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Peds 2 68WM6

Care of the pediatric patient 2

Cardiac disorders in children are divided into two major groups? Congenital heart disease which are anatomic abnormalities present at birth. Acquired heart disease occurs after birth.
Assessment of Cardiac Patients should include? Accurate Hx. Include details about the mother’s pregnancy and birth hX. Inspect nutritional state. Color. Chest deformities. Unusual pulses. Respiratory status. Clubbing of fingers(late stage)
Diagnostic Evaluation of the Cardiac Patient inlcudes? ECG: most commonly used. Echocardiography: non-invasive and painless. Cardiac catheterization: most invasive.
Nursing Considerations for the Cardiac Patient Pre-procedural Care: Complete assessment. Height and weight. Baseline vital signs with pulse oximetry. Assess pedal pulses. Prepare the child and family for procedure. Provide sedation medications as ordered. Child must be NPO. Make sure the child has IV access.
Nursing Considerations for the Cardiac Patient Post-procedural Care: Assess pedal pulses. Assess temperature and color of extremity. Vital signs per protocol. Observe dressing. Fluid intake. Hypoglycemia. If bleeding, apply direct continuous pressure 1 inch above the site. Bedrest for 4 to 6 hours.
What is a cardiac catheterization? A radiopaque catheter that is passed through the femoral artery directly into the heart and large vessels.
Congenital Heart Disease Pathophysiology Heart defect or open pathway that produces SS indicating anatomical heart defect Intrauterine rubella exposure Diabetes mellitus maternal age Maternal drug ingestion. Exposure to environmental toxins and infections. Sibling/parent has hx of CHD
Congenital Heart Disease is a principle cause of death during the ____year of life. First
Congenital Heart Disease Diagnostic Tests Arterial Blood Gas (ABG). Fluoroscopy. Angiography. Cardiac catheterization. Non-invasive tests: Cardiac magnetic resonance imaging (MRI). Echocardiogram.
Congenital Heart Disease Signs and Symptoms Cyanosis. Pallor. Cardiomegaly. Pericardial rubs. Murmurs. Additional Heart Sounds (S3 or S4). Discrepancies between apical and radial pulses Tachypnea Congenital Heart Disease Clinical Manifestations Con’t Dyspnea. Grunting. Digital clubbing.
Congenital Heart Disease Treatment Median sternotomy with cardiopulmonary bypass. Pulmonary artery banding. Prophylactic antibiotics. Prognosis. Follow-up care.
Congenital Heart Disease Nursing Care Observation Assist with diagnosis Poor weight gain or sudden increase in weight Poor feeding habits Frequent respiratory infections Unusual posturing Exercise intolerance Would rather sit than crawl or walk frequent rest after limited play periods
Congenital Heart Disease Nursing Care Give medications. Maintain nutrition. Prevent infection.
Congenital Heart Disease Patient Teaching Assess family's understanding of diagnosis. written instructions regarding medication schedules and treatment protocols. Encourage family to verbalize questions, fears, and concerns Allow family to participate in care when appropriate
How can the nurse help parents and child adjust to CHD? Accept initial shock and disbelief, allow for period of grief. Repeat information in simple terms as often as necessary. Foster parent-child attachment, especially with newborns. Introduce parents to other families who have similarly diagnosed children
Teach family to recognize signs of what complications? Heart Failure. Digoxin toxicity. Vomiting. Bradycardia. Dysrhythmias. Increased respiratory effort. Hypoxemia. Cerebral thrombosis. Cardiovascular collapse.
What is pulmonary artery banding? Through a thoracotomy, a strip of woven prosthetic material is passed around the pulmonary artery to constrict it. This reduces the volume and pressure of pulmonary blood flow, thus relieving symptoms of congestive heart failure
Why would you want to minimize crying? Because it can be too tiring for the child and may cause cyanosis due to exhaustion.
Congenital Defects that Increase Pulmonary Blood Flow abnormal openings between the atria, allowing blood from the higher pressure left atrium to flow into the lower pressure right atrium.
Three Types of Congenital Defects Ostium primum (ASD 1). Ostium secundum (ASD 2). Sinus venosus defect.
Ostium primum (ASD 1): Opening at lower end of septum. May be associated with mitral valve abnormalities.
Ostium secundum (ASD 2): opening near center of septum.
Sinus venosus defect: Opening near junction of superior vena cava and right atrium. May be associated with partial anomalous pulmonary venous connection.
ASD Pathophysiology: At birth, pressure in left atrium exceeds that in right atrium, causing blood to flow from left to right. Oxygenated blood is forced from left atrium (high pressure) to right atrium (low pressure) which recirculates through the lungs.
ASD Manifestations: May be asymptomatic. Systolic murmur heard over left intercostal space. Pulmonary congestion.
Atrial Septal Defect (ASD) Treatment dacron patch closure of moderate to large defects Median sternotomy with cardiopulonary bypass is usually performed before school age. ASD 2 may also be closed using devices during cardiac catheterization. At some centers, still in clinical trials.
Ventricular Septal Defect (VSD) an abnormal opening in the intraventricular septum; may vary from a small pinhole to complete absence of the septum.
VSD Pathophysiology: blood flows from higher-pressure left ventricle (oxygenated blood) to lower pressure right ventricle (unoxygenated blood).
Ventricular Septal Defect (VSD) Manifestations Usually asymptomatic at birth, but signs of heart failure eventually manifest. Loud harsh systolic murmur with palpable thrill. Poor feeding. Cyanosis (late sign- due to reversal of shunt). Pulmonary congestion.
Ventricular Septal Defect (VSD) Treatment 20-60% VSDs close spontaneously during the 1 yr of life Median sternotomy with cardiopulmonary bypass. Moderate to large defects are repaired with Dacron patch placed over opening. May be closed using devices during cardiac catheterization.
VSD Medical Treatment prophylactic antibiotics to prevent bacterial endocarditis.
Patent Ductus Arteriosus (PDA) failure of fetal ductus arteriosus to completely close within first few weeks after birth.
PDA Pathophysiology Blood from aorta (high pressure) is forced into pulmonary artery (lower pressure) to be reoxygenated in lungs and returned to left atrium and ventricle Increases workload on left side of heart PDA may be lifesaving in neonates with cyanotic heart disease
Patent Ductus Arteriosus (PDA) Manifestations Continuous "machinelike" murmur, left second intercostal space. Full and bounding pulses due to "runoff" of aortic blood flow into pulmonary artery. Dyspnea with age. Wide range between systolic and diastolic blood pressure. Hypoxia
Patent Ductus Arteriosus (PDA) Treatment indomethacin (Indocin) closes patent ductus in newborns Left thoracotomy duct tied off Visual-Assisted Thoracoscopic Surgery (VATS) 3 small incisions on left side of chest; then a thorascope and instruments are used to place clip on ductus arteriosus.
Which defect may be necessary to sustain life in neonates with a cyanotic heart defect? Patent ductus arteriosus.
Palliative pulmonary artery banding in symptomatic infants to equalize shunting until old enough for surgery.
Coarctation of the Aorta (COA) constriction or narrowing of aortic arch, or descending aorta.
COA Pathophysiology Increased pressure proximal to defect. Decreased pressure distal to defect.
Coarctation of the Aorta (COA) Manifestations Blood pressure in arms will be 20 mmHg higher than in legs. Bounding pulses in upper extremities. Signs of heart failure. Leg cramping on exertion in older children. Epistaxis.
Coarctation of the Aorta (COA) Treatment Anastomosis Graft replacement Closed heart surgery is performed because structures are outside of heart. Aorta will grow but graft will not. Ballon angioplasty If restenosis occurs after surgery for coarctation, a balloon can relieve the obstruction
Coarctation of the Aorta (COA) Nursing Care Observe post operatively for: Hypertension. Abdominal pain associated with nausea and vomiting. Leukocytosis. Gastrointestinal bleeding or obstruction. Administer medications per orders.
What is the treatment for coarctation of the aorta? Surgical repair.
Tetralogy of Fallot (TOF) tetralogy means "four".
Four Defects TOF Ventricular septal defect. Pulmonic stenosis. Overriding (dextraposition- to the right) aorta. Right ventricular hypertrophy.
Tetralogy of Fallot (TOF) Pathophysiology an abnormal opening in the intraventricular septum. Stenosis of the pulmonary artery decreases blood flow to the lungs. Dextraposition of the aorta. Obstruction of flow to the pulmonary artery.
Tetralogy of Fallot (TOF) Manifestations Clubbing of fingers and toes Cyanosis increases with age Feeding problems Growth retardation Frequent respiratory infections Dyspnea on exertion Polycythemia Paroxysmal hyper cyanotic episodes, or "tet" spells occur during the first 2 years of life
Tetralogy of Fallot (TOF) Treatment Blalock-Taussig procedure. Corrective surgery for all defects performed on older children with good results. IV prostaglandin E1 therapy.
How many defects are there in tetralogy of fallot? Four.
Hypoplastic Left Heart Syndrome (HLHS) underdevelopment of the left side of the heart, resulting in an absent or nonfunctional ventricle and hypoplasia of the ascending aorta.
HLHS Pathophysiology: blood from left atrium flows across a patent foramen ovale into right atrium where it mixes with desaturated blood. Blood flows to right ventricle and into pulmonary artery. Descending aorta receives mixed blood from PDA to supply systemic circulation
Hypoplastic Left Heart Syndrome (HLHS) Manifestations: Symptomatic in the first week of life with cyanosis and CHF. Fatal in the first months of life without interventions.
HLHS Treatment Neonates require stabilization with mechanical ventilation and inotropic support preoperatively. Norwood procedure: anastomosis of the main pulmonary artery. Bidirectional Glenn shunt: performed at 3-6 months of age to relieve cyanosis. Transplantation
What two defects are necessary for survival with hypoplastic left heart syndrome? Patent foramen ovale and patent ductus arteriosus.
Congestive Heart Failure the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.
Two Categories of CHF Right-sided failure. Left-sided failure. Signs and symptoms are not indicative of which category of defect the child has.
Congestive Heart Failure Groups Impaired Myocardium Functioning. Pulmonary Congestion. Systemic Venous Congestion.
How does CHF Impair Myocardial Functioning Tachycardia. Sweating. Decreased urine output. Fatigue, weakness and restlessness. Anorexia. Decreased peripheral pulses. Decreased blood pressure. Gallop rhythm. Cardiomegaly. Pulmonary Congestion
Diagnosis of CHF Based on symptoms. Chest x-ray. EKG
Therapeutic Management Goals of CHF Improve cardiac function. Remove accumulated fluid and sodium. Decrease cardiac demands. Improve tissue oxygenation. Improve Cardiac Function
Increase contractility and decrease afterload: digitalis glycosides CHF Digoxin is given orally or intravenously in divided doses over 24 hours to produce optimal effects. Digoxin (Lanoxin): slow and strengthen the heartbeat.
Angiotensin-Converting Enzyme (ACE) inhibitors Captopril (Capoten): given three times a day. Enalapril (Vasotec): given two times a day.
Decrease Cardiac Demands by? Limit physical activity Preserving body temperature Treating infections Reduce the effort of breathing Prescribed medications to sedate an irritable child Improve Tissue Oxygenation and Decrease Oxygen Consumption Use supplemental oxygen as ordered.
Modified Fontan procedure? systemic venous return is directed to the lungs without a ventricular pump through surgical connections between the right atrium and the pulmonary artery.
An oxyhood is preferred with who and why? young infants whereas a nasal cannula or face tent may be used with older infants and children.
Congestive Heart Failure Nursing Considerations Position for ventilation Administer o2 IV access Cardiac monitor and pulse oximetry Assist in measures to improve cardiac function Decrease cardiac demands Reduce respiratory distress Protect child from infections Maintain nutritional status
Congestive Heart Failure Nursing Diagnoses Decreased cardiac output. Ineffective breathing pattern. Fluid volume excess. Activity intolerance. Risk for infection. Altered family processes.
Decreased urine output can be a sign of what? Decreased cardiac output.
Bacterial Endocarditis? infection of the valves and inner lining of the heart.
Causes of Bacterial Endocarditis? Most common: streptococcus viridans. Staphylococcus aureus. Gram-negative bacteria. Fungi: candida albicans.
Bacterial Endocarditis Pathophysiology? Organisms enter the bloodstream: Via mouth after dental work. UTI. Heart from cardiac surgery. Directly. Lesions can break off and invade other tissue.
Bacterial Endocarditis Diagnostic Evaluation? Based on Clinical Manifestations: Unexplained fever. Anorexia, malaise and weight loss. Splinter hemorrhages under nails. Petechiae. CHF. Cardiac dysrhythmias. New murmur. EKG can visualize.
Endocarditis Therapeutic Management: High dose antibiotics 2-8 weeks. Blood cultures. Preventative measures.
Nursing Considerations for Endocarditis? Educate parents of high-risk children on: Need for prophylactic antibiotic therapy. Signs and symptoms of infection. Signs and symptoms of complications.
Once a patient has been diagnosed with bacterial endocarditis, what must be done in order to prevent recurrence prior to invasive procedures? Preventative measures include prophylactic antibiotic therapy 1 week prior to procedures.
Rheumatic Fever an inflammatory disease that occurs after infection with group A beta hemolytic streptococcal pharyngitis. It involves the joints, skin, brain, serous surfaces, and heart.
Rheumatic Fever Etiology: a strong relationship between upper respiratory infection with group A beta hemolytic streptococci and development of RF.
Rheumatic Fever Diagnostic Evaluation the presence of two major manifestations or one major and two minor manifestations. Children tested for streptococcal antibodies (antistreptolysin-O) titer, elevated or rising in children with RF.
Rheumatic Fever Treatment Goals Eradicate Group A beta hemolytic streptococcal infection. Penicillin (PCN) is the drug of choice. Erythromycin (if allergic to PCN). Prevent permanent cardiac damage. Treat other symptoms: salicylates to control inflammation, fever and pain.
Rheumatic Fever Nursing Care Encourage compliance. Facilitate recovery. Provide support. Prevent disease. During home care, tx should be focused on rest and adequate nutrition. Educate children on preventing spread of throat infections. Pts with chorea need to be protected
What infection is responsible for triggering rheumatic fever? Group A beta hemolytic streptococci.
Hyperlipidemia excessive lipids hypercholesterolemia refers to excessive cholesterol in the blood. Both are believed to play a role in producing atherosclerosis which eventually can lead to coronary heart disease. focuses on screening and management of lipids
Hyperlipidemia Treatment Tx is primarily dietary. restricting intake of cholestero/fat If child does not respond to diet changes, drug therapy may be needed: Cholestyramine (Questran). Colestipol (Colestid). These 2 drugs are bile acid-resins or sequestrants
Side effects of Colestid include Constipation. Abdominal pain. GI bloating. Flatulence. Nausea.
Hyperlipidemia Nursing Considerations Screening, education and support. Education parents and child: About cholesterol, HDLs and LDLs and triglycerides. Behavioral risk factors. Medications. Dietary changes. Keeping all appointments.
True or False: Treatment of high cholesterol is primarily through changing the diet. True. Medications are only used if there is no response from changing the diet.
Factors for Cardiomyopathy include Familial or genetic causes. Infection. Deficiency states. Metabolic abnormalities. Collagen vascular disease.
Cardiomyopathy abnormality in myocardium where cardiac contraction is impaired.
Secondary factors: Anthracycline toxicity. Hemochromatosis. Duchenne muscular dystropy. Kawasaki disease. Collagen diseases. Thyroid dysfunction. Cardiomyopathy Divided into 3 categories Dilated cardiomyopathy. Hypertrophic cardiomyopathy. Restrictive cardiomyopathy.
Dilated Cardiomyopathy Where ventricles are dilated and contractility is greatly decreased. Most common category with children. Signs and symptoms: Tachycardia. Dyspnea. Hepatosplenomegaly. Fatigue. Poor growth.
Hypertrophic Cardiomyopathy Characterized by an increase in heart muscle mass without an increase in cavity size. Symptoms include: Chest pain. Dysrhythmias. Syncope. Chest x-rays show enlarged heart. ECG shows ST-T changes.
Restrictive Cardiomyopathy Describes a restriction to ventricular filling caused by endocardial disease. Symptoms are those common with CHF.
Cardiomyopathy Therapeutic Management Treatment is directed towards correcting the underlying problem or managing the symptoms. Medications are given such as: Digoxin. Diuretics. Beta Blocker: propranolol (Inderal). Calcium-Channel blocker: verapamil (Calan).
Dysrhythmias are monitored and treated with anticoagulants.
Heart transplantation may be needed for children with worsening symptoms despite medical therapy.
Cardiomyopathy Nursing Considerations Restrict activity to decrease demand on the heart. Treat as you would treat a child with CHF. Prepare the patient and family for postoperative period.
Name the three categories of cardiomyopathy. Dilated, hypertrophic and restrictive cardiomyopathy.
Systemic Hypertension consistent elevation of blood pressure.
Two Major Categories of Systemic Hypertension? Essential. Secondary.
Etiology of Systemic Hypertension? Most occurs secondary to structural abnormalities or underlying pathologic processes. Most common cause is renal disease, followed by congenital, vascular and endocrine disorders.
Systemic Hypertension Diagnostic Evaluation? Infants and young children: Irritability. Head-banging or head-rubbing. May wake up screaming at night. Adolescents and older children: Frequent headaches. Dizziness. Changes in vision.
Labs for Systemic Hypertension includes? Urinalysis. (proteinurea is an indicator) Renal function panel. Lipid profile. CBC. Electrolytes.
Systemic Hypertension Therapeutic Management? Treating underlying causes. Non-pharmacologic interventions: Nutrition counseling. Weight reduction. Weight control. Exercise program. Counsel adolescents on effects of drug(cocaine), alcohol and tobacco use.
Pharmacologic interventions for systemic Hypertension? Beta blockers. ACE inhibitors. Diuretics.
Systemic Hypertension Nursing Considerations? The nurse is active in detection, diagnosis, and therapy in many settings. BP measurement.
Education of child and parent for systemic hypertension includes? How to take BP at home When to contact provider. Medications. Follow-up. Compliance. Referrals.
Why is BP cuff size important in getting accurate readings in children? Cuffs that are too small will give a falsely high reading while cuffs that are too large will give a falsely low reading.
Kawasaki Disease? an acute systemic vasculitis.
Pathophysiology of Kawasaki Disease? Initially extensive inflammation. Progresses to formation of coronary artery aneurysms.
Kawasaki Disease Clinical Manifestations? at least 5 Sustained fever Bilateral conjunctivitis. Fissured lips Strawberry tongue Inflammation of the mouth and pharyngeal airways Peripheral edema Erythema and desquamation of palms and soles. Polymorphous rash Enlarged lymph nodes
Kawasaki Disease Treatment? IV gamma globulin. Salicylate therapy. Warfarin (Coumadin) therapy.
Kawasaki Disease Nursing Care? Initial phase-monitor cardiac status. Assess for signs of CHF. Symptomatic relief such as using cool cloths, unscented lotions and soft, loose clothing. Educate parents on suspending all immunizations. Reinforce teaching on recognition of problems.
What can a nurse do to minimize skin discomforts for a child with Kawasaki Disease? Provide cool cloths, unscented lotions and soft, loose clothing.
What is the most important aspect of the assessment of the Congenital Heart Disease? Thorough and accurate hx including prenatal!
What color may infants with CHD appear? Blue or Gray
Clubbing of fingers normally indicates what? Late Stage hypoxia
What is a murmur? Turbulant blood flow
What defect is a left to right shunt? VSD (Ventricular Septal Defect)
_____ may vary from a small pin hole to complete abscense of the septum. VSD
What are the two most common signs and symptoms of VSD? Loud harsh Systolic murmur and failure to thrive by 6 months.
Left thoracotomy is? duct tied off (ligated) or divided.
Visual-Assisted Thoracoscopic Surgery (VATS) is? three small incisions on left side of chest; then a thorascope and instruments are used to place clip on ductus arteriosus.
What might a PDA lead to if left untreated? Right sided cardiac heart failure.
Acyanotic Heart Defects ASD VSD PDA All shunt left to Right (no signs of cyanosis)
Coarctation of the Aorta Definition: Page 871 Localized narrowing near the insertion of the ductus arteriosus which results in increased pressure.
Coarctation of the Aorta Signs and Symptoms: pg 871 high blood pressure bounding pulses in arms weak or absent femoral pulses and cool lower extremeties.
Coarctation of the Aorta Complications Stroke hypertension ruptured aorta aortic aneurysm and stroke.
What is the surgical management of Coarctation of the Aorta? Thoracotomy with long segment stenosis. Secondary is percutaneous balloon angioplasty.
Blue spells or tet spells are _________ acute episodes and are associated with ___________ defect. cyanotic, tetralogy of Fallot
Blalock Taussig Shunt operation which provides blood flow to the pulmonary arteries from the left or right subclavian artery via a tube graft. Sometimes avoided because of pulmonary artery distortion.
Total anomalous Pulmonary Venous Connection Rare defect characterized by failure of pulmonary veins to join the left atrium, insteas the veins are abnormally connceted to the systemic venous circuit.
Most significant __________ is rheumatic heart disease. sequelae
Increase contractility and decrease afterload of CHF patients: Dig and ACE inhibitors
Decrease preload in CHF patients by: Diuretics
The nurse can decrease cardiac demand for CHF patients by: Limit physical activity. Preserving body temperature. Treating infections. Reduce the effort of breathing. Prescribed medications to sedate an irritable child.
Improve Tissue Oxygenation and Decrease Oxygen Consumption in CHF patients by: Use supplemental oxygen as ordered. An oxyhood is preferred with young infants whereas a nasal cannula or face tent may be used with older infants and children.   Cool humidification is necessary to counteract the drying effects of the oxygen.
______most frequently occurs secondary to structural abnormalties that result in increased blood pressure within the heart. CHF
Subacute bacterial endocartditis is an infection involving the valves and inner lining of the heart.
____________ is the most common cause of bacterial endocarditis. Steptococcus Viridans
modifications of the Jones criteria is? suggests the presence of two major manifestations or two minor manifestations such as fever and arthralgia with evidence of Strept infection indicates a high priority for RF
Chorea spasmodic reactions the onset is gradual soemtimes can occur in children who are not diagnosed with RF.
PAH describes a group of rare disorders that result in an elevation of pulmonary artery pressure above 25 mmhg at rest after the neonatal period.
Kawasaki disease is also known as _______ _________ _____ ________. Mucocutaneous Lymph Node Syndrome
Stage 1 hypertension BP readings between 95th- 99th %
Stage 2 hypertension Bp readings over 99th % plus 5mm Hg
Gamma Globulin Antibodies given to help reduce Kawasaki Disease
Kawasaki Disease Phases Acute Phase - child is typically ver irritable. Sub acute phase- resolution of fever greatest risk for aneurysms. Convalescent phase- all signs have resolved but lab values have not returned to normal. 6-8 weeks.
TGA (Transposition of the Great Artery) Pulmonary artery leaves the left ventricle with no communication between the systemic and pulmonary circulations.
TGA Signs and Symptoms Newborns may be cyanotic Abnormal heart sounds may be observed.
TGA IV prostaglandin E1 to keep the PDA open balloon cath. Arterial switch procedure may be performed in the first few weeks of life(transects the great artery and anastomosing the main pulmonary artery. Intraatrial baffle repairs and rastelli procedure.
AV Canal Defect Incomplete fusion of the endocardial cushions. Surgical repair consists of patch closure of the septal defect.
Blood Components include? Plasma. Formed Elements: Erythrocytes. Leukocytes. Thrombocytes.
Formation of Blood starts in the _____________ Marrow of long bones.
Hematopoesis in _____________ adolescence.
______________regulates production. Erythropoietin
Lymphatic system drains regions of the body to lymph nodes.
Lymphatic system includes Lymphocytes. Lymphatic vessels. Lymph nodes. Spleen. Tonsils, adenoids, and thymus gland. Lymphocyte
What are the three formed elements of blood? Erythrocytes, leukocytes and thrombocytes.
Anemia There is a reduction in the number of RBCs or amount of hemoglobin is below normal.
_________ is the most common hematologic disorder of infancy and childhood Anemia
Severe anemia _____________ peripheral resistance. decreases
Diagnostic Evaluation for Anemia includes Decreased RBCs, HgB and Hct. Fatigue, lack of energy and pallor.
Therapeutic Management of Anemia Supportive. Supplemental oxygen. Bedrest. IV fluids. Treat underlying cause.
Anemia Nursing Considerations Prepare for tests Note signs of exertion: Tachycardia and palpitations Tachypnea Dyspnea and shortness of breath Hyperpnea or breathlessness Dizziness or lightheadedness Diaphoresis
How can the nurse support the parents of a anemic child? Allow parents to stay with child.
What bursing interventions can help prevent complications? Provide oxygen as ordered. Prevent infections. Observe for signs of infections.
What is one nursing responsibility when caring for a child with anemia? Prepare the child and family for lab tests, decrease tissue oxygen needs and prevent complications.
Iron Deficiency Anemia Most prevalent nutritional disorder. Children 12 to 36 months are at highest risk. Premature infants are at risk.
Iron Deficiency Anemia Pathophysiology May be caused by many things. If iron supplies do not meet demand, iron deficiency results.
Therapeutic Management of Iron Deficiency Anemia Diet counseling and iron supplements. Supplement with iron-fortified infant formula and cereal. Transfuse if severely anemic.
Iron Deficiency Anemia Nursing Considerations Instruct the parents on iron administration: Give as prescribed. Juice with the medication helps absorption.
What should the nurse teach the patient regarding the iron supplement? Iron turns: Stools tarry. Vomiting and diarrhea can occur. Liquid iron may stain teeth: Give medication with a syringe, straw or dropper. Use Z-track method to administer IM and do not massage site.
Name three causes of iron-deficiency anemia? Severe hemorrhage, inability to absorb iron, excessive growth requirements, inadequate diet, and GI bleeding r/t lactose intolerance.
Sickle Cell Disease occurs mainly in ____________. African Americans.
When the child inherits both_____ and _______, they are said to have the sickle cell trait. HbA and HbS
When the child inherits predominately_____, they have sickle cell anemia. HbS
Sickle Cell Disease Pathophysiology Features are a result of obstruction caused by the sickled RBCs and increased RBC destruction. Obstruction causes vaso-occlusion. Leads to hypoxia and cell death.
Tissue Effects of Sickle Cell Anemia Clinical manifestations of SCA vary greatly in severity and frequency. Sickle cell crisis is a period of exacerbation of symptoms and is painful and can be fatal.
Types of Sickle Cell Crises Vaso-occlusive Splenic sequestration- Aplastic -without RBC Hyperhemolytic-accelerated RBC breakdown.(jaundice)
Acute chest syndrome is another complication, signs and symptoms include? Chest Pain, Fever Cough Tachypnea Wheezing Hypoxia
Sickle Cell Disease Diagnostic Evaluation Newborn screening. Sickledex. Hemoglobin electrophoresis.
Sickle Cell Disease Therapeutic Management Treat conditions that enhance sickling. Treat medical emergencies. Prevention = maintaining hemodilution. Medical management is supportive and symptomatic. Rest. Hydration. Electrolyte replacement. Analgesics. Blood transfusion. Antibiotics.
Sickle Cell Disease Medication Management Administer all vaccines Short term oxygen may be helpful. Exchange transfusions. Splenectomy. Ibuprofen or acetaminophen. Codeine. PCA. Steroids.
Sickle Cell Disease Nursing Care Educate family and child: Disease. When to seek intervention. Give meds as ordered. Recognize signs and symptoms of impending crises. Treat the child normally.
Sickle Cell Disease Patient Teaching and Interventions Emphasize the importance of hydration. Manage pain Apply heat & keep child on bed rest Observe signs and symptoms of transfusion reaction Be aware of spleen size Recognize other complications Support family
What is the most common type of sickle cell crisis? Vaso-occlusive.
What nursing interventions are appropriate to manage the pain a child experiences during a vaso-occlusive crisis? Provide analgesics as ordered; notify the provider if medication is ineffective.
Beta-Thalassemia Refers to inherited blood disorders characterized by deficiencies in the rate of production of specific globin chains in Hgb. Occurs most often in persons leaving near the Mediterranean sea.
Beta-Thalassemia Pathophysiology Partial or complete deficiency in the synthesis of hemoglobin. Compensatory increase in different chains. Increases the production of defective hemoglobin. Damages the RBC causing severe anemia.
Beta-Thalassemia Diagnostic Evaluation Hematologic studies: changes in RBCs. Low Hgb and Hct. Hgb electrophoresis. X-rays.
Beta-Thalassemia Therapeutic Management Goals Maintain sufficient Hgb levels. Provide sufficient RBC. Transfusions are necessary. An iron chelating agent is given with oral supplements of vitamin C. A splenectomy may be necessary.
Beta-Thalassemia Nursing Considerations Promote compliance. Assist with coping. Foster adjusting. Observe for complications. Refer for genetic counseling. Support the family.
Which form of Thalassemia is the most severe form with the potential to lead to death if untreated? Thalassemia major known as Cooley anemia.
Aplastic Anemia a bone marrow failure condition in which the formed elements of blood are simultaneously depressed.
Aplastic Anemia Etiology Can be primary or secondary. Fanconi syndrome occurs. Aplastic Anemia Factors Infection. Irradiation. Drugs. Exposure to household or industrial chemicals. Idiopathic.
Aplastic Anemia Diagnostic Evaluation Clinical Manifestations: Anemia. Leukopenia. Decreased platelet count. Bone marrow aspiration.
Aplastic Anemia Therapeutic Management Directed at restoring function of the marrow: Immunosuppression therapy. Replacement of bone marrow. Antilymphocyte globulin (ALG) or antithymocyte globulin (ATG). Hemopatopoietic stem cell transplantation.
Aplastic Anemia Nursing Considerations Similar to the care of a child with leukemia: Prepare the family and child for procedures. Prevent complications from the severe pancytopenia. Emotional support.
Hemophilia a disorder where the blood does not clot normally and any injury can cause bleeding, pattern is demonstrated as X-linked recessive so it affects males almost exclusively, but is transmitted by symptom free females via a defective gene on the X chromosome.
Hemophilia Most Common Forms: Factor VIII deficiency. Factor IX deficiency. von Willebrand disease.
Hemophilia Pathophysiology Factor VIII is needed for forming thromboplastin. Less factor VIII = more severe disease. Leads to patients bleeding longer but not faster.
Hemophilia Diagnostic Evaluation History of bleeding episodes, evidence of X-linked inheritance and lab findings.
Common signs and symptoms of Hemophilia? Prolonged bleeding. Hemorrhage. Subcutaneous and intramuscular hemorrhages. Hemarthrosis. Hematomas. Spontaneous hematuria.
Hemophilia Therapeutic Management Primary therapy: replacing missing clotting factor. Corticosteroids. NSAIDS with caution. Regular exercise is encouraged. Prophylactic infusions of factor VIII concentrate.
Hemophilia Nursing Considerations Maintain a high level of suspicion. Prevent bleeding by preventing trauma. Educate the family. Use an extra soft toothbrush. Medical alert bracelet.
What should the nurse teach the parents regarding hemophilia? Educate the family on measures to control bleeding
Define hemophilia A genetic disorder where blood does not clot normally.
What does RICE stand for and when should it be used? RICE stands for Rest, Ice, Compression and Elevation and is used to help control bleeding episodes.
Idiopathic Thrombocytopenic Purpura an acquired platelet disorder that occurs in childhood. Characterized by: Thrombocytopenia: excessive destruction of platelets.
Purpura a discoloration caused by petechiae.
Idiopathic Thrombocytopenic Purpura (ITP) Diagnostic Evaluation Based on manifestations: Easy bruising, petechiae, ecchymosis. Bleeding from mucous membranes, epistaxis, bleeding gums and internal hemorrhage. Hematomas over lower extremities. Test to rule out other disorders.
Idiopathic Thrombocytopenic Purpura (ITP) Con’t Therapeutic Management Primarily supportive. Restrict activity. Treat symptoms. Splenectomy if ITP has persisted for >1 yr.
Nursing Care for Idiopathic Thrombocytopenic Purpura Supportive. Teach family to limit activity. Teach family not to use aspirin or NSAIDS.
What is the cause of ITP? Unknown, thought to be an auto immune system reaction to a virus.
Leukemia a malignant disease of the blood forming organs of the body that results in an uncontrolled growth of immature white blood cells. Most common form of childhood cancer. More frequent in males between 2-6 years of age. Chromosomal abnormalities identified
Leukemia Overproduction of immature WBC’s cannot fight infection. Infiltration of WBCs of platelet forming centers in the marrow cause bleeding tendencies and weakening of bones Infiltration in spleen, liver and lymph glands results in diminished function
Leukemia is classified according to? Type
Leukemia Manifestations Initial Phase: Low-grade fever. Pallor. Tendency to bruise. Leg & joint pain, pathologic fractures. Listlessness. Abdominal pain. Enlargement of lymph nodes.
As Leukemia progresses: Hepatomegaly & splenomegaly. Anemia despite transfusions. Lemon-yellow skin. Petechiae & purpura. Ulcerations. Anorexia, N/V, weight loss Dyspnea Enlargement of kidneys & testicles Hematuria
Leukemia Diagnosis History & symptoms. Blood tests. Bone marrow aspiration. Spinal tap. Kidney & liver function tests. Bone Marrow Aspiration
Leukemia Treatment Multidisciplinary. Specialized facility. Chemotherapeutic agents with steroids. Antibiotics, sedatives & analgesics. Bone marrow transplant. Blood transfusions. TPN.
Leukemia Nursing Care Assist with administration of blood products. Pain relief. Minimize risk of infection. Prevent hemorrhage. Promote rest & reduce fatigue. Prevent skin breakdown. Stimulate appetite. Help child & family cope.
Name three diagnostic tests associated with leukemia. Bone marrow aspirate; Kidney and liver function tests; Spinal tap; Blood tests; X-rays.
Name two ways to provide appropriate nursing care for a child with leukemia. 1. Pain relief. 2. Promote rest and reduce fatigue.
Hodgkin’s Disease Pathophysiology a malignancy of the lymph system. May metastasize Presence of Reed-Sternberg cells. Non-Hodgkin’s lymphoma is more prevalent in children less than 14 years. Hodgkin’s disease is prevalent in adolescence and increases in 15 to 19 years
Hodgkin’s Disease Manifestations Painless lump along neck. Unexplained low-grade fever, night sweats. Anorexia, unexplained weight loss, malaise. Rash & pruritis.
Hodgkin’s Disease Diagnosis X-ray, body scan, lymphangiogram & node biopsy. Accurate Staging: I: Restricted. II: Two or more lymph nodes. III: Involves nodes on both sides of diaphragm. IV: Diffuse disease.
Hodgkin’s Disease Treatment Radiation therapy. Chemotherapy: MOPP. ABVD. Splenectomy.
Hodgkin’s Disease Nursing Care Symptomatic relief. Education. Prevent over fatigue. Inform adolescents of side effects of treatment. Age appropriate emotional support.
What is a definitive test for Hodgkin's lymphoma? A blood test that identifies Reed-Sternberg cells.
Thalassemia minor which is an asymptomatic form.
Thalassemia trait, which produces a mild microcytic anemia.
Thalassemia intermedia which is manifested as Splenomegaly and moderate to severe anemia.
Thalassemia major known as Cooley anemia which results in severe anemia that can lead to cardiac failure and death in early childhood without treatment.
Gastrointestinal System of a Child differ from a adult? Newborn’s resistance to infection incompletely developed. Infant’s stomach small & empties rapidly. Newborn produces little saliva. Infants have poor fat absorption and immature livers. Swallowing is reflex for 3 months Children have increased needs
What makes newborns more prone to jaundice? Immature livers.
Water Balance & Dehydration Dehydration occurs when the total output exceeds the total intake.
Dehydration can be caused by? Lack of intake. Abnormal losses: Vomiting. Diarrhea.
Why is water balance important in newborns? Infants needs are greater and they are more vulnerable to alterations. Newborns lose a large amount at birth and maintains a larger amount of extracellular fluid than the adult. Children have a greater surface area. Increased metabolic rates and heat p
Types of Dehydration Isotonic: Primary form in children. Shock is greatest threat. Hypotonic: Electrolyte deficit exceeds water deficit. Hypertonic: Proportionately larger loss of water in excess of electrolyte loss. Most dangerous.
Dehydration Diagnostic Evaluation Based upon the amount of weight the child has lost. If weight is unknown, based upon LOC Response to stimuli Decreased skin turgor capillary refill Increased heart rate Sunken eyes/ fontanel
Dehydration Nursing Care Observe for signs and symptoms. Accurate measurement of intake and output. Observe: Urine color, frequency and volume. Stool volume and frequency. Vomit for volume, frequency and type. Sweating.
Dehydration Nursing Interventions Observe: Vital signs. Skin color, temperature, turgor and presence of edema. Mucous membranes. Body weight. Sensory alterations and presence of thirst.
What are the signs of dehydration? Percentage of weight loss, increased pulse, irritability and lethargy, dry mucous membranes, absence of tears, sunken eyes or fontanel and delayed capillary refill.
Diarrhea Caused by abnormal intestinal water and electrolyte transport.
Diarrhea can be classified as? Acute: Usually self limiting. Referred to as acute infectious gastroenteritis caused by a variety of viral, bacterial and parasitic pathogens. Chronic: Diarrhea lasting over 14 days. Caused by chronic conditions. Intractable diarrhea occurs in first
Diarrhea Etiology Most are spread by fecal-oral route through contaminated water or food and is spread from person to person. Rotavirus is the most common cause of serious gastroenteritis.
Diarrhea Pathophysiology Invasion of the GI tract Increased intestinal secretions Dehydration, Acid-base imbalance, Shock
Diarrhea Diagnosis: Lab tests: CBC, Electrolytes, Creatinine and Blood urea nitrogen. Stool cultures.
Diarrhea Therapeutic Management Goal of treatment: Assess imbalance. Oral rehydration. Avoid fruit juices or caffeinated soft drinks Maintenance fluid therapy. (5% dextrose in water.) Reintroduction of an adequate diet Once under control, investigate and treat cause of diarrhea.
Diarrhea Nursing Care Monitor for signs of dehydration. Obtain accurate daily weights. Collect specimens as ordered. Protect the skin from excoriation. Support the child and family. What can the nurse teach the patient and family regarding diarrhea?
Constipation Constipation is an alteration in the frequency, consistency, or ease of passing stool. Obstipation is when there are long intervals between stools. Encopresis is constipation with fecal soiling. Constipation may be secondary to many organic disorders o
Constipation in the Newborn Normally passes first meconium stool within 24 – 36 hours after birth. Meconium plugs are caused by meconium with reduced water content. Meconium ileus is an actual obstruction of the small intestines by abnormal meconium.
Constipation during Infancy: Constipation may result from organic causes. Often constipation is due to dietary practices.
Constipation during Childhood: Most constipation is due to environmental changes or normal development. The onset of constipation in the school-age child is due to environmental changes and stresses.
Constipation Nursing Care Dietary modifications: Increase the amount of carbohydrates in infant’s formula will often relieve the problem. Increase amounts of fiber and fluids. Differentiate between acute and chronic constipation.
What is the difference between obstipation and encopresis? Obstipation is when there are long periods between stools whereas encopresis is the lack of stools.
Hirschsprung’s Disease Absence of ganglionic innervation of bowel. Lack of normal peristalsis. More common in boys. Familial tendency.
Hirschsprung’s Disease Manifestations Failure to pass meconium. Constipation. Ribbon-like stools. Abdominal distention. Anorexia. Vomiting. Failure to thrive. Shock. Enterocolitis.
Hirschsprung’s Disease Treatment & Nursing Care Surgically corrected. Temporary colostomy. Avoid tap water enemas.
What is the earliest sign of Hirschsprung's disease? Failure to pass meconium stools.
Vomiting Is common and is usually self-limiting. Complications occur when it leads to dehydration and electrolyte disturbances, malnutrition, aspiration and Mallory-Weiss syndrome.
Vomiting Therapeutic Management Management is directed towards: Detection. Treatment of the cause. Prevention of complications. Fluids are given. Antiemetic drugs may be given: Zofran. Reglan. Phenergan.
Vomiting Nursing Considerations Focus is on observation and reporting episodes. Teach feeding techniques. After episodes have stopped, offer fluids. Position the child on their side or semi-reclining to prevent aspiration. Emphasize need to wash teeth or rinse mouth after vomiting.
Gastroesophageal Reflux Is the transfer of gastric contents into the esophagus. Infants and children especially prone include: Premature infants. Infants with bronchopulmonary dysplasia. Children with tracheoesophageal or esophageal atresia repair. Children with neurologic
HGB and HCT Levels 10-15, 35-45
Gastroesophageal Reflux Is the transfer of gastric contents into the esophagus.
Who is predisposed to Gastroesophageal Reflux? Infants and children especially prone Premature infants. Infants with bronchopulmonary dysplasia. Children with tracheoesophageal or esophageal atresia repair. Children with neurologic disorders, cystic fibrosis or cerebral palsy. Child with GER
Gastroesophageal Reflux Signs and Symptoms Spitting up, regurgitation, vomiting. Excessive crying, irritability, arching of the back. Weight loss or failure to thrive. Respiratory problems. Heartburn or abdominal pain. Dysphagia. Esophagitis.
GER Diagnositc Esophageal pH monitoring. An upper GI series.
Gastroesophageal Reflux Therapeutic Management depends on severity: No treatment if thriving. Small frequent feedings with thicker formula and positioning. Medications if persistent: H2 agonists. Proton pump inhibitors. Nissen fundoplication Nissen Fundoplication
Gastroesophageal Reflux Nursing Considerations Care is directed at: Identifying children with symptoms. Educating parents. Providing care for the child undergoing surgery. Teaching older children and adolescents that caffeine, chocolate, and spicy foods may aggravate symptoms. Weight management.
Which position is recommended for a child with GER? The upright prone position.
When teaching an adolescent about GER, how do they need to adapt their diets? They need to avoid caffeine, chocolate and spicy foods because they may aggravate their symptoms.
Sickle Cell Anemias main Sign is? PAIN!!
Appendicitis Pathophysiology Inflammation of the appendix. Appendix may become gangrenous or rupture. Average age is 10 years.
Appendicitis Manifestations Periumbilical pain with Vomiting mucus diarrhea McBurney’s point Guarding Rebound tenderness Pain on lifting the thigh while supine Elevated WBC Ultrasound/CT scan.
Appendicitis Treatment & Nursing Care Use pain perception scales and observe behavior. Prepare child and family for procedures and preoperative teaching. Pain management. Prevention of infection. Early ambulation.
What tests may show an enlarged appendix? Ultrasound or CT.
VATER: Vertebral Tracheoshageal AnorectalRenal
VACTERL: Vertebral Anorectal Cardiovascular Limb
EA & TEF Diagnostic Evaluation Suspected based on manifestations: Excessive salivation and drooling. Three C’s: coughing, choking, cyanosis. Apnea. Increased respiratory distress after feeding. Abdominal distension. The exact type is based on chest films
Meckel’s Diverticulum Pathophysiology A small blind pouch near the ileocecal valve fails to disappear completely and may be connected to the umbilicus by a cord. A fistula may form. Susceptible to inflammation. More common in boys. The most common congenital malformation of the GI tract.
Meckel’s Diverticulum Manifestations Symptoms before 2 years. Painless bright red or dark red bleeding. Abdominal pain. Barium enema for diagnosis.
Symptoms for Meckel's diverticulum usually appear at what age? Before 2 years old.
Crohn's Disease Manifestations Is a chronic inflammation that involves all layers of the bowel wall.
Crohns Manifestations include: Abdominal pain. Weight loss. Fever. Anorexia. Rectal bleeding. Anal fistulas.
Crohn's Disease Diagnostic Evaluation Lab tests. Stool studies. GI series.
Crohn’s Disease Therapeutic Management Goals Control the inflammation. Obtain long-term remission. Promote normal growth and development. Normal lifestyle.
Meds to control Crohns inflammation include: Corticosteroids. Sulfasalazine. Antibiotics to treat complications and fight bacteria.
Crohn’s Disease Therapeutic Management Nutritional Support: Well-balanced, high-protein, high-calorie diet. Enteral formulas. TPN.
Crohns Surgical Management : Intestinal resections.
Crohn’s Disease Nursing Considerations appropriate nutrition Plan meals with child. Encourage small, frequent meals. Serve meals around medication schedules. Prepare high-protein, high-calorie foods. Educate child and family on medication regimes. Support family and child.
What type of diet should be encouraged for the child with Crohn’s disease? A well balanced, high-protein, high-calorie diet.
PUD Ulcers are described as? Gastric: Involve the mucosa of the stomach. Duodenal: Involve the pylorus or duodenum. Primary: Absence of predisposing factors and common in children over 6 years. Secondary: unknown cause
Peptic Ulcer Disease Signs and Symptoms Epigastric abdominal pain. Nocturnal pain. Oral regurgitation. Heart burn. Weight loss. Hematemesis. Melana. PUD Diagnostic Studies
Peptic Ulcer Disease Therapeutic Management Goals: Relieve discomfort. Promote healing. Prevent complications & recurrence.
PUD Medications Antacids. H2 receptor antagonists: Cimetidine (Tagamet). Rantidine (Zantac). Famotidine (Pepcid). Proton pump inhibitors: omeprazole (Prilosec, Prilosec OTC). lansoprazole (Prevacid).
What can the nurse teach the PUD patient? A nutritious diet. Avoid caffeine, alcohol and smoking. Peptic Ulcer Disease Nursing Considerations Promote healing through encouraging the family. Educate the child and family on the role of stress and the development of ulcers.
Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF) The tissues of the gastrointestinal tract fail to separate properly from the respiratory tract in utero. May occur in combination or separate. Fatal without early diagnosis and treatment.
EA & TEF Therapeutic Management surgical emergency. Maintain airway and pouch must be decompressed. Upon suspicion, keep infant NPO, start an IV and place in position to prevent aspiration. Surgical correction consists of dividing the fistula and doing an end-to-end anastomosis.
EA & TEF Nursing Considerations Keep infant NPO. Notify the provider immediately if you suspect EA/TEF. Place a NG tube to low intermittent suction. Postoperative care: Leave G-tube open to air. Attempt oral feedings after order is written, using sterile water first.
EA & TEF Nursing Interventions Special problems may occur including: Respiratory complications. Provide a pacifier for non-nutritive sucking to prevent oral aversions. Support the parents.
What are some Discharge planning for EA TAF? Teach skills to care for infant at home. Signs of respiratory distress. Signs of constriction of the esophagus: Poor feeding. Dysphasia. Regurgitation of undigested food.
What does VATER and VACTERL stand for? VATER: vertebral, anorectal, tracheoesophageal and renal. VACTERL: vertebral, anorectal, cardiovascular, tracheoesophageal, renal and limb abnormalities that may be present with children who have EA/TEF.
You expect a newborn has EA/TEF. What is the first thing you should do? The first thing you should do is stop oral feedings, then notify the provider immediately.
Hernia Pathophysiology Maybe congenital or acquired. A reducible hernia can be put back into place by gentle pressure. incarcerated hernia cannot be reduced.
Hernia Manifestations Unilateral or bilateral. Symptom free. Irritability, fretfulness, & constipation. Vomiting & sever abdominal pain if strangulated.
Hernia Treatment & Nursing Care Surgery. Well-tolerated & simple. Routine postoperative care.
What is the surgery called to repair a hernia? Herniorrhaphy.
Pyloric Stenosis Pathophysiology Narrowing of the lower end of the stomach occurs related to hypertrophy of the circular muscles of the pylorus or by spasms of the sphincter. A congenital anomaly that is more common in boys and has a hereditary tendency.
Pyloric Stenosis Manifestations Symptoms at 2-3 weeks of age. Projectile vomiting. Constant hunger. Dehydration. Olive-shaped mass in RUQ.
Pyloric Stenosis Treatment and Nursing Care Pyloromyotomy. IV therapy. Thickened feedings. Burp before & during feedings. Daily weights. I & O. Frequent position changes. Monitor VS. Avoid overfeeding.
What is pyloromyotomy? It is a surgical procedure in which the pyloric muscle is incised to enlarge the opening to allow food to pass.
Intussusception Pathophysiology A slipping of one part of the intestine into another portion of the intestine below it ("telescoping of the bowel"). The intestinal obstruction can strangulate and burst causing peritonitis. boys, usually ages 3 months to 3 years of age
Intussusception Manifestations Sudden, severe abdominal pain. Loud cry, straining efforts, kicks & draws legs in. Vomiting. Diminished flatus & BMs. Currant jelly stools. Febrile. Shock. Rigid abdomen.
Intussusception Treatment Medical emergency. Barium enema. Surgery if barium enema unsuccessful.
Children with Intussusception may have bowel movements containing blood and mucus and no feces. What are these called? Currant-jelly stools.
Celiac Disease Pathophysiology Leading malabsorption disorder in children. Inherited disposition. Symptoms at 1 year to 5 years of age.
Celiac Disease Manifestations Failure to thrive. Large, bulky & frothy stools. Abdominal distention with atrophy of buttocks.
Celiac Disease Treatment & Nursing Care A child diagnosed with celiac disease must restrict foods containing what? Gluten.
Umbilical hernia is a protrusion of part of the intestines through the umbilical ring.
Inguinal hernia is a protrusion of part of the abdominal contents into the groin.
A strangulated hernia has a diminished blood supply occurs before 6 mths
Battered Child Syndrome: A broad term that refers to the clinical condition in young children who have received serious physical abuse, neglect, or maltreatment. Generally from a parent or foster parent.
Child Maltreatment Includes intentional physical abuse or neglect, emotional abuse or neglect, and sexual abuse of children, usually by adults. It is one of the most significant social problems affecting children.
Incidence of Child Abuse In 2004 over 2. 9 million cases were referred for possible abuse. 50% from professionals. 1/2 ruled out. 1/3 ruled in.
True or False: Child abuse refers to the clinical condition of a child who has received physical abuse or neglect? TRUE.
Perpetrators Statistical Facts 3/5 female (60%). 3/4 one parent (87%). 11% sexual abuse cases committed by male (parent, relative or other).
Child Neglect Neglect is the failure of a parent or other person legally responsible for the child’s welfare to provide for the child’s basic needs. 3 forms: Physical neglect. Emotional neglect. Emotional abuse.
Neglect Child’s Appearance: Not clean, tired, no energy. Lack of food, no breakfast. Alone. Needs medical attention.
Neglect Child’s Behavior: Absent from school. Begs or steals. Substance abuse. Vandalism. Sexual misconduct.
Neglect Parent’s or Caretaker’s Behavior Substance abuse. Upset home life. Disinterested, apathy. Isolation. Lack of social skills. Chronic illness. History of neglect.
What are the three forms of neglect? Physical neglect. Emotional neglect. Emotional abuse.
Physical Abuse is the deliberate infliction of physical injury on a child.
Incidence of Physical Abuse Approx. 1 million cases reported per year. Many cases are not reported.
Risk Factors Children from large families. Younger children are at greater risk of death. Pre-term babies are at a greater risk of abuse. Temperament of parent and child. Often one child is singled out. Different children are at greater risk for Abuse
Have difficulty coping with stress and controlling anger. Are socially isolated and have no available support systems. Have low self-esteem. Regulatory Agencies United States Children’s Bureau Child Protective Services UCMJ Regulatory Agencies Each state has its own laws. Any professional is obligated by law to report suspected abuse to CPS. Any person can report child abuse.
Warning Signs of Physical Abuse Bruises. Welts. Burns. Fractures. Bite marks. “Accidents”.
Warning Signs Child’s Behavior Self-report (innocently). Little or no response to pain. Indiscriminate friendliness to strangers. Fear of being touched.
List 3 factors that predispose children to physical abuse. They include: Multiple siblings. Premature babies. Difficult temperament. Hyperactive. Physically disabled. Illegitimate or unwanted.
True False: The law actually prescribes that a health care professional must only report confirmed cases of abuse to the appropriate authorities. FALSE report all suspected cases to the appropriate authorities.
What are 3 behaviors from parents or caretakers which may be considered warning signs for child abuse? Inappropriate responses, conflicting stories with the child, excessive delay in seeking treatment, repeated visits to the emergency room with injuries to the child.
Munchausen by Proxy Is illness that one person fabricates or induces in another person. It is done usually to gain the attention of the medical professionals.
Munchausen by Proxy Forms Adding maternal blood to the child’s urine to simulate hematuria. Presenting a fictitious medical history. Chronic poisoning of the child. It is very hard to confirm and requires a high index of suspicion to protect the children.
Munchausen by Proxy Warning Signs Unexplained, prolonged, recurrent or extremely rare illness. Discrepancies between clinical findings and history. Illness unresponsive to treatments. Signs and symptoms occurring only in the parents’ presence.
Warning Signs Demonstrated by Parents Parents knowledgeable about illness, procedures and treatments. Parents very interested in interacting with the health care team. Parents overly attentive toward child. Family members with similar symptoms.
Emotional Abuse Emotional abuse refers to the deliberate attempt to destroy or significantly impair a child’s self-esteem or competence.
Emotional abuse may include: Rejecting. Isolating. Terrorizing. Ignoring. Corrupting. Verbally assaulting. Overpressuring the child.
Child’s Appearance and Behavior of Child Abuse often less obvious than other forms of maltreatment. Behavior is best indicator. Child’s Behavior: Extremes: Unusually pleasant or disruptive. Adult behavior or overly young for age. Behind in age in physical, emotional, or intellectual development.
Emotional Abuse Parent or caretaker’s behavior: Blames and belittles the child. Rejecting to child, withholds love. Unequal treatment to other children.
What is emotional abuse? Emotional abuse refers to the deliberate attempt to destroy or significantly impair a child’s self-esteem or competence.
Sexual Abuse constitutes 10% of officially substantiated child maltreatment Sexual abuse is “the use, persuasion, or coercion of any child to engage in sexually explicit conduct for producing any visual depiction of such conduct or rape, molestation, prostitution
Sexual Abuse Child’s Appearance Torn, stained, bloody underclothing. Pain on urination, swelling or itching in genitals. STD’s, nonspecific vaginitis or HPV. Pregnancy in young adolescents. Difficulty walking or sitting.
Sexual Abuse Child’s Behavior: Withdrawn. Regressive behavior like bedwetting or thumb sucking. Poor relationships with other children. Delinquent acts, runs away from home. Suicidal attempts or ideation.
Sexual Abuse Parent’s or caretaker’s behavior Protective or jealous. Comes from all levels of society. Parents have an estranged relationship. Have difficulty showing concern towards their child. During hospitalization, the parents do not become involved in the child’s care.
Nursing Care for Sexual Abuse Maintain a high level of suspicion. Document factually and objectively. Review records to discover patterns. Be suspicious of delays in seeking medical care. Be suspicious of children who are upset about being discharged.
Nursing Care Approaching the child about Abuse Approach quietly and explain all treatments carefully. Allow child to express feelings through play. Keep direct questioning to a minimum and praise. Avoid speaking about the parents negatively in front of the child.
Points to Remember concerning Child Abuse The child’s needs are basically the same as those of any hospitalized child. Do not become a substitute parent. The goal is to provide a role model for the parents in helping them to relate positively and constructively to their child.
Nursing Considerations for Sexual Abuse Identify high-risks parents early: Use questionnaires. Observe the mother-infant bonding process. Look at the social, financial, and parental history. A lack of interest, indifference, or negative comments about the baby may be significant.
Nursing Care Approaching the Parents Parents experience loss and mourn when children are placed in foster homes. This is a time of crisis- remain open to the parents. Maintain a non-judgmental attitude at all times. Don’t assume that you know who did it.
Support of the Family- Child Abuse Family planning. Protective services. Child care centers. Parenthood education Classes. Hotline to child shelters. Child advocate.
Child Abuse Other related services Financial assistance. Employment services. Transportation. Emotional support and long term follow-up.
Nursing Interventions for Sexual Abuse PREVENTION Home health nursing Educate parents/children Inform children what good touch is. Inform them, their body belongs to them. Secrets and surprises are not the same. Stay away from strangers. Remember that “nice” people can also be offenders.
___________is the most common cause of serious gastroenteritis. Rotavirus
________ are frequently associated with diarrhea. Antibiotics
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ROTATEQ v Rotarix Human Bovine Reassortant Rotavirus Vaccine(2,4,6 months of age). Live Human Rotavirus Vaccine 2 doses
Rehydration usually involves IV fluids containing ____% Saline 5
What should the nurse teach the parents on how to prevent diarrhea? Do not let food sit out for more than two hours, cheak meat with fork to make sure it is not pink, quickly freeze all ground beef.
Obstipation Long intervals between poops
Encopresis fecal soiling
Ea & TEF is suspected based on what manifestations? Excessive salivation and drooling. Three C’s: coughing, choking, cyanosis. Apnea. Increased respiratory distress after feeding. Abdominal distension. The exact type is based on chest films
Skin Lesions Result from causes such as Contact with injurious agents. Hereditary factors. External factors. Systemic diseases.
Remember ___ when considering etiology of skin manifestations. AGE
Skin of Younger Children: epidermis is thinner and blisters easily.
More than half of the dermatologic problems in children are forms of _______ dermatitis
Acute responses create edema, vesicles and vascular dilation which leads to lesions
Skin Lesions Diagnostic Evaluation Pruritis. Pain or tenderness. Burning or stinging. Alterations in sensation. Increased sensation. Decreased sensation. When the lesion appeared. Whether it occurred with food or other substances. Whether it is related to activity.
Skin Lesion Terms Erythema Ecchymosis Petechia Primary lesions Secondary lesions
If a skin problem is related to a _______ ______, laboratory studies are performed to identify that causative factor. systemic disease
Wounds Structural or physiologic disruptions. Wounds can be classified as?
3 categories of Burns? Superficial. Partial-thickness. Full-thickness.
_________ are the most common epidermal injuries. Abrasions
_______usually result in rapid, uneventful healing and recovery. Superficial
Injury to deeper tissues involves permanent cells which are _______to regenerate. unable
Factors that influence wound healing The best environment depending on the wound. Moist environment is preferred over dry because of recent research.
What things can delay wound healing? Antiseptics.
What are the common symptoms of skin lesions? include pruritis that varies in intensity is the most common, pain or tenderness, burning or stinging and alterations in sensation.
What is the most common epidermal wound in children? Abrasions.
Skin Lesions Goal of Therapy Prevent further damage. Prevent complications. Manage discomfort.
Remove causative factors. Wound Dressings: Traditional dry dressings should not be used. Moist dressings increase rate of healing and decrease pain and inflammation. Balance must be achieved.
Skin Lesions Therapeutic Management Topical Therapy Treat disorder. Reduce itching. Decrease external stimuli. Apply external heat or cold.
Other topical therapies Chemical cautery Cryosurgery Ultraviolet therapy Laser therapy Acne therapy Dermabrasion Chemical peels Antibiotics Antifungal agents
Skin Lesion Nursing Care Assess: Document the description of the skin lesions and wounds. Note: Color. Shape. Distribution of lesions and wounds. When palpating the skin what should the nurse note?
Wounds Nursing Care Note signs of wound infection Increased erythema. Edema. Purulent exudate. Pain. Increased temperature.
It is not usually necessary to _____ the child unless you suspect viral infections such as chickenpox or measles. Isolate
Patient Teaching for wound care should include? Wash hands Do not put on anything that is not ordered Open wounds are covered with a dressing Remove with care Apply pressure if laceration is bleeding Clean and examine wound Do NOT open blisters
What can the nurse teach the patient regarding symptom relief? Cool affected area Soft lightweight clothing and bed linen NO scratching Mittens Keep fingernails short antipruritic medications Treat pain with nonpharmacological measures or mild analgesia.
Topical Therapy Nursing Care Wash hands prior to and after Plain water or Burrow’s solution may be used Hold dressing in place with Kerlix gauze Remove dressing Soaks are used for removal of crusts Baths are useful for antipruritic and anti-inflammatory effects.
What should the nurse consider regarding home care? Ensure the parents and child are properly educated on dressing changes, expected results and side effects. Be aware that some children may experience alterations in self esteem.
What is the goal when treating skin disorders? To prevent further damage and complications and to manage discomfort while the tissue heals.
What nonpharmacological measures can be taken to prevent an infant or small child from scratching lesions? Place mittens or other device on the child and keep their fingernails short, clean and trimmed.
Impetigo Pathophysiology An infectious disease of the skin caused by staphylococci or by group A beta-hemolytic streptococci. It results when the organism comes in contact with a break in the skin.
Impetigo Manifestations First symptoms are red papules. Eventually become small vesicles or pustules surrounded by reddened area. When blisters break, surface is raw and weeping. May occur anywhere; often in moist areas i.e. nose, mouth, neck, axilla and groin.
Impetigo Treatment & Nursing Care Systemic antibiotics. Strict handwashing. Wash lesions 3-4 times daily. Bactroban ointment. Prevention. Compliance with treatment. Infant in newborn nursery isolated. Nephritis is complication of beta-hemolytic strep.
Staphylococcal Infections common bacteria that are found in dust and on the skin. Under normal conditions, it does not present a problem to the healthy body.
In the newborn Staphylococcal can cause Septicemia. Pneumonia. Osteomyelitis. Meningitis.
Staphylococcal Infections Manifestations Scalded Skin Syndrome: Mild erythema. Sandpaper texture. Vesicles may appear. Rupture and peeling may occur.
Methicillin-Resistant Staphylococcus Aureus (MRSA) resistant to antibiotics.
Staphylococcal Infection Treatment & Nursing Care Antibiotics. Ointments. Strict isolation.
What is a complication of beta-hemolytic streptococcal infections? Nephritis.
What is the organism responsible for causing scalded skin syndrome? Staphylococcus Aureus.
Verruca (warts) can occur anywhere and can be either single or multiples.
Verruca can appear? Usually well circumscribed. Appear gray or brown. Papules are raised, firm with a roughened texture.
Verruca Management Local destructive therapy depending on location, type and number. Surgical removal. Electrocautery. Curettage. Cryotherapy. Most will disappear spontaneously.
Nursing Care for Verruca Caution parents not to try to remove wart. Apply topical anesthetic at least 30 – 45 mins prior to removal.
Herpes Simplex Virus Two types Type I: Cold sores and fever blisters on mouth or face. Type II: Genital blisters.
HSV Signs and symptoms: Grouped, burning and itching vesicles As healing. progresses, vesicles dry and crust. May be accompanied by lymphadenopathy.
Herpes Simplex Virus Treatment and Nursing Care Topical therapy can shorten duration and reduce severity of symptoms. Oral antivirals will shorten duration and reduce severity. Acyclovir. Valacyclovir (Valtrex) is used mainly for type II. It reduces pain and stops viral shedding.
A child with a wart on his finger. The mother states she tried several times to remove the wart, but it just keeps getting larger. Why is this phenomenon occurring and as the nurse taking care of this child, what education provide to the mother? Warts may increase in size if you manipulate them. Their course is unpredictable, but most warts tend to disappear on their own. If the parent is concerned, she should seek medical advice and let the provider choose a course of action to remove the wart.
Tinea Capitis a highly infectious fungal infection transmitted from person to person or from infected animals to persons; seen in school-age children.
Tinea Capitis Signs and symptoms Fungus attacks hairs at their bases, causing them to break off close to the skin, loses pigment and leave circular, patches of balding areas (alopecia). Papules on the scalp become pustules, which progress to red scales.
Tinea Capitis Diagnostic Evaluation Clinical history and appearance. Observation with an ultraviolet light (Some stains glow green under a Wood's light). Microscopic examination of the affected hairs.
Tinea Capitis Treatment & Nursing Care Oral administration of Griseofulvin (Fulvicin, Grisactin). Exposure to sun is avoided. Treatment may be necessary for 8-12 weeks. Emphasize good health and hygiene. The infected child should not share grooming aids, or headgear. Children may go to sc
What is the ultraviolet light called used to diagnose Tinea Capitis? Wood's light.
Pediculosis Capitis Pathophysiology pediculus capitus of the scalp and hair. More common in females seen in school-age and day care age children. Transmitted from one person to another or by contact with personal items. Observation of the eggs attached to base of hair shafts.
Wood's light: nits will fluoresce white.
Pediculosis Capitis Treatment Pyrethrin cream rinse kills both lice and nits Remove nits from the head with a fine-tooth comb dipped in a 1:1 solution of white vinegar and water followed by washing hair
Pediculosis Capitis Treatment For eyebrow and eyelash involvement apply thick coat of petroleum jelly (Vaseline) followed by manual removal of remaining nits.
Pediculosis Capitis Nursing Care Parents are instructed to inspect the child's head regularly and children should be cautioned regularly against swapping caps, head scarves and combs. Protect self by wearing gloves and cap.
Scabies Caused by a parasite or "itch mite." Spread by close personal contact, including sexual relations. Rarely transmitted by fomites.
Scabies Manifestations Female mite burrows under the skin and lays eggs, leaves feces; makes a tunnel sometimes seen under the skin. Visible by microscopic examination. Lesion- thrives in moist body folds. Pruritus is intense, especially at night.
Scabies Treatment & Nursing Care Scabicide. Treat all who had contact with child. Wear gloves. Instruct family. Treat bedding and clothing.
What are the manifestations of head lice? Pruritus of the scalp, grayish-white eggs (nits) firmly attached to hair shafts near the scalp, and excoriations from itching and pustules may be seen about the face. Hair becomes matted with foul odor.
Lyme Disease Caused by the spirochete that enters the skin and bloodstream through the saliva and feces of ticks, especially deer ticks.
Lyme Disease Occurs in 3 stages Stage 1: tick bite to development of erythema migrans at site. Stage 2: Most serious; systemic involvement of neurologic, cardiac and musculoskeletal systems Stage 3: Includes musculoskeletal pain that involves tendons, bursae, muscles and synovia
Lyme Disease Diagnosis & Therapeutic Management Diagnosis is best made during the early stages by recognizing the characteristic rash. Therapeutic Management: Children >8 years are treated with oral Doxycycline. Children < 8 years are treated with Amoxicillin.
Lyme Disease Nursing Considerations Wear light clothing Tuck pant legs into socks and wear long-sleeved shirts tucked in Avoid grass and shrubbery where ticks live. Insect repellents with DEET are pest, but should be used cautiously and not on face, hands or any areas of irritated skin
What is the characteristic rash that is noted on children with lyme disease? Erythema migrans which appears as annular red rings.
Intertrigo Medical terminology for chafing; dermatitis occurring in folds of skin.
Intertrigo Manifestations Patches of red, moist skin, and are usually along the neck and in the inguinal and gluteal folds. Condition is aggravated by urine, feces, heat, and moisture.
Intertrigo Treatment and Nursing Care keep affected areas clean and dry. Expose the area to air and light. Maceration of the skin can lead to secondary infection.
Seborrheic Dermatitis inflammation of the skin involving sebaceous glands.
Seborrheic Dermatitis Manifestation Thick, adherent, oily, yellowish, crust-like scales on scalp and forehead. May involve the eyelids, external ear, and inguinal area. Lesions usually do not itch Skin beneath patches may be red. Seen in newborns, infants and at puberty. No family hx
Seborrheic Dermatitis Treatment Directed at adequate scalp and hair hygiene. Shampooing areas with a mild shampoo on a regular basis. Oil may be massaged into scalp to soften crusts, night prior to washing. Rinse scalp well. Use soft brush to remove particles.
Seborrheic Dermatitis Nursing Care Teach parents how to shampoo football hold. Mild medications containing sulfur, salicylic acid, or hydrocortisone often prescribed. Managed best with the topical antifungal agent effective against Pityrosporan.
Diaper Dermatitis skin irritation caused by prolonged and repetitive contact with an irritant.
Diaper Dermatitis Manifestation may take forms from simple erythema to scales, blister, and ulcerations, depending on the cause. A beefy red rash in diaper area may be indicative of a candida infection.
Diaper Dermatitis Treatment & Nursing Care Prevention. Exposure to light and air. Frequent diaper changes. Medicated powder or ointment. Cleanse diaper area. Avoid plastic pants. Super absorbent disposable diapers. Petrolatum, A&D ointment, or zinc oxide ointments.
How can diaper dermatitis be prevented? Frequent diaper changes and exposure to air and light.
Acne Vulgaris Pathophysiology Inflammation of the sebaceous glands and hair follicles in the skin. Peak incidence at puberty; more common in males. Genetic factors and stress play a part. Course may be brief or prolonged. Premenstrual acne is not uncommon.
Acne Vulgaris Manifestations Principal lesions include comedones, papules, and nodulocystic growths
Inflamed lesion ________is a plug of keratin, sebum and bacteria. (comedones)
Open comedones (blackheads) the surface is darkened by melanin.
Closed comedones (whiteheads) responsible for inflammatory process of acne.
Acne Vulgaris lesions are most often located? on the chin, cheeks, and forehead. Also develop on chest, shoulders, and upper back.
Acne Vulgaris Treatment & Nursing Care Antibacterial soaps & skin cleansers. Topical dermatologic agents. Vitamin A. Tetracyclines. Avoid oily makeup, moisturizers. Accutane for severe pustulocystic acne.
Acne Vulgaris Medical Treatment Dermabrasion. Oral contraceptives.
Patient teaching for Acne? Education on disease & treatment. Caution against vigorous scrubbing. Understanding support. Include parents.
What is sebum? A fatty substance secreted from the sebaceous follicles.
What should children do if their clothes are on fire? Stop, drop and roll.
Burns skin or mucous membranes. Assessing for resulting edema and respiratory distress is a PRIORITY. The response, therapy, prognosis and disposition of the injured child are directly related to the amount of tissue destroyed.
Types of Burns Thermal. Chemical. Electrical.
Burns Classification Major: requires treatment at a specialized burn center. Moderate: may be treated in any hospital with expertise in burn care. Minor: may be treated as an outpatient.
Children have_______ ______, leading to a more serious depth of burn with lower temperatures and short exposure. thinner skin
Children less than __ years have a significantly high mortality rate. 2
Inhalation Injury Trauma to the tracheobronchial tree often follows inhalation of heated gases and toxic chemicals produced during combustion.
Clinical manifestations of Inhalation Injury may not be present until 24 to 48 hours after inhaling the gasses Wheezing. Increased secretions. Hoarseness. Wet rales
Burns Pathophysiology Thermal injuries produce both a local and systemic effect. With a major burn > 30% TBSA, there is a systemic response. Anemia is the result of heat destruction of red blood cells, hemolysis and trapping of red blood cells in the damaged cells.
Burns Complications The immediate treat: Airway compromise. Profound shock. During healing stages: Infection.
Pulmonary problems are a major cause of death in children with either thermal burns or complications in the respiratory tract; Bacterial pneumonia is the most common cause of respiratory failure with pediatrics.
Burns Therapeutic Management stop the burning process. Smother flames. Place injured child in horizontal position and roll in a blanket, rug or similar article without covering the head or face. Do not cool major burns Do not use wet dressings. Remove all clothing and jewelry.
Burns Therapeutic Management Assess the victims condition when flames are out; start CPR Cover the burn with a clean cloth. Transport the child to a mtf Establish the largest bore IV catheter and administer 100% O2 Provide reassurance and psychologic support to the family and child
Burns Therapeutic Management Minor burns can be treated on an outpatient basis. Cleanse the wound with mild soap and water. Cover it with an antimicrobial ointment. Do not disturb blisters unless they are the result of chemical contact. Change dressings as prescribed.
Burns Therapeutic Management for Major burns: First priority: Airway management. Intubate if edema is suspected. Administer 100% O2 and get blood gases. If full-thickness burns encircle chest, an escharotomy is done.
Burns Therapeutic Medical Management of Major Burns FLUIDS- Compensate for water and sodium lost. Reestablish sodium balance. Restore circulating volume. Provide adequate perfusion. Correct acidosis. Improve renal function. CRYSTALLOID solutions are used initially. After 24 hrs COLLOID solution
Burns Therapeutic Management Medications Surveillance cultures and monitoring help determine when antibiotics are started. Some sedation and analgesia is required. Morphine or Versed with Fentanyl.
Burns Medical or Surgical Management After initial period, devitalized tissue must be removed Primary excision Debridement of partial-thickness burns Topical antimicrobial agents are applied Allograft-from human cadavers Xenograft-most often from pigs. Synthetic skin.
What is the difference between a partial-thickness and full thickness burn? A partial-thickness burn involves the epidermis and varying degrees of the dermis; they are painful. A full-thickness burn involves the entire epidermis and dermis and extends into subcutaneous tissue; since the nerve endings are burnt, often not painful.
What type of solutions is used for fluid resuscitation of a burn patient during the initial 24 hours? Crystalloids are used.
Severe Burn Nursing Care Acute Phase Primary emphasis is on treatment of burn shock and management of pulmonary status. Monitor vital signs. Urine output should be at least 1 to 2 mL/kg in children weighing < 30 kg. Urine output should be at least 30 to 50 mL/hr for a child >30 kg.
Nursing Care during the Acute Phase the nurse should monitor for? Confusion. Weakness. Cardiac irregularities. Seizures. Be alert to changes in respiratory function Restlessness. Irritability. Increased work of breathing. Alterations in blood gas values.
Children are at an increased risk for________when suffering from severe burns. hypothermia.
Evaluate extremities and check the pulse every _____ notify provider immediately if unable to palpate pulse. hour
The psychosocial needs of the child with a severe burn and family should be attended to how? Child will be frightened, uncomfortable and confused. Family may experience different degrees of guilt. Consistent information is essential. Staff must show a caring, compassionate attitude.
Nursing Care Management and Rehabilitation Phase A multidisciplinary team focuses on preventing infection, closing wounds and managing complications.
Nursing Care Management and Rehabilitation Phase Comfort Management Medications as ordered prior to procedures. Relaxation techniques. Distraction therapy. Family participation. Explain all procedures in an age-appropriate manner.
Nursing Role during the Management and Rehabilitation Phase Care of the burn wound is the primary responsibility of the nurse. Cleaning the wound. Debriding. Applying topical ointments and dressings. Standard precautions must be adhered to in order to decrease the risk of cross-contamination.
Monitor children on Enteral feedings for intolerance how? Abdominal distention. Diarrhea. Electrolyte and metabolic deviations.
Nursing Care Prevention of Complications During acute phase, monitor and support the child’s core body temp: The environment should be maintained between 82-91 degrees F. Warm solutions, linens, occlusive dressings, heat shields, radiant warmer and warming blankets help.
_______is the chief danger during the acute phase. Infection
Sings and Symptoms of infection during the Acute Phase A change in the LOC Rising or falling WBC Hypo or hyperthermia A loss of progression of wound healing Increasing fluid reqs Hypoactive or absent bowel sounds. A rising or falling blood glucose level. Tachycardia. Tachypnea Thrombocytopenia
Nurses are responsible for preventing contractures how? Maintain proper body alignment. Positioning and splinting involved extremities. Active and passive physical therapy. Encouraging passive movement.
Intense itching is a problem in burn patients how can the nurse stop it? Treat with a combination of H1 and H2 antagonists such as Zyrtec and Tagament. Apply moisturizers.
Patient Teaching on Preventing Complications Keeping hot liquids out of reach. Secure tablecloths Reduce hot water thermostats to a max of 120 degrees F. Test water before placing your child in it. Formulas, pastries and hot liquids should be reheated with caution; Test them prior
Why are range of motion exercises and proper positioning important? To avoid pressure ulcers and contractures.
What are the two major systems that control and monitor the functions of the body? The nervous system and the endocrine system.
Hypopituitarism Is a disorder associated with deficient secretion of growth hormone.
Hypopituitarism results from a variety of conditions Developmental defects. Destructive lesions. Hereditary disorders. Functional disorders. Anterior Pituitary Problems
Hypopituitarism Diagnostic Evaluation Chief complaint is short stature. An MRI of the brain detects pituitary abnormalities or lesions. Plasma growth hormone is examined. Endocrine studies are done. Hypothyroidism. Hypersecretion of cortisol. Gonadal aplasia.
Hypopituitarism Therapeutic Management Correcting underlying disease.
Definitive Treatment of Therapeutic Management Growth Hormone replacement. Successful in 80 – 90%.
Hypopituitarism Nursing Care establishing the diagnosis and providing emotional support. Educate parents on treating the child according to their age and developmental levels. Educate parents on giving injections at bedtime. Provide assistance in setting realistic expectations.
When should growth hormone injections be given? At nighttime, closest to bedtime because this is when there is a natural physiologic release of GH.
Posterior Pituitary Problems Decreased: DI Diabetes Insipidus. Increased: SIADH; Syndrome of Inappropriate Antidiuretic Hormone secretion.
Diabetes Insipidus Result of the hyposecretion of Antidiuretic hormone or vasopressin. Primary causes: Familial. Idiopathic. Secondary causes: Trauma. Tumors. Granulomatous disease. Infections. Vascular anomalies.
Diabetes Insipidus Manifestations Polyuria. Polydipsia. First sign: enuresis. Infants are irritability that is relieved with feedings of water.
Diagnostic Evaluation DI Fluid is restricted, yet there is little or no effect on urine formation. If test is positive, child is given Vasopressin (Pitressin).
Diabetes Insipidus Therapeutic Management replacement of vasopressin using desmopressin acetate Can be given Po, nasal or injectable. suspended in oil Signs of Od: Water intoxication signs. Anorexia and nausea Stomach cramps Irritability and changes in personality Seizures Changes in LOC
Diabetes Insipidus Nursing Considerations Goal is identification of the disorder Parents need instruction on the disease and treatment. Treatment is lifelong. Parents and older children need instructions on how to prepare and administer the DDVAP. Child should wear a medic alert bracelet.
Syndrome of Inappropriate Antidiuretic Hormone Caused by: Infections. Tumors. Trauma of the CNS.
Syndrome of Inappropriate Antidiuretic Hormone Secretion Manifestations Increased fluid volume. Low sodium levels. Anorexia and nausea. Stomach cramps. Irritability and personality changes. Changes in level of consciousness. Seizures.
Syndrome of Inappropriate Antidiuretic Hormone Secretion Nursing Considerations I&Os Daily weight. Implement seizure precautions. Instruct the child and parents on fluid restrictions. What is the different between DI and SIADH?
What is the most important thing to remember when preparing to administer DDAVP? DDAVP must be thoroughly suspended in the oil that it is mixed with prior to administering it. Hypothyroidism
Endocrine System of a Child Newborn endocrine system supplemented by maternal hormones Swelling of breasts & genital changes. Hormone disturbances during childhood. Congenital hypothyroidism. Type I Diabetes.
Early signs of an inborn error of metabolism in the newborn include? Lethargy. Failure to thrive. Vomiting
Hypothyroidism Pathophysiology Occurs when there is a deficiency in the secretions of the thyroid gland.
The thyroid gland controls the rate of metabolism in the body by producing? thyroxine (T4) and triiodothyronine (T3).
Hypothyroidism Manifestations Infant sluggish. Tongue enlarged. Skin dry. Hand & feet cold. Infant floppy. Hypotonic bowel causing constipation. Hair dry & brittle. Irreversible complications if untreated.
Hypothyroidism Treatment & Nursing Care Early recognition & diagnosis are essential. Screening test at birth. Synthetic hormone administration. Monitor hormone levels. Take meds at same time. Teach parents not to interchange brands.
Hypothyroidism Nursing Care Teach pt may experience Reversible hair loss. Insomnia. Aggressiveness. Schoolwork may decline during first few months of therapy. Instruct that this is temporary.
Hypothyroidism Treatment 1-3 weeks to reach therapeutic effect. Do not discontinue because the replacement for hypothyroidism is life long. Consult physician prior to giving other meds. Parents should be aware of side effects of medications.
Hypothyroidism Medication Overdose: Rapid pulse. Dyspnea. Irritability. Fever. Sweating. Weight loss. Inadequate: Fatigue. Sleepiness. Decreased appetite. Constipation.
What are the signs of Synthroid overdose? Signs of overdose include rapid pulse, dyspnea, irritability, fever, sweating and weight loss.
Hyperthyroidism Called Graves Disease. Associated with an enlarged thyroid gland and exophthalmos.
Hyperthyroidism Diagnosis Development of Manifestations Emotional lability. Physical restlessness. Voracious appetite with weight loss. Tachycardia, hypertension and widened pulse pressure. Dyspnea on exertion. Exophthalmos. Goiter. Heat intolerance. Systolic murmurs.
Hyperthyroidism Diagnosis Development of Manifestations Acute onset of thyroid storm: Severe irritability and restlessness. Vomiting and diarrhea. Hyperthermia. Hypertension and severe tachycardia. Diagnosis is based on increased levels of T4, T3 with suppressed TSH.
Hyperthyroidism Therapeutic Management Therapy is directed at retarding the rate of hormone secretion: Antithyroid drugs. Subtotal thyroidectomy. Ablation.
Thyroid storm may occur from a sudden release of hormones Life threatening. Treat with additional antithyroid meds. Administer beta-adrenergic blocking agents.
Hyperthyroidism Nursing Considerations Treat symptoms by providing a quiet, unstimulating environment. Explain drug regimen. Educate the parents on signs of hypothyroidism. If surgery is anticipated, educate the parents on the administration of iodine
Hyperthyroidism Nursing Considerations Postoperatively, teach child to support neck when changing positions. Teach signs of hypoparathyroidism: Causes hypocalcemia. Chvostek’s sign. Trousseau sign. Tetany.
What are the signs of hypoparathyroidism and hypocalcemia that nurses need to be aware of when taking care of a child who is post-thyroidectomy? Signs include: Chvostek’s sign, Trousseau’s sign and Tetany.
Diabetes Mellitus Genetics: Type I is not inherited, but heredity has a role in its etiology. Type II has a strong correlation to heredity. Autoimmune mechanisms: An autoimmune process is involved with Type I.
Diabetes Mellitus Those at risk for DM Have glycosuria, polyuria and history of weight loss or failure to gain despite appetite. Those with transient or persistent glycosuria. Those who display manifestations of metabolic acidosis with or without stupor or coma.
Glucose tolerance test (GTT): if >200mg/dl.
Diabetes Mellitus Therapeutic Management Dose is measured in units. Administered SQ bid Lispro, Regular, or NPH are given in combination. The insulin pump is designed to deliver fixed amounts of regular or Lispro insulin continuously. Do not remove for more than 1 to 2 hours at a time.
Diabetes Mellitus Therapeutic Management Hypoglycemia signs and symptoms Most commonly in response to increased activity without increased food Children should carry a source of glucose Nutrition Exercise Glucagon for hypoglycemia.
Diabetes Mellitus Illness management Do not eliminate insulin, but may need to adjust dosage depending on the severity of illness and appetite. Hyperglycemia contributes to dehydration. Management of DKA: Rapid assessment. Adequate insulin. Fluids. Electrolyte replacement.
Diabetes Mellitus Nursing Considerations Educate the newly diagnosed child and family. Child should wear a medic alert bracelet.
Educate parents and child on DM Meal planning. Insulin and signs of hyper & hypoglycemia. Properly dispose of needles. Supervise blood glucose monitoring Purchase glucometer Record info and take record to all appointments wear shoes with socks, sandals or walk barefoot
Which type of DM is most common in children? Type I.
What is the treatment for hyperglycemia? Regular insulin.
What are common signs for hypoglycemia? Irritability, difficulty speaking, shaky feeling, dizziness, sweating and tachycardia.
Diabetes Mellitus Testing Results Blood Glucose 330 Ph 7.3 bi carb less than 15 ketonurea
Chickenpox primarily secretions of the respiratory tract of infected persons; to lesser degree skin lesions.
Signs & Symptoms of Chicken Pox Begins with mild fever. Macules, papules, vesicles, and pustules. Scabs form later. Incubation Period: 2-3 weeks. (Test Question) Contagious Period: probably 1 day prior to eruption of lesions to 6 days after crusts form on vesicles.
Chickenpox Interventions Trim fingernails to prevent scratching. Do not remove scabs prematurely. Administer calamine lotion. Isolate from others.
Prevention of Chicken Pox Vaccine is now routinely administered. Acyclovir (Zovirax) or immune globulin (VZIG) is given to immunosuppressed children who are exposed.
German Measles primarily nasopharyngeal secretions of infected person; also present in blood, urine, and stool.
Signs & Symptoms of German Measles Mild fever and sore throat. Maculopapular rash. Enlarged glands at back of neck. Incubation Period: 2-3 weeks. Contagious Period: 7 days prior until rash fades, about 5 days after.
German Measles Interventions Avoid exposing women in early months of pregnancy. Give plenty of rest and employ comfort measures. Antipyretics. Analgesics.
German Measles Prevention all infants should receive vaccine, with boosters at preschool age. All children should be immunized prior to starting school with MMR vaccine. Hepatitis A
Signs & Symptoms of Hep A Fever. Anorexia. Headache. Abdominal pain. Malaise. Jaundice. Dark urine. Chalk-like bowel movements.
Hepatitis A Prevention Incubation Period: 15-50 days (average 25-30) Contagious Period: uncertain, virus may be shielded for 6 months in neonates. Avoid ingestion of fecal-contaminated water; swimming in contaminated water or shellfish from such water
Hepatitis A Prevention: Hepatitis A vaccine is recommended for children traveling to endemic areas. Injection of gamma globulin gives temporary immunity when exposed. Vaccine is required for all children in some states.
Hepatitis B Source: blood or blood products contaminated with HBV; exchange of blood or any body secretion; intimate physical contact; mother to infant. Signs & Symptoms of Hep B
Hepatitis B Interventions: Avoid direct contact with blood or blood products. Identify high-risk mothers and newborns. Educate concerning need for vaccination. Prevention of Hep B
Infectious Mononucleosis Source: oral secretions, spread by direct contact only.
Signs & Symptoms of Mono Incubation Period: 4-6 weeks. Contagious Period: unknown; spread by direct contact only. Low grade fever. Malaise. Jaundice. Enlarged spleen.
Infectious Mononucleosis Interventions Rest and supportive treatment; isolation if required. Provide school tutoring to maintain grade level. Prevention of Mono
Measles respiratory tract secretions, blood, and urine of infected person.
Signs & Symptoms of Measles Fever, cough, and conjunctivitis. Koplik's spots. Maculopapular rash erupts. Incubation Period: 2-3 weeks. Contagious Period: from 4 days before to 5 days after rash appears.
Measles Interventions Symptomatic care. Isolate and provide quiet activities. Utilize measures to reduce eyestrain caused by photophobia. Detailed oral care.
Prevention of Measles Vaccine at 15 months. If exposed without vaccine, gamma globulin may be given after exposure. Vitamin A is recommended to reduce morbidity.
Mumps saliva of infected persons. Incubation Period: 14-21 days (average 18d). Contagious Period: prior to, and until all swelling subsides. Signs & Symptoms of Mumps
Mumps Interventions Encourage fluids. Isolate. Ice compresses to neck for comfort. Prevention: Start complete series of polio vaccines in infancy. May require respirator care.
Polio caused by infection with the poliovirus. Incubation Period: 7 – 14 days. Contagious Period: 1 week for throat secretions; 4 weeks for feces.
Signs & Symptoms of Polio Headache, fever. Stiff neck and stiff back. Paralysis.
Polio Interventions Isolate. Bed rest. Observe for respiratory distress. Position; physiotherapy. Range of movement exercises.
Prevention of Polio Start complete series of polio vaccines in infancy. May require respirator care.
Tuberculosis airborne; contact with an infected person. Incubation Period: 2-10 weeks. Contagious Period: after treatment when cough subsides.
Signs & Symptoms of TB Low grade fever, malaise, anorexia, weight loss, cough, and night sweats. Positive tuberculin skin test. Immunocompromised patients, such as with AIDS, are at increased risk.
Tuberculosis Interventions Isolate newborn from infected mother. Identify contacts. Isolate using a special mask. Prevention: early detection by tuberculin skin test (PPD). INH Rifampin PZA IM every day two months
Whooping Cough discharge from respiratory tract of infected person.
Signs & Symptoms of Whooping Cough Begins with cold-like symptoms, fever, cold, cough. Spells of coughing, accompanied by a noisy gasp for air that creates "whoop“. Contagious Period: 5-21 days (average 10d). Infectious Period: several weeks.
Whooping Cough Interventions Isolate, bed rest. Provide abdominal support during coughing spell. Re-feed child if he/she vomits. Observe for airway obstruction.
Prevention of Whooping Cough vaccine in infancy (DPT). Diphtheria
Signs & Symptoms Diphtheria Common cold with purulent nasal discharge. Malaise, sore throat. White or gray membrane forms in the throat, causing respiratory distress. Incubation Period: 2-5 days. Contagious Period: usually 2 weeks.
Diphtheria Interventions Observe for respiratory, cardiac, and CNS involvement. Identify contacts for treatment. Intravenous antibiotics and antitoxin. Isolate. Prevention: DPT vaccine to all infants.
Roseola viral.
Signs & Symptoms Roseola Persistent high (103-105 F) fever that drops rapidly as the rash appears. Macupapular rash is non-pruritic and blanches easily. Incubation Period: 5-15 days. Contagious Period: until rash fades.
Roseola Interventions Rest and quiet should be provided. Teach parents temperature reducing techniques and prevention of seizures. Prevention: none.
Smallpox virus.
Signs & Symptoms of Smallpox Child appears toxic. Macules, papules, pustules, and scabs appear. Only one stage of the lesion at time is present on the body. Incubation Period: 7-17 days (average 12d). Contagious Period: highly contagious (CDC notification required).
Smallpox Interventions Strict isolation required. Utilize negative pressure room if available. Restrict number of caregivers. Prevention: Routine smallpox vaccine is no longer recommended unless traveling into high-risk countries.
Fifth Disease Source: human parvovirus B19 (HPV).
Signs & Symptoms of Fifth Disease Child has "slapped check" appearance. Generalized rash appears, and then subsides. Rash may reappear if skin is irritated by sun or heat. Incubation Period: 4-14 days. Contagious Period: during incubation period.
Fifth Disease Interventions This is a benign condition unless child is immunocompromised. Isolation not required. May last 1-3 weeks. Prevention: None.
Scarlet Fever Source: Group A beta-hemolytic streptococcus.
Signs & Symptoms of Scarlet Fever Tachycardia. Strawberry tongue, pinpoint rash. Circumoral pallor, desquamation. Incubation Period: 2-5 days. Contagious Period: during incubation and clinical illness, may become a carrier.
Scarlet Fever Interventions Respiratory precautions. Bed rest; quiet activity. Teach regarding prevention of streptococcal infections. Prevention: Penicillin therapy is given for 10 days; Culture/treat streptococcal infection.
What is the disease that causes a "slapped cheek" appearance? Fifth disease.
A term used to describe a lesion or symptom that is characteristic of a specific illness. Erythema Lesions Pustule Scab Pathognomonic
A circular reddened area on the skin that is elevated describes what type of rash? Papule.
Immunization of SmallPox Must remain alert to signs and symptoms of smallpox Education about need for immunizations. Nurse should check label for refrigeration needs. Educate parents and school about immunization schedules. Assess immunization status at every clinic visit.
Name three biological agents used as weapons. 1. Anthrax. 2. Smallpox. 3. Ebola virus.
Pediatric AIDS 5th leading cause of death in the US of children under 15 years old. AIDS transmission: Oral, anal or vaginal sex with someone infected. Sharing drug needles and syringes with an infected person. Blood transfusions contaminated with the virus.
Not transmitted by? Casual relationships. Living conditions. Blood, semen, vaginal secretions, and human milk all can transmit the AIDS virus.
Pediatric AIDS Pathophysiology HIV attacks lymphocytes. Imbalance between the helper T cells that support the immune system, and the suppressor T cells that shut it down. Over time, the number of helper cells drops.
Pediatric AIDS Manifestations Failure to thrive or developmental delays. Repeated respiratory infectious. Chronic ear infections and sinusitis. Chronic diarrhea. Recurrent fever. Anemia.
Pediatric AIDS Manifestations Hepatosplenomegaly. Oral candidiasis (thrush). Lymphadenopathy. No response to treatment of infections. Herpes viruses and cytomegalovirus.
Pediatric AIDS Diagnostic Evaluations ELISA and Western Blot not as reliable in diagnosing infants and young children. Based on clinical signs and symptoms defined by the CDC. Presence of risk factors associated with AIDS in the mother.
Pediatric AIDS Treatment and Nursing Care Didanosine (DDI), Nevirapine, and Invirase or Ritonavir are sometimes used. Antimicrobial therapy and antipyretics given for active infections. Supportive measures for other symptoms. Preventing the transmission of the virus. Provide supportive care t
Pediatric AIDS Nursing Care Support child and family with grieving process. Encourage discussion of feelings related to the stigma of AIDS. Education concerning long-term compliance with prescribed medication. Nurse should be alert for central nervous system involvement.
List three ways in which children can acquire the human immunodeficiency virus (HIV). 1. Contact with an infected mother at birth. 2. Sexual contact with an infected person. 3. Use of contaminated needles or contact with infected blood.
Bioterrorism Initial observation (quick examination): Appearance. Respiratory effort. Skin color.
Triage categories: Immediate. Delayed. Minimal. Expectant. Bioterrorism
Which triage category requires outpatient care only? Minimal.
Pustule Purulent Fluid
Vesicle Raised Serous Filled Lesion
Nodule Elevated firm deeper in dermais than papule
Macule Flat non palpable round lesion
Oral Medications Oral route is preferred for administering medications to children whenever possible. GI tract provides a vast absorption area for meds.
Nursing Alert for PO syringe or medication cup should be used to ensure accurate dosage measurement. Use of a household teaspoon or tablespoon may result in dosage error because they are inaccurate. Infant / child may cry and refuse to take the medication or spit it out.
Oral Medication Nursing Considerations Infant hold hands away from face. Place in small amount of apple sauce or cereal. Put in nipple without formula. DO NOT ADD MEDICATION TO FORMULA. Give by oral syringe or dropper. Have parent help. Stay in room while parent gives PO
Nursing Considerations Toddler Mix with small amount of juice or fruit. Use simple terms to explain while they are getting medication. Be firm, don’t offer to may choices. Use distraction: offer syringe or medicine cup. Parent may give Stickers/rewards
Nursing Considerations Preschool Offer choices: offer syringe or medicine cup. Praise / reward / stickers. School-Age: Concrete explanations. Give choices. Interact with child whenever possible. Medical play.
Nursing Considerations Adolescent: Use more abstract rationale for medication. Include in decision making especially for long term medication administration.
Nursing Tip for PO Tell the child to drink juice or milk after distasteful medication. Older child can take medication from a syringe, pinch their nose, or drink through a straw to decrease the input of smell, which adds to the unpleasantness of oral medications.
The nurse can minimize the problem of an unpleasant-tasting drug by: Administering the drug through a straw will diminish an unpleasant taste. Having the child hold his nose is helpful, as bad taste is associated with the smell of the drug.
Intradermal, Subcutaneous, and Intramuscular Medications Injections are a source of pain and fear for children. Recommended to give injections when other routes cannot be used.
Guidelines for Injections Use safety precautions. Apply EMLA topically over site if time permits.
Prepare medications for Injection Select needle and syringe appropriate to the following: Amount of fluid to be administered. Viscosity of fluid to be administered. Amount of tissue to be penetrated. Max volume to be admin is determined on the muscle used.
Guidelines for IM, SQ, ID Medications Determine the site of injection: Vastus lateralis: Largest muscle in infants / small child. Max amount of volume administered Infant: < 0.5 mL. Toddler: < 1 mL. Pre-School: < 2 mL. Needle Size: 5/8 to 1 inch needle.
Guidelines for IM, SQ, ID Medications Dorsogluteal NOT SAFE for infants and small children due to muscle is insufficiently developed. (Children under 5 years.) Amount of volume 1.5 to 2 mL. Needle Size: ½ to 1 ½ inch needle.
Guidelines for IM, SQ, ID Medications Deltoid More rapid absorption than gluteal regions. Older children: site selection as with an adult patient. Amount of volume administered: 0.5 to 1 mL. Needle Size: ½ to 1 inch needle.
Guidelines for IM, SQ, ID Medications Subcutaneous Site Upper arm. Lower abdomen. Anterior thigh. Amount of volume administered: < 0.5mL. Needle Size: 3/4 to 5/8 inch needle. Needle Gauge: 23 - 26.
Guidelines for IM, SQ, ID Medications Intradermal Site: ventral forearm. Amount of volume administered: < 0.5mL. Needle Size: 3/8 to 1/2 inch needle. Needle Gauge: 25 - 27.
Guidelines for IM, SQ, ID Medications Administer medication Provide help in restraining child is uncooperative. Explain briefly what will be done. Expose injection site. Position child for injection. Have medication at room temperature.
Guidelines for IM, SQ, ID Medications Decrease pain perception: Distract child with conversation. Apply a cold compress prior to injection. Toddler: band-aid if injection / distraction.
Preschool pain distraction Band-Aid after injection. Assistance for IM injection. Tell the child it is all right to make noise or cry out during the injection. His or her job is to try not to move the extremity.
Guidelines for IM, SQ, ID Medications Insert needle quickly. Avoid tracking any medication through superficial tissues. Aspirate for blood. Inject medication slowly (over 20 seconds). Remove needle quickly. Apply firm pressure. Apply band-aid.
The nurse using anticipatory guidance to prepare a 5-year-old for an IM injection will say: Anticipatory guidance is the psychological preparation of a patient for a stressful event by explaining what will happen and the probable outcome.
Intravenous Medications Intravenous medications is frequently used for pediatric therapy. Often selected for: Immediately distributed to the tissues and prompt physiological action occurs.
IV Medication Administration Check for compatibilities with IV solution and other IV medications. Flush well between administration of incompatible drugs. IV medications are usually diluted.
Nursing Alert The extra fluid given to administer IV medications and flush the tubing must be included in the calculation of the child’s total fluid intake, particularly in the young children or those with unstable fluid balance.
Adverse effects of IV medication administration Extravasation of drug into surrounding tissue. Immediate reaction to drug.
Central Venous Line Site: A large bore catheter that are inserted either percutaneously or by cut down and advanced into the superior or inferior vena cava. Umbilical line may be used in the neonate.
Uses for Central Line Long term administration of meds. Chemotherapy. Total parental nutrition (TPN). Maintenance. Fluid resuscitation. Acute volume expander.
IV Administration Type of Fluids: Glucose. Electrolytes. Normal Saline or lactated ringers. Albumin / plasma / frozen plasma.
Complications of Fluids Infiltration: fluid leaks into the subcutaneous tissue. Fluid leaking around catheter site. Site cool to touch. Solution rate slows are pump alarm registers down-stream-occlusion. Tenderness or pain: infant is restless or crying.
IV Administration Catheter occlusion Fluid will not infuse or unable to flush. Frequent pump alarm. Flush line. Check line for kinks.. Look to see that there is fluid in the IV bag or buretrol. Slow IV rate. Remove air from tubing with syringe.
IV Administration Phlebitis Often due to chemical irritation. When medications are given by direct intravenous injection, or by bolus (directly into the line) it is important to give them at the prescribed rate. Always check the site for infiltrate before giving an IV medication.
Signs and Symptoms of Phlebitis Erythema at site. Pain or burning at the site. Warmth over the site. Slowed infusion rate / pump alarm goes off. Infection.
The nurse explains that for stability of the IV insertion site in an infant younger than 9 months of age, the insertion site is the A superficial scalp vein is the injection site for administering IV medication to infants younger than 9 months of age.
Optic, Otic, and Nasal Medications The major difficulty is in gaining children's cooperation. Explain that the medication is not painful. May cause unpleasant sensations. Parental involvement can decrease level of anxiety in the child.
Eye Drops (Optic) Position: supine or sitting with head extended. Instruct child to look up. Pull the lower lid down. Rest hand holding the dropper with the medication on the child’s forehead to reduce risk of trauma to the eye.
Nursing Alert for Eye Drops If both eye ointment and drops are ordered, give drops first. Wait 3 minutes and apply ointment. This allows for both medications to work as prescribed.
Ear Drops (Otic) Position: prone or supine with head turned to the appropriate side. In children younger than age 3 years the pinna is pulled down and back to straighten the ear canal. In the child older than 3 years, the pinna is pulled up and back.
Nose Drops (Nasal) Head hyper extended over pillow or bed to prevent strangling sensation caused by medication trickling into the throat.
Rectal Medications Suppository is lubricated with water-soluable jelly or warm water. Quickly inserted into the rectum beyond the rectal sphincters. Buttocks are held together firmly
The nurse approaches a group of school-age patients to administer medication to Sam Hart. To identify the correct child, the nurse should do which of the following? Check the patient’s identification name band.
When teaching a mother how to administer eye drops, where should the nurse tell her to place them? Not on the Eye
The physician is treating a child with meningitis with a course of antibiotic therapy. The nurse assures the parents that the child will be out of isolation when The child is isolated until antibiotic therapy has been administered for at least 24 hours.
Nursing Implications for EMLA Assessment Assess application site for open wounds. Apply only to intact skin. Assess application site for anesthesia following removal of system and prior to procedure.
Implementation (topical) EMLA When used for minor dermal procedures (venipuncture, IV cannulation, arterial puncture, lumbar puncture), apply the 2.5-g tube of cream (1/2 of the 5-g tube) to each 2 in. by 2 in. area of skin in a thick layer at the site.
EMLA Implementation Cover so that there is a thick layer underneath the occlusive dressing. Dont spread out or rub in the cream. Smooth the dressing edges carefully and ensure it is secure to avoid leakage.
EMLA should be applied? Anesthesia may be more profound with 90 min-2 hr application.
EMLA Con’t Patient/Family Teaching Explain the purpose OF occlusive dressing to patient and parents. Caution patient to avoid trauma to the area from scratching, rubbing, or exposure to extreme heat or cold temperatures
Home Care Issues for EMLA Instruct patient or parent in proper application. Provide a diagram of location for application.
The nurse explains to the anxious parents that the administration of an opioid analgesic to their 3-year-old is? Opioid analgesia does not have any greater respiratory depression than on an adult and the addiction risk is virtually nonexistent in children. It is an effective type of analgesia.
There are several disorders which affect the musculoskeletal system. These disorders are treated with the following classfications of medications Antirheumatic agents. Corticosteroids. Nonsteroidal antiinflammatory drugs (NSAIDs).
Antiarrhythmics: Digitalis Glycosides Nursing Implications Monitor apical pulse for 1 full minute Withhold < 70 bpm (child). Withhold < 90 bpm (infant). Notify physician of changes in rate, rhythm, and quality of pulse. Heart rates varies in children depending on age
Antiarrhythmics Nursing Implications . Observe IV site for Redness. Infiltration. Extravasation. Monitor I&O. Monitor daily weights. Assess peripheral edema. Auscultate lungs (rales, crackles)
Antiarrhythmics Nursing Implications Con’t Lab Test potassium, magnesium, and calcium. Renal and hepatic functions. Neonates: falsely elevated serum digoxin concentrations. Toxicity and Overdose: Therapeutic serum digoxin levels range 0.5 – 2 ng/mL. Drawn 6-8 hr after dose is administered.
Signs and Symptoms of OD DIG CV: bradycardia and dysrhythmias. GI: N, V, Anorexia. Call Poison Control or local emergency room for overdose.
Antiarrhythmics Nursing Implications Implementation High Alert Narrow therapeutic range. Medication errors. Have second practitioner check dose and order. Monitor therapeutic drug levels.
Antiarrhythmics Nursing Implications Patient Teaching Teach parents and caregivers to be aware of changes in heart rate, especially bradycardia. Instruct parents to take apical heart rate and notify physician if outside range. Review S & S of digoxin toxicity. Decrease CHF Increase cardiac output
Nursing Implications ACE Inhibitor Assessment Hypertension: Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes. Assess patient for signs of angioedema (dyspnea, facial swelling).
Antihypertensives Nursing Implications Lab Test Monitor BUN, creatinine, and electrolyte levels periodically Serum potassium, BUN and creatinine may be ↑, whereas sodium levels may be ↓. If ↑ BUN or serum creatinine concentrations occur, dose reduction or withdrawal may be required. Monitor CBC
Antihypertensives Patient Teaching Instruct pt to take med as directed at the same time each day Warn patient not to discontinue therapy unless directed by health care professional. Instruct patient and family on correct technique for monitoring BP. check Bp at least weekly
Antihypertensives Evaluation Decrease in bp without appearance of excessive side effects. Decrease in S/S of CHF Decrease in development of overt CHF Reduction of risk of death or development of CHF following MI. Decrease in progression of diabetic nephropathy (captopril).
Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics? Potassium supplementation is required with the use of some diuretics. Bananas, citrus fruits, bran, legumes, and peanut butter are some of the foods that are significant sources of potassium.
Urinary System Chief function is regulation of volume and composition of body fluids and excretion of waste materials.
Components of the Urinary System Kidneys Ureters Bladder Urethra Function of Kidneys (two)
Nephron- microscopic functional unit of kidneys.
Urinary System of a Child Fluid of greater importance in infants and small children because it constitutes larger fraction of total body weight. more susceptible to trauma in children due to lack of fat Kidney function immature until 2 yr old
Reproductive System Each gender has gonads and accessory organs. Gonads produce sex cells and hormones that affect reproductive organs and other body systems.
Female gonads: ovaries.
Male gonads: testes.
Gender genetically determined at time of fertilization. Y chromosome essential for development of testes and their hormones.
Genitals of preterm female appear _____________ swollen. Labia minora may protrude beyond labia majora.
Testicles may appear _______at birth in proportion to size of newborn. Large May fail to move into the scrotum.
Foreskin may be tight at birth, which could cause __________ phimosis
Sex organs mature when? with onset of puberty
T / F Infants are more susceptible to fluid volume excess and dehydration. True.
T / F The sex organs of the child do not mature until the onset of puberty. True.
Genitourinary Tract Dysfunction includes a Assessment of kidney and urinary tract function and diagnoses of disease are based on several diagnostic tests including Urinalysis including culture and sensitivity. Renal/bladder ultrasonography. IV pyelogram. CT scan of kidneys.
Renal biopsy diagnose extent of kidney disease.
Urodynamics determines the rate of urine flow by volume and pressure.
Uroflowmetry: efficiency of urination.
Cystometrogram: graphic comparison of bladder pressure as a function of volume.
Voiding pressure study: comparison of detrusor contraction pressure, sphincter electromyelogram and urinary flow.
Cystoscopy: diagnosis of congenital abnormalities or acquired lesions in the bladder and lower urinary tract.
Blood tests BUN, uric acid and creatinine.
Nursing Considerations Observe for signs and symptoms of dysfunction Obtain specimens Strict I & O
What is the nurse primarily responsible for when taking care of a child with GU dysfunction? The nurse is responsible for recognizing the signs and symptoms, obtaining the appropriate urine and blood specimens as ordered and maintaining strict I & O.
Urinary Tract Infections Infection of the urinary tract may involve urethra, bladder, kidneys, pelvis, and ureters.
Why are UTIs more common in girls? Shorter urethra and/or location near anus. Wearing nylon underwear. Use of bubble baths. Urine retention and vaginitis. Incest or other sexual abuse.
UTI’s 80% caused by __ ____. E. Coli
Chemical and physical factors which increase risk of UTI’s? Alkaline urine favor pathogens. Retention of urine= medium for growth. Vesicoureteral reflux.
UTIs Manifestations Symptoms Infants Fever Weight loss Vomiting Increased voiding Foul-smelling urine Persistent diaper rash
Signs and Symptoms UTI’s Older Children: Urinary frequency Pain during micturition Onset of bedwetting Abdominal pain Hematuria Vomiting Signs and Symptoms with renal involvement: Fever Chills Flank pain Many children asymptomatic.
Urine culture on a child Midstream urine if child toilet trained. Catheterization as needed. Not collected from diaper.
UTIs Treatment Objectives of treatment are: Eliminate current infection. Identify contributing factors to reduce risk of recurrence. Prevent systemic spread of the infection. Preserve renal function.
UTIs Treatment Antibiotic therapy Initiated on the basis of identification of the pathogen. Child’s history of antibiotic use. Location of infection.
Several antimicrobial drugs are available for treating UTI all of them can occasionally be ineffective because of resistance of organisms.
Common antiinfective agents used for UTI include: Pencillins. Sulfonamide (trimethoprim and sulfisoxazole in combination). Cephalosporins. Nitrofurantoin.
Nursing Care for UTIs Teach prevention Proper amounts of fluid to flush the bladder. Encourage complete bladder emptying. Remind child to void frequently; anticipate incontinence. Accurate I & O. Teach child how to collect urine specimens.
Nursing Care for UTIs Patient teaching Instruct females on importance of wiping front to back Emphasize avoiding bubble baths, water softeners, hot tubs or whirlpool baths. Explain the need for cotton underwear. Suggest drinking juices to maintain acidity Recommend frequent pad change
Nursing Care for UTIs Teach parents about medications Instruct parents and children that recurrence is most likely within 1-2 months after infection and is often asymptomatic. Monitor vital signs. Periodic follow-up for urine cultures.
Repeated UTIs can result in? Renal scarring, decreased renal function and can contribute to hypertension as an adult.
Recurrence of a UTI is most likely to occur within how many months? One to two months after termination of treatment.
Obstructive Uropathy Obstruction of normal flow of urine. Calculi (stones). Tumors. Strictures. Scarring. Congenital or acquired. Partial or complete. One or both kidneys affected.
Obstructive Uropathy Pathophysiology Hydronephrosis is distention of the renal pelvis because of an obstruction. The pelvis of the kidney becomes enlarged and cysts form. This may eventually damage renal nephrons, resulting in deterioration of the kidneys.
Polycystic kidney refers to a condition in which large, fluid-filled cysts form in place of healthy kidney tissue in the fetus. This is inherited as an autosomal recessive trait
Urine that is not excreted promptly can promote the growth of organisms that causes urinary tract infection.
Obstructive Uropathy Treatment and Nursing Care: Urinary diversion. Surgery may cause apprehension in parents. Physical care r/t urinary stoma: Hygiene problems. Skin problems. Difficulty with child care.
Obstructive Uropathy Treatment and Nursing Care Age related stress Toddler unable to attain toilet training. School-aged child may have distorted body image. Adolescent may have lower self-esteem and concern about sexuality.
Obstructive Uropathy Treatment and Nursing Care Psychosocial Issues Parents of newborn grieve loss of perfect child & concerned about future. Incorporate appropriate psychological interventions into daily care. Emotional support for parents. Teach parents to prevent infections.
Genitourinary Surgery Surgery of the urinary or genital tract impacts growth and development.
Preschoolers perception of urinary Surgery May perceive the treatment as punishment. Separation anxiety during hospitalizations peak at this age. Explain preventive strategies to parents. Body image of child must be maintained when surgery delayed beyond infancy.
Genitourinary Surgery 3-6 year olds: Curious about sexual differences and may masturbate. Guidance and preparation to minimize negative impact on growth and development.
Genitourinary Surgery Adolescents Concerned about effect of surgery on appearance and sexual ability.
Genitourinary Surgery Nursing Care Tub baths may be contraindicated. Dressings to "private parts" inspected daily. Restrictions on play activities, such as straddle toys (tricycles, rocking horse).
What type of growth and development impact does surgery of the urinary or genital tract have on a preschooler? Treatment perceived as punishment, separation anxiety during hospitalization, body image disturbance.
Nephrotic Syndrome Pathophysiology Nephrotic syndrome refers to a number of different types of kidney conditions that is distinguished by the presence of marked amounts of protein in the urine, edema, and hypoalbuminemia.
Minimal change nephrotic syndrome (MCNS), found in approximately______ of cases. 80%
Nephrotic Syndrome Facts More common in males. Most often in children 2-8 years old. Prognosis: good in steroid-responsive patients. Most pts have periods of relapse until the disease resolves itself.
Nephrotic Syndrome Manifestations Edema: characteristic symptom. Pale. Listless. Irritable. Poor appetite. Albumin & RBCs in urine. Decreased albumin in RBCs.
Nephrotic Syndrome Treatment Goals Minimize edema: Administer medications designed to reduce proteinuria and consequently edema. Steroid therapy: prednisone for 1-2 months. Prevent infection: Examine site of punctures, wounds, pierced ears, body piercings Prompt antimicrobial therapy
Nephrotic Syndrome Nursing Care Emotional support for child & parents. Parent teaching of daily care. Teach signs to report. Good skin care. Turn frequently. Return to normal activity after acute phase. Strict I & O. Neutropenic precautions.
Nephrosis is more common in which gender? Is more prevalent at what ages? Boys, 2 - 8 years old.
How are weights measured? On the same scale at the same time each day.
Acute Glomerulonephritis Pathophysiology Bright's disease. Allergic reaction to infection in the body. May appear after scarlet fever or skin infections, strep infections. Most common form in children; more in boys 3-7 years old. Glomerulus become inflamed/blocked May recover in 10-14 days
Acute Glomerulonephritis Manifestations 1-3 weeks after strep infection. Periorbital edema upon awakening. Smoky brown or bloody urine. Decreased urine output, specific gravity w/albumin, RBCs and WBCs. Reduced serum complement. Hyperkalemia. Hypertension.
Acute Glomerulonephritis Treatment and Nursing Care Limited activity Urine exam Sodium and fluid restriction; foods high in potassium are restricted during oliguria. Prevention of nosocomial infection. Maintain strict i&os. Monitor vs Outpatient care requires follow-up blood and urine tests
Describe the appearance of the urine from a child with acute glomerulonephritis? Smoky brown or bloody urine.
Wilms Tumor an embryonal adenosarcoma. common Associated with certain congenital anomalies particularly of the genitourinary tract. Two-thirds of growths are discovered before 3 years of age. Few or no symptoms during the early stages of growth
Wilms Tumor Pathophysiology and Diagnostic Testing X-ray examinations Tumor compresses kidney tissue and is usually encapsulated. may cause hypertension. chest x-ray, ultrasound, bone surveys, liver scan and CT
Wilms Tumor Treatment Combination of surgery, radiation therapy, and chemotherapy. Removal of kidney and tumor as soon as possible after diagnosed. Avoid handling of the abdomen to prevent the spread of disease. Chemotherapy and ration therapy after surgery
Wilms Tumor Nursing Care Anxiety related to surgical experience: Provide surgical tour. Encourage parents to remain. Explain anesthesia equipment. Determine child’s vocabulary. Provide support and reassurance.
Wilms Tumor Nursing Considerations High risk ineffective airway clearance related to poor cough effort associated with post anesthesia, postoperative immobility, pain: Turn, cough, and deep breathe. Frequent vital signs. Teach splinting. Teach i/s bladder spasms & pain
Wilms Tumor Nursing Care High risk for deficient fluid volume related to patient’s age, surgery, catheters, refusal to drink: Regulate IV fluids. Accurate I & O. Daily weight. Record drainage output. Observe turgor & fontanels.
The sign inside the crib of a child with Wilms tumor should state what? "Do Not Palpate Abdomen“.
Acute Renal Failure When kidneys suddenly are unable to regulate the volume and composition of urine appropriately. Principle features: Oliguria with azotemia, metabolic acidosis and diverse electrolyte imbalances.
Acute Renal Failure Conditions that cause ARF Glomerulonephritis. Hemolytic-uremic syndrome. Poor renal perfusion. Urinary tract obstructions. Acute renal injury. Severe dehydration.
Acute Renal Failure Diagnostic Evaluation The infant or child is already critically ill with precipitating disorders. Significant lab measurements guide therapy: BUN. Serum creatinine. pH. Sodium. Potassium. Calcium.
Acute Renal Failure Manifestations Oliguria. Anuria. Nausea and vomiting. Drowsiness. Edema. Hypertension.
Acute Renal Failure Manifestations If any of the following signs of hyperkalemia are present, it is an emergency: Serum potassium > 7 mEq/L. Presence of ECG abnormalities: Prolonged QRS. Depressed ST segment. High peaked T waves. Bradycardia. Heart block.
Acute Renal Failure Therapeutic Management Treat the underlying cause. Manage complications. Supportive therapy. Volume restoration. Foley to rule out urinary retention.
Acute Renal Failure Therapeutic Management Complications: Water intoxication. Hyponatremia. Hyperkalemia. Hypertension. Anemia, seizures and cardiac failure with progression.
Acute Renal Failure Nursing Considerations Meticulous attention to I & O. Limit fluid intake as ordered. Be alert to complications: Changes in behavior. Neurologic involvement: Coma. Seizures. Alterations in LOC.
Chronic Renal Failure Pathophysiology no longer able to maintain the normal chemical structure of body fluid child may be asymptomatic. Midway through, nephrons are destroyed and there are definite biochemical abnormalities. Endstage, kidneys are no longer able to maintain f/e balance.
Chronic Renal Failure Pathophysiology Uremic syndrome Anorexia, n/v Bruising. Blood diarrhea. Stomatitis. Bleeding form lips and mouth. Intractable itching. Uremic frost. Deep respirations. Hypertension and CHF. Pulmonary edema.
Chronic Renal Failure Diagnostic Evaluation Based on clinical manifestations, history and biochemical factors. Initial signs and symptoms are vague: Loss of normal energy. Increased fatigue. Pallor. Elevated blood pressure.
Chronic Renal Failure Diagnostic Evaluation As disease progresses: Decreased appetite. Less interest in normal activities. Increased or decrease urine output. Pallor. Sallow, muddy appearance to skin. Headaches. Muscle cramps.
Chronic Renal Failure Signs and Symptoms Nausea. Weight loss. Facial edema. Malaise. Bone or joint pain. Dry or itching of the skin. Bruised skin. Sensory motor loss. Amenorrhea.
Chronic Renal Failure Diagnostic Laboratory tests are used to detect biochemical disturbances and other tools help to establish the nature of the underlying disease and differentiate between other disease processes.
Chronic Renal Failure Therapeutic Management Goals Promote maximum renal function Maintain body f&e balance Treat systemic complications. Promote as active and normal a life as possible. Child can do whatever activities they can tolerate Provide sufficient calories for growth.
Chronic Renal Failure Therapeutic Management Protein is restricted while sodium and water and not initially limited. Growth hormone may counteract growth failure. Dental defects are common. Correct anemia. Treat infections with antimicrobials. Aggressive dialysis or kidney transplant.
Chronic Renal Failure Nursing Considerations Risk for injury. Fluid volume excess. Altered nutrition: less than body requirements. Body-image disturbance. Altered family processes. Child and family need constant reassurance. Access graft, if necessary, under strict aseptic conditions.
What are some of the complications a child with ARF can experience? Hyperkalemia, hypertension, fluid overload, anemia, seizures and cardiac failure.
What is the most important thing to remember when accessing the graft of a child with CRF who is undergoing dialysis? You must maintain strict asepsis.
Ostomies Major differences include preparation of the child for the procedure and teaching ostomy care to the child and family. Preparation includes simple language together with illustrations and a replica model.
Children are fitted with an appliance _________after surgery. immediately
__________ tissue may grow around ostomy site-it is not a sign of infection. Granulated
Skin can be protected with a _______ or a barrier substance such as____ _________ . wafer, zinc oxide
Ostomies Patient Teaching Begin preparing for discharge early. Early evidence of skin breakdown or complications: Ribbon-like stools. Excessive diarrhea. Bleeding. Prolapse. Failure to pass stool or flatus. Notify provider.
What type of enema solution should be administered to a child? Isotonic, like saline.
What should the nurse stress to an adolescent who is post-ostomy placement? The nurse should stress to adolescents that the presence of the stoma need not interfere with activities.
Oxygen Therapy Primarily carried out in hospital setting.
Can deliver oxygen in different ways Via incubator. When low levels are needed. Oxyhood. Can supply the highest concentration. Nasal cannula. Can supply about 50%. Mask. Not well tolerated by children.
Oxygen Therapy Devices Oxygen Tent: 30% - 50%. Difficult to keep closed. Warm inside: Use cooling mechanism. Check temperature inside tent periodically.
Monitoring Oxygen Therapy Pulse Oximetry Apply to the great toe of an infant. Use index finger of a child. Pressure necrosis. Transcutaneous: Change site every 3 to 4 hours. Calibrate with site changes.
Aerosol Therapy Handheld nebulizers. Nursing responsibility
Postural Drainage Indicated whenever excessive fluid or mucus is not being removed by normal activity and cough. Performed three to four times daily, before meals and when it follows other respiratory therapy.
Chest Physiotherapy Postural drainage in combination with adjunctive techniques. Manual percussion and vibration. Contraindicated: Pulmonary hemorrhage. Pulmonary embolism. End-stage renal disease. Increased ICP. Osteogenesis imperfecta. Minimal cardiac reserves.
Artificial Ventilation Artificial airways ET intubation: Nasal, oral or direct tracheal. Use only uncuffed ET tubes in children < 8 years. Tracheostomy Made without an inner cannula. Complications include: Hemorrhage. Edema. Aspiration. Accidental decannulation.
Respiratory assessments include Breath sounds. Work of breathing. Vital signs. Security of trach ties. Type and amount of secretions.
Tracheostomy Good nursing care is Maintaining airway. Facilitating removal of secretions. Providing humidified air or oxygen. Cleansing the stoma. Monitoring the child’s ability to swallow. Raise head of bed trach supplies at bedside including extra trach tubes/ties
Tracheostomy Care Suctioning Carry out as often as needed. Pressure should be no higher than 100mmHg. The catheter should be ½ the diameter of the trach tube. Insert just beyond the end of the trach tube. Limit to no more than 15 seconds.
Tracheostomy Care Routine care includes Assessments for signs of infection and skin breakdown. Clean around stoma with ½ hydrogen peroxide and saline per unit protocol. Change ties daily. The first tube change is done by the surgeon and subsequent changes are done by nursing.
Tracheostomy Care Teaching Family teaching should begin as soon as it is recognized that the child will go home with the trach. Teaching should be short. Use identical supplies that the child will go home using if possible. Teach infant and child CPR.
For which patients is chest PT contraindicated? Chest PT is contraindicated for patients with pulmonary hemorrhages, pulmonary embolism, end-stage renal disease, increased ICP, osteogenesis imperfecta or minimal cardiac reserves.
What is the maximum time that should be spent on one suctioning attempt? No more than 15 seconds.
Akinesia Abnormal state of motor and psychic hypoactivity
Dysarthria Difficulty speaking
Aphasia Defective or absent vocal function
Dysphagia Difficulty swallowing
Hemiplegia Paralysis on one side of the body
Senile State of physical and mental deterioration associated with
Presbycusis Decreased hearing associated with aging
Presbyopia - Decreased vision associated with aging
The Older Adult (Late Adulthood) Senescence the last stage in the life cycle causes a gradual degeneration of body processes rate is slowed by diet, exercise, stress reduction and health promotion
Ageism characterized as living in the past, sick, feeble, rigid, disagreeable, opinionated or demented some Americans believe life is over after middle age and they are no longer expected to remain physically or mentally healthy forces them to retire early
Gerontology Study of aging, including physiological, psychological and social aspects Current research is seeking: actual cause of aging ways to extend quantity & quality of life
Aging Theories Autophagocytosis  energy needs +  the potential for survival a cell eats part of itself lipofuscin - a brown colored residue cell shrinkage   Ht /Wt ; atropy tissues
Aging Theories: Wear & Tear Response Biological stress is caused by physical, psychological and social changes Weakening of the defense mechanisms associated with the stress response due to aging eventually leads to death
Aging Theories: Immune System Decline immune system--most important mechanism for preserving health immune body’s defenses + body’s vulnerability to infection/cancer Misidentification of normal cells  attack healthy cells aging process
Aging Theories: Faulty DNA Replication becomes dysfunctional is no longer able to continue orderly synthesis of proteins.
Free Radicals Unstable atoms damage DNA -antioxidants fight the damaging effects by blocking the chemical reactions which cause free radicals -Vitamins C and E, and provitamin A (beta-carotene)—under investigation
Implication of an Aging Society Life expectancy males 73, females 79
1980-2000 older population has grown twice as fast as the rest of the population
2011: baby boomers begin to reach age 65
2030: 21% of the population will be over 65
2050 5% of the population >85 years old Currently 90.5% White 9.5% Other races
Myths Related to Aging Myth: All old people become senile Fact: Decline is not inevitable, creativity and intelligence do not change Myth: Older adults are isolated and alone Fact: Most older adults have at least weekly contact with family and have friends
Myths Related to Aging Myth: Most older adults live in nursing homes Fact: 90% of older adults live in own home Myth: Older adults are poor Fact: The median net worth of older households is over $60,000. The U.S. average for other households is $32,000
Myth: Older adults are ill or disabled Fact: Most older adults have at least one chronic illness, but does not restrict their ability to manage their lives. 7 of 10 older adults report their health to be good or excellent
Healthy People 2010 for Aging Access to quality care Cancer Kidney disease Health communication Diabetes Heart disease/stroke Healthy People 2010 for Aging Disabilities Product safety Activity/fitness Community based programs HIV Substance abuse
Changes Associated with Aging Musculoskeletal System Decreases in height, kyphosis, wide stance with standing and walking Hips and knees flexed Stiffness in weight bearing joints Limited in ROM, Clearly defined muscles due to loss of subcutaneous fat Flabby, thin muscles in arms and legs
Changes Associated with Aging Cognition Age incidence of serious cognitive deficits memory long-term -- intact short-term -- fails Respond slowly to interview questions hearing or anxiety slows responses Clinical depression is mistaken for dementia
Changes Associated with Aging Sight Presbyopia becomes more pronounced Visual acuity declines as structures of the eye degenerate Formation of cataracts Difficulty adjusting to glare of lights
Changes Associated with Aging Hearing Presbycusis becomes more pronounced Senses of smell and taste are decreased Position sense and reaction time Decline gradually until age 70 then decline rapidly increases Decline causes accidents
Changes Associated with Aging Skin adjust to heat and cold changes Dry, thin and flaky Wrinkling due to decreased skin elasticity Susceptible to irritation Liver spots appear on arms, hands or face Easily bruised due to capillary fragility Poor healing
Changes Associated with Aging Hair: Dry, thin, gray & balding Nails: Thick, brittle & yellowed Teeth Gums recede and teeth loosen Fall out due to poor oral hygiene Jaw bones shrink
Changes Associated with Aging Cardiovascular/Pulmonary Systems cardiac output, vital capacity & pulmonary elasticity bp & respiratory rate Aorta & arteries stiffen Circulatory system less efficiently to activity & exercise irregular pulse, SOB with exertion, postural hypotension, impaired arterial circulation
Changes Associated with Aging Reproductive System Female breasts hang flat against chest male breasts due to testosterone Require increased stimulation to cause arousal during intercourse Penis and testes/vagina size Prostate vaginal lubrication & epithelial thinning
Changes Associated with Aging Urinary System bladder capacity by 50% frequency Incontinence abdominal pressure with coughing, sneezing, laughing, and lifting Inability to delay voiding Female ligaments & muscles stretched during pregnancy -unable to keep bladder suspended in bladder
Changes Associated with Aging Gastrointestinal System Constipation Indigestion Flatulence saliva, gag reflex, digestive juices, and nutrient absorption & peristalsis Increased risk for aspiration Food remains in esophagus longer Colon cells atrophy
Pt Teaching of Elderly time to process new ideas Use slow distinct speech Allow time for ?s Visual aides--clear and large Use pt’s knowledge & past experiences to facilitate learning new information
Depression and Suicide Incidence is high Assess for alcohol consumption, anger, hopelessness, helplessness, anhedonia interest in friends/social activities, energy, suicidal thoughts—report to supervisor
Nutrition & Dietary Modifications Dietary insufficiencies may be caused by Loss of or changes in teeth Eating alone Fatigue Lack of money Diet nutrients calories Soft, ground, pureed and easy to digest foods if chewing or swallowing is impaired supplemental vitamins & minerals
Nutrition & Dietary Modifications use wheat bran or whole grain breads if fresh fruits and vegetables are too difficult 6-8 glasses of water Skin and Nail Care circulation injuries and infection have a prolonged healing time Post bathing cream or lotion for dry skin Toe nails trimmed
Physical Care Bathing and Hygiene No frequent bathing  dries skin Daily partial baths & biweekly tub baths best Showers are preferred overall Stalls provide a safer in and out than tubs Provide more thorough rinsing of soap from skin
Physical Care Thinning vaginal mucous infections Report any signs of infection to physician Good perineal care and use of disposable pads help keep the patient clean and comfortable
Physical Care Elimination: urinary frequency/ constipation Place call button within reach of patient Assist with trips to the bathroom at night Use commodes and bedpans or urinals prn  physical activity, fluid & fiber intake Encourage a regular time for evacuation
Physical Care Immobility causes chest expansion hypostatic pneumonia Pressure ulcers muscle tone loss Interventions Promote active or passive exercises Provide with supplies Allow sufficient time for completion
Safety Provide safe environment Bed is in lowest position Night lights assist with orientation and help prevent falls Side rails up on one side Place call bells within reach Safety
Nursing Diagnoses Self care deficit, bathing, feeding, dressing r/t weakness Risk for falls r/t age related changes Impaired physical mobility r/t age related changes
Medication for Elderly Patients Lower doses of medications are often indicated due to the slower excretion of drugs by the older adult Normal doses may actually cause toxicity Many drugs cause confusion in the elderly Sudden confusion necessitates review of the medication regime
Medication for Elderly Patients Careful monitoring of the older adult taking antipsychotics, hypnotics, antihypertensives and cardiovascular drugs and narcotic analgesics is essential Antidepressants must be taken for 6-8 weeks before effects are seen;
Created by: alexandra.bell