Intestines & Esophagus
This surgical defect may appear as a "double bubble" on xray.
Duodenal Atresia
Fill in the blank. The umbilical cord has ____ vein(s) and ______ arteries.
1 vein
2 arteries
What is the slimy substance that makes up the umbilical cord?
Wharton's jelly
You former 24 week infant corrects to 42 weeks. He is preparing to go home but has ongoing non-bilious projectile vomiting. What condition must be ruled out?
Pyloric stenosis
What is the initial post-op care for a patient with an ostomy?
You get an admission from the delivery room for respiratory distress. You are suctioning your patient for copies clear oral secretions. You attempt to place an NG tube and are unable to. What defect do you suspect?
Esophageal Atresia
You're taking care of a former 32 weeker who is now DOL. 4. You note redness surrounding his umbilical stump that seems to be extending outward. This area is warm to the touch. What condition may your patient have?
Omphalitis- this is an infection of the umbilicus and/or surrounding tissues, occurring primarily in the neonatal period.
You attend a Level 3 delivery for a vacuum assisted delivery. The baby comes out crying but is having trouble keeping their O2 saturations in goal range. When listening to their left lung you notice you hear bowel sounds. What defect are you concerned for?
Congenital diaphragmatic hernia
Gastroschisis.
Name 5 components of general pre-operative care for a patient in the NICU.
Vital signs, fluids, pain management plan, NPO, replogle decompression, antibiotic coverage, IV access, airway (if needed prior), foley (or send supplies to OR), lab work, blood products on hold.
A baby is transferred from a community hospital with ongoing bilious emesis.
1. What condition must be immediately ruled out?
2. Why does an Upper GI need to be done in a timely fashion.
1. Malrotation
2. There is a high risk of bowl necrosis with malrotation.
You are taking care of a patient with PPHN. They are intubated and on 20 ppm of nitric oxide. The team is preparing to place a UVC and UAC. You noticed their umbilical cord appears to be discolored with a green hue. What do you suspect was present at delivery for this patient?
Meconium
How many hours after birth do you expect a KUB to show air in the entire GI tract?
6-8 hours.
This congenital defect is characterized by the bladder protruding through the abdominal wall
and is not covered by any membranous sac.
1. What defect is this?
2. What is the treatment for this?
1. Bladder extrophy
2. Surgical fixation to ensure proper function
What is a replogle used for? What are the standard settings for a replogle?
Replogles are used for gastric decompression. They are typically set to low intermittent wall suction (LIWS) at -10 to -20 mmHG.
Fill in the blank! A SIP or ____1____ occurs primarily in VLBW/ELBWs with unknown etiology and is when a hole forms in the wall of the intestines allowing ____2___ to leak into the __3____.
1. Sudden intestinal perforation
2. Stool and bacteria
3. Peritoneal cavity
You are taking care of a large for gestational age infant. Mom is an uncontrolled diabetic. What might their umbilical cord look like?
A baby is transferred from MIU at 56 hours of life. They have not passed meconium yet. If they have a meconium ileus, what might their physical exam look like?
abdominal distention, palpable rubbery loops of bowel
You attend the delivery of a patient with an unexpected abdominal wall defect. The stomach, intestines, and spleen seem to be protruding from the abdomen in the cord and covered by a peritoneal sack. What abdominal wall defect do you suspect?
Omphalocele
You are taking care of a patient with an ostomy and mucus fistula. A nursing student asks "why are you refeeding stool into the mucus fistula?" How do you explain this to them?
Referring allows for a second chance at absorption and maintains function of the distal segment.
This defect is characterized by a lack of connection between the upper esophagus and the
trachea.
1. What is this defect?
2. Name 3 management strategies for this patient population.
1. Tracheoesophageal fistula
2. HOB elevated, high placed replogle to manage secretions, minimize crying (to decrease secretions)
You are anticipating the delivery of a baby with an omphalocele. Identify two specific supplies that must be brought to the delivery room.
Warm normal saline, sterile gauze, repogle
Fill in the blank: Hirshsprungs disease is the congenital absence of ___1____ cells in the submucosal plexus of the ___2____
1. Ganglion cells
2. Colon
Describe the disease process of NEC. What may you see on a KUB of a patient you suspect has NEC?
NEC occurs when the intestinal wall is invaded by bacteria and bowel inflammation and death occurs. Pneumatosis is typically seen on KUB and if progresses or untreated can lead to infant death.
Describe hypovolemia management for a patient returning from the OR for an ostomy and mucus fistula placement.
Perfusion >3-5 seconds, monitor for third spacing or edema, BP and hemodynamics, maintain UOP >1 ml/kg/hr.