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917
Nursing Assessments
Congenital hydrocephalus
Enlarged head
Enlarged or full fontanelles
Split or widened sutures
Setting sun eyes
Head circumference 90% on growth
chart
Choanal atresia
Cleft lip
Cleft palate
Tracheoesophageal fistula
(type 3)
(At left) Unilateral cleft lip with cleft abnormality involving both hard and soft palates.
(continued)
918
SIX
THE NEWBORN
CONTINUED
Congenital Anomaly
Nursing Assessments
Tracheoesophageal fistula
(type 3) continued
Esophagus
Trachea
(At left) The most frequently seen type of congenital tracheoesophageal fistula and
esophageal atresia.
Diaphragmatic hernia
Nurse should never ventilate with bag and mask O2 because the stomach and
intestines will become distended with air, further compressing the lungs.
Maintain respiratory status: Immediately administer oxygen. May need to be
intubated and ventilated.
Initiate gastric decompression.
Place in high semi-Fowlers position (to use gravity to keep abdominal organs
pressure off diaphragm).
Turn to affected side to allow unaffected lung expansion.
Carry out interventions to alleviate respiratory and metabolic acidosis.
Assess for increased secretions around suction tube (denotes possible
obstruction).
Aspirate and irrigate tube with air or sterile water.
Esophagus
Lung
Diaphragm
Liver
Bowel through
opening in
diaphragm
Stomach
919
CONTINUED
Congenital Anomaly
Nursing Assessments
Myelomeningocele
Omphalocele
Gastroschisis
may suffer withdrawal. In addition, the drugs the mother ingested may be teratogenic, resulting in congenital anomalies.
Alcohol Dependence
The fetal alcohol syndrome (FAS) includes a series of malformations (identified shortly) frequently found in infants
exposed to alcohol in utero. It has been estimated that complete FAS occurs in 5.2 live births per 1000 (AAP Committee on Substance Abuse and Committee on Children with