Respond to at least two of your classmates’ posts using

Respond to at least two of your classmates’ posts using the 3C+Q method. Please use update references from 2022-2024. For example, you will need to include the following components in your response: A compliment: “I appreciate that…” A comment: “I agree with that…I disagree because…” A connection: “I also thought…” A thought-provoking question. Disease-Based Concept Map Activity Image transcription text Patient Education: Pharmacological Tx after Esophageal Atresia Preparing for Surgery & Surgery: 5 Facts from the CDC Omeprazole (PPI) Patho &am… Show more Pathophysiology and Risk Factors The most common congenital abnormality of the esophagus is esophageal atresia (EA), a blind pouch that forms in the esophagus with or without an accompanying fistula called tracheoesophageal fistula (TEF). Between 1 in 3500 and 4000 infants have EA, with or without TEF. The most vulnerable infants are those who are associated with congenital heart defects and early birth. Risk factors include maternal polyhydramnios and the incapacity to insert a nasogastric tube into the stomach during neonatal resuscitation or later in the nursery, particularly in a child experiencing respiratory distress, vomiting, or copious oral secretions. Garzon, D.L., Dirks, M., Driessnack, M., Duderstadt, K.G., & Gaylord, N.M. (2025). Burns’ pediatric primary care (8th ed.). Elsevier. Assessment The NP may find that history reveals feedings increase symptoms and spitting or vomiting is present. Assessment of the infant’s airway, respiratory system, and secretions, especially during feeding, is crucial. Respiratory distress, excessive oral secretions, choking, coughing, and cyanosis during feedings are findings consistent with the disease. Garzon, D.L., Dirks, M., Driessnack, M., Duderstadt, K.G., & Gaylord, N.M. (2025). Burns’ pediatric primary care (8th ed.). Elsevier. The NP can diagnose this disease through an assessment using water-soluble radiography of the upper esophagus, which reveals the structure of the atresia and the existence of a related TEF. When a nasogastric (NG) tube is inserted, X-rays of the chest and abdomen will reveal that the NG tube is coiled in the pouch in the thoracic area, confirming EA and air in the stomach, indicating a possible TEF. An abnormal finding would be that the NG tube can pass down into the stomach. Garzon, D.L., Dirks, M., Driessnack, M., Duderstadt, K.G., & Gaylord, N.M. (2025). Burns’ pediatric primary care (8th ed.). Elsevier. Nonpharmacologic Tx Because this is a surgical emergency, a suction-equipped NG tube is placed inside the blind pouch to stop aspiration until surgery is performed to fix the esophagus. The infant should be placed in a prone posture and routinely suctioned orally before surgery. Garzon, D.L., Dirks, M., Driessnack, M., Duderstadt, K.G., & Gaylord, N.M. (2025). Burns’ pediatric primary care (8th ed.). Elsevier. The birth condition known as esophageal atresia affects the esophagus, the swallowing tube that joins the mouth and stomach. This disorder prevents food from moving from the mouth to the stomach, which might cause breathing problems for the infant. A congenital abnormality known as tracheoesophageal fistula frequently coexists with esophageal atresia. This is the connection point between the trachea, or windpipe, and a portion of the esophagus. Most often, esophageal atresia is discovered after birth when the infant chokes or throws up during their first feeding attempt. Esophageal atresia is a surgical emergency and will require operation. https://www.cdc.gov/birth-defects/about/esophageal-atresia.html#:~:text=Esophageal%20atresia%20(ee%2Dsof%2D,esophageal%20atresia%20in%20the%20US. A PPI such as omeprazole should be used postoperatively if the infant has issues with gastrointestinal reflux. MOA: Reduces the production of stomach acid by selectively inhibiting the H+/K+-ATPase system, which is present on the secretory surface of gastric parietal cells. Indications: GERD, esophageal strictures Common AE: Headache, diarrhea, abdominal pain, nausea, rash, constipation. Serious AE: Increased risk of C. difficile and other enteric infections; increased risk for lower respiratory tract infections in infants (pediatric reports). Malabsorption of magnesium, calcium, and, to a lesser extent, vitamin B12 and iron (adult reports). Dosing: Infants 1 to 11 months (daily): 3 to <5 kg - 2.5 mg, 5 to <10 kg - 5 mg, ≥ 10 kg - 10 mg Administration: Capsules can be opened and sprinkled on soft food (10, 20, and 40 mg), Flavored oral suspension (2 mg/mL), Granules for oral suspension (2.5 and 10 mg) CI: Hypersensitivity, patients taking rilpivirine Interactions: Warfarin, CYP2C19 substrates Shah N, Gossman W. Omeprazole. [Updated 2023 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539786/ Evaluation After the initial plan of care has been implemented, the NP should focus on postoperative care and recommendations. The most common complications from the surgery are anastomosis leakage, tension pneumothorax, and sepsis. Recurrence of TEF, tracheomalacia, dysphagia, gastroesophageal reflux, dysphagia, esophageal strictures, and cough are long-term problems that may follow the surgery. Pharmacological treatment with a PPI may be warranted if these complications occur. Parents should be educated on the signs and symptoms of these complications and instructed when to return to the clinic or the ER. Referral to a GI provider is also imperative after the surgery. Syed, M. K., Al Faqeeh, A. A., Othman, A., Almas, T., Khedro, T., Alsufyani, R., Almubarak, D., Al Faqeh, R., Syed, S., & Syed, S. K. (2020). Management of Early Post-Operative Complications of Esophageal Atresia With Tracheoesophageal Fistula: A Retrospective Study. Cureus, 12(12), e11904. https://doi.org/10.7759/cureus.11904 EBP Guideline and Source ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula https://pubmed.ncbi.nlm.nih.gov/27579697/ Krishnan, U., Mousa, H., Dall'Oglio, L., Homaira, N., Rosen, R., Faure, C., & Gottrand, F. (2016). ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula. Journal of pediatric gastroenterology and nutrition, 63(5), 550-570. https://doi.org/10.1097/MPG.0000000000001401

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