Pedia Disorder

pediatric disorders common problems, disorders and diseases in

infants

a. prematurity: - birth before 37th week of gestation 1. associated medical problems maternal • placenta previa • abruptio placenta • cervical incompetence • hypertensive disease of pregnancy

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weight fontanels infections tachypnea urine integrity skin integrity apgar scoring

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fetal assessment -

gestational age multiple gestations respiratory distress arterial blood gases abnormal breath sounds vernix caseosa signs of birth trauma

nursing interventions

feed slowly keep infant warm maintain clear airway rub back or soles of feet to stimulate infant’s breathing.

• transport infant to special care facility as soon as possible. • avoid handling infant more than necessary for feeding and changing of diapers.

congenital malformations

general nursing care of infant with physical anomalies assessment • determine the child’s immediate physiologic needs to sustain life • know the parent’s immediate emotional needs to promote bonding between child and parents

nursing diagnosis

• anticipated grief related to the loss of “perfect” child. • self-esteem disturbance related to interference with establishing parent-infant bond • altered nutrition, less than body requirements, related to malabsorption of necessary nutrients

nursing interventions • • • • •

prevent infection establish extra uterine circulation. establish proper waste elimination. establish body temperature control. expose the child to adequate stimulation.

• • • •

establish and maintain adequate respiration. ensure ability to take in adequate nourishment. foster the development of an infant-parent bond. nurses should be familiar with the most frequently encountered physical anomalies so that they can make truthful statements regarding the child’s

nursing interventions

condition to the parents.

cleft lip

• failure of fusion of the maxillary and median nasal processes • occurs between 5 to 8 weeks of intrauterine life • more common among males than females • repaired surgically shortly after birth

cleft palate

• an opening of the palate usually found on the midline due to incomplete development • may involve the anterior hard palate or the posterior soft palate • occurs more frequent in females than in males • repair is usually postponed until the child is 18 to 24 months old.

cleft lip & palate

nursing interventions:

• preoperatively the child must take an adequate amount of food. feed the child via commercial cleft lip nipple to prevent aspiration • postoperatively the infant is kept on npo status for at least 4 hours. • bottle or breast-feeding is contraindicated following surgery.

cleft lip & palate

nursing interventions:

• after 3 to 4 days a soft diet is given until healing is complete. • when the child begins eating soft food, spoon

should not be used. • suction if there is the need to remove mucus, blood and unswallowed saliva.

cleft lip & palate

nursing interventions:

• after cleft lip surgery, do not lay infants on their abdomen. • position child on his/her side as soon as awake. • clean the suture line with a sterile saline, or 50% hydrogen peroxide in sterile water and sterile cotton-tipped applicators after every feeding

cleft lip & palate

nursing interventions:

• administer acetaminophen as prescribed to make patient comfortable.

pierre robin syndrome

• a complex of congenital anomalies, including small mandible, cleft palate, other craniofacial abnormalities and defects of the eyes and ears • the infant is positioned on the side or a gastrostomy tube may be inserted for feeding.

tracheoesophageal atresia and fistula

types • the esophagus ends in a blind pouch. there is tracheoesophageal fistula between the distal part of the esophagus and the trachea. • the esophagus ends in a blind pouch. there is no connection to the trachea. • a fistula is present between an otherwise normal esophagus and trachea.

tracheoesophageal atresia and fistula

types • the esophagus ends in a blind pouch. a fistula connects the blind pouch of the proximal esophagus to the trachea • there is a blind end portion of the esophagus. fistulas are present between both widely spaced segments of the esophagus and the trachea.

tracheoesophageal atresia and fistula

characteristic: • presence of large amounts of amniotic fluid and large amounts of mucus in the mouth appearing like blowing bubbles management: • immediate surgery is done to prevent pneumonia. antibiotics are administered as ordered.

tracheoesophageal atresia and fistula

nursing interventions: preoperative • give iv therapy • keep child in an upright position and on the right side to prevent aspiration

tracheoesophageal atresia and fistula

nursing interventions postoperative • keep infant on npo status for 7-10 days until suture line heals. • turn the patient frequently to discourage fluid from accumulating in the lungs. • encourage crying to help expand lung tissue.

omphalocele

• the protrusion of the abdominal contents through the

• • • •

abdominal wall at the point of the junction of the umblical cord and abdomen. the herniated organs are usually the intestines, but may include the stomach and liver. elastic bandaging may be performed as conservative therapy. topical solution such as silver sulfadiazine may be applied to prevent infection of the sac. delayed surgical closure may follow.

intestinal obstruction

• failure of canalization of intestine in utero at some point in the bowel which results to atresia or stenosis of the bowel • the most common site is the duodenal bowel portion. • anticipated if the mother had duodenal bowel portion. • anticipated if the mother had hydramnios during pregnancy or if 30 ml of gastric secretion was aspirated from the newborn’s stomach • monitoring body fluid and electrolyte is important until surgery is done.

meconium ileus

• the obstruction of the intestinal lumen by hardened meconium • most commonly found in infants with cystic fibrosis. • results in abdominal distention and vomiting of bile stained fluid • characterized by the failure to pass meconium within the first 24 to 48 hours after birth, rapid dehydration associated with electrolyte imbalance and abdominal distention • management includes use of enema or surgery

imperforate anus

• absence of opening in the anus • managed through surgery

imperforate anus

nursing interventions: preoperative • put the client on npo status. • attach the nasogastric tube to low intermittent suction for decompression. postoperative • if the bowel sounds are present and the nasogastric tube is removed, small oral feedings is advised • rectal dilation is done once or twice a day to ensure the proper patency of the rectal sphincter.

diaphragmatic hernia

• the protrusion of the abdominal organ through a defect in the diaphragm into the chest cavity which usually involves the stomach and the intestine • characterized by the absence of breath sounds on the affected side of the chest • managed through surgery

diaphragmatic hernia

nursing intervention • elevate head to provide maximum respiratory space. • perform gastrostomy to prevent distention of the herniated intestine. • use low intermittent suction to avoid injury to the lining of the stomach.

• after surgery, the infant is kept in a semi-fowler’s position. • keep the infant in a warm, humidified environment to encourage lung fluid drainage.

anomalies of the nervous system

hydrocephalus • an excess of cerebrospinal fluid in the ventricles and subarachnoid space of the brain • the nursing care is same as the child with increase icp.

neural tube disorders

anencephaly • the absence of cerebral hemisphere microcephaly • characterized by slow brain growth which falls more than three standard deviations below normal on growth charts • results in mental retardation because of the lack of functioning brain tissue.

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spina bifida occulta

incomplete fusion of spinal cord usually occurs in the lubosacral area (l5 and s1) there is positive tuft of hair or dimple over the affected area • may result to progressive disturbance of gait with weak foot or bowel and bladder disturbances

meningocele

• hernial protrusion of a saclike cyst of meninges filled with spinal fluid

• positive cystic swelling beneath the skin which contains csf

myelomeningocele

• hernial protrusion of a saclike cyst containing meninges, spinal fluid and a portion of the spinal cord • may result to either positive or negative neurologic deficits • usually seen with hydrocephalus and arnold chiari malformation

encephalocele

• cranial meningocele or myelomeningocele • occurs most often in the occipital area of the skull

neutral tube disorder

preoperative • the position should be prone or supported on the side. • a sterile wet compress of saline, antiseptic or antibiotic gauze over the lesion may be used to keep the sac moist. • maintain body heat • check any leakage. • measure head circumstance once a day in the preoperative period. • the child must be observed frequently for signs of increased intracranial pressure

neutral tube disorder

postoperative • a child is placed on the abdomen until the skin

incision has healed (7-14 days) • practice careful precautions in preventing urine or feces to touch the incision • keep the infant prone or on the side to prevent pressure on the incision.

nursing care of infants with skeletal anomalies finger conditions

polydactyly • the condition characterized by the presence of one or more additional fingers • supernumerary finger is usually amputated in infancy or early childhood. syndactyly • a condition characterized by two fingers which are fused • the fusion is usually caused by simple webbing. • treatment consists of separation of the fingers into two, which should be functional and cosmetically appealing.

torticollis (wry neck)

• the head is inclined to one side as a result of the contraction of muscles on that side of the neck • occurs as a congenital anomaly when the congenital muscle is injured and bleeds during birth • managed through passive stretching exercises where the infant is encouraged to look in the direction of the affected muscles • surgical correction followed by a neck immobilizer is necessary if the condition persists after one year.

craniosynostosis

• the premature closure of the sutures of the skull which may lead to deformed face and orbits of the eyes and increased intracranial pressure • may be associated with cardiac anomalies, choanal atresia, or defects of the elbows and knee joints • if the coronal suture is involved, surgery is needed.

achondroplasia

• a form of dwarfism inherited as a dominant trait which involves a defect in the cartilage production in utero. • characterized by less than 140 cm in height, and flattened bridge of the nose • x-ray films reveal characteristic abnormal flaring of epiphyseal lines

congenital clubfoot

a. talipes equinovarus • most common congenital deformity of the foot • characterized by internal tibial torsion, plantarflexion, inversion and adduction of the forefoot b. calcaneovalgus • foot turns out and the heel is held lower than the anterior foot. • both are managed through serial casting, corrective surgery or shoe correction

congenital clubfoot

nursing interventions: • change diapers frequently • teach parents on the following: • how to check the infant’s toes for coldness or cyanosis • how to blanch a toenail bed and watch it turn pink to assess for good circulation • how to perform passive foot exercises.

developmental hip dysplasia

• flattering of the acetabulum of the pelvis which results in subluxation and dislocation at the hip joint • six times more common in females than in males because of the flaring of the hips and the hormone relaxin • management includes the use of traction (older children) or surgery.

pavlik harness

• the harness is worn continually. • teach the parents on how to remove the harness before bathing and how to reduce the hip again before using the harness. • parents should assess the skin under the straps daily for irritation or redness.

spica cast

• before discharge, teach the parents how to do neurovascular assessment (check temperature

and circulation in the toes) to prevent circulatory compression

common prolems in toddlers, preschoolers, schoolers and adolescents concept of illness to a child

younger children ( 2 - 7 years ) • the cause of illness is magical or is the consequence of breaking a rule. • getting well again is possible only if they follow a set of rules, such as staying in bed and taking medicine.

concept of illness to a child

fourth graders (7-10 years) • generally aware of the role of germs in illness but may have the misconception that all illnesses are caused by germs • see a passive role for them in getting well because illness comes from outside influences.

concept of illness to a child

eighth graders (13 years and above) • able to voice an understanding that illness can occur from several causes • can take an active role in getting better

nursing process for an ill child

nursing diagnosis 1: • anxiety of the child • related factor: • separation during hospitalization • nursing priority:

• for the child to actively relate with hospital personnel and hospital routine in ways appropriate to child’s age and stage of development.

nursing process for an iii child

nursing diagnosis 2: • fear of the child • related factors: • diagnosis or therapeutic procedure. • nursing priority: • for the child to voice satisfaction with comfort measures, child describes how he participates in a procedure.

nursing intervention:

• provide opportunities for parents to participate in the child’s care. • promote open parent visiting. • support sibling and grandparent visitations. • ample analgesia, including techniques of distraction or imagery; traditional comforts such as a change of clothing or positions; and reading to the child.

nursing intervention:

• to assure children that their bed is an area that is safe, all painful procedures should be done in the treatment room away from the bed. • offer children a sense of control. • explain to the children the procedures and give choices whenever possible to limit their fear of hospitalization.

nursing intervention:

• make the children admitted as in-patient feel that their stay is transient even upon admission.

• allow parents to perform the procedures that need to be done at home first until they become comfortable with the techniques. • be certain that parents/guardian know who to contact if nursing care plans do not work as anticipated and that they have a definite return appointment for follow-up care.

care of a child with muscular-skeletal disorders musculoskeletal disorders

nursing diagnosis • pain related to chronic inflammation of joints. • impaired physical mobility related to cast on leg. • self-esteem disturbance related to continued use of body brace. • diversional activity deficit related to the need for imposed activity restriction for weeks.

assessment of musculoskeletal function

diagnostic tests • x-ray • bone scan • arthroscopy • muscle or bone biopsy • electromyography

medical/surgical management

casting • made of plastic or open-woven bandage impregnated with plaster of paris • designed to protect a broken bone and to prevent movement of the aligned bone ends until healing has progressed sufficiently

casting

nursing intervention: • keep the extremity in cast elevated to prevent edema. • check circulation frequently (every 15-min. during the first hour, hourly in the first 24 hours, and then every 4 hours thereafter). • assess color, warmth, presence of pedal pulses, and sensations of numbness or tingling. after removing the cast, bathe the extremity.

crutches

• prescribed for children for the following reasons: • to keep weight off both legs • to support weakened legs • to maintain balance • nursing intervention: • ensure that the crutches are properly fit. • teach the child to support his weight at the hand grip not on the axilla • always assess if the rubber tip is intact.

traction

• involves pulling on a body part in one against a counter pull exerted in the opposite direction. • used to reduce dislocations and immobilize fractures nursing intervention: • provide good skin care on the child’s back, elbows, and heels. • provide a trapeze suspended over the bed of the child to position oneself in using the bedpan.

traction

nursing intervention: • do not move the weights or interfere with the

traction when changing the child’s bed linens or carrying out nursing functions. • check the extremity in fraction every 15 minutes during the first hour, hourly for 24 hours, and every 4 hours, thereafter. monitor for signs of pallor, lack of warmth, tingling, absent of paripheral pulse, edema or pain.

traction

• involves the use of an external device to separate opposing bones to encourage new bone growth. • used to lengthen the bone when one limb is shorter than the other • also used to immobilize fractures or correct defects when the bone is rotated or angled

open reduction

• a surgical technique used to align and repair bone • internal fixations, such as use of rods or screws, are rarely used in children except in those with scoliosis.

disorders of the skeletal structures achondroplasia

• the most common form of short limb dwarfism • transmitted as an autosomal dominant trait • achodroplastic infants may be stillborn or die in their first year after birth.

osteogenesis imperfecta

• aka fragilitas ossium, brittle bones

• uncommon hereditary generalized connective tissue disorder in which the occurrence of multiple fractures is rendered inevitable by extreme fragility of the bones

vitamin c (ascorbic acid) deficiency

• interferes with osteoblastic activity resulting in diminished formation of bone matrix • clinical manifestation includes hemorrhage which results from defective capillary walls. • causes scurvy

scurvy

• an acquired constitutional disease caused by deficient dietary intake of vitamin c • manifested by changes in mesenchymal tissue of the body, especially collagen, bone, teeth, and blood vessels.

vitamin d deficiency

• produces rickets in the children and osteomalacia in adults

rickets

• a constitutional disease of infancy and childhood caused by lack of vitamin d • evidenced by bone deformities, which may be striking in degree and widespread in distribution

nursing care for children with congenital hip dislocation congenital hip dislocation (chd)

• types • teratologic (intra-utero) • typical (unstable, dislocated or subluxated) • more than 50% of the cases is unilateral • left hip involvement is more common for unilateral cases • occurs more often in girls than in boys (8:1) • abnormal laxity • assessed using the ortolani’s test management varies according to age

knee conditions

chondromalacia patella • the softening of the articular cartilage of the patella of diverse origin • may be progressive and managed conservatively • has three categories: • primary idiopathic type • secondary adolescent type • adult type

genu varum (bowlegs)

• the lateral bowing of the tibia with the medial malleoli of the ankles touching and the medial surfaces of the knees are over 2 inches part • seen most commonly in 2 years old

• part of normal development in children which is gradually corrected at age 3 and latest at school age • if condition worsens or persists beyond school age, the child needs referral to an orthopedist.

genu valgum (knock-knee)

• the medial surfaces of the knees touch and the medial surfaces of the ankle malleoli are separated by more than 3 inches • usually seen in children 3 to 4 years • gradually corrects itself and at the latest by school age • if condition worsens or persists beyond school age, the child needs referral to an orthopedist.

foot and ankle conditions pes planus (flatfoot)

• a foot without depression or complete loss of the medial longitudinal arch • may either be congenital or acquired • management include arch support, exercises and shoe modification

pes cavus

• a foot with a usually high arch and synonymous with clawfoot, pes arcuatus and hollow foot. • may either be primary (idiopathic) or secondary (with known cause)

talipes equinovarus or congenital clubfoot

primary deformities • inversion and adduction of the forefoot

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varus of the calcaneus (heel inversion) equinus (plantarflexion) internal tibia torsion

talipes equinovarus or congenital clubfoot

secondary deformities: • contractures of the tissues on the medial side of the foot • underdeveloped and contracted calf muscles • more common in males • management includes astronomy, arthrodesis and tendon transfer

osteomyelitis

• an infection of the bone which typically begins at the metaphysis • most commonly caused by staphylococcus aureus in older children and haemophilus influenza in younger children • carried to the bone site by septicemia (blood infection)

osteomyelitis

• children with sickle cell anemia have a special susceptibility to salmonella invasion in long bones. • may also occur directly from an outside invasion due to a penetrating wound, open fracture, or contamination during surgery • characterized by altered bone growth

synovitis

• an acute, nonpurulent inflammation of the synovial membrane of a joint, which occurs most commonly in the hip joint of children • peak age of incidence: between 2 and 10 years

juvenile rheumatoid arthritis (jra)

• inflammatory disease of childhood with an unknown cause • characterized by chronic inflammation of the synovium with joint effusion and eventual erosion • management includes the use of steroids, nsaids, slow acting anti-inflammatory drugs; surgery, bracing or shoe correction.

juvenile rheumatoid arthritis (jra)

nursing intervention: • exercises • institute a set of exercises (to preserve and strengthen muscle and joint functions) • avoid running, jumping, prolonged walking and kicking (to prevent strains of the joint)

juvenile rheumatoid arthritis (jra)

nursing intervention: • apply heat using warm water soaked for 20-30 minutes • hot baths • paraffin soaks
juvenile rheumatoid arthritis (jra)

nursing intervention :

• splinting • encourage client to wear splint continuously even during sleep during period of achieve inflammation • instruct the client to use splint until the inflammation subsides

juvenile rheumatoid arthritis (jra)

nursing intervention : • nutrition • help parents plan mealtime for “best time” of the day (to prevent malnutrition due to poor appetite secondary to anorexia, pain and fatigue)

disorders of the spine scoliosis

• lateral deformity of the spine with vertebral rotation • the incidence of thoracic curve is greater than lumbar curve • lumbar is the least common pattern.

non-structural scoliosis

• the lateral curvature of vertebral column not associated with any true structural deformity at the vertebra • associated with abnormal posture, by length discrepancy, muscle spasm (as in lbp of disc herniation), tumors, inflammation etc. • non-progressive though may develop to structural scoliosis, and become progressive if present over prolonged period of time.

structural scoliosis

• the lateral spine curve that cannot be fully corrected by lateral flexion • associated with bony changed and fixed rotatory deformity of the vertebral bodies toward the convexity of the curve • primarily involves bony deformity • may either be idiopathic (65%) or acquired • managed through surgery or use of braces

scoliosis

preoperative care • introduce deep-breathing exercises and incentive spirometry to increase lung function postoperatively to children • explain what they can expect after surgery (pain, fatigue, and feeling “not themselves”)

scoliosis

preoperative care • in some instances, a child may receive postoperative care on a stryker frame. if so, introduce a frame preoperatively. • a nasogastric tube is inserted prior to surgery to prevent abdominal distention. major surgery may cause paralytic ileus and lack of bowel tone.

scoliosis

postoperatively care • do not bend the back once rods are in place and the spinal fusion has been done. • tape the hatch of the bed in place or unplug electric controls so that the bed cannot be raised by accident by the parent or any uninformed

auxiliary personnel. • let the child lie flat after surgery.

scoliosis

postoperative care • position to side lying every two hours to enhance respiratory status unless segmented rod was used • perform neurovascular assessment of lower extremity every 2 hours • record the vital signs carefully • keep the child on npo status until bowel sounds return.

disorders of the skeletal muscles duchenne muscular dystrophy

• the most common type of muscular dystrophy characterized by progressive symmetric wasting of the leg and pelvic muscles • associated muscle weakness produces a waddling gait and pronounced lordosis • the onset of symptoms is at 2-7 years old and on the average at 4-5 years old. • young boys are asymptomatic until 3-6 years old.

duchenne muscular dystrophy

• male is more affected than females (9:1) • the primary causes of death are cardiac and respiratory failure. • characterized by macroglosia, (+) gower’s sign, tip-toeing, intellectual impairment in 30% of cases, wheelchair dependency by 9-10 years old, lumbar lordosis with protuberant abdomen, (+) waddling gait, and trendelenburg sign and gait.

duchenne muscular dystrophy

stage 1 (patient still ambulatory) • confirm diagnosis. refer to a genetic counselor when carrier status is detected. • do routine nursing care. immunization, dental care, etc., • maximize self-care as long as possible • encourage social activities, hobbies, education • encourage ambulation for as long as possible to prevent contractures • implement an exercise program

duchenne muscular dystrophy

stage ii (patient in wheelchair mobility) • selection of appropriate wheelchair • maintain maximum ability for self-care for a s long as possible • plastic body jacket (custom made) • stabilize spine with plastic body jacket • assist in pulmophysiotherapy • facilitate ventilation and clearing of secretions. • assist in postural drainage, chest percussion, suctioning. • teach the client and family on the use of assistive device and equipment

duchenne muscular dystrophy

stage iii (totality dependent patient) • maintain activities that patient are still capable of doing • perform general nursing care • perform assisted ventilation.

fracture

injuries of the extremities

• a traumatic injury to a bone in which the

continuity of the bone tissue is broken • most common injury in children • fat embolism may occur as complication • management include traction, casting, closed reduction and plaster immobilization nursing management: • care of the cast, traction • reassure and calm the child and parents

sprain and strain

• sprain: an over stretching or tearing of ligaments or tendons or both secondary to joint trauma • strain: an injury to the muscle nursing intervention: • r- rest i- ice • i – ice c- compression • c- compression e- elevation • e – elevation s- support

head trauma skull fractures

• a break in the continuity of the skull caused by forceful trauma which may occur with or without damage to the brain • classified as linear, comminuted, depressed and basilar nursing intervention: • stabilize the neck with a brace until cervical trauma has been ruled out. • assess neurologic function at frequent interval to detect increased intracranial pressure.

• assess vital signs to detect changes in these areas and observe the child’s pupils to be certain that they are equal and they react to light.

concussion

• a temporary injury from a hard jarring shock types: • coup injury (direct injury of anterior brain) • countercoup injury (injury resulting from the recoil and striking of posterior brain to posterior skull) manifested by: irrational behavior (frontal lobe), complete loss of consciousness (if severe), temporary amnesia (temporal lobe) and temporary loss of neurologic function without apparent structural damage

contusion

• a more severe injury in which the brain is bruised, and with possible surface hemorrhage. manifested by: • abnormal motor function, abnormal eye movements, and elevated icp

subdural hematoma

• venous bleeding into the space between the dura and the arachnoid membrane • more often occurs in infants than in older children • occurs when the head trauma lacerates minute veins in this area • symptoms which include anemia, seizures, vomiting and increased icp may occur three days after the trauma or for as long as after 20 days • management: includes subdural puncture in infants and surgery in older children.

epidural hematoma

• bleeding into the space between the dura and the skull • usually results from the rupture of the middle meningeal artery • manifested by decorticate posturing, unequal pupilary dilation or constriction, convulsions, hemiparesis and loss of consciousness • management: includes surgical removal of accumulated blood or cauterization of torn artery.

intracerebral hemorrhage

• bleeding into the substance of the brain • commonly seen in head injuries due to missile injuries or bullet wounds, stab injury • results from intracranial tumors, leukemia, aplastic anemia, and thrombocytopenia and complication of anticoagulant therapy. • onset may be insidious, beginning with the development of neurologic deficits followed by headache. • management: includes control of icp, administration of fluids and electrolytes and antihypertensive drugs

abdominal trauma

• generally non-penetrating and occurs from a direct blow to the abdomen from an object such as baseball bat or an automobile dashboard. • the most frequently injured organs are spleen and liver.

nursing intervention: • monitor iv line. • administer pneumococci vaccine to prevent pneumococci infections. • provide post surgical care for the clients after a splenectomy.

near drowning

• drowning: death due to suffocation from submersion of liquid • near drowning: submersion injury requiring emergency treatment with recovery within 24hour post-injury • management: includes cpr, mechanical ventilation, administration of 100% 02, administration of plasma and insertion of nasogastric tube to decompress the stomach.

poisoning

• intake of a substance that causes illness, injury, or death • occurs most commonly in children between 3 and 12 years old • common agents in childhood poisoning include soap, detergent or cleaner, and plants. • before administering an emetic, call a poison control center to make certain that vomiting is desirable. unless the poison is caustic, corrosive, or a hydrocarbon, vomiting is the most effective way to remove the poison from the body, more effective than lavage.

poisoning

nursing management • empty mouth of pills, plant parts, other materials • flush eyes continuously with normal saline for 1520 mins. • flush skin and wash with soap and soft cloth

• remove contaminated clothes • bring a victim of an inhalation poisoning into fresh air • identify the poison • be alert to signs and symptoms of potential poisoning in the absence of other evidence • call poison control center or other emergency facility

poisoning

nursing management • remove poison and prevent absorption • induce vomiting: administer ipecac if ordered • 6-12 mos = 10 ml; do not repeat • 1 -12 yrs =15 ml; rpt dosage once if vomiting does not occur within 20 min • do not induce vomiting if: • victim is comatose, in severe shock, or convulsing or has lost gag reflex • poison is a low-viscosity hydrocarbon • place the child in side-lying, sitting or kneeling position with head below the chest to avoid aspiration

frostbite

• a tissue injury caused by extreme cold resulting to peripheral vasoconstriction • classified according to the degree of damage (1st erythematous to 4th –narcotic) • analgesics may address the pain and epidural anesthesia is used if the feet are involved.

frostbite

nursing management: • assess body temperature to diligently defect early

symptoms of infections. • apply dressing as necessary to avoid secondary bacterial contamination of a necrotic injury site.

bites

• an injury that is caused by an animal or insect puncturing or tearing the skin with teeth, fangs, or mouthparts management: focuses on the isolation of the extremity and removal of any venom. nursing management • use rubber suction cups to remove venom. • urge the child to lie quietly to slow circulation • apply a cold compress to slow the spread of the venom and to reduce the formation of edema.

burn trauma burn

thermal • most common burn, which usually results from contact with flame or hot liquid chemicals • infection is the most common cause of death. • the extent of the injury depends on duration and intensity of the heat exposure. • superficial partial thickness burn: heals in 7 to 21 days • deep partial thickness burn: heals in 3-5 weeks • full thickness burn: not capable of reepithelialization and grafting to close the wounds. electrical

burns

• the most devastating type of burn which is associated with systemic complications • symptoms of cns injury may be late onset within one month or as late a three years post-injury, so long term follow-up is needed • management: includes homograft; debridement, escharotomy and fasciotomy.

burns

nursing intervention: • comfort management • care of the burn wound (cleansing, debriding, and applying topical medications and dressings to the burn wounds) prevention of complications: • maintain the body temperature through warmed solutions, linens, occlusive dressings, heat shields, radiant warmer and warming blankets • monitor for symptoms of wound infection, generalized sepsis or bacterial pneumonia. • reposition the child frequently.

nursing process

assessment • weight loss • dehydration • poor skin turgor • metabolic alkalosis • electrolyte imbalance • diarrhea and vomiting • dry mucous membrane

nursing diagnoses

• altered nutrition, less than body requirements, related to malabsorption of necessary nutrients • altered nutrition, less than body requirements,

• • •

related to interference with establishing parentinfant bond risk for fluid deficit altered family process related to chronic illness in child self-esteem disturbance related to feelings of being different resulting from special dietary restrictions

nursing intervention

• monitor input and output

• determine serum electrolyte levels • give appropriate nutrition management.

dehydration

• excessive body fluid loss. • may result from a number of diseases (diabetic ketoacidosis, gastrointestinal infections) and extensive burns • may be classified as isotonic, hypotonic or hypertonic dehydration

diarrhea

• the frequent passage of loose, watery stools • major cause of infant mortality • results from disorders involving digestive, absorptive, and secretory functions • caused by abnormal intestinal water and electrolyte transport • the most common viral pathogens are rotaviruses and adenoviruses • most common bacterial pathogens are campylobacter jejuni, salmonella, giardia lamblia, and clostridium difficile

constipation

• alteration in the frequency, consistency and ease of passing stool • may arise secondary to a variety of organic disorders of the g1 tract or wide range of systemic disorders • majority of children have idiopathic or functional constipation

vomiting

• the forcible voluntary or involuntary emptying of the stomach contents through the mouth • the primary cause is either viral or bacterial invasion of the gastrointestinal tract. • management: includes oral rehydration, iv therapy and administration of antiemetics.

gastroesophageal reflux (ger)

• backflow of gastric contents into the esophagus as a result of relaxation or incompetence of the lower esophageal or cardiac sphincter • may be associated with hiatal hernia

gastroesophageal reflux (ger)

nursing intervention • place client in head-elevated position following feedings and at night. • provide small, frequent feedings to decrease the amount of regurgitation • for infants, thicken formula by adding 1 table spoon of rice cereal per 6 ounces of formula and crosscut the nipple;

• for toddlers, feed solids first, followed by liquids • instruct parents to avoid feeding the child fatty foods, chocolate, tomato products, carbonated liquids, fruit juices, citrus products, and spicy foods.

pyloric stenosis

• hypertrophy of the circular muscles of the pylorus which causes narrowing of the pyloric canal between the stomach and the duodenum • usually develops in the first few-weeks of life nursing intervention: preoperative • administer iv fluid to correct electrolyte imbalance, dehydration and starvation, preoperatively • withheld oral feedings to prevent further electrolyte depletion

hepatitis

• an acute or chronic inflammation and infection of her liver types • hepatitis a • mode of transmission: ingestion of locally contaminated water or shellfish • hepatitis b • mode of transmission :transfusion of contaminated blood and plasma or semen • inoculation by a contaminated syringe or needle through intravenous drug use • spread to fetus if mother has infection in third trimester of pregnancy

hepatitis

• hepatitis c • mode of transmission: parenteral route • hepatitis d • occurs in children already infected with hbv • hepatitis e • uncommon in children • hepatitis g • uncommon in children • blood borne and is similar to hcv • high-risk groups include transfusion recipients, iv drug users, and individuals infected with hcv

intussusception

• invagination of one portion of the intestine into another • a surgical emergency that occurs between 3 months and 5 years nursing intervention: • preoperative • keep infants on npo status before surgery or non-surgical reduction • monitor laboratory results (cbc, urinalysis)

intussusception

nursing intervention: • preoperative • monitor the stool, inform the physician of the passage of normal brown stool to allow the change of therapeutic plan. • monitor for signs of electrolyte imbalance, hemorrhage, or peritonitis and manage accordingly. • if non-surgical reduction is done, keep child on

npo for a few hours then graduate to regular feeding

intussusception

• postoperative • monitor the vital signs, blood pressure, intact sutures and dressing, and return of bowel sounds. • observe the passage of barium or water-soluble contrast material and stool patterns for 24 hours to know if there is recurrence of intussusception.

volvulus

• an abnormal twisting of the digestive tract which leads to partial or complete obstruction and a reduction in blood supply • management includes surgery

necrotizing enterocolitis

• acute inflammation of the small and large intestine caused by clostridium perfringens • results from ischemia or poor perfusion of blood vessels in sections • risk factors: immaturity, history of anorexia or shock, enteral feedings and infections • management: includes iv or total parenteral nutrition and surgery.

appendicitis

• inflammation of the appendix which may lead to peritonitis and sepsis

• results from obstruction of the lumen of the appendix by hardened fecal material, foreign bodies, microorganisms and parasite • most common cause of abdominal surgery in children

appendicitis

nursing intervention • preoperative • keep infants on npo status. use of analgesics, cathartics and heat are contraindicated • obtain urine sample for urinalysis and blood sample for cbc • initiate iv fluid therapy with electrolytes as ordered

appendicitis

nursing intervention • postoperative • observe for possible signs of infection • maintain the iv fluid until they can take adequate oral feedings • for ruptured appendix, iv fluid and antibiotic therapy are continued until full bowel function is restored.

meckel’s diverticulum

• a small, naturally occurring, outward profusion of the inner lining of the small intestine through the muscular wall • most common congenital malformation of the gi tract • may cause intussusception • managed through surgery

celiac disease

• sensitivity or immunologic response to protein, particularly the gluten factor found in grains • results in the accumulation of glutamine, which is toxic in intestinal mucosal cells and the inability to absorb fats • occurs most often between the ages of 1 and 5 years • management includes gluten-free diet and substituting corn, rice and millet as grain sources and minerals and vitamin supplements.

hernia

• a protrusion of the bowel through an abnormal opening in the abdominal wall • usually occurs at the umbilicus and through the inguinal canal • danger occurs when the organ protruding through the opening is constricted to the extent that circulation is impaired or the function of other structures are affected • managed: through surgery to return the bowel to the abdominal cavity

hernia

nursing intervention • keep the suture line dry and free from urine or fecal matter to prevent infection. • assess circulation in the leg on the side of the surgical repair

hirschprung’s disease (congenital aganglionic megacolon)

• absence of ganglionic innervations in the rectum and upward in the colon leading to absence of peristaltic waves • leads to mechanical obstruction from the inadequate motility in an intestinal segment • may be familial congenital defect or may be associated with other anomalies, such as down syndrome and genital urinary abnormalities • occurs more often in males than in females • results to chronic constipation (ribbon-like stools)

hirschprung’s disease

nursing intervention: • preoperative • provide a low-residue diet, stool softener and vitamin supplements to improve the child’s condition • administer enemas to achieve bowel movements. use normal saline not tap water.

hirschprung’s disease

nursing intervention: • postoperative • observe for abdominal distention • assess bowel sounds • observe for passage of flatus and stools • administer antibiotic solution or saline, as prescribed, to reduce the possibility of infection • offer small frequent feedings of fluid as soon as nasogastric tube is removed. change diet gradually from fluid to soft to minimal residue diet and to normal diet.

inflammatory bowel disease

• involves the development of ulceration of the mucosa or submucosa layers • occurs most frequently in young adults and adolescents • probable cause is the alteration in immune system response or autoimmune processes

inflammatory bowel disease

• crohn’s disease: chronic inflammatory disease of the lower intestinal tract • ulcerative colitis: inflammation of the walls of the bowel accompanied by the formation of ulcers • management: includes enteral or parenteral nutrition, high protein, carbohydrate and vitamin diet, anti-inflammatory drugs, immunosuppressant drugs, colectomy followed by an ileoanal pull-through, and colostomy or ileostomy

disorders caused by food, vitamin, and mineral deficiencies kwashiorkor

• caused by protein deficiency • may also occur after weaning, when children change from breast milk to a diet consisting mainly of carbohydrate • management: includes high-protein diet, oral dehydration, antibiotics and antidiarrheals and iv fluids and electrolytes

• • • • •

marasmus

a form of starvation caused by deficiency of all food groups commonly seen in developing countries usually occurs in infants younger than 1 year old managed: through adequate nutrition rich in nutrients, oral dehydration , antibiotics, antidiarrheals and iv fluids and electrolytes

iodine deficiency

• may lead to hyperplasia of the thyroid gland (goiter) • occur most commonly in girls at puberty and during pregnancy • management: includes supplemental iodine or synthetic thyroxine and diet with adequate iodine content.

cardiovascular disorders cardiovascular disorders

assessment • chest discomfort (angina pectoris, valvular heart disease) • fatigue (earliest symptom associated with several cardiovascular disease) • shortness of breath or dyspnea (left ventricular failure or congestive heart failure) • edema and weight gain (isolated right ventricular failure or congestive heart failure) • dizziness and syncope (postural hypotension, dysrhythmias< vasovagal effect, cerebrovascular disorders)

cardiovascular disorders

nursing interventions: • monitor input and output • observe respiratory status • determine serum electrolyte levels • monitor foe development of rales or crackles • other nursing care that would answer the nursing diagnoses

congenital heart diseases

• usually caused by the failure of a heart structure to progress beyond an early stage of embryonic development • conditions such as valvular aortic stenosis, coarctations of the aorta. tetralogy of fallot, and transposition of the great vessels occurs more often in males • maternal rubella is associated with defects such as patent ductus arteriosus, pulmonary or aortic stenosis, atrial septal defects, venticular septal defect, or pulmonary stenosis. • atrial septal defect and ventricular septal defect tend to be familial

old classification

• cyanotic (deoxygenated blood to oxygenated blood or right-to-left shunt) • acyanotic (oxygenated to unoxygenated blood or left-to-right shunt) • note: this classification system leads to difficulties because children with acyanotic defects might be pink in color with manifestations of heart failure.

new classification defects with increased pulmonary blood flow

ventricular septal defect (vsd)

• characterized by one or more abnormal openings in the septum separating the ventricles. • the most common of all congenital cardiac defects (25% of all congenital heart disease or about 2 in every 1000 live births) • about 60% of small ventricular septal defects close spontaneously • management: includes cardiac catheterization and open heart surgery

atrial septal defect (asd) • an abnormal communication between the two atria • occurs more frequently in girls than in boys • blood flow is from left to right (oxygenated to deoxygenated) because of the stronger contraction of the left side of the heart. this increases the volume in the right side of the heart and generally results in ventricular hypertrophy and increased pulmonary blood flow. • management: includes open heart surgery and interventional cardiac catheterization

atrioventricular canal defect (endocardial cushion defect)

• a cardiac defect resulting from the failure of the endocardial cushions in the embryonic heart to fuse and form the atrial septum.

• about 1 in 9 children with down syndrome has this type of congenital cardiac defect • blood may flow between all four heart chambers • managed through surgery and prophylactic anticoagulation and antibiotic therapy

patent ductus arteriosus (pda)

• an abnormal opening between the pulmonary artery and the aorta caused by failure of the ductus arteriosus to close after birth due to stimulation by prostaglandins • managed: through the surgical ligation of defect and indomethacin therapy

obstructive defects pulmonic stenosis

• the narrowing of the pulmonary valve or the pulmonary artery just distal to the valve • accounts for 25% to 35% of congenital heart anomalies • inability of the right ventricles to evacuate blood by way of the pulmonary artery leads to right ventricular hypertrophy. • surgery is postponed until 4 to 5 years old. • managed: through continuous iv infusion of pge1 and cardiac catheterization

aortic stenosis

• the stricture of the aortic valve which prevents the blood from passing freely from the left ventricles into the aorta. • accounts for about 5% of congenital cardiac abnormalities

• leads to hypertrophy of the left ventricle • managed: through balloon angioplasty or replacement

coarctation of the aorta

• narrowing of the lumen of the aorta due to a constricting band • may either be infantile or preductal or postductal • management: includes continued antihypertensive therapy, graft of transplanted subclavian artery and angiography.

tricuspid atresia

• the tricuspid valve is completely closed allowing no blood to flow from the right atrium to the right ventricles. • managed: through surgery

tetralogy of fallot

• consists of four defects namely pulmonary stenosis, ventricular septal defect, dextroposition of the aorta and hypertrophy of the right ventricle • occurs in about 10% of children with congenital cardiac disease • may cause complications such as embolism, cerebrovascular accident and thrombophlebitis

clinical consequences of congenital heart disease • congenital heart failure (chf)

• inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures causes: • secondary to structural abnormalities • myocardial infarction • excessive demands on normal heart muscles

acquired heart diseases rheumatic heart disease

• damage to the heart valves which occurs as a sequel of rheumatic fever. • the course of rheumatic is 6-8 weeks. • often follows an attack of pharyngitis, tonsillitis, scarlet fever, “step throat” and impetigo. • occurs most often in children 6 to 15 years of age, with peak incidence at 8 years • seen most often in low-socioeconomic, crowded places,and urban areas • managed through mitral valve replacement

endocarditis

• the inflammation and infection of the endocardium or valves of the heart • occurs as a complication of a congenital heart disease such as tetralogy of fallot, ventricular septal defect, or coarctation of the aorta • caused by streptococci (viridans var) • vegetative process more commonly occurs on left side of heart • managed: with antibiotic therapy and oral surgery for children with chd

vascular dysfunction kawasaki disease

• an acute systemic vasculitis caused by a retrovirus

with the cardiovascular system as the primary area of involvement • occurs almost exclusively in children before the age of puberty • management: focuses on the reduction of the immune response (gamma globulin) and platelet aggregation (salicylic acid)

toxic shock syndrome

• characterized by inadequate tissue perfusion to meet the metabolic demands of the body • may result to cellular dysfunction and organ failure • caused by staphylococcus aureus • occurs predominantly in previously healthy women during their menstrual periods • observed primarily in women who use tampoons • management includes the use of vasodilators, catecholamine, corticosteroids, calcium chloride, and sodium bicarbonate.

cardiopulmonary arrest

• acute emergency • cessation of the heart function as a result of anoxia in the heart muscles due to respiratory failure • other causes include airway obstruction, trauma, anaphylactic allergic reactions, cns depression, drowning and electrocution. • characterized: by the absence of audible heart sounds or pulses and blood pressure reading • management: includes resuscitation, administration of epinephrine, lidocaine and atropine via iv or endotracheal tube.

hematologic dysfunction hematologic disorders

assessment • skin pallor, petechiae, bruising • lethargy • frequent infections • bleeding that is difficult to control • diagnostic tests include cbc, test for iron, coagulation and immune system status

nursing diagnoses: • knowledge deficit related to cause of illness • altered nutrition: less than body requirement • anxiety related to frequent blood sampling procedures • pain related to tissue ischemia • family coping, compromised, ineffective related to long-term care needs of child with chronic hematological disorder

hematologic disorders

nursing intervention: • use individual distraction techniques to help child deal with pain and anxiety. • help with blood sampling, blood or marrow transfusion • educate the parents with proper nutrition specially the need for iron-rich foods. • manage pain from venipuncture or finger stick

disorders of the red blood cells anemia

• a condition wherein the number of rbcs and/or hemoglobin (hgb or hb) concentration is reduced

below normal level • the oxygen carrying capacity of the blood is diminished causing a reduction in the oxygen available to the tissues. • the most common hematologic disorder of infancy and childhood

anemia

types: • normochromic and normocytic anemia • marked by impaired production of erythrocytes by the bone marrow or by abnormal or uncompensated loss of circulating red blood cells such as in acute hemorrhage • hypochromic anemias • inadequate hemoglobin synthesis leading to hypochromia and reduction in the diameter of the cells like in iron-deficiency anemia

types: • macrocytic (megaloblastic anemia) • characterized by abnormally large, immature and nucleated rbc • observed in conditions such as anemia due to folic acid deficiency and pernicious anemia (vitamin b12 deficiency) • hemolytic anemia • decreased erythrocytes due to increased destruction resulting from abnormal structure (sickle-cell anemia) or from extracellular destructive forces (autoimmune acquired hemolytic anemia) thalassemia • associated with abnormalities of the beta chain of

adult hemoglobin (hgba) • types: • thalassemia minor (heterozygous) • thalassemia major (homozygous) polycythemia • an increase in the number of red blood cells that results as a compensatory response to insufficient oxygenation of the blood • may result to cerebrovascular accident or emboli • the risk increases if the child becomes dehydrated (fever or during surgery)

disorders of the white blood cells

neutropenia

• reduced number of wbc which may be due to response to drugs or nonpyogenic infections • neutrophilia • increased number of circulating wbc primarily neutrophil is in response to infection or inflammation • leukemia • uncontrolled proliferation of wbc • eosinophilia • increased number of eosinophils associated with allergic reaction caused by parasitic and atopic dermatitis • lymphocytosis • increased number of lymphocytes

disorders of homeostasis

disseminated intravascular coagulation (dic) • an imbalance between clotting activity and fibrinolysis in response to disease or injury hemophilia - deficiency of a blood coagulation factor • hemophilia a (factor viii deficiency, von

willebrand’s disease • hemophilia b (christmas disease, factor ix deficiency) • hemophilia c (factor xi deficiency)

disorders of homeostasis

purpuras • hemorrhagic rashes occuring in the superficial layer of the skin • types: • idiopathic thrombocytopenic purpura • results from decreased circulating platelets even in the presence of adequate megakaryocytes • henoch-schönlein syndrome • caused by increased vessel permeability

respiratory disorders respiratory illness in children

physical assessment: • cough • rate and depth of respirations • retractions • cyanosis • clubbing of fingers • adventitious sounds • chest diameters

respiratory illness in children

laboratory tests: • pulse oximetry • blood gas studies • nasopharyngeal syncytial virus nasal washings • sputum analysis diagnostic procedures: • chest x-ray • bronchography

respiratory illness in children

nursing care: • expectorant therapy • oral fluid • liquefying agent • metered-dose inhalers • nebulizers • effective coughing • chest physiotherapy • mucus–clearing device

respiratory illness in children

therapy to improve oxygenation: • oxygen administration • pharmacologic therapy • nasal sprays • corticosteroid • antihistamines • expectorants • bronchodilators • incentive spirometry • breathing techniques • tracheostomy

common upper respiratory tract disorders choanal atresia

• a congenital obstruction of the posterior nares by an obstructing membrane or bony growth • may be unilateral or bilateral • presence of signs of respiratory distress at birth

acute nasopharyngitis (common cold)

• caused by one several viruses, most predominantly by rhinovirus, coxsackle virus, respiratory syncytial virus, adenovirus, parainfluenza and influenza viruses. • stress factors also appear to play a role in susceptibility. • characterized by dehydration, watery rhinitis, nasal congestion and low grade fever

pharyngitis

• inflammation of the pharynx • may be caused by virus or group a beta hemolytic streptococcus • characterized by fever, sore throat, enlarged regional lymph nodes and erythematous pharnyx

tonsillitis

• infection and inflammation of the palatine tonsils • adenitis refers to infection and inflammation of the adenoid (pharyngeal) tonsils. • characterized by fever, halitosis, drooling, lethargy and enlarged and bright red tonsillar tissues

epistaxis

• bleeding from the nose caused by direct trauma, mucosal inflammation secondary to allergy or urt infection

sinusitis

• inflammation of the membrane lining a sinus of the skull • occurs as a secondary infection (staphylococcal, streptococcal, or haemophilus influenza) in older children • characterized by fever, headache, purulent nasal discharge and tenderness over the affected sinus

laryngitis

• inflammation of the larynx • may occur as a spread of pharyngitis or from excessive use of the vocal cords • characterized by brassy voice or inability to make audible sounds

croup (laryngotracheobronchitis)

• inflammation of the larynx, trachea and major bronchi • caused by viruses: parainfluenza (6 months-3 years old) and heamophilus influenza (3-6 years old) • characterized by barky/seal cough, inspiratory stridor and marked retraction at night

epiglottitis

• inflammation of the epiglottitis caused by bacteria (h. influenzae, streptococci, pneumococci and staphylococci) and echovirus (rsv) • occurs most frequently in children from 3 to about 8 years of age • characterized by high fever, dysphagia, stridor and drooling

aspiration

• the inhalation of a foreign object into the airway • characterized by hard, forceful cough and choking

bronchial obstruction

• an aspirated foreign object occludes the bronchi (right-more common) of children younger than 2 years old • may cause atelectasis, hyperinflation and pneumothorax • characterized by violent cough, dyspnea and hemoptysis

common lower respiratory tract

disorders bronchitis

• inflammation of the major bronchi and trachea • causative agents include influenza viruses, adenovirus and mycoplasma pneumonia, among others • symptoms may last for a week and full recovery takes as long as 2 weeks • clinical manifestation: includes nasal congestation, audible coarse rales, fever, alveolar hyperinflation and dry, hacking cough

bronchiolitis

• the inflammation of the fine bronchioles and small bronchi • occurs most often in children younger than 2 years of age, with peak incidence at 6 months of age • precipitates the development of asthma later in life. • caused by viruses, such as adenovirus, parainfluenza virus, respiratory syncytial virus (rsv) • clinical manifestations: include mild fever, atelectasis, nasal flaring and increased respiratory rate • • •

asthma

the chronic inflammatory disease of the airways an immediate hypersensitivity response commonly caused by physical and chemical irritants such as foods, pollens, dust mites,

cockroaches, smoke, animal dander, temperature, respiratory infection, activities, and stresses • can precipitate a late bronchial obstructive reaction several hours after the initial exposure

asthma

• characterized by: hypoxemia, exacerbations, ventilatory failure and asphyxia, hacking, irritable, nonproductive cough, restlessness, apprehension and diaphoresis, dark red color of lips which may progress to cyanosis of nail beds, episodes of wheezing, breathlessness, dyspnea, chest tightness, and cough at night and/or early morning

pneumonia

• the inflammation of the pulmonary parenchyma caused by virus, mycoplasmal agents, bacteria, or the aspiration of foreign substances

types: • viral pneumonia • characterized by diminished breath sounds, lowgrade fever nonproductive cough, fine rales and diffused infiltrated areas • primary atypical pneumonia • characterized by fever, chills, anorexia, headache, malaise, and muscle pain, rhinitis, sore throat, and nonproductive cough to seromucoid sputum then blood-streaked types:

pneumonia

• bacterial pneumonia • characterized by acute onset of fever, hacking and nonproductive cough and diminished breath sounds or scattered crackles • viral pneumonia occurs more frequently than bacterial from. • primary atypical pneumonia (mycoplasma pneumoniae) is the most common cause of pneumonia in children between the ages of 5 and 12 years. • occurs primarily in the fall and winter months and is more prevalent in crowded living conditions

tuberculosis

• a chronic granulomatous infection • caused by mycobacterium tuberculosis and mycobacterium bovis transmitted through the inhalation of droplets from an individual with tb or ingestion of unpasteurized milk. • usually asymptomatic, but may develop symptoms such as malaise, fever, cough, weight loss, anorexia, and lymphadenopathy. • isoniazid (inh), rifampin (rifadin), ethambutol and pyrazinamide are used for treatment.

cystic fibrosis

• a chronic multisystem disorder due to autosomal recessive trait causing exocrine gland dysfunction • thick mucus produced by the exocrine gland obstructs small passageways of the affected organs. • common symptoms include pancreatic enzyme deficiency, progressive chronic lung disease

associated with infection, and sweet gland dysfunction resulting in increased sodium and chloride sweat concentrations.

atelectasis

• the collapse of lung alveoli which occurs in children as a primary or a secondary condition • types: primary (failure of the lungs to expand at birth) and secondary (developed secondary to rt obstruction) • manifested by low apgar score, asymmetry of the chest, respiratory grunt and cyanosis, decreased breath sounds on the affected side, irregular respiration with nasal flaring and apnea and hypotonic and flaccid pressure in respiratory tract.

pneumothorax

• the presence of atmospheric air in the pleural space which causes the collapse of alveoli • characterized by mediastinal shift of apical pulse, absent or decreased breath sounds, tachypnea, grunting respiration and cyanosis.

sudden infant death syndrome

• unexpected death of an apparently healthy infant under 1 year for which a through autopsy fails to demonstrate an adequate cause of death • occurs most frequently during winter • occurs during sleep • most frequently occurs from 2 to 4 months of life

sudden infant death syndrome

• more observed in males

• the risk factors include maternal smoking and or/substance abuse, prematurity, fetal cns problems and sleep risks • manifestations include frothy, blood-tinged fluid in the nose and mouth and apneic, blue and lifeless infant

excretory disorders

children with renal disorders

assessment • weight loss • edema • dehydration and vomiting • poor skin turgor • metabolic alkalosis • electrolyte imbalance

children with renal disorders

nursing diagnoses: • risk for fluid and electrolyte imbalance • altered family process related to chronic illness in child • altered parenting related to interference with establishing parent-infant bond • altered nutrition, less than body requirements, related to malabsorption of necessary nutrients • self-esteem disturbance related to feelings of being different resulting from special dietary restrictions

children with renal disorders

nursing intervention: • monitor input and output • determine serum electrolyte levels • give appropriate nutrition management • compare current weight with past weight measurements

• other nursing care that would answer the nursing diagnoses

congenital disorders of the renal or urinary tract cryptorchidism

• occurs when one or both testes fail to descent through the inguinal canal into the scrotal sac • managed through surgical correction

hypospadias

• congenital defects involving abnormal placement of the urethral orifice of the penis • corrected through surgery preferably between 1618 months

infections of the urinary system and related disorders urinary tract infection (uti) • an infection of one or more structures in the urinary system such as urethra, bladder, and ureters, renal pelvis, calyces and renal parenchyma • occurs most often in preschool girls • most urinary pathogens are gram-negative rodsescherichia coli • characterized by hematuria,proteinuria ,painful ,frequent urination with burning sensation, low grade fever, mild abdominal pain , and enuresis (cystitis), high fever , abdominal or flank pain , vomiting, and malaise (pyelonephritis)

• managed through antibiotic therapy and increased fluid intake

vesicoureteral reflux

• retrograde flow of urine from the bladder into the ureters because of defective value that guards entrance from the bladder to the ureter • occurs due to scarring from repeated uti’s bladder pressures or ureters that are implanted at abnormal sites or angels • management includes prophylactic antibiotic therapy and laparoscopic surgery

hydronephrosis

• enlargement of the pelvis of the kidney with urine as a result of backpressure in the ureter • occurs at any age, most often in the first 6 months of life • surgical correction must be done before glomerular or tubular destruction occurs

disorder affecting normal urinary elimination

enuresis • involuntary discharge of urine especially while asleep • usually occurs at 5-7 years • may be nocturnal, diurnal, or both

disorders of altered kidney function glomerulonephritis

• an inflammatory disease affecting the clusters of capillaries in the cortex of a kidney • destruction, inflammation, and sclerosis of the glomeruli of both kidneys occur • usually caused by immunological diseases,

autoimmune diseases, streptococcal infection (group a beta-hemolytic)

glomerulonephritis

types: • acute (occur 2-3 weeks after streptococcal infection) • chronic (occurs after the acute phase) management includes administration of antihypertensive, diuretic, antibiotics and anticonvulsaant as prescribed

nephrotic syndrome

• a group of symptoms caused by the excretion of large amount of protein in the urine due to kidney impairment • characterized by low levels of albumin and high levels of cholesterol and lipids in the blood • management includes antibiotic therapy, loop diuretics and corticosteroid therapy.

polycystic kidney

• an abnormal condition in which the kidneys are enlarge and contain many cysts • inherited as autosomal recessive trait • management includes surgical removal of affected kidney and kidney transplant

renal failure

• inability of the kidneys to excrete waste, concentrate urine and conserve electrolytes types: • acute (occurs suddenly due to inadequate perfusion, kidney disease or urinary tract obstruction) • chronic (results from chronic renal disease)

• management includes diuretics, dialysis, and kidney transplant

neurologic disorders neurologic disorders

assessment • mother’s pregnancy history • child’s developmental milestones and ability to perform age-appropriate tasks: • denver developmental screening test for the preschool child • school performance for the older child

neurologic examination

• cerebral function • general cerebral functions: level of consciousness, intelligence, performance, mood, and general behavior. • specific cerebral functions: stereognosis, grasphesthesia. kinesthesia. • cranial nerve function • assess each pair of cranial nerves separately • cerebellar function • test for balance and coordination are romberg test, tandem walk, finger to nose test, and past pointing test

neurologic examination

• motor function • compare the size of the extremities on each side • feel muscles for tone. move the extremities through passive range of motion • evaluate symmetry, spasticity, and flaccidity bilaterally • sensory function • distinguishing light touch, pain, vibration, and temperature for intact sensory system

• reflex testing (see stages of growth and development of the child)

neurologic disorders

diagnoses: • risk for disuse syndrome related to neurologic deficit affecting one area of functioning • altered family processes related to stress associated with the long-term effects of the neurologic dysfunction

neurologic disorders

nursing intervention: • let the child’s family discuss fears about the child’s illness • provide immediate preoperative and postoperative care and long-term care (rehabilitative and home care) if the child undergoes surgery.

increased intracranial pressure

• a sign that may occur with many neurologic disorders, such as increased csf volume, cerebral edema, or space-occupying lesion such as tumors • etiology • infection • brain tumor • head trauma • birth trauma or hydrocephalus • clinical manifestations include increased head circumstance, changes in the fontanel, eyes, vital signs; vomiting; pain; and altered consciousness • management includes barbiturates, osmotic diuretics and corticosteroids

cerebral palsy

• a group of non-progressive disorders of the upper

motor neuron that results in motor dysfunction types : • spastic type: (lesion in pyramidal tract which accounts for 50-60% of all cp) • dyskinetic type or athetoid type: (extrapyramidal tract lesion which accounts for 25-30% of all cp) • ataxic type: (cerebellar lesion which accounts for 5% of all cp) • mixed type (characterized by spasticity and athetoid movements)

cerebral palsy

types (based on topographic classification) • monoplegia • hemiplegia • quadriplegia or tetraplegia • diplegia • paraplegia or double hemiplegia clinical findings: include delayed motor development skills management: prevention of further complication and promote development of posture and movement control

meningitis

• the inflammation of the meninges due to bacterial invasion of haemophilus influenzae type b, neisseria meningitis (meningococcal meningitis), or group b streptococcus pneumoniae and diplococcus pneumoniae (pneumococcal meningitis) • usually seen in children between 1 month and 5 years

meningitis

• mode of entry: upper respiratory tract to the meninges • clinical manifestations: include papilledema, cranial nerve paralysis, convulsions and shock, fever, petechial skin rash and bulging fontanels, positive brudzinski’s and kernig’s sign • managed through antibiotic therapy

encephalitis

• inflammation of brain tissue • may arise from protozoan, bacterial, fungal, or viral invasion; direct csf invasion during lumbar puncture; mosquito-transmission and complication of common childhood diseases such as measles, mumps, and chickenpox • other viruses: arbovirus (togavirus) st. louis encephalitis and eastern equine encephalitis

reye’s syndrome

• a combination of acute encephalopathy and fatty infiltration of the internal organs that may follow acute viral infections • associated with the use of aspirin (asa) and nsaids during viral infection • usually affects 1 to 18 years of age

reye’s syndrome

• characterized: by lethargy, vomiting, blood ammonia levels, respiratory arrest and seizures leading to coma • management: includes administration of corticosteroids, mannitol and 10% or 15% dextrose.

guillain-barre syndrome

• aka inflammatory polyradiculoneuropathy

• a peripheral polyneuritis involving both motor and sensory nerves which occurs 1 to 3 weeks after a mild episode of fever • cause: unknown but suspected to be immunemediated • associated with viral infection • occurs in school-age children

guillain-barre syndrome

• characterized by impossible spontaneous respiration, peripheral neuritis after primary infection, muscle paralysis and paresthesia in leg, trunk and head, facial weakness and difficulty in swallowing (cranial nerve involvement), elevated csf protein level and denervation and decreased nerve conduction velocity

botulism

• a fetal form of food poisoning caused by an endotoxin produced by the bacillus clostridium botulinum • most common source of toxin: improperly sterilized home-canned foods • characterized by constipation, flaccid paralysis if the bulbar muscles that lead to diminished respiratory function, generalized weakness, hypotonia, listlessness, a weak cry, and a diminished gag reflex

poliomyelitis

• an infectious disease caused by one of the three polioviruses • transmitted from person to person through fecal contamination or oropharyngeal secretions types: • early/acute

poliomyelitis

• •

• characterized by fever, upper respiratory tract infection, g1 manifestations, joints and muscle pains, asymmetric muscle weakness intermediate/convalescent • characterized by atrophy, contractures and other complications late/residual

seizure disorders

• brief malfunctions of the brain’s electrical system • results from paroxysmal discharge in cortical neurons

febrile seizures

• one of the most common neurologic disorders in children • boys are more affected than females • cause is still uncertain • risk of neurologic deficit, epilepsy, mental retardation or altered behavior are observed

epilepsy

• a chronic seizure disorder with recurrent and unprovoked seizures causes: • idiopathic • acquired such as brain injury during prenatal, perinatal, or postnatal periods • classification: • partial • generalized

special senses eye disorders

stye (hordeolum) • a purulent infection of a sebaceous gland of the eyelid caused by a staphylococcal organism

conjunctivitis • the inflammation of the conjunctiva caused by viral or bacterial infections, allergy or environmental factors inner keratitis • inflammatory of the cornea which results when a foreign body strikes the cornea with an invading fungal, bacterial, or viral organism

congenital glaucoma

• an abnormal condition of elevated pressure within an eye caused by obstruction of the outflow of aqueous humor • increased eye globe size and pressure ultimately destroys the optic nerve. • progressive, usually bilateral • incidence rate: 1 per 30,000 births

cataract

• an abnormal progressive condition of the lens characterized by loss of transparency which is usually caused by trauma from eye injury and genetic predisposition • characterized by marked opacity of the lens, which may be present at birth or may become apparent in early childhood

cataract

types: • anterior - due to birth injury • edge - due to nutritional deficiency in intrauterine life • central - familial or due to prenatal rubella

hyperopia (farsightedness)

• inability of the eye to focus on nearby objects due to errors or refraction, in which light rays that enter the eye are brought into focus behind the retina

myopia (nearsightedness)

• inability of the eye to focus on far objects caused by elongation of the eyeball or by error of refraction such that parallel light rays are focused in front of the retina

astigmatism

• an abnormal condition of the eye characterized by blurring of vision in which the light rays cannot be focused clearly in a point on the retina and the spheric curve of the cornea or the lens is not equal to all meridians • visual discomfort occurs if the condition is not corrected

• • •

nystagmus

rapid, irregular eye-movement a symptom of an underlying disease condition there is a lesion of the cerebellum or a brain stem

amblyopia

• • •

reduced vision in the eye no obvious pathological or structural cause not correctable by a manifest refraction

color blindness

• inability to distinguish color of the spectrum clearly

disorder of the ears

otitis media • infection of the middle ear which occurs as a result of a blocked eustachian tube that prevents normal drainage • a common complication of an acute respiratory infection • usually caused by streptococcus pneumoniae and haemophilus influenzae

endocrine system disorders endocrine disorders

assessment: • health history • changes is mood • changes in appetite • nausea and vomiting • changes in sleep pattern • changes in elimination patterns • changes in growth (significant weight gain or loss) • increased or decreased sweating; cold or heat intolerance • visual disturbances (for pituitary tumors and pancreatic disorders)

endocrine disorders

assessment: • changes in activity pattern (inability to keep up

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with peers and delayed developmental milestones) family risk factors: family history of endocrine disorders in growth or development or both prenatal risk factors: maternal illness, use of substance or medications, poor nutrition, and intrauterine growth retardation personal risk factors: history of prematurity, viral illness, central nervous system trauma and chromosomal abnormalities

endocrine disorders

physical examination: • hair: brittle (hypothyroidism) • face: round with hair growth (cushing’s syndrome) • mouth: delayed dentition (hypocalcemia) • enlargement of anterior neck (goiter) • tachycardia (hyperthyroidism) • fingers: trembling (hyperthyroidism) • genitals: excessive growth- (adrenogenital syndrome; early growth- precocious puberty; delayed growth- hypopituitarism) • height and weight below 5th percentile

endocrine disorders

nursing diagnoses: • fear • altered body image • grief • altered family process • knowledge deficit • altered nutritional needs

endocrine disorders

nursing intervention: • monitor input and output • provide comfort measures • administer medications • let the required nutritional needs

• let the child’s family discuss fears about the child’s illness • provide immediate preoperative and postoperative care and long-term care (rehabilitative and home care) if the child undergoes surgery)

pituitary dysfunction hypopitutary dwarfism

• may either be due to congenital anomaly or the destruction of the anterior pituitary gland by tumor, histiocytosis, or chronic infection leading to decreased production of growth hormone

growth hormone deficiency

• decreased somatotropin resulting from nonmalignant cystic tumor or from the increased intracranial pressure due to other causes • characterized by high-pitched voice, infantile appearance of face, small nose and recessed mandible, delayed onset of genital growth and pubic, facial, and axillary hair and short but wellproportioned stature • managed through injection of growth hormone 2-3 times a week

hyperpituitarism

• gigantism a skeletal overgrowth due to excessive production of growth hormone. associated with acidophil cell hyperplasia or adenoma • acromegaly gradual bony thickening resulting from the stimulation of periosteal intramembranous growth. caused by acidophil adenoma

diabetes insipidus

• a metabolic disorder characterized by deficient production of anti-diuretic hormone or inability of the kidney tubules to respond to adh • may due to either a lesion, tumor or injury to the posterior pituitary or sex-linked recessive gene • characterized by polyuria, polydipsia and polyphagia, hyponatremia • surgery is performed to remove the tumor. administration of desmopressin is used to control idiopathic conditions

thyroid dysfunction hyperthyroidism

• a condition characterized by hyperactivity of the thyroid gland, secreting greater than normal amounts of thyroid hormone • characterized by tremor, fatigue, diarrhea, palpitations, weight loss, nervousness, exopthalmus, constant hunger and heat intolerance • may lead to death due to cardiac failure, if untreated • management includes surgical ablation, radioactive iodine and antithyroid drugs.

congenital hypothyroidism (thyroid dysgenesis)

• condition resulting from a deficiency in the production of thyroid hormones due to an absent or nonfunctioning thyroid gland • becomes apparent during the first 3 months of life in a formula-fed infant and at about 6 months in breast-fed infant

congenital hypothyroidism (thyroid dysgenesis)

• characterized by obesity, umbilical hernia, enlarged tongue, trouble in feeding, dry and brittle hair, short and thick neck, respiratory difficulty chronic constipation, slow deep tendon reflex, subnormal body temperature, rag-doll appearance, and elevated thyroid stimulating factor but low iodine, t3 and t4 levels • management includes vitamin d supplement, thyroid hormone and sodium levothyroxine

cretinism (hypothyroidism)

• a form of dwarfism caused by hypofunction of the thyroid gland which usually manifests in the second 6 months of life. • may be caused by a congenital lack of thyroid tissue or by inability of the gland to synthesize thyroid hormone • characterized by impaired mental development, irregular and delayed ossification of epiphysis

thyroiditis (hashimoto’s disease)

• an autoimmune thyroid disorder characterized by the production of antibodies in response to thyroid antigens and the replacement of normal thyroid structures with lymphocytes and lymphoid germinal centers • the most common form of acquired hypothyroidism in childhood

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thyroiditis (hashimoto’s disease)

age of onset: 10 to 11 years - occurs more often in girls then in boys characterized by impaired body growth, hypertrophy of the thyroid, airway obstruction in

infants and obesity, lethargy and delayed sexual growth in children • management includes synthetic thyroid hormone medication

hyperparathyroidism

• aka generalized osteitis fibrosa cystica • causes generalized osteoporosis on the localized areas of bone destruction

adrenal dysfunction androgenital syndrome (congenital adrenal hyperplasia)

• characterized by increased levels of testosterone in blood plasma • in females, it is characterized by deep, masculine voice and features, no breast development or menstruation at puberty in females and precocious development of acne and pubic and axillary hair

androgenital syndrome (congenital adrenal hyperplasia)

• in males, development of acne and a deep, mature voice, advanced bone age and closing of the epiphysis line, normal size of testes but appear small in rotation to the size of the penis, and growth of pubic hair and prostate at age 3 to 4 • oral cortisone is given to the client

cushing’s syndrome

• a metabolic disorder characterized by abnormally increased secretion of adrenocortical steroids, particularly cortisol • characterized by edema, moon face, buffalo hump, muscular atrophy, increased glucose intolerance, abnormally pigmented and fragile skin,

hypertension, kidney stones and psychosis