Peds Exam 4 Cleft lip/Cleft Palate

enlarge nipple stimulate( sucking reflex swallow( upright position) rest( allow them to rest)

ESSR method for feeding

4

The parent of a newborn diagnosed wit a cleft lip and cleft palate asks the nurse when their child lip ad palate will most likely be repaired. select the nurses best response 1. the palate and lip are usually repaired in the first few weeks of life so that the baby can grow and gain weight 2. the palate and the lip are usually not repaired until the baby is approximately 6 months old so that the mouth has had enough time to grow 3. the lip is repaired in th efirst few months of life, but the palate is not usually repaired until the child is 3 years old 4. The lip is repaired in the first few weeks of life, but the palate is not usually reaired until the child is 18 months old

1 and 3

Which should included in the plan of care for a 14 month old whose cleft palate was repaired 12 hours ago. selct all that apply 1. allow the infant to have familar items of comfort such as a favorite stuffed animal and a sippy cup 2. once liquids have been tolerated, encourage a bland diet, such as soup, jello, and saltine crackers 3. adminster pain meds on a regular schedule as opposed to an as needed schedule 4. use an yaunker suction catheter on the infants mouth to decrease the risk of aspiration of oral secretions 5. when discharged remove elbow restraints

no suction, nothing in mouth if spoon use the side of the spoon, put it in side of mouth cheek...NO FORKS

post-op cleft palate

iv fluids may be used to keep hydration status adequate to give the mouth time to heal cleft palate can be prone( dont have logams bow)

post-op cleft palate repair

prone so they dont hit their face( logans bow)

post-op with logans bow what position do we avoid?

cleft

seperation or opening in a body struture

special long nipples

special considerations for feeding

6

surgeries are usually scheduled ___ months apart

3 avergae of about 10 weeks,,,,, surgery can take 2-3 hours and requires overnight stay at hospital

surgery for cleft lip is usually done at about ___ months of age

6-12

surgery for cleft palate is usually done between___ and ___ months to take advantage of the palatal changes that occur with normal growth.( there are some dr who will operate during neonatal period 0-28 days)

3

The nurse is caring for a 4 month old who is just had an isolated cleft lip repair. selct the best position for the child in the post-op period. 1. right side lying 2. left side lying 3. supine 4. prone

2

A nurse who floats to the infant and toddler nursing unit asks the peds nurse about the notaiton ESSR,. on the care plan of a client. the nurse explains that this documentation refers to which item. 1. the feeding method for children with GERD 2. feeding method for children with cleft lip or cleft palate

3-6 months

ent specialist within ___-___ months of life.

dr decision

how long does the logans bow stay on?

sucking reflex test( feel the roof of the mouth)

may be detected in utero by US or detected after birth by

4-10 weeks( smoking/drinking high risk)

nasal and maxiallary proccesses fail to close around __-___ weeks after conception

!!!!!!!!!!!!!

pass nipple past the area of deficit so they dont aspirate

tolerated, keep lip area clean( cottom swab with saline) abt ointment s/sx infection( errythema)

post-op clear liquids, resume feeding when____

2

the nurse is caring for a newborn with a cleft lip and palate. the mother states i will not be able to brestfeed my baby . select the nurses best response 1. it sounds like you are feeling discouraged, woudl you like to talk about it 2. sometimes breastfeeding is still an option for babies with a cleft lip and palate. would you like more information? 3. although breastfeeding is not an option, you have the option of pumping your milk and then feeding it to your baby with a special nipple 4. we usually discourage breastfeeding babies with cleft lip and palate as it puts them at an increased risk of aspiration

antiseizure meds/ chemotherpy maternal smoking and alcohol use!!!!! decreased levels of folic acid phenytoin( dilantin) 10x greater chance of having a child with it if taking during pregnacy

what are some contributing factors to CL/CP?

prevents tension on the suture site caused by cying or facial movement

whats the purpose of a logans bow?

elbow restraints( take off, rom) keep them from grabbing logans bow order only good for 24 hours

when would you use restraints on a baby post-op with a logans bow?

improper drainage of the middle ear r/t fluid buildup

why are cleft plate kids at risk for otitis media

minimize scarring protected with a logans bow

why is the suture line after cleft lip surgery staggered?

it can be done just very very hard to do

breastfeeding with cleft palate

opening in the lip

can range in severity from a simple notch in the upper lip to a complete ________ extending into the floor of the nostril

1. upright position 2. feed slowly 3. burp frequently

3 things that are a must with nutrition for cleft palate

true

chromosomal abnormalities are the etiology of cl/cp true or false

true

cleft lip and cleft palate are more common in males and asians, and american indians true or false

more inside

cleft palate is more inside or outside damage?

true

cleft palate is repairded before cleft lip t/f

hearing loss-scaring of the tympanic membrane faulty dentition/orthodontic problems-many have extra, malformed, or absent teeth uper respiratory infections- aspiration of secretions( nipple not in mouth correctly)

cleft palate kids may have

7-10 weeks

cleft palate--primary and secondary palantine plates fail to fuse together by ___-___ weeks of gestation...

13-14 weeks or visually at birth...

diagnosed by ultrasound at __-_ weeks or visualy