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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