 INTRODUCTION

Cleft lip and cleft palate are the most common birth defect in the United States one of
every 600 newborn by cleft lip and/or cleft palate. Cleft lip and cleft palate occur every
early in pregnancy. The majority of clefts appear to be due to genetic or environmental
factors, through there is no known cause in many cases. The risk of recurrence of a cleft
condition are dependent upon many factors, including the number of affected persons in
the family, the closeness of affected relatives, the race and sex of all affected persons, and
the severity of the clefts.

 OBJECTIVES

General Objective:

This study aims to fully understand the underlying causes of the disease of Acute
Gastroenteritis and to express familiarity and to offer an effective midwifery care to a
patient diagnosed with Acute Gastroenteritis through understanding the patient history,
disease process and management.

Specific Objectives:

 To know the other complications that affects Acute Gastroenteritis.

 To determine the present and past history of the patient.
 To perform a thorough assessment, through Nursing Health History, Physical
Assessment, and the interpretation of the laboratory examination done on the
patient.
 To show laboratory examinations result with corresponding normal values, actual
result from the patient.
 To trace and understand the pathophysiology of Acute Gastroenteritis.
 To have knowledge to the client medication and be familiar to that medication.

 PATIENT’S PROFILE

A. Biographical Data:
Name: Bb. Boy N.A
Age: 8 days old
Gender: Male
Religion: Islam
Citizenship: Filipino
Address: Zone 3, Bantay, Ilocos Sur
Date of Birth: March 20, 2021
Weight: 3.4 kgs
Place of Birth: Gabriela Silang General Hospital, Tamag, Ilocos Sur


A. History of Present Illness:

Baby Boy N.A was born on a 22 year old mother with GRAVIDA 3 PARA 2 through
Caesarean Section. Baby boy was diagnosed to have unilateral cleft lip and cleft
palate. The vital sign were normal having temperature: 36.7 degree celcius;
respiratory rate: 41 cpm; heart rate; 124bpm; weight; 3400grams and with normal
reflexes.

 FAMILY HISTORY
Paternal Side:
(-) Deformities of the lip and palate
Maternal Side:
(+) from his father side.

 PHYSICAL ASSESSMENT
Date assessed: March 29, 2021
General assessment: neat, conscious and coherent
Nutritional Status: Fairly nourished
Initial vital signs: T=36.2 C, RR=30 bpm, PR=112bpm
Height: 30 ½ inches
Weight: 7.3 kg
Chest circumference: 19 ½ inches / 50 cm

 DEFINITION

Cleft Lip and Cleft Palate – an opening in the lip and palate – may occur separately or in
combination. Cleft lip and palate are twice as common in males as in females; isolated
cleft palate is more common in females.

Cleft lip (Cheiloschisis)

Cleft lip is a congenital anomaly that occurs at a rate of 1 in 800 births.
 In the cleft does not affect the palate structure of the mouth it is referred to as cleft
lip.
  Cleft lip is formed in the top of the lip as either a small gap or an indentation in
the lip (partial or incomplete cleft) or it continues into the nose (complete cleft).
 Cleft lip can be unilateral or bilateral.
 It is due to the failure of fusion of the maxillary and medial nasal processes
(formation of the primary palate).

Cleft Palate (Palatocshisis)

Cleft palate is a congenital anomaly that occurs in approximately 1 of vey 2000 births,
and it is more common in boys than girls.
 It is a condition in which the two plates of the skull that form the hard palate (roof
of the mouth) are not completely joined.
 It ranges in severity from soft palate involvement alone to a defect including the
hard palate and portions of the maxilla.
 Cleft palate may or may not be associated with cleft lip.

Children with these structural disorders mat have associated:

 Dental malformations
 Speech problems
 Frequent otitis media, the latter resulting from improper functioning of the
Eutachian tubes.

Babies with cleft lip do not usually have feeding problems or speech impairments. Infants
with cleft palate, with or without cleft lip, often have difficulty feeding and impaired
speech. The baby may feed too slowly, take in too much air while eating, or bring milk up
through the nose.

 ANATOMY AND PHYSIOLOGY

PATHOPHYSIOLOGY:
 failure of the maxillary process to fuse with the elevations on the
frontal prominence during sixth week of gestation.

results in interupted fusion of the maxillary and medial nasal

prominences.

failure of the tounge to move downward at the correct time will

prevent the palatine process from fusing

Intrauterine development of hard and soft palate is incompleted

during first trimester

Cleft Lip and Cleft Palate

Signs and Symptoms

 Symptoms of cleft lip and cleft palate vary from person to person, depending on the
extent of the defect.
 Cleft lip may show up only as a small notch in the border of the upper lip. It may also
involve a complete split of the lip that extends into the floor of the nose.
 Cleft lip may involve one or both sides of the upper lip. Often, the bone that supports
the upper teeth is involved to some degree. Extra, missing, or deformed teeth may
also be part of cleft lip. Frequently, the outside of the nostril is somewhat flattened,
too.
 Cleft palate may involve only the uvula, or it may involve the entire roof of the
mouth. The uvula is the soft, fleshy mass that hangs down from the roof of the back of
the mouth.

What are the complications of clefts?

 Breathing: when the palate and jaw are malformed, breathing becomes difficult.
Treatment include surgery and oral appliances.
 Feeding: problems with feeding are more common in cleft children. A nutritionist
and speech therapist that specializes in swallowing may be helpful. Special feeding
devices are also available.
 Ear infections and hearing loss: any malformation of the upper airway can affect the
function of the Eustachian tube and increase the possibility of persistent fluid in the
middle ear, which is the primary cause of repeat ear infections and persistent middle
ear fluid. Tubes can be inserted in the ear by an otolaryngologist to alleviate fluid
build-up and restore hearing.
  Speech and language delays: normal development of the lips and palate are essential
for a child to properly form sounds and speak clearly. Cleft surgery repairs the
structures; speech therapy helps with language development.
 Dental problems; sometimes a cleft involves the gums and jaw, affecting the proper
growth of teeth and alignment of the jaw. A pediatrics dentist or orthodontist can
assist with this problem.

MANAGEMENT
 Assess for the problems with feeding, breathing parental bonding, and speech.
 Ensure adequate nutrition and prevent aspiration.
a. Provides special nipples or feeding devices (eg. Soft pliable bottle with soft
nipple with enlarged opening) for a child unable to suck adequately on
standard nipples.
b. Hold the child in a semi upright position; direct the formula away from the
cleft and toward the side and back of the mouth to prevent aspiration.
c. Feed the infant slowly and burp frequently to prevent excessive swallowing of
air and regurgitation.
d. Stimulate sucking by gently rubbing the nipple against the lower lip.

REVIEW SYSTEM

Digestive System

The primary function of the digestive system is to break down the food we eat into
smaller parts so the body can use them to build and nourish cells and provide energy. There
occurs propulsion which is the movement of food along the digestive tract. The major means
of propulsion is peristalsis, a series of alternating contractions and relaxations of smooth
muscle that lines the walls of the digestive organs and that forces food to move forward. It
secretes digestive enzymes and other substances liquefies, adjusts the pH of, and chemically
breaks down the food. Mechanical digestion is the process of physically breaking down food
into smaller pieces. This process begins with the chewing of food and continues with the
muscular churning of the stomach

. Additional churning occurs in the small intestine through muscular constriction of the
intestinal wall. This process, called segmentation, is similar to peristalsis, except that the
rhythmic timing of the muscle constrictions forces the food backward and forward rather than
forward only. Chemical digestion which is the process of chemically breaking down food into
simple molecules. The process is carried out by enzymes in the stomach and small intestines.
Then absorption or the movement of molecules (by passive diffusion or active transport)
from the digestive tract to adjacent blood and lymphatic vessels. Absorption is the entrance of
the digested food into the body. And lastly, defecation which is the process of eliminating
undigested material through the anus.

But because of acute gastroenteritis the normal functions were altered.

The infectious agents that cause acute gastroenteritis causes diarrhea by adherence, mucosal
invasion, enterotoxin production, and/or cytotoxin production.
 These mechanisms result in increased fluid secretion and/or decreased absorption leading
to diarrhea. This produces an increased luminal fluid content that cannot be adequately
reabsorbed, leading to dehydration and the loss of electrolytes and nutrients.

 PATHOPHYSIOLOGY