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surgical condition of the intestinal tract in infancy. It occurs most frequently in some family strain, in firstborn infants, and in males. Pathologically, there is an increase in size of the circular musculature of the pylorus. The musculature is greatly thickened, and the resulting tumor like mass constricts the lumen of the pyloric canal. This impedes emptying of the stomach content through the constricted pylorus. Clinical manifestations and x-ray, finding The symptoms appear in infants 2-4 weeks old. The initial symptom is vomiting during and after feeding. The vomiting is at first mild, becomes progressively more forceful until it is projectile. Since little of the feeding is retained the infant is always hungry. There is either failure to gain weight or loss of weight. The signs of pyloric stenosis, dehydration with poor skin turgor, distention of the epigastrium and an olive-shaped mass, located by palpation, in the right upper quadrant of the abdomen. If barium is added to the feeding, an x-ray film will show the enlargement of the stomach, and the narrowing and enlargement of the pylorus, increased peristaltic waves, and an abnormal retention of the barium in the stomach. Treatment Pediatric Nursing and child health care 67 Pyloromyotomy involving longitudinal splitting of the hypertrophied circular muscle of the pylorus without incising the mucus membrane allow more food to pass through. Preoperative care • Correction of fluid and electrolyte imbalance since a dehydrated infant is at surgical risk. • After rehydration, whole blood, vitamin B, C and K are given as needed. • Just before operation NG tube is passed. • Feedings must be recorded. Post operative care • IV fluids for the first few days • Position the infant on side or abdomen and prevent aspiration of vomits. • Frequent change of position • Watching for indication of shock (rapid, week pulse, cool skin, pallor, and restlessness) • Observing the abdomen for distention • The mother’s breast milk is expressed and given as soon as he can tolerate it • Prevention of wound infection Pediatric Nursing and child health care 68 Prognosis: The prognosis is excellent complete relief follows successful surgical repair. The mortality rate is low, proceeded operation is undertaken before the infant has become too dehydrated and malnurished. 5.5. Phimosis and paraphimosis Phimosis is a tight for skin, i.e, a fore skin or prepuce which has a very small opening, so that it may interfere with the passage of urine and can not be drown back over the glanis penis for cleansing. In severe case this will prevent the scape of urine, so that the fore skin is distended during mictaration, and the infant screams with pain and strains during the act. Paraphimosis, a condition due to a tight foreskin being pushed up and constrict the circulation, causing swelling of the parts below so that the foreskin cannot be pushed down again, and requiring operative treatment. Treatment: - Circumcision, cutting away the foreskin - After this operation the wound must be kept clean, antiseptic dressing applied, and the parts cleansed after passing of the urine. - Mild cases of phimosis can be relieved by gradually stretching the foreskin by pulling it back over the glanis penis, so that operation is avoided. Pediatric Nursing and child health care 69 5.6 Spina Bifida Spina bifida is a malformation of the spina in which the posterior portion of the laminae of the vertebrae fails to close. It may occur in almost in any area of the spina but most common in lumbosacral region. It is the most common developmental defect of the central nervous system occurring in about one of 1000 newborn infant. The three types are: 1. spinabifida occulta in which the spinalcord and meninges are normal, the defect being only of the vertebrae, 2. Meningocele, in which the meninges protrude through the opening in the spinal canal. 3. Meningomylocele, in which both the spinal cord and the meninges protrude through the defect in the bony rings of the spinal canal. Meningomyelocele is the most serious one. Spina bifida occulta: The majority of patients with spina bifida occulta have no symptoms. Some may have a dimple in the skin or growth of hair over the malformed vertebra. There is no need for treatment unless neurological symptoms indicate that the
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