DIAPHRAGMATIC HERNIA
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DIAPHRAGMATIC HERNIA
A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm which results in protrusion of abdominal organs (stomach,spleen,intestine,colon) into chest cavity.
Herniated abdominal organs put pressure on heart and lungs which leads to clinical manifestations related to respiratory system.
Sign and symptoms of Diaphragmatic hernia
Ø Increased respiratory rate(Tachypnoea)
Ø Bluish skin (Cyanosis)
Ø Broad chest & scaphoid abdomen
Ø Difficulty in breathing(Dyspnoea)
Ø Reduced left side chest movement
Ø Auscultation of peristalsis in chest cavity
Ø Shifting of heart sound
Diagnostic Investigations-
Ø Chest X-ray (shows midiastinal shift, presence of airfilled intesting)
Ø Abdominal X-ray (shows gas shadows and absence of abdominal organs)
Ø USG abdomen.
Ø Routine blood investigations.
Treatment -
Medical management includes-
Ø Nasogastric tube insertion to decompress the stomach.
Ø IV fluids to correct fluid and electrolyte imbalance.
Ø Body temperature should be maintained.
Ø Anitbiotics may be needed control infections.
Ø Surgical management needed to replace abdominal organs and repair diaphragmatic defects. Chest drainage is also done to help lungs to expand .
Nursing Management -
Ø - Preoperatively vital signs should be monitored and recorded.
Ø - The infant is kept in up-right or at 45 angle position .
Ø - Nasogastric tube insertion may be needed to decompress the stomach. So frequent suctioning of the tube and tube care is provided.
Ø IV fluid may be required for prevention of hydro-electrolyte imbalance.
Ø - Parents are explained about the disorder, treatment procedure and all questions are answered to alleviate anxiety.
Ø - Oxygen may be administerd to maintained proper oxygenation.
Ø - After surgery proper observation and vital signs monitoring should be done.
Ø - Watch out for abdominal distension, bleeding at operative site should be reported immediately.
Ø - Thoracic drainage tube care should be done. It is observed for oscillation of fluid column. Make sure that tubes are not kinked or blocked.
Ø -Surgical site should be prevented form infection and injury. Aseptic technique should be maintained.
Ø - Parents are explained about follow up and care after discharge.
Ø Other Nursing interventions – includes all nursing care of hospitalized child that we have discussed in previous lecture under heading Nursing care of hospitalized child in the lecture “Child Health Nursing”.
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