GI n470

Obturators

Improve feeding and reduce nasal air emission by occluding the abnormal opening between the oral and nasal cavities "...My brother's tongue just fell out!" Speech issues Risk for Aspiration, Otitis media Appearance, potential for impaired attachment, social issues

Gastric Decompression

Reduce pressure to inside of gut

a nurse is caring for a child who has Hirschsprung's disease. Which of the following actions should the nurse take? A. Encourage a high-fiber, low protein, low-calorie diet. B. Prepare the family for surgery C. Place an NG tube for decompression D. Initiate bed rest

A. Encourage a high-fiber, low protein, low-calorie diet.

An 18-month-old is scheduled for a cleft palate repair. The usual type of restraints for the child with a cleft palate repair are: A. Elbow restraints. B. Full arm restraints. C. Wrist restraints. D. Mummy restraints.

A: Elbow restraints. The least restrictive restraint for the infant with cleft lip and cleft palate repair is elbow restraints. B, C, D: Answers B, C, and D are more restrictive and unnecessary; therefore, they are incorrect.

A home care nurse provides instructions to the mother of an infant with cleft palate regarding feeding. Which statement if made by the mother indicates a need for further instructions? A. "I will use a nipple with a small hole to prevent choking." B. "I will stimulate sucking by rubbing the nipple on the lower lip." C. "I will allow the infant time to swallow." D. "I will allow the infant to rest frequently to provide time for swallowing what has been placed in the mouth."

Answer: B. "I will stimulate sucking by rubbing the nipple on the lower lip." B: An infant with cleft palate would have difficulty in feeding despite stimulation for sucking. A, C, D: All these options are correct for an infant with cleft palate.

When assessing a child with a cleft palate, the nurse is aware that the child is at risk for more frequent episodes of otitis media due to which of the following? 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. Ineffective functioning of the Eustachian tubes. Because of the structural defect, children with cleft palate may have ineffective functioning of their Eustachian tubes creating frequent bouts of otitis media.

When providing postoperative care for the child with a cleft palate, the nurse should position the child in which of the following positions? A. Supine. B. Prone. C. In an infant seat. D. On the side.

B: Prone Postoperatively children with cleft palate should be placed on their abdomens to facilitate drainage.

Surgical repair

Closure of lip often done in the first few weeks of life, sooner than palate repair Delayed palate repair facilitates palate changes that occur with normal growth Timing of repair is individualized Cleft palate- often a multi stage surgery- may require several surgeries

Cleft Lip and Palate nursing issues

Feeding / nutrition Feeding systems Breastfeeding Haberman Feeder Cost ~ $30 (!) per bottle Pigeon Cleft and Palate Nurser Mead Johnson Palate Nurser

A nurse is assessing an infant who has hypertrophic pyloric stenosis. Which of the following findings should the nurse expect? (Select all that apply) A. Projectile vomiting B. Dry mucous membranes C. Currant jelly stools D. Sausage-shaped abdominal mass E. Constant hunger

Projectile vomiting Dry mucous membranes Currant jelly stools Sausage-shaped abdominal mass Constant hunger

Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that which of the following will most likely be compromised? A GI function B Locomotion C Sucking ability D Respiratory status

Sucking ability Because of the defect, the child will be unable to from the mouth adequately around the nipple, thereby requiring special devices to allow for feeding and sucking gratification.

Preoperative Nursing Care

Teaching and family support Special feeding devices Other feeding issues Frequent burping, downward pressure against tongue Breastfeeding- positions, team approach, lactation consultant Monitor for ...? Oral stimulation and speech development Daily Weights Challenges re. growth (corrected after surgery)

: Sucking / swallowing become coordinated

Week 34-35

Embryonic Development

Week 4: Intestine present, esophagus and stomach become distinct Week 5 & 6: Intestine elongates into a loop and begins to rotate Week 12: Muscular layers of intestine present. Week 16: Meconium present, swallowing observed Week 26: Random peristalsis begins Week 34-35: Sucking / swallowing become coordinated Week 36-38: Maturity of GI system complete

Cleft Lip and Palate Diagnosis

in utero via ultrasound by 14-16 weeks gestation

Intestine present, esophagus and stomach become distinct

week 4