GASTROSCHISIS Prepared by: Estrada, Sharmaine P. PCU-MJCN, SN
GASTROSCHISIS Is a congenital malformations in which a defect in the abdominal wall allows portions of the abdominal contents to herniate outside the abdominal cavity. Their incidence is 0.1 to 0.3 percent of 1,000 live births. The defect in the abdominal wall permits extrusions of the abdominal contents, primarily the small and the large intestines, without involving the umbilical cord
The defect is usually at the right side of the umbilicus, and there is no protective sac covering the intestines. The etiology is unclear, although one theory explains gastroschisis as resulting from an incomplete lateral in infolding of the embryonic disc, which allows herination of the bowels
ASSOCIATED ANOMALIES Prematurity Malrotation of the intestines Decreased abdominal capacity Atresia Stenosis Meckel’s diverticulum
CLINICAL MANIFESTATIONS In Gastroschisis the bowel eviscerates into the amniotic cavity, and exposure to the amniotic fluid results in thickened, beefy- red, edematous intestines.
THERAPEUTIC MANAGEMENT When bowel obstruction in confirmed, an orogastric o nasogastric tube in inserted and then attached to low suction or left open to the air to prevent further gastrointestinal distention from swallowed air. Intravenous therapy is necessary to restore fluid Immediate surgery is scheduled because bowel obstruction is an emergency that must be treated before dehydration ,electrolyte imbalance, or aspiration of vomitus occurs
NURSING MANAGEMENT Thermoregulation is critical because significant heat loss can occur through the exposed intestines . Use warmers and monitor the child’s temperature Use sterile technique in dealing with the defect.Immediately cover w/ warm, moist, sterile gauze;and wrap w/ plastic to keep moist. minimize movement of the infant and handling of the intestines.
Assess for circulatory compromise, obstruction, sepsis: monitor temperature, pulses, capillary refill time, skin color, changes in the respiratory patterns and heart rate. Observe for respiratory distress secondary to high intraabdominal pressure as the gut returns to the peritoneal cavity. Fluid-volume management is crucial nursing responsibility: monitor intake and output and daily weights, assess fontanels and maintain IV line.
Maintain NG tube for decompression, monitor bowel sounds and stools, measure abdominal girth. Maintain parenteral nutrition to sustain growth Offer pacifier to meet sucking needs Provide emotional support for parents as they deal with the loss of the “perfect child” Encourage parents to provide care as they are able, talk to and touch infant, and hold the infant when appropriate.
TWO ACCEPTED SURGICAL TECHNIQUES Primary Repair - is the procedure of choice if the abdominal contents will fit into the abdominal cavity.
Staged Repair - a synthetic material (silastic) is used to create a sac to cover the abdominal contents.