Necrotizing Enterocolitis (NEC)
Pathophysiology
Signs and symptoms
Bells' Criteria
The pathophysiology of NEC is inflammation of the intestine leading to bacterial invasion causing cellular damage and cellular death and necrosis of the colon and intestine. As NEC progresses, it can lead to intestinal perforation causing peritonitis, sepsis, and death.
Feeding intolerance
Emesis
Bloody stools
Abdomen distension
Changes in physiological stability
Vital signs (HR, central-peripheral temperature)
Glucose , Blood counts
Nursing Diagnostics
1.Have an infection in the gastrointestinal tract
2.Risk of not getting enough nutrients to meet the body's needs.
3.There is a chance of hypoxia due to decreased oxygen conductivity.
Nursing intervention
NPO on OG-tube, open the connecting cable into the bag, evaluate the content, appearance, color and quantity, measure AC every 8 hours.
Provide nursing care according to infection prevention standards, emphasizing washing hands before and after nursing every time.
Give antibiotics according to the 7R standards, watch for side effects from the medicine.
Check v/s measure BT every 4 hours to assess for increased infection such as lethargy, fever, chills, unable to accept milk, increased bloating, etc. and report doctor.
Nursing intervention
Take care of giving fluids and nutrients intravenously.
Weigh once a day. Should increase approximately 20-30kgs per day.
Blood was drawn to follow up on electrolyte lab results.
Nursing intervention
Position yourself in bed with your shoulders supported so that your airway is straight. Observe breathing, skin color
Check V/S, SpO2 every 1-2 hours.
Give LPRC according to the Check V/S treatment plan according to blood transfusion standards. Watch for side effects from the blood. Drill HCT 4 hours after the blood has run out.
Treatment
Stages 1 and 2 are treated without surgery.
NPO 10-14 days to stop intestinal function.
inserting a nasogastric (NG) tube (nose into stomach) to keep the stomach empty
antibiotics for infection
intravenous fluids (IV) for nutrition and fluid replacement
Severe cases
surgery to remove diseased intestine or bowel
connecting part of the intestine or bowel to an ostomy (opening on the abdomen)
Nursing goals : To prevent oxygen depletion
Evaluation criteria :
1.V/S is within normal limits at age 1–8 years. RR=15–30 beats/minute PR=80–100 beats/minute BP=80–110/60–75 mmHg BT=37+-2 degrees Celsius.
2.No signs and symptoms of deficiency such as cyanosis, decreased level of consciousness. Short, shallow or difficult breathing, sweating, fast heartbeat, widening of the wings of the nose, sunken chest.
3.O2sat ≥ 95%
Nursing goals : Patients receive adequate nutrition
Nursing goals : To reduce infections of the gastrointestinal tract and prevent repeated infections.
Evaluation criteria :
1.V/S is within normal limits at age 1–8 years. RR=15–30 beats/minute PR=80–100 beats/minute BP=80–110/60–75 mmHg BT=37+-2 degrees Celsius.
2.Normal content color
Evaluation criteria :
1.Weight is within normal range
2.Normal Electrolyte lab
Na = 136 - 145 mmol/L.
K = 3.4 - 4.5 mmol/L.
Cl = 98 - 107 mmol/L.
Necrotizing enterocolitis (NEC) can be staged into three groups
stage I
lethargy, temperature instability, apnea, bradycardia
emesis, abdominal distension, hematochezia
stage II (clinical signs as in stage I)
metabolic acidosis, thrombocytopenia
abdominal tenderness, absent bowel signs
stage III (clinical signs as in stage I and II) respiratory or circulatory arrest
นางสาวณัฐชยา วีระชาติ 65110007-5 No. 7
อ้างอิง Yusra Sheikh/2019/Necrotizing enterocolitis (staging)/เข้าถึงได้จาก: https://radiopaedia.org/articles/necrotising-enterocolitis-staging-1
Jacob G. Ginglen; Nikolai Butki.,Necrotizing Enterocolitis.(August 2023).