Term
| Malformations of the face and oral cavity that seem to be multifactorial in hereditary origin |
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Definition
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Term
| Characteristics of cleft lip or palate |
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Definition
a. cleft lip is realily apparent
b.cleft palate may not be identified until the infant has difficulty with feeding
c. initial closure of cleft lip is performed when infant weighs approximately 10 pounds and has an Hgb of 10 g/dL
d. closure of palate defect is usually performed at 1 year of age to minimizes speech impairment |
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Term
| Variations of cleft lip and palate at birth: |
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Definition
A. notch in vermillion border
B. Unilateral cleft lip and cleft palate
C. Bilateral cleft lip and cleft palate
D. Cleft palate |
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Term
| Nursing Assessments for Cleft Lip or Palate |
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Definition
a. failure of fusion of the lip, palate or both
b. difficulty sucking and swallowing
c. parent reaction to facial defect |
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Term
| Nursing Diagnoses for Cleft Lip or Palate |
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Definition
a. Imbalanced nutrition less than body requirements related to...
b. Risk for impaired attachment related to... |
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Term
| For cleft lip or palate, inform family that |
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Definition
| successful corrective surgery is available |
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Term
| For cleft lip or palate, in the newborn period, assist with feeding in the following ways: |
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Definition
a. feed in upright position
b. feed slowly, with frequent bubbling
c. Use soft, large nipples; lambs nipples; prosthetic palate; or rubber tipped Asepto syringe
d. support mother's breast feeding if possible.
e. Consider the ESSR method for feeding: Enlarge nipple opening, stimulate the child to Suck, Swallow normally, and Rest |
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Term
| In cleft lip or palate postoperatively maintain patent |
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Definition
| airway and proper positioning |
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Term
| The proper placement postoperatively of a child with a cleft lip is |
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Definition
| place client on side or upright in infant seat (not prone) |
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Term
| The proper placement postoperatively of a child with a cleft palate is |
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Definition
| Place client on side or abdomen |
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Term
| In cleft lip or palate, postoperatively, remove oral secretions carefully with |
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Definition
| bulb syringe or Yankauer suction set |
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Term
| For cleft lip or palate, protect the surgical site by |
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Definition
a. apply elbow restraints
b. minimize crying to prevent strain on lip suture lines
c. maintain Logan bow to lip if applied |
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Term
| In cleft lip or palate, provide care for restrained child by |
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Definition
a. remove one restraint at a time and perform ROM exercises
b. provide age appropriate stimulation |
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Term
| Postoperatively for the cleft lip or palate resume feeding as prescribe and cleanse |
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Definition
| suture site with sterile water after feeding; formula remaining on suture line may impede healing and lead to infection |
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Term
| for cleft lip or palate, encourage family participation in care and feeding and teach |
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Definition
a. fluids are taken by a cup or an asepto syringe with a rubber tip (gravity feeder)
b. the diet progresses from a clear to a full liquid diet
c. the child may go home on a soft diet (nothing harder than mashed potatoes.) |
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Term
| Usually for cleft palate: Coordinate long=term care with other team members including: |
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Definition
| Plastic surgeon, ENT specialist, nutritionist, speech therapist, orthodontist, pediatrician,nurse |
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Term
| What are the typical parent and family reactions to a child with an obvious malformation such as cleft lip or palate are |
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Definition
| guilt, disappointment, grief, sense of loss, anger |
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Term
| Congenital anomaly in which the esophagus does not fully develop. |
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Definition
| Esophageal Atresia with Tracheoesophageal Fistula (TEF) |
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Term
| With Esophageal Atresia with Tracheoesophageal Fistula (TEF) the most common is |
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Definition
| Upper esophagus ends in a blind pouch, and the lower part of the esophagus is connected to the trachea --- this condition is clinical and a surgical emergency |
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Term
| The 3 C's of Esophageal Atresia with Tracheoesophageal Fistula (TEF) in the newborn |
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Definition
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Term
| Other nursing assessments for Esophageal Atresia with Tracheoesophageal Fistula (TEF) |
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Definition
Excessive salivation
Respiratory distress
Aspiration pneumonia |
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Term
| Nursing Diagnoses for Esophageal Atresia with Tracheoesophageal Fistula (TEF) |
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Definition
a. Risk for aspiration related to...
b. Imbalanced nutrition: less than body requirements related to... |
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Term
| Provide preoperative care for Esophageal Atresia with Tracheoesophageal Fistula (TEF) by |
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Definition
a. monitor respiratory status
b. remove excess secretions (suction is usually continuous to blind pouch)
c. elevate infant into antireflux position of 30 degrees
d. provide oxygen as prescribed
e. maintain NPO
f. administer IV fluids as prescribed |
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Term
| Provide postoperative care for Esophageal Atresia with Tracheoesophageal Fistula (TEF) by |
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Definition
a. Maintain NPO
b. Administer IV fluids
c. Monitor I&O
d. provide gastrostomy tube care and feedings as prescribed
e. provide pacifier to meet developmental needs
f. monitor child for postoperative stricture of the esophagus |
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Term
| Signs of Postoperative stricture of the esophagus in Esophageal Atresia with Tracheoesophageal Fistula (TEF) |
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Definition
a. poor feeding
b. dysphagia
c. drooling
d. regurgitating undigested food |
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Term
| Narrowing of the pyloric canal; the sphincter (circular muscle of the pylorus hypertrophies to twice the normal size |
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Definition
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Term
| Pyloric Stenosis usually occurs in |
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Definition
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Term
| In pyloric stenosis, vomiting (free of bile) usually begins after |
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Definition
| 14 days of birth and becomes projectile |
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Term
| Other signs of pyloric stenosis |
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Definition
a. hungry, fretful infant
b. weight loss, failure to gain weight
c. |
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Term
| Pyloric Stenosis usually occurs in |
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Definition
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Term
| In pyloric stenosis, vomiting (free of bile) usually begins after |
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Definition
| 14 days of life and becomes projectile |
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Term
| Other signs of pyloric stenosis |
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Definition
a. hungry, fretful infant
b. weight loss, failure to gain weight
c. dehydration with decreased sodium and potassium
d. metabolic alkalosis (decreased serum chloride, increased pH and bicarbonate or CO2 content)
e. palpable olive-shaped mass in upper right quadrant of the abdomen
f. visible peristaltic waves |
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Term
| Nursing diagnoses for pyloric stenosis |
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Definition
a. Imbalanced nutrition: less than body requirements related to...
b. Deficient fluid volume related to... |
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Term
| Children with cleft lip or palate and those with pyloric stenosis both have a nursing diagnosis of "Alteration of nutrition: less than body requirements" This is because |
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Definition
In the cleft lip or palate it is related to decreased ability to suck.
In pyloric stenosis it is related to frequent vomiting |
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Term
| Nursing Plans and Interventions for Preoperative care for pyloric stenosis |
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Definition
a. assess for dehydration
b. administer IV fluids and electrolytes as prescribed
c. weigh daily; monitor I&O
d. provide small frequent feedings if prescribed |
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Term
| In pyloric stenosis, prepare family for surgery by teaching that |
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Definition
a. hypertrophied muscle will be split
b. prognosis is excellent |
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Term
| Postoperative care for pyloric stenosis includes: |
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Definition
a. Continue IV fluids as prescribed
b. provide small oral feedings with electrolyte solutions or glucose (usually 4 to 6 hours postoperative)
c. position on right side in semi-Fowler position after feeding
d. Burp frequently to avoid stomach becoming distended and putting pressure on surgical site
e. weigh daily, monitor I&O |
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Term
| Telescoping of one part of the intestine into another part of the intestine, usually the ileum into the colon (called ileocolic) |
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Definition
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Term
| In Intussusception there is |
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Definition
a. partial to complete bowel obstruction
b. blood vessels become trapped in the telescoping bowel, causing necrosis |
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Term
| Nursing Assessments/signs, symptoms for Intussusception |
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Definition
a. child under 1 year of age
b. acute, intermittent abdominal pain
c. screaming, with legs drawn up to abdomen
d. vomiting
e. "currant jelly" stools (mixed with blood and mucus
f. Sausage-shaped mass in upper right quadrant while lower right quadrant is empty |
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Term
| Nursing Diagnoses for Intussusception |
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Definition
a. Ineffective tissue perfusion (bowel) related to...
b. Risk for deficient fluid volume related to... |
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Term
| Nursing Plans and Interventions for Intussusception |
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Definition
a. monitor carefully for shock and bowel perforation
b. administer IV fluids as prescribed
c. monitor I&O
d. Prepare family for emergency intervention
e. prepare child for barium enema (which provides hydrostatic reduction ) Two of three cases respond to this treatment, if not, surgery is necessary
f. provide postoperative care for infants who require abdominal surgery |
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Term
| Nutritional needs and fluid and electrolyte balance are key problems for children with GI disorders. |
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Definition
| The younger the children, the more vulnerable they are on fluid and electrolyte imbalances and the greater is the need for the caloric intake required for growth. |
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Term
| Congenital absence of autonomic parasympathetic ganglion cells in a distol portion of the colon and rectum |
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Definition
| Congenital Aganglionic Megacolon (Hirschsprung Disease) |
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Term
| Characteristics of Congenital Aganglionic Megacolon (Hirschsprung Disease) |
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Definition
a. There is a lack of peristalsis in the area of the colon where the ganglion cells are absent.
b. fecal contents accumulate above the aganglionic area of the bowel. |
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Term
| Correction of Congenital Aganglionic Megacolon (Hirschsprung Disease)usually involves a series of surgical procedures |
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Definition
a. a temporary colostomy
b. Later, a reanastomosis and closure of the colostomy |
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Term
| Signs/symptoms of Congenital Aganglionic Megacolon (Hirschsprung Disease) |
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Definition
a. suspicion in newborn who fails to pass meconium within 24 hours
b.distended abdomen, chronic constipation alternating with diarrhea
c. nutritionally deficient child
d. enterocolitis that occurs as an emergency event
e. ribbon like stools in older child |
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Term
| Nursing diagnoses for Congenital Aganglionic Megacolon (Hirschsprung Disease) |
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Definition
Constipation related to...
Diarrhea related to...
Imbalanced nutrition: less than body requirements related to... |
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Term
| Provide for preoperative care for Congenital Aganglionic Megacolon (Hirschsprung Disease) by |
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Definition
a. begin preparation for abdominal surgery
b. provide bowel cleansing programs as prescribed
c. insert rectal tube if prescribed
d. observe for symptoms of bowel perforation
e. initiate preoperative teaching regarding colostomy |
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Term
| Signs / symptoms of bowel perforation in Congenital Aganglionic Megacolon (Hirschsprung Disease) |
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Definition
a. abdominal distention (measure abdominal girth)
b. vomiting
c. increased abdominal tenderness
d. irritability
e. dyspnea and cyanosis |
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Term
| For a child with congenital megacolon, take an |
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Definition
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Term
| Provide the following postoperative care for Congenital Aganglionic Megacolon (Hirschsprung Disease) |
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Definition
a. check vital signs, axillary temperature
b. administer IV fluids as prescribed
c. monitor I&O
d. care for nasogastric tube with connection to intermittent suction
e. check abdominal and perineal dressings
f. Assess bowel sounds |
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Term
| Prepare the family for home care |
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Definition
a. teach care of temporary colonostomy
b. teach skin care
c. refer family to enterostomal therapist and social services
d. prepare child and family for closure of temporary colostomy
e. after closure, encourage family to be patient with child when toileting
f. teach family to begin toilet training after age 2 |
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Term
| Congenital malformation of the anorectal section of the GI tract (imperforate anus) |
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Definition
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Term
| Anorectal Malformation characteristics |
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Definition
a. often associated with a fistula
b. may be associated with urinary tract anomalies
c. type and level of rectal anomaly determine surgical procedure and degree of bowel control possible |
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Term
| Signs / symptoms of Anorectal Malformation |
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Definition
a. an unusual appearing anal dimple
b. newborn who does not pass meconium stool within 24 hours
c. meconium appearing from perineal fistula or in urine |
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Term
| Nursing Diagnoses for anorectal malformation |
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Definition
Bowel incontinence related to...
Deficient knowledge (bowel or colostomy home program) related to... |
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Term
| For anorectal malformation, determine newborn's first temperature; |
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Definition
| axillary or tympanic temperature is used to determine first reading unless hospital policy indicates otherwise |
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Term
| For anorectal malformation assess newborn for passage of meconium and assist |
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Definition
| family's ability to cope with diagnosis |
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Term
| For anorectal malformation, provide preoperative care to infant |
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Definition
a. assess vital signs
b. administer IV fluids (NPO)
c. monitor I&O |
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Term
| For anorectal malformation, provide postoperative care for anal reconstruction |
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Definition
a. keep perineal site clean
b. position infant in side-lying prone position with hips elevated (decreases pressure on perineal sutures)
c. Provide colostomy care if needed |
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Term
| For anorectal malformation teach home care |
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Definition
a. teach home care of colostomy if necessary
b. teach that with high level defects, long-term follow-up is required
c. teach that toilet training is delayed and full continence may not be achieved |
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Term
| Explain why a barium enema is used to treat intussusception. |
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Definition
| A barium enema reduces the telescoping of the intestine through hydrostatic pressure without surgical intervention. |
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