Chapter 60
Infants with special needs: birth to 12 months
I.RESPIRATORY SYSTEM:
OTITIS MEDIA:
1. Definition: inflammation of the middle ear
2. Infants more than adults prone to OM because their Eustachian tube shorter, wider and
more horizontal than adults
a. as a result drainage is impaired causing
i. retention of secretions
ii. air in middle ear
iii. bacteria backflows up Eustachian tube from pharynx
3. URI precedes development of OM
4. Flu often the common causative agent
5. S/S:
a. irritability
b. pulling at infected ear(s)
c. diarrhea
d. vomiting
e. fever
f. hearing loss
g. red, bulging, non-mobile eardrum
6. Prolonged OM resulted in sensoineural for conductive hearing loss
7. Medical management:
a. Eliminate infection
b. F/U evaluation
8. Symptom management:
a. For recurring OM- do Myringotomy which is surgical incision of eardrum
b. Tympanoplasty tubes are inserted to drain fluid from middle ear
9. Pharmacological:
a. Antibiotics:
i. Amoxil (amoxicillin)
ii. Ceclor (cefaclor
iii. Suprax
iv. Lorabid
b. Antipyretics- decrease fever- Tylenol or Motrin
c. Analgesics for pain
10. Primary nursing concerns:
a. Relieve pain and fever
b. Heating pad on low setting
c. Ice packs compress
d. Decrease pain from chewing by giving liquids and soft foods
e. Facilitate drainage by lying on affected side after Myringotomy or if eardrum
ruptured
f. Teach parents S/S, management, and prevention
11. Prevention:
a. Proper positioning during feeding:
i. Bottle-fed- head slightly elevated so prevents formula from draining to
middle ear thru wide Eustachian tube
ii. Breast-fed receive immunoglobulin A in breast milk- helps protect against
infections
b. Immunizations are preventative
c. Smoke-free environment
i. Relationship exists between environmental tobacco smoke and OM
ii. Passive smoke associated with increased blocked Eustachian tube leading
to nasopharyngeal congestion and URI.
LARYNGOTRACHEOBRONCHITIS;
1. Most common type of croup
2. Viral illness
3. Causes swelling of upper airway
4. Severe cases caused by RSV (respiratory syncytial virus)
5. S/S:
a. Initially:
i. Inspiratory stridor (high pitched harsh sound)
ii. Barking cough
iii. Hoarseness
b. Persistent low grade fever
c. History of profuse nasal drainage, increased respiratory effort for several
days
6. Medical management:
a. Maintain patent airway
b. Improve respiratory effort
c. Create a highly humid, cool mist environment
7. Pharmacological:
a. Bronchodilators
b. Corticosteroids
c. sedatives
d. ribavirin- aerosoled antiviral agent
8. Nursing management:
a. Mild croup- home management
b. If more serious- hospital
i. Mist hood/tent with O2
ii. IV therapy
c. Infants may be held with mist blowing in face if tent causes stress
d. Parent to remain with infant
e. Familiar toy
f. Keep bed linens clean and dry
g. O2 administration to keep sats at 95%
PNEUMONIA:
1. Definition:
a. Inflammation of the bronchioles and alveolar space of the lungs
i. Most common cause is RSV
ii. Preceded by URI
iii. Viral or bacterial (pneumococcal)
2. S/S:
a. Onset abrupt
b. Increased fever
c. Flaring nostrils
d. Circumoral cyanosis
e. Chest retraction
f. Pulse rate of 140-180 bpm
g. Respiratory rate of 60-80 rpm
h. Non-productive cough
3. Diagnose by:
a. Chest x-ray
b. Secretion cultures
4. Medical management :
a. O2- cool mist administration
b. Chest physiotherapy
c. Postural drainage
d. Hydration
e. Family support
f. Antipyretics
g. Antitussives
h. Antibiotics
5. Nursing management:
a. Monitor respiratory status
b. Prevent further infection
c. Promote safety
d. Monitor hydration
i. I&O
ii. Check skin turgor
iii. Assess anterior fontanel for depression or bulging
e. Suction nose with bulb syringe prior to feeding
f. Change position frequently
i. Prevents stasis of drainage in lungs and draining into Eustachian tube
RESPIRATORY DISTRESS SYNDROME:
1. Usually occurs in preterm infants because lungs are deficient in surfactant
a. Surfactant- soapy substance that decreases surface tension inside the air sacs
b. Lungs collapse post each breath greatly decreasing o2 supply thus damages
lung cells contributing to the formation of hyaline membrane which blocks
gas exchange in the alveoli
2. First 96 hours critical for recovery!
3. S/S:
a. Tachypnea (70-120 rpm)
b. Retractioins
c. Grunting
d. Crackles
e. Pallor
f. Cyanosis
g. Sluggish capillary refill
h. Hypothermia
i. Periorbital edema
j. Flaccid muscle tone
k. GI system shuts down
l. Acidosis
m. Jaundice
4. Diagnosis by:
a. Chest x-ray
5. Complications:
a. Intraventricular hemorrhage
b. Bronchopulmonary dysplasia
c. Necrotizing enterocolitis
6. Medical management:
a. O2 administration
b. Give surfactant through endotracheal tube immediately or soon after birth
c. CPAP- keeps lungs partially expanded till lungs start producing surfactant
(about 5 days)
7. Health promotion:
a. Administer surfactant to at risk infants
b. Measure lecithin (major component of surfactant) to determine lung
maturity
i. If lecithin level low, mother given glucocorticosteroids- crosses
placenta and causes infants lungs to produce surfactant in 72 hours
8. Nursing management:
a. Monitor respirations
b. Eliminate unnecessary physical stimulation to decrease metabolic needs
c. Positive relationship with parents
d. Infant placed under warmer and O2 hood or mechanical ventilation
CYSTIC FIBROSIS:
1. Definition:
a. Major dysfunction of all exocrine glands, primarily affects lungs, pancreas.
Liver and reproductive organs
b. Transmitted as an autosomal-recessive trait (both parents carriers)
2. S/S:
a. Increased viscosity of mucus
b. Increased sweat electrolytes
c. Increased organic and enzymatic construction of saliva
d. Abnormality in autonomic nervous system function
e. Evidence of disease appears by 1 year of age
i. Meconium ileus- impacted feces leads to bowel obstruction in the
newborn
ii. Intussusceptions (telescoping of bowel)
3. Common problems:
a. Rectal prolapse due to difficulty passing sticky, thick stool
b. GI problems due to lack of pancreatic enzymes
c. Difficulty gaining and maintaining weight
d. Pulmonary:
i. Chronic, moist, productive cough
ii. Infection
iii. Barrel chest and clubbed fingers due to chronic lack of O2
e. Salty kisses due to increased sweat electrolytes
4. Diagnose by:
a. Sweat chloride test
5. Medical management:
a. Manage pulmonary complications first
b. Adequate nutrition
c. Help family and child adapt to chronic condition
d. Chest physiotherapy – postural drainage 1-3 times a day to keep airway open
(patent)
6. Pharmacological:
a. Aerosol treatment
b. Antibiotic therapy
c. Commercially prepared pancreatic enzymes to aid digestion and absorption
of fats and protein
d. CPX- chemical derivative of existing lead components
e. New- protein repair therapy
7. Diet:
a. Well-balanced and increased calorie intake as they only absorb about 50% of
ingested foods
8. Nursing management:
a. Monitor respiratory status, adventitious lung sounds (irregular, sporadic)
cough, stool, abdominal distention and weight
b. Assess G&D, hydration and nutritio9n
c. Give O2 and meds per dr. orders
d. Chest physiotherapy (pulmonary toilet)
e. Teach family how to care for child
9. Nursing Process
SIDS- CRIB DEATH
1. Sudden, unexpected death of apparently healthy infant
a. Leading cause of death in infants > 1 month; 90% by 6 months.
b. No single cause identified
2. American academy of pediatrics recommends:
a. Infants sleep on their backs
3. Risk Factors:
a. Sleeping on soft surfaces
b. Maternal smoking
c. Overheating
4. Not caused by:
a. Vomiting
b. Choking
c. Minor illness
d. Vaccinations
e. Immaturity
5. Nursing management:
a. Empathetic support to family
b. Only ask factual questions- don’t suggest any responsibility
c. Reassure
i. SIDS not predictable
6. Diagnose:
a. Autopsy
7. Tell family:
a. Hold child
b. Say goodbye
II.CARDIOVASCULAR SYSTEM:
1. Congenital cardiovascular defects:
a. Range mild to severe
b. Detected immediately or months later
c. Leading causes of death in the first year
d. Errors in the formation of the heart or Great Vessels occur pre and post
natally
2. Defects are characterized according to blood flow pattern:
a. Increased pulmonary blood flow
b. Decreased pulmonary blood flow
c. Obstructed blood flow out of heart
d. Mixed blood flow
3. Infants born with severe CV defect:
a. Obvious signs of distress caused by hypoxia:
b. Congestive Heart Failure:
i. Fatigue
ii. Orthopnea
iii. Failure to thrive
iv. Pale
v. Mottled
vi. Cyanotic skin
vii. Hoarse, weak cry
viii. Tachycardia- > 60
ix. Respiratory distress- costal retractions, wheeze, cough
4. Infants born with less serious CV defects:
a. Appear normal at birth
b. Have heart murmur
5. Surgical management:
a. Repair defect surgically
b. The older, the better
6. Pharmacological:
a. Digoxin- improves heart contraction so increases cardiac output
b. Lasix- diuretic
c. Monitor potassium (K+) levels; K+ supplements as needed
7. Diet:
a. Small, frequent feedings
b.
c.
d.
e.
Softer nipple
Due to dyspnea while feeding - may need special feeding technique
Increased calorie formula
Infant exhausted while feeding- just doesn’t have the energy to suck so may
need gavage feeding
8. Nursing management:
a. Assess cardiac and respiratory function
b. Monitor behavioral pattern and G&D
c. O2 and meds
d. I&O
e. Weight
f. Increase calorie feeding
g. Gavage
III. HEMATOLOGIC AND LYMPHATIC SYSTEM:
HYPERBILIRUBENEMIA:
1. Also called jaundice
a. Yellow discoloration of skin, sclera, mucous membranes and body fluids
b. Results from excess bilirubin and deposition of bile pigments
2. Normally, hemoglobin breaks down to bilirubin that binds to albumin and is
transported to liver where it is conjugated and then eliminated through the
intestines
3. In infants, the conjugated bilirubin is converted back into unconjugated bilirubin
that is then reabsorbed into the blood stream leading to hyperbilirubinemia
4. A high level of bilirubin leads to kernicterus leads to brain damage
5. Objectives of treatment:
a. Decrease amount of unconjugated bilirubin
b. Change bilirubin to a form that can be excreted usually in urine
(urobilinogen)
6. Treatment:
a. Bililight (phototherapy) or fiberoptic blanket
b. The lights causes the bilirubin to change to urobilinogen
c. Can interrupt lights for short time only for holding and feeding
7. Pharmacological:
a. Phenobarbital
b. Breast feeding can make it worse- may have to stop for 24 to 48 hours
8. Nursing management:
a. Assess for jaundice
b. Encourage frequent feedings
c. Maintain phototherapy as ordered
d. May need to teach parent s phototherapy at home
e.
9. Assess for:
a. Family history, induced delivery
b. Jaundice by applying light pressure to the skin over either tip of nose or
sternum in natural daylight
c. If dark-skinned, check sclera, conjunctiva, oral mucosa for yellow color
d. Bruising, petechiae and pallor
IRON-DEFICIENCY ANEMIA:
1. Diagnosed between 9-24 months
2. Not seen sooner due to iron stores that full-term infants have
3. Related to infant drinking large amounts of milk and foods that don’t contain iron
4. S/S:
a. Extreme pallor (porcelain like in fair-skinned infants)
b. Tachycardia
c. Lethargy
d. Irritability
e. Decreased hemoglobin, hematocrit and iron levels
5. Pharmacologic:
a. Iron therapy
b. Continued for 3 months after Hgb and Hct return to normal
c. Will see increase in Hgb within 4 to 30 days
d. Given IM or IV if oral doesn’t work within 1 month
e. May order Vitamin C with the iron to aid in the absorption of the iron
f. Transfusions only for severe cases
6. Diet:
a. Increase dietary iron
b. Use iron-fortified formula until 12 months of age
c. Can use iron-fortified cereal 4-6 months of age
7. Nursing management:
a. Prevent by education:
i. important to teach an overweight infant doesn’t mean a healthy
infant
b. Encourage foods rich in iron:
i. Dried beans, iron-fortified cereals, apricots, prunes, egg yolks, dark
green leafy vegetables
c. Give liquid iron with a straw or medicine dropper to avoid staining of teeth
d. When given IM- give no more than 1 ml deep in muscle using a z-track
method to avoid leaking out of iron and staining of skin.
e. Expect dark , black stools
f. Mix liquid iron with orange or citrus juice in order to increase iron absorption
g. Brush or wipe teeth after giving liquid iron
SICKLE-CELL ANEMIA (SCA):
1. Genetic disorder
2. RBCs take on “sickle” shape
3. Abnormal Hgb production
4. S/S:
a. Abdominal pain (spleen enlargement)
b. Fever
c. Severe leg pain
d. Hot, swollen joints
e. Growth retardation
f. Chronic anemia
g. Increased susceptibility to infection
5. Symptoms usually do not appear until 6 months of age
6. Sickling can occur due to infection, dehydration, hypoxia, trauma, general physical or
emotional stress. This leads to impaired circulation and obstruction and increased
RBC destruction.
7. Occurs primarily in African- Americans
8. Transmitted as an autosomal-recessive trait and both parents are carriers
9. Goal:
a. Between episodes prevent crises with ADEQUATE HYDRATION (1500 to 3000
ml/day)
b. During crises
i. Bedrest
ii. O2
iii. Analgesics (morphine)
iv. Increased fluids
10. Pharmacologic:
a. If have disease, MUST BE IMMUNIZED with influenza, pneumococcal,
meningococcal and hepatitis B vaccines
b. Prophylactic Penicillin BID until 5-6 years of age
c. Daily supplement of folic acid
11. Health promotion:
a. Avoid high altitudes, poorly pressurized airplanes and exposure to extreme
heat or cold
b. Maintain hydration
c. Neonatal screening
d. Early intervention
e. Prophylactic antibiotics
f. Parent education
12. Nursing management:
a. Encourage adequate hydration
b. Encourage immunizations
c. Prevent exposure to extreme heat/cold
d. Provide parent education
e. Monitor growth and development
f. Treat crises as they occur
13. Assessment:
a. History of child’s health
b. Events leading to a crisis
c. Vital signs
d. Vision
e. Hearing
f. G&D
g. Respiratory, GI, Renal, Neurological and Musculoskeletal
IV.GASTROINTESTINAL SYSTEM:
THRUSH:
1. Also called moniliasis or candidiasis
2. Oral fungal infection
3. Transmitted from vaginal canal of an infected mother to newborn, poor hand
hygiene, inadequate washing of nipples and bottles, and antibiotics.
4. S/S:
a. Painless, white patches that look like curdled milk on the infant’s oral mucosa
5. Incidence:
a. 2-4%
b. Bottle fed at greater risk
6. Pharmacologic:
a. Topical Nystatin (Mycostatin)
b. Use 4 times a day with applicator or gloved finger and then swallowed
c. Rinse mouth before medicating
d. If infant breast-fed, also apply to breasts
7. Nursing management:
a. Teach proper hand hygiene
b. Boil nipples and bottles for 20 minutes to kill spores
ACUTE GASTROENTERITIS (AGE):
1. Inflammation of stomach and intestines
2. Accompanied by vomiting and diarrhea
3. Causes:
a. Malnutrition
b. Lactose intolerance
c. Chronic conditions
d. Infections by viruses, bacteria or parasites
4. Increased number of green liquid stools- blood /mucous tinged
5. S/S:
a. Fluid and electrolytes imbalances
b. Cramping
c. Extreme irritability
d. Vomiting
6. Infant can become greatly dehydrated and gravely ill
7. Goal:
a. Regain and maintain fluid balance
i. Use Pedialyte or Lytren for mild dehydration; Ivs for severe
dehydration
8. If stool shows bacterial infection use antibiotics
9. Diet:
a. Usual diet continued once rehydrated
10. Nursing management:
a. Assess for dehydration
b. Monitor I&O and electrolyte blood levels
c. Give fluid and electrolytes as ordered
d. Give oral fluids and rehydrating solutions
e. Proper hand hygiene
f. Assess for skin breakdown
g. Look for etiologic agents:
i. Introduction of new foods
ii. Exposure to infectious agents
iii. Travel to an area where infectious agent is endemic
iv. Contact with foods that might be contaminated
v. Crowded, dirty living conditions
vi. Contact with certain types of pets (pet turtle)
h. See infection control- diaper hygiene
COLIC:
1. Sudden, periodic attack of abdominal pain and cramping
2. Severe crying for several hours and draws up legs to abdomen
3. Usually occurs between birth and 3 months of age and at same time each day (late
afternoon, early evening)
4. Infant usually inconsolable
5. Usually eager to eat and is growing appropriately
6. No known cause but possibly overfeeding, overly rapid feeding, improper burping,
swallowing of large amounts air and emotional stress between infant and parent
7. Medical management:
a. Rule out other problems
i. Sensitivity to formula
ii. Food allergies
iii. Peritoneal infection
iv. Intestinal obstruction
b. If breastfeeding avoid dairy products, onions, cabbage, dry beans
8. Pharmacologic:
a. Sedatives
b. Antispasmodics
c. Antihistamines
d. Antiflatulent
9. Nursing management:
a. Assess circumstances surrounding colicky event
b. Explore techniques to relieve symptoms
c. Support parents during colicky periods
d. Assess:
i. feeding technique
ii. Relationship between mother, father and child
iii. Can parents recognize infant’s cues and respond appropriately?
10. Usually resolves by 3 months of age
11. Encourage parents to verbalize feelings about infant and any inadequancies
FAILURE TO THRIVE (FTT):
1. Infants who fail to gain weight and who show signs of delayed development
2. Types:
a. Organic
i. Caused by physical defect or condition
b. Nonorganic:
i. Psychosocial factors such as parent – child relationship
3. S/S:
a. Sustained growth failure (below 5% on standardized growth chart)
b. Developmental delays in all areas
c. Poor feeding patterns
d. Poor sleeping patterns
4. Medical management:
a. Treat physical defect or condition
5. Primary goals:
a. Provide adequate nutrition
b. Promote G&D
c. Assist parents in developing nurturing skills
6. Health promotion:
a. Non-organic:
i. Need multidisciplinary approach for physical, psychosocial, mental
and emotional problems
ii. All family members need to be involved
7. Nursing management:
a. Monitor weight gain and development
b. Provide adequate nutrition
c. Assist parents to develop nurturing skills
8. Assess:
a. Infant’s routine, respiratory status, and diet history
b. Family for problems:
i. substance abuse,
ii. depression,
iii. MR,
iv. psychosis)
v. socioeconomic level
vi. education
vii. social isolation
viii. stress factors
ix. support systems
c. for malnutrition
d. parent child interactions
CLEFT LIP/PALATE:
1. facial malformation of non-fusion of palates and/or lips
2. can occur separately or together
3. is evident at birth
4. can be unilateral or bilateral
5. can be varying degrees of severity
6. Cause: unclear; may have genetic component
7. S/S:
a. nasal, lip, palate distortions
b. risk for aspiration
c. feeding difficulties
d. respiratory infections
8. medical management:
a. close defects
b. maintain adequate nutrition
c. prevent complications
d. foster normal G&D
e. approach is multidisciplinary
f. prone to otitis media - treat with antibiotics
9. surgical management:
a. closure of lip precedes that of palate
b. closure of lip at 6-12 weeks
c. closure of palate at 12 to 18 months of age to facilitate speech development
10. health promotion:
a. can help decrease risk of cleft malformation by up to 50% if maternal
multivitamins with folic acid are taken
12. nursing management:
a. Encourage parents to hold and interact with infant and participate in care
b. Provide feedings as ordered using assistive devices
c. Upright position for feeding
d. Burp often
13. Assessment:
a. Emotional impact on family
b. Family’s acceptance of child
c. Can palpate palate with fingers
d. Document degree of involvement
e. Evaluate ability to suck, swallow, breath and handle secretions
ESOPHAGEAL ATRESIA WITH TACHEOESOPHAGEAL FISTULA:
1. Are rare
2. Can occur separately or together
3. Failure of esophagus to develop as a continuous passage (atresia) to the stomach
and/or an unnatural connection between esophagus and trachea (fistula)
4. Cause unknown
5. S/S:
a. Excessive salivation
b. Drooling
c. Choking when feeding
d. Coughing
e. Cyanosis
6. Mother may have a history of excessive amniotic fluid during prenatal period
7. Medical management:
a. Goal:
i. Prevention and treatment of aspirational pneumonia
ii. Treat with antibiotics
b. Kept NPO until surgery
c. IV fluids
d. Frequent or continuous suctioning of secretions from mouth and esophagus
through a Nasogastric tube
8. Surgical management:
a. Critical neonatal emergency
b. May need several surgeries
c. If need staged repair- g-tube placed for feedings
d. Prognosis good with surgery
9. Nursing management:
a. Assess for:
i. Color
ii. Amount of saliva
iii. Ability to swallow
iv. Respiratory distress
v. Abdominal distention
vi. Immediately after birth
b. Maternal history of polyhydraminous causes increased risk
c. NPO till assessed
d. Prepare family for immediate surgery
PYLORIC STENOSIS:
1.Circular muscle surrounding the pylorus hypertrophies (enlarges) and blocks gastric
emptying
2. rarely diagnosed before 3rd week of life
3. S/S:
a. classis symptom: PROJECTILE VOMITING
b. stomach contents can eject up to 3 feet
c.
ravenous hunger
d.
hyperactive bowel sounds
e.
irritability
f.
FTT
g.
decreased number and volume of stools
h.
olive-shaped mass in right upper abdominal quadrant
i.
visible peristaltic waves
4. Medical management:
a. diagnosis usually made before malnutrition, dehydration and alkalosis are severe
5. Surgical management:
a. repaired immediately after discovery
b. good prognosis with surgery
6. Nursing management:
a. recognize signs and symptoms early
b. pre and post op care routine
c. can resume feedings 4 to 6 hours postoperatively
d. usually discharged from hospital within 72 hours
HIRSCHSPRUNG’S DISEASE/MEGACOLON:
1. Congenital anomaly
2. Can be partial or complete mechanical obstruction from inadequate motility of part of the
colon
3. Absence of parasympathetic ganglion cells of distal colon and rectum thus leading to
decreased peristalsis of muscular walls
4. Affected portion of bowel narrows and the portion above the affected area becomes greatly
dilated and fills with feces and flatus
5. Failure of infant to have a stool within 24-48 hours may indicate this defect
6. Older infants have constipation, ribbon-like stools and an enlarged, distended abdomen
7. Medical management:
a. If mildi. Dietary modifications
ii. Stool softeners
iii. Isotonic irrigations until toilet trained
b. Most need surgery
8. Surgical management:
a. Removal of the aganglionic bowel and creation of a temporary colostomy
b. Resection and colostomy closure occurs once child reaches 10 kgs. (22lbs.)
9. Nursing management:
a. Assess:
i. For stool passage
ii. Constipation
iii. Malformed stools
iv. For weight gain
v. Nutritional intake
vi. Bowel habits
b. Educate parents in daily saline irrigations and a balanced diet and to observe for sxs
of fluid and electrolyte imbalances and dehydration (dry mucous membranes and
increased thirst)
c. Post-op care:
i. Decrease anxiety
ii. Teach home care of colostomy
GASTROESOPHAGEAL REFLUX (GER):
1. Return of stomach contents into esophagus
2. Cause:
a. Immature sphincter
3. S/S:
a. Hunger
b. Irritability
c. FTT
d. Vomiting
e. Frequent URIs
f. Occur during the 1st 6 weeks of life
4. If mild, usually resolves by 1 year
5. If severe and doesn’t respond to treatment can lead to esophageal strictures,
respiratory distress and FTT
6. Medical management:
a. Resolves with dietary modifications, medication and positioning
b. Small frequent feedings
c. Burp often
d. Thicker formula with cereal
e. Position of choice-prone with head elevated 30 degrees
f. Positioning in infant seat can lead to increased intra-abdominal pressure and
is not recommended
g. Thicker formula with cereal
7. Surgical management:
a. Fundoplication:
i. Loosely wrapping gastric fundus around lower esophagus
8. Pharmacologic:
a. Tagamet
b. Zantac
c. Pepcid
d. All used to decrease gastric acid
9. Nursing management:
a. Recognize symptoms
b. Teach parents care of infant
c. Pre and post op care
INTUSSUSCEPTION:
1. When one portion of bowel (usually ileum) telescopes into a distal portion (usually
ascending colon)
2. Sudden symptoms:
a. Paleness
b. Cries out sharply
c. Drawn up legs in a severe colicky spasm of pain
d. Can last several minutes and recur within 20 minutes
e. Vomiting
f. “currant-jelly”stools that contain bloody mucous-usually fewer than 50%
g. Symptoms of shock:
i. Increased heart rate
ii. Change in LOC
iii. Appear suddenly
3. Morbidity is minimal if found and reduced in 24 hours
4. Complications are:
a. Perforation
b. Peritonitis
c. Sepsis
5. Medical management:
a. Hydrostatic reduction with BARIUM or AIR ENEMA
b. Success rate 70-85%
6. Surgical management:
a. Surgery done immediately if medical management not effective or bowel
damage is seen on x-ray
b. May be manual reduction, resection and anastomosis, colostomy if bowel
gangrenous
7. Nursing management:
a. Recognize symptoms early
V. MUSCULOSKELETAL SYSTEM:
CONGENITAL TALIPES EQUINOVARUS (CLUB FOOT):
1. Foot has a club-like appearance, entire foot is inverted, heel drawn up and forefoot
abducted
2. Can be a single anomaly or with other defects (myelomeningocele)
3. Apparent at birth
4. May be unilateral or bilateral
5. Degree of malformation and likelihood for complete correction varies
6. Reoccurrence common
7. Medical management:
a. Manipulation and casting of foot
b. Done in 1st month of life
c. Long leg cast is changed q few days for first few weeks and then q week or
two for several months
d. Correction confirmed by x-ray
e. After casting, a splint with shoes attached is used for several months to
maintain correction
8. Surgical management:
a. If doesn’t respond to medical treatment within 3-6 months, then need
surgery
b. After surgery cast is applied with knee in flexed position
c. Cast kept on for 6-12 weeks then corrective shoes or braces are used
d. Foot seldom entirely normal and calf atrophy may occur
9. Nursing management:
a. Assess knowledge of parents
b. Assess feelings of parents regarding deformity
c. Teach family cast care, to watch for complications,
d. Encourage compliance with long-term follow-up and to facilitate normal
development
e. Cast care
DEVELOPMENTAL DYSPLASIA OF HIP (DDH):
1. Dysplasia means abnormal development
2. A variety of conditions where in the femoral head and acetabulum are improperly
aligned
3. Types:
a. Dislocation
i. Displacement of bone from itrs normal position in a joint
b. Subluxatuion:
i. Partial dislocation
c. Acetabular dysplasia
4. Can be congenital or develop after birth
5. S/S:
a. Abduction (lateral movement away from the body) of the affected hip
b. Asymmetry of gluteal and thigh fat folds
c. Telescoping or pistoning of thigh
6. If walking, may show minimal to pronounced variations in gait with lurching towards
affected side
7. Longer it goes untreated, worse it becomes and prognosis worsens
8. Medical management:
a. Can be cured if detected and treated early
b. PAVLIK HARNESS for young infants is used
i. Keeps hip and leg in flexion, abduction and external rotation
c. If doesn’t work try hip spica cast
d. If older infant- traction
9. Surgical management:
a. Older infant
i. Closed reduction under anesthesia and/or open reduction followed
by a hip spica cast
10. Nursing management:
a. Teach parents use of Pavlik Harness or cast care
11. Assessment:
a. Higher risk of occurrence if C/S or frank breech birth, LGA or a twin
b. Assess for:
i. Limited abduction of hip
ii. A wide perineum
iii. Unequal gluteal folds (asymmetrical)
iv. If walking, assess for limp or unusual gait
POSITIONAL PLAGIOCEPHALY (FLATTENED HEAD SYNDROME):
1. Condition in which one side of head or back of infant’s head is flattened
2. Cause:
a. When infant put to sleep in same position repeatedly or by neck muscle
problems
3. Excellent prognosis if treated early
4. Not self-correcting
5. Increase in it after SIDS prevention position stressed (sleep on back)
6. Medical management:
a. Early identification and treatment allows time for head to reshape before
sutures and fontanels close
b. Placed in a light-weight plastic helmet kor band- helps to redirect
symmetrical growth of infant’s head
7. Nursing management:
a. Prevention key through parent education
b. Alternate head during sleep
c. Don’t leave in infant car seat, carrier or swing for extended periods
d. When awake, place on tummy
VI. INTEGUMENTARY SYSTEM:
MILIA RUBRA:
1. Also called prickly heat
2. Found in folds of skin, chest, neck
3. Pinhead sized erythematous (reddishness of skin) papules
4. Occurs with fever or overdressing in summer heat
5. Infant may be irritable because it itches
6. Nursing management:
a. Primarily preventative
b. Do not bundle infants in hot weather
c. Tepid baths to help itching
DIAPER DERMATITIS:
1. Also called diaper rash
2. S/S:
a. Erythema (redness)
b. Edema
c. Vesicles
d. Papules
e. Scaling on perineum, genitals, buttocks and skin folds
3. Cause:
a. Repetitive exposure to an irritant (urine, feces, soap, detergent, friction,
infection from bacteria or yeast {candidiasis – candida albicans})
4. More common in bottle feeding infants than breast feeding infants
5. Nursing management:
a. Instruct to change diaper frequently
b. Keep skin clean and dry
c. Use disposable diapers
d. Expose skin to air not heat
e. Zinc oxide, pertrolatum- both protect inflamed skin
f. Nystatin or mycostatin used for candida.
SEBORRHEIC DERMATITIS:
1. Also called cradle cap
2. S/S: yellowish, scaly or crusted patches on scalp of infants up to 32 months of age
3. Cause:
a. excessive sebaceous gland activity
4. Eventually disappears
5. NOT due to poor hygiene
6. May leave mild shampoo or mineral oil on scalp for few minutes to help soften and
loosen crusts
7. Use fine-toothed comb to remove crust
ATOPIC DERMATITIS:
1. Also called eczema
2. Chronic, superficial inflammatory skin disorder
3. S/S: intense pruritus (severe itching)
4. Cause:
a. Allergic reaction to irritants such as wool nylon, plastics, detergents,
perspiration, cosmetics, perfumed lotions and soaps and allergens such as
dust, pollens, foods
5. Family history predisposes infant/child to eczema
6. Uncommon among breast fed infants before other foods are introduced
7. Papules, vesicles form on cheeks, spreads to arms and legs then trunk; they drain
and crust over
8. Infantile eczema usually resolves by 3 years of age
9. Can predispose one to asthma or hay fever later in life
10. Medical management:
a. Goals:
i. Relieve pruritis
ii. Hydrate skin
iii. Reduce inflammation
iv. Prevent secondary infection
b. Baths and compresses helpful temporarily
c. See professional tip
11. Pharmacologic:
a. Lotions
b. Oral antihistamines
c. Topical corticosteroids
d. Antibiotics
12. Diet:
a. To rule out offending foods try diet that includes milk substitute (soy
formula), vitamin supplement, foods known to be hypoallergenic
b. Add foods one at a time at intervals approximately 1 week- if develops an
allergy to the food, eliminate from diet
13. Health promotion:
a. Practice breastfeeding
b. No milk, eggs, fish, corn citrus, peanuts, nuts or chocolate for 1 st 12 months
of life
c. Delay introduction of solid foods until 6 months of life
d. Control dust, smoke, mold and pets
14. Nursing management:
a. Nursing goals:
i. Soothe and relieve pruritis
ii. Maintain skin integrity
iii. Provide adequate nutrition/fluids
iv. Offer sensory stimulation
v. Teach family about condition
b. Is temporary
c. May be distressing to look at
d. Encourage expression of feelings by parents
VII.NEUROLOGICAL SYSTEM:
SPINA BIFIDA:
1. Neural tube defect where the vertebrae doesn’t completely close and neural tube
results in an opening through which meninges and spinal cord may protrude
2. Cause:
a. Unknown but genetic predisposition, maternal folic acid deficiency during
pregnancy and environmental factors may be at fault
3. Can range from a dimple or small tuft of hair to a large sac-like protrusion anywhere
along the lumbar or sacral area
4. Most severe form is myelomeningocele
5. Degree of neurological impairment depends ion lo=cation of defect on spinal cord
and size of defect
6. S/S:
a. May be asymptomatic
b. May display neurological impairment from mild sensory loss to complete
paralysis below the lesion
c. Can occur in conjunction with hydrocephalus (90%) and genitourinaryt and
orthopedic defects
7. Medical management:
a. Needs multidisciplinary approach
b. May need long term therapy
8. Surgical management:
a. Need to close defect
b. Done several days after birth to allow family to adjust
c. Closure reduces risk of infection and facilitates earlier bonding
9. Nursing management:
a. Pre-op
i. Monitor vs
ii. Monitor neurological status and behavior
iii. Keep in prone position
iv. Keep sac covered with moist, warm, sterile dressings (usually NSS)
and change q 2 hrs.
v. Give meds as ordered
b. Post-op
i. Monitor vs
ii. I&O
iii. Provide wound care
iv. Instruct parents
1. to intermittently catherize infant to allow incision to heal
2. how to elicit sucking
3. feed and cuddle infant
4. in signs of increased ICP (irritability, increased head
circumference, vomiting, seizures, lethargy, headache
changing LOC)
5. in signs of constipation
c. Refer to Spina Bifida Association
10. Assess:
a. Parents feelings re problems
b. Parents knowledge about defect, treatment, and need for long-term care
c. At birth, intactness of membranous sac
d. Neurological status:
i. Movement of extremities
ii. Reflexes
iii. Anal reflex
iv. Urinary output
v. Vs
vi. Fontanels
vii. Head circumference
HYDROCEPHALUS:
1.A disturbance between rate of CSF formation and absorption
2. Cause:
a. obstruction in circulation of CSF or defective absorption
3. Can be recognized at birth but also weeks or months later
4. May be congenital or as result of neoplasm, head injury or infection
5. S/S:
a. excessive large head at birth or a rapid increase with widening cranial sutures
b. anterior fontanel tenses and bulges
c. eyes look pushed downward with sclera visible over the iris (sunset eyes)
d. irritability
e. restlessness
f. high-pitched cry
g. vomiting
h. seizures
i. change in LOC
6. Surgical management:
a. remove obstruction or
b. insert shunt that bypasses the obstruction and drains excess CSF usually into
the peritoneum
7.Nursing management:
a. Monitor vs
b. Measure head circumference
c. Assess neurological signs
d. Prevent infections
e. Support child and family
f. Teach family about condition
FEBRILE CONVULSIONS (SEIZURES):
1. Involuntary muscle contraction and relaxation
2. Can be a symptom of many conditions
3. Usually goes along with otitis media, URI, and meningitis
4. S/S:
a. Sudden occurrence
b. Body stiffening
c. Loss of consciousness
d. Followed by quick, jerking movements of arms and legs and facial muscles
e. Irregular breathing
f. Absent swallowing ability
5.
6.
7.
8.
Usually occurs early in high fever state
Usually one seizure occurs and lasts <3 minutes.
Little neurological damage- RARELY develops into epilepsy
Pharmacological:
a. Valium
b. Antipyretics- Tylenol, Ibuprophen
9. Nursing management:
a. Instruct family in febrile seizures and treating of a fever
b. Not life threatening
c. Common in children < 5 years old with infection
d. Usually do not reoccur
e. Usually last < 3 minutes
f. See client teaching
MENINGITIS:
1. Most common CNS infection in infants
2. Causes:
a. Bacterial
b. Tubercular
c. Viral
d. Neurosurgery
e. Trauma
f. Systemic infection
g. Sinus/ear infection
3. Bacterial most common
4. S/S:
a. Occur suddenly or gradually
b. High-pitched cry
c. Fever
d. Seizures
e. Irritability
f. Vomiting
g. Bulging anterior fontanel
h. Poor feeding
5. Medical management:
a. Early diagnosis and treatment important
b. Medical emergency is bacterial
c. Need spinal tap (lumbar puncture)- is done before administration of
antibiotics
d. C&S is done of spinal fluid and treated with appropriate antibiotics
e. Isolation for at least 24 hours after treatment started
6. Health promotion:
a. Haemophilus influenza type b conjugate vaccine
7. Nursing management:
a. Spinal tap
b. IVs
c. Hx and physical
d. I&O
e. Assess if nausea, vomiting, anorexia (loss of appetite)
f. Check if had recent immunizations, illnesses, surgery, injuries and previous
lumbar puncture
g. Complete neurological assessment
h. Evaluate head circumference
i. Check fontanelles for bulging
j. Isolation times 24 hours
k. Give antibiotics
l. Assess neurological status q 4 hours
m. Maintain fluid balance
n. Provide support
o. Instruct about disease
p. Others in family to get checked and treated prophylactically
CEREBRAL PALSY (CP):
1. Nonprogressive motor disorder resulting from damage to motor centers of the brain
2. Can ossur before, during or after birth
3. S/S:
a. Vary in severity
b. Delayed gross motor development
c. Persistent head lag
d. Alterations in muscle tone
e. Body stiffness
f. Abnormal motor performance
g. Uncoordinated or involuntary movements and reflex abnormalities
h. Persistent tonic neck
i. Seizures
j. Impaired vision and hearing
k. Difficulty swallowing
l. Subnormal learning and reasoning
m. Sometimes if not severe may not be diagnosed till 2 years of age
4. Medical management:
a. Multidisciplinary approach to assist to develop maximum potential
5. Surgical management:
a. To improve ambulation may need to lengthen Achille’s tendon and release
hamstrings
6. Nursing management:
a. Encourage parents to stimulate and interact with infant
b. Participate in infant-stimulation program – Easter Seals, Helping Hands
7. Assess:
a. History to see if any maternal diabetes, ABO or Rh incompatibilities
Rubella in 1st trimester, prematurity, prolonged labor and postnatal infection,
or trauma that may predispose infant to brain damage and CP
b. If feeds poorly and is rigid, tense or hypotonic
c. Denver II test to see if any developmental delays
GENITOURINARY SYSTEM:
HYPOSPADIAS:
1. Urethral opening is on underside of penis (ventral surface)
2. Often goes along with undescended testes and inguinal hernia
3. Can be seen at birth
4. Surgical management:
a. Corrected surgically during 1st year of life
b. Not circumcised at birth as may need skin to correct defect
5. Nursing management:
a. Normal urination will be restored
b. Sexual functioning won’t be impeded
c. Prepare family for surgery, post-op and home care
d. Penis may never look perfectly normal
e. Catheter till healed
HYDROCELE:
1. Processus vaginalis fails to close
2. Allows fluid to enter scrotum
3. Palpable, round, nontender mass felt in scrotum
4. Associated with inguinal hernia
5. Medical management:
a. May close by one year of age without any intervention
6. Surgical management:
a. If doesn’t spontaneously close by one year of age, do surgery to correct
7. Nursing management:
a. Pre and post op care
b. Post-op focuses on pain management, infection control and activity
restriction
c. Area may be swollen and discolored post-op
CRYPTORCHIDISM:
1. One or both testes do not descend into scrotal sac
2.
3.
4.
5.
One or both scrotal sides are smaller than normal
When palpated, scrotum is empty
Often associated with inguinal hernia
Medical management:
a. Usually descends spontaneously by 1 year of age
b. If they don’t descend, hormone therapy used
6. Surgical management:
a. Surgical correction by 3 years of age to prevent STERILITY
7. Nursing management:
a. Pre-op preparation
b. Post-op care- pain management, infection control, and activity restriction
c. See community/home health care
VESICOURETERAL REFLUX:
1. Backflow of urine from bladder into ureters and /or kidneys
2. Can be caused by abnormal insertion of ureters into bladder when developing in
utero or a UTI
3. Primary symptom: recurring UTIs
4. S/S:
a. Poor feeding
b. Vomiting
c. Failure to gain weight
5. C&S of urine done
6. Early diagnosis with x-rays important
7. Medical management:
a. Prevent UTIs
i. Low dose prophylactic antibiotic therapy
ii. Monitor for UTI and kidney function
iii. Less severe- will resolve spontaneously
8. Surgical management:
a. Reimplantation of ureters into the bladder
9. Nursing management:
a. Treatment and prevention of UTIs
b. May be long term treatment
c. Compliance important
d. Pre and post-op care if surgery
WILM’S TUMOR (NEPHROBLASTOMA):
1. Found in kidney region
2.
3.
4.
5.
6.
One of most common early childhood cancers
Made of embryonic tissue that remains after growth and turns cancerous
Etiology unknown
Associated with other anomalies (GU, microencephaly and MR)
S/S:
a. Abdominal mass located to one side of midline
b. Abdominal pain
c. Malaise
d. Anemia
e. Fever
7. Surgical management:
a. Surgical removal of involved kidney and lymph nodes
b. Chemo/radiation
8. Nursing management:
a. See professional tip
b. If mass felt- STOP PALPATION STAT as can dislodge cells and spread the
tumor
c. Pre and post-op care
d. Chemo
e. Family support
COGNITIVE AND SENSORY SYSTEMS:
DOWN SYNDROME:
1. Chromosomal anomaly
2. Causes MR- moderate to severe
3. Causes:
a. Trisomy 21 (an extra chromosome)
b. Translocation of chromosomes 15,21 and 22
c. Advanced parental age
4. S/S:
a. Facial and body abnormalities
b. Intellectual, language and social alterations
c. Upwards and outwards slanted , almond-shaped eyes
d. A depressed nasal bridge
e. A protruding tongue
f. Small, short low-set ears
g. A short, broad neck
h. Transverse palmar crease
i. Broad, short hands with stubby fingers
j. A protruding abdomen
k. Hypotonia – lax muscle tone
l. And a blunted affect
5. Often goes along with cardiac anomalies, GI defects, endocrine disoprders and
leukemia
6. Medical management:
a. multidisciplinary approach
7. Goal to assist child to reach personal maximum potential
8. During 1st year, monitor for GI and cardiac problems
9. Between 2nd and 4th years focus is on sleep and behavioral problems, thyroid
screening and visual and dental assessments
10. Frequent infections can be a problem
11. Surgical management:
a. Repair of cardiac and GI anomalies
12. Health promotion:
a. Prenatal diagnosis possible through genetic testing and counseling, AlphaFetoprotein (AFP) level or amniotic fluid samples
b. Number of children with Down syndrome is decreasing due to elective
termination in women >35 years of age
13. Nursing management:
a. Assist parents to see positive features and behaviors
b. Provide play, discipline, social interaction
14. Assess:
a. At birth:
i. Family’s health history
ii. Results of amniocentesis if done
iii. Parental ages
iv. Unique features (physical)
b. As grows:
i. Interaction between child and family
ii. Family’s coping abilities
iii. Degree to which child is thriving
iv. As grows- developmental milestones
c. Client teaching
VISUAL IMPAIRMENT:
1. Eye not fully developed until 10-12 year old
2. Visual acuity increases from 20/50 to 20/80 at birth to a range of 20/20 to 20/30 by
5 year
3. Visual impairments:
a. Sighted with eye problem
b. Partially sighted (20/70 to 20/200)
c. Legally blind (20/200 or less)
d. Refractory disorders most common
e. Strabismus (crossed eyed)
i. Lack of coordination of extraocular muscles
ii. Prevents diplopia- double vision
f. Amblyopia
i. Blindness from disuse
ii. Develops if strabismus isn’t treated early
g. S/S:
i. failure to follow an object or to react to bright light
ii.excessive rubbing of eyes
iii. Squinting
iv. Tilting of head
v. Crossed eyes (after 6 month of age)
h. Causes:
i. Perinatal and postnatal infections
ii. Sickle cell anemia
iii. Juvenile RA
iv. Glaucoma
v. Cataracts
vi. Retinoblastoma
vii. Injuries
4. Medical management:
a. Most treated with corrective lenses
b. Strabismus
i. Patch stronger eye to increase visual stimulation of weaker eye
c. Earlier the treatment the better to promote normal development and
function and adequate vision
5. Surgical management:
a. Glaucoma, cataracts and strasbismus
6. Nursing management:
a. Early detection and referral crucial
b. At birth, assess response to visual stimuli, ability to fixate and follow an
object to midline and ability to make eye contact
c. At three months of age, assess ability to follow moving objects
d. If eyes are crossed after 6 months, need evaluation
e. Make referrals to support groups/associations
f. Pre and post-op care if surgery
g. Instruct parents re: condition, prescribed treatment and home care and
follow-up
HEARING IMPAIRMENT:
1. At birth, ear completely developed
2. Hearing problems can be mild (hard of hearing) to profound (deafness)
3. 4 categories of hearing loss:
a. Conductive:
i. Middle ear hearing loss
ii. Most common type
iii. Interference of transmission of sound
iv. Usually caused by OM
b. Sensorineural:
i. Nerve deafness
ii. Damage to inner ear structures and/or auditory nerves
c. Mixed hearing loss
i. Combination of conductive and sensorineural loss
ii. Caused by recurrent OM
d. Central hearing loss
i. Damage to conduction system between brainstem and cortex
4. At risk infants include:
a. Family history of hearing problems
b. Physical malformations
c. Low birthweight
d. Asphyxia
e. Infection
f. CP
g. Down Syndrome
h. History of being given ototoxic drugs
5. S/S:
a. Failure to startle or awaken to loud sound
b. Failure to turn head to sound by 4 months
c. Failure to babble by 3 months
6. Hearing loss can affect language skills and seen as cognitive and/or behavioral
problems
7. Medical management:
a. Treatment depends on cause and type of loss
b. Antibiotics for OM
c. Sensorineural loss irreversible
d. Hearing aids or cochlear implants may help
8. Surgical management:
a. Insertion of tympanostomy tubes (controversial) for chronic OM
9. Nursing management:
a. Detection and prevention goals
b. Assess for hearing acuity
c. If child has language delays may have a hearing impairment
CHILD ABUSE:
1. Any intentional act of physical neglect or physical, emotional, or sexual abuse
committed by a person responsible for the care of a child
2. Physical neglect:
a. failure to provide the adequate hygiene, health care, nutrition, love, nurturing
and supervision needed for an infant’s normal G&D
b.S/S:
i. inadequate weight gain
ii. dental caries
iii. Poor hygiene
iv. Lack of immunizations
3. Physical abuse:
a. Physical punishment that leaves marks, causes injury or threatens a child’s
physical or emotional well-being
b. S/S:
i. Bruises on abdomen, buttocks, genital, thighs and mouth, bone
fractures at various stages of healing, spinal fractures, cerebral edema
or hemorrhage, and burns
ii. Child may appear sad and forlorn or any actively seek to please
c. Predisposing factors include:
i. Characteristics of parents, child, environment
ii. Parental history of being punished themselves or having difficulty
controlling aggressive behavior, be socially isolated, and have few
supportive relationships
iii. Child at greatest risk- premature, illegitimate, unwanted, brain
damaged, hyperactive, physically disabled or “difficult”’
iv. Environmental factors such as: divorce, poverty, unemployed, poor
housing, frequent relocation and drug addiction
v. Abuse occurs at all educational, social and economic levels
d. Manchausen syndrome:
i. One person either fabricates or induces illness in another tro get
attention (usually mom to child)
4. Emotional abuse:
a. Acts or omissions by the caregiver that could cause serious behavioral,
cognitive, emotional or mental disorders
b. Can be shaming, ridiculing, embarrassing or insulting the child, and
destruction of a child’s personal property
c. S/S:
i. developmental delays
ii. failure to thrive
iii. disruptive behavior
iv. extreme behavior such as withdrawal, aggression, unusual
fearfulness, obsessions and suicide attempts
5. Sexual abuse:
a. Exploitation of a child for the sexual gratification of an adult
b. Forms include:
i. Oral-genital contact
ii. Fondling
iii. Caressing of genitals
iv. Intercourse (vaginal or anal)
v. Rape
vi. Sodomy
vii. Prostitution
c. S/S:
i. Vaginal discharge
ii. Blood-stained diapers
iii. Genital redness
iv. Pain
v. Itching
vi. Bruising
vii. Lax rectal tone
viii. Difficulty sitting
ix. UTIs
6. Medical management:
a. Diagnose:
i. By history
ii. Thorough physical exam
b. Treat injuries as needed
c. Legally required to report suspected or real child abuse
7. Nursing management:
a. Assess for:
i. Inadequate weight gain
ii. Lack of immunizations
iii. Poor hygiene
iv. Bruises
v. Bone fractures at different stages of healing
vi. Cerebral edema or hemorrhage
vii. Burns
viii. Developmental delays
ix. FTT
x. Disruptive behavior
xi. Unusual fearfulness
xii. Vaginal discharge
xiii. Blood-stained diapers
xiv. Genital redness
xv. Pain itching bruising
xvi. Difficulty sitting
xvii. UTIs
b. Assess:
i. History and physical exam
ii. Parent-child interactions
iii. Child’s response to surroundings and strangers
iv. Developmental level
8. Assess:
a. Parental concerns
b. General family history
c. Specific child history
d. Begin with non-threatening topics
e. Document verbatim details about the way the injuries occurred
f. Use quotation marks
g. Physical exam
h. Use figure diagrams to mark areas of injuries
i. Assess for inconsistencies
ENVIRONMENTAL SAFETY:
 Becomes major concern, once infants become mobile
 Educate parents/caregivers in safe environment practices
POISONING:
1. found everywhere
2. examples of items:
a. cosmetics
b. personal care products
c. medicines
d. cleaning products
e. plants
f. gasoline
g. toys
h. lead-based paint
3. medical management:
a. call poison control center to see if child can be treated at home or taken to ER
b. if don’t know substance/amount ingested, take to ER
c. vomiting induced immediately is substance noncorrosive or nonirritating
d. if corrosive or highly irritating gastric lavage used
e. may use activated charcoal to absorb poison
4. medications:
a. activated charcoal:
i. given orally or by orogastric tube
ii. used to absorb poison and remove it from body
iii.cna mix with cathartic: ex. Mag sulfate
b. mag sulfate:
i. assists with rapid elimination
ii. helps to decrease absorption of poison
iii.can mix it with a sweet liquid to make it palatable
iv.2-4 hours for results to occur
5.nursing management:
a. poison prevention:
i. ways to decrease incidence of poisoning
ii.checklist for poison proofing a home
iii.illustrated first aid guidelines
iv.phone # of poison control center
c. Poisoning incident goals:
i.maintain vital functions
ii.prevent continued absorption
iii.prevent complications
iv.reduce fear
v.educate regarding poison prevention
vi.terminate exposure to poison
vii.remove manually from mouth then a sip of water; from eye by NSS
flush; skin by removing contaminated clothing then washing with soap
and water
viii.once exposure terminated, identify substance
ix.call poison control center
x. induce vomiting and prevent absorption or take to ER depending on
substance
d. Poison prevention see client teaching
TRAUMA:
1.MVAS, FALLS
2. provide safe environment as child grows and becomes active
3. stress car seat safety
4. educate regarding safety issues
5. see client teaching
SUFFOCATION:
1.Occur by:
a. Covering mouth/nose
b.Applying pressure to throat/chest
c.Excluding air (refrigerator entrapment)
2. Nursing management:
a. cribs should have no more than 2 3/8th between slats
b. crib mattress fits snugly against slats
c. keep crib out of reach of cords (windows), strings
d. keep electrical cords, toys with strings, plastic bags, pieces of balloons, crib
mobiles, pieces of hard food, and restraining straps out of reach
DROWNING:
1.Can occur in toilets, buckets of water,, tubs, pools