Concept about Gastroschisis – Health of the children has been considered as the vital importance to all societies because children are the basic resource for the future of humankind. Nursing care of children is concerned for both the health of the children and for the illnesses that affect their growth and development. The increasing complexity of medical and nursing science has created a need for special area of child care, i.e. pediatric- nursing.
Pediatric nursing is the specialized area of nursing practice concerning the care of children during wellness and illness. It includes preventive, promotive, curative and rehabilitative care of children. It emphasizes on all round development of body, mind and spirit of the growing individual. Thus, pediatric nursing involves in giving assistance, care and support to the growing and developing children to achieve their individual potential for functioning with fullest capacity.
Concept about Gastroschisis
Gastroschisis is characterized by herniation of the abdominal viscera through the defect in the abdominal wall to the right of the umbilical cord and through the rectus muscle.
[Ref-Paediatric Nursing, Parul Datta/34/294]
Or
Gastroschisis is a birth defect of the abdominal (belly) wall. The baby’s intestines are found outside of the baby’s body, exiting through a hole beside the belly button.
Management of Gastroschisis:
Surgical management:
- It is done to reposition the abdominal viscera either by creating skin flaps or making an artificial silo followed by closure of abdominal wall.
- The exposed bowel is loosely covered with saline soaked pads and the abdomen is wrapped in a plastic drape in preoperative period.
Supportive measures: It should include
- Prevention of infection
- Maintenance of warmth
- Ventilatory support.
- Maintenance of fluid and electrolyte balance.
- Provision of total parenteral nutrition along with routine care.
[Ref-Paediatric Nursing, Parul Datta/3/294]
Associated Anomalies Of Gastroschisis:
1. Prematurity
2. Intestinal anomalies.
3. Decreased abdominal capacity.
4. Atresia, stenosis (rare)
5. Higher incidence of Meckel’s diverticulum.
Nursing Cares of Gastroschisis Patient:
1. Use warmers and monitor the child’s temperature.
2. Use sterile technique in dealing with the defect. Immediately cover with warm moist, sterile gauze and wrap with plastic to keep moist.
3. Minimize movement of the infant and handling of the intestines.
4. Assess circulatory compromise, obstruction, sepsis: monitor temperature, pulses, skin color, changes in respiratory pattern, heart rate.
5. Observe for respiratory distress secondary to secondary to high intra-abdominal pressure as the gut returns to the peritoneal cavity.
6. Monitor intake and output, daily weights, assess fontanels, monitor electrolytes, and maintain VV line.
7. Postoperatively, monitor and manage ileus, maintain nasogastric tube for decompression, monitor bowel sound and stools, measure abdominal girth
8. Maintain parenteral nutrition to sustain growth.
9. Provide emotional support for parents as they deal with the loss of the child
10. Encourage patients to provide care as they are able, talk to and touch infant and hold the infant, when appropriate.
Read more: