Beruflich Dokumente
Kultur Dokumente
Alterations in
Gastrointestinal
Function
Reported by Kintanar, Frances Lorelle - Montana, Flos Carmeli - Subires, Julie - Tan, Laurence
STRUCTURAL DEFECTS
CLEFT LIP (CHEILOSCHISIS)
CLEFT PALATE (PALATOSCHISIS)
CLEFT LIP, AN EXAMPLE OF A
MALFORMATION, OCCURS AT
APPROXIMATELY 5 WEEKS OF GESTATION
WHEN THE DEVELOPING EMBRYO
NATURALLY HAS TWO CLEFTS IN THE
AREA. NORMALLY BETWEEN 5 AND 7
WEEKS, CELLS RAPIDLY DIVIDE AND
MIGRATE TO FILL IN THOSE CLEFTS. IF
THERE IS AN ABNORMALITY IN THIS
DEVELOPMENTAL PROCESS, THE EMBRYO
IS LEFT WITH EITHER A UNILATERAL OR
BILATERAL CLEFT LIP THAT MAY ALSO
INVOLVE THE PALATE.
MULTIFACTORIAL DISORDER
CL appears more often in Native Americans and Asians and less frequently in
Cleft lip occurs as a familial tendency or most likely occurs from the
intrauterine life, such as viral infection or possibly a disorder to avoid any local
bruising of tissue.
Alcohol use
Cigarette smoking
WEEK OF GESTATION.
CLEFT LIP
PATHOPHYSIOLOGY
DEVELOPMENT OF THE PRIMARY AND SECONDARY
IMBALANCED
IMPAIRED NUTRITION,
RISK FOR
SWALLOWING LESS THAN
IMPAIRED
RELATED TO BODY
PARENT/INFA
IMPAIRED REQUIREMENT
NT/CHILD
SUCKING AND S RELATED TO
ATTACHMENT
PALATAL PALATAL
CLEFT DEFECT
Nursing Diagnosis:
Post Operative Care
RISK FOR
TRAUMA TO
SURGICAL IMBALANCED
SITE RELATED NUTRITION,
ACUTE PAIN
TO SURGICAL LESS THAN
RELATED TO
PROCEDURE, BODY
SURGICAL
DEVELOPMENT
REQUIREMENT
REPAIR OF
AL AGE OF
S RELATED TO
CHILD, SKIN
CL/ CP
PALATAL
AND MUCOUS
DEFECT
MEMBRANE
FRAGILITY
ALTHOUGH THE INITIAL CLEFT LIP
CLEFT, PREVENTION OF
IT IS TREATED BY A CLEFT/
CRANIOFACIAL MULTIDISCIPLINARY
ORTHODONTICS, SPEECH-LANGUAGE
MANAGEMENT PATHOLOGY,
AUDIOLOGY,
PEDIATRICS,
SOCIAL WORK,
NURSING,
AND
PSYCHOLOGY.
MANAGEMENT
When caring for a child with a cleft lip, remind the
3 months old.
alveolus into better alignment, resulting in less tension on the lip repair
orthodontist)
CHEILOPLASTY
SURGICAL LIP RESTORATION
Medical and
Pharmacologic
Administer analgesics for pain after surgery.
weeks.
NURSING:
Avoid the prone position to prevent suture damage.
POST-
surgery to prevent the infant from rubbing the suture
OPERATIVE
practice.
straws.
respiratory complications.
more successfully
decrease the width of the cleft) may also help the infant
FURLOW DOUBLE
OPPOSING Z-PLASTY
Observe child closely for signs of airway obstruction, hemorrhage
preference
OPERATIVE The child with a CP repair may be placed on clear liquids for 24
CARE A soft diet may be encouraged for a full 6 weeks following palate
repair.
Acceptable feeding devices include open cup for liquids, but rigid
Elbow restraints can keep the hands away from the mouth, and the
healed.
Teach parent to careful position the child in the car seat and in
-- She may try pumping her breast milk and providing the milk with an adapted
-- After bottle-feeding, the infant may be put to the mother’s breast for nonnutritive
sucking.
The soft palate must elevate and separate the oral and nasal cavities in order to
including the:
Both uses a one-way flow valve that allows the infant to feed by
compressing the nipple chamber between the tongue and the intact
palatal segments. The liquid flows into the baby’s mouth rather than
Watch for indications that the infant needs to stop feeding momentarily (
watery eyes)
ESOPHAGEAL ATRESIA
AND TRACHEO-
ESOPHAGEAL FISTULA
ESOPHAGEAL ATRESIA
AND TRACHEO-ESOPHAGEAL
FISTULA
CONGENITAL ESOPHAGEAL ATRESIA (EA), OBSTRUCTION OF
THE ESOPHAGUS, AND TRACHEOESOPHAGEAL FISTULA (TEF),
AN ABNORMAL CONNECTION IN ONE OR MORE PLACES
BETWEEN THE ESOPHAGUS AND THE TRACHEA, ARE RARE
MALFORMATIONS THAT REPRESENT A FAILURE OF THE
ESOPHAGUS TO DEVELOP AS A CONTINUOUS PASSAGE AND A
FAILURE OF THE TRACHEA AND ESOPHAGUS TO SEPARATE INTO
DISTINCT STRUCTURES. THESE DEFECTS MAY OCCUR AS
SEPARATE ENTITIES OR IN COMBINATION.
ETIOLOGY
embryonic gut.
PATHOPHYSIOLOGY ↓
During the fourth and fifth weeks of gestation, the foregut
↓
Each longitudinal portion fuses to form two parallel
↓
Defective separation
↓
Incomplete fusion of the tracheal folds after this
development.
↓
Formation of fistula between trachea and esophagus
TYPES
RISK FOR
RISK FOR IMPAIRED RISK FOR
SUFFOCATION PARENTING DISPROPORTION
RELATED TO RELATED TO ATE GROWTH
ABNORMAL INFANT’S RELATED TO
OPENING PHYSICAL INADEQUATE
BETWEEN DEFECT AND NUTRITIONAL
ESOPHAGUS AND ENVIRONMENTAL INTAKE
TRACHEA FACTORS SECONDARY TO
CAUSING SURGICAL
SEPARATION
Medical and
Pharmacologic
esophageal pouch.
Percutaneous gastrostomy tube is inserted and left open so that any air
entering the stomach through the fistula can escape, thus minimizing the
A double-lumen catheter should be placed into the upper esophageal pouch and attached to intermittent or
The gastrostomy tube (if applicable) is returned to gravity drainage until feedings are tolerated
The nurse must carefully observe the initial attempt at oral feeding to make certain the infant is able to swallow
without choking. Oral feedings are begun with sterile water, followed by frequent small feedings of breast milk
or formula. Until the infant is able to take a sufficient amount by mouth, oral intake may need to be
supplemented by bolus or continuous gastrostomy feedings. Ordinarily infants are not discharged until they can
take oral fluids well. The gastrostomy tube may be removed before discharge or maintained for supplemental
feedings at home.
Educate the parent on feeding techniques and signs of respiratory difficulty and esophageal stricture upon
discharge
PYLORIC STENOSIS
Pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened,
resulting in elongation and narrowing of the pyloric canal. This produces an outlet obstruction and
compensatory dilation, hypertrophy, and hyperperistalsis of the stomach. This condition usually
develops in the first few weeks of life, causing nonbilious vomiting, which occurs after a feeding;
projectile vomiting may develop and the infant is fussy and hungry after vomiting. If the condition is
not diagnosed early, dehydration, metabolic alkalosis, and failure to thrive may occur.
ETIOLOGY
The exact cause is unknown, but multifactorial inheritance is the likely cause.
Inheritance is polygenic, with an increased risk in the siblings and offspring of affected
persons.
It occurs less frequently in breastfed infants than in formula-fed infants. Formula-fed infants
typically begin having symptoms at approximately 4 weeks of age. Breastfed infants begin
having symptoms at 6 weeks because the curd of breast milk is smaller than that of cow’s
For unknown reasons, an increased incidence is seen in infants who receive a macrolide
It is more common in firstborn children, and boys are affected four to six times more
Race (PS is seen less frequently in African-American infants than in Caucasian infants, and it
is rare in Asians)
SYMPTOMS
Persistent hunger
Stomach contractions
Weight problems
the umbilicus
Visible gastric peristaltic waves that move from left to right across the
↓
This produces severe narrowing of the pyloric canal between the
partially obstructed.
↓
Over time the size of the opening is reduced, and the partial
↓
Pyloric Stenosis
CANAL
MEDICAL AND
PHARMACOLOGIC
CHARACTER OF STOOLS.
PYOLOROMYOTOMY WO
OR FREDET-RAMSTEDT
NURSING
Encourage feedings after 4 to 6 hours postoperatively, beginning with small,
Must be alert to signs of HPS in infants and refer them for medical evaluation
weeks of age are at higher risk for postoperative apnea as a result of CNS
Ensure that the NG tube is patent and functioning properly and that the type
Assess the skin and mucous membranes for alterations in hydration status.