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OB unit 5 study guide

CLEFT LIP & PALATE

repair: can be in 2-10 weeks of life, usually a correctional surgery is needed sometimes afterwards. there can be a two step repair process with soft palette being repaired in 3-6 months of age and hard palette being repaired in 15-18 months of age.

preop care: depending on the physician the baby may be allowed to suck on the breast or regular bottle. some surgeons want to prevent bruising of that tissue, so the baby will be fed with a cleft lip nipple. They must be burped well because they have a tendency to such in more air. if the surgery doesn't happen before soft foods are introduced make sure that the parents are aware that the food has to be SOFT.

post-op: NPO for approximately 4 hours. introduce very small amounts of liquid. liquids for 3-4 days post. prevent pressures on sutures. dont allow spoons until sutures are taken out.

GDB

DX: glucose tolerance test -

NPO at midnight,

ingest 50 gram glucose

venous blood sample in 60 minutes, i

> 180 schedule a 3 hour, if two of the

four samples are abnormal or fasting > 95, diagnosis of Diabetes

DIET: 1800-2000 cal. 20% protein, 40% cholesterol, 40% fat. 3 meals and 3 snacks every day. snacks must be a complex carb with a protein.

INSULINS:

INSULIN (REG AND MED ACTING SUCH AS NPH),

INSULIN IS DECREASED IN THE FIRST TRIMESTER

DO NOT RECOMMEND HUMALOG-LESS THAN 1 HOUR

PEAK-LEADS TO BLOOD GLUCOSE FLUCTUATIONS

HUMALIN IS RECOMMENDED, GIVE IN AM AND

PM Inject AT A 90 DEGREE ANGLE (MOST PREFER

NOT TO USE THE ABDOMEN

Hyperemesis Gravidarum

etiology unknown, but might have something to do with an overactive thyroid.

TX: hospitalized for 24 hours to watch labs. everything oral is usually held.

IV of RL with B1, I&)s carefully monitored.

after 24 hours of NPO, small amounts of liquid are approved. after going home and being able to handle liquids toast, crackers, or dry cereal may be added. after tolerating those soft food can be taken in. if vomiting continues client may need to be put on TPN.

MEDS: metoclopramide.

Tracheosophageal atresia and fistula

signs: born preterm, can't swallow, coughs, cyanotic, and resp difficulty as liquid is aspirated. newborns with a lot of mucus in mouth.

nurses assess for this by passing an NG tube down and attempting to aspirate stomach contents.

PREOP: position infant upright or on right side.

frequent suctioning

radiant heat warmer with high humidity O2 source helps liquefy bronchial secretions.

try to keep baby from crying, paci may help alot and give some sucking comfort.

POSTOP: care of chest tubes

first few days observe closely for resp. distress

suction as ordered

turn frequently

keep laryngoscope and endotracheal tube ready at bedside.

GI Abnormalities

imperforate anus: absence of anal opening.

S/S: no anal opening. opening really close to vagina. fecal matter coming through vagina, penis, or urethra. no passage of stool in first 24-48 hours of life.

TX: surgery to correct defect.

Meckels diverticulum:

gastroschisis: Uncontained intestinal protrusion near umbilicus.

TX: surgery

int: no warmers, sterile saline soaked gauze until surgery. TPN

Intussusception:

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