Spring 2016, Volume 7, Issue 2

EBSCO Health Nursing Newsletter including topics on Total Shoulder Arthroplasty, Vander Woude Syndrome, and Breastfeeding and the Risk of Developing Breast Cancer

Welcome!

Welcome back to EBSCO Health's free evidence-based nursing newsletter. We will periodically send news on the latest evidence in nursing. Please share this with your colleagues, students, practitioners and others who would benefit from this information.

Nursing Reference CenterPlus in Daily Practice

Total Shoulder Arthroplasty

Mr. M is a 78-year-old patient, status post total shoulder arthroplasty in the post-surgical unit. The student nurse caring for this patient wants to learn more about total shoulder arthroplasty, so she consults Nursing Reference Center Plus, keying in the words "total shoulder arthroplasty." She retrieves the quick lesson "Total Shoulder Arthroplasty."

The nurse learns a great deal about total shoulder arthroplasty, including indications, potential complications, laboratory tests, preoperative and postoperative treatment goals and interventions. Based on the information in the quick lesson, the nurse carefully monitors the patient for postoperative complications. She provides Mr. M with emotional support.

Note: The above-referenced quick lesson is freely accessible to all readers of the EBSCO Health Nursing Newsletter.

Quick Overview

Caring for Patients with Van der Woude Syndrome

Van der Woude syndrome (VWS) is a rare genetic condition that affects the development of the face and is characterized by abnormal fusion of the lips and palate at approximately 30-50 days post-conception. Individuals with VWS have one or more of the following: cleft lip and/or palate (CLP); lower lip pits or mucous cyst; and/or hypodontia (i.e., missing teeth as a result of their failure to develop). VWS is caused by a mutation in the interferon regulatory factor-6 (IRF-6) gene, which produces a protein that is responsible for the development and maturation of the face and head. Detection of an IRF-6 gene mutation can assist in differentiating between VWS and other causes of CLP.

Lower lip pits with or without CLP are the cardinal sign of VWS. The pits are usually symmetrical and are typically located on the vermillion portion of the lower lip on each side of center. They are usually circular but can be transverse slits. In some cases the pits are deep enough to communicate with salivary glands, which causes intermittent or persistent watery secretions. Lip pits may be a sign of popliteal pterygium syndrome (PPS), which is also caused by mutations of the IRF-6 gene but manifests with additional abnormalities of the limbs and genitalia. Other syndromes in the differential diagnosis are oral-facial-digital syndrome and Kabuki syndrome, both of which have characteristics in addition to those of VWS. Diagnosis of VWS is made based on clinical presentation and confirmed by genetic testing that identifies IRF-6 gene mutation. The severity of physical abnormalities in VWS varies widely, even in affected individuals of the same family.

Treatment of VWS is multidisciplinary and may include consultation with a surgeon, orthodontist, speech-language pathologist, otolaryngologist, geneticist, mental health clinician and other specialists. Surgical repair of cleft lip is usually performed at 10-12 weeks of age; cleft palate is typically repaired at 6-12 months of age. Close supervision of feeding and weight gain are important for at least the first month of life. Consultation with a lactation and nutrition specialist may be needed initially, and a removable orthodontic prosthesis can be used to assist with more productive sucking and swallowing. Surgical resection of lip pits and/or reconstruction of the lower lip and nasal deformity by a plastic surgeon may be necessary. Continued surveillance for hearing, speech and dental abnormalities is important. Middle ear dysfunction is often reported in children with cleft palate and results in frequent otitis media and hearing loss. Education, emotional support and assistance seeking genetic counseling and testing are an important part of the treatment plan for patients with VWS and their families.

Please log in to your Nursing Reference Center™ or Nursing Reference Center Plus subscription to read the quick lesson on "Van der Woude Syndrome," which includes additional information about assessment and treatment of this condition.

Evidence-Based Content Update

Recently, the evidence-based care sheet "Breastfeeding and the Risk of Developing Breast Cancer" was revised following review under the Systematic Literature Surveillance Program. Among new information of value to nursing practice was a research study regarding breastfeeding and the risk of developing breast cancer.

Researchers evaluating the correlation between breastfeeding and breast cancer risk found that breastfeeding is associated with a reduction in the risk of developing breast cancer, with a longer duration of breastfeeding (both cumulative and per child) correlated with lower breast cancer risk.

We invite you to log in to Nursing Reference Center or Nursing Reference Center Plus to read updated content as it becomes available.


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