Tracheoesophageal Fistula: Assessment

Tracheoesophageal Fistula- Assessment

  • Congenital defects of the esophagus
  • Incomplete formation of the esophagus, terminates before reaching the stomach
  • Often associated with fistula between the trachea and esophagus, many variations
  • Associated other defects present in approx. ½ of all infants with EA with TEF

VACTERL
V – Vertebral defect
A – Anorectal defect
C – Cardiac defects
T – Tracheoesophageal fistula
E – Esophageal atresia
R – Renal anomalies
L – Limb defects

Pathophysiology:

  • Occurs during the 6-8th week
  • Defective separation of the foregut into the esophagus and the trachea

Clinical Manifestations:

  • Fine, frothy bubbles of mucous, clear with suctioning only to return
  • 3 C’s- Episodes of coughing, choking and cyanosis, esp. with feeding
  • Abdominal distention, air builds up in the stomach

Diagnosis:

  • History of polyhydramnious
  • Unable to view stomach bubble on ultrasound
  • Feeding tube passed stops at 10-12 cm instead of 17 cm.
  • Follow-up with radiographic studies, absence of air in stomach – EA w/o TEF

Treatment :

  • Before 1939 fatal
  • Now surgery in the first few days
  • Goal is to prevent aspiration until then
  • One stage repair preferred
  • Premie or fragile infants close fistula, gastrostomy tube
  • Anastomosis of esophagus later

Nursing Management:

  • Preop –
    • Goal prevent aspiration and regurgitation
    • NPO
    • Continuous suction
    • Supine with elevated head
  • Postop –
    • Goals patent airway, prevent trauma
    • Gentle suctioning
    • Observation for airway obstruction – anxious look, tachypnea, abnormal breath sounds
    • NPO until bowel sounds return
    • IV
    • Glucose water if tolerated then formula or breast milk
    • Pacifier for sucking needs
    • Family teaching:
    • Observe for esophageal stricture- dysphagia, increased drooling, coughing, choking
    • If gastrostomy, care and feeding

Case Study 3: Esophageal Atresia with Tracheoesophageal Fistula

The young mother is crying and upset. Her husband stands by her mutely unsure of what to do or say. Shortly before their newborn boy, Dillon, had been rushed to the NICU. He was cyanotic, coughing and choking after his first feeding. The mother says the doctor came in and said Dillon’s “eso..esopha..jus wasn’t formed right…what does this mean? Is my baby going to die?” As the primary care nurse, you know the child has been diagnosed with esophageal atresia with tracheoesphageal fistula.
What might be some nursing diagnoses at this moment and what other nursing interventions, nursing outcomes would be appropriate?
Explain the anomaly to the mother and father. Draw pictures.
Explain the probable surgical intervention and what to expect.
What pregnancy condition might have been noted prior to delivery.
What other conditions might be associated with this condition? What is the acronym?
What is the prognosis? Prior to 1939 what was the prognosis?

References:

Daigneau, C. V. (2005). The child with gastrointestinal dysfunction. In M. Hockenberry, D. Wilson & M. Winkelstein (Eds.), Wong’s essentials of pediatric nursing (7th ed., pp. 839-889). St. Louis, Missouri: Elsevier Mosby.

Ellett, M. L. (2009). Chapter 24: The child with gastrointestinal dysfunction. In M. J. Hockenberry & D. Wilson (Eds.), Wong’s essentials of pediatric nursing (8th ed., pp. 813-860). St. Louis, MO: Mosby Elsevier.

https://nursingclass.wikispaces.com/GI+Round+3

Videos:

Tracheoesophageal fistula by Children’s miracle network
http://youtu.be/qbdVzd1A2rU