestive system is usually to blame. They add that most infants grow out of GERD by the time they are 1 year old.


Symptoms of Acid Reflux in Infants and Children
  • Frequent or persistent cough
  • Crying with feeding or after feeding
  • Heartburn, gas, or abdominal pain
  • Frequent or recurrent vomiting
  • Refusing to eat or difficulty eating (choking or gagging with feeding)


Nursing Diagnosis for Gastroesophageal Reflux Disease (GERD)
  1. Deficient Fluid Volume related to input, nausea and vomiting / excessive spending.
  2. Acute pain related to inflammation of the esophagus lining.
  3. Imbalanced Nutrition: less than body requirements related to anorexia, nausea, vomiting.
  4. Risk for Impaired Gas Exchange
  5. Risk for Impaired Home Maintenance
  6. Risk for Aspiration related to barriers to swallow, decreased reflux larynx and glottis to liquid reflux.
  7. Ineffective airway clearance related to fluid reflux into the larynx and throat.
  8. Impaired swallowing related to narrowing / stricture of the esophagus due to gastroesophageal reflux disease.
  9. Anxiety related to the disease process.

Nursing Interventions for Gastroesophageal Reflux Disease (GERD)

1. Increase fluid intake and adequate nutrition.
  • Keep head of bed at a position 60 degrees for 30 minutes to 40 minutes.
  • Give food a little but often 2 to 3 hours.
  • Thicken the milk with cereal.
  • Give dinner.
  • Measure weight each morning.
  • Monitor intake and output.
2. Observe and report any signs of respiratory distress, assess for changes in respiratory status.

3. Before the surgery is done to prepare the client and family for surgery.

4. Monitor the operating side to wholeness.

5. Prevent abdominal distension.
  • Maintain patency of a nasogastric tube (NG) or gastrostomy, if installed.
  • Check hose NG position.
  • Auscultation bowel sounds.
6. Monitor for signs and symptoms of postoperative hemorrhage.
  • Decreased blood pressure and increased pulse apex.
  • Blood in NG drainage.
  • Drainage like coffee grounds would exist in the first 24 hours.
7. Help the parents to express feelings or frustration because they feel responsible or not enough help.

8. Give the stimulation activity.
  • Discharge planning and home care.
  • Encourage parents about drug administration.
  • Encourage parents about feeding.
  • Encourage parents to report any vomiting or presence of fresh blood.
 

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