EDUCATION FOR THE HEALTH: MANUAL OF
SERVICE TO THE NEWBORN WITH
GASTROSCHISIS IN AMAZONAS – BRAZIL
Authors: : ¹Fabíola Silva dos Santos; ²Thaís Helena C.
Corrêa; ³Selma Barboza Perdomo;⁴ Maria de Nazaré de Souza
Ribeiro;⁵ Karina Maria S.C. de Barros
Barcelona, 2014
Gastroschisis
The
gastroschisis
is
the
protrusion of the intra-abdominal
content without the involvement
of the umbilical cord or the
peritoneal sack through defect in
the previous abdominal wall,
usually on the right side, lateral
to the umbilical ring, which
involves all its layers, from the
peritoneum to the skin, resulting
from the incomplete closing of
the lateral pleats of the body,
event that happened during the
fourth
week
of
gestation
(American Pediatric Surgical
Association, 2013).
Fonte: http://saude.hsw.uol.com.br
* During
the last two decades, the global incidence of
gastroschisis is in ascension (Curry, 2000
* . The gastroschisis incidence varies from 1,4 - 2,5 for 10.000
born alive without predilection for sex (Brazil, 2000; Hume,
1997; Curry, 2010; Blakelock, 1997).
* Factors
associated with an increased risk of gastroschisis
include maternal age, parity and maternal use of drugs in
the gestational period.
Being so, this study had as main objective verifies the profile of
newborn admitted with gastroschisis in 2012 in ICAM, through
the analysis of the handbooks and to originate a guide of
nursing service for this public.
A field research took place from documental and retrospective
nature with quantitative approach.
The source of the
documents was the particular files of the public Institution of
the Health Institute of the Child from Amazonas - ICAM. The
study was accomplished in the Intensive Therapy Unit (UTI)
neonatal of Health of the Institute of the Child from Amazonas
(ICAM), in Manaus - AM.
type of study
Quantitative, descriptive,
exploratory,documentary, retrospective
Place of study
Fonte: portalamazonia.globo.com
Sample
Records
of Newborns
with
N: 40 newborns
with diagnosed
gastroschisis
gastroschisis
No:Diagnosis
39 recordsonly
of infants
gastroschisis
other with
malformatios
 Served
in the period
fromgroup;
january 1 to
indigenous
ethnic
31,
2012. or illegible
Records withdecember
incomplete
records,
Data collection
SAME- Through the analysis of medical
records, standardized instrument
ethical aspects
Data Analysis
with erasures.
CNS Resolution 196/96
Approval IRB / UEA 24/05/2013
number of CAAE: 16284113.0.0000.5016
Excel spreadsheet and tables
6
CENSUS
2010
Tannuri
et al
2010
Census
2010
234 Admitted in
surgical ICU
40 with of
gastroschisis
Institute of
Child Hospital
of São Paulo
08 years
fertility rate
in Brazil
fertility rate in
northern
Brazil
17.09% on year
3,33%
months
103 cases in
total
12,87 of
years
high birth
rate
higher
incidence
of gastroschisis
Table 1. Clinical profile of the newborns with gastroschisis assisted in
ICAM in 2012. Manaus-AM, 2013
Sex
Number
f(%)
Female
18
46,15%
Male
21
53,85%
Total
Weight of newborn in grams
39
100,00%
f (%)
Number
Information not registered in the
handbook
4
10,26%
Recém-nascido à termo
17
43,59%
Recém-nascido pré termo
18
46,15%
Total
39
100,00%
Table 1. Clinical profile of the newborns with gastroschisis assisted in
ICAM in 2012. Manaus-AM, 2013
Newborn weight in grams
Number
Information not registered in the
handbook
3
1.000
1.500
2.501
3.001
Total
-
1.499
2.500
3.000
3.500
Skin
2
17
12
4
39
number
f(%)
7,69%
5,13%
43,59%
30,77%
10,26%
100,00%
f(%)
Cyanotic
3
7,69%
Pale
Information not registered in the
handbook
2
5,13%
12
30,77%
Normal skin color
22
56,41%
Table 1. Clinical profile of the newborns with gastroschisis assisted in
ICAM in 2012. Manaus-AM, 2013
Skin
number
f(%)
Cyanotic
3
7,69%
Pale
Information not registered in the
handbook
2
5,13%
12
30,77%
Normal skin color
22
56,41%
Total
39
100,00%
Temperature of the newborn
number
f(%)
Hypothermic
Information not registered in the
handbook
20
51,28%
18
46,15%
Normothermic
1
2,56%
Total
39
100,00%
Manual of Orientations
This manual has the intention to offer an assistant plan to the nurses that
helps newborns with so much gastroschisis in the maternities of Manaus as in
the institute of reference of pediatric surgery of the state, it was created
subsidized in the profile of these newborns and it approaches in a didactic
way the nursing actions in the preoperative in the transfer through ambulance
to the reference unit as well as in the trans and postoperative, promoting this
way the health and improving the prognosis of the newborn attacked by such
malformation.
Attendance of Nursing in the preoperative - Delivery room
Action
Theoretical Justification
To maintain sterile paramentation;
The newborn must be handled with
sterilized gloves avoiding this way the
hypothermia and probable infection
(Tamez; Silva, 2013).
To accommodate the newborn in right The positioning in right lateral decubitus
lateral decubitus in a cradle or warm improves the veined return and the
incubator;
perfusion of the intestinal loops (Neblet,
2000). .
To maintain aerial superior vias free; To In order to maintain the permeability of
aspirate aerial superior vias;
the aerial vias, the head is positioned with
light extension of the neck, avoiding the
hyperextension or exaggerating flexing.
Per times, it is necessary to put a cushion
under the shoulders of the newborn, if
there is excess of secretions in the aerial
vias (Brazil, 2012).
To involve intestinal loops with humid and warm The hernial content must be protected with
sterile compresses involved by plastic sack of sterile compress and to involve it with porous
polyethylene;
plastic to avoid rupture, contamination and liquid
loss and heat (Brazil, 2012).
To maintain the viscus in vertical position
The way of protection of the intestinal loops, aims
to protect and involve them avoiding their
compression, it is “sine quo non”, that the intestine
is maintained in the medium line and that is
observed continually to assure the appropriate
perfusion and to avoid the torsion of the mesentery
(Moura, 2013).
It is important to maintain the viscus in vertical
position, because the fold of the viscus can take to
ischemia and necrosis(Santos, 2010).
To substitute curative when gauzes be saturated The curative with sterile gases is ineffective in
by peritoneal exudate;
preventing the bacterial contamination, because the
microbial
contamination
happens
by
capillarity(Ramos; Milk, 2013).
To check vital signs, attempting to the The newborn must be monitored, for precocious
temperature;
detection of signs that indicate: hypothermia,
hypotension, breathing insufficiency and shock
(Moura, 2006).
To pass orogastric probe type nelaton n°10;
In the intention of promoting the drainage of the
gastric content, avoiding larger distention of the
intestinal loops (Moura, 2006).
To install peripheral veined access of The
installation
of
the
patent
thick caliber;
peripheral veined access is important
for the hydroelectrolytic replacement
and antibiotic therapy administration
(Brazil, 2012).
To begin antibiotic therapy of wide The protocol of antibiotic administration
Spectrum, according to the protocol;
has the intention to reduce the infection
risk by pathogenic bacteria (Moura,
2006)
To install hydroelectrolitic restitution; The
hydro
restitution
must
be
accomplished and observed strictly,
because the volume administered to
newborn is twice larger than newborn
without gastroschisis (Gaines; Col, 2000).
To register in the proper form of The lack of precise registrations, as well
transfer: Pregnancy age of the as the access absence to the relevant
newborn, weight, classification per information described in the handbook
weight, sex, state hemodynamic aspect during transfers from an unit to other,
of the hernial viscus and accomplished for the professionals of health, increases
nursing cares;
in a significant way the risk of damages
to the patient, taking to disastrous
consequences in their attendance
(Goldsmith et al, 2010)
Attendance of Nursing in the transfer of newborns with gastroschisis
Action
Theoretical Justification
To evaluate hemodynamic stability of the After the stabilization of newborn in the delivery
newborn;
room, the same should be directed for the
surgical center, minimizing like this the
intercurrence risk during the transfer (Silva et al,
2003).
To handle the newborn with sterile gloves and The principles "pattern precautions" should be
use of EPI.
followed and the cares to avoid spread of the
secretions in the hospital environment (Brazil,
2012).
To attempt to the fixation of tubes, probes, and During the transfer in ambulance can happen
curative.
accidental retreat of tubes, drains and probes, for
that the importance of maintaining them fixed
(Roche, 2011).
To use transport incubator heated up;
To Avoid shock by hypothermia (Rodriquez et al,
2010).
To maintain continues monitoring of vital signs The
hemodynamic
monitoring
should
be
through transport monitoring;
established as essential factor for the verification
of shock signs (Montalto and Conz, 2012).
To control infusion of electrolytes for leak or To Avoid accidents as hypervolemia, sharp edema
infusion bomb;
of lung because liquid excess30.
To maintain orogastric probe open N° 10;
To Reduce the gastric content, through drainage
(Roche, 2011).
To maintain viscus involved in warm compresses Maintenance of the corporal temperature due to
and transparent film, or vertically fixed bag of solid area of exposed surface, taking what takes
polyethylene;
the hypothermia (Rodriquez et al, 2010).
Attendance of Nursing in the Transoperative - gastroschisis / Surgical Center
Action
Theoretical Justification
To maintain control of vital signs through To monitor hemodynamics signs, to prevent
continuous monitoring;
hemodynamic instability (Nascimento, 2013).
To maintain sterile paramentation;
To reduce the infection risk by
pathogens transmission (Moura, 2006).
bacterial
To inject physiologic warm serum with rectal To maintain the small and thick intestine totally
probe, smoothly.
empty (Tamez and Silva, 2013).
To maintain continuous gastric aspiration;
To minimize the risk of lung aspiration
(Nascimento, 2013)
To accomplish reading and evaluation of the To obtain predictive values to establish total or
pressures,
abdominal,
intravesical
and step by step reduction (Nascimento, 2013).
splanchnic;
To accomplish curative in operative wound (if The surgical closing can happen for primary fatial
completely close) or silo
(closed step by closing or, in cases
that the disproportion
step)
visceroabdominal is big, due to inflammation of
the exposed organs, we should choose the closing
step by step with skin silo of skin or silicon, being
suitable the complete closing after some weeks
(Whistles et al, 2003)
To direct for intensive unit.
In the intensive neonatal therapy unit newborn
will be monitored by a qualified multidisciplinar
team, this one important factor in their
evolution (Brazil, 2012)
Attendance of Nursing in postoperative - Intensive Neonatal Unit
Action
Theoretical Justification
To welcome the parents answering The nursing team when receiving a
their doubts about what will be newborn with gastroschisis must guide
accomplished with their newborn.
the relatives together with the
multidisciplinary team on what will be
accomplished with their son in the
intention to reduce the anxiety
promoting the knowledge on the
services offered giving them support
(Tamez and Silva, 2013).
To position the newborn in right lateral When accommodating the newborn in
decubitus;
right lateral decubitus the professional
promotes the improvement of veined
return to this newborn (Moura, 2006).
To install oxygen support (mechanical Until the first 72 hours after the
Ventilation)
intervention it is primordial the
pressure intra-abdominal monitoring,
due to the increase of the intraabdominal pressure, because it can
influence in the thoracic expansibility, in
the veined return, reducing the
To
install
monitoring;
continues
hemodynamic The
monitoring
made
through
wrist/cardioscope
oximeter,
electrocardiogram (ECG) and monitors of
blood pressure non invasive must be
inserted as routine procedure, in the
intention of foreseeing possible shock
states (Voice, 2005).
To install continuous analgesia;
The nurses have a role of extreme
importance in the handling of the pain,
because they stay more time beside the
patient having so the opportunity to address
actions for the handling of the pain
(Presbytero, 2010).
To accomplish curative in operative
wound and or silo once a day, registering
aspect of the operative wound, if
presence of SILO, to evaluate and to
register aspect of the viscus;
To aspirate the orotracheal tube and
superior aerial vias, whenever necessary;
Fits to the nurse to accomplish the daily
curative with gauzes and sterile ties,
maintaining the loops in vertical position,
reducing this way the postoperative risk of
infection (Tamez, 2013).
If there is excess of secretions in the aerial
vias (Brazil, 2012).
To register weight and edema daily
To install parenteral nutrition;
To restore volume drained by orogastric probe; to
register aspect and volume of secretion of the
orogastric probe; registering acceptance of the
diet after its introduction;
To maintain rigorous hydric control;
To register diet acceptance;
When of the discharge, to guide the relatives
about the feeding of the newborn and attendance
in the infirmary.
Soon after the surgical correction newborn must
present big exudative losses as, for instance,
water, sodium and proteins for the third space or
for the inflamed intestinal walls (Moura, 2006).
Newborns with gastroschisis, develop with some
degree of intestinal dysfunction, so they need
parenteral nutritional contribution (Nichol, 2008).
The volemic replacement in newborns should be
two or three times larger than in newborns without
that anomaly. Therefore, it is maintained the
rigorous control of the diuresis and replacement of
the losses by the orogastric probe in the intention
to prevent dehydration or even prerenal inadequacy
(Gaines and col., 2000).
The increase of the intraabdominal pressure of the
closing of the wall contributes to the decrease of
the renal perfusion, what is responsible for the
oliguria (Moura, 2006).
One of the factors that should be taken in
consideration as predictive factor of improvement
of the mobility is the decrease of bilious residue
and retention of the diet (Moura, 2006).
The nursing has fundamental paper in the relatives'
orientation about the handling of feeding of
newborns with gastroschisis, it fits to the
professional the orientation about the risk of
complications and prevention of them (Tamez and
Silva, 2013).
CONCLUSION
The results of that research, together with the studied
bibliographical theoretical referential, served as subsidies for
the creation of the manual of orientation of cares for the nurses'
team that, now is in implementation phase in ICAM. It is waited
that this manual orientates the actions of the nursing team and,
consequently, reduce the inherent complications to the disease
and the death occurrence.
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