Question

A 2-year-old child has had a cleft palate repair. Elbow restraints have been placed on the child's arms to prevent the child from damaging the suture line. How does the nurse manage the restraints? The nurse A. never removes the restraints. B. removes both restraints at the same time every 2 hours. C. removes the restraints one at a time when providing range of motion. D. removes the restraints only when there is another adult present to prevent suture damage.

Short answer

Option C: Remove the restraints one at a time when providing range of motion.

Step-by-step solution

Understand the Purpose of the Restraints

The restraints are used to prevent the child from touching or damaging the suture line after cleft palate repair. This is critical to allow proper healing.

Review Proper Restraint Management

Proper management includes regular removal to ensure adequate circulation and to provide opportunities for range of motion (ROM) exercises.

Evaluate Each Option

Consider each answer choice:A. Never removing the restraints can lead to circulation issues and muscle atrophy.B. Removing both restraints at once could allow the child to damage the suture.C. Removing the restraints one at a time for ROM exercises is a balanced approach that prevents suture damage and maintains circulation and muscle function.D. Requiring another adult every time restraints are removed is impractical and not necessarily safer.

Choose the Best Answer

Considering the guidelines and the practicality of each option, the best approach is to remove the restraints one at a time to allow for ROM exercises (Option C).

Key concepts

Restraint Management in Children

When managing restraints for children, it's essential to prioritize their safety and comfort. Restraints are often used in post-surgical care to prevent children from interfering with their healing process. However, improper use can lead to complications such as decreased circulation and muscle atrophy.
To manage restraints effectively, follow these guidelines:

• Regularly check the child's skin under the restraints to ensure there are no signs of irritation or decreased circulation.
• It is crucial to remove the restraints for short periods, one at a time, to allow for range of motion (ROM) exercises. This helps maintain muscle function and prevents stiffness.
• Always monitor the child closely after removing a restraint to prevent the child from touching or damaging the healing area.

Proper restraint management is a balance between ensuring the injury or surgical site remains undisturbed while also maintaining the child's overall physical health.

Post-Surgical Care

Post-surgical care plays a vital role in a child's recovery process. After a cleft palate repair, there are specific steps to ensure the surgery's success and the child's well-being:

• Monitoring for signs of infection at the surgical site, such as redness, swelling, or unusual discharge.
• Ensuring proper pain management to keep the child comfortable, which may include medication and non-pharmacological interventions like comforting techniques and distractions.
• Encouraging fluid intake and suitable nutrition to promote healing. This might involve special feeding techniques if the child has difficulty sucking or swallowing due to the surgery.
• Providing clear instructions on follow-up care, including when to seek medical advice if complications arise.

Comprehensive post-surgical care supports the child's recovery, minimizes complications, and speeds up the healing process.

Cleft Palate Repair

Cleft palate repair is a surgical procedure performed to fix an opening in the roof of the mouth, which can affect feeding, speech, and overall oral health. This surgery is typically performed in the first few years of life and involves several crucial aspects:

• Timing of the surgery is essential. Pediatric surgeons often aim for around 10-12 months of age, considering the child's growth and health status.
• Preventing injury to the surgical site is a priority. Techniques like using elbow restraints can help prevent the child from putting fingers or objects in their mouth, which can disrupt the healing process.
• Post-operative care involves monitoring for any complications, ensuring the child remains hydrated, and providing appropriate pain relief.

By understanding the comprehensive care required for cleft palate repair, caregivers can better support the child's recovery process and contribute to a successful outcome.