Copy of Common Health Problems of Infancy Powpt

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