Chapter 11

Diagnosis of CDH happens as early as...

25 weeks of gestation

Umbilcal hernias usually resolve themselves by the ages of...

3 to 5

.... is the most common birth defect in the United States

Cleft lip

... occurs for approximately 80% of all childhood hernias and occurs more frequently in boys than in girls.

Inguinal hernias

What are the four drugs that can cause CL/CP

Phenytoin Valproic Acid Thalidomide Pesticide dioxin

The nurse observes frothy saliva in the mouth and nose of the neonate, as well as frequent drooling. When fed, the infant swallows normally, but suddenly the fluid returns through the infant's nose and mouth. The nurse should suspect what medical condition? a. Esophageal atresia b. Cleft palate c. Anorectal malformation d. Biliary atresia

a

The most common manifestation of CDH is ...

acute respiratory distress

Inguinal hernias are most often ... unless the abdominal contents are forced into the patent sac.

asymptomatic

A mother has just given birth to an infant with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" The most appropriate nursing action is to: a.encourage mother to express her feelings. b.explain in simple language that the baby has a cleft lip. c.provide emotional support until practitioner can talk to mother. d.tell mother a pediatrician will talk to her as soon as the baby is examined.

b

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) would be which of the following? a.Discourage parents from making a last visit with the infant. b.Make a follow-up home visit to parents as soon as possible after the child's death. c.Explain how SIDS could have been predicted and prevented. d.Interview parents in depth concerning the circumstances surrounding the child's death.

b

In preparing the parents of a child with cleft palate, the nurse includes which of the following in the long-term family teaching plan? a. Explanation that tooth development will be delayed b. Guidelines to use for speech development c. Use of decongestants and acetaminophen to care for frequent upper respiratory tract symptoms d. All of the above

b

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include which of the following? a. Arm restraints, postural drainage, mouth irrigations b. Cleansing suture line, supine and side-lying position, appropriate analgesia c. Mouth irrigations, prone position, cleansing suture line d. Supine and side-lying positions, postural drainage, arm restraints

b

40. Which feeding practices should be used for the infant with a cleft lip or palate? a. Use a large, hard nipple with a large hole. b. Use a normal nipple and position it sideways in the mouth. c. Use a special nipple, positioned so it is compressed by the infant's tongue and existing palate. d. Withhold breast-feeding until after surgical correction of the defect.

c

A 4-month-old child is discharged home after surgery for the repair of a cleft lip. Instructions to the parents include: a. provide crib toys for distraction. b. breast- or bottle-feeding can begin immediately. c. give pain medication to infant to minimize crying. d. leave infant in crib at all times to prevent suture strain.

c

Caring for the newborn with a cleft lip and palate before surgical repair includes which of the following? a. Gastrostomy feedings b. Allowing little or no sucking c. Providing satisfaction of sucking needs d. Keeping infant in near-horizontal position during feedings

c

The priority nursing goal in the immediate care of a postoperative infant after repair of a cleft lip is to: a. keep the infant well hydrated. b. prevent vomiting. c. prevent trauma to operative site. d. administer medications to prevent drooling.

c

.... anomalies may also occur with TEF, therefore all patients should undergo a workup for associated anomalies

cardiac

.... results when the diaphragm does not form completely, resulting in an opening between the thorax and the abdominal cavity

congenital diaphragmatic hernia (cdh)

The danger of herniation arises when the protrusion is ...., impairing circulation

constricted

The association of cleft palate with otitis media is primarily the result of which of the following? a. Coexisting defects of middle ear and eustachian tube b. Lowered resistance because of poor nutritional status c. Plugging of the eustachian tube with food particles d. Inefficient function of eustachian tubes and improper middle ear drainage

d

Which of the following is acceptable in providing postoperative care for the infant with a cleft lip or palate? a. Use of tongue depressor in the mouth to assess surgical site b. Continuous elbow restraints to prevent injury c. Placement of infant in the prone position after cleft lip repair d. Placement of infant in the prone position after cleft palate repair

d

Which of the following is contraindicated as part of the therapeutic management for the neonate with congenital diaphragmatic hernia? a. Endotracheal intubation b. Gastrointestinal decompression c. Positioning the infant with the head and chest elevated above the abdomen d. Bag and mask ventilation

d

A common sign of a infant with TEF is...

drooling, frothy secretions

When infants are born with CDH they are usually .. and .. with a ... abdomen

dyspneic cyanotic scaphoid (abdomen)

omphalocele is related to true failure of ....

embryonic development

The immediate nursing problems in the care of an infant with CL and CP deformities are related to...and...

feeding parental reaction

.... hernias are rare in children and has a higher incidence in girls. This hernia may also be a recurrent hernia even with repair and symptoms include swelling in the grown area and severe abdominal pain and cramps.

femoral

Maternal nutrition, especially .... has been linked to clefting in humans. Along with alcohol intaking (spec. ....) and smoking

folic acid deficiency binge drinking

.... occurs when the bowel herniates through a defect in the abdnomial wall to the right of the umbilical cord and through the rectus muscle. There is no membrane covering the exposed bowel.

gastroschisis

.... failure in these infants has been attributed to preoperative feeding difficulties.

growth

A .... is a protrusion of a portion of an organ or organs through an abnormal opening.

hernia

The problem with css is that if the diaphragm does not form completely the ... and other abdomnial structures will enter the thoracic cavity .... the lung. Thus lung ... is arrested.

intestines compressing growth

An umbilal hernia usually is an...

isolated defect

Umbilical hernias are most often seen in infants who have... and are ...

low birth weight pretrem

CL and Cp can often lead to frequent ....... infections due to pooling secretions.

middle ear (infections) / otitis media

In an infant with omphalocele if the bowel covering is intact a non adherent dressing is placed over the defect to prevent injury. If the bowel is exposed the membranes are than covered with .... to prevent fluid lose and ..... IV and .... are administer and a further eval is done for associated anomalies

moist dressing temperature instability antibiotics

The majority of cases of CL are associated with ...

multifactorial inheritance (evidenced by an increased incidence in relatives and a higher concordance in monozygotic twins rather than dizygotic)

After bottle feeding infants with CL and CP may be put to the mother's breast or on a special nipple for...

nonnutritive sucking

Gastroschisis is .... with other major congenital anomalies

not associated

Omphalocele is .... associated with other anomalies

often (including cardiac, neurologic, skeletal and GU)

.... is related to true failure of embryonic development.

omphalocele

.... is when there is a failure of the caudal or lateral infolding of the abdominal wall at approximately the .... week of gestation. The bowel is unable to complete its return to the abdomen an those is only covered by a translucent sac. The sac is on the outside of the infants body.

omphalocele third (week)

Omphalocele is primarily diagnosed ...

prenatally

.... closure is used when the omphalocele defect is small and when it is large .... is used.

primary closure staged reduction

A cleft lip is seen at...

readily apparent at birth

Even with adequate anatomic closure many children with CL and CP have ... which requires ... therapy

speech impairment speech (therapy)

With preop care of an infant with TEF the nurse will carefully .... the mouth and nasopharynx and place the infant ... to facilitate drainage and avoid aspiration.

suction upright

Treatment of the child with isolated CL is...

surgical

CL and CP can also involve missing, malformed or malpositioned .....

teeth

.... and ...are extremely important nursing concerns for both omphalocele and gastroschisis

thermoregulation and fluid management

... is a rare malformation that represents a failure of the trachea and esophagus to separate into distance structures

tracheoesophageal fistula (TEF)

... is a very common hernia observed in infants. It occurs when the fusion of the ... ring is incomplete. It affects ... more than Caucasians

umbilical hernia umbilical african americans

The columella of the nose is deviated to the ..... side pulling the nasal tip in that direction

unaffected

An infant with TEF will have its head in a ..... position to facilitate removal of fluid collected in the pouch and to prevent aspiration.

upright

Infants with gastroschissis are typically operated on when they are...

within 24 hours of birth