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44 Cards in this Set

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when does the cleft lip deformity occur?
7-8 wks of embryonic development
failure of palate to fuse properly during the 9th to 12th weeks of intrauterine life
cleft palate
who is cleft lip more common in?
males
what may cause cleft lip?
maternal smoking/etoh use in the 1st trimester
as a single entity, cleft palate occurs more freq. in
FEMALES
with cleft lip and palate, teach the parents who will be involved, including:
plastic surgeon, orthodontist, otolaryngologist, speech/lang pathologist, audiologist, nurse, social worker
closure of the lip defect is usually first. This happens at what age typically?
6-12wks
with repair of cleft lip, lay on
back
children with cleft palate repair should avoid
hard foods until healed
avoid use of suction or object in mouth (straw):
after repair of cleft palate
After repair of CL/CP, child may have improper drainage of middle ear causing:
recurrent otitis media
hearing loss
healing from cl/cp surgery takes how long?
4-6wks
feeding the infant with cl/cp: they have reduced ability to suck because they are unable to
create negative pressure
feed child with cl/cp in what position?
upright
Bottle feeding with cl: ESSR
-enlarge nipple
-stimulate suck
-swallow fluid appropriatly (watch neck)
-Rest freq. (baby needs breaks)
results from failed separation of the esophagus and trachea by a septum that forms during the 4th wk of gestation
esophageal atresia with tracheoesophageal fistula
esophageal atresia with tracheoesophageal fistula is associated with :
low birth wt
prematurity
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
80-90
esophageal atresia with tracheoesophageal fistula: a blind pouch at eah end of the esophagus- no connections to the trachea. this represents ___-___% cases
5-8
esophageal atresia with tracheoesophageal fistula: normal trachea and esophagus connected by fistula. this represents __%
5
sx of TEF:
excessive salivation/drooling
coughing
choking
cyanosis
apnea
^ resp. distress after feeding
abd distention
history of maternal__________ in 50% of infants with these defects
polyhrdramnios
how is TEF confirmed?
radiographic studies (XRAY)
esophageal atresia is a surgical emergency. Surgery is done:
DAY BABY IS BORN
Since esophageal atresia is a surgical emergency:
-stop________
-Start______
-position to ____ ______
-suction____ _____
-start ______ to ward off aspiration pneumonia
-support and educate fam
-oral intake
-iv hydration
-prevent aspiration
-oral secretions
-abx therapy
If theres insufficient esophagus for anastomosis, an esophageal segment replacement may be done using
a colon segment
complications of surgical correction of esophageal atresia
anastomotic leak
strictures
motility disorders causing dysphagia
gi reflux
first feeding of undiagnosed newborns should be plain ____ (bottle) or observed breast feeding
water
excessive frothy saliva or cyanosis should be suspected of having an ___ /_____
EA
TEF
increase in size and mass of the muscle surrounding the pyloric sphincter and obstruction of the gastric outlet
hypertropic pyloric stenosis
HPS stands for:
hypertropic pyloric stenosis
when does hypertropic pyloric stenosis usually occur?
first few weeks after birth
hypertropic pyloric stenosis causes: (4)
projectile vomiting
dehydration
met alkalosis
failure to thrive
symptoms of pyloric stenosis:
-forceful projectile vomiting with sour odor after feedings
-dehydration/met alkalosis
-failure to thrive
-wt loss
-infacts act hungry
Pyloric stenosis can be palpated where? what does it feel like?
R of umbilicus
olive
s/s dehydration
tachycardia
no tears when crying
no wet diapers
lethargy
weakness
with hypertropic pyloric stenosis, upon percussion we will here
tympany
with pyloric stenosis, you will see visible
gastric peristaltic waves moving from L to R
diagnostic eval of client that may have pyloric stenosis:
H&P
ultrasound or upper gi series
lab findings (bld-lyte imbal)
Therapeutic management for pyloric stenosis:
1. Correct ______&______
2. assess___________
3. surgery (___________)
lyte imbalance/fluid vol status

nutritional status

pyloromyotomy
Theres a high success rate in pyloromyotomy. an incision is made where? through what?
RUQ
muscle fibers of pylorus
preop care for pyloric stenosis surgery client (pyloromyotomy):
1. restore
2. 0
3. careful monitoring of
4. ____ and ____
5. assess amt and character of ____ & ____
1. fluid and lyte imbalance
2. oral feedings
3. iv infusion
4. i&o/specific gravity
5. emesis/stools
post op care for client that underwent pyloromyotomy:
1. monitor ________
2. assess for ___ and provide_____
3. progressive ________
4. observe response to _______
5. care for _______________
1. iv fluids
2. pain/analgesia
3. feedings
4. feedings
5. operative site
teach parents that vomiting may still occur even is pylormyotomy is successful. This may happen for (___-____hrs)
24-48