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HAIZEL RABOY
BSN 2B
 Intussusception Small intestine inside large
intestine

Etiology
Intussusception, which is defined as the telescoping or invagination of ● Viral infection
a proximal portion of intestine (intussusceptum) into a more distal ● Intestinal polyp
portion (intussuscipiens), is one of the most common causes of bowel ● Meckel’s diverticulum
obstruction in infants and toddlers. ● Lymphoma
Ileocecal is the most
S&S common site
Diagnoses
● Acute abdominal pain (pulling knees to their chest) ● History taking
● Passage of currant jelly-like stool; red stool ● Confirmed Radiographs & UTZ of Treatment
● Vomiting ● Pallor abdomen
● Enema w/ saline aqueous contrast material
● Lethargy ● Barium enema
● Surgical intervention
● Palpable mass on the URQ ● Abdominal X-ray, CBC

Complications
● Abdominal pain ● Abdominal swelling
● Fever ● Vomiting
● Weak & rapid pulse
● Abnormal breathing
● Anxiety or agitation
● Profound listlessness Management Diagnosis
● Cool, clammy skin that may be pale or gray
● Maintenance of fluid & electrolyte balance ● Alteration in Comfort
● Post operative care ● Risk for Injuryy
● Monitor any signs of infection ● Fluid Volume Deficit
● Manage the NB’s pain ● Risk for infection
● Assess v/s ● Hyperthermia
● Check abdominal distention ● Pain r/t abdominal peristalsis
● Monitor all stools
 Failure to Thrive Failure to Thrive (FTT) or growth failure, is a sign of inadequate growth
resulting from inability to obtain or use calories required for growth. FTT can
Etiology also define as a condition in which a child fails to gain weight and is
persistently less than the 5th percentile on growth charts.
● Organic FTT
Growth failure is due to an acute or chronic disorder that interferes with nutrient intake,
absorption, metabolism, or excretion or that increases energy requirements. Illness of any
organ system can be a cause.
Pathophysiology
● Nonorganic FTT ● Inadequate caloric intake – incorrect formula preparation, neglect, food
Up to 80% of children with growth failure do not have an apparent growth-inhibiting fads, excessive juice consumption, poverty, behavioral problems affecting
(organic) disorder; growth failure occurs because of environmental neglect (eg, lack of eating, or CNS problems affecting intake
food), stimulus deprivation, or both. ● Inadequate absorption – cystic fibrosis, celiac disease, vitamin or mineral
● Mixed FTT deficiencies, biliary atresia, or hepatic disease
In mixed FTT, organic and nonorganic causes can overlap; children with organic disorders ● Increased metabolism – hyperthyroidism, CHD, chronic
also have disturbed environments or dysfunctional parental interactions. Likewise, children immunodeficiency
with severe undernutrition caused by nonorganic FTT can develop organic medical ● Defective utilization – genetic anomaly such as trisomy 21 or 18,
problems. congenital infection.

S&S
● Poor sucking (does not feed well) ● Hard to feed
● Vomiting or diarrhea ● Sleeps too much or not enough
● Fussiness ● Weak cry
● Loses weight or does not gain enough weight
● Stiff or "floppy" muscles
● Slow in growth and development
● Delayed motor development
● Delays in reaching developmental milestones
● May not show interest in things around him
● Does not move around much
● Does not make eye contact when being held
Failure to Thrive
Risk Factors Diagnostic Tests
● Down Syndrome Testing
● Prematurity Extensive laboratory testing is usually non-productive. If a thorough history or physical
● Intrauterine growth restriction (IUGR) examination does not indicate a particular cause, most experts recommend limiting
● Developmental delay screening tests to
● Congenital anomaly ● CBC with differential
● Intrauterine drug exposure ● ESR (Erythrocyte Sedimentation Rate)
● Lead poisoning ● BUN and serum creatinine and electrolyte levels
● Anemia ● Urinalysis (including ability to concentrate and acidify) and culture
● Metabolic derangement ● Stool for pH, reducing substances, odor, color, consistency, and fat content

Nursing Intervention Diagnosis

● Provide consistent care ● Imbalance Nutrition: Less than Body
● Provides adequate nutrition Requirements
● Promotes growth and development; ● Risk for Delayed Development
● Monitor height, weight gain and development ● Risk for Impaired Parenting r/t lack of
● Assist parents in developing the skills needed to knowledge about nutritional needs
nurture the infant ● Fatigue r/t malnutrition
● Teach parent positive feeding technique ● Disturbed sensory perception r/t insufficient
● Each member must be helped to change nurturing
● Praise positive attempts at care
● Multidisciplinary health care team
is needed to deal with the physical,
psychosocial, mental and emotional
problems that may be occurring in the family.
Trisomy 21
Risk Factors
Formerly known as Mongolism. Trisomy 21 is a genetic ● Advancing maternal age.
condition caused by an extra chromosome. Down ● Being carriers of the genetic translocation for Down
Syndrome is one of the most common genetic birth defects. syndrome.
● Having had one child with Down syndrome.
Etiology
Diagnostic Tests Complications
● Full copies of Trisomy 21
● Translocation ● Karyotyping ● Heart defects
● Mosaicism – very rare form ● Ultrasonography ● Gastrointestinal (GI) defects.
● Nuchal Translucency Scan ● Immune disorders
● Amniocentesis ● Sleep apnea
S&S ● Chorionic Villi Sampling (CVS) ● Spinal problems
● Flattened face ● Leukemia
● Small head (with slow brain growth) ● Dementia
● Short neck ● Other problems: endocrine
● Protruding tongue (due to the small oral cavity) problems, dental problems, seizures,
● Upward slanting eye lids (palpebral fissures) ear infections, and hearing and vision
● Unusually shaped or small ears problems.
● Poor muscle tone
● Broad, short hands with a single crease in the palm
● Relatively short fingers and small hands and feet
Diagnosis
● Excessive flexibility ● Delayed Growth & Development
● Tiny white spots on the colored part (iris) of the eye ● Imbalanced Nutrition
called Brushfield's spots ● Self-care Deficit
● Short height ● Impaired Verbal Communication
simian crease (a single crease along the palm with an in- ● Risk for Injury
curved little finger) ● Compromised Family Coping
 Trisomy 21
Nursing Intervention
Supportive Management
● Offer assistance and support to the parents; give clear explanations to promote understanding and compliance
● Assist in identifying positive features and behaviors in the child to alleviate anxiety and promote parental acceptance of the child’s disabilities.
● Plan activities based on the child’s cognitive and motor abilities, rather than chronological age, to promote a healthy emotional and physical environment.
● Provide activities and toys appropriate for the child to support optimal development.
● Refer the parents for nutritional counseling as needed
● Teach parents to recognize symptoms of problems, such as upper respiratory infections and constipation, and to administer thyroid medication if needed.
● Keep the environment as routine as possible; a change in routine commonly results in frustration and decreased coping abilities.
● Refer the parents for genetic counseling to explore the cause of the disorder and to discuss the risk of recurrence in a future pregnancy.
● Encourage participation in success-oriented activities such as Special Olympics.
● Refer the parents to a social worker or grief counselor, if needed; many parents grieve for the “normal” child they had.

Management
● History taking
● Developmental assessment
● Assess adaptive functioning
● Assess language, sensory, & psychomotor
functioning
● Safety hazards home & community
● Observe how the family is managing the child
community & school
● Availability of services, special
education opportunities
● Evaluate the coping skills of the
family members