Nursing Care Plan (NCP) for Omphalocele

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Outline

Pathophysiology

Omphalocele is a birth defect in which the intestines and possibly other abdominal organs, such as the liver, protrude outside the body through a hole in the belly button. These organs are contained in a peritoneal sac with a thin membrane. Infants born with this condition often have other accompanying congenital defects including cardiovascular or genitourinary problems.  This is a rare condition that only affects 1 in every 4,000 – 7,000 live births.

Etiology

During gestational weeks 6 -10, the intestines grow and push out of the abdomen by the umbilical cord. By week 11, if the intestines do not return, the result is an omphalocele. While the exact cause of omphalocele is unknown, it is believed by researchers that some factors (advanced maternal age, smoking and drinking alcohol during pregnancy, use of selective serotonin reuptake inhibitors during pregnancy and obesity) may increase the risk of the development of this and other birth defects.

Desired Outcome

Patient will be free from infection; patient will have adequate nutrition; patient will be free from intestinal obstruction.

Omphalocele Nursing Care Plan

Subjective Data:

  • Difficulty feeding
  • Colicky

Objective Data:

  • Protrusion of organs through belly button
  • Increased respiratory effort

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Perform a complete nursing assessment of systems: heart, lungs, skin, neurologic and GI system Infants born with this condition often have other accompanying congenital defects including cardiovascular or GI problems. Some patients may have central nervous system defects as well.

Omphalocele- Measure sac, note changes in color, presence of organs (liver) within the sac, twisting of intestines or defects in the sac

This helps to prevent loss of fluids and to keep the intestines moist to prevent drying/damage.

Assess vitals Monitor patient for temperature fluctuations and signs of hypothermia or fever.
Initiate IV access Loss of fluids can be detrimental to the infant. Maintain adequate hydration.
Evaluate nutritional needs and manage TPN if required The infant may require TPN for nutrition while the intestines are being decompressed, since the enteral route will be unavailable.
Insert nasogastric tube for decompression The intestines should be decompressed to decrease stress on the intestines and to decrease the size of the intestines within the sac. This will help the infant’s chances of not requiring surgical intervention.
Prepare patient for intubation / manage endotracheal tube and ventilator Infants with omphalocele may experience respiratory distress or require sedation and intubation to protect their respiratory system.
Prepare patient for surgery Surgery may be done all at once or in stages to protect the internal organs and prevent obstruction
Perform dressings and care of omphalocele as appropriate Sterile dressings will be used to protect the sac and the infant from infection. Helps to prevent fluid loss and keep intestines moist to prevent drying out/damage. 
Provide education for parents / caregivers of patient and instructions for home care Some forms of treatment may require home care that will be provided by the parents / caregivers.

Provide instruction and demonstrations to help the family become more comfortable with caring for the infant.

Provide information and resources including support groups for caregivers.

Answer questions to help relieve anxieties.

Writing a Nursing Care Plan (NCP) for Omphalocele

A Nursing Care Plan (NCP) for Omphalocele 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

  • https://my.clevelandclinic.org/health/diseases/10030-omphalocele
  • https://www.cdc.gov/ncbddd/birthdefects/omphalocele.html
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Transcript

Hey everyone, today, we’re going to be putting together a nursing care plan for omphalocele. So, let’s get started. First, we’re going to look at the path of physiology. So omphalocele is a birth defect in which the intestines, possibly other abdominal organs, such as the liver, protrude outside the body through a hole in the belly button. Some nursing considerations: you want to do a full assessment, vital signs, evaluate nutritional needs, NG tube insertion, and prepare the patient for surgery and the family and caregiver. Some desired outcomes: the patient will be free from infection, the patient will have adequate nutrition, the patient will be free from intestinal obstruction. 

So, we’re going to go through this care plan. One of the first things we’re going to be looking at is subjective and objective data. So, one of the first things is subjective data of what you’re going to see in the patient. You’re going to see that the parents are going to be telling you they’re having difficulty breathing or that the infant is pretty colicky. And what you’re going to see if you’re going to see that protrusion. So, you’re going to see organs that are through that belly button on the outside. And they’re typically in a sac that you will see, and you’ll also see that there is an increased respiratory effort on the infant. 

Some interventions that we want to look at, you want to make sure you’re performing a complete nursing assessment. So, assessment is always one of the first key things that you want to do. And so, when you do your assessment, you’re going to be looking at all of the systems. You’re going to be looking for the heart. You’re going to be looking through the lungs, the skin, a neurologic assessment, and a GI system assessment, because infants born with this condition often have other accompanying congenital defects, including cardiovascular or GI problems. Some patients may even have central nervous system defects as well. One of the things you’re assessing is the omphalocele itself. You’re going to want to make sure that you’re measuring the sac. You want to make sure that you’re noting any changes in the color, the presence of the organs or the liver within the sac, if there’s any sort of twist of the intestines or any defects of the sac. Another thing we’re going to be looking at is we’re going to be assessing the vital signs. Vital signs are another big thing for the patient. You want to make sure that you’re monitoring the patient for temperature fluctuations and any sort of hypothermia or fever. Another thing of an intervention we’re going to be looking for, we’re going to want to manage their nutrition, making sure they’re getting adequate nutrition, because you might need to be doing TPN or total parenteral nutrition. The infant may require it while the intestines are still being decompressed. Since the internal route will be unavailable for them. Another intervention we’re going to be doing is inserting a nasogastric for the decompression. So, an NG tube. So, the intestines should be decompressed and able to decrease the stress on the intestines and to decrease the size of the intestines within that sac. This will help with the infant’s chances of not requiring surgical intervention down the line. Another intervention we want to do is prepare for possible surgery for this patient. So, surgery may be done all at once or it could be in stages and able to protect those internal organs and prevent any sort of obstruction. Performing dressing changes and care is appropriate. And when you do so you want to make sure you’re using sterile dressings that will be used to protect that sac and the infant from any sort of infection, helping to prevent fluid loss is also part of the dressing changes and keeping the intestines moist is able to prevent any sort of drying out or any further damage done to the sac. Another intervention is always giving proper education. So, in education for the parents and the caregivers of the patient, you want to make sure you’re giving them instructions for home care after surgery because after treatment. You’re going to be requiring home care, that’s going to be provided, and must make sure that the parent is fairly comfortable and able to care for that infant afterwards. So that kind of support groups for caregivers or for families being able to answer any questions that are related to the surgery itself and how to do proper dressing changes from home and just to be able to relieve any sort of anxiety they may be having from the surgery. 

Okay, we’re going to go over some key points now. So, we’re going to go over patho and etiology. So basically, it is a birth defect in which the intestines and other organs such as the liver, protrude outside of the body, through the hole of the belly button. And its causes are advanced maternal age, smoking and drinking, which increases the risk of an omphalocele. Some subjective and objective data. So, what you’re going to see with the patient, they’re going to have difficulty feeding and feeling colicky. You’re going to see the protrusions of the organs through the belly button on the outside, increasing respiratory effort in the patient. Assess nutrition and NG tube. So, you’re going to want to do a complete assessment of the heart and lungs and you’re going to do the assessment on the actual omphalocele itself and evaluate nutritional needs. They might need some TPN, inserting the NG tube for that decompression of the stomach, and surgery education. You’re going to prepare the family for surgery. You’re going to perform those dressing changes and you’re going to educate that family or caregiver on the infant after surgery. 

Wonderful job guys. We love you. Go out and be your best self today and as always happy nursing.

 

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