Alterations in Gastrointestinal Function CL and CP

Question 1

Amelia

Answer 1

Loss of a limb

Question 2

Cleft lip and Cleft Palate

Answer 2

Failure of maxillary processes to fuse with elevations on frontal prominence during 6th week of gestation
Union of upper lip normally occurs by 7th-8th week
Development of soft & hard palate during 7th-12th week
Occur singly or in combination

Question 3

Cleft palate

Answer 3

1:2500
less obvious is no CL (may be unilateral or bilateral and involve just soft palate or both soft & hard palates)

Question 4

Cleft Lip

Answer 4

1:600
More common than cleft palate
apparent at birth
may unilateral or bilateral

Question 5

Causes of Cleft Lip and Palate

Answer 5

Multifactorial cause: environmental & genetic
- responsible gene unknown
- chormosomal abnormalities (associated with TEFm omphalocele, trisomy 13 & skeletal dysplasias in 15% of cases)
- Drugs (phenytoin, valproic acid, thalidomide)
- Pesticides (dioxin)
- Folic acid deficiency
- Alcohol ingestion & smoking
- Teratogens. Smoking in early pregnancy. Many syndromes include cleft lip or palate

Question 6

Cleft Lip & Palate: Diagnosis and Treatment

Answer 6

May be diagnosed by ultrasound @ 14-16 weeks
Multidisciplinary approach: affects feeding, speech, hearing, dentition
Cleft lip repair: @ 2-3 months (lip sutured together with stabilizing device put in place to prevent tension on suture line -> minimize crying)

Question 7

Cleft Palate repair: 6-12 months

Answer 7

• Early repair protects formation of taste buds & allows more normal speech to develop
• Multidisciplinary - pediatrics, plastics, orthodontics, otolaryngology, speech & language pathology, audiology, nursing, social work (increased ear infections)

Question 8

Cleft Lip and Palate: Long-term problems (5)

Answer 8

• Prone to recurrent otitis media -> may lead to hearing loss
• often have “tubes” placed at time of repair surgery
• Malformed, missing, or malpositioned teeth
• Misaligned mandible & maxilla
• Speech difficulties (compensatory speech pattern)

Question 9

Nursing Care Plan - Pre-Op Care CL and CP: Risk of aspiration (5)

Answer 9

• Assess respiratory status & monitor VS q2h
• Suction nose & mouth prn
• Position upright for feedings
• Hold upright for 30 min after feeding
• Burp frequently (q15-30 min)

Question 10

Nursing Care Plan - Pre-Op Care CL and CP: Risk for compromised parent coping

Answer 10

Help parents see whole child, not just physical defect

Question 11

Nursing Care Plan - Pre-Op Care CL and CP: Imbalanced Nutrition - less than body requirements

Answer 11

• may use special bottles (Haberman feeder)
• may need NG feeds
• breastfeeding is possible but may be very difficult for those with CP!
• Monitor weight

Question 12

Nursing Care Plan - Post-Op Care CL and CP: Impaired tissue integrity (7)

Answer 12

Position supine
Avoid straws, hard utensils, or objects (pacifiers)
Use soft elbow restraints
Maintain metal bar or steri-strips over lip repair
Maintain stitches
Infection may interfere with healing -> clean suture line with water or NS after each feed
Minimize crying!

Question 13

Nursing Care Plan - POST-OP Care CL and CP: Risk for feeding difficulties or aspiration

Answer 13

Sit semi-upright for feeding
Position to prevent airway obstruction

Question 14

Nursing Care Plan - POST-OP Care CL and CP: Imbalanced nutrition - less than body requirements

Answer 14

Modify feeding technique; use modified feeding appliances prn
Frequent burping

Question 15

Nursing Care Plan - POST-OP Care CL and CP: Acute Pain

Answer 15

Good pain management; may use sedation but remember sedation does not equal analgesia!!!
Cuddling & tactile stimulation

Question 16

Nursing Care Plan - POST-OP Care CL and CP: Interrupted family processes

Answer 16

Refer to support groups prn

Question 17

Nursing Care Plan - POST-OP Care CL and CP: Knowledge deficit (parent)

Answer 17

Feeding techniques
Sign & symptoms of infection
Care for suture lines
Preparation of siblings (& others)