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When a child is born, they are transitioning from the womb to the world outside which is a hard transition for them, but sometimes they are also face with conditions that are congenital or deformations that affect them throughout their whole life. One of them is biliary atresia which is an obstruction of the bile ducts which generally occurs from congenital, stenosis, or absence of the duct. On average, there is one case of biliary atresia out of every 15,000 live births. Biliary atresia occurs slightly more often in females than in males and affects children of all races. In the United States, around 300 new cases in infants are diagnosed each year.
The chief sign, jaundice, does not develop until between 2 and 6 weeks of age even though biliary atresia is considered a congenital disorder. To distinguish this type of jaundice from other types labs will show a rise in direct bilirubin and alkaline phosphatase levels. Later with continues obstruction and back pressure will cause liver cell damage which will show by abnormal AST levels. Soon after the child will show low levels of fat and fat-soluble absorption due to lack of bile salts reaching the intestine which will cause diarrhea and weight loss. The child’s stools will appear light colored from lack of bile pigments and urine will be dark due to buildup of bilirubin. If a biliary atresia is detected early on a procedure called Kasai will be performed to redirect the bile duct to drain into the bowel. If the surgery is successful, the child’s stool will become darker and jaundice will slowly disappear. Due to location of the bile duct surgery may not be possible so after prolong obstruction the child will need a liver transplant or death from liver failure will occur. If not detected most children die before the age of two and even with a successful surgery most children have liver problems their whole life.
First nursing diagnosis that is presented in the assignment is Risk for imbalanced nutrition, less than body requirements, related to inability to digest fat. Recommendation will be to place child in a low-fat, high-carbohydrate diet. Water-soluble forms of fat-soluble vitamins are given to improve their levels, epecially vitamin K which is needed for adequate coagulation. Most children will remain on a similar diet or total parenteral nutrition until liver transplant can happen for them. Second nursing diagnosis is risk for bleeding due to lack of vitamin k absorption. The parents of the child will need to adhere to anticoagulant medication and lab work regiments. Also, monitor for sign and symptoms of bleeding to report to provider immediately. Avoid given NSAIDs to children which will increase the chances for bleeding. Third nursing diagnosis is impaired comfort due to illness-related symptoms. The child will have a hard time being comfortable due to inflammation of the skin with extreme itching, which is caused by accumulation of bile salts in the body. The child will also have a hard time breathing due to increased abdominal distension which will create extreme discomfort. Teach the parents on what to expect when the child goes home is important due to severity of the illness. Their child will be most likely place on a strict diet with more calories than a normal child because they have a faster metabolism due to their liver not working properly. They should be referred to a pediatric nutritionist to help them with proper feedings due to child being too sick to eat.
Most children are placed on a high-calorie liquid feedings through a nasogastric tube to help them reach required nutrition, parents need to be taught to administer the feedings. If transplant is provided the child will be put on strict medication to prevent attacking or rejection of the transplant. Antibiotics will also be prescribed to keep infections from forming. Keeping the child away from public setting and sick people will be needed to prevent infections as well. Reminding the parents to keep all appointments and work closely with the provider due to this condition possible being fatal if not treated properly.
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