NU 236 EXAM 3 (CLEFT LIP/PALATE)
Terms
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- CLEFT LIP/PALATE
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A LONGITUDINAL OPENING/SPLIT IN UPPER LIP OR PALATE
MAY OCCUR ALONE OR MAY BE C.LIP&PALATE
MORE COMMON IN ASIANS,NATIVE AMER.,&MALES - WHEN DOES C.LIP OCCUR
- 7-8 WKS GESTATION
- WHEN DOES C.PALATE OCCUR
- 7-12 WKS
- HOW IS DIAGNOSIS OF C.LIP/PALATE MADE?
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1.C.PALATE DETECTED BY EXAMINATION OF MOUTH W/ FINGER
-THE DEFECTS INVOLVE DENTAL ABN.-TOO MANY TEETH OR NOT ENOUGH TEETH - HOW IS C.LIP TREATED?
-
CHEILOPALSTY (Z-PLASTY)
-REPAIRED 6-12 WKS OF AGE (10-15 LBS)
-CHILD MUST BE INFECTION FREE
-REPAIR 1ST SIDE THEN 2ND SIDE REPAIRED MOS LATER - HOW IS CLEFT PALATE TREATED?
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LONG TERM PROCESS
-PALATOPLASTY
-REPAIRED 6-18 MOS (DONE BEOFRE CHILD DEV. SPEECH HABITS)
-OTHER INVOLVEMENTS NEEDED:SOCIAL WORKER,SPEECH THERAPIST,AUDIOLOGY - EFFECTS OF CP AND CL
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1.PROB W/ FEEDING (INFANTS CHOKE,GAG,SWALLOW AIR)
2.RISK OF ASPIRATION
3.DIFFICULTY GAINING WT
4.SPEECH IMPAIRMENTS
5.EAR INFECTIONS(CAUSE SCARRING OF TYMPANIC MEMBRANE)
6.UPPER RESPIRATORY INFECTIONS - NURSING DIAGNOSES FOR CL AND CP
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1.ALTERED NUTRITION:LESS THAN
2.RISK FOR ALTERED PARENTING
3.RISK FOR TRAUMA TO SURGICAL SITE
4.PAIN - HOW SHOULD BABY WITH CL AND PALATE BE FED?
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-UPRIGHT POSITION
-BURP FREQUENTLY
-USE HABERMAN FEEDER
-CLEAN MOUTH & LIP AREA - AS NURSE:ENCOURAGE PARENTS TO__
- HOLD & FEED INFANT
- POST OP CARE FOR CLEFT LIP
-
1.HOSPITALIZED FOR 1-2 DAYS
2.CHILD WEARS NO-NO'S (ELBOW RESTRAINT)
3.POSITIONED ON SIDE OR BACK
4.EXERCISE ARMS Q 1-2 HRS
5.PREVENT TENSION ON SUTURE LINE (CHILD WEARS LOGAN BAR FOR 1 WK)
6.PREVENT BABY FROM CRYING (GIVE ANALGESIA & HOLD) - POST OP CARE FOR CLEFT PALATE
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1.MAINTAIN AIRWAY-(POSITION ON ABDOMEN)
2.MIST TENT
3.NO-NO RESTRAINT FOR WKS
4.NO PACIFIER,NO STRAWS,NOTHING IN MOUTH
5.SOFT DIET WHEN D/C - WHAT IS BABY GIVEN FOR PAIN
- TYLENOL W/ CODEINE
- HOW IS BABY FED POST OP FOR CLEFT LIP
-
STARTED W/ CLEAR LIQUIDS-->ADVANCED
PARENT CAN BREAST FEED,USE CUP,SYRINGE
SUTURE LINE CLEANED W/ Q-TIP & SALINE - HOW IS BABY FED POST OP CLEFT PALATE
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FEEDING CAN BE BOTTLE,BREAST,CUP
CUP USED MOST-FOOD BLENDED
DONT WANT TO PUT ANYTHING IN MOUTH (NO FORK OR SPOON)
CHILD SHOULD BE FED BY PARENT - ESOPHAGEAL ATRESIA W/ TRACHEOESOPHAGEAL FISTULA (TEF)
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ATRESIA=CONGENITAL ABSENCE OR CLOSURE OF BODY OPENING
FISTULA=ABNORMAL PASSAGE - CAUSE OF ESOPHAGEAL ATRESIA W/ TEF:
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CAUSE IS UNKNOWN
OCCURS 4-5 WKS GESTATION (1 WK INTO PREGNANCY) - S/S OF ESOPHAGEAL ATRESIA W/ TEF
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1.DROOLING,EXCESSIVE SALIVATION
2.3 C'S-COUGHING,CHOKING,CYANOSIS
3.PERIODS OF APNEA DUE TO SECRETIONS
4.RESP. DISTRESS WHILE BEING FED
5.ABDOMINAL DISTENTION
6.RISK OF ASPIRATION - THERAPEUTIC MANAGEMENT OF ESOPHAGEAL ATRESIA W/ TEF:
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CHECK DIAGNOSIS W/ CATHETER DIRECTLY AFTER BIRTH
1ST-X RAY ---> BRONCHOSCOPY
GOAL:MAINTAIN AIRWAY
BABY NPO-->IMMEDIATELY IV FLUIDS & SUCTION POUCH
PREVENT RESPIRATORY INJURY - SURGICAL REPAIR OF ESOPHAGEAL ATRESIA W/ TEF:
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1.THORANCOTOMY (MIDLINE CHEST INCISION)
2.TEMPORARY GASTRONOMY-TO PROVIDE A FEEDING ROUTE
3.CLOSE OFF/LIGATE FISTULAS
4.REPAIR OF ESOPHAGUS-END-TO-END ANASTAMOSIS
5.CERVICAL ESOPHAGOSTOMY - PRE-OP FOR EA & TEF
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1.1ST DETECT DEFECT
2.NPO
3.IV FLUIDS
4.POSITION-HEAD UP 30 DEGREES
5.SUCTION,HUMIDIFIED O2
6.BROAD SPECTRUM ANTIBIOTICS
7.PREVENT BABY FROM CRYING - POST OP CARE FOR EA W/ TEF:
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1.BABY IN INTENSIVE CARE-ICU
2.RADIANT WARMER
3.HYPERALIMENTATION
4.MONITOR FOR RESP COMPLICATION-CHECK FOR PNEUMONIA,TEMP,ATELECTASIS,DRAINAGE FROM TEST TUBES
5.GT TUBE-FOR 5-7 DAYS - COMPLICATIONS OF AT AND TEF POST OP
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1.LEAKS AROUND SITE
2.**STRICTURES/NARROWING OF ESOPHAGUS**
3.REFLUX-GER
4.DYSPHAGIA-REFUSAL TO EAT,SPITTING UP
5.D/C TEACHING-CUT FOOD IN SMALL & WATCH FOR SWALLOWING OBJECTS