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PEDIATRICS UNIT 3
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Revised 2010
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Hematologic Disorders
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Anemia ( Iron-Deficiency)
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Sickle Cell Anemia
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Hemophilia
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ALL ( Acute Lymphoblastic Leukemia)
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Iron Deficiency Anemia
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Insufficient dietary iron
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Maternal stored depleted at 6 mo.
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Inadequate iron intake
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Clinical Manifestations
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Hgb 6-10
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Irritability, weakness, decreased play activity
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Fatique
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Hgb <5
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Anorexia
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Pale
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tachycardic
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Treatment
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Iron replacement – ferrous sulfate
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Give with straw or syringe
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Nsg. Interventions:
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Dietary instruction
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Teaching of long term complications of anemia
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Sickle Cell Anemia
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Inherited
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African-American / Mediteranian
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No cure
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Sickling:
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Clumping of abnormal shaped cells
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Note: Sickle shaped cell in center of picture
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Factors that precipitate a crisis
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Infection
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Dehydration
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Cold
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Emotional stress
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Nursing Interventions
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Hydration
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Analgesics
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O2
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Avoid precipitating factors
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Coagulation Disorder
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Hemophilia
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Inherited – X linked
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Lack clotting factors:
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Factor VIII or Factor IX
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s/s:
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Bleeding
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Bruising
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Diag test: PTT
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Tx:
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Replace clotting factors
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Nsg interventions:
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Prevent injury
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Family teaching
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Neoplastic Disorder
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Acute Lymphoblastic Leukemia
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Increased blast cells
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Decreased rbc’s and platelets
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Tx: chemo
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Nsg interventions:
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Family support
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Prevent infection
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Monitor temp
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Oral care
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Nutrition
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Immune Disorders
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AIDS
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RHEUMATOID ARTHRITIS
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HIV/AIDS
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Causes:
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Maternal
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Blood products
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Sexual abuse
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Tx:
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Antiretroviral drugs
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Nsg interventions:
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Prevent infection
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Nutrition / meds
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Family support
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Juvenile Rheumatoid Arthritis
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Chronic inflammatory autoimmune connective tissue disease
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Destroys cartilage
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Clinical Manifestations
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Stiffness, edema
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Loss of motion
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Warm to touch
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Increase temp
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Macula rash
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Diagnostic Tests
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Clinical findings
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No specific tests
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ESR
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X-rays
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Tx:
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Preserve joint function
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NSAIDS – SAARDS
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Moist heat - PT
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Nursing Interventions
Balance rest / exercise
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Pain management
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Support groups
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Respiratory Disorders
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Respiratory Distress Syndrome
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Lack surfactant to keep lungs expanded
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Gestational age at birth influences severity
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#1 s/s  respiratory distress
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Treatment
Exogenous Surfactant
O2 therapy
Parenteral therapy
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Pneumonia
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Inflammation of lung tissue
Most common cause:
RSV = Respiratory Syncytial Virus
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Tx:
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O2
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Fluids
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Nebs.
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Nsg. Interventions:
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Resp asses
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Suction only if needed
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Rest
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Sudden Infant Death Syndrome
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No cause
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Occurs during sleep
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Diagnosed on autopsy
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Prevention:
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“back to sleep”
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Never prone
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Nsg. Interventions
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Family grief support
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Allay feelings of guilt and blame
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Acute Pharyngitis
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“sore throat”
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80% viral
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20% strep
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s/s:
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Fever
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Sore throat
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White exudate
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Diag test: strep throat culture
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Tx: ABX if strep
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Nsg. Interventions:
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Antipyretics / analgesics
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Saline gargle
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Cool liquids p.o.
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Tonsillitis
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S/S same as pharyngitis
Treatment :
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1)Same as pharyngitis
2) tonsillectomy
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Pre-op:
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Notify M.D. of any fever or abnormal assessment findings
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Post-op: Semi prone
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Monitor for bleeding
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Analgesics
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No straws
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Laryngeotracheobronchitis
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LTB = Croup
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Viral
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s/s: barking cough, tachypnea
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retractions
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Treatment
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Maintain airway
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Cool mist
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NPO
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Epinephrine
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Nursing Assessment
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Check for the 4 “D’s”
1) Drooling
2) Dyspnea
3) Dysphonia
4) Dysphagia
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Epiglottitis
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Cause: H influenzae bacteria
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Life threatening airway obstruction
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Signs & Symptoms
Drooling
High Fever
Resp distress
Muffled voice
Progressive resp. distress
Anxiety
Fear
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Treatment
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Maintain airway
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O2
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Eppi
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ABX
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IV fluids
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Nursing Interventions
^ HOB
Assess resp. status
Freq. VS
Trach tray @ bedside
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Bronchitis
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Usually viral
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s/s: same as with URI + cough
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Common during winter months
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Children < 4 y.o.
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Nsg interventions:
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Cool mist
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Fluids
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Cough med
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Cystic Fibrosis
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Inherited
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No cure
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Excessive thick mucus produced
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Obstructs lungs & GI system
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s/s: steatorrhea
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Barrel chest
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Increased NaCl in sweat & saliva
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Nsg interventions:
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^ nutrition
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Pancreatic enzymes
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CPT / postural drainage
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Asthma
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Common chronic childhood illness
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Cause: allergy or hypersensitivity
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Bronchospasm
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Bronchial edema
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s/s: SOB
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Expiratory wheeze
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tx:
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Quick relief meds
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Long term meds
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Allergen testing
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Nsg interventions:
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^HOB
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Meds
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hydration
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Avoid triggers
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Teach children self care and use of nebulizers
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GASTROINTESTINAL DISORDERS
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Cleft Lip / Cleft Palate
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Facial malformation during fetal development
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Cleft lip alone may feed without difficulty
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Cleft palate and extensive cleft lip:
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Difficulty feeding & speech
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Psychological difficulty due to deformity
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Tx.:
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Surgical repair
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Lip repaired at 1-2 mo.
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Palate repaired by 1 yr
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Nsg. Interventions:
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Parental support
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Assistive feeding devices
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Post op care lip:
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Breck feeder
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Suture line care
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Back or side lying
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Post op care palate:
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Semi prone
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No straws, pacifier
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No spoons
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Follow up care:
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Speech therapy
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Observe for ear infections
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Dehydration
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Intake less then output
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Determined by change in wt.
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Infants and young children more easily effected
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Diarrhea
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Frequent liquid stools
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Chronic
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Acute
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Infectious
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Non-infectious
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Tx:
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Treat cause
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Restore fluids and electrolytes
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Modified BRAT diet, Pedialyte,
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Rehydralyte, Infalyte
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Nursing Interventions
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I&O
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Infection control
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Nutrition
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Daily weights
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Gastroenteritis
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Diarrhea caused by infection
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Tx:
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Same as for diarrhea plus
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ABX
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Constipation
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Passage of hard infrequent stool
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Structural disorders
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Diet, meds
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Repressed urge to defecate
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Signs & Symptoms
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Abd pain
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Bloody stools
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Decreased appetite
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Treatment
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Treat cause
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Nursing Interventions
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Educate parents
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Stool and diet history
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Bowel retraining
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Hypertrophic Pyloric Stenosis
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Hypertrophied pyloric muscle obstructs gastric outlet
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Unknown etiology
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Fig. 31-16 pg. 1028
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Signs & Symptoms
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Projectile vomiting
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Olive shaped mass, R. abd
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Treatment
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Surgical repair
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Pyloromyotomy ( Fredet-Ranstedt procedure)
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Intussusception
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One part of intestine telescopes into another
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s/s
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Currant – jelly stool
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Abd pain
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Diag test:
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Barium enema
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Tx: barium enema
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Surgical repair
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Hirschsprungs Disease=Megacolon
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Portion of colon lacks parasympathetic nerve cells
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Signs & Symptoms
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Vary acc. To age
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Abd distention
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Failure to pass meconium
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Constipation & diarrhea
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Decrease appetite
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Two Stage Surgical Treatment
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Temporary colostomy
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Endo-rectal pull through
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Nsg interventions:
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Pre/post op care
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Parent education
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Colostomy care
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Hernia
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Organ protrudes through weakened muscle wall
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Appendicitis
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Inflammation of appendix
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s/s
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Rebound tenderness
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Elevated WBC
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Pain at McBurneys point
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Gastroesophageal Reflux
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s/s
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Vomiting
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Chronic cough
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Heme. + stool
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Tx:
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Small frequent thickened feedings
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Surgical repair
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Nsg interventions:
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Parent education
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Pre/post op care
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nutrition
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Genitourinary Disorders
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Nephrosis or Nephrotic Syndrome
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Proteinuria
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Edema
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Hypoproteinemia
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hyperlipidemia
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s/s
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Peri-orbital edema
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Ascites
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Generalized edema
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Nsg interventions:
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I&O
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Skin care
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^pro. diet
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Acute Glomerulonephritis
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Inflammation of glomerulus
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Most common cause: strep
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s/s
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Proteinuria
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Tea colored urine
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HTN
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Tx:
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Bedrest
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Diuretics
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Meds
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Nursing Interventions
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Bedrest
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Restrict fluids & Na +
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I&O
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Wilms Tumor = Nephroblastoma
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Most common malignant tumor of childhood
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Develops from immature kidney cells
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Prognosis greatly improved in recent decades
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s/s:
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Large, firm, asymptomatic abd mass
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Do not palpate abd
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Nursing interventions:
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Pre/post op care
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Family support
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Structural Urinary Defects
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Impact psychological well-being
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Require prompt correction
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See Table 31-3
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See Fig. 31-21
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Endocrine Disorders
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Hypothyroidism = Cretinism
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Lack thyroid hormones
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Tx. Thyroid hormone replacement
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Nsg. Intervention:
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Teach parents importance of med administration to prevent cognitive & growth impairment
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Diabetes Mellitus
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Type I Diabetes (IDDM)
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Lack insulin
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Tx:
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Insulin
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Diet
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exercise
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Nsg interventions:
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Family teaching
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S/S of hyper / hypoglycemia
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Blood glucose testing
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Insulin admin.
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Diet
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Good control prevents complications