Peds Final Review - Gastrointestinal Disorders Flashcards
CLEFT LIP AND PALATE
Description: Malformations of the face and oral cavity that seem to be multifactorial in hereditary origin.
Cleft lip is readily apparent.
Cleft palate may not be identified until the infant has difficulty with feeding.
Initial closure of cleft lip is performed when infant weighs approximately 10 pounds, is at least 10 weeks, and has an Hgb of 10.
Closure of palate is performed between 6 and 12 months to minimize speech impairment.
CLEFT LIP AND PALATE
Nursing Assessment:
Failure of fusion of the lip, palate, or both
Difficulty sucking and swallowing
Parent reaction to facial defect
CLEFT LIP AND PALATE
Nursing Diagnosis:
Imbalanced nutrition: less than body requirements R/T
Impaired parenting R/T
CLEFT LIP AND PALATE
Nursing Interventions:
–Promote family bonding and grieving during newborn period
–Inform family that successful corrective surgery is available.
–In newborn period, assist with feeding.
a. Feed in upright position
b. Feed slowly, with
frequent burping
c. Use soft, large nipples;
Haberman feeder, etc.
d. Support mother’s breast-
feeding and/or pumping
CLEFT LIP AND PALATE
Nursing Interventions:
Provide postoperative care:
–Maintain patent airway and proper positioning.
-Cleft lip: Client upright
in infant seat
- Cleft palate: Place
client on side or
abdomen
-Remove oral secretions
carefully with bulb syringe
Protect surgical site:
1. Apply elbow restraints
- Minimize crying to prevent strain on lip suture
- Maintain Logan bow to lip if applied
Provide care for restrained child.
- Remove one restraint at a time, and perform ROM exercises.
- Provide age-appropriate stimulation.
Resume feeding as prescribed. Cleanse suture site with sterile water after feeding; formula remaining on suture line may impede healing and lead to infection.
Encourage family participation in care and feeding:
1.Fluids are taken by a cup or an oral feeding syringe with a rubber tip
- The diet progresses from a clear to a full liquid diet
- The child may go home on a soft diet – nothing harder than mashed potatoes.
CLEFT LIP AND PALATE
Usually for cleft palate: Coordinate long-term care with other team members: plastic surgeon, ENT specialist, nutritionist, speech therapist, orthodontist, pediatrician, nurse.
CLEFT LIP AND PALATE
NCLEX HINT: Typical parent and family reactions to a child with an obvious malformation such as cleft lip or palate are guilt, disappointment, grief, sense of loss, and anger.
ACUTE APPENDICITIS
Nursing Assessment:
Pain precedes vomiting
Periumbilical pain, right lower quadrant pain (McBurney point), vomiting with fever
The absence of fever does not exclude appendicitis
Rebound tenderness is not a reliable sign of appendicitis
Ruptured appendix:
–Relief of pain, then child becomes seriously ill
–Rigid guarding of abdomen
–Fever, tachycardia, abdominal distention
–Rapid shallow breathing
ACUTE APPENDICITIS
Nursing diagnosis:
Risk of Infection R/T ruptured appendix
Risk of Fluid Imbalance R/T NPO status, IV fluid infusions, NG tube to intermittent low wall suction
ACUTE APPENDICITIS
Nursing Interventions Post-op:
Monitor vital signs
Monitor and manage IV fluid infusion
NG tube in place for decompression to intermittent low-wall suction
Pain relief – PCA pump
Monitor intake and output closely
Auscultation of bowel sounds
Post-op drains – JP, Penrose
Early initiation of enteral nutrition to minimize the degree of mucosal atrophy
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL
FISTULA
Description: congenital anomaly in which the esophagus does not fully develop.
Most common: upper esophagus ends in a blind pouch, and the lower part of the esophagus is connected to the trachea.
This condition is a clinical and surgical emergency.
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA
Nursing Assessment:
Three C’s of TEF in the newborn:
- -Choking
- -Coughing
- -Cyanosis
Excess salivation
Respiratory distress
Aspiration pneumonia
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA
Nursing Diagnosis:
Risk for aspiration R/T
Imbalanced nutrition: less than body requirements R/T
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA
Nursing Interventions:
Provide preoperative care
Monitor respiratory status
Remove excess secretions – suctions is usually continuous to blind pouch
Elevate infant 30 degrees
Provide oxygen as prescribed
Maintain NPO
Administer IV fluids as prescribed
ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA
Provide postoperative care.
Maintain NPO
Administer IV fluids as prescribed
Monitor I&O
Provide gastrostomy tube care and feedings as prescribed
Provide pacifier to meet developmental needs
Monitor child for postoperative stricture of the esophagus --Poor feeding --Dysphagia --Drooling --Regurgitating undigested food
Promote parent-infant bonding for high-risk infant
