Southern Luzon State University

College of Allied Medicine

NCM 09 Risk Pediatrics
Performance Task 3
Name: __Kurt Cyrus R. Laqueo___ Date: ______________
Course, year and sec: _BSN-2B______ Score: _____________
Health Problems During Infancy:
I Discuss the descriptions and or definition, etiology, S/S, treatment and management and
Nursing Care of cleft lip and cleft palate in a matrix or table.
II-
1. It is an uncommon condition among infants characterized by abnormal thickening of the
pylorus muscles in the stomach leading the gastric outlet obstructions
___Hypertrophic Pyloric Stenosis_______

2. Show a picture of the normal anatomy of the esophagus, stomach duodenum and
pylorus muscle VS the Hypertrophic Pyloric Stenosis (draw or obtain a picture)

3. Discuss briefly the etiology or causes.

 Genetic Factors: The condition tends to run in families, and first-degree relatives
of affected infants have a higher risk of developing it. Several genetic factors and
variations may contribute to the development of HPS.
Muscle Hyperplasia: The primary pathology of HPS is hypertrophy (enlargement)
and hyperplasia (increase in the number) of the smooth muscle cells in the
pyloric region. This abnormal muscle growth leads to the thickening of the
pyloric channel, causing the narrowing and obstruction.
Maternal Factors: Factors such as firstborn status, advanced maternal age, and
certain maternal medications (such as erythromycin, a macrolide antibiotic)
during pregnancy have been explored as potential contributors.
Hormonal Influence: Elevated levels of certain hormones, such as gastrin and
somatostatin, may contribute to the abnormal muscle growth in the pyloric
region.
Birth-related Factors: Bottle-feeding and the use of certain types of formula an
increases risk of developing HPS.

4. Hypertrophic Pyloric Stenosis is an uncommon condition in infants that prevent the

food from entering the __small intestine_____

5. Enumerate the signs and symptoms:

 Projectile vomiting after feeding

 Persistent hunger
 Weight loss
 Dehydration
 Visible Peristalsis
 Palpable olive-like mass
 Prolonged fussiness or irritation
 Changes in bowel movements

6. Discuss the management, treatment and nursing care –

Medical and Surgical interventions

 Intravenous Fluids: Intravenous fluids are administered to restore hydration and

correct electrolyte imbalances.
 Correcting Electrolyte Imbalances: Ensuring that electrolyte imbalances are
corrected before surgery is vital for a smoother perioperative course.
 Electrolyte Monitoring: Regular monitoring of electrolyte levels, especially
potassium, is essential due to potential imbalances caused by vomiting.
 Nasogastric (NG) Tube: Inserting an NG tube can help decompress the stomach
and relieve vomiting. It also prevents aspiration of stomach contents.
 Pyloromyotomy: This involves making a small incision in the thickened pyloric
muscle to relieve the obstruction without removing any tissue.
 Laparoscopic surgery which involves smaller incisions and generally results in a
faster recovery.
Nursing care
  Monitoring vital signs and assessing for signs of infection, bleeding, or other
complications.
 Monitoring for Complications: After surgery, the infant is closely monitored for
potential complications such as infection, bleeding, or obstruction.
 Assisting with pain management to ensure the infant is comfortable.
 Observing for the return of normal feeding patterns and bowel movements.
 Providing guidance to parents on caring for the incision site and recognizing signs
of infection or other complications.
 Educating parents about follow-up care and signs that warrant immediate
medical attention.
 Restarting Feeds: Feeding is usually resumed gradually after surgery, starting with
clear fluids and progressing to full feeds.
 Educating parents about the diagnosis, surgery, and postoperative care.
 Providing emotional support to parents and addressing any concerns or
questions.
 Ensuring that the infant is NPO (nothing by mouth) for an appropriate period
before surgery.
III – 1. Illustrate the health problem of an infant Intussusceptions

 Abdominal Pain: Intussusception often presents with severe, intermittent

abdominal pain. Infants may draw their knees to their chest and cry due to the
discomfort.
 Vomiting: Intussusception can cause vomiting, which may be bilious (containing
bile) and persistent.
 Bloody Stools: There may be the presence of "currant jelly" stools, which are
stool mixed with mucus and blood. This is a characteristic sign of compromised
blood flow to the intestine.
 Palpable Abdominal Mass: A physician may be able to feel a sausage-shaped
mass in the abdomen, especially during an episode of intussusception.
 Lethargy and Irritability: Infants with intussusception may become lethargic,
irritable, or appear generally unwell.
 Fever: Some infants may develop a fever, although it is not always present.
 Dehydration: Prolonged intussusception can lead to dehydration due to vomiting,
reduced oral intake, and potential fluid loss from the intestine.

2. Create a pictograph or caricature showing the outstanding signs and symptoms of

intussusception
3. What are the consequences or effects of intussusceptions?

 Bowel Obstruction: blockage of the bowel, preventing the normal passage of

food, fluids, and gas. This obstruction can cause abdominal pain, distension,
vomiting, and other symptoms.
 Ischemia and Necrosis: The telescoping of the intestine can compromise blood
flow to the affected segment. If left untreated, this reduced blood supply can
lead to ischemia) and necrosis of the affected portion of the intestine.
 Perforation: In severe cases, the pressure within the telescoped bowel can cause
a perforation or rupture. This can lead to the leakage of intestinal contents into
the abdominal cavity, causing peritonitis.
 Sepsis: If there is a perforation and subsequent infection, it can lead to sepsis—a
systemic and potentially fatal inflammatory response to infection.
 Dehydration: Vomiting, reduced oral intake, and potential fluid loss from the
intestine can lead to dehydration, especially in infants.
 Shock: In severe cases with complications such as perforation, shock may occur.
Shock is a life-threatening condition where there is insufficient blood flow to
meet the body's needs, leading to organ dysfunction.
 Long-term Complications: These may include adhesions or strictures in the
affected portion of the intestine, potentially leading to recurrent episodes of
obstruction.

4. Discuss its etiology and cause

Intussusception occurs when one segment of the intestine telescopes into another,
causing an obstruction. The exact cause of intussusception is often unknown, but several
factors and conditions may contribute to its development such as bacterial or viral
infections, diverticulum or polyp, and abnormal peristaltic movements. These disrupt
the tissue of the intestines and are believed to be associated with intussusception.
 5. Enumerate the diagnostic lab and or procedure and management

 The healthcare provider will assess the patient's medical history, including
symptoms and their duration.
 A physical examination may reveal a palpable abdominal mass and signs of
distress.
 Ultrasound: This is the preferred imaging modality for diagnosing
intussusception. It can visualize the telescoping of the intestine and provide
valuable information about the location and severity of the condition.
 Abdominal X-rays: X-rays may be used to rule out other causes of abdominal pain
and assess for signs of bowel obstruction.

6. Explain the nursing care

 Vital Signs: Changes in vital signs can indicate complications.

 Pain Assessment: Assess and document the intensity and location of abdominal
pain. Use appropriate pain scales for accurate assessment.
 Intravenous (IV) Fluids: Administer and monitor IV fluids as ordered to maintain
hydration and correct electrolyte imbalances.
 Nasogastric (NG) Tube: In some cases, an NG tube may be inserted to
decompress the stomach and prevent further vomiting.
 Abdominal Assessment: Regularly assess the abdomen for distension,
tenderness, and the presence of an abdominal mass. Report any changes
promptly.
 Bowel Sounds: Monitor bowel sounds to assess for normal peristalsis and the
resolution of the intussusception.
 Medication Education: Provide information about any prescribed medications,
including their purpose, dosage, and potential side effects.
 Dietary Guidelines: Offer guidance on dietary modifications and restrictions
based on the healthcare provider's recommendations.
 Family Involvement: Encourage family involvement in the care of the child and
keep them informed about the child's condition and treatment plan.
IV-
1.Discuss the case of a child with Hirschsprung Disease
Hirschsprung disease is a congenital disorder that affects the large intestine (colon) and
causes problems with bowel movements. It is characterized by the absence of nerve cells
(ganglion cells) in the lower part of the colon, leading to difficulty in passing stool. This
condition is usually present at birth and can vary in severity. Common signs and symptoms are:

 Failure to pass meconium

 Constipation
 Abdominal distention
 Vomiting
 Poor feeding
 Diarrhea
 Enterocolitis
2. Show a picture of a child with Hirschsprung Disease
3. What are the management and nursing care?
Management

 Initial therapy should include intravenous hydration, withholding of enteral

intake, and intestinal and gastric decompression.
 Decompression can be accomplished through the placement of a nasogastric
tube and either digital rectal examination or normal saline rectal irrigations 3-
4 times daily.
 Diet. A special diet is not required; however, preoperatively and in the early
postoperative period, infants on a nonconstipated regimen, such as breast
milk, are more easily managed.
 Antibiotics. Administer broad-spectrum antibiotics to patients with
enterocolitis.
 Leveling colostomy. Surgical options include leveling colostomy, which is a
colostomy at the level of normal bowel; a staged procedure with placement
of a leveled colostomy followed by a pull-through procedure.
 Single-stage pull-through procedure. This procedure can be performed at the
time of diagnosis or after the newborn has had rectal irrigations at home and
has passed the physiologic nadir.
Nursing care

 Education: Provide thorough education to parents about Hirschsprung disease, the

planned surgical procedure (pull-through operation), potential complications, and
expected outcomes. Ensure parents are well-informed and comfortable asking
questions.
 Emotional Support: Offer emotional support to parents and the child. Acknowledge
their concerns and fears and provide reassurance. Encourage open communication
and collaboration with the healthcare team.
 Nutritional Assessment: Assess the child's nutritional status and work with a dietitian
to optimize nutrition before surgery. Adequate nutrition is crucial for overall health
and postoperative recovery.
V- 1. Discuss the important topics and ideas about the hydrocephalus that nurses must know.

Hydrocephalus refers to the abnormal accumulation of cerebrospinal fluid (CSF) in the

ventricles of the brain in infants or children. This condition can occur for various reasons, and it
is important to address it promptly to prevent potential complications.
There are two main types:

 Congenital Hydrocephalus: This type of hydrocephalus is present at birth and may be

caused by genetic factors, developmental abnormalities, or prenatal infections.
Congenital hydrocephalus can sometimes be diagnosed during pregnancy through
ultrasound examinations. The enlarged head size, also known as macrocephaly, is a
common early sign in infants.
 Acquired Hydrocephalus: This form of hydrocephalus develops after birth and may be a
result of infections (such as meningitis), tumors, bleeding within the brain
(intraventricular hemorrhage), or other conditions that interfere with the normal flow or
absorption of cerebrospinal fluid.

The symptoms of hydrocephalus may include:

 Enlarged head (macrocephaly): This is often a noticeable sign, especially in infants.

 Bulging fontanelles: The soft spots on an infant's skull may appear swollen.
 Irritability or changes in behavior
 Poor feeding and vomiting
 Seizures
 Delayed development milestones
 Eyes fixed downward (sunsetting of the eyes)
Diagnosis typically involves imaging studies, such as ultrasound, computed tomography
(CT), or magnetic resonance imaging (MRI), to visualize the ventricles and assess the extent of
hydrocephalus.
Treatment for pediatric hydrocephalus often involves surgical intervention to divert and
manage the excess cerebrospinal fluid. The most common procedure is the insertion of a shunt,
a flexible tube that allows the fluid to drain from the brain to another part of the body where it
can be absorbed. The shunt helps regulate the fluid balance and relieve intracranial pressure.
Early diagnosis and treatment are crucial in pediatric hydrocephalus to prevent potential
complications and optimize the child's neurological development. The specific treatment plan
will depend on the underlying cause and the individual characteristics of the case. Regular
follow-up and monitoring are essential to ensure the ongoing effectiveness of the chosen
treatment approach.