CONGENITAL HEART DISEASE

1. Acyanotic diseases
Pulmonary circulation and systemic circulation are not connected
I t!ere is a connection" t!e #ressure is !i$!er in t!e let side t!an in t!e
ri$!t side
PATENT D%CT%S ARTERIOS%S
&ost common con$enital !eart deect
Sym#toms de#end on si'e o t!e (essel and a$e o t!e c!ild
&ay !a(e no sym#toms) indication may *e a murmur
Increasin$ dys#nea" ull *oundin$ #ulse" +ide #ulse #ressure
S#ontaneous closure ater inancy rarely occurs
,it!out treatment - lie e.#ectancy s!ort
ATRIAL SEPTAL DE/ECTS
101 o all orms o con$enital !eart disease
Allo+s o.y$enated *lood returnin$ rom t!e lun$s to #ass into t!e ri$!t
atrium
2ENTRIC%LAR SEPTAL DE/ECT
constitute 301 o all orms o CHD
allo+s systemic (enous and o.y$enated arterial *lood to mi.
may #roduce no sym#toms at all
re4uire no s#eciic treatment and oten close s#ontaneously
COARCTATION O/ THE AORTA
narro+in$ o t!e lumen o t!e aorta
may *e an isolated deect or associated +it! ot!er cardiac malormation
Assessment5 measure 6P in *ot! arms and a le$ and to assess t!e
#ulse
in *ot! u##er and lo+er e.tremities
sur$ical re#air - only #ermanent treatment) usually deerred until 7 years
o a$e
P%L&ONIC 2AL2E STENOSIS
usually do not #roduce sym#toms) ty#ical murmur
AORTIC 2AL2E STENOSIS
mild to moderate asym#tomatic) ty#ical murmur
C8ANOTIC DISEASES
TETRALOG8 O/ /ALLOT
1. 2SD
3. O(erridin$ o t!e aorta
7. Pulmonary (al(e stenosis
9. Enlar$ed ri$!t (entricular +all
Assessment5
Primary si$n - cyanosis
Hy#o.ic s#ells - usually initiated *y cryin$
/aintin$ - due to cere*ral !y#o.ia
Stunted $ro+t!" clu**ed in$ers and toes
S4uattin$ #osition - c!aracteristic #osition to relie(e dys#nea
Im#lementation
Decrease !y#o.ic s#ells - do not #ermit c!ild to cry
Place in :nee c!est #osition
O3 as needed
TRANSPOSITION O/ THE GREAT 2ESSELS
aorta arises rom t!e ri$!t (entricle
de$ree o cyanosis de#ends on t!e a*normal connections
Assessment5
cyanotic at *irt!
de(elo# #olycyt!emia ris: or em*oli and t!rom*oses
may de(elo# CH/ or #ulmonary (ascular o*structi(e
Im#lementation5
re4uire emer$ency medical treatment
cardiac cat!eteri'ation
*allool atrial se#tostomy
TRIC%SPID ATRESIA
condition in +!ic! tricus#id (al(e did not orm
no o#enin$ *et+een t!e ri$!t atrium and ri$!t (entricle
31 o con$enital !eart deects
#roound cyanosis and dys#nea at *irt!
emer$ency cat!eteri'ation +it! *alloon atrial se#totomy
TOTAL ANO&ALO%S 2ENO%S RET%RN
condition in +!ic! all t!e #ulmonary (enous *lood returns to t!e !eart
cyanosis and se(ere res#iratory distress
emer$ency sur$ical inter(ention
TR%NC%S ARTERIOS%S
sin$le (essel arisin$ rom t!e (entricles ;ust a*o(e a lar$e 2SD
retarded $ro+t!) enlar$ed li(er and !eart
usually inants die +it!in t!e irst year
CARDIO2ASC%LAR DE/ECTS
&onitor (ital si$ns closely
&onitor res#iratory status
Auscultate *reat! sounds or crac:les" ronc!i or rales
i res#iratory eort is increased" #lace c!ild in re(erse Trendelen*ur$
#osition
administer !umidiied o.y$en
&onitor or !y#ercyanotic s#ells5
1. Place inant in a :nee c!est #osition
3. Administer 1001 o.y$en *y mas:
7. Administer mor#!ine as ordered
9. I2/ as #rescri*ed
Assess or si$ns o CH/
Assess #eri#!eral #ulses
<ee# c!ild stress ree as #ossi*le) allo+ ma.imal rest
CARDIAC S%RGER8
Posto#erati(ely5
monitor or si$ns o discomort
monitor or si$ns o se#sis =e(er" let!ar$y" dia#!oresis" altered LOC>
&onitor lines" tu*es or cat!eters ) remo(e #rom#tly
administer #ain medications) note eecti(eness
encoura$e rest #eriods
acilitate #arent?c!ild contact as soon as #ossi*le
Home Care
omit acti(ities in +!ic! c!ild could all or 3?9 +ee:s
a(oid cro+ds or 3 +ee:s ater disc!ar$e
no added salt diet
do not #ut creams" lotions or #o+ders on t!e incision site
c!ild may return to sc!ool 7rd +ee: ater disc!ar$e
no #!ysical education or 3 mont!s
ollo+ u# ater 3 +ee:s
a(oid immuni'ations" in(asi(e #rocedure and dental (isits or 3 mont!s
ad(ise #arents re$ardin$ im#ortance o dental (isit e(ery @ mont!s
inorm dentist o cardiac #ro*lem
instruct #arents to call &D i +it! cou$!in$" tac!y#nea" cyanosis"
diarr!ea
CONGESTI2E HEART /AIL%RE
ina*ility o t!e !eart to #um# suiciently to meet t!e meta*olic demands
o t!e *ody
inants - most commonly caused *y con$enital !eart deects
com*ination o *ot! let sided and ri$!t sided !eart ailure
$oal o treatment5 to im#ro(e cardiac unction" remo(e accumulated luid
and sodium" decrease cardiac demands" im#ro(e tissue o.y$enation
Assessment5
tac!ycardia
tac!y#nea
#rouse scal# s+eatin$ es#ecially in inants
ati$ue and irrita*ility
sudden +ei$!t $ain
res#iratory distress
Im#lementation5
monitor (ital si$ns closely and or early si$ns o CH/
monitor or res#iratory distress
monitor I and O) +ei$! dia#ers
&onitor daily +ei$!t to assess or luid retention) +ei$!t $ain o 0.A :$
= 1 l* Bday>
monitor or acial or #eri#!eral edema " auscultate lun$ sounds
ele(ate HO6
maintain neutral t!ermal en(ironment to #re(ent cold stress in inants
administer cool" !umidiied o.y$en
or$ani'e nursin$ acti(ities to allo+ uninterru#ted slee#
maintain ade4uate nutritional status
#ro(ide rest) decrease en(ironmental stimuli
eed +!en !un$ry and soon ater a+a:enin$
inant s!ould *e +ell rested *eore eedin$
#ro(ide small" re4uent eedin$s
administer sedation
administer di$o.in
c!ec: +it! #!ysician #arameters or +it!oldin$ di$o.in
Note t!at inants rarely recei(e more t!an 1 mL =A0 u$ or 0.0A m$> o
di$o.in
Administer diuretics) monitor or !y#o:alemia
administer #otassium su##lements
monitor serum electrolytes
restrict luid in acute sta$es
c!ec: +it! #!ysician re$ardin$ sodium restriction) inant ormulas !a(e
sli$!tly
more sodium t!an does *reast mil:
Home care Instructions or Administerin$ Di$o.in
administer 1 !r *eore or 3 !rs ater eedin$
do not mi. medication +it! ood or drin:
i t!e c!ild (omits" do not administer a second dose
i more t!an 3 consecuti(e doses !a(e *een missed" notiy &D) do not
increase or dou*le t!e dose or missed doses
:ee# t!e medication in a loc:ed ca*inet
i t!e c!ild *ecomes ill" notiy &D
RHE%&ATIC /E2ER
an inlammatory autoimmune disease
aects connecti(e tissue o t!e !eart" ;oints" su*cutaneous tissues and
*lood (essels o t!e CNS
most serious com#lication - RHD aectin$ t!e cardiac (al(es
#resents 3?@ +ee:s ollo+in$ an untreated Grou# A *eta !emolytic stre#
Cones criteria
Asssessment5
si$ns o carditis5 SO6" edema o t!e ace" a*domen or an:les" #recordial
#ain
si$ns o #olyart!ritis5 edema" inlammation o t!e lar$e ;oints" ;oint #ain
eryt!ema mar$inatum5 macular ras! on trun: and e.tremities
su*cutaneous nodules
e(er
ele(ated ASO
ele(ated ESR
ele(ated CRP
Im#lementation5
Assess (ital si$ns
Control ;oint #ain and inlammation +it! massa$e
/e*rile #!ase - #ro(ide *ed rest
limit #!ysical e.ercise in c!ild +it! carditis
Administer anti*iotics =#enicillin> as #rescri*ed
administer salicylates and anti?inlammatory a$ents
Instruct #arents a*out t!e im#ortance o ollo+ u# and need or
anti*iotic #ro#!yla.is or dental +or:" inection" in(asi(e #rocedures
ad(ise c!ild to inorm t!e #arents i anyone in sc!ool de(elo#s a
stre# t!roat inection
<A,ASA<I DISEASE
:no+n as mucocutaneous lym#! node syndrome
acute systemic inlammatory illness
un:no+n cause
cardiac in(ol(ement - most serious com#lication
Assessment5
e(er
con;uncti(al in;ection
red t!roat
S+ollen !ands" ras!" enlar$ement o t!e cer(ical lym#! nodes
Im#lementation5
monitor tem#erature re4uently
assess !eart sounds and r!yt!m
assess e.tremities or edema" redness" des4uamation
monitor mucus mem*rane or inlammation
+ei$! daily
administer I2 immune $lo*ulin
instruct #arents in t!e administration o #rescri*ed meds
as#irin - need to monitor *leedin$
GASTROINTESTINAL SYSTEM
P!ysiolo$y o DIGESTI2E S8STE&
&ec!anical unctions o di$estion immature at *irt!
No (oluntary control o(er s+allo+in$ until @ +ee:s
Stomac! ca#acity decreased
Rela.ed s#!incter contri*utes to tendency to re$ur$itate
Li(er unctions immature t!rou$!out inancy
Gastric acidity lo+ in inants rises until a$e 10
Di$esti(e #rocesses are mature *y toddler!ood
Assessment5
Presentin$ #ro*lem
a. 2omitin$
*. A*normal *o+el !a*its5 diarr!ea" consti#ation" *leedin$
c. ,ei$!t loss" ailure to t!ri(e
d. Pain
Nutritional !istory
P!ysical E.amination5
General a##earance5
a. Hei$!t and +ei$!t
*. &easure mid arm circumerence
c. O*ser(e color5 ;aundice
&out!5 dentition
A*domen
a. S:in inte$rity
*. A*dominal distension) (isi*le #eristaltic +a(es
c. Ins#ect or !ernias
d. Auscultate *o+el sounds = e(ery 10?70 seconds>
e. Pal#ate or tenderness
. Li(er s#an =inerior ed$e #al#ated 1?3 cm *elo+ RC&>
$. S#leen =elt on ins#iration 1?3 cm *elo+ let costal mar$in>
DISORDERS O/ THE TEETH
DENTAL CARIES
erosion o t!e enamel and dentine o teet!
results rom com*ination o ermentin$ su$ars and starc!ed
and acid ormin$ or$anisms
Pre(ention5
dental !y$iene
re$ular dental !y$iene
$ood nutrition
luoridation
CLE/T LIP AND CLE/T PALATE
1 in 1000 *irt!s
multiactorial
common amon$ c!ildren +it! c!romosomal a*normalities
results rom ailure o t!e em*ryonic structures o t!e ace to unite
may occur se#arately or may com*ine to #roduce a sin$le unilateral
or *ilateral clet rom t!e li# t!rou$! t!e sot #alate
interere +it! t!e c!ildDs ca#acity to meet o.y$enation and
nutritional needs
may seriously !am#er normal *ondin$ #rocess o c!ildren +it! #arents
Assessment5
acial a*normality (isi*le at *irt!
? clet li# or #alate or *ot!" unilateral or *ilateral
diiculty suc:in$
ina*ility to orm airti$!t seal around ni##le
ormulaBmil: esca#es t!rou$! nose in inants +it! clet #alate
#redis#ose to inection - communication *et+een mout! and nose
diiculty s+allo+in$
a*dominal distension - air s+allo+in$
&ana$ement5
team a##roac!
otolaryn$olo$ist" audiolo$ist" #ediatrician" dentist" ort!odontist" s#eec!
t!era#ist
Sur$ical correction5
early correction - #re(ent s#eec! deects
C!eilo#lasty
correction o clet li#
unite ed$es to allo+ li#s to *e *ot! unctional) aest!etic reasons
#erormed usually at a$e 3 mont!s
Clet #alate re#air
not done until a$e 1E mont!s - antici#ation or s#eec! de(elo#ment
c!ild s!ould *e +eaned and a*le to ta:e li4uids rom a cu# *eore
#alate re#air
N%RSING INTER2ENTION5
Clet Li# =PreOP>
eed in u#ri$!t #osition
*ur# re4uently
#ress clet li# to$et!er +it! in$ers - to encoura$e suc:in$ and to
stren$t!en muscles
i una*le to suc:" use a ru**er ti##ed syrin$e) dri# onto side
o mout!
inis! eedin$ +it! +ater to +as! a+ay ormula in #alate area
#ro(ide small" re4uent eedin$s
#ro(ide emotional su##ort or #arents
Post OP5 Clet Li# re#air
maintain #atent air+ay
monitor amount o s+allo+in$ to detect !emorr!a$e
do not #lace in #rone #osition or +it! #ressure on c!ee:s
a(oid any tension on suture line
a(oidin$ strainin$ on suture line
#re(ent cryin$
:ee# c!ild comorta*le and contented
use el*o+ restraint
:ee# suture line clean - clean ater eac! eedin$ +it! saline"
#ero.ide or +ater to remo(e crusts
#ain relie
Nursin$ Inter(ention5 Preo# clet #alate re#air
#re#are #arents to care ro c!ild ater sur$ery
instruct concernin$ eedin$ met!ods and #ositionin$
Post O# clet #alate re#air
#osition on side or draina$e o *lood
!a(e suction a(aila*le
#re(ent in;ury or trauma on suture line
1. %se cu#s only or li4uids) no *ottles
3. a(oid stra+s" utensils" #o#sicle stic:s" c!e+in$ $um
7. #ro(ide sot toys
9. %se el*o+ and +rist restraints
A. Pro(ide li4uid diet initially sot normal diet
@. Gi(e +ater ater eac! eedin$ to clean suture line
F. Hold and cuddle
ESOPHAGEAL ATRESIA and TRAACHEOESOPHAGEAL FISTULA
Eso#!a$eal atresia
con$enital deect) u##er se$ment o t!e eso#!a$us ends in a *lind
#ouc!
TE/
deect in +!ic! em*ryonic structures ail to di(ide into a se#arate
eso#!a$us and trac!ea
o#enin$ *et+een t!e t+o structures
usually occur to$et!er
Assessment5
co#ious oral and nasal secretions -irst si$n o a deect
c!o:e or cou$!
+!en suctionin$ or $a(a$e is attem#ted - cat!eter cannot #ass
into stomac!
&edical and Sur$ical inter(ention
#re(ention o as#iration
draina$e tu*e may *e #laced in t!e *lind #ouc! - to suction secretions
eso#!a$eal atresia - medical emer$ency
? end to end anastomoses
eedin$ tu*e may*e inserted into t!e stomac! t!rou$! $astrostomy until
re#air !eals
Nursin$ inter(ention5
#ro(ide nutrition
1. Pro(ide $astrostomy tu*e eedin$ until anastomosis site !as !ealed
3. start oral eedin$s +!en inant can s+allo+ +ell
#romote res#iratory unction
1. #osition #ro#erly
PYLORIC STENOSIS
narro+in$ o t!e outlet o t!e stomac!
caused *y e.cessi(e $ro+t! o circular muscles t!at surrounds t!e
#ylorus
!y#ertro#!y de(elo#s o(er 9?@ +ee:s o lie +!en sym#toms *e$in to
a##ear
more common in Caucasian) irst *orn" ull term *oys
Assessment5
oli(e si'e *ul$e under ri$!t ri* ca$e
(omitin$ - #ro;ectile) non *ilous
#eristaltic +a(es durin$ and ater eedin$
ailure to t!ri(e
de!ydration
dia$nostic tests5
a. %GIS - narro+in$ o diameter o #ylorus
*. Decreased serum Na" <" Cl
c. Increased Hct
d. &eta*olic al:alosis
Nursin$ inter(ention5 Preo#
re#lace luids and electrolytes
#re(ent (omitin$
1. Gi(e t!ic:ened eedin$s
3. Hi$! /o+lerDs
7. Place on ri$!t side ater eedin$
9. &inimi'e !andlin$
A. Strict I and O" daily +ei$!ts" urine s# $ra(ity
Nursin$ Inter(ention5 #ost O#
Ad(ance diet as tolerated
Place on ri$!t side ater eedin$
O*ser(e incision or si$ns o inection
Pro(ide client teac!in$ and disc!ar$e #lannin$
INTUSSUSCEPTION
telesco#in$ o *o+el into itsel
ileocecal re$ion
edema" necrosis o *o+el" o*struction
most common at a$e @ mont!s
more in *oys t!an in $irls
associated +it! cystic i*rosis
Assessment5
#iercin$ cry
se(ere a*dominal #ain =#ulls le$ u#>
(omitin$ o *ile stained luid
*loody mucus in stool
Gcurrant ;ellyH stool
&ana$ement5
1. *arium enema
3. sur$ery
Nursin$ Inter(ention5
1. #ro(ide routine #re and #ost o# care
3. monitor or #eritonitis
HIRSCHSPRUNGS DISEASE
a*sence o autonomic #arasym#at!etic $an$lion cells in lar$e intestines
results in decreased motility in t!at #ortion o t!e colon and si$ns o
unctional o*struction
Assessment5
ailure or delay in #assin$ meconium
a*dominal distension
ailure to #ass stool
tem#orary relie ollo+in$ rectal e.am
loose stools - only li4uid can #ass t!ru
ri**on li:e stools
nausea" anore.ia" ecal (omitin$
+ei$!t loss" ailure to $ro+
(ol(ulus - *o+el t+ists u#on itsel
dia$nostic tests5 rectal *io#sy - conirms #resence o a$an$lionic cells

Nursin$ inter(ention5
enema as ordered
A. &ineral oil or isotonic saline
6. Do not use +ater or soa# suds - +ater into.ication
C. %se (olume a##ro#riate to +ei$!t o c!ild
inants - 1A0?300ml
c!ildren - 3A0?A00 ml
administer TPN as ordered
Pro(ide lo+ residue diet
#ro(ide client teac!in$ and disc!ar$e teac!in$
Colostomy care
Lo+ residue diet
IMPERFORATE ANUS
durin$ em*ryonic lie - mem*rane t!at se#arates t!e rectum and anus is
a*sor*ed
a*sor#tion ails to occur ?I im#erorate anus
anus a##ear as a dim#le
istula may *e #resent - recto(a$inal" rectouret!ral
Assessment5
ins#ection o anus" c!ec: rectum or #atency
insert rectal t!ermometer
a*sence o stool durin$ 1st 39 !ours
de(elo#ment o a distended a*domen
Inter(ention5
sur$ery
ano#lasty - i #ossi*le
tem#orary colostomy
i +it! distension - naso$astric suction
Nursin$ inter(ention5
:ee# o#erati(e site clean
o*ser(e inant or si$ns o !y#o(olemic s!oc: and inection
i ano#lasty !eals - re$ular dilatation o anus to #re(ent stricture
colostomy care
a. <e#t clean
*. 'inc o.ide
ater sur$ery - side lyin$ or #rone +it! !i#s ele(ated
CELIAC DISEASE
mala*sor#tion syndrome c!aracteri'ed *y intolerance o $luten"
ound in rye" oats" +!eat and *arley
amilial disease
more common in Caucasians
cause un:no+n
lat mucosal surace and atro#!y o (illi o t!e intestine
reduced a*sor#ti(e surace ?I mar:ed mala*sor#tion o ats
Assessment5
steatorr!ea
c!ronic diarr!ea
ailure to t!ri(e
distended a*domen
a*dominal #ain" irrita*ility" listlessness" (omitin$
sym#toms o ADE< deiciency
dia$nostic tests5
1. #ancreatic en'ymes
3. ;e;unal or duodenal *io#sies
&ana$ement5
diet t!era#y
$luten ree diet
TPN in c!ildren
Nursin$ Inter(ention5
$luten ree diet =6RO, - 6arley" Rye" Oatmeal" ,!eat>
su##lemental at solu*le (itamins
client teac!in$
1. $luten ree diet
3. im#ortance o readin$ t!e la*el
7. a(oidance o inection
9. ad!erin$ to diet e(en i sym#toms are controlled
A. im#ortance o lon$ term ollo+ u#
APPENDICITIS
inlammation o t!e a##endi.
isc!emia" $an$rene" ru#ture" #eritonitis - i untreated
sc!ool a$e c!ildren - most common
due to mec!anical o*struction or anatomic deects
Assessment5
diuse #ain RLJ
nausea" (omitin$
$uardin$ o a*domen
re*ound tenderness
decreased *o+el sounds
e(er
dia$nostic tests5
1. C6C
3. ele(ated acetone in urine
Nursin$ Inter(ention5
anti*ioticsB anti#yretics as ordered
no enemas
no !eatin$ #ads
routine #reo# care
#ost o# care5
1. semi?/o+lerDs #osition
3. &onitor NGT
7. &onitor #enrose drains
PARASITISM
round+orms" #in+orms
Assessment5
#in+orms - anal itc!in$" distur*ed slee#
round+orms - colic " a*dominal #ain" lac: o a##etite" +ei$!t loss
Nursin$ inter(ention5
o*tain stool culture
o*ser(e all e.creta or +orms
Scot! ta#e s+a*
instruct #arents to c!an$e clot!in$" *ed linens" to+els and launder in !ot
+ater
instruct all amily mem*ers to scru* !ands and in$ernails #rior to eatin$
and ater usin$ toilet
DIABETES MELLITUS
most common endocrine disease o c!ildren
onset may*e any a$e
ty#e 1 IDD&
ris: o com#lication is !i$! - retino#at!y" neuro#at!y" ne#!ro#at!y"
s:in c!an$es" #redis#osition to inection
Assessment5
ra#id onset
#olyuria" #olydi#sia" #oly#!a$ia" ati$ue
+ei$!t loss
:etoacidosis
?Dry lus!ed s:in
&ana$ement5
insulin
diet t!era#y
e.ercise
#re(ention o com#lications
Nursin$ inter(ention5
administer insulin as ordered
orce luids +it!out su$ar
monitor *lood $lucose le(els daily
o*ser(e or !y#o$lycemia5 *e!a(ior c!an$es" s+eatin$
#ro(ide client teac!in$
a. Daily re$imen or !ome care
*. %rine and *lood $lucose monitorin$
c. Nutrition mana$ement
d. Eects o inection and e.ercise on CHO meta*olism
e. Pre(ention o acute and c!ronic com#lications
RESPIRATOR8 S8STE&
EPIGLOTTITIS
inlammation o t!e e#i$lottis
H. inluen'ae Ty#e * ) Stre# #neumoniae
a$e 3?A
a*ru#t onset) +inter
considered an emer$ency situation
Assessment5
e(er
sore" red and inlamed t!roat
droolin$" diiculty o s+allo+in$
ins#iratory stridor
muled (oice
nasal larin$
Im#lementation
maintain #atent air+ay
assess res#iratory status and *reat! sounds
use o accessory muscles) #resence o stridor
assess tem#erature
do not attem#t to (isuali'e t!e #osterior #!aryn. or o*tain t!roat culture
lateral nec: ilm
do not orce c!ild to lie do+n
do not restrain
administer anti*iotics) I2 luids
cool mist o.y$en
!i$! !umidiication
!a(e resuscitation e4ui#ment a(aila*le
immuni'ation
LAR8NGOTRACHEO6RONCHITIS =LT6>
inlammation o t!e laryn." trac!ea" *ronc!i
most common ty#e o crou#) may*e (iral or *acterial
#arainluen'a (irus
$radual onset ) #receded *y %RI
Assessment5
e(er
irrita*ility and restlessness
!oarse (oice
ins#iratory stridor and su#rasternal retractions
crac:les and +!ee'in$
cyanosis
Im#lementation5
#atent air+ay
(ital si$ns
ele(ate HO6
!umidiied o.y$en) I2/
ne*uli'ed e#ine#!rine
resuscitation e4ui#ments a(aila*le
6RONCHITIS
inection o t!e ma;or *ronc!i
assessment5 cou$!" +orse at ni$!t) *ecomes #roducti(e in 3?7 days
Im#lementation5
1. &onitor or res#iratory distress
3. Increased luid inta:e
7. Acetamino#!en
6RONCHIOLITISBRESPIRATOR8 S8NC8TIAL 2IR%S =RS2>
Inlammation o t!e *ronc!ioles) #roduction o mucus t!at occludes
*ronc!iole tu*es and small *ronc!i
RS2 - !i$!ly communica*le" usually transerred *y !ands
Assessment5
%RI
Let!ar$y" #oor eedin$" tac!y#nea
E.#iratory +!ee'es and $runt
Diminis!ed *reat! sounds
T!e c!ild +it! RS25
isolate in a sin$le room or #lace +it! same #atient
$ood !and+as!in$
nurses carin$ or t!ese c!ildren do not care or ot!er !i$! ris: c!ildren
+ear $o+ns +!en soilin$ may occur
ri*a(irin - may *e aerosol
nurses +earin$ contact lenses must +ear $o$$les - ri*a(irin may
dissol(e
contact lenses
PNE%&ONIA
inlammation o t!e al(eoli
in!alation o causati(e a$ent *loodstream
Primary aty#ical #neumonia - most common cause o #neumonia
*et+een A?13 years
Im#lementation5
antimicro*ial t!era#y
o.y$en
cool !umidiication
encoura$e c!ild to lie on t!e aected side
isolation #rocedures as needed
anti#yretics
I2/) li*eral luid inta:e
ASTH&A
c!ronic inlammatory disease o air+ays
commonly caused *y #!ysical and c!emical irritants common sym#toms
- cou$!in$ in t!e a*sence o res#iratory inection"
es#ecially at ni$!t
Assessment5
e#isodes o +!ee'in$" *reat!lessness" dys#nea" c!est ti$!tness
SO6" cou$!" +!ee'in$
c!ild s#ea:s in s!ort" *ro:en #!rases
retractions
e.ercise induced *ronc!os#asm
se(ere s#asm or o*struction
Im#lementation
continuously monitor res#iratory status
administer 4uic:?relie =rescue> medication
initiate an I2 line) #re#are to correct de!ydration" acidosis or electrolyte
im*alance
&edications
1. Juic: relie
To treat sym#toms and e.acer*ations
S!ort actin$ *3 a$onists
Antic!oliner$ics - or relie o acute *ronc!os#asm =i#ratro#ium *romide>
3. Lon$ term control
Corticosteroids
Lon$ actin$ *3 a$onist
Lon$ actin$ *ronc!odilator
7. Ne*uli'er" &DI
%sed to deli(er many medications
Non?C/C =c!loroluorocar*on> - al*uterol
9. C!est #!ysiot!era#y
Includes *reat!in$ e.ercises
Home care measures5
instruct in measures to eliminate aller$ens
a(oid e.tremes o en(ironmental tem#erature
a(oid e.#osure to indi(iduals +it! a (iral inection
instruct t!e c!ild in !o+ to reco$ni'e early sym#toms
instruct t!e c!ild in t!e cleanin$ o de(ices used or in!aled medications
:ee# immuni'ation u# to date
OTITIS &EDIA
Inection o t!e middle ear occurin$ as a result o a *loc:ed eustac!ian
tu*e" #re(entin$ normal draina$e
common com#lication o ARI
inants and c!ildren more #rone - ET s!orter" +ider" strai$!ter
Assessment5
e(er
irrita*ility and restlessness
rollin$ o !ead rom side to side
#ullin$ or ru**in$ t!e ear
earac!e) si$ns o !earin$ loss
#urulent ear disc!ar$e
otosco#ic e.am
Inter(ention
Encoura$e luids
u#ri$!t #osition +!en eedin$
a(oid c!e+in$ - increases #ain
!a(e t!e c!ild lie +it! t!e aected ear do+n
instruct on a##ro#riate tec!ni4ue to clean draina$e rom t!e ear +it!
sterile cotton s+a*s
administer anal$esics and anti*iotics =10?19 days>
screenin$ or !earin$ loss
otic medications
1. I youn$er t!an a$e 7 - auditory canal is strai$!tened *y #ullin$ t!e #inna
do+n and *ac:
3. I older t!an 7 years - #ull #inna u# and *ac:
&yrin$otomy
Insertion o tym#ano#lasty tu*es into t!e middle ear to e4uali'e #ressure
and :ee# ear aerated
<ee# ears dry
Ear#lu$s s!ould *e +orn durin$ *at!in$" s!am#ooin$" s+immin$
TONSILLECTO&8 AND ADENOIDECTO&8
Assessment5
#ersistent or recurrent sore t!roat
enlar$ed *ri$!t red tonsils ) +it! e.udates at times
dys#!a$ia
mout! *reat!in$) un#leasant mout! odor
e(er) cou$!
Preo#5
assess or #resence o inection
assess *leedin$ and clottin$ studies
assess or loose teet!
#re#are t!e c!ild or a sore t!roat
Posto#erati(ely5
Position - #rone or side lyin$ to acilitate draina$e
!a(e suction e4ui#ment a(aila*le
monitor or si$ns o !emorr!a$e
may $i(e a##ly ice collar
discoura$e cou$!in$ or clearin$ t!e t!roat
#ro(ide clear" cool" noncitrus and non car*onated drin:s
a(oid mil: #roducts intially - +ill coat t!e t!roat
a(oid red li4uids
do not $i(e c!ild any stra+" or:s" or s!ar# o*;ects
administer #aracetamol as ordered
instruct #arents to notiy &D i *leedin$" #ersistent earac!e or e(er
occurs
instruct #arents to :ee# c!ild a+ay rom cro+ds until !ealin$ occurred
HE&ATOLOGIC S8STE&
LE%<E&IA - t!e most re4uent ty#e o c!ild!ood cancer
6rain tumors - 3nd
Etiolo$y5
1. En(ironmental
3. 2iruses
7. /amilialB$enetic
9. Host actors
STAGES O/ TREAT&ENT
1. IND%CTION
Goal5 to remo(e *ul: o tumor
&et!ods5 sur$ery" radiot!era#y" c!emot!era#y" 6& trans#lant
Eects5 oten t!e most intensi(e #!ase
Side eects are #otentially lie t!reatenin$
3. CONSOLIDATION
Goal5 to eliminated any remainin$ mali$nant cells
&et!ods5 c!emoBradio
Side eects +ill still *e e(ident
7. &AINTENANCE
Goal5 to :ee# t!e c!ild disease ree
C!emot!era#y
T!is #!ase may last se(eral years
9. O6SER2ATION
Goal5 to monitor t!e c!ild at inter(als or e(idence o recurrent
disease and com#lications o treatment
&et!od5 treatment is com#lete
C!ild may continue in t!is sta$e indeinitely
A. LATE E//ECTS O/ TREAT&ENT
Im#aired $ro+t! and de(elo#ment
CNS dama$e
Im#aired #u*ertal de(elo#ment
De(elo#ment o secondary mali$nancy
Psyc!olo$ic #ro*lems related to li(in$ +it! a lie t!reatenin$ disease and
com#le. treatment re$imen

N%RSING INTER2ENTION
1. Hel# c!ild co#e +it! intrusi(e #rocedures
Pro(ide inormation $eared to de(elo#mental le(el and emotional
readiness
E.#lain +!at is $oin$ to !a##en" +!y it is necessary" !o+ it +ill eel
Allo+ c!ild to !andle to !andle and mani#ulate e4ui#ments
Allo+ c!ild some control in situations
? #ositionin$" selectin$ in;ection site
3. Su##ort c!ild and #arents
&aintain re4uent clinical conerences to :ee# all inormed
Al+ays tell t!e trut!
Ac:no+led$e eelin$s and encoura$e c!ildBamily to e.#ress t!em
Pro(ide contact +it! anot!er #arent or su##ort $rou#
7. &inimi'e side eects o treatment
a. S:in *rea:do+n
<ee# clean and dry) +as! +it! +arm +ater) no soa#s or creams
Do not +as! o radiation mar:s
A(oid all to#ical a$ents +it! alco!ol
Do not use !eatin$ #ads or !ot +ater *ottle
*. 6one marro+ su##ression
Pro(ide re4uent rest #eriods
A(oid cro+ds
E(aluate any #otential site o inection
&onitor tem#erature
A(oid use o as#irin
Select acti(ities t!at are #!ysically sae
c. Nausea and (omitin$
Administer antiemetic at least !al an !our *eore c!emot!era#y
Eat li$!t meal #rior to administration o t!era#y
Administer I2/ i needed
d. Alo#ecia
Reduce trauma o !air loss
6uy +i$ *eore !air alls out
Discuss (arious !ead co(erin$s
A(oid e.#osin$ !ead to sunli$!t
9. Nutrition deicits
Esta*lis! *aseline
Pro(ide !i$! calorie" !i$! #rotein
A. De(elo#mental delay
/acilitate return to sc!ool as soon as #ossi*le
Discuss limit settin$" disci#line
LE%<E&IA
most common orm o c!ild!ood cancer
#ea: 7?A years
#rolieration o a*normal +*c t!at do not mature *eyond t!e *last #!ase
*last cells - iniltrate ot!er or$ans - li(er" s#leen" lym#! tissue
Ty#es5
1. Acute Lym#!ocytic leu:emia =ALL>
E0?EA1
Acute
FA1 c!ance o sur(i(in$
3. Acute nonlym#!ocytic leu:emia
Includes $ranulocytic and monocytic ty#es
@0?E01 +ill o*tain remission
70?901 cure rate
Assessment5
1. anemia" +ea:ness" #allor" dys#nea
3. 6leedin$" #etecc!iae" s#ontaneous *leedin$" ecc!ymoses
7. Inection" e(er" malaise
9. Enlar$ed lym#! node
A. Enlar$ed s#leen and li(er
@. 6one #ain
&ana$ement5
1. dia$nosis5 *lood studies" 6&A
3. Treatment sta$es
a. Induction
*. CNS #ro#!yla.is
c. &aintenance
Nursin$ Inter(ention5
1. Pro(ide care or t!e c!ild recei(in$ c!emo and radiot!era#y
3. Pro(ide su##ort or t!e amilyBc!ild
7. Su##ort c!ild durin$ #ainul #rocedures
a. %se distraction" $uided ima$ery
*. Allo+ t!e c!ild to retain as muc! control as #ossi*le
c. Administer sedation #rior to #rocedure as ordered
Sic:le Cell Disease
!emo$lo*in A is #artly or com#letely re#laced *y a*normal sic:le
!emo$lo*in =H$*S>
H$*S sensiti(e to c!an$es in t!e o.y$en content o t!e red *lood cell
Ris: actors5 Arican American
Insuicient o.y$en causes t!e cells to assume a sic:le s!a#e and t!e
cells *ecome ri$id and clum#ed to$et!er" o*structin$ ca#illary *lood lo+
T!e sic:lin$ res#onse - re(ersi*le under ade4uate o.y$enation
Sic:le cell crises - (aso?occlusi(e crisis" s#lenic se4uestration" a#lastic
crisis
Assessment5
1. 2aso?occlusi(e crisis
&ost common ty#e o crisis
Caused *y stasis o *lood +it! clum#in$ o t!e
cells in microcirculation" isc!emia and inraction
/e(er" #ain and tissue en$or$ement
3. S#lenic se4uestration
Poolin$ o *lood in t!e s#leen
Proound anemia" !y#o(olemia" s!oc:
7. A#lastic crisis
Caused *y t!e diminis!ed #roduction and increased destruction o R6Cs"
tri$$ered *y (iral inection or t!e de#letion o olic acid
Proound anemia and #allor
Im#lementation5
Administer o.y$en and *lood transusions
administer anal$esics
maintain ade4uate !ydration and *lood lo+ +it! I2 normal saline as
#rescri*ed and +it! oral
luids
Assist t!e c!ild to assume a comorta*le #osition so t!at t!e c!ild :ee#s
t!e e.tremities e.tended
to *ed no more t!an 70 de$rees
a(oid #uttin$ strain on #ainul ;oints
encoura$e consum#tion o a !i$! calorie" !i$! #rotein diet +it! olic acid
su##lementation
administer anti*iotics as #rescri*ed
&onitor or si$ns o increasin$ anemia and s!oc: =#allor" (ital si$n
c!an$es>

IRON DE/ICIENC8 ANE&IA
Iron stores are de#leted" resultin$ in a decreased su##ly o iron or t!e
manuacture or t!e
manuacture o !emo$lo*in in R6Cs
Results rom *lood loss" increased meta*olic demands" syndromes o GI
mala*sor#tion" dietary
inade4uacy
Assessment5
#allor
+ea:ness and ati$ue
irrita*ility
Im#lementation5
Increase t!e oral inta:e o iron
Instruct t!e c!ild and #arents in ood c!oices t!at are !i$! in iron
Administer iron su##lements as #rescri*ed
Li4uid iron #re# stains - stains teet!) +it! stra+
side eects o iron t!era#y
APLASTIC ANE&IA
a deiciency o circulatin$ eryt!rocytes resultin$ rom t!e arrested
de(elo#ment o R6Cs +it!in t!e *one marro+
causes5 e.#osure to to.ic a$ents" (iruses" inection" autoimmune
disorders" aller$ic states
deiniti(e dia$nosis5 6&A
T!era#eutic mana$ement5 *lood transusions" s#lenectomy"
corticosteroids" immunosu##ressi(e t!era#y" *one marro+ trans#lantation
Assessment
Pancyto#enia
Petecc!iae" #ur#ura" *leedin$" #allor" +ea:ness" tac!ycardia and ati$ue
Im#lementation5
6lood transusion
corticosteroids and immunosu##resi(es
s#lenectomy
*one marro+ trans#lant
&edic Alert *racelet
HE&OPHILIA
. lin:ed recessi(e trait
Hemo#!ilia A - deiciency o /actor 2III
Hemo#!ilia 6 - deiciency o actor IK
&ales in!erit !emo#!ilia rom t!eir mot!ers and emales in!erit t!e
carrier status rom t!eir
at!ers
Assessment5
#rolon$ed *leedin$ ater minor in;ury
1. At *irt! ater cuttin$ cord
3. /ollo+in$ circumcision
7. /ollo+in$ I& immuni'ation
9. Increase *ruisin$ as c!ild learns to cra+l and +al:
a*normal *leedin$ in res#onse to trauma
;oint *leedin$ - #ain" tenderness" s+ellin$ limited ran$e o motion
tendency to *ruise easily
#rolon$ed PTT
normal 6T" PT" #latelet count
Im#lementation5
#re#are to administer /actor 2III concentrate Bcryo#reci#itate
a. T!a+ slo+ly
*. Gently rotate *ottle
c. Inuse immediately) deteriorates at room tem#erature
monitor or *leedin$
monitor or ;oint #ain) immo*ili'e t!e aected e.tremity i ;oint #ain
occurs
assess neurolo$ical status = c!ild at ris: or IC *leed>
monitor urine or !ematuria
Control *leedin$ *y immo*ili'ation" ele(ation" a##lication o ice) a##ly
#ressure =1A mins>
or su#ericial *leedin$
instruct #arents re$ardin$ acti(ities o t!e c!ild
a(oidance o contact s#orts
6ETA THALASSE&IA &ACOR
CooleyDs anemia
autosomal recessi(e disorder
c!aracteri'ed *y reduced #roduction o one o t!e $lo*in c!ains in t!e
synt!esis o !emo$lo*in
incidence !i$!est in &editerranean descent
Assessment5
se(ere anemia
#allor
ailure to t!ri(e
!e#atos#lenome$aly
microcytic" !y#oc!romic R6Cs
Im#lementation
Instruct t!e administration o olic acid =2it 6L>
administer *lood transusion as #rescri*ed
&onitor or iron o(erload
iron o(erload - c!elation t!era#y +it! deero.amine
$enetic counselin$
IDIOPATHIC THRO&6OC8TOPENIC P%RP%RA
increased destruction o #latelets +it! resultant #latelet count less t!an
100"000Bmm7
c!aracteri'ed *y #etec!iae and ecc!ymoses o s:in
e.act mec!anism un:no+n
oten #receded *y a (iral illness
s#leen not enlar$e
Assessment5
#etec!iae5 s#ider +e* a##earance o *leedin$ under t!e s:in due to
small si'e o #latelets
ecc!ymosis
*lood in any *ody secretions" *leedin$ rom mucus mem*ranes"
nose*leeds
dia$nostic test5 #latelet count decreases" anemia
&ana$ement5
steroids and immunosu##ressi(es
#latelet transusion
sur$ery) s#lenectomy
Nursin$ Inter(ention
control *leedin$
1. Administer #latelet transusion as ordered
3. A##ly #ressure to *leedin$ sites as needed
7. Position *leedin$ #art a*o(e !eart le(el i #ossi*le
Pre(ent *ruisin$
Protect rom inection
&easure normal circumerence o e.tremities or *aseline
Administer meds orally" rectally or I2 rat!er t!an I&) !old #ressure on site
or A mins
A(oid as#irin
Pro(ide client teac!in$ and disc!ar$e #lannin$
1. Pad cri* and #lay#en
3. Pro(ide sot toys
7. Pro(ide #rotecti(e !ead$ear durin$ toddler!ood
9. %se sot toot!*rus!
A. A(oid contact s#orts
INTEGUMENTARY SYSTEM
ECME&A
ato#ic dermatitis ? oten t!e irst si$n o an aller$ic #redis#osition in a
c!ild
usually maniests durin$ inancy
Asssessment5
eryt!ema" +ee#in$ (esicles t!at ru#ture and crusts
se(ere #ruritus) scratc!in$ causes t!ic:enin$ and dar:enin$
dry s:in" sometimes urticaria
Inter(ention5
to#ical steroids
anti!istamines
coal tar #re#aration
colloid *at!s
diet t!era#y5 elimination o oendin$ ood
Nursin$ Inter(ention5
a(oid !eat and #re(ent s+eatin$
c!ec: materials in contact +it! c!ildDs s:in =s!eets" lotions" soa#>
a(oid re4uent *at!s
a(oid use o soa#
#ro(ide lu*ricant immediately ater *at!
administer to#ical steroids as ordered
use cotton instead o +ool
:ee# c!ildDs nails s!ort) use el*o+ or $lo(e restraints i needed
a##ly +et saline or 6urro+Ds solution com#resses
DIAPER RASH
contact dermatitis
#lasticBru**er #ants and linin$s o dis#osa*le dia#ers
e.acer*ate t!e condition *y #rolon$in$ contact +it!
moist" +arm en(ironment
s:in urt!er irritated *y acidic urine
Assessment5
eryt!emaBe.coriation in t!e #erineal area
irrita*ility
Nursin$ inter(ention5
:ee# area clean and dry) clean +it! mild soa# and +ater ater eac! stool
and soon as c!ild urinates
ta:e o dia#er and e.#ose area to air durin$ t!e day
client teac!in$5
1. Pro#er !y$iene
3. A(oid use o #lastic #ants or dis#osa*le dia#ers +it! a #lastic linin$
7. A(oid commercially #re#ared dia#er +i#es containin$ alco!ols
9. A(oid cornstarc!) $ood medium or *acteria
&%SC%LOS<ELETAL S8STE&
Care o t!e c!ild +it! a Cast
i cast is o #laster - +ill remain +et or at least 39 !rs
use only t!e lats o t!eir !ands to mo(e c!ildren
casts must remain o#en to t!e air until dry
casted e.tremities are ele(ated to !el# *lood return and reduce s+ellin$
Initial c!emical !ardenin$ reaction may cause a c!an$e in an inantDs
*ody
C!oose toys too *i$ to it do+n cast
do not use *a*y #o+der near cast - medium or *acteria
#re#are or antici#ated castin$ *y !a(in$ c!ild !el# a##ly cast in a doll
Dia$noses and inter(entions5
1. Potential or alteration in tissue #erusion related to constriction o cast
C!ec: color" sensation and motion distal to t!e cast e(ery !al !our
C!ec: #edal or radial #ulse
C!ec: or ti$!tness *y sli##in$ in$er under ed$e) i im#ossi*le - cast is
too ti$!t
As: c!ild to mo(e toes or in$ers
Ele(ate casted e.tremity
3. Potential or alteration in s:in inte$rity
Remo(e #laster la:es rom s:in
Handle +et cast careully so as not to cause indentations
E.#ose +et cast to air to !asten dryin$
Su##ort !ea(y cast +it! slin$ or #illo+ to decrease #ressure o cast ed$es
C!ec: cast or oul or musty odors
7. Potential or ear and loneliness
Encoura$e e.#ression o eelin$s
Pro(ide di(ersional #lay
Encoura$e riends and amily to (isit c!ildren as oten
Pro(ide educational o##ortunity or c!ildren conined or lon$ #eriods
9. Potential or :no+led$e deicit o amily
Encoura$e discussion o eelin$s and ears
Pro(ide inormation and reassurance as a##ro#riate
In(ol(e amily in c!ildDs care in !os#ital
Pre#are amily or some emotional re$ression
CONGENITAL HIP DISLOCATION
dis#lacement o t!e !ead o t!e emur rom t!e aceta*ulum
#resent at *irt! alt!ou$! not al+ays dia$nosed
amilial disorder
un:no+n cause) may *e etal #osition in utero
aceta*ulum is s!allo+ and t!e !ead o emur is cartila$inous at *irt!
Assessment5
may*e unilateral or *ilateral
limitation o a*duction =cannot s#read le$s to c!an$e dia#er>
OrtolaniDs clic:
a. ,it! an inant su#ine" *end :nees and #lace t!um* on *ent :nees"
in$ers at !i# ;oint
*. 6rin$ emur L0de$rees to !i#" t!en a*duct
c. Pal#a*le clic: - dislocation
6arlo+Ds test
a. ,it! inant on *ac:" *end :nees
*. Aected :nee +ill *e lo+er *ecause t!e !ead o t!e emur dislocates
to+ards t!e *ed o $ra(ity
additional s:in olds +it! :nees *ent
+!en lyin$ on a*domen" *uttoc:s o aected side +ill *e latter
Trendelen*ur$ test - i c!ild can +al:
a. Ha(e c!ild stand on aected le$ only
*. Pel(is +ill di# on normal side as c!ild attem#ts to stay erect
&ana$ement5
Goal 5 to enlar$e and dee#en t!e soc:et
Early treatment5 #ositionin$ t!e !i# in a*duction +it! t!e !ead o t!e
emur in t!e aceta*ulum and maintainin$ it in #osition or se(eral mont!s
Traction and castin$ =!i# s#ica>
Sur$ery
Nursin$ inter(ention5
&aintain #ro#er #ositionin$5 :ee# le$s a*ducted
1. %se tri#le dia#erin$
3. %se /re;:a #illo+ s#lint =;um#erli:e suit to :ee# le$s a*ducted>
7. Place inant on a*domen +it! le$s in Gro$H #osition
9. %se immo*ili'ation de(ices
Pro(ide ade4uate nutrition
Pro(ide sensory stimulation
Client teac!in$ and disc!ar$e #lannin$5
CL%6/OOT =Tali#es>
a*normal rotation o oot at an:le
2arus - in+ard rotation) *ottom o eet ace eac! ot!er
2al$us - out+ard rotation
Calcaneous - u#+ard rotation) +ould +al: on !eels
E4uinas - do+n+ard rotation) +ould +al: on toes
&ost common - tali#es e4uino(arus
Assessment5
oot cannot *e mani#ulated *y #assi(e e.ercises into correct #osition
&ana$ement5
e.ercises
castin$
Denis 6ro+ne s#lint =*ar s!oe>
sur$ery and castin$
Nursin$ Inter(ention5
#erorm e.ercises as ordered
#ro(ide cast care
c!ild +!o is learnin$ to +al: must *e #re(ented rom tryin$ to stand)
a##ly restraints i necessary
#ro(ide di(ersional acti(ities
#ro(ide s:in care
client teac!in$
SCOLIOSIS
lateral cur(ature o t!e s#ine
most commonly in adolescent $irls
amilial #attern) associated +it! ot!er nueromuscular condition
idio#at!ic ma;ority
Assessment5
ailure o cur(e to strai$!ten +!en c!ild *ends or+ard +it! :nees
strai$!t and arms !an$in$ do+n eet
une(en *ra stra# mar:s
une(en !i#s
une(en s!oulders
asymmetry o ri* ca$e
.ray5 re(eals cur(ature
&ana$ement5
stretc!in$ e.ercises
&il+au:ee *race - +orn 37 !oursBday or 7 years
#laster ;ac:et (est
s#inal usion

Nursin$ Inter(ention5
teac!Bencoura$e e.ercise
#ro(ide care or t!e c!ild +it! &il+au:ee *race
a. C!ild +ears *race 37 !oursBday
*. &onitor #ressure #oints
c. Promote #ositi(e *ody ima$e +it! *race
Pro(ide cast care
Assist +it! modiyin$ clot!in$ or immo*ili'ation de(ices
Ad;ust diet +it! decreased acti(ity
Pro(ide client teac!in$ and disc!ar$e instructions
a. E.ercise
*. Cast care
c. Correct *ody mec!anics
d. Alternati(e education or lon$ term !os#itali'ation
e. A(aila*ility o community a$encies
C%2ENILE RHE%&ATOID ARTHRITIS
systemic" c!ronic disorder o connecti(e tissue
autoimmune reaction
results rom e(entual ;oint destruction
aected *y stress" climate and $enetics
Ty#es5
1. &onoarticular CRA
/e+er t!an 9 ;oints in(ol(ed =usually le$s>
Asymmetric
Good #ro$nosis
&ild si$ns o art!ritis
3. Polyarticular CRA
&ulti#le ;oints aected
Symmetrical
In(ol(ement o T&C
Remissions and e.acer*ations
#oor #ro$nosis
7. Systemic disease +it! #olyart!ritis =StillDs disease>
/e(er" ras!" LADP" anore.ia" +ei$!t loss
E.acer*ations and remissions
Assessment5
No s#eciic dia$nostic tests
ESR" ASO" R/? not s#eciic
Inter(ention
Dru$s5 ASA" corticosteroids
NSAIDS
P!ysical t!era#y - stren$t!enin$ muscles" #re(entin$ deormities
S#lints - used or :nees" +rists and !ands - to reduce #ain and #re(ent
or reduce le.ion deormities
Nursin$ inter(ention5
Assess ;oints or #ain" s+ellin$" tenderness
#romote maintenance o ;oint mo*ility
a. RO& e.ercises
*. Isometric e.ercises
c!an$e #osition re4uently) alternate sittin$" standin$" lyin$
#romote comort and relie
#ro(ide irm mattress
maintain #ro#er *ody ali$nment
:ee# ;oints mainly in e.tension" not le.ion
cold treatments5 in acute e#isodes
ocus on c!ildDs stren$t!
GENITO%RINAR8 S8STE&
Ne#!rons continue to de(elo# ater *irt!
G/R is 701 *elo+ adult le(el at *irt!
reac!es normal le(el *y a$e 3 years
tu*ular unction immature at *irt!) reac! adult le(el
*y a$e 3 years
uret!ra s!orter in c!ildren and more #rone to ascendin$
inection
%NDESCENDED TESTES =Cry#torc!idism>
unilateral or *ilateral a*sence o testes in scrotal sac
testes normally descend at E mont!s o $estation
increased incidence in t!ose +it! $enetic disorder
FA1 +ill descend s#ontaneously *y a$e 1 year
Assessment5
una*le to #al#ate testes in scrotal sac
&ana$ement5
i testes remains in a*domen" dama$e to testes is #ossi*le *ecause o
increased
c!orionic $onadotro#in
orc!i#e.y5 sur$ical #rocedure to retrie(e and secure testes #lacement)
#erormed *et+een a$es 1?7 yrs
Nursin$ &ana$ement5
#ro(ide treatment o#tions
su##ort #arents i sur$ery +ill *e done
#ost o#5 a(oid distur*in$ t!e tension mec!anism
a(oid contamination o incision
H8POSPADIAS
uret!ral o#enin$ located any+!ere alon$ t!e (entral surace o #enis
Assessment5
urinary meatus mis#laced
ina*ility to ma:e strai$!t stream o urine
&ana$ement5
minimal deects - no inter(ention
neonatal circumcision delayed" tissue may*e needed or correcti(e re#air
sur$ery at a$e 7?L mont!s
Nursin$ Inter(ention5
dia#er normally
#ro(ide su##ort or #arents
#ost o#5 c!ec: #ressure #ressure dressin$
monitor cat!eter draina$e
PHI&OSIS
an a*normal narro+in$ o t!e ores:in so t!at it cannot *e retracted o(er
t!e $lans #enis
may *e #resent at *irt! or may de(elo# as a result o #oor !y$iene +it!
accumulation o sme$ma
&ana$ement5
Pre(ention - re$ular #ullin$ t!e ores:in *ac: and cleanin$
circumcision
Nursin$ inter(ention5
circumcision care5
1. Close o*ser(ation or *leedin$
3. Ice a##lication
7. Administration o anal$esics
EN%RESIS
in(oluntary #assa$e o urine ater t!e a$e o control is e.#ected =9 years>
ty#es5
1. Primary - in c!ildren +!o !a(e ne(er ac!ie(ed control
3. Secondary5 in c!ildren +!o !a(e de(elo#ed com#lete
control
&ay occur anytime *ut most re4uent at ni$!t
&ore common in *oys
No or$anic cause
Etiolo$ic #ossi*ilities5
1. Slee# distur*ances
3. Delayed neurolo$ic de(elo#ment
7. Immature de(elo#ment o *ladder
9. Psyc!olo$ic #ro*lems
Assessment5
PE normal
History o re#eated (oluntary urination mana$ement5
*ladder retention e.ercises
dru$ t!era#y
1. TCA - imi#ramine
3. Antic!oliner$ics
Nursin$ Inter(ention5
Pro(ide inormationBcounselin$ to amily5
1. Conirm t!at t!is not conscious *e!a(ior and t!at t!e c!ild is not
#ur#osely mis*e!a(in$
3. Assure #arents t!at t!ey are not res#onsi*le and t!at t!is is a relati(ely
common #ro*lem
In(ol(e c!ild in care) $i(e #raises and su##ort +it! small accom#lis!ments
1. A$e A?@ years - can stri# +et *eddin$s
3. A$e 10?13 years - can do laundry and c!an$e *ed
A(oid scoldin$ and *elittlin$ t!e c!ild
EKSTROPH8 O/ THE 6LADDER
con$enital malormation ) nonusion o a*dominal
and anterior +alls o t!e *ladder durin$ em*ryolo$ic
de(elo#ment
anterior surace o *ladder lie o#en on a*dominal +all
Assessment5
Associated structural c!an$es
1. Prola#sed rectum
3. In$uinal !ernia
7. ,idely s#lit sym#!ysis
9. Rotated !i#s
Associated anomalies
1. E#is#adias
3. Clet scrotum or clitoris
7. %ndescended testes
9. C!ordee =do+n+ard delection o t!e #enis>
&ana$ement5
reconstructi(e sur$ery
urinary di(ersion
delayed until 7?@ mont!s
Nursin$ inter(ention5 Preo#5
Pro(ide *ladder care) #re(ent inection
a. <ee# area as clean as #ossi*le
*. C!an$e dia#er re4uently) :ee# loose ittin$
c. ,as! +it! mild soa# and +ater
d. Co(er e.#osed *ladder +it! (aseline $au'e
Posto#5
Desi$n #lay acti(ities to oster toddlerDs need or autonomy
? c!ild +ill *e immo*ili'ed or e.tended #eriod o time
Pre(ent trauma) as c!ild $ets older and more mo*ile"
trauma is more li:ely
NEPHROTIC S8NDRO&E
autoimmune #rocess
structural alteration o $lomerular mem*rane
results in increased #ermea*ility* to #lasma #roteins
course5 e.acer*ations and remissions o(er a #eriod o mont!s to years
commonly aects #resc!oolers) *oysI$irls
Assessment5
1. Proteinuria
3. Hy#o#roteinemia
7. Hy#erli#idemia
9. De#endent edema
Puiness around t!e eyes in mornin$
Ascites
Scrotal edema
An:le edema
A. anore.ia" (omitin$" diarr!ea
@. Pallor" let!ar$y
F. He#atome$aly
&ana$ement5
dru$ t!era#y
1. Corticosteroids
3. Anti*iotics
7. T!ia'ide diuretics
Nursin$ Inter(ention5
Pro(ide *ed rest
1. Conser(e ener$y
3. /ind acti(ities or 4uiet #lay
Pro(ide !i$! #rotein" lo+ sodium diet - durin$ edema #!ase
&aintain s:in inte$rity
A(oid I& in;ections - meds not a*sor*ed in edematous tissues
O*tain mornin$ urine or #rotein studies
Pro(ide scrotal su##ort
&onitor I and O" (ital si$ns
Daily +ei$!t
Administer as ordered
Protect rom sources o inection
AC%TE GLO&ER%LONEPHRITIS
immune com#le. disease
*eta !emolytic stre#
&ore re4uently in *oys) @?F years
resol(es in 19 days
sel limitin$
Assessment5
1. History o stre# inection =%RTI or im#eti$o>
3. Edema" anore.ia" let!ar$y
7. Hematuria or dar: colored urine
9. /e(er
A. Hy#ertension
@. Dia$nostic tests5
%rinalysis - r*c"+*c"#rotein" cellular casts
%rine s#eciic $ra(ity increased
6%N" crea increased
ESR ele(ated
H$*" Hct decreased
&ana$ement5
anti*iotics
Anti!y#ertensi(es
di$italis - i +it! CH/
luid restriction
#eritoneal dialysis - i se(ere renal com#lication occurs
Nursin$ &ana$ement5
1. &onitor I and O" 6P
3. ,ei$! daily
7. Pro(ide di(ersional acti(ity
9. Pro(ide client teac!in$ and disc!ar$e #lannin$
&edication administration
Pre(ention o inection
Si$ns o renal com#lications
Im#ortance o lon$ term ollo+ u#
,IL&DS T%&OR =NEPHRO6LASTO&A>
lar$e" enca#sulated tumor t!at de(elo#s in t!e renal #arenc!yma"
more re4uently in let :idney
ori$inates durin$ etal lie
#ea: a$e 5 1?7 years
Assessment5
non tender mass" usually midline near li(er
!y#ertension
!ematuria
test5 I2P
Nursin$ inter(ention5
1. Do not #al#ate a*domen - to a(oid dissemination o CA cells
3. Handle c!ild careully +!en *at!in$ and $i(in$ care
7. Pro(ide care or t!e client +it! a ne#!rectomy
9. Pro(ide care or t!e c!ild recei(in$ c!emot!era#y
MALFORMATIONS OF THE NERVOUS SYSTEM
Cranial Deects5
1. Craniosynostosis
one or more o t!e sutures close too soon
ICP increases) intereeres +it! normal *rain $ro+t! &R
Assessment5
suture lines o t!e s:ull manually #al#ated
Radio$ra#!s are made to conirm
3. &icroce#!aly
T!e *rain ails to $ro+
&ay *e due to a c!romosomal deect or rom dru$s" to.ins or radiation
&R
7. Hydroce#!alus
Im*alance o CS/ a*sor#tion or #roduction
caused *y malormations" tumors" !emorr!a$e" inection" trauma
Ty#es5
1. Communicatin$ - im#aired a*sor#tion +it!in arac!noid s#ace
3. Non?communicatin$ - o*struction o CS/ lo+ +it!in t!e (entricular
system
Assessment5
Inant - increased HC
&ace+enDs si$n - crac:ed?#ot sound on #ercussion o *ones o !ead
Anterior ontanel tense" *ul$in$
Scal# (eins dilated
/rontal *ossin$" sunsettin$ eyes
C!ild - *e!a(ior c!an$es
Headac!e" nausea and (omitin$
Ata.ia" nysta$mus
Sur$ical Im#lementation5 Hydroce#!alus
Goal5 to #re(ent urt!er CS/ accumulation *y *y#assin$ t!e *loc:a$e and
drainin$ t!e luid rom t!e (entricles to a location +!ere it may *e
rea*sor*ed
1. 2P S!unt - CS/ drains into t!e #eritoneal ca(ity rom t!e lateral (entricle
3. A2 s!unt - CS/ drains into t!e ri$!t atrium
PostOP Care5
1. <ee# c!ild lat as #rescri*ed - to a(oid ra#id reduction o intracranial luid
3. O*ser(e increase ICP - i #resent" ele(ate HO6 1A?70 de$
7. &onitor or inection
9. &easure HC
A. &onitor I and O
@. Pro(ide comort measures) administer medications =diuretics" anti*iotics"
or anticon(ulsants>
F. Toddler - !eadac!e and anore.ia earliest common si$ns o s!unt
malunction
SPINA 6I/IDA
CNS deect t!at occurs as a result o neural tu*e ailure to
close durin$ em*ryonic de(elo#ment
deect closure usually done durin$ inancy
Ty#es5
1. S#ina *iida occulta
Posterior (erte*ral arc!es ail to close in t!e lum*osacral area
S#inal cord intact) not (isi*le
&enin$es not e.#osed on t!e s:in suraces
3. &enin$ocoele
Protrusion in(ol(es menin$es and a sac?li:e cyst
Lum*osacral area
7. &yelomenin$ocoele
Protrusion o menin$es" CS/" ner(e roots" #ortion o s#inal cord
Sac co(ered *y a t!in mem*rane may ru#ture or lea:
Neuro deicit e(idence
Assessment5
De#ends on s#inal cord in(ol(ement
2isi*le s#inal deect
/laccid #aralysis o le$s
Altered *ladder and *o+el unction
Im#lementation5
E(aluate sac) measure lesion
neuro c!ec:
monitor or increase ICP
measure HC) assess ontanelles
Protect t!e sac
1. Co(er +it! sterile" moist =normal saline> non?ad!erent
dressin$
3. C!an$e dressin$ e(ery 3?9 !ours
Place #rone #osition
!ead is turned to one side or eedin$
dia#erin$ may *e CBI until deect re#aired
Ase#tic tec!ni4ue
,atc! or early si$ns o inection
Administer anti*iotics
Administer antic!oliner$ics - im#ro(e urinary continence
Administer la.ati(es " antis#asmodics
&ENINGITIS
inectious #rocess o t!e CNS caused *y *acteria and (iruses
ac4uired as a #rimary or as a result o com#lications
dia$nosis - CS/ analysis =increase #ressure" cloudy CS/" !i$! #rotein"
lo+ $lucose
*acterial or (iral
Assessment5
si$ns and sym#toms (ary de#endin$ o a$e $rou#
e(er" c!ills
(omitin$" diarr!ea
#oor eedin$ or anore.ia
altered LOC
*ul$in$ anterior ontanel
nuc!al ri$idity
Im#lementation5
isolation) maintain or at least 39 !ours ater anti*iotics are initiated
administer anti*iotics as #rescri*ed
monitor 2S and neuro status
&onitor I and O
assess nutritional status
determine close contacts o t!e c!ild +it! menin$itis
SEIM%RE DISORDERS
Sudden transient alterations in *rain unction resultin$ rom e.cessi(e
le(els o electrical acti(ity in t!e *rain
Assessment5
o*tain inormation rom #arents a*out t!e time o onset" #reci#itatin$
e(ents and *e!a(ior *eore and ater t!e sei'ure
sei'ure #recautions5
1. Raise side rails
3. Pad side rails
7. Place +ater#roo mattress on *ed
9. Instruct c!ild to s+im +it! com#anion
A. Alert care$i(ers to t!e need or s#ecial #recautions
Emer$ency Treatment or Sei'ures5
Ensure #atency o air+ays
I t!e c!ild is standin$ or sittin$" ease t!e c!ild do+n to t!e loor
#lace #illo+ or olded *lan:et under t!e c!ildDs !ead
loosen restricti(e clot!in$
clear area o any !a'ards
i (omitin$ occurs" turn c!ild to one side
do not restrain c!ild) do not #lace anyt!in$ in t!e c!ildDsmout!
Remain +it! t!e c!ild until ully reco(ers
Pre#are to administer medications
CERE6RAL PALS8
disorder c!aracteri'ed *y im#aired mo(ement and #osture resultin$ rom
an a*normality in t!e e.tra#yramidal motor system
s#astic ty#e? most common
Assessment5
e.treme irrita*ility and cryin$
eedin$ diiculties
sti and ri$id arms and le$s
delayed $ross de(elo#ment
a*normal motor #erormance
alterations o muscle tone
a*normal #osturin$
#ersistence o #rimiti(e rele.es
Im#lementattion5
early reco$nition
PT" OT" s#eec! t!era#y" eduaction and recreation
assess t!e c!ildDs de(elo#mental le(el and intelli$ence
early inter(ention
encoura$e communication and interaction +it! t!e c!ild on a unctional
le(el
#ro(ide sae en(ironment
#osition u#ri$!t ater meals
#ro(ide sae" a##ro#riate toys or a$e and de(elo#mental le(el