Impaired Swallowing and Altered Family Processes r/t Newborns with Esophageal Atresia

Nursing Diagnosis and Interventions for Newborns with Esophageal Atresia

Nursing Diagnosis : Impaired Swallowing related to mechanical obstruction.

Goal: Patient getting adequate nutrition.

Outcomes: The baby gets enough nutrients and showed satisfactory weight gain.

Intervention:

• Give fed through gastrostomy in accordance with the provisions.
• Continue oral feeding as applicable, under the conditions of infants and surgical repair.
• With strict observation.
• Monitor input and output weight.
• Teach families about proper feeding techniques.

Rational:

• To meet the nutritional needs of infants
• To assess the adequacy of nutrient inputs.
• To make sure the baby is able to swallow without choking.
• To provide nutrients to allow oral feeding.
• To prepare for the return.

Nursing Diagnosis : Altered Family Processes related to babies with physical defects.

Goal: patient (family) prepared for child care at home.

Outcomes : Families demonstrate the ability to provide care to infants, understanding the signs of complications, and appropriate action.

Intervention:
Teach the family about the skills and needs of nursing home observations:

• Give position.
• Signs of respiratory distress.
• Signs of complications; refusing to eat, dysphagia, increased cough.
• The need for tools and materials needed.
• Gastrostomy care if the infant had surgery, including techniques such as suction, feeding, or ostomy care operasidan side, and a replacement bandage.

Rational

• To prevent aspiration.
• To prevent delays in action.
• So that practitioners can be notified.
• To ensure proper care after discharge.

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Nursing Care Plan for Impaired Swallowing

Impaired Swallowing. Swallowing is a unique process that requires good performance of the muscles in the throat , face, tongue, and palate. The presence of the disease, disorders or abnormalities in one of these organs will interfere with the process of swallowing.

Difficulty swallowing or dysphagia. It is usually a sign of a problem in the throat or esophagus (esophageal), tube-shaped muscle that moves food and liquid from the back of the mouth to the stomach. Although dysphagia can happen to anyone, but generally only occur in the elderly, infants, and those who have problems with the nervous system or brain.

There are many causes that can lead to throat or esophagus does not function normally. It could be because of some small things, but some other things that might cause it is a serious disorder. If only having one or two times only, not to worry, the possibility of not having a medical problem. But if trouble swallowing continuously, it is likely to suffer a serious problem that requires proper handling.

In normal circumstances, the muscles in the throat and esophagus will squeeze or contract to move food and liquids from the mouth to the stomach without obstacles. There are two types of problems that can make it difficult for food and liquid move into the esophagus, namely :

1. The muscles and nerves that help move food through the throat and esophagus does not work properly. This can happen because :

• Suffered a stroke, brain or spinal injury.
• Problems with the nervous system, such as post - polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson's disease as well. It could also be caused after diphtheria, syphilis, poisoning, bibulous, and hysteria.
• Immune system problems that cause swelling or inflammation, and weakness, such as polymyositis or dermatomyositis.
• Esophageal spasms. This means that the muscles of the esophagus suddenly pressing. Sometimes this can prevent the food to reach the stomach.
• Scleroderma. In this condition, the tissues of the esophagus become hard and narrow. Scleroderma can also make the muscles become weak lower esophagus, which can cause food and stomach acid back up into the throat and mouth.

2. There is something blocking the throat or esophagus. This may occur because :

• Gastroesophageal reflux disease (GERD). When stomach acid up into your esophagus, it can cause ulcers in the esophagus, which then can cause scars or wounds. These scars can make a narrow esophagus.
• Esophagitis. It is an inflammation of the esophagus. It can be caused by many things, such as GERD or an infection or because the pill is stuck in the esophagus. In addition, difficulty swallowing can also be caused by allergic reactions to certain foods or things other airborne.
• Diverticula. It is a small sac that grows on the wall of the esophagus or throat.
• Esophageal tumors. Growth in the esophagus may be cancerous or noncancerous.
• Lymph nodes and tumors that suppress the esophagus.

In addition , dry mouth could make matters worse dysphagia . This is because you may not have enough saliva to help the food from the mouth to enter the esophagus . Dry mouth can be caused by the influence of the consumption of drugs or other health problems.


Dysphagia can come and go at any time, mild or severe, or worse than would occur continuously. If experiencing dysphagia, may be :

• Food or liquid could not swallow at swallowing the first experiment.
• Vomiting, choking, or coughing when swallowing.
• Food or liquid back up into the throat, mouth, or nose after swallowing.
• Feeling like food or fluid trapped in one or several parts of the throat or chest.
• Pain when swallowing.
• Pain or distress in the chest or stomach.
• Weight loss due to not getting enough food or fluid intake.

Nursing Care Plan for Dysphagia : Impaired Swallowing
will depend on what is causing dysphagia. Treatment for dysphagia includes :

• Exercise for the muscles to swallow. If there is a problem with the brain, nerves, or muscles, may need to do exercises to train the muscles to work together to help swallow. Also may need to learn how to good posture or how to put food in the mouth in order to swallow either.
• Change in eating food. The doctor may suggest to avoid or change certain types of foods and liquids to make the process easier to swallow.
• Dilation (widening). In this treatment, the device is placed into the esophagus, then carefully will expand the narrow areas of the esophagus. Perhaps this treatment should be done several times.
• Endoscopy. In some cases, a long, thin scope can be used to retrieve the object that is stuck in the esophagus.
• Food that is stuck mashed with similar chemicals such as papain, that blob can continue down the food into the stomach.
• Surgery. If there is something blocking the esophagus (such as a tumor or diverticula), may need surgery to remove it. Surgery is also sometimes used in people who have a problem that affects the muscles of the esophagus (achalasia).
• Drugs. If experiencing dysphagia associated with GERD, the heat in the stomach, or esophagitis, prescription drugs can help prevent stomach acids enter the esophagus. Infections of the esophagus are often treated with antibiotic drugs.

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Nursing Care Plan for Dysphagia : Impaired Swallowing

Nursing Diagnosis for Dysphagia -Impaired Swallowing


Swallowing is a complex process that allows the movement of food and liquids from the mouth to the stomach. This process involves structures in the mouth, pharynx, larynx and esophagus.

Complaints of difficulty in swallowing (dysphagia) is one of the symptoms of the disorder or disease in the oropharynx and esophagus. These complaints will arise when there is interference with the movement of the muscles of swallowing and impaired transport of food from the mouth to the stomach. Types of foods that cause dysphagia can provide information regarding disorders that occur.


Purpose

1. General Purpose

• Knowing nursing care in patients with Dysphagia.

2. Special Purpose
To know the nursing care for patients who experience such as :

• Definition of Dysphagia.
• Etiology of Disphagya.
• Pathophysiology of Disphagya.
• Diagnosis and treatment Disphagya.
• Disphagya nursing care to patients.

Nursing Care Plan for Dysphagia


Definition

Disphagya is difficulty in swallowing and getting food from the esophagus into the stomach. Dysphagia can cause all sorts. Important to know the difference dysphagia, because orofaring and esophageal disorders. If not carefully observed, the symptoms are very similar.

On the problems of the esophagus, dysphagia sometimes there is, in the event of esophagitis or esophageal obstruction. Problems of the esophagus is usually also accompanied by regurgitation. Hypersalivation never or rarely occurs and when there is usually a result of a foreign object is actually a pseudo - hypersalivation.


Etiology

Disphagya can be found on some of the causes that can cause the condition include:

• Stroke.
• Progressive neurological disease.
• The tube on trachestomy.
• Paralise or absence of movement of the vocal cords.
• Tumors in the mouth.
• Surgery of the head.

Pathophysiology

Normally people swallow solid food or drinking liquids and swallow saliva or mucus produced by the body hundreds of times every day. The swallowing process has four stages : the first stage of preparation in the mouth, where food or solids mobilized / manipulated and chewed in preparation for swallowing. During the oral stage, the tongue pushing food or solids into the back of the mouth, and began to swallow response. Pharyngeal phase began immediately after food or liquid pass through the pharynx (the tube that connects the mouth to the esophagus) into the esophagus or gastrointestinal tract. The last stage is the stage of esophageal, food or liquid pass through the esophagus into the stomach. Although the first and second stages have some control voluntair, stages three and four occur by itself without realizing it. If the swallowing process stalled due to various reasons, will result in difficulty swallowing.





Nursing Assessment

Nursing assessment needs to be done in patients with swallowing disorders or disphagya include :

• History of the disease.
• History of stroke.
• History of the use of medical devices : tracheostomy, nasogastric tube, mayo tube, ETT, post endoscopy examination.
• History surgery laryx blood, pharynx, esophagus, thyroid.
• Postoperative mouth area.

Physical examination :

• Mouth shape is not symmetrical.
• Looks an inflammation of the pharynx.
• The presence of Candida in the oral / mouth.
• Edema of the pharynx.

Nursing Diagnosis and Nursing Interventions

1. Impaired swallowing related to muscle weakness due to swallowing paralise

Outcomes :
Patients can demonstrate the proper method of swallowing food without causing despair.


Intervention :
a. Review the patient's ability to swallow , note the extent of facial paralysis.
b. Increase efforts to be able to perform effective ingestion such as helping the patient hold his head.
c. Place the patient in a sitting position / upright during and after eating.
d. Stimulation lips to open and close the mouth manually by pressing lightly on the lips / under the chin.
e. Place the food in the mouth is not ill / disturbed.
f. Tap the deepest part of the cheek with a spatula to know the weakness of the tongue.
g. Give eat slowly in a quiet environment.
h. Start by giving a semi-liquid food orally , soft foods when patients can not swallow water.
i. Help the patient to choose foods that are small or do not need to chew and easy to swallow.
j. Instruct the patient to use a straw to drink liquids.
k. Suggest to participate in the exercise program.


2. Imbalanced Nutrition Less than Body Requirements related to lack of adequate food intake.

Outcomes :
Adequate nutritional intake.

Intervention :
a. Instruct the patient to eat slowly and chew food thoroughly.
b. Feeding little and often with foods that are not irritating.
c. Serve food in interesting ways.
d. Avoid eating or drinking foods that contain irritant substances.
e. Measure body weight each day and record the increase.
f. Observation of the patient's intake of nutrients and review the things that hinder / complicate the swallowing.

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