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Unformatted text preview: By: Romeo Benjamin D. Laurente Group 4 BSN-2A Congenital anomaly that results in mechanical obstruction from inadequate motility of part of the intestine. Specifically the aganglionic portion. It is also associated with other anomalies like Down syndrome. It may be an acute life threatening condition or chronic disorder. Relates to the absence of Ganglion cells in the affected areas of the intestine resulting in a loss of the rectosphinteric reflex and an abnormal microenvironment of the cells of the affected intestine. And also resulting to a lack of ENS stimulation which decreases the int. sphincters ability to relax. Resulting to a lack of peristalsis and contipation. Constipation w/ ribbon like foul smelling stool Abdominal distension Vomiting Delayed meconium passage Once the child is stabilized with fluid and electrolyte replacement, if needed, surgery is performed. Surgical management consists primarily of the removal of the aganglionic portion of the bowel to relieve obstruction, restore normal motility, and preserve function of the external anal sphincter. Post transanal endorectal pull through In Hirschsprung disease, several areas must be investigated: 1) Frequency of bowel movements 2) Characteristics of stool 3) Onset of constipation If enema is indicated use of normal saline solution is strongly advised. Low fiber, high calorie, high protein diet Fluid and electrolyte replacement Constipation related to reduced bowel function Imbalanced nutrition, less than body requirements, related to reduced bowel function Risk for compromised family coping related to chronic illness in child Needs/Problems/ Cues
I. Physiologic A. Overload Subjective Cues: I find it so hard to defecate normally. As verbalized by the client Objective Cues: -Abdominal distension -Delayed meconium passage -Ribbon-like stool -Facial grimace -Sweating Nursing Scientific Basis Diagnosis
Constipation r/t reduced bowel function The absence of ganglion cells in the affected areas of the intestine results in a lack of ENS stimulation which decreases the int. sphincters ability to relax. Resulting to a lack of peristalsis and constipation. Objective of Care
After 8 hours of nursing intervention the child will accomplish adequate bowel elimination w/ some adaptation until normal bowel function can be achieved Nursing Interventions
-Monitor intake and output -Administer laxatives Per doctors order -Increase fluid intake -High fiber diet -Administer enema with normal saline solution when indicated -Teach client relaxation techniques like deep breathing Rationale
In order to notice need to increase fluid intake and note the characteristics of the stool In order to facilitate bowel movement To soften stool and increase peristalsis To increase peristalsis To trigger peristalsis and evacuate left over stool To relax the body and anal sphincter to allow easier passage of stool ...
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- Spring '11