Pediatric Nursing Demystified

Signs and Symptoms

Frothy saliva

Coughing due to excessive secretions

Gagging when feeding

Feedings exiting the mouth and nose

Aspiration

Difficulty breathing

Distended stomach

Nursing alert Monitor for aspiration when first feeding a newborn.

Test Results

Radiopaque catheterradiograph: A radiograph is taken after the radiopaque

catheter is inserted into the esophagus to identify the fistula or blind pouch.

Bronchoscopy: Shows the fistula.

Chest radiograph: Shows pneumonia and air in the esophageal pouch.

Treatment

Suction the contents of the blind pouch.

Insert NG tube to decompress the stomach.

Surgery: Repair the fistula and/or blind pouch.

Nursing Intervention

Nothing by mouth:

• Insert the NG tube as ordered.


• Suction the contents of the blind pouch as ordered.


• No pacifier because this increases saliva production.


• Elevate the child’s head.
  Postoperative care:


• Monitor vital signs.


• Place NG tube to low suction per order.


• Monitor output of NG tube every 4 hours.


• Provide gastrostomy feeding until esophagus returns to normal.


• Monitor chest tube drain, if necessary.


• Use pacifier.


• Start feeding by mouth with sterile water and then advance diet as
  tolerated.
  Explain the disorder and treatment to the family.

Nursing alert No pacifier prior to surgery because sucking increases saliva

production. Saliva can enter the lungs through the fistula and/or accumulate in

the blind pouch.

CHAPTER 11/ Gastrointestinal Conditions^247