Nursing Care Plan (NCP) for Omphalocele
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Lesson Objective for Nursing Care Plan (NCP) for Omphalocele
By the end of this lesson, nursing students will be able to develop a comprehensive Nursing Care Plan (NCP) for a neonate diagnosed with Omphalocele
- Understanding Omphalocele:
- Gain knowledge about the pathophysiology and classification of Omphalocele.
- Differentiate between Omphalocele and Gastroschisis.
- Assessment and Stabilization:
- Learn how to conduct a swift and accurate assessment of the neonate with Omphalocele.
- Understand the immediate stabilization measures required for these infants.
- Preoperative and Postoperative Care:
- Explore preoperative nursing interventions, including preparation for surgical correction.
- Understand postoperative care strategies, focusing on wound management and prevention of complications.
- Family Education and Support:
- Recognize the impact of Omphalocele on the family.
- Gain insights into providing education and emotional support to the family, addressing their concerns and fostering coping mechanisms.
- Interdisciplinary Collaboration:
- Understand the importance of collaboration with surgical teams, neonatologists, and other healthcare professionals.
- Emphasize the need for a multidisciplinary approach in caring for infants with Omphalocele.
Pathophysiology of Omphalocele
- Abdominal Wall Defect:
- Omphalocele is characterized by a congenital malformation in which the abdominal wall fails to close properly during fetal development. This results in a herniation of abdominal organs, typically involving the liver and sometimes other organs, into the base of the umbilical cord.
- Covering Membrane Presence:
- Unlike gastroschisis, another abdominal wall defect, omphalocele is covered by a membrane composed of peritoneum and amnion. This membrane protects the herniated organs and prevents direct exposure to the external environment.
- Variable Severity:
- The severity of omphalocele can vary, ranging from a small defect with minimal herniation to a larger opening involving multiple organs. The size of the defect influences the clinical presentation and potential complications.
- Associated Genetic Syndromes:
- Omphalocele is often associated with genetic syndromes and chromosomal abnormalities, such as trisomies 13, 18, and 21. Therefore, a thorough genetic evaluation may be necessary to identify any underlying conditions and inform the overall care plan.
- Impaired Abdominal Organ Development:
- The failure of the abdominal wall to close properly during embryonic development can lead to impaired growth and development of abdominal organs. This, in turn, contributes to the herniation of these organs into the omphalocele sac.
- Risk of Complications:
- Omphalocele is associated with an increased risk of complications, including respiratory distress due to limited lung development, gastrointestinal issues related to the herniated organs, and potential infections. The presence of associated anomalies and the size of the defect can impact the severity and management of these complications.
Etiology of Omphalocele
- Failure of Abdominal Wall Closure:
- Omphalocele results from the incomplete closure of the abdominal wall during embryonic development. This failure of closure allows for the protrusion of abdominal organs through the umbilical ring, leading to the characteristic defect.
- Genetic Factors:
- Genetic factors play a role in the development of omphalocele. The condition is often associated with chromosomal abnormalities, such as trisomies 13, 18, and 21, as well as other genetic syndromes. A detailed genetic evaluation may be warranted to assess the underlying genetic contributors.
- Maternal Age:
- Advanced maternal age has been identified as a risk factor for omphalocele. Women who conceive at an older age may have an increased likelihood of giving birth to a child with congenital anomalies, including abdominal wall defects.
- Environmental Exposures:
- Exposure to certain environmental factors during pregnancy, such as teratogenic substances or certain medications, may contribute to the development of omphalocele. A thorough assessment of maternal exposures is important in understanding potential contributing factors.
- Maternal Health Conditions:
- Certain maternal health conditions, such as diabetes, have been linked to an increased risk of omphalocele. Managing pre-existing health conditions during pregnancy is crucial to reducing the risk of congenital anomalies in the developing fetus.
- Multifactorial Influence:
- The etiology of omphalocele is often multifactorial, involving a complex interplay of genetic and environmental factors. The specific combination of these factors can contribute to the varying degrees of severity and associated complications observed in infants with omphalocele.
Desired Outcome of Nursing Care Plan (NCP) for Omphalocele
- Successful Surgical Repair:
- Achieve a successful surgical closure of the omphalocele defect, with the aim of restoring the integrity of the abdominal wall and preventing further herniation of abdominal organs.
- Optimal Wound Healing:
- Promote optimal wound healing at the surgical site to minimize the risk of complications, such as infection or dehiscence. Provide appropriate wound care and monitor for signs of infection.
- Normal Gastrointestinal Function:
- Facilitate the return to normal gastrointestinal function by ensuring the proper placement and function of the abdominal organs post-surgery. Monitor bowel function, address any feeding issues, and promote nutritional support as needed.
- Respiratory Stability:
- Ensure respiratory stability by monitoring the infant’s respiratory status closely, especially if there were associated lung and respiratory complications. Implement interventions to support respiratory function as needed.
- Parental Education and Support:
- Provide education and support to parents regarding the care of their infant, including wound care, feeding strategies, and signs of potential complications. Empower parents to participate in the care of their child and facilitate a smooth transition to home care.
Omphalocele Nursing Care Plan
Subjective Data:
- Difficulty feeding
- Colicky
Objective Data:
- Protrusion of organs through belly button
- Increased respiratory effort
Nursing Assessment of Nursing Care Plan (NCP) for Omphalocele
- Immediate Assessment:
- Assess the size and content of the Omphalocele sac.
- Evaluate vital signs and overall stability.
- Associated Anomalies:
- Collaborate with other healthcare professionals to identify associated anomalies.
- Conduct screenings for cardiac and chromosomal abnormalities.
- Preoperative Assessment:
- Prepare for surgery by assessing the infant’s overall health.
- Ensure appropriate preoperative laboratory tests are conducted.
- Wound Assessment:
- Monitor the Omphalocele sac and wound site for signs of infection.
- Assess the integrity of the surgical closure.
- Bowel Function:
- Monitor bowel function and assess for signs of obstruction or dysfunction.
- Implement measures to prevent complications related to bowel function.
- Parental Coping:
- Assess the emotional well-being of parents.
- Provide resources for emotional support and coping.
- Feeding Assessment:
- Assess the feasibility of oral feeding and the need for alternative feeding methods.
- Collaborate with a lactation consultant or feeding specialist.
- Developmental Assessment:
- Monitor developmental milestones.
- Implement interventions to support developmental progress.
Implementation of Nursing Care Plan (NCP) for Omphalocele
- Stabilization and Preoperative Care:
- Implement measures for the immediate stabilization of the neonate.
- Collaborate with the surgical team to prepare for surgery.
- Postoperative Wound Care:
- Provide meticulous care for the postoperative wound.
- Monitor for signs of infection and complications.
- Feeding Support:
- Implement feeding strategies based on the infant’s capabilities.
- Provide education and support for alternative feeding methods.
- Family Education:
- Educate the family on the condition, treatment, and expected outcomes.
- Provide guidance on caring for the infant at home.
- Psychosocial Support:
- Facilitate support groups and counseling services for the family.
- Encourage open communication and address emotional needs.
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. |
Evaluation of Nursing Care Plan (NCP) for Omphalocele
- Surgical Outcome:
- Evaluate the success of the surgical correction.
- Monitor for any signs of dehiscence or complications.
- Wound Healing:
- Assess the wound healing process.
- Modify wound care interventions as needed.
- Complications Prevention:
- Evaluate the effectiveness of interventions in preventing complications.
- Adjust strategies as necessary.
- Feeding Progress:
- Monitor the progress of feeding strategies.
- Modify feeding plans based on the infant’s tolerance.
- Psychosocial Well-being:
- Assess the family’s adaptation and coping.
- Modify support services to meet ongoing psychosocial needs.
References
- https://my.clevelandclinic.org/health/diseases/10030-omphalocele
- https://www.cdc.gov/ncbddd/birthdefects/omphalocele.html
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Omphalocele
- Risk for Infection: Omphalocele involves an exposed abdominal organ, increasing the risk of infection. This diagnosis emphasizes infection prevention.
- Altered Parent-Infant Attachment: Omphalocele may affect the bonding process between parents and the newborn. This diagnosis addresses attachment concerns.
- Impaired Tissue Integrity: Omphalocele requires careful wound care to prevent injury and infection. This diagnosis focuses on maintaining tissue integrity.
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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