Question

a 9 month old baby who swallowed a quarter and is caught into his esophagus as evidenced by x-ray. Mom brought the baby to the emergency department due to vomiting, fussiness, unable to swallow properly. Mom did not noticed that the baby swallowed an object, until 2 days later she decided to bring the baby to the hospital to get check because the baby is trying to cough and gag something out.

MEDICAL DIAGNOSIS

DEFINITION/Description of medical diagnosis

DIAGNOSTIC TESTS expected to be ordered/findings you might anticipate

(LIST NORMAL VALUES)

SIGNS AND SYMPTOMS, Underline the S/S your patient exhibited

NURSING INTERVENTIONS to include teaching

PROCEDURES AND NURSING IMPLICATIONS

MEDICAL INTERVENTIONS/Orders

Answer 1

Medical diagnosis =

Via X-ray, it is diagnosed that the baby has swallowed a quarter and it is stuck in the esophagus.

Via endoscopy also the diagnosis can be made.

Description of medical diagnosis =

X-ray in the undersigned position is done--

a) Lateral view of the neck.

b) AP and lateral view of the chest.

The coin will either be seen on, transverse on the PA view, and on the lateral side coin could be seen in the edge view or opaque shadow of a quarter above the level of the clavicle will appear.

Diagnostic tests =

a. Swallowing test- The baby is made to drink water and the water gets drooled out or the baby wouldn't be able to drink water.

b. An X-ray is done from time to time to check the position of the quarter.

c. Endoscope is used to monitor the depth and to view the swallowed object.

S/S =

Drooling, gagging, chest pain, irritational behavior of the baby, unexplained fever, nausea, vomiting, coughing, bloody saliva, refusing food, not doing hyperactivity, crying, fussiness.

Nursing intervention=

Hold the baby in the hand firmly and back slap for 5 or 6 times and then some chest thrust should be given to make the coin come out easily.

Tell the diet of the baby.

Procedures and nursing implications=

Fill the catheter with some barium and then pull it back out to leave a thin stream inside it, it helps while taking the x-ray to see the position of foley's catheter when it is put inside the throat to remove the swallowed object.

Make the child busy by manipulating him as we don't want the child to fall asleep.

Medical interventions=

Little sedation with propofol, general anesthesia, or muscle relaxant is induced to relax the esophageal muscle to make the path easy to extract the coin.

Foley's catheter is passed beyond the coin, the catheter is blown up and then pulled back and this will dislodge the coin up into the posterior pharynx by passing the tube through the mouth into the esophagus beyond the coin and once it's beyond the coin blow the catheter up and generally in the range of 3 to 5 cc and then pull it out when you feel a tug and the coin will come out.

A scope is passed into the esophagus, with an endoscopy, or esophagoscopy. During this minimally-invasive procedure, a thin, flexible tube with a tiny camera and light attached at the end is carefully inserted in the neck and with some special tools, the swallowed coin is pulled outside.