Case Study NCM 109 Apacible

COLLEGE OF NURSING
SAMAR STATE UNIVERSITY
CHOANAL ATRESIA
CASE REPORT
Members:
Carbonell, Joanna Shyra Yvonne B.
Centino, Jade P.
Cinco, John Darwin C.
Cinco, Russel Roque E.
Collantes, Krizza Mae L.
Bilateral Choanal Atresia
A. Updated Case Study conducted within the year 2012-2023.
We present a case study entitled “Bilateral Choanal Atresia (CA) in

cyanotic and with respiratory distress newborn baby – case report”
conducted by Gupti, M., Kour, C., and was published in year 2017. It
focused on a case of a female newborn who developed respiratory
distress and cyanosis immediately after birth and need to undergo
several medications to attain optimal health. (Can be found on this
source: https://raredisorders.imedpub.com/congenital-bilateral-
choanal-atresia-a-rare-case.php?aid=19915)
INFORMATION ABOUT THE DISEASE
Congenital Choanal Atresia (CCA) is the developmental misstep or

inadequacy of the nasal cavity to connect posteriorly with the
nasopharynx. Bilateral atresia presents with life threatening asphyxia at
birth, while unilateral variety often remains unnoticed and presents later.
This is to highlight the importance of taking into account the bilateral
form in differential diagnosis of severe respiratory distress in the
newborn.
In our case a full term, newborn baby presented with attacks of cyanosis
and respiratory distress soon after birth. The insertion of nasal suction
catheters in both nasal cavity and its non-passage into oropharynx,
confirmed the diagnosis of bilateral Choanal atresia. As surgical repair is
recommended at the earliest in bilateral cases thus immediate transnasal
endoscopic repair was done relieving the life-threatening nasal
obstruction.
Congenital Choanal Atresia (CCA) is an uncommon anomaly that causes

upper airway obstruction in newborns, with a frequency of 1 in 7000 to
8000 births. It affects females twice more commonly than males and is
frequently unilateral and right-sided than bilateral. It is hypothesized to
be the consequence of an abnormality of rupture of the buccopharyngeal
membrane. The atresia may be classified as bony, mixed bony and
membranous or purely membranous. Nature of the obstructing atretic
plate has often been described as 90% bony and 10% membranous. Most
cases of CA are isolated malformations, but it may be associated with
charge syndrome (includes coloboma, heart defect, CA, retardation of
growth, genital anomalies, and ear anomalies like hypoplasia of the
external ear and hearing loss). Bilateral CCA is an emergency, because
immediate maintaining an airway and relieving the obstruction is
essential, to avoid cyanosis and subsequent death. The urgent treatment
of neonates presenting with intermittent cyanosis is the insertion of an
oral airway and feeding via an oro-gastric tube. The surgery gives the
definitive treatment and commonly used methods are the trans-palatal
approach, the trans-septal approach and the endoscopic transnasal
approach.
PAST AND PRESENT MEDICAL HISTORY
The patient was born via emergency cesarean section to a to a 26-

year-old mother. At birth, he developed respiratory distress and cyanosis.
She was shifted to NICU for further education and management. The
examination in NICU, revealed an active vigorous baby with intermittent
cyanosis which resolved on crying. Supportive treatment has started
which include oxygen intravenous fluids and prophylactic broad-spectrum
antibiotics.
There was differential diagnosis considered but Bilateral Choanal

Atresia was established clinically by failure to pass size 5 French suction
tube from nostril, nasal cavity to the pharynx. There were no other
associated congenital anomalies.
On 4th day of life patient was taken up for surgical repair via nasal
route, with endoscopes and debrider, under general anesthesia. No
intraoperative or postoperative complications documented, the patient
was discharged on the 4th post-operative day.
The child underwent follow up for a year with no complications of

recurrence of symptoms or any complications.
SUBJECTIVE AND OBJECTIVE DATA ARE TAKEN FROM THE PATIENT
PHYSICAL EXAM
 Vitals:
o The respiratory rate was 50 breaths/min and required 30%
FiO2 with mouth airway and face mask to maintain oxygen
saturation up to 95%.
o On pulse oxymetry her PaO2 was 88% at room air.
Growth parameters:
o Weight: 2.8 kg
The APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score

at birth was 8 and 9 at 1st and 5th minute respectively.
The cardiac and other systemic examination was normal. Supportive

treatment was started which included oxygen, intravenous fluids and
prophylactic broad-spectrum antibiotics. The chest X- ray was normal.
Besides complete blood count, C-reactive protein and blood culture were
done to rule out sepsis.
NURSING DIAGNOSIS
 Ineffective breathing patter related to obstruction of nasal airway

as evidenced by respiratory distress immediately after birth
resulting to intermittent cyanosis which resolves on crying.
 Risk for infection related to breathing by mouth

NURSING CARE PLAN
Assessment:
Objective Data:
o The respiratory rate was 50 breaths/min and required 30%
FiO2 with mouth airway and face mask to maintain oxygen
saturation up to 95%.
o On pulse oxymetry her PaO2 was 88% at room air.
Growth parameters:
o Weight: 2.8 kg
Diagnosis:
Ineffective breathing patter related to obstruction of nasal airway as
evidenced by respiratory distress immediately after birth resulting to
intermittent cyanosis which resolves on crying.
Outcome Identification:
1. The newborn will be able to breathe through nose.

2. The newborn will show no sign of respiratory distress.
3. The newborn will show no recurring symptoms.
4. The show newborn will show no sign of infection.
INTERVENTION RATIONALE
Guide and assist on medication Medication may be prescribed to
prescribed by physician. manage the surgical repair of
choanal atresia.
Assess respiratory rate, depth, Any of these signs may indicate
effort, oxygen saturation and respiratory distress and may need
cyanosis. specific intervention.
Maintain a patent airway. Preventing complications of
respiratory failure.
Provide supplemental oxygen if Occurrence of respiratory failure
required. would require life saving action
such as supplemental oxygen
administration.
Educate the parents about the Correct knowledge will help avoid
associated specific symptoms of further damage to the respiratory
BCA and triggers them. system of the newborn.
Educate the parents about the To prevent further complications,
importance of follow up checkup, this will help manage the condition
especially of symptoms and at of the child.
least during the first few of life.
Support the parental. Assure them Supporting them makes them
that their baby will be in good more knowledgeable about the
condition as long as in proper regimens they should do to keep
management is carried out. their child well and healthy.
Evaluation:
After months of Care and Monitoring the following outcomes are

expected;
1. The newborn shows able to breathe through nose.
2. The newborn shows no sign of respiratory distress.
3. The newborn shows no recurring symptoms.
4. The newborn shows no signs of infection.

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COLLEGE OF NURSING

SAMAR STATE UNIVERSITY

A. Updated Case Study conducted within the year 2012-2023.

We present a case study entitled “Bilateral Choanal Atresia (CA) in

Congenital Choanal Atresia (CCA) is the developmental misstep or

Congenital Choanal Atresia (CCA) is an uncommon anomaly that causes

The patient was born via emergency cesarean section to a to a 26-

There was differential diagnosis considered but Bilateral Choanal

The child underwent follow up for a year with no complications of

The APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score

The cardiac and other systemic examination was normal. Supportive

 Ineffective breathing patter related to obstruction of nasal airway

 Risk for infection related to breathing by mouth

1. The newborn will be able to breathe through nose.

After months of Care and Monitoring the following outcomes are

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