module 10 and 11 Flashcards
Esophageal atresia
Esophageal atresia: proximal and distal ends of do not connect (upper esophagus and stomach do not connect)
Tracheoesophageal fistula
an abnormal connection between the trachea and esophagus
May be from genetics, infection, or teratogens but most often idiopathic
Pneumonitis and atelectasis
Esophageal atresia & tracheoesophageal fistula
Nursing assessment
Did mom have polyhydramnios?
Couldn’t swallow amniotic fluid leading to excess fluid
Copious, frothy bubbles of mucus in mouth and nose
Abdominal distention develops as air builds up in stomach
Three C’s: coughing, choking, and cyanosis
Prepare for surgery because they can’t absorb nutrients
NPO, elevate HOB, IV hydration and feedings, oxygen, suction, comfort
Non-nutritive sucking
Postoperative
Antibiotics
Oral feedings within a week of anastomosis
Provide teaching on warning signs
Omphalocele
evisceration of abdominal contents into external peritoneal sac herniating through umbilical cord
Very very worried about thermoregulation
gastroschisis
no peritoneal sac
A lot more complications
Very inflamed organs from exposure to amniotic fluid
Associated with congenital anomalies involving cardiovascular, GI, and CNS
Gastroschisis Nursing management
Usually diagnosed in prenatal ultrasound and a C-section is done to reduce infection risk
Sterile see-through drawstring bowel bag → prevent hypothermia, maintain perfusion to minimize fluid loss, protect contents from trauma and infection
Can’t just put them under a warmer because it will dry them out
Strict I & O
Orogastric low suction, IV therapy for fluid and electrolytes → watch for dehydration
Pain management
Very high risk for short bowel syndrome → sign is diarrhea
Still need contact with parents
anorectal malformation
Absence or abnormal location of anus → nurse’s job to check for a patent anus
Needs surgery → perhaps colostomy
May be fistula and redirected to urethra → recipe for infection
Usually has other abnormalities
Preoperative
NPO and gastric decompression
Postoperative
Maintain NPO and gastric decompression until normal bowel function is restored
cleft lip and palate
Worried about feedings for gagging and choking
Cleft lip usually does better
Breastfeeding is better
Haberman bottle has a really long nipple to go far back
Altered dentition and speech
A lot of ear infections
May regurgitate out of their nose
Surgery
Cleft lip is repaired around 2-3 months
Cleft palate is repaired around 6-9 months
Postoperative
Don’t want them putting their fingers in their mouth
Avoid all suction
Hirschsprungs
Lack of ganglion cells cause inadequate motility
Failure to pass meconium within 24-48 hours → may need rectal stimulation to pass meconium plug
May need a rectal exam
Uncommon but could explode poop after
Distended abdomen, vomiting, difficulty feeding, weight loss, constipation, gas, or diarrhea
Diagnosed by rectal biopsy
Surgical resection and reanastomosis
Need bowel rest → give fluids and IV antibiotics to prevent sepsis and potential death
Continue to monitor for constipation, incontinence, and diarrhea
Diarrhea will indicate short bowel syndrome
Metatarsus adductus & clubfoot
Usually due to positioning in utero
See an orthopedic!
Child may need serial casting before 8 months to prevent walking issues
New cast every two weeks
Ankle-foot orthotic (AFO) → neurovascular assessment is very important
Worried about cap refill, pedal pulses, skin integrity
Developmental dysplasia of the hip
Dislocation, subluxation, and dysplasia of hip
More common in females
If it isn’t diagnosed and fixed by 6 weeks, it becomes a very big issue
Horrible hip pain and problems walking
Complications: avascular necrosis of femoral head, loss of ROM, recurrent hip instability, femoral nerve palsy, leg-length discrepancy & early osteoarthritis
Barlow and Ortolani’s maneuver
Pavlik harness → 20 hours/day
Worried about cap refill, pedal pulses, skin integrity
down syndrome
Trisomy 21 abnormality
Sleep apnea is an issue
Promote growth and development
Promote nutrition → worried about muscle tone
Prone to constipation
spina bifida Meningocele
Neural tube defects
Note dimpling or abnormal tuft on the spine
Meningocele is less serious → minor ot no neurological deficits
Covered by skin
spina bifida Myelomeningocele
more serious
Not covered by skin
Risk for meningitis
Paralyzed from defect down
Bladder and bowel incontinence → catheterize for the rest of their lives
Prevent infection, skin breakdown
Congenital heart disease hypoxemia
Hypoxemia → clubbing of fingers, polycythemia, exercise intolerance
