OUTLINE

● HIGH-RISK Children HIGH-RISK

NEWBORN
● COMMON HEALTH PROBLEM DURING
INFANCY
● HIGH RISK TODDLER
● COMMON HEALTH PROBLEMS IN
PRESCHOOL AGE
● COMMON HEALTH PROBLEMS IN
SCHOOL AGE CHILDREN
● COMMON HEALTH PROBLEMS IN
ADOLESCENT
● ACCIDENTS AND INJURY
● CONGENITAL HEART PROBLEMS

● Cause:
HIGH-RISK Children HIGH-RISK NEWBORN ○ unknown
● Maternal factors:
○ age, smoking, poor nutrition,
PROBLEMS RELATED TO MATURITY Placental problem,
Preeclampsia/eclampsia Fetal
factors: multiple pregnancy, infection
PRETERM NEWBORN
● A neonate born before 37 weeks of ● Other factors:
gestation ○ poor socioeconomic status,
● Primary concern relates to immaturity of all environmental exposure to harmful
body systems substance

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 ○ Square window wrist

○ SCARF SIGN

● Assessment
○ Respirations are irregular with
periods of apnea
○ Body temperature is below normal
○ Skin is thin, with visible blood
vessels and minimal subcutaneous ● Common or special problem of preterm
fat pads, may appear neonates
○ jaundiced (Poikilothermic-easily take
on the temperature of the ○ Respiratory Distress Syndrome
environment) ■ Hyaline membrane disease
○ Poor sucking and swallowing ■ due to lung immaturity;
reflexes deficient in surfactant
○ Bowel sounds are diminished ○ Hyperbilirubinemia
■ high level of bilirubin in the
POIKILOTHERMIC blood,
■ neonate become jaundice
● easily take on the temperature of the due to immaturity of the liver
environment. ■ Kernicterus staining of brain
● Poor sucking and swallowing reflexes cells with bilirubin, causing
● Bowel sounds are diminished irreversible brain damage
● Extremities are thin, with minimal creasing
on soles and palms
● Extension of extremities and does not
maintain flexion

○ Abundance of lanugo hair

○ Infection
○ Labia are narrow in girls
○ Testes are undescended in boys
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 ■ not able to receive IgG ● Neonate born after 42 weeks of gestation
globulins ● About 12% of all infants are post-term
○ Cold stress ● Causes
■ less subcutaneous tissue, ○ delayed birth is unknown
poikilothermic ○
● Maternal factors:
○ Anemia ○ First pregnancies between the ages
■ less iron stores 15 to 19years
● Management ○ Woman older than 35 years
○ Improving respiratory function ○ Multiparity
■ Oxygen therapy, ● Fetal factors
■ Mechanical ventilator ○ Fetal anomalies such as
○ Maintaining body temperature anencephaly
Isolette ● Assessment
■ maintains ideal temperature, ○ Depleted subcutaneous fat: old
humidity concentration looking "old man facies"
isolates infant from infection, ○ Parchment-like skin (dry, wrinkled
Kangaroo Care and cracked) without lanugo
○ Preventing infection ○ Fingernails long and extended over
■ Handwashing ends of fingers
○ Promoting nutrition ○ Abundant scalp hair Long and thin
■ Gavage feeding, Milk feeding body
○ Promoting Sensory stimulation ○ Sign of meconium staining
■ Gentle touch, speaking ○ Nails and umbilical cord (yellow to
gently and softly, music box green)
or low tuned radio

● Nursing Interventions
COMPLICATIONS OF POST MATURITY
○ Monitor vital signs every 2 to 4
hours ● The placenta begins to aged toward the
○ Administer oxygen and end of pregnancy, and may not function as
humidification as prescribed. efficiently as before.
○ Monitor intake and output ● The failing placental function will place
○ Monitor daily weight. infant at risk for intrauterine hypoxia during
○ Maintain newborn in a warming labor and delivery.
device. ○ MECONIUM ASPIRATION
○ Reposition every 1 to 2 hours, and SYNDROME
handle newborn carefully ○ HYPOGLYCEMIA
○ Avoid exposure to infections. ■ FROM NUTRITIONAL
○ Provide newborn with appropriate DEPRIVATION AND POOR
stimulation, such as touch STORAGE OF GLYCOGEN
○ Suctioning of secretions as needed AT BIRTH
○ Monitor for signs of infection ○ POLYCYTHEMIA- increase RBC
○ Provide skin care ● Management
○ Provide a complete explanation for ○ Ultrasound is done to evaluate fetal
parents development, amount of amniotic
fluids and the placenta signs of
aging
POST-TERM NEWBORN

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 ○ To reduce the chance of meconium
resistance midline of the
aspiration, upon delivery of chest
newborn's head and just before the
baby takes his first breath suctioning Grasp reflex weak Strong,
of the mouth and nose is done allowing the
infant to be
lifted up from
the mattress
● Nursing management
○ Closely monitor the newborn
cardiopulmonary status PROBLEMS RELATED TO GESTATIONAL
○ Administer supplemental oxygen WEIGHT
therapy as needed
● SMALL FOR GESTATIONAL AGE
○ Frequent monitoring of blood sugar;
○ (SGA) babies are those whose birth
assess for sign of hypoglycemia
weight lies below the 10th percentile
○ Provide thermoregulated
for that gestational age
environment-use of isolette or
○ SGA babies may be:
radiant heat warmer
■ premature (born before 37
○ Monitor for signs of meconium
weeks of pregnancy),
aspiration syndrome
■ full term (37 to 41 weeks),
or
DIFFERENCES PRETERM FULL TERM ■ post term (after 42 weeks of
pregnancy)
posture “Relaxed More flexed
○ Intrauterine growth restriction
attitude” limbs attitude
more (IUGR) is the most common
extended underlying condition leading to SGA
newborn
Ear Ear cartilages Well formed
are poorly cartilages
developed,
may fold easily

Sole Only fine Well and

wrinkles deeply
creased

Female Clitoris is Clitoris is not

genitalia prominent; as prominent;
labia majora labia majora
poorly fully ● Some factors that may contribute to
developed developed SGA are the following:

Male genitalia Scrotum is Scrotum is ○ Maternal factors:

underdevelope fully
■ high blood pressure chronic
d and not developed,
pendulous, pendulous, kidney disease
with minimal raugated ■ advanced diabetes
rugae ■ heart or respiratory disease
■ malnutrition, anemia
Scarf sign Elbow is easily With resisting infection
brought across attempt when
■ substance use (alcohol,
the chest with elbow is
little or no brought to the drugs)

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 ■ cigarette smoking Placental ■ unknown (genetic factors
anomaly is the most and maternal conditions)
common cause of IUGR
○ Maternal diabetes
○ Factors related to the fetus ■ is the most widely known
■ multiple gestation (twins) contributing factor
■ Infection ○ Increase insulin acts as a fetal
■ chromosomal abnormality growth hormone
○ Macrosomia
● Assessment ■ an unusually large newborn
○ Respiratory distress - hypoxic with birth weight of more
episodes than 4500grams
○ Loose and dry skin,little fat, little ● Assessment
muscle mass ○ large, obese
○ Wasted Appearance ○ Lethargic and limp
○ Small liver ○ May feed poorly
○ Head is larger compared to body ○ Sign and symptoms of birth trauma
○ Wide skull sutures ■ Bruising
○ Poor skin turgor o Sunken abdomen ■ Broken clavicle
■ Evidence of molding
● Babies with SGA may have problems at ■ Cephalhematoma
birth such as: ■ Caput succedaneum
○ Respiratory distress (asphyxia) ● Problems of LGA babies
○ Meconium aspiration ○ Hypoglycemia (low blood sugar) of
○ Hypoglycemia baby after delivery
○ Difficulty maintaining normal body ○ Respiratory distress
temperature ○ Hyperbilirubinemia
○ Polycythemia too many red blood ○ Potential complications related to
cells increase in body size:
■ Leading cause of breech
● Nursing Interventions position and shoulder
○ Obeserve for signs of respiratory dystocia
distress ■ Fractured skull, clavicles,
○ Maintain body temperature cervical or brachial plexus
○ Monitor for infection and intiate injury and erb’s palsy
measures to prevent sepsis ■ Generally, there is no
○ Monitor blood glucose levels and treatment other than lifting
for signs of hypoglcemia the child gently to prevent
○ Initiate early feedings and monitor discomfort. Occasionally the
for signs of aspiration arm on the affected side may
○ Provide stimulation, such as touch be immobilized.
and cudding

● LARGE FOR GESTATIONAL AGE

○ Neonate who is plotted at or above
the 90th percentile on the
intrauterine growth curve
○ Weigh more than 4,000 grams
○ Cause
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 ● Assessment
○ Expiratory grunting
● Management ■ major- is the body's way of
○ Routine newborn care with special trying to keep air in the lungs
emphasis on the following: so they will stay open
■ Monitor vital signs frequently,
especially respiratory status.
■ Monitor blood glucose levels
and for signs of
hypoglycemia
■ Initiate early feedings
○ Note any signs of birth trauma or
injury
○ Monitor for infection and initiate
measures to prevent sepsis
○ Provide stimulation, such as touch
and cuddling.
○ Tachypnea
○ Nasal flaring
COMMON ACUTE CONDITIONS OF ○ Retractions
NEWBORN ○ Seesaw
● RESPIRATORY DISTRESS SYNDROME ■ like respirations (chest wall
(RDS) retracts and the abdomen
○ Serious lung disorder caused by protrudes)
immaturity and inability to produce
surfactant. resulting in hypoxia and
acidosis
○ Surfactant
■ a biochemical compound
that reduces surface tension
inside the air sac
○ Decrease in surfactant results to
lung collapse, thus greatly reducing
infant's vital supply of oxygen

○ Decreased breath sounds

○ Apnea
○ Pallor and cyanosis
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 ○ Hypothermia
● Management
○ Oxygen therapy ● RETINOPATHY OF PREMATURITY
■ hood, nasal prong, mask, ○ Vascular disorder involving gradual
endotracheal tube, CPAP replacement of retina by fibrous
(Continuous Positive Airway tissue and blood vessels
Pressure) or PEEP (Positive ○ Primarily caused by prematurity and
End -Expiratory Pressure) use of supplemental oxygen (longer
may be used than 30 days)
○ Oxygen administration should never
be more than 40% unless hypoxia is
documented
○ Any premature newborn who
required oxygen support should be
scheduled for an eye examination
before discharge to assess for
retinal damag
○ Bronchopulmonary Dysplasia- over
expanded lungs prolonged use of
O2

○ Muscle relaxants - Pancuronium

(Pavulon)
■ Reduces muscular
resistance
■ Prevents pneumothorax
■ Prepare Atropine or
Neostigmine Methylsulfate
○ Liquid Ventilation
■ Uses perfluorocarbons
■ substances used in industry
to assess leaks
○ Nitric Acid
● Management:
■ Causes pulmonary
○ Suction every 2 hours or more often
vasodilation
as necessary.
■ increases blood flow to the
○ Prepare to administer surfactant
alveoli
replacement therapy (instilled into
● Nursing Interventions
the endotracheal tube)
○ Monitor color, respiratory rate, and
○ Administer respiratory therapy
degree of effort in breathing
(percussion and vibration)
○ Support respirations as prescribed
○ Provide nutrition
○ Monitor arterial blood gases and
○ Support bonding
oxygen saturation levels (arterial
○ Encourage as much parental
blood gases from umbilical
participation in newborn's care as
artery).so that oxygen administered
condition allows.
to the newborn is at the lowest
possible concentration necessary to
maintain adequate arterial
oxygenation.
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● HYPERBILIRUBINEMIA ○ Cover the genital area, and monitor
○ is an abnormally high level of the genital area for skin irritation or
Bilirubin in the blood; results to breakdown.
jaundiced ○ Cover the newborn's eyes with eye
○ In physiologic jaundiced: shields or patches; make sure that
■ occurs on the second day to eyelids are closed when shields or
seventh day patches are applied.
■ average increase of 2mg/dl; ○ Remove the shields or patches at
not exceeding 12mg/dl least once per shift (during a feeding
○ Pathological Jaundice of time) to inspect the eyes for
Neonates infection or irritation and to allow eye
■ Any of the following features contact and bonding with parents.
characterizes pathological ○ Monitor skin temperature closely.
jaundice: ○ Increase fluids to compensate for
■ Clinical jaundice appearing water loss.
in the first 24 hours. ○ Expect loose green stools and green
■ Increases in the level of total urine.
bilirubin by more than 12 ○ Monitor the newborn's skin colorwith
mg/dl the fluorescent light turned off, every
● Therapy is aimed at preventing Kernicterus, 4 to 8 hours.
which results in permanent neurological ○ Monitor the skin for bronze baby
damage resulting from the deposition of syndrome- a grayish-brown
bilirubin in the brain cells. discoloration of the skin.
● Causes: ○ Reposition newborn every 2 hours.
○ Immaturity of the liver ○ Provide stimulation.
○ Rh or ABO incompatibility ○ After treatment, continue monitoring
○ Infections for signs of hyperbilirubinemia,
○ Birth trauma because rebound elevations are
○ Maternal diabetes normal after therapy is discontinued.
○ Medications ○ Turn off phototherapy lights before
● Assessment drawing blood specimen for serum
○ Jaundice bilirubin levels and avoid allowing
○ Dark concentrated urine blood specimen to remain
○ Enlarged liver uncovered under fluorescent lights
○ Poor muscles tone (to prevent the breakdown of
○ Lethargy bilirubin in the blood specimen).
○ Poor sucking reflex ○ Monitor for the presence of jaundice;
● Management assess skin and sclera for jaundice.
○ Phototherapy ○ Examine the newborn's skin color in
○ Exchange blood transfusion via natural light.
umbilical catheter-for very severe ○ Press finger over a bony
cases prominence or tip of the newborn's
■ Infants blood nose to press out capillary blood
■ Remove 5/10 ml at a time from the tissues.
● Nursing Interventions ○ Jaundice starts at the head first,
○ Expose as much of the newborn's spreads to the chest, abdomen, and
skin as possible. then the arms and legs, followed by
the hands and feet

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 ○ Keep newborn well hydrated to ● Management
maintain blood volume. ○ Suctioning must be done
○ Facilitate early, frequent feeding to immediately after the head is
hasten passage of meconium and delivered before the first breath is
encourage excretion of bilirubin. taken;
○ Report to the physician any signs of ○ Vocal cords should be viewed to see
jaundice in the first 24 hours of life if the airway is clear before
and any abnormal S&S stimulation and crying
○ Prepare for phototherapy, and ○ Extracorporeal membrane
monitor the newborn closely during oxygenation (ECMO)-
the treatment. Cardiopulmonary bypass to support
gas exchange allows the lungs to
● MECONIUM ASPIRATION SYNDROME rest
(MAS) ● Nursing interventions
○ occurs when infants take meconium ○ Observing neonates respiratory
into their lungs during or before status
delivery ○ Ensuring adequate oxygenation
○ Occurs in term or post-term infants closely
○ During fetal distress there is ○ Administration of antibiotic therapy
increases intestinal peristalsis, ○ Maintain thermoregulation
relaxing the anal sphincter and
releasing meconium into the ● SEPSIS
amniotic fluid. ○ Generalized infection resulting from
○ Aspiration can occur in utero or with the presence of bacteria in the blood
the first breath. ○ Major common cause is group B
○ Meconium can block the airway beta-hemolytic streptococci
partially or completely and can ○ Contributing factors:
irritate the newborn' airway, causing ■ Prolonged rupture of
respiratory distress membranes
■ Prolonged or difficult labor
● Assessment: ○ Maternal infection
○ Respiratory distress is present at ○ Cross contamination
birth: ○ Aspiration
■ tachypnea, ● Assessment findings
■ cyanosis, ○ often does not have specific sign of
■ Retractions, illness
■ nasal flaring. ■ Poor feeding
■ Grunting ■ Irritability
■ Crackles, and rhonchi may ■ Lethargy
be present ■ Pallor
■ Infant’s nails, skin, and ■ Tachypnea
umbilical cord may be ■ Tachycardia
stained a yellow-green color ■ Abdominal distention
● CAUSES and RISK FACTORS: ■ Temperature instability
○ Common to post mature ● difficulty keeping
○ Maternal history of diabetes temperature within
○ Hypertension normal range
○ Difficult delivery
○ Poor intrauterine growth
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● Diagnosis: ○ Soft moldable mattresses and
○ Blood, urine, and cerebrospinal fluid bedding, such as pillows or quilts,
cultures should not be used bedding.
○ Routine CBC, urinalysis, fecalysis ○ Stuffed animals should be removed
○ Radiographic test from the crib while the infant is
● Management sleeping.
○ Intensive antibiotic therapy ○ Discourage bed sharing (sleeping
○ IV fluids with an adult).
○ Respiratory therapy ○ Home apnea monitor to infant with
● Nursing interventions- Routine newborn near miss SIDS
care with special emphasis on the following:
○ Monitor vital signs, assess for
periods of apnea or irregular
respirations..
COMMON HEALTH PROBLEM DURING
○ Administer oxygen as prescribed
INFANCY
○ Provide isolation as necessary-
Monitor and limit visitors
○ Handwashing before after handling FAILURE TO THRIVE
neonate
● A condition in which a child fails to gain
● SUDDEN INFANT DEATH SYNDROME weight and is persistently less than the fifth
○ Sudden death of any young child percentile on standard growth chart
that is unexpected by history and ● Persistent deviation from established
which thorough postmortem growth curve.
examination fails to demonstrate ● Delay in physical growth and weight gain
adequate cause of death might lead to cognitive impairment or even
○ Usually occurs during sleep death
○ Diagnosis is made after autopsy
○ High incidence in preterm infants, ● 4 principal factors for human growth:
infants with abnormalities in ○ Food
respiration ○ Rest and activity
○ Unknown cause: may be related to a ○ Adequate secretions of hormones
brainstem abnormality in the ○ Satisfactory relationship with
neurological regulation of caregiver
cardio-respiratory control ● Classified as
● Nursing Role: ● Organic (OFTT)
○ Care is directed at supporting ○ due to pathologic condition such as
parents/family problem in absorption and hormonal
○ Provide a room for the family to be dysfunction
alone ● Nonorganic (NFTT)
○ Reinforce that death was not their ○ due to psychosocial factor disrupted
fault maternal child relationship
○ Provide appropriate support ● Idiopathic(IFTT)
referrals ○ Unexplained by the usual organic
○ Explain how parents can receive and environmental etiologies but
autopsy results ○ usually classified as NFTT
● Prevention:
○ Infants should be placed in the
supine position for sleep.
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● A thorough history is the best guide to ■ Keep an accurate record of
establishing the etiology of the failure to intake.
thrive: ■ Weigh daily.
○ Poverty is the greatest single risk ○ Introduce positive feeding
factor worldwide and in the United environment:
States ■ Establish a structured
○ Nutritional deficiency is the routine
fundamental cause ■ Hold the young child for
feeding
● Assessment findings ■ Maintain eye-to-eye contact
○ Poor muscle tone, loss of ■ Maintain a calm, even
subcutaneous fats, skin breakdown temperament
○ Rumination ■ Provide a quiet, non
■ common characteristic: stimulating environment
voluntary regurgitation ■ Talk to child giving
○ Lethargic appropriate directions and
■ unresponsive praise for eating
○ Positive delay in growth and ■ Increase stimulation
development appropriate to the child's
○ Signs of disturbed maternal-child present developmental level.
interaction ■ Provide the parent an
○ Diminished or nonexistent crying opportunity to talk.
○ Radar gaze wide-eyed gaze and ■ When necessary, relieve the
continual scan of environment parent of childrearing
responsibilities until able and
● Characteristics of the individual ready emotionally to support
providing care: the child.
○ Difficulty perceiving and assessing ■ Demonstrate proper infant
the infant's needs care by example, not
○ Frustrated and angered at the lecturing.
infant's dissatisfied response ■ Supply the parent with
○ Frequently under stress and in emotional support with
crisis, with emotional, social and fostering dependency.
financial problems Promote the parent's
● All children with failure to thrive need self-respect and confidence
additional calories for catch-up growth: by praising achievements
○ Treatment depends on the cause with child.
○ Medical disorder
■ specific treatment is given
HYDROCEPHALUS
Parent-child relationship -
Family counseling ● An imbalance of cerebrospinal fluid (CSF)
○ Nutritious, high-calorie feedings absorption or production caused by:
● malformations, tumors, hemorrhage.
● Nursing Interventions infections, or trauma
○ Provide consistent caregiver. ● Results in head enlargement and increased
○ Provide sufficient nutrients. ICP
■ Make feeding a priority
intervention. ● Types:
○ COMMUNICATING
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 ■
occurs as a result of the ventricles to a location where it
impaired absorption within may be reabsorbed.
the subarachnoid space. A. Ventriculoperitoneal shunt-
○ NONCOMMUNICATING the CSF drains into the
■ blockage in the ventricular peritoneal cavity
system that prevents CSF B. Atrioventricular shunt
from entering the -CSF drains into the right
subarachnoid space atrium of the heart
C. Acetazolamide (Diamox)-
● Assessment: promote the excretions of
○ Increased head circumference excess fluids
○ Thin, widely separated bones of the
head that produce a cracked pot ○ Preoperative interventions
sound (Macewen's sign) on ■ Give small frequent feedings
percussion as tolerated until a
○ Anterior fontanel tense, bulging, and preoperative NPO status is
nonpulsating prescribed.
○ Dilated scalp veins ■ Reposition head frequently
○ Sunsetting eyes and use an egg crate
○ Behavior changes, such as irritability mattress under the head to
and lethargy prevent pressure sores.
○ Headache on awakening ■ Prepare the child and family
○ Nausea and vomiting for diagnostic procedures
○ Ataxia and surgery
■ lack of coordination of
muscle movement ● Postoperative interventions
○ Nystagmus ○ Monitor vital signs and neurological
■ involuntary movement of the signs.
eyes ○ Position the child on the unoperated
○ Late signs: High, shrill cry and side
seizures. ○ Observe for signs of increased ICP
○ ○ elevate head 15-30 degrees
○ Diagnostic Test: ○ Monitor for signs of infection
■ CT scan, MRI, Skull X-ray ○ Measure head circumference.
○ Provide comfort measures;
○ Transillumination expected level of functioning
■ holding a bright light such as ○ Administer medications as
a flashlight or specialized prescribed, diuretics, antibiotics, or
light (Chun gun) against the anticonvulsants.
skull in a darkened room; a ○ Instructions on parents re: wound
skull filled with fluids rather care, shunt revision
than solid brain substance ○ Availability of support groups;
● Management - treatment depends to community agencies
cause ○ Instruct the parents on how to
● Surgical interventions recognize shunt infection or
○ GOAL: Prevent further CSF malfunction
accumulation by bypassing the ■ In an infant- irritability,
blockage and draining the fluid from lethargy, and feeding poorly

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 ■ In a toddler-headache and a
lack of appetite
■ In older children- an
alteration in the child's level
of consciousness.

SPINA BIFIDA
● A central nervous system defect results
from fallure of the neural tube to close
during embryonic development generally in
the lumbosacral region ○ Spina bifida cystica- Protrusion of
the spinal cord and/or its meninges
with varying degrees nervous tissue
involvement.
■ Meningocele
● part of spinal
protrudes through
opening in the spinal
canal
● sac is covered with
○ Causes: thin skin no nerve
■ Actual cause is unknown; roots involved
multiple factors ● no motor or sensory
■ Genetic - if a sibling has had loss Good prognosis
neural tube defect after surgery
■ Environmental factors ■ Myelomeningocele
■ Medications, viral infection (meningomyelocele)
and radiation ● with spinal nerves
● Types: roots in the sac
○ Spina bifida occulta- Posterior ● have sensory or
vertebral arches fail to close in the motor deficit
lumbosacral area. ● below site of the
■ Spinal cord and meninges lesion
remains in the normal ● 80% have multiple
anatomic position handicaps
■ Defect may not be visible
dimple or a tuff of hair on the
spine
■ Asymptomatic may have
slight neuromuscular deficits
■ No treatment if
asymptomatic aimed at
specific symptoms

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 ■ closure of sac within 48
hours, shunt, orthopedic
○ Drug therapy
■ Antibiotic, Anticholinergic
● Nursing Management:
○ Prevent trauma to the sac
■ cover with a sterile, moist
(normal saline), non
adherent dressing
■ change the dressing every 2
to 4 hours as prescribed,
keep area tree from
contamination
■ place in a prone position to
● Assessment Depends on the spinal cord minimize tension on the sac
involvement ■ head is turned to one side for
○ Visible spinal defect feeding e) Administer meds
○ Motor/sensory involvement a ○ Prevent Complication
■ Flaccid paralysis of the legs ■ Use aseptic technique to
■ Altered bladder and bowel prevent infection.
function ■ Assess the sac for redness,
■ Hip and joint deformities clear or purulent drainage,
■ Hydrocephalus abrasions, irritation, and
● Diagnostics: signs of infection.
○ Prenatal ■ Clean intermittent
■ ultrasound, amniocentesis catheterization
■ Perform neurological
assessment
■ Assess for physical
impairments such as hip and
joint deformities
○ Provide adequate nutrition
○ Provide sensory stimulation
○ Provide emotional support to
parents and family
○ Postnatal ○ Provide discharge teachings
■ x-ray of spine ■ wound care
■ ct scan ■ ROM, PT
○ Myelogram ■ signs of complications
■ uses a special dye and an medication regimen
X-ray (fluoroscopy) to ■ positioning-feeding diaper
provide a very detailed change
picture of the spinal cord and
spinal column
○ Encephalogram
○ urinalysis, BUN, Creatinine
clearance
● Management:
○ Surgery
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 MENINGITIS
● inflammations of meninges of the brain and
spinal cord
● Cause by bacteria, viruses, other
microorganism
● as a primary disease or as a result of
complications of neurosurgery, trauma,
infection of the sinus or ears, or systemic ○ Brudzinski sign
infections. ■ Flexion at the hip in
● H Influenzae Meningitis response to forward flexion
○ the most common form; between 6
to 12 months
● Bacterial meningitis
○ Haemophilus influenza type B,
Streptococcus pneumoniae, or
Neisseria meningitis
○ Viral meningitis is associated with
viruses such as mumps,
herpesvirus, and enterovirus.
of the neck
● Assessment
○ Fever, chills, headache, ● Interventions
○ high-pitched cry, irritability ○ Provide isolation and maintain it for
○ Vomiting, Poor feeding or anorexia at least 24 hours after antibiotics are
○ Bulging anterior fontanel in the initiated.
infant ○ Administer antibiotics and
○ Signs of meningeal irritations antipyretics as prescribed.
■ Nuchal rigidity-stiff neck ○ Perform neurological assessment
■ Positive Kernig sign- and monitor for seizures and
Severe stiffness of the complications
hamstring muscle causes an ○ Assess for changes in level of
inability to straighten the leg consciousness and irritability.
when the hip is flexed to 90 ○ Monitor intake and output.
degrees ○ Assess nutritional status.
○ Determine close contacts of the
child with meningitis because the
contacts will need prophylactic
treatment.
○ Meningococcal vaccine is
recommended to protect against
meningitis.

○ Opisthotonos
■ arching of the back
■ head and heels bent
backward
■ and body arched forward

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 ○ Absence
SEIZURES
■ rarely 20 seconds
● Recurrent sudden changes in ■ stares straight, does not fall
consciousness, behavior, sensations and or ● Status Epilepticus
muscular activities beyond voluntary control
cause by excess neuronal discharge ● Contributing factors: seizure disorder
● Normally the neuron sends out messages in ○ Intracranial infection
electrical impulses periodically and the firing ○ Space occupying lesion
Individual neuron is regulated by an ○ CNS defects
inhibitory feedback loop mechanism
● With seizures many more neurons than ● Assessment findings
normal fire in a synchronus fashion in a ○ Restlessness/irritability
particular area of the brain; the energy ○ Body stiffens and loss of
generated overcomes the inhibitory consciousness
feedback mechanism ○ Clonic movements - quick, jerking
movements of arms, legs, and facial
● FEBRILE SEIZURES muscle
○ Common in children between ○ Pupils dilate and roll up
6mos-3yrs old
○ Common in 5% of population under ● Diagnostic Test:
5 years old, familial Nonprogressive, ○ Blood studies
does not generally result in brain ○ to rule out lead poisoning.
damage ○ hypoglycemia infection
○ Commonly associated with high ○ Electrolytes imbalance
fever -38.9 to 41.1 Celsius ○ EEG to detect abnormal wave
○ Some appear to have a low seizure
threshold and convulse when a ● Treatment:
fever of 37.8 to 39.8 ○ Drug Therapy
■ Diazepam
● Classification: ■ Phenobarbital
● Partial seizure ■ Dilantin
○ simple- localized motor activity ○ Surgery
■ shaking of arm or leg ■ for tumor and hematoma
■ limited to one side of the ● Interventions
body ○ Reduce fever with antipyretics.
○ Comple- psychomotor seizure ○ Give prescribed medication
■ memory loss and staring ○ Generalized seizure precautions
■ non purposeful movements ○ Do not restrain: pad crib rails: do not
● AURA use tongue blade
○ sensation that signals an attack ○ Observe and record the time of
● After seizure, duration, and body parts
○ sleep or confuse; unaware of the involved.
seizure ○ Suction and administer oxygen after
● Generalized the seizure as required.
○ Tonic-clonic ○ Observe the degree of
■ Prodromal consciousness and behavior after
■ AURA seizure
■ Tonic ○ Provide rest after the seizure.
■ post ictal
16
 ● Management
○ Antibiotics, analgesics
OTITIS MEDIA
○ Myringotomy incision into the
● Bacterial or viral infection of the middle ear tympanic membrane to relieve
● Common in infants and preschoolers pressure and drain the fluid
● Eustachian is shorter, wider, and straighter with/without tube
thereby, allowing nasopharyngeal secretion
to enter middle ear more easily ● Postoperative Interventions
○ Wear earplugs while bathing,
shampooing, and swimming.
○ Diving and submerging under water
are not allowed.
○ Child should not blow his or her
nose for 7 to 10 days after surgery.

● Interventions
○ Encourage fluid intake.
○ Teach the parents to feed infants in
● Assessment Findings upright position, to prevent reflux.
○ Behavior that would indicate pain ○ Instruct the child to avoid chewing
■ restless and repeatedly as much as possible during the
shakes the head acute period because chewing
■ frequently pulls or tugs at Increases pain.
affected ear ○ Provide local heat and have the
○ Irritability, cough, nasal congestion, child lie with the affected ear down.
fever ○ Instruct the parents in the
○ Hearing impairment appropriate procedure to clean
○ Purulent discharges drainage from the ear with sterile
cotton swabs.
● Diagnosis ○ Instruct the parents in
○ Examination of ear with otoscope- ■ Administration of analgesics
■ reveals bright red bulging or antipyretics
eardrum ■ Administration of the
○ Culture and sensitivity of ear prescribed antibiotics,
discharges emphasizing that the 10- to
○ Possible Complication 14-day period is necessary
■ permanent hearing loss - to eradicate infective
mastoiditis organisms.
■ Screening for hearing loss
may be necessary.
■ Administering ear
medications.
● Younger than age 3,
pull the lobe down
and back.
● Older than 3 years,
pull the pinna up and
● Back.

17
 CLEFT LIP AND CLEFT PALATE
● Nonunion of the tissue and bone of the
upper lip and hard/soft palate during
embryonic development
● Failure of the maxillary and premaxillary
processes to fuse during fetal development

● Etiology
○ primarily genetic
○ environmental factors
○ viral infection
○ exposure to radiation: ● Management
○ Folic acid deficiency ○ Surgical correction (Rule of Ten)
○ teratogenic factors ■ Cheiloplasty-Correction of
cleft lip
● Assessment Findings ■ Palatoplasty - Cleft palate
○ Facial abnormality surgery
○ Difficulty sucking and swallowing ● Done before speech
○ Milk escapes through nose development
● Allow for palatal
● Assessment changes
○ Cleft lip ■ Logan bar/steri strips- to
■ can range from a slight notch take the tension off the
to a complete separation sutures
from the floor of the nose. ○ Team Approach Therapy
○ Cleft palate ■ Dentist and orthodontist
■ nasal distortion ■ Audiologist
■ midline or bilateral cleft ■ Speech Therapist
■ variable extension from the ■ Pediatrician
uvula and soft and hard
palate.
● Associated Problems
○ Feeding problems
○ URTI
○ Ear infection
○ Speech defect, dental malformation
○ Body image
● Nursing Intervention (Pre-op Cleft Lip)
○ Feed in upright position' in small
frequent feedings
○ Burp frequently
○ Use large-holed nipples
○ Use rubber-tipped syringe - if unable
to suck
○ Gavage feeding as ordered
○ Finish feeding with water

18
 ○ Provide emotional support for ○ Type I/A
parents and family ■ lower segments of the
esophagus are blind;
● Nursing Intervention (Post-op Cleft Lip) ○ Type II B
○ Maintain patent airway ■ upper end of esophagus
○ Assess color: monitor for frequent opens into the trachea; blind
swallowing lower segment
○ Do not place in prone position 4. ○ Type II C
Avoid straining suture lines ■ upper end blind; lower end
○ Use elbow restraints connects into trachea
○ Resume feedings as ordered
(Haberman feeder)
○ Provide pain control as ordered

● Nursing Intervention (Pre-op Cleft

Palate)
○ Prepare parents to care for child ● Clinical Manifestation
after surgery ○ Excessive amount of secretions
○ Instruct concerning feeding methods constant drooling large secretion
and positioning from the nose
○ Intermittent/unexplained cyanosis
● Nursing Intervention (Post-op Cleft ○ Coughs and chokes
Palate) ○ Fluids returns through nose and
○ Suction mucus and saliva gently and mouth
do not touch the sutures ○ Regurgitation & vomiting
○ Incision care ○ Abdominal distention
○ Clean suture with sterile cotton ○ Inability to pass a small catheter
swab with half strength hydrogen through
peroxide followed by saline ○ The mouth or nose into the
○ Apply antibiotic ointment stomach.
○ Do not displace Logan bar ● Diagnostic Evaluation
○ Do not place in prone position, ○ X-ray of abdomen and Chest X-ray
Place in side lying position ○ X-ray with radiopaque catheter
○ Keep spoons, pacifier, straws, away ○ Insertion of a catheter
from child's mouth for 7 to 10 days ● Management Includes maintenance of
post op ○ a patent airway
○ Elbow strain ○ prevention of aspiration pneumonia
○ Special feeder - syringe with rubber ○ gastric or blind pouch
tubing into side of mouth, Breck decompression
feeder ○ supportive therapy surgical repair
○ Drug Therapy
ESOPHAGEAL ATRESIA/TEF
■ Antibiotics- for respiratory
● The esophagus terminates before it infection
reaches the stomach, ending in a blind ○ Surgery
pouch, and/or fistula is present that forms ■ Primary repair-esophageal
an unnatural connection with the trachea. anastomosis
■ Gastrostomy-feeding
■ Esophagostomy- drain
secretions
19
 ○ Monitor for anastomotic leaks as
evidenced by purulent drainage from
the chest tube, increased
temperature, and increased white
blood cell count.
○ Observe for signs of stricture at the
anastomosis site (e.g... poor/refusal
to feed, dysphagia. drooling,
regurgitated undigested food).

● Interventions
● Pre-operative
○ The infant may be placed in an
incubator or radiant warmer with
high humidity (intubation and
mechanical ventilation may be HYPERTROPHIC PYLORIC STENOSIS
necessary if respiratory distress ● Congenital hypertrophy of the circular
occurs). muscles of the pylorus in the stomach; the
○ Upright position muscle becomes progressively thickened
○ Maintain an NPO status. and elongated with narrowing of the pyloric
○ Regular suctioning canal.
○ Maintain IV fluids or ● The stenosis usually develops in the first
hyperalimentation as prescribed. few weeks of life, causing projectile
○ Observe closely for vomiting. dehydration, metabolic alkalosis,
■ vital signs; respiratory and failure to thrive.
behavior
■ amount of secretions
■ abdominal distention
■ skin color

● Post-operative Interventions
○ Monitor respiratory status.
○ Maintain patent airway; continued
use of incubator
○ Suction as needed, change position
frequently; avoid hyperextension of
neck
○ Maintain IV fluids, antibiotics, and
parenteral nutrition as prescribed.
○ Maintain adequate ● Assessment
nutrition-gastrostomy ○ Vomiting that progresses from mild
○ Monitor strict intake and output. regurgitation to forceful and
○ Monitor daily weight. projectile vomiting
○ Inspect the surgical site for signs ○ Vomitus contains gastric contents
and symptoms of infection. such as milk or formula, may contain

20
 mucus, maybe blood tinged, and ○ Feed by gavage
does not usually contain bile. ■ Thickened feedings
○ Exhibits hunger and irritability. ■ Slowly upright
■ Burp frequently
● Prepare the child and parents for surgery if
prescribed.
○ Pyloromyotomy Pre-op
■ Monitor hydration status
■ Correct F/E imbalances
■ NPO
■ Monitor character of stools
■ NGT
○ Post-operative
○ Peristaltic waves are visible from ■ Monitor intake and output
left to right across the epigastrium ■ Start SFF
during or immediately following a ■ Feed slowly, upright
feeding. ■ Monitor for abdominal
○ Olive-shaped mass is in the distention
epigastrium just right of the ■ Monitor for signs of infection
umbilicus. ■ Instruct parents on wound
○ On barium enema, string sign can care and feeding
be seen
○ Dehydration and malnutrition can
occur. HIRSCHSPRUNG'S DISEASE (AGANGLIONIC
○ Electrolyte imbalances can occur. MEGACOLON)
● Absence of ganglion cells in a portion of the
large intestine
● Is a parasympathetic nerve cells that
regulates peristalsis in the intestine The
absence of the ganglion cells would result
to absence peristalsis and affected colon
becomes dilated and filled with feces and
gas
● The disease may be a familial congenital
defect or may be associated with other
● Management anomalies, such as Down syndrome and
○ Fredet-Ramstedt Pyloromyotomy genitourinary abnormalities.
■ splits the hypertrophic pyloric
muscle down to the
submucosa allowing pylorus
to expand so that food may
pass

● Nursing Interventions ● Assessment Findings

○ Monitor vital signs. ○ Newborn
○ Monitor strict intake and output. ■ Failure to pass meconium
○ Obtain daily weights. stool
○ Monitor for signs of dehydration and ■ Refusal to suck
electrolyte imbalances. ■ Abdominal distention
21
 ■ Bile-stained vomitus
INTUSSUSCEPTION
○ Children
■ Failure to gain weight and ● Invagination or telescoping of a portion of
delayed growth the small intestine into a more distal
■ Abdominal distention segment of the intestine
■ Vomiting ● 3 times more likely in boys than girls and
■ Constipation alternating with the common cause of intestinal obstruction
diarrhea in childhood Cause is unknown
■ Ribbon-like and foul-smelling
stools

● Factors
○ Hyperperistalsis and unusual
● Diagnostic Studies - Rectal biopsy mobility of cecum and ileum
○ Lesion such as polyp and tumor
● Management ■ It is considered a surgical
● Surgery abdominal emergency in
○ Temporary colostomy children
■ A portion of the large ■ Mechanical Bowel
intestine is brought through Obstruction Occurs:
the abdominal wall to carry intestinal walls press against
stool out of the body each other causing
○ Bowel repair inflammation, edema and
■ Dissection and removal of decreased blood flow.
the affected section with ○ May progress to necrosis,
anastomosis of intestine perforation and peritonitis.
■ Abdominal-perineal pull ○ Gangrene of the bowel
through

● Nursing Management
○ Administer enema as ordered with
Isotonic solution only
○ Do not treat loose stools-child is
constipated
○ Administer TPN
○ Instruct parents on colostomy care,
correct diet

22
● Clinical Presentation
○ Sudden onset of abdominal pain (in
a healthy baby)
○ Infant cries out sharply and draws
knees up to abdomen.
○ Vomiting occurs and increases
overtime (Bile stained vomitus)
Currant jelly stool
○ Signs of shock ● Immediate Treatment
○ (+) for Occult blood in stools ○ IV fluids
○ Sausage-shaped mass in RLQ ○ NPO status
○ Diagnostic barium enema

● Surgery
○ manual reduction of invagination -
○ resection with anastomosis
○ possible colostomy (gangrenous)

● Diagnosis
○ Often based on history and physical
examination alone
■ Barium enema Is definitive
(in 75% of cases)
■ It is therapeutic and curative ● Nursing Management
in most cases with less than ○ Provide routine pre- and
24-hour duration post-operative care for abdominal
surgery
○ Monitor fluid and electrolyte status
○ Maintain nutrition and hydration
○ Resume feedings 24 hours
post-operative

IMPERFORATE ANUS
● Congenital malformation in which there is
no anal opening or there is stricture of the
anus
● Digital rectal exam ● Etiology is unknown
○ reveals mucous, blood ● An arrest in embryonic development on 7th
to 8th week of intrauterine life
● A membrane remains and blocks the union
between the rectum and the anus
● Blind rectal pouch with normal anus

23
 ○ NGT for gastric decompression
Change position frequently
○ Oral feeding started gradually as
soon as peristalsis function returned
○ Instruct the parents to use only a
water-soluble lubricant and to insert
the dilator no more than 1 to 2cm

● Clinical Presentation DISPLACED URETHRAL OPENINGS

○ No stool passage with in 24 hours ● HYPOSPADIAS
after birth ○ Males:
○ Meconium stool from other orifice ■ urethra opens on the lower
○ Only a dimple indicates the site of surface of the penis
the anus ○ Females:
○ Inability to insert thermometer ■ urethra opens into the
vagina
● EPISPADIAS
○ Only in males
○ Urethra opens on the dorsal surface
of the penis
○ Congenital absence of the upper
wall of the urethra

● Diagnosis
○ Digital rectal exam
○ Ultrasound
○ Abdominal X-rays

● Management:
○ If suspected, do not take rectal
temperature ● Procreation may be interfered with in
○ Pre-operative care severe cases
■ Monitor for the presence of ● Increased risk of urinary tract infection
stool in the urine and vagina
(indicates a fistula) and ● MANAGEMENT
report immediately. ○ Circumcision is delayed until
■ Administer IV fluids as surgical repair
prescribed ○ Surgical repair
■ Prepare the child and ■ Meatotomy
parents for the surgical
procedures, including the
potential for colostomy. DOWN SYNDROME
○ Post-operative Care ● Chromosomal disorder caused by the
○ Expose perineum to air presence of all or part of an extra 21st
○ Check bowel sounds chromosome.

24
● It is named after John Langdon Down, the ○ Encourage fluids and foods rich in
British doctor who described the syndrome fiber.
in 1866. ○ Constipation results from decreased
● The disorder was identified as a muscle tone, which affects gastric
chromosome 21 trisomy motility.
○ Provide good skin care because the
skin is dry and prone to infection.
○ Family education-counseling
○ developmental progress

AUTISM

● Assessment Findings ● Severe mental disorder beginning in infancy

○ Small head, flat facial profile or toddlerhood
○ Low-set ears. ● Pervasive developmental disorder
○ Simian creases ● Disorder apparent to the parents before the
○ 40% congenital heart defects child is 3 years old
○ With moderate retardation 6. Wide
space between 1st-2n toes ● Characterized by:
○ Lax muscle tone ○ Severe deficit in language,
○ perceptual and motor development
○ Defective reality testing
○ Inability to function in social setting
● The cause is unknown and the prognosis
may be poor.

● Possible causes
○ Unsatisfactory mother-child
relationship
○ CNS abnormalities
● Management ● Diagnosis is established based on
○ Prevent respiratory infections - symptoms and the use of specialized
■ Clearing the nose autism assessment tools.
■ Cool mist vaporizer
■ Chest physiotherapy: ● Categories
■ Handwashing and avoiding ○ Inability to relate with others
exposure to infection. ○ Inability to communicate
○ When feeding infants and young ○ Obvious limited activities/interest
children, use a small,
straight-handled spoon to push food ● Clinical presentation
to the side and back of the mouth. ○ Infant not responsive to cuddling

25
 ○ No eye contact or facial ● One of the most common reasons for
responsiveness referral of children to mental health services
○ Impaired/no verbal communication ● Childhood problems include lowered
○ Echolalia intellectual development, some minor
○ Inability to tolerate change physical abnormalities, sleeping
○ Fascination with movement disturbances, behavioral or emotional
○ Labile moods disorders, and difficulty in social
relationships.
● Assessment ● Diagnosis Established on:
○ Bizzare responses to the ○ parent and teachers reports
environment ○ psychological assessments
■ Intense reaction to minor ○ Diagnosable by 36 months
changes ○ 3 major characteristics revealed
■ Attachment to objects before 7 years of age
■ Intensely preoccupied to
moving object ● Assessment
○ Self-absorbed and unable to relate ○ Fidgets with hands or feet or
to others. squirms in the seat
○ Repetitive hand movement, rocking, ○ Easily distracted with external or
and rhythmic body movement internal stimuli
○ Hitting, head banging, and biting ○ Difficulty with following through on
○ Music often holds a special interest instructions
for them ○ Poor attention span
○ No delusions, hallucinations, or ○ Shifting from one uncompleted
incoherence activity to another
○ Excellent long-term memory ○ Talking excessively
○ May play happily alone for hours but ○ Interrupting or intruding on others
have temper tantrums if interrupted. ○ Engaging in physically dangerous
activities without considering the
● Nursing intervention possible consequences
○ Provide parents /family with support
and information about the disorder ● Therapeutic Management
○ Assist child with ADL ○ Environment
○ Promote reality testing ■ construction of stable
○ Encourage the child to develop environment
relationship with another person ■ special instruction free from
○ Maintain regular schedule of distractions
activities ■ fair but firm and set
○ Provide constant routine for child consistent limits
○ Protect from self injury ○ Medications
○ Provide safe environment ■ controls excessive activity
○ Provide seizure precaution ■ lengthening the attention
span
■ decreasing the distractibility
ATTENTION DEFICIT HYPERACTIVITY
DISORDER
● Interventions
● Developmental disorder characterized by ○ Provide environmental and physical
inappropriate degrees of inattention, safety measures.
overactivity, and impulsivity
26
 ○ Encourage support groups for ● Intussusception
parents. ○ Immediate treatment
○ Administer prescribed medication; ■ IV fluids, NPO status and
some commonly prescribed diagnostic barium enema
medications that include: ○ Surgery
■ methylphenidate ■ Manual Reduction of
hydrochloride (Ritalin). invagination Resection with
■ pemoline (Cylert), and anastomosis Possible
■ dextroamphetamine sulfate colostomy (gangrenous)
(Dexedrine ● Nursing management
○ Inform the child and parents that ○ Provide routine pre- and post
positive effects of the medication operative care for abdominal
may be seen within 1 to 2 weeks surgery
○ Monitor fluid and electrolyte status
● INTUSSUSCEPTION :Clinical ○ Maintain nutrition & hydration
presentation ○ Resume feedings 24 hrs post
○ Sudden onset of abdominal pain (in operative
a healthy baby)
○ Infant cries out sharply and draws
knees up to abdomen
○ Vomiting occurs and increases
overtime (Bile stained vomitus)
○ Currant jelly stool
○ Signs of shock
■ Rapid weak pulse, pallor,
marked sweating
○ + for occult blood in stools
○ Sausage - shaped mass in RLQ Imperforate Anus
● Congenital malformation in which there is
● Diagnosis: no anal opening or there is stricture of the
○ Often based on history and physical anus
examination alone ● Etiology is unknown
○ Barium Enema ○ An arrest in embryonic development
■ Definitive (in 75% of cases) it on 7th to 8th week of intrauterine life
is therapeutic and curative in ○ A membrane remains and blocks
most cases with less than the union between the rectum and
24- hour duration. the anus
○ Digital rectal exam ○ Blind rectal pouch with normal anus
■ Reveals mucous, blood
● Clinical presentation
○ No stool passage with in 24 hours
after birth
○ Meconium stool from other orifice
○ Only a dimple indicates the site of
the anus
○ Inability to insert thermometer
● Diagnosis
○ Digital Rectal Exam

27
 ○ Ultrasound ○ Low-set ears
○ Abdominal X-Rays ○ Simian creases
○ 40% - congenital heart defects
● Management ○ With moderate retardation
○ NPO, NGT ○ Wide space bet 1st - 2nd toes
○ Manual dilatation ○ Lax muscle tone
○ Surgery
● Anoplasty Temporary colostomy
○ Antibiotics
● Nursing management
○ If suspected, do not take rectal
temperature
○ Pre operative care
■ Monitor for the presence of
stool in the urine and vagina
(indicates a fistula) and ● Prevent respiratory infections
report immediately. ○ Clearing the nose
■ Administer IV fluids as ○ Cool mist vaporizer
prescribed ○ Chest physiotherapy
■ Prepare the child and ○ Handwashing and avoiding
parents for the surgical exposure to infection.
procedures, including the ● When feeding infants and young children,
potential for colostomy. use a small, straight-handled spoon to push
■ Expose perineum to air food to the side and back of the mouth.
■ Check bowel sound ● Encourage fluids and foods rich in fiber.
■ NGT for gastric ● Constipation results from decreased muscle
decompression tone, which affects gastric motility.
■ Change position frequently ● Provide good skin care because the skin is
■ Oral feeding started dry and prone to infection.
gradually as soon as ● Family education
peristalsis function returned ○ counseling developmental progress
■ Instruct the parents to use
only a water-soluble lubricant
and to insert the dilator no HIGH RISK TODDLER
more than 1 to 2 cm

BURNS
DOWN SYNDROME
● It is the most severe form of trauma to the
● Chromosomal disorder caused by the
integumentary system
presence of all or part of an extra 21st
● Types:
chromosome.
○ Thermal -
● It is named after John Langdon Down, the
■ Caused by flames, flash,
British doctor who described the syndrome
scalding (hot liquid), contact
in 1866.
to hot metal, grease
● The disorder was identified as a
○ Chemical
chromosome 21 trisomy
■ Inhalation or ingestions of
acids, alkalines, or vesicant
● Assessment findings
○ Smoke inhalation
○ Small head, flat facial profile
28
 ■ Fire, gases, superheated air
– smoke causes respiratory
tissue damage
○ Electrical burn
■ Damage of nerves and
vessels due to electric
current
● Classification accdg. to depth:
○ Partial thickness
■ Superficial partial
thickness
● Epidermis
● painful erythema
● no vesicles
■ Deep partial thickness
● Epidermis/dermis
● Phases/Stages of Burns
● Very painful
○ Emergent Phase
● Fluid filled vesicles
■ Remove the person from the
● Red, shiny, wet
source of burn
● Thermal – smother
burn beginning with
the head
● Smoke inhalation –
ensure patent airway
● Chemicals – remove
clothing
● Electrical – maintain
airway, identify entry
and exit route
■ Wrap in dry, clean sheet
■ Assess how and when burn
occurred
■ Provide IV route if possible
○ Full thickness ■ Transport immediately
■ All skin layers and nerve ■ Shock Phase - Fluid shift
endings; may involve the from plasma to interstitial
muscles, tendons, and causing hypovolemia
bones ● Assessment Findings
■ little or no pain - wound is - Sign of dehydration,
dry, white leathery BP, tachycardia, urine
○ Eschar output, thirst
■ the tough, leathery scab that ● Diagnostic Test-
form over moderate or hyponatremia,
severe burn area hypoproteinemia,
hyperkalemia
■ Diuretic Phase/Fluid
remobilization - Intertesial

29
 fluids returns to the vascular
space
● Assessment Findings
– elevated BP,
increase urine output
■ Convalescent Phase –
wound healing

● Assessment Focus
○ Extent of injury
■ Rule of 9
■ Lund and Browder
● Severity of Burn classification:
○ Minor
■ partial thickness (1st /2nd
degree); less than 10 -15%
of body surface
■ full thickness (3rd degree);
less than 2% of body surface
■ No burn on area of face,
feet, hands, or genitalia
○ Moderate
■ partial thickness (2nd
degree) between15-25% of
body surface
■ full thickness less than 10%
■ smoke inhalation
○ Major
■ partial thickness greater than
25% of body surface ● Basic Burn Treatment
■ full thickness greater than or ○ Minor burns
equal to 10% ■ Antibiotic
■ Analgesic ointment
■ Gauze bandage
○ Moderate burns
■ do not rupture blisters
■ analgesia/antipyretic
ointment
■ warm water and mild soap
burn dressing
■ bulky dressing
○ Severe burns
■ Supportive Therapy; Fluid
Management
■ Crystalloid solutions:
Lactated Ringer
■ Colloid solutions such FFP -
■ Catheterization
○ Wound Care
30
 ■ open or closed burn therapy, ● Other Considerations in the Treatment of
hydrotherapy Burn:
○ Drug Therapy ○ Hand injuries
■ Topical antibiotic (Silver ■ each individual finger should
Sulfadiazine) be dressed and movement
■ systemic antibiotics - encouraged
■ Tetanus toxoid/HTIG - ○ Facial burns
■ Analgesic – morphine sulfate ■ open technique with
○ Physical Therapy ointment use only
■ to prevent disability caused ○ Topical antimicrobials
by scarring, contracture ■ silver sulfadiazine and
○ Surgery sulfamylon - used only for
■ Escharotomy major burns and should not
■ Debridement be used in outpatients
■ Skin graftin ○ Any burn that does not heal in a
● Parameters such as: month should be referred to a burn
○ vital sign (heart rate), surgeon
○ urine output, ● Parkland Formula
○ adequacy of capillary filling, and ○ LACTATED RINGERS (LR)
sensorium status determine ■ 4cc x Wt in kg x total BSA%
adequacy of fluid resuscitation (deliver ½ over first 8hrs;
then other ½ over the next
Comparing Open and Closed Burn Therapy 16hrs)
○ Fresh Frozen Plasma (FFP)
METHOD DESCRIPT ADVANTA DISADVANTA
■ 0.5cc x Wt in kg x total
ION GE GE BSA% (deliver over the next
four hours following fluids)
OPEN Exposed Allow - Requires ○ MAINTENANCE (D5W) 1cc x Wt in
to air; for frequent isolation kg x total BSA
superficial inspection -Area may
or body of site scrape and
parts bleed easily ● Nursing Interventions
prone to ○ Provide relief or control of pain
infection ○ Monitor alterations in fluid and
electrolytes
CLOSED Burn is Provide Changing ○ Promote maximum nutritional status
covered better dressing is
with protection painful; ○ Prevent wound infection
nonadher from possibility of ○ Prevent GI complications
ent gauze; injury; infection ○ Provide health teachings
for easier to
moderate turn and
and position CEREBRAL PALSY
severe child; ● Neuromuscular disorder characterized by
allow impaired movement and posture resulting
more
freedom from an abnormality in the extrapyramidal
to play or pyramidal motor system
● CP is caused by damage to the motor
control centers of the developing brain and
can occur during:
○ Pregnancy -about 75 percent -
31
 ○ Childbirth – 5 percent ○ Speech/ audiotherapy.
○ After birth -15 percent up to about ○ Physical/occupational therapy
age three ■ Surgical interventions are
● Etiology reserved for the child who
○ Prenatal does not respond to more
■ genetic, mother with rubella, conservative measures or for
accidents, PIH the child whose spasticity
○ Perinatal causes progressive
■ drugs at delivery, precipitate deformity.
delivery, breech deliveries ● Nursing Interventions
○ Postnatal ○ The goal of management is early
■ kernicterus,head truma (falls recognition and interventions to
out of crib, car accidents) maximize the child's abilities
○ A multidisciplinary team approach.
● Types of Cerebral Palsy ○ Assess the child's developmental
○ Spastic level and intelligence.
■ tense, contracted muscles ○ Encourage early intervention and
(most common type of CP) participation in school programs.
○ Athetoid Prepare for using mobilizing
■ constant, uncontrolled devices.
motion of limbs, head and ○ Encourage communication and
eyes interaction with the child on his or
○ Ataxic her developmental level rather than
■ poor sense of balance, often chronological age level.
causing falls and stumbles ○ Provide a safe environment
○ Rigidity ○ Assist in ADL
■ tight muscles that resist ○ Provide safe appropriate toys for the
effort to make them move child's age and developmental level.
○ Tremor ○ Position the child upright after
■ uncontrollable shaking, meals.
interfering with coordination ○ Administer medications as
● Common Problems prescribed to decrease spasticity.
○ visual defects (strabismus, ○ Therapy
nystagmus, refractory errors), -
○ hearing loss
INGESTION OF POISONS
○ speech or language delay
○ seizures ● Poisoning
○ mental retardation ○ any substance that is harmful to the
● Patient Care Management body - Ingestion of toxic substance
○ Promotion of optimal rehabilitation in ● Common agent in childhood
the areas of locomotion, ○ soaps, cosmetics, detergents or
communication, and the activities of cleaner and plants
daily living.
○ Correction of associated disabilities ● Modes of exposure
● Medical Management ○ Ingestion
○ Drug therapy ○ nhalation
■ Antianxiety ○ spray
■ skeletal muscle relaxants ● Signs and Symptoms
■ local nerve block ○ GI disturbances
32
 ■ Vomiting, abdominal pain, ■ commonly used analgesics
anorexia, distinctive odor ■ risk – liver damage
○ Respiratory/circulatory ■ Antidote
disturbances mucomyst(N-Acetylcysteine)
■ collapse , shock, ■ S/S – vomiting,liver
unexplained cyanosis tenderness, abdominal pain
○ CNS manifestation ○ Lead Poisoning (Plumbism) –
■ Confusion ■ common in toddlers and
■ Disorientation preschoolers
■ sudden loss of conc ■ Lead interferes with RBC
■ Convulsion function
● General Medical Treatment ■ Lead value of 15ug/dl –
○ Elimination of poisons health hazard
○ Antidote administration ■ Symptoms appear when lead
○ General supportive measures level is – 70ug/dl
● General Interventions ■ Most serious effect: Lead
○ Stabilize child’s condition - patent encephalitis
airway ■ Air, soil, water, houses,
○ Prevent absorption ceramic cookware, solder
■ Determine the type of used in metal cans and pipes
substance ingested S/S:
■ Induce emesis – except ○ Abdominal complaints
caustic material ingestion, ■ colicky pain
comatose, active seizure or ■ Constipation
lacking gag reflex ■ Vomiting
■ Syrup of ipecac ■ Pallor
■ Gastric lavage ■ Irritability
■ Cathartic ■ Loss of coordination
○ Provide treatment and prevention ■ Encephalopathy (+ lead in
information to parents the blood
○ Incorporate anticipatory guidance
related to the developmental stage ● Nursing Action
of the child ○ Administer chelating agents
○ Discuss general first aid measures ■ dimercaprol (BAL in Oil) -
with parents not given if allergy w/
● Methods of Prevention peanuts(prepared in peanut
○ Child proofing the environment oil solution
○ Educating parents and child ■ edatate calcium disodium
○ Anticipatory guidance (calcium EDTA)
○ Understanding and applying the ○ Provide nutritional counseling
principles of G/D ○ Aid in eliminating environmental
● Specific Poisoning conditions that led to lead ingestion
○ Salicylate poisoning = aspirin, oils
of wintergreen, Toxicity begins at ● LEAD
doses of 150 - 200 mg/kg. S/S – ○ When lead enters the body, it affects
CNS depression the erythrocytes, bones and teeth,
■ vomiting and organs and tissues, including
■ respiratory failure the brain and nervous system; the
○ Acetaminophen poisoning = most serious consequences are the
33
 effects on the central nervous
investigation, and
system. lead-hazard control.
○ Common route is hand to mouth
● CAUSTIC POISONING
from contaminated objects or from
○ Ingestion of strong alkali
eating loose paint chips, crayons, or
○ May cause burns and tissue
pottery that contains lead.
necrosis in the mouth, esophagus,
● Chelation Therapy
stomach
○ removes lead from the circulating
○ Pharyngeal edema may cause
blood and from some organs and
airway obstruction – intubation might
tissues.
be necessary
Blood lead level test: Used for screening and
diagnosis
CHILD ABUSE
LEVEL INTERVENTION ● Child abuse involves emotional or physical
abuse or neglect, as well as sexual
exploitation or molestation by caretakers or
Less than 10 mcg/dL Reassess or rescreen other individuals.
in 1 year or sooner if
● Problem – related to parents’ limited ability
exposure status
changes. to cope or relate to the child
● Also victims of abuse
10 to 14 mcg/dL Provide family lead
education, follow-up
testing, and social
service referral if
necessary; on
follow-up testing,
initiate actions for
blood lead level of 20
to 44 mcg/dL.

20 to 69 mcg/dL A blood lead level

greater than 20 mcg/dL
is considered acute;
provide coordination of ● Emotional Abuse
care, clinical ○ Speech disorders
management, including
○ Habit disorders such as sucking,
treatment,
environmental biting, and rocking
investigation, and ○ Psychoneurotic reactions
leadhazard control (the ○ Learning disorders o Suicide
child must not remain attempts
in a lead-hazardous ● Sexual Abuse
environment if
○ Torn, stained, or bloody
resolution is
necessary). underclothing
○ Pain, swelling, or itching of the
70 mcg/dL or greater Medical treatment is genitals
provided immediately, ○ Bruises, bleeding, or lacerations in
including coordination the genital or anal area
of care, clinical
○ Difficulty walking or sitting
management,
environmental

34
 ○ Unwillingness to change clothes or ○ Place the child in an environment
unwillingness to participate in gym that is safe, thereby preventing
activities further injury.
○ Poor peer relations ○ Document information related to the
● Physical Abuse suspected abuse in an objective
○ Unexplained bruises, burns, or manner.
fractures ○ Assess parents' strengths and
○ bald spots on the scalp weaknesses, normal coping
○ Apprehensive child mechanisms, and presence or
○ Extreme aggressiveness or absence of support systems
withdrawal ○ Assist the family in identifying
○ Fear of parents stressors, support systems, and
○ Lack of crying (older infant, toddler, resources.
or young preschool child) when ○ Refer the family to appropriate
approached by a stranger support groups.
● Physical Neglect ○ If shaken baby syndrome is
○ Inadequate weight gain suspected, monitor the infant's level
○ Poor hygiene of consciousness.
○ Consistent hunger
○ Inconsistent school attendance
IRON DEFICIENCY ANEMIA
Constant fatigue
○ Reports of lack of child supervision ● Iron stores are depleted, resulting in a
○ Delinquency decreased supply of iron for the
manufacture of hemoglobin in RBC
● Goal of Care ● Causes: blood loss, increased metabolic
○ Client will be safe demands, syndromes of GI malabsorption,
○ Child will participate with nurse for dietary inadequacy
emotional support ● More common in:
○ Parents will participate in therapy ○ Child bearing women
● Nursing Intervention ○ Poor iron intake
○ Attend to the needs of the child ○ Infants and children in rapid growth
○ Report suspected child abuse case ○ Pregnant/lactating mothers
to appropriate agency
○ Provide role models for parents ● Assessment
○ Encourage parents to be involved in ○ Compensatory tachycardia
child’s care ○ Pallor
○ Encourage parents to express their ○ Weakness, fatigue, irritability
feelings ○ Lab results
○ Provide family education
○ Initiate referrals for long term ● Management
follow-up ○ Food choices: meats, dark green &
● Interventions leafy vegetables, egg yolks, liver,
○ Support the child during a thorough kidney beans, iron-enriched formula
physical assessment. & cereal
○ Assess injuries. ○ Administer iron supplements as
○ Report case of suspected abuse; prescribed
nurses are legally required to report ○ Teach parents to administer iron
all cases of suspected abuse to the supplements:
appropriate local/state agency.
35
 ■ Between meals Give with Vit
C
■ Do not give with antacids or
milk
■ Oral care
■ Side effects
○ Monitor signs and symptoms of
bleeding
○ Adequate rest periods
○ Explanation of all diagnostic test
● Symptoms
CYSTIC FIBROSIS ○ Respiratory
● This is a chronic multisystem disorder ■ Wheezing and dry
(autosomal recessive trait disorder) nonproductive cough
characterized by exocrine gland ■ Dyspnea
dysfunction. ■ Cyanosis
● The mucus produced by the exocrine ■ Clubbing of the fingers and
glands is abnormally thick, tenacious, and toes
copious, causing obstruction of the small ■ Barrel chest
passageways of the affected organs, ■ Repeated episodes of
particularly in the respiratory, bronchitis and pneumonia
gastrointestinal, and reproductive systems. ○ Gastrointestinal
● CF is a fatal genetic disorder and ■ Meconium ileus in the
respiratory failure is the most common neonate
cause of death. ■ Intestinal obstruction (pain,
● There is also a marked electrolytes change abdominal distention,
in the secretion of sweat glands nausea, and vomiting)
● The most common symptoms are ■ Steatorrhea (frothy,
pancreatic enzyme deficiency caused by foul-smelling stools)
duct blockage, progressive chronic lung ■ easy bruising and anemia
disease associated with infection, and ■ Malnutrition and failure to
sweat gland dysfunction resulting in thrive
increased sodium and chloride sweat ■ Generalized edema (due to
concentrations. hypoalbuminemia)
● 4 Symptoms Same With Celiac Disease: ■ Rectal prolapse (due large,
○ malnutrition bulky stools and lack of the
○ protuberant abdomen supportive fat pads around
○ steatorrhea the rectum)
○ fat-soluble vitamin deficiency ○ Integumentary
■ Abnormally high
concentrations of sodium
and chloride in sweat
■ Parents reporting that the
infant tastes “salty” when
kissed
■ Dehydration and electrolyte
imbalances, especially

36
 during hyperthermic pulmonary infection by
conditions improving aeration, removing
○ Reproductive secretions, and
■ Delay puberty in girls. administering antimicrobial
■ Infertility (highly viscous medications.
cervical secretions) ■ Chest physiotherapy b.
■ Sterility (caused by the ■ Aerosol Therapy
blockage of the vas deferens ● Bronchodilator
by abnormal secretions or by ● Antimicrobial
failure of normal ● Mucolytic
development of duct ■ Use of a Flutter Mucus
structures. Clearance Device (a small,
● Diagnostic Tests hand-held plastic pipe with a
○ Quantitative sweat chloride test - the stainless steel ball on the
most reliable diagnostic test inside)
○ Pilocarpine ■ Use of a ThAIRapy vest
■ a cholinergic drug that device that provides
stimulate production of sweat high-frequency chest wall
■ the sweat is collected, and oscillation to help loosen
the sweat electrolytes are secretions
measured ○ Gastrointestinal System
○ Normal ■ The goal of treatment for
■ if sweat chloride pancreatic insufficiency is to
concentration is 20 meq/L or replace pancreatic enzymes
lower than 40mEq/L. ■ The amount of pancreatic
○ Chloride concentrations of 50 to 60 enzymes administered is
mEq/L are highly suggestive of adjusted to achieve normal
cystic fibrosis and require a repeat growth and a decrease in the
test. number of stools to two or
○ A chloride concentration higher three daily.
than 60 mEq/L is a positive test ● Enteric-coated
result pancreatic enzymes
○ Chest x-ray film reveals atelectasis should not be
and obstructive emphysema. crushed or chewed.
○ Pulmonary function tests provide ● Pancreatic enzymes
evidence of abnormal small airway should not be given if
function. the child is NPO
○ Stool, fat, enzyme analysis: A ● Encourage a
72-hour stool sample is collected to well-balanced,
check the fat and/or enzyme high-protein,
(trypsin) content (food intake is high-calorie diet;
recorded during the collection). multivitamins and
○ Duodenal analysis – nasogastric vitamins A, D, E, and
tube is inserted to aspirate duodenal K are also
secretion administered.
● Therapeutic Management ● Assess weight and
○ Respiratory System monitor for failure to
■ Goals of treatment include thrive.
preventing and treating
37
 ● Monitor for ● Celiac Crisis
constipation and ○ Precipitated by infection, fasting,
intestinal obstruction. ingestion of gluten
● Ensure adequate salt ○ Extreme and acute profuse watery
intake and fluids that diarrhea and vomiting occurs
provide an adequate ○ Can lead to electrolyte imbalance,
supply of electrolytes rapid dehydration, severe acidosis
during extremely hot ○ Intensive therapy to replace fluids
weather and if the and electrolytes is required
child has a fever. ● Interventions
● Home care ○ Maintain a gluten-free diet,
○ Instruct the child and family about substituting corn, rice, and millet as
the prescribed treatment measures grain sources.
and their importance. ○ Instruct parents and child about
○ Instruct the parents and caregivers lifelong elimination of gluten sources
to be sure immunizations are up to such as wheat, rye, oats, and barley.
date. ○ Administer mineral and vitamin
○ Inform the parents and caregivers supplements, including iron, folic
that the child should be vaccinated acid, and fat-soluble supplements A,
yearly for influenza; pneumococcus D, E, and K
vaccine may also be prescribed. ○ Teach the child and parents about a
gluten-free diet and about reading
food labels carefully for hidden
sources of gluten
CELIAC DISEASE (Gluten-Induced
○ Instruct the parents in measures to
Enteropathy)
prevent celiac crisis
● Malabsorption Syndrome
● Is a sensitivity or immunologic response to ● Basics of a Gluten-Free Diet
protein, particularly the gluten factor of ○ FOODS ALLOWED
protein found in grains of wheat, barley, rye, ■ Meat such as beef, pork, and
and oats poultry and fish, eggs, milk
● Results in the accumulation of the amino and dairy products,
acid vegetables, fruits, rice, corn,
○ glutamine, which is toxic to intestinal gluten-free wheat flour,
mucosal cells. puffed rice, cornflakes,
● Intestinal villi atrophy occurs, which affects cornmeal, and precooked
absorption of ingested nutrients gluten-free cereals
○ FOODS PROHIBITED
● Assessment ■ Commercially prepared ice
○ Acute or insidious diarrhea cream, malted milk, prepared
○ Steatorrhea puddings,grains, including
○ Anorexia anything made from wheat,
○ Abdominal pain and distention rye, oats, or barley, such as
○ Muscle wasting, particularly in the breads, rolls, cookies, cakes,
buttocks and extremities crackers, cereal, spaghetti,
○ Vomiting macaroni noodles& beer
○ Anemia
○ Irritability

38
● Prognosis ■ ABG respiratory
○ Dietary avoidance of gluten results ■ acidosis Peak flow meter
in improvement of symptoms in 70% ■ An objective way to measure
of patients within 2 weeks airway obstruction
○ Serologic antibody titers decrease ■ The most reliable early sign
on a gluten-free diet of an asthma attack is a drop
○ After 3-6 months antibody levels in the child peak expiratory
may become undetectable flow rate
○ Complete histological resolution of ● Spirometry measures the amount and rate
small bowel inflammation may take of air a person breathes in oder to diagnose
up to 2 year illness or determine progree in treatment

● Medical management
COMMON HEALTH PROBLEMS IN
○ Drug therapy
PRESCHOOL
■ Brochodilators
Beta-2-agonist
Bronchial Asthma bronchodilator xanthine
derivative
● it is an obstructive disease of the lower ■ Antiasthma corticosteroids
respiratory tract mast cell stabilizer
● often cause by an allergic reaction to an leukotriene inhibitors
environmental allergen ■ Antibiotics
● allergic reaction results in ○ Hyponsensitization
● histamine release - airway responses ○ Exercise
■ Aimed to increased
expiratory function
● ALLERGIC REACTION RESULTS TO 3 ● Nursing Interventions
MAIN AIRWAY RESPONSES ○ Place client in high fowler's position
○ Edema of mucous membrane ○ Administer oxygen as ordered
○ Spasm of the smooth muscles ○ Administer medications as ordered
○ Accumulation of secretions ○ Provide good hydration
● Risk Factor ○ Provide chest physiotherapy
○ Family history of allergies and ○ Promoting energy conservation
asthma ○ Monitor respiratory function
○ Client history of eczema ○ Provide family health teachings
● Clinical manifestations
○ Expiratory wheeze
○ Cough Wilm's Tumor Nephroblastoma
○ Thick tenacious ● A large malignant tumor that develops in
○ Barrel chest - if chronic the renal parenchyma
○ Severe attack ● Arises from bits of embryonic tissue that
○ Shortness of breath remains after birth
○ Use of accessory muscles ● It accounts for 20% of solid tumors in
○ Retractions childhood
○ Nasal flaring ● Tumor is rarely discovered until it is large
○ Irritability (earliest sign hypoxia) enough to be palpated
○ Diaphoresis
● Diagnosis ● Assessment
○ assessment findings ○ Palpable mass
39
 ○ Hematuria ■ Observe for any post
○ Hypertension operative complications
○ Anemia ■ Provide care for child
○ Renal vein receiving radiation and
○ Low grade fever chemotherapy
● Diagnostic tests ● Urinary Tract Infection
○ Sonogram ○ It is a bacterial invasion of the
○ CT scan kidneys or bladder
○ IVP- intravenous pyelogram ○ E. Coli accounts for about 80% of
○ The kidneys are responsible for acute episodes
removing wastes from the body, ● Predisposing factors
regulating electrolyte balance and ○ Poor hygiene
blood pressure, and stimulating red ○ Irritation from bubble
blood cell production. ● Assessment findings
● Staging of Nephroblastoma ○ Low grade fever
○ stage 1: ○ Abdominal pain - lower region
■ limited to kidney ○ Burning pain upon urination
○ stage II: ○ Hematuria
■ tumor extends beyond ○ Foul-smelling
completely kidney but ○ Urinary frequency
encapsulated ○ Enuresis common sign for
○ stage III: preschooler
■ tumor confined to abdomen ● Diagnostic test
○ stage IV ○ Urine analysis - presence of pus
■ tumor has metastasized to cells
lung, liver, bone or brain
○ stage V
■ bilateral renal involvement ● Treatment
● Management ○ Antibiotic
○ Surgery- nephrectomy ○ Analgesic and antispasmodic
○ Radiation therapy Increase fluid intake
○ Chemotherapy ● Nursing intervention
○ post a visible sign "NO ABDOMINAL ○ Administer antibiotics as ordere
PALPATION" ○ Provide warm baths and allow to
● Nursing intervention void in water
○ Pre operative ○ Force fluids
■ Do not palpate the abdomen ○ Encourage measures to acidify urine
■ Handle the child carefully ○ Provide health teaching
■ Monitor BP, Intake and ○ Avoidance of bubble bath
output ○ For girls to wipe perineum from front
■ Provide routine preoperative to back
care
○ Post operative
Glomerulonephritis
■ Assess the respiratory,
circulatory, fluid and ● Refers to a group of kidney disorders
electrolytes status characterized by inflammatory injury in the
■ Monitor patency and glomerulus, most of which are caused by an
adequacy of urinary output immunological reaction.

40
● CAUSES a "no added salt to foods"
○ Immunological diseases diet.
○ Autoimmune diseases ■ Moderate sodium restriction:
○ Antecedent group A beta-hemolytic Hypertension or edema.
streptococcal infection of the ■ Foods high in potassium are
pharynx or skin restricted during periods of
○ History of pharyngitis or tonsillitis 2 oliguria.
to 3 weeks before symptoms ■ Protein is restricted if the
● Types child has severe azotemia
○ Acute: Occurs 2 to 3 weeks after a resulting from prolonged
streptococcal infection oliguria.
○ Chronic Can occur after the acute ○ Monitor for complications
phase or slowly over time ○ Administer diuretics,
● Assessment antihypertensives, and antibiotics as
○ Periorbital and facial edema that is prescribed.
more prominent in the morning ○ Instruct the parents to report signs
○ Anorexia, hypertension of bloody urine, headache, or
○ Decreased urinary output edema.
○ Cloudy, smoky, brown-colored urine ○ Instruct the parents that the child
(hematuria) needs to obtain appropriate
○ Pallor, irritability, lethargy adequate treatment for infections,
○ In the older child, headaches, specifically infections.
abdominal or flank pain, dysuria
○ Proteinuria that produces a
Nephrotic syndrome
persistent and excessive foam in the
urine ● Nephrotic syndrome is a kidney disorder
○ Azotemia characterized by massive proteinuria,
○ Increased blood urea nitrogen and hypoalbuminemia (hypoproteinemia), and
creatinine levels edema.
○ Increased antistreptolysin ● Autoimmune process
■ titer (used to diagnose ● The primary objective of therapeutic
disorders caused by management is to reduce the excretion of
streptococcal infections) urinary protein and maintain protein-free
● Interventions urine.
○ Monitor vital signs, weight, intake
and output, and the characteristics
of urine.
○ Limit activity; provide safety
measures.
○ Provide high-quality nutrient
foods.
■ Restrictions depend on the
stage and severity of the
disease, especially the
extent of the edema.
■ In uncomplicated cases:
Regular diet is permitted ● Assessment
but sodium is restricted to ○ Periorbital and facial edema is most
prominent in the morning.
41
 ○ Leg, ankle, labial, or scrotal edema
group A B- hypersensitivity
Occurs. hemolytic
○ Urine output decreases; urine is streptococal
dark and frothy. infection
○ Ascites (fluid in the abdominal
cavity) Onset abrupt insidious
○ Blood pressure is normal or slightly Hematuria Grossly bloody rare
decreased.
○ Massive proteinuria is seen. Edema mild mild
○ Decreased serum protein
Peak age 5-10 years 2-3years old
(hypoproteinemia) and elevated
● Interventions Diet No added salt High protein, low
○ Monitor vital signs, intake and if child is salt
output, and daily weights. hypertensive
○ Monitor urine for specific gravity and
Intervention Limited Bed rest during
albumin.
activity; edema stage;
○ Monitor for edema. antihypertensi corticosteroid;
○ Nutrition: A regular diet without ves as needed
added salt is prescribed if the
child is in remission; sodium is
restricted during periods of Leukemia
massive edema. ● (refers to cancers of the white blood cells)
○ Corticosteroid therapy is prescribed ● proliferation of abnormal white blood cells
as soon as the diagnosis has been that do not mature beyond the blast phase
determined; monitor the child closely ● In the bone marrow, blast cell crowd out
for signs of infection. healthy white blood cells, red blood cells,
○ Immunosuppressant therapy and platelets, leading to bone marrow
(reduce the relapse rate and induce depression
long-term remission) ● Blast cells also infiltrates other organs most
○ Diuretics may be prescribed to commonly the liver, spleen, kidneys, and
reduce edema. lymph tissue
○ Plasma expanders such as
salt-poor human albumin may be ● Types of Leukemia
prescribed for the severely ○ In general, leukemias are classified
edematous child. into
○ Instruct the parents regarding the ○ acute (rapidly developing)
signs of infection and the need to ○ chronic (slowly developing) forms.
avoid contact with other children ○ In children, about 98% of leukemia
who may be infectious. are acute
○ ■ Acute Lymphocytic
● Comparison of features of acute Leukemia
glomerulonephritis and nephrotic syndrome ● Primarily strikes
children and young
Assessment Acute Nephrotic adults
Factor glomerulonep syndrome ● 80-85% of childhood
hritis leukemia the
malignant cell
Cause Immune Idiopathic;
reaction to possibly
42
 involved is the ○ Administration of the drugs
lymphoblast previously used plus additional
■ Acute Myeloid Leukemia drugs
● Also known as - ● Bone marrow transplant
Acute ○ Usually recommended after the
nonlymphocytic second remission in children
Leukemia Cells ● Nursing intervention
involved is the ○ Preventing infection
granulocytes ○ Reducing pain
● Assessment Findings ○ Promoting energy conservation and
○ Anemia (weakness, pallor, dyspnea) relieving anxiety
○ Bleeding (petechiae, bruise) ○ Promoting normal growth and
○ Infection (fever, chills, malaise) development
○ Enlarged lymph nodes. ○ Promoting a positive body image
○ Enlarged spleen and liver ○ Promoting family coping
(spleenomegaly and hepatomegaly)
○ Abdominal pain
○ Bone and joint pain
TONSILLITIS AND ADENOIDITIS
● Tonsillitis refers to inflammation and
● Diagnosis infection of the tonsils.
○ blood studies bone marrow ● Adenoiditis refers to inflammation and
○ aspiration infection of the adenoids.
○ Lumbar tap
○ Xray of bone ● Assessment
● Management ○ Persistent or recurrent sore
○ Goal of care: complete cure throat
○ Enlarged, bright red tonsils that
● Chemotherapy Treatment phase: may be covered with white exudate
○ Induction ○ Difficulty in swallowing
■ achieving complete ○ Mouth breathing and an unpleasant
remisssion or absence of mouth odor
leukemic cells ○ Fever
○ Consolidation / Sanctuary ○ Cough
■ preventing leukemic cells ○ Enlarged adenoids may cause nasal
from invading or growing in quality of speech, mouth breathing,
the CNS hearing difficulty, snoring, and/or
○ Maintenance - obstructive sleep apnea.
■ aims to eliminate completely
any remaining leukemic ● Preoperative interventions
cells; or maintaining ○ Assess for signs of active infection.
remission Intensifies the ○ Assess bleeding and clotting studies
assault against leukemic because the throat is vascular.
cells using chemotherapy ○ Prepare the child for a sore throat
Given for 2 to 3 years postoperatively, and inform the child
● Two additional phases are instituted for that he or she will need to drink
children who experience relapse liquids.
● Reinduction

43
 ○ Assess for any loose teeth to ■Fever
decrease the risk of aspiration ■Conjunctival hyperemia
during surgery. ■Red throat
■Swollen hands, rash, and
● Interventions postoperatively enlargement of the cervical
○ Position the child prone or side-lying lymph nodes
to facilitate drainage. ○ SUBACUTE STAGE
○ Have suction equipment available, ■ Cracking lips and fissures
but do not suction unless there is an ■ Desquamation of the skin on
airway obstruction. the tips of the fingers and
○ Monitor for signs of hemorrhage toes
(frequent swallowing may indicate ■ Joint pain
hemorrhage); if hemorrhage occurs, ■ Cardiac manifestations
turn the child to the side and notify ■ Thrombocytosis
the physician.
○ Discourage coughing or clearing the ○ CONVALESCENT STAGE
throat. ■ Child appears normal but
○ Provide clear, cool, noncitrus and signs inflammation may be
noncarbonated fluids. present.
○ Avoid milk products initially because
they will coat the throat. ● Diagnosis
○ Avoid red liquids, which simulate ○ fever x 3/5days + 4/5 diagnostic
the appearance of blood if the criteria
child vomits. ○ Erythema
○ Do not give the child any straws, ○ rash on trunk
forks, or sharp objects that can ○ swelling of hands or feet
be put into the mouth. ○ red eyes
○ Administer acetaminophen (Tylenol) ○ swollen lymph nodes
for sore throat as prescribed. ● Interventions
○ * Instruct the parents to notify the ○ Monitor temperature frequently.
physician if bleeding, persistent ○ Assess heart sounds, rate, and
earache, or fever occurs. rhythm.
○ * Instruct the parents to keep the ○ Assess extremities for edema,
child away from crowds until healing redness, and desquamation.
has occurred. ○ Examine eyes for conjunctivitis.
○ Monitor mucous membranes for
inflammation.
○ Monitor strict intake and output.
Kawasaki disease
■ Medication
● A mucocutaneous lymph node syndrome ● IVIG
and is an acute systemic inflammatory ● Aspirin
illness ● steroids
● cause: is unknown but may be associated ● Parent education
with an infection from an organism or toxin. ○ Follow-up care is essential to
● Cardiac involvement is the most serious recovery.
complication; aneurysms can develop. ○ The signs and symptoms of
Kawasaki disease include the
● Assessment following:
○ ACUTE STAGE
44
■ Irritability may last up for up
to 2 months after the onset
COMMON HEALTH PROBLEMS IN SCHOOL
of symptoms.
AGE CHILDREN
■ Peeling of the hands and
feet may occur.
■ Pain in the joints may persist PEDICULOSIS
for several weeks.
■ Stiffness in the morning, ● Head lice
after naps, and in cold ● Parasitic Infection
temperatures may occur. ● Spread by close physical contact
■ Record the temperature until ● Occurs in school age, particularly with long
child has been afebrile for hair
several days.
■ Notify the physician if the ● Findings
temperature is 101 °F or ○ White eggs firmly attached to base
higher. of hair shafts
■ Salicylates such as ○ Pruritus of scalp
acetylsalicylic acid (aspirin) ● Management
may be given. ○ Special shampoos
■ Signs of aspirin toxicity ○ Fine tooth comb
include tinnitus, headache,
vertigo, bruising; do not ● Nursing Intervention
administer aspirin or aspirin- ○ Institute skin isolation precautions -
containing products if child ■ Head covering
has been exposed to ■ Gloves
chickenpox or the flu. ○ Use specific shampoo/comb
■ * S/sx of bleeding: epistaxis, ○ Provide health teachings on
hemoptysis, hematemesis, treatment and prevention
hematuria, melena, and ■ Check on other family
bruises on body. members
■ S/sx of cardiac complications ■ Washing of bed linens
chest pain or tightness (older ■ No sharing of combs and
children), cool and pale hats
extremities, abdominal pain,
nausea and vomiting, IMPETIGO
irritability, restlessness, and
● Superficial bacterial infection of the outer
uncontrollable crying.
layers of the skin
■ Child should avoid contact
● Etiology: Staphylococcus aureus/ Beta H.
sports, if age appropriate, if
streptococcus
taking aspirin or
● Incubation period – 2 to 5 days;
anticoagulants.
● Period of communicability – outbreak of
■ Avoid administration of MMR
lesion until healed
or varicella vaccine to the
● Mode of transmission direct contact
child for 11 months
post-intravenous immune
globulin therapy, if
appropriate.

45
 be used in children younger
● Assessment Findings than 2 years because of the
○ Well demarcated lesions risk of neurotoxicity and
○ Macules,vesicles, papule that seizures.
rupture - moist erosion ○ Instruction:
○ Once most area dries; honey ■ body is scrubbed with soap
colored crust and water before application
○ Pruritu left on the skin for 8 – 14
● Management hours then completely
○ Topical antibiotic – bactroban washed with warm wate
○ Systemic antibiotic - penicillin or ○ Stress importance of proper hygiene
erythromycin ● Interventions
● Nursing Management ○ When permethrin is used, the cream
○ Implement skin isolation techniques is massaged thoroughly and gently
○ Soften skin and crust with burrow’s into all skin surfaces from the head
solution; then removes crust slowly to the soles of the feet; care should
○ Cover lesion to prevent spread of be taken to avoid contact with the
infection eyes.
○ Remove crust gently ○ Household members and contacts
○ Administer antibiotics as ordered of the infected child need to be
○ Health teachings treated at the same time.

SCABIES (THE ITCH) RHEUMATIC FEVER

● A contagious skin infestation caused by the ● An inflammatory disorder that may involve
scabies mite Sarcoptes scabiei the connective tissue of heart,
Characterized by : joints,lungs and brain
○ superficial burrows ● Is an autoimmune disease that occurs as a
○ intense pruritus(itching) reaction to a group A
○ Papular rash beta-hemolyticstreptococcal infection
● Mites are small eight-legged parasites,they ● It is precipitated by streptococcal infection
are tiny (not visible with the naked eye), and which is undiagnosed and untreated
burrow into the skin to produce intense ● Antigenic markers for streptococcal toxin
itching, which tends to be worse at night. closely resemble markers of the heart
● Scabies may involve: valves; this resemblance causes antibodies
○ webs between the fingers, made against the streptococcal to also
○ wrists attacks the heart valve
○ Elbows
○ Knees, ● Assessment Findings
○ waist ○ Divided to major and minor
○ umbilicus, symptoms according to Jones
○ axillary folds, criteria
○ around the nipples, ○ 5 major symptoms/criteria
○ sides and backs of the feet, ■ Carditis
○ genital area, and the buttocks. ● inflammation of the
● Management heart muscle around
○ Medication (SCABICIDES) ● heart valves;
■ Permethrin cream / Lindane aschoff’s nodules
lotion - Lindane should not
46
 ■ Polyarthritis/Migratory ● Medical management
Polyarthritis – ○ Drug therapy
● a temporary ■ Penicillin – used in acute
migrating phase - given as prophylactic
inflammation of the until age 20 or for 5 years -
large joints ■ Erythromycin as substitute
■ Chorea ■ Salicylates – analgesics,
● Sydenham’s chorea; anti-inflammatory, antipyretic
St. Vitus’ dance effect
● A CNS disorder ■ Steroids – anti-inflammatory
characterized by effect
abrupt, purposeless ○ Bed rest
involuntary ■ is essential during the active
movement process of rheumatic fever to
■ Subcutaneous nodules – reduce cardiac workload - 1
● painless, firm week to 6 months
collections of ● Selected Nursing Diagnosis
collagen fibers over ○ Acute pain related to inflammatory
bones or tendons process
■ Erythema marginatum – ○ Deficient diversional activity related
● transient, non pruritic to prescribed bed rest
rash (resembles ○ Activity intolerance related to pain
giraffe spots) and fatigue
● Minor symptoms/criteria ○ Risk for injury related to involuntary
○ Clinical findings movement
○ Arthralgia ○ Risk for noncompliance with
○ Fever prophylactic drug therapy related to
● Laboratory findings financial
○ Erythrocyte sedimentation rate ○ or emotional burden of lifelong
○ C-reactive protein therapy
○ antistreptolysin ● Whenever the child is to have oral surgery,
○ O (ASO) titer including dental work, extra prophylactic
○ ECG - Prolonged PR interval precaution should be taken, even in
leukocytosis adulthood
○ Evidence of previous group A
streptococcal infection
JUVENILE RHEUMATOID ARTHRITIS
○ (+) Throat culture or rapid
streptococcal antigen test ● Systemic, chronic disorder of connective
● Two of the major criteria, or one major tissue resulting from an autoimmune
criterion plus two minor criteria, are present reaction
along with evidence of streptococcal ● Primarily involves joints
infection. ● results in eventual joint destruction
● Exceptions are chorea and indolent carditis ● affected by stress, climate
each of which by itself can indicate ● genetic predisposition may increase the risk
rheumatic fever. in some people
● More common in girls; peak age 1 to 3
years and 8 to 12 years

47
● Types ● splenomegaly,
○ Monoarticular / pauciarticular hepatomegaly,
■ involving 4 joints or less lymphadenopathy
joints usually large joints ● Assessment Findings
affected, such as knee, ○ Painful joints, warm and swollen
ankles or elbow of one side ○ Muscle weakness
of body (asymmetric) - ○ Affected area has limited motion
■ generally mild signs of ○ Crippling deformity
arthritis ■ due to reversible changes in
■ mild fever joint cartilage due to
■ Other symptoms such as: - inflammation
■ Iridocyclitis (eye ○ Fatigue, anorexia, malaise, weight
inflammation) loss
■ Uveitis (inflammation of the ● Diagnostic Tests
iris, ciliary body, choroid ○ X-ray
mebrane) ○ CBC
■ Painless joint swelling with ○ Erythrocyte sedimentation rate
little redness (ESR)
○ Polyarticular ○ C-reactive protein
■ multiple joints affected (five ○ ANA ( antinuclear antibody)
or more) ○ Rheumatoid Factor
■ usually small joints of finger ● Medical management
and hands are affected also ● To relieve pain, restore function and
possibly weight-bearing maintain joint mobility
joints often same joint on ○ 1. Drug Therapy
both sides of the ■ Aspirin – analgesic and
body(symmetrical) disability anti-inflammatory effect
may be mild or severe with ■ NSAIDS (nonsteroidal
periods of remission and anti-inflammatory drugs)
exacerbations ■ Gold compounds
■ low grade fever (Chrysotherapy)
■ Other symptoms such as: - ■ Corticosteroids
● stiffness and minimal ■ Methotrexate
joint swelling ○ Physical Therapy/exercise
● limited motion - ■ to minimize joint deformity
● rheumatoid nodules ○ Surgery
○ Systemic Disease with Polyarthritis ■ to remove severely damaged
(Still’s Disease) joints
■ any joints might be affected - ■ Total hip replacement
■ begins with high fever ■ Knee replacement
associated with macular rash
on chest, thigh
■ Other symptoms included
are:
● anemia
● anorexia
● weight loss -

48
 ○ Heat application splinting ■ due to destruction of beta
■ Gold Therapy - It is believed cells in the Islets of
that gold attaches itself to Langerhans
certain proteins (albumin). ○ DM Type II
Once absorbed into the cell, ■ Formerly called non insulin
it is then purported to kill dependent
particular cells in order to ■ occurs in adults / obese
affect the inflammation and individual
erosion of joints. It does not ■ may result from partial
necessarily act as a cure, but deficiency of insulin
is rather believed to merely production and insulin
relieve symptoms of joint resistance
disease.
● Nursing Interventions ASSESSMENT TYPE I TYPE II
○ Assess joints for pain, swelling,
tenderness, or limitationof motion Age of onset 5 – 7 yr / Increasily
○ Promote maintenance of joint puberty occuring in
mobility younger
○ Change position frequently children
○ Promote comfort and relief of pain Type of onset abrupt Gradual
○ Ensure bed rest
○ Provide heat treatments Weight Marked wt Associated
○ Provide cold treatments as ordered changes loss with obesity
■ acute
Other - Polydipsia -Polydipsia
○ Provide psychologic support and symptoms -Polyuria -Polyuria
encourage to verbalize feelings -Polyphagia -Fatigue
-Fatigue -Blurred vision
-Blurred vision -Glycosuria
DIABETES MELLITUS
-Glycosuria -Pruritus
● Is a condition resulting from dysfunction of -Pruritus
the beta (insulin- secreting) cells of islet of
therapy -insulin Diet -Diet
Langerhans in the pancreas -Regular -Regular
● There is a lack pancreatic hormone exercise exercise
○ INSULIN which is essential for -Foot care -Hypoglycemic
carbohydrate metabolism and is agent
important to the metabolism of fats -Skin and foot
and protein care
● Hyperglycemia Period of 1-12 months Not
○ Excessive accumulation of sugar in remission after initial demonstrable
the bloodstream diagnosis
● 2 major types: “honeymoon
○ DM Type I period”
■ formerly called Insulin
Dependent Diabetes (IDDM)
■ Juvenile diabetes
■ common in children; affect 1
in 1500 below 5 years and
increases to 1 in every 350
children by age 16
49
 ■ Rotate site to prevent
DIABETIC KETOACIDOSIS (DKA)
lipodystrophy/lipohypertroph
● Is a potentially life-threatening complication y
in patients with diabetes mellitus type I ○ Meal planning
Ketones bodies, the acid end-product of fat ■ Calories should be made up
breakdown, begin to accumulate in the of 50-60% carbohydrates,15
blood stream and spill into the urine -20% protein, and no more
● Characterized by drowsiness, dry skin, 30% 0f fats
flushed cheeks,and cherry ■ Avoid simple sugar; serve
○ red lips, acetone breath with fruity complex carbohydrates
smell and Kussmaul breathing( ■ Make sure the child would
abnormal increase in the depth and not skip meals
rate of the respiratory movement) ■ Teach child about food plan
so that he can independently
● Risk Factors for Type 1 Diabetes choose food selection
○ Autoimmunity ○ Exercise
○ Inherited (or genetic) factors ■ Exercise decrease the blood
○ Environmental glucose level because
■ A virus or chemical carbohydrates are being
■ Injuring the pancreatic cells burned for energy
● Diagnosis ○ Stress management
○ Fasting blood sugar ○ Blood glucose and urine ketone
■ 126 mg/dl monitoring
○ Random blood sugar ● Nursing Intervention
■ 200 mg/dl ○ Provide special diet – diabetic diet
○ 2 hours oral glucose tolerance ○ Monitor urine sugar or blood sugar
test (OGTT) levels
■ 200 mg/dl or greater ○ Observe for signs of hypoglycemia
○ Glycosylated hemoglobin and hyperglycemia
■ provide information about ○ Provide meticulous skin care
what the child’s glucose level ○ Monitor Intake and Output every
have been during the shift, weigh daily
preceding 3 to 4 months ○ Provide emotional support
○ Observe for complications
● Management for Type I Diabetes
● Goal: to keep your blood sugars as close to
normal as possible to prevent the
complications of diabetes
○ Insulin Therapy
■ Dosage of insulin is adjusted
according to blood glucose
level
■ A short acting and
intermediate acting insulin is
usually given (70/30 insulin) -
■ Adverse effect: insulin
reaction (insulin shock or
hypoglycemia)
■ Glucose monitoring
50
 ○ Bumb or rib hump on one side of the
COMMON HEALTH PROBLEMS IN
spine
ADOLESCENT
● Diagnosis
○ Forward bend test/ Adam’s bend
SCOLIOSIS test
■ A test used most often in
● A lateral curvature of the spine school & doctor’s offices to
● Fibe times more common in girls and has screen for scoliosis
peak incidence at 8 to 15 yrs ○ Scoliometer
● Majority 75% - idioplathic has familial ■ A commercial device used to
pattern (30% of child with scoliosis) document the extent of
● Associated with other neuromuscular spinal curve
disorders ○ Cobb angle
● Etiology: unknown ■ Standard method for
○ Theories postulated assessing the curvature
○ Malfunctioning of the vestibular quantitatively
balancing system ○ Radiograph (X-ray)
■ Genetic patterns ■ Assess the angle of the
■ Muscular weakness curve and determine extent
■ Collagen metabolism of deformity
○ Cause is unknown called idiopathic ● Using scliometer
scoliosis ○ Ask the child to slowly bend forward
● Condition to causes spinal deformity until the shoulders are level with the
○ Congenital spinal calumn hips
abnormalities ○ Adjust the bending position height
○ Neuromuscular disorder (CP, spinal so the defomoty of the spine is most
bifida) muscular dystrophy pronounced
○ Radiation therapy ○ Gently lay the scoliometer across
● Form the deformity at right angles to the
○ Structural / progressive form body with the marking centered o er
■ “S” curve of the spine usually the curve
idiopathic ● Management
■ Does not disappear with ○ Depends on the maturity of the
position changes needs skeleton and on the degree of
more aggressive treatment curvature
○ Functional /Non structural ○ Spinal curve of less 20 degree no
■ “C” curve of the spine therapy observation until 18 years of
■ Cause by poor posture, age
muscle spasm due to truma, ○ Spinal curve greater than 20 degree
or unequal length of legs conservative, nonsurgical approach
■ Disappears when child lies braces, traction, plaster jacket cast
down can be treated with ○ Spinal curve of more than 40 degree
posture exercise surgery
○ Spinal fusin with insertion of
● Assessment findings harrington rod
○ Uneven shoulders ○ 23 hours/ for 3 years
○ Uneven hips
○ Asymmetry of rib cage
○ Unequal length of bar strap
51
● Spinal fusion ○ Log roll; do not raise the head of the
○ Steel rods help support the fusion of bed
the vertebrae ○ Stress correct body mechanics
○ Bone grafts are placed to grow into ○ Promoting mobility, positive body
the bone and fuse the vertebrae image and compliance with therapy
● Traction ○ Preventing injury and
○ Halo-pelvic traction ○ Preventing skin irritation
○ Halo-femoral traction
BONE TUMORS
● Sarcoma
○ Tumors arising from connective
tissue, such bones and cartilage,
muscle, blood vessels or lymhoid
tissue
○ Common neoplasm in adolescent
○ Arise during adolescent because of
rapid bone growth
● Two most frequently occurring types of
bone cancer:
○ Osteogenic sarcoma
● Electrical stimulation ○ Ewing’s sarcoma
○ Use as an alternative for brace
○ Electrodes are applied to the skin or
surgically implanted
○ Electrical stimulation is unusually
employed at night, during sleeping
hours
○ To stimulate muscle to contract to
straighten the spine
○ Stretching exercise of the spine
for non structural changes ● Osteogenic sarcom/osteosarcoma
● Nursing Intervention ● Tumor that occurs in the growth metaphysis
○ Provide care for child brace ● Trauma brings the mali gnacy
○ Teach the child to wear it constantly, ● Most common in children
except when bathing ● Cause: unknown
○ Wear over a t-shirt to protect the ● Children with hereditary form of
skin retinoblastoma (eye tumor) have an
○ Report if there is rubbing increased risk
○ Encourage exercise as prescribed
○ Provide cast or traction care ● OSTEOGENIC SARCOMA
○ Frequent cleansing on the pin sites ○ A malignant tumor of long bone
○ Provide diversional activities involving rapidly growing bone
○ Monitor for signs of complications tissue (mesenchymal matrix forming
○ Provide preoperative and post cells)
operative nursing care ○ Characterized by formation of
○ Deep breathing exercise osteoid (immature bones)
○ Use of incentive spirometry ○ Common sites of occurrence
■ Distal femur - 50%

52
 ■ Proximal tibia - 20% prosthesis crutch phantom limb
■ Proximal humerus - 10 to sensation as normal recurrence
15% ○ Prevent hip and knee contractures
○ High incidence in children expose to prone position several times a day
radiation and with retinoblastoma (unless otherwise ordered)
○ Provide stump care
● Assessment
○ Pain ● EWING’S SARCOMA
○ swelling, redness ○ Malignant tumor arising most of ten
○ Tender mass, warm to touch in the bone marrow of the
○ Limitation of movement diaphyseals area (midshaft) of long
○ Pathologic fracture bones
○ The diaphyses of the femur are the
most common site, followed by the
tibia and the humerus
● Clinical findings
○ Pain and swelling on affected part
○ Palpable mass
○ Tender and warm to touch
○ 15-35% of clients have metastasis
@ time of diagnosis
● Diagnosis ● Management
○ Bone biopsy ○ High doses of radiation therapy
○ Ct scan ○ Chemotherapy
○ Bone scan ○ Surgery
● Diagnosis
○ X-ray
● Management ○ Bone scan
○ Surgery ○ Biopsy
○ Limb salvage procedures ○ Bone marrow aspiration
○ Bone or skin grafts ● Nursing Intervention
○ Amputation ○ Caution adolescent to continue to be
○ Reconstructions careful and avoid activities that may
○ Resections of metastases cause added stress to affected limb
○ Radiation therapy such as football and weight lifting
○ Chemotherapy
○ Rehabilitation
MENSTRUAL DYSFUNCTION OR
■ Physical and occupational
DISORDER
therapy
■ Psychosocial adapting ● SEXUALLY TRANSMITTED DISORDERS
■ Prosthesis fitting and training ○ Are those disease spread through
● Nursing Management sexual contact
○ Provide routine preoperartive care ● A. gonorrhea
○ Offer support or encouragement and ○ Causative agent neisseria
accept client’s response of anger gonorrhea
and grief ○ Signs & symptoms
○ Discuss to patient and family ■ Offten asymptomatic in
rehabilatation program and used of females purulent yello-green
vaginal discharge
53
 ■ Mau cause ophthalmia the point of infection site
neonatorum and sepsis to disappear without treament
newborn in 4-6 weeks
■ Treatment ○ Secondary
● Penicillin ■ Rash, malaise, alopecia
● Erthromycin
● Ceftriaxone ○ Tertiary
● Doxycycline ■ Effect any organ system -
● All sexual contacts cardiovascular
must treated neurovascular system
■ Treament in early stage is ○ Treatment
curative ■ Penicillin or erythromyin
● Most common ● D. TRICHOMONIASIS
● IM dose of ○ Trichomonas vaginalis
ceftriaxone (rocephin) ■ A singles cell protozon
● B. CHLAMYDIA ○ Sign & symptom
○ Chlamydia trachomatid ■ Thin, irritating, forty
■ Most common STD gray-green dischargestrong
(Sexually transmitted odor, itching to genitalia
diseases) ○ Treatment
○ Signs & symtoms ■ Metronidazole
■ Watery ■ Douche with weak vinegar
■ Gray-white vaginal discharge solution to reduce pruritus
■ Vulvar itching
■ May acuses ophthalmia
neonatorum sterility in
female or male, tubal
pregnancy
○ Drug ● E.CANDIDIASIS
■ Doxycycline ○ Candida albicans
■ Tetracycline ■ Fungus
■ Azithromycin ■ Cause by a yeast transmitted
● C. SYPHILIS from GI tract to vagina
○ Sign & symptoms
■ thick , white cheese-like
vaginal discharges
■ Vulvar reddening and
pruritus
○ Treatment
■ Topical application or
suppositories of antifungal
○ Treponema pallidum (spirochete) drug such as:
■ Crosses placenta after 16 ● Clotrimazle
week of prenancy ● Nystatin
○ Manifestation ● Miconazole
○ Primary ● Diflucan
■ Cardinal sign - CHANCRE ● Gentian violet
a hard res painless lesion @

54
 ○ Bathing with diluted sodium
bicarbonate solution to reduce
BULIMIA NERVOSA
pruritus
● Bulimia
○ Refers to recurrent and episodes
binge eating and purging
○ Accompanied by an awareness that
eatinvg pattern is abnormal but
being able to stop
○ Bulimic person is of normal of
ANOREXIA NERVOSA weight or slightly overweight or
● A disorder characterized by refusal to underweight
maintain a minimally normal body weight ○ May abuse purgative, laxatives and
because of a disturbance in perception of diuretic to aid weight control
the size or appearance of the body ○ Etiology: unknown
● An eating disorder characterized by
extremely low body weight, body image ● Clinical manifestation and diagnosis
distraction and obsessive fear of gaining ○ Dental caries and erosion
weight. ○ Throat irritation
● May be manifested as severe weight ○ Electrolytes imbalance -
restriction controlled by: hypokalemia
○ Limiting food intake ○ Behavior problem
○ Excessive exercise ■ Drug abuse
○ Bring eating/purging ■ Alcoholism
■ Stealing
● Clinical findings and diagnosis ■ Impulsive activities
○ The american psychiatri criteria for ● Management
diagnosis ○ Pharmacology
○ Body mass index - less than 85% of ■ Antidepressant
expected weight ○ Psychotherapy
○ Extreme weight loss ● Nursing Intervention
○ Intense fear of getting fat or gaining ○ Monitor vital signs
weight even though underweight ○ Monitor intake and output
○ Severely distorted body image ○ Record food intake
○ Refusal to acknowledge seriousness ○ Monitor weight
of weight loss ○ Encourage client to express feel
○ Amenorrhea ○ Help client to set realistic goal for
● Management self
○ Nutritional therapy ○ Help client identify interest and
■ Total parenteral nutrition positive aspect of self
■ Enteral tube feeding
○ Behavior modification OBESITY
○ Medication
● An excessive accumulation of fat that
■ Antidepressant
increases body weight by 20% or more
○ Counselling
● Obesity is now among the most widespread
■ Individual therapy
medical problems affecting children and
■ Group therapy
adolescent developed countries
■ Family therapy

55
● Obesity increases the child risk of serious ■ Increase physical activity
health problems such as heart disease, DM and have a more active
type 2 and stroke lifestyle
● It also can create emotional and social ■ Known what use food as a
problems reward
● Often feels isolated from the peer group ■ Limit snack
embarrassed tp participate in sports ■ Attend a support group
● Adolescent may have difficulty achieving a (overaters anonymous)
sense of identity if they are aways excluded
from group and if they don’t like their image
SUBSTANCE ABUSE
in the a minor
● BMI- most accurate method of assessment ● The misuse of an addictive substance that
indicates relationship between height and changes the user’s mental state
weight ● Refers to the use of chemicals to improve a
mental stae or induce euphoria
● Commonly abuse substance
○ Alcohol
○ Tobacco and ilict drug
● Cause / reason; a means of relieving the
tension and pressure of their lives
● Causes ● Adolescent
○ Many different factors contribute to ○ A desire to feel more confic=dent
this imbalance between calories and mature due to peer pressure a
intake & consumption form of rebellion
● GENETIC FACTOR ○
○ Obesity tends to run in familie ● Children at greates risk
● DIETARY HABITS ○ Have family in which alcohol or
○ Fast food, processed snack foods, drugs abuse is present
and sugary drinks ○ Suffer from abuse, neglect
○ Use food as means of satisfying ○ Have behavior problems
emotional needs ■ Aggressiveness and
○ Indulging in late - night eating excessively rebellious
● PHYSICAL INACTIVITY ○ Slow learners
○ The popularity of television, ○ Have problems with depression and
computers and video games result low-self esteem
into an increasing sedentary lifestyle
● Management ● Stage of substance abuse
○ Lifestyle modification ○ Stage 0 PRE ABUSE OR
○ Physical activity CURIOSITY STAGE
○ Nutrition education ■ Describes the adolescent
○ Ways to manage obesity in children with an increased potential
and adolescents include: for substance abuse
■ Start a weight management ■ Need for peer acceptance;
program anger and boredom
■ Change eating habits (eat ○ Stage 1 EXPERIMENTAL STAGE
slowly, develop aroutine) (LEARNING THE EUPHORIA)
■ Plan meals and make better ■ Adolescents have already
food selections made a decision to “try”
drugs and begun learing the
56
 drug induced mood swing or ● Common assessment findings
euhoria ○ Failure to complete assignments in
■ Drug use is confined to school
social situations there are ○ Demonstration of poor reasoning
few behavioral changes ability
other than “lying” ○ Decreased school attendance
○ Stage 2 EARLY REGULAR USE ○ Frequent mood swings
(SEEKING THE EUPHORIA) ○ Deteriorating physical appearance
■ The adolescent now actively ○ Recent change in peer group
seeks the drug-induecd ○ Expressed negative perceptions of
mood swing parents
■ Use drugs to seeks relief ● Treatment
from everyday stress ○ Prevention is the most effective and
■ Changes in dress, decline in least expensive treatment for
personal hygiene, substance abuse
deterioration in ● Medication
schoolperformance, loss of ○ Nicotine patches and methadone
previous interest in extra ○ Rehabilitation, counseling, social
curricular activities support, family support
adolescent exhibits more
mood swings, engages in
SUICIDE
regular lying
○ Stage 3 LATE REGULAR USE ● Is a deliberate self-injury with the intent to
(PREOCCUPATION WITH end one’s life
EUPHORIA) ● Successful suicide occurs more frequently
■ Dependent on substance in male than females
abuse ● Third cause of death between 15-19 years
■ Dependence- compulsive of age
need to use a substance for ● Suicide as viable solution to life problems
its satisfying effect
■ Deterioration of behavior ● Risk factors
such as fighting, ○ Previous suicide attempts close
lying,stealing, prostitution family member who has committed
often depressed, suididal suicide
ideation, self-destructive and ○ Past psychiatric hospitalization
risk-taking behavior ○ Recent losses
○ Stage 4 END STAGE OR “BURN ■ Death of a relative, a family
OUT” divorce or a breakeup with a
■ Adolescent needs drugs just girlfriend social isolation
to feel normal and to avoid ○ Drug or alcohol abuse exposure to
the profound and nearly violence in the home or the social
constant dysphoria. environment
■ depressing , guilt, shame, ● Warning signs for suicide
and other remorse may be ○ Suicidal talk
overwhelming, and suicidal ○ Preoccupating with death and dying
ideation becames more ○ Signs of depression
common ○ Behavioral changes
■ Paranoia, anger outbursts,
and aggression are common
57
 ○ Giving away special possessions
ACCIDENTS AND INJURY
and making arrangements to take
care of unfinished business
○ Difficulty with appetite and sleep TRAUMATIC BRAIN INJURY (TBI)
○ Taking excessive risks
○ Increased drug use ● Brain injury
○ Loss of interest in usual activities ○ Leading cause of death under age
○ As a nurse confidential and 35
compassionate approach is ● Traumatic brain injury (TBI)
essential ○ Depens on the location and severity
of the injury and health, age, health
● Tips for parents of child and adolescent
○ Know the warning signs! Do not ○ Leading of cause in children
be afraid to talk to your child ○ More frequent I males than females
■ The message is “suicide is ○ Largest source of intellectual
not an option help is impairment, seizure, physical
available” disability
○ Suicide-proof your home ● Category of head inhury
■ Make the knives, pills and ○ Primary
firearms inaccessible ■ Occurs at the moment of
○ Utilize school and community impact when cellular damage
resources occurs
■ School psychologist crisis ○ Secondary
intervention personal ■ Involves the brain and the
○ Take immediate action boyd’s response to trauma
■ If your child indicates and is evident immediately
contemplating suicide after impact
○ Do not leave your child alone ● Head Injury Types:
■ Seek professional ○ CONCUSSION
○ Listen to your child’s friends ■ Severe blow to the head
■ Be open. Ask questions jostles brain causing it to
strike the skull and results in
● Three steps teens can take temporary neural dysfunction
○ Take your friend’s actions seriously ■ Caused by stretching,
○ Encourage your friends to seek compression or tearing of
professional help, accompany if nerve fibers near the brain
necessary stem without accompanying
○ Talk to an adult you trust. Don’t be gross structural damage
alone in helping your friend. ■ Signs & symptoms
● Headache
● Transient loss of
consciousness
● Nausea
● Vomiting
● Dizziness
● Irritability

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○ CONTUSION ○ FRACTURES
■ Results from more severe ■ Linear, depressed
blow that bruises the brain communited compound
and disrupts neural function ■ S/S leakage of CSF from
■ Signs & symptoms nose or ear
● Neurologic deficits ● Diagnostics
depend on site and ○ Skull x-ray
extent of damage ○ CT scan
● Dec LOC,sensory
deficits,hemiplegia ● Nursing Intervention
○ Maintain a patent airway and
adequate ventilation
○ Monitor VS and NVS
○ Observe for CSF leakage
○ Prevent complications of immobility
○ Prepare client for surgery if
indicated
○ Provide psychologic support to client
○ HEMORRHAGE
and family
■ EPIDURAL
○ Client teaching: rehabilitation
● Blood between dura
○ Fractures
matter and skull
○ Immobilize
laceration of middle
○ Splint
meningeal artery
during skull fracture
● INTRACRANIAL SURGERY TYPES
blood accumulates
○ CRANIOTOMY
rapidly
■ Surgical opening of skull to
● S/S brief loss of conc,
gain access to intracranial
severe headache,
structures removal of tumor,
vomiting possible
evacuate blood clots, control
seizures
hemorrhage
■ SUBDURAL
■ Relieve increased ICP
● Blood in the dura and
○ CRANIECTOMY
arachnoid venous
■ Excision of a portion of skull
bleeding that form
use for decompression
slowly acute, sub
○ CRANIOPLASTY
acute or chronic
■ Repair of a cranial defect
● S/S alteration in LOC,
with a metal or plastic plate
Headache
● Nursing Intervention
■ SUBARACHNOID
○ Post operative
● Bleeding in
■ Maintain a patent airway
subarachnoid space
■ Check VS and NVS
■ INTRACEREBRAL
■ Monitor fluid and electrolytes
● Accumulation of
■ Assess dressing frequently
blood in the cerebrum
and report for any
● S/S headache, dec
abnormalities
LOC, pupillary
■ Administer medications as
dilatation
ordered

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 ■ Apply ice to swollen eyelids, ■ Spinal shock - occurs
lubricatelids with petroleum immediately insult to the
jelly CNS several days to 3
■ Refer for rehabilitation months absence of reflexes
below the level of the lesion
● Management
SPINAL CORD INJURY
○ Immobilization and maintenance of
● Common in males age 15 to 24 normal spinal alignment to promote
● Causes: motor vehicle, diving in shallow fracture healing
water, falls industrial accidents, sports ○ HORIZONTAL TURING FRAME
injuries ■ Stryker frame
● Non traumatic ○ SKELETAL TRACTION
○ Tumors ■ Cervical tongs
○ Spina bifida ■ Halo traction
○ Aneurysms ○ SURGERY
● Classification ■ Decompression
○ EXTENT OF INJURY ■ Laminectomy
■ May affect vertebral column ■ Spinal fusion
fractures, dislocation ● Spinal fusion or spondylodesis
anterior/posterior ligaments ○ Is a neurosurgical or othropedic
compression of spional cord surgical technique that joints two or
and its roots more vertebrae
■ S/S ● Nursing Intervention- emergency care
● Complete cord ○ Assess ABC
transection - loss of ○ Quick head to toe assessment
voluntary movements ○ Immobilize client
and sensation below ● Acute care
the level of injury ○ Maintain optimum respiratory
● Incomplete - will function
depend on damage ○ Maintain optimum cardiovascular
neurological tracts function
○ LEVEL OF INJURY ○ Maintain fluid and electrolyte
■ CERVICAL C1-C8 balance and nutrition
(QUADRIPLEGIA) ○ Maintrain immobilitation and spinal
● Paralysis of all four alignment always
extremities ○ Prevent complication of immobility
respiratory paralysis - ○ Monitor temp control
C6 ○ Observe for and prevent infection
■ THORACIC LUMBAT ○ Obseve for and prevent stress
-T1-L4 unlcers
● Paraplegia
● Paralysis of the lower
half of the body
involving both legs
○ MECHANISMS OF INJURY
■ Hypeflexion
■ Hyperrextension
■ Axial loading - diving
accident penetrating wounds
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 ○ + MURMUR - heard best @ lower
CONGENITAL HEART PROBLEMS
left sternal border
○ Congestion - pulmonary
HEART
● Four chambers: two atria and two PATENT DUCTUS ARTERIOSUS
ventricles ● Connects pulmonary trunk to aorta
○ The right atrium receives
oxygen-poor blood from the body ● Signs & Symptoms
and pumps it to the right ventricle ○ + murmur- machinery type @ middle
○ The right ventricle pumps the to upper left sternal border
oxygen-poor blood to the lungs ○ Poor feeding
○ The left atrium receives oxygen-rich ○ Tiring easily
blood from the lungs and pumps it to ● management : INDOMETHACIN
the left ventricle. ○ SURGERY - LIGATION

● CONGENITAL HEART PROBLEMS

● ACYANOTIC TYPE
○ ATRIAL SEPTAL DEFECT (ASD)
■ Abnormal opening in the
septum between left and
right atria
■ Usually detected after
neonatal period
■ S/S; decrease activity COARCTATION OF THE AORTA
tolerance dyspnea ● Narrowing of the aorta significant decrease
■ + murmur- upper left strenal in blood flow to abdomen and legs BLOOD
border SHUNTED TO HEAD AND ARMS
■ MGT: surgery- 2 and 4 yrs of
age ● Signs & Symptoms
○ BP/pulse-higher in arms than legs
○ High pulse pressure in carotid and
radial pulse warm upper body

● Management
○ Surgery angioplasty
■ Repaired of narrowed vessel

VENTRICULAR SEPTAL DEFECT

● Opening in the septum between ventricles,
causing a left to right shunt
● Small VSD- asymptomatic
● Large - hypertrophy and/or failure of right

● Signs & Symptoms

○ increase respiratory effort
○ Frequent respiratory infection

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 ○ Severe progressive pulmonary
hypertension
VALVULAR DEFECTS
● Right side - tricuspid ● Complication
○ Pulmonic valve ○ Arrhythmias
● Left side- mitral ○ Heart failure
○ Aortic
● Signs & Symptoms
TETRALOGY OF FALLOT
○ Palpitations
○ Pain ● Result in cysnosis (bluish color of the skin
○ Edema and mucous membranes due to lack of
○ Weakness oxygen)
○ Dizziness ● Epidemiology
● Management ○ 7%-10& of congenital heart defects
○ Surgery ○ Most common cyanotic congenital
○ Valvotomy heart disease
○ Valvuloplasty ○ Prevalence - 4-5 per 10,000 live
○ ECG births
■ A test that records the ○ boys = girls
electrical activity of the heart
(arrhythmias) ● Signs and Symptoms
○ Transesophageal ○ Cyanosis develops within the first
○ Echocardiogram (TEE) few year of life
■ This test involves passing a ○ Firs presentation may include poor
small ultrasound transducer feeding, fussiness, tachypnea and
down into the esophagus agitation
○ Echocardiogram (echo) ○ Cyanosis occurs and demands
■ This noninvasive test uses surgical repair
sound waves to evaluate the ○ Dyspnea on exertion is common
heart’s chambers and valves ○ Squatting position
○ Birth weight is slow
○ Growth is retarded
CYANOTIC
○ Development and puberty may be
● TRANSPOSITION OF GREAT VESSELS delayed
○ Aorta arises from right ventricle ○ Right ventricular predominance on
pulmonary artery arises from left palpation
ventricle oxygenated blood therefore ○ May have a bulging left hemothorax
circulates through left side of heart ○ Systolic thrill at the lower left sternal
to lungs and back to left side border
○ Unoxygenated blood enters the right ○ Single S2 - pulmonic valve closure
atrium from body, goes back to right not heard
ventricle and back to circulation ○ Systolic ejection murmur
without being oxygenated ○ Cyanosis and clubbing - variable
● Signs & Symptoms ○ Scoliosis - common
○ Blueness of the skin ○ Retinal engorgement
○ Shortness of breath ○ Hemoptysis
○ Poor feeding ● Hypoxic “TET” spells are potentially lethal
○ Clubbing of the fingers or toes unpredictable episodes that occur even in
○ Peripheral hypoxemia noncyanotic patients with TOF.
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● These spells can be aborted with relatively
simple procedures

● Management: TET SPELLS

○ Knee-chest position
■ This provides a calming
effect, reduces systemic
venous return
○ Oxygen therapy
○ Morphine sulfate
■ Decrease systemic venous
return
○ Surgery
● Corrective surgery
○ Pott’s
■ Orifice in descending aorta
to left pulmonary artery
○ Brock
■ Pulmonary stenosis is
corrected

63