The nurse is caring for a newborn suspected to have esophageal atresia. Which of the following interventions must be the FIRST priority?
A.
Place the child in low flow oxygen.
B.
Place the infant in an isolette or radiant warmer.
C.
Obtain a stat chest X-ray.
D.
Elevate the head of the bed 30 to 35 degrees.
The Correct Answer and Explanation is:
The correct answer is D. Elevate the head of the bed 30 to 35 degrees.
Esophageal atresia is a congenital defect where the esophagus ends in a blind pouch and does not connect to the stomach, which can lead to complications such as aspiration and choking. A tracheoesophageal fistula may also accompany this condition, increasing the risk of respiratory distress due to the abnormal connection between the esophagus and the trachea. The priority in managing this condition is to reduce the risk of aspiration and protect the infant’s airway.
Explanation:
Airway management and prevention of aspiration are the first priorities. By elevating the head of the bed 30 to 35 degrees, gravity helps prevent gastric contents or saliva from flowing back into the lungs, which significantly reduces the risk of aspiration. This position also helps to decrease the likelihood of choking, which can occur due to the accumulation of secretions in the upper airway in infants with esophageal atresia.
Other interventions, while important, do not address the immediate priority of airway protection:
- A. Place the child in low flow oxygen: Administering oxygen might be necessary if the newborn shows signs of respiratory distress, but this intervention is secondary to protecting the airway. Aspiration must be prevented first to avoid further respiratory complications.
- B. Place the infant in an isolette or radiant warmer: Thermoregulation is important for newborns, but in cases of esophageal atresia, the immediate focus should be on preventing aspiration. A radiant warmer or isolette helps maintain the infant’s temperature, but this is not the first priority in this specific situation.
- C. Obtain a stat chest X-ray: While a chest X-ray is necessary to confirm the diagnosis of esophageal atresia and tracheoesophageal fistula, airway protection should come first. Waiting for diagnostic imaging could delay life-saving interventions.
By elevating the head of the bed, the nurse helps stabilize the newborn’s condition while further diagnostic and therapeutic measures are planned.