Question

Case study Ch. 41

Pyloric Stenosis

Lucy is a 44-day-old formula-fed infant with a 4-day history of vomiting.

Subjective Data

Mother states that the infant has:

Been vomiting undigested formula after feedings.
Has not had fever or diarrhea.
Has had eight wet diapers in the last 24 hours.
Objective Data

Weight: 4.8 kg

Birth weight: 3.5 kg

Vital signs: temp, 37.1º C (rectal); pulse, 130 bpm; resp, 30 breaths/min; blood pressure,
92/52 mm Hg

Moist mucous membranes; flat and soft anterior fontanel

Awake and alert, lusty cry

Good muscle tone

Olive-sized mass palpated at epigastrium

Questions:

What test will be used to diagnose pyloric stenosis?
What actions should the nurse take in this clinical situation? Prioritize the actions.

Answer 1

How to diagnose Pyloric Stenosis?

• Physical examination;-Olive shaped lump will be present on the abdomen while palpating,which is due to enlarged pyloric muscle.
• Blood tests to check for dehydration and electrolyte imbalance.
• Ultrasound abdomen to view the pylorus .
• Barium meal examination;-Beak like tapering projection of barium entering into the narrowed and compressed pyloric channel can be seen in infants with Pyloric stenosis.

Nursing actions;-

• History collection;-Ask mother ,when the vomiting started and determine the character of vomiting along with eliminatory pattern.
• Physical examination;-To find out any signs of dehydration,obtain infant's weight,observe skin condition and turger.
• Monitor vital signs;-Along with vital signs check anterior fontanelle,lips and mucus membranes of mouth.
• Maintain adequate nutrition and fluid intake;-Administer intravenous fluids and electrolytes according to the order,also provide feeding if the baby tolerates.
• Provide mouth care;-Mucus membranes can get dry if dehydration occurs.
• Promote skin integrity;-Repositioning the baby every 2 hourly,change the diaper as soon as it gets wet,avoid dryness of skin.
• Promte family coping;-Inform the mother before every procedure done.
• Documentation; It includes,Individual findings,intake output, vital signs,plan of care, response to interventions and teaching ,attainment of desired outcome