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COMMON HEALTH PROBLEMS COMMON HEALTH PROBLEMS OF INFANCYOF INFANCY
SUDDEN INFANT SYNDROMESUDDEN INFANT SYNDROME Defined as sudden unexpected death of an Defined as sudden unexpected death of an
infant under 1 year of ageinfant under 1 year of age Leading cause of death in children between Leading cause of death in children between
the ages of 1 month and 1 yearthe ages of 1 month and 1 year Death usually occurs during sleepDeath usually occurs during sleep Infants at grater risks for SIDS:Infants at grater risks for SIDS:
have a family hx of SIDS (esp siblings)have a family hx of SIDS (esp siblings) have a hx of seizurehave a hx of seizure are born prematurelyare born prematurely closely spaced pregnanciesclosely spaced pregnancies twinstwins
Etiology : remains unknownEtiology : remains unknown Management : Teach parent how to Management : Teach parent how to
minimize the risks of SIDSminimize the risks of SIDS avoid smoking during and after avoid smoking during and after
pregnancypregnancy encourage putting infants to sleep in encourage putting infants to sleep in
supine position unless contraindicated. supine position unless contraindicated. Side-lying position may also be usedSide-lying position may also be used
avoid soft, moldable mattressavoid soft, moldable mattress avoid use of pillowsavoid use of pillows
LARYNGOTRACHEOBRONCHITLARYNGOTRACHEOBRONCHITISIS
Inflammation of the larynx, Inflammation of the larynx, trachea and bronchitrachea and bronchi
Characterized by a narrowing of Characterized by a narrowing of the air passages which causes the air passages which causes edema of the the respiratory edema of the the respiratory mucosamucosa
Most often seen in children ages Most often seen in children ages 3 moths to 3 years and usually of 3 moths to 3 years and usually of viral originviral origin
Clinical Manifestation:Clinical Manifestation: irritabilityirritability ““brassy” or barking coughbrassy” or barking cough hoarsenesshoarseness restlessnessrestlessness inspiratory stridorinspiratory stridor anorexiaanorexia low-grade feverlow-grade fever nausea and vomitingnausea and vomiting rales, wheezing, cracklesrales, wheezing, crackles
Nursing Management:Nursing Management: Assess for airway obstruction by Assess for airway obstruction by
evaluating respiratory statusevaluating respiratory status Keep emergency equipment at Keep emergency equipment at
bedside (tracheostomy and intubation bedside (tracheostomy and intubation traytray
Administer prescribed medications Administer prescribed medications which may include bronchodilator and which may include bronchodilator and anti-inflammatory drugsanti-inflammatory drugs
Family teaching may include telling Family teaching may include telling the parents to place the child in the the parents to place the child in the bathroom and to run hot water to bathroom and to run hot water to produce steam.produce steam.
EPIGLOTITISEPIGLOTITIS
Inflammation of the supraglottis Inflammation of the supraglottis and epiglottis generally caused and epiglottis generally caused by Haaemophilus influenza by Haaemophilus influenza bacteria. Echovirus and bacteria. Echovirus and respiratory sncytial virus can respiratory sncytial virus can also cause this disorderalso cause this disorder
Abrupt onset and progresses Abrupt onset and progresses rapidlyrapidly
Clinical Manifestations:Clinical Manifestations: sudden onset of fever, lethargy and sudden onset of fever, lethargy and
dypneadypnea restlessness and anxietyrestlessness and anxiety hyperextension of the neck, drooling hyperextension of the neck, drooling
and severe sore throat with refusal to and severe sore throat with refusal to drinkdrink
stridor and hoarsenessstridor and hoarseness ““tripod position”tripod position” red and inflamed throat with a large, red and inflamed throat with a large,
cherry red, edematous epiglottischerry red, edematous epiglottis
Nursing Management:Nursing Management: Closely monitor respiratory status to ensure Closely monitor respiratory status to ensure
airway patency. The throat of a child with airway patency. The throat of a child with epiglotitis should only be examined by a epiglotitis should only be examined by a trained professional under extreme caretrained professional under extreme care
Emergengency endotracheal or tracheostomy Emergengency endotracheal or tracheostomy equipment should be available.equipment should be available.
Administer prescribed medications which may Administer prescribed medications which may include an antibiotic, and anti-inflammatory include an antibiotic, and anti-inflammatory such as steroidssuch as steroids
Recommend that all children receive Hib Recommend that all children receive Hib conjugate vaccine beginning at 2 months of conjugate vaccine beginning at 2 months of ageage
COMMON HEALTH PROBLEMS COMMON HEALTH PROBLEMS OF EARLY CHILDHOODOF EARLY CHILDHOOD
ACUTE OTITIS MEDIA ( AOM )ACUTE OTITIS MEDIA ( AOM )Inflammation of the middle earInflammation of the middle earOne of the most common health One of the most common health
problems in childhood due to the problems in childhood due to the short, straight short, straight
eustachian tube of children eustachian tube of children aged 6-24 monthsaged 6-24 months
Etiology: usually caused by Etiology: usually caused by Haemophilus inflenzaeHaemophilus inflenzae
Contributing factors Contributing factors includes:includes:
poorly developed cartilage liningpoorly developed cartilage lining enlarged lymphoid tissueenlarged lymphoid tissue bottle feeding an infant in supine bottle feeding an infant in supine
positionposition passive smokingpassive smoking
Clinical Manifestations:Clinical Manifestations:Otitis media typically follows an Otitis media typically follows an
URTI s/sURTI s/sPainPainfeverfeverirritabilityirritabilityloss of appetiteloss of appetitenasal congestionnasal congestioncoughcough
Nursing Management:Nursing Management: Assess child for fever and pain level and assess for Assess child for fever and pain level and assess for
possible complicationspossible complications Administer prescribed medications. Antibiotic Administer prescribed medications. Antibiotic
therapy usually amoxicillintherapy usually amoxicillin If tympanic membrane is ruptured, facilitate If tympanic membrane is ruptured, facilitate
drainage by having the child lie with affected ear in a drainage by having the child lie with affected ear in a dependent positiondependent position
Health teaching would include:Health teaching would include: importance of completing the entire course of antibioticimportance of completing the entire course of antibiotic discussing preventive measures such as holding the discussing preventive measures such as holding the
child upright for feedings, having him blow his nose child upright for feedings, having him blow his nose gentlygently
identify the signs of hearing loss and stress the identify the signs of hearing loss and stress the importance of audiologic test if neededimportance of audiologic test if needed
UPPER RESPIRATORY TRACT UPPER RESPIRATORY TRACT INFECTIONINFECTION
URTI include nasopharyngitis, URTI include nasopharyngitis, pharyngitis, and tonsillitispharyngitis, and tonsillitis
Also called the common cold, Also called the common cold, nasopharyngitis is a viral infection of nasopharyngitis is a viral infection of the nose and throatthe nose and throat
Pharyngitis and Tonsilitis can be either Pharyngitis and Tonsilitis can be either viral or bacterial in origin. The viral or bacterial in origin. The organism common in bacterial infection organism common in bacterial infection is GABS W/C HAS THE POTENTIAL TO is GABS W/C HAS THE POTENTIAL TO LEAD TO COMPLICATIONS SUCH AS LEAD TO COMPLICATIONS SUCH AS Rheumatic Fever and AGNRheumatic Fever and AGN
Clinical Manifestations:Clinical Manifestations:NasopharyngitisNasopharyngitis
nasal congestionnasal congestionwatery rhinitiswatery rhinitislow grade feverlow grade feverdifficulty breathing secondary to difficulty breathing secondary to
edema and congestionedema and congestionenlarged cervical lymph nodesenlarged cervical lymph nodes
PharyngitisPharyngitis Viral pharyngitis manifestations are Viral pharyngitis manifestations are
generally mildgenerally mild s/s include sore throat and general s/s include sore throat and general
malaisemalaise Bacterial pharyngitis manifestations Bacterial pharyngitis manifestations
varyvary s/s include severe sore throat, high s/s include severe sore throat, high
fever and lethargyfever and lethargy child usually looks sick and may have child usually looks sick and may have
difficulty swallowingdifficulty swallowing
TonsillitisTonsillitis Viral Tonsillitis is characterized Viral Tonsillitis is characterized
by a gradual onset, low-grade by a gradual onset, low-grade fever, mild headache, sorethroat, fever, mild headache, sorethroat, hoarseness and coughhoarseness and cough
Bacterial Tonsillitis is a more Bacterial Tonsillitis is a more dramatic disorder marked by rapid dramatic disorder marked by rapid onset of high fever, headache onset of high fever, headache generalized muscles aches and generalized muscles aches and vomitingvomiting
Nursing Management:Nursing Management: Assess respiratory statusAssess respiratory status Provide liquids and soft foodsProvide liquids and soft foods Administer prescribed medications. A 10-Administer prescribed medications. A 10-
day old course of antibiotic (Penicillin or day old course of antibiotic (Penicillin or Erythromycin if allergic to Penicillin) Erythromycin if allergic to Penicillin)
Provide preoperative and postoperative Provide preoperative and postoperative nursing care if surgery is performednursing care if surgery is performedA. Preoperative nursing care (Tonsillectomy)A. Preoperative nursing care (Tonsillectomy) prepare the child according to his developmental prepare the child according to his developmental
levellevel explain that the child will have sore throat after explain that the child will have sore throat after
surgery but he will be able to talk and swallowsurgery but he will be able to talk and swallow
B. PostoperativeB. Postoperative observe and report unusual bleedingobserve and report unusual bleeding monitor v/smonitor v/s discouraging the child from coughing discouraging the child from coughing
and use of straw for fluidsand use of straw for fluids position child on his side or the position child on his side or the
abdomen to facilitate drainageabdomen to facilitate drainage medicate for pain as ordered. Ice medicate for pain as ordered. Ice
collar may be used.collar may be used. Encourage fluids but not with red Encourage fluids but not with red
colorcolor
ALTERATIONS IN ALTERATIONS IN RESPIRATORY FUNCTIONRESPIRATORY FUNCTION
URGENT RESPIRATORY THREATS:URGENT RESPIRATORY THREATS:RESPIRATORY DISTRESS ANDRESPIRATORY DISTRESS ANDRESPIRATORY FAILURERESPIRATORY FAILURE
Clinical ManifestationsClinical ManifestationsSigns of respiratory distress: Signs of respiratory distress:
tachypnea, retractions, nasal tachypnea, retractions, nasal flaring, inspiratory stridor, and flaring, inspiratory stridor, and expiratory grunting.expiratory grunting.
Signs of respiratory failure include:Signs of respiratory failure include: Early signs: restlessness, tachypnea, Early signs: restlessness, tachypnea,
tachycardia, and diaphoresistachycardia, and diaphoresis Early decompensation: nasal flaring, Early decompensation: nasal flaring,
retractions, grunting, wheezing, retractions, grunting, wheezing, anxiety and irritability, mood anxiety and irritability, mood changes, headache, hypertension changes, headache, hypertension confusionconfusion
Signs of imminent respiratory arrest: Signs of imminent respiratory arrest: dyspnea, bradycardia, cyanosis, dyspnea, bradycardia, cyanosis, stupor, and comastupor, and coma
PNEUMONIAPNEUMONIA
Acute inflammation of the lung Acute inflammation of the lung parenchyma (bronchioles, alveolar parenchyma (bronchioles, alveolar ducts and sacs and alveoli) that ducts and sacs and alveoli) that impairs gas exchangeimpairs gas exchange
Etiology: Etiology: Pneumonia most commonly results Pneumonia most commonly results
from infection with bacteria, from infection with bacteria, viruses, or mycoplasmas, or from viruses, or mycoplasmas, or from aspiration of foreign substancesaspiration of foreign substances
Clinical Manifestation:Clinical Manifestation: a. a. Common findings in bacterial pneumonia Common findings in bacterial pneumonia
include:include: -high fever -high fever -respiratory signs and symptoms, including -respiratory signs and symptoms, including
cough (nonproductive to productive with cough (nonproductive to productive with whitish sputum), tachypnea, rhonchi, whitish sputum), tachypnea, rhonchi, crackles, dullness on percussion, chest pain, crackles, dullness on percussion, chest pain, retraction nasal flaring and pallor or retraction nasal flaring and pallor or cyanosis (depending on severity)cyanosis (depending on severity)
-irritability, restlessness and lethargy-irritability, restlessness and lethargy -nausea, vomiting, anorexia, diarrhea, and -nausea, vomiting, anorexia, diarrhea, and
abdominal pain abdominal pain -meningeal signs (meningism)-meningeal signs (meningism)
b. b. Common findings in viral Common findings in viral pneumonia include:pneumonia include:
-variations ranging from mild -variations ranging from mild fever, slight cough, and malaise fever, slight cough, and malaise to high fever, severe to high fever, severe
cough, and prostrationcough, and prostration -nonproductive or productive -nonproductive or productive
cough with whitish sputucough with whitish sputu-rhonchi of fine crackles-rhonchi of fine crackles
cc. Common findings in mycoplasma . Common findings in mycoplasma pneumonia include:pneumonia include:
-sudden or insidious onset -sudden or insidious onset -fever, chills, malaise, headache, -fever, chills, malaise, headache,
anorexia, and myalgiaanorexia, and myalgia -hacking cough, rhinitis, and sore throat -hacking cough, rhinitis, and sore throat -cough progresses from nonproductive -cough progresses from nonproductive
to productive with seromucoid sputum to productive with seromucoid sputum that later becomes mucopurulent or that later becomes mucopurulent or blood streakedblood streaked
Laboratory and diagnostic study Laboratory and diagnostic study findings:findings:
Chest x-raysChest x-raysComplete blood count Complete blood count Blood culture, Gram stain, and sputum Blood culture, Gram stain, and sputum
cultureculturePositive antistreptolysin-O titer is Positive antistreptolysin-O titer is
diagnostic of streptococcal pneumoniadiagnostic of streptococcal pneumonia
Nursing management Nursing management Assess for respiratory distress Assess for respiratory distress Administer prescribed Administer prescribed
medicationsmedicationsPromote adequate oxygenation Promote adequate oxygenation
and a normal breathing patternand a normal breathing patternRecommend the pneumococcal Recommend the pneumococcal
vaccine vaccine
ASTHMAASTHMA
Asthma is a chronic, reversible, Asthma is a chronic, reversible, obstructive airway disease, obstructive airway disease, characterized by wheezing. It is caused characterized by wheezing. It is caused by a spasm of the bronchial tubes or by a spasm of the bronchial tubes or the swelling of the bronchial mucosa the swelling of the bronchial mucosa after exposure to various stimuliafter exposure to various stimuli
Asthma is the most common chronic Asthma is the most common chronic disease in childhood, most children disease in childhood, most children experience their first symptoms by 5 experience their first symptoms by 5 years of age.years of age.
Etiology: Extrinsic (allergic asthma) - Etiology: Extrinsic (allergic asthma) - pollens, dust spores and animal pollens, dust spores and animal dandersdanders
Intrinsic (Idiopathic asthma) - URTI, Intrinsic (Idiopathic asthma) - URTI, emotional upsets and exerciseemotional upsets and exercise
Mixed asthma - has characteristics Mixed asthma - has characteristics of both allergic and idiopathic of both allergic and idiopathic asthma.asthma.
Mixed asthma is the most common Mixed asthma is the most common form.form.
Common irritants:Common irritants: a. a. allergen exposure (in sensitized persons). Common allergen exposure (in sensitized persons). Common
allergens include:allergens include:-dust mites -dust mites -molds-molds-animal dander-animal danderb. b. viral infectionsviral infectionsc. c. irritants, which include: irritants, which include: --air pollutionair pollution--smokesmoke--perfumesperfumes--laundry detergentslaundry detergentsd.d. certain foods (especially food additives) certain foods (especially food additives)e.e. rapid changes in environmental temperatures rapid changes in environmental temperatures f.f. exercise exercise g.g. psychological stress psychological stress
Assessment findings: Assessment findings: Clinical manifestations:Clinical manifestations: -increased respiratory rate-increased respiratory rate -wheezing (intensifies as attack -wheezing (intensifies as attack
progresses) progresses) -cough (productive) -cough (productive) -use of accessory muscles -use of accessory muscles -distant breath sounds-distant breath sounds -fatigue -fatigue -moist skin-moist skin
-anxiety-anxiety
Nursing management:Nursing management:assess respiratory statusassess respiratory statusadminister prescribed medications. administer prescribed medications. promote adequate oxygenation and promote adequate oxygenation and
a normal breathing pattern a normal breathing pattern explain possible use of explain possible use of
desensitizationdesensitizationmake the child live a normal lifemake the child live a normal lifeenroll child in swimmingenroll child in swimming
Diet: High calorie, high protein, Diet: High calorie, high protein, low carbohydratelow carbohydrate
Bronchial hygiene measures: Bronchial hygiene measures:
Steam inhalationSteam inhalation
Aerosol inhalationAerosol inhalation
Medimist Medimist inhalationinhalation
Pharmacotherapy:Pharmacotherapy: bronchodilatorsbronchodilators EpinephrineEpinephrine Albuterol (Ventolin)Albuterol (Ventolin) Aminophylline (Theophylline)Aminophylline (Theophylline) Terbutaline (Bricanyl)Terbutaline (Bricanyl) Metaproterenol (Allupent)Metaproterenol (Allupent)observe for tachycardiaobserve for tachycardia corticosteroids - anti-inflammatory corticosteroids - anti-inflammatory
effecteffect Triamcinolone (Azmacort)Triamcinolone (Azmacort)
CYSTIC FIBROSISCYSTIC FIBROSIS
Cystic fibrosis (CF) is a chronic, Cystic fibrosis (CF) is a chronic, multisystem disorder of the exocrine multisystem disorder of the exocrine glands characterized by abnormally glands characterized by abnormally thick pulmonary secretions. CF affects thick pulmonary secretions. CF affects the pancreas, respiratory system, GI the pancreas, respiratory system, GI tract, salivary glands, and tract, salivary glands, and reproductive tract.reproductive tract.
Etiology: Etiology: -CF is an autosomal recessive hereditary -CF is an autosomal recessive hereditary
disorder by a defective gene.disorder by a defective gene.
Assessment findings:Assessment findings: Clinical manifestations:Clinical manifestations: Respiratory – wheezing, dyspnea, Respiratory – wheezing, dyspnea,
cough ,cyanosiscough ,cyanosis GI - meconium ileus at birth, rectal prolapse, GI - meconium ileus at birth, rectal prolapse,
loose,bulky, frothy, fatty stoolloose,bulky, frothy, fatty stool Voracious appetite, wt. loss, ftt,distended Voracious appetite, wt. loss, ftt,distended
abdomenabdomen Reproductive - females will have delayed Reproductive - females will have delayed
puberty and decreased fertilitypuberty and decreased fertility males with few exceptions, are infertilemales with few exceptions, are infertile Cardiovascular - cor pulmonale, rt-sided Cardiovascular - cor pulmonale, rt-sided
heart enlargement and heart failure, heart enlargement and heart failure, HyponatremiaHyponatremia
Integumentary - salty taste, Integumentary - salty taste, hypoalbumineria due to ftthypoalbumineria due to ftt
Nursing management: Nursing management:
1. promote adequate oxygenation 1. promote adequate oxygenation and a normal breathing pattern. and a normal breathing pattern.
2. assess nutritional status 2. assess nutritional status
3. promote desired nutritional 3. promote desired nutritional intakeintake
4. administer prescribed 4. administer prescribed medications such as pancreatic medications such as pancreatic enzymes, bronchodilators, enzymes, bronchodilators,
antibiotic and fat soluble vitaminsantibiotic and fat soluble vitamins
PYLORIC STENOSISPYLORIC STENOSIS
Pyloric stenosis is the narrowing Pyloric stenosis is the narrowing of the pyloric sphincter at the of the pyloric sphincter at the outlet of the outlet of the
stomachstomach
Congenital hypertrophy of pyloric Congenital hypertrophy of pyloric sphinctersphincter
Etiology:Etiology:
-Unknown-Unknown
Assessment findings:Assessment findings:Clinical manifestations:Clinical manifestations: regurgitation and non projectile regurgitation and non projectile
vomitingvomiting weight lossweight loss no sign of anorexiano sign of anorexia upper palpable distention, olive shape upper palpable distention, olive shape
mass in the epigastrium just to the right mass in the epigastrium just to the right of umbilicusof umbilicus
visible gastric peristalsis wave from left visible gastric peristalsis wave from left to rightto right
decrease frequency and volume of stoolsdecrease frequency and volume of stools
Laboratory and diagnostic studies:Laboratory and diagnostic studies: -ultrasonography and an upper-GI-ultrasonography and an upper-GI -Arterial blood gas analysis-Arterial blood gas analysis -electrolyte studies-electrolyte studies Nursing management: Nursing management: -monitor feeding pattern and the -monitor feeding pattern and the
association between feedings and vomiting association between feedings and vomiting -access the amount, character, and -access the amount, character, and
frequency of vomitusfrequency of vomitus -promote adequate hydration-promote adequate hydration -prevent aspiration-prevent aspiration -provide postoperative care -provide postoperative care
(Pyloromyotomy)(Pyloromyotomy)
CELIAC DISEASE (GLUTEN-CELIAC DISEASE (GLUTEN-SENSITIVE ENTEROPATHY SENSITIVE ENTEROPATHY
CELIAC SPRUECELIAC SPRUE))
Celiac disease is a malabsorption syndrome Celiac disease is a malabsorption syndrome that occurs when the mucosa of that occurs when the mucosa of
the proximal is small intestine is the proximal is small intestine is sensitive to, or undergoes an immunologic sensitive to, or undergoes an immunologic
response to gluten response to gluten
Etiology: inborn error of metabolism to Etiology: inborn error of metabolism to digest glutenin and gliadin (protein digest glutenin and gliadin (protein fractions)fractions)
Assessment findings:Assessment findings:Clinical manifestations:Clinical manifestations:
diarrheadiarrhea anorexia and abdominal painanorexia and abdominal pain vomitingvomiting severe abdominal distentionsevere abdominal distentionLaboratory and diagnostic study findings:Laboratory and diagnostic study findings: bowel biopsybowel biopsyNursing management:Nursing management: -promote adequate hydration -promote adequate hydration -promote adherence to dietary guidelines -promote adherence to dietary guidelines -provide a gluten-free diet (meat, eggs, -provide a gluten-free diet (meat, eggs,
fruit, vegetables,, Vit. ADEK (fat soluble)fruit, vegetables,, Vit. ADEK (fat soluble) AVOID: BROW - barley, rye, oats, wheatAVOID: BROW - barley, rye, oats, wheat
HIRSCHSPRUNG’S HIRSCHSPRUNG’S DISEASEDISEASE
congenital absence of congenital absence of parasympathetic ganglion in parasympathetic ganglion in distal colon. Bowel proximal to distal colon. Bowel proximal to aganglionic section becomes aganglionic section becomes enlargedenlarged
Etiology:Etiology:Hirschsprung’s disease is Hirschsprung’s disease is
believed to be a familial, believed to be a familial, congenital effect.congenital effect.
Assessment findings:Assessment findings: Clinical manifestations:Clinical manifestations:Neonates Neonates : failure to pass meconium, : failure to pass meconium, abdominal distentionabdominal distentionInfants Infants : FTT, constipation abdominal : FTT, constipation abdominal
distention, distention, vomitingvomiting Older children Older children : anorexia, chronic constipation, : anorexia, chronic constipation,
foul foul smelling and RIBBON-LIKE smelling and RIBBON-LIKE
STOOLSTOOL
Laboratory and diagnostic study findings:Laboratory and diagnostic study findings: -barium enema -barium enema -rectal biopsy -rectal biopsy -anorectal manometry-anorectal manometry
Nursing management:Nursing management:
Assess for and promptly report signs of enterocolitis Assess for and promptly report signs of enterocolitis (explosive bloody diarrhea)(explosive bloody diarrhea)
Promote adequate hydration, assess bowel Promote adequate hydration, assess bowel functioning functioning
Promote adequate nutrition according to the child’s Promote adequate nutrition according to the child’s age and nutritional requirements age and nutritional requirements
Administer enemas as prescribed, to relieve Administer enemas as prescribed, to relieve constipationconstipation
Avoid taking temperatures rectally Avoid taking temperatures rectally Decrease discomfort caused by abdominal distention Decrease discomfort caused by abdominal distention Administer prescribed medication such as, antibiotic Administer prescribed medication such as, antibiotic
and stool softenersand stool softeners Prepare child and parents for procedure and Prepare child and parents for procedure and
treatment such as, TEMPORARY COLOSTOMY and treatment such as, TEMPORARY COLOSTOMY and BOWEL RESECTION to remove aganglionic portion.BOWEL RESECTION to remove aganglionic portion.
Colostomy care same as adult patientColostomy care same as adult patient
INTUSSUSCEPTIONINTUSSUSCEPTION
Intussusception is an invagination Intussusception is an invagination or telescoping of one portion of or telescoping of one portion of the intestine into an adjacent the intestine into an adjacent portion, causing obstructionportion, causing obstruction
Etiology: Etiology:
UnknownUnknown
Assessment findings:Assessment findings:
Clinical manifestationsClinical manifestations -severe paroxysmal abdominal pain, causing the -severe paroxysmal abdominal pain, causing the
child to child to scream and draw his knees to the abdomen scream and draw his knees to the abdomen -vomiting of gastric contents -vomiting of gastric contents -tender, distended abdomen, possibly with a -tender, distended abdomen, possibly with a
palpable palpable massmass -with continued obstruction, the following occur: -with continued obstruction, the following occur: lethargy, “currant jelly” lethargy, “currant jelly” stools (containing blood and mucus), bile-stained stools (containing blood and mucus), bile-stained
or or fecal vomitus, and shocklike syndrome, which fecal vomitus, and shocklike syndrome, which
may may progress to deathprogress to death
Nursing management:Nursing management:1. promote adequate hydration1. promote adequate hydration2. promote adequate nutrition2. promote adequate nutrition3. monitor bowel elimination 3. monitor bowel elimination status status 4. monitor for inspection 4. monitor for inspection 5. support the parents for possible 5. support the parents for possible surgery (Bowel resection)surgery (Bowel resection)
HERNIASHERNIAS Protrusion of the bowel through an abdominal Protrusion of the bowel through an abdominal
opening in the abdominal wall, in children this opening in the abdominal wall, in children this occurs most commonly at the umbilicus and through occurs most commonly at the umbilicus and through the inguinal canalthe inguinal canal
Clinical Manifestations:Clinical Manifestations: Umbilical hernia - swelling or protrusion around the Umbilical hernia - swelling or protrusion around the
umbilicusumbilicus Inguinal hernia - usually a painless swelling in the Inguinal hernia - usually a painless swelling in the
inguinal areainguinal area Nursing Management:Nursing Management: Assess for signs of strangulation and incarcerationAssess for signs of strangulation and incarceration Perform postoperative care.Perform postoperative care.
IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA
Inadequate supply of iron for normal red Inadequate supply of iron for normal red blood cell formationblood cell formation
Fe iron from mother is already used upFe iron from mother is already used up Typically occurs between ages 6 mos and 3 Typically occurs between ages 6 mos and 3
years.years. Clinical Manifestations:Clinical Manifestations:
pale skinpale skin fatiquefatique pica (eating non food items)pica (eating non food items) irritabilityirritability headache, dizzinessheadache, dizziness slowed thought processesslowed thought processes
Nursing Management:Nursing Management:1. Assess for s/s of impaired tissue 1. Assess for s/s of impaired tissue
oxygenationoxygenation2. Administer prescribed medication or 2. Administer prescribed medication or
therapy such as iron prep (Ferrous sulfate)therapy such as iron prep (Ferrous sulfate) parenteral iron, transfusions for severe parenteral iron, transfusions for severe
anemiaanemia3. Promote adequate intake of iron-rich foods 3. Promote adequate intake of iron-rich foods
(iron fortified formula, lean meat, fish, (iron fortified formula, lean meat, fish, legumes, potatoes, dried fruitslegumes, potatoes, dried fruits
SICKLE CELL DISEASESICKLE CELL DISEASE
A group of chronic, severe, genetic A group of chronic, severe, genetic hemolytic disease associated with hemolytic disease associated with hemoglobin S w/c transform RBC into a hemoglobin S w/c transform RBC into a sickle shapesickle shape
Etiology: autosomal recessive disorderEtiology: autosomal recessive disorder Clinical Manifestations:Clinical Manifestations:
enlarged spleenenlarged spleen enlarged and tender liver from blood stasisenlarged and tender liver from blood stasis hematuriahematuria inability to concentrate urineinability to concentrate urine enuresisenuresis dactilytis (symmetric swelling of the hands and dactilytis (symmetric swelling of the hands and
feet hand –foot syndrome)feet hand –foot syndrome)
other problems include:other problems include: strokestroke MIMI growth retardationgrowth retardation delayed sexual maturationdelayed sexual maturation priapism (unwanted painful erection)priapism (unwanted painful erection)
Nursing Management:Nursing Management: Promote tissue oxygenationPromote tissue oxygenation Administer appropriate therapeutic measuresAdminister appropriate therapeutic measures
provide oral and IV hydrationprovide oral and IV hydration administer electrolytes replacementsadminister electrolytes replacements deliver O2 therapydeliver O2 therapy initiate bed rest and careful organization of the initiate bed rest and careful organization of the
child’s activitieschild’s activities
Relieve pain. Avoid giving Demerol to Relieve pain. Avoid giving Demerol to avoid seizureavoid seizure
Apply heat and avoid cold compresses Apply heat and avoid cold compresses to prevent vasoconstriction and to prevent vasoconstriction and sicklingsickling
Position the child for maximum comfortPosition the child for maximum comfort Teach parents to assess early signs of Teach parents to assess early signs of
infection and regular check-upinfection and regular check-up Address the significance of genetic Address the significance of genetic
counselingcounseling
THALLASEMIATHALLASEMIA
Group of inherited blood disorders Group of inherited blood disorders characterized by a deficient synthesis of characterized by a deficient synthesis of specific globulin. Common type is B-specific globulin. Common type is B-thalassemia also know as “Cooley’s anemiathalassemia also know as “Cooley’s anemia
Etiology: autosomal recessive disorderEtiology: autosomal recessive disorder Clinical Manifestations:Clinical Manifestations:
pallorpallor FttFtt HepatosplenomegalyHepatosplenomegaly Severe anemia (hgb of less than 6 g/dL)Severe anemia (hgb of less than 6 g/dL) AnorexiaAnorexia Chronic hypoxiaChronic hypoxia
Nursing Management:Nursing Management: Supportive, involving transfusion of Supportive, involving transfusion of
normal cell q 3-4 weeksnormal cell q 3-4 weeks Treatment of iron overload with DesferalTreatment of iron overload with Desferal Postoperative care after potential Postoperative care after potential
SplenectomySplenectomy Assist in giving of diet high in folic acid, Assist in giving of diet high in folic acid,
high in ascorbic acid and low in ironhigh in ascorbic acid and low in iron Address the significance of genetic Address the significance of genetic
counselingcounseling
HEMOPHILIAHEMOPHILIA Group of hereditary bleeding disorders resulting from Group of hereditary bleeding disorders resulting from
specific clotting factor deficiencies. specific clotting factor deficiencies. Two most common include hemophilia A (factor VIII Two most common include hemophilia A (factor VIII
deficiency) and hemophilia B (factor IX deficiency also deficiency) and hemophilia B (factor IX deficiency also known as Christmas disease)known as Christmas disease)
Etiology: x-linked recessive disorder transmitted by Etiology: x-linked recessive disorder transmitted by females , but common in malesfemales , but common in males
Clinical Manifestations:Clinical Manifestations: spontaneous bleedingspontaneous bleeding hemarthrosis (bleeding into a joint space)hemarthrosis (bleeding into a joint space) limited motionlimited motion painpain tenderness and joint swellingtenderness and joint swelling easy bruising easy bruising nosebleedsnosebleeds intracranial hemorrhageintracranial hemorrhage
Nursing Management:Nursing Management: Prevention and control of bleeding Prevention and control of bleeding
episodesepisodes Limiting joint movement and Limiting joint movement and
managing painmanaging pain Promotion of normal growth and Promotion of normal growth and
developmentdevelopment Administer the missing clot factorAdminister the missing clot factor Administer desmopressin (DDAVP) for Administer desmopressin (DDAVP) for
hemophilia A onlyhemophilia A only
CONGENITAL HEART CONGENITAL HEART DEFECTSDEFECTS
Hemodynamics of Fetal Hemodynamics of Fetal CirculationCirculation
Ductus venosus: carries Ductus venosus: carries oxygenated blood from placenta to oxygenated blood from placenta to IVC, partially bypasses liver, closes IVC, partially bypasses liver, closes approximately by 2 mos.approximately by 2 mos.
Ductus arteriosus: bypasses flow Ductus arteriosus: bypasses flow of blood through lungs by shunting of blood through lungs by shunting oxygenated and unoxygenated oxygenated and unoxygenated blood from pulmonary artery to blood from pulmonary artery to aorta, closes 7 – 10 days after birthaorta, closes 7 – 10 days after birth
Foramen ovale: connects right and and left Foramen ovale: connects right and and left atria, allows blood to flow from right atrium to atria, allows blood to flow from right atrium to left atrium thereby bypassing the right ventricle left atrium thereby bypassing the right ventricle and pulmonary circuit, closes by 2 – 3 mos.and pulmonary circuit, closes by 2 – 3 mos.
Transition to newborn circulationTransition to newborn circulation:: At first breath, lungs expand w/c increases At first breath, lungs expand w/c increases
blood flow to pulmonary systemblood flow to pulmonary system Pulmonary vascular resistance is decreased and Pulmonary vascular resistance is decreased and
systemic vascular resistance increasessystemic vascular resistance increases These changes lead to the closure of the ductus These changes lead to the closure of the ductus
venosus, ductus arteriosus and foramen ovalevenosus, ductus arteriosus and foramen ovale
Diagnostic procedure:Diagnostic procedure: cardiac catheterizationcardiac catheterization echocardiographyechocardiography
REVIEW OF ACYANOTIC REVIEW OF ACYANOTIC CONGENITAL HEART CONGENITAL HEART
ANOMALIESANOMALIESANOMALY DESCRIPTION SYMPTOMS TREATMENT BLOOD
SHUNTING
PATENT DUCTUS ARTERIOSUS(spontaneous closure at 3 wks)
Failure of the ductus arteriosus to close, often a complication of respiratory distress
- recurrent apnea- wide pulse pressure- machine-like murmur
Medical: administration of indomethacin (Indocin)Surgical:Ligation of patent ductus(in infancy)
From pulmonary artery to aorta
ATRIAL SEPTAL DEFECT (A.S.D)
A communication between the left and right atria
- systolic murmur- acyanotic, asymptomatic- thin and asthenic- frequent episodes of pulmonary inflammatory diseases- poor exercise tolerance
Open heart with direct closure or suturing with plastic prosthesis(usually done at pre-school age)
Left to right
VENTRICULAR VENTRICULAR SEPTAL DEFECTSEPTAL DEFECT
A communicationA communication
Between the right Between the right and left ventriclesand left ventricles
- failure to thrive- failure to thrive
- frequent - frequent
respiratory respiratory
infectionsinfections
- loud, harsh - loud, harsh
murmurmurmur
- systolic thrill- systolic thrill
Some small defects Some small defects may close may close spontaneously.spontaneously.
(during first year of (during first year of life)life)
Open heart with Open heart with direct direct closure/suturing closure/suturing with plasticwith plastic prosthesisprosthesis
(usually at pre-(usually at pre-school age, for school age, for large defects mybe large defects mybe done in earlier done in earlier infancyinfancy
Left to rightLeft to right
COARCTATION OF COARCTATION OF AORTAAORTA
Preductal Preductal constriction of the constriction of the aorta bet. aorta bet. Subclavian artery Subclavian artery and ductus and ductus arteriosusarteriosus
Postductal Postductal constriction of aorta constriction of aorta directly beyond the directly beyond the ductusductus
- hypertension in - hypertension in upper extremities upper extremities with decreased BP with decreased BP in lower extremitiesin lower extremities
- weak or absent - weak or absent pulsations in lower pulsations in lower extremitiesextremities
Surgical resection Surgical resection of coarctate area of coarctate area with direct with direct anastomosis or with anastomosis or with use of a graftuse of a graft
(correction usually (correction usually done by 2 yrs of age done by 2 yrs of age to prevent to prevent permanent permanent hypertension)hypertension)
Obstruction of Obstruction of blood flow through blood flow through the constricted the constricted segmentssegments
REVIEW OF CYANOTIC REVIEW OF CYANOTIC CONGENITAL ANOMALIESCONGENITAL ANOMALIES
ANOMALYANOMALY DESCRIPTIONDESCRIPTION SYMPTOMSSYMPTOMS TREATMENTTREATMENT BLOOD SHUNTINGBLOOD SHUNTING
TETRALOGY OF TETRALOGY OF FALLOTFALLOT
(T.O.F)(T.O.F)
1. Pulmonary 1. Pulmonary
stenosisstenosis
2. Right-sided 2. Right-sided
hypertrophyhypertrophy
3. Overriding of 3. Overriding of
the aortathe aorta
4. Ventricular 4. Ventricular
Septal DefectSeptal Defect
(VSD)(VSD)
- acute cyanosis at - acute cyanosis at
birthbirth
- clubbing of fingers - clubbing of fingers
and toesand toes
- systolic murmur- systolic murmur
- “tet spell”(acute - “tet spell”(acute
episodes of episodes of
cyanosis and cyanosis and
hypoxia)hypoxia)
- squatting- squatting
- growth retardation- growth retardation
Surgical: Blalock Surgical: Blalock TaussigTaussig
Repair: open heart Repair: open heart closure of VSD and closure of VSD and resection of resection of stenosisstenosis
(usually done (usually done during the first two during the first two years of life)years of life)
Right to leftRight to left
TRANSPOSITION OF TRANSPOSITION OF THE GREAT VESSELSTHE GREAT VESSELS
(TGV)(TGV)
The aorta originates The aorta originates from the right from the right ventricle and the ventricle and the pulmonary artery pulmonary artery from the left from the left ventricleventricle
- early clubbing of - early clubbing of toes and fingerstoes and fingers
- poor growth and - poor growth and developmentdevelopment
- rapid respirations, - rapid respirations, fatiguefatigue
- failure to thrive- failure to thrive
Administration of IV Administration of IV prostaglandin and prostaglandin and surgical repairsurgical repair
TRUNCUS TRUNCUS ARTERIOSUSARTERIOSUS
Failure of normal Failure of normal septation and septation and division of the division of the embryonic bulbar embryonic bulbar trunk into the trunk into the pulmonary artery pulmonary artery and aortaand aorta
- severe pulmonary - severe pulmonary edema and heart edema and heart failurefailure
RHEUMATIC FEVERRHEUMATIC FEVER
systemic inflammatory disease systemic inflammatory disease that occurs as a result of that occurs as a result of naturally acquired immunity to naturally acquired immunity to GABHS infectionGABHS infection
Etiology:Etiology:
usually occurs 2 to 6 weeks after usually occurs 2 to 6 weeks after an untreated upper respiratory an untreated upper respiratory tract infectiontract infection
Clinical manifestations:Clinical manifestations: Major characteristics:Major characteristics: a. subcutaneous nodulesa. subcutaneous nodules b. erythema marginatumb. erythema marginatum c. polyarthritisc. polyarthritis d. choread. chorea e. carditise. carditis Minor characteristics:Minor characteristics: a. fevera. fever b. arthralgiab. arthralgia c. elevated ESRc. elevated ESR d. elevated ASO titerd. elevated ASO titer
Nursing management:Nursing management: Assess and monitor cardiac, joint, skin Assess and monitor cardiac, joint, skin
and neurologic statusand neurologic status Promote compliance with bed rest and Promote compliance with bed rest and
activity restrictionsactivity restrictions Provide adequate nutritionProvide adequate nutrition Prevent skin breakdownPrevent skin breakdown Administer prescribed medications.Administer prescribed medications. Emphasize the importance of Emphasize the importance of
minimizing contact with infected minimizing contact with infected persons and proper handwashing persons and proper handwashing techniquetechnique
Promote optimal growth and Promote optimal growth and developmentdevelopment
HYDROCEPHALUSHYDROCEPHALUS Imbalance in either absorption or production of CSF within Imbalance in either absorption or production of CSF within
the intracranial cavitythe intracranial cavity Etiology: often associated with neural tube defectEtiology: often associated with neural tube defect Clinical manifestations:Clinical manifestations: Categorized by age:Categorized by age: Infants: increased head circumferenceInfants: increased head circumference Bulging anterior fontanelBulging anterior fontanel Distended scalp veinDistended scalp vein High pitch cryHigh pitch cry Feeding problemsFeeding problems Discomfort when heldDiscomfort when held Older children:Older children: HeadacheHeadache VomitingVomiting DiplopiaDiplopia Blurred visionBlurred vision
Nursing management:Nursing management: Preoperative measurement of head Preoperative measurement of head
circumferencecircumference Postoperatively: Postoperatively:
Perform frequent neurologic Perform frequent neurologic assessment with daily head assessment with daily head circumferencecircumference
Position on non-operative sitePosition on non-operative site
Institute seizure precautionsInstitute seizure precautions Monitor for s/s of shunt infectionsMonitor for s/s of shunt infections Give frequent small feedings, planned Give frequent small feedings, planned
rest period after feeding. Daily weightsrest period after feeding. Daily weights
MYELOMENINGOCELEMYELOMENINGOCELE
Type of Spina Bifida, a fissure in spinal Type of Spina Bifida, a fissure in spinal column leaving meninges and spinal cord column leaving meninges and spinal cord exposedexposed
Unknown etiologyUnknown etiology
Clinical manifestation:Clinical manifestation: partial to complete paralysis depending on partial to complete paralysis depending on
the location of defectthe location of defect clubfoot, scoliosis, clubfoot, scoliosis, bowel and bladder problemsbowel and bladder problems elevated AFPelevated AFP visible sacvisible sac
Nursing management:Nursing management:
A. Preoperative: main goal is to A. Preoperative: main goal is to prevent rupture of sacprevent rupture of sackeep infant in prone positionkeep infant in prone positioncover sac with gauze moistened cover sac with gauze moistened
with sterile salinewith sterile salinecheck sac for tears and crackscheck sac for tears and cracksdo not cover sac with cloth and do not cover sac with cloth and
diaperdiapermonitor for s/s of meningitismonitor for s/s of meningitis
B. Postoperative: main goal is to B. Postoperative: main goal is to promote healing and reduce promote healing and reduce neurological complicationsneurological complications
place infant in prone position with place infant in prone position with head slightly lower than the bodyhead slightly lower than the body
place protective barrier across place protective barrier across incision to prevent contaminationincision to prevent contamination
be aware of long-term problems of be aware of long-term problems of infection related to urinary infection related to urinary retention reflux, chronic UTIretention reflux, chronic UTI
Monitor for s/s of IICPMonitor for s/s of IICP
CEREBRAL PALSYCEREBRAL PALSY
Chronic , nonprogressive caused by Chronic , nonprogressive caused by malformation of the motor pathways malformation of the motor pathways of the brainof the brain
Clinical manifestations:Clinical manifestations:common clinical manifestation in all types of common clinical manifestation in all types of
cerebral palsy is DELAYED GROSS MOTOR cerebral palsy is DELAYED GROSS MOTOR DEVELOPMENTDEVELOPMENT
infantile reflexes do not go awayinfantile reflexes do not go awaydelayed speech developmentdelayed speech development lack of head controllack of head controlhearing and visual deficits mental retardationhearing and visual deficits mental retardationbehavioral problemsbehavioral problems
Nursing management:Nursing management:Prevent physical injuryPrevent physical injuryPrevent physical deformityPrevent physical deformityAdminister prescribed meds: Administer prescribed meds:
sedative, muscle relaxants and sedative, muscle relaxants and anticonvulsantsanticonvulsants
Encourage self-careEncourage self-careRefer to OT and speech therapyRefer to OT and speech therapy
REYE’S SYNDROMEREYE’S SYNDROME
acute, multisystem disorder that acute, multisystem disorder that follows a mild viral infection, follows a mild viral infection, usually influenza or varicellausually influenza or varicella
Etiology: salicylates, Etiology: salicylates, acetaminophen toxicity and acetaminophen toxicity and antidiarrhealsantidiarrheals
aspirin toxicityaspirin toxicity
CONGENITAL DYSPLASIA OF CONGENITAL DYSPLASIA OF THE HIP (CDH)THE HIP (CDH)
imperfect development of the imperfect development of the hip of varying degreeship of varying degrees
etiology unknown, females are 8 etiology unknown, females are 8 times more likely to developtimes more likely to develop
Clinical manifestations:Clinical manifestations:shortening of affected legshortening of affected leg
assymetrical gluteal foldsassymetrical gluteal folds limited abductionlimited abduction ortolani’s clickortolani’s click
Nursing ManagementNursing Management
If diagnosed within 2-3 mos, If diagnosed within 2-3 mos, abduction of the hip is maintained abduction of the hip is maintained via DOUBLE DIAPERING and Pavlik via DOUBLE DIAPERING and Pavlik harness to be worn 24 hrs/dayharness to be worn 24 hrs/day
Frequent CMS checks. Frequent CMS checks. (circulation, motion, sensation)(circulation, motion, sensation)
Routine cast care (hip spica)Routine cast care (hip spica)Routine traction care (Bryant’s)Routine traction care (Bryant’s)
GASTROINTESTINAL DEFECTSGASTROINTESTINAL DEFECTS
CLEFT LIPCLEFT LIP Failure of the maxillary processes Failure of the maxillary processes
to fuse with the nasal passageto fuse with the nasal passage Etiology unknown but strong Etiology unknown but strong
genetic and environmental factorsgenetic and environmental factors more common in malesmore common in males prone to ear, nose and throat prone to ear, nose and throat
infectioninfection
Nursing management:Nursing management: Preoperatively: be aware of sucking Preoperatively: be aware of sucking
problems and infants swallow a great problems and infants swallow a great deal of air during feeding, burp deal of air during feeding, burp frequently and use adaptive feeding frequently and use adaptive feeding devices: large soft nipples, syringe devices: large soft nipples, syringe with rubber tubingwith rubber tubing
Postoperatively: use medicine dropperPostoperatively: use medicine dropper Elbow restraints, do not position on Elbow restraints, do not position on
abdomenabdomen Advise parent not to use pacifierAdvise parent not to use pacifier Apply LOGAN BAR to reduce tension on Apply LOGAN BAR to reduce tension on
the suture linethe suture line
Cleft PalateCleft Palate failure of the palatine processes to failure of the palatine processes to
fusefuse more common among femalesmore common among females repair usually completed by 12-18 repair usually completed by 12-18
mos to prevent speech problem mos to prevent speech problem Nursing management: PostoperativelyNursing management: Postoperatively Child is fed through a cup, cannot use Child is fed through a cup, cannot use
spoonspoon Use of elbow restraintsUse of elbow restraints May position on the abdomenMay position on the abdomen