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Cards In This Set
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What is the difference between cleft lip and cleft palate?
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Lip: involving one or more clefts in the upper lip
palate: consists of a cleft ranging from soft paalte involvement alone to a defect including hard palate and portion of maxilla in severe cases (both are cogenital anomalies) |
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Nursing care for surgical correction of cleft lip or palate during the preop period?
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Assess repiratory status continuously during feedings, feed infant in upright position, use ESSR, alternative feeding devices may be used, assess degree of cleft and ability to suck, support family, promote bonding
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Nursing care during the postop period after surgical correction of cleft lip/palate?
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Monitor for respiratory distress (lung sounds, deep breathing w/o placing stress on suture line), no oral temps, advance feedings as tolerated, no straw/pacifiers, spoons, or finger in or around mouth for 7-10 days, can resume previous feedings for lip-for palate-liquids from a cup, no straws, soft foods taken from the side of a spoon, no tooth brushing for 1-2 weeks, infant should be sidelying (to avoid excessive contact with bed linens of affected side)
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Upon d/c of a post-surgical child for cleft palate, what parent education should be provided?
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Precautions to prevent aspiration of formula, provide emergency phone numbers, CPR instruction, safety regarding restraints (don't apply too tight, remove at least every 2 h and encourage flexion, remove only 1 restraint at a time) , speech therapy, good dental hygiene/care
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Describe the pathophysiology of pyloric stenosis
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Results when circular areas of muscle surrounding pylorus hypertophy and block gastric emptying , pylorus narrows, leads to obstruction of pyloric sphincter
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What subjective/objective data will you expact to find for an infant with pyloric stenosis?
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Progressive progectile, non-bilious vomiting, movable palpable, firm, olive-shaped mass in RUQ, visible and deep peristaltic waves LUQ --> RUQ immediately before vomiting, signs of dehydration/malnutrition
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What would we expect to see on an U/S and upper Gi series in an infant with pyloric stenosis? What will labs reveal?
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Delayed gastric emptying and an elongated pyloric canal; increased ph and bicarb (metabolic alkalosis, decreased Na and K, increased H/H
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Congenital anomaly resulting from an absence of ganglion cells in the colon, believed to be familial, lack of peristalisis causes accumulation of intestinal contents and distention of bowel proximal to defect
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Hirschsprung's disease
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How do we treat hirschsprung's disease?
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Involves removing agangliionic bowel, a temporary colostomy is created soon after dx or around 6 mos, colostomy will be closed and the bowel reanastomosed at a later time, usually around two yo
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What is the preop care for an infant with hirschsprung's?
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Assess bowel function and characteristic of stools, measure abd circumference, monitor for vomiting and resp distress,
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Postop, a child with hirschsprungs will have a temporary colostomy; what is the postop care for this pt?
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Monitor VS, measure abd, assess stoma for color, bleeding, skin breakdown, keep NPO until bowel sounds return, daily weights,
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Obstruction of lumen of appendix by hardened fecal material, foreign bodies, microorganisms, or parasties-leading to inflammation
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Appendicitis
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Upon assessment of a child with appendicitis, what would you expect to find?
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Generalized abd pain progressively worsening and localizing in RLQ (McBurney's point), NV, fever/chills, anorexia, diarrhea or actue constipation, Elevated WBCs, U/S indicating an enlarged incompressable appendix
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With appendicits, surgical removal (appendectomy) is done as soon as dx is made. What is the preop nursing care for this dx?
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NPO status, IV fluids, semi fowlers/right-side lying to help localize and prevent spread of any infection, assess bowel activity (abd distention, auscultate, observe elimination patterns), DO NOT stimulate peristalis ( no laxative, enemas, or heat applications), sudden relief of pain usually indicates rupture
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What is the postop care for appendectomy?
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VS, ass abd distention, inspect surg site for infection, encourage ambulation w/in 6-8 h after surgery, TCDB, monitor INOs, (if appendix ruptures-postop will be slowed; NG to decompress the stomach and a penrose drain, antibiotics will be administered)
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