NURSING CARE OF THE CHILD BORN WITH A PHYSICAL

OR DEVELOPMENTAL CHALLENGE | 1
UNIVERSITY OF CEBU- BANILAD
COLLEGE OF NURSING ❖ Providing nursing support as part of an
BSN CLASS OF 2024 interdisciplinary team, including social workers,
Compiled by: Labus, Marie Joy B. therapists, nutritionists, medical specialists, and other
Reference: Ms. Rosalind Navarro’s PPT
community resources can also help with parental
adjustment
Module 11, Chapter 27:
Implementation
❖ Include immediate life sustaining measures such as
providing oxygen or adequate intake of nutrients when a
disorder prevents the infant from establishing respirations
CARE OF A NEWBORN WHO IS PHYSICALLY OR or sucking
DEVELOPMENTALLY CHALLENGED ❖ Encouraging skin to skin contact and interacting with the
newborn promotes infant parent bonding
Assessment
❖ Educating the parents about procedures the infant may
❖ Focuses on determining the infant’s immediate undergo lessens the parental anxiety and enhances self
physiologic needs required to sustain life and the parents’ esteem
immediate emotional needs to promote bonding.
❖ Parents experience the same stages of grief as those
❖ The following eight primary needs of newborns should be whose child has died at birth. :
assessed:
• Denial
1. Adequate respiration • Anger
2. Extrauterine circulation • Bargaining
3. Body temperature stabilization • Depression, and
4. Blood sugar stabilization • Adjustment
5. Prevention of infection
❖ It is important for the nurse to provide positive role
6. An infant-parent bond
modeling when caring for the emotional and physical
7. Adequate stimulation needs of the newborn;
8. Ability to take in adequate nutrients
- It helps the parents to adjust to parenting a child born
9. Ability to achieve waste elimination with a physical or developmental challenge

Nursing Diagnosis Outcome Evaluation

❖ Imbalanced nutrition, less than body requirements, ❖ Focuses on:
related to inability to take in adequate nutrition
- Establishing expected outcomes for the child’s
secondary to a physical challenge
physical and developmental health needs
❖ Impaired physical mobility related to congenital
- Family’s coping ability for current and future health of
anomaly
the child.
❖ Risk for impaired parenting related to the birth of child
➢ This includes addressing the family concerns and
with a congenital anomaly
providing resources to support the family during
❖ Anticipatory grieving (parental) related to loss of the idea and after discharge.
of the “perfect” child

OROFACIAL CLEFTS
Outcome Identification and Planning Cleft Lip
❖ Nurses play an important role in providing immediate ❖ More common in boys
care to high-risk newborns at birth as well as stabilizing
❖ The maxillary and median nasal processes fail to fuse
them until the pediatric team arrives to assume care or
transport of the newborn to a high-risk nursery ❖ Normally fuse between 5-8 wks. of intrauterine life
(embryonic stage)
❖ Consideration of the family’s resources, both emotional
and financial, is an important aspect of planning care ❖ May be unilateral or bilateral
and establishing expected outcomes
❖ It’s important to consider both the short and long term
needs of the newborn and how these needs may affect
the family

❖ Supportive family members can be a critical asset to

parental adjustment

Compiled by: Labus, Marie Joy B.


Cleft Palate
❖ More common in girls
❖ Palatal structures fail to close
❖ There is an opening at the palate, usually at the midline.
❖ May involve the anterior hard palate, posterior soft
palate, or both
❖ Normally closes at 9-12 wks. of intrauterine life.
Causes
❖ Heredity
❖ Teratogenic Factors
✓ Viral infections (e.g., rubella)
✓ Exposure to radiation
✓ Smoking during pregnancy
Nursing Diagnoses & Interventions
❖ Risk for imbalanced nutrition less than body requirements
r/t feeding problem caused by cleft or palate
PREOPERATIVE PERIOD
1. Assess ability to suck & swallow
2. Monitor weight daily
3. Modify feeding techniques
- Support the baby in an upright position
- Direct the formula to the side and back of the
mouth to prevent aspiration
- Feed the infant gently using a commercial cleft lip
nipple
- Feed small amounts gradually
frequently
- Keep suction equipment and bulb syringe at
bedside
- Teach parents the ESSR method of feeding:
E nlarge the nipple
S timulate the suck reflex
S wallow
R est to allow the child to finish
swallowing what has been
placed in the mouth
NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 2
Specialty feeding devices for infants with cleft lip and/or cleft
palate
Mead-Johnson cleft palate nurser
- As the baby begins to suck,
squeeze the bottle with a firm
steady pressure to the count of
squ-e-e-ze two three," relaxing your
squeeze on the two three count
- This provides the baby with an
intermittent flow of milk.
Haberman feeder
- Medela Special Needs Feeder
- Works well for babies who are small
or premature, or who have cleft
palate only.
- It has a one-way valve that keeps
milk in the nipple.
- The baby can obtain milk by
compressing the nipple against the
roof of the mouth, without need for
suction.
✓ Closure of cleft lip
- Performed usually between 6 wks. to 9 months
✓ Cleft palate repair
- Performed between 12 to 18 mos. of age to allow
for the palatal changes that take place with normal
growth
- A prosthetic device may be used to close the
and burp
palate
POSTOPERATIVE PERIOD
1. Keep infant NPO for 4 hrs.
2. Avoid tension on a lip suture line
3. After palate surgery, liquids are generally continued for 3
to 4 days followed by soft diet until healing is complete
4. After a cleft palate repair, should not use spoon because
they will invariably push it against the roof of the mouth
and possibly disrupt sutures
5. Do not include milk in the first fluids offered
- Milk curds tend to adhere to the suture line
6. After feeding, offer the child clear water to rinse the
suture line
Compiled by: Labus, Marie Joy B.
 NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 3
❖ Risk for ineffective airway clearance r/t oral surgery
1. Observe for respiratory distress due to: TRACHEOESOPHAGEAL ATRESIA & FISTULA
- Local edema at the operative site.
❖ The esophagus terminates before it reaches the stomach
- Before surgery, the infant breathes through their
and/or a fistula is present that forms an unnatural
mouth, after surgery, the infant now has to learn
connection with the trachea
to breathe through their nose.
❖ The condition causes the oral intake to enter the lungs or
2. Suction secretions
a large amount of air to enter the stomach.
- Be gentle
❖ Choking, coughing and severe abdominal distention
- Do not touch suture line
can occur
3. After cleft lip surgery (cheiloplasty), place infant on ❖ Aspiration pneumonia and severe respiratory distress will
their side to drain secretion develop, and death will occur without surgical
intervention
❖ Impaired tissue integrity at incision line r/t cleft lip or cleft
palate surgery
1. After cleft lip surgery, the
suture line is held close by
a Logan Bar, or an
adhesive bandage
- Assess after each
feeding to be certain
that it is secure

2. If possible, prevent the infant from crying. Assessment

- Provide pain relief 1. Frothy saliva in the mouth and nose, and drooling.
- Anticipate the infant’s needs 2. Coughing and choking during feeding
- Help parents use whatever measures such as 3. Unexplained cyanosis
rocking, carrying, or holding to make infant feel 4. Regurgitation and vomiting
secure and comfortable 5. Abdominal distention
3. Observe infant after palate repair not to place toys 6. Inability to pass a small gauge (no. 5 French) orogastric
with sharp edges into their mouth. feeding tube
4. Do not use straw to drink, nor brush their own teeth.
5. Soft elbow or jacket restraints may be used when no Treatment
one is with them, to keep the child from touching the 1. Maintenance of a patent airway
repair site.
2. Prevention of pneumonia
6. Instruct parents to monitor for signs of infection at the 3. Gastric or blind pouch decompression
surgical site:
4. Supportive therapy
✓ Redness 5. Surgical repair
✓ Swelling
✓ Drainage Implementation

❖ Risk for infection r/t surgical incision PREOPERATIVE PERIOD

1. Clean the suture line with sterile water, sterile saline
1. Intubation and mechanical ventilation may be
or 50% hydrogen peroxide used with sterile cotton
necessary if respiratory distress occurs
tipped applicators every after feeding
2. Maintain NPO status
- Use a smooth, gentle rolling motion to apply the
solution 3. Monitor and regulate IV fluids as prescribed

- Dry the suture line with a sterile cotton tipped 4. Suction secretions
applicator 5. A double-lumen catheter
is placed into the upper
❖ Risk for impaired parenting r/t to the birth of an infant who esophageal pouch and
is physically challenged attached to intermittent
or continuous low suction
1. Promote bonding to keep the pouch empty
2. Caution them the incision line will appear swollen in
the immediate postop period
6. Maintain in an upright position to facilitate drainage and
3. Caution the parents that time will be needed for the
to prevent aspiration of gastric secretions.
infant to learn how to suck
Compiled by: Labus, Marie Joy B.
 NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 4
7. A gastrostomy tube may be placed and is left open so
that air entering the stomach through the fistula can STEP 2
escape, minimizing the danger of regurgitation.
✓ Lift infant by placing one hand beneath her head and
shoulders, the other beneath her buttocks
8. Adm. Broad spectrum antibiotics as prescribed because
of the high risk for aspiration pneumonia. ➢ Don't lift an infant with a chest tube by clasping her
under the arms and lifting, as this may cause her
POSTOPERATIVE PERIOD pain and dislodge the tube placement
➢ You may hold the
1. Monitor respiratory status
child on your lap or
2. Maintain IVFs, antibiotics, and parenteral nutrition as encourage her to
prescribed breast feed or bottle
3. Monitor I & O and weigh daily feed, always taking
care to provide
4. Inspect surgical site
adequate back and
5. Assess for signs of pain neck support
6. Assess for dehydration and possible fluid overload ➢ Don't place the
7. Provide care to the chest tube if in place infant on her
8. Monitor for anastomotic leaks as evidenced by purulent stomach.
chest drainage, increased temp., and increased WBC
count. STEP 3

9. If a gastrostomy tube is present, it is attached to gravity
drainage until the infant can tolerate feedings (usually 5
– 7 th day postop).
10. Before oral feedings and removal of the chest tube, a
barium swallow is performed to verify the integrity of the
esophageal anastomosis.
11. Feedings through the gastrostomy tube may be
prescribed until the anastomosis is healed.
12. Oral feedings are begun with sterile water, followed by
small frequent feedings of formula.
✓ You can start giving the infant a tub bath or shower after
the stitches have been removed or after about one-
week post-surgery.
✓ Make sure the bathing area and water are clean
HYPERTROPHIC PYLORIC STENOSIS
❖ Hypertrophy of the circular muscles of the pylorus
causing narrowing of the pyloric canal between the
stomach and the duodenum

13. Instruct parents to identify behaviors that indicate the Baby fails to grow
need for suctioning, signs of respiratory distress, and signs Less fluid can pass through this defect
of constricted esophagus: Majority of absorption in the small intestine
a. Poor feeding, dysphagia, drooling, or Because of distention baby will vomit
regurgitated undigested food. (characteristics: projectile vomiting); fast intake
slow discharge

CARE OF AN INFANT WITH CHEST TUBE Tracheoesophageal – non-projective; equal to

the amount that is ingested
STEP 1
✓ Examine the area around the tubing often to help
prevent potential infection.
➢ Make sure the area surrounding the chest tube is as
clean and sterile as possible
➢ The area surrounding the incision and chest tube
should be covered and protected from the
surrounding environment
➢ Ensure that tubing is not kinked or otherwise bent

❖ Usually develops in the first few weeks of life, causing

projectile vomiting, dehydration, metabolic alkalosis,
and failure to thrive.
Not-readily; empty ang stomach but very slow
“kusog mutotoy pero niwang”
Metabolic alkalosis (upper GI) = stomach
Metabolic acidosis (below) = sigeg diarrhea
Baby does not grow

Compiled by: Labus, Marie Joy B.

 NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 5
❖ Vomiting is the first symptom in most children:
✓ Vomiting may occur after every feeding or only
after some feedings
✓ Vomiting usually starts around 3 weeks of age, but
may start any time between 1 week and 5 months
of age (dependent on the extent of the narrowing
of the pylorus)
✓ Vomiting is forceful (projectile vomiting =
overdistended ang stomach))
✓ The infant is hungry after vomiting and wants to
feed again

❖ Other symptoms generally appear several weeks after

PREOPERATIVE CARE
birth and may include:
✓ Abdominal pain (overdistention)
The patient will be given fluids through a vein, usually before
✓ Belching (dug-ab)
surgery.
✓ Constant hunger (less nutrients are absorbed)
✓ Dehydration (gets worse with the severity of the 1. Monitor hydration status by daily weights, I & O, and urine
vomiting) for specific gravity.
Less fluid enters small intestine = less fluid Abdominal surgery – general anesthesia’ causes
relaxation of all muscles; danger: aspiration and
✓ Failure to gain weight or weight loss obstruction of airway of baby)
✓ Wave-like motion of the abdomen shortly after
2. Correct fluid and electrolyte imbalances.
feeding and just before vomiting occurs
• Adm. IVF as prescribed.

3. Maintain NPO status

Signs and Tests
4. Monitor the number and character of stools.
❖ Diagnosed before the baby is 6 months old.
5. Maintain patency of NGT for stomach decompression.
❖ A physical exam may reveal signs of dehydration.
Abdominal surgery – NGT inserted not for feeding,
❖ The infant may have a swollen abdomen
but used for removing air liquids inside stomach
❖ The doctor may detect the abnormal pylorus, which feels
like an olive-shaped mass, when touching the stomach
area. POSTOPERATIVE CARE
❖ An ultrasound of the abdomen may be the first imaging 1. Monitor I & O.
test performed.
2. Maintain IVF until infant is taking and retaining adequate
❖ Other tests that may be done include: amounts by mouth.
a. Barium x-ray - reveals a swollen stomach and Before resuming wait go signal from doctor =
narrowed pylorus return of peristalsis
Upper GI (barium swallow) = nay ipainom Abdomen auscultate bowel sound (present)
nga liquid nya ma trace dayon
If resumed = liquid diet first
b. Blood chemistry panel - often reveals an 3. Begin small, frequent feedings of glucose, water, or
electrolyte imbalance electrolyte solution 4 – 6 hrs. postop as prescribed.
Glucose water - water mixed with sugar
Treatment
4. Advance the diet to formula 24 hrs. postop as prescribed.
❖ Involves surgery to split the overdeveloped muscles. 5. Gradually increase amount and interval between
• Pyloromyotomy – pyloroplasty (ultimate feedings until a full feeding sched. Is reinstated (48 hrs.
intervention) postop)

➢ A surgical procedure to widen the opening in
the lower part of the stomach (pylorus) so that
the stomach contents can empty into the
small intestine (duodenum).
➢ Balloon dilation does not work as well as
surgery, but may be considered for infants
when the risk of general anesthesia is high.
➢ The patient will be given fluids through a vein,
usually before surgery (NPO ang baby)
6. Feed the infant slowly, burping frequently
To prevent tension on the suture line on the pylorus
7. Monitor for abdominal distention
8. Monitor the surgical wound and for signs of infection
Tissue injury/trauma
Assess operative site – redness, drainage, puss
formation
9. Instruct the parents about wound care and feeding.

Compiled by: Labus, Marie Joy B.


DIAPHRAGMATIC HERNIA
❖ A diaphragmatic hernia is a birth defect, which is an
abnormality that occurs before birth as a fetus is forming
in the mother's uterus.
Cyanotic ang baby inig gawas
In-utero problem
❖ An opening is present in the diaphragm (the muscle that
separates the chest cavity from the abdominal cavity).
❖ With this type of birth defect, some of the organs that are
normally found in the abdomen move up into the chest
cavity through this abnormal opening
As the fetus grows; increase intrabdominal
pressure; enlarge abdominal organs
If diaphragm is open because of increase
pressure, this displaces abdominal contents to
chest
Because of compression lungs would fail to grow
– exist once baby is born
TWO TYPES OF DIAPHRAGMATIC HERNIA:
1. Bochdalek hernia
- Usually involves an opening on the left side (85%) of
the diaphragm.
- The stomach, liver, spleen and/or intestines usually
move up into the chest cavity (mas grabi)
2. Morgagni (morgañi) hernia
- Involves an opening on the right side of the
diaphragm.
- The liver and/or intestines usually move up into the
chest cavity.
Causes
❖ Genetic and environmental (exposure to teratogens)
❖ The diaphragm forms between the 7th and 10th week of
pregnancy (any alteration result to major congenital
anomalies)
❖ The esophagus, the stomach, and the intestines are also
developing at this time.
❖ In a Bochdalek hernia, the diaphragm may not develop
properly, or the intestine may become trapped in the
chest cavity as the diaphragm is forming (intestine in
chest; close ang diaphragm)
❖ In a Morgagni hernia, the tendon that should develop in
the middle of the diaphragm does not develop properly.
NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 6
In both cases, normal development of the
diaphragm and the digestive tract does not occur
Symptoms
✓ The symptoms of a Bochdalek diaphragmatic hernia are
often observable soon after the baby is born.
✓ May include:
1. Difficulty breathing
2. Fast breathing
3. Fast heart rate
4. Cyanosis
5. Abnormal chest development, with one side
being larger than the other
6. Abdomen that appears caved in (concave) =
hiyak
✓ A baby born with a Morgagni hernia may or may not
show any symptoms
Diagnosis
1. Physical examination
2. Chest x-ray to look at the abnormalities of the lungs,
diaphragm, and intestine
3. Arterial blood gas is often performed to evaluate the
baby's breathing ability
4. Other tests that may be performed include:
• Blood test for chromosomes (to determine if there
is a genetic problem)
• Ultrasound of the heart (echocardiogram)
Treatment
1. Neonatal Intensive Care
➢ A diaphragmatic hernia is a life-threatening illness
and requires care in a neonatal intensive care unit
(NICU).
➢ Babies with diaphragmatic hernia are often unable
to breathe effectively on their own because their
lungs are underdeveloped.
➢ Most babies will need to be placed on a breathing
machine called a mechanical ventilator to help
their breathing.
2. ECMO - Extracorporeal Membrane Oxygenation
➢ Some infants may need to be placed on a
temporary heart/lung bypass machine called
ECMO if they have severe problems.
➢ ECMO does the job that the heart and lungs would
be doing: putting oxygen in the bloodstream and
pumping blood to the body
➢ ECMO may be used temporarily while a baby's
condition stabilizes and improves.
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 NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 7
3. Surgery
➢ When the baby's condition has improved, the b. To decrease the right-to-left shunting through
diaphragmatic hernia will be repaired with an the ductus arteriosus and foreman ovale
operation (surgery from the chest down of the c. Increase the pulmonary blood flow.
abdomen; more difficult) d. The most common pressors include:
➢ The stomach, intestine, and other abdominal ❖ Dopamine
organs are moved from the chest cavity back to the - Increases peripheral vascular
abdominal cavity. resistance
The Babies born with diaphragmatic hernia can have - 2mcg/kg/min to a max of
long-term problems and often need regular follow-up 20mcg/kg/min
after going home from the hospital. - Continuous infusion
Many babies will have chronic lung disease and may ❖ Dobutamine
require oxygen or medications to help their breathing for - Increases cardiac contractility
weeks, months, or years after the hole in the diaphragm
- 2mcg/kg/min to a max of
is repaired.
20mcg/kg/min
- Continuous infusion
Treatment/Nursing Care
4. Parent education
a. Has been described as a physiologic emergency rather
➢ Pre-operative Education
than a surgical emergency
- Update parents to plans for surgery and what
➢ The critical concern is the avoidance of or
to expect post-operatively
improvement of PPHN (Persistent Pulmonary
Hypertension of the Newborn).
➢ Post-operative Education
➢ The standard of care is to stabilize the infant and
- Update parents about infant’s status
manage the associated pulmonary dysfunction
postoperatively and review any new
prior to surgical intervention.
equipment, medication, or therapies that
b. Surgical intervention can be delayed from a few days to have been added to infant’s care.
up to two weeks, depending on the infant (oxygenation,
nutritional status)
INTESTINAL OBSTRUCTION
The goal of the medical management is to stabilize the Imperforate Anus
pulmonary dysfunction and decrease the pulmonary
hypertension. ❖ Lower GI
The goal of the respiratory management is to provide ❖ A defect that is present from birth (congenital) in which
adequate ventilation and oxygenation but to avoid the opening to the anus is missing or blocked
causing permanent lung damage.
FORMS OF IMPERFORATE ANUS AND ANORECTAL
MALFORMATIONS
Treatment for the infant with CDH may consist of:

1. Gastric decompression 1. A Low Lesion

➢ Oro/nasogastric tube to low continuous suction is
used to decrease the amount of air entering the
intestines and obstructing the lung (prevent
regurgitation
2. Inhaled Nitric Oxide
➢ Is a powerful vasodilator that is minimally toxic.
- The colon remains close to the skin (covered by a
membrane)
- In this case, there may be a stenosis (narrowing) of
the anus, or the anus may be missing altogether,
with the rectum ending in a blind pouch.
2. A High Lesion

➢ It acts to dilate the pulmonary vascular bed and
decrease the PPHN (Persistent Pulmonary
Hypertension of the Newborn)
3. Pressors (drugs=hypertensive)
➢ Used to increase systemic blood pressure to
decrease the effect of PPHN
- In which the colon is higher up in the pelvis and
there is a fistula connecting the rectum and the
bladder, urethra or the vagina
Assess – meconium mixed in the urine (green
colored)
3. A persistent cloaca

➢ Goal - From the term cloaca, an analogous orifice in

reptiles and amphibians
a. To increase the systemic pressure to a level
that will help to override the resistance from - The rectum, vagina and urinary tract are joined
the pulmonary bed into a single channel.

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 NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 8
Associated Anomalies (develop in the same germ layer)
- Instruct parents to use only dilators supplied by the
• V - Vertebral anomalies physician and a water-soluble lubricant.
• A - Anal atresia
- Insert the dilator no more than 1 – 2 cm into the anus
• C - Cardiovascular anomalies
to prevent damage to the mucosa.
• T - Tracheoesophageal fistula
• R - Renal (Kidney) and/or radial (bone) anomalies
• E - Esophageal atresia Hirschprung’s Disease
• L - Limb defects
❖ Aganglionic Megacolon
❖ Absence of ganglionic innervation to the muscle of a
Forms
section to the bowel, usually at the lower portion of the
sigmoid colon, just above the anus
Responsible of peristalsis
of the intestine
If absent, no peristalsis;
affected there is certain
portion of the intestine
❖ This results to chronic
constipation or ribbon-like
stools.

Cause

❖ Abnormal gene on chromosome 10

Diagnosis

❖ Sonography
- Used to determine the type of imperforate anus

Treatment

❖ Surgery
- To open a passage for feces unless a fistula can be
relied on until corrective surgery takes place.
- Depending on the severity of the imperforate, it is
Assessment
treated either with a perineal anoplasty or with a 1. Infant fail to pass meconium by 24 hrs. of age.
colostomy (labi na if higher defect)
2. Abdominal distention (stagnant of stool)
3. History of constipation, or intermittent constipation and
POSTOPERATIVE CARE diarrhea
1. Monitor skin for signs of infection. If something obstructs in our intestine – attempt to
remove by increase by peristalsis
2. Position side-lying, with legs flexed or in prone position:
Retain stool will be pushed forcefully
- To keep hips elevated to reduce edema and pressure
on the surgical site. 4. If a gloved finger is inserted into the rectum, the rectum
is empty.
3. Keep surgical incision clean & dry.
- Due to failure of the fecal material to pass into the
4. Maintain NPO status and NGT if in place.
rectum through the obstructed portion
5. Maintain IVFs until GI motility returns.
5. Barium enema
6. Provide colostomy care if prescribed.
Lower GI; to determine the extent up to what level
Keep surrounding area dry
the affected area
Change colostomy bag
6. Biopsy
7. A fresh colostomy stoma will be red and edematous but
this should decrease with time.
8. Instruct parents to perform anal dilatation if prescribed to
achieve and maintain bowel patency.
Bago gi repair, create sphincter, di ma dilate
Padung heal mu sira balik

Compiled by: Labus, Marie Joy B.


Therapeutic Management
❖ Surgery
➢ Dissection and removal of the affected section,
with anastomosis of the intestine.
- Temporary colostomy is established followed
by bowel repair at 12 – 18 months of age.
Diagnosis
1. Constipation r/t reduced bowel function.
2. Imbalanced nutrition, less than body requirements, r/t
reduced bowel function.
3. Risk for compromised family coping r/t chronic illness in
child (postponed)
Nursing Interventions
PREOPERATIVE
1. Assist in emptying the bowel by giving repeated enemas
and colonic irrigations.
2. If abdominal distention is not relieved by enemas,
discomfort is significant, and rectal tube insertion fails to
give relief (makautot), consult doctor for a nasogastric
(NG) tube.
3. Offer pacifier for infant to suck if on parenteral fluids (NPO
ang baby; preparation for surgery)
4. Encourage parents to hold and rock the infant.
5. Maintain position of comfort with head elevated (Semi-
Fowler’s) (to prevent compression of the diaphragm; to
relieve dyspnea)
6. Offer soothing stimulation (e.g., music, touch, play
therapy).
7. Offer small frequent feedings.
- Low residue diet will aid in keeping the stool soft.
8. Administer parenteral nutrition if feeding causes
additional discomfort because of distention and nausea.
9. For older child, provide demonstration and written and
verbal instruction to family for saline enema
administration and use of stool softeners (as ordered)
NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 9
7. In older child, encourage frequent coughing and deep
breathing to maintain respiratory status.
8. Allow the infant to cry for a short period to prevent
atelectasis.
9. Change position of infant frequently to increase
circulation and allow for aeration of all lung areas.
10. Maintain patency of NG tube immediately
postoperatively (prevents abdominal distention)
11. Maintain NPO status until bowel sounds return and the
bowel is ready for feedings as determined by the
physician.
12. Provide frequent oral hygiene while on NPO status.
13. Administer fluids to maintain hydration and replace lost
electrolytes. Begin oral feedings as ordered.
14. Support the parents when teaching them to care for their
child’s colostomy. Reassure parents that colostomy will
not cause delay in the child’s normal development.
15. Involve the entire family in teaching colostomy care to
enhance acceptance of body change of the child.
Intussusception
❖ Is the invagination of one portion of the intestine into
another.
❖ Usually occur in the 2nd half of the first year of life
Causes
❖ Unknown (for infants below 1 yr.)
❖ In infants older than 1 yr.
- Meckel’s diverticulum
- Polyp
- Hypertrophy of Peyer’s
patches
- Tumors

POSTOPERATIVE ❖ Peyer’s Patches

1. Change wound dressing using sterile technique.

2. Prevent wound contamination from diaper.
3. Prevent perianal and anal excoriation by thorough
cleaning and use of ointments after the infant soils
(postoperative stools can number 7 to 10 per day).
4. Use careful handwashing technique.
5. Report any wound redness, swelling or drainage, Early Symptoms
evisceration (internal organs are coming out of the
✓ Nausea
wound - poorly nourished ang baby; delayed wound
✓ Vomiting (sometimes bile stained (green color)
healing), or dehiscence immediately
✓ Pulling legs to the chest area (ma relieve ang pain)
6. Suction oral secretions frequently to prevent infection of
✓ Intermittent moderate to severe cramping abdominal
the tracheobronchial tree and lungs.
pain

Compiled by: Labus, Marie Joy B.

 NURSING CARE OF THE CHILD BORN WITH A PHYSICAL
OR DEVELOPMENTAL CHALLENGE | 10
➢ Pain is intermittent not because the intussusception
temporarily resolves, but because the Nursing Diagnosis/Intervention
intussuscepted bowel segment transiently stops
contracting. ❖ Risk for deficient fluid volume r/t bowel obstruction

1. Keep infant on NPO prior to surgery or nonsurgical

Later Signs reduction
- Infant may find comfort in sucking pacifier
✓ “Red currant jelly" stool (stool mixed with blood and
mucus) 2. IVF may be started to re-establish F&E balance
✓ "Sausage-shaped" mass felt at the upper right quadrant 3. After non-surgical reduction
upon palpation of the abdomen. a. Keep infant NPO for a few hrs
b. Introduce gradually to regular feedings
Pathophysiology Barium enema, na correct na ang defect
then resume regular feeding

4. After surgery
a. Keep NGT in place and attached to low,
intermittent suction until healing of suture line
and return of peristalsis.
b. Keep IVF in place
c. When bowel sounds are present:
• Oral feedings can be started gradually

Ma compromise ang blood supply ato nga area,

leading to ischemia (lack of blood supply)
Which leads to necrosis (death of tissues)
Eventually leads to perforation (dead tissues leaking of
the fetal material in the peritoneal cavity)
Which can lead to sepsis full of bacteria spread into the
peritoneal cavity

Therapeutic Management

Reduction of intussusception
1. Instillation of water-soluble
contrast enema (if
perforation is suspected)
- Less irritating to the
peritoneal cavity

2. Barium enema, or air-

contrast enema
(pneumatic insufflation)

3. Surgical reduction
a. The abdomen is opened and the part that has
telescoped in is squeezed out manually by the
surgeon (kung wala pay necrosis; if naa e dissect sa
doctor)
b. The affected section will be resected (if naa nay
ischemia or necrosis)
c. Laparoscopy, whereby the segments of intestine
are pulled apart by forceps

Compiled by: Labus, Marie Joy B.