NOOTAN COLLEGE OF NURSING

SUBJECT: Child Health Nursing

TOPIC: Case Presentation on Tracheo -Esophageal

Fistula

SUBMITTED TO, SUBMITED BY,

Mrs, Mahalakshmi. B Mrs. Saymabanu Mansuri
Associate professior, 2nd year M.sc Nursing
Nootan College of Nursing, Roll no: 03
Visnagar Nootan college of Nursing,

INTRODUCTION
 I am M. Sc. Nursing student of second year is posted in the NICU. As per our INC syllabus
we are posted during my posting I came across with one interesting case of congenital anomalies. I
felt to present that case as my case presentation.

So here I am presenting the case on Tracheo-esophageal fistula.

Tracheo esophageal fistula, a congenital anomaly, is an abnormal opening between the

esophagus and trachea. This is a case of a 1 month old female child, diagnosed with Tracheo
esophageal fistula. He was admitted at Nootan General Hospital on Feb. 22, 2020at 11:00 am with
chief complaints of tachypnoea & comic breathing sound. Upon assessment, the group found out that
the child is suffering by a congenital anomaly Tracheo esophageal fistula.

PATIENT’S PROFILE
 I. IDENTIFICATION DATE
1. Name Of The Patient :- Baby Of savita kale
2. Name Of Informant :- Mrs. Savita kale (Mother)
3. Father Name :- Sh. subhash kale
4. Age / Sex :- 1 Month and 10 days / Female
5. Date Of Admission :- Feb 19, 2020 At 01:00 Pm
6. MRD No. :- 171060787
7. Registration No. :- 171060787
8. IPD No. :- I-121090998
9. Marital Status :- Unmarried
10. Religion :- Hindu,
11. Diagnosis :- Tracheoesophageal Fistula
12. Permanent Address :- Lakshami society near adarsh school,
visnagar
Present Complains :-
a. Frothing at the mouth
b. Cyanosis.
c. Respiratory distress.
d. Assessments of fistula by pass a tube into esophagus.

FAMILY HISTORY :-
 The family has no any genetic disease like X-Linked disease. No other history of
medical illness like T.B., Diabetes, leprosy, and any infectious disease, and also no
having history of any surgical intervention.

Family Tree:-
Sh. Raman (53 Years) Mrs. Laxmi (47 Years)

Sh. Subhash (25 Years) Mrs. Savita(22 Years)

B/O savitasubhash (01 Month)

BIRTH HISTORY : -
a. Antenatal History:-
i. The mother was antenatally registered at Nootan General Hospital, visnagar at
3rd month.
ii. She was not suffered by any infectious disease during pregnancy like fever
with rash (Rubella.)
iii. She was not suffered by any other condition like Hypertension, Diabetes, etc.
iv. She has received 2 doses of TT injection during pregnancy.
v. She has received Folic acid tablets, Vitamin & calcium supplements.

b. Perinatal History:-
i. The 38 weeks female baby was delivered by elective Caesarean section
because of mal-presentation on 15 jan, 2020 at 10:00 pm at Nootan General
Hospital, visnagar by obstetrician Dr. Mishara
ii. After birth the baby was cried well but developed Cyanosis. There was no
history of Icterus, Convulsion and the APGAR acore was at 1 Min. 7 out of 10
and after 05 min.9 out of 10.
iii. The Vitamin K was given after birth.

c. Immunization History:-
i. The BCG & OPV was given at Birth.

d. Growth & Development:-

SR. CHILD’S NORMAL
MEASUREMENT REMARK
NO. PICTURE PICTURE

1. LENGTH 48 cm 45 – 50 cm Considered normal

2. WEIGHT 2120 gm 2500 gm Considered normal

3. HEAD
33 cm 31 – 34 cm Considered normal
CIRCUMFERENCE

4. CHEST
30 cm 30 – 33 cm Considered normal
CIRCUMFERENCE
 5. MID ARM
8 cm 07 – 10 cm Considered normal
CIRCUMFERENCE

e. Dietary pattern :- NBM (Nil by mouth). So TPN was started from 06

January with 80 ml / kg / day. i.e. 160 ml TPN was
infused content
i. 10 ml Calcium-gluconet
ii. 1.5 gm amino acid In
Dextrose 10 %
iii. 1 gm lipid
SOCIO ECONOMIC STATUS: -
ii. There are5 members living together in family.
iii. The family occupation history is the father & grandfather is businessmen.
iv. Monthly income of the family is Rs. 15,000 – 20,000 /-.
v. The per Capita Income is Rs. 3,000 - 4,000/-.
vi. They have own house
vii. They have Bore well for water supply and having closed drainage system for
water and sewage disposal.
FAMILY HISTORY

NAME OF THE RELATION

SR. AGE /
FAMILY WITH THE EDUCATION REMARK
NO. SEX
MEMBER PATIENT

Sh. Jairam 53 Years Grand Father 5th Pass ----

Mrs. SurekhaJairam 47 Years Grand Mother Illiterate ----

Sh. Lanka Jairam 25 Years Father B. Com. ----

Mrs. Mergal Lanka

22 Years Mother B. A. ----
Jairam

Female Baby 1 Month Self ----- ----

PHYSICAL ASSESSMENT

I. BASE LINE DATA:-

 1. Weight :- 2.7 kg
2. Length :- 48 Cm
3. Temperature :- 36.1 °C
4. Pulse :- 142 P /Min.
5. Respiration :- 44 B / Min.
6. Chest Circumference :- 30 Cm

II. GENERAL APPEARANCE:-

1. Nourishment :- Weak
2. Body fluid :- Poor
3. Health :- Unhealthy
4. Activity :- Mild

III. MENTAL STATUS

1. Consciousness :- Fully conscious
2. Look :- Anxious

IV. ANTHROPOMETRIC CATEGORIES OF CHILD

1. Height for Age :- Normal
2. Weight for Age :- Average gestational age
3. Weight for height :- Normal

V. POSTURE
1. Body curve :- Normal
2. Movement :- Normal He could show all range of motion with
my help.

VI. SKIN CONDITION

1. Color :- Pink
2. Texture :- Good skin Turgor, warm
3. Lesion & Infection :- No lesion and infection were present
4. Rash :- Absent
5. Sign of Vitamin K deficiency :- Toad skin was not found
 6. Nails :- there is no sign of pallor and cyanosis, clubbing, iron
deficiency, No Brittleness of nails. No
Paronychia was present.
VII. HEAD & NECK
1. Hair color :- light brown
2. Scalp :- Clean hair turned, gray due to old age.
3. Face :- Anxiety

VIII. EYES:-
1. Eye brows :- Normal
2. Eye lashes :- Normal
3. Eye lids :- Normal
4. Eye ball :- Normal
5. Eye conjunctiva :- Normal
6. Sclera :- Normal
7. Cornea & iris :- Normal
8. Lens :- Normal
9. Fundus :- No congestion, no Hemorrhage

IX. EARS
1. External ear :- Normal & no discharge
2. Hearing :- Normal

X. NOSE
1. External nares :- Normal
2. Nostrils :- Normal
3. Nasal Flaring Was Present

XI. MOUTH & PHARYNX

1. Lips :- Dry due to dehydration
2. Odour of mouth :- No bad Odor
3. Teeth :- None
4. Palate :- Normal
5. Gums :- Inflamed gums
6. Uvula :- Normal
 XII. NECK
1. Shape :- Normal, symmetrical
2. Lymph nodes :- Normal, No any abnormality has been detect
3. Movements :- Normal
4. Thyroid glands :- Normal, Not enlarge.

XIII. ABDOMEN
1. Inspection :- Shape of the abdomen is symmetrical on both the sides.
No any type of infection found.
2. Abdominal girths :- 45 cm
3. Palpation :- On palpation, he has no any
tenderness in the pelvic region and no abdominal distension.
4. Auscultation :- Bowel sound presents it was found
normal.
5. Percussion :- No fluid thrill, & no any presence of gas or any mass or
swelling of visceral organ.
6. First stool (Meconium) was passed.
7. On the assessments fistula was found by pass a tube into esophagus so
Tracheoesophageal Fistula is confirmed.
XIV. BACK :- Body curve normal as well as spine also found
normal
XV. EXTREMITIES
 My patient has no any type of numbness & weakness in the body that’s way he can
move their limbs normally.

XVI. GENITALIA :- No any deformity found

XVII. RECTUM :- No any deformity found

XVIII. RESPIRATORY ASSESSMENT

1. Tachypnoea
 2. Chest movement symmetrical
3. Effort was found normal.
4. Respiratory rate was 44 B / min.
 Use of accessory muscle : (+)
 chest retractions Nasal flaring : (+)
 Breath sounds : Comic sound upon auscultation.

XIX. ELIMINATION PATTERN

1. Bowel habits:
 Frequency :- Twice
 Color :- Yellow
 Consistency :- Loose and Watery
 Amount :- 20 cc
2. Bladder habits:
 Frequency :- 2 - 3 times
 Color :- Straw yellow
 Amount :- 25 cc
ANATOMY & PHYSIOLOGY OF DIGESTIVE SYSTEM

INTRODUCTION:-
The digestive system consists of gastrointestinal tract (alimentary canal) and its glands. The
functions of gastrointestinal tract are ingestion, digestion and absorption of food and excretion of
waste products.

ANATOMY

PARTS OF DIGESTIVE SYSTEM

1. mouth
2. pharynx
3. esophagus
4. stomach
5. small intestine
6. large intestine
7. rectum
8. anus
TRACHEOESOPHAGEAL FISTULA

INTRODUCTION:-

The trachea and esophagus are formed from the primitive foregut around the fourth week of
intrauterine life. The foregut tube at this stage develops lateral indentation forming ridges, which
deepen and fuse, to form two separate tubes. An abnormality in this process causes this anomaly.

DEFINITION:-

Because of intrauterine malformation or abnormality of esophagus to develop lateral

indentation forming ridges, which fuse and deepen at fourth week and by abnormality it opens in the
trachea. This anomaly is known as TRACHEOESOPHAGEAL FISTULA.

(IAP, 2007)

ETIOLOGY:-

The exact etiology is unknown. Associated anomalies occur as a part of the VACTERL
syndrome i.e.

V - Vertebral

A - Anal Anomalies

C - Cardiac anomalies

T&E - Tracheoesophageal Anomalies

R - Radial & Renal Anomalies

L - Limb Anomalies

INCIDENCE:-

Incidence range from 1: 3000 to 4500 live births. 30 % of the effected infants are born
prematurely.
TYPES OF THE TRACHEOESOPHAGEAL FISTULA

SR.
TYPES DETAIL PICTURES
NO.

1. Type - 1 Blind upper and lower segment

Tracheoesophageal fistula from the upper

2. Type - 2
esophageal segment

Tracheoesophageal fistula from the lower

Type - 3 esophageal segment

3.
(It is very common 85 %)

Tracheoesophageal fistula from the upper

4. Type - 4
and lower esophageal segment
 H – Type Tracheoesophageal fistula without
5. Type - 5
esophageal artesia.

6. Type - 6 Congenital stenosis or narrowing of esophagus artesia or fistula

CLINICAL FRACTURES

SR. NO. BOOK PICTURE PATIENT PROFILE

1. Inability to swallow the saliva manifesting

PRESENT
as frothing at the mouth.

2. Choking PRESENT
Attempt to feed the
3. Dyspnea PRESENT
baby
4. Cyanosis PRESENT

5. Splinting of the
Respiratory distress PRESENT
diaphragm
due to
6. Pneumonia ----------

DIAGNOSTIC EVALUATING:-
SR. NO. BOOK PICTURE PATIENT PROFILE

1. History, Physical examination

Catheter was stop at 10 to 11 cm from
i.e. catheter usually stops 10 to 11 cm from upper gum line.
upper gum line.

2. Plain X-ray X-ray shows fistula is present at lower

esophageal segment

3. Contrast medium if used for

roentgenography, should be water soluble,
control is sufficient to outline the blind upper USUALLY NOT DONE
pouch. The contrast should be withdrawn
immediately to prevent overflow into lungs.

4. 2D ECHO

1. Type – 3 Tracheoesophageal fistula shows

2. VISCERO-ARTERIAL SITUS SOLITUS
3. 5 mm defect noted in interior portion of the interstitial septum. (ASD)
4. Right atrium & Right Ventricles dilated
Impression:- CAHD

Mild pulmonary arterial hypertension

INVESTIGATION

SR. PATIENT’S
INVESTIGATION NORMAL VALUE REMARKS
NO. VALUE

BLOOD ANALYSIS

1. 4000 – 11,000 /
WBC 243300 / cmm3 Infections
cmm3

2. Platelet 232,000 / mm 150000 - 350000 Normal

3. Hemoglobin 13.1 gm/dl 11 – 14 gm / dl Normal

4. RBC 3.54 Million / cmm3 3 – 5 Million / cmm3 Normal

5. PCV 40.6 % Normal

6. MCV 114.8 lit / mm 78 – 96 lit. / mm Abnormal

ABGs

7. PH 7.452 7.350 – 7.450 Normal

8. PCO2 13.4 35 – 45 Abnormal

9. PO2 141 83 – 108 Abnormal

10. CHCO3 13.3 22 – 26 Abnormal

11. SO2 98.1 95 – 100% Normal

2D ECHO EXAMINATION

1. IMPRESSION

MANAGEMENT

According To Book Picture:-

Emergency surgery needs to be performed in order to restore deglutition and disconnect the
fistula achieving normal respiration and prevention of further acid reflux into lungs. This is done
after stabilizing the baby with chest physiotherapy, good oral suction and after assessing the cardiac
status to rule out any serious anomalies. Surgery is performed through a right sided thoracotomy.
The upper and lower ends of the esophagus are identified. The fistula is seen, disconnected and the
two ends anastomosed to restore the tube.

PROGNOSIS:-

Depends on the weight, associated anomalies especially cardiac and the amount of time elapsed
before treatment can be started. Sometime the anomaly is missed for a few days, by which time
severe pneumonia sets in. this is a sign significant cause of postoperative death. Very small and
preterm babies do not do as well as normal sized term babies. If all factors are favorable, survival
rates of over 80 percentages can be achieved.

ACTUAL MANAGEMENT

MEDICAL MANAGEMENT

DATE FEEDS IV FLUIDS MEDICATION

D 10% + 10 ml CaGluconate Inj. Augentine

23TH March NBM 130 ml (60 ml / Kg / day) by the (30 mg / kg / day)

infusion rate of 4.5 ml / hr.

TPN (D 10% + 10 ml Inj. Augentine

CaGluconate + 1.5 gm amino acid
(30 mg / kg / day)
24TH March Feed 5 ml / 2hr. and 1 gm lipid)

130 ml (60 ml / Kg / day) by the

infusion rate of 4.5 ml / hr.

(NS bolus 90 ml + Dopamine 60 Inj. Gardinal 40 mg

mg + D5 % 50 ml) with infusion
Inj. Vancomycin 20 mg
25TH March Feed 7 ml / 2hr. rate 5 ml / hr

TPN 140 CC (2.5 gm amino acid

+ 2 gm lipid)

TPN 140 CC (2.5 gm amino acid

26TH March Feed 13 ml / 2hr.
+ 2 gm lipid)
 TPN 140 CC (2.5 gm amino acid
27TH March Feed 22 ml / 2hr.
+ 2 gm lipid)

28TH MAY Feed 25 ml / 2hr. ------

PATIENT SURGICAL MANAGEMENT:-(Surgical notes)

1. Diagnosis :- Tracheoesophageal fistula Type – 3

2. Operation :- Thoractomy&Tracheoesophageal fistula repair
3. Surgeon :- Dr. parkash joshi
4. Asst. surgeon :- Dr. Abhijeet
5. Intubation:-
6. Cuffed Endotracheal tube 3.5 mm was incubates on 26 March 2019 under inj. Pesto 10 mg +
Inj. Vec. And circuit Y piece was attached and the estimated blood loss was 5 ml.
7. Procedure steps:-
a. The general anesthesia was given to the baby in lateral position.
b. After the anesthesia baby was draped by sheets and only chest was opened.
c. Standard thorectomy incision was done.
d. Lungs pushed anteriorly (at extra plural approaches)
e. Azygous vein identified and clamped
f. Tracheoesophageal fistula identified and ligated divide
g. Upper pouch dissection done to upto adequate length
h. Primary anastomosis with vicryl 5-0
i. Inter-costal drainage tube no. 8 kept anteriorly.
j. Thorax closed with 4-0 Vicryl
k. Closed the layer
l. Subcutaneous layer was sutured by 5-0.
m. Dressing was done and baby tolerated procedure well.
8. The bay was put on the multipara monitor for assessing vitals and oxygen saturation.
9. Post operative medication was administered and post operative care was given.

COMPLICATION:-

 Aspiration pneumonia
 Death.
 VACTERL syndrome.
NURSING CARE PLAN

Nursing Diagnosis:-

1. Ineffective airway breathing

2. Nutrition imbalance
3. Anxiety of mother related to surgical procedure.
4. Pain related to surgical procedure
5. Knowledge deficit of mother
6. Risk for infection & complication related to emergency procedure for corrective surgery.
NURSING CARE PLAN

Nursing Nursing Diagnosis Expected Out Come Planning Interventions Evaluation

Assessment

Subjective data: Acute pain related Patient will Assess the level of the pain by Assessed the level of the pain Expected
to infection and demonstrate pain scale. and the pain scale reading was outcome is
Patient is saying
suppuration at the reduction in pain 6 units. partially met as
that he is having Assess pain location and
previous surgical evidenced by
pain at the characteristics. Assessed the location and
site. reducing pain
surgical site . characteristic, pain is around
To give the comfortable on pain scale,
the previous surgical incision
Objective data : position to the patient. showing the
and is squeezing kind of pain.
score of 3units
Patient is restless, .To maintain immobilization of
Given the supine position to and by relaxed
facial expression surgical part.
minimize the pain. facial
exhibits severe
To provide diversional therapy expressions.
pain and Given proper alignment to the
to the mind.
discomfort. affected leg an d provided
extra cushioning to maintain
Surgical site
the postion
shows presence of To provide calm and quite
redness and pus environment. The diversional therapy like
collection. giving newspaper, listening a
To administer analgesics as per
music and talking with the
doctors order.
patient.
 Provided calm and quite
environment.

Administered analgesics as per

doctors order Inj. Dynaper AQ

Nursing N Nursing Diagnosis Expected Out Come Planning Interventions Evaluation

Assessment

Subjective data: Impaired physical Patient obtain To Assess the patient condition Assessed the patient condition Expected
mobility related to optimal mobility (level of mobility). for the further planning. outcome is
Patient is says
pain and discomfort. within limitations. partially met as
that he can’t able To Support the affected Provided support by the splint.
and participates in evidenced by
to walk. extremity.
the going Administered active and patient is
To Give active and passive passive exercises. participated in
programme of
exercises. his daily
rehabilitation and Given the supine and sitting
routine
physical therapy. To Give the comfortable position on bed.
activity.
position.
Assist the patient for the self-
Objective data :
To assist the patient for self- activity like bathing, eating
- Patient cant care activity. etc.
able to do his
To encourage patient to Encouraged patient to keep the
work because of
increase the fluid intake. body hydrated and decreased
is occurred.
 To provide all things near to risk for urinary tract infection.
the patient
Provided all things near to the
patient like fruits, knife,
medication, water bottle etc.

Nursing Nursing Diagnosis Expected Out Planning Interventions Evaluation

Assessment Come

Subjective data:Acu Self-care deficit Patient will able to Assess ability to carry out Assessed ability to carry out Expected
related to do his daily activity. activities of daily living such activities of daily living. outcome is met
Patient is says
immobilization, as feeding, dressing, grooming, to a great extend
that he is not able Assessed the specific cause is
pain and chronic bathing, toileting, transferring as evidenced
to do his daily pain and surgery.
fracture secondary an ambulating on a regular byverbalization.
activity.
to disease basis. Allowed adequate time it help
condition. the patient organize a carry out
Assess the specific cause of
self-care skill.
Objective data : each deficit. (e.g. weakness)
Encouraged patient for feed
Patient is having - Used consistent routines and
self as soon as possible.
Incision. allow adequate time for the
patient to complete task. Assist the patient.
- Pain
Encourage patient to feed self Assist with ambulation. This
- Not able to walk
as soon as possible. enhance patient safety.
 - Surgery. Assist the patient with bathing
and meet his daily activity.

Assist with ambulation, teach

the use of ambulation devices
such as walker and crutches.

Nursing Nursing Expected Out Planning Interventions Evaluation

Assessment Diagnosis Come

Subjective Sleep pattern Patient will Assess the actual cause of the Actual cause of disturb sleep is Expected outcome
data : disturbance related demonstrate normal disturb. pain, immobilization and is partially met as
to pain, sleep pattern as hospitalization. evidenced by
Patient says that To ask the patient about day
immobilization, evidenced by patient looks fresh
he can’t sleep time sleeping. Told patient to avoid day time
surgery and verbalization. and active, patient
properly in sleeping.
hospitalization. Provide calm and quite taking sleep pattern
night of pain, - Patient looks fresh
environment. Provided calm and quite in night 7-8 hrs.
immobilization, and active.
environment.
and To Administered analgesics
- reduced pain.
hospitalization. Administered analgesics, Inj.
To Instruct patient to decrease
Dynaper AQ BD IV.
Objective fluid intake before going to
data : sleep. Advised patient for decrease
fluid intake before going to
He is having To advice the patient to wear a
sleep.
pain on loose cloths during night.
operational site.
- He looks a Advised the patient to wear a
restless. loose cloths during night.

Nursing Nursing Expected Out Planning Interventions Evaluation

Assessment Diagnosis Come

Subjective Anxiety related Client will exhibit To assess the cause of Assessed cause of anxiety. Client exhibit positive
data: to upcoming reduction in anxiety. attitude as evidenced by
Provided safe and calm
surgery and its anxiety. verbalization of optimistic
Client To provide safe and calm environment.
outcome. thoughts and reduction in
complains of environment.
Client was explained all level of anxiety.
restlessnessand
To provide psychological treatment regimen about
feeling of
support and build hope in disease and hospitalization.
helplessness
treatment.
and discomfort He was asked to verbalize all
and about To encourage patient to the feelings and question/
hospitalization. express the feelings of doubts.
anxiety and fear.
Objective Using reassurance and
data : To use reassurance and therapeutic conversation to
therapeutic conversation to relieve feat and anxiety.
Lack of
relieve feat and anxiety.
confidence Provided the divisional
expression of To provide divisional therapy like listening music,
helplessness therapy. reading newspapers, jokes
and discomfort etc.
To prepare to coping the
patient and family for long Explained all about the
time bed rest of the patient disease condition, treatment
and giving care to him during regimen, bed rest,
hospitalization. reoccurrence of disease and
hospitalization.

Nursing Nursing Expected Out Planning Interventions Evaluation

Assessment Diagnosis Come

Subjective Parents will exhibit Assess the level of the Assessed the level of the Expected outcome is
data improved knowledge of the parents. knowledge of the parents by partially met as
def Knowledge deficit
knowledge on the asking question about disease evidenced by
Mother says related to surgical To Explain about the surgery
surgical intervention condition. verbalization.
that she is not intervention , and disease condition.
, prognosis and
known about prognosis and Explained about the surgery
healing process To explain about the
his medical healing process. and disease condition.
importance of medication and
treatment and
side effects. Explained about the
about disease
importance of medication and
condition and To encourage the patient to
side effects.
surgery. ask the question and clear his
doubts. Encouraged the patient to ask
Objective data
the question and clear his
 : To explain about the diet. doubts.

- Asking Explained about the diet like

questioning his high fibre, high protein
regarding his and high calorie diet.
disease
condition.

- Lack of
knowledge.

-
Misconception

- He is asking
about his
surgery.

Nursing Nursing Expected Out Planning Interventions Evaluation

Assessment Diagnosis Come

Subjective data: Ineffective Patient will be able Assess for specific stressors, Client assessed for stressors Patient is cope to
individual coping to cope effectively past and present coping as its elimination will help effectively as
Client asks
related to as evidenced by mechanisms. improving coping evidenced by
question about
knowledge about identifying own mechanism. verbalization of
severity of Evaluate resources and
prevention of maladaptive coping maladaptive
disease, diagnosis support system available to Availability of support
recurrence, behaviours, behaviour, available
and available system eg. Family, friends
resources. severity of available resources patient. was identified. resources and
disease, surgical and support system. support system.
Objective data : To encourage the patient to Client was encouraged to
treatment and
identify his own strengths identify his strengths and
Diagnosis of symptoms of
and ability. abilities.
serious illness, recurrence.
inadequate To encourage the patient to Setting goal will help to
support system set realistic goals. achieve desired results.
and available
To establish a working It establishes trust and
resources.
relationship with the patient reduces feelings of isolation.
through continuity of care.
DISCHARGE PLANNING

Objectives:

This plan aims to continue treatment and care for client by involving significant others to
participate in plan of care.

Treatment:

 Instruct the patient’s mother to continue talking all the medications prescribed by the
physician and return to hospital for follow-up.
 Asses mother’s understanding of treatment regimen as well as concerns of fear

Health Teachings:

 Adequate rest and sleep

 Timing and quantity of medication to be administered

Out Patient Follow-up:

 Instruct family to return to their attending physician for scheduled check-up.

 Advise family to report to the physician any reoccurrence of dyspnea, and unusual
complaints.
 Encourage family to ask and inquire to the physician if there are unclear of things.

Diet:

 Breastfed per demand

NOTE: - All above mentioned care should be taken after discharge.

PROGNOSIS OF THE PATIENT:-

With treatment, Childs improves within 3 weeks. Elderly or debilitated patients may need
treatment for longer. If the patient will fail to respond to treatment may die from respiratory failure.
The doctor will make sure that the chest x-ray becomes normal again after the patient have taken a
course of antibiotics.
SUMMARY:-

The baby of MERGAL LANKA JAIRAM 1 Month / FEMALE was delivered at Nootan
General Hospital at 1:00 pm at 12 feb by cesarean section because of mal-presentation. After verse
baby was referred to Nootan General Hospital on march 22, 2019 at 01:00 pm at; she was severely
suffered by congenital disease; complain with frothing from mouth, Cyanosis, Respiratory distress,
and Assessments of fistula by pass a tube into esophagus. The various investigations were done such
as X-ray, 2D-ECHO, Blood analysis, and urinalysis. Then it was confirmed that the baby was
suffering from T r a c h e o e s o p h a g e a l F i s t u l a . In emergency the surgical intervention like
primary anastomosis and fistula repair was done. Simultaneously proper course of treatment like
antibiotic (augmantin, vancomycin), analgesics and fluid was given for 06 days. From the starting
the baby was NBM for 11 days so TPN was started from 3 rd day and terminate on 17th day. The
breast feeding was initiated at 13th day with 5CC per 2 hours and was continue by 5 cc per day.

In course of treatment multi social convulsion was seen so anticonvulsant drug was given
with 10 mg / kg / day. The baby was received Nursing care and finally, baby recovered back from
the agony of T r a c h e o e s o p h a g e a l F i s t u l a . Finally the baby was discharge on 30th march with
health education about care of baby and diet management. Also advice to come for follows up care
after 7 days.

CONCLUSION:-

It is essential to understand the case of the patient at the NICU of Dhiraj General Hospital by
studying it in different aspects. The proponents of this case study were able to understand the
contributing factors that led to the patients’ condition. Also, the group provided nursing interventions
that were relevant and needed by the patient.

Furthermore, the understanding of the possible threats or risks that may occur during the
disease process is also emphasized. It is therefore vital to assess properly the status of the patient’s
condition and its complications. The case “T r a c h e o e s o p h a g e a l F i s t u l a ” as diagnosed, paved
the way for innovative inputs and setting the grounds for new learning of the group.
BIBLIOGRAPHY

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