LEGEND:

 - Manifested by the client

x - Not manifested by the client

- Nursing and Medical Interventions

- Signs and symptoms

 - Interventions given to the client

□ - Interventions not given to the client

- Undergone by the client

- Not undergone by the client

Defective separation and malfunction of

the esophagus
 PATHOPHYSIOLOGY OF ESOPHAGEAL ATRESIA, TRACHEO – ESOPHAGEAL FISTULA, PATENT FORAMEN OVALE, PATENT DUCTUS
ARTERIOSUS AND PREMATURITY

Predisposing Factors:
Non – Modifiable:
 Infant:
a. Sex – males have 1.26 times higher Precipitating Factors:
risk than females
 Mother:  Abnormalities in the chromosomes
b. Age – higher risk for mothers older
than 30 years old and younger than 19
years old
 Father:
c. Genetics – history of chromosomal
defect
Modifiable:
 Stress – mother is a nursing student
 Occupation – Environmental exposure to
radiation/ drugs and microorganisms since
mother is a medical technologist
 Nutrition – inadequate intake of Folic acid

Failure of fetal ductus arteriosus to close

after birth

Blood flows from higher pressure aorta to

lower pressure pulmonary artery
Failure of fetal foramen ovale to close
after birth
Blind pouch develops in the proximal part Distal esophagus connected to trachea
of the esophagus (type A) by means of a fistula

Inability to take in amniotic fluid

Fetus continuously exert effort to swallow

amniotic fluid

Accumulation of amniotic fluid in the

pouch

Hypertrophy and dilatation of the pouch

Backflow of amniotic fluid in the maternal

environment

Uncompensated increase in amniotic

fluid as fetus develops
Mixture of oxygenated and unoxygenated
blood into the systemic circulation
Increased amount of blood
circulates in the lungs

Blood compensate by producing RBC for

tissue oxygenation needs
Pulmonary pressure increases

Polycythemia
Pulmonary vascular
congestion

Pulmonary edema
 Shifting of oxygenated (higher pressure) in
the left shunt to the right atrium

Increased amount of blood Some of the blood flows back

enters the pulmonary veins to the right ventricle The right atrium accommodates large
volume of blood

Pressure at left side of the Pressure exerted on the walls

heart increases of the right ventricle increases

Treatment and Management:

Supplemental oxygen – O2 at
Blood regurgitate back to the Increased workload of the right 1 LPM
lungs ventricle Prostaglandin synthetase
inhibitor (Indomethacin)
Corrective surgery to close
septal defect
Further lung congestion Right ventricular hypertrophy Diuretics
occurs

Right ventricular failure

RECOVERY
 Polyhydramnios

Over distention of the uterine wall

Increase pressure in the uterine wall

Contraction of uterine muscle as a

compensatory mechanism

Preterm Labor

Prematurity
(Birth of Preterm infant)

Immature Lungs Underdeveloped Immune System

Entry of pathogenic organisms in the lower respiratory tract

Immature red blood cells
 Respiratory failure

Impaired oxygen transport

Impaired circulation

Hypoxia

Ischemia

Necrosis of tissues

Multiple organ damage

DEATH
Inadequate production of lung surfactant Bacterial growth in the spores between
the cells and adjacent alveoli

Decrease lung expansion

Invades the air sacs through the connecting pores

Inadequate exchange of air

Triggers the immune system to respond

Impaired gas diffusion

Inflammatory process

Further exertion of the lungs to

compensate Macrophage and leukocyte stimulation
and migration (Chemotaxis)

Lung Collapse (Atelectasis)

Mucus production

Regeneration of the alveolar membrane

with thick epithelial cells Accumulation of secretions in the alveoli
Increase breakdown of RBC due to shorter life span

Increase release of Hemoglobin into the circulation

Increase in Heme as product of the

breakdown of Hemoglobin

Heme attached to albumin travels to the liver

Conversion of Heme into unconjugated

bilirubin

Increase number of unconjugated

bilirubin

Impaired liver function

 Eventual scarring and loss of functional Parenchymal and alveolar inflammation
lung tissue

Pneumonia
Hyaline Membrane Disease

Bacteria travel to the blood

Impaired oxygen transport, Signs and Symptoms:

Septic shock
Breathlessness
Chest Indrawing / retractions
Hypoxia and hypercapnea X – ray result dated last January
29, 2010 and February 1, 2010 Multiple organ damage
Tachypnea
Hypoxemia
Compromised Respiratory Grunting
Function Reduced urine outrput DEATH
Flaring of nostrils
Swollen limbs
Swallow breathing
DEATH Cyanosis
 Signs and Symptoms:

Chest indrawing / retractions Impaired conversion of unconjugated

X – ray result dated last January 29, bilirubin into conjugated bilirubin
2010 and Februaury 1, 2010
High fever
Chills
Chest pain in breathing Unconjugated bilirubin goes with the bile
Dry cough

Unconjugated bilirubin goes to the

intestines

Treatment and Management:

Bronchodilator (PAI) - Salbutamol 0.5cc + 1cc
PNSS q8H and Ipratropium bromide (Duavent) Absence of normal bacteria in the
Antibiotics intestines
Meropenem 60 mg IV drip x 30minutes
every 8 hours Signs and Symptoms:
Vancomycin 22mg IV q12H x 30 mins
Ciprofloxacin 16mg IVTT q12H
Chalky white stool
Ampicillin 78mg IVTT every 8 hours Failure of the bilirubin to be broken down
Ceftazidime 47mg IVTT every 12 hours Diluted urine
into urobilirubin and stercobilirubin
Cefipime 48mg IVTT q 12H
Amikacin 29mg IVTT q36H
Oxygen – O2 at 1 LPM
Placing on moderate high back rest
Pulse oximeter – oxygen saturation of 99% as of Unconjugated bilirubin returned to the
Februaury 2, 2010
circulation

RECOVERY Increase levels of unconjugated bilirubin

in the blood
Treatment and Management:
Supplemental oxygen – O2 at 1 LPM
Placement of endotracheal tube
Mechanical ventilator
Continuous Positive Airway Pressure
Surfactant replacement with artificial
surfactant

RECOVERY
 Signs and Symptoms:

Jaundice / yellowing of the skin and Signs and Symptoms:

sclera based on physical
assessment on January 30, 2010, Accumulation of unconjugated Increase indirect bilirubin of
February 2 and 9, 2010. bilirubin in the tissues and 122.05 umol/L as of January
Pruritus organs 29, 2010
Increase total bilirubin of
127.74 umol/L as of January
29, 2010
Hyperbilirubinemia

Excess bilirubin enters the Treatment and Management:

blood brain barrier Phototherapy
Frequent feedings

Kernicterus

Conversion of unconjugated
bilirubin to conjugated bilirubin
CNS damage Signs and Symptoms:

Dark green stool

Excretion of bilirubin in the urine Yellow urine
DEATH and stool

RECOVERY