N201 Cleft Lip & Palate, Pyloric Stenosis

Front 1

when does the cleft lip deformity occur?

Back 1

7-8 wks of embryonic development

Front 2

failure of palate to fuse properly during the 9th to 12th weeks of intrauterine life

Back 2

cleft palate

Front 3

who is cleft lip more common in?

Back 3

males

Front 4

what may cause cleft lip?

Back 4

maternal smoking/etoh use in the 1st trimester

Front 5

as a single entity, cleft palate occurs more freq. in

Back 5

FEMALES

Front 6

with cleft lip and palate, teach the parents who will be involved, including:

Back 6

plastic surgeon, orthodontist, otolaryngologist, speech/lang pathologist, audiologist, nurse, social worker

Front 7

closure of the lip defect is usually first. This happens at what age typically?

Back 7

6-12wks

Front 8

with repair of cleft lip, lay on

Back 8

back

Front 9

children with cleft palate repair should avoid

Back 9

hard foods until healed

Front 10

avoid use of suction or object in mouth (straw):

Back 10

after repair of cleft palate

Front 11

After repair of CL/CP, child may have improper drainage of middle ear causing:

Back 11

recurrent otitis media
hearing loss

Front 12

healing from cl/cp surgery takes how long?

Back 12

4-6wks

Front 13

feeding the infant with cl/cp: they have reduced ability to suck because they are unable to

Back 13

create negative pressure

Front 14

feed child with cl/cp in what position?

Back 14

upright

Front 15

Bottle feeding with cl: ESSR

Back 15

-enlarge nipple
-stimulate suck
-swallow fluid appropriatly (watch neck)
-Rest freq. (baby needs breaks)

Front 16

results from failed separation of the esophagus and trachea by a septum that forms during the 4th wk of gestation

Back 16

esophageal atresia with tracheoesophageal fistula

Front 17

esophageal atresia with tracheoesophageal fistula is associated with :

Back 17

low birth wt
prematurity

Front 18

esophageal atresia with tracheoesophageal fistula:
Proximal esophagus ends in a blind pouch and distal end connects to trachea or bronchus by a short fistula. This represents ___-___% of cases

Back 18

80-90

Front 19

esophageal atresia with tracheoesophageal fistula: a blind pouch at eah end of the esophagus- no connections to the trachea. this represents ___-___% cases

Back 19

5-8

Front 20

esophageal atresia with tracheoesophageal fistula: normal trachea and esophagus connected by fistula. this represents __%

Back 20

5

Front 21

sx of TEF:

Back 21

excessive salivation/drooling
coughing
choking
cyanosis
apnea
^ resp. distress after feeding
abd distention

Front 22

history of maternal__________ in 50% of infants with these defects

Back 22

polyhrdramnios

Front 23

how is TEF confirmed?

Back 23

radiographic studies (XRAY)

Front 24

esophageal atresia is a surgical emergency. Surgery is done:

Back 24

DAY BABY IS BORN

Front 25

Since esophageal atresia is a surgical emergency:
-stop________
-Start______
-position to ____ ______
-suction____ _____
-start ______ to ward off aspiration pneumonia
-support and educate fam

Back 25

-oral intake
-iv hydration
-prevent aspiration
-oral secretions
-abx therapy

Front 26

If theres insufficient esophagus for anastomosis, an esophageal segment replacement may be done using

Back 26

a colon segment

Front 27

complications of surgical correction of esophageal atresia

Back 27

anastomotic leak
strictures
motility disorders causing dysphagia
gi reflux

Front 28

first feeding of undiagnosed newborns should be plain ____ (bottle) or observed breast feeding

Back 28

water

Front 29

excessive frothy saliva or cyanosis should be suspected of having an ___ /_____

Back 29

EA
TEF

Front 30

increase in size and mass of the muscle surrounding the pyloric sphincter and obstruction of the gastric outlet

Back 30

hypertropic pyloric stenosis

Front 31

HPS stands for:

Back 31

hypertropic pyloric stenosis

Front 32

when does hypertropic pyloric stenosis usually occur?

Back 32

first few weeks after birth

Front 33

hypertropic pyloric stenosis causes: (4)

Back 33

projectile vomiting
dehydration
met alkalosis
failure to thrive

Front 34

symptoms of pyloric stenosis:

Back 34

-forceful projectile vomiting with sour odor after feedings
-dehydration/met alkalosis
-failure to thrive
-wt loss
-infacts act hungry

Front 35

Pyloric stenosis can be palpated where? what does it feel like?

Back 35

R of umbilicus
olive

Front 36

s/s dehydration

Back 36

tachycardia
no tears when crying
no wet diapers
lethargy
weakness

Front 37

with hypertropic pyloric stenosis, upon percussion we will here

Back 37

tympany

Front 38

with pyloric stenosis, you will see visible

Back 38

gastric peristaltic waves moving from L to R

Front 39

diagnostic eval of client that may have pyloric stenosis:

Back 39

H&P
ultrasound or upper gi series
lab findings (bld-lyte imbal)

Front 40

Therapeutic management for pyloric stenosis:
1. Correct ______&______
2. assess___________
3. surgery (___________)

Back 40

lyte imbalance/fluid vol status

nutritional status

pyloromyotomy

Front 41

Theres a high success rate in pyloromyotomy. an incision is made where? through what?

Back 41

RUQ
muscle fibers of pylorus

Front 42

preop care for pyloric stenosis surgery client (pyloromyotomy):
1. restore
2. 0
3. careful monitoring of
4. ____ and ____
5. assess amt and character of ____ & ____

Back 42

1. fluid and lyte imbalance
2. oral feedings
3. iv infusion
4. i&o/specific gravity
5. emesis/stools

Front 43

post op care for client that underwent pyloromyotomy:
1. monitor ________
2. assess for ___ and provide_____
3. progressive ________
4. observe response to _______
5. care for _______________

Back 43

1. iv fluids
2. pain/analgesia
3. feedings
4. feedings
5. operative site

Front 44

teach parents that vomiting may still occur even is pylormyotomy is successful. This may happen for (___-____hrs)

Back 44

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