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Differences 1. CLEFT LIP (HARELIP)/CLEFT PALATE Distinct facial defect that occurs singly or in combination Both occur during embryonic development Merging of the upper lip is completed between 7-8th wk AOG Fusion of the palate is completed between 9-12th wk AOG Significant concerns: Negative sucking reflex Prone to Otitis media w/c can lead to hearing loss Causes: Multi-factorial 1. Genetics 2. Environmental 3. Maternal Diseases Diagnosis: Ultrasound Physical Assessment CL is apparent at birth CP may not be detected without thorough assessment of the mouth Management: Surgery For Cleft lip: CHEILOPLASTY - before 2 months/6-12th wks after birth - Rule of 10 - done earlier because: * center of pleasure is oral * Psychological * Nutrition For Cleft palate: URANOPLASTY - done 12-18 months after birth - done in anticipation of speech development - done before the child develops faulty speech habits Nursing Care: 1. Help parents cope with the impact of the defect 2. Provide adequate nutrition A. ESSR (Richard, 1991) Enlarge the nipple (long and soft) Stimulate the suck reflex Swallow fluid appropriately Rest B. Upright position when feeding to facilitate swallowing and prevent aspiration. C. Burp frequently because more air is swallowed which can cause regurgitation. D. NGT feeding as ordered. 3. Prepare for surgery 4. Post -operative Care A. Airway - if necessary gentle aspiration - NO SUCTIONING - Positioning B. Bleeding C. Avoid trauma to the operative site - Logan’s bow/butterfly adhesive - Restraints - Minimize crying - No to sucking - No hard items on the mouth 5. Optimum Nutrition 6. Prevent infection A. Assess vs.
careful hand washing and sterile technique.Complication: persistent pyloric obstruction. Hyperactive Bowel sounds Diagnosis: 1. wound dehiscence and GER Nursing Care: 1. maintain fluid and electrolyte balance B. Cleanse cleft areas by giving 5-15 cc of H2O after feeding D. C.I. Promote rest and comfort D. Post OP A. series 4. Visible peristaltic waves 7. Prevent infection * Discharge planning and patient’s family home care teachings. S/s of dehydration -decreased number of stools. HYPERTROPHIC PYLORIC STENOSIS .A hypertrophy obstruction of the circular muscle of the pyloric canal Incidence: One of the most common conditions requiring surgery in infants First few weeks of life (1-10 weeks) First born male infants Full term. Ultrasonography 3.abnormal opening between the esophagus and the trachea Incidence: .failure of the esophagus to develop a continuous passage . ESOPHAGEAL ATRESIA with TRACHEOESOPHAGEAL FISTULA * Esophageal Atresia . use cotton swab to apply a half strength peroxide solution E. 3. If crust has formed. History and physical exam. but not including the sub mucosa . Upper G.rare . Cleanse suture line with normal saline/ sterile water if ordered. weight loss.B.equal sex incidence .Longitudinal incision through the circular muscle fibers of the pylorus down to.esophagus ends in a blind pouch with no entry to the stomach * Tracheoesophageal Fistula . Minimize weight loss C. Projectile vomiting * Nonbilous * Blood Tinged 2. 4. Prepare infant for surgery 4. Readily palpable olive mass in the upper abdomen. No evidence of pain or discomfort except that of chronic hunger 3. Distended upper abdomen 5. 2. Maintain fluid and electrolyte balance and minimize weight loss 2. Provide supportive care to parents. 6. 2. Blood test for metabolic alterations from extensive vomiting Management: Surgery PYLOROMYTOMY (FREDET RAMSTEDT PROICEDURE) . genetic predisposition (children of parents who had PS as infants) Clinical Manifestations: 1. 3. less frequently in Asians and Black Cause: unknown.low birth weight . antibiotic cream as prescribed F. premature infants Caucasians.
Provide optimum nutrition A. Copious. Promote respiratory function 2. Inability to insert an NGT 3.Several stages. Use of Pacifier E. Fluoroscopy Management: 1. Oxygen to relieve respiratory distress 5. NPO 3.EA 3. fine white frothy bubbles of mucus in the mouth and nose . Surgery to repair anomaly . Oral feeding when anastomosis site is healed C.Liquid . Gastrostomy tube feedings * elevated and secured t a point above level of the stomach (4‘’) B. Maintain IVF D. lower end connects into the trachea . History and clinical manifestations 2. COUGHING & CYANOSIS 2. in poor condition LIGATION OF TEF Gastrostomy .most common Both upper and lower ends of the esophagus open into the trachea by a fistula Esophageal atresia but with fistula between normal esophagus and trachea Clinical Manifestation: 1. Administer IVF as ordered 4. Diet .small frequent feedings .prematurely Cause: unknown Types: Name A B C D E Simple Esophageal atresia with no fistula (Isolated EA) EA with proximal TEF EA with Distal TEF EA with double TEF Isolated TEF Description Upper and lower ends of the esophagus are blind.for gastric decompression and jejunostomy feeding Provision of constant drainage of the esophageal pouch . Distended abdomen 5. no connection to the trachea Upper end of the esophagus ends into the trachea Upper end of esophagus is blind. Positioning * Post-operative 1.indicated for premature.tube in the mouth to upper pouch Complications of Surgery: Anastomostic leak Stricture due to tension Esophageal motility disorders Nursing Care: * Pre-operative 1. Aspiration Pneumonia Diagnosis: 1. 3 C’s of TEF .CHOKING. Radiogrphy 4. Maintain open airway 2.. Prevention of aspiration pneumonia 2. Increased respiratory distress after feeding 4. multiple anomalies.
Proton Pump Inhibitor .alternative for children with neurologic impairment who are continuously tube fed Nursing Care: 1.SURGICAL PERCUTANEOUS GASTROJEJUNOSTOMY and placement of jejunostomy tube .4. Asthma 4. Prokinetic Agents . wheezes.Metochlopromide Hcl (Placil) 3. Surgery for severe complications * NISSEN FUNDOPLICATION . Gastrostomy placement 6. choking at end of feeding 8.A gastrostomy tube is usually inserted during the procedure Complications: . chronic cough.small bowel obstruction. 24 hour pH probe study Complications of GERD 1.Valve mechanism by 360 degrees wrap of the fundus around the esophagus . H2 antagonist . Neurologic disorders Causes: 1. Diet 2. Identifying children with symptoms that suggest GER 2. Maintaining adequate nutrition . TEF/EA repair 5.return of gastric contents into the esophagus Risk Factors: 1. gagging. Pharmacologic A.Cimetidine (Tagamet). spitting up/vomiting 2. History and clinical manifestations 2.pneumonia. Heartburn in older clients 6. Respiratory problems . Irritability or excessive crying 5. Persistent esophagi is with scarring 2. Prematurity 2. Lansoprazole (Prevacid) C. Increased abdominal pressure Clinical Manifestations: 1. GASTROESOPHAGEAL REFLUX . Ranidine (Zantac) B.Omeprazol (Prilosec). Hematemesis and melena 4. NON. Poor weight gain 3. Dumping Syndrome 4. Preparing for surgery and post-OP care 3. Neurologic disorders 3. Dysphagia Diagnosis: 1. Anemia 7. Famotidine (Pepcid). Barium swallow (esophagography) 3. stridor. retching. Passive regurgitation. Recurrent aspiration pneumonia * Barret’s syndrome disorder of the lower esophagus marked by benign ulcer like lesions resulting most often from chronic irritation of the esophagus by gastric reflux of acidic digestive juices Management: 1. Delayed gastric emptying 3. Related to the dysfunction of the lower esophageal sphincter (LES) 2. gas-bloat syndrome.
Mechanical obstruction due to inadequate motility of the intestines Incidence: . Preparing for hydrostatic reduction and/or surgery 6.4. Sepsis Diagnosis: 1. Non-surgical A. Tender. PNEUMATIC INSUUFFLATION 2. History and physical exam 2.1:5000 . Monitoring for S/s of complications 2. Passage of red currant jelly like stools 4.one of the most frequent cause of intestinal obstruction between 3 months to five years of age.4X greater in males than in females . absence of bowel sounds and increased abdominal distention . Ultrasound 5. vomiting. severe. Rectal Exam Management: 1. Peritonitis 3.onset: abrupt . Lethargy Complications: 1. Palpable sausage-shaped in RUQ 5.s/s: relief of pain. increased RR and PR. Vomiting 3. likely a result of hypertrophy of intestinal lymphoid tissue secondary to viral infection Clinical Manifestations: 1.An invagination or telescoping of one portion of intestines into another Incidence: . fever. 4. Obstruction 2. Educating parents regarding home care A. Feeding B. Maintain or establishing fluid and electrolyte balance 3. Bowel perforation A. Gastrostomy feeding and site care 5. Pain (acute). Positioning C. 50 % below 1 year (3-12 mos. Perforation 2. Abdominal radiograph to detect intraperitoneal air from a bowel perforation 3. Empty RLQ (Dance sign) 6. HYDROSTATIC REDUCTION B.2X greater in males than in females Cause: unknown . Medications and their side effects D. Surgical-manual reduction of invagination and resection of nonviable intestines when necessary Nursing Care: 1.can present as an acute or chronic disorder Complications: 1. HIRSCHPRUNG’S DISEASE/CONGENITAL AGANGLIONIC MEGACOLON .More common in children with Down’s syndrome . How to suction mouth and nose when vomiting occurs E.) of age . Peritonitis . Barium enema. INTUSSUSCEPTION . colicky abdominal pain 2. distended abdomen 7.Accounts for ¼ of all cases of neonatal obstruction although diagnosed in later infancy/childhood .
Removal of aganglionic segment and temporary colostomy made with the part of the bowel with normal nerve transmission. Discharge .s/s: fever. Low residue diet 2. including abdominal circumference and ominous sign (enterocolitis) 2. Maintain adequate nutrition 4. Maintain fluid and electrolyte balance 3. Rectal Biopsy Management: (most require surgery rather than medical therapy) Mild Cases (#s 1-3) 1. Nursing Care: 1. Isotonic irrgations 4.closure of the colostomy and reanastomosis of working part of colon to point near rectum. History and clinical manifestations 2. Enterocolitis . Barium enema 3. Dehydration Diagnosis: 1. Monitoring vs. severe prostration 4.B. dehydration. Corrective . Post-OP care 7. 2. Stool softeners 3. Help parent adjust to the congenital defect in the child 5.assisting parents in proper colostomy care . Staged Repair 1. Bleeding 3. Prepare client for surgery 6. Surgery A. explosive watery diarrhea.
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