Nursing care of infants with terminal ileum and rectum malformations: a case study

ความพิการแต่กำเนิดบริเวณทวารหนัก (Anorectal malformation) เป็นความผิดปกติแต่กำเนิดซึ่งเกิดจากสาเหตุความบกพร่องทางพันธุกรรม หรือเป็นโรคติดเชื้อในครรภ์ ความพิการแต่กำเนิดบริเวณทวารหนักทำให้ไม่สามารถถ่ายอุจจาระได้ ส่งผลให้เกิดการอุดตันและ/หรือติดเชื้อ ควรได้รับการผ่าตัดอย่างเร่งด่วนภายใน 24 ชั่วโมง ทารกต้องได้รับการเตรียมความพร้อมในระยะก่อนผ่าตัด หลังผ่าตัดและดูแลต่อเนื่องที่บ้านอย่างปลอดภัย

Abstract

Anorectal malformation is a congenital abnormality caused by genetic defects or infection in the womb. Anorectal malformations prevent defecation, resulting in obstruction and/or infection. Urgent surgery should be performed within 24 hours. The infant must be prepared for the preoperative period, postoperative period and continued care at home safely.

Objective: To study and compare the use of nursing care for infants with abnormalities of the distal intestine and rectum who were admitted to Khon Kaen Hospital.

Method: This is a comparative study by assessing the problems, needs, monitoring and following up on symptoms, possible complications, preoperative period, postoperative period and continued care at home safely. The study was conducted from April to July 2024.

Results: Male, birth weight 2,180 grams, APGAR scores of 9, 10, 10 at 1 minute, 5 minutes and 10 minutes, respectively. Gestational age was assessed at 37+1 weeks. Diagnosis: Congenital malformation of the distal intestine and rectum, non-anal opening type congenital heart disease, non-cyanotic tetralogy of Fallot, and abnormal thyroid hormone levels. He was transferred to the neonatal ward for further treatment. He was treated in the neonatal ward for rectal anus correction and transferred to the neonatal intensive care unit 1 for observation. When his condition stabilized, he was transferred back to the neonatal ward for further treatment. During treatment, he was found to have an infection in the body, an imbalance of water and nutrients, shortness of breath, and incomplete body temperature control. The treatment period was 21 days. His weight before discharge was 2,370 grams. The second case study patient was male with a birth weight of 3,060 grams. His APGAR score was 9, 10, 10 at 1 minute, 5 minutes, and 10 minutes, respectively. The gestational age of the infant was 39+2 weeks. He was diagnosed with congenital malformations of the terminal intestine and rectum, with an anus that does not open to the outside. He was transferred to the neonatal ward for further treatment. He was treated in the neonatal ward for rectal anus correction and anus surgery. He was transferred to the neonatal intensive care unit for observation. When his condition stabilized, he was transferred back to the neonatal ward for further treatment. During treatment, he was found to have an infection in the body. Imbalance of fluids and nutrients, shortness of breath and incomplete body temperature control. Treatment period: 9 days. Weight before discharge: 3,190 grams. The infant received quality nursing care, free from the effects of preventable complications, including hypothermia. There were no complications before surgery, postoperative care, and infection prevention in caring for the infant's stoma. The mother was able to adjust to stress and had confidence and was ready to care for the infant with an stoma.