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pediatric disorderscommon problems, disorders and diseases ina. prematurity: - birth before 37th week of gestation 1. associated medical problems maternal placenta previa abruptio placenta cervical incompetence hypertensive disease of pregnancy

infants

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weight fontanels infections tachypnea urine integrity skin integrity apgar scoring

fetal assessment-

gestational age multiple gestations respiratory distress arterial blood gases abnormal breath sounds vernix caseosa signs of birth trauma

feed slowly keep infant warm maintain clear airway rub back or soles of feet to stimulate infants breathing.

nursing interventions

transport infant to special care facility as soon as possible. avoid handling infant more than necessary for feeding and changing of diapers.

general nursing care of infant with physical anomaliesassessment determine the childs immediate physiologic needs to sustain life know the parents immediate emotional needs to promote bonding between child and parents

congenital malformations

nursing diagnosis


anticipated grief related to the loss of perfect child. self-esteem disturbance related to interference with establishing parent-infant bond altered nutrition, less than body requirements, related to malabsorption of necessary nutrients prevent infection establish extra uterine circulation. establish proper waste elimination. establish body temperature control. expose the child to adequate stimulation. establish and maintain adequate respiration. ensure ability to take in adequate nourishment. foster the development of an infant-parent bond. nurses should be familiar with the most frequently encountered physical anomalies so that they can make truthful statements regarding the childs


condition to the parents.

failure of fusion of the maxillary and median nasal processes occurs between 5 to 8 weeks of intrauterine life more common among males than females repaired surgically shortly after birth

cleft lip

an opening of the palate usually found on the midline due to incomplete development may involve the anterior hard palate or the posterior soft palate occurs more frequent in females than in males repair is usually postponed until the child is 18 to 24 months old.

cleft palate

nursing interventions:

cleft lip & palate

preoperatively the child must take an adequate amount of food. feed the child via commercial cleft lip nipple to prevent aspiration postoperatively the infant is kept on npo status for at least 4 hours. bottle or breast-feeding is contraindicated following surgery.


cleft lip & palate

after 3 to 4 days a soft diet is given until healing is complete. when the child begins eating soft food, spoon

should not be used. suction if there is the need to remove mucus, blood and unswallowed saliva.


cleft lip & palate

after cleft lip surgery, do not lay infants on their abdomen. position child on his/her side as soon as awake. clean the suture line with a sterile saline, or 50% hydrogen peroxide in sterile water and sterile cotton-tipped applicators after every feeding


cleft lip & palate

administer acetaminophen as prescribed to make patient comfortable.

a complex of congenital anomalies, including small mandible, cleft palate, other craniofacial abnormalities and defects of the eyes and ears the infant is positioned on the side or a gastrostomy tube may be inserted for feeding. types the esophagus ends in a blind pouch. there is tracheoesophageal fistula between the distal part of the esophagus and the trachea. the esophagus ends in a blind pouch. there is no connection to the trachea. a fistula is present between an otherwise normal esophagus and trachea.

pierre robin syndrome

tracheoesophageal atresia and fistula


types the esophagus ends in a blind pouch. a fistula connects the blind pouch of the proximal esophagus to the trachea there is a blind end portion of the esophagus. fistulas are present between both widely spaced segments of the esophagus and the trachea.

characteristic: presence of large amounts of amniotic fluid and large amounts of mucus in the mouth appearing like blowing bubbles management: immediate surgery is done to prevent pneumonia. antibiotics are administered as ordered.


nursing interventions: preoperative give iv therapy keep child in an upright position and on the right side to prevent aspiration nursing interventions postoperative keep infant on npo status for 7-10 days until suture line heals. turn the patient frequently to discourage fluid from accumulating in the lungs. encourage crying to help expand lung tissue.



the protrusion of the abdominal contents through the

omphalocele

abdominal wall at the point of the junction of the umblical cord and abdomen. the herniated organs are usually the intestines, but may include the stomach and liver. elastic bandaging may be performed as conservative therapy. topical solution such as silver sulfadiazine may be applied to prevent infection of the sac. delayed surgical closure may follow.

failure of canalization of intestine in utero at some point in the bowel which results to atresia or stenosis of the bowel the most common site is the duodenal bowel portion. anticipated if the mother had duodenal bowel portion. anticipated if the mother had hydramnios during pregnancy or if 30 ml of gastric secretion was aspirated from the newborns stomach monitoring body fluid and electrolyte is important until surgery is done. the obstruction of the intestinal lumen by hardened meconium most commonly found in infants with cystic fibrosis. results in abdominal distention and vomiting of bile stained fluid characterized by the failure to pass meconium within the first 24 to 48 hours after birth, rapid dehydration associated with electrolyte imbalance and abdominal distention management includes use of enema or surgery

intestinal obstruction

meconium ileus

absence of opening in the anus managed through surgery

imperforate anus

nursing interventions: preoperative put the client on npo status. attach the nasogastric tube to low intermittent suction for decompression. postoperative if the bowel sounds are present and the nasogastric tube is removed, small oral feedings is advised rectal dilation is done once or twice a day to ensure the proper patency of the rectal sphincter. the protrusion of the abdominal organ through a defect in the diaphragm into the chest cavity which usually involves the stomach and the intestine characterized by the absence of breath sounds on the affected side of the chest managed through surgery

imperforate anus

diaphragmatic hernia

nursing intervention elevate head to provide maximum respiratory space. perform gastrostomy to prevent distention of the herniated intestine. use low intermittent suction to avoid injury to the lining of the stomach.

diaphragmatic hernia

after surgery, the infant is kept in a semi-fowlers position. keep the infant in a warm, humidified environment to encourage lung fluid drainage. hydrocephalus an excess of cerebrospinal fluid in the ventricles and subarachnoid space of the brain the nursing care is same as the child with increase icp.

anomalies of the nervous system

anencephaly the absence of cerebral hemisphere microcephaly characterized by slow brain growth which falls more than three standard deviations below normal on growth charts results in mental retardation because of the lack of functioning brain tissue.

neural tube disorders

incomplete fusion of spinal cord usually occurs in the lubosacral area (l5 and s1) there is positive tuft of hair or dimple over the affected area may result to progressive disturbance of gait with weak foot or bowel and bladder disturbances hernial protrusion of a saclike cyst of meninges filled with spinal fluid

spina bifida occulta

meningocele

positive cystic swelling beneath the skin which contains csf hernial protrusion of a saclike cyst containing meninges, spinal fluid and a portion of the spinal cord may result to either positive or negative neurologic deficits usually seen with hydrocephalus and arnold chiari malformation

myelomeningocele

cranial meningocele or myelomeningocele occurs most often in the occipital area of the skull

encephalocele

preoperative the position should be prone or supported on the side. a sterile wet compress of saline, antiseptic or antibiotic gauze over the lesion may be used to keep the sac moist. maintain body heat check any leakage. measure head circumstance once a day in the preoperative period. the child must be observed frequently for signs of increased intracranial pressure postoperative a child is placed on the abdomen until the skin

neutral tube disorder

neutral tube disorder

incision has healed (7-14 days) practice careful precautions in preventing urine or feces to touch the incision keep the infant prone or on the side to prevent pressure on the incision.

polydactyly the condition characterized by the presence of one or more additional fingers supernumerary finger is usually amputated in infancy or early childhood. syndactyly a condition characterized by two fingers which are fused the fusion is usually caused by simple webbing. treatment consists of separation of the fingers into two, which should be functional and cosmetically appealing.

nursing care of infants with skeletal anomalies finger conditions

the head is inclined to one side as a result of the contraction of muscles on that side of the neck occurs as a congenital anomaly when the congenital muscle is injured and bleeds during birth managed through passive stretching exercises where the infant is encouraged to look in the direction of the affected muscles surgical correction followed by a neck immobilizer is necessary if the condition persists after one year.

torticollis (wry neck)

the premature closure of the sutures of the skull which may lead to deformed face and orbits of the eyes and increased intracranial pressure may be associated with cardiac anomalies, choanal atresia, or defects of the elbows and knee joints if the coronal suture is involved, surgery is needed.

craniosynostosis

a form of dwarfism inherited as a dominant trait which involves a defect in the cartilage production in utero. characterized by less than 140 cm in height, and flattened bridge of the nose x-ray films reveal characteristic abnormal flaring of epiphyseal lines

achondroplasia

a. talipes equinovarus most common congenital deformity of the foot characterized by internal tibial torsion, plantarflexion, inversion and adduction of the forefoot b. calcaneovalgus foot turns out and the heel is held lower than the anterior foot. both are managed through serial casting, corrective surgery or shoe correction

congenital clubfoot

nursing interventions: change diapers frequently teach parents on the following: how to check the infants toes for coldness or cyanosis how to blanch a toenail bed and watch it turn pink to assess for good circulation how to perform passive foot exercises.

congenital clubfoot

flattering of the acetabulum of the pelvis which results in subluxation and dislocation at the hip joint six times more common in females than in males because of the flaring of the hips and the hormone relaxin management includes the use of traction (older children) or surgery.

developmental hip dysplasia

the harness is worn continually. teach the parents on how to remove the harness before bathing and how to reduce the hip again before using the harness. parents should assess the skin under the straps daily for irritation or redness.

pavlik harness

before discharge, teach the parents how to do neurovascular assessment (check temperature

spica cast

and circulation in the toes) to prevent circulatory compression

common prolems in toddlers, preschoolers, schoolers and adolescentsyounger children ( 2 - 7 years ) the cause of illness is magical or is the consequence of breaking a rule. getting well again is possible only if they follow a set of rules, such as staying in bed and taking medicine.

concept of illness to a child

fourth graders (7-10 years) generally aware of the role of germs in illness but may have the misconception that all illnesses are caused by germs see a passive role for them in getting well because illness comes from outside influences. eighth graders (13 years and above) able to voice an understanding that illness can occur from several causes can take an active role in getting better nursing diagnosis 1: anxiety of the child related factor: separation during hospitalization nursing priority:



nursing process for an ill child

for the child to actively relate with hospital personnel and hospital routine in ways appropriate to childs age and stage of development.

nursing diagnosis 2: fear of the child related factors: diagnosis or therapeutic procedure. nursing priority: for the child to voice satisfaction with comfort measures, child describes how he participates in a procedure. provide opportunities for parents to participate in the childs care. promote open parent visiting. support sibling and grandparent visitations. ample analgesia, including techniques of distraction or imagery; traditional comforts such as a change of clothing or positions; and reading to the child. to assure children that their bed is an area that is safe, all painful procedures should be done in the treatment room away from the bed. offer children a sense of control. explain to the children the procedures and give choices whenever possible to limit their fear of hospitalization. make the children admitted as in-patient feel that their stay is transient even upon admission.

nursing process for an iii child

nursing intervention:



allow parents to perform the procedures that need to be done at home first until they become comfortable with the techniques. be certain that parents/guardian know who to contact if nursing care plans do not work as anticipated and that they have a definite return appointment for follow-up care.

care of a child with muscular-skeletal disorders musculoskeletal disorders

nursing diagnosis pain related to chronic inflammation of joints. impaired physical mobility related to cast on leg. self-esteem disturbance related to continued use of body brace. diversional activity deficit related to the need for imposed activity restriction for weeks. diagnostic tests x-ray bone scan arthroscopy muscle or bone biopsy electromyography

assessment of musculoskeletal function

casting made of plastic or open-woven bandage impregnated with plaster of paris designed to protect a broken bone and to prevent movement of the aligned bone ends until healing has progressed sufficiently

medical/surgical management

nursing intervention: keep the extremity in cast elevated to prevent edema. check circulation frequently (every 15-min. during the first hour, hourly in the first 24 hours, and then every 4 hours thereafter). assess color, warmth, presence of pedal pulses, and sensations of numbness or tingling. after removing the cast, bathe the extremity. prescribed for children for the following reasons: to keep weight off both legs to support weakened legs to maintain balance nursing intervention: ensure that the crutches are properly fit. teach the child to support his weight at the hand grip not on the axilla always assess if the rubber tip is intact.

casting

crutches

involves pulling on a body part in one against a counter pull exerted in the opposite direction. used to reduce dislocations and immobilize fractures nursing intervention: provide good skin care on the childs back, elbows, and heels. provide a trapeze suspended over the bed of the child to position oneself in using the bedpan. nursing intervention: do not move the weights or interfere with the

traction

traction

traction when changing the childs bed linens or carrying out nursing functions. check the extremity in fraction every 15 minutes during the first hour, hourly for 24 hours, and every 4 hours, thereafter. monitor for signs of pallor, lack of warmth, tingling, absent of paripheral pulse, edema or pain.

involves the use of an external device to separate opposing bones to encourage new bone growth. used to lengthen the bone when one limb is shorter than the other also used to immobilize fractures or correct defects when the bone is rotated or angled

traction

a surgical technique used to align and repair bone internal fixations, such as use of rods or screws, are rarely used in children except in those with scoliosis.

open reduction

the most common form of short limb dwarfism transmitted as an autosomal dominant trait achodroplastic infants may be stillborn or die in their first year after birth.

disorders of the skeletal structures achondroplasia

aka fragilitas ossium, brittle bones

osteogenesis imperfecta

uncommon hereditary generalized connective tissue disorder in which the occurrence of multiple fractures is rendered inevitable by extreme fragility of the bones

interferes with osteoblastic activity resulting in diminished formation of bone matrix clinical manifestation includes hemorrhage which results from defective capillary walls. causes scurvy an acquired constitutional disease caused by deficient dietary intake of vitamin c manifested by changes in mesenchymal tissue of the body, especially collagen, bone, teeth, and blood vessels.

vitamin c (ascorbic acid) deficiency

scurvy

produces rickets in the children and osteomalacia in adults

vitamin d deficiency

a constitutional disease of infancy and childhood caused by lack of vitamin d evidenced by bone deformities, which may be striking in degree and widespread in distribution

rickets

nursing care for children with congenital hip dislocation congenital hip dislocation (chd)

types teratologic (intra-utero) typical (unstable, dislocated or subluxated) more than 50% of the cases is unilateral left hip involvement is more common for unilateral cases occurs more often in girls than in boys (8:1) abnormal laxity assessed using the ortolanis test management varies according to age

chondromalacia patella the softening of the articular cartilage of the patella of diverse origin may be progressive and managed conservatively has three categories: primary idiopathic type secondary adolescent type adult type

knee conditions

the lateral bowing of the tibia with the medial malleoli of the ankles touching and the medial surfaces of the knees are over 2 inches part seen most commonly in 2 years old

genu varum (bowlegs)

part of normal development in children which is gradually corrected at age 3 and latest at school age if condition worsens or persists beyond school age, the child needs referral to an orthopedist.

the medial surfaces of the knees touch and the medial surfaces of the ankle malleoli are separated by more than 3 inches usually seen in children 3 to 4 years gradually corrects itself and at the latest by school age if condition worsens or persists beyond school age, the child needs referral to an orthopedist.

genu valgum (knock-knee)

a foot without depression or complete loss of the medial longitudinal arch may either be congenital or acquired management include arch support, exercises and shoe modification

foot and ankle conditions pes planus (flatfoot)

a foot with a usually high arch and synonymous with clawfoot, pes arcuatus and hollow foot. may either be primary (idiopathic) or secondary (with known cause)

pes cavus

primary deformities inversion and adduction of the forefoot

talipes equinovarus or congenital clubfoot

varus of the calcaneus (heel inversion) equinus (plantarflexion) internal tibia torsion

secondary deformities: contractures of the tissues on the medial side of the foot underdeveloped and contracted calf muscles more common in males management includes astronomy, arthrodesis and tendon transfer

talipes equinovarus or congenital clubfoot

an infection of the bone which typically begins at the metaphysis most commonly caused by staphylococcus aureus in older children and haemophilus influenza in younger children carried to the bone site by septicemia (blood infection) children with sickle cell anemia have a special susceptibility to salmonella invasion in long bones. may also occur directly from an outside invasion due to a penetrating wound, open fracture, or contamination during surgery characterized by altered bone growth

osteomyelitis

osteomyelitis

an acute, nonpurulent inflammation of the synovial membrane of a joint, which occurs most commonly in the hip joint of children peak age of incidence: between 2 and 10 years

synovitis

inflammatory disease of childhood with an unknown cause characterized by chronic inflammation of the synovium with joint effusion and eventual erosion management includes the use of steroids, nsaids, slow acting anti-inflammatory drugs; surgery, bracing or shoe correction.

juvenile rheumatoid arthritis (jra)

nursing intervention: exercises institute a set of exercises (to preserve and strengthen muscle and joint functions) avoid running, jumping, prolonged walking and kicking (to prevent strains of the joint) nursing intervention: apply heat using warm water soaked for 20-30 minutes hot baths paraffin soaks

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