copyright © 2008 wolters kluwer health | lippincott williams & wilkins the infant with a major...

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Infant With a Major Illness

Chapter 17


Factors That Determine Manifestations of Health Problems in Infants

• Pathogenic agent

• The environment

• The infant

Most acute health problems result from a respiratory or gastrointestinal (GI) infection or from a congenital deviation


Sensory Disorders: Otitis Media• Any disorder related to the senses can significantly

impact the infant’s development

• Symptoms are repeated shaking of head and rubbing or pulling at one ear; fever, irritability, and hearing impairment

• Diagnosis is bright-red, bulging eardrum and drainage; rupture may occur

• Treatment is with antibiotics; amoxicillin is common

• Repeated otitis media is treated with prophylactic oral penicillin or sulfonamide

• Mastoiditis is a complication of untreated otitis media


Neurologic Disorders: Acute or Nonrecurrent Seizures

• In children between 6 months and 3 years of age, febrile seizures are most common

– May occur suddenly without warning

– Treatment based on presenting symptoms

– Treatment: protection; diazepam (Valium) for continuous seizure activity; acetaminophen


Monitoring for Complications of Seizures

• Signs of increased intracranial pressure (IICP)

• Preventing aspiration

• Keeping child safe

• Monitoring intake and output

• Supporting the child’s family


Nursing Process for the Child at Risk for Seizures

• Assessment: family caregiver interview, ask about history of seizures and presence of fever

• Baseline temperature and physical exam

• Nursing diagnoses: risk for aspiration, risk for injury, compromised family coping, deficient knowledge of caregivers

• Outcome identification and planning: prevent aspiration and prevent injury


Nursing Process for the Child at Risk for Seizures (cont.)

• Implementation

– Prevention of aspiration

– Safety

– Family coping

– Family teaching

• Evaluation


Neurologic Disorders: Haemophilus Influenzae Meningitis

• Peaks between ages 6 and 12

• Spread by droplet infection from an infected person

• HIB vaccine at 2, 4, 6, and 12 months of age

• High-pitched cry, irritability, fever, headache, nuchal rigidity, projectile vomiting

• Lumbar puncture

•Complications:

– Hydrocephalus

– Nerve deafness

– Mental retardation

– Paralysis


Two Positions for a Lumbar Puncture


Treatment of Haemophilus Influenzae Meningitis

• IV antibiotics, based on sensitivity studies

• IV steroid early in the course has decreased the incidence of deafness as a complication

• If seizures occur, anticonvulsants are often given


Nursing Process for the Child With Meningitis

• Assessment

• Nursing diagnoses

• Outcome identification and planning


Nursing Process for the Child With Meningitis (cont.)

• Implementation

– Monitoring for complications

– Prevention of aspiration

– Safety

– Fluid balance

– Family teaching

– Family coping

• Evaluation


Respiratory Disorders

• Acute nasopharyngitis (common cold)

• Most common complication is otitis media

• Illness of viral origin

– Fever: older than 3 months, congested nasal passages, vomiting, diarrhea

– May be first symptom of childhood contagious diseases, such as measles

• Treatment and nursing care


Acute Bronchiolitis/Respiratory Syncytial Virus Infection

• Most common during first 6 months of life; rare after age 2

• Viral infection

• Causative agent in 50% is RSV

• Dyspnea, cough, nasal drainage, shallow respirations, marked cyanosis, sternal retraction, respiration rate 60-80 breaths per minute, fever, dehydration

• Diagnosis: clinical findings and ELISA of mucus by nasal aspiration or nasopharyngeal washing


Treatment of Acute Bronchiolitis/Respiratory Syncytial Virus Infection

• Mist tent, rest, increased fluids, oxygen

• Antibiotics are not prescribed because the causative organism is a virus

• IV fluids

• Contact transmission precautions

• Ribavirin (Virazole): category X drug for severe or complicated RSV

– Women who are pregnant should stay out of the room where ribavirin is being administered


Respiratory Disorders (cont.)

• Bacterial pneumonia: occurs secondary to upper respiratory viral infection

– Clinical manifestations: follows mild upper respiratory illness, fever, respiratory distress, flaring nostrils, circumoral cyanosis, chest retractions, convulsions

– Diagnosis: symptoms, chest x-ray, culture

– Treatment: penicillin or ampicillin; if penicillin allergy, use cephalosporin anti-infectives


Nursing Process for the Child With Pneumonia

• Assessment



See Nursing Care Plan 17.1


Implementation of Nursing Process for Child with Pneumonia

• Implementation

– Maintaining airway clearance

– Monitoring respiratory function

– Promoting adequate fluid intake

– Maintaining body temperature

– Promoting energy conservation

- Preventing additional infections

- Reducing the child’s anxiety

- Promoting family coping

- Providing family teaching

• Evaluation


Cardiovascular Disorders: Congestive Heart Failure

• Occurs when blood and fluids accumulate in the organs and body tissues

• Heart loses ability to pump and circulate

• Fatigue, feeding problems, failure to gain weight; pale, mottled, or cyanotic color; tachycardia, rapid respirations; dyspnea; flaring nostrils; use of accessory muscles

• Based on clinical symptoms; chest radiograph reveals enlarged heart; ECG; echocardiogram


Treatment of Congestive Heart Failure

• Cardiac glycosides: Lanoxin

• ACE inhibitors: Capoten, Vasotec

• Diuretics: Lasix, Aldactone

• Fluid restriction

• Physical activity limitation

• Improving tissue oxygenation

Nursing process:

• Assessment



• Implementation

• Evaluation


Hematologic Disorders: Iron Deficiency Anemia

• Below-average body weight, pale mucous membranes, anorexia, growth retardation, and listlessness

• Hemoglobin lower than 11 g/dL or a hematocrit lower than 33%

• Stool tested for occult blood to rule out GI bleed

• Treatment: ferrous sulfate administration between meals with juice (vitamin C aids in iron absorption)


Sickle Cell Disease

• Hereditary trait most common in African Americans

• Production of abnormal hemoglobin that causes the red blood cells to assume a sickle shape

• Chronic anemia


Sickle Cell Crisis

• Viscosity of blood increases

• Impaired circulation results in tissue damage and infarction

• Acute abdominal pain, fever, severe leg pain; hot, swollen joints; board-like abdomen with absent bowel sounds

• Several days after a crisis: jaundice from hemolysis

• Diagnosis: Sickledex screening

• Prevention of crises: hydration, avoid strenuous activity, small blood transfusions; iron preparations have no effect on sickle cell disease

• Nursing process for the child with sickle cell crisis


Thalassemia

• Mild to severe anemias: hemoglobin production is abnormal

• Thalassemia major (Cooley’s anemia): presents in childhood and is the most common of the thalassemia blood disorders; often occurs in people of Mediterranean descent

• Anemia, fatigue, pallor, irritability, anorexia; bone pain and fractures

• Treatment: blood transfusions; diet and medications to prevent heart failure; splenectomy or bone marrow transplant; deferral to treat iron overload


Gastrointestinal Disorders: Malnutrition and Nutritional Problems

• Protein malnutrition

– Kwashiorkor

o Marasmus

• Vitamin deficiency disease

– Vitamin D

– Vitamin C

– Thiamine

– Riboflavin

– Niacin


Gastrointestinal Disorders: Malnutrition and Nutritional Problems (cont.)

• Mineral insufficiencies

• Food allergies

– Milk allergy

– Lactose intolerance


Nursing Process for the Child With Nutritional Problems

• Assessment

• Nursing diagnoses: imbalanced nutrition; less than body requirements; deficient fluid volume; constipation; impaired skin integrity


• Implementation

• Evaluation


Gastrointestinal Disorders: Gastroesophageal Reflux (GER)

• Occurs when the sphincter in the lower portion of esophagus is relaxed and allows gastric contents to be regurgitated back into the esophagus

• Usually noted within first week of life; resolved within first 18 months

• Effortless vomiting, irritable, hungry; possible aspiration

• Diagnostics: endoscopy

• Treatment: Zantac, Prilosec, Nissan fundoplication

• Nursing care


Gastrointestinal Disorders:Diarrhea and Gastroenteritis

• Diarrhea can be mild or severe

• Severe diarrhea can cause the child to become severely dehydrated and gravely ill

• Infectious diarrhea-gastroenteritis

• Stool specimen for culture and sensitivity; antibiotics if indicated

• Treatment: oral rehydration therapy; breast-fed or formula fed; IV fluids

• Nursing process


Other Gastrointestinal Disorders

• Colic: recurrent paroxysmal abdominal pain; disappears at about 3 months of age

• Pyloric stenosis: hypertrophy of the circular muscle fibers of the pylorus, with a severe narrowing of its lumen

• Congenital aganglionic megacolon (Hirschsprung disease): persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin

• Intussusception: telescoping of one portion of the bowel into a distal portion

• Nursing process


Genitourinary Disorders

• Hydrocele: collection of peritoneal fluid that accumulates in the scrotum through a small passage (processus vaginalis)

• Cryptorchidism: occurs when one or both testes do not descend into the scrotum

• Urinary tract infections: Escherichia coli accounts for about 80% of acute episodes

• Wilms’ tumor (nephroblastoma): adenosarcoma in the kidney region

• Nursing process


Integumentary Disorders

• Seborrheic dermatitis (cradle cap)

• Miliaria rubra (prickly heat)

• Diaper rash

• Candidiasis: Candida albicans

• Impetigo: superficial bacterial skin infection

• Atopic dermatitis (infantile eczema)

– Hereditary predisposition

– Hypersensitivity

– Allergens

• Nursing process


Psychosocial Disorders: Nonorganic Failure to Thrive

• Infants who fail to gain weight and who show signs of delayed development

– Organic failure to thrive: result of a disease condition

– Nonorganic failure to thrive (NFTT): has no apparent physical cause


Nursing Process for the Child With Nonorganic Failure to Thrive

• Assessment



• Implementation

• Evaluation

copyright © 2008 wolters kluwer health | lippincott williams & wilkins the infant with a major...

Documents

injury slide

acute health problems

childs family slide

lumbar puncture slide

congenital deviation

nonrecurrent seizures

history of seizures

seizures assessment