Anorectal malformations are developmental deformities of the lower end of the alimentary tract that occur due to arrest in embryonic development between weeks 4-12. They range from minor abnormalities like anal stenosis to major ones where there is no anal opening. Surgical correction depends on type and aims to reconstruct bowel continuity. Post-operative care focuses on perineal care, feeding, bowel habits and prevention of complications like infection and obstruction. Prognosis is good for most, with majority achieving bowel control.
Bladder exstrophy is a congenital (present at birth) abnormality of the bladder. It happens when the skin over the lower abdominal wall (bottom part of the tummy) does not form properly, so the bladder is open and exposed on the outside of the abdomen. In epispadias, the urethra does not form properly.
Bladder exstrophy is a congenital (present at birth) abnormality of the bladder. It happens when the skin over the lower abdominal wall (bottom part of the tummy) does not form properly, so the bladder is open and exposed on the outside of the abdomen. In epispadias, the urethra does not form properly.
a short demonstration on appendicitis in children describing the anatomy,embryology,anatomical variations,etio-patho-physiology of appendicitis,different presentations in various age groups,diagnostic pathways,differential diagnosis,management,complication and outcome
A developmental anomaly is a broad term used to define conditions which are present at conception or occur before the end of pregnancy. In the case of cerebral palsy, a small number also occur after birth. this is also a birth defect.
A Tracheoesophageal fistula is a congenital disease. It is a acquired communication between the trachea and esophagus. Most of the patient with TEF are diagnosed immediately following after birth.TEF are often associated with life threatening complications.
Detailed Powerpoint Presentation on Wilms Tumour …. It includes definition with images, causes, sign and symptoms all treatment modalities with nursing responsibilities and recent research related to this...
PYLORIC STENOSIS:
Review the anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of pyloric stenosis
Enumerate the complications of pyloric stenosis
A Tracheoesophageal fistula (TEF) is an abnormal connection (fistula) between the Oesophagus and the trachea. TEF is a common congenital abnormality.
Oesophageal atresia is failure of oesophagus to form a continuous passage from the pharynx to the stomach
TEF is an abnormal connection between the trachea and the oesophagus
a short demonstration on appendicitis in children describing the anatomy,embryology,anatomical variations,etio-patho-physiology of appendicitis,different presentations in various age groups,diagnostic pathways,differential diagnosis,management,complication and outcome
A developmental anomaly is a broad term used to define conditions which are present at conception or occur before the end of pregnancy. In the case of cerebral palsy, a small number also occur after birth. this is also a birth defect.
A Tracheoesophageal fistula is a congenital disease. It is a acquired communication between the trachea and esophagus. Most of the patient with TEF are diagnosed immediately following after birth.TEF are often associated with life threatening complications.
Detailed Powerpoint Presentation on Wilms Tumour …. It includes definition with images, causes, sign and symptoms all treatment modalities with nursing responsibilities and recent research related to this...
PYLORIC STENOSIS:
Review the anatomy and physiology of digestive system
Review the incidence of pyloric stenosis
Define pyloric stenosis
Explain the causes and risk factors of pyloric stenosis
Describe the pathophysiology of pyloric stenosis
Enumerate clinical features of pyloric stenosis
Enlist the diagnostic evaluation for pyloric stenosis
Explain the management of pyloric stenosis
Enumerate the complications of pyloric stenosis
A Tracheoesophageal fistula (TEF) is an abnormal connection (fistula) between the Oesophagus and the trachea. TEF is a common congenital abnormality.
Oesophageal atresia is failure of oesophagus to form a continuous passage from the pharynx to the stomach
TEF is an abnormal connection between the trachea and the oesophagus
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
3. INCIDENCEINCIDENCE
Minor abnormalities of the anus and rectumMinor abnormalities of the anus and rectum
occur in 1 in 500 living newborns whileoccur in 1 in 500 living newborns while
major abnormalities occur in 1 in 5000major abnormalities occur in 1 in 5000
living infants.living infants.
4. CAUSECAUSE
The exact cause of these malformations isThe exact cause of these malformations is
not known. It occurs due to the arrest in thenot known. It occurs due to the arrest in the
embryonic development of the anus, lowerembryonic development of the anus, lower
rectum and urogenital tract at the 8th weekrectum and urogenital tract at the 8th week
of embryonic life.of embryonic life.
5. CAUSECAUSE CONTDCONTD……
The membrane that separates theThe membrane that separates the
endodermal hindgut from the ectodermalendodermal hindgut from the ectodermal
anal dimple perforates and a continuousanal dimple perforates and a continuous
canal is formed, the outlet of which is thecanal is formed, the outlet of which is the
anus.anus.
6. CAUSECAUSE CONTDCONTD……
If the membrane separating the rectumIf the membrane separating the rectum
from the anus is not absorbed, and if thefrom the anus is not absorbed, and if the
union does not take place, an anorectalunion does not take place, an anorectal
anomaly results.anomaly results.
7. CAUSE CONTDCAUSE CONTD……
Approximately 40% of the neonates withApproximately 40% of the neonates with
anorectal malformations have associatedanorectal malformations have associated
anomalies like Down’s syndrome,anomalies like Down’s syndrome,
congenital heart disease, undescendedcongenital heart disease, undescended
testes, renal abnormalities, esophagealtestes, renal abnormalities, esophageal
atresia and neural tube defect.atresia and neural tube defect.
8. TYPESTYPES
ACCORDING TO THE VISIBILITY OFACCORDING TO THE VISIBILITY OF
THE ANUS:THE ANUS:
a) With a visible abnormal opening ofa) With a visible abnormal opening of
the bowelthe bowel
1)Anal stenosis:1)Anal stenosis: It accounts for 10% of allIt accounts for 10% of all
ARMs. A stricture is at the anus or at levels 1ARMs. A stricture is at the anus or at levels 1
to 4 cm above the anus, or extends the entireto 4 cm above the anus, or extends the entire
length of the anus.length of the anus.
12. TYPES CONTDTYPES CONTD……
b) With an invisible but manifested openingb) With an invisible but manifested opening
of the bowelof the bowel::
1)1) Rectovaginal fistula in femaleRectovaginal fistula in female
15. TYPES CONTD…TYPES CONTD…
c)c) No manifested opening of the bowelNo manifested opening of the bowel
1)1) Persistent anal membrane or imperforatePersistent anal membrane or imperforate
anusanus: Here there is an imperforate anal: Here there is an imperforate anal
membrane that produces obstructionmembrane that produces obstruction
behind which the meconium is seen.behind which the meconium is seen.
18. TYPES CONTD…TYPES CONTD…
a) On the basis of levator ani musclea) On the basis of levator ani muscle
1) Supralevator or high ano-rectal1) Supralevator or high ano-rectal
malformationmalformation:: When rectum terminatesWhen rectum terminates
above the levator ani muscle, which is foundabove the levator ani muscle, which is found
as rectal atresia, rectoprostatic fistula andas rectal atresia, rectoprostatic fistula and
rectovaginal fistula.rectovaginal fistula.
19. TYPES CONTDTYPES CONTD……
2)2) Translevator or low anoTranslevator or low ano--rectal malformationrectal malformation
: When rectum terminates below the levator: When rectum terminates below the levator
ani muscle found in ano-cutaneous fistulaani muscle found in ano-cutaneous fistula
and anovestibular fistula.and anovestibular fistula.
20. ANAL AGENESISANAL AGENESIS
There is an imperforate anus, possibly seenThere is an imperforate anus, possibly seen
as a dimple. The rectal pouch ends blindlyas a dimple. The rectal pouch ends blindly
some distance above the anus or forms asome distance above the anus or forms a
fistula with other organs leading tofistula with other organs leading to
– Rectovaginal fistula- low and high (female)Rectovaginal fistula- low and high (female)
– Rectoperineal fistula (male and female)Rectoperineal fistula (male and female)
– Rectovesical fistula (male)Rectovesical fistula (male)
– Rectourethral fistula (male)Rectourethral fistula (male)
– Rectoprostatic fistula (male)Rectoprostatic fistula (male)
23. RECTAL ATRESIARECTAL ATRESIA
There is a normal anus and anal pouch.There is a normal anus and anal pouch.
The rectal pouch ends blindly in the hollowThe rectal pouch ends blindly in the hollow
of the sacrum. The anus might form aof the sacrum. The anus might form a
fistula with other parts leading tofistula with other parts leading to
– Ano vestibular fistula (female)Ano vestibular fistula (female)
– Ano perineal fistula (male and female)Ano perineal fistula (male and female)
– Ano cutaneous fistula (male and female)Ano cutaneous fistula (male and female)
24. CLOACAL EXSTROPHYCLOACAL EXSTROPHY
It is a rare, severe defect in which there isIt is a rare, severe defect in which there is
externalization of the bladder and bowel throughexternalization of the bladder and bowel through
the abdominal wall. Often the genetalia arethe abdominal wall. Often the genetalia are
indefinite, and the chromosome studies areindefinite, and the chromosome studies are
necessary to determine the child’s sex. Thesenecessary to determine the child’s sex. These
children are mostly femaleschildren are mostly females
25. CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
– Absence of meconiumAbsence of meconium
– No anal openingNo anal opening
– Unable to insert a gloved finger or a rectalUnable to insert a gloved finger or a rectal
thermometer into the rectumthermometer into the rectum
– Abdominal distentionAbdominal distention
26. CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
– History of difficult defecation, abdominal distentionHistory of difficult defecation, abdominal distention
and ribbon like stools in an older child in case of analand ribbon like stools in an older child in case of anal
stenosis.stenosis.
– Greenish bulging membrane behind anus in case ofGreenish bulging membrane behind anus in case of
imperforate anal membraneimperforate anal membrane
– Intestinal obstruction if no fistulasIntestinal obstruction if no fistulas
– Passage of meconium through vagina, perineal orificePassage of meconium through vagina, perineal orifice
or with urine in case of fistulaor with urine in case of fistula
27. DIAGNOSTIC TESTSDIAGNOSTIC TESTS
Physical examination by passing the glovedPhysical examination by passing the gloved
little finger through the anus and bylittle finger through the anus and by
observing the passage through whichobserving the passage through which
meconium was passed.meconium was passed.
Ultrasounds scan to locate the rectal pouch.Ultrasounds scan to locate the rectal pouch.
28. DIAGNOSTIC TESTSDIAGNOSTIC TESTS contd…contd…
X-ray with inverted infant called asX-ray with inverted infant called as
invertogram or Wangensteen-Rice X-rayinvertogram or Wangensteen-Rice X-ray
when the infant is 24 hrs of age.when the infant is 24 hrs of age.
Urine examination for presence ofUrine examination for presence of
meconium and epithelial debris.meconium and epithelial debris.
29. DIAGNOSTIC TESTSDIAGNOSTIC TESTS contd…contd…
Micturating cystourethrogram (MCU) toMicturating cystourethrogram (MCU) to
detect urinary abnormalities.detect urinary abnormalities.
Intravenous pyelogram to rule outIntravenous pyelogram to rule out
vesicourethral reflux.vesicourethral reflux.
30. MANAGEMENTMANAGEMENT
The reconstructive surgery is done toThe reconstructive surgery is done to
correct or repair the congenitalcorrect or repair the congenital
malformations. It depends upon the type ofmalformations. It depends upon the type of
anomaly and sex of the infant.anomaly and sex of the infant.
31. MANAGEMENT CONTDMANAGEMENT CONTD……
In case of low ARMs, where there is lessIn case of low ARMs, where there is less
than 1.5cm distance between the analthan 1.5cm distance between the anal
dimple and the rectal pouch, rectal cutbackdimple and the rectal pouch, rectal cutback
anoplasty or Y-V plasty is done for maleanoplasty or Y-V plasty is done for male
infants and dilation of fistula with definitiveinfants and dilation of fistula with definitive
repair or perineal anoplasty is performedrepair or perineal anoplasty is performed
for female infants.for female infants.
32. MANAGEMENT CONTDMANAGEMENT CONTD……
In case of high ARMs, where there is more than 1.5cmIn case of high ARMs, where there is more than 1.5cm
distance between the anal dimple and the rectal pouch,distance between the anal dimple and the rectal pouch,
initial colostomy is done in the neonatal period followed byinitial colostomy is done in the neonatal period followed by
definitive reconstructive surgery as posterior sagittal ano-definitive reconstructive surgery as posterior sagittal ano-
rectoplasty at the age of 10 to 12 months or when therectoplasty at the age of 10 to 12 months or when the
infant is having 7 to 9 kg body weight. Colostomy closure isinfant is having 7 to 9 kg body weight. Colostomy closure is
done after 10 to 12 weeks of successful definitive surgery.done after 10 to 12 weeks of successful definitive surgery.
33. MANAGEMENT CONTD…MANAGEMENT CONTD…
In case of imperforate anal membrane, theIn case of imperforate anal membrane, the
membrane is perforated with a bluntmembrane is perforated with a blunt
instrument. Repeated dilatation might beinstrument. Repeated dilatation might be
necessary to prevent scar formation.necessary to prevent scar formation.
34. MANAGEMENT CONTDMANAGEMENT CONTD……
In case of anal stenosis, dilatation is done every 4-6In case of anal stenosis, dilatation is done every 4-6
months.months.
In case of fistulas, the colon can be brought downIn case of fistulas, the colon can be brought down
through the anal dimple by an abdominoperinealthrough the anal dimple by an abdominoperineal
procedure. The anus is positioned in the area ofprocedure. The anus is positioned in the area of
external sphincter and the fistula is removed.external sphincter and the fistula is removed.
35. PREOPERATIVE CARE:PREOPERATIVE CARE:
– Gastric suction may be doneGastric suction may be done
– Withhold oral feedingsWithhold oral feedings
– Start parenteral hydrationStart parenteral hydration
– Measurement of abdominal girthMeasurement of abdominal girth
– Intake output chartIntake output chart
– Consent from parentsConsent from parents
– Pre-medicationsPre-medications
36. POST OPERATIVE CAREPOST OPERATIVE CARE
Scrupulous perineal careScrupulous perineal care
Change perineal dressings whenever soiledChange perineal dressings whenever soiled
Apply protective ointments such as zinc oxides toApply protective ointments such as zinc oxides to
decrease skin irritation.decrease skin irritation.
Position baby in a side-lying or a supine positionPosition baby in a side-lying or a supine position
with the legs suspended at a 90° angle to the trunkwith the legs suspended at a 90° angle to the trunk
to prevent pressure on perineal suturesto prevent pressure on perineal sutures
37. POST OPERATIVE CAREPOST OPERATIVE CARE contdcontd……
Intravenous feedings till the wound heals orIntravenous feedings till the wound heals or
until peristalsis appear.until peristalsis appear.
Prevention of constipation by exclusivePrevention of constipation by exclusive
breastfeeding and proper weaning withbreastfeeding and proper weaning with
stool softeners or fibers.stool softeners or fibers.
Bowel habit trainingBowel habit training
38. POST OPERATIVE CARE contdPOST OPERATIVE CARE contd……
Daily enemas until control are achieved ifDaily enemas until control are achieved if
necessary.necessary.
Do not use diaper in case of anoplastyDo not use diaper in case of anoplasty
Colostomy care by changing the collection deviceColostomy care by changing the collection device
and meticulous skin care.and meticulous skin care.
Family support, discharge planning and homeFamily support, discharge planning and home
carecare
39. COMPLICATIONSCOMPLICATIONS
Urinary tract infectionUrinary tract infection
Intestinal obstructionIntestinal obstruction
Fecal impactionFecal impaction
Colostomy related problemsColostomy related problems
Recurrence of fistulaRecurrence of fistula
Anal stenosisAnal stenosis
Poor bowel controlPoor bowel control
ConstipationConstipation
40. PROGNOSISPROGNOSIS
– About 30% of children with high ARMs orAbout 30% of children with high ARMs or
associated genitor urinary fistula achieve bowelassociated genitor urinary fistula achieve bowel
continence.continence.
– About 90% of children with low ARMs achieveAbout 90% of children with low ARMs achieve
bowel continence.bowel continence.
41. NURSING CARENURSING CARE
Preoperative :Preoperative : Impaired bowel elimination related to bowelImpaired bowel elimination related to bowel
malformation as evidenced by lack of patency ormalformation as evidenced by lack of patency or
passage of stool through a different opening.passage of stool through a different opening.
Goal: The child will pass meconium and will not have abdominal distentionGoal: The child will pass meconium and will not have abdominal distention
Interventions:Interventions:
If there is a fistula, keep the perineum clean until surgery.If there is a fistula, keep the perineum clean until surgery.
Follow pre-operative orders.Follow pre-operative orders.
Do gastric decompression with NG tube.Do gastric decompression with NG tube.
Start IV line.Start IV line.
Follow strict nil per oral.Follow strict nil per oral.
42. Nursing care contdNursing care contd……
2) Fluid volume deficit related to nil per oral2) Fluid volume deficit related to nil per oral
Goal: The child will maintain normal fluid balanceGoal: The child will maintain normal fluid balance
Interventions:Interventions:
– Maintain intake output chartMaintain intake output chart
– Administer IV fluids as ordered.Administer IV fluids as ordered.
– Do gastric decompression.Do gastric decompression.
43. Nursing care contdNursing care contd……
3)3) Risk for infection (UTI) related to passage of meconium throughRisk for infection (UTI) related to passage of meconium through
urethra.urethra.
Goal: The child will have no risk for infection.Goal: The child will have no risk for infection.
Interventions:Interventions:
If there is a fistula, keep the perineum clean until surgery.If there is a fistula, keep the perineum clean until surgery.
Follow pre-operative orders.Follow pre-operative orders.
Start IV line.Start IV line.
Administer plenty of IV fluids as ordered.Administer plenty of IV fluids as ordered.
Send urine for examination.Send urine for examination.
44. Nursing care contdNursing care contd……
Postoperative:Postoperative:
1) Pain related to surgery1) Pain related to surgery
Goal: The child will have less painGoal: The child will have less pain
Interventions:Interventions:
Keep the sutured site clean.Keep the sutured site clean.
Do not spread the legs or place in prone position to avoidDo not spread the legs or place in prone position to avoid
strain on the sutures.strain on the sutures.
Keep the legs suspended at 90°angle to the trunk.Keep the legs suspended at 90°angle to the trunk.
Prevent constipation by restarting breastfeeding whenPrevent constipation by restarting breastfeeding when
peristalsis appears.peristalsis appears.
45. Nursing care contdNursing care contd……
2)Impaired skin integrity related to surgery2)Impaired skin integrity related to surgery
Goal: The wound heals faster.Goal: The wound heals faster.
Interventions:Interventions:
Keep the sutured site clean.Keep the sutured site clean.
Do not spread the legs or place in prone position to avoid strain on theDo not spread the legs or place in prone position to avoid strain on the
sutures.sutures.
Keep the legs suspended at 90°angle to the trunk.Keep the legs suspended at 90°angle to the trunk.
Prevent constipation by restarting breastfeeding when peristalsis appears.Prevent constipation by restarting breastfeeding when peristalsis appears.
Apply zinc oxide ointment to prevent skin irritation.Apply zinc oxide ointment to prevent skin irritation.
Change dressing often.Change dressing often.
Do not use diaper.Do not use diaper.
A heat lamp may be used to facilitate healing.A heat lamp may be used to facilitate healing.
46. Nursing care contdNursing care contd……
3)Risk for infection related to surgical incision in the least3)Risk for infection related to surgical incision in the least
clean area.clean area.
Goal: The child will have no risk for infection Interventions:Goal: The child will have no risk for infection Interventions:
Keep the sutured site clean.Keep the sutured site clean.
Change dressing often.Change dressing often.
Do not use diaper.Do not use diaper.
Change colostomy bag soon as it is soiled.Change colostomy bag soon as it is soiled.
Administer antibiotics if prescribed.Administer antibiotics if prescribed.
Keep the site dry.Keep the site dry.
47. Nursing care contd..Nursing care contd..
4)Impaired nutrition less than body requirement related to4)Impaired nutrition less than body requirement related to
nil per oral.nil per oral.
Goal: The child will take adequate feeds.Goal: The child will take adequate feeds.
Interventions:Interventions:
Maintain intake output chartMaintain intake output chart
Administer IV fluids as ordered.Administer IV fluids as ordered.
Do gastric decompression immediately after sugery.Do gastric decompression immediately after sugery.
Start breastfeeding when peristalsis begins.Start breastfeeding when peristalsis begins.
Monitor abdominal girth.Monitor abdominal girth.
Give laxative if child is on cow’s milk.Give laxative if child is on cow’s milk.
Increase fiber content during weaning.Increase fiber content during weaning.
48. Nursing care contdNursing care contd……
Risk for complication (constipation, fecalRisk for complication (constipation, fecal
impaction) related to interference withimpaction) related to interference with
neurological control of defecation.neurological control of defecation.
Impaired family process related to diagnosis of aImpaired family process related to diagnosis of a
congenital conditioncongenital condition
Anxiety related to surgery and hospitalization.Anxiety related to surgery and hospitalization.
Knowledge deficit regarding post operative careKnowledge deficit regarding post operative care