1229 Exam 5: Cleft lip palate Flashcards Preview

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Flashcards in 1229 Exam 5: Cleft lip palate Deck (20)
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1
Q

Choamal Atresia

A

most common congenital anomaly of the nose
during the 6th week of pregnancy a membrane fails to properly develop and an obstruction occurs
life threatening d/t infants are nose breathers, can take up to 6-12 weeks to develop the ability to breathe through mouth
Is a bony or membranous septum located between the nose & pharynx
Maybe unilateral or bilateral

2
Q

Bilateral

A

maybe associated with apnea & cyanosis when the infant is at rest
When infant cries & breathes in the mouth, they begin to “pink up”
Will require to be intubated immediately after birth

3
Q

Unilateral

A

May not be associated with apnea
Inability to pass a suction catheter though the nose into the pharynx
Have cyanosis w/o obvious respiratory distress can lead to its detection
Nasal obstruction
Right nare

4
Q

CT Scan

A

Axial CT scan of neonate with mixed bony-membranous choanal atresia. Note the posterior bony thickening with central membranous connection on both sides (arrowheads)

5
Q

Symptoms

A

Cyclic respiratory distress relieved with crying
Noisy breathing (snorting)
Feeding difficulties (eat & breathe at same time)
Inability to pass a 5/6 French catheter into nasopharynx
Nasal drainage

6
Q

Treatment

A

Depends on severity of the anomaly, how much it affects the child’s breathing & eating, & what other medical conditions are present
Surgery to open the nasal airways
Nasal stents to hold open the airway and stay in place for up to 1 year
Parent teaching on 24 hr monitoring, cleaning stents, and suctioning

7
Q

Cleft Lip & Palate

A

Facial malformations that occur during embryonic development & are most common congenital deformaties of the head & neck
Can appear separately or together

8
Q

Cleft Lip

A

is the failure of the maxillary & median nasal processes to fuse
develops between the 5th-8th week of gestation

9
Q

Cleft Palate

A

is a midline fissure of the palate that results in the failure of the two sides to fuse
develops between the 7th-12th weeks gestation

10
Q

Etiology

A

May be caused by exposure to ETOH, anticonvulsants, steroids, and retinoids
Use of phenytoin (dilantin) during pregnancy is associated with a tenfold increase incidence of cleft lip. Also diazepam (valium)
Smoking during pregnancy is twice as great incidence of cleft lip then those who do not
ETOH consumption in 1st trimester is associated with a higher incidence of oral clefts

11
Q

Patho

A

Genetic defect in cell migration that results in a failure of the maxillary and pre maxillary processes to come together between the 3rd & 12th week of embryonic development
Cleft lip & palate are often seen together, but are each distinct & occur at diff times during the developmental process

12
Q

Diagnostic Evaluation

A

Evident on birth
Small cleft of palate can be seen on visual inspection & palpitation
If not diagnosed at birth, formula coming from nose may be the 1st sign
Can be diagnosed in utero by ultrasound

13
Q

Types of Cleft Lip/Palate

A

Cleft lip-3 mo-12lbs
Cleft Palate-1 year
Repair of Cleft lip
Repair of Cleft Palate

14
Q

Results of Surgery

A

Long term complications
Speech difficulties
Malocclusion problems (abnormal tooth eruption)
Hearing problems

15
Q

Major Emphasis after Surgery

A
Protection of the operative area
Placed only on back side
Arm or elbow restraints may be used
Pain med
Logan's Bow-heavy stainless steel wire bent in an arc & taped to both cheeks to protect a freshly repaired cleft lip
16
Q

Pre Op

A

Imbalanced nutrition:less than body requirements r/t feeding difficulties
Altered Parenting r/t interruption in the bonding process

17
Q

Post Op

A

Risk of injury & infection to surgical site
Acute pain
Knowldege deficit r/t the condition, treatment, & long term care

18
Q

Feeding choices for clefts

A
Breastfeeding
Pumping & using bottle & special nipples
Formula with bottle & special nipples
Pigeon nipple-y cut in the tip & a v cut at the base for an air vent
Haberman bottles
19
Q

Family Teaching

A

Feeding techniques & care of op site
clean the suture line after feeding & PRN with cotton tipped appicators dipped in peroxide diluted
Small amts of water should be offered after feedings to rinse away milk residue
Remove any restraints & exercise limbs
Reinforce how to lay infant down(back or side lying)
Discuss the possibility of additional surgeries on the lip, nose, & palate as the child grows & matures

20
Q

Teaching cont..

A

Help the caregivers understand that:
Clefting occurs by the 35th day after conception, often before preg is realized
Reassure mother
Counsel caregivers about feelings of guilt
Nothing is missing from face; pieces just need to be put back together

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