Pediatric GI Disorders & Nursing Care: Vomiting, Cleft Lip/Palate, Hirschsprung’s, Poisoning | Saunders NCLEX-PN Review Chapter 31
Pediatric GI Disorders & Nursing Care: Vomiting, Cleft Lip/Palate, Hirschsprung’s, Poisoning | Saunders NCLEX-PN Review Chapter 31

Chapter 31 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri is a comprehensive guide to pediatric gastrointestinal (GI) disorders, focusing on nursing care, clinical priorities, and NCLEX-style scenarios for infants and children. From managing acute dehydration and feeding challenges to providing post-surgical care and emergency interventions, this chapter equips practical nurses with the knowledge and confidence needed for safe and effective pediatric GI nursing.
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Vomiting, Diarrhea, and Dehydration Risks
- Vomiting & Diarrhea: Monitor for dehydration, electrolyte imbalances, and aspiration. Prioritize oral rehydration (ORS) for mild/moderate cases; IV fluids for severe dehydration. Observe for metabolic acidosis/alkalosis and weigh diapers for accurate output tracking.
- Key Nursing Actions: Maintain NPO during active vomiting, resume feeding slowly, use antiemetics per provider, and educate caregivers on signs of worsening status.
Congenital Disorders: Cleft Lip/Palate, Esophageal Atresia, TEF
- Cleft Lip & Palate: Use specialized bottles/nipples, upright feeding position, and frequent burping. Protect the surgical site post-op (restraints, wound care, pain control). Teach families about feeding modifications and infection prevention.
- Esophageal Atresia/TEF: Watch for the “3 Cs”—coughing, choking, cyanosis. Keep suction available, maintain head elevation, and prepare for surgical correction. Prevent aspiration and monitor respiratory status closely.
Common GI Conditions: GERD, Pyloric Stenosis, Hirschsprung’s
- GERD: Offer thickened feeds, small frequent meals, and position upright after feeding. Monitor for aspiration and teach caregivers safe feeding practices.
- Hypertrophic Pyloric Stenosis: Signs include projectile vomiting, palpable “olive” mass. Pre-op: NPO, IV fluids, NG decompression. Post-op: Gradual feeding, monitor for complications.
- Hirschsprung’s Disease: Ribbon-like, foul stools and abdominal distention. Pre-op: bowel prep, monitor fluids/electrolytes. Post-op: stoma/colostomy care, monitor for enterocolitis.
Acute & Chronic GI Issues: Appendicitis, Intussusception, Celiac, Lactose Intolerance
- Appendicitis: McBurney’s point tenderness, guarding, fever. Pre-op: NPO, pain management, IV fluids. Post-op: wound care, monitor for peritonitis if rupture occurs.
- Intussusception: Currant jelly stools, intermittent pain, shock signs. Treatment may include air/barium enema or surgery.
- Celiac Disease: Gluten-free diet for life. Watch for steatorrhea, failure to thrive, and celiac crisis. Provide family education on hidden gluten sources.
- Lactose Intolerance: Dietary management (lactose-free or enzyme supplements), monitor for calcium/vitamin D deficiency.
Pediatric Hernias, Abdominal Wall Defects & Imperforate Anus
- Omphalocele & Gastroschisis: Cover exposed organs with sterile saline dressings, prevent heat loss, monitor for infection, and prep for surgery.
- Hernias & Hydroceles: Assess for incarceration or strangulation. Post-op: provide scrotal support, monitor for complications.
- Imperforate Anus: Pre-op: NPO, IV fluids, colostomy care. Post-op: monitor for anal patency, provide skin/stoma care, and educate on feeding modifications.
Hepatitis, Poisonings, and Parasitic Infections
- Hepatitis A–E: Review transmission (A & E—fecal/oral; B, C, D—blood/body fluids), vaccination, symptom management, and prevention. Teach about dietary adjustments and infection control.
- Pediatric Poisoning: Identify substance (lead, acetaminophen, aspirin, corrosives). Administer antidotes (chelation for lead, N-acetylcysteine for acetaminophen, activated charcoal, etc.), follow emergency protocols, and teach prevention/safe storage.
- Intestinal Parasites: Giardiasis and pinworms. Diagnose with stool/tape test, treat with antiparasitics, and provide family hygiene education to prevent reinfection.
Constipation, Encopresis, and IBS
- Increase dietary fiber and fluids, establish regular toileting routines, and provide positive reinforcement. Address psychosocial factors for encopresis and IBS, and educate the family on long-term management.
Conclusion:
Pediatric GI disorders require vigilant assessment, fluid/electrolyte management, careful feeding practices, and patient/family education. Mastering these concepts prepares practical nurses for NCLEX-PN success and safe, effective care in a variety of pediatric settings.
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