# A nurse is assessing a newborn with gastroschisis. Which assessment finding would be the priority concern requiring immediate intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542091 > language: ko > subject: Child Health ## 문제 A nurse is assessing a newborn with gastroschisis. Which assessment finding would be the priority concern requiring immediate intervention? ## 보기 1. Bowel loops appearing dusky and edematous with decreased peristalsis **✔ 정답** 2. Clear fluid drainage from the exposed intestinal surface 3. Newborn crying and showing signs of discomfort during assessment 4. Temperature of 98.2°F (36.8°C) with stable vital signs **정답: 1** ## 해설 Dusky, edematous bowel with decreased peristalsis indicates compromised blood flow and potential necrosis, requiring immediate surgical intervention. Other findings like clear drainage, discomfort, or stable vitals are less urgent concerns in gastroschisis. ## 심화 해설 Priority Assessment for a Newborn with Gastroschisis The correct answer identifies a finding indicative of bowel compromise, which is the most immediate threat to tissue viability and requires urgent surgical evaluation. Analysis of the Correct Answer Gastroschisis is a congenital anomaly where abdominal organs extrude through a full-thickness defect in the anterior abdominal wall, typically to the right of the umbilical cord, without a protective sac [2]. The exposed bowel is vulnerable to vascular compromise. Bowel loops that appear dusky (a sign of poor perfusion and oxygenation) and edematous with decreased peristalsis signal intestinal ischemia or impending necrosis. This constitutes a surgical emergency because the viability of the bowel is directly threatened. In the context of gastroschisis, this clinical picture can be associated with a severe form known as closing or closed gastroschisis (CGS), where the abdominal wall defect narrows, constricting the mesenteric blood supply and leading to intestinal atresia, necrosis, or volvulus [1]. Immediate intervention is required to restore perfusion and salvage the bowel, making this the absolute priority over other assessment findings. Analysis of Incorrect Answers Option 2: Clear fluid drainage from the exposed intestinal surface While the exposed bowel in gastroschisis is not covered by a sac, leading to fluid and heat loss, clear serous drainage is an expected finding. The immediate nursing intervention for this is to protect the exposed viscera with a sterile, moist, non-adherent dressing to prevent contamination and further fluid loss. This is a standard and critical nursing action, but it does not represent an acute change in condition like the vascular compromise described in option 1. Option 3: Newborn crying and showing signs of discomfort during assessment Crying and discomfort are non-specific findings in a newborn. The physical manipulation of the exposed bowel during an assessment is inherently uncomfortable and painful. While pain management and gentle handling are essential components of care, this finding does not indicate an acute, life- or organ-threatening complication that supersedes a loss of bowel perfusion. Option 4: Temperature of 98.2°F (36.8°C) with stable vital signs A temperature of 98.2°F (36.8°C) is normothermic for a newborn. Combined with stable vital signs, this is a reassuring assessment. The primary thermal concern with gastroschisis is hypothermia due to heat loss from the exposed viscera, but this finding indicates that thermoregulation is currently effective. This is a positive sign and not a concern requiring immediate intervention.References (research sources) - [1]Closing/Closed Gastroschisis (CGS): Antenatal Predictors and Surgical Strategies in Cases of Unique Anatomy from a Case Series.Case reportMorozov D, Vanyan L, Morozova M, Erokhina N, Velichko E, Morozova O, Yagodkina M, Shumikhin V, Mokrushina O. (2026) · DOI: 10.3390/children13030408 - [2]Gastroschisis: diagnosis, prognosis and treatment options.Research articleRustemov D, Sakuov Z, Kucherbayeva Z, Shayakhmetov S, Bilal R. (2025) · DOI: 10.3389/fped.2025.1717874 ## 임상 시나리오 Gastroschisis: Recognizing Bowel CompromiseImmediate Priority for Viability The priority assessment for gastroschisis is identifying intestinal ischemia. A dusky, edematous appearance with decreased peristalsis indicates vascular compromise and impending necrosis. This finding is a surgical emergency requiring immediate notification of the provider to restore perfusion and salvage the bowel. It is often linked to closing gastroschisis, where a tightening defect constricts mesenteric blood flow. CautionDo not confuse expected clear serous drainage from the exposed bowel with a sign of infection or perforation. The immediate threat is loss of tissue viability, not fluid loss. ## 핵심 개념 - **Gastroschisis** — A congenital anterior abdominal wall defect, usually to the right of the umbilical cord, through which abdominal organs, typically the bowel, herniate without a protective sac. - **Bowel ischemia** — A condition of inadequate blood flow to the intestines, leading to tissue hypoxia; in gastroschisis, it is often caused by compression of mesenteric vessels and presents with a dusky or dark discoloration. - **Viscero-abdominal disproportion** — A mismatch where the volume of herniated abdominal contents exceeds the capacity of the abdominal cavity, increasing the risk of compartment syndrome and impaired perfusion after reduction. ## 같은 주제 문제 - [A nurse is assessing a newborn with gastroschisis. Which assessment finding would be most …](https://mymerci.kr/pages/nclex_q.php?qn_id=542090) - [A nurse is caring for a newborn with gastroschisis. 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