Nursing Care Plan for Imperforate Anus

Pathophysiology

Known as an anorectal malformation, imperforate anus is a birth defect in which the anus and the rectum are not properly developed and the patient is born without an anal opening, or the anal opening is in the wrong place. Anorectal malformations occur in 1 out of 5,000 infants born.

Etiology

Normally, the rectum and anus are formed during the 5th – 8th weeks of gestation.  In the case of imperforate anus, the anal membrane fails to rupture and form the anus. There may be some genetic links to the development of imperforate anus. Studies have shown a link in patients with this condition and Down’s Syndrome and other congenital abnormalities. This condition is normally diagnosed within the first 24 hours of life and surgical intervention is usually necessary.  

Desired Outcome

Patient will have normal fluid balance; patient will be free from infection; patient will have a normal elimination pattern.

Imperforate Anus Nursing Care Plan

Subjective Data:

  • Reports of passing stool from the vagina, scrotum, urethra or other abnormal location (may indicate a fistula has formed)
  • Report of no bowel movement after birth

Objective Data:

  • No anal opening
  • Anal opening in the wrong place
  • Abdominal distention
  • Failure to pass stool (meconium)

Nursing Interventions and Rationales

  1. Perform complete physical assessment

  2. This condition is usually diagnosed within the first 24 hours of life. Note if the patient has anal opening and if it appears to be located in the anatomically correct location.

  3. Observe for passage of meconium stools

  4. Patients with imperforate anus are either unable to pass stool (meconium) at all, or it is passed from an inappropriate location. For female infants, carefully note if the meconium is passed from anus, vagina or urethra. For male patients, the anal opening may be located below the penis or the scrotum.

  5. Monitor vital signs

  6. Patients will often have other congenital malformations. Monitor heart rate and rhythm, respiratory effort and rate and temperature. Axillary temperature may be more appropriate instead of rectal.

  7. Prepare patient for diagnostic tests and surgery

  8. Patient will likely undergo several tests including imaging and labs prior to the determination for surgery. Ultimately, the patient may require a colostomy placed.

  9. Monitor skin integrity and provide wound care following surgery

  10. The passage of stool from incorrect locations can lead to rapid skin breakdown. Following surgery, assess incision site and provide wound care per facility protocol. Observe for signs of infection.

  11. Provide colostomy care if appropriate

  12. A colostomy may be required. Provide colostomy care per facility protocol and as needed. Educate parents to care for patient with colostomy. Assess the stoma for bleeding or signs of infection.

  13. Provide education for parents

    • Parents will often be very anxious about their baby’s condition. Help by providing resources and information or contacts for support groups.
    • Educate parents on how to care for the patient post-surgery and at home.
    • As the child grows, constipation may be an issue and a longer period may be required for toilet training.
    • Encourage good nutrition with high fiber foods.


References

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