Nursing Care Plan (NCP) for Imperforate Anus

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Outline

Pathophysiology

Known as an anorectal malformation, imperforate anus is a birth defect in which the anus and the rectum are not properly developed and the patient is born without an anal opening, or the anal opening is in the wrong place. Anorectal malformations occur in 1 out of 5,000 infants born.

Etiology

Normally, the rectum and anus are formed during the 5th – 8th weeks of gestation.  In the case of imperforate anus, the anal membrane fails to rupture and form the anus. There may be some genetic links to the development of imperforate anus. Studies have shown a link in patients with this condition and Down’s Syndrome and other congenital abnormalities. This condition is normally diagnosed within the first 24 hours of life and surgical intervention is usually necessary.  

Desired Outcome

Patient will have normal fluid balance; patient will be free from infection; patient will have a normal elimination pattern.

Imperforate Anus Nursing Care Plan

Subjective Data:

  • Reports of passing stool from the vagina, scrotum, urethra or other abnormal location (may indicate a fistula has formed)
  • Report of no bowel movement after birth

Objective Data:

  • No anal opening
  • Anal opening in the wrong place
  • Abdominal distention
  • Failure to pass stool (meconium)

Nursing Interventions and Rationales

  • Perform complete physical assessment

 

This condition is usually diagnosed within the first 24 hours of life. Note if the patient has anal opening and if it appears to be located in the anatomically correct location.

 

  • Observe for passage of meconium stools

 

Patients with imperforate anus are either unable to pass stool (meconium) at all, or it is passed from an inappropriate location. For female infants, carefully note if the meconium is passed from anus, vagina or urethra. For male patients, the anal opening may be located below the penis or the scrotum.

 

  • Monitor vital signs

 

Patients will often have other congenital malformations. Monitor heart rate and rhythm, respiratory effort and rate and temperature. Axillary temperature may be more appropriate instead of rectal.

 

  • Prepare patient for diagnostic tests and surgery

 

Patient will likely undergo several tests including imaging and labs prior to the determination for surgery. Ultimately, the patient may require a colostomy placed.

 

  • Monitor skin integrity and provide wound care following surgery

 

The passage of stool from incorrect locations can lead to rapid skin breakdown. Following surgery, assess incision site and provide wound care per facility protocol. Observe for signs of infection.

 

  • Provide colostomy care if appropriate

 

A colostomy may be required. Provide colostomy care per facility protocol and as needed. Educate parents to care for patient with colostomy. Assess the stoma for bleeding or signs of infection.

 

  • Provide education for parents

 

  • Parents will often be very anxious about their baby’s condition. Help by providing resources and information or contacts for support groups.
  • Educate parents on how to care for the patient post-surgery and at home.
  • As the child grows, constipation may be an issue and a longer period may be required for toilet training.
  • Encourage good nutrition with high fiber foods.

Writing a Nursing Care Plan (NCP) for Imperforate Anus

A Nursing Care Plan (NCP) for Imperforate Anus starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Let’s work on the following nursing care plan for imperforate anus. So imperforate anus, also known as anorectal malformation, is a birth defect in which the anus and the rectum are not properly developed. And the patient is born without an anal opening or the opening is in the wrong place. Nursing considerations: so we want to assess for meconium in the stool. If you recall, the meconium stool is that first stool that has passed at birth. We want to assess heart sounds for other congenital defects. And we want to confirm the presence of the anus. The desired outcome is that the patient will have a normal fluid balance. The patient will be free from infection and the patient will have a normal elimination pattern. 

So because this typically happens in newborns, a lot of the subjective data is going to come from the parents. So some things that the parent may report is there may be a passing of stool from the vagina, the scrotum, or other abnormal location. This may indicate that a fistula has formed. And remember a fistula is just an opening between two areas. And there also may be a report of no bowel movement after birth. Some things that we are going to observe as nurses during our assessment is we are going to assess the patient. So there’s going to be no anal opening. The anal opening may be in the wrong place. The patient may have some abdominal distension and there may be a failure to pass their first stool. And again, that is called meconium. So we’re going to do a full physical assessment. 

That’s most important. We’re going to use our assessment skills and we are going to do a full physical assessment. We’re going to make sure that this condition is diagnosed and it’s usually diagnosed within the first 24 hours of life. Please know that if the patient has an anal opening, makes sure that it appears to be located in atomically in the correct location. We’re going to observe for meconium passage. We’re going to make sure that patients actually have a stool. So patients with imperforate anus are either unable to pass the meconium or it’s passed from an inappropriate location. For female infants, carefully know if it has passed from anus, vagina, or urethra. For male patients the opening may be located below the penis or the scrotum. 

So we want to prepare the patient for diagnostic tests and surgery. So let’s write that here. Prepare for surgery. This patient will undergo a lot of diagnostic tests and surgery more than likely. They will have some imaging and labs prior to the determination for surgery. Ultimately, the patient may require a colostomy to be placed. We want to provide colostomy care if appropriate; this is very important. This patient will have a colostomy placed based on the area of the valve that is resected. We want to make sure that we educate parents for the care of the patient of the colostomy. We want to make sure we assess the stoma of the opening of the colostomy for bleeding or any signs of infection. And we also want to make sure that we provide education to the parents. It’s very important to educate the parents on how to take care of the patient post-operatively and how to care for the colostomy at home. 

The key points, remember that this is a birth defect in which the anus and rectum are not properly developed. It can be in an incorrect location or not there at all. Some of the subjective data that we are going to get from the patient or the family is that the stool is going to come from an unusual location, such as the vagina, the scrotum, or the urethra or other abnormal location. There’s going to be a report of no bowel movement after birth or no meconium. The objective data that we’re going to see is that there’s going to be no anal opening, or it’s going to be in the wrong place. Upon our physical assessment. The patient is going to have a failure to pass that first stool, the meconium. So the things that we are going to really focus on is we are going to check for meconium because remember this store should be passed within the first 24 hours of life. So failure to pass meconium indicates that surgery is needed and more than likely they’re going to have a colostomy. So colostomy care is also very important. We want to make sure we provide really detailed colostomy care education for the parents. We want to do a demonstration for the parents and we’ll have the parent demonstrate back to us on how to properly care for the patient at home. We love you guys. Remember, go out and be your best self today, and, as always, happy nursing.

 

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