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158 Cards in this Set
- Front
- Back
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What type of child abuse is most common?
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Neglect
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Definition of Neglect
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Persistent failure to meet the basic physical and/or psychological needs of a child, likely to result in serious impairment of health or development.
May also include neglect of, or unresponsiveness to the basic emotional needs of a child |
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Types of Neglect
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Physical neglect
-Deprivation of food, clothing, shelter, supervision, medical care, and education Emotional neglect -Lack of affection, attention, and emotional nurturance Emotional abuse—destroy or impair child’s self-esteem |
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Stressors of Hospitalization
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Separation anxiety
Loss of Control Fear of Pain and Bodily Injury Stages of child’s development influences how stressors are expressed |
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Infant's Needs for Loss of Control
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Trust
Consistent loving caregivers Daily routines |
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Toddler's Needs for Loss of Control
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Autonomy
Daily routines and rituals Loss of control may contribute to: -Regression of behavior -Negativity -Temper tantrums |
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Loss of Control in Preschoolers
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Egocentric and magical thinking typical of age
May view illness or hospitalization as punishment for misdeeds Preoperational thought |
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Loss of Control in the School Age Child
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Striving for independence and productivity
Fears of death, abandonment, permanent injury Boredom Can have classmates come in or call them (peer contact) Have them do homework |
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Loss of Control in Adolescents
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Struggle for independence and liberation
Separation from peer group May respond with anger, frustration Need for information about their condition |
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Fears of Bodily Injury and Pain
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Common fears among children
May persist into adulthood and result in avoidance of needed care |
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Young Infants Response to Pain
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Generalized response of rigidity, thrashing
Loud crying Facial expressions of pain (grimace) No understanding of relationship between stimuli and subsequent pain Assess for pain using the FLACC Scale |
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FLACC scale
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FACE No particular expression or smile
LEGS Normal position or relaxed. ACTIVITY Lying quietly, normal position moves easily. CRY No cry, (awake or asleep) CONSOLABILITY Content, relaxed. |
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FLACC Scale: Face
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No particular expression or smile
Occasional grimace or frown, withdrawn, disinterested. Frequent to constant quivering chin, clenched jaw. |
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FLACC Scale: Legs
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Normal position or relaxed.
Uneasy, restless, tense. Kicking, or legs drawn up. |
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FLACC Scale: Activity
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Lying quietly, normal position moves easily.
Squirming, shifting back and forth, tense.Arched, rigid or jerking. |
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FLACC Scale: Cry
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No cry, (awake or asleep)
Moans or whimpers;occasional complaint Crying steadily, screams or sobs, frequent complaints. |
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FLACC Scale: Consolability
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Content, relaxed.
Reassured by occasional touching hugging or being talked to, distractable. Difficulty to console or comfort |
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Older Infant’s Response to Pain
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Withdrawal from painful stimulus
Loud crying Facial grimace Physical resistance Always get helper, Hugs are good for immobilizing |
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Young Child’s Response to Pain
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Loud crying, screaming
Verbalizations: “Ow,” “Ouch,” “It hurts” Thrashing of limbs Attempts to push away stimulus |
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Physical Abuse
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May involve causing physical harm by hitting, shaking, burning, smothering, poisoning, biting or throwing the child.
Physical harm may also be caused when a parent of caregiver fabricates symptoms or deliberately induces illness. Injuries can result in bruises, fractures, burns, oral injuries, bites, head and spinal injuries and abdominal injuries. |
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What kinds of things would you look for when you're suspicious of child abuse
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Looks for unexplained bruises, shapes of items: teeth, handprint, rope, belt buckle, circular burns (cigarettes)
Unusual for child to bruise on back, buttocks, underarms, central facial- face gums lips mouth torso back and external genitalia Fractures- especially to face or skull bones. Spiral fractures- if someone’s holding onto arm or leg and writhing to get free Dislocations of hip or shoulder Multiple fractures in different healing stages Forced Ingestion Bald Patches on the scalp- left in crib all day long an never turned over or parents pulling hair out Subdural hematomas Retinal Hemorrhages- can happen when baby is shaken |
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Children's Hospital Eastern Ontario Pain Scale (CHEOPS)
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(Recommended for children 1-7 years old) - A score greater than 4 indicates pain
Scale items: Cry Facial Child Verbal Torso Position Touch Legs Also use FACES scales |
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Munchausen’s Syndrome by Proxy
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Caregiver fabricates signs and symptoms of illness in child (the proxy) to gain attention from medical staff
Parent may be enjoying the process Look for this especially when the child doesn’t seem to be getting well Child may undergo needless and painful procedures and treatments—10% of cases may be fatal to the child |
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School-Age Child’s Response to Pain
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Stalling behavior (“wait a minute”)
Muscle rigidity May use all behaviors of young child Can explain procedures |
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Adolescent's Response to Pain
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Less vocal protest, less motor activity
Increased muscle tension and body control More verbalizations (“It hurts,” “You’re hurting me”) |
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Factors/Characteristics Presdisposing to Physical Abuse
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Parental characteristics
Social isolation, poor support systems Parental low self-esteem and less than adequate maternal functioning Ongoing domestic violence within the family Chronic stress Low parental education or lack of knowledge of child care (growth and development needs) Divorce, poverty or economic crisis, unemployment, poor housing, substance abuse, frequent relocation, crowded living conditions Child abuse can occur in any socioeconomic population |
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Child Characteristics Predisposing to Physical Abuse
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Compatibility between child’s and parent’s temperament and parent’s ability to deal with behavioral style, tantrums or excessive crying
Removing the child victim from the home may place other siblings at risk for abuse Child with physical or mental challenges at higher risk Low birth weight baby Girls at greater risk for sexual abuse |
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Sexual Abuse Definition
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Defined as: “the use, persuasion, or coercion of any child to engage in sexually explicit conduct or simulation of such conduct for producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children”
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Sexual Abuse- Noncontact
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Activities may involve physical contact, including penetrative or nonpenetrative acts.
Noncontact activities can include involving children in the viewing of or production of sexual online images or the watching of sexual activities or encouraging children to behave in sexually inappropriate ways. |
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Characteristics of Abusers and Victims
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Typical abuser is a male the victim knows but may be ANYONE
All socioeconomic backgrounds Around 80% of child abuse is perpetrated by caregivers or parents |
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Physical Indicators of Sexual Abuse
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difficulty walking or sitting,
pain or swelling of genital area, brusing or bleeding or genital or anal area, pregnancy in early teen years torn, stained or bloody clothing pain with urinary/ UTI STIs in preadolescences Recurrent vaginal infections Recurrent sore throat Relaxed anal sphincter tone |
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Emotional Abuse
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Persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on emotional development.
May involve conveying to the child that he or she is worthless, unloved, inadequate or valued only as long as he or she meets the needs of another person |
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Possible Indications of Emotional Abuse
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May feature age or developmentally inappropriate expectation being imposed on the child. Imbedded within all types of abuse.
May include interactions that are beyond the developmental capability of the child, overprotection and limitation of exploration and learning, or preventing the child from participating in normal social interaction. May involve the child seeing or hearing the ill treatment of another child. |
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Nursing Care of the Maltreated Child
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Identify abusive situations as early as possible
History pertaining to the incident Evidence of maltreatment -Pattern or combination of indicators that arouse suspicion and further investigation -Protect child from further abuse -Document well, take serial pictures |
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Effects of Hospitalization on the Child may be seen _________
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Effects may be seen before admission, during hospitalization, or after discharge
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What's important about predicting a child's anxiety?
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Child’s concept of illness is more important than intellectual maturity in predicting anxiety
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Factors That Increase Vulnerability to Stressors of Hospitalization
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“Difficult” temperament
Lack of fit between child and parent Age (especially from 6 months to 5 years) Male gender Below-average intelligence Multiple and continuing stresses (e.g., frequent hospitalizations) |
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Parental Responses to Stressors of Hospitalization
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Disbelief, anger, guilt
-Especially if sudden illness Fear, anxiety -Related to child’s pain, seriousness of illness Frustration -Especially related to need for information Depression |
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Ways to Prevent or Minimizing Separation
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Primary nursing goal
Especially for children younger than 5 years Family-centered care Parents are not “visitors” Familiar items from home |
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"Normalizing” the Hospital Environment
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Promote freedom of achievement
Maintain child’s routine, if possible Time structuring Self-care (age appropriate) Schoolwork Friends and visitors |
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Providing Developmentally Appropriate Activities
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Using play/expressive activities to minimize stress
-Diversional activities -Toys -Expressive activities -Play therapy -Dramatic play |
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Nursing Care of the Family during Child Hospitalization
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Family assessment
Discharge assessment and planning Encourage parent participation in planning and care Information! Preparing for discharge and home care |
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Locations of Respiratory Infections
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Upper Resp. Tract
-nose, pharynx, ears Lower Resp. Tract -bronchi & bronchioles Croup Syndroms -infections of epiglottis & larynx |
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Respiratory Rate
Birth - 6 months |
30-60/min
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Respiratory Rate
6 months - 2 years |
20-30/min
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Respiratory Rate
3 years - 10 years |
20-28/min
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Respiratory Rate
10 years - 18 years |
12-20/min
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Influence of Age on Resp. Illness
a.) 0 - 3 months b.) 3- 6 months c.) Toddler Preschooler d.) 5 + years |
a.) maternal antibodies
b.) infection rate increases c.) high rate of viral infections d.) increase in Mycoplasma pneumonia and β-strep infections |
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Children are more susceptible to Resp. Diseases because
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Size
Diameter of airways Distance between structure is shorter, allowing organisms to rapidly move down Short Eustacian tubes |
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What account for much of overall childhood diseases
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chronic respiratory diseases
(responsible for significant morbidity, school absences & quality of life issues) |
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Most common respiratory diseases
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Cystic Fibrosis and Asthma
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Most common chronic lung disease in children
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Asthma
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Asthma is
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chronic inflammatory disorder of airways
bronchial hyperresponsiveness It's episodic can reverse spontaneously or with treatment |
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Therapeutic Management of Asthma
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Regular visits to health care provider
Avoidance of triggers Extrinsic allergen and irritant control Intrinsic factors control Drug therapy Stepwise approach based on severity – page 1355 Long term control: Many different possible combinations of bronchodialators. May have leukotriene modifiers to block inflammation and bronchospasm (Example is Singulair) Quick relief: short acting beta2 agonists. (Albuterol is example) Corticosteriods |
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Status Asthmaticus
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Medical Emergency!
Respiratory distress continues despite vigorous therapeutic measures May be concurrent infection in some cases. Child can die. :( |
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Tx for Status Asthmaticus
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Sympathomimetics
Epinephrine -0.01 ml/kg subq (max dose 0.3 ml) or subq terbutaline. Inhaled aerosolized Beta2 agonists (albuterol) spaced 20 to 30 minutes Steroids to decrease inflammation |
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Signs of Respiratory Distress
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Shortness of breath
Sweats profusely Remains upright, tripod position Refuses to lie down Restless and Apprehensive Speaks in short broken phases Breath sounds can be coarse or barely audible |
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Nursing Care for Asthma
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Educate child and family regarding asthma management
Teach to avoid exacerbation Teach to avoid allergens Teach how to relieve acute asthmatic episodes promptly Reinforce long term care of bronchospasm Monitor function with peak flowmeter Self-management of inhalers, devices, and activity regulation |
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Cystic Fibrosis (CF)
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Exocrine gland dysfunction that produces multisystem involvement
Abnormalities in salt and water transport across epithelial surfaces Average survival 38 years old Most common lethal genetic illness among white children Approximately 3% of U.S. white population are symptom-free carriers |
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Etiology of Cystic Fibrosis
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Primarily found in Caucasians
Incidence 1 in every 1800 live Caucasian births Autosomal recessive trait Carrier rate 1 in 20 Caucasians Inherits defective gene from both parents with an overall incidence of 1:4 |
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Mucus properties in Cystic Fibrosis
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Increased Viscosity of Mucous Gland Secretion
Results in mechanical obstruction Thick mucoprotein accumulates, dilates, precipitates, coagulates to form concretions in glands and ducts Respiratory tract and pancreas are predominantly affected Pulmonary complications most serious threat to life |
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How are people diagnosed with Cystic Fibrosis?
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Most reliable test is for increased sweat chlorides
- Averages less than 40 meq/l - Diagnosed at > 60 meq/l History of multiple resp infections CXR Pancreatic insufficiency (malnourished) Stool fat analysis (float) Family hx of disease (premature deaths in family tree) |
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Respiratory Manifestations of Cystic Fibrosis
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Onset/extent is variable
Stagnation of mucus and bacterial colonization result in destruction of lung tissue Tenacious secretions are difficult to expectorate—obstruct bronchi/bronchioles Decreased O2/CO2 exchange Results in hypoxia, hypercapnea, acidosis Compression of the pulmonary blood vessels and progressive lung dysfunction lead to pulmonary hypertension, respiratory failure, and death |
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Pulmonary Toilet
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Good pulmonary hygiene.
When young a child with CF with lay child across lap and tap to loosen mucus and drain out. As they get older, they must exercise to move secretions out. If they get an infection they must get on top of it immediately. They must have good high protein diet |
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Respiratory Progression of Cystic Fibrosis
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Gradual progression follows chronic infection
Bronchial epithelium is destroyed Infection spreads to peribronchial tissues, weakening bronchial walls Peribronchial fibrosis Decreased O2/CO2 exchange Chronic hypoxemia causes contraction/hypertrophy of muscle fibers in pulmonary arteries/arterioles Pulmonary hypertension Cor pulmonale Pneumothorax Hemoptysis (lungs bleed out) |
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Cystic Fibrosis effects on GI Tract
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Thick secretions block ducts → cystic dilation → degeneration → diffuse fibrosis
Prevents pancreatic enzymes from reaching duodenum Impaired digestion/absorption of fat → steatorrhea Impaired digestion/absorption of protein → azotorrhea Endocrine function of pancreas initially stays unchanged Eventually pancreatic fibrosis occurs; may result in diabetes mellitus Focal biliary obstruction results in multilobular biliary cirrhosis Impaired salivation |
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What must the child with CF take to improve absorption of nutrients?
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Must take supplementary pancreatic enzymes with every meal
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Clinical Manifestations of Cystic Fibrosis
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Pancreatic enzyme deficiency
Progressive COPD associated with infection Sweat gland dysfunction Failure to thrive Increased weight loss despite increased appetite Gradual respiratory deterioration Delayed puberty in females Sterility in males Parents report children taste “salty” Dehydration Hyponatremic/hypochloremic alkalosis Hypoalbuminemia |
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Clinical Presentation of Cystic Fibrosis
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Wheezing respiration, dry nonproductive cough
Generalized obstructive emphysema Patchy atelectasis Cyanosis Clubbing of fingers and toes Repeated bronchitis and pneumonia Meconium ileus (excess mucus produced blocks tract) Distal intestinal obstruction syndrome Excretion of undigested food in stool—increased bulk, frothy, and foul Tissue wasting Prolapse of the rectum |
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Respiratory Management of Cystic Fibrosis
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CPT (Chest Physiotherapy) before eating
Bronchodilator medication Forced expiration Aggressive treatment of pulmonary infections Home IV antibiotic therapy Aerosolized antibiotics Exercise such as swimming for older kids |
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GI Management of Cystic Fibrosis
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Replacement of pancreatic enzymes
High-protein, high-calorie diet as much as 150% RDA Intestinal obstruction Reduction of rectal prolapse Salt supplementation |
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Family Support for Cystic Fibrosis
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Coping with emotional needs of child and family
Child requires treatments multiple times per day Frequent hospitalization Implications of genetic transmission of disease |
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Promoting Health for Cystic Fibrosis
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Maximize health potential
Nutrition Regular Exercise Prevention/early aggressive treatment of infection Pulmonary hygiene/CPT |
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Croup Syndromes
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Characterized by hoarseness, “barking” cough, inspiratory stridor and varying degrees of respiratory distress
Croup syndromes affect larynx, trachea, and bronchi Epiglottis, laryngitis, LTB, tracheitis Child will sound worse than they are |
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What croup syndromes are life threatening
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Epiglottitis and Tracheitis because of the bacterial component
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Clinical manifestations of Acute Epiglottitis
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Sore throat, pain, tripod positioning, retractions
Inspiratory stridor, mild hypoxia, distress Bacterial origin: Prevention: Hib vaccine |
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Therapeutic Managment of Acute Epiglottitis
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Potential for respiratory obstruction (drooling)
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Nursing Considerations for Acute Epiglottitis
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Antibiotics
Airway Protection (don't use tongue depressor or anything that may irritate) Potential Medical Emergency |
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Acute Spasmodic Laryngitis
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More common in older children and adolescents
Usually caused by virus |
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Chief complaint of Acute Spasmodic Laryngitis
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hoarseness
Generally self-limiting and without long-term sequelae Don't look bad |
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Treatment of Acute Spasmodic Laryngitis
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symptomatic
may just need cold mist humidity |
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Acute Laryngotracheobronchitis (LTB)
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Most common of the croup syndromes
Generally affects children younger than 3 months to 5 years Organisms responsible RSV, parainfluenza virus, Mycoplasma pneumoniae, influenza A and B |
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Symptoms of Acute Laryngotracheobronchitis (LTB)
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Brassy Cough
Low-grade fever Nontoxic appearance |
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Tx of Acute Laryngotracheobronchitis (LTB)
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humidity
ER visit for epinephrine if gets worse |
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Acute Spasmodic Laryngitis
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Also called spasmodic croup, midnight croup
Paroxysmal attacks of laryngeal obstruction Occur chiefly at night, sudden onset Most often affects children ages 1 through 3 |
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Inflammation in Acute Spasmodic Laryngitis
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mild or absent
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Tx of Acute Spasmodic Laryngitis
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Humidity
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Acute Bacterial Tracheitis
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Infection of the mucosa of the upper trachea
Distinct entity with features of croup and epiglottitis May be complication of LTB Thick, purulent secretions result in respiratory distress |
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Clinical Manifestations Acute Bacterial Tracheitis
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Brassy Cough
Low-grade fever Nontoxic appearance |
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Therapeutic Management ofAcute Bacterial Tracheitis
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Therapeutic Management
Humidified oxygen Antipyretics Antibiotics May require intubation Potential Medical Emergency |
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Pediatric Indicators of Possible Cardiac Dysfunction
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Poor feeding
Tachypnea/tachycardia Failure to thrive/poor weight gain/activity intolerance Developmental delays Prenatal history Maternal drug use Fetal alcohol syndrome—50% have CHD Maternal illness Rubella in first 7 weeks of pregnancy → 50% risk of defects including PDA and pulmonary branch stenosis CMV, toxoplasmosis, other viral illnesses → cardiac defects Maternal obesity associated with CHD Family history of cardiac disease |
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Tests of Cardiac Function
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Chest x-ray
ECG Echocardiography Cardiac catheterization |
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Two Types of Cardiac Defects
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Congenital
Anatomic → abnormal function Acquired Infectious and inflammatory processes |
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CHD Classified by....
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hemodynamic characteristics
Increased pulmonary blood flow Decreased pulmonary blood flow Obstruction of blood flow out of the heart Mixed blood flow |
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Increased pulmonary blood flow
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acyanotic defects
Atrial Septal Defect, Ventricular Septal Defect, Patent Ductus Arteriosus |
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Decreased pulmonary blood flow
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Tetralology of Fallot
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Obstruction of blood flow out of the heart
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Coarctation of the Aorta
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Mixed blood flow
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Transposition of Great Arteries
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Normal RA pressure
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3 mm Hg
72% to 80% |
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Normal RV pressure
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25/0-5 mm Hg
72% to 80% |
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Normal Inferior Vena Cava pressure
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8 mm Hg
78% |
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Normal LA pressure
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5-10 mm Hg
95% |
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Normal LV pressure
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120/0 - 10 mm Hg
95% |
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Normal Aorta Pressure
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115/80 mm Hg
95% |
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Normal Pulmonary Artery Pressure
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25/15 mm Hg
72% to 80% |
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Normal Pulmonary Vein Pressure
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9 mm Hg
95% |
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Shunt
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the ratio of pulmonary blood flow to systemic blood flow
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Ventricular Septal Defect
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Description: 2nd part of septum is missing, not as efficient
Altered Hemodynamics: Left to right shunt Complications: leads to heart failure (right sided, as it must work harder) pulmonary artery has more blood flow- Leads to increase pulmonary vascular resistance, progressive pulmonary vascular disease can occur if defect is not repaired. Would hear a murmur at left lower sternal border (between tricuspid and mitral valve) because of turbulent blood flow 80% with small VSD the body will repair itself by age 10 Surgical correction is by patch Nursing Care: edema, bed rest, monitor energy level, O2, prevent infections (bacterial endocarditis), keep child calm |
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Atrial Septal Defect
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Description: Between two atria
Alter :still L to R Complications: more work on R artery and atria, atrial and ventricular hypertrophy cardiomegaly, cardiac failure is unusual, in ASD child does better- takes decades before repair is needed Clinically asymptomatic Will hear murmur (crescendo descrescendo) 2nd-3rd interspace, better over pulmonic valve Surgery will be recommended by Age 4 (school and more active) minimal risk with faster recovery than VSD. A patch is used. Nursing Care: use toys and dolls to prepare them for surgery, show them the unit and let them know about the equipment they’ll be using, prep for smells feels and sights |
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Patent Ductus Arteriosus
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Description: failure of the ductus arteriosus to close after birth (connects pulmonary artery to aorta) normally, at birth there’s functional closure within a few hours, may take as long as 5-7 days
Hemodynamics: L-R shunt, cardiac lesion that increase cardiac blood flow (oxygenated blood from aorta flows into unoxygenated blood in pulmonary artery to lungs then returned to left atrium and left ventricle. Increased workload of left side of heart from volume overload More likely with premies- tx involves prostaglandin inhibitor within 10 days of birth or can be surgically closed |
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Tetralogy of Fallot
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Blue Babies or Tet babies called Cyanota Heart Defects
4 defects- Ventricular Septal Defect, Overriding aorta, Right Ventricular Hypertrophy R- L Shunt because of the stenosis that increases pressure in the R ventricle Decreases pulmonary blood flow- some of the blood from R ventricle will go out the aorta Manifestation: appear cyanotic, murmur 2nd/3rd intercostal space over pulmonic and tricuspid regions with a thrill of left sternal border Complications: May have tet (aka anoxic) spells (when they turn blue, periodically) Will squat to help blood flow by decreasing venous return. Often have polycythemia (increase RBC production) increase risk for clots and stroke. Slow brain function, growth and development stunted If kid is on digitalis hold under 90 bpm. Surgical fix typically done in stages, like to wait until baby is older (18 mnts) Nursing Care: good iron intake as they tend to be anemic, risk for endocarditis, prepare family for multiple operations |
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Tricuspid Atresia
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Lesions that decrease pulmonary blood flow
Atresia- blind pouch no opening Surgical emergency |
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Transposition of Great Vessels
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No cross circulation
Surgical emergency |
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Symptoms caused by underlying cardiac defect
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Impaired myocardial function
Tachycardia; fatigue; weakness; restless, pale, cool extremities; decreased BP; decreased urine output Pulmonary congestion Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis Systemic venous congestion Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention |
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What is CHF
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Symptoms caused by underlying cardiac defect
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Nursing Care Priorities for Child with CHF
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Care of the Family and Child with Congenital Heart Disease
Help family adjust to the disorder Educate family Help family cope with effects of the disorder Prepare child and family for surgery |
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Surgical Interventions Medical Management for CHF
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Surgical Interventions
Open heart Closed heart procedures Staged procedures Prepare child and family for procedures |
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Postoperative Care for the Child with CHF
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Monitor vital signs and A/V pressures
Intraarterial monitoring of BP Intracardiac monitoring Respiratory needs Rest, comfort, and pain management Fluid management Progression of activity |
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Potential Postoperative Complications
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CHF
Dysrhythmias Decreased cardiac output Decreased peripheral perfusion Pulmonary changes Neurologic changes Death |
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Acquired Cardiovascular Disorders
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Infectious and inflammatory cardiac disorders
Bacterial endocarditis Rheumatic heart disease Kawasaki disease Hypertension Henoch-Schonlen purpura |
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Rheumatic Fever (RF) and Rheumatic Heart Disease
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RF
Inflammatory disease occurs after group A β-hemolytic streptococcal pharyngitis Infrequently seen in U.S.; big problem in Third World Self-limiting Affects joints, skin, brain, serous surfaces, and heart Rheumatic heart disease Most common complication of RF Damage to valves as result of RF |
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Prevention of RHD
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Treatment of streptococcal tonsillitis/pharyngitis
Penicillin G—IM x 1 Penicillin V—oral x 10 days Sulfa—oral x 10 days Erythromycin (if allergic to above)—oral x 10 days Treatment of recurrent RF Same as above |
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Kawasaki Disease
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Widespread inflammation of small and medium sized blood vessels
Etiology unknown May damage coronary arteries and heart itself esp under 1 year old Leading cause of acquired heart disease in children in U.S.A. |
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Kawasaki Disease S & Sx
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Abrupt onset high fever x 5 days unresponsive to antibiotics
Strawberry tongue, cracked lips Red palms of hands and soles of feet Peeling rash Swollen hands and feet Joints hurt Swollen lymph nodes Irritable |
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Kawasaki Disease Treatment
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Kawasaki Disease Treatment
IV IgG ASA 80-100 mg/kg/day—fever Then 3-5 mg/kg/day—antiplatelet |
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Henoch-Schonlein Purpura
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Inflammation of small blood vessels
Etiology unknown Follows URI Associated with allergies or drug sensitivities Ages 2 to 11 years most common Purpura around buttocks and lower extremities Swelling around joints Potential renal involvement with blood and protein in urine Tx symptomatically with analgesics, NSAIDS Corticosteriods for severe edema Nephropathy can lead to high b/p Antihypertensives may be needed |
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Systemic Hypertension
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Primary = no known cause
Secondary = identifiable cause Pediatrics: HTN generally secondary to structural abnormality or underlying pathology Renal disease CV disease Endocrine or neurologic disorders |
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Hyperlipidemia
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Identify kids at risk and treat early
Treatment = dietary Restrict intake of cholesterol and fats If no response to diet → Rx Colestipol (Colestid) Cholestyramine (Questran) |
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Cardiomyopathy
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Contractibility of myocardium is impaired
Therapeutic Management of Cardiomyopathy : Correct underlying cause if possible Often treatment is aimed at managing CHF and dysrhythmias |
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Cleft Lip and/or Cleft Palate
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Facial malformations that occur during embryonic development
May appear separately or together Bilateral cleft lip usually with cleft palate Defect may involve deformed or absent teeth Immediate feeding difficulties |
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Surgical Correction of Cleft Lip
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Closure of lip defect precedes correction of the palate
Z-plasty to minimize retraction of scar Protect suture line with Logan bow or other methods |
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Surgical Correction of Cleft Palate
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Typically 12 to 18 months of age
Effect on speech development Prognosis Nursing considerations |
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Esophageal Atresia and Tracheoesophageal Fistula (TEF)
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Failure of esophagus to develop as a continuous passage
May occur separately or in combination |
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Management of TEF and Esophageal Atresia
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Surgical interventions – atresia is a surgical emergency
Prognosis – prevent aspiration Associated post surgical tracheomalacia Nursing considerations Post op care of thoracotomy site, chest tubes, and respiratory management |
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Congenital Diaphragmatic Hernia
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Diaphragm is not completely formed; herniation of abdominal contents into thoracic cavity
Fetal lungs are compressed; fetal lung development is altered Incidence is 0.3 in 3300 live births |
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CHD Repair
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If repaired during fetal life results in larger, more functional lungs
CHD Repair After Birth Immediate respiratory assistance Surgical repair of the defect Prognosis variable Depending on organ immaturity |
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Hypertrophic Pyloric Stenosis (HPS)
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Constriction of the pyloric sphincter with obstruction of the gastric outlet
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Pyloric Stenosis
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Pathophysiology- overgrowth pyloric sphincter muscle
Diagnostic evaluation- hx projectile vomiting, weight loss, delayed gastric emptying, + string sign Therapeutic management- surgical repair Nursing considerations –feeding, I & O, pain control after surgery |
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Intussusception
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Telescoping or invagination of one portion of intestine into another
Occasionally due to intestinal lesions Often cause is unknown More common in kids with Cystic Fibrosis, Celiac Disease, Gastroenteritis |
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Diarrhea
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Acute diarrhea is leading cause of illness in children younger than 5 years
20% of all deaths in developing countries are related to diarrhea and dehydration Acute infectious diarrhea: variety of causative organisms |
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Diagnoses that are Associated with Diarrheal Disturbances
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Gastroenteritis
Enteritis Colitis Enterocolitis |
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Etiology of Diarrhea
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Rotavirus
Salmonella, Shigella, Campylobacter Giardia Cryptosporidium Clostridium difficile Antibiotic therapy |
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Types of Diarrhea
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Acute
Acute infectious/infectious gastroenteritis Chronic Intractable diarrhea of infancy Chronic nonspecific diarrhea (CNSD) |
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Nursing Assessment of Diarrhea
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Observation of general appearance and behavior
History |
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Prevention of Diarrhea
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Most diarrhea is spread by the fecal-oral route
Teach personal hygiene Clean water supply/protect from contamination Careful food preparation Hand washing |
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Concept of Oral Rehydration
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Rehydration solution of 75 to 90 mEq Na+ per liter
Give 40 to 50 ml/kg over first 4 hours Maintain hydration with solution of 40 to 60 mEq Na+ per liter Daily volume of maintenance hydration 150 ml/kg/day |
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Color and Characteristics of Vomitus
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Hematemesis: bright red blood may indicate acute upper GI bleed.
Bilious: emesis with bile. Green or yellow indicates GI obstruction Feculent: emesis with stool. Brown, foul smelling. Indicates GI obstruction |
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Nursing Interventions for Vomiting
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Administer IV fluids as ordered for severe dehydration
Recognize signs and symptoms of dehydration Weigh Daily Monitor I & O (measure emesis) Monitor urine specific gravity Encourage fluids and small frequent meals Provide good oral hygiene |
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Daily Maintenance Fluid Requirements
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Calculate child’s weight in kg
Allow 100 ml/kg for first 10 kg body weight Allow 50 ml/kg for second 10 kg body weight Allow 20 ml/kg for remaining body weight |
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Disorders of Motility
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Constipation
An alteration in the frequency, consistency, or ease of passage of stool May be secondary to other disorders Idiopathic (functional) constipation—no known cause Chronic constipation—may be due to environmental or psychosocial factors |
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Bowel Motility in Infancy
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Often related to diet
Constipation in exclusively breastfed infant almost unknown Infrequent stool may occur because of minimal residue from digested breast milk Formula-fed infants may develop constipation |
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Constipation: Nursing Considerations
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Often due to environmental changes or control over body functions
Encopresis: inappropriate passage of feces, often with soiling May result from stress History of bowel patterns, medications, diet Educate parents and child Dietary modifications (age appropriate) |
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Hirschsprung Disease
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Also called congenital aganglionic megacolon
Mechanical obstruction from inadequate motility of intestine Incidence: 1 in 5000 live births; more common in males and in Down syndrome Absence of ganglion cells in colon |
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Clinical Manifestations of Hirschprung Disease
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Aganglionic segment usually includes the rectum and proximal colon
Accumulation of stool with distention Failure of internal anal sphincter to relax Enterocolitis may occur Therapeutic management is surgery |
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Pathology Affecting Body’s Use of Food
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Celiac Disease
Also called gluten-induced enteropathy and celiac sprue Four characteristics Steatorrhea General malnutrition Abdominal distention Secondary vitamin deficiencies |
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Celiac Disease
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Pathophysiology
Small bowel villi atrophy from exposure to gluten containing foods. Leads to malabsorption Diagnosed by jejunal biopsy Therapeutic management: Dietary with gluten free or as low gluten as possible Nursing considerations: Education and support for child and family |
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Acute Appendicitis
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Etiology – physical obstruction of the lumen by fecaliths causing inflammation
Diagnostic evaluation: periumbilical or lower right quad pain, vomiting, fever Therapeutic management Surgical removal Prognosis – Usually good esp. if not ruptured Nursing considerations – abdominal surgery |
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Inflammatory Bowel Disease (IBD)
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Ulcerative Colitis (UC): large intestine and rectum
Crohn disease (CD): mouth to anus + Family history frequently present Pathophysiology – immune mediated response to an environmental trigger Diagnostic evaluation: endoscopy, intestinal biopsy to distinguish type of IBD Therapeutic management: corticosteriods and sulfasalazine for inflammation, Antibiotics and Antiprotozoal drugs: Metronidazole, Ciprofloxacin Nursing considerations: Reinforce diet of adequate protein and calories. Managing a chronic illness. Observe for side effects from steroids |
