# A nurse is caring for a newborn with gastroschisis. Which nursing intervention should be the highest priority immediately after birth? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542092 > language: ko > subject: Child Health ## 문제 A nurse is caring for a newborn with gastroschisis. Which nursing intervention should be the highest priority immediately after birth? ## 보기 1. Cover the exposed bowel with warm, moist sterile saline dressings and plastic wrap **✔ 정답** 2. Place the infant in a supine position to prevent further bowel protrusion 3. Begin immediate oral feeding to prevent hypoglycemia 4. Administer prophylactic antibiotics to prevent infection **정답: 1** ## 해설 The highest priority is to protect the exposed bowel from drying, contamination, and heat loss by covering it with warm, moist sterile saline dressings and plastic wrap. Other options are incorrect as supine positioning may cause pressure, oral feeding is contraindicated, and antibiotics are secondary to physical protection. ## 심화 해설 Understanding Gastroschisis and Immediate Priorities Gastroschisis is a congenital anomaly where the abdominal wall fails to close during fetal development, resulting in the bowel and other abdominal contents herniating outside the body. A hallmark sign, as noted in the literature, is the absence of a protective membrane covering the exposed viscera [1][3]. This means the bowel floats freely in amniotic fluid in utero and is completely exposed to the external environment after birth. The immediate postnatal period is critical because the exposed bowel is at extreme risk for two major complications: fluid and heat loss leading to hypothermia and dehydration, and infection due to the lack of a protective barrier [1]. The highest priority intervention is to cover the exposed bowel with warm, moist sterile saline dressings and plastic wrap. This action directly addresses the life-threatening risks of insensible water loss and evaporative heat loss from the exposed viscera. The saline dressing keeps the bowel moist, preventing tissue desiccation and necrosis, while the plastic wrap creates an occlusive barrier that traps heat and moisture. This is the first step in the clinical management algorithm before any surgical repair, such as the Spatulated Umbilical Cord Technique (SUCT) or primary fascial closure, is considered [2]. Placing the infant supine is incorrect because it can cause kinking of the mesenteric vessels at the defect site, compromising blood flow to the herniated bowel. Immediate oral feeding is contraindicated as the bowel is often not functional immediately, and surgery is required; the infant will be kept NPO and placed on intravenous fluids. While prophylactic antibiotics are administered to prevent infection, they are a secondary priority after the immediate physical protection of the bowel from environmental exposure and fluid loss. In resource-limited settings, task-sharing initiatives emphasize that the first responder's immediate action of protecting the bowel with a clean, occlusive dressing is the most crucial step in reducing mortality before transfer to a surgical center [4].References (research sources) - [1]Don't Cut the Cord! Sutureless Repair of Gastroschisis-A Case Report.Case reportSilvestri K, Gwartney T, Whalen MB. (2026) · DOI: 10.1891/nn-2025-0031 - [2]Spatulated umbilical cord technique embracing Wharton's jelly for gastroschisis repair.Research articleSharma S, Mansour SM, Tsang TTM. (2026) · DOI: 10.1038/s41598-026-39279-9 - [3]A Challenging Case of Closing Gastroschisis With Gangrenous Bowel: A Case Report.Case reportMadan AJ, Janahi S, Haider F. (2025) · DOI: 10.7759/cureus.91515 - [4]A Pilot Study to Advance Task-Sharing of Gastroschisis Management in Uganda.Research articleEze AN, Oyania F, Hissein WS, Kyasimire D, Nuwagaba IN, Atuheire G, Adaramola OG, McGinnis O, Barter S, Fitzgerald TN. (2026) · DOI: 10.5334/aogh.5088 ## 임상 시나리오 Initial Management of GastroschisisPrioritize protection of exposed viscera from heat and fluid loss Immediately after birth, cover the exposed bowel with warm, moist sterile saline dressings followed by an occlusive plastic wrap or a bowel bag. This creates a barrier that minimizes evaporative heat loss and insensible water loss, preventing hypothermia and tissue desiccation. Position the newborn in a right lateral or supine position with support to avoid kinking the mesenteric vessels at the defect site. Never place the infant flat supine without ensuring the bowel is supported and free of tension. Keep the infant NPO and insert an orogastric tube for decompression. Establish IV access for fluid resuscitation, as the goal is to replace ongoing losses and maintain perfusion. CautionDo not allow the dressing to dry out; continuously monitor and remoisten with warm sterile saline. Avoid direct pressure on the exposed bowel and handle the defect gently to prevent injury or perforation. ## 핵심 개념 - **Gastroschisis** — A congenital abdominal wall defect where the bowel herniates outside the body without a protective membrane, usually to the right of the umbilical cord. - **Insensible Water Loss** — Fluid loss from the body that is not easily perceived, occurring through evaporation from the skin and respiratory tract, which is massive from exposed bowel. - **Mesenteric Vessels** — Blood vessels in the mesentery that supply the intestines; kinking or compression at the defect site can lead to bowel ischemia. - **Occlusive Barrier** — A physical covering, such as plastic wrap, that prevents the passage of heat and moisture, used to protect exposed organs. - **Desiccation** — The process of extreme drying; exposed bowel is highly susceptible to tissue desiccation and subsequent necrosis if not kept moist. ## 같은 주제 문제 - [A nurse is assessing a newborn with gastroschisis. 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