Case Study Assignment Necrotizing Enterocolitis

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CASE STUDY ASSIGNMENT 7

CaseStudy Assignment: Necrotizing Enterocolitis

CaseStudy Assignment: Necrotizing Enterocolitis

PATIENTINITIALS:

AGE:6 months

GENDER:Male

PATIENTDISEASE /DISORDER: Necrotizing Enterocolitis

Chiefcomplaint and history of present illnesses

  • Hermatochezia- fresh blood around the anus and sometimes in stool (Fuchs, et, 2007)

  • Intermittent diarrhea

  • Diminished bowel sounds

  • Temperature instability

  • Feeding intolerance

  • Intermittent anal fissures

  • Vomiting

Pastmedical history:

  • Born prematurely

  • Diagnosed as Lethargic in the first two weeks after birth

  • Mild thromboplastin and currently corrective medication

  • Reported apnea in the first 1.5 weeks

  • Pneumatosis coli in the first week after birth

  • Infectious Enterocolitis one week after birth

  • No family history of necrotizing Enterocolitis

  • No surgical history

Physicalexam/assessment:

  • Test for platelet count

  • Test for neutrophil count

  • Stool guaiac for blood

  • Extraction of blood cultures and cerebrospinal fluid

  • Abdominal film of the supine, decubitus

Labfindings:

  • Decreased platelet count

  • Increased prothrombin

  • Salmonella and C. Difficile present in stool

  • Partial thromboplastin

  • Disseminated intravascular coagulation

  • Reduced neutrophil count

  • Positive stool guaiac for blood

  • No intestinal obstruction

  • Persistent metabolic acidosis

  • Hypernatremia

  • Sepsis and meningitis negative

  • Pneumatosis intestinalis positive

  • Intestinal perforation

  • Abdominal distention

  • Hermatochezia present

Diagnosis/Plan

Nursingdiagnosis: StageII necrotizing Enterocolitis confirmed

Treatmentplan

  • Treatment will be based on the clinical staging after diagnosis

  • Medical treatment to be basically supportive

  • Obtain initial laboratory studies

  • Conduct serial abdominal films

Nursinggoals

  • Appropriate diagnostic studies

  • Vigorous medical therapy

  • Supportive treatment

  • Provide total parenteral nutrition

  • Correct diarrhea and further malnutrition

  • Correct hypoglycemia

  • Promote and encourage breastfeeding or use of donor milk when possible

  • Allow the bowel to rest

Nursinginterventions

  • Oral feedings should be withheld

  • Nasogastric suction and intravenous fluid administered

  • Provide total parenteral nutrition to maintain the nutritional status of the infant as ordered. Observe for:

  • Check for hyper/hypoglycemia after every six hours

  • Edema

  • Jaundice

  • Electrolyte imbalances

  • Cardiac abnormalities

  • Broad aerobic and anaerobic organisms administered based on the resistance patterns.

  • Administer combinations of ampicillin and aminoglycosides (Crocetti, Barone, &amp Oski, 2004).

  • Serial abdominal films in the supine and left lateral decubitus positions after every 6 to 8 hours.

  • Daily monitoring of the abdominal girth

  • Maintain nilper mouth for +10 days

  • Observe adequate urinary output (1 ml/kg/hr)

  • Consistency of stool color, amount, and odor

  • Check hemoglobin

PatientEducation

Patienteducation basically focused on educating parents on food safetyissues such as:

  • Hand washing with soap and hot water before preparing formula or meals.

  • Use clean utensils and containers for mixing formula

  • Follow the 2-hour rule: discard any food or beverage left over at room temperature for two hours or longer.

  • Do not use honey in the diet of the infant to decrease potential risk of botulism.

  • Where possible, offer donor milk if mother cannot breastfeed.

  • Some partially elemental formulas are available, such as pregestimil or nutramigen, or more elemental nutrients may be required if the digestive tract has not recovered fully (Escott-Stump, 2008).

  • Ensure adequate iron and zinc

  • Occasional colostomy or ileostomy

Evaluation

  • Radiographic studies to test of intestinal distention

  • Acute complications arising from sepsis (Kaiser, 2012).

  • Peritonitis

  • Abscess formation

  • Intestinal bleeding

  • Fresh-frozen plasma

  • Disseminated intravascular coagulation platelet concentrates

  • Thrombocytopenia

References

Crocetti,M., Barone, M. A., &amp Oski, F. A. (2004). Oski`sEssential pediatrics.Philadelphia: Lippincott Williams &amp Wilkins.

Escott-Stump,S. (2008). Nutritionand diagnosis-related care.Philadelphia: Wolters Kluwer Health/Lippincott Williams &ampWilkins.

Fuchs,S., Gausche-Hill, M., Yamamoto, L., American Academy of Pediatrics, &ampAmerican College of Emergency Physicians. (2007). Thepediatric emergency medicine resource.Sudbury, Mass: Jones &amp Bartlett.

Kaiser,G. L. (2012). Symptomsand signs in pediatric surgery.Heidelberg: Springer.

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