06.10 Imperforate Anus

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Overview

  1. Spectrum of congenital anomalies in which there is incomplete development of anus or complete absence of anus.

Nursing Points

General

  1. Child will require surgical repair and colostomy

Assessment

  1. Determine absence of anal opening
  2. Assess for presence of stool in urine
    1. May indicate a fistula

Therapeutic

  1. Surgical repair is required

Management

  1. Do not feed the child preoperatively
  2. Postoperatively
    1. Instruct the parents on colostomy use
      1. Colostomy and stoma care (MedSurg Course)
    2. Educate parents on dilator use
    3. Prevent infant from touching surgical site

Nursing Concepts

  1. Gastrointestinal/Liver Metabolism
  2. Elimination
  3. Human Development

Patient Education

  1. Colostomy Care
  2. Use of Dilator

Reference Links

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Transcript

Imperforate anus, well, not very common, is one that I have a personal draw to because my son, Taz, was actually born with an imperforate anus. Now, we didn’t know this, going into delivery or anything like that. When he was born, there is a nursing student there that actually, you know, did the first assessment on him when she went to take his rectal temperature, she wasn’t able to get the thermometer in there. And so, she said to her professor, you know, I’m having some struggles here. Luckily, the professor was there, he was a pediatric practitioner. You know, she assessed sure enough, she saw the imperforate anus. The director of the NICU, who just happen to be her buddy. She called him, he came, the pediatric surgeon was his buddy. He called him, he came, and so things were very for 2 of us when our son was born with imporferate anus.

Basically, what imperforated anus is it’s a spectrum of congenital anomalies in which there’s incomplete development of the anus or complete absence of the anus. The large intestine will just stop and it doesn’t, there is no where for anything to go. Now, it’s a very wide spectrum, there’s some that can be very severe, where there’s other anomalies too with the heart, with the kidneys, etc, musculoskeletal, neuro development, and that can be pretty minor. You know, where it’s really just going in and repairing this. And that’s, you know, where our son, he wasn’t very severe. It was still, you know, trying, he was our first child and he was in the NICU for a couple of weeks and then had 3 surgeries during the first year of his life. But basically, regardless of how severe it is, surgery is required to create an anus. And so, what happens is they actually will go in and create an ostomy and the child will use the ostomy for a little bit and they’ll create an anus surgically and the child will continue to use the ostomy and then will go back in and actually connect the large intestine to the anus. And what you’re hoping is, then the child will be able to function normally, have normal bowel movements and everything like that.

So, what needs to happen, first of all is you need to determine the absence of the anal opening. You need to assess for any stool in the urine. And then, you also need make sure you’re not feeding the child post operatively. Okay, the child needs to have gastric suctioning going. We don’t want any bowel movement, actually. We really want things to not be moving. If they get any sort of breastfeeding or anything like that, the bowel will start moving and then, there’s nowhere for that to go. So, it’s really important that you understand colostomy care and stomach care. We actually have a lecture in the medsurg course covering that. And you wanna educate the parents on dilator use. And what this does, is after the surgery, you know, there’s a lot of scar tissue can develop and so you actually have to create and make sure that opening stays open and doesn’t close, you know, that was made by the surgeon. And then, we wanna prevent the infant from touching the site. We don’t want them to touch their ostomy site. We don’t want them to touch their surgical site and we want them to stay clean and it to heal as needed.

So, the biggest thing to keep in mind here is do a really thorough, really good newborn assessment. You gotta check everything and there’s a reason that we do, so many little checks on these newborn babies, okay? There’s so much that can go wrong, there’s so much that won’t be knowing when the baby is first born. So, it’s really important that we check everything. And then, second of all, with this condition specifically, educate the parents that this is gonna be a long road for them. I mean, there’s a lot that needs to occur, and there’s a lot that needs to happen with this baby. But that is imperforate anus.

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  • Question 1 of 4

The nurse caring for a one-day-old infant asks the mother if the infant has had his first bowel movement yet. This first stool is called which of the following terms?

  • Question 2 of 4

The nurse caring for an infant who is 24 hours old notes the absence of meconium passage. Which of the following diagnoses could cause this? Select all that apply.

  • Question 3 of 4

Which of the following educational topics would be appropriate for the parents of a newborn who has just undergone surgery to repair an anorectal malformation? Select all that apply.

  • Question 4 of 4

The nurse speaking with the parents of a two-year-old who was born with imperforate anus and is discussing the topic of toilet training. Which of the following statements would be most important to include in the discussion?

Module 0 – Pediatrics Course Introduction

Module 5 – Metabolic And Endocrine Disorders

Module 12 – Musculoskeletal Disorders

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