Cleft Lip and Palate
Included In This Lesson
Study Tools For Cleft Lip and Palate
Outline
Overview
- The most common congenital deformity in the United States
- Abnormal openings in the lip and palate
Nursing Points
General
- Facial structures not forming properly in utero
- Diagnosed at birth or 12 wk ultrasound
- Child is at increased risk for-
- Feeding difficulties
- Aspiration
- Speech and hearing problems
- Ear infections
- Surgery is required for repair
- Cleft lip: 3-6 mo
- Cleft palate: 6-24 mo
Assessment
- Respiratory status
- Coughing, choking while feeding
- Nutritional status
- Weight gain
- Hydration status
Therapeutic Management
- Feeding
- Specialized bottles
- Stimulation of sucking reflex
- Allow time for rest during feeds
- Encourage maternal bonding
- Aspiration prevention
- Feed in upright position
- Direct flow toward the side and back of mouth
- Small feedings
- Frequent burping
- Allow for additional feeding time
- Suction equipment on hand
- Postoperative
- Protect operative site
- Elbow immobilizers for child
- Syringe feeds
- Avoid hard foods
- Avoid suction
- Monitor for airway obstruction
- Position in upright position
- Protect operative site
Nursing Concepts
- Safety
- Nutrition
- Human Development
Patient Education
- Proper feeding techniques
- Signs of aspiration
[lesson-linker lesson=221467 background=”white”]
References:
Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.
Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited.
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Cleft Lip and Palate
Transcript
Hey guys, in this lesson we’re going to be talking about cleft lip and cleft palate. We are primarily going to focus on how these deformities are treated and the nursing care related to that treatment.
Cleft lip and cleft palate are abnormal openings in the lip and in the palate. These abnormal openings occur during the child’s development in utero and is actually the most common congenital deformity in the United States. Usually it’s diagnosed during the 12 week ultrasound, but a lot of times it is first detected a birth. You can see in this top line of photos what a cleft lip can look like and then the bottom row shows you what different degrees of the cleft palate.
Surgery for a cleft lip is usually done between 3 and 6 months and the cleft palate is usually repaired a bit later between 6 and 24 months.
Your assessment for a child with cleft lip and cleft palate is all about assessing complications that can occur from the difficult time they have with feeding. Now, feeding is actually a really complicated thing for babies to learn how to do. It takes a lot of coordination and uses a lot of energy. With a cleft lip and palate this is made even more difficult. These babies really struggle to get a proper latch on a nipple and they’re also at risk for aspirating because they have this extra hole that’s connecting their mouth to their nose. So the first thing that we need to assess for are signs of respiratory distress and aspiration. so we are looking for things like coughing and sputtering and choking while they’re feeding.
We also have to pay close attention to the infant’s hydration status and their nutritional status. Remember, feeding is hard work for every baby, but for these babies it takes even more effort so they are really at risk for not getting enough fluids and calories to make up for the extra work they are putting in to feed. Because of this frequent weights and strict I’s and O’s are super important.
So like I said management of these two deformities is ultimately down to surgical repair. But if you remember back to that first slide, they actually have to wait to have these procedures. So the cleft lip is usually done between 3 to 6 months and the cleft palate is repaired from 6 to 24 months, so there’s this gap of time where parents have to go on feeding while they wait. So a lot of what we do during this time is provide feeding support. Our priorities with this are to prevent aspiration and ensure growth is happening as it should. These babies will likely use specialized bottles and nippes that help promote a good suction and reduce the flow of the formula to reduce the risk of choking. With all of these added stressors parents can have a really tough time, so it’s important to make sure our nursing interventions are encouraging maternal bonding.
Once the child does have surgery our nursing interventions are focused on protecting the operative site and monitoring the airway. A lot of times these babies will need to wear splints on their arms to keep them from reaching up and putting things in their mouths. They also need to avoid using anything that creates a suction in the mouth because this can damage the repaired palate – so no pacifiers or straws or sippy cups!
Long term issues to keep in mind for these patients are an increased risk for ear infections, dental problems and speech problems. These will require follow up and support – especially in the early years of life.
Your priority nursing concepts for a patient with cleft lip and cleft palate are safety, nutrition and human development.
Ok, so let’s just go back through and highlight the key points for this lesson. So the first thing is just remember that cleft lip and cleft palate are facial malformations and this just means that they are abnormal openings in the lip and the palate. Because these affect feeding we have to monitor for aspiration, weight loss and dehydration. The majority of our nursing care is going to focus on providing support to parents so they can feed their baby while they’re waiting on the surgical repair. these surgeries usually take place between 3 and 6 months for the cleft lip and 6 and 24 months for the cleft palate. Our post-op nursing care is focused on protecting the incision and monitoring their airway.
That’s it for our lesson on cleft lip and cleft palate. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
Dorsha Study Plan
Concepts Covered:
- Cardiac Disorders
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Central Nervous System Disorders – Brain
- Neurological
- Noninfectious Respiratory Disorder
- Respiratory
- Hematologic Disorders
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Factors Influencing Community Health
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Vascular Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Gastrointestinal Disorders
- Newborn Complications
- Peripheral Nervous System Disorders
- Studying
- Integumentary Disorders
- Communication
- Microbiology
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Circulatory System
- EENT Disorders
- Postoperative Nursing
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Fundamentals of Emergency Nursing
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Tissues and Glands
- Urinary System
- Emergency Care of the Neurological Patient
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Nervous System
- Respiratory Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Emergency Care of the Respiratory Patient
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Pregnancy Risks
- Labor Complications
- Fetal Development
- Terminology
- Prenatal Concepts
- Newborn Care
- Labor and Delivery
- Postpartum Care
- Postpartum Complications
- Developmental Considerations
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Trauma-Stress Disorders
- Developmental Theories
- Adulthood Growth and Development
- Concepts of Mental Health
- Medication Administration
- Adult
- Anxiety Disorders
- Depressive Disorders
- Dosage Calculations
- Understanding Society
- Concepts of Pharmacology
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders