Module 9 1. Discuss systemic infant disorders, child abuse, environmental safety Discuss other...

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Maternal child healthModule 9

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Objectives

Discuss systemic infant disorders, child abuse, environmental safety

Discuss other common disorders and topics in pediatrics

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Introduction: 0-12 months

Depend and relate to parents Interpret illness as general pain and

discomfort Interventions should be considered with

developmental age in mind

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Infants: GI Thrush

◦ Fungal infection of mouth, throat◦ Candida albicans; common < 6 months age◦ Sources: Hands, nipples, pacifiers, vaginal canal◦ Teaching:

Carefully clean hands, bottles and nipples, may need to apply antifungal to breast between feedings – teach how to wash before offering to baby

◦ Baby may require antifungal applied to mouth

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Infants: GI

Diarrhea ◦disturbed GI motility -> diarrhea◦Acute gastroenteritis Caused by infection

◦Other common causes: juices, formulas, allergens

◦Dehydration, electrolyte imbalance◦Labs: serum sodium, serum glucose,

serum bicarbonate, blood urea nitrogen (BUN) help determine severity

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Infants: GI diarrhea

◦Avoid concentrated juices and medications not approved by pediatrician

◦Frozen liquids (popsicles), Pedialyte may help rehydrate

◦Keep skin clean, dry

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Infants: GI Colic

◦3 x3 x 3 Crying > 3 hours daily Starts about 3 weeks, lasting about 3 weeks

◦No discernible physical cause◦Overly sensitive to stimulation

Dehydration

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Infants: GI

Colic◦Infants may be more at risk for injuries like shaken baby, abuse, neglect

◦Educate parents and caregivers◦Encourage parents to take breaks◦Assess parents’ coping

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Infants: GI Failure to thrive

◦May indicate feeding or nutritional problems

◦May indicate abuse, neglect◦Must be assessed carefully Growth chart should be appropriate to

race, feeding style Growth charts: tool Development should be assessed

◦Care plan: nutrition, medical hx, psychosocial

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Infants: GI

Cleft lip/palate◦Malformation of hard and/or soft tissues

of mouth, palate◦May interfere with feeding◦Predisposed to thrush -> GI infection◦May require speech therapy and

nutritional therapy◦Prevent aspiration: hold upright to feed◦ESSR feed techniques: Enlarge nipple,

Stimulate suck reflex, Swallow fluid appropriately, Rest

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Infants: GI Cleft lip/palate

◦Allow frequent burping d/t extra air swallowed

◦Requires surgical repair: photos, expectations

◦Promote bonding◦Post-op feeds: avoid suture line◦Clean suture line with saline after feeds◦Have baby lie on stomach to drain

surgical area◦Monitor for dehydration

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Types of cleft lip/palate

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Cleft palate: before/after surgery

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Cleft lip before/after surgery

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Infants: GI Esophageal atresia with

tracheoesophageal fistula◦Esophagus not connected to stomach◦Hole between esophagus/trachea◦Requires surgery◦Requires IV nutrition until healed◦s/s: coughing/choking with swallowing,

breathing problems

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Infants/children: GI

Pyloric stenosis◦Valve between stomach and duodenum enlarged

◦Projectile vomiting◦Malnutrition/dehydration◦Visible peristaltic waves from left to right across the epigastric region may be seen

◦May require surgery

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Infants: GI Megacolon (Hirschsprung’s)

◦Nerves defective along portion of colon◦No peristalsis -> intestinal obstruction◦Enlarged colon◦Surgery: temporary colostomy and

removal of dead tissues, then restructuring GI tract

◦Pre-op diet: low fiber, high-protein/calorie

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Hirschsprung’s Disease/megacolon

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Infants/children: GI

Gastroesophageal reflux (GER)◦Effortless regurgitation ◦Most common cause vomiting

term/preterm infants◦Incompetent lower esophageal sphincter

Intussusception◦Part of intestine pulls up inside itself◦Most common cause intestinal

obstruction ages 3 months- 6 years◦Unknown cause

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Nursing care: infants GI

Assess nutrition, hydration Provide age-appropriate education, pre/post-op care

Teach parents how to help their child eat, drink

Teach ostomy, incision care Provide support for families

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Infant musculoskeletal disorders

Congenital talipes equinovarus◦Clubbed foot

Developmental dysplasia of the hip◦Partial or full dislocation of femoral head from hip

Treatment: ◦spica cast◦Pavlik harness

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Hip immobilization

Spica cast Pavlik harness

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Nursing care: musculoskeletal

Keep case in proper shape until dry

Assess, protect skinAssess CMS, report changesEncourage growth/development

Activities Learning social

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infant: integumentary system Milia rubra Diaper rash: diaper dermatitis Cradle cap: seborrheic dermatitis Atopic dermatitis Newborn rash: erythema toxicum neonatorum

Stork bite: telangiectatic nevi Port-wine stain: nevus flammeus Strawberry birthmarks: nevus vasculosus

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Cradle cap

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Nursing care: infant skin

reassure parents teach preventive care for rashes Show how to apply and remove creams

Caution against drying soaps, teaching thorough rinsing of skin – avoid overdrying!

provide support of worries over appearance

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infant: nervous system Spina bifida

◦Failure of neural tube to close◦May be result of low folic acid in mom’s diet during pregnancy

◦Sensorineural deficit below site◦Elimination, ambulation problems◦Treatment: surgery to close◦Variation :myelomeningocele: portion of spinal cord, meninges, spinal fluid, nerves protrude

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infant: nervous sytem Hydrocephalus

◦Too much CSF in/around brain◦Shunt from brain to peritoneal cavity◦May require surgery series during growth◦“Sunset sign”◦S/S (infants): Frontal bossing of forehead,

sunset eyes, slow pupil response to light, irritability, high-pitched cry, difficulty consoling, lethargy, altered LOC, difficulty sucking/feeding

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Nursing care: infant nervous system

◦Education: disease, surgery, recovery

◦Pre/post operative nursing care Monitor baseline and changes in motor, sensory, circulation

Monitor level of consciousness Assess for failure to thrive d/t malnutrition, dehydration r/t poor feeding

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Sunset sign

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Infant: nervous system Seizure disorders

◦Partial or generalized◦Fever, infection, trauma, hypoxia, poisons, tumors, metabolic disturbances

◦birth-2 years most common◦Assess for safety and interruption of age-related tasks

◦Promote safe behaviors Bed rail pads, helmets

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Types of seizure protection

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Infant: nervous system Meningitis

◦Inflammation of meninges (central nervous system)

◦<5 years old◦Usually follows an URI, skull fracture,

lumbar puncture◦S/S (infants): bulging fontanelle, high-

pitched cry◦Kernig’s, Brudzinski’s signs◦Haemophilus influenzae type b vaccine

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Exam for meningitis

Kernig’s sign Brudzinski’s sign

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Infants: nervous system

Cerebral palsy◦ Nonprogressive disorders -> motor dysfunction◦ No specific treatment – care given to treat

disabilities: occupational, physical, speech and hearing specialists

◦ Many implicated causes: maternal, perinatal, infancy/childhood

◦ Careful history taking important to find causes◦ Botox may be used to treat spastic muscles –

can help avoid contractures and surgeries later

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Child with cerebral palsy

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Nursing care: infants: neuro

Assist with use and learning of adaptive devices for ADLs: eating utensils, ambulation devices, protective headgear

Teach new ways to do ADLs independently Encourage mobility and age-appropriate

activities Help families adjust to multiple therapies Direct to support services Assess family adaptation

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Infants : genitourinary system Hypospadias

◦Urethra opening on underside of penis

Hydrocele◦Fluid in scrotum

Phimosis◦Foreskin too tight

Cryptorchidism◦Undescended testes

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Hypospadias repair

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Infants: GU system Inguinal hernia

◦Abdominal organ(s) protrude into groin◦More often in boys than girls◦Present at birth or developed later◦May be put into place by pressure – done

by pediatrician – or surgery◦If blood supply to organ cuts off, infant

may show signs of severe abdominal pain and vomit – requires emergency bowel resection

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Inguinal hernias

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Nursing care: infants GU

Educate parents: cause of defect, risks and benefits of surgery, post-surgical home care, address reproductive concerns

Monitor I&O, hydration status, pain Anti-infectives in underlying infection

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infants: cognitive/sensory

Down syndrome◦Extra chromosome on pair 21◦Distinct head/face/hand characteristics: simian crease, low-set ears at birth

◦Some degree of cognitive impairment

◦May have URIs, cardiac and thyroid problems

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Infants: cognitive/sensory

Visual or hearing impairment◦Deficit or loss of sight or hearing◦May be related to illness , injury or congenital

◦Early assessment, correction to prevent learning problems

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Nursing care: cognitive/sensory

refer to appropriate support services and developmental specialists

Assess adaptation: infant and family Help families develop appropriate stimuli for child

Assess adaptation and age-appropriate development

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Assessing child abuse: all ages Physical neglect

◦Failure to thrive◦Hunger◦Poor hygiene ◦Clothes too heavy or too light for season◦Unattended medical needs◦Abandonment ◦Extended stays at school◦Delinquency◦Alcohol, drugs

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Assessing child abuse Physical abuse

◦ Injuries explained away as “accidents”◦ Injuries don’t fit explanation, conflicting stories

Symmetrical burns without splash marks Bruises, welts, human bite marks Multiple, spiral fractures in various stages

healing Fractures to skull, nose, face Unreported injuries discovered by exam

◦ Apprehension when other children cry◦ Concealing clothing worn to hide injuries◦ Object-shaped marks: belt buckle, iron, cords

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Assessing child abuse Emotional abuse

◦Withdrawal, inappropriate fearfulness

◦Emotional/intellectual development lag

◦Language difficulties◦Suicide attempts◦Failure to thrive◦Feeding problems◦Bedwetting◦Disturbed sleep

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Assessing child abuse Sexual abuse

◦Promiscuous behaviors◦Age-inappropriate sexual knowledge◦Forcing sexual acts on other children◦Fear of being touched ◦Difficulty walking, sitting◦Adolescent pregnancy◦Vaginal/penile discharge◦Bruising in genital area, hard/soft palate◦Recurrent UTIs

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Nursing care: abuse

Assess family cultural practices◦ Coining

Assess stress within family ◦ Strained resources

Using drawings, anatomically correct dolls, play, diagrams to help child express abuse

Report can be based on suspicion alone Exams and procedures must be explained

clearly Document parent/child interactions

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Environmental safety: all ages Poisoning

◦ Common cause illness/death <5 years of age

◦ Poison Prevention Packaging Act 1970 Childproof medicine

containers and caps

◦ American Association Poison Control Centers 1-800-222-1222 Common household

poisons, radiation, batteries, etc

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Environmental safety Trauma

◦As independence increases, so do chances for trauma

◦Injuries common to stages of development Broken arm at 10 Concussions in contact sports Scraped knees at six

◦Help parents “child-proof” house, yard◦Burns, fractures, scrapes, cuts, bruises,

concussion, car accident without restraints

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Environmental safety Suffocation/drowning

◦Never leave unsupervised in a bathtub

◦Prevent access to toilets, buckets, washtubs, containers, rainwater collection, swimming pools, wading pools

◦Keep sleeping area clear of too many things

◦Keep plastic away from children

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Nursing care: safety Educate families regarding specific dangers according to age group

Help families identify ways to avoid common dangers in the environment

Refer families to sources of safety devices

Supply information: web sites, telephone numbers, programs

Adapt education if family has disabled child

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Promotion, maintenance and restoration of health◦Family centered planning◦Care of child with special needs

Care planning based on developmental assessments ◦Developmental milestones◦Guidelines and averages for growth and

development◦Early diagnoses and interventions with

anticipatory guidance

Basics of pediatric care

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Preparing child and family for hospitalization◦ Admission

Age group Confidentiality Appropriate environment (flexible schedule,

separate living/treatment areas, roommates, parent involvement, preferred foods)

ADLs (play rooms, activities) Weight-based ID band for child, matching one

for parent Labs: minimal sticks, appropriate explanation Routines and expectations: child, parents and

hospital


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Safety and protection◦ Environmental hazards according to age◦ Security system: custodial parents, kidnapping◦ How would you “child-proof” a hospital?

Child undergoing surgery◦ Preoperative procedures◦ Pain management, expectations, explanations

Truthfulness Minimizing anxiety

◦ Parenting vs nursing roles


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Child undergoing surgery: Preparation

◦ Psychological According to age/developmental level Address pain, preconceptions, privacy, parental

involvement, timing (3 p.m. for teens = “snack time” for toddler, etc), alleviate anxiety, address expectations

◦ Physical Involve parent with younger children, let older

children help Privacy, “no-touch zones”, confidentiality

◦ Post-operatively Pain, anxiety, n/v, side effects, recovery, expected

outcomes


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Child undergoing surgery ◦ Age-related concerns

Infant: needs parents close, responds to parents’ emotions, tension

Toddlers: fear separation from parents, dislike physical restraint, needs routines, fears pain

Preschool: hospitalization may be perceived as rejection/punishment. Needs parents. May have mutilation fears. Concerned by bodily penetration by instruments, injections

School-age: fears loss of bodily control/mastery, needs knowledge

Adolescence: fears loss of control, independence, peer separation


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Child undergoing surgery Pain management

◦Pain is 5th vital sign, recorded at least q shift

◦Wong-Baker FACES pain Rating Scale (FON p 962)

◦Verbal estimation of pain by number scale

◦Infant behavioral pain rating scale


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Child undergoing surgery Discharge/discharge planning

◦Reintegration of child into normal home routine

◦teach child/parents about devices, incisions, etc. and/or to follow new diets, activity restrictions, measurements

◦Teaching: clear, measurable, and supportive

◦Teach expected outcomes◦Referrals, continuity of care, follow-up,

support systems


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Child undergoing surgery◦ Psychological

Address fears, anxiety, misconceptions, cause/effect, expected outcomes appropriate to age

Give time lines (three o’clock to teen, “snack-time” to toddler)

Concrete terms for younger children◦ Physical

Disrupt privacy, bodily integrity and functions as little as possible: be aware of “private zones”

Avoid pain whenever possible Involve parents as much as is appropriate


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Physical assessments◦Growth measurements Length Weight Head circumference Chest circumference Abdominal circumference Vital signs

Pediatric procedures

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Pediatric vital signs ranges◦1 year: HR 90-150, RR 22-30◦5 years: HR 70-115, RR 20-24◦10 years: HR 60-100, RR 16-22

By age 10, vital sign ranges are similar to adult V/S

Lower range for SBP: ◦Up to age 10: 70+ 2 (age in years) up to age 10

◦10+: 90


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Pediatric fever: ◦100.4F/38C rectally◦99.5F/37.5C orally◦99F/37.2C axillary

Babies under 4-6 months should have all fevers checked by provider at once


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Developmental assessment ◦Factors: Nutrition Metabolism Higher in newborn

Sleep/rest


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Ahhh… sleep!

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Speech/communication Follows developmental pattern: crying, cooing/laughing/babbling, mimicking speech sounds, 1-4 word vocabulary at 1 year, increasing at defined increments

Rapid vocabulary development at preschool age


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Safety reminder devices/restraints◦Elbow: IV◦Mummy: gavage or chest auscultation – infant

◦Clove-hitch: umbilical artery/vein IV placement – infant

◦Jacket: keeping active older infant/toddler in bed, high chair


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Safety reminders/restraints◦NO safety device should be used instead of continual monitoring

◦Assess for restriction of circulation, motor, sensory, or for injury

◦Discontinue as soon as possible


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Specimen collection◦Urine: collection bag, suprapubic bladder tap, catheter

◦Stool: sample taken from diaper or plastic wrap over toilet after urination

◦Blood: jugular, femoral may be used in infants/young children; umbilical site may be used in newborns. Prevent injury from sharp, immobilize site


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◦ Lumbar puncture: Pain/anxiety

Address safety concerns, use lidocaine cream 1 hour prior Side-lying position, well-secured. Gentle flexion of

neck and legs (increases space between vertebrae to subarachnoid space)

Physician and nurses wear mask, also parent if present Sterile procedure Warmth, privacy, distraction Assess for change in s/s, decrease in

circulation/motor/sensory ability, H/A in adolescents Have adolescents lie flat for several hours; younger

children can play quietly


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Intake and output◦ Important especially with:

Diarrhea, burns, renal disorders, impaired PO intake, IV fluids, etc

◦ Can help rule out intake deficiencies vs other problems (acute illness, metabolism problem)

◦ Give fluids in cups with measure markers◦ Bottles should have measure markers◦ Breastfeeding may be evaluated in length of

successful feed and output, skin turgor, etc◦ Older children/teens can help track


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Administration of medications: approaches to pediatric clients◦ Accuracy important: pediatric patients have lower

tolerance for error, do not eliminate toxins and byproducts at rate of adults

◦ Age-appropriate explanations: meds are not candy, more is not better, only take what Mommy/Daddy gives, etc

◦ Minimize side effects◦ May have to teach child to swallow pills◦ Child and parent education


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Medication administration◦Usually require smaller dose than adult

◦Overdose in pediatric patients can have more serious outcomes than in adults: Metabolism Absorption, distribution, excretion

Less tolerance for error


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◦ Dosage should be ordered in units/weight unit/time measurement Body-surface area (BSA)

Used by physician to calculate correct dose When adult dose known, may be applied:

(child’s BSA/adult BSA) x adult dose = estimated child’s dose

Mg/kg every X hours on label Mg/volume unit must be known because oral

medications frequently in liquid Dosage unique to child’s current weight should

be on label and checked against physician order

Weight child on same scale every time


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Safety in medication administration◦ Two-nurse dose check◦ Check labels, MARs against original orders◦ Clarify any discrepancies before administration◦ Right equipment in correct working order◦ Know 6 rights:

Medication, amount, child, time, route, documentation

◦ Know facts: Reason for giving, type of drug, onset, peak and

duration, side effects, child’s allergies, nursing considerations, contraindications


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Medication administration: oral medications◦Liquids: prevent aspiration, use correct

measuring device◦Non-liquids: may give with non-essential

food◦Minimize side effects and reasons for

protest: soda for N/V, cold foods for numbing taste, pinch nose and use straw to minimize bad taste

◦When using sweets to disguise taste, avoid honey for infants <1 years – risk of botulism


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Medication administration◦Intramuscular: Use vastus lateralis (medio-lateral

aspect of thigh) until walking well May use ventrogluteal site after walking

well and at least one year of age Use numbing cream 1 hour- 2.5 hours

prior to injection Prepare child for realistic sensation Minimize movement of child – prevent

injury


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Optic, otic, nasal administration◦Cooperation, possible restraint needed◦Optic: minimize injury potential, apply

drops at least 3 minutes before ointments, try to apply before sleep

◦Otic: pull pinnae down and back <3 years Upward and back >3 years May need sterile cotton

◦Nasal: hyperextend head to facilitate medication of nasal passages rather than pharynx


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Intravenous medications◦immediate and systemic effect◦initial stick rather than several◦easily titrated for therapeutic dosing◦Scalp veins in infants < 9 months have

no valves, permitting insertion either direction – also minimize disruption because child can’t see them

◦IV lines must have filter, safety chamber (Buretrol) and must be on safety pump

◦Use care to avoid air in line, at site of line/saline lock juncture


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The dying child◦ Child’s understanding and response influenced by

age, developmental level, parental values/beliefs, culture, religious orientation

◦ “small deaths” of pets, animals can help children relate to death

◦ Be aware of words: “sleep”, “dreaming”, “heaven”, “angels” and preconceived ideas of child or siblings

◦ Concrete thinking: fear of being left alone, left underground, unknown

◦ Older child: fear of unknown, influenced by beliefs◦ Do not mix parenting/nursing roles


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1-18 years: introduction

Goals: Protect from illness and injury Foster growth/development Promote healthy family interactions

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1-18 years Assessment:

◦Observe respirations while child is calm and unaware Range: 30 in 11 month old, 21 at six

years and 20 at ten and older◦Heart rate: use age-appropriate language

to gain cooperation Try to measure while child is sleeping

◦Blood pressure Cuff should cover 2/3 of area used Choose cuff according to child’s size,

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1-18 years

Blood pressure◦ To calculate normal systolic BP 1 – 7 years: age in years + 90

6 years = 96 8-18 years: (2x age in years) + 83

17 years= 117◦ To calculate normal diastolic BP 1-5 years: 56 6-8 years: age in years + 52

7 years= 59

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Measuring pediatric B/P

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1-18 years

Temperature◦Higher norm for younger children◦Fever in < 6 months should be reported

at once◦1 year: 99.7 degrees Fahrenheit◦5 years: 98.6 F◦9 years: 98.1 F◦13 years: 97.8 F◦Crying, activity, infections all raise

temperatures◦Oral, axillary, rectal, tympanic readings

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1-18 years Oral temperature

◦May be used > 6 years◦Do not use glass/mercury types –

breakage can leak poisonous mercury◦Rectal: may be first temp on newborn◦Axillary: newborns, young children◦Tympanic: may not detect fevers

accurately < 3 years

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Exam: Toddler

Consider child’s developmental age and attitude towards illness◦Self as separate person May tolerate separation from caregiver Expresses self

◦Increasing attention span◦Developing communication and self-

control skills◦Mastering toilet-training◦Achieving basic mobility◦Developing independence

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Exam: toddler Gross motor skills

◦Walking, hopping, stair climbing, running, pulling, exploring

Fine motor skills◦Drawing circles, scribbling

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Exam: toddler Tasks

◦Bowel, bladder control Encourage mastery Avoid shaming Praise

Behavioral◦May be loving and cuddly or striking out

Erikson’s stages◦Autonomy vs shame and self-doubt

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The game of potty-training

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Exam: toddler

Hospitalized toddlers:◦Keep with parents◦Give control in minor things◦Maintain ritual and routines◦Minimize pain Lidocaine cream before injections, IVs

Distract child during interventions

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Exam: preschool

Keep with parents Reinforce that hospitalization and treatment aren’t punishment

Ease mutilation fears Assess if child fears penetration of body by instruments, injections

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Keep parents with sick preschoolers

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Exam: preschool Fine motor skills improve Body slims, becomes more graceful, less

top-heavy Erikson: initiative vs. guilt: encourage child

to act and learn without making him feel guilty

Role-play with stereotypes and interest in sexual differences

Magical thinking: believes wishes can make things happen (fears negative consequences of own powerful thinking)

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Exam: preschool

Avoid untruthsEncourage beneficial imaginationSupport nutrition during picky eating periods

Still need 11-12 hours sleep/night

Need limits set on behavior

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Exam: preschool Empower child

◦Let them initiate contact if possible◦Get down on their level◦Avoid prolonged eye contact until they are comfortable

Use clear language Substitute gentle descriptive language for threatening words

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Exam: school-age

Erikson: industry vs inferiority: learning to master skills and feel satisfaction

Motor skills develop and posture straightens

Strength increases and child loses baby fat “Growing pains” as long bones develop Becomes more aware of rules/regulations,

expectations and structure Learning compromise and competition

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Exam: school-age Listen for

underlying messages when child talks

Avoid passing judgment or appearing to do so

Avoid embarrassing and lecturing child

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Exam: adolescents

May experience wide range of emotions/behaviors

Use concrete language even though child developing abstract thinking abilities

Develop trust Exchange information while avoiding

questions that “pin down” the adolescent – ask open-ended questions before specific ones

Erikson’s: Identity vs. Role Confusion

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Exam: general

Use speech appropriate age of child Don’t rush exam – allow and use play as part of exam

Make child comfortable Involve child in exam:

◦Have preschooler “blow out” exam light while auscultating lungs

◦Allow adolescents to control environment as suitable

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Exam: general Do exam in efficient, low-key manner Be flexible according to child’s needs Allow privacy and respect boundaries Examine painful areas last Use dolls and drawings to explain in clear, concrete terms what you’re going to do and why

Keep parents involved

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Pediatric assessments

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Growth/development Circumference of infant

◦Head◦Chest◦Abdomen

Height/length Weight – use same scale, minimize extra weight while maintaining privacy and warmth

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Measuring head circumference

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Growth charts

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Respiratory system Upper respiratory infections

◦ Sore throat (acute pharyngitis) Usually viral If caused by group A beta hemolytic

Streptococci, can cause scarlet fever, rheumatic fever

◦ Tonsillitis May also be caused by Streptococci -

throat culture can rule out Allergic rhinitis (runny nose from allergies)

◦ Identify and avoid causes

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Respiratory system Bronchial asthma

◦Triggers: environment, respiratory infection, allergies

◦Audible expiratory wheeze, hypoxemia, increased work of breathing

Choking (foreign-body aspiration)◦A leading cause fatal injury in children younger than 1 year

◦Prevention and safety!◦Troubleshoot foods

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asthma

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Nursing care: respiratory

Educate children and parents regarding disease process

Teach parents how to give medications to children and teach older children how to use inhalers

Teach importance of avoiding stressors: allergens, not enough rest, etc.

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Cardiovascular cardiovascular

◦Rheumatic fever: caused by group A beta hemolytic Streptococcus

◦Treatment of causative infections can prevent rheumatic fever – rule out strep throat

Nursing care: rheumatic fever◦minimize activity for heart involvement, support of regimen, comfort measures for joints, educate to reinforce path of disease from original source.

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Nursing care: cardiovascular Encourage activities and independence

according to age and cardiac tolerance Teach parents importance of ruling out strep

infections Teach parents and children how to apply

comfort care Refer to developmental specialists in severe

or debilitating illness

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Blood/lymph Blood/lymph

◦ Leukemia Most common cancer of childhood Most common leukemia is acute lymphoid leukemia

(ALL) Too many immature WBC, crowding out other cells in

marrow Genetic disorder Can spread to other organs: testes, kidneys,

prostate, ovaries, GI tract, lungs Risk factors: radiation exposure, siblings with ALL

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Nursing care: leukemia

Encourage independence and normalcy in childhood according to developmental age

Educate children and families Support families Ease side effects of medications to

encourage eating, activity, hydration, rest, play

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Twins

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Blood/lymph Hodgkins’ Disease

◦ Cancer of lymph tissues

◦ Painless, progressive enlargement of lymph tissues

◦ More common in males younger than 5 years

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blood

Idiopathic thrombocytopenic purpura◦Reduced circulating platelets◦No known cause◦May follow viral infection: chickenpox,

respiratory infection, rubella, mumps, rubeola

◦Bruising, pinpoint rash, bloody nose and gums, lips, intracranial hemorrhage

◦Blood in urine, feces, vomit, joint spaces, heavy menstruation

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blood

Hemophilia◦Recessive genetic disorder carried by

females and affecting males◦Missing coagulation factor VIII◦Normal childhood injuries cause

excessive bleeding◦Increased bleed time shows up on tests◦Factors VIII and IX low or absent on tests◦May need only cold, pressure on bleeds

or may need infusion of clotting factors◦Encourage non-contact play and sports

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Nursing care: blood/lymph

Teach parents had children how to avoid and treat injuries, when to call 9-1-1

Educate families about alternatives to contact sports and explain how many things child can still do safely

Assess compliance with safety strategies Give accurate education about genetic

disorders or refer to someone who can

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Gastrointestinal Constipation

◦May be primary (not associated with underlying disorder) or secondary (caused by a disorder)

◦S/S: pain when defecating, abdominal pain/cramping, bright red blood with defecation (anal fissures), loss of appetite, irritability

◦May be caused by formula, iron supplements, anticonvulsants, low-fiber diets, antacids

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Nursing care: constipation

increase fluid and fiber intake Assess and treat cause Teach parents how to do anal dilation if ordered

Teach parents how to administer stool softeners/laxatives/enemas to empty rectum

Encourage support with toilet retraining

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Gastrointestinal Intestinal parasitic infections

◦Pinworms (E. vermicularis) Asymptomatic or may feel itching,

abdominal pain/nausea, restless sleep School-aged children susceptible Eggs can survive weeks on hard

surfaces Treat whole family, teach handwashing Clear tape applied to anus can pick up

eggs for diagnosis

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pinworms

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Endocrine system Type 1 diabetes (insulin-dependent,

juvenile)◦Pancreatic beta cells don’t produce

insulin◦Insulin must be supplied◦Fat, carbohydrate and protein

metabolism affected◦May result in diabetic ketoacidosis (DKA) Dehydration, electrolyte imbalance,

acidosis, coma, death

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Endocrine system Type 2 diabetes

◦Not enough insulin and/or insulin resistance

◦Related to lifestyle factors, genetics◦Lifestyle changes, oral

antihypoglycemics, insulin◦Sign: acanthosis nigracans: dark pigment

at back of neck, armpits; slow to heal Childhood obesity

◦BMI ◦Exercise and activity◦Nutrition

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Pediatric insulin pumps

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Nursing care: endocrine Educate families about disease process Teach proper insulin administration – have

child and/or parent demonstrate Teach s/s hyper- and hypoglycemia and

importance of carrying snacks Make sure parents/child understand sliding

scales Encourage healthy activity and weight

control Encourage learning about nutrition –

parents model behaviors

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Pediatrics: musculoskeletal Scoliosis

◦Abnormal curvature of the spine◦May need brace, surgery◦Self-acceptance, peer acceptance concerns

Duchenne muscular dystrophy◦Most common and severe form◦Gower’s sign

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Gower’s sign

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Pediatrics: musculoskeletal Fractures

◦ Complete (total break)

◦ Open or closed ◦ Incomplete,

greenstick (not complete break)

◦ Spiral fracture (possibly child abuse)

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Nursing care: musculoskeletal

Be very specific when educating about braces, disease processes, surgery

Provide age-appropriate pre/post operative care

Teach parents how to assess CMS Fractures

◦ Protect break until casted◦ Let cast dry without pressure spots◦ Assess and protect skin◦ Assess distal CMS and report changes

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Immune system: communicables

Chickenpox◦ Varicella zoster virus◦ serious complications in older patients◦ Prevented by vaccine

Diphtheria◦ Corynebacterium diphtheriae◦ Can obstruct airway ◦ Prevented by vaccine

Fifth’s disease◦ Causes “slapped cheek” rash

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Rubella (“German measles”)◦Rubivirus◦Respiratory isolation◦teratogen

Mononucleosis (“Kissing disease”)◦Epstein-Barr virus common cause◦Most adults resistant/immune d/t minor infections as children

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Immune system: communicables Mumps

◦paramyxovirus◦Inflammation of salivary glands◦May require scrotal support if orchitis

present◦Prevented by vaccine

Whooping cough◦Bordetella pertussis◦dry hacking cough with long whooping

inspiration afterward◦Choking common in infants◦High humidity helpful

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vaccinations

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Polio◦ Poliovirus◦ Most cases without symptoms◦ Can cause paralysis◦ Development of vaccine ended years of

worldwide epidemics◦ Part of DtaP vaccines

Scarlet fever◦ Caused by Group A beta-hemolytic Streptococcus◦ Carditis, acute glomerulonephritis, rash

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Nursing care: communicable illness

Support respiratory system◦Cool mist humidifier◦Suction, tracheostomy equipment,

oxygen Encourage fluids and rest Isolate as needed

◦Prevent scratching Teach parents to give all of medicine even

after child feels better Comfort measures: ice, oatmeal baths Educate about vaccines

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Pediatrics: noncommunicable Tetanus

◦ Vaccinate◦ Clean wounds ◦ Beware deep

wounds◦ Booster Q 10

years

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Pediatric: integumentary

Bacterial infections◦Impetigo Honey-colored exudate, crusting of

lesions itchy

◦Cellulitis Red, edematous, warm, painful areas Lymph node tenderness nearby May require hospitalization if near

airway

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Pediatric: integumentary Viral infections

◦Herpes simplex type 1◦Cause cold sores, fever blisters◦Antibody present in 30%-60% young

adults◦Most dangerous in immunosuppressed

children◦Aggravated by ultraviolet light, stress,

hormonal changes Infestations

◦Head lice ◦Scabies

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HSV1 cold sore

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Fungal: ringworm candidiasis/thrush

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Pediatric: integumentary Bites/stings

◦Animal and human bites◦Spider and tick bites◦Insect bites

Contact dermatitis◦Poison ivy rash◦Allergens◦Be careful with medicated creams: don’t

overdose!

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Poison ivy/oak rash insect bite

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Pediatric: integumentary Acne

◦Teach antibiotic compliance, side effects

Burns◦Prevention and safety◦Airway, breathing, circulation: emergency

◦Tetanus immunity◦fluid and electrolyte balance◦Pain control

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Nursing care: integumentary

Demonstrate treatment: make sure parents understand why they’re doing what

teach compliance: finish full treatments assess for infection/resolution teach infection control educate about causes, treatments,

preventions

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Pediatric: urinary Acute post-streptococcal glomerulonephritis

◦ Kidney inflammation after viral, pneumococcal or streptococcal infection

◦ Evaluate, follow up after childhood illnesses◦ May be avoided if strep throat and skin infections

are treated◦ Nursing care: activity as tolerated Restrict fluids, sodium, postassium,

phosphate Anticipate and treat hypertension weigh

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Pediatric: urinary Nephrotic syndrome

◦ Proteinuria, edema, hyperlipidemia, hypoproteinemia

◦ Periorbital edema on wakening◦ Severe edema: abdominal, generalized ◦ Nursing care: avoid diuretics, which decrease blood

volume further Monitor edema, weight Teach compliance and side effects of

steroids

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Pediatric: urinary Enuresis (bedwetting)

◦May be post-toilet-training or regression◦Psychosocial support◦May or may not be sign of abuse◦Avoid shaming◦Behavior modification may help Nighttime routine Waking to urinate Liquid-sensitive alarm

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Pediatric: psychosocial

Obesity and overweight◦Increasing among younger populations

◦Contributes to cardiovascular disease, injury, endocrine dysfunction

Anorexia nervosa, bulemia nervosa◦Eating disorders tied to misperception of self, beliefs and

Suicide

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Pediatric: psychosocial Attention Deficit Hyperactivity Disorder

◦Easily overstimulated ◦Needs daily routines with limits, rewards

Autism◦Complex disorder, mild to severe◦Unknown cause: probably multiple

biologic causes◦Affects social interaction, may be upset

at contact◦Structured, intensive behavior

modification useful

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Nursing care: psychosocial

Utilize peer support, do not shame Teach behavior changes appropriately to

age Teach parents to model good nutrition

habits Appropriate psychiatric/psychological

referrals Support families emotionally Pediatric patients with eating disorders

need a specialized recovery program

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The End. That is all

Module 9 1. Discuss systemic infant disorders, child abuse, environmental safety Discuss other...

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