(Addressograph)
POST-OPERATIVE CLEFT LIP REPAIR
DATE OF ADMISSION: _______________ TIME OF ADMISSION: ___________ ANTICIPATED LOS : __2 DAYS____
PRIMARY CARE PHYSICIAN __________________________
ALLERGIES: _________________________________
INPATIENT PATH
PHASES OF CARE
OUTCOMES
DAY OF SURGERY
‰
‰
INCISION CLEAN WITH MINIMAL DRAINAGE
PAIN MANAGEMENT WITH PO ANALGESIA
POST-OP DAY 1
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‰
‰
‰
SAFETY /
ACTIVITY
•
•
•
•
DEVELOPMENT
•
•
•
Maintain mouth free of fingers, toys, pacifiers, bottles or spoons for 3
weeks
Infant may be held in arms of parent
Position on back
Maintain elbow splints at all times except when supervised during
- Daily bath
Arm exercises (do frequently to prevent skin breakdown &
maintain ROM)
- Used to prevent disruption of surgical site
Assess coping
Assess level of understanding
Age appropriate therapeutic activities
ADEQUATE PAIN MANAGEMENT
PO FLUIDS
AFEBRILE
PARENTAL UNDERSTANDING OF CARE NEEDS AT HOME
•
•
•
•
Maintain mouth free of fingers, toys, pacifiers, bottles or spoons for 3 weeks
Infant may be held in arms of parent
Position on back
Maintain elbow splints at all times except when supervised during
- Daily bath
- Arm exercises (do frequently to prevent skin breakdown)
- Used to prevent disruption of surgical site
•
•
•
Assess coping
Assess level of understanding
Age appropriate therapeutic activities
*CLINPATH*
ASPECT OF
CARE MGMT
ASPECT OF
CARE MGMT
ASSESSMENT
DAY OF SURGERY
•
•
•
•
•
INTERVENTIONS
•
PAIN MGMT
•
•
•
MEDICATION
•
•
NUTRITION /
HYDRATION
•
•
•
•
•
•
PATIENT /
FAMILY
EDUCATION
Vital signs q 4h x 4, then q shift
CV monitor / pulse oximeter
Evaluate surgical site
- Bleeding from nose / mouth / suture line
- Integrity of sutures
- Pain indicators / response to pain management interventions
Maintain Logan Bow at all times after lip repair, reapplying as
necessary. If the metal bar falls off (LOGAN BOW) clean the cheeks
with soap and water and dry them thoroughly.
One person should keep the baby’s cheeks pinched together while the
other person changes the tape on the bow
•
Apply the mastisol (yellow liquid in the capsule) to the cheeks
where the tape will go and let it dry for 10 seconds, it will be a
little sticky
•
Put the new tape on the bow and put it back on the cheeks
where it was initially. Teach parents
Perform lip repair incision care TID-QID/after each feeding (use sterile
cotton swabs) or more frequently as needed
- Cleanse with ½ strength H202
- Apply thin film of Bacitracin
Use age-appropriate pain scale
Non-pharmacological comfort measures (parental support, distraction)
Analgesia administration when indicated (see Pain Management Guide
“The Child in Acute Pain”)
Morphine 0.05 mg / kg IV q 2h x 24h , then q2h prn for pain (Max
dose: 5 mg / dose)
Tylenol suspension 15mg/kg p.o. q 4h x 24h , then q4h prn for pain
pain (Max dose: 650 mg / dose)
Monitor intake and output
Maintain IV patency. Discontinue IV per physician order when patient
tolerates oral fluids in adequate volume.
Administer oral fluids frequently via Brecht feeder ( only syringe with
soft tubing attached)
NO spoons, straws or bottles
NO ice chips
NO pacifiers, fingers or toys in mouth
POST-OP DAY 1
•
•
•
•
•
•
Vital signs q shift
CV monitor / pulse oximeter
Evaluate surgical site
- Bleeding from nose / mouth / suture line
- Integrity of sutures / packing
- Pain indicators / response to pain management interventions
Maintain Logan Bow at all times after lip repair, reapplying as necessary. If the
metal bar falls off (LOGAN BOW) clean the cheeks with soap and water and dry
them thoroughly
One person should keep the baby’s cheeks pinched together while the other person
changes the tape on the bow
•
Apply the mastisol (yellow liquid in the capsule) to the cheeks where the
tape will go and let it dry for 10 seconds, it will be a little sticky
Put the new tape on the bow and put it back on the cheeks where it was initially.
Teach parents
•
Perform lip repair incision care TID-QID/after each feeding (use sterile cotton
swabs) or more frequently as needed
Cleanse with ½ strength H202
Apply thin film of Bacitracin
•
Use age-appropriate pain scale
•
Non-pharmacological comfort measures (parental support, distraction)
•
Analgesia administration when indicated (see Pain Management Guide “The Child
in Acute Pain”)
•
Morphine 0.05 mg / kg IV q 2h x 24h , then q2h prn n for pain (Max dose: 5 mg /
dose)
•
Tylenol suspension 15mg/kg p.o. q 4h x 24h , then q4h prn for pain pain (Max dose:
650 mg / dose)
•
Monitor intake and output
•
Maintain IV patency. Discontinue IV per physician order when patient tolerates oral
fluids in adequate volume.
•
Administer oral fluids frequently via Brecht feeder ( only syringe with soft tubing
attached)
•
NO spoons, straws or bottles
•
NO ice chips
•
NO pacifiers, fingers or toys in mouth
•
Advance from clear to full liquids as tolerated
INSTRUCT PARENT(S) / CAREGIVER TO: (complete discharge checklist on care of
the cleft lip)
•
•
•
•
Maintain adequate hydration/nutrition
- Encourage frequent feedings
- Offer liquids via Brecht feeder or standard cup
Reapply Logan Bow (give parents instruction handout & give adequate supplies of
Mastisol)
Assemble/apply/remove elbow splints
•
•
D / C PLANNINGCLINICAL
RESOURCE
MANAGEMENT
•
1)
2)
3)
4)
Exercise arms frequently / check for signs of pressure
Medicate PRN for discomfort
- Ensure safety of surgical site
- Limit activity/positioning (on back only at all times)
- Provide toys age-appropriate
- Prohibit the following for 3 weeks
- Use of pacifiers
- Use of bottles
- Consumption of ice chips
- Use of spoons / straws
- Use of toys in mouth
When / how to contact surgeon for development of:
Fever greater than 38..5° C (or 39°C Rectal)
Excessive bleeding
Disruption of lip
Alterations in CV or respiratory status
•
•
Call Plastic Surgery office during regular business hours for Clinical Coordinator
Page Plastic Surgeon on call after hours and weekends
•
Schedule follow-up appointment with Plastic Surgery Clinic
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•
•
•
CONSULTS
INITIALS &
SIGNATURE
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________________________
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________________________
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VARIANCES
F FEVER > 38..5° C (OR 39°C RECTAL)
F ALTERATIONS IN CV OR RESPIRATORY STATUS
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Speech
OT
Genetis
Nutrition
________________________
________________________
________________________
________________________
________________________
F EXCESSIVE BLEEDING
Note: (Please date and sign each entry)
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THIS PATHWAY IS A GUIDELINE FOR PATIENT CARE. IT IS NOT INTENDED TO REPLACE CLINICAL JUDGMENT OR PREDICT CLINICAL OUTCOME.
© CNMC 8 / 2006