NSG 434 Health Clinical Manifestation Assessment Exam Questions and verified Answers latest 2024/2025
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NSG 434 Health Clinical Manifestation Assessment Exam Questions and verified Answers latest 2024/2025
Cleft lip and palate - correct answer -Results from embryonic failure of the soft tissue and/or bony structure to fuse during embryonic development
-The defect occurs at approximately 6‐8...
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NSG 434 Health Clinical Manifestation
Assessment Exam Questions and verified
Answers latest 2024/2025
Cleft lip and palate - correct answer -Results from embryonic failure of the
soft tissue and/or bony structure to fuse during embryonic development
-The defect occurs at approximately 6‐8 weeks gestation
-Cleft lip is a separation of the two sides of the lip; may affect both sides of the
lip, bone, or soft tissue of the alveolus (gum line)
-Cleft palate is a midline opening of the palate; results from the failure of the
two sides to fuse during embryonic development
-Exact cause unknown, but most cases thought to be multifactorial: a
combination of environmental and genetic factors
-Usually an isolated event but may happen as part of a syndrome
-Happens in utero fairly early
Clinical Manifestations:
-Visible unilateral or bilateral cleft lip
-Palpable and/or visible cleft palate
-Cleft of the alveolus (gum line)
-Nasal distortion
-Feeding difficulties
-Cannot always see it
-May be a complete cleft through the nares or an incomplete cleft of part of
the lip
Complications:
-Speech difficulties
,-Malocclusion: abnormal tooth eruption pattern; abnormal development of the
way the mandible and maxilla meet
-Excessive dental decay
-Chronic otitis media: secondary to Eustachian tube dysfunction; may result in
hearing loss
-Altered self-esteem and body image
Surgical Management:
-Cleft lip:
•Goal: to achieve lip competence and to create the most natural-appearing lip
•Repaired at 2 to 3 months of age
•May need modifications at 4 to 5 years of age
-Cleft palate:
•Reconstruction of the palatal musculature with the goal of allowing normal
speech development
•Repaired before 12 months of age
•Depends on the degree of deformity and size of child
Preoperative Care:
-Facilitate parents' positive adjustment to infant
-Important to encourage infant-parent bonding
-Refer to cleft palate team
-Provide information and resources to parents
-Maintain adequate nutritional intake:
•Use special feeding equipment
•Sit upright
•Learn baby's feeding cues
,•Watch for nipple flowing too fast or slow
•Rest periods
•Don't feed over 30 minutes
•Many times cannot breastfeed: Mom can pump and feed with a bottle
-Monitor respiratory status
Post-op Care:
-Do not allow the child to use anything that creates suction in the mouth
(straws, pacifiers)
-Nothing hard in the mouth (candy, crackers, or a spoon)
-Remove any hard toys from the crib to protect the mouth
-Clean suture line with normal saline
-Position to allow secretions to drain
-Provide pain medication regularly to prevent crying which can place stress on
the suture line
-Position: usually on back to prevent rubbing the face on bedding
Feeding Tips:
-Haberman bottle: special needs feeder consisting of a squeeze bottle and a
soft nipple with a valve; prevents the baby from ingesting excess air during the
feeding
-Some mothers are able to breastfeed with a cleft lip and palate; the breast
can fill in the cleft and help the infant create suction
-Place infant in an upright (almost sitting) position
-Place nipple in the mouth in a position where there is more palate tissue
-Use chin support with your pinky finger to improve the oral seal
-The nipple should have a X cut in it (soft nipple), may have to adjust the size
of the X
, -If using a Haberman, compress the bottle in time with the infant's chewing
motions
-Allow for rest periods
-Keep infant's hands away from incision to reduce potential complications
-Advance diet from clear liquid to soft foods (if age appropriate) when
tolerated
-Feeding techniques post op same as pre op
-Rinse mouth after feeding, palate repair, clean lip repair site with a wet sterile
cotton swab after feeding
-Elbow immobilizers keep hands away from mouth for 7-10 days
-No-nos: help keep infant's hands away from incision; considered a restraint,
so remove them every two hours to let the infant move their arms
Esophageal atresia/TEF - correct answer -Esophageal atresia and
tracheoesophageal fistula (TEF): failure of the esophagus to develop as a
continuous passage and a failure of the trachea and esophagus to separate
into distinct structures.
-Maternal polyhydramnios is present in approximately 50% of newborns; if the
baby has this in utero, the mom will become extra big due to excess water
-Most cases have the proximal esophageal segment terminating in a blind
pouch and the distal segment is connected to the trachea or primary bronchus
by a short fistula at or near the bifurcation.
-Oxygenation and aspiration issues are the most serious concern with this
disorder
Clinical Manifestations:
-Excessive salivation and drooling
-Three C's of tracheoesophageal fistula:
•Coughing
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