you are problem solving here so follow the 5 steps of the nursing process.
- nursing diagnosis
pyloric stenosis and pylorotomy (pyloromyotomy) should be researched as part of assessment. pyloric stenosis is one of the causes of pediatric vomiting. these infants often suffer from failure to thrive.
pylorotomy is a surgical treatment for the pyloric stenosis. what do you want to know about medical treatments?
- expected patient behavior during the healing phase
- anticipated physician orders
- potential complications
after assessment you can move on to nursing diagnosis (problem identification). you are concerned with actual problems that exist now
or that may come about in the future (complications
problem #1 (most important) dehyrdation
#2 nutrition and intake
#3??? maybe infection?
the patient has had surgery. therefore, they are postop. the pyloric stenosis has been repaired. read the article "hypertrophic pyloric stenosis: surgical perspective" on the emedicine website listed above. is this patient still dehydrated postoperatively? if not, then dehydration isn't a problem any longer. going into the surgery was the patient below a normal weight because of problems with vomiting? is that still true? is the patient "out of the woods" as far as keeping formula down and not throwing it up after the pylorotomy? is the patient still underweight? then, these are still problems (imbalanced nutrition: less than body requirements
). was this an open or a laparoscopic procedure? is there an incision that needs care? (impaired tissue integrity
). superficial wound infection or peritonitis due to internal rupture are complications that can occur (risk for infection
). with regard to discharge, how is the child's feeding schedule likely to change? will the parents need to be taught that before discharge? do the parents know and understand what this condition is and what was done to correct it? who does that teaching? what about care of any incisions? (ineffective health maintenance r/t deficient knowledge of parents regarding condition, feeding regimen and wound care
). discharge planning includes diet, allowed physical activity, medications they will need to take, treatments and tests they need to be doing after discharge, follow up appointments with doctors have been made and patient knows about them, referrals to any outside agencies or support groups have been made, and teaching materials and/or contact with outpatient professionals for continued care and teaching have been provided to the patient or caregivers.
- guidelines for fluids after vomiting