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Causes of cleft lip/palate
Causes can be multifactorial
- Risk factors: folic acid deficit, smoking, anticonvulsants, and steroids during pregnancy.
Clinical Manifestations of Cleft lip/palate
- May be a simple dimple in the vermilion board of the lip or a complete separation extending to the floor of the nose
- May be unilateral or bilateral and may occur alone or in combination with a cleft palate defect.
Diagnostic tests for Cleft lip/palate
- Diagnosed prenatally, at birth or during the newborn assessment.
- Can be associated with other defects:
Clinical therapy for cleft lip/palate
- Cleft lip is usually repaired around 3 months of age.
- Coordinated care by specialists is necessary
- The lip is sutured together using a diagonal incision or a staggered suture line.
- After surgery, soft elbow immobilizers are used to prevent flexion of the arms.
- DISTRACTION AND PAIN MEDICATION ARE NEEDED TO PREVENT CRYING
- Timing of the cleft palate repair varies among surgeons and depends on the size and severity of the cleft defect.
- Most surgeons perform closure operations before the child reaches 18 months of age.
- Special nipples or syringes to breastfeeding are used postoperative feeding protocols
Complications for cleft lip/palate
• Feeding problems → the child is unable to suck successful/excess air intake results in GI distress → refer to feeding specialist for evaluation and need for special nipples / teach parents to encourage slow feeding in upright position and burp frequently / measure frequently to assess growth
• Otologic → high risk for otitis media and hearing loss may occur with increased otitis → monitor ear infection, child may ear tubes to promote drainage, audiology screening is conducted on a regular basis.
• Dental → children with cleft palates/ tooth enamel may be underdeveloped → promote good oral hygiene and provide fluoride supplements
• Speech development → persistent structural abnormalities cause problems with speech, hearing, speech, and dental problems.
• Developmental → affected parent baby attachment, self image problems in older children that still have speech problems → support attachment, refer child and family to counseling, and screen for learning disabilities.
nursing Management for cleft lip/palate
- Feeding the Infant with Cleft Lip or Cleft Palate
• These kids may need more time to feed and may tire afterwards. (give them time to eat and let them rest after)
• Feed with head and chest elevated
• Breastfeeding is encouraged - special techniques can help achieve success
• Burp the baby frequently because babies because cleft lip palates swallow a lot of air
• Follow up appointments are important to evaluate growth
• Make sure to let provider know if the child has problems such as vomiting and respiratory difficulty.
- Associated with Inflammatory Disease
- Diarrhea may be an acute problem caused by a viral, bacterial, parasite, or chronic problem
- Leading cause in children is the Rotavirus
- Can affect any part of the GI tract
- Gastroenteritis can cause dehydration rapidly
Causes of Gastroenteritis
- Specific cause is unknown
- Common mechanism is a decrease in the absorptive capacity of the bowel through inflammation, decrease in surface area for absorption, or alteration of parasympathetic innervations
- Children living in substandard housing with improper sanitation are at increased risk.
Clinical manifestations of Gastroenteritis
- Mild: stools are slightly increased in number and have a more liquid consistency.
- Moderate diarrhea: several loose or watery stools. Other symptoms include irritability, anorexia, nausea, and vomiting. Usually self limiting, resolving without treatment within 1-2days.
- Severe: watery stools are continous. The child exhibits symptoms of fluid and electrolyte imbalance, cramps, and irritable and difficult to console.
diagnostic tests for Gastroenteritis
- History, physical examination and laboratory findings.
- s/s of dehydration
- stool cultures: show pus/blood, ova, parasites, infectious organisms, viruses, fat, and undigested sugars.
Clinical therapy of gastroenteritis
• Mild/Moderate - oral rehydration at home or with a short hospital stay.
• Severe - rehydrate with intravenous fluids, as soon as possible clear liquids and breast milk started, if bacterial antibiotics, antiemetics, and antidiarrheals.
• CARBONATED BEVERAGES AND THOSE CONTAINING HIGH AMOUNTS OF SUGAR SHOULD NOT BE GIVEN. FERMENTATION OF SUGAR IN THE GI TRACT CAUSES INCREASED, ABDOMINAL DISTENTION, AND AN INCREASED FREQUENCY OF DIARRHEA.
Nursing diagnoses for gastroenteritis
• Anxiety r/t change in health status
• Disturbed sleep pattern r/t pain
• Imbalanced nutrition: less than body requirements r/t inability to ingest sufficient nutrients.
An abnormal elimination pattern characterized by the recurrent soiling or passage of stool at inappropriate times by a child who should have achieved bowel continence.
Causes of encopresis
- Associated with voluntary or involuntary retention of stool in the lower bowel and rectum, leading to constipation, dilation of the lower bowel, and incompetence of the inner sphincter.
- Retention is a result of "being to busy", putting off going to bathroom because of inconvenience of leaving an activity. The retention of stool leads to constipation that is untreated and chronic.
- Soiling may occur during the day or night.
- Bowel movements are irregular, painful, small and hard.
- May be ridiculed by peers because of the offensive body odor.
- Caused by stress of environmental changes (birth of a sibling, moving to a new house, and attending a new school), issues of anger and control related to bowel training, diet, a full schedule of activities or a genetic predisposition.
Nursing management of encopresis
- Partners to teach toilet training techniques
- Emphasizing the child's developmental readiness
- Praise successes and avoid punishment and power struggles
- Encourage high-fiber diets and regular times for elimination.
a congenital malformation in which intraabdominal contents herniated through the umbilical cord. When the intestines fail to return to the abdomen when the abdominal wall closes in the 10th week of gestation.
Congential defect of the ventral abdominal wall, characterized by herniation of abdominal viscera outside the abdominal cavity through a defect in the abdominal wall to the side of the umbilicus (commonly the small intestine and ascending colon).
Clinical therapy for omphalocele/gastroschisis
- Protect the sac or exposed abdominal contents from injury by placing the infant feet first into a bowel bag that extends to the nipple line and is secured with ties. The bowel bag decreases heat loss and allows for visualization of the defect. The child with gastroschisis should first have the exposed abdominal contents covered with moist sterile gauze.
- Temperature regulation is needed for the newborn due to heat loss through exposed viscera.
- Fluids are required to replace those lost through viscera.
- Blood cultures are performed before administering antibiotics.
- An orogastric or nasogastric tube may be inserted to prevent distention.
Surgical repair of omphalocele/ gastroschisis
- may occur in one or two stages-
For small defects, one surgery may be all is needed to repair the defect.
For larger defects, the first stage of repair may involve nonoperative placement of the abdominal contents or sac into a Silastic silo.
• Once the abdominal cavity can accommodate the intestinal contents, the child will have surgery to close the abdominal wall.
Preoperative nursing for omphalocele/ gastroschisis
- Protecting the sac or protruding organs
- Preventing hypothermia
- Preventing infection
- Maintaining electrolyte balance with intravenous fluids.
- Ensure adequate nutritional intake.
- Attain bowel motility and function.
- Types of Pathophysiology Associated with Structural Defects of the Gastrointestinal System
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