Intestinal Failure AKA Short Gut Syndrome

Definition Inability of the small bowel to digest and absorb enteral nutrients for normal growth and development resulting from an alteration in the process of peristalsis, digestion and absorption

Etiology Necrotizing Enterocolitis Atresias (Duodenal, jejunal, ileal) Gastroschisis Midgut volvulus Hirschsprungs disease Intestinal pseudo-obstruction

Common features Altered bowel anatomy and function Malabsorption of nutrients, vitamins and minerals Increased nutritional needs Increased stool/ostomy output Increased fluid needs

Malabsorption and Increased Nutritional Needs Malabsorption is dependent upon extent and location of bowel resection Degree of malabsorption is difficult to assess and contributes to higher nutritional needs Nutritional needs are based on the amount of calories, protein and fluids that promote growth Requires ongoing monitoring Potential for growth failure

Increased Stool/Ostomy Output Dependent on length and function of remaining bowel Prone to gastric/intestinal hypersecretion Disproportionate to amount of enteral nutrition provided Potential for increased fluid, sodium, bicarbonate and zinc losses At risk for bacterial overgrowth

Increased Fluid Needs Vary greatly and are based on remaining anatomy (+/- colon) Often have excessive output which requires strict monitoring to determine and maintain baseline fluid needs Needs are generally increased as enteral feedings are advanced due to greater output

Monitoring Look at trends rather than day to day fluctuations Weights Stool output (< 50ml/kg/day) Laboratory values: CBC with Differential, TPN profile and urine electrolytes weekly

Home Care Education

Home Health Care Agency Central Line therapy Administration of home TPN Enteral therapy Monitoring: Intake and output Weight Specific gravity

Bedside Nurses Well baby care Reinforce Home Health Care teaching Feeding tube care (NG/NJ/GT/JT) Ostomy care Medications including administration Formula including recipe and preparation

Bedside Nurses Measuring intake and output Diaper weights Measuring Stool Documenting with intake and output sheets Ensure that family has obtained medications and formula before discharge

Followup Nutritional and Intestinal Care Clinic Pediatrician Other specialists (High Risk, Surgery) Home Health Care Visits

Home Care Teaching Sheets

Central Line Therapy Central Line care Flushing, securing, cap and dressing changes Safety Guidelines for activities Supplies and equipment Delivery, storage and use, reordering Assessment/problems/emergency care Home Care services

Home TPN Preparing for administration Adding vitamins Priming tubing Pump operation and trouble shooting Hooking up to central line Setting rate and volume Tapering

Enteral Therapy Administrating Feedings Formula preparation Pump operation- setup and trouble shooting Use of Farrell bag Daily feeding schedule Care of feeding tube Recording intake and output

Enteral Therapy Safety Guidelines for activities Possible problems Aspiration, feeding intolerance, clogged tube, skin care Supplies and equipment Delivery, storage and use, reordering Home Care services