Nursing NotesMy Student Support System
Oesophageal atresia is a rare birth defect that
affects a baby's oesophagus (the tube through which food passes from the
mouth to the stomach).
The upper part of the oesophagus doesn't connect with the lower
oesophagus and stomach. It usually ends in a pouch, which means food can't
reach the stomach.
Oesophageal atresia often happens along with another birth
defect called a tracheo-oesophageal fistula, which is a connection between
the lower part of the oesophagus and the windpipe (trachea).
CLASSIFICATION of Tracheo-oesophageal Fistula
CLASSIFICATION depends upon the pattern by which oesopahgus is
attached to trachea . It may be of 5 types
Type 1, Type 2, Type 3 Type
4, Type 5
Type
1- in this type there is a blind pouch at upper segment and a
blind pouch at lower segment of oesophagus . There is no fistula between
oesophagus and trachea.
Type
2- in this type there is a blind pouch at lower segment of
oesophagus and fistula is formed between upper segment of oesophagus and
trachea.
Type
3- in this type there is a blind pouch at upper segment of
oesophagus and fistula is formed between lower segment of oesophagus and
trachea
Type
4- in this type There are two fistulas between oesophagus and
trachea. Both upper segment and lower segment of oesophagus develop fistula
with trachea.
Type
5- in this type there is no atresia of oesophagus . Only fistula
is developed between oesophagus and trachea.
Sign and symptoms depends upon types of
Tofistula which may include-
Ø Frothy,
white bubbles in the mouth
Ø Coughing
or choking when feeding
Ø Vomiting
Ø Blue
color of the skin (cyanosis), especially when
the baby is feeding
Ø Difficulty
breathing
Ø Abdominal
distension
Ø Excessive
salivation or drooling
Diagnostic investigations of Tracheo-oesophageal Fistula
Ø physical
examination and history taking
Ø Presence
of sign and symptoms
Ø passing
of catheter into stomach.
Ø X-ray
with radio opaque catheter insertion.
Treatment of
Tracheo-oesophageal Fistula
Ø An
operation to repair an oesophageal atresia and tracheo-oesophageal fistula
is usually done soon after birth.
Ø Surgical
intervention depends upon type of T-O fistula. It includes closing of fistula
and anastomosis between both ends of oesophagus.
Ø After
surgery, the child will be kept in the intensive care unit and placed in an
incubator. They may also need:
Ø Antibiotics
to prevent infection.
Ø a
machine to help them breathe (ventilator)
Ø a tube
into their chest to drain fluids or air that might be trapped
Ø oxygen
Ø pain
medication
Nursing management of
Tracheo-oesophageal Fistula
Ø The care should start from the time of birth. The
nurse should suspect a tracheo-oesophageal fistula in neonates when the infants
are drooling. The doctor should be notified.
Ø The infants
may be treated in an incubator to maintain the body temperature and
oxygenation.
Ø The infants should be treated in the head high
position.
Ø Frequent suctioning of pharynx and oesophagus and
continuous drainage of secretion is necessary.
Ø The air passage needs to be maintained clear and the
oxygen needs to be administered.
Ø Vital signs must be monitored.
Ø Abdominal distension must be checked, recorded and
inform to pediatrician.
Ø Sometimes,
gastrostomy tube is placed to remove the secretions from the stomach and
relieve the distension. So gastrostomy care is provided.
Ø Post
operatively Special care of the nasogastric, post-anastomotic tube should be
given to prevent withdrawal or injury to the operative site, the infant's
elbows should be restrained.
Ø When
the healing is complete, the test feeding is started, If tolerated, then, the
proper feeding is started.
Ø After
some time The oral feeds are started with small amount of clear liquid and then
advanced to the breast milk or formula.
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.
Nursing NotesMy Student Support System
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