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Prior to Surgery

  • Vital signs
  • Respiratory status
  • Feed slowly
  • Lie down to left or right side
  • Use suitable equipments
  • Burp frequently (after every 15-30 ml of fluid)

NURSING CARE SYSTEM FOR PATIENTS WITH CLEFT LIP AND PALATE AT ERCIYES UNIVERSITY FACULTY OF DENTISTRY

Breathing

Wound care

  • Assess respiratory status
  • Keep suction equipment and bulb syringe at bedside
  • Provide cool mist
  • Reposition every 2 hours

Handan Varol, Nükhet Kütük

Erciyes University Faculty of Dentistry Department of

Oral and Maxillofacial Surgery

Last Preoperative Time

  • Assess oral cavity every 2 hours
  • Cleanse suture line - saline or sterile water

- 4 times/day

- After feeding

  • Clear nutrients 2-3 hours before the surgery
  • Oral intake stopped

After Birth

Bottle Feeding

  • Soft nipple
  • 3 lines

Feeding splint - 1 to 3 days after the birth

Hygene procedures

After Birth

  • Help parents to hold the infant
  • Surgical procedures and outcomes
  • Show pictures of repaired CLP’s
  • Encourage family

- Interact other family members

- Keep in touch with friends

- Participate in caretaking

Treatment Plan

  • 1-3 day……..…...… Orthodontic feed splint
  • 1 week……………………………………..Diagnose
  • 3-4 month………………………………Lip surgery
  • 9-18 month……………………….Palate surgery
  • 2 years……………………Logopaedic exercises
  • 7-9 years…………….Alveolar reconstruction

PRENATAL

  • Prenatal counselling
  • Basic information about the malformation
  • Support and encourage

PURPOSE

  • Promote continuity and quality of care for CLP patients
  • Present our nursing care system
  • Present educational materials

Solid Foods

Nutrition

Brest Feeding (only cleft lip)

  • Encourage brest feeding
  • Remind for upright position
  • Express other methods

  • 4-6 months
  • Use spoon
  • Upright position

POSTOPERATIVE CARE

  • Intravenous fluids(1/3 poliflex ,total volüme 1000ml/day)
  • Begin clear liquids
  • Fully awake patient
  • Use syringe, dropper or spoon
  • Do not allow pacifiers

  • Explain care and treatment
  • Parents are involved in wound care
  • Demonstrate feeding techniques
  • Provide written instructions for follow-up care (e.g. brochures)

Cleanse the cleft areas – 5 to 15 ml of water

Cotton swab - crusts and ointment application

PREOPERATIVE CARE

POSTOPERATIVE CARE

Pain management

Bleeding

  • Temperature, pulse and respiration (TPR)
  • Oxygen saturations
  • Hourly TPRs (for 4 hours)
  • 4th hourly TPRs

Pain relief half an hour before feeding

  • Assess bleeding -Excessive swallowing!
  • Contact surgery team

Conclusion

  • Providing comprehensive information to the parents is important
  • Close relationship and written instructions enhances the results of the treatment

Wound care

Postoperative recommendations for home care

  • Use soft elbow restraints
  • Scar prevention (Steri-Strips)
  • Nasal splints
  • Pain control

  • Lip dressing, 3-5 days postop.
  • Daily wound care, 1 week
  • Massage+silicone gel sheet, two finger technique - 4 months

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