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96 Cards in this Set

  • Front
  • Back
• Affects 1 in 800. More
common in boys
• Etiology: hereditary,
environmental, teratogenic
factors.
• Readily apparent
• Degree affected may vary
from small notch to
complete separation
Cleft Lip
Occurs around
7 weeks
gestation
Surgical closure @ ____ months.
OR
by RULE OF _____ lbs and
Hgb of ____ g/dL
1‐2 months
10:10
10g/dL
Cleft lip diagnosed by
visual
assessment
Cleft palate diagnosed by
palpation of palate
until sutures
removed, no what?
No sucking and try to
prevent crying
What is important to remember about the suture line?
-Keep suture line clean and dry to prevent infection,
promote healing, and less
scaring
Clean suture line with?
after?
sterile water after feeding
______ to ease strain on
suture line.
Logan bar
May have ___.
Do not put in __________.
Elbow restraints
prone position
• 1‐2800 affected. More girls affect
• May involve soft palate alone to hard palate
• Nurse is to be sure parents understand that a
successful corrective surgery is available
• Promote bonding: Include parents in care
Cleft Palate
Surgical repair between
6‐18mo (Average 1 year)
May have collaboritive care with?
Plastic surgeon, ENT, Nutritionist, Speech Therapy,
Orthodontist, Pediatrician
What are 3 important assessments you should make with a cleft palate?
• Assess degree of cleft
• Assess Respiratory status
• Assess ability to suck (will see difficulty with sucking
and swallowing)
What about with feedings-Nursing Interventions?
• Assist with feeding: head upright/special
nipples/ESSR
• Continuous monitoring during feeding
• Remove oral secretions carefully
When not feeding...
place
on side to prevent
aspiration of secretions
• Ineffective airway clearance
• Alt. Nutrition‐Less than Body Requirements
• Potential for Alt. in parenting
• Risk for infection
• Pain
MAJOR NURSING DIAGNOSES FOR?
Cleft Palate
Nursing Care Post‐Op
Cleft Lip Cleft Palate Includes:
-Maintain patent airway.
-Lung assessment before/after
feeding
What are NO NO's for Post-Op care of pts with Cleft Lip Cleft Palate?
-NO ORAL TEMPS or red juice
-No straws, pacifiers, spoons, or fingers around mouth
for 7-10 days
-give liquids from side of cup or from spoon
-No toothbrushes for 1 to 2 weeks
Nursing Care Post‐Op
Cleft Lip Cleft Palate:
• PROTECT SURGICAL SITE!!!
• Monitor weight to ensure gaining
• Assess pain
• Resume feedings as ordered (begin with Clear liquid)
• Care of site after feeding
Esophageal Atresia with
Tracheoesophageal Fistula:
• Clinical and Surgical
Emergency
• Assessment
– Three C’s of TEF
• Choking, coughing, cyanosis
• Plain water at birth
• Management/Nursing Care:
– Surgical
correction(thoracotomy)
– Monitor Resp. status
– Remove excessive secretions
– Maintain NPO
– IVF
– O2 as needed
Esophageal Atresia with Tracheoesophageal
Fistula Plan of Care Includes:
• Elevate infant
– anti‐reflux position 30 degree incline
– At risk for aspiration pneumonia
• NPO(non‐nutritive sucking ok….pacifier)
• IVF’s
• Provide gastrostomy care/feedings
• Education/Family involved in care
Narrowing of pyloric canal: pyloric
muscle enlarged
Pyloric Stenosis
Assessment Findings Include:
– Characteristic projectile
vomiting (bile free)..usually
after 14 days of life
– Hungry, fretful, irritable,
dehydration
– Weight loss/failure to gain
weight
– Dehydration, Metabolic
alkalosis
– Palpable olive‐shaped mass in
RUQ
– Visible peristaltic waves
Will have low ___ lab values.
Low NA+ & K+
Diagnosis:
US/UGI delayed
Emptying
May require ___ intervention such as?
surgical intervention:
Pylorotomy
Nursing Care:
– Monitor respiratory status
– Hydration status
– IVF’s, electrolytes
– Daily WT
– I/O
– small frequent meals(clears) then
NPO prior to surgery
– Burp Freuently
Post op feedings:
• Resumed 4‐6hrs after surgery
• small frequent feeding with
electrolytes solution or glucose
Postop Position:
– R side/Semi‐Fowler’s after feeding
• Also called Hirshsprung’s Disease
• Congenital 1 in 500
– Is the absence of parasympathetic
ganglion cells in distal portion of
colon and rectum
Congenital/Aganglionic Megacolon
Assessment Findings:
– Lack of peristalsis
– Fecal contents accumulate
– Mechanical obstruction
– Distended abdomen
(Constipation alternating with
diarrhea)
– Ribbon like stools
Suspected in newborn who:
fails to pass meconium within 24
hours
Management/Nursing Care
• Correction‐
series of surgical interventions.
– E.G: Temporary colostomy with reanastamosis and closure later
Pre‐op care:
– Bowel cleansing
– Observe for bowel perforation
• Abdominal distention
• Vomiting
• Increased abdominal tenderness
Post‐op care:
• NPO
• Routine ABC’s (axillary temps)
• Monitor colostomy..note stoma color
• Monitor bowel function
– Bowel sounds
– abdominal circumference
• NGT to intermittent suction
• Teach family ostomy care
Telescoping of a portion of bowel
into colon
• Partial or complete bowel
obstruction.
Intussusception
Assessment:
– Current jelly stools
– Sausage shaped mass in RUQ
– Child may present screaming
with legs drawn up
-– Vomiting
Usually occurs in infant ____.
less than 1 yr/old
________ to reduce intussception.
• Barium enema
• Will see unusual anal dimpling
• Suspicion in newborn for failure to pass
meconium in 24 hrs
• Meconium appearing from perianal fistula or
in urine
Imperforate Anus
______ helps to diagnose
first temp rectally
• Protrusion of an organ through abnormal
opening
• Results in organ constriction and impaired
blood flow
Hernias
• Abdominal content protrude
into thoracic cavity through
an opening in the diaphragm
Diaphragmatic Hernia
Assessment Findings:
• Findings depend on severity
– diminished/absent breath
sounds
– bowel sound may be heard
over chest
– Cardiac sounds may be
heard on right side of chest
– Dyspnea, cyanosis, nasal
flaring, retractions
– Sunken abdomen and
barrel chest
• Protrusion of abdominal
structure(stomach)
through the esophageal
Hiatus
Hiatal Hernia
Diagnosis-
Assessment Findings:
Fluoroscopy-
– Dysphagia
– Failure to thrive
– Vomiting
– GER
– Manage GER symptoms Medication:
Zantac, Prilosec
• Soft, skin covered
protrusion of intestine
around umbilicus
• Easily reduced
• See in more in:
– Premature infants
– And African American infants
more often
Umbilical Hernia
Most Spontaneous closure
by _____.

Surgery only if:
1 yr

– Causes symptoms
– Persist past 5 years
– Becomes strangulated
– Continues to grow
• Monilial (yeast) infection of
mouth
• May or may not have
symptoms
– White coating in oral cavity
– Fussy and gassy
Thrush
Treatment:
– If breast fed: treat mother
and baby
– Anti‐fungal cream to nipples
after feeding
– Nystatin orally x 7 days
– Careful hand washing to
prevent spread
Infectious Gastroenteritis
• Cause:
-Virus, bacteria or
parasite
– Ingest contaminated
food/water
– Person to person (most
frequent transmission)
Big S/S of Infectious Gastroenteritis?
Tenesmus (constant feeling of need to
pass stool)
Pt c Infectious Gastroenteritis
Diet:
NPO, Pedialyte 1‐3 tsp q 10‐15 minutes,
• No juices, carbonated drinks, or milk while
infectious
• Diet when NOT dehydrated:
– Breast Milk/Formula at full strength
– NO high fat high sugar
– Yogurt or lactobacillus supplement
-ORT
5‐10 mL (_______/_______)every 2 minutes when vomiting.
Not vomiting offer fluids every _____.
(pedialyte/rehydralyte)
30 minutes
• Diet with mild to moderate
dehydration:
– 50‐100 mL/kg over 3‐4 hrs in addition to
replacing fluid from vomiting and
diarrhea
– Once rehydrated resume regular diet
• Blockage leads to
Inflammation & infection
of the appendix
• Bacteria in blocked
appendix multiply causing
ulceration of mucosa and
possibly rupture
• Most common reason for
surgery in childhood
Appendicitis
Assessment Findings:
– Generalized abd pain
that increases in
intensity and localizes in
RLQ at McBurney’s point
– N/V
– Fever
– Anorexia
– Diarrhea or acute
constipation
– ↑ WBC
Diagnosis:
Treatment:
– US
– Surgical removal
(appendectomy)
– Laproscopic
– Open incision if
perforation occurs
• Worms that live as parasites in the human
body
• They are NOT your average worm!
Helminths Infection
Hookworm
• Transmission:
– Skin penetration from
direct contact with
contaminated soil
Manifestations:
– Dermatitis
– Anemia
– Malnutrition
Treatment:
– Pyrantel
– Treat Entire Family
Pinworm
• Transmission:
– Ingestion/inhalation
of eggs
Manifestations:
– Nocturnal anal itching
– Sleeplessness
Treatment:
– Pyrantel pamoate
– Mebendazole
– Treat entire family
Roundworms
• Transmitted
– Ingested Eggs from
contaminated soil or food
– Transmitted from
contaminated toys/other
vectors via fingers to mouth
Manifestations:
– Abdominal pain
– Abd Distention/Obstruction
Treatment (entire family):
– Antihelmenths
• Mebendazole
• Pyrantel pamoate
Tapeworm
• Transmission:
– Ingestion from handling
infected beef or pork
Manifestations:
– May be asymptomatic
– Segments seen in stool
– Abd pain
– Nausea
– Anorexia
– Weight loss
• Treatment:
– Praziquantel
• Regurgitation of gastric
contents back into the
esophagus
• Caused by:
Gastroesophageal Reflux (GER)
incompetent
cardiac sphincter
• Repeated episodes
damages esophageal
mucosa
• Gastric fundus is wrapped
around the distal esaphagus
Nissen fundoplication
Management/Nursing Care:
infrequent
difficult passage of dry
hard stool
• Constipation:
fecal soiling
or incontinence (r/t
constipation)
• Encopresis:
Clinical Sign of Fluid and Electrolyte Imbalance:
MILD MODERATE SEVERE
Weight loss 3‐5% 6‐10% >10%
General Appearance:
Infants Fussy, thirsty, alert Fussy, restless, thirsty
Lethargic but arousable
Drowsy to comatose, Not
arousable, gray, limp, cold,
sweaty
Older children-General Appearance:
Thirsty, restless, alert Thirsty, restless,
postural hypotension
Apprehensive, comatose,
cold, mottled, cyanotic
Monitoring For Shock
• Early S/S:
– Changes in HR
– Change in sensorium
– Skin color changes
• Late S/S:
– Changes in BP
Daily maintenance IVF based on weight in kg-
– 100 ml/kg for 1st 10 kg
– 50 ml/kg for 2nd 10 kg (up to 20 kg)
– 20 ml/kg remaining of kg
– Then divide total amount by 24 hrs
– This will be the rate in ml/hr
• Minimum urine output by age:
– Infants & Toddlers
> 2‐3 mL/kg/hr
– Preschoolers & Young school age
> 1‐2 mL/kg/hr
– School Age & Adolescents
0.5‐1mL/kg/hr
Weigh diapers
1 gram=
1 mL
Management/Nursing Care of Poisoning/Foreign Bodies:
• Assess victim
• Terminate exposure
• Identify poison
• Call poison control
• Remove poison/Prevent absorption
– Syrup of Ipecac (if indicated by poison control)
Do not induce vomiting if...
patient has absent
gag reflex Or if poison is corrosive.
-Place child in ___ position.
-Administer....
side‐lying, sitting or kneeling
position

activated charcoal with cathartic
usual dose 1gm/kg
• Persistent abdominal pain characterized by:
– loud crying
– drawing up legs to abdomen
– lasting greater than 3 hrs.
Colic
• Possible causes:
– Too rapid feeding, excessive air
– Overeating, milk allergy
– Parental tension, or smoking
Medications:
Simethicone