A client arrives for her first prenatal appointment.

Exhibits

What is the correct way for the nurse to document the GTPAL for this client?

A. Provide the caregiver with resources in the community for support: Ensures the caregiver has access to additional help and knowledge about asthma management.
B. Provide the child with a pamphlet on how to use an inhaler: While education for the child is important, at 5 years old, the ability to manage an inhaler independently may not be developmentally appropriate.
C. Refer the caregiver to the asthma educator: Specialized instruction can enhance the caregiver's understanding of asthma management.
D. Ask the caregiver, "what worries you about your child?": Understanding concerns helps tailor education and support to address specific needs.
E. Teach the child how to use the inhaler: Similar to B, teaching the child directly to use the inhaler without supervision may not be feasible at this age.
F. Provide information on child development: Educates the caregiver about realistic expectations regarding the child's ability to manage asthma independently.

Complication: Otitis Media

Anatomical Changes:

• Small external ear structure: Infants born with a cleft palate often have smaller external ear structures, which can affect the drainage of fluids and increase the risk of infections.
• Horizontal eustachian tubes: Eustachian tubes in individuals with cleft palate are typically more horizontal than normal, impairing the drainage of fluid from the middle ear.
• Large tongue: A large tongue may obstruct the upper airway and interfere with normal swallowing and speaking functions.

Complication: Otitis Media

• Due to the anatomical changes associated with cleft palate, such as horizontal eustachian tubes and impaired drainage, individuals are prone to recurrent middle ear infections (otitis media). These infections can lead to fluid accumulation behind the eardrum, which can further impair hearing and potentially lead to more serious complications if untreated.

Priority Interventions:

• Ear drops (for otitis media): Ear drops containing antibiotics may be prescribed to treat bacterial infections in the middle ear, which are common in individuals with cleft palate.
  • Rationale: Ear drops help to directly treat the infection in the ear canal and middle ear, reducing inflammation and preventing complications such as hearing loss or spread of infection.
• Corticosteroids (for inflammation): Corticosteroids may be used to reduce inflammation in the ear canal and middle ear, particularly in cases of severe otitis media.
  • Rationale: Corticosteroids help to decrease swelling and inflammation, which can improve symptoms and aid in the healing process of the ear.