Omphalocele and gastroschisis are congenital defects of the abdominal wall. An omphalocele occurs when bowel, usually covered with a peritoneal sac, herniates through the abdominal wall via the umbilical opening. Gastroschisis occurs when bowel herniates through the abdominal wall without a protective peritoneal sac.
Immediately after birth, the nurse should cover the herniated bowel to prevent injury; a nonadherent dressing (eg, plastic bowel bag; sterile, saline-soaked gauze covered by loose plastic) is necessary to prevent fluid loss and protect the bowel from drying (Option 1). The nurse should monitor for temperature instability, infection, and fluid loss and initiate IV access to facilitate antibiotic administration and fluid and electrolyte replacement (Options 3 and 4).
(Option 2) If immediate surgical repair of the defect is planned, the nurse should keep the newborn NPO in preparation for surgery.
(Option 5) The nurse should not apply petroleum jelly to the bowel. Covering exposed bowel with sterile, saline-soaked dressings and/or a plastic bowel bag is appropriate for newborns with gastroschisis.
Educational objective:
Omphalocele and gastroschisis are congenital defects of the abdominal wall that place the newborn at risk for temperature instability, infection, and fluid loss. Immediately after birth, the nurse should cover the herniated bowel with a nonadherent dressing (eg, plastic bowel
bag; sterile, saline-soaked gauze covered by loose plastic) and initiate IV access.