Congenital Hypertrophic Pyloric Stenosis
This is a common surgical condition of the intestinal tract in infancy. It occurs most frequently in first born infant and occurs in males more than females.
1) The symptoms appear in infant 2-4 weeks old.
2) Vomiting occurs both during and after feeding, at first vomiting is mild progressively becomes more forceful and projectile whitish in colour (not contain bile).
3) The infant will take formula immediately after vomiting only to vomit again.
4) Dehydration with failure to thrive.
5) Olive shaped mass located by palpation in right upper quad rent of abdomen
c-U.S of abdomen.
If operation is performed early the prognosis is excellent. Before operation the fluid and electrolyte balance must be corrected.
Responsibility of nurse:-
-1-Assist the physician in examination of the infant.
-2-The infant is fed slowly and bubbled frequently to prevent vomiting ,after
feeding the infant is handled as little as possible and moved very gently.
Charting of feeding is very important(whether he vomits, the presence of
-3-The infant is weighed daily at the same time in days schedule.
-4-The infant must be protected from infection.
-5-The infant position must be changed frequently to prevent hypostatic
-6-The infant must be kept warm.
-7-Charting of voiding, type and number of stool.
(Post operative care):
-1-I.V fluid for first few days may be given.
-2-The infant should be kept on his right side or on his abdomen. Then after the danger of vomiting had passed an upright position of the infant is started.
-3-If symptom of shock appear the foot of the crib should be elevated and additional warmth provided.
-4-Feeding are started4-6 hours after operation.The infant is given small amount1/2-1ounce 5 percent G.W orally at frequent interval, this may be increased gradualy,then a diluted formula of half skimmed milk, then a gradual increase in the amount and thickness. If the infant was breastfed, the mothers milk is expressed and given as soon as he can tolerate it.
-5-Prevention of infection of the wound is important by:
a-A pediatric urine collecting bag is used to prevent contamination of the wound with urine.
b-To observe for redness around the wound.
c-The mother is instructed also not to give the infant a bath until the incision is completely healed.
Is excellent provided the operation is undertaken before the infant has become too dehydrated and malnourished.