Level III- RNSG 1412 Pedi GI

Latham device

"pulls" two separated segments of palate closer together through turning of screw

What position is the infant placed during feeding? After feeding?

Upright, supine No laying in the nook of arm Can do sidelying as well

What Nursing interventions are implemented during pre-op care of Esophageal Atresia? (4)

- Maintain Airway; Offer warm O2, Suctioning pouch, Gastric suction - Make them NPO, IV fluids, Offer tube feeds - Thermoregulation - Antibiotics; Prophylactic

An 18-month old is scheduled for a cleft palate repair. The usual type of restraints for the child with cleft palate repair are: a.Elbow restraints b.Full arm restraints c.Wrist restraints d.Mummy restraint

A

The nurse is providing discharge instructions to the parents of a newborn who had surgery to repair an imperforate anus. The nurse knows that discharge instructions have been understood when the parents say: a. "We will take the temperature axillary because we cannot perform it rectally." b. "We will call the HCP if the stools change in consistency." c. "Our infant will never be toilet trained." d. "We understand that it will not be unusual for our infant's urine to contain stool."

A

What is the purpose of the Logan Bar?

Allows pressure and keeps suture line taute. Keeps it from having tension on it

What is the major risk factor with feeding a baby with a cleft lip or palate? How is this prevented?

Aspiration Go slow, bubble frequently (Q0.5ounce)

When assessing a child with cleft lip palate, the nurse is aware that the child is a risk for more frequent episodes of otitis media due to? a. Lowered resistance from malnutrition b. Ineffective functioning of the Eustachian tubes c. Plugging of the Eustachian tubes with food particles d. Associated congenital defects of the middle ear

B

The nurse is caring for a 4 month old who had a cleft lip repaired. Select the best position for the infant in the immediate post op period. a. Right side lying b. Supine c. Left side lying d. Prone

B (Best Immediate)

Post Op Care Cleft Lip & Palate What are measures to prevent infection?

Clear liquids after milk or food to rinse the mouth out to make sure nothing's sitting on suture lines Cotton tip swab cleaning Sterile water or saline antibiotic ointment to keep skin area protected

Post Op Care Cleft Lip & Palate How is nutrition maintained?

Clear liquids, advanced to soft diet (depending on age) within 48 hrs Syringe with rubber tip to instill formula or breast milk

What are symptoms of this complication with a tracheoesophageal fistula? (3 C's)

Coughing Choking Cyanosis If you see these going on after a baby just eaten think fistula, or pouch

Malformation from failure of esophagus to develop as a continuous tube

Esophageal Atresia

What is the relationship between the maternal history and the current problem that might clue the nurse that the infant may have esophageal atresia?

Excessive amniotic fluid; polyhydramios

What is the most common symptom of of Imperforate Anus?

Failure to pass first meconium stool

The intestines are outside of the abdomen through a hole in the abdomen

Gastroschisis

Incomplete development or absence of anus in its normal position in perineum

Imperforate Anus Most commonly diagnosed upon Newborn Assessment

Complications of Post Op Cleft Lip & Palate closure What are complications that the nurse needs to anticipate and prevent?

Infection, Scarring, Respiratory Distress, Ear Infection & Impaired verbal communication

Post Op Care Cleft Lip & Palate What are the measures used to Prevent Trauma to the suture line?

Logan bar allows pressure & keeps suture line taute keeps it from having tension on it. "No-No's" keep elbow from bending so baby can't grab it.

How is cleft lip/palate diagnosed?

Observation when doing newborn assessment Might notice nasal reguritation of milk stick a gloved finger in mouth and make sure top palate is fused could be really small initially choking and gagging a lot

The intestines, liver and other organs remain outside of the abdomen in a sac

Omphalocele

When is surgical repair typically done for Esophageal Atresia?

Once stable and safe to do so, baby needs to be 2 kilos in wt at least

Diagnosis & Management of Esophageal Atresia Early Diagnosis

Orogastric Placement Radiopaque catheter inserted in the esophagus to illuminate defect on Xray Ultrasound

A Multidisciplinary team involving many specialist all work together. Who are members of this team?

Plastic Surgeon, Nurses, ENT specialist, Orthodontist, Audiologost, Speech therapist

Preop Nursing Care Prevention of Aspiration & Assist with Feeding Since nutrition is a major concern, How is the infant fed? Can the mom breastfeed?

Special nipple with larger hole to ↓ energy consumption Yes mom can BF breasts can usually mold and shape to fit babies mouth with the help of an LC (lactation consultant) depends on ability to transfer milk

Sometimes there is a fistula between the bladder & bowel which will cause what to be present in the urine?

Stool

Pre-Op Nursing Care for Cleft lip & Palate

Support the family, remind the parents that the defect is operable- show photos of corrected clefts. Connect them with support groups

Nursing Interventions for patient waiting for Esophageal atresia repair

While waiting for surgery tube will be inserted to suction to keep pouch empty May have G tube for feedings or IV nutrition ABX prophylactically Supine; HOB ↑ to prevent aspiration Continuous suction to keep secretions away from airway

Surgical Repair of Esophageal Atresia

Will have a chest tube post op connected to low intermittent suction goes for 7-10 days while they heal Thoracotomy & anastomosis

What is the difference between a) cleft lip & b) cleft palate?

a) nasal & maxillary fail to join b) nasal cavity becomes involved because it does not fuse at the roof of the mouth so nasal passagesare exposed at the roof of the mouth

Symptoms of Cleft Lip and Palate

abdominal distention from swallowing air from extra openings

What is an atresia?

absence of closure of a normal body part

mainly 1yr first repair growth success

again at 4-5 yrs for cosmetic reasons

What would be the two life threatening concerns r/t a Cleft lip and Palate?

airway, aspiration & Respiratory distress Failure to thrive & Nutrition

What would be the nurses major concern r/t to the child with tracheoesophageal fistula?

airway; aspiration

More symptoms of tracheoesophageal fistula

baby will have excessive oral secretions, frothy bubbles in mouth, trouble swallowing, vomit, trouble breathing & gastric distention

Anal Stenosis

can be treated with repeated anal dilation

cleft lip repair is started 6 mos-3yrs of age

depending on severity & how many times they think they need to go in for repair

Post Op Care Cleft Lip & Palate How is pain reduced?

pain meds are given around the clock, hold babies to comfort them

palate and lip closure is done in phases

somewhere between 6 mos-2 yrs

What is an important nursing implication regarding "No-No's"?

these are treated like a restraint regarding care, checking and removal.

What is the main goal of cleft lip repair?

to get it done before development of speech

What is a fistula?

two body parts connecting that shouldn't be