Nursing Management for Necrotizing Enterocolitis

Necrotizing Enterocolitis (NEC) is a serious disease of the newborn gastrointestinal tract, characterized by extensive tissue death occurs in the intestinal wall. The disease is becoming one of the problems in neonates with very low birth weight (VLBW infants). In general, NEC is more common in premature neonates than full-term neonates. Risk factors causes of NEC are premature birth, early enteral feeding, the intestinal mucosal injury, and the presence of bacteria in the intestine.

Causes

This disease most often appears in sick neonates, and is a surgical emergency that occurs most frequently among neonates. Necrotizing enterocolitis is a disease that predominantly occurs in preterm neonates. In the premature neonate, there is a lowering immunocompetence, immaturity of the gastrointestinal tract, and abnormalities of peristalsis. This can lead to maldigestion and malabsorption of nutrients that stimulate the growth of bacteria, colonization and intestinal ischemia in premature neonates. Moreover, cardiorespiratory instability, homeostatic, and poor blood flow autoregulation, causing premature neonates more susceptible to ischemic events, or hypoxia and put them at risk for NEC.


Predisposing Factors

• Low birth weight and preterm.
• Neonates with asphyxia.
• Neonates with respiratory distress syndrome / recurrent apnea.
• Neonates born PRM or other perinatal infections.
• Neonates with umbilical vein catheterization.
• Cyanotic congenital heart disease.
• Hypothermia, hypotension and other general state of disorder.

Clinical Manifestation

Symptoms that appear on the NEC may occur suddenly but onset usually occurs in 1-2 weeks after birth and can occur up to several weeks. NEC onset inversely related to gestational age, where neonates born at 28 weeks tend to suffer from the disease is greater than in more mature age neonates.

Here are some of the clinical picture shown by the neonate:

• Aspirate / bilious vomiting.
• Food intolerance.
• Bloody stools.
• Distension and abdominal pain may progress to the stage of perforation with an overview: Abdominal pain increases. Abdominal wall hard and looked pale. Edema of the abdominal wall. Bowel sounds disappear. There are abdominal mass.
• Sepsis with clinical features: temperature instability. Jaundice. Apnea and bradycardia. Lethargy. À hypoperfusion shock (Lissaueur Tom and Avroy Fanaroff: 86).

Nursing Management for Necrotizing Enterocolitis

Basic principles of nursing management of NEC is planning nursing care in acute abdomen with the threat of septic peritonitis. The aim is to prevent worsening of the disease, intestinal perforation, and shock. If NEC occurs in epidemic group, the patients should be considered for isolation.


1. General Care
Neonates treated in an incubator in a private room with a notice of action aseptic / antiseptic. Monitoring of vital signs carried out continuously, fluid and electrolyte balance properly recorded and performed abdominal x-ray.

2. Rest Intestine
Oral feeding was stopped, decompression of the stomach by placing orogastric tube (evidence level III, level B recommendation). Lavement given when the neonate has not defecation.

3. Nutrition: Parenteral and Enteral.

4. Antibiotics.

5. Acidosis.

6. Disseminated intravascular coagulation
This situation can be suspected when: Low hematocrit. Low platelets. Prothrombin time elongated. Thromboplastin time elongated. Decreased fibrinogen.

7. Surgery.

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Nursing Process Management

Definition of Management

According to Gillies (1986) Management is defined as a process in completing the work through others. While the nursing management is a process of working through a member of the nursing staff to provide nursing care in a professional manner. The nursing manager is required to plan, organize, lead, and evaluate the facilities and infrastructure available to provide nursing care as effectively and efficiently as possible for individuals, families, and communities.

Nursing management process in accordance with the nursing process as a method of execution in a professional nursing care, so expect the two can be mutually supportive. As the process of nursing, nursing management consists of the above: data collection, diagnosis / problem identification, planning, implementation, and evaluation of results. Because the nursing management have specificity against the majority of power rather than a clerk, then each stage in the management process more complicated when compared with the nursing process.


Management for Nurses

Why a nurse must learn the science of leadership and management? At least three reasons why the answer as a nurse had to learn it. The reason is because the nurses have a role are as follows:

1. The role of the nurse as coordinator.

That the task of providing nursing care, a nurse should be able to manage the patient which it is responsible. For the treatment of patients is not carried out by nurses themselves but must cooperate with doctors, nutritionists, physiotherapists and other health team. To manage other health team. To manage other health team to be more orderly, organized, planned well coordinated, then the nurse needs to master the science of leadership and management.

2. Nurses act as leaders and managers.

The number and qualifications of nurses who work in the treatment room are many and varied. In the implementation of nursing care, nurses are organized and led by the head of the infirmary. The head of the infirmary will perform the role as a manager at the same time play the role as a leader, organize and direct the nurse in charge. In reality though is set up and directed, either frequent conflicts among nurses and between nurses and head room as a leader. Therefore, in order to anticipate and address the problems that will arise nurses need to learn and master the science of management and leadership.

3. Nurses act as leaders and managers themselves.

As a professional nurse, each nurse must be able to lead and to govern themselves. Without a good self-management skills hard to nurse will be able to provide professional nursing care services to patients.

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