Newborn Congenital Anomalies PDF

NEWBORN CONGENITAL ANOMALIES IMPORTANT PRIVACY INFORMATION IT IS SAD TO HAVE TO MAKE THIS AN INTRODUCTION SLIDE; HOWEVER, WE HAVE BEEN FINDING OUR CONTENT SHARED ON OTHER SITES OR EDITED AND USED WITHOUT OUR PERMISSION. THANK YOU FOR YOUR UNDERSTANDING AND COMPLIANCE.  The following content i...

NEWBORN CONGENITAL ANOMALIES IMPORTANT PRIVACY INFORMATION IT IS SAD TO HAVE TO MAKE THIS AN INTRODUCTION SLIDE; HOWEVER, WE HAVE BEEN FINDING OUR CONTENT SHARED ON OTHER SITES OR EDITED AND USED WITHOUT OUR PERMISSION. THANK YOU FOR YOUR UNDERSTANDING AND COMPLIANCE.  The following content is protected and may not be shared, edited, or distributed. This PowerPoint Presentation is protected by U.S. copyright law.  I am the exclusive owner of the copyright in the course materials that I create. You may not reproduce, distribute, display, post, or upload my course materials or recordings or course materials in any other way without my express written consent, whether a fee is charged or not. It is for your personal educational use in this course only.  The following Textbook is used throughout this presentation: Perry, S., Lowdermilk, D., Cashion, K., Alden, K., Olshansky, E., Hockenberry, M. (2023). Maternal child nursing Care (7th ed.). Elsevier. ISBN: 978-0-323-77671-4 Textbook Reading: Chapter 25-The High-Risk Newborn *Note- Congenital Anomalies (Use links to pediatric systems and conditions chapters) NEWBORN CONGENITAL ANOMALIES OBJECTIVES Discuss common congenital anomalies and associated nursing care management of the following: Central Nervous System Anomalies: Encephalocele and Anencephaly Respiratory System Anomalies: Congenital Diaphragmatic Hernia, Choanal Atresia Gastrointestinal System Anomalies: Omphalocele and Gastroschisis, Gastrointestinal Obstruction, Anorectal Malformations Genitourinary System Anomalies: Exstrophy of the Bladder  Defect present at birth caused by genetic or environmental factors CONGENITAL ANOMALIES 2%-3% of live births Leading cause of infant deaths under 1 year of age No identifiable cause in 50% of congenital defects Cardiac most common congenital anomaly 5  CONGENITAL ANOMALIES CENTRAL NERVOUS SYSTEM ⚫ Encephalocele ⚫ Often found with other congenital anomalies ie. cardiac, cleft lip/palate, microencephaly → small brain and head ⚫ Herniation of the brain and meninges usually found in the occipital area of the skull ⚫ Treatment is surgery ⚫ Shunt placed to remove excess cerebral spinal fluid (CSF) cdc.gov 6  CONGENITAL ANOMALIES CENTRAL NERVOUS SYSTEM A for absent ⚫ Anencephaly ⚫ Most severe neural tube defect ⚫ Absence of both cerebral hemispheres and the overlying skull ⚫ Many still born, incompatible with life → fetus dies after 20 wks of pregnancy but either before or during birth ⚫ Palliative care and family support 7 cdc.gov  If surgical repair indicated- NURSING post surgery care INTERVENTIONS CENTRAL NERVOUS SYSTEM CONGENITAL ANOMALIES Family support and care always! RESPIRATORY CONGENITAL ANOMALIES  Diaphragmatic Hernia The intestine are all the way up in the chest cavity → lungs are compressed to the side  Barrel chest and scaphoid abdomen  Asymmetric chest expansion One sided  Respiratory distress  Displacement of heart sounds to the right  Spasmodic attacks of cyanosis and difficulty feeding  Bowel sounds heard in thoracic cavity → significantly louder in the chest area 9   Nursing Interventions  Maintenance of adequate respiratory status → mostly intubated DIAPHRAGMATIC  Gastric decompression HERNIA  Place infant in high semi-Fowler’s position NURSING  Turn to affected side to allow unaffected lung INTERVENTIONS expansion  Involve parents in care 10  RESPIRATORY CONGENITAL ANOMALIES  Choanal Atresia  Most common nasal congenital anomaly  Posterior nares blocked/ obstructed by membrane or bone → no air intake thro nares  Cyanosis and retractions at rest  Color improves with crying → signature sign  Noisy respirations  Difficulty breathing during feeding  Copious/thick mucous → signature sign  Nursing Interventions:  Pass feeding tube to confirm the diagnosis Try both nares CHOANAL ATRESIA  Will not advance NURSING  Insert oral airway INTERVENTIONS  Keep infant prone to prevent aspiration on secretions 12  Good prognosis with surgical repair Herniated abdominal contents contained in the peritoneal sac Intestines only or contain liver and spleen May be associated with other congenital anomalies- (mainly cardiac) or chromosomal, i.e., trisomy's Risk factors: Young/Advanced maternal age → extreme both way Obesity Use of SSRIs, alcohol, or tobacco Omphalocele GASTROINTESTINAL CONGENITAL ANOMALIES OMPHALOCELE 13 → should turn the baby on its side to support the intestine Herniation of bowel through abdominal wall defect NOT usually associated with other congenital anomalies Risk factors: Maternal age less than 20 y/o LOW maternal weight IUGR Tobacco, recreational drug and antidepressant use Genitourinary infections → any UTIs Gastroschisis Exposure to Agricultural chemical atrazine GASTROINTESTINAL CONGENITAL ANOMALIES GASTROSCHISIS 14  ⚫ Nursing Interventions Dlt insensible water loss GASTROSCHISIS  Immediately cover with saline-soaked sterile gauze and plastic wrap to avoid & insensible water loss  Thermoregulation → baby lose heat quickly OMPHALOCELE  Prevent infection NURSING  Decompress gut with orogastric tube to low wall suction INTERVENTIONS  Monitor perfusion and position on the side with support to prevent torsion of intestines 15 GI OBSTRUCTION  Obstructions can occur anywhere in GI tract  Symptoms → greenish color = red flag  Bilious emesis  Abdominal distention → bloating appearance  Failure to pass meconium  Respiratory distress if high obstruction 16  ⚫ Nursing Interventions GI  Hold feeds OBSTRUCTION  Place orogastric tube to low wall suction NURSING  Immediate surgical intervention necessary INTERVENTIONS  Bowel resection  Ostomy allowing bowel rest 17 GASTROINTESTINAL CONGENITAL ANOMALIES ANORECTAL MALFORMATION  Imperforate Anus  Infant does not pass meconium during first 24 hours  Occur in male more than female  No anal opening or abnormally located → can be thin of full covering tissue of the anus  Common fistula to genitourinary tract  Repair depends on location and if thin membrane covering anal opening  ALWAYS ASSESS FOR PATENCY! http://www.childrenshospital.org/conditions-and- → some hospital do rectal temperature to check for patency treatments/conditions/a/anorectal-malformation 18  Bladder is exposed and outside CONGENITAL ANOMALIES EXSTROPHY OF THE BLADDER  Most common bladder anomaly  Males 2X more than females  Epispadias often concurrent  Immediately cover exposed bladder with sterile gauze That soak in normal saline to keep them moist  Surgical closure of bladder often done within 48 hours after birth  Staged surgical repairs completed before school age Mayo Clinic 19 MOST IMPORTANT INTERVENTION FOR CONGENITAL ANOMALIES OF THE NEWBORN  Parental and family support  Families in crisis When they first see their newborn even tho with preknown dx  Deformities are emotionally traumatic  Parents blame themselves  Grief and loss even though infant may survive  Individuals deal with grief and loss uniquely → some become quiet, angry or emotionally NURSING THEORY TO  Caring Theory  Model of practice to help deal with loss SUPPORT FAMILIES WITH  Knowing- Understand the loss for the family A NEWBORN WITH  Being with- caring presence and CONGENITAL acceptance  Doing for- providing care for mother ANOMALIES and family  Enabling- providing information, guidance and allowing parents to make choices  Maintaining belief- encourage ability to overcome the loss