Lesson plan

ON

Pyloric stenosis
Child health nursing

Submitted to: submitted by:

Mr. Vinayaka a.m. jayesh soni
LECTURER M.Sc. (N) 2nd year
S.No. PARTICULARS CONTENTS

1 NAME OF STUDENT TEACHER MR. JAYESH SONI

2 SUBJECT CHILD HEALTH NURSING

3 UNIT UNIT

4 TOPIC PYLORIC STENOSIS

5 GROUP III YEAR B.SC NURSING

6 SIZE OF THE GROUP 100

7 METHOD OF TEACHING LECTURE CUM DISCUSSION

8 A.V.AIDS USED BLACK BOARD & PPT, CHART

9 PLACE OF TEACHING 3RD YEAR CLASS ROOM

10 TIME AND DURATION OF 3PM TO 4PM & 1 HOUR

TEACHING
11 DATE OF TEACHING 14 -02 -2014
General objective:
After completion of the topic students will be able to develop fair knowledge about pyloric stenosis & positive
attitude towards application of Pyloric stenosis services in clinical postings and their services.
Specific Objectives:
After completion of topic students will be able
 define the definition of Pyloric stenosis.
 describe the etiology of Pyloric stenosis
 list the pathophysiology of Pyloric stenosis
 explain the clinical manifestations of Pyloric stenosis
 list down the diagnostic evaluation of Pyloric stenosis
 describe the management of Pyloric stenosis
 explain the nursing management of pyloric stenosis

BIBLIOGRAPHY:-
 Sharma Rimple. Essentials of Pediatric Nursing: 2013. Jaypee publisher, New Delhi: Pp 355-8
 Manivannan C. Text Book Of Pediatric Nursing: 2nd Ed. 2010. EMMESS Publishers, Bangalore; Pp 206-7
 Dorthy R marlow. Text book of pediatric nursing:2012.Elsevier publication: Pp 619-20
 http://en.wikipedia.org/wiki/congenital-hypertrophic-pyloric-stenosis;

TEACHING LEARNING
ACTIVITY A.V. EVALUA
SL. TIME SPECIFIC CONTENT AIDS TION
NO OBJECTIVES TEACHER LEARNER

1 INTRODUCTION
Pyloric stenosis is a narrowing and obstruction of lower
3 min part of the stomach (pylorus), that prevents food from
moving from the stomach to the intestine. The pylorus is
greatly enlarged, hyperplasic and causes progressive
narrowing of the canal between the stomach and duodenum.
As the canal becomes obstructed over time, associated
inflammation and edema result in-complete obstruction. The
enlarged pylorus muscle may be felt as an "olive-like" mass
in the upper abdomen.

2 define the DEFINITION- defining the Listening

2 min definition of Pyloric stenosis is defined as an obstruction at the pyloric definition of and PPT
Pyloric stenosis sphincter caused by a hypertrophy and hyperplasia of the Pyloric stenosis clarifying
circular muscle of the pylorus. the doubts

INCIDENCE AND ETIOLOGY-

3 Pyloric stenosis typically occurs in infant between 2-8
weeks of age. The infant appears very hungry but exhibits
projectile vomiting soon after eating and fails to gain
describe the appropriate weight The exact cause is unknown although describing the Listening
5 min etiology of heredity is suspected, Immature pyloric muscles ganglion etiology of and PPT
Pyloric stenosis with abnormal muscle innervations and Maternal stress in Pyloric stenosis clarifying
the 3rd trimester has been implicated. Elevated serum the doubts
prostaglandin, reduced levels of pyloric nitric oxide
syntheses and infant hypergastrinemia have been found.
The abnormality is most common in young children between
1 to 6 months of age. It affects 1 out of every 500-1000 live
births. It is five times more common in boys than girls, so
the ratio is 5:1 in infants.

4
PATHOPHYSIOLOGY-
 A diffuse hypertrophy and hyperplasia of smooth muscles of
list the the antral region and Pyloric sphincter listing the
10 min pathophysiology pathophysiology Listening
of Pyloric stenosis of Pyloric and PPT
stenosis clarifying
The pylorus is usually twice in its normal size, assuming the the doubts
size & shape of an olive

This increases the size of circular muscles of the pylorus

Narrowing the pylorus with partial and then complete

obstruction

Stomach contains con not flow easily through the constricted

pylorus

Vigorous peristalsis movement

Hypertrophy and dilatation of the stomach musculature

Infant become dehydrated and develop hypochloremic

alkalosis, gastritis with some bleeding from mucosa may
also occurs.
5
explain the CLINICAL FEATURES- explaining the
5 min clinical features 1) Regurgitation {projectile vomiting} clinical features Listening PPT
of Pyloric stenosis 2) A palpable pyloric tumor is palpable in the upper of Pyloric and
right quadrant of abdomen. stenosis clarifying
3) Weight looses or failure to weight gain the doubts
4) Dehydration: - poor skin turgor, loss of elasticity of
skin, dryness, sunken eyes etc.
5) Fewer bowel movements
6) Constipation due to small amount of food intake
6 list down the
diagnostic DIAGNOSTIC EVALUATION- listing down the
5 min evaluation of  Abdominal examination diagnostic Listening PPT
Pyloric stenosis  Severely malnourished evaluation of and
 X-rays shows vigorous peristaltic stomach with delay Pyloric stenosis clarifying
 string like pyloric canal the doubts
 Laboratory study- low serum sodium, potassium
levels and decrease serum chloride concentration
with increase in pH and bicarbonate contents.
7 describe the describeing the
3 min management of MANAGEMENT management of Listening PPT
Pyloric stenosis Considered a medical emergency due to dehydration and Pyloric stenosis and
electrolyte imbalance, with initial treatment to rehydrate to clarifying
correct electrolytes and correct alkalosis. the doubts

SURGICAL MANAGEMENT-
Pyloric stenosis is managed by surgical relief of the
pyloric obstruction (pyloromyotomy) after the metabolic
imbalances have been corrected. The procedure performed
through a short transverse incision in the right upper
quadrant over the rectus muscle at or above the liver edge.
This surgery opens up the tight circular muscles of pylorus
that had caused the narrowing, thereby allowing passage of
food from stomach to the intestine.
8
explain the NURSING MANAGEMENT- explaining the
nursing nursing Listening
12 min management of Pre operative nursing care- management of and PPT
Pyloric stenosis 1) Observe and record vital signs of the infant, as they Pyloric stenosis clarifying
help to detecting alkalosis and fluid/electrolyte the doubts
imbalance
2) Record the amount and characteristics of vomits and
stool
3) Stop oral feeding and administer intravenous fluids,
as prescribed
4) If oral feeds allowed then feeds the infants semi
upright position. Feed slowly to prevent vomiting.
5) Give small frequent feeds
6) Weight infants daily
7) Maintain strict input-output chart
8) Fluid and electrolyte looses must be corrected, 24-48
hrs befory surgery
 Post- operative nursing care-
1) Observe the sign of complications
 Nurse must observe for drainage or signs of infection
12 min or inflammation at incision site, and provide care to
incision as ordered.
 Keep the incision site clean and dry.

2) Management of pain
 To minimize post-operative pain, administer
acetaminophen, as percribed.
 Provide clam, quite, and restful environment to the
infant

3) Provision of adequate fluid and nutrition

 Administer I.V. fluids until adequate intake has been
established.
 Resume oral feeding 2 to 8 hours (standard is 6
hours) after surgery when infant is alert.
 Start with small, frequent feedings of glucose water,
and slowly advance to full – strength.

4) Parental education and follow-up surgery

 Teach feeding technique to be continued at home;
length of feeding technique varies depending on
wound healing, nutritional status, and growth.
 Provide written and verbal instructions as to infant's
care and follow - up schedule.
 Review with family when medical attention is
needed and appropriate resource:
a. Signs of infection
b. Frequent vomiting, vomiting longer than 5
days, or poor feeding with signs of dehydration
c. Abdominal distention

9
3 min
NursingDiagnosis-
Preoperative
1. Deficient Fluid Volume related to frequent vomiting
2. Imbalanced Nutrition: Less Than Body Requirements
related to vomiting
3. Acute Pain related to gastric distention
4. Anxiety of parents related to illness, hospitalization,
and impending surgery of child

Postoperative
1. Risk for Injury related to postoperative complications
2. Risk for Deficient Fluid Volume after surgery
3. Impaired Tissue Integrity related to surgical incision