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Pediatrics ch 12

Disorders of the Preschool Child

The burn wound is classified according to percentage of body surface involved, the depth and location of the injury, and association with other injuries
Priority treatment and nursing care for burns first priority is airway and breathing; second priority is circulation/fluid resuscitation
Nutritional management and burns NPO for first 24-48 hours if burn is severe; high-protein, high-calorie diet; oral feeding preferred but may need nasogastric feedings; small, frequent feedings of favorite foods-may add supplements to meet requirements
Amblyopia a decrease in or loss of vision, usually in one eye
Amblyopia cause the vision loss is not caused by structural eye damage but results from the brain “turning off” confusing visual images
Occlusion therapy maintenance may be difficult to maintain due to ridicule from peers and impact on self-esteem. Much support is necessary.
Strabismus ocular misalignment; a condition in which the child is not able to direct both eyes toward the same object
Strabismus can lead to what other eye problems? esotropia or exotropia
Esotropia an inward deviation of one or both eyes
Exotropia outward turning of one or both eyes
Surgery to correct strabismus is reserved for patients in whom nonsurgical methods are likely to be unsuccessful
Surgery procedures and expectations for strabismus short hospitalization; usually no need for restraints, if so child will be told before; minimal eye dressings; parents should stay with child during hospitalization
Leukemia most common type of cancer in children
Areas of body affected by leukemia All tissues of the body are affected, either by direct infiltration by cancer cells or by the change in the blood that is carried to them
Leukemia treatment Glucocorticosteroids are used, such as prednisone
Steroids and leukemia mask the symptoms of infection, may induce personality changes and cause the child’s face to become moon-shaped
Leukemia and chemotherapy medication side effects varying degrees of nausea, diarrhea, alopecia, fever, anuria, anemia, and bone marrow depression
Leukemia nursing care mouth is inspected daily for ulcerations and hemorrhage from the gums; Water-Pik may be used to massage and toughen the tissue; A soft sponge brush may be used or wiping the mouth with gauze; Apply lip balm or petroleum jelly to cracked, dry lips.
What to avoid when managing bleeding in leukemia patients Alcohol-based mouth washes, milk of magnesia , hydrogen peroxide, and lemon glycerin swabs
The Child with Possible Posttonsillectomy Bleeding Frequent swallowing (a cardinal sign of bleeding); Pallor; Restlessness; Increased pulse; Vomiting bright red blood; Decreasing BP; Visible blood on careful examination of the throat with a flashlight
What to avoid postoperatively in patients with tonsillitis and adenoiditis citrus juices, carbonated drinks and milk products; extremes in food or beverage temperature; red colored food or beverages
Psychological considerations of Duchenne Muscular Dystrophy have to do with the chronic and progressive nature of this disease and its fatal outcome.
Duchenne Muscular Dystrophy treatment and nursing care Encourage the child to be as active as possible as long as possible; Provide support for daily issues; Public health nurses, home health agencies, family therapists, and eventually hospice care provide care and support to child and family.
Generalized tonic-clonic (grand mal) seizure symptoms sudden loss of consciousness with a cry; fall; rigid muscles followed by muscle jerking; rolling of eyes; pallor or blue skin color associated with slowing or cessation of breathing; possible loss of bowel or bladder control
Generalized tonic-clonic (grand mal) seizure duration a few minutes
Generalized tonic-clonic (grand mal) seizure after effects and postictal state breathing resumes; child is sleepy and confused and often sleeps 30 minutes to 2 hours after the seizure. Postictal state may involve vomiting and intense bifrontal headache. Seizure may be preceded by an aura.
Absence (petit mal) seizure symptoms sudden cessation of motor activity or speech with a blank facial expression and flickering of the eyelids (uncommon in children less than 5 years old); chewing movements
Absence (petit mal) seizure duration a few seconds (usually less than 30 seconds)
Absence (petit mal) seizure after effects child resumes full activity, unaware of what happened during seizure; no aura or postictal state, may experience various seizures during the day; can cause learning difficulties if not recognized
(Typical) myoclonic seizure symptoms repetitive seizures consisting of brief muscular contractions with loss of body tone and falling or slumping forward; can cause injuries to face and mouth. Can be associated with generalized tonic-clonic seizures
(Typical) myoclonic seizure onset between 6 months and 4 years; may have learning, language, emotional, and behavioral problems; however, more than 50% are seizure free several years later
Infantile spasms symptoms brief symmetric contractions of the neck, trunk, and extremities; involve sudden flexion of the neck, arms, and legs onto the trunk; extension of the trunk and extremities; or a combination
When do Infantile spasms commonly occur while patients are drowsy or immediately on wakening
Infantile spasms onset between 4 and 8 months; may or may not be associated with underlying neurological disorder or trauma
Landau-Kleffner syndrome a rare condition of unknown cause
Landau-Kleffner syndrome symptoms often confused with autism; loss of language occurs in a previously normal child; many have an associated seizure disorder; hearing is normal; behavior problems are common
Landau-Kleffner syndrome onset 5 ½ years, affecting more boys
First aid for a child with a convulsive seizure includes protecting the child from harm, loosening clothing around the neck, turning on the side to maintain an airway, and reassuring the child when consciousness returns
Observe the seizure and record activity immediately before the seizure began; body movements; changes in color, respiration, or muscle tone; incontinence; and parts of the body involved When possible the seizure is timed
During seizures do not place any object into the mouth of the seizing child; try to hold the seizing child down
Epilepsy treatment and nursing care Rescue breathing is done if child is not breathing when the seizure is finished
UTI nurse teaching on proper hygiene avoid bubble baths or irritating diaper wipes; wipe from front to back
UTI preventive measures wearing cotton underwear, adequate fluid intake, encouraging children to not put off going to the bathroom when needed, investigating and treating signs of intestinal parasites (pinworms), and avoiding bubble baths
Acute Glomerulonephritis Treatment and Nursing Care Activity should be limited until gross hematuria disappears; low-sodium diet; Fluid restriction; Protein is not usually restricted
Developmental Disability Treatment and Nursing Care Good communication with parents is essential
Developmental Disability support areas include home living, education, human development, community living, employment, health and safety, behavior, social, and protection and advocacy
The parents of a developmental disabled child need support, compassion, and understanding, not pity; they must face their own feelings and develop a positive attitude
What can help nurses acquire enthusiasm for what developmentally disabled children and their families can accomplish Sharing ideas and feelings with experienced professionals who work with developmentally disabled individuals
Created by: laotracuata