Post Op:
Nothing in mouth! Supine or on side (NOT tummy)
*Elbow restraints- skin checks regularly
Clean incision w/ NS + hydrogen peroxide
Gently aspirate secretions prn (bulb syringe)
Cleft Palate - Answer-surgery @ 6-12 months
NI:
*position UPRIGHT for feedings
*burp frequently (don't want spit up! they work so hard for feedings!!!!)
*may need to syringe feed
Post Op:
Change positions, promote drainage (CAN put on belly, or side-lying)
NPO for a long time after surgery- IV fluids and clear liquids for first 24 hrs
*close observation- airway, bleeding, laryngeal spasm/ might need O2
Complications of Cleft Lip/ Palate - Answer-1. ear infections/ hearing loss (palate)-
*upright for feedings
2. speech and language impairment (palate)
3. dental problems (both)
, Esophageal Atresia - Answer-*esophagus not connected to stomach - EMERGENCY
90% occur with trachoesophageal fistula (TEF)- esophagus connected to trachea
*aspiration, pneumonia risk
Dx: tube down esophagus- resistance = positive. CXR to confirm.
Treatment/NI: *surgery
1. NGT to suction- suction out secretions
2. HOB up- minimize aspiration risk
3. NPO, IV fluids
4. IV antibiotics
5. surgery within first 24-48 hours. May need G tube
Metatarsus Adductus - Answer-"in-toeing" - toes point INWARD. most common.
Most of time - spontaneously resolves by a few months
Sometimes - therapy/ exercise, casting
Compartment Syndrome - Answer-compression of the nerves and blood vessel in
confined place- top priority!! Can result in Volkmann contracture
Club Foot (Equinovarus) - Answer-*Muscles, tendons, and bones involved- cannot be
corrected w/ exercise!
Foot = small, achilles tendon = shortened/ TIGHT, leg lengths = normal
*Start treatment EARLY, all steps must be followed or will not work!!!
Ponseti Method:
1. serial casting w/ weekly manipulation
2. heel cord tenotomy (cut achilles tendon)
3. shoes/ braces on foot (Denis Browne Bar)
Developmental Dysplasia of the Hip (DDH) - Answer-*acetabulum (hip socket) and
femoral head are not aligned.
Newborns- perform U/S
After 4 months- X-ray (won't SEE bones on x-ray early on, mostly cartilage!)
Test: Barlow + Ortolani
S/S: ASYMMETRY of gluteal and thigh folds, limited hip abduction, shortened femur
Treatment: *start right away
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