Nursing Care Plan for Omphalocele

Pathophysiology

Omphalocele is a birth defect in which the intestines and possibly other abdominal organs, such as the liver, protrude outside the body through a hole in the belly button. These organs are contained in a peritoneal sac with a thin membrane. Infants born with this condition often have other accompanying congenital defects including cardiovascular or genitourinary problems.  This is a rare condition that only affects 1 in every 4,000 – 7,000 live births.

Etiology

During gestational weeks 6 -10, the intestines grow and push out of the abdomen by the umbilical cord. By week 11,  if the intestines do not return, the result is an omphalocele. While the exact cause of omphalocele is unknown, it is believed by researchers that some factors (advanced maternal age, smoking and drinking alcohol during pregnancy, use of selective serotonin reuptake inhibitors during pregnancy and obesity) may increase the risk of the development of this and other birth defects.

Desired Outcome

Patient will be free from infection; patient will have adequate nutrition; patient will be free from intestinal obstruction

Omphalocele Nursing Care Plan

Subjective Data:

  • Difficulty feeding
  • Colicky

Objective Data:

  • Protrusion of organs through belly button
  • Increased respiratory effort

Nursing Interventions and Rationales

  1. Perform a complete nursing assessment of systems: heart, lungs, skin, neurologic and genitourinary system

  2. Infants born with this condition often have other accompanying congenital defects including cardiovascular or genitourinary problems. Some patients may have central nervous system defects as well.

  3. Cover sac with saline-soaked sterile gauze and plastic bowel bag

  4. This helps to prevent loss of fluids and to keep the intestines moist to prevent drying/damage.

  5. Assess appearance of omphalocele

  6. Measure sac, note changes in color, presence of organs (liver) within the sac, twisting of intestines or defects in the sac

  7. Assess vitals

  8. Monitor patient for temperature fluctuations and signs of hypothermia or fever.

  9. Initiate IV access

  10. Loss of fluids can be detrimental to the infant. Maintain adequate hydration.

    Provide access for administration of antibiotics if necessary and sedation for surgery. Central access may be required for TPN.

  11. Evaluate nutritional needs and manage TPN if required

  12. The infant may require TPN for nutrition while the intestines are being decompressed, since the enteral route will be unavailable.

  13. Insert nasogastric tube for decompression

  14. The intestines should be decompressed to decrease stress on the intestines and to decrease the size of the intestines within the sac. This will help the infant’s chances of not requiring surgical intervention.

  15. Prepare patient for intubation / manage endotracheal tube and ventilator

  16. Infants with omphalocele may experience respiratory distress or require sedation and intubation to protect their respiratory system.

  17. Prepare patient for surgery

  18. Surgery may be done all at once or  in stages to protect the internal organs and prevent obstruction

  19. Perform dressings and care of omphalocele as appropriate

  20. Sterile dressings will be used to protect the sac and the infant from infection

  21. Provide education for parents / caregivers of patient and instructions for home care

    • Some forms of treatment may require home care that will be provided by the parents / caregivers.
    • Provide instruction and demonstrations to help the family become more comfortable with caring for the infant.
    • Provide information and resources including support groups for caregivers.
    • Answer questions to help relieve anxieties.


References

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