Chronic intestinal pseudo-obstruction: pediatric case presentations and review of the literature.

ISSUES AND PURPOSE: Chronic intestinal pseudo-obstruction (CIP) is a rare condition characterized by small bowel dysmotility. Its effects are severe and disabling in pediatric clients. The purpose of this article is to provide an overview of CIP and summarize information useful to pediatric nurses. CONCLUSION: Nursing management of the pediatric client with CIP is challenging, not only in terms of direct care provided to the child, but also in ongoing support and education of the child and family. PRACTICE IMPLICATIONS: Nurses practicing in either inpatient or outpatient settings may encounter children and families dealing with this disorder. Nurses are in a key position to educate others and influence the outcomes of care provided to children with CIP and their families.

Understanding pediatric intestinal pseudo-obstruction: implications for nurses.

Pseudo-obstruction is actually a group of disorders resulting in bowel dysmotility in the absence of anatomic obstruction. Because of varied pathologic abnormalities of the GI tract involved in the disorder, pseudo-obstruction has been reported in the literature under different names, including hypoganglionosis, chronic adynamic ileus, pseudo-Hirschprung's disease, visceral neuropathy, visceral myopathy, and megacystis-microcolon-intestinal hypoperistalsis syndrome. Although a rare condition, its effects are severe, disabling, and life-threatening in pediatric clients. Prognosis is inversely correlated with age and is especially poor in those children with symptoms as newborns. Management involves promoting nutrition adequate for growth, treating symptoms, and preventing complications. Total parenteral nutrition is almost always required, and its long-term use is associated with chronic cholestasis and potential hepatic failure. Nurses may encounter pediatric clients with this disorder and their families in many different healthcare arenas, such as in radiology departments, ambulatory care, and acute and home care settings. The purpose of this article is to review current literature on this disease and summarize information useful to nurses.

Caring for the technology dependent child--a case study.

Children who are dependent on medical technology present unique challenges for families and health professionals who attempt to care for them at home. The medical and nursing needs of these children challenge and stretch the financial, social and emotional capacities of parents in ways that service providers do not fully understand. Case management is a collaborative parent/nurse model of community nursing practice that has been implemented to meet the needs of children and families with complex special needs where the care goes across primary and secondary care settings. The aim of case management is to facilitate communication and coordination of services between the multi-disciplinary team and the family to achieve desirable goals. This case study describes the special needs of a technology dependent child and the impact of chronic illness on both child and family. From a deeper understanding of the parent's perspective, implications for nursing practice are discussed.

Pseudo-obstruction in children.

Pseudo-obstruction of the gastrointestinal tract is a rare disorder of impaired gastrointestinal motility. The more common symptoms of pseudo-obstruction in the infant or child include dysphagia, nausea, vomiting, abdominal distention, abdominal pain, and constipation. The majority of children have symptoms within the first year of life. Chronic cases of pseudo-obstruction are associated with neuropathic or myopathic changes in other parts of the body. Bladder dysfunction and neurological problems have been reported. The diagnosis of pseudo-obstruction is based on history, physical examination, radiographic studies and motility studies. Advances in medical technology have facilitated the identification of abnormal motility patterns in children. Therapy for pseudo-obstruction is primarily supportive. The use of motility agents has been unsuccessful in treating pseudo-obstruction. Nutritional and antibiotic therapy are the mainstays of treatment. Nursing interventions, patient/family education and advances in home care technology have improved the quality of life for children with pseudo-obstruction. Small bowel transplantation offers hope for the future.