Meconium plug or meconium ileus cystic fibrosis Constipation in Infancy Often

Meconium plug or meconium ileus cystic fibrosis

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Meconium plug or meconium ileus (cystic fibrosis) - Constipation in Infancy - Often related to diet - Constipation in exclusively breastfed infants is almost unknown - Infrequent stool may occur because of minimal residue from digested breast milk - Formula-fed infants may develop constipation - Nursing management - Infancy – usually related to diet - Transition to cow milk - Medical conditions – GERD, cleft palate, CP - Constipation in Childhood
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- Often a result of environmental changes or control over body functions - Encopresis is inappropriate passage of feces, often with soiling - May result from stress - Relationship to urinary tract infections - Nursing management Toddlers and Preschoolers - Diet - Painful bowel movements (stool toileting refusal) - Withholding stool – accumulates in and dilates rectum School-age and Adolescent – results in overflow fecal incontinence, may present with recurrent UTIs or enuresis - Clinical manifestations; Formation of hard, dry stools, Oozing of liquid stool past a collection of hard, dry stool - Diagnosis; History and PE, Abdominal x-ray - Clinical Therapy Dietary and fluid management Infants – Ps – pears, peaches, prunes, peas - High fiber foods (whole grains, raw fruits and veggies - Increase fluid intake in older infants and children - Withhold constipating foods (bananas, rice, carrots, cheese) Toileting: Allow adequate time Medications – first soften, then facilitate evacuation - Stool softeners – - Laxatives: Miralax, Senekot, lactulose - MiraLax (polyethylene glycol 3350) is a laxative solution that increases the amount of water in the intestinal tract to stimulate bowel movements. Evacuation of stool - Stressful - Enemas and suppositories - Oral – Golytely or miralax (electrolyte free) Long-term: stimulant laxative – Senekot Behavior modification - Younger children – rewards for toileting, Routine times of toileting - Older children ; Rewards, Psych referral if relevant Minimal daily fluid requirement formula - Calculate the child’s weight in kilograms - Allow 100 ml/kg for the first 10 kg of body weight - Allow 50 ml/kg for the second 10 kg of body weight - Allow 20 ml/kg for the remaining kilograms of body weight - Child weighs 32 kg - 100 x 10 for the first 10 kg of body weight = 1000 ml - 50 x 10 for the second 10 kg of body weight = 500 ml
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- 20 x 12 for the remaining body weight = 240 ml - 1000 + 500 + 240 = 1740 ml/24 hr Cleft palate - 4 th most common birth defect in US - More common in Native Americans and Asians - Multifactorial causes - Cleft lip (1:750) ( incidence in Asian children), Maxillary processes fail to fuse, Apparent at birth - Cleft palate (1:2000) – less obvious, Continuous opening b/t mouth and nasal cavity, Unilateral or bilateral - Feeding: - Education lactation consult - Pump if breastfeeding difficult - Special feeding bottles - May require additional time to feed - Keep head and chest elevated - Frequent burping** - Needed due to excessive swallowing of air - Monitor growth - Surgical correction; - Closure of the lip defect precedes correction of the palate - Z-plasty to minimize retraction of the scar -
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