CURRENT DIAGNOSIS AND TREATMENT
PEDIATRICS 24TH EDITION HAY LEVIN
ACTUAL PAPER SOLVED QUESTIONS
◉ Inflammatory GI disorders
Answer: Appendicitis, Meckel diverticulum.
◉ Cleft lip
Answer: Incomplete fusion of oral cavity during intrauterine life.
Can occur with cleft palate or alone. Unilateral or bilateral.****
◉ Cleft palate
Answer: Incomplete fusion of palatine plates during intrauterine
life. Can occur with cleft lip or alone. Unilateral or bilateral.****
◉ Risk factors for cleft lip and palate
Answer: Maternal and environmental factors. Folate deficiency
during pregnancy. Exposure during pregnancy to alcohol,
smoking, anticonvulsants, steroids.**** Family history of cleft lip
or palate. Other syndromes.
◉ Physical exam findings
,Answer: Visible separation from upper lip toward nose and/or
visible or palpable opening of palate connecting mouth and nasal
cavity.
◉ Nursing care of cleft lip and palate
Answer: Support parents in general care. Promote parent-infant
bonding. Promote self-esteem.
◉ Teamwork and collaboration for cleft lip and palate
Answer: Plastic surgery, orthodontics, ENT, speech and language
pathology, OT, dietary, social services.
◉ Surgical intervention for cleft lip
Answer: Should be at least 10 weeks old, weight 10 pounds, have
hemoglobin of 10.**** Repair usually done at age 2-3 months.
Revisions required if severe.
◉ Surgical intervention for cleft palate
Answer: Repair usually done at age 6-12 months. Most require
second surgery.****
◉ Preoperative nursing care for cleft lip/palate surgery
Answer: Inspect lip and palate using gloved finger. Assess ability
to suck. Baseline weight. Observe interaction with family.
Determine family coping and support. Support group referrals.
Social service consult for financial support. Instruct family on
, proper feeding technique. Assess ability to feed. Initiate strategies
for successful feeding.
◉ Strategies for feeding infant with isolated cleft lip
Answer: Encourage breast feeding. Use wide-based nipple for
bottle feeding. Squeeze infant's cheeks together during feeding to
decrease gap.
◉ Strategies for feeding infant with cleft palate or cleft lip and
palate
Answer: Position infant upright while cradling head during
feeding. Use special bottle with one-way valve and specially cut
nipple. Burp infant frequently. If other methods unsuccessful,
syringe feed infant.
◉ Acceptable positions for child who is post-op for cleft lip repair
Answer: Upright, on back, on side opposite repair. Surgical site
needs to be up to protect it from rubbing against sheet. Place in
elbow restraints to prevent injury to surgical site.****
◉ Acceptable positions for child who is post-op for cleft palate
repair
Answer: Change the infant's position frequently to facilitate
breathing. The infant may be placed on the abdomen in the
immediate postoperative period because, unlike cleft lip, the
surgical site is inside the mouth. Lying on face will not cause
damage.****
PEDIATRICS 24TH EDITION HAY LEVIN
ACTUAL PAPER SOLVED QUESTIONS
◉ Inflammatory GI disorders
Answer: Appendicitis, Meckel diverticulum.
◉ Cleft lip
Answer: Incomplete fusion of oral cavity during intrauterine life.
Can occur with cleft palate or alone. Unilateral or bilateral.****
◉ Cleft palate
Answer: Incomplete fusion of palatine plates during intrauterine
life. Can occur with cleft lip or alone. Unilateral or bilateral.****
◉ Risk factors for cleft lip and palate
Answer: Maternal and environmental factors. Folate deficiency
during pregnancy. Exposure during pregnancy to alcohol,
smoking, anticonvulsants, steroids.**** Family history of cleft lip
or palate. Other syndromes.
◉ Physical exam findings
,Answer: Visible separation from upper lip toward nose and/or
visible or palpable opening of palate connecting mouth and nasal
cavity.
◉ Nursing care of cleft lip and palate
Answer: Support parents in general care. Promote parent-infant
bonding. Promote self-esteem.
◉ Teamwork and collaboration for cleft lip and palate
Answer: Plastic surgery, orthodontics, ENT, speech and language
pathology, OT, dietary, social services.
◉ Surgical intervention for cleft lip
Answer: Should be at least 10 weeks old, weight 10 pounds, have
hemoglobin of 10.**** Repair usually done at age 2-3 months.
Revisions required if severe.
◉ Surgical intervention for cleft palate
Answer: Repair usually done at age 6-12 months. Most require
second surgery.****
◉ Preoperative nursing care for cleft lip/palate surgery
Answer: Inspect lip and palate using gloved finger. Assess ability
to suck. Baseline weight. Observe interaction with family.
Determine family coping and support. Support group referrals.
Social service consult for financial support. Instruct family on
, proper feeding technique. Assess ability to feed. Initiate strategies
for successful feeding.
◉ Strategies for feeding infant with isolated cleft lip
Answer: Encourage breast feeding. Use wide-based nipple for
bottle feeding. Squeeze infant's cheeks together during feeding to
decrease gap.
◉ Strategies for feeding infant with cleft palate or cleft lip and
palate
Answer: Position infant upright while cradling head during
feeding. Use special bottle with one-way valve and specially cut
nipple. Burp infant frequently. If other methods unsuccessful,
syringe feed infant.
◉ Acceptable positions for child who is post-op for cleft lip repair
Answer: Upright, on back, on side opposite repair. Surgical site
needs to be up to protect it from rubbing against sheet. Place in
elbow restraints to prevent injury to surgical site.****
◉ Acceptable positions for child who is post-op for cleft palate
repair
Answer: Change the infant's position frequently to facilitate
breathing. The infant may be placed on the abdomen in the
immediate postoperative period because, unlike cleft lip, the
surgical site is inside the mouth. Lying on face will not cause
damage.****
