Alawiya, Jamal Tango P.

8/3/2019 Alawiya, Jamal Tango P.

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Alawiya, Jamal Tango P.

NCM 102 TUV

1.) Identify the (a)predisposing factors, (b)precipitating factors, (c)etiology, (d)clinicalmanifestation and nursing management of the following health problems of pediatric patients:

Otitis Media

Predisposing Factors

y Age under 5y Any condition that causes a weakening of the immune system such as:

o D iabeteso O rgan transplanto C hemotherapy: the administration of medicines that kill cancer cells.o AIDS

y P oorly developed cartilage lining, which makes Eustachian tubes more likely to open prematurely

y Enlarged lymphoid tissue, which obstruct Eustachian tube openings

Precipitating Factors

y Allergic rhinitisy C hronic sinusitisy Enlarged tonsils and adenoidsy Exposure to high altitudey Exposure to smokey P acifier use after six months of agey F ood allergiesy R uptured eardrum or other ear injury

E tiology

y B acterial P athogen: S treptococcus pnuemoniae, haemophilis influenza and streptococcusaureus.



Clinical Manifestation

Acute O titis Media

y U pper R espiratory Infectiony O

talgia (earache)y F ever y P urulent discharge may or may not be present.

Infant or very young child

y C ryingy F ussy, restless, irritabley T endency to rub, hold or pull affected ear y R olls head side to sidey D ifficulty comforting childy L oss of appetite

O lder C hild

y C rying and or verbalizes feelings of discomforty Irritabilityy L ethargyy L oss of appetite

C hronic O titis Media

y H earing lossy D ifficulty communicatingy F eeling of fullness, tinnitus, vertigo may be present

Nursing Management

y P revent child in exposing in secondhand smoke.y D on¶t use pacifier to the infant age 6 months above.y P revent skin breakdown by keeping external ear clean and dry.y Always hold the infant in an upright, seated position during bottle feeding.y B reastfeeding for at least 6 months can make a child less prone to ear infections.

L aryngotracheobronchitis




y Age: 6 months to 4 yearsy Abnormality of the upper airwayy F amily history of croupy P rematurity


y U pper respiratory infectionsy P rematurityy Asthma, specifically for spasmodic croup

E tiology

y V iral infection; 75% of all cases are the result of infection with parainfluenza virus ,most commonly type I . O ther causes include respiratory syncytial virus (RSV) ,metapneumovirus, influenzaA and B, adenovirus, and mycoplasma.


y Mild cold with low grade fever and a runny nosey F atiguey L oss of appetitey Acute LTB : gradual onset from upper respiratory infection, processing to signs of distressy H ave low-grade fever y R estlessness and irritabilityy Inspiratory stridor y H arsh or brassy coughy H oarsenessy W heezing, rales, rhonchi and localized areas o f diminished breath sounds

Nursing Management

y Assess for airway obstruction by evaluating respiratory status: color, respiratory effort,

evidence of fatigue, and vital signs.y R educe the child¶s anxiety by maintain a quit environment, promoting rest and relaxation,

and minimizing intrusive procedures.y Encourage parent and child interaction and diversion.y P rovide parental support to reduce anxiety.y P rovide H ealth teaching to the mother such as define symptoms to watch for.y Assess for airway obstruction by evaluating respiratory status.



y K eep emergency equipment near the bedside.

Pertussis (Whooping Cough)


y F amily historyy Age (less than 4 years old)


y Exposure to person with pertussis, through direct contact, air and objects.y O titis Mediay H erniay P neumoniay P rolapsed R ectumy U lcerative tongue

E tiology

y W hooping cough is caused by bacteria called Bordetella pertussis (also called B. pertussis ). S everal types of Bordetella bacteria have been identified. S ome types causeillness in humans (e.g., B. pertussis , B. parapertussis ) and others affect animals (e.g., B.bronchiseptica causes kennel cough in dogs and respiratory infections and pneumonia incats and pigs).


F irst S tage ( C atarhal S tage)

y R unny nosey S neezingy L ow-grade fever y Mild, occasional cough



S econd S tage ( P aroxysmal S tage)

y T here are bursts (paroxysms) of coughing, or numerous rapid coughs, apparently due todifficulty expelling thick mucus from the airways in the lungs.

y At the end of the bursts of rapid coughs, a long inspiratory effort (breathing in) is usually

accompanied by a characteristic high-pitched "whoop" sound

y D uring an attack, the individual may become cyanotic (turn blue) from lack of oxygen.y C hildren and young infants appear especially ill and distressed.y V omiting (referred to by doctors as post-tussive vomiting) and exhaustion commonly

follows the episodes of coughing.y T he person usually appears normal between episodes.y P aroxysmal attacks occur more frequently at night, with an average of 15-24 attacks per

24 hours.y T he paroxysmal stage usually lasts from one to six weeks but may persist for up to 10

weeks.y Infants under 6 months of age may not have the strength to have a whoop, but they do

have paroxysms of coughing.

T hird S tage

y T he cough becomes less paroxysmal and usually disappears over two to three weeks.

Nursing Management

y Encourage parents to increase fluid intake of the infant to help expectoration of secretion.y P rovide restful environment and reduce factors that promote paroxysm (dust, smoking)y Increase humidityy O bserve for signs of air way obstructiony S mall amount of sedatives may be necessary to quiet the childy P rotect the child from secondary infectiony Isolationy B ed R est

PneumoniaPredisposing Factors

y Age is a non-modifiable factor in which the client¶s immunity against possible diseases isnot that developed in comparison to adults.

y Sex is a non-modifiable factor in which the occurrence of the said disease in prevalent inmales more it is in females.




y Poor Diet is a modifiable factor in which this is crucial in the strengthening of theimmune system of the client. W ithout the sufficient intake of vitamins and minerals that

are present in the diet, the defense mechanism of the body is weakened; making itsusceptible to infection and invasion of possible microorganisms that are present in theenvironment. T his can be attributed to the possibility that these microorganisms aredwelling in the environment itself.

y Place of residence is underdeveloped is another modifiable factor since crowdedness of the people living in a particular geographical area would facilitate direct contact mode of transmission of possible microorganisms or through droplet infection, as well. T his willmake the client susceptible for acquiring a disease from someone proximal to him;therefore, a disease may or may not develop depending on the distance of the client froman infected person and the virulence of the disease.

E tiology

y B acterial pneumonia: S treptococcus pneumoniay V iral pneumonia: R hinoviruses, coronavirusisy F ungal pneumonia: H istoplasma, capsulatum


y F ever y S haking chillsy P roductive coughy S putum productiony P leuritic chest pain due to the friction between the pleural layer

Nursing Management

y Monitor v/sy Auscultate both lung to determine adventitious lung soundy T urn the patient towards affected sidey Maintain patient airwayy P rovide adequate resty P rovide comfort measuresy O btain sputum specimens as needed

G astroesophagela Refulx




y G ER is the most common esophageal problem in infancy. S ome reflux occurs normally

in infants, children, and adults. G ER is deemed pathologic when it is severe, persists intolate infancy, or is associated with complications. Approximately 1 of 3oo to 1000children has a significant problem with G ER .


y E ating Pattern. P eople who eat a heavy meal and then lie on their back or bend over fromthe waist are at risk for an attack of heartburn. Anyone who snacks at bedtime is also athigh risk for heartburn

y O besity. A number of studies suggest that obesity contributes to G ER D , and it mayincrease the risk for erosive esophagitis (severe inflammation in the esophagus) in G ER D

patients. H aving a large amount of fat in the abdomen may be the most important risk factor for the development of acid reflux and associated complications such as B arrett'sesophagus and cancer of the esophagus, studies indicate. R esearchers have also reportedthat increased B MI is associated with more severe G ER D symptoms. L osing weightappears to help reduce G ER D symptoms. H owever, gastric banding surgery to combatobesity may actually increase the risk for, or worsen symptoms of G ER D .

E tiology

y T he cause is unknown, but G ER may result from delayed maturation of lower esophagealneuromuscular function or impaired local hormonal, control mechanisms.

Clinical Management

y F orceful vomiting, possibly with hematemesisy W eight lossy Aspiration and recurrent respiratory infectionsy C yanotic and apneic episodes that may be life-threateningy Esophagitis and bleeding from repeated irritation of the esophageal lining with gastric

acid.y Melelnay H eartburn, abdominal pain, and bitter taste in the mouth.

Nursing Management

y Improve nutritional status through feeding techniques such as formula thickened withcereal, enlarging nipple holes, and burping infant frequently.



y Ensure adequate hydration by assessing for signs and symptoms of dehydration,monitoring I & O , and administering intravenous ( I V )

fluids as prescribed.y Assess the amount, frequency, and characteristics of emesis.y Assess the relationship between feeding and vomiting and the infant¶s activity level.y H elp prevent reflux and respiratory complications by positioning the infant upright, as

prescribed, through feedings, and afterwards, in infant seat.y Assist in diagnostic procedures as well as surgical procedures prescribed.

Acute AppendicitisPredisposing Factors

y Weak

Factor <6 months of breastfeeding


y low dietary fiber y personal hygieney smoking

E tiology

y Acute appendicitis is due to obstruction of the blind ending appendix, resulting in aclosed loop. In children, obstruction usually results from lymphoid hyperplasia of thesubmucosal follicles. T he cause of this hyperplasia is controversial, but dehydration andviral infection have been proposed. Another common cause of obstruction of theappendix is a fecalith.

y R are causes include foreign bodies, parasitic infections (eg, nematodes), andinflammatory strictures.


y S udden onset of chills with rising fever, stabbing chest pain, paroxysmal or chokingcough, sputum is rusty or prune juice in color, pain on the abdomen, herpes may appear on the lips, body malaise, respiratory grunting with marked tachypnea and flaring of thenares, labored respiration, pulse is rapid and bounding, diaphoresis, convulsion andvomiting in children.

Nursing Management



y Monitor frequently for signs and symptoms of worsening condition, indicating

perforation, abscess, or peritonitis (increasing severity of pain, tenderness, rigidity,distention, absent bowel sounds, fever, malaise, and tachycardia).

y N otify health care provider immediately if pain suddenly ceases, this indicates

perforation, which is a medical emergency.y Assist patient to position of comfort such as semi-fowlers with knees are flexed.y R estrict activity that may aggravate pain, such as coughing and ambulation.y Apply ice bag to abdomen for comfort.y Avoid indiscriminate palpation of the abdomen to avoid increasing the patients

discomfort.y P romptly prepare patient for surgery once diagnosis is established.y Explain signs and symptoms of postoperative complications to report-elevated

temperature, nausea and vomiting, or abdominal distention; these may indicate infection.y Instruct patient on turning, coughing, or deep breathing, use of incentive spirometer, and

ambulation. D iscuss purpose and continued importance of these maneuvers duringrecovery period.

y T each incisional care and avoidance of heavy lifting or driving until advised by thesurgeon.

y Advice avoidance of enemas or harsh laxatives; increased fluids and stool softeners may be used for postoperative constipation.

Cleft L ip and Palate


y Family history. P arents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft.

y Sex. Males are twice as likely to have a cleft lip with or without cleft palate. C left palatewithout cleft lip is more common in females.


y E nvironmental factors. Exposure in early pregnancy to cigarette smoke, alcohol or illicit drugs may put a baby at higher risk of developing a cleft.

y Maternal obesity. O besity in the mother is associated with a slightly increased risk of cleft lip and palate

E tiology

y C auses include genetic, environmental, and teratogenic factors.



y C hildren may have associated dental malformations, speech problems, and frequent otitismedia, the latter resulting from improper functioning of the Eustachian tubes.


y C L and C P are readily apparent at birth. C areful physical assessment should be performed to rule out other midline birth defects. y C L and C P appear as incomplete or complete defects and maybe unilateral or bilateral.

Nursing Management

y S upport the infant¶s and parent¶s emotional and social adjustmenty Assess for problems with feeding, breathing parental bonding, and speech.y Ensure adequate nutrition and prevent aspiration. y S upport the infant¶s and parent¶s emotional and social adjustment. y P rovide mouth care to prevent infections. y Assess airway patency and vital signs. N ote for edema. y S how proper feeding techniques and positions. y Attempt to keep child from putting tongue up to palate sutures.

Dehydration


y Age:o Y ounger than 2 years oldo 65 and older

y D ehydration may result from the anumber of diseases that cause insensible losses throughthe skin and respiratory tract, through increased renal secretion, and through the G I tract.


y N eurological conditions, such S troke or C erebral P alsyy Memory problems or D ementiay C hronic medical conditionsy Athletic competition

E tiology

y D ehydration is most often caused by a viral infection that causes fever, diarrhea,vomiting, and a decreased ability to drink or eat. C ommon viral infections causing



vomiting and diarrhea include rotavirus, N orwalk virus, and adenovirus. S ometimessores in a child's mouth(caused by a virus) make it painful to eat or drink, which helps tocause or worsen dehydration.More serious bacterial infections may make a child lesslikely to eat and may cause vomiting and diarrhea. C ommon bacterial infectionsinclude S almonella, E scherichia coli, Campylobacter,and Clostridiumdifficile. P arasitic infections such as Giardia lamblia cause the condition knownasgiardiasis , which can lead to diarrhea and fluid loss. Increased sweating from a veryhot environment can cause dehydration. Excessive urination caused by unrecognized or

poorly treated diabetesmellitus (not taking insulin) or diabetesinsipidus are other causes. C onditions such as cystic fibrosis or celiac sprue do not allow food to beabsorbed and can cause dehydration.


Minimal D ehydration

y N ormal thirst or may refuse some liquidsy A moist mouth and tonguey N ormal to slightly decreased urine outputy L ess than 3% weight lossy N ormal heart rate, pulses, breathing, and warm extremitiesy C apillary refill less than 2 sec.y Instant recoil on skin turgor testy Eyes not sunken

Mild D ehydration

y Increased thirsty A dry mouth and tonguey D ecrease urine outputy 3 to 9% weight lossy N ormal heart rate, pulses, breathing, and cool extremitiesy C apillary refill less than 2 sec.y S lightly sunken eyes

S evere D ehydration

y P oor drinking or may be unable to drink y A parched mouth and tonguey Minimal or no urine outputy G reater than 9% weight lossy Increased HR , weak pulse, deep breathing, and cool, mottled extremitiesy C apillary refill that is very prolonged/minimal



y R ecoil on skin turgor in more than 2 secondsy D eeply sunken eyes

Nursing Management

y Monitor v/sy Encourage parents to increase fluid intake and electrolytes intake to promote hydration.y Maintain I V lines and fluids.y O btain an accurate initial weight and monitor weight changes indicating fluid gains and

losses.y O ffer oral fluids in small quantities.y Monitor I V replacement therapy and check the I V site frequently.y T each parent about positioning, moving and caring for a child with an I V line.

Kawasaki Disease


y Age. C hildren under 5 years old are most at risk of K awasaki disease.y Sex. B oys are slightly more likely than girls are to develop K awasaki disease.y E thnicity. C hildren of Asian descent, such as Japanese or K orean, have higher rates of

K awasaki disease.


y Myocarditisy H eart valve problemsy Abnormal heart rhythm

E tiology

y N o one knows what causes K awasaki disease, but scientists don't believe the disease iscontagious from person to person. A number of theories link the disease to bacteria,viruses or other environmental factors, but none has been proved. C ertain genes mayincrease your child's susceptibility to K awasaki disease.




y Extremely bloodshot or red eyes (without pus or drainage)y B right red, chapped, or cracked lipsy R ed mucous membranes in the mouthy S trawberry tongue, white coating on the tongue, or prominent red bumps on the back of

the tonguey R ed palms of the hands and the soles of the feety S wollen hands and feety S kin rashes on the middle of the body, N O T blister-likey P eeling skin in the genital area, hands, and feet (especially around the nails, palms, and

soles)y S wollen lymph nodes (frequently only one lymph node is swollen), particularly in the

neck areay Joint pain and swelling, frequently on both sides of the body

Nursing Management

y Monitor pain level and child¶s response to analgesics.y Institute continual cardiac monitoring and assessment for complications; report

arrhythmias.y T ake vital signs as directed by condition; report abnormalities.y Assess for signs of myocarditis (tachycardia, gallop rhythm, chest pain).y C losely monitor intake and output, and administer oral and I. V fluids as ordered.y Monitor hydration status by checking skin turgor, weight, urinary output, specific gravity,

and presence of tears.y O bserve mouth and skin frequently for signs of infectiony

K eep the family informed about progress and reinforce stages and prognosis.

Cardiac Dysrhythmia


y C ardiac dysrhythmia occur less frequently in children than in adults.y C ongenital


y Acquired, as seen in postoperative patients following surgery in the area of the A- V valves and ventricular system.

y T achydysrhythmias: caused by fever, anxiety, pain, anemia, dehydration, or any other factor requiring increased cardiac output.

E tiology



y Bradydysrhythmias

T his can be either congenital or acquired as seen in postoperative patients followingsurgery in the area of the A- V valves and ventricular system

y S inus Bradycardia

In children is caused the influence of the autonomic nervous system, as with thehypervagal tone, or in response to hypoxia and hypotension.

y T achydysrhythmias

T his is caused by fever, anxiety, pain, anemia, dehydration, or any other factor requiringincreased cardiac output.


y D izzinessy F aintingy C hest discomforty D ifficulty of breathingy P alpitationsy F atiguey P ounding in your heart

Nursing Management

y P rovide adequate oxygen and reduce heart workload.y Evaluate the monitored patient¶s E C G regularly for arrhythmia.y Monitor for predisposing factors, such as fluid and electrolyte imbalance, and signs

of drug toxicity, especially with digoxin.y T each the patient how to take his pulse and recognize an irregular rhythm and instruct

him to report alterations from his baseline to the doctor.y Emphasize the importance of keeping laboratory and physician¶s appointments.

HemophiliaPredisposing Factors

y F amily members with hemophiliay F amily history of bleeding disordersy S ex: male




y Excessive bleeding from the umbilical cord or after circumcision

E tiology

y H emophilia is caused by a faulty gene inherited from one or both parent. It is called aninherited sex-linked recessive gene. T he gene is located on the X chromosome.

y F emales carry two copies of the X chromosome. If the faulty gene is only on one X, thenormal gene on the second X will take over. As a result, they will not get the disease.Instead they are carriers of the gene. T he risk for their male offspring to inherit the geneis 1 in 2 or 50%. T he chance that their female offspring will inherit the gene is also 50%.T hese offspring will be carriers like their mothers.

y It is possible for a female to have hemophilia. F or this to happen she must inherit thefaulty gene from both her mother and her father.

y Males carry only one X chromosome. If they get the faulty gene the disease will develop.


y F requent bruising.y F requent nose bleeds or bleeding gums.y P ain and swelling in joints or muscles.y P rolonged bleeding or oozing of blood from injuries, surgical incisions (cuts), or a

pulled tooth site.y S tools (bowel movements) that are dark or black.y U rine that is pinkish or reddish in color.

Nursing Management

y Assess for acute or chronic bleeding: skin, joints, and muscles are assessment priorities.C heck vision, hearing and neurologic development. Also check for hematuria and

bleeding from the mouth, lips, gums, and rectum.y P revention is a primary goal.y P revent or minimize bleedingy P rovide S upporty P rovide the child and family teaching

Anemia


y B iologic F actors



y P rominent in age groups experiencing rapid growth: toddlers, adolescents, pregnant andlactating women.

y In children, it occurs often between the ages 6 months and 3 years; adolescents and premature infants are also at risk.

y Pregnancy. If you're pregnant, you're at an increased risk of iron deficiency anemia because your iron stores have to serve your increased blood volume as well as be a sourceof hemoglobin for your growing fetus.

y Family history. If your family has a history of an inherited anemia, such as sickle cellanemia, you also may be at increased risk of the condition.

y Other factors. A history of certain infections, blood diseases and autoimmune disorders,exposure to toxic chemicals, and the use of some medications can affect red blood cell

production and lead to anemia.


y Infants young than 12 months who drink cow¶s milk rather than breast milk or ironfortified formula.

y Y oung children who drink a lot of cow¶s milk rather than eating foods that supply the body with more iron.

E tiology

y An iron-poor diety B ody not being able to absorb iron very well, even though you¶re eating enough iron.y L ong-term, slow blood loss usually through menstrual periods or bleeding in the

digestive tract.y R apid growth, when more iron is needed.y It is caused by inadequate intake of iron-rich foods or inadequate absorption of iron.


y B lue-tinged or very pale whites of eyesy B lood in the stoolsy B rittle nailsy D ecreased appetitey F atiguey H eadachey Irritabilityy P ale skin color y S hortness of breathy S ore tonguey U nusual food cravingsy W eakness

Nursing Management



y Asses for fatigue, activity intolerance, and other signs of impaired tissue oxygenationy Asses for fatigue, activity intolerance, and other sings of impaired tissue oxygenationy P romote an adequate intake of iron-rich foods (iron fortified formula and cereals, liver,

egg yolk, and organ meatsy

Explain the potential adverse effects of iron which includes nausea and vomiting,diarrhea or constipation or black stools and tooth discoloration.y Instruct care givers to keep iron supplements out of reach of children since it is toxic

when overdosed.

HydrocephalusPredisposing Factors

y N eural tube defectsy Mother has infection during pregnancy, such as:

o C ytomegaloviruso T oxoplasmosiso L ymphocytic choriomeningitis viruso C hickenpoxo Mumps

y B rain infectionsy Malformations of the brainy B rain injuries


y C onditions of hydrocephalus can be also affected by the environment. O ther conditionsof non-communicating hydrocephalus can increase by the infection from theenvironment.

E tiology

y C ysts in the brainy Malformation of the brainy B rain injuriesy B lood vessels abnormalities in the brainy B leeding into the brain


y R apid increase of head circumferencey V omitingy S leepinessy Irritability



y D ownward deviation of the eyes also called as sunsettingy S eizuresy H eadachey P apilledemay P oor coordinationy D

iplopia

Nursing Management

y T each the family about the management required for the disorder y P rovide preoperative carey P rovide postoperative nursing carey Encourage the child to participate in age-appropriate activities as tolerated.y Asses for acute or chronic bleeding: skin, joints, and muscle are assessment priorities. y O bserve for swelling and tenderness in the joints, and prevent contractures. y Monitor for signs of hypovolemia. y

Avoid analgesics that promote bleeding such as aspirin. y Administer medication as prescribed. y Assist the child and parents to recognize signs of major bleeding. y D emonstrate passive range-of-motion exercises. y P rovide diet information because weight increases can impose further stress on joints.

Alawiya, Jamal Tango P.

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