Vomiting is a common manifestation in the neonates.
INTRODUCTION
Vomiting
is one of the common manifestation in the neonate persistent vomiting may be
serious ether be trivial or manifestation of some graver pathology this may
result in dehydration and electrolyte imbalance mucus vomiting tinged with blood
is quite common soon after birth. It is due to irritation of the gastric mucosa
by the swallowed material during birth.
Definition
It is the forcible exaction of gastric
content, via the esophagus and mouth.
Etiology
a)
Contaminated food and infections
b)
In case of gastro esophageal
reflux, the infant regurgitates frequently.
c)
In case of pyloric stenosis the
vomiting is projectile
The colour of
the vomiting is important in determining the source and causation.
Ø
Uncurdled or unchanged food
containing no gastric juice originated in the esophagus.
Ø
Curdled milk containing gastric
juice originated in the stomach.
Ø
Greenish coloured vomiting
indicates the presence of bile pigments due to intestinal obstruction.
Ø
Fecal colour and odour
indicates the vomitus originated low in the intestinal obstruction or
peritonitis.
Ø
Blood in the vomitus may be
red, if it is originated high in the gastrointestinal tract or resemble coffee
grounds if it has been mixed with digestive juices.
Other causes are
Ø
Gastric irritation
Ø
Toxic effect on vomiting center
Ø
Reflex vomiting
Ø
Obstruction to alimentary tract
Ø
Increased intracranial tension
Ø
Metabolic disorders
Ø
Emotional disturbances
Ø
Milk allergy
Types of vomiting
A. Bile
stained.
This is seen
in.
a) Distal
duodenal obstruction
b) Malrotation
c)
Intestinal obstruction
B. Non-bile
stained and projectile
This is seen
in
a) Hypertrophy
b) Congenital
adrenal hyperplasia
c)
Haitus hernia
C. Non-bile
stained and non-projectile
This is seen
by
a) Infection
b) Increased
intra cranial pressure
c)
Proximal duodenal atresia
d) Feeding
problem
e)
Uraemia
Pathophysiology
Vomiting center is situated in the
reticular core of the medulla oblongata gets executed by impulse.
Stimulation
received by afferent impulse
Mechanical
stimuli such as
a) Increased icp
b) Disturbances
of semicircular canal of inner ear
Vomiting
During
vomiting
Duodenum
contract in spasm
Through
sharp contraction of the abdominal musculature
Stomach
forcefully empties
Clinical
manifestation
Ø
Electrolyte fluid imbalance
Ø
Weight loss
Ø
Tachycardia
Ø
Hypovolemia
Ø
Dehydration
Ø
Metabolic change (Hypernatraemia,
Hypocalcemia)
Ø
Fatigue
Ø
Tachy pnoea
Diagnostic
evaluation
The newborn who have persistent
vomiting must be carefully evaluated to determine the cause.
The
diagnostic evaluation is:
Ø
History from parents
Ø
Physical examination
Ø
Laboratory lest
Ø
X-ray
Ø
Daily checking of weight,
urinary output etc
Management
Medical
management
Vomiting is only a symptom of illness
and management is corrected towards detecting and treating the cause.
1.
Parenteral fluid and
electrolyte therapy may be indicated to correct the resulting dehydration and
alkalosis.
2.
Anti-emetic drugs may be given
to control vomiting eg. Stemetil,
domstal, emset, perinorm.
3.
In case of obstruction the
child should be given nothing by mouth and aspiration by nasogastric tube is necessary.
Nursing Management
i.
The
nurse should check the vital sign regularly.
ii. The nurse should advice the
mother to clean the child.
iii. Recording of urinary output and
specific gravity of urine can assist in establishing diagnosis and evaluating
complication.
iv. If the problems is one of the
improper feeding techniques, the nurse should teach the parents about corrector
feeding technique.
v. The nurse should prescribe a balance
formula, if the problem is caused by incorrect composition of the formula.
vi. Monitor intake and output chart.
vii. Advice not to stop breast feeding.
viii. In order to
prevent the aspiration of vomitus, the nurse should turn the head of the child
to one side so that it can run into a kidney basin.
ix.The face, skin behind the ears
and neck should be kept clean and dry.
x. In case of hypovolemia.
o
Nurse should check the vital
signs
o
Maintain fluid and electrolyte
balance
o
Oxygen saturation should be
checked
o
Cardiac monitoring should be
done
o
Observe for any signs and
symptoms of shock
xi. In case of dehydration
o
Check for skin turgor
o
Check the mental status of
child
o
Observe for any cyanosis
o
Check the vital sings intervally
o
Check the weight of the
baby.
CONCLUSION
Vomiting is a
common manifestation in the neonates. Vomiting in neonates may be the
manifestation of some graver pathology. All vomits should be checked for the
presence of bile or blood. Keen observation of the infants for other sings such
as abdominal distension, watery or blood stained stools and temperature
instability. Vomiting in neonates, its
definition, etiology, types, pathophysiology, clinical manifestation,
diagnostic evaluation and management are clearly substantiated in this
presentation.
BIBLIOGRAPHY
1)
Annamma Jacob; a comprehensive textbook of midwifery.
Jaypee publishers (P) Ltd;
IInd Edition.
P.No.611-612.
2) V.Ruth Bennett, Linda.K.Brown,
MYLE’S TEXTBOOK FOR MIDWIVES,
Churchill Livingston
14th Edition
P.no.806-807
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