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B. Analysis/Nursing Diagnoses
• 1. Altered family process related to having
a seriously ill child
• 2. Risk for infection related to shunt
• 3. Risk for injury related to increased
intracranial pressure
• 4. Risk for skin breakdown related to
immobility
Planning/Implementation
• 1. Prevent breakdown of scalp, infection, and
damage to spinal cord
– a. Place the infant in a Fowler's position to
facilitate draining of fluid; infant should be
positioned flat postoperatively with no pressure on
shunted side
– b. When holding the infant, support the neck and
head
– c. Observe shunt site (abdominal site in peritoneal
procedure) for infection
• 2. Monitor for increasing intracranial pressure
– a. Carefully observe neurologic signs
– b. Measure head circumference
– c. Use minimal sedatives or analgesics, which can
mask symptoms
– d. Check the valve frequently for patency
Promote adequate nutrition
– a. Monitor for vomiting, irritability,
lethargy, and anorexia, because these
will decrease the intake of nutrients
– b. Perform all care before feeding to
prevent vomiting; hold infant if possible
– c. Observe for signs of dehydration
NURSING INTERVENTIONS
1. Obtain a careful pregnancy, birth, and childhood history
2. Limit stimulation
3. Assist in ADL, demonstration of procedure is essential
4. Provide a safe environment ( safety helmet, padded
crib )
5. PT
Meningitis
• A. Most common CNS infection of
infants and children
• B. Inflammation of the meninges
by viral or bacteria that travel
via the cerebrospinal fluid
Classification: culture of cerebrospinal fluid
used to help identify organism
A. Assessment
• 1. Fever
• 2. Headache, irritability
• 3. Vomiting
• 4. Seizures
• 5. Nuchal rigidity
B. Analysis/Nursing Diagnoses
• 1. Altered family processes related to
having a child with a serious illness
NURSING:
Oxygenation
Emotional Support
Education
Ventricular Septal Defect
• A ventricular septal defect (VSD),
which is a hole between the 2 lower
chambers of the heart, may occur as
a primary anomaly with or without
additional major associated cardiac
defects
• VSD is a developmental defect of the
interventricular septum whereby a
communication exists between the
cavities of the two ventricles.
Manifestations
• Infants with small defects
– Normal vital signs
– Clear lungs
– Absence of jugular venous distension
(JVD), hepatomegaly, or edema
– Mildly hyperactive precordial impulse
– Second heart sound (S2): S2 may be
obscured entirely by the holosystolic
murmur, which is well localized at the
left sternal border.
Manifestations
• Infants with large VSDs
– Cyanosis
– Clubbing
– Erythrocytosis
– Prominent RV lift, maximal in xiphoid region, revealed on
palpation
– Very short or no systolic murmur
– S2 - Loud, palpable, single, or closely split
– S3 of right ventricular origin - May be present
– Squatting in 15% of patients
• Hemoptysis: Hemoptysis occurs in 33% of patients
(never in patients <24 y); it occurs in 100% of
patients by age 40 years and contributes to cause of
death.
Management
– Furosemide in a dosage of 1-3 mg/kg/d in 2 or
3 divided doses is used. Long-term furosemide
treatment results in hypercalcemia and renal
damage and electrolyte disturbances. Increase
the caloric density of the feedings.
– Captopril in a dosage of 0.1-0.3 mg/kg 3 times
daily can be useful to reduce systemic
afterload.
– Digoxin in a dosage of 5-10 mcg/kg/d may be
indicated if diuresis and afterload reduction do
not relieve symptoms adequately
Patent Ductus Arteriosus
• The ductus arteriosus is normally patent during fetal
life. This patency is promoted by continual production
of prostaglandin E2 (PGE2) by the ductus.
Prostaglandin antagonism, such as maternal use of
nonsteroidal anti-inflammatory medications, can
cause fetal closure of the ductus arteriosus. This can
be associated with severe fetal cardiovascular
compromise.
• Normally, functional closure of the ductus arteriosus
occurs by about 15 hours of life in healthy infants
born at term. This occurs by abrupt contraction of the
muscular wall of the ductus arteriosus, which is
associated with increases in the partial pressure of
oxygen (PO2) coincident with the first breath.
Manifestations
– The apical impulse is laterally displaced.
A thrill may be present in the
suprasternal notch or in the left
infraclavicular region.
– The first heart sound (S1) is typically
normal. The second heart sound (S2)
often is obscured by the murmur
• MANAGEMENT
– Surgical ligation
Cyanotic Heart Defects
• Tetralogy of fallot
– Pulmonary stenosis
– Coarctation of the Aorta
– Ventricular Septal Defect
– Right Ventricular Hypertrophy
• Symptoms Depends on the degree of
pulmonary stenosis
Cyanotic Heart Defects
ASSESSMENT
S/SX= CYANOSIS, Polycythemia, clubbing of
digits, poor growth, squatting, risk for blood
clots, CHF( LEFT SIDE )
A.3. NURSING INTERVENTIONS
a.3.1. Don’t interfere when squatting
a.3.2. Organize care
a.3.3. Administer oxygen
a.3.4. Meet needs quickly
a.3.5. Use soft nipple for feeding
a.3.6. Provide careful skin care
a.3. 7. Antibiotic prophylaxis
RHD
• Caused by GABHS
• Signs and symptoms
– Fever
– Migratory poly arthritis
– Malnourished
• Treatment:
– Aspirin
– Sumapen
– Supportive
Disorder of the
Hematologic
System
SICKLE CELL ANEMIA
• A. Autosomal disorder affecting hemoglobin
• B. Defective hemoglobin causes red blood cells
to become sickle shaped and clump together
under reduced oxygen tension; initially fetal
hemoglobin prevents sickling
MEDICAL MANAGEMENT
b.1. Drug therapy: UREA,
ANALGESIC/NARCOTICS( avoid aspirin ), ANTIBIOTICS
b.2. Exchange/blood transfusion
b.3. Hydration
b.4. Bed rest
b.5. Surgery
SICKLE CELL ANEMIA
ASSESSMENT FINDINGS
1. Abdomen ( first sign: colic )
2. Lower extremities ( hand-foot syndrome,
ulcers)
3. Spleen ( splenomegaly )
4. Bones ( osteoporosis )
5. Nervous system ( CVA )
6. Kidneys ( infarts, enuresis )
7. Heart ( Heart failure = hemosiderosis )
8. Genitals (impotence)
SICKLE CELL ANEMIA
Vasoocclusive crisis (pain episode): most
common and non–life-threatening
– a. Results from sickled cells obstructing
blood vessels, causing occlusion,
ischemia, and potential necrosis
– b. Symptoms include fever, acute
abdominal pain (visceral hypoxia), hand-
foot syndrome, priapism, and arthralgia
without an exacerbation of anemia
SICKLE CELL ANEMIA
2. Splenic sequestration crisis
• a. Results from the spleen pooling large
quantities of blood, which causes a
precipitous drop in blood pressure and
ultimately shock
• b. Acute episode occurs most commonly in
children between 8 months and 5 years of
age; can result in death from anemia and
cardiovascular collapse
• c. Chronic manifestation is termed
functional asplenia
SICKLE CELL ANEMIA
3. Aplastic crisis: diminished red blood cell production
• a. May be triggered by a viral or other infection
• b. Profound anemia results due to rapid destruction
of red blood cells combined with a decreased
production
NURSING INTERVENTIONS
1. Hydration & oxygenation
2. Avoid tight clothing
3. Bed rest
4. Correct metabolic acidosis
5. Decrease emotional stress
SICKLE CELL ANEMIA
Therapeutic interventions
• 1. Prevention of sickling phenomenon
– a. Adequate oxygenation
– b. Adequate hydration
– c. Administration of hydroxyurea to limit
sickling
• 2. Treatment of crisis
– a. Rest
– b. Hydration/electrolyte replacement
– c. Pain management
– d. Antibiotic therapy
– e. Blood products
SICKLE CELL ANEMIA
Assessment
• 1. Vital signs
• 2. Neurologic signs
• 3. Vision/hearing
• 4. Location and intensity of pain
SICKLE CELL ANEMIA
. Analysis/Nursing Diagnoses
• 1. Body image disturbance related to:
– a. Retarded growth and maturation
– b. Limited activity tolerance
– c. Chronic illness
• ASSESSMENT FINDINGS
1. Olive-size bulge under right rib cage
2. FTT
3. Projectile vomiting
4. Dehydration
• 5. DIAGNOSTIC TEST: UGIS, Serum electrolytes, Hematocrit
PYLORIC STENOSIS
• NURSING INTERVENTIONS
• D.1. PRE-OPERATIVE
• 1. Administer replacement fluids
• 2. Prevent vomiting ( give thickened feeding,
high fowler’s position, place on right side after
feeding )
• 3. Prevent aspiration
• D.2. POST-OPERATIVE
• 1. Advance DAT
• 2. Place on right side after feeding
• 3. Monitor I & O, signs of infection
INTUSSUSCEPTION
GENERAL INFORMATION
– a segment of intestine invaginates into
the adjoining intestinal lumen, causing a
bowel obstruction.
• A. Telescoping of one portion of the
intestine into another; occurs most
frequently at the ileocecal valve
• B. Males affected two times more
frequently than females
• C. Usually occurs between 3 to 12 months
of age
INTUSSUSCEPTION
Classification
• 1. Ileocecal: invagination at the
ileocecal valve; most common type
• 2. Ileoileal: one part of ileum
invaginates on another section of the
ileum
• 3. Colocolic: one part of the colon
invaginates on another section of the
colon
Clinical findings
• 1. Healthy, well-nourished infant or child
who wakes up with severe paroxysmal
abdominal pain, evidenced by kicking
and drawing legs up to the abdomen
• 2. One or two normal stools, then bloody
mucus stool ("currant jelly-like“ stool)
• 3. Palpation of sausage-shaped mass
• 4. Other signs of intestinal obstruction
usually present
MEDICAL MANAGEMENT
Assessment
• 1. Sudden, acute, intermittent
abdominal pain
• 2. Vomiting
• 3. Red "currant jelly-like" stools
• 4. Tender, distended abdomen
INTUSSUSCEPTION
Planning/Implementation
• 1. Same as for any abdominal
surgery
• 2. Make provisions for frequent
parental visits because the problem
usually occurs when the child is 6 to
8 months of age and separation
anxiety is acute
Evaluation/Outcomes
• 1. Child does not show physiologic
manifestation of pain
• 2. Family can verbalize feelings
about the illness
• 3. Child consumes sufficient
nutrients for growth
• 4. Child does not exhibit signs of
dehydration
Analysis/Nursing Diagnoses
• 1. Pain related to invaginating bowel
• 2. Altered family processes related to
having a child with life-threatening illness
• 3. Altered nutrition: less than body
requirements related to:
– a. Decreased intake
– b. Increased peristalsis
• 4. Risk for fluid volume deficit related to:
– a. Vomiting
– b. Diarrhea
CELIAC DISEASE
– Absorptive disorder of the GI tract
• MEDICAL MANAGEMENT
• 1. Diet therapy: BROW free/gluten-
free
• 2. TPN
• ASSESSMENT FINDINGS
• 1 Steatorrhea
• 2. Chronic diarrhea
• 3. FTT
•
CELIAC DISEASE
• 4. Distended abdomen, muscle wasting
• 5. Abdominal pain, listlessness
• 6. Vit A,D,E,K deficiency
• 7. Diagnostic test: ( 1 ) PANCREATIC
ENZYMES & SWEAT CHLORIDE
• TEST ( 2 ) Jejunal &
duodenal biopsy: ATROPHY OF MUCOSA
• NURSING INTERVENTIONS
• 1. Monitor gluten-free diet
• 2. Provide fat-soluble vitamins
Hirschsprung Disease
• Absence of aganglionic nerve in the
portion of the colon
• Characteristic sign:
– Ribbon-like stool
– Symptoms, same as pyloric stenosis
• Management:
– Resection of the colon
– Colostomy
Disorder of the
Renal System
NEPHROSIS/NEPHROTIC SYNDROME
• PATHOPHYSIOLOGY
• 1. PROTEINURIA
• 2. HYPOALBUMINEMIA
• 3. EDEMA
• 4. HYPERLIPIDEMIA
• MEDICAL MANAGEMENT
• 1. DRUG THERAPY: Steroids, antibiotics,
diuretics, Antimetabolites ( Cytoxan )
• 2. Bed rest
• 3. Diet: HIGH PROTEIN, LOW
SODIUM
NEPHROSIS/NEPHROTIC SYNDROME
• ASSESSMENT FINDINGS
• 1. Anorexia, vomiting, diarrhea, malnutrition
• 2. Pallor, lethargy
• 3. Hepatomegaly
• NURSING INTERVENTIONS
• 1. Bed rest 4. I & O and weight
monitoring
• 2. Diet 5. Protect from
known sources of infection
• 3. Maintain skin integrity 6.
Provide scrotal support
•
Pediatric
Oncology
LEUKEMIA
• GENERAL INFORMATION
• TYPES
• b.1. ACUTE LYMPHOCYTIC LEUKEMIA
( ALL )
• b.2. ACUTE NONLYMPHOCYTIC LEUKEMIA
( ANLL )
• MEDICAL MANAGEMENT
• 1. Diagnosis: blood studies, bone marrow biopsy
• 2. Treatment stages
• a. Induction: intense & potentially life
threatening
• b. CNS prophylaxis
• c. Maintenance: 2 to 3 years
LEUKEMIA
• ASSESSMENT FINDINGS
• 1. BLOOD: ANEMIA, BLEEDING,
INFECTION
• 2. Enlarged lymph nodes
• 3. Enlarged spleen & liver
• 4. Abdominal pain with weight loss & anorexia
• 5. Bone pain
• NURSING INTERVENTIONS
• 1. Provide care for client receiving
chemotherapy, radiation therapy
• 2. Support for family & child
WILM’S TUMOR/NEPHROBLASTOMA
• GENERAL INFORMATION
– is the most common type of kidney cancer in children.
About 90% of kidney cancers in children are Wilms
tumors.
• MEDICAL MANAGEMENT
• 1. Nephrectomy( 24-48 hours of diagnosis )
• 2. Radiation therapy
• 3. Chemotherapy: Vincristine, Daunorubicin,
Doxorubicin
• ASSESSMENT FINDINGS
• 1. Mother notices MASS while bathing or dressing child;
nontender, midline near
• liver
• 2. Hypertension, hematuria, anemia
• 3. Diagnostic test: IVP
WILM’S TUMOR/NEPHROBLASTOMA
• NURSING INTERVENTIONS
• 1. DO NOT PALPATE ABDOMEN
• 2. Handle carefully when bathing
• 3. Provide care for a client post
nephrectomy
• 4. Provide care for a client
receiving chemotherapy, radiation
therapy
HODGKIN’S LYMPHOMA
• GENERAL INFORMATION
– is a cancer that starts in lymphatic tissue. Lymphatic
tissue includes the lymph nodes and related organs
that are part of the body's immune and blood-forming
systems.
MEDICAL MANAGEMENT
• 1. DIAGNOSIS: Lymphangiogram, biopsy( REED-
STERNBERG CELLS ),
• splenectomy
• 2. RADIATION THERAPY, CHEMOTHERAPY
• ASSESSMENT FINDINGS
• 1. Enlarged nodes in lower cervical region; nodes are
NONTENDER, PAINLESS,
• FIRM & MOVABLE
• 2. Recurrent, intermittent fever
•
HODGKIN’S LYMPHOMA
• 3. Night sweats
• 4. Weight loss, malaise, lethargy
• 5. Pruritus
• NURSING INTERVENTIONS
• 1. Provide care for child on
chemotherapy, radiation therapy
• 2. Protect from infection if
splenectomy is performed
• 3. Provide support for child/adolescent
parents
POISONING
Poisoning
• A. Ingestion of a toxic substance or
an excessive amount of a substance
• B. More than 90% of poisonings
occur in the home
• C. Highest incidence occurs in
children under 4
• D. Improper storage is the major
contributing factor to poisonings
Poisoning
A. Assessment
• 1. Vital signs
• 2. Need for respiratory or cardiac
support
• 3. Treat other symptoms such as
seizures
• 4. See Clinical Findings under type of
poisoning
Poisoning
Analysis/Nursing Diagnoses
• 1. Altered family processes related to sudden hospitalization
and
emergency aspects of illness