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Cleft lip and palate are congenital (present from before birth) abnormalities that affect the upper lip and the hard and soft palate of the mouth. That may occur separately or together. Cleft lip: It results from the failure of maxillary processes to fuse with the nose elevation on the frontal prominence. This defect varies from a notch in the lip to complete separation of the lip into a hare. The cleft lip may be unilateral or bilateral.
Unilateral Cleft lip
Bilateral Cleft lip
Cleft palate (isolated): Isolated cleft palate results from a failure of the fusion of secondary palate with each other, and with the primary palate. It can be unilateral or bilateral. Cleft lip and palate: This condition results from a combined defect of cleft lip and cleft palate.
Cleft lip occurs in approximately 1 in 800 births. It is more common in Asians and American Indians and less common in African-Americans. Cleft palate occurs in approximately 1 in 2000 births. There are various degrees of
severity with each defect.
Idiopathic (exact cause are unknown). Suspected causes include- mutant genes inherited from one or both parents, and teratogens (drugs, viruses, or other toxins that can cause abnormalities in a developing fetus).
Separation of the lip alone. Separation of the palate.
Complications Recurrent ear infections Hearing loss Dental cavities Displaced teeth Poor speech Lip deformities Nasal deformities Management Treatment of cleft lip and cleft palate may require joint efforts of pediatrician. orthodontist. Growth retardation. Feeding problems. Closure of the cleft lip is done firstly then the closure of the cleft palate. prosthodontist. Only cleft palate may be identified when thorough assessment of the mouth is done or when the infant has difficulty with initial feeding. Cleft palate surgery is postponed later in order to wait for the changes in the palate. Investigations Cleft lip with or without the cleft palate is easily apparent at birth. the suture line is protected from tension by an arched metal device taped to the cheek. Misaligned teeth. Surgical Management The cleft lip is usually repaired by about 2-3 months of age and cleft palate is usually repaired by about 18-24 months of age of the baby. to reduce notching of the lip. plastic surgeon. After the surgery. Orthodeontic and prosthodontic treatment may be required to correct malposition of the teeth and maxillary arch. Nasal regurgitations during bottle feeding. Recurrent ear infections. Varying amounts of nasal distortion. and speech therapist. nurses. Cleft lip is generally repaired by Z-shaped sutures. Separation of the lip and palate. Failure to gain weight. Poor speech. .
. the baby may look unattractive but the nurse should not show her reactions. a syringe with the rubber tube may be used to feed. The skin is sewn together with very small. tissue from the back of the mouth (pharynx) may be taken to add tissue to the deficient soft palate (this is called a pharyngeal flap). Feeding of an infant: The immediate problem faced is the feeding an infant with the cleft lip and palate. In cleft palate repair. the tissues around the defect are trimmed and sewn together with several layers of stitches (absorbable sutures). Children with cleft palate may have speech problem and may require speech therapy. because this defect reduces the ability of the infant to suck. fine stitches (sutures) to make the scar as small as possible. The nurse should explain the positive aspects about the correction of the defect and other possible treatment. the infant should be hold in upright position. When the infants have the problem to take feeds with the nipple. Occasionally more than one surgery is required for complete palate closure General instructions Soon after the birth. The baby is anesthetized and asleep (general anesthesia). A large and soft nipple with the large hole or a long and soft lamb's nipples are useful. The disfiguring defect may cause negative reaction and shock in the parents. A special cleft palate nipple can be used. While feeding.
The of infant gagging will or Assess respiratory status Allows problems. Position feedings. and monitor vital signs at least every 2 hours. Burp frequently (after every 15-30 ml of fluid). Facilitates intake while minimizing aspiration.Nursing Management NURSING CARE PLAN GOAL INTERVENTIONN RATIONALE Pre-operative Care 1. Minimizes passage of feedings through cleft. Position feedings. Assess weight daily (same scale. . Provides an objective measurement receiving mote of sufficient Using whether the infant is caloric intake to progrowth. Altered Nutrition: Less than Body Requirements related to the infant's inability to form an adequate seal for sucking The infant will Assess fluid and calorie intake daily. same time. Suctioning necessary may to be remove risk of milk or mucus. 2. for early of have no episodes aspiration. with infant completely undressed). upright for slowly and use as adaptive equipment on side after identification Prevents aspiration of feedings. gain weight. Risk for Aspiration (Breast Milk or Mucus) related to anatomic defect. Feed needed. Keep suction equipment and bulb syringe at bedside. Helps to prevent and regurgitation aspiration.
Observe for any respiratory impairment. be of initiated only if there respiratory distress. The process feeding promote between infant. Any symptoms comparability between of respiratory compromise will interfere with the infant's ability Feedings are no to should signs suck. initiate bottle feeding: Hold infant in an upright or Facilitates swallowing Information specific may encourage and suggestions the of breastto and bonding mother helps mother to persist with breast-feeding. Give the mother information on breast-feeding the infant with a cleft lip and/or palate such as plugging the cleft lip and eliciting a let-down reflex before nursing. If the mother is unable to breast-feed (or prefers not to).the same scale the and when infant for procedure weighing provides daily weights. Breast milk is recommended as the best food for an infant. . Facilitate breast-feeding.
lesions.semisitting feeding. of secretions. Small tire amounts the as infant do given at and as a Feed small amounts slowly. Use of a feeding tube allows the infant who has difficulty with oral feeding to receive adequate growth. allow feeding do not quickly amounts larger faster rate. Risk for Infection related to surgical procedure and accumulation of formula and secretions the oral cavity Assess vital signs every 2 The mucosal infection. nutrition for Post-operative Care 3. will heal without areas. reddened Elevated Aids in temperature identifying may indicate infection infection. They also decrease the calories used during feeding. Assess oral cavity every 2 hours or as needed for tenderness. Adequate must be nutrition maintained. Initiate nasogastric feedings if the infant is unable to ingest sufficient calories by mouth. infant’s tissue hours. position for and minimizes the amount of fluid return from the nose. . or presence Cleanse normal suture saline line or with sterile Helps decrease the presence of bacteria.
Apply a cardio respiratory monitor. every cool 24 Gentle suctioning will keep the airway clear. Cleanse the cleft areas by giving 5-15 ml of water after each feeding. identification breathing pattern. Ineffective Breathing Pattern related to anesthesia and increased secretions The infant will an Assess respiratory Allows problems. Ensures expansion of all lung fields for early of maintain effective status and monitor vital signs at least every 2 hours. Moisturizes oral cavity.water if ordered. Helps loosen the crust. Reposition hours. Use careful hand washing and sterile technique when working with suture line Counteracts the growth of bacteria. facilitating prompt intervention. Apply antibiotic cream to suture line as ordered. use a cotton swab to apply a halfstrength peroxide solution. If a crust has formed. Moisturizes secretions to reduce pooling in lungs. encourage bacterial growth. 4. aiding in removal. nasopharynx as needed. Gently suction and mist for if 2 oropharynx Provide first ordered. Prevents the spread of microorganisms other sources from Prevents accumulation of which carbohydrates. Keep suction equipment and bulb syringe at bedside. Suctioning that is too vigorous can irritate the mucosa. hours postoperatively . Enables early detection of abnormal respirations.
fluids and nutrienls. Avoids sulure line and resullant accumulation of formula in Ihat area. and disrupt site.5. slraws the could surgical . Sucking can disrupt Provides NPO. Do not allow pacifiers. Begin with clear liquids. Ensures adequate fluid when The infant will receive adequate nutritional intake. Rough foods. then give half-strength formula or breast milk as ordered. Give high-calorie soft foods after cleft palate repair. Altered Nutrition: Less Than Body Requirements related to surgery and feeding difficulties Maintain intravenous infusion as ordered. Use Asepto syringe or dropper in side of mouth. sulure line. utensils.
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