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Hirschsprung's Disease - Assessment and Nursing Diagnosis

Hirschsprung's disease (HD) is a blockage of the large intestine. Hirschsprung's disease (HD) is a disorder of the abdomen that occurs when part or all of the large intestine or antecedent parts of the gastrointestinal tract have no ganglion cells and therefore cannot function.

Symptoms that may be present in newborns and infants include:
  • Difficulty with bowel movements
  • Failure to pass a first stool within 24 - 48 hours after birth
  • Failure to pass meconium shortly after birth
  • Infrequent but explosive stools
  • Poor feeding
  • Jaundice
  • Vomiting
  • Watery diarrhea (in the newborn)
  • Poor weight gain

Symptoms in older children:
  • Fecal impaction
  • Constipation that gradually gets worse
  • Slow growth
  • Malnutrition
  • Swollen belly

Nursing Assessment for Hirschsprung's Disease

Hirschsprung's Disease is mostly found in term infants and is the sole abnormality. Rarely in premature babies or in conjunction with other congenital abnormalities. At aganglionic segment from the anus to the sigmoid is more common in boys than girls. While abnormalities that exceed even the entire sigmoid colon or small intestine
found as much in boys and girls.

Patient Health History

1. The main complaint
Problems perceived by the client which is very annoying at the time of the assessment, the client Hirschsprung for example, difficult bowel movement, abdominal distension, bloating, vomiting. Obstipasi is a major sign and in newborns. Flatulence and vomiting green. Other symptoms are vomiting and diarrhea.

2. History of present illness
Ask how long the symptoms felt by the client and ask how the client attempts to resolve the issue. Babies often experience constipation, vomiting and dehydration. Mild symptoms of constipation for weeks or months, followed by acute intestinal obstruction.
But there is also a mild constipation, enterocolitis with diarrhea, distension
abdomen, and fever. Foul-smelling diarrhea may occur.

3. Past medical history
History of illness, history of immunization.

4. Family health history
Ask the parents of clients, whether there are other family members who suffered from Hirschsprung.

5. History of growth and development
Presence / absence of abnormalities of growth and development experienced since birth.

6. Nutrition
Maternal nutrition during pregnancy, exclusive breastfeeding.

Physical Examination

1. Cardiovascular system
Presence / absence of abnormality due to Hirschsprung's disease or congenital abnormality.

2. Respiratory system
Shortness of breath, respiratory distress due to abdominal distension.

3. Digestive system
Generally constipation. Abdominal bloating / abdominal strain, vomiting green. In the older children are chronic diarrhea. In the anus plug finger will feel pins and at times withdrawn will be followed by the release of air and spraying meconium or stool.

4. Musculoskeletal system
Impaired sense of comfort.

5. Integumentary System
Skin turgor, capillary refill less than 3 seconds

6. Visual system
Conjunctival pallor / no, jaundice / no.

7. Hearing System
Hearing, ear conditions, presence or absence of wax in the ear.

Nursing Diagnosis for Hirschsprung's Disease
  1. Fluid Volume Deficit related to nausea, vomiting.
  2. Alteration in bowel Elimination: constipation / obstipation related to the absence of intestinal peristalsis, the accumulation of feces.
  3. Imbalanced Nutrition: less than body requirements related to inadequate intake.
  4. Acute pain related to distension of the abdomen.

Home Care - If Children Suffer Measles

If Children Suffer Measles - There are certain times where transmission of the disease is growing rapidly as if a plague. Measles is caused by a virus that is easily transmitted. However, measles is not a serious illness and dangerous. We can take care of its own children with measles at home. The important thing, always vigilant and take precautions against the dangers of complications, due to a decrease in endurance of the disease.

Know the Symptoms

Symptoms in the first level similar to the symptoms of flu or other diseases caused by viruses. At first it appears the distinctive sign, namely the emergence of grayish-white spots at the tip of the needle circled reddish color that appears on the mucous membranes of the cheeks, near the molars.

After 4-5 days, raised red blotches on some parts of the body, such as face, neck, upper arms and legs. Symptoms, such as flu, cough and cold is getting worse. In addition the mucous membranes in the mouth becomes reddish, so that the mouth and lips were red. Patients also feel itching on the whole body.

Once that period is completed, the original body temperature up and down is not necessarily the body heat can be increased up to 40 degrees Celsius, will gradually return to normal. Similarly, the rash will disappear and leave scars dark.


To prevent children exposed to measles in the event of an epidemic, can ask the doctor to give immunizations. This preventive injections are usually given to children aged nine months. Had remains exposed to measles, it will cause milder symptoms than children who are not immunized.

Giving good nutrition and appropriate for children need to be considered. Good endurance allows the child to avoid complications from measles.

Home Care
  • In the first stage, the child feels dazzled when seeing bright light. Therefore extinguish or reduce his bedroom light.
  • If the child's body temperature rose to 40 degrees Celsius for more than half an hour, try to compress with warm water. If the eyes feel hot, compressed with cold water. Better not to wrap the body of a child with a thick blanket.
  • If the third phase (recovery phase) child's body temperature does not decrease, it is necessary to be aware of the presence of complications, due to a decrease in child's immune system. Complications easily arise in children who from the beginning have low immunity. For example, children suffering from malnutrition. Circumstances worsened if the child is suffering from complications. Complications arise normally in the form of pneumonia and encephalitis. If such circumstances, the need for help physicians.
  • When the situation improves, and appetite recovered, try to give foods high in nutrients. There is a possibility of children suffering from malnutrition after measles disease and loss of appetite.
  • Measles sick child will lose appetite and drinking. Seek child to drink fluids as often as possible.
  • Clean the body with warm water. Children with high body temperature, should not be bathed first, sufficiently cleaned with a cloth and warm water.
  • Can be given the powder on the child's body, to relieve itching.
  • Seek for children to stay at home and not playing around with friends, considering the disease is easily transmitted.

Dental Care in Children

When does a child have to check the teeth to the doctor for the first time? Should take the child to the dentist when the first tooth starts to look. The first new tooth looks at the age of 6 months. In some children, the teeth can appear early as age 4 months or even too late. When up to the age of 1 year has been no visible teeth, still take the child to the dentist to check it. When the first teeth appear here, child dental care should begin.

Before the first teeth appear, clean the gum once or twice a day. The trick is to use a clean cloth baby wipes, wrap it into the index finger and rubbed on the gums. Clean the gums will prevent bacteria collected. Then after the first tooth appears, begin cleaning the teeth with a toothbrush. Although the milk teeth will be loose and replaced the permanent teeth, milk teeth play a role in the development of the face and mouth. Good chewing habits affect the way a good meal, and dental health affects the body's overall health. For that child dental care is required since the beginning.

Avoid the accumulation of sugar

Caries is tooth decay that occurs because of the sugar on the teeth, which would then form the acid vandal tooth enamel. To prevent caries, avoid sugar buildup on teeth. Milk contains sugar, as well as candy and other sweet foods. For children who still had to sleep while sucking on a bottle of milk, you should replace the milk with water during sleep. And also do not dip a pacifier in honey or sugar water when sleeping. Slowly, sleep habits accompanied pacifier and bottle of milk is to be reduced, so that the child accustomed to sleeping without such assistance.

Regular dental checkups

Care of children's teeth everyday should be coupled with an examination of the child's teeth regularly. Notice if the child's teeth appear brown or black plaque, and bring the child to the dentist when you find it. If there is no problem on the teeth, take your child to the dentist at least 1 year for routine checks.

Doctor Amr Moursi, New York University, gives simple tips for the care of children's teeth. Here are suggestions:

Avoid the transfer of bacteria from parents

Many child tooth decay caused by bacterial transfer from the parents who have caries. To avoid this, avoid the use of mugs and cutlery same when eating. Do not lick or suck pacifier to clean it.

Parents also need to have good dental care habits. In addition to avoiding the transfer of bacteria that cause caries, children tend to imitate the behavior and habits of their parents.

Brushing your child's teeth regularly

Brush your child's teeth two times a day, morning and evening before going to bed. Use a bit of toothpaste, about the size of peas for toddlers. Before the 2 year old child, avoid toothpaste that contains fluoride for fear of swallowing. Instead, use a special toothpaste for children.

Regular meals

With regular brushing schedule, set the schedule also eat, namely 3 main meals and 2 snacks in between the three main meals. With this schedule, the child does not eat anymore after toothbrush night and sleep in the condition of the teeth clean.

Lack of Sleep, Children Can be Fussy and Impaired Growth

When your child have trouble sleeping, need sleep time in children can be reduced. Though ideally children, especially those under the age of five years, it took 10-12 hours of sleep. Sometimes, they also need a nap.

If the child insomnia, the cause is very diverse, which must be ascertained whether there is pain like flu, cough, runny nose, fever, diarrhea, or itching. Well it must be addressed immediately.

In addition, insomnia is experienced by children can also be caused by environmental problems such as air hot, stuffy, noisy or there is a TV in the room. Or it could be a child feel uncomfortable with the condition, such as a diaper that is too full or itchy rash that resulted.

If the child is sleep deprived, growth can be disrupted because of the hormone are useful to support the development of the child to work when the child fell asleep.

Aggressive behavior, fussy, and the decline in achievement is an example of the negative impact. Because the impact of sleepiness, the child will be naughty, fussy, and likes his friends continue everynight.

In addition to experiencing the direct impact, children who lack sleep also had an influence on the people around him. Children due to lack of sleep, for example it would be difficult to find friends because of aggressive behavior.

Pediatric Nurses