Revised 2012

Anemia (Iron Deficiency)Sickle Cell AnemiaHemophiliaALL ( Acute Lymphobalstic Leukemia)

Insufficient dietary iron Maternal stored depleted at 6 mo.

Inadequate iron intake

Hgb 6-10 Irritability, weakness, decreased

play activity Fatique Hgb <5 Anorexia Pale tachycardic

Iron replacement – ferrous sulfate

Give with straw or syringe^ citrus fruits or juices

Dietary instruction Teaching of long term complications of anemia

Dark, tarry stools

Inherited African-American / Mediteranian

No cure

Sickling:Clumping of abnormal shaped cells

Results in obstruction w/ severe tissue hypoxia

Severe sickling can lead to sickle cell crisis, an acutely painful period that occurs intermittent throughout life.

InfectionDehydrationColdEmotional stress

HydrationAnalgesicsO2Warm baths, local heatAvoid precipitating factors

Hemophilia Inherited – X linked Lack clotting factors: Factor VIII or Factor IX

Bleeding, bruisingHemarthrosisBone deformities, contracturesHematomasDiag test: PTT

Replace clotting factors

What are your nrsg interventions?

What is RICE? What are s/s of intracranial bleed?

Acute Lymphoblastic Leukemia

Most commom malignancy in children, ^ males

Increased blast cellsDecreased rbc’s and platelets

Internal organs enlarge

Chemo & steroids Intrathecal drugs Goal is remission

Pallor, fatigue Fever, ^ infections Bleeding, bone pain Limping s/s of ICP

Monitor s/s infection & reduce risk

Oral care Enc. Nutrition

AIDS

RHEUMATOID ARTHRITIS

Chronic, usually fatal Perinatal infection, 91% Blood & bodily fluids Sexual abuse Adolescents have ^ risk d/t risky behaviors

Keep viral load low Prev. infections Restore normal G & D Improve quality of life Box 31-2 drugs

Prevent infection Nutrition / meds Family support

Chronic inflammatory autoimmune connective tissue disease

Destroys cartilage, affects joints & tissues

Occuring bet. 1-3 & 8-10 yrs old

Stiffness, edema Loss of motion Warm to touch Increase temp Macula rash

Clinical findings No specific tests ESR X-rays

Preserve joint functionNSAIDS – SAARDSMoist heat - PT

Manage pain, educate Support groups to express fears & concerns

Balance rest/exercise

Acute respiratory infections are common in infancts & children. They range from minor to life threatening illnesses.

Lack surfactant to keep lungs expanded

Gestational age at birth influences severity

#1 s/s respiratory distress

Exogenous Surfactant

O2 therapy

Parenteral therapy

Inflammation of lung tissue

Common cause RSV Viral more common than bacterial

See Box 31-3Dx x-rayTx O2, fluids, nebulizers, antx if bacterial cause

Resp & CV assessmtInfection controlHydration, IV fluidsO2 & antx as ordered

No cause Occurs during sleep 3rd leading cau of death betw. 2-4 mos.

Diagnosed on autopsy

Family grief support Allay feelings of guilt and blame

Teach “back to sleep”

“sore throat” 80% viral 20% strep H-influenza in children , 3 yrs

s/s:FeverSore throatWhite exudate

S/S same as pharyngitis

Treatment : 1)Same as pharyngitis 2) Tonsillectomy

Pre-op Notify MD of temp

Post-op Monitor for bleeding, no straws, analgesics

Acute viral disease marked by resonant barking cough,

difficult breathing & laryngeal spasm.

LTB = most common form of Croup

Follows an URIs/s: barking cough, tachypnea

retractions

Cause: H influenzae bacteria

Life threatening airway obstruction

Drooling High Fever Resp distress Muffled voice Progressive resp. distress Anxiety Fear

Check for the 4 “D’s” 1) Drooling 2) Dyspnea 3) Dysphonia 4) Dysphagia

Maintain airway Cool mist NPO – IV fluids Epinephrine, Antx

^ HOBAssess resp. statusFreq. VSTrach tray @ bedside

Usually virals/s: same as with URI + cough

Common during winter months

Children < 4 y.o.

Inherited, defective gene

No cureExcessive thick mucus produced

Obstructs lungs & GI system

steatorrhea Barrel chest Increased NaCl in sweat & saliva

^ nutritionPancreatic enzymesCPT / postural drainage

Common chronic childhood illness

Obstructive resp. disorder, familial tendency

Comparison of a normal bronchial tube and a bronchial tube during an

asthma episode.

(From Ashwill, J.W., Droske, S.C. [1997]. Nursing care of children: principles and practice. Philadelphia: Saunders.)

Bronchospasm Bronchial edema s/s: SOB Expiratory wheeze

Quick relief medsLong term medsAllergen testing

^HOBMeds, hydrationRest, breathing exercisesAvoid triggersTeach self-care

An 8-year-old child has a history of asthma and lives with her mother and younger sister. In assessing the home environment, the nurse learns that the family lives in a townhouse and has one cat and two dogs. The mother smokes two packs of cigarettes a day, the child shares a room with her younger sister, and the house is carpeted. How could the mother modify the home environment to better control her daughter’s asthma?

Any alteration in GI function has the potential to affect other bodily systems.

Facial malformation during fetal development

Assoc. w/ folic acid deficiency, ETOH & smoking

Variations in clefts of lip and palate at birth.

B, Unilateral cleft lip and palate.

(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of infants and children. [7th ed.]. St. Louis: Mosby.)

Variations in clefts of lip and palate at birth.

C, Bilateral cleft lip and palate.

(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of infants and children. [7th ed.]. St. Louis: Mosby.)

Variations in clefts of lip and palate at birth.D, Cleft palate.

(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of infants and children. [7th ed.]. St. Louis: Mosby.)

Cleft lip little feeding diff.

Extensive cleft lip & palate dif. Feeding & speech

Lip repaired at 1-2 mo.Palate repaired by 1 yr.Multidisciplinary hlth care approach

Parental support Assistive feeding devices

ESSR feeding techniques

Freq. burping

Maintain integrity of suture line

Adv. Diet as tol Soft rubber tipped feeder, no breast

Back or side lying only

Intake less then outputDetermined by change in wt.

Infants and young children more easily effected

Treat causeRestore fluids and electrolytesModified BRAT diet, Pedialyte,Rehydralyte, Infalyte

I&O Infection control Nutrition, rehydrate Daily weights

Passage of hard infrequent stool

Structural disordersDiet, medsRepressed urge to defecate

Hypertrophied pyloric muscle obstructs gastric outlet

Unknown etiology Fig. 31-16 pg. 1022

Comparison of normal pyloric opening with evidence of pyloric stenosis.

(From Ashwill, J.W., Droske, S.C. [1997]. Nursing care of children: principles and practice. Philadelphia: Saunders.)

Projectile vomiting Olive shaped mass, R. abd

Wt loss, poor skin turgor dehydration

Pyloromyotomy ( Fredet-Ranstedt procedure)

One part of intestine telescopes into another

S/S currant – jelly like stool

Abd. pain

Barium enema Tx: barium enema Surgical repair

Presents as Megacolon Hirschsprung's disease is a condition

that affects the large intestine (colon) and causes problems with passing stool. It's present when a baby is born (congenital) and results from missing nerve cells in the muscles of a portion of the baby's colon.

The affected bowel in Hirschsprung’s disease.

(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of infants and children. [7th ed.]. St. Louis: Mosby.)

Temporary colostomy Endo-rectal pull through

Pre-Op Care??

Post-Op Care ??

Organ protrudes through weakened muscle wall

Location of hernias.

(From Wong, D.L. [1997]. Whaley & Wong's essentials of pediatric nursing. [5th ed.]. St. Louis: Mosby.)

Inflammation of appendix

s/s rebound tenderness

Elevated WBCPain @ McBurneys point

Regurgitation of gastric contents

Vomiting/spitting up/choking/gagging

Esophageal ulceration Heme. + stool

Small frequent thickened feedingsPepcid, Zantac, TagametSurgical repair

Proteinuria Edema Hypoproteinemia hyperlipidemia

Peri-orbital edemaAscitesGeneralized edema

I&OSkin care^pro. diet

Inflammation of glomerulus

Strep is most common cause

s/sproteinuriatea colored urineHTN ( idiopathic )

CRITICAL THINKING QUESTIONThe nurse has admitted a 7-year-old male to the pediatric unit with a diagnosis of acute glomerulonephritis. The nurse informs the mother that a urine specimen is needed and gives the patient a urinal. The mother states, “I don’t understand why he is having kidney problems. He had bronchitis a week ago and was feeling better.” How should the nurse manage this situation?

Guidelines: The nurse should inform the mother that occasionally an upper respiratory infection can lead to acute glomerulonephritis. The nurse should explain to the mother that for her son to heal, he must have his fluids restricted, strict bed rest, and eat a balanced diet.

BedrestRestrict fluids & Na +I&ODiuretics and antihypertensive

Most common malignant tumor of childhood

Develops from immature kidney cells

Prognosis greatly improved in recent decades

Large, firm, asymptomatic abd mass Do not palpate abd

Pre/post op careFamily supportSurgery Nephrectomy

Disorders are usually from over or under production of hormones. Can affect all aspects of body function including appearance, G & D and psychologic well being.

Lack thyroid hormones Tx. Thyroid hormone replacement

Teach parents importance of med administration to prevent cognitive & growth impairment

Type I Diabetes (IDDM) Lack of insulin TXexogenous insulin, diet & exercise

Family teaching is paramount

What topics would be included in your teaching?

Question: A pediatric nurse is caring for an infant who has been diagnosed with GERD. The nurse places infant cereal into the bottle with formula for the mother to feed the infant. The mother asks why she placed cereal in the bottle when her pediatrician has instructed her not to feed the infant foods until he is 6 months of age. How should the nurse manage this situation?

Question: A 2-month-old infant, with failure to thrive and projectile vomiting, is scheduled for surgery to repair the hypertrophic pyloric stenosis. The mother does not understand why her daughter cannot receive medication to treat this disorder. How can the nurse manage this situation?