Omphalocele and Gastroschisis.pptx GROUP 5 FINAL COPY.pptx

Nursing management of children with omphalocele

1. Omphalocele and Gastroschisis GROUP FIVE

2. GROUP MEMBERS Martha Satumba Integrity Banda Thandizo Lungu Funny Makhumbiza Hope Mkwanda Tamandani Chilinda Mercy Jere

3. BROAD OBJECTIVE By the end of this presentation student nurses should acquire knowledge about omphalocele and gastroschisis

4. SPECIFIC OBJECTIVES By the end of this presentation student nurses should be able to: Describe omphalocele and gastr o schisis State the incidence of the omphalocele and gastr o schisis State the etiology omphalocele and gastr o schisis State the predisposing factors Describe the pathophysiology of omphalocele and gastr o schisis

5. SPECIFIC OBJECTIVES E xplain the clinical manifestations of omphalocele and gastr o schisis Desribe how gastroschisis and omphalocele is diagnosed State the nursing diagnosis and nursing mananagement Describe the medical and surgical management of omphalocele and gastroschisis Explain the patient teachings about omphalocele and gastroschisis

6. SPECIFIC OBJECTIVES State the complications of omphalocele and gastroschisis

7. DEFINITION OF TERMS Gastro "belly"or "abdomen " -schisis ‘to split,to separate’ "omphalo-", refers to the umbilicus -cele meaning pouch

8. DESCRIPTION Gastroschisis and omphalocele are two of the most com mon congenital abdominal wall defects. In gastroschisis an infant’s intestines, and sometimes other abdominal organs like the stomach or liver, protrude through a hole in the abdominal wall next/lateral to the umbilicus (Hockenberry et al., 2019) .

9. DESCRIPTION In o mphalocele an infant's abdominal organs, such as the intestines, liver, and sometimes other organs, protrude outside the abdominal cavity through the base of the umbilical cord. Unlike gastroschisis, the organs in omphalocele are covered by a thin, translucent sac made of peritoneum and amniotic membrane.

10. GASTROSCHISIS OMPHALOCELE

11. INCIDENCE Lack of data on the prevalence in Malawi 60% mortality in Malawi Incidence 2-5 per 10000 births (Stevens et al., 2016) .

12. AETIOLOGY The exact aetiology of gastroschisis /omphalocele is not fully understood I t is believed to result from a combination of genetic, environmental, and maternal factors. M ultiple risk factors have been identified.

13. PREDISPOSING FACTORS Genetic factors G a stroschisis associations with certain gene mutations, but there is no clear pattern of inheritance Omphalocele is often associated with genetic conditions and chromosomal abnormalities, such as:

14. PREDISPOSING FACTORS Trisomy 13 (Patau syndrome) Trisomy 18 (Edwards syndrome) Trisomy 21 (Down syndrome) It can also occur as part of genetic syndromes like Beckwith-Wiedemann syndrome.

15. PREDISPOSING FACTORS Maternal smoking I ncreased risk of gastroschisis in mothers who smoke during pregnancy. Drug and alcohol use Recreational drug use (especially cocaine) and alcohol consumption have also been linked to gastroschisis.

16. PREDISPOSING FACTORS Exposure to environmental toxins Certain environmental chemicals and agricultural pesticides may be associated with the condition. Maternal age Gastroschisis is more common in younger mothers < 20 (Raitio et al., 2020) . May involve biological, social, or environmental factors unique to younger women.

17. PREDISPOSING FACTORS Nutritional factors Poor maternal nutrition V itamins deficiencies .e.g. folic acidSocioeconomic factors Lower socioeconomic status P otentially related to lifestyle factors, limited prenatal care, and higher exposure to environmental toxins

18. DIFFERENCES IN RISK FACTORS Maternal Age Gastroschisis is more common in younger mothers, while omphalocele is more common in older mothers. Omphalocele is frequently associated with genetic syndromes and chromosomal abnormalities, whereas gastroschisis typically occurs as an isolated condition.

19. DIFFERENCES IN RISK FACTORS Environmental Exposures: Gastroschisis has stronger links to environmental factors .e.g. smoking, drug use, and poor nutrition, while omphalocele is more associated with genetic factors.

20. PATHOPHYSIOLOGY G astroschisis involves an abnormal development of the abdominal wall during early embryogenesis The abdominal wall normally forms by the fusion of lateral body folds that meet at the midline around the 6th week of gestation. In gastroschisis, this process is disrupted, leading to a small defect (usually to the right of the umbilicus) through which the intestines herniate.

21. PATHOPHYSIOLOGY Omphalocele T he intestines temporarily protrude outside the abdominal cavity into the umbilical cord due to rapid growth of the liver and intestines, a process known as physiological herniation. By the 10th to 12th week, the intestines are supposed to return to the abdominal cavity as it enlarges. In omphalocele, this process fails, and the organs remain outside the abdomen, enclosed in a thin sac of peritoneum and amnion (Zahouani & Mendez, 2021) .

22. CLINICAL MANIFESTATIONS Visible abdominal wall defect (usually to the right of the umbilicus) Exposed intestines with no protective membrane Inflamed and thickened intestines (due to exposure to amniotic fluid) Delayed or absent bowel movements (delayed meconium passage) Feeding intolerance (difficulty in feeding, vomiting) Abdominal distension

23. CLINICAL MANIFESTATIONS Malrotation of the intestines (abnormal twisting or positioning) Bowel atresia (absence or narrowing of sections of the intestine) Dehydration (fluid loss from exposed intestines) Electrolyte imbalances Respiratory distress (in severe cases due to increased abdominal pressure)

24. CLINICAL MANIFESTATIONS IN OMPHALOCELE Organs covered by a protective membrane (peritoneum and amnion). Large or small abdominal herniation, depending on the size of the defect. Associated congenital anomalies (e.g.heart defects, neural tube defects). Chromosomal abnormalities (e.g.Trisomy 13, 18, 21) often associated (Pijpers et al., 2023) .

25. NURSING ASSESSMENT AND DIAGNOSTIC TESTS History Physical examination Prenatal Diagnostic Tests s .g. Ultrasound Detects abdominal wall defects and herniated organs. early diagnosis, planning treatment, and managing associated conditions.

26. DIAGNOSTIC TESTS Amniocentesis Used primarily for omphalocele to screen for chromosomal abnormalities. Fetal Echocardiogram Performed in cases of omphalocele due to the high risk of congenital heart defects.

27. DIAGNOSTIC TESTS Postnatal Diagnostic Tests: Physical Examination Visual confirmation of the abdominal defect. X-rays/Abdominal Radiographs Blood Tests To check for electrolyte imbalances, dehydration, and infection (especially in gastroschisis).

28. DIAGNOSTIC TESTS CT Scan or MRI For detailed imaging in severe or complex cases. Genetic Testing For chromosomal anomalies, especially in omphalocele.

29. NURSING DIAGNOSIS AND MANAGEMENT Risk for infection related to the presence of an exposed abdominal sac Goal: The patient will remain free from signs of infection, as evidenced by normal body temperature after nursing interventions

30. NURSING DIAGNOSIS AND MANAGEMENT Risk for fluid volume deficit related to exposed abdominal organs and potential fluid loss. Goal: The patient will maintain adequate fluid and electrolyte balance as evidenced by stable laboratory values, urine output, and normal vital signs.

31. NURSING DIAGNOSIS AND MANAGEMENT Interventions : Monitor the integrity of the abdominal sac Rationale: To identify early signs of rupture or infection. Maintain sterile dressings over the sac Rationale: Prevent contamination of the exposed sac, which is highly susceptible to infection. Administer prophylactic antibiotics as prescribed Rationale: To reduce the risk of infection in an open area.

32. NURSING DIAGNOSIS AND MANAGEMENT Monitor vital signs, especially temperature and heart rate Rationale: Fever and tachycardia can be early signs of infection. Prepare the family for surgical repair by educating them about the procedure and postoperative care Rationale: Early surgery is essential to protect the exposed organs, and family understanding can promote compliance and reduce anxiety.

33. NURSING DIAGNOSIS AND MANAGEMENT Impaired skin integrity related to exposed abdominal organs. Goal: The patient's skin and underlying tissue will remain intact without signs of injury or infection.

34. NURSING DIAGNOSIS AND MANAGEMENT Interventions: Apply a sterile, non-adherent dressing to the omphalocele sac Rationale: To protect the exposed organs and prevent friction or trauma. Position the infant to avoid pressure on the sac Rationale: Protects the sac from rupturing and causing further complications.

35. NURSING DIAGNOSIS AND MANAGEMENT Maintain hydration by administering IV fluids Rationale: To maintain adequate circulation and tissue perfusion, promoting healing and reducing the risk of skin breakdown Assess for any changes in the sac's appearance (color, size, or leakage) Rationale: Changes may indicate deterioration or rupture, necessitating immediate medical attention.

36. NURSING DIAGNOSIS AND MANAGEMENT Risk for fluid volume deficit related to exposed abdominal organs and potential fluid loss. Goal: The patient will maintain adequate fluid and electrolyte balance as evidenced by stable laboratory values, urine output, and normal vital signs.

37. NURSING DIAGNOSIS AND MANAGEMENT Interventions: Monitor fluid and electrolyte levels regularly Rationale: Exposed organs increase fluid loss, making it crucial to monitor for imbalances.

38. NURSING DIAGNOSIS AND MANAGEMENT Administer IV fluids and electrolytes as ordered Rationale: To replace fluid losses and prevent dehydration and electrolyte imbalances. Measure urine output hourly Rationale: Urine output is a reliable indicator of fluid status and kidney function.

39. NURSING DIAGNOSIS AND MANAGEMENT Maintain a sterile, moist dressing over the exposed organs Rationale: Prevent dehydration of the exposed organs and minimize fluid loss. Collaborate with a surgical team for prompt repair of the defect Rationale: Early surgical closure is key to reducing ongoing fluid losses.

40. MEDICAL AND SURGICAL MANAGEMENT Immediate Postnatal Care Protection of Exposed Organs Temperature Regulation Fluid and Electrolyte Management Keep NPO NGT for drainage TPN

41. MEDICAL AND SURGICAL MANAGEMENT Intake and output chart Antibiotics Respiratory Support Preoperative Monitoring and Stabilization Monitoring for Complications Stomach Decompression via nasogastric tube

42. SURGICAL MANAGEMENT Primary Surgical Closure If the abdominal cavity can accommodate the exposed organs without causing excessive pressure on the lungs or other organs, a primary closure is performed. T he surgeon returns the intestines and other exposed organs to the abdominal cavity and closes the abdominal wall defect in one operation.

43. MEDICAL AND SURGICAL MANAGEMENT Staged (Delayed) Surgical Closure In many cases, the intestines are swollen and cannot fit back into the abdominal cavity at once so a staged or delayed approach is used A silo (a sterile, protective, mesh-like bag) is placed over the intestines. This allows the intestines to be gradually returned to the abdomen over several days (Davenport, 2018) ‌

44. PATIENT TEACHING E xplain the condition in simple terms Pre-surgery care: explain that the exposed organs are wrapped in sterile, moist dressings to protect them until surgery. Explain that s urgical repair is needed Nutrition: Initially, the baby will be kept NPO and receive nutrition intravenously (TPN). Oral or tube feedings will be introduced gradually after surgery

45. PATIENT TEACHING Wound care: Teach parents how to clean and care for the surgical site after discharge. Joining support groups or seeking counseling can help with coping.

46. PATIENT TEACHING Follow the guidance on feeding, wound care, and monitoring for complications. Regular pediatric checkups to monitor growth and development Teach the parents s igns to report: Fever, lack of bowel movements, vomiting, or swelling at the surgical site Emphasiese importance of attending all f ollow-up care appointments

47. COMPLICATIONS Bowel d ysfunction .e.g. Malrotation Bowel i nflammation , ischemia or necrosis Infection Electrolyte abnormalities .e.g. Hypokalemia, Hyponatremia Sepsis Omphalocele may have a ssociated co ngenital an omalies .e.g. c ardiac defects

48. REFERENCES Davenport, M. (2018) . Paediatric Surgery. Oxford Univ Press. Frolov, P., Alali, J., & Klein, M. D. (2010). Clinical risk factors for gastroschisis and omphalocele in humans: a review of the literature. Pediatric Surgery International, 26 (12), 1135–1148. https://doi.org/10.1007/s00383-010- 2701-7 Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong’s nursing care of infants and children (11th ed.). Elsevier.

49. REFERENCES Pijpers, A. G. H., de Beaufort, C. M. C., Maat, S. C., Broers, C. J. M., Straver, B., van Heurn, E., Gorter, R. R., & Derikx, J. P. M. (2023). Additional Anomalies in Children with Gastroschisis and Omphalocele: A Retrospective Cohort Study. Children , 10(4), 688. https://doi.org/10.3390/children10040688 Raitio, A., Tauriainen, A., Leinonen, M. K., Syvänen, J., Kemppainen, T., Löyttyniemi, E., Sankilampi, U., Gissler, M., Hyvärinen, A., & Helenius, I. (2020). Maternal risk factors for gastroschisis: A population‐based case–control study. Birth Defects Research, 112 (13), 989–995. https://doi.org/10.1002/bdr2.1703

50. REFERENCES Stevens, P., Muller, E., & Becker, P. (2016). Gastroschisis in a developing country: Poor resuscitation is a more significant predictor of mortality than postnatal transfer time. South African Journal of Surgery, 54(1), 4–9. https://www.scielo.org.za/scielo.php?script=sci_arttext&pid =S0038-2361201600010000 rg/10.3390/children10040688 Zahouani, T., & Mendez, M. D. (2021) . Omphalocele. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519010/