A postoperative child on day 2 after cleft palate repair (palatoplasty) is under nursing care. Which of the following interventions is appropriate?

1. A

   Use tongue depressor for oral examination

2. B

   Measure oral temperature

3. C

   Provide pacifier to soothe the child

4. D

   Administer IV morphine as advised

Appeared in: NORCET 10 Mains

Explanation

Listen in Hindi

• The primary goal after palatoplasty is to protect the suture line from tension and trauma.
• Crying significantly increases intraoral pressure, which puts stress on the delicate sutures.
• Administering prescribed analgesics, such as IV morphine, is a crucial intervention to manage pain, keep the child calm, and prevent crying.
• Effective pain control promotes rest and healing, contributing to a successful surgical outcome.

Why Other Options Were Wrong

• Option A: A tongue depressor is a hard object that can cause direct trauma to the fresh surgical site on the palate, potentially disrupting the sutures.
• Option B: Placing a thermometer in the mouth can injure the suture line. Temperature must be measured using a non-oral route, such as axillary or temporal.
• Option C: Sucking on a pacifier creates negative pressure and tension on the palate, which can pull the sutures apart and lead to the failure of the repair.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Postoperative nursing care following cleft palate repair (palatoplasty) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Protecting the integrity of the surgical repair is a critical nursing responsibility that directly impacts the long-term outcomes for speech and feeding.
• Patient and family education is paramount. The nurse must clearly instruct caregivers on feeding techniques, activity restrictions (including the use of elbow restraints), and signs of complications.
• What if? If the child remains inconsolable despite receiving the prescribed dose of morphine, the nurse's first action should be to assess for other causes of distress (e.g., a wet diaper, hunger, position discomfort) before notifying the surgeon. Persistent, vigorous crying poses a significant risk to the suture line.

How to Approach the Question

• First, identify the core clinical scenario: postoperative care for a child after cleft palate repair (palatoplasty).
• Recall the primary goal in this situation, which is to protect the fresh suture line in the mouth from any form of trauma or tension.
• Evaluate each option based on this primary goal.
• Option A (tongue depressor): Does this introduce trauma? Yes, it's a hard object. Eliminate.
• Option B (oral temperature): Does this introduce trauma? Yes, the thermometer can injure the site. Eliminate.
• Option C (pacifier): Does this create tension? Yes, sucking creates pressure. Eliminate.

Concept Tested & Keywords

• Concept Tested: Postoperative nursing care following cleft palate repair (palatoplasty).
• Stem keywords: postoperative child, day 2, cleft palate repair, palatoplasty, nursing care
• Lead-in keywords: appropriate
• Clinical cues: The procedure is a palatoplasty, which involves a fresh suture line inside the mouth that needs protection.

Question ID

Qao1vELoxQLPtdUsBGnC_O

Copy ID

Reference Book

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 156-158

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 21-23