GI+Round+1

//GI Round 1//
**The gastrointestinal system** encompasses the esophagus, stomach, small and large intestine, or the accessory organs of the liver, gallbladder, and pancreas.

Primary function: Ingestion Digestion Absorption of nutrients Maintenance of fluid and electrolyte balance Elimination

Newborn GI system immature at birth Sucking and swallowing automatic reflexes at birth, controlled by 6 weeks Newborn stomach capacity 60 ml. Peristalsis stronger in the infant Emptying time 2-3 hours, 3-6 hours at 2 months Infants require 100 calories per kilogram of body weight (Adults 30-40) Infants small intestine longer, infant secretes more fluid and electrolytes into the intestine. <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">If diarrhea more electrolytes lost. <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Large intestine shorter so less absorption. <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Liver functions are immature, toxins and meds inefficiently processed

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Infant deficient in digestive enzymes <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Amylase responsible for digestion of carbohydrates <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">(no cereal before 4-6 months) <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Lactase breaks down lactose in infant formula and breast milk <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Lipase is responsible for the breakdown of fats <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">***Fat in breast milk absorbed more readily because breast milk contains lipase*** <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Receive protective immunoglobulin proteins

<span style="color: #db0713; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Gastroenteritis:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">media type="youtube" key="pIDmePznLBo" width="560" height="315"

<span style="color: #de3f3f; font-family: 'Times New Roman',Times,serif;">Rotavirus
media type="youtube" key="sYoCIfeVcFk?version=3" height="346" width="616" <span style="color: #e80202; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Dehydration:

media type="youtube" key="IAnL-Viyd5M" width="560" height="315"

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 180%;">**Upper Gastrointestinal problems include:** <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">GERD <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hypertropic Pyloric Stenosis (HPS) <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Cleft lip and cleft palate <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Esophageal atresia, tracheoesophageal atresia

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 180%;">**GERD** media type="youtube" key="FXEpnVwLXcA" width="560" height="315"

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 180%;">**Hypertropic pyloric stenosis (HPS)** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Most common intra –abdominal condition requiring surgery <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">First born Caucasian males, more males than females <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cause? Genetic predisposition & environmental allergies, pylorospasm <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">New theory duodenal hyperacidity

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Pathology: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pylorus- opening between stomach and the intestines <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Opening surrounded by muscular ring, pyloric sphincter <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Increases to 4xs normal width, narrowed opening, prevents emptying into the duodenum

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Clinical Manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Symptoms 3-4 week of life <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nonbilious vomiting starting between the 2 and 4 week, progressive, projectile <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Small bms due to food not passing through <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hungry will eat again <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Poor weight gain or weight loss <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Irritable, lethargic

media type="youtube" key="PWiny8noUbY" width="504" height="377" <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">History <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Physical assessment <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Olive shaped mass above & to the right of the umbilicus <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Abdominal ultrasound (procedure of choice) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Barium upper GI series

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pyloromyotomy muscle fiber released <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Open or laparoscopic <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Preop- NG tube, fluid imbalance corrected <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Medical management- antispasmodic meds to relax sphincter <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Thickened feeds

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Post-op <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">ng removed <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Blood glucose, electrolytes, CBC monitored <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">IV until can feed <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Gastric motility slowed for up to 24 hours <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Small frequent feedings resume at 4-6 hours

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Nursing management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assessment- history, signs of dehydration

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Nursing Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Deficient fluid volume <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Imbalanced nutrition <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Acute pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Risk for infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Deficit knowledge

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Outcome identification: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Improved fluid and electrolyte balance <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Tolerate feedings and demonstrate improved nutrition, weight gain <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Minimal postoperative pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Surgical site free from infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Caregivers verbalize and demonstrate care, S&S of infections or complications

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Planning and implementation: <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Preop- <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">IV, rehydrate <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Daily weights <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">NPO <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">I&O <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">NG suctioning <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Review labs

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Postop- <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor IV <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor oral feeds <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Analgesics <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Observation of S&S of infection

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Family teaching <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nothing they did caused this <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Reassure may have some postop vomiting (> 48 hrs call)

media type="youtube" key="2v5U6M7cfyM" width="560" height="315"

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 24px; line-height: 32px;">**//Case Study 2: Pyloric Stenosis//** = = <span style="font-family: 'Times New Roman',Times,serif; font-size: 160%;">David is a // 2-month-old // infant who has //failed to gain weight// in spite of his //alert nature and vigorous appetite.// He has a history of //projectile vomiting 30-60 minutes after a feeding// that has // steadily gotten worse. // His mother is very upset. “I don’t understand; I feed him all the time! Look at him!” The examining doctor thinks he feels a //small olive shaped mass in the epigastrum.// The doctors have scheduled to admit David to the hospital for some tests.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 160%;">What might be noted on a physical exam?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 160%;">What tests are likely to be ordered for this infant and why?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 160%;">What might be the likely diagnosis?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 160%;">What treatment or surgical intervention might be instituted?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 160%;">What are the //immediate// nursing needs in this situation?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 160%;">Is gastroesophageal reflux a possible diagnosis, why or why not?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 1.1em;">media type="youtube" key="6vhbA1vyBfU?version=3" height="515" width="630"

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">**Cleft lip and cleft palate:**

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Classification of Cleft Lip and Palate: media type="youtube" key="ghL4idjlBnA?version=3" height="443" width="546"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">1/700 births more common Asian, Caucasians, males; palates alone females

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Environmental- alcohol, drug exposure (Dilantin, Valium), dietary (low folic acid, vitamins), smoking
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Etiology: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Genetic

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Failure to fuse nasal and maxillary processes 5-8th week <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Failure of palatine plates to fuse between 7-12th week <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Unilateral or bilateral
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Pathophysiology: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Obvious at birth <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Mouth checked at birth for sucking reflex <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Later milk coming through the nose <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Can be seen on ultrasound
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Diagnosis: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Complex <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Specialists – plastic surgeon, orthodontist, speech pathologist, pediatrician, nurse, audiologist <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Closure of lip at 3 months of age/ 12 pounds <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Clefts of hard and soft palate at 12 months so not to interfere with speech
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Treatment: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Long-term- problems with ear infections, speech, tooth eruption, body image

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">**Nursing Management**: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Newborn Assessment examines visually and palpation with a gloved finger <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Ability to suck, swallow and feed <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Caregivers reactions


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Nursing diagnosis: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Preop <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Imbalanced nutrition <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Altered parenting

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Postop <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Risk of injury or infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Acute pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Deficient knowledge

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Adequate nutrients <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Caregivers adjust, bond <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Infant comfort <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Caregivers verbalize understanding <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Infant normal growth and development
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Outcome identification: **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Preop: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Support for caregivers- shock, grief, (anger, guilt, frustration, depression) isolation, inadequacy, failure; these are normal reactions. Fears relieved by seeing before and after photos. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Prevent aspiration and infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Ensure adequate nutrition- poor inadequate suctioning, prolonged feeding time, nasal regurgitation, and inadequate weight gain. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Breast feeding possible, CL infants have no more trouble than other infants as the breast molds and tends to fill in the empty space or breast pump <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Bottle feeding - Enlarge, Stimulate, Swallow and Rest (ESSR) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Feed in upright position <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Burp frequently
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Planning: **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Postop <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Protect the operative area with Logan Bow <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Decrease tension on the suture line <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Elbow restraints <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Back or side position <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Decrease crying, adequate pain med. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Clean suture line with Q-tip dipped in Hydrogen peroxide, sterile water <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Small amounts of water to rinse away milk residue <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Take restraints off several times a day for 10 min., *one at a time* <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">NO oral thermometers, tongue depressors, straws, forks

**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 24.309999465942383px;">Case Study 2: Cleft lip and Cleft Palate **
<span style="font-family: 'Times New Roman',Times,serif;">media type="youtube" key="QpLJFr4Yel4?version=3" height="345" width="560"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">What is often the first reaction to the birth of a child with cleft lip and/or cleft palate?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Can these children breast feed?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Do they require special equipment or accommodations for feeding?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">At what age is the repair of cleft lip performed? Cleft palate?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">The mother wants to know what she did wrong. How would you respond?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Post surgery what are some appropriate nursing diagnoses, interventions, and outcomes?


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 23.399999618530273px;">Esophageal atresia **
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 23.399999618530273px;">Tracheoesophageal fistula **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Congenital defects of the esophagus <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Incomplete formation of the esophagus, terminates before reaching the stomach <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Often associated with fistula between the trachea and esophagus, many variations <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Associated other defects present in approx. ½ of all infants with EA with TEF

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">VACTERL <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">V - Vertebral defect <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">A - Anorectal defect <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">C - Cardiac defects <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">T – Tracheoesophageal fistula <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">E – Esophageal atresia <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">R – Renal anomalies <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">L – Limb defects

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Pathophysiology: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Occurs during the 6-8th week <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Defective separation of the foregut into the esophagus and the trachea

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Clinical Manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Fine, frothy bubbles of mucous, clear with suctioning only to return <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">3 C’s- Episodes of coughing, choking and cyanosis, esp. with feeding <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Abdominal distention, air builds up in the stomach

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">History of polyhydramnious <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Unable to view stomach bubble on ultrasound <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Feeding tube passed stops at 10-12 cm instead of 17 cm. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Follow-up with radiographic studies, absence of air in stomach – EA w/o TEF

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Treatment : <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Before 1939 fatal <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Now surgery in the first few days <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Goal is to prevent aspiration until then <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">One stage repair preferred <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Premie or fragile infants close fistula, gastrostomy tube <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Anastomosis of esophagus later

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Nursing Management: <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Preop – <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Goal prevent aspiration and regurgitation <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">NPO <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Continuous suction <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Supine with elevated head

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Postop – <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Goals patent airway, prevent trauma <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Gentle suctioning <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Observation for airway obstruction – anxious look, tachypnea, abnormal breath sounds <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">NPO until bowel sounds return <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">IV <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Glucose water if tolerated then formula or breast milk <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Pacifier for sucking needs <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Family teaching: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">Observe for esophageal stricture- dysphagia, increased drooling, coughing, choking <span style="font-family: 'Times New Roman',Times,serif; font-size: 18.200000762939453px;">If gastrostomy, care and feeding

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 21.486398696899414px;">//The young mother is crying and upset. Her husband stands by her mutely unsure of what to do or say. Shortly before their newborn boy, Dillon, had been rushed to the NICU. He was cyanotic, coughing and choking after his first feeding. The mother says the doctor came in and said Dillon's "eso..esopha..jus wasn't formed right...what does this mean? Is my baby going to die?" As the primary care nurse, you know the child has been diagnosed with esophageal atresia with tracheoesphageal fistula. // =====

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.800600051879883px;">What might be some nursing diagnoses at this moment and what other nursing interventions, nursing outcomes would be appropriate? =====

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18.800600051879883px;">What is the prognosis? Prior to 1939 what was the prognosis?
media type="youtube" key="qbdVzd1A2rU?version=3" height="617" width="756"

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Daigneau, C. V. (2005). The child with gastrointestinal dysfunction. In M. Hockenberry, D. Wilson & M. Winkelstein (Eds.), Wong's essentials of pediatric nursing (7th ed., pp. 839-889). St. Louis, Missouri: Elsevier Mosby.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Ellett, M. L. (2009). Chapter 24: The child with gastrointestinal dysfunction. In M. J. Hockenberry & D. Wilson (Eds.), Wong's essentials of pediatric nursing (8th ed., pp. 813-860). St. Louis, MO: Mosby Elsevier.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Videos: Gastroenteritis: https://youtu.be/pIDmePznLBo?list=PLziHOo2bzkwDAHharVuFsVw3RYnflultD

Dehydration: https://youtu.be/IAnL-Viyd5M

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">GERD https://youtu.be/FXEpnVwLXcA

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Healthy kid tips Pyloric Stenosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/6vhbA1vyBfU

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Classification of Cleft lip and Palate http://youtu.be/ghL4idjlBnA

Nationwide Children's Hospital cleft lip and palate http://youtu.be/QpLJFr4Yel4

Tracheoesophageal fistula by Children's miracle network http://youtu.be/qbdVzd1A2rU