Child With Severe Respiratory Issues, Case Study Example

Case study:Gastro esophageal reflux disease Toddler with Nissen Fundoplication and G-tube insertionImportance of twenty four (24) hour monitoring.

According to this 17 month oldCaucasianmale child’s history, there is evidence of severe gastro esophageal reflex disease. Consequently, aNissen fundoplication and G-tube is in situ since August last year. Besides, there have been series of life threatening episodes inclusive of failure to thrive syndrome; Plagiocephaly and torticollis leading to respiratory failure. The importance of this child being monitored twenty four hours a day lies in the condition itself, gastro esophageal reflux disease (GERD) with complicating conditions including respiratory failure. Secondly, the Nissen fundoplication and G-tube insertion is also a major nursing intervention priory.

Gastro esophageal reflux disease (GERD) occurring in children is a very serious abnormality wherebymucus enters the esophagus due to damage of the stomach mucus lining(Gupta, Marshall & Munoz, 2013). In the United States of America four million (4m) infants are born withgastroesophageal reflux disease (GERD) yearly (Katz, Gerson, & Vela, 2013). The etiology in children is closely associated with a congenital abnormality causing dysfunction ofthe lower esophageal sphincter. In children ages of 17 months and older, the condition progresses towards a chronic stage where aggressive intervention becomes mandatory to save the child’s life, Importantly, children experience severe symptoms such as vomiting and respiratory failure, which is a serious complication(Katz, et. al, 2013).

As such, in this case Nissen Fundoplication and G-tube was inserted. While this intubation allows for reduction in the acid reflux itself many children do not tolerate the insertion. Consequently, a serious reaction is respiratory failure ultimately leading to death (Kurian,Bhayani, Sharata, Reavis, 2013).  Therefore, this child requires twenty four hour monitoring.Wheezing often becomes a significant dilemma to manage in children with chronic GERD as presentedby the child in this case study (Vega, 2013).

Importantly, theNissen fundoplication and G-tube insertion site has to be monitored for displacement even though it wasinserted one year ago. Any gastro influx incidences must be observed also, because faulty insertion could contribute to Sony Xperia z2 (Kurian, et.al, 2013).

Extended 18 – 24 hour monitoring has been recommended by nursing care experts.This includes evaluation of the esophageal pH at the distal esophagus. This helps in determining a relationship between the respiratory distress symptoms and GERDin children. Researchers have advanced without any profound evidence that aspiration of gastric contents is the main feature in reflux-related respiratory symptoms. Therefore, during an 18-24 hour monitoring, the focus must be onbe on measuring the proximal esophageal pH in infants and children (Vega, 2013).

In this case study the toddler has other abnormalities along with GERD inclusive of Plagiocephaly and torticollis. While there are no significant scientific relationships among them and severe respiratory distress they must bemonitored because these physical abnormalities could intensify the condition.

References

Vega, C. (2013). Guidelines Updated on Reflux Management in Infants, Children. Retrieved on August 13th, 2014 fromhttp://www.medscape.org/viewarticle/805103

Gupta, R. Marshall, J., & Munoz J. (2013). Decreased acid suppression therapy overuse after education and medication reconciliation. International Journal of Clinical Practice, 67 (1); 60–65.

Katz, P. Gerson, L., & Vela, M. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 108:

Kurian, A. Bhayani, N.Sharata, A., &Reavis, K. (2013). Partial anterior vs partial posterior fundoplication following transabdominal esophagocardiomyotomy for achalasia of the esophagus: meta-regression of objective postoperative gastroesophageal reflux and dysphagia. JAMA Surg 148 (1); 85–90