Cleft Lip and Palate Nursing Care

Cleft Lip and Palate Nursing Diagnosis & Care Plan

Nanda Nursing Diagnosis Definition:

Cleft Lip and Palate: Cleft lip and palate refer to a congenital condition characterized by a split or opening in the lip and/or roof of the mouth (palate). This condition occurs during fetal development when the facial structures fail to fuse properly.

Cleft lip and palate can vary in severity, ranging from a small notch in the lip to a complete separation of the lip and palate. Nursing diagnosis for cleft lip and palate involves identifying the client’s specific problems and formulating appropriate nursing interventions to promote optimal health outcomes.

Defining Characteristics of Cleft Lip and Palate

Defining characteristics are subjective and objective signs or symptoms that indicate the presence of a specific nursing diagnosis. In the case of cleft lip and palate, the defining characteristics include:

Subjective

  1. Parental or patient concern regarding the appearance of the lip and/or mouth.
  2. Difficulties with breastfeeding or bottle feeding reported by parents.
  3. Altered self-esteem and body image concerns related to the visible deformity.

Objective

  1. Visible separation or opening in the lip and/or roof of the mouth.
  2. Difficulty in feeding, such as poor latch, choking, or nasal regurgitation.
  3. Nasal speech or hypernasality.
  4. Recurrent otitis media or ear infections.
  5. Dental malocclusion or misalignment of teeth.

The following factors may contribute to the development of cleft lip and palate:

  1. Genetic factors or family history of cleft lip/palate.
  2. Maternal exposure to certain teratogens during pregnancy (e.g., tobacco, alcohol, certain medications).
  3. Maternal nutritional deficiencies, especially in folic acid.
  4. Environmental factors.

Risk Population

Cleft lip and palate can affect individuals from any ethnic or socioeconomic background. However, certain populations may have a higher risk, including:

  1. Individuals with a family history of cleft lip/palate.
  2. Prenatally diagnosed cases of cleft lip/palate.
  3. Male infants (cleft lip with or without palate involvement is more common in males).
  4. Certain ethnic groups, such as Asians and Native Americans.

Associated Problems

Individuals with cleft lip and palate may experience the following associated problems:

  1. Feeding difficulties and poor weight gain.
  2. Speech and language delays.
  3. Dental problems.
  4. Otitis media (ear infections).
  5. Hearing loss.
  6. Impaired psychosocial development and self-esteem issues.

Suggestions for Use

When utilizing the nursing diagnosis of cleft lip and palate, consider the following suggestions:

  1. Collaborate with the healthcare team, including the surgeon, pediatrician, speech therapist, and lactation consultant.
  2. Provide education and support to parents regarding feeding techniques, hygiene, and developmental milestones.
  3. Promote a supportive environment that encourages positive body image and self-esteem for the child and family.
  4. Monitor and manage associated problems, such as feeding difficulties and speech delays, through appropriate interventions.

Suggested Alternative NANDA Diagnoses:

  1. Impaired Parent-Infant Attachment related to altered feeding experience.
  2. Risk for Impaired Verbal Communication related to structural deformity.
  3. Risk for Infection related to compromised integrity of the lip/palate.
  4. Altered Nutrition: Less Than Body Requirements related to feeding difficulties.
  5. Risk for Delayed Growth and Development related to altered feeding and speech difficulties.

Usage Tips

  1. Assess the severity and extent of the cleft lip and palate to tailor interventions accordingly.
  2. Involve the family in the care plan and provide them with resources and support groups for additional assistance.
  3. Continuously monitor and evaluate the progress of the child’s feeding.

NOC Outcomes

NOC (Nursing Outcomes Classification) outcomes are measurable indicators that demonstrate the effectiveness of nursing interventions. For the nursing diagnosis of cleft lip and palate, the following NOC outcomes may be relevant:

  1. Parent-Infant Attachment: Demonstrates bonding behaviors and verbalizes positive feelings toward the infant.
  2. Verbal Communication: Expresses needs and desires effectively through appropriate speech patterns.
  3. Tissue Integrity: Demonstrates healing and absence of infection in the lip and/or palate.
  4. Nutritional Status: Attains and maintains appropriate weight for age.
  5. Growth and Development: Achieves age-appropriate milestones related to feeding, speech, and social skills.
  6. Self-Esteem: Exhibits positive body image and self-confidence.

NOC Results

NOC results indicate the level of achievement for each outcome. For the nursing diagnosis of cleft lip and palate, the following NOC results may be expected:

  1. Parent-Infant Attachment: Strong attachment demonstrated by consistent nurturing behaviors and positive interactions with the infant.
  2. Verbal Communication: Improved speech clarity and ability to communicate effectively.
  3. Tissue Integrity: Wound healing without signs of infection or complications.
  4. Nutritional Status: Adequate weight gain and appropriate growth.
  5. Growth and Development: Attainment of developmental milestones related to feeding, speech, and social skills.
  6. Self-Esteem: Improved body image and increased self-confidence.

NIC Interventions

NIC (Nursing Interventions Classification) interventions are evidence-based actions that nurses implement to address specific nursing diagnoses. For cleft lip and palate, the following NIC interventions may be appropriate:

  1. Feeding Assistance: Provide guidance and support to parents regarding appropriate feeding techniques, such as proper positioning and use of specialized feeding devices.
  2. Parent Education: Educate parents about the condition, surgical interventions, feeding techniques, and potential complications.
  3. Referral to Specialist: Facilitate referrals to specialists, such as speech therapists, lactation consultants, and social workers, to address specific needs and promote optimal development.
  4. Wound Care: Provide meticulous care to the surgical site, including cleansing, dressing changes, and monitoring for signs of infection.
  5. Speech Therapy Referral: Coordinate with the speech therapist to assess and manage speech delays and hypernasality.
  6. Psychosocial Support: Offer emotional support and counseling to parents and children to address self-esteem issues and promote positive body image.

Cleft Lip and Palate Nursing Care Plan 1

Nursing Diagnosis: Risk for Impaired Verbal Communication related to structural deformity of cleft lip and/or palate.

Related Factors/Causes:

  1. Presence of cleft lip and/or palate.
  2. Anatomic abnormalities affecting the articulation of speech sounds.
  3. Nasal regurgitation and hypernasality due to the opening between the oral and nasal cavities.
  4. Surgical interventions or repair procedures that may impact speech development.

Desired Outcomes:

  1. The child will develop age-appropriate speech patterns.
  2. The child will communicate effectively and be understood by others.
  3. The child will demonstrate improved articulation of speech sounds.
  4. The child will exhibit increased confidence in verbal communication.

Nursing Interventions:

  1. Assess the child’s speech patterns, articulation, and overall communication skills.
  2. Collaborate with speech therapists to develop a specialized speech therapy plan tailored to the child’s needs.
  3. Educate parents and caregivers about strategies to promote speech development and effective communication.
  4. Encourage and provide opportunities for the child to practice verbal communication, such as engaging in conversations and participating in age-appropriate activities.
  5. Facilitate referrals to support groups or counseling services to address emotional and psychosocial challenges associated with impaired verbal communication.
  6. Monitor and evaluate the child’s progress in speech therapy, and adjust interventions as needed.

Evaluation:

  1. The child demonstrates improved articulation and pronunciation of speech sounds.
  2. The child’s speech patterns become more age-appropriate.
  3. The child effectively communicates and is understood by others.
  4. The child exhibits increased confidence in verbal communication.

Cleft Lip and Palate Nursing Care Plan 2

Nursing Diagnosis: Impaired Parent-Infant Attachment related to altered feeding experience in a child with cleft lip and/or palate.

Related Factors/Causes:

  1. Parental anxiety and concern regarding the appearance and feeding challenges associated with cleft lip and/or palate.
  2. Altered feeding experience due to difficulties in breastfeeding or bottle feeding.
  3. Emotional distress and feelings of inadequacy in meeting the child’s nutritional needs.
  4. Lack of knowledge and understanding about cleft lip and palate and its management.

Desired Outcomes:

  1. Parents will demonstrate positive bonding behaviors with the infant.
  2. Parents will express confidence and satisfaction in their ability to meet the child’s feeding needs.
  3. Parents will seek appropriate support and resources to address their concerns and cope with the challenges related to cleft lip and palate.
  4. Parents will verbalize understanding of the condition and its management.

Nursing Interventions:

  1. Assess parental knowledge and emotional state regarding the child’s condition and feeding challenges.
  2. Provide information and education about cleft lip and palate, including its causes, treatment options, and available support resources.
  3. Offer emotional support and reassurance to parents, addressing their concerns and promoting a positive parent-infant relationship.
  4. Collaborate with lactation consultants to support and guide parents in establishing successful breastfeeding techniques or alternative feeding methods.
  5. Encourage parents to express their feelings and concerns openly and provide a safe space for them to discuss their experiences.
  6. Facilitate connections with support groups or counseling services for parents to seek additional support and share experiences with others facing similar challenges.

Evaluation:

  1. Parents demonstrate positive bonding behaviors, such as holding, cuddling, and engaging in eye contact with the infant.
  2. Parents express confidence and satisfaction in their ability to feed and nurture the child with cleft lip and/or palate.
  3. Parents seek appropriate support and resources to address their concerns and cope with the challenges related to cleft lip and palate.
  4. Parents verbalize understanding of the condition and its management, demonstrating increased knowledge and ability to make informed decisions.

Cleft Lip and Palate questions for nursing students:

Question 1: Which statement best describes cleft lip and palate?

A) Cleft lip and palate occur due to trauma or injury to the facial structures.

B) Cleft lip and palate are congenital conditions resulting from incomplete fusion of facial structures during fetal development.

C) Cleft lip and palate develop after birth as a result of bacterial infection.

D) Cleft lip and palate are acquired conditions caused by nutritional deficiencies during childhood.

Answer: B) Cleft lip and palate are congenital conditions resulting from incomplete fusion of facial structures during fetal development.

Rationale: Cleft lip and palate are present at birth and occur due to a failure of fusion during embryonic development.

Question 2: Which of the following is a common characteristic of cleft lip and palate?

A) Difficulty in swallowing solid foods.

B) Excessive salivation.

C) Misalignment of teeth.

D) Nasal speech.

Answer: D) Nasal speech.

Rationale: Nasal speech, also known as hypernasality, is a common characteristic of cleft lip and palate due to the opening between the oral and nasal cavities.

Question 3: What is the primary nursing intervention for a newborn with cleft lip and palate?

A) Educating the parents about the condition and available treatment options.

B) Initiating feeding through a specialized bottle.

C) Administering antibiotics to prevent infection.

D) Referring the newborn to a speech therapist.

Answer: B) Initiating feeding through a specialized bottle.

Rationale: The primary nursing intervention for a newborn with cleft lip and palate is to initiate feeding through a specialized bottle or nipple that is designed to accommodate the structural deformity and facilitate proper feeding.

Question 4: A nursing student is assessing a child with cleft lip and palate. Which finding should be reported to the healthcare provider?

A) Presence of nasal regurgitation during feeding.

B) Mild dental misalignment.

C) Redness and swelling at the surgical site.

D) Difficulty pronouncing certain sounds.

Answer: C) Redness and swelling at the surgical site.

Rationale: Redness and swelling at the surgical site may indicate infection or complications following the surgical repair of cleft lip and palate and should be reported to the healthcare provider for further evaluation and intervention.

Question 5: When providing psychosocial support to a child with cleft lip and palate, the nurse should focus on:

A) Encouraging the child to hide the condition from peers.

B) Promoting a positive body image and self-esteem.

C) Discouraging the child from participating in social activities.

D) Advising the child to avoid speaking in public.

Answer: B) Promoting a positive body image and self-esteem.

Rationale: Psychosocial support for a child with cleft lip and palate should focus on promoting a positive body image and self-esteem. The nurse should encourage the child to embrace their uniqueness and engage in social activities to foster a sense of belonging and confidence.

References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. 

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. 

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. 

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Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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