CONCEPT MAP- HIRSCHPRUNG’S DISEASE

MODIFIABLE FACTORS NON-MODIFIABLE FACTORS

●Exposure to cigarette smoking ●Gender: Male

●Genetic
●Having other inherited conditions

Absence of ganglion cells

(-) ganglionic innervation= (-) nerve cell

(-) peristalsis

Chronic constipation Red, Bark Blood Stool

Intestinal obstruction/discomfort Impaction Anemia

Abdominal pain SHOCK

Abdominal fullness/distention

DEATH

INTEGUMENTARY GASTROINTESTINAL HEENT

SYSTEM SYSTEM
 ●Sclerema ●Abdominal distention ●Eyes- Anicteric Sclera

●Constipation ●Mouth- Dry Lips

Fluid volume ●Change in Bowel movement

excess Impaired oral and nasal
●Soft to touch
mucous membrane
●Hypoactive Bowel Sound
a. Careful monitoring, correction of
electrolyte, respiratory support, correction
a. Assess oral cavity of the least once
of hypovolemia and control of hypothermia Acute Pain
daily and note any discoloration, lesion,
are important in infants with sclerema.
Constipation edema, bleeding, exudate or dryness.
Refer to a physician or specialists as
Altered Bowel appropriate.
MEDICATIONS: Elimination
b. Inspect for any indication of infection,
and culture lesions as needed. Refer to a
●Metronidazole 6mg IV Imbalanced nutrition: less
physician, nurse or specialist as
than body requirements
●Paracetamol 65mg slow IVTT appropriate.

●Ranitidine 6mg slow IVTT

a. Assess pain using facial expression
●Calcium Gluconate 5cc scale that is appropriate to the age. DIAGNOSTIC TESTS:

●Amikacin 90mg IV b. Observed non-verbal cues of pain and ●Hemoglucotest

other characteristics.
●Digoxin 0.02mg ●Serum Calcium
c. Provide comfort measures like calming
●Piperacillin and Tazobactam 600mg the infant after a stress procedure, gently ●Serum Potassium and Sodium
slow IV pat or massage the infant, talking in a
●ABG
●Dopamine soothing voice, hold your infant with as
much skin to skin as possible. ●CBC and Platelet Count
●Salbutamol (Asmacare) ½ neb.
●Abdominal X-ray
 a. Before surgery, the child may be
prescribed daily enemas to observe
bowel movements.

b. Remind parents that the fluid used for

enemas must be normal saline (0.9%
NaCL) and not tap water.

a. Determine stool color, consistency,

frequency and amount.

b. Auscultate bowel sounds.

c. Monitor intake output with specific

attention to food of fluid intake.

d. Assess perianal skin condition

frequently, noting changes or beginning
breakdown. Encourage or assist with
perineal care after each bowel
movement.
LEGENDS:

PATHOPHYSIOLOGY
a. Placed on a minimal residue diet. Stool
MEDICATIONS
softeners, vitamin supplements and perhaps
DIAGNOSTIC TESTS daily enemas until their condition improves.

NURSING DIAGNOSTIC b. TPN can offer another source of nutrition.

NURSING INTERVENTION c. If a child is to be cared for at home, help

the parents learn about minimal- residue diet
MANIFESTATION or are that is slow in indigestible fiber and
BODY SYSTEM AFFECTED residue.

d. Observe for abdominal distention.