Common Problems 1 to 18 years- Chapter 61- Pediatrics
Respiratory System
URI- nasopharangitis (Common cold) pharyngitis, influenza
Nasopharangitis- most common childhood resp. illness
See Table 57-1 Pg 1642 Mostly Viral
Goals: Keep hydrated
Tx symptoms
Avoid spreading of infection
TX- fluids, rest, Tylenol, NO aspirin d/t Reyes’ syndrome
Warm salt H2O gargles (1/4 tsp NaCl to 8 oz H2O)
Cool mist humidifier
Meds to liquefy mucous (NaCl drops)
Medical aseptic techniques – hand washing, proper disposal of tissues
Cover mouth and nose when coughing and sneezing
Avoid contact with infectious people
*Note – If streptococcal Infection – complication – rheumatic fever, meningitis,
glomerulonephritis, Important to complete entire course of antibiotics if “strep” throat
Allergic Rhinitis
Hayfever- inflammation of nasal mucosa
Seasonal
Recurrent response to allergens (avoid dander, mold, house dust, pollen)
Sx:
Rhinorrhea (runny nose)
Post nasal drip
Allergic conjunctivitis
Itchy nose and palate
Dark circles under eyes
Allergic salute- transverse nasal crease from pushing nose up and back
Meds: antihistamines, decongestants, bronchodilators, topical/systemic corticosteroids
Try: immunotherapy or desensitization to allergens
Desensitization: if allergen tests positive on skin testing, Inj. of allergen given in increasing
doses until maintenance does is reached. If immunotherapy –watch for 30 minutes post injection
(anaphylaxis)
Tx:
Eliminate allergens from environment
Avoid wool and down
Dust proof covers on bedding
Remove carpets, draperies, blinds
50% on less humidity
Keep pets outside
Use air filters
Antihistamine side effects: drowsiness, dry mouth, excitability
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Tonsilitis: Inflammation of tonsils
Tonsils normally enlarge btw 2-10 years of age
Reduce during preadolescence
Sx:
Difficulty breathing, swallowing, causes partial deafness, sore throat, enlarged bright red
tonsils, mouth breathing, halitosis, nasal speech, snoring
Tonsillectomy –removal of tonsils: done for abscess, upper airway obstruction and apnea
Adenoidectomy- removal of lymphoid (adenoids) tissue in nasal (throat) pharynx. Done if
chronically ill with otitis media or airway obstruction
If tonsillectomy can be postponed until 4-5 years of age- after outgrown problem.
Meds: Analgesics for pain, antipyretics for fever, antibiotics if strep infection
Nrgs Mng.:
Prepare for surgery, may use puppets, dolls, CBC, clotting factor, UA
Post Op:
maintain UA, I&O, check for blood loss
Place on side lying position
Cool clear liquids
Analgesics as needed
NOTE: If frequently swallowing post op – may mean they are hemorrhaging or bleeding at post
op site. Also restlessness, rapid pulse
Always check if any signs of infection day of surgery
Check for loose teeth
Check pharynx with flashlight each time
Asthma – Restrictive Airway Disease (RAD) – narrowing or obstruction of airway
Triggered by stimuli (cold air, smoke, viral infection, exercise, stress, drugs and allergens) and
inflammation leading to mucosal edema and mucus hyper secretion
Leading cause of school absenteeism
Most common admitting diagnosis
Sx:
dry hacking cough, wheezing, difficulty breathing
Sit-up to breathe
Attack can be hrs to days
Thick tanicous mucous
If frequently acute exacerbation – get barrel chest and uses accessory muscles to breathe
If chronic- small for age
Can outgrow it
Possibility hereditary
+ diag. if airway obstruction is reversed with bronchodilator
Meds: Early recognition and treatment
ID and eliminate allergens
Educate family and child: ways to prevent attacks, drug therapy, appropriate exercise,
early signs of episode, chest physiotherapy (CPT)
Allergy proof house
Desensitization, peak flow meter- measures airway obstruction
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Early Sx:
wheezing
cough at night, early morning or along with exercise, respiratory infections and
Meds: Bronchodilators
relax bronchial smooth muscles
Allbuteral (Ventolin)
inhalation or parenterally
Alupent
Brethine
Avoid repeated use as masks airway inflammation and hyper responsiveness
MDI (Metered Dose Inhaler)
Theophylline- req. cont. oral or IV administration
Keep level of drug at 10-20 mcg/ml
Early adverse effects of Theo are irritability, restlessness, insomnia, headache,
vomiting, and diarrhea
Anti-InflammatoryCromolyn Sodium (Crolom)- antiasthmatic – prevents sxs does not Rx
Adverse effects- airway irritation with mild cough and bad taste
Corticosteriods- Prednisone (Deltasone)- effectively reduces mucosal edema
Potentiate the effects of bronchodilators
Inhalation or oral
Long term use of oral preparation is reserved for chronic asthma that has not responded to other
drugs
Rx: Adverse effects of LT use: Cushings Syndrome, growth suppression, osteoporosis,
glaucoma, cataracts, peptic ulcer, hyperglycemia, decreased resistance to infection,
Activity: with adequate Rx can participate in most physical activities, gymnastics, baseball,
weight lifting, swimming
Foreign Body Aspiration:
Inhalation of any object into resp. tract
Ex: Nuts, grapes, popcorn, hard candy, dried beans, bones, coins, parts of toys, screws, balloons
Most common btw 6months and 4 years
Sx:
Spasmatic coughing, resp. distress, gagging
Tx: Removal by laryngocopy on bronchoscopy
Post surgery stay overnight for observation for laryngeal edema and resp. distress
Cool mist humidifier
Antibiotics
Iin safety measures in relationship to development level.
Objects no smaller than 1 ¼” – keep out of childs reach
Cardiovascular System:
Rheumatic fever
Chronic childhood disease affects heart, joints, lungs, brain
Cause: autoimmune response to untreated group A beta-hemolytic streptococcus infection
Ss: can be minor or major
Minor:
Major:
Fever
Polyarthritis
Listlessness
Chorea (Spasmatic twitching)
Anorexia
Carditis
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Pallor
Wt. Loss
Vague muscle, joint or
Abd pain
Erythema marginatum (red skin lesions)
Sub. Nodules
Elevated antistreptolysin-O (ASO)
Medical:
Dx: made by signs and symptoms, lab results, throat culture, ESR, C-reactive protein, leukocyte
CT (all increased) chest x-ray, EKG, Echocardiogram—carditis
Goals:
Tx any existing strep infection
Prevent reoccurrence and heart damage
Alleviate pain and fever
Meds: Penicillin, salicylates, corticosteroids,
Penicillin- can be given 5 years to prevent reoccurrence
Digitalis and diuretics if CHF
If chorea severe- give anticonvulsants
Diet- Lo Na if CHF
Activity- bed rest
Tx: bed rest, heat and cold to affected joints, provide distraction,
Imp. To evaluate child with URD for strep infection
Assess if family member has had a sore throat or unexplained fever in past 2 mths
Assess for cardiac complication: abnormal VS, SOB, edema, pericardial pain
Hematologic & Lymphatic System
Leukemia:
Most common childhood cancer
Uncontrolled production of lymphacts (immature WBCs)
Most common form is ALL (Acute Lymphocytic Leukemia)
Prognosis – better
But adverse effects d/t Rx (decrease RBCs, Platelets, neutrapenia
Sx:
pallor, weakness, fever, excessive bruising, petechia, purpura, bone and joint pain, abd.
Pain
Medical: to confirm Dx: bone marrow aspiration is done
Goals: eradicate leukemia cells via chemo
Provide support during Rx
Surgical: bone marrow transplant may be recommended after 2nd remission
Meds: combination of drugs via subclavian catheter and/or intrathecally (into subclavian space)
Rx: 2-3 years
After 30 days of Rx see if remission- do bone marrow biopsy and lumbar puncture. If remission,
prognosis good. If relapse – decrease chance of survival
Assist family and child in resolving feelings and fear
Idiopathic Thrombo-cytopenic purpura (ITP)- blood disorder with a deficient of platelets in
circulatory system
Autoimmune disorder often preceded by a viral infection
Can be acute and self limiting or chronic and require therapy
Peak age of occurrence is 2-4 yrs
Sx: bruising and petechiae
Medical: Dx by Hx, meds, decreased platelets
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Doe Bone marrow biopsy to r/o cancer
Most cases self limiting – 6 month recovered platelet count without therapy
If chronic and active uncontrolled bleeding- platelet transfusion
Surgical:
If doesn’t respond to meds- splenectomy (usually 5 yrs or older)
Meds: steroids, immune globin, given to block the autoimmune destruction of platelets
No sports and physical activities till resolved
Soft bristle tooth brush
Safe age appropriate environment
I- s/s of infection
Hemophilia- excessive bleeding
Early manifestation of severe Hemophilia –neonate –bleeding from umbilical cord
Mild Hemophilia- may not be detected until toddler
Nsg. Intervention- prevention and teaching
Need regular physical activity
GI System:
Constipation: infrequent or difficult passage of hard dry stool.
Most common –toddler and preschool age
Causes: toilet training, busy schedule, limited bathroom privileges, lack of fresh fruit and vegs.,
grains, dehydration, lack of exercise, emotional stress, drugs, excessive milk intake, painful
defecation, etc.
If chronic- leads to enlarged rectum, encopresis (passage of watery stool around a hard fecal
mass)
Sx:
Abd. Pain, cramping, movable fecal mass, large amt. of stool in rectum, diarrhea,
malaise, headache, anorexia.
Medical:
Xrays, fecal impaction – remove manually and/or enema
Diet: Increase water and fiber, limit milk intake
Encl. reg. toileting habits, adeq. Hydration, eating a hi-fiber diet, regular exercise
Nsg. Mng:
educate parents re: normal bowel pattern and imp of diet and exercise
Intestinal Parasitic Infection: giardiasis (protozoan)
Helminths (pinworms, roundworms, hookworms)
Frequent found in temperate climates, crowded conditions, untreated water, and poor hygiene
practices
See Table 57-2 Pg 1652
Dx: fecal smear on microscopic exam
Meds: Helminths: anthelmintic-Atiminth or Vermox; repeat 2-3 wks. Tx all family members
Giardiasis- Flagyl, Atrabrine HCl—may cause yellow discoloration to skin
See Professional tip Pg 1653 and HHcare
Diet: Hookworm- increase protein
Need meticulous sanitary precautions
Client teaching pg 1653
Endocrine System:
Type I (insulin dependena) DM: child management has some unique challenges-physical
immaturity and dependence lifestyle for care
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Family lifestyle change for entire family. Stick to regimen
Puberty special time for compliance to diet, insulin and exercise
School age child should learn injections
More and more Diab Type 2 showing up in children – overweight or obese
Pg 1654 –Testing for Type 2 Diabetes
Usually treated with nutrition therapy and exercise program. Eventually most will need drug
therapy (oral agents)
Musculoskeletal System
Scoliosis: most common spinal deformity in children
Is lateral curvature greater than 2- degrees, spinal rotation, rib asymmetry, thoracic hypokyphosis
Most frequently in prepubescent girls
Sx: visible curve of spine, posterior rib hump when bending forward, asymmetrical rib cage,
uneven shoulder on pelvic height
Medical: Goal- stop curvature of the spine
For mild or moderate curvatures use of electrical stimulation, bracing and/or exercise is
prescribed
If curve >40degrees, surgery. Goal: to correct the curvature with internal fixation and
instrumentation
Nsg Mng: Involve child in care
Encourage to do exercise
Protect bony prominence when wearing brace
Post Op: assess extremities for color, capillary refill, warmth, sensation, and movement
Log roll q2hrs. VS, check for bowel distention and urinary retention. Assess pain level, possible
analgesics.
I-family involved with care, discuss restrictions on activity –keep follow up appt.
C/O of sore back, improperly fitting clothes, slight limp
Assess complication with Tx regimen
Screening is important. Children 10 yrs or age or older should be screened.
See Fig. 57-2 pg 1655
Legg-Calve-Perthes Disease
Necrosis of the head of the femur due to inadequate blood supply
Cause- unknown
Sx: hip and knee soreness, stiffness, painful limp, quadriceps muscle atrophy
Dx: X-ray
Goal to maintain shape of femoral head, reduce risk of arthritis
Tx: Traction, bracing, surgery
Medical:
Child hospitalized from non-wt bearing ROM exercise and red rest
If no improvement in 10 days then other tx tried.
Traction followed by a use of a non-wt bearing abduction brace, positions head of femur in
acetabulum. May need to wear 1-3 years
Surgical: Tx of choice- 3-4 month back to normal
Nsg Mng: Maintain mobility
Education child and family re: tx plans, including adherence to followup visits and
compliance with tx plans. Check skin daily, do exercises
Duchenne Muscular Dystrophy
X-linked, recession, heredity, degeneration disease of muscle
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Disease carried by females but seen primarily in males
Sx: delayed motor development, difficulty standing or waking, progressive muscle weakness,
increased abnormalities of gait and posture, lordosis, pelvic waddling, frequent falling, flat affect
and smile
Gowers’ Sign- walking the hands up legs to move from a sitting to a standing position
Can go till young adulthood-usually diet d/t resp. failure- rarely live beyond 20 yoa
Complications- obesity, contractures, resp. infections, cardiac failure,
Dx: serum enzyme assay, muscle biopsy and electromyography
Medical: keep as independent and mobile as long as possible with PT and bracing
Then maximize sitting capabilities, resp. function and self care,
Genetic counseling
Surgical: release of contractures
Nsg Mng: monitor when family his of medical, focus on what child can do
Juvenile Arthritis (JA)- autoimmune inflammatory disease
Asystemic, multisystem disorder that affects connective tissue
Sx: joint swelling, limited ROM of affected joints, pain, tenderness, inflammation lasting longer
than 6 wks
Complication blindness, disability
If detected early and txed-prognosis good
Medical: Tx-Goal- maintain mobility
Preserve joint function
Use of drugs, PT and/or surgery is therapeutic regimen
Surgical: release contractures, correct leg-length discrepancies, replace joints
Meds: ASA, NSAIDs (Motrin, Naprosyn), Myochrysine (gold Na), Penicillamine
Cytoxic drugs for severe case
Corticosteriod- use spacring when disease is life threatening
Fractures- childhood fx less complicated, heal quicker than adult
Most commonly fixed –clavicle, femur, tibia, humerus, wrist and finger
If epiphyseal plate is fxd- severely impaired growth can occur and permanent damage
Greenstick fx- common in young children as they have incomplete ossification
If old fxs in child- possible child abuse
If infant fracture- look for osteogenesis imperfecta (brittle bone disease)
Tx:- realignment
Immobilization using traction
Closed manipulation and casting
Immune System
Communicable diseases- an illness that is directly or indirectly transmitted form one person to
another
Infants and young children highly susceptible – immune systems don’t’ mature till 6 years of age
and hygiene habits are not the best
See Table 57-4 Pg 1659-1661
Nsg. Mg: Immunization very important. Inform family about nature, prevalence, risk of disease,
type of immunization product to be used, expected benefits and risk of side effects of vaccine.
Need for accurate immunization records
Must get informed consent of parents
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On child’s immunization record- note type of vaccine, date of administration, manufacture and
lot #, expiration date and administration site
Integumentary System
Bacterial Infection- Streptococcia
Stphylococcia
Impetigo- bacteria infection- most common skin infection of childhood
Face, mouth, hands, neck and extremities –common areas
Sx: primary lesions- macules that change to small, thin walled vesicles with a reddened halo
Secondary Lesions- ruptured vesicle covered by a honey-colored crust over an ulcerated base
Itching, burning, lymph node enlargement
Goes away in about 2 wks
If caused by strep- complications can occur- rheumatic fever or glomerulonephritis
Meds: topical bactericidal ointment – Neosporin 5-7 days
If multiple lesions- oral antibiotics
If severe – parenteral antibiotics
Nsg Mng: Goals: prevent spread, promote healing.
Tx at home not return to school for 2 days after antibiotic started
Important to take antibiotics as ordered
Preventative hygiene measure
Sleep alone, bathe daily with antibacterial soap, use separate towel, proper hand washing, use
separate eating utensils
Wash lesions 3x day with warm soapy wash cloth
Remove soaked crusts and apply topical bactericidal ointment
Lease lesions uncovered
Important not to touch lesions
Cellulitis—bacterial infection of skin and subq tissue
Face or lower extremities
Strep, staph
Sx: rapid onset of red or lilac color, tender hot edematous skin, enlarged lymph nodes
Complication- septic arthritis, osteomylitis, meningitis, brain abscess, blindness
Med Surg- tx at home with oral antibiotics and warm compresses
If involves face or joints, need hospital with IV antibiotic
Surgical- Incision and drainage of affected area needed
Nsg Mng: Elevate extremity and immobilize
Warm moist soaks q4h to increase circulation to affected area, relieve pain, and promote
healing
Important- to take entire course of antibiotics
Fungal InfectionTinea (Ringworm)- apply lotion/cream to entire lesion extending to approximately 1” beyond
lesion
Important to take entire course of antibiotics even if symptoms disappear
See table 57-5 pg. 1663
Viral InfectionLesions- rashes, macules, papules, vesicles, urticaria (hives), warts
Many of the communicable diseases are viral in nature
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Herpes Simplex Virus Type I- often recurring infection of the mouth/cold sore/fever blister,
throat, eyes, finger
Once have it, it lies dormant until reactivated by stress, trauma, sun exposure, menstruation, or
immunosuppression
Sx: clusters of blood filled vesicles, ulcerations, swelling, inflammation, pruritus & severe pain
Lesions usually dry and crust in 7-10 days
Tx: relieve sxs, adequate hydration, pain management, secondary infection, prevention
Meds: antibiotic ointment –use for secondary infection, acetaminophen, topical and mouth-rinse
anesthetics for pain
Nsg Mng: assess for dehydration and secondary infection
Offer items that are easily swallowed ex: ice pops, jell-o, milk, flat soda, noncitrus juices
Small frequent feedings of bland food, soft foods
Important- don’t touch lesions, remains contagious contagious until lesions fall off on mucous
membranes ulcerations have to heal. Place in contact isolation in hospital.
InfestationsPediculosis-(lice)
Pediculosis capitis-head
Pediculosis pubis- pubic hair
Pediculosis corporis-body
Head lice- Sx- lice attaché eggs (nits) to hair shafts close to scalp, nits hatch in weeks
Looks like Dandruff not easily removed, severe scalp itching, bugs in hair (usually behind ears
and nape of neck)
Body lice Sx: intense pruritis and papulas, rose colored dermatitis in area under tight fitting
clothes
Don’t share headgear, combs, brushes, pillow, blanket, towels
Meds: See Table 57-6 pg 1665
Nsg Mng: focus on screening and educate
Check daily for lice
Don’t cut hair or shave scalp
Don’t tease ----anyone can get this
Scabies- impregnated “itch mite” burrows into epidermis to lay eggs
Sx: rash (papula, vesicles, nodules) intense pruritus, rash found on wrist, finger webs, elbow,
axillae, feet, ankles, head, neck, abdomen, waist, groin, buttocks
Can develop secondary infection due to scratching
Tx: Lotion for older than 2 yr old affected people
If under 2 yrs old- use Cromatmitine lotion
Oral antibiotics (Benadryl, Atarax) for itching
Nsg Mng: focus on promoting healing, preventing secondary infection and prevent spreading of
scabies
Everyone should be txtd in household and direct care provider
Itching and rash may last 2-3 wks
Bites/Stings
Animal bites- can be domestic or wild animal usually family dog
Children younger than 4 usual targets due to size/height and be near dogs face
Occur on face, extremities, usually – can result in crushing and puncture wounds and lacerations
Concerns: rabies, tenanus, scaring
Wash wound with soap and water, rinse, apply dry clean dressing
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If animal unvaccinated for rabies, child must undergo series of rabies shots to prevent it
If wounds deep—antibiotics
Tetanus toxiod
Important- animal safety rules pg. 1666 Teaching
Important – Care of wounds
Keep immunization up to date
Animal bites reported to community animal control agency
Spider Bites
Black Widow, Brown Recluse- found in wood piles and closets
Spiders avoid light, non-aggressive –bite in self defense
Initial bite may go unnoticed (venom)
A few hours later swollen, painful eyrthemia results
Black Widow- neurotoxic, dizziness, weakness, abdominal pain, paralysis, seizures, possible
death(shock and renal failure)
Brown Recluse- necrotoxic-bite becomes a necrotic ulcer within 1-2 weeks
Fever, N&V, joint pain, not fatal but ulcer takes months to heal
Black Widow- hospital until neurological symptoms subside and renal function confirmed
Brown Recluse- not usually hospitalized, wound care and pain management, pt may need skin
graft
If Black Widow- antivenin given, if no allergy to horse serum, also analgesics, muscle relaxants,
tetanus prophylactic given
No antivenim for Brown Recluse-antibiotics, corticosteroids, analgesics, tetanus
Tick Bites- live in fields and woods
Feed on blood of mammals
Embed head into skin
Pruritis modules at pt of attachment
Possible: fever, rash, paralysis, ex of diseases caused by tick –Lyme Disease and Rocky
Mountain Spotted Fever
Important- to prevent tick bites – Client Teaching Pg. 1667
Remove embedded ticks
Apply vasoline, or nail polish for 30 minutes (to suffocate tick)
Grasp ticks body with tweezer –pull straight up-remove head and body. If head parts remain, use
sterile needle dot remove
Thoroughly wash hands
Med: Alleviate itching
Prevent infection
Baths and cool compresses
Meds: Antipyretics
Antihistamines
May need to treat mattress, carpet, furniture and pet (insecticides)
Contact Dermatitis
Inflammatory reaction of skin to allergen or irritant
Some of the items are rubber, dyes, nickel, poison ivy, soaps, wool, urine, stool.
Blisters if irritant contact dermatitis.
Sx: include localized, dry, inflamed pruritic skin
Med Tx: discontinue exposure to the offending agent. Wash skin thoroughly and apply cool
compress
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Meds: after compresses apply steroid cream 1% in thin layer. If severe case-oral steroids given.
Oral antihistamine, antipruritic
Nsg Goals: relieve itching, lotion and tepid aveeno baths, prevent infection, remover offensive
substance, avoid overheating
Acne- adolescence problem
Noninfection, inflammatory disease of skin, hair follicles, and sebaceous glands
Cause: overproduction of sebum, formation of comedones, or whiteheads and blackheads and
growth of proliferation acne bacteria in hair follicles
Sx: comedones, papules, pustules, nodules on face, neck, back, shoulder and upper chest
Infection development Acne- increase hormone levels (especially androgens)
Presdisposition, emotional stress, hot, humid environment, premenstrual period, growth of
anaerobid bacteria
Very distressing to adolescence due to appearance of visual lesions
Meds: Tx individualized
Goals: decrease sebum production
Prevent infection
1-Benzoyl peroxide- (Clearasil, Benoxyl)
2-Retin-A- used as cleansers, lotion, cream, etc
3-Keratalytic agents containing sulfur, resorcinol, salicylic acid –drying and peeling
4-Topical and oral antibiotics-infection
5-Accutane- used for nodulocystic acne.
SE: dry lips and skin, eye irritation, temporary worsening of acne, epistaxis, bleeding and
inflammation of gums, itching, photosensitivity, joint and muscle pain.
If get pregnant on this can cause abnormalities in fetus!
Must be on contraception during use. Pregnancy tests done 2 weeks before start of med, q month
during and 1 month after stopping med
Nsg. Mgn: healthy lifestyle (rest, diet, exercise), help lesions to heal
Be empathetic
Adolescents should assume responsibility for treatment
Burns- 2nd leading cause of death 1-14 yoa
Adult carelessness, poor supervision of child, child curiosity and increase mobility
Child abuse (electrical, thermal, chemical)
Sx: severe wounds, pain, fluid and nutritional deficits, resp. complications, secondary infections
Besides burns, smoke inhalation can be fatal. Burning plastic, polyurethane, and some fabrics
can cause cyanide poisoning.
Sx of cyanide poisoning and carbon monoxide inhalationN&V
Lethargy
Confusion
Tachycardia
Metabolic acidosis
Seizure
Coma with some inhalation always risk of airway obstruction
Medical Management-Severity based on % of surface burned and depth of wound
See Burn Wheel pg 1669 Fig. 57-98
If certain body parts (face, hand, feet, perineal area, ant. Chest and circumferential burns of
thorax or extremity) or certain specific burn distribution can increase burn severity
Meds:
1-Tetanus antitoxin/or toxoid
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2-Morphine Sulfate –given 20-30 mins before dressing changes and debridement
3-antipruritis meds
Health Promotion- prevent scarring and contractures, wear pressure dressing and suits for 1
year to minimize scarring, PT needed
Nsg Mng: Initial Care
Establish airway, given O2, IV therapy of ringer lactated solution, foley catheter, monitor
output, analgesics as ordered, monitor VS, I&O, assess pulse oximetry reading, LOC, electrolyte
lab results
Once Stable:
Monitor VS, I&O, resp. pattern, daily, wt. and pain. Stick standard precautions, asses
wound for infection, mental status, bowel sounds, reaction to TPN or enteral tube feeding,
passive ROM, turn q2h (use pillows, splints), provide emotional support and education for
ventilation of feelings
Psychosocial aspects of burn- client may be angry, self-conscious, embarrassed, feel isolated,
frightened, anxious, guilt and depressed
Urinary SystemAcute Poststereptococcal Glomerulonephritis- inflammation of glomureli of kidneys.
APSGN occurs as a immune reaction to streptococcal infection of throat on skin
Sx: appear after 1-3 weeks after infection
Sxs: per orbital edema, hematuria, decreased urine output, hypertension, fever, fatigue
Prognosis: excellent
Sx: by hx, presenting symptoms and lab results
No Treatment for it
Medical Management: focus on presenting signs and symptoms, and the degree of renal
dysfunction
Meds:
Tx HTN with diuretics, antihypertensives, or limit Na and water intake
Nsg. Mng: monitor VS, diagnostic tests results (UA and lab studies)
I&O (cola colored urine)
Assess for headache, flank pain, edema, heart sound, lung sounds, weight pt daily
Nephrotic Syndrome- kidney disorder characterized by proteinuria, hypoalbuminemia and
edema
Most common childhood nephritic disease – minimal change nephritic syndrome (MCNS)
Cause – Unknown
Sxs: pitting edema (per orbital and dependent), anorexia, fatigue, abdominal pain, increase wt.,
normal BP
Complications: resp compromise, periotonitis
May experience remissions and exacerbations for months –Prognosis good
Medical: Dx by clinical presentation, age of child, massive protenuria (50mg/kg/day) and
hypoalbuminemia (below 27g/l)
Surgical: Kidney biopsy may be done
Pharmacological: Corticosteriods- prednisone induces remission in most cases. Usually makes
them void in 7-14 days. Once this happens, decrease to 3x week. Test urine daily to check to
proteinuria until protein absent 7 days. Prednisone then gradually decreased and discontinued
over a 4 week period. If relapses, repeat treatment. If don’t respond adequately to prednisone,
use Cytoxin to produce remission.
When in remission- vaccinate for pneumonia and flue.
Diet: NAS small frequent meals
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Nsg Mng: education parents re: disease process.
Hourly I&O, weight daily, Do abd. Girth, VS, check for pallor, edema
Keep skin clean and dry. Turn child q2h, check for skin breakdown
Avoid others with infection
Use standard precautions
Enuresis
Involuntary urination after age of potty training. Also called nocturnal enuresis or bedwetting.
Usually outgrown by age 8. If occurs beyond 8 or recurs in a child who has been trained assess
for reason why
Poss Cause: UTI, minor abnormalities of urinary tract, pinworm infestation, constipation,
diabetes, sickle cell anemia, sexual abuse, stress and sleep disorder.
Medical Management: Do UA C&S to rule out UTI
Do other tests to rule out all causes
Tx if no physical cause by fluid restrictions, bladder stretching, exercises, behavioral
conditioning and reward system
Meds:
-Anticholinergic- oxybutynin chloride (Ditropam) may decrease uninhibited bladder contractions
-Vasopressions desmopressin acetate nasal spray (DDAVP) reduce nighttime urine output
-Antidepressants (Tofranil)
May need psychosocial support- multidisciplinary approach
Psychosocial Disorders:
-responses to stressors
Facts influence response to stressors include: temperament, developmental level, nature of stress,
duration of stress, past experiences and coping abilities of family
Sx: depression, anxiety, enuresis, passive-aggressive behavior, learning problems
Obesity
-body wt 20% or more above ideal wt. (accumulation of fat)
-can be precursor for diabetes, cardiovascular disease, hypertension,
-Contributing factors: over consumption of food, a sedentary lifestyle, lack of parental
knowledge re: nutrition and food preparation, unstructured meals, genetic predisposition, peer
pressure
-may overeat to compensate for lack of parental love and relieve stress
-low self esteem, poor body image, diff in relationship, recurring anxiety/depression,
Medical Mng: difficult to treat
Fall victim to quick wt loss program
Outcomes better if have a good support system, understand how important this is to lose wt, must
be actively involved in plan of care
Needs daily exercise
Nsg Mgn” focus on meeting nutritional needs, managing related problems and promote self
esteem. Regularly assess wt, nutritional intake and exercise compliance. Give positive feedback.
Support group may help. Need team approach
Anorexia Nervosa and Bulima Nervosa
-2 of most common eating disorders in children
-AN is self inflicted starving.
BN is binge eating followed by purging
Begin usually middle to late adolescents. Can last indefinitely.
Highest incidence in white girls in higher socioeconomic classes.
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Poss cause: sensitivity to social pressure for thinner, distorted body image and longstanding
dysfunctional family pattern
Sx: Body wt 15% below norm for age and ht., intense fear of gaining wt, dry skin, brittle nails,
downy hair on back and extremities, amenorrhea, constipation, hypothermia, bradycardia, low
BP, fluid and electrolyte imbalance and anemia
Psych. Manifestations: depression, crying spells, feeling of isolation and loneliness, suicidal
feelings and thoughts. Suspect frequent vomiting if dental caries, erosion of teeth and throat
irritation
Family Type: over protective, rigid, lack of privacy, cant resolve conflicts, child perfectionist
Goal Medical Tx: correct malnutrition and resulting complications
Want wt gain of 0.1 to 0.2 kg/day until desired wt is attained.
May need enteral feeding on TN if severe
Meds: Antidepressants (imipromine hydrochloride-Tafromil) or Napromin
Also need family/individual psychotherapy –long term tx.
Autism
Complex disorder of brain function involving abnormal emotional, social and linguistic
development
Cause- unknown
Sx: lack of eye contact, aversion to touch, delayed language development, lack expression, lack
of responses to verbal stimulation, repetitive behavior, bizarre body movements, and self
destructive behavior.
Can be mild to severe
Prog depends on early detection, and child response to tx
Dx: must meet certain guidelines in DSM-IV. Need complete physical and neurological exam to
rule out other problems
Multidisciplinary team approach needed.
Focus on promoting normal development, social interaction and learning. Behavior modification
techniques used to reward desirable behavior and foster positive coping skills
Nsg Mng: early detection decrease environmental stimuli, provide supportive care, maintain safe
environment, give parents anticipatory guidance
-Monitor growth and development, ascertain routines, rituals, like and dislikes, surround with
favorite objects
See Client teaching pg 1673
May need assistance with self care
Keep schedule and care provider consistent
Needs close supervision
Special education program to help child reach his/her maximum potential
Support groups and Autism Society of America
ADHD
Development disorder characterized by developmentally inappropriate degrees of inattention,
over activity and impulsivity
Usually dx’d between 3-6 years old
Sx: poor impulse control, distractibility, fidgeting with hands, squirming in seat, excessive
talking, difficulty following instructions
Dx: made based on diagnostic criteria in DSMIV.
Needs multidisciplinary evaluation
Tx: decrease distraction, modify behavior, and/or starting meds
Meds: Ritalin
Cylent
All stimulate part of brain that facilitates concentration
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Dexedrine
Side effects-loss of appetite with resulting delayed growth
Nsg Mng: -improve child social interaction
-educate family and teacher
Suicide3rd leading cause of death among adolescents
Boys complete act 4x more often then girls but girls attempt it 5x more often than boys
Males: guns, hanging, jumping form high elevation
Females: overdose or cut wrists
Once attempted- greater risk to try again
Attempted suicide rarely occurs without warning
Sx: depression, boredom, restlessness, concentration problem, irritability, lethargy and
intentional misbehavior
High Risk:
Depression, pregnancy, failure in school, drug use, death of a friend or parent, problems with a
relationship, sexual abuse, chronic illness or a broken home
Medical: If thought to be high risk, admit to inpatient psychiatric unit
Tx: individual, group or family therapy
If severe allusive behavior may need to be physically or chemically restrained
Try use of contract. No suicide- child agrees to attempt suicide for a certain amount of time. If
unable to do this, seek help
Meds: Benadryl, Mellaril, Thorazine, Ativan. All used for chemical restraint. May need
antidepressants or antipsychotic meds
Nsg Mng: Asses risk factors, behavior, attitude, how lethal is proposed method of suicide,
coping mechanisms, and support system
Be nonjudgmental and be empathetic
Make environment safe
Monitor high risk child at all times
Give meds as ordered
Encourage to follow-up with psycho therapy
Keep all fallow up appts
Assess for physical/sexual abuse, self destruction behavior and sudden change in behavior.
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