RNSG 1412 Exam 3
INFANTS HAVE:
○ high percentage of body weight comprised of water,
especially extracellular fluid (lymph fluid, plasma, CSF,
pericardial, pleural, synovial, sweat, digestive), which is
lost from the body easily
○ increased body surface area
○ small stomach size which limits ability to rehydrate
Why is dehydration more quickly
common and more severe in ○ increased metabolic rate
an infant? ○ less able to concentrate urine due to immature renal
system
What is oral re-hydration providing oral solution or IV fluids that replace and
support fluid balance
therapy
fluids high in sugar content (high osmotic load can worsen
for hydration in children, diarrhea) ie soft drinks, jello, gatorade, juice, tea
what should be avoided?
lactobacillus (yogurt or supplement)
what can be used to restore
normal bowel flora
Failure of maxillary and median
nasal processes to fuse during
embryonic development
Cleft Lip and Palate
prenatal ultrasound
Cleft lip and palate diagnosis postnatal assessment
clinical manifestation of cleft ○ opening in the lip and/or palate
○ milk or formula coming out of the nose
lip and palate
○ inadequate intake
potential complications of ○ aspiration
cleft lip and palate ○ otitis media
1
, RNSG 1412 Exam 3
Management is based on severity multidisciplinary
approach pre-op care by family
○ Surgical repair
lip at ~3 to 6 m/o
palate at ~6-24 m/o
Cleft lip and palate treatment
reconstruction begins in infancy and can continue
through childhood and adulthood
facilitate bonding, easier feeding, speech development
Earlier cleft lip and palate REMINDER parents that the defect is operable
repair can
○ prevent trauma to suture line
prevent rolling & grabbing
maintain Logan's Bow
no hard objective in oral cavity
○ pain control
○ prevent infection
cleanse suture line after each feeding and prn
give small amounts of water following milk
keep suture line dry
○ promote nutrition
feedings can resume ~6 h post-op, advancing as
Post op cleft lip and palate ordered and tolerated over weeks
repair no sucking for 10 days post-op
feeding w/ syringe + rubber tubing, then special
nipple that does not rest on suture
aspiration precautions
otitis media and hearing loss
speech difficulties
inadequate intake → Failure to Thrive, growth &
development delays
scarring
cleft lip and palate repair aspiration → pneumonia, respiratory distress
possible complications altered dentition
emotional impact
2
, RNSG 1412 Exam 3
A congenital malformation where the esophagus fails to
develop as a continuous tube, resulting in a blind pouch
Esophageal atresia:
A congenital malformation where the esophagus is
Tracheoesophageal fistula: connected with the trachea
Esophageal atresia and
tracheoesophageal
combinations
Aspiration & Feeding Problems
What is the nurse's major
concerns related to the child
with tracheoesophageal
fistula & esophageal atresia?
○ Three “C’s” - coughing, choking, cyanosis
○ rattling respirations
Esophageal Atresia & ○ inability to pass suction catheter at birth
Tracheoesophageal Fistula ○ gastric distention, if fistula
Clinical Manifestations ○ maternal history of polyhydramnios
○ if suspected prenatally, diagnosis can be made
immediately at birth
Esophageal Atresia & ○ otherwise, diagnosis made after infant presents
Tracheoesophageal Fistula with clinical manifestations of EA/TEF
Diagnosis and Management ○ surgical repair: thoracotomy and anastomosis
Incomplete development or
absence of anus in its normal
position in perineum.
Imperforate Anus
●Commonly diagnosed during newborn assessment
●Clinical Manifestations
● failure to pass meconium
Imperforate Anus diagnosis ● absent anorectal canal
and manifestations ● presence of anal membrane
● external fistula
3
, RNSG 1412 Exam 3
● anal stenosis is treated with repeated anal dilation
● surgery if no opening is present w/ possible colostomy
imperforate anus treatment
● monitor for stool in urine
● assess for anal patency
imperforate anus nursing ● facilitate bonding
care ● colostomy care
GS - malformation of anterior
abdominal wall, intestines exposed
O - herniation of bowel into
umbilical cord - intestines covered
Gastroschisis vs by peritoneum and amnion
omphalocele
○ early diagnosis is key to mitigate morbidity and
mortality
Gastroschisis & ○ alpha-fetoprotein
Omphalocele Diagnosis ○ ultrasound
○ herniation of intestines outside
the abdominal
cavity through a defect in the
abdominal wall to the side of the
umbilicus
● stomach, intestines, liver,
ovaries, and/or testes
○ contents not covered
Gastroschisis ○ issues with organ damage and
Pathophysiology necrosis, thermoregulation, fluid
loss, intestinal obstruction, and
sepsis
4
INFANTS HAVE:
○ high percentage of body weight comprised of water,
especially extracellular fluid (lymph fluid, plasma, CSF,
pericardial, pleural, synovial, sweat, digestive), which is
lost from the body easily
○ increased body surface area
○ small stomach size which limits ability to rehydrate
Why is dehydration more quickly
common and more severe in ○ increased metabolic rate
an infant? ○ less able to concentrate urine due to immature renal
system
What is oral re-hydration providing oral solution or IV fluids that replace and
support fluid balance
therapy
fluids high in sugar content (high osmotic load can worsen
for hydration in children, diarrhea) ie soft drinks, jello, gatorade, juice, tea
what should be avoided?
lactobacillus (yogurt or supplement)
what can be used to restore
normal bowel flora
Failure of maxillary and median
nasal processes to fuse during
embryonic development
Cleft Lip and Palate
prenatal ultrasound
Cleft lip and palate diagnosis postnatal assessment
clinical manifestation of cleft ○ opening in the lip and/or palate
○ milk or formula coming out of the nose
lip and palate
○ inadequate intake
potential complications of ○ aspiration
cleft lip and palate ○ otitis media
1
, RNSG 1412 Exam 3
Management is based on severity multidisciplinary
approach pre-op care by family
○ Surgical repair
lip at ~3 to 6 m/o
palate at ~6-24 m/o
Cleft lip and palate treatment
reconstruction begins in infancy and can continue
through childhood and adulthood
facilitate bonding, easier feeding, speech development
Earlier cleft lip and palate REMINDER parents that the defect is operable
repair can
○ prevent trauma to suture line
prevent rolling & grabbing
maintain Logan's Bow
no hard objective in oral cavity
○ pain control
○ prevent infection
cleanse suture line after each feeding and prn
give small amounts of water following milk
keep suture line dry
○ promote nutrition
feedings can resume ~6 h post-op, advancing as
Post op cleft lip and palate ordered and tolerated over weeks
repair no sucking for 10 days post-op
feeding w/ syringe + rubber tubing, then special
nipple that does not rest on suture
aspiration precautions
otitis media and hearing loss
speech difficulties
inadequate intake → Failure to Thrive, growth &
development delays
scarring
cleft lip and palate repair aspiration → pneumonia, respiratory distress
possible complications altered dentition
emotional impact
2
, RNSG 1412 Exam 3
A congenital malformation where the esophagus fails to
develop as a continuous tube, resulting in a blind pouch
Esophageal atresia:
A congenital malformation where the esophagus is
Tracheoesophageal fistula: connected with the trachea
Esophageal atresia and
tracheoesophageal
combinations
Aspiration & Feeding Problems
What is the nurse's major
concerns related to the child
with tracheoesophageal
fistula & esophageal atresia?
○ Three “C’s” - coughing, choking, cyanosis
○ rattling respirations
Esophageal Atresia & ○ inability to pass suction catheter at birth
Tracheoesophageal Fistula ○ gastric distention, if fistula
Clinical Manifestations ○ maternal history of polyhydramnios
○ if suspected prenatally, diagnosis can be made
immediately at birth
Esophageal Atresia & ○ otherwise, diagnosis made after infant presents
Tracheoesophageal Fistula with clinical manifestations of EA/TEF
Diagnosis and Management ○ surgical repair: thoracotomy and anastomosis
Incomplete development or
absence of anus in its normal
position in perineum.
Imperforate Anus
●Commonly diagnosed during newborn assessment
●Clinical Manifestations
● failure to pass meconium
Imperforate Anus diagnosis ● absent anorectal canal
and manifestations ● presence of anal membrane
● external fistula
3
, RNSG 1412 Exam 3
● anal stenosis is treated with repeated anal dilation
● surgery if no opening is present w/ possible colostomy
imperforate anus treatment
● monitor for stool in urine
● assess for anal patency
imperforate anus nursing ● facilitate bonding
care ● colostomy care
GS - malformation of anterior
abdominal wall, intestines exposed
O - herniation of bowel into
umbilical cord - intestines covered
Gastroschisis vs by peritoneum and amnion
omphalocele
○ early diagnosis is key to mitigate morbidity and
mortality
Gastroschisis & ○ alpha-fetoprotein
Omphalocele Diagnosis ○ ultrasound
○ herniation of intestines outside
the abdominal
cavity through a defect in the
abdominal wall to the side of the
umbilicus
● stomach, intestines, liver,
ovaries, and/or testes
○ contents not covered
Gastroschisis ○ issues with organ damage and
Pathophysiology necrosis, thermoregulation, fluid
loss, intestinal obstruction, and
sepsis
4
