EDULEARN- 6th International Conference on Education and New Learning Technologies  EDUCATION FOR THE HEALTH: MANUAL OF SERVICE TO THE NEWBORN WITH GASTROSCHISIS.

Apresentação em tema: "EDULEARN- 6th International Conference on Education and New Learning Technologies  EDUCATION FOR THE HEALTH: MANUAL OF SERVICE TO THE NEWBORN WITH GASTROSCHISIS."— Transcrição da apresentação:

1 EDULEARN- 6th International Conference on Education and New Learning Technologies 
EDUCATION FOR THE HEALTH: MANUAL OF SERVICE TO THE NEWBORN WITH GASTROSCHISIS IN AMAZONAS – BRAZIL Authors: : ¹Fabíola Silva dos Santos; ²Thaís Helena C. Corrêa; ³Selma Barboza Perdomo;⁴ Maria de Nazaré de Souza Ribeiro;⁵ Karina Maria S.C. de Barros Barcelona, 2014

2 CONCEPT Gastroschisis The gastroschisis is the protrusion of the intra-abdominal content without the involvement of the umbilical cord or the peritoneal sack through defect in the previous abdominal wall, usually on the right side, lateral to the umbilical ring, which involves all its layers, from the peritoneum to the skin, resulting from the incomplete closing of the lateral pleats of the body, event that happened during the fourth week of gestation (American Pediatric Surgical Association, 2013). Fonte:

3 INCIDENCE During the last two decades, the global incidence of gastroschisis is in ascension (Curry, 2000 . The gastroschisis incidence varies from 1,4 - 2,5 for born alive without predilection for sex (Brazil, 2000; Hume, 1997; Curry, 2010; Blakelock, 1997). Factors associated with an increased risk of gastroschisis include maternal age, parity and maternal use of drugs in the gestational period.

4 OBJECTIVE Being so, this study had as main objective verifies the profile of newborn admitted with gastroschisis in 2012 in ICAM, through the analysis of the handbooks and to originate a guide of nursing service for this public.

5 METHOD A field research took place from documental and retrospective nature with quantitative approach. The source of the documents was the particular files of the public Institution of the Health Institute of the Child from Amazonas - ICAM. The study was accomplished in the Intensive Therapy Unit (UTI) neonatal of Health of the Institute of the Child from Amazonas (ICAM), in Manaus - AM.

6 METHODOLOGICAL GUIDELINES
type of study Quantitative, descriptive, exploratory,documentary, retrospective Place of study Fonte: portalamazonia.globo.com Records of Newborns diagnosed with gastroschisis Served in the period from january 1 to december 31, 2012. N: 40 newborns with gastroschisis No: 39 records of infants with gastroschisis Sample Diagnosis only other malformatios indigenous ethnic group; Records with incomplete records, or illegible with erasures. Data collection SAME- Through the analysis of medical records, standardized instrument CNS Resolution 196/96 Approval IRB / UEA 24/05/2013 number of CAAE: ethical aspects Data Analysis Excel spreadsheet and tables

7 RESULTS 40 with of gastroschisis 3,33% months CENSUS 2010
234 Admitted in surgical ICU 17.09% on year Tannuri et al 2010 Institute of Child Hospital of São Paulo 08 years 12,87 of years 103 cases in total Census 2010 fertility rate in northern Brazil higher incidence of gastroschisis fertility rate in Brazil high birth rate

8 Weight of newborn in grams Information not registered in the handbook
Table 1. Clinical profile of the newborns with gastroschisis assisted in ICAM in Manaus-AM, 2013 Sex Number f(%) Female 18 46,15% Male 21 53,85% Total 39 100,00% Weight of newborn in grams f (%) Information not registered in the handbook 4 10,26% Recém-nascido à termo 17 43,59% Recém-nascido pré termo

9 Newborn weight in grams
Table 1. Clinical profile of the newborns with gastroschisis assisted in ICAM in Manaus-AM, 2013 Newborn weight in grams Number f(%) Information not registered in the handbook 3 7,69% 2 5,13% 17 43,59% 12 30,77% 4 10,26% Total 39 100,00% Skin number Cyanotic Pale Normal skin color 22 56,41%

10 Information not registered in the handbook 12 30,77% Normal skin color
Table 1. Clinical profile of the newborns with gastroschisis assisted in ICAM in Manaus-AM, 2013 Skin number f(%) Cyanotic 3 7,69% Pale 2 5,13% Information not registered in the handbook 12 30,77% Normal skin color 22 56,41% Total 39 100,00% Temperature of the newborn Hypothermic 20 51,28% Information not registered in the handbook 18 46,15% Normothermic 1 2,56%

11 Manual of Orientations
This manual has the intention to offer an assistant plan to the nurses that helps newborns with so much gastroschisis in the maternities of Manaus as in the institute of reference of pediatric surgery of the state, it was created subsidized in the profile of these newborns and it approaches in a didactic way the nursing actions in the preoperative in the transfer through ambulance to the reference unit as well as in the trans and postoperative, promoting this way the health and improving the prognosis of the newborn attacked by such malformation.

12 Manual of Orientations
Attendance of Nursing in the preoperative - Delivery room Action Theoretical Justification To maintain sterile paramentation; The newborn must be handled with sterilized gloves avoiding this way the hypothermia and probable infection (Tamez; Silva, 2013). To accommodate the newborn in right lateral decubitus in a cradle or warm incubator; The positioning in right lateral decubitus improves the veined return and the perfusion of the intestinal loops (Neblet, ). . To maintain aerial superior vias free; To aspirate aerial superior vias; In order to maintain the permeability of the aerial vias, the head is positioned with light extension of the neck, avoiding the hyperextension or exaggerating flexing. Per times, it is necessary to put a cushion under the shoulders of the newborn, if there is excess of secretions in the aerial vias (Brazil, 2012).

13 Manual of Orientations
To involve intestinal loops with humid and warm sterile compresses involved by plastic sack of polyethylene; The hernial content must be protected with sterile compress and to involve it with porous plastic to avoid rupture, contamination and liquid loss and heat (Brazil, 2012). To maintain the viscus in vertical position The way of protection of the intestinal loops, aims to protect and involve them avoiding their compression, it is “sine quo non”, that the intestine is maintained in the medium line and that is observed continually to assure the appropriate perfusion and to avoid the torsion of the mesentery (Moura, 2013). It is important to maintain the viscus in vertical position, because the fold of the viscus can take to ischemia and necrosis(Santos, 2010). To substitute curative when gauzes be saturated by peritoneal exudate; The curative with sterile gases is ineffective in preventing the bacterial contamination, because the microbial contamination happens by capillarity(Ramos; Milk, 2013). To check vital signs, attempting to the temperature; The newborn must be monitored, for precocious detection of signs that indicate: hypothermia, hypotension, breathing insufficiency and shock (Moura, 2006). To pass orogastric probe type nelaton n°10; In the intention of promoting the drainage of the gastric content, avoiding larger distention of the intestinal loops (Moura, 2006).

14 Manual of Orientations
To install peripheral veined access of thick caliber; The installation of the patent peripheral veined access is important for the hydroelectrolytic replacement and antibiotic therapy administration (Brazil, 2012). To begin antibiotic therapy of wide Spectrum, according to the protocol; The protocol of antibiotic administration has the intention to reduce the infection risk by pathogenic bacteria (Moura, ) To install hydroelectrolitic restitution; The hydro restitution must be accomplished and observed strictly, because the volume administered to newborn is twice larger than newborn without gastroschisis (Gaines; Col, 2000). To register in the proper form of transfer: Pregnancy age of the newborn, weight, classification per weight, sex, state hemodynamic aspect of the hernial viscus and accomplished nursing cares; The lack of precise registrations, as well as the access absence to the relevant information described in the handbook during transfers from an unit to other, for the professionals of health, increases in a significant way the risk of damages to the patient, taking to disastrous consequences in their attendance (Goldsmith et al, 2010)

15 Manual of Orientations
Attendance of Nursing in the transfer of newborns with gastroschisis Action Theoretical Justification To evaluate hemodynamic stability of the newborn; After the stabilization of newborn in the delivery room, the same should be directed for the surgical center, minimizing like this the intercurrence risk during the transfer (Silva et al, ). To handle the newborn with sterile gloves and use of EPI. The principles "pattern precautions" should be followed and the cares to avoid spread of the secretions in the hospital environment (Brazil, ). To attempt to the fixation of tubes, probes, and curative. During the transfer in ambulance can happen accidental retreat of tubes, drains and probes, for that the importance of maintaining them fixed (Roche, 2011). To use transport incubator heated up; To Avoid shock by hypothermia (Rodriquez et al, ). To maintain continues monitoring of vital signs through transport monitoring; The hemodynamic monitoring should be established as essential factor for the verification of shock signs (Montalto and Conz, 2012). To control infusion of electrolytes for leak or infusion bomb; To Avoid accidents as hypervolemia, sharp edema of lung because liquid excess30. To maintain orogastric probe open N° 10; To Reduce the gastric content, through drainage (Roche, 2011). To maintain viscus involved in warm compresses and transparent film, or vertically fixed bag of polyethylene; Maintenance of the corporal temperature due to solid area of exposed surface, taking what takes the hypothermia (Rodriquez et al, 2010).

16 Manual of Orientations
Attendance of Nursing in the Transoperative - gastroschisis / Surgical Center Action Theoretical Justification To maintain control of vital signs through continuous monitoring; To monitor hemodynamics signs, to prevent hemodynamic instability (Nascimento, 2013). To maintain sterile paramentation; To reduce the infection risk by bacterial pathogens transmission (Moura, 2006). To inject physiologic warm serum with rectal probe, smoothly. To maintain the small and thick intestine totally empty (Tamez and Silva, 2013). To maintain continuous gastric aspiration; To minimize the risk of lung aspiration (Nascimento, 2013) To accomplish reading and evaluation of the pressures, abdominal, intravesical and splanchnic; To obtain predictive values to establish total or step by step reduction (Nascimento, 2013). To accomplish curative in operative wound (if completely close) or silo (closed step by step) The surgical closing can happen for primary fatial closing or, in cases that the disproportion visceroabdominal is big, due to inflammation of the exposed organs, we should choose the closing step by step with skin silo of skin or silicon, being suitable the complete closing after some weeks (Whistles et al, 2003) To direct for intensive unit. In the intensive neonatal therapy unit newborn will be monitored by a qualified multidisciplinar team, this one important factor in their evolution (Brazil, 2012)

17 Manual of Orientations
Attendance of Nursing in postoperative - Intensive Neonatal Unit Action Theoretical Justification To welcome the parents answering their doubts about what will be accomplished with their newborn. The nursing team when receiving a newborn with gastroschisis must guide the relatives together with the multidisciplinary team on what will be accomplished with their son in the intention to reduce the anxiety promoting the knowledge on the services offered giving them support (Tamez and Silva, 2013). To position the newborn in right lateral decubitus; When accommodating the newborn in right lateral decubitus the professional promotes the improvement of veined return to this newborn (Moura, 2006). To install oxygen support (mechanical Ventilation) Until the first 72 hours after the intervention it is primordial the pressure intra-abdominal monitoring, due to the increase of the intra- abdominal pressure, because it can influence in the thoracic expansibility, in the veined return, reducing the appropriate oxygenation (Scopesi et al, ).

18 Manual of Orientations
To install continues hemodynamic monitoring; The monitoring made through wrist/cardioscope oximeter, electrocardiogram (ECG) and monitors of blood pressure non invasive must be inserted as routine procedure, in the intention of foreseeing possible shock states (Voice, 2005). To install continuous analgesia; The nurses have a role of extreme importance in the handling of the pain, because they stay more time beside the patient having so the opportunity to address actions for the handling of the pain (Presbytero, 2010). To accomplish curative in operative wound and or silo once a day, registering aspect of the operative wound, if presence of SILO, to evaluate and to register aspect of the viscus; Fits to the nurse to accomplish the daily curative with gauzes and sterile ties, maintaining the loops in vertical position, reducing this way the postoperative risk of infection (Tamez, 2013). To aspirate the orotracheal tube and superior aerial vias, whenever necessary; If there is excess of secretions in the aerial vias (Brazil, 2012).

19 Manual of Orientations
To register weight and edema daily Soon after the surgical correction newborn must present big exudative losses as, for instance, water, sodium and proteins for the third space or for the inflamed intestinal walls (Moura, 2006). To install parenteral nutrition; Newborns with gastroschisis, develop with some degree of intestinal dysfunction, so they need parenteral nutritional contribution (Nichol, 2008). To restore volume drained by orogastric probe; to register aspect and volume of secretion of the orogastric probe; registering acceptance of the diet after its introduction; The volemic replacement in newborns should be two or three times larger than in newborns without that anomaly. Therefore, it is maintained the rigorous control of the diuresis and replacement of the losses by the orogastric probe in the intention to prevent dehydration or even prerenal inadequacy (Gaines and col., 2000). To maintain rigorous hydric control; The increase of the intraabdominal pressure of the closing of the wall contributes to the decrease of the renal perfusion, what is responsible for the oliguria (Moura, 2006). To register diet acceptance; One of the factors that should be taken in consideration as predictive factor of improvement of the mobility is the decrease of bilious residue and retention of the diet (Moura, 2006). When of the discharge, to guide the relatives about the feeding of the newborn and attendance in the infirmary. The nursing has fundamental paper in the relatives' orientation about the handling of feeding of newborns with gastroschisis, it fits to the professional the orientation about the risk of complications and prevention of them (Tamez and Silva, 2013).

20 CONCLUSION The results of that research, together with the studied bibliographical theoretical referential, served as subsidies for the creation of the manual of orientation of cares for the nurses' team that, now is in implementation phase in ICAM. It is waited that this manual orientates the actions of the nursing team and, consequently, reduce the inherent complications to the disease and the death occurrence.

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