Case study...Peds...GI

Nurses General Nursing

Published

Hey all,

Been assigned a case study for Peds....

Would appreciate any insight, but I will tell you what I have thought of thus far and am trying to narrow it to top two choices.....We were to try to come up with possible Dx and tests we might anticipate ordered, etc...

Number one dx would be Hiatal Hernia although not too frequent in kids

Numer two dx GERD But i wonder if it's not something more since it's unresponsive to on H2 and two PPI's...

Tests I would anticipate would be another barium swallow, a gastric motility, perhaps a 24 hour pH, maybe an H. Pylori breath test...

Here are the details that were given to us, I want to see if I am missing anything, Thanks!!

7 year old male, 59 pounds, normal neuro signs. C/O daily regugitation post meals, up to 20 times per day, quantity usually a mouthful...Sometimes vomitus in nature and sometimes undigested from meals 4 hours prior.

Unresponsive to Zantac, Prevacid and Prilosec. Prior dx of reflux at age of two with a barium swallow. Hx of occasional bouts of wheezing Tx with albuterol..

I am trying to give this my best shot, but it seem too vague??? Any thoughts would be greatly appreciated!!!

Thanks!

sydinco

1 Post

First to come to my mind is that any Ped nurse knows that You have 2-3 patients per case. The parents are also your patients, as they are at bedside part time or full time. These parents often take more time and energy than the official "patient". Don't neglect this aspect:wink2:

Syd

angelnurse80

54 Posts

how about pud as a dx

FlyingScot, RN

2,016 Posts

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

So are you trying to do a nursing care plan? Critical thinking exercise? Not sure what you are asking for. If it's a nursing care plan here's a leading question. What would a young child with frequent regurgitation and a history of wheezing be at risk for?

hopefornursing

87 Posts

So are you trying to do a nursing care plan? Critical thinking exercise? Not sure what you are asking for. If it's a nursing care plan here's a leading question. What would a young child with frequent regurgitation and a history of wheezing be at risk for?

No, not a nursing care plan, our instructor just called it a case study, we've had to do these things before, which I DON"T like because we are not training to be Drs. and diagnosis people, but this is what they want.... I think they are trying to see our thought processes with the subject matter.....

Obviously, the child is at risk for aspiration pneumonia......

I did have another thought for another possible diagnosis,,,,slow gastic motility...It's like trying to find WHAT the instructor wants us to come up with as the "correct answer" and it's always like looking for a needle in a haystack because they tend to be a bit, how shall I say, vague...

FlyingScot, RN

2,016 Posts

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Second leading question. Why do you think the patient has not improved while on Zantac, Prevacid and Protonix (hint: what do these drugs do)? What do you think is anatomically going on with this patient?

FlyingScot, RN

2,016 Posts

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Obviously, the child is at risk for aspiration pneumonia......

I did have another thought for another possible diagnosis,,,,slow gastic motility...It's like trying to find WHAT the instructor wants us to come up with as the "correct answer" and it's always like looking for a needle in a haystack because they tend to be a bit, how shall I say, vague...

You are doing a great job analyzing this. I think your diagnosis of slow gastric motility is very likely correct. Especially in light of the fact that he is regurging undigested food 4 hours after eating. Can you tell me what usually causes reflux in children who are not neurologically compromised?

hopefornursing

87 Posts

Second leading question. Why do you think the patient has not improved while on Zantac, Prevacid and Protonix (hint: what do these drugs do)? What do you think is anatomically going on with this patient?

Well, these drugs all in one way or another alter the amount of acid produced or present in the stomach....Perhaps these drugs arent' working because the amount of acid is NOT the problem....

I am leaning on an anatomical problem, perhaps the LES is weak, maybe there is a hiatal hernia, slow gastric peristasis/motility, or perhaps a problem with the lower sphincter of the stomach being obstructed somehow? What would be the most likely thing???

PS I appreciate your playing along and making me think!!!Thank you.

leslie :-D

11,191 Posts

is his wt normal for his age/height?

alt nutrition?

growth/development?

i would think you'd want to focus more on nsg dxs than medical?

just throwing it out there...

in middle of making a strawberry shortcake.

of course, laptop in kitchen.

leslie

hopefornursing

87 Posts

You are doing a great job analyzing this. I think your diagnosis of slow gastric motility is very likely correct. Especially in light of the fact that he is regurging undigested food 4 hours after eating. Can you tell me what usually causes reflux in children who are not neurologically compromised?

I am going to have to go with either A. Weak LES or B. Allergies. AGHHHH.

hopefornursing

87 Posts

is his wt normal for his age/height?

alt nutrition?

growth/development?

i would think you'd want to focus more on nsg dxs than medical?

just throwing it out there...

in middle of making a strawberry shortcake.

of course, laptop in kitchen.

leslie

His wt is within normal for age and height, nurtition seems fine, and growth and devel also appeared nonremarkable.

I know, I know, it does seem as though a N Dx would be what they want, but they do like to throw us these little exercises. I don't know if they are screening us for candidates for the MCAT or what.:lol2:

Thanks for the reply, mmmm strawberry shortcake...

FlyingScot, RN

2,016 Posts

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
Well, these drugs all in one way or another alter the amount of acid produced or present in the stomach....Perhaps these drugs arent' working because the amount of acid is NOT the problem....

I am leaning on an anatomical problem, perhaps the LES is weak, maybe there is a hiatal hernia, slow gastric peristasis/motility, or perhaps a problem with the lower sphincter of the stomach being obstructed somehow? What would be the most likely thing???

PS I appreciate your playing along and making me think!!!Thank you.

You are one smart cookie. Your critical thinking skills are excellent. The medications he is on treat the SYMPTOMS of GERD but don't address the problem. A weak LES is common in children although it is more common in children less than 12 months of age. I also agree there is some motility issue as well. Do they say anything about frequent URI's?

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