When caring for the post operative cleft palate the nurse should position the child?
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A. Description Show 1.Cleft lip (cheiloschisis) is a congenital anomaly that occurs at a rate of 1 in 800 births. a.If the cleft does not affect the palate structure of the mouth it is referred to as cleft lip. b.Cleft lip is formed in the top of the lip as either a small gap or an indentation in the lip (partial or incomplete cleft) or it continues into the nose (complete cleft) c.Cleft lip can be unilateral or bilateral. d.It is due to the failure of fusion of the maxillary and medial nasal processes (formation of the primary palate). 2.Cleft palate (palatoschisis) is a congenital anomaly that occurs in approximately 1 of every 2000 births, and it is more common in boys than girls. a. It is a condition in which the two plates of the skull that form the hard palate (roof of the mouth) are not completely joined. b.It ranges in severity from soft palate involvement alone to a defect including the hard palate and portions of the maxilla. c.Cleft palate may or may not be associated with cleft lip. 3.Children with these structural disorders may have associated dental malformations, speech problems, and frequent otitis media, the latter resulting from improper functioning of the Eustachian tubes.  B. Etiology 1.Many factors are associated with the development of cleft lip and cleft palate, and cleft lip with or without cleft palate is developmentally and genetically different from isolated cleft palate. 2.Most cases appear to be consistent with the concept of multifactorial inheritance as evidenced by an increase incidence in relatives and monozygotic twins. C. Pathophysiology 1.During embryonic development the lateral and medial tissues forming the upper lip palates fuse between weeks 7 and 8 of gestation; the palatal tissues forming the hard and soft palates fuse between weeks 7 and 12 gestation. 2.Cleft lip and cleft palate result when these tissues fail to fuse. D. Assessment findings 1.Clinical manifestations a.Cleft lip and cleft palate are readily apparent at birth. Careful physical assessment should be performed to rule out other midline birth defects. b.Cleft lip and cleft palate appear as incomplete or complete defects, and may be unilateral or bilateral. 2.Laboratory and diagnostic study findings. Obstetric ultrasound will reveal cleft lip while the infant is in utero. E. Nursing management 1.Assess for problems with feeding, breathing parental bonding, and speech. 2.Ensure adequate nutrition and prevent aspiration. a.Provide special nipples or feeding devices (eg, soft pliable bottle with soft nipple with enlarged opening) for a child unable to suck adequately on standard nipples. b.Hold the child in a semiupright position; direct the formula away from the cleft and toward the side and back of the mouth to prevent aspiration. c.Feed the infant slowly and burp frequently to prevent excessive swallowing of air and regurgitation. d.Stimulate sucking by gently rubbing the nipple against the lower lip. 3.Support the infant’s and parents’ emotional and social adjustment. a.Help facilitate the family’s acceptance of the infant by encouraging the parents to express their feelings and concerns and by conveying an attitude of acceptance toward the infant. b.Emphasize the infant’s positive aspects and express optimism regarding surgical correction.
a.Depending in the defect and the child’s general condition, surgical correction of the cleft lip usually occurs at 1 to 3 months of age; repair of the cleft palate is usually performed between 6 and 18 months of age. Repair of the cleft palate may require several stages of surgery as the child grows. b.Early correction of cleft lip enables more normal sucking patterns and facilitates bonding. Early correction of cleft palate enables development of more normal speech patterns. c.Delayed closure or large defects may require the use of orthodontic appliances. d.The responsibilities of the nurse are to: 1.Reinforce the physician’s explanation of surgical procedures. 2.Provide mouth care to prevent infection. 5.Provide postoperative care. a.Assess airway patency and vital signs; observe for edema and respiratory distress. b.Use a mist tent, if prescribed, to minimize edema, liquefy secretions, and minimize distress. c.Position the child with cleft lip on her back, in an infant seat, or propped on a side to avoid injury to the operative site; position the child with a cleft palate on the abdomen to facilities drainage. d.Clean the suture line and apply an antibacterial ointment as prescribed to prevent infection and scarring. Monitor the site for signs of infection. e.Use elbow restraints to maintain suture line integrity. Remove them every 2 hours for skin care and range-of-motion exercises. f.Feed the infant with a rubber-tipped medicine dropper, bulb syringe, Breck feeder, or soft bottle-nipples, as prescribed, to help preserve suture integrity. For older children, diet progresses from clear fluids; they should not use straws or sharp objects. g.Attempt to keep the child from putting tongue up to palate sutures. h.Manage pain by administering analgesic as prescribed. 6.Provide child and family teaching.
Daisy Jane Antipuesto RN MN Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer. What Do You Think?What position should be given to child after cleft palate surgery?A child who has had a cleft lip repair should be positioned on their side or back to keep them from rubbing their face in the bed. A child with only a cleft palate repair may sleep on their stomach. It is important to keep the stitches clean and without crusting.
Which position is best for cleft palate?Those centres treat babies with a cleft palate identically to non-affected babies and therefore recommend the standard back lying position. If a child started showing any breathing problems then they would be advised to sleep on their side.
What is the position for a cleft lip?Holding Your Infant
In general, it works well to hold infants with a cleft in an upright or semi-upright position for feedings. This will help direct the flow of milk and decrease the amount of liquid that either spills out of the mouth or enters the nose through the cleft.
What is a priority of nursing care for an infant after cleft lip repair?Following a cleft lip repair, be sure the infant does not turn onto their abdomen because this could put pressure on the suture line, possibly tearing it. Careful positioning ensures the prevention of injury to the operative site.
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