Child Health Final

8/17/2019 Child Health Final

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Child Health Final

Child Development: Chapters 1,5,6,21 &22 (7 questions)

General Trends in Height & Weight Gain During childhood Birth ei!ht dou"les by the frst #$7 months Birth ei!ht triples by end o the %rst ear

Birth ei!ht quadruples by the age o 2'5 ears

irth hei!ht increases by 5* " end o+ 1st ear

Hei!ht at age 2 ears is about 5* o+ eventual adult hei!ht

How to help them with the milestone

ri-.son/s 0ta!es: Trust vs. mistrust ($1 ears)

utonomy vs. shame and doubt (1$ ears)!nitiative vs. guilt ($6 ears)!ndustry vs. ineriority (6$12 ears)!dentity vs role conusion (12$1 ears)

3ole o+ 4la n Development

Content o+ 4lao 0o-ial$ae-tive 4la

" !nant ta#es pleasure in relationships with peopleo 0ense 4leasure 4la

" $onsocial stimulating e%perience that originates rom

obects in the environment. nything that canstimulate their senses

o 0.ill pla" 'epeating an action over and over again

o no--upied "ehavior" (ocusing attention momentarily on anything that

stri#es their interesto Dramati-84retend 4la

" Begins in late inancy )**+*, months-. !s thepredominate orm o play in preschool children

o 9ames

" !mitative games pat+a+ca#e" (ormal games ring+around+a+rosy" /ompetitive games board games

0o-ial Chara-ter o+ 4lao nloo.er 4la


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" /hildren watch what other children are doing0 but donot enter into play

o 0olitar 4la" !nterest is centered on their own activity. 1lay with

toys alone0 di2erent rom those used by others in

their same areao 4arallel 4la" /hildren play independently but among other

childreno ;sso-iative 4la

" /hildren play together and are engaged in a similaror even identical activity0 but there is noorgani3ation0 division o labor0 leadership assignmentor mutual goal

o Cooperative 4la" 1lay is organi3ed0 and children play in a group with

other children4there is a goal or this type o play

Chapter 6 +o-uses on assessin! a Child and Ho to-ommuni-ate ith themHo to administer medi-ation<=utrition: "reast mil. (no +eedin! until +ood the start sitin!up)> i+ "reast+eed the need iron and vitamin D'

D ? =D @ A=? 4;9@ C9=@B @H3< 4;9 71(a"e< 0he does not remem"er i+ there are 4ia!et questions

on the %nal)

n+e-tious disorders8Communi-a"le Diseases: Chapters 1# (#questions)

Communi-a"le Disease:

• !dentifcation o the inectious agent is o primary importance to prevente%posure o susceptible individuals

• 1rodromal symptoms 5 symptoms that occur between early maniestations o the disease and its overt clinical syndrome

• /an be prevented through immuni3ations and hand+washing0 as will asstandard precautions

=ursin! ;lert:

• ! a child is admitted to the hospital with an undiagnosed e%anthema )s#ineruption- strict Transmission+Based 1recautions )/ontact0 irborne0 andDroplet- and 6tandard 1recautions are instituted until diagnosis is confrmed./hildhood communicable disease re7uiring these precautions includediphtheria0 chic#enpo%0 measles0 TB0 adenovirus0 Haemophilus in8uen3a type


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b0 in8uen3a0 mumps0 9ycoplasma pneumonia inection0 pertussis0 plague0strep pharyngitis0 pneumonia0 and scarlet ever.

• When lotions with active ingredients such as diphenhydramine in /aladryl areused0 they are applied sparingly0 especially over open lesions0 wheree%cessive absorption can lead to drug to%i%ity0 :se these lotions with cautionin children who are simultaneously receiving an oral antihistamine. /ooling

the lotion in the rerigerator beorehand oten ma#es it more soothing on thes#in than at room temperature.Chi-.en 4oE:@ransmission:

• Direct /ontact0 droplet airborne spreadClini-al ani+estations

• 1rodromal 6tageo 6light evero 9alaiseo nore%iao 'ash highly pruritic )begins as macule papule vesicle-

• Distributiono /entripetal spreads to ace and pro%imal e%tremities )sparse on

distal limbs and areas e%posed to less heat-• /onstitutional s;s

o (evero !rritability rom pruritus

=ursin! Consideration8@reatment

• ;ir"orne and -onta-t pre-autions )negative air pressure room-

•


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o 1ossibly ac7uired rom saliva o health adult4no reported contact withinected

o !ncubation @+*@ dayso imited to children C, years o age

Clini-al ani+estations

o 1ersistent hi!h +ever0 while child appears well

o 'ashJ Discrete rose+pin# macules or maculopapules 1st on @3=A spread to =CA, F;C and K@3@0

" $onpruriticJ Fades on pressure ("lan-ha"le)" ast *+> days

o ssociated 6;6" /ervical and post auricular lymphadenopathy" !n8amed pharyn%" /ough" cory3a

=ursin! Considerations8@reatment

o Teach parents measures to redu-e +ever0 and dosage on antipyretics

to prevent overdoseo + -hild is prone to seiGures0 discuss appropriate precautions andpossibility o recurrent ebrile sei3ures.

umps@ransmission:

Dire-t -onta-t ith or droplet spread +rom an in+e-ted person

• gent paramysovirus

• 6aliva rom inected person

• !ncubation >+, wee#sClini-al ani+estations:

• (ever

• Headache

• 9alaise

• (ollowed by parotitis=ursin! Considerations8@reatment:

Droplet and Conta-t 4re-autions> maintain isolation during period

9ay cause orchitis and meningoencephalitis

Ancourage rest and decreased activity until swelling subsides

Ancourage 8uids and sot bland diet oods0 avoid chewing

pply hot or cold compresses to nec#

@o relieve or-hitis provide armth and lo-al support ith ti!ht %ttin!

underpants (-an lead to sterilit +or males)

4ain+ul +or them to -he

9erman easles (3u"ella )

gent 'ubella virus

, day measles )#ids recover during , days-

Droplet pre-autions

;void -onta-t ith pre!nant omen

accine given at *@ monthsClini-al ani+estations

• 1rodromal 6tage


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o low grade evero headacheo malaiseo anore%ia

o mild conunctivitiso cory3ao sore throato cough'ash


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o *st appears on +a-e rapidl appears donard to ne-., arms, trun., le!so By the end o frst day0 body E disappears in the same order it began


Droplet pre-autions

ntipyretics and analgesics

/hild should be completely recovered in ,+? days

void contact with durin! pre!nan- (terato!eni- ee-t on +etus)@he -hild re-eives the immuniGation =@ the mother

0-arlet Fever

Group strep

Droplet 4re-autions until 2# hours a+ter initiation

!ncubation period ,+@ days )with symptoms beginning on the >nd day-

Compli-ations 1eri+tonsillar and retropharyngeal abscess & carditis

3ash appears ithin 12 hrs everhere, eE-ept +a-e

Clini-al ani+estations


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brupt high ever

!ncreased pulse

omiting

Headache

/hills

9alaise

bdominal pain

Halitosis

(irst day hite stra"errton!ue

Third day 3ed 0tra"errton!ue


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ntibiotics

Ancourage rest during ebrile time

'elive discomort o sore throat with analgesics0 gargles0 lo3enges antiseptic throat sprays and cool mists

Ancourage 8uid inta#e

e!in ith so+t diet hen -hild -an eat

Discard toothbrush0 avoid sharing drin#s and eating utensils

The child receives the

ConLun-tivitis (4in. e) 1in# eye is caused by many things

!n $Bs chlamydia0 gonorrhea0 or Herpes

!nants can by sign o tear duct obstruction

!nections and is H9HM C=@;90Clini-al ani+estations

!tching

1urulent drainage

!n8amed /onunctivitis

/rusting eyelids=ursin! Considerations


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/old 6ores or (ever Blisters Treatment 9anagement

" 'elie & prevention o the spreado Herpes irus

Good hand washing is a must Wear !loves when e%amining lesions.

Health 4romotion: Chapter1,12,16 & 17 (# questions)

Health promotion and problems odi2erent age groups

ilestones: Moo. at @;M 1$1pa!e 1$1#


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Separation Anxiety


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Between ages 4 and 8 months, infants progress through the first stage of separation-individuation and begin to have some

awareness of themselves and their mothers as separate beings. At the same time, object permanence is developing, and infants

are aware that their parents can be absent and is manifested through a predictable sequence of behaviors.


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During the early second half of the first year, infants

protest when placed in their cribs, and a short time

later, they object when their mothers leave the room.

Infants may not notice the mother’s absence if they

are absorbed in an activity. However, when they

realize her absence, they protest. From this point on,

they become alert to her activities and whereabouts.

By 11 to 12 months, they are able to anticipate her

imminent departure by watching her behaviors, andthey begin to protest before she leaves. At this point,

many parents learn to postpone alerting the child to

their departure until just before leaving.

Stranger Fear

As infants demonstrate attachment to one person, they

correspondingly exhibit less friendliness to others.

Between ages 6 and 8 months, fear of strangers and

stranger anxiety become prominent and are related to

infants’ ability to discriminate between familiar and

unfamiliar people. Behaviors such as clinging to the

parent, crying, and turning away from the stranger are

common.


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The best approach for the stranger (including nurses) is

to talk softly; meet the child at eye level (to appear

smaller); maintain a safe distance from the infant; and

avoid sudden, intrusive gestures, such as holding out

the arms and smiling broadly.

Teething

One of the more difficult periods in infants’ (andparents’) lives is the eruption of the deciduous

(primary) teeth, often referred to as teething. The age

of tooth eruption shows considerable variation among

children, but the order of their appearance is fairly

regular and predictable (Fig. 10-10). The first primary

teeth to erupt are the lower central incisors, which

appear at approximately 6 to 10 months of age

(average, 8 months). These are followed closely by the upper central incisors. A quick guide to assessment of deciduous teeth

during the first 2 years is: Age of the child in months – 6 = Number of teeth. For example: 8 months of age – 6 = 2 teeth at this

time.

Teething is a physiologic process; some discomfort is common as the crown of the tooth breaks through the periodontal

membrane. Some children show minimum evidence of teething, such as drooling, gum rubbing, increased finger sucking, or

biting on hard objects. Others are very irritable, have difficulty sleeping, and refuse to eat solid foods. Generally, signs ofillness such as fever (


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Dis-ipline ("oEp!)mmuniGations(.no hi-h onesto !ive at hata!e)

nLur prevention

Disorder 4athophsiolo! Clini-al ani+estation @reatment8@ea-hin!


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;DHD • Developmentallyinappropriate degree oinattention0impulsiveness andhyperactivity

• Hyperactive

• K 17$2 on pa!e52 has the diagnosticcriteria

• Drug therapyI

9ethyphenidatehydrochloride (3italin)

De%toamphentaminesulate (DeEedrine)

• Began on a smalldosage that is graduallyincreased

ust "e assessedever 6 months +orappropriate !rothand developmentmilestones

3equire a morestru-turedenvironment thanmost -hildren

• The nurse should helpamilies identiy newappropriatecontingencies and

reward systems to meetthe child=s developingneeds

• Ancourage consumptiono nutritious snac#s inthe evening when thee2ects o themedication aredecreasing0 and servingre7uent small mealswith healthy Jon the goKsnac#s are helpul


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Chroni- llness in Children: Chapter 1 (# questions)

!mpact o /hild=s /hronic !llness or disability1age @?LA major goal in working with the family of a child with chronic or complex illness is to support the family’s coping and

promote their optimal functioning throughout the child’s life. Long-term, comprehensive, family-centered approaches extend

beyond supporting the child and family during the critical periods of diagnosis and hospitalization. Rather, comprehensive care

involves forming parent– professional partnerships that can

support a family’s adaptation across the trajectory of the illness to

the many changes that may be necessary in day-to-day life, determine

expectations of and for the child, and provide a long- term

perspective (Box 18-2)


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BFM *N+? page @?> E 6upporting siblings o children with specialneeds

The child with special$eedsBFM *N+O )/oping1atterns :sed By/hildren with 6pecial

$eeds )page @?@-

Co!nitive Disorders:Chapter 1N (2questions)/ognitive !mpairment)page @P>-Nurses play a major role in

identifying children with CI. In

the newborn and early infancy

periods, few signs are present, with the exception of Down syndrome (p. 576). After

this age, however, delayed developmental milestones are the major clues to CI. In

addition, nurses must have a high index of suspicion for early behavior patterns thatmay suggest CI (see Box 19-2). Parental concerns, such as delayed development

compared with siblings, need to be taken seriously. All children should receive

regular developmental assessment, and the nurse is often the person responsible for

performing such assessments (see Chapter 5). When delays are found, the nurse must

use sensitivity and discretion in revealing this finding to parents.

- Educate Child and Family

- Teach Child Self Care Skills


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- Promote Child’s Optimal Development

- Encourage Play and Exercise

- Provide Means of Communication

- Establish Discipline

Discipline must begin early. Limit-setting measures need to be simple, consistently applied, and appropriate for the child’s

mental age. Control measures are based primarily on teaching a specific behavior rather than on understanding the reasonsbehind it. Stressing moral lessons is of little value to a child who lacks the cognitive skills to learn from self-criticism or from a

lesson based on previous wrong-doing. Behavior modification, especially reinforcement of desired actions, and time- out are

appropriate forms of behavior control.

- Encourage Socialization

- Provide Information of Sexuality

- Help Family Adjust to Future Care

- Care for Child During Hospitalization

Down 6yndrome )1age @PP-

+ 6upport (amily at Time o DiagnosisParents usually prefer that both of them be present during the informing interview so they can support one another emotionally.

They appreciate receiving reading material about the syndrome and being referred to others for help or advice, such as parent

groups or professional counseling.

+ ssist (amily in 1reventing 1hysical 1roblems


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+ ssist in 1renatal Diagnosis and Genetic /ounseling

3espirator Disorders: Chapter 2 (# questions)

Disease 4athophsiolo! Clini-al ani+estations @reatment8 @ea-hin!


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=asopharn!itis • #a the common cold'hinovirus )winter & spring-

oun!er -hildren

• (ever

• !rritability

• 'estlessness

• 1oor eeding and decrease8uid inta#e

• $asal mucus

• ;D

lder -hildren• Dryness & irritation o

nose & throat• $asal d;c

• 6nee3ing

• 9uscle aches

• /ough4hsi-al ;ssessment:

• Adema

• asodilation o themucosa

• 9anaged at home

• ntipyretics

• 'est

De-on!estants &-ou!h suppressants D=@ 9B i+ O6 ears(For de-on!estants the"oo. a-tuall sas ou

-an !ive, "ut "e-autions +or -hildrenover 12 months, so shesaid she ont as. aquestion a"out it)

• Alevate the HFB

0u-tionin! andvaporiGation (salinenose drops & !entlesu-tion ith a "ul"srin!e "e+ore +eedin!and sleep time ma"euse+ul

• !ncrease 8uids

n+e-tion o+ -ontrol

(proper 44)• 1revention avoid contact

with inected person0 andhygiene

• 1arents are instructed tonotiy H/1 i any o theollowing s;s• 'eusal to ta#e oral 8uids

and decreased urination• Avidence o earache

• 'espirations aster than@L+OL bpm in a toddler or


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Marn!otra-heso"ron-hitis

• 1art o the croupsyndrome

• 2ects children C@ years

• /ause by 1ara+in8uen3a0'6 and in8uen3a &B

• !n8ammation o mucosalining o the laryn% andtrachea causing narrowing

o the airway• Will go to bed and wa#e

up with a bad cough

• 6lowly progressive

0tridor

• 6uprasternal retractions

ar.in! or seal$li.e-ou!h

• !ncreasing respiratorydistress and hypo%ia

Can pro!ress to

respirator a-idosis,respirator +ailure, anddeath

=30=9 ;M3@:

• arl si!ns o+impendin! airao"stru-tion in-ludein-reased pulse andrespirator rate>su"sternal andinter-ostal retra-tions>Parin! nares andin-reased restlessness

• Cold humidi+ air

;ira maintenan-e ispriorit

• 1roviding ade7uaterespiratory e%change

• 9aintain hydration )1F or!-

• Watch or dehydration

• Weigh diaper over a >?

hour period• 6hould be *m;#g;hr.

• Q O months0 Q,L#gshould be ,L m;hr.

• High humidity with coolmist

• F%ygenation status thrupulse o%imetry

• $ebuli3er treatments

• Apinephrine

• 6teroids )!9 preer- slowrelease rom muscletissue vs. oral they withclear a lot ater


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4harn!itis • 6trep throat• JGBH6K

• t ris# or rheumatic ever& acuteglomerulonephritis

oun!er -hildren

• (ever

• General malaise

• Dysphagia

• bdominal pain4hsi-al assessment:

• 9ild+to+moderate+hyperemia

lder -hildren

• (ever )may reach ?L/ *L?(-

• Headache

• nore%ia

• Dysphagia

• bdominal pain

• omiting4hsi-al ;ssessment>

• 9ild to bright red0edematous pharyn%

• Hyperemia o tonsils andpharyn%0 may e%tended tosot palate and uvula

• Ften abundant olliculare%udate that spreads andcoalesces to ormpseudomembrane ontonsils

• /ervical glands enlargedand tender

• Throat culture to rule outGBH6

• ! streptococcal inection ispresent oral peni-illin isprescribed0 erthrom-inor children allergic to 1/$

• Fbtain a throat swabculture

• !nstruct parents onadministering antibiotics0

• /old or warm compressesto the nec#0

• Warm saline gargles

• 9anage pain withacetaminophen oribuproen

• F2er cool li7uids or icechips

• Children -onsiderin+e-tious to others atthe onset o+ smptomsand up to 2# hoursa+ter the initiation o+

anti"ioti- therapy0replace toothbrush aterhave been ta#ingantibiotics or >? hours

D39 ;M3@

=ever administer4eni-illin via B, it ma-ause an em"olism, ortoEi- rea-tion8insurin! deaths inminutes insteadadminister to


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pi!lottitis • 6erious obstructivein8ammatory process thatoccurs predominantly inchildren >+@ yrs.

• /aused by H in8uen3a

• brupt onset

• Amergency $AAD6 or61

predi-tiveo"servations:

Cou!h

Droolin!

;!itation

Child !oes to "easmptomati- to

aa.en later-omplainin! o+ sorethroat and pain onsalloin!

0tridor )aggravated whensupine-

Hi!h +ever

3apid pulse andrespiration

@ripod position

=30=9 ;M3@:

• @hroat inspe-tionshould "e attemptedonl hen immediateendotra-healintu"ation -an "eper+ormed

• ?hen epi!lottis issuspe-ted the nurseshould not attempt tovisualiGe epi!lottisdire-tl ith ton!uedepressor or ta.e athroat -ulture "ut re+erto the -hild +or medi-alevaluation

• 6tart ! inusion

• /ontinuous monitoring orespiratory status andpulse o%imetry

• BGs i child is intubated

• 1revention H!b vaccine

Croup 0ndrome • 2ect laryn%0 tracheabronchi

• !e. re epiglottis0laryngitis0larngotracheobronchitis)TB- and tracheitis

• Hoarseness• Bar#ing cough

• !nspiratory stridor


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30B (;=D3=CHM@0)

• 'espiratory syncytialvirus. 9ost common causeo bronchiolitis

• '6 a2ects the epithelialcells o the respiratorytract. The ciliated cellsswell0 protrude into thelumen0 and lose their cilia

• Bronchiolar mucosa swellsand lumina aresubse7uently flled withmucus and e%caudatewalls o the bronchi andbronchioles are infltrated

• !ntraluminal obstructionleads to • Hyperin8ation

• Amphysema

• telectasis

nitial:

• 'hinorrhea )*st-

• 1haryngitis

• /ough0 snee3ing

• Whee3ing

• 1ossible ear or eyedrainage

• !ntermittent ever )*st-

?ith pro!ression o+illness:

• !ncreased coughing andwhee3ing

• Tachypnea andretractions

• cyanosis

0evere illness:

• Tachypnea QPL bpm

• istlessness

• pneic spells

• 1oor air e%change

• 1oor breath sounds

• Treat the symptoms

• /ontact precautions


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;sthma • /hronic in8ammationdisorder o the airways

• /haracteri3ed by

• 'ecurring symptoms

• irway obstruction

• Bronchial hyper+responsiveness

• Dyspnea

• Whee3ing

• /oughing

• TM

• 6hort acting medication

• B> agonist

• nticholinergic

• 6ystemic corticosteroids

• ong acting medication

• !nhaled corticosteroids

• /romolyn sodium &

nedocromil• ong acting b> agonist

• 9ethyl%anthines

• eu#otrines modifers


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Csti- Fi"rosis • !nherited autosomalrecessive trait

• 9echanical obstructioncaused by theincreased viscosity omucous glandsecretions

• 2ects other organs

e-onium ileus

• bdomen distention

• omiting

• (ailure to pass stool

• 'apid development odehydration

9

• arge0 bul#y0 loose0 oulstool

• Aat a lot )early indisease-

• ose appetite )later indisease-

• Weight loss

• 9ar#ed tissue wasting

• (ailure to grow

• Distended abdomen

• Thin e%tremities

• Rellow or pale browns#in

De%-ient in vitamins

;, D, , A

anemiaMun!s

• Whee3ing

• Dry non+productivecough

• !ncreased dyspnea

• 1aro%ysmal cough

• Fbstructive emphysemaand patchy areas o

• Diet High caloriecdietwith high at

• Treat and preventpulmonary inections

• (lutter muscu clearancedevice

• High re7uency chestcompression

• Broncholdilatormedication

• 'eplacement opancreatic en3ymesgiven with meals andsnac#s )ta#e e%traen3ymes when high atoods are eaten-

=30=9 ;M3@

0i!ns o+pneumothoraE areusuall nonspe-i%-and in-lude

ta-h-ardia, dspnea,pallor, and -anosis'; su"tle drop in 2saturation (in-reased" pulseoEimetr)ma "e a earl si!no+ pneumothoraE


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9edications associated with respiratory dysunction )action & adverse e2ects-

6!D6+pg ?L*

9 Disorders: Chapter 2# (5 questions)

Disease 4athophsiolo! Clini-al ani+estation @herapeuti- ana!ement


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Hirs-hsprun!Disease

• /ongenitalabnormality

• 'esults in obstructionrom inade7uatemotility o part o theintestine

• #a aganglionicmegacolon• 9utations o 'ATproto+oncogene havebeen ound

• !n the maority ocases aganglionosisis restricted to theinternal sphincter0rectum and part othe sigmoid colon

• bsence o ganglioncells in the intestinesthat results in loss orectosphinctericre8e% and anabnormalmicroenvironment ocells o the a2ectedintestine

• bsence o thesecells results in a lac#o enteric nervoussystem stimulation0which decreases theinternal sphinctersability to rela%

Table >?+, =

• (ailure to passmeconium within >?+?N hours

• 'eusal to eed

• Biolous vomiting

• bdominal distention

n+an-

• Growth ailure

• /onstipation


• Apisode o diarrheaand vomiting

• 6igns o enterocolitise%plosive0 waterydiarrhea0 ever0appears signifcantlyill

Childhood

• /onstipation

Ribbon-like, foulsmelling stools


• isible peristalsis

• Aasily palpable ecalmass

• :ndernourishedanemic appearance

0ur!er

• 'emoval o the aganglion portion othe bowel to remove obstruction0restore normal motility and preserveunction o e%ternal sphincter

• 6oave endorectal pull+through pullinthe end o the normal bowel throughthe muscular sleeve o the rectumI

/omplication constipation)enterocolitis- and ecal incontinence

Diet lo in %"er, hi!h -alorie,

hi!h protein

• norectal myomectomy or veryshort segment diseases

• 1rior to surgery child is stabili3ed wit8uid and electrolyte replacement

4reop

• 9a#e sure that physical status isgood0 i not treat with enemasI a lowfber0 high calorie and high proteindiet or T1$ in severe cases

De-rease "a-terial Pora ithanti"ioti-s and -oloni-irri!ations usin! anti"ioti- sol/n

• !n -hildren empty bowels with salinenemas and decrease bacterial 8orawith oral or systemic antibiotics andcolonic irrigations )bowel cleansing-

• mer!en- preop care includesmonitor vital signs or signs o shoc#8uid0 electrolyte replacement0 plasmor blood derivatives and observe or


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Cle+t lip or Cle+t4alate

• (acial malormationthat occurs duringembryonicdevelopment

• 9ost commoncongenitaldeormities

• /lets o the lip )/-

and palate )/1- canoccur alone ortogether

• 9ost are caused bygenetics andenvironmentalactors

• A%posure toteratogens such asalcohol0 cigarettesmo#ing0anticonvulsants0steroids and retinoidsare associated withhigher ris#

• The severity o /1has an impact oneedingI the inant isunable to createsuction in the oralcavity that isnecessary or eeding)ability to swallow isnormal-

• pparent at birth

• 6ometimes seenon ultra sounds

Surgical correction of Cleft Lip

• Fccurs >+, months

• 'ule o JtenK *L wee#s old0 *Llbs0hgb o *L

• Tennison+'andall triangular 8ap )Splasty-

• 9illard rotational advancementtechni7ue

• $asoallveolar may be used to bringclet segments together prior tosurgery

Surgical Correction of CleftPalate

• Fccurs between O+*> months

• eau Wardill+nd surgery to improvevelopharyngeal or speech.

=ursin! tea-hin! hi!hest priorit

is learnin! ho to +eed their

in+ants and• / may interere with the inant=sability to achieve an ade7uateanterior lip sealI no dicultybreasteeding0 use wide based bottle

• /1 reduces the inant=s inability tosuc#0 which intereres withbreasteeding and traditional bottleeeding

• 1ositioning in an upright position0 withead supported by caregivers hand


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sopha!eal;tresia ith@ra-heoesopha!eal Fistula

• 'are malormationsthat represent aailure o theesophagus todevelop as acontinuous passageand the trachea &esophagus to

separate into distinctstructures

• /an occur alone orboth

• /ause is un#nown

• When a mother had polyhydraminose)e%cessive amnioc8uid in sac-0 that=swhen you wouldsuspect it

Bo% >?+U• A%cessive rothy

mucus rom noseand mouth

• , /s otracheoesophageal fstula

• /oughing

• /ho#ing• /yanosis

• pnea

• !ncreasedrespiratorydistress duringeeding

• bdominaldistention

• 6uspected incases opolyhydramnios)e%cessive 8uid in

the amniotic sac-

• s a nurse0 i you suspect this you wbe there or the *st eeding andadminister water in a medicine cup tloo# or the ,/s

• ! its there stop giving them the watebaby stays $1F and

• s a nurse you want to maintainpatent airway0 prevention o

pneumonia0 gastric blind pouchdecompression0 supportive therapyand surgical repair o anomaly.

When A with TA( is suspected0 theinant is immediately deprived oforal intake0 IV uids are initiatedand the infant is positioned tofacilitate drainage of secretionsand decrease the likelihood ofaspiration

• 9outh and pharyn% suctionedre7uently because o accumulatedsecretions

Double+lumen catheter placed intothe upper esophageal pouch andattached intermittent orcontinuous lo! suction

• !nants head kept upright"#$degrees- to help with removal o8uid collected in the pouch andprevent aspiration o gastric content

• %ntibiotics i there is concern oaspiration o gastric content

• 6urgery

• thoracotomy


32/83


33/83

Hpertrophi-4lori-0tenosis

• Fccurs when thecircumerentialmuscle o the pyloricsphincter becomesthic#ened0 resultingin elongation andnarrowing o thepyloric channel

• !t produces an outletobstruction andcompensatorydilation0 hypertrophyand hyperperistalsiso stomach

• Develops frst >+@wee#s o birth

• /auses proectilevomiting0dehydration0metabolic al#alosisand growth ailure

• Geneticpredisposition

• /ircular muscle o thepylorus thic#ens as aresult o hypertrophyand hyperplasia)increased mass-.

This produces severnarrowing o thepyloric canal betweenstomach andduodenum0 causing

Bo% >?+**• 1roectile vomiting

• 9ay be eected ,+? trom child when in aside+lying position or *oot when in supineposition

• Fccurs shortly ater

eeding0 but may notoccur or several hours

• =on"ilious vomitus that may be bloodtinged

• n+ant hungry0 avideeder0 eagerlyaccepts a secondeeding ater vomitingepisode

• $o evidence o pain ordiscomort other thanhunger

?ei!ht loss or+ailure to !ainei!ht

• 6igns o dehydration

• Distended upperabdomen

• 'eadily palpa"leolive$shaped tumor in epigastrium ust tothe right o theumbilicus

4reop

• 'estoring hydration and electrolytebalance0 metabolic al#alosis must becorrected

• $1F receive ! 8uids with glucose andelectrolyte replacement

• ssess ital signs0 s#in mucousmembranes0 and daily weight

• 6tomach decompress with an $G tubethe nurse must ensure the tube ispatent and unctioning properly. lsoresponsible or measuring andrecording the type and amount odrainage

4ostop

• ! 8uids administered until the inant ta#ing and retaining ade7uateamounts by mouth

• 9onitoring same things that wereassessed

• Fbserved or responses to the stress

surgery and or evidence o pain• 6urgical incision is inspected ordrainage or erythema and any signs oinection0 report 61

• (eedings usually being ?+O hours postop

• Teach parents how to care or incision

• Fbservation and eeding recordingsare important


34/83

ntussus-eption

• /hildren ages,months+,years

• /ommon in childrenwith cystic fbrosis

• :n#nown cause

• Fccurs when onesegment o the boweltelescopes intoanother segment0pulling the mesenterywith it

• The mesentery iscompressed andangled resulting inlymphatic and venousobstruction

s edema romobstruction increasespressure increases.When pressuree7uals arterialpressure0 arterialblood 8ow stops results in ischemiaand pouring o mucusinto the intestine Vlea#ing o "loodand mu-us intointestinal lumenresultin! in -urrant

Lell$li.e stools

• 6udden acuteabdominal pain

• /hild screaming anddrawing #nees intochest

• /hild appearing normaland comortablebetween episodes o

pain• omiting

• ethargy

• 1assage o red,-urrent Lell$li.estools )mi%ed withblood and mucus-

@ender, distendeda"domen

4alpa"le sausa!e$

shaped mass inupper ri!htquadrant

•

Ampty lower right7uadrant )dance sign-

• Aventual ever0prostration and othersigns o peritonitis

• (etal position in pain

• ssess children with severe colic#yabdominal pain combined withvomiting0 which is a signifcant sign

• $:'6!$G A'T The classical traid s;sa"dominal mass0 a"dominal pain0and "lood stools. /hildren mightinitially be seen screaming0 irritable0lethargy0 vomiting0 diarrhea or

constipation0 ever0 dehydration andshoc#. /an be lie threatening0 thenurse should be aware o alternativepresentations0 observe the childclosely0 and reer them or urtherevaluation.

• Treatment consists o radiologist+guided pneumonia (air enema) witor without water+soluble contrast orultrasound guided hdrostati-(saline) enema.

• ! 8uids 0 $G decompression andantibiotic therapy may be used beorehydrostatic reduction

• Maparos-opi- sur!er that involvesmanually reducing the invaginationand when indicated0 resecting anynonviable intestine

• oo# at stool0 i stool is normal then nurther procedureI however0 i stoolremains elly+bloody li#e then surgeryis re7uired

=30=9 ;M3@: 4assa!e o+normal "ron stool usuallindi-ates that intussus-eption ha


35/83

Celia- Disease • /haracteri3ed by

villous atrophyin the

small bowel in

response to the

protein gluten

• !t is a permanent

intestinal intoleranceto dietary wheat

gliadin and related

proteins that

produces mucosal

lesions in genetically

susceptible

individuals

• A%act cause is

un#nown0 accepted

that it is an

immunologically

mediated smallintestine enteropathy

• Gluten is ound in

wheat0 barley0 rye

and oat grains

• When individuals are

unable to digest the

gliadin component o

• !mpaired (at

absorption

• 6teatorrhea

)e%cessively large0

pale0 oily0 rothy stools

• A%ceeding oul+

smelling stools

• !mpaired nutrient

absorption

• 9alnutrition

• 9uscle wasting

)especially prominent

in legs and buttoc#s-

• nemia

•

nore%ia


• Behavioral changes

• !rritability

• :ncooperativeness

• pathy

• /eliac crisis cute0

• /orn and rice become substitute grain

oods

• dvise child and patients to read labe

careully

• Diet re7uires a wheat+barley0 and rye

ree diet

• diet high in calories and proteins

with simple carbohydrates such as

ruits and vegetables0 but low in at

• void high fber oods0 such as nuts0

raisins0 raw vegetables and raw ruits

with s#in until in8ammation has

subsided


36/83

Con!enital Disorders: Chapter 25 (7 questions)

4athophsiolo! Clini-al ani+estations =ursin!Consideration8@ea-hin

!s


37/83

Con!estive HeartFailure

• !nability o the heart topump an ade7uateamount o blood to thesystemic circulation atnormal fling pressures tomeet demands

• !n children0 it occurssecondary to structuralabnormalities that resultin increased blood volumeand pressure within theheart

• 'ight+sided ailure 5 'ventricle is unable topump blood e2ectivelyinto the pulmonary artery0resulting in increasespressure in the ' atriumand systemic venouscirculation

• et+sided+ailure 5 ventricle is unable topump blood into thesystemic circulation0

resulting in increasespressure in the atriumand pulmonary veins. Thelungs become congestedwith blood0 causingelevated pulmonarypressures and pulmonaryedema

mpaired o-ardialFun-tion

• Tachycardia

• 6weating

• Decreased urinaryoutput

• (atigue

• Wea#ness

•

'estlessness• nore%ia

• 1ale0 cool e%tremities

• Wea#0 peripheral pulses

• Decreased B1

• Gallop rhythm

• /ardiomegaly4ulmonar Con!estion

• Tachypnea

• Dyspnea

• 'etractions )inants-

• (laring nares

• A%ercise intolerance

• Frthopnea

• /ough0 hoarseness• /yanosis

• Whee3ing

• Grunting0stemi- BenousCon!estion

• Weight gain )best wayto determine H( inchild;inant-

• Hepatomegaly

• 1eripheral edema)especially periorbital-

dminister di!oEin.But frst chec# theapical pulse. Do notadminister i to anin+ant i the pulse isON$11 "pmI andoun! -hildren i thepulse is O7 "pm

• 9onitor aterloadreduction by measureB1 beore and ater /Aadministration

• ssess serumelectrolytes and renalunction

• /lustering treatment tominimi3e unnecessarystress

• 9onitor temperaturebecause hyperthermiaor hypothermia becauseit increases the need oro%ygen

• 6#in brea#down romedema is prevented witha change o positionevery > hours

• 'educe 'espiratoryDistress0 through careulassessment0 positioningand o%ygenadministration whichcan reduce respiratory


38/83

ndo-arditis • !s an inection o theinner lining o the heart)endocardium-0generally involving thevalves

• 9ainly caused by staphor strep

• Fnset usually insidious

• :ne%plained ever )lowgrade and intermittent-

• nore%ia

• 9alaise

• Weight loss

• /haracteristic fndings

caused by e%tra cardiacemboli ormation• 6plinter hemorrhages)thin blac# nails- undernails

• Fsler nodes )red0painul intradermalnodes ound on pads o phalanges-

• 1ainless hemorrhagicareas on palms andsoles

• 1etechiae on oralmucous membranes

• 9ay be present• Hear ailure

• /ardiac dysrhythmias

• $ew murmur orchange in previouslye%isting one

dministration o high+doses o anti"ioti-s B2$ ee.s

• Ta#e blood culturesperiodically

• 1rophylactic antibioticstherapy * hour beorecertain procedure that

increase ris# =oti+ the dentist, i+

the -hild !ets andental pro-edure

• Fral care needs to bemaintained to reducedthe chance obacteremia rom oralinection

• The nurse teaches thatany une%plained ever0weight loss0 or changein behavior )lethargy0malaise0 anore%ia- mustbe brought to the H/1sattention


39/83

HpoEia • reduction in tissueo%ygenation that resultsrom low o%ygensaturation and 1aF> andresults in impairedcellular processes

Canosis

• Desaturated venousblood

Clu""in!

• Hypercyanotic spells

• 4ol-themia)increased blood cells-

•


40/83

Aaasa.i Disease • cute systemic vacuitieso un#nown cause

• Fccur in children inyounger than @ years oage

• !nitial stage o theillness0 is e%tensivein8ammation o the

arterioles0 venules andcapillaries occurs0causing many o the s;s

• Can -ause +ormationo+ -oronar arteraneursms in somechildren

• /hild must have +ever+or more than 5 dasalong with ?+@ clinicalcriteria /hanges in thee%tremities in theacute phase edema,erthema o+ the

palms and soles> inthe su"a-ute phase,periun!ualdesquamation(peelin!) o+ thehands and +eet

• Bilateral conunctivalinection(inPammation-without e%udation

/hanges in the oralmucous membranes0such as erthema o+the lips0oropharn!ealreddenin!I orstra"err ton!ue

1olymorphous rash

• Cervi-al

lmphadenopath )one lymph node Q *.@cm-

High does o B!amma !lo"ulin(B99) along withaspirin and thenantiplatelets

• 9onitor heart unction

• !&F

• Daily weights

• ssess or signs o heartailure

• 6ymptoms relie

• /ool clothes

• :nscented lotions

• 6ot loose clothing

• 9outh care

• /lear li7uids

• 6ot oods

• uiet environment

•

@ea-h parents a"outC43


41/83

Con!enital Heart De+e-ts:

De+e-t 8in-reased

pulmonar "loodPo

;trial 0eptalDe+e-t (;0D)

Bentri-le 0eptalDe+e-t (B0D)

;trioventri-ularCanal De+e-t

4atent Du-tus;rteriosus (4D;)


42/83

4athophsiolo!

opening in theseptum between theatriums

blood rom atrium)high pressure- 8owsinto the ' atrium)low pressure- causes 8ow oo%ygenated bloodinto the ' side oheart

Fpening in theseptum between theventricles

+to+' shunt iscaused by the 8owo blood rom ventricle )highpressure- to 'ventricle )lowpressure-.

!ncreased pressurein the ' ventricle-auses the mus-leto hpertroph

0pontaneous-losure mostli.el o--ursdurin! the 1st earo+ li+e in -hildrenhaving small ormoderate deects)usually by ? years-

i!ht "e noti-ed2$ ee.s

!ncomplete usion o the endocardialcushions

/onsists o lo ;0Dwith a hi!h B0D

; lar!e ;B valvethat allos "loodto Po "eteenall # -ham"ers

9ost commondeect in childrenwith Don0ndrome

Failure o the etalductus arteriosus)arter -onne-tin!the aorta &pulmonar arter-to -lose w;in thefrst wee#

llows blood to 8owrom the orta to1ulmonary rtery

@his shunt usuall-loses at 12$72hours> 2$ ee.sseals shut

' shunt

Causes anin-rease or.loado+ the M side o+heart, in-rease inpulmonarvas-ular-on!estion &potentiallin-rease in in 3'

ventri-ularpressure andhpertroph

=0;D0 ill -an itto premature-losure


43/83

Clini-alani+estations

;smptomati-

;-onoti-

(atigue easily

Heart +ailure is-ommon

;-onoti-

oderate tosevere heart+ailure

! asymptomaticollow child andwatch or it to closeon its own

ild -anosis increases withcrying

High ris# orpulmonary vascularobstructive disease

'esults going romaorta pulmonaryartery

?idened pulsepressure

oundin! pulse

;smptomati-

0i!ns o+ heart+ailure

;-ontoi-

a hear a heartmurmur at "irthand hen the-ome +or a +ollo

up ou mi!ht nothear anthin!

@reatment8@ea-hin!s

1ericardial patch orDarcon patch

1rocedures

1atient receives low+dose o aspirin or Omonths

• 1rocedures • 1rocedures ndometha-in(i"eupro+en)promotes -losure

Rou don=t want it toclose in utero onlywhen the baby isborn

$6!Ds promoteopening0 andindomethacinpromotes closure


44/83

"stru-tive De+e-ts Coartatation o+ the;orta

;orti- 0tenosis 4ulmoni- 0tenosis

4athophsiolo! orta is narrowed

n-reased pressure

proEimal )head and

upper e%tremities- De-reases distalpressure )body andlower e%tremities-

$arrowing o aorticvalve closer to theventricles

/auses resistance oblood 8ow in the ventricle0 andpulmonary vascularcongestion )pulmonaryedema-

=arroin! o+ theentran-e o+ thepulmonar arter

'esistance to blood 8owcauses ' ventricularhypertrophy

Can reopen +oramenovale, shuntin! o+unoE!enated "loodinto the M atrium


45/83

Clini-al ani+estations n-rease 4 upper

eEtremities, lo 4 inloer eEtremities

oundin! pulses in

arms

?ea. or a"sent+emoral pulses

/ool lower e%tremities

Hear ailure signs

6ince side is wor#ingharder0 it may cause ventricle hypertrophy

9ay go unnoticed i the1D does not close

MD3 AD0:

Di33iness

Headaches

(ainting

nosebleeds

eads to heart ailure=

Decrease /F )hard orblood to come out-

(aint pulses

Hypotension

Tachycardia

1oor eeding syncapy )pass out-Children

A%ercise intolerance

/hest pain

Di33iness when standingor a long time

6ystolic eectionmurmur may be present

symptomatic

/yanosis

Heart ailure

Decrease o /F )severecases-

/ardiomegaly

@reatment8 @ea-hin!s • prosta!landin to#eep the 1D open

• Balloon angioplasty

! they have severe+moderate they need toavoid competitive orintense sports becauseit can lead to suddendeath

Balloon angioplasy

Balloon angioplasty


46/83

De-reased 4ulmonarlood Flo

4athophsiolo! Clini-al mani+estations @reatment8@ea-hin!

@etraolo! o+ Fallot ? deects in *

B0D

40

verridin! aorta

3 Bentri-ularhpertroph

shunt direction dependson the di2erencebetween pulmonary andsystemic vascularresistance

uno%ygenated blood tothe body

Canoti-

"luespells or tet

spells (.nee to -hestposition)

clubbing

hypo%ia

Blaloc# Taussing 6hunt

Di2erent procedures

iEed De+e-ts (iEedlood)

@ransposition o+ the9reat ;rteries89reat

Bessels

@run-us ;rteriosus Hpoplasti- M Heart0ndrome


47/83

4athophsiolo! • E!enated "lood!oes "a-. and +ourthunless there isanother de+e-t thatallos the "lood to!o to the other side0the child can be o#ay ora while

4ulmonar arterleaves the 3 ventri-le

;orta leaves the 3ventri-le

• Blood eected rom the and ' ventricles entersthe common trun# sothat pulmonary andsystemic circulation aremi%ed

• lood !oes toards

the lun!s since the

pressure in the lungs islower.

• :nderdevelopment o side o heart results inhypoplastic ventricleaortic atresia

• n 6D or patentoramen ovale allowsblood to 8ow rom atrium+to+' atrium and

' ventricle+to+out topulmonary arterylungs aortasystemically

• Gives lungs e%tra blood

• 1ulmonary congestion

Clini-al ani+estations Canoti-

• Heart ailure

• cardiomegaly

• heart ailure

• poor eeding

• poor growth

• lung congestion

• atigue

• hypo%emia

-anosis

• poor growth

• activity intolerance

• 9ild cyanosis

• 6igns o heart ailureuntil 1D closes

• Fnce 1D closesprogressivedeterioration withcyanosis and decreases/F

• 1ulmonary congestion


48/83

@reatment8@ea-hin! • prosta!landin! )#eeps it open-

• procedure

• procedures )preerablywithin the frst month olie-

• !t is a step procedure0more than * procedurewill occur

edi-ations:

• Di!italis !l-osides (di!oEin) improve contractility )read page N,U (amily+/entered /are or

dministering-o =30=9 ;M3@ !nants rarely receive more than * ml )@L mcg or L.L@ mg- o digo%in

in one doesI a higher dose is an immediate warning o a dosage error. To ensure saety0compare the calculation with another sta2 member=s calculation beore giving the drug

o 9easure the eli%ir in the dropper and stresses the level mar# as the meniscus o the 8uidthat is observed at eye level.

• ;n!iotensin$-onvertin! enGme (;C ) inhi"itors reduce the aterload on the heart0 whichma#es it easier or the heart to pump

o 9onitor B1 beore and ater administration and observe symptoms o hypotension andnotiy H/1 i B1 is low

o /areul assessment o serum electrolytes and renal unction• eta$lo-.ers decrease in heart rate0 decreases B1 and decreases vasodilation

o 9onitor B1o 6ide e2ects di33iness0 headaches and hypotension

• Diureti-s eliminate e%cess H>F and salt to prevent accumulationo Furosemide (MasiE):

" Drug o choice" /auses e%cretion o /l+ and


49/83

/linical /onse7uences o /ongenital Heart Disease

/are o children ater /ardiac !nterventions• 9onitor B1

• 9ontior

Hematolo!i- Disorders: Chapter 26 ( questions

Disorder 4athophsiolo! Clini-al ani+estation =ursin! ana!ement


50/83

Meu.emia (;MM-lassi%-ations)

• /ancer o the lymphoidprogenitor0 a2ecting B or

T cells• 9ost common in children,+P

• Fverproduction o WB/s0but count is low

• These cells do notdeliberately attac#0instead cellulardestruction happens byinfltration andsubse7uent competitionor metabolic elements

9alaise and Fati!ue

Fever

• Bleeding gums

• ymphadenopathy

• 6plenomegaly

4ete-hiae

• Weight oss

•

9eningitis• nore%ia

• Dyspnea

• :se o chemotherapeutic ainduction therapy0 /$6 protherapy0 intensifcation themaintenance therapy

• 1repare child and amily otherapeutic procedure

• 'elieve pain0 narcotics are titrated and administered a

or best control o pain• 4revent -ompli-ation o+

melosuprression -ause-hemotherapeuti- a!ent

• n+e-tion secondary to ne$urse must use all measurtranser o inection0 monitinection and elevation in tantibiotics givenI ade7uateinta#e provides child with bdeense against inection atolerance o chemo therapyprivate room0 restrictions ohealth personal with activestrict0 hand+washing techniantiseptic solution.=30=9 @4: @he -hild immuniGed a!ainst live v(measles, ru"ella, mumpimmune sstem is -apa"respondin! appropriateva--ine' ost institutionindividual !uidelines re!va--inations in -hildren immunosuppressive the


51/83

Mmphomas(Hod!.in and =on$Hod!.ins Disease

• ymphomas are the ,rd most common group omalignancies in #ids andadolescents

• group o neoplasticdiseases that arise romthe lymphoid andhematopoietic systems

• Divide into two• H Eoriginates in thelymphocytes and mainlyinvolves the lymphsystem

• 9etastasi3es to nonnodalor e%tralymphatic sitesspleen0 liver0 bonemarrow and lungs.

!ncreased lymph nodes Treatment is chemotherapy $on+Hodg#innd or Hodg#in=s it is chem/hemo is or children youngradiation can be used on chi,.6imilar to treatment therapy


52/83

0i-.le Cell Disease

(0CD)

• !ncludes all the thosehereditary disorderswhose clinical0hematologic andpathologic eatures arerelated to the presence o Hb6.

• 6/ is a type o 6/D

• 9ost common geneticdisease world wide

• 1allor0 aundice

• 6plenomegaly

• eg ulcers

• 1riapism

• Delayed puberty

• !nection

• cute pain crisis rom

inractions o the lung0

#idney0 spleen0 or

emoral head will also

have ever

• Blindness

• 6tro#e

• 9alnutrition

6/D )frst > years-

• Dactylitis

• 6evere anemia

• leu#ocytosis

• 'ecord !&F including ! 8u

• /hild=s weight should be ta

admission to compare to ba

evaluating hydration

• Be aware o signs o /6 a

• /6 signs

• Whee3ing

• Hypo%ia

• /hest pain

• (ever

• /ough

• Tachypnea

• /6 signs

• $eurological impairment

• 1aralysis

• ital signs & B1 monitor clo

impeding shoc#

• $arcotics given around the


53/83

9astriurinar Disorders: Chapter 27 (7 questions)

Disorder 4athophsiolo! Clini-alani+estation

=ursin! ana!ement


54/83

rinar @ra-tn+e-tion

4redisposin! Fa-tors:

• 6hort emale urethra close tovagina and anus

• !ncomplete emptyingbladder0 they have stasisallows any bacteria thatcome rom the urethra togrow

• 0tasis o+ rePuE0 when thechild voids0 urine bac#8owsup the ureters and then 8owsbac# down into the emptybladder. !t sits in the bladderand then bacteria rom theurethra grow and the ne%ttime the child voids ithappens again0 e%cept thatnow the urine that was in thebladder goes into the ureters0and can then go into the#idneys.

• Fver distention o bladder

• /oncentrated urine• /onstipation

• A.coli NLX

• The #ey to prevention :T! isto maintain ade7uate bloodsupply to the bladder wall byavoidance o over distentionand higher bladder pressure

=30=9 ;M3@: a -hildho eEhi"its the +olloin!should "e evaluated +or

Bo% >P+*=eonatal 4eriod("irth$1month):

Poor feeding

Vomiting

Failure to gainweight

'apid respiration)acidosis-

'espiratorydistress

6pontaneouspneumothora% orpneumomomediastinum

Frequent urinationscreaming onurination

1oor urine stream

Yaundice

Seizures

Dehydration Enlarged kidneysor bladder

n+an- (1$2#months)

Poor feeding

Vomiting

Failure to gain

weight

A%cessive thirst

Frequent urination

• antibiotic therapy should beadministered once pathogenis identifed

• 6everal antibiotics arespecifcally used to treat:T!s

• 1enicillin=s

• 6ulonamide

• /ephalosporin

• $itrournatoion

• 6urgical correction orprimary re8u% or bladdernec# obstruction

• When a :T! is suspectedcollect a specimen )clean+voided specimen-

• !n inants and youngchildren suprapubicaspiration o urine or sterilecatheteri3ation should bedone in inants and young

children who are seen withhigh ever

• !ncrease 8uid inta#e

• /hildren who have recurrent:T! might be given low doseantibiotics0 given at bedtimeto allow the drug to remainin the bladder.

4revention:

• Wipe ront to bac#


55/83

=ephroti-0ndrome

• /haracteri3ed by increasedglomerular permeability toplasma protein0 which resultsin massive urinary proteinloss.

• 'are in children younger thanO months

• :ncommon inants younger

than * year• :nusual ater N years

• 9ost common between >+Pyears o age

• loss o protein reduces theserum albumin level)hypoalbuminemia-0decreasing colloidal osmoticpressure in the capillaries.

• s a result the vascularhydrostatic pressure e%ceedsthe pull o the colloidalosmotic pressure0 causing

8uid to accumulate in theinterstitial spaces )edema-and body cavities0 particularlyin the abdominal cavity)ascites-.

• 6hit o 8uid rom the plasmato the interstitial spacesreduces vascular 8uid)hypovolemia-0 which in turnstimulates the renin+angiotensis system and thesecretion o antidiuretic

'eer to chartbelow

• Adema

• 1roteinuria

• Hypoalbuminemia

• Hypercholestolemia in the absenceo hematuria andHT$

• Hallmar. ismassiveproteinuria )higher than >Von urine dipstic#-

• G(' is usuallynormal or high

• 6erum proteinconcentration islow

• 6erum albuminsignifcantly

reduced• 1lasma lipidselevated

Compli-ations:

• /irculatoryinsuciencysecondary tohypervolemia andthermo+embolism

• !nections thatmay be seen in

'eer to chart below

Compli-ations:

• 'arely do children developrenal ailure with oliguriathat signifcantly alters 8uidand electrolyte imbalanceresulting in hyper#alemia0

acidosis0 hypocalcaemia0 orhyperphosphatemia

• /erebral complications


56/83

;-ute9lomerulonephritis

• 9ay be a primary event ormaniested by a systemicdisorder

• 9ost cases are post+inectionand have been associatedwith pneumococcal0streptococcal0 and viralinection.

• /an occur at any age• 2ects early school agedchildren with pea# age onseto O+P years

• :ncommon in childrenyounger than > years

• /an occur ater a strepinection with certain strains

• !mmune comple%es aredeposited in the glomerularbasement membrane.

• The glomeruli becomeedematous and infltrated with

polymorphonuclearleu#ocytes0 which occludecapillary lumen

• The resulting decrease inplasma fltration results in ane%cessive plasma andinterstitial 8uid volumes0leading to circulatorycongestion and edema.

• HT$ due to 8uid retention andrenin production

'eer bac# to7uestion * above

• Fliguria

• Adema

• HT$

• /irculatorycongestion

• Hematuria

• 1roteinuria

• 6ometimes theyonly have ahistory o mildcold

• Fnset appearsater an averageo *L days

• :rinalysis o acutephase shows

• Hematuria

• 1roteinuria

• They usually bothparallel each other,V or ? V

• Grossdiscoloration ourine re8ects 'B/and hemoglobincontent

• 9icroscopicreveals many 'B/0leu#ocytes0

@reated at home i+:

• :rine output is o#

• B1 is o#ay

@reated in a hospital i+:

• lot o edema

• HT$

• Gross hematuria

• oliguria


57/83

?ilms @umor • nephroblastoma

• most common malignant renaland intra+abdominal tumor ochildhood

• more commonly to occur inrican mericans

• pea# age o d% is , years

• probably arises rommalignant 0 undi2erentiatedcluster o primordial cellscapable o intitiating theregeneration an abnormalstructure

• (F'6 the A(T #idney.

• Test used or diagnosis M+ray0ultrasounds0 /T0 /T scan0bone marrow biopsy

0@;90 F ?M0 @3

0ta!e : tumor is limited to#idney and completelyresected

0ta!e : tumor e%tendsbeyond #idney but iscompletely resected

0ta!e : 'esidual non+hematogenous tumor isconfned to abdomen

0ta!e B: heamatogenousmetastasesI deposits arebeyond stage !!!0 namely0 tolun!0 liver0 "one and "rain

0ta!e B: bilateral renal

• bdominal swelling

• (irm

• $on+tender

• /onfned to oneside )-

• Hematuria )lessthan one ourth ocases-

• (atigue and malaise

• HT$ )occasionally-

• Weight loss

• (ever

• 9aniestationsresulting romcompression otumor mass

• 6econdarymetabolic alterationrom tumor ormetastasis

• ! metastasis

symptoms o lunginvolvement

• Dyspnea

• /ough

• 6FB

• /hest pain

• $ursing lert To reinorcethe need or cautions post asign on the bed that readsJD =@ 4;M4;@;D='I /areulbathing and handling arealso important in preventingtrauma to the tumor site

• Fnce confrmed0 surgery isscheduled 61 >?+?N hoursupon admission

• s a nurse it is important toprep parents and childrenwithin this >?+>N hourperiod simple0 repetitiveand ocused )not muchtime-

• B1 is monitored becauseHT$ rom e%cess reninproduction is possible

• 1rep parents aboutchemotherapy side e2ectsbeore surgery and childrenaterI ie alopecia )hair loss-

• Tumor a2ected #idney andadacent adrenal gland areremoved

• large trans+abdominalincision is perormed

• Great care is needed to#eep the encapsulatedtumor intact0 because iruptured it can spread to


58/83

;-ute 3enal

Failure

• When #idneys are suddenly

unable to regulate the volume

and composition or urine

appropriately in response to

ood and 8uid inta#e

• The eatured principal is

oliguria0 associated witha3otemia0 metabolic acidosis0

and diverse electrolyte

disturbances

• $ot common in childhood

• :sually reversible

• 6evere reduction o G('0 an

elevated B:$ level0 and

signifcant reduction in renal

blood 8ow

• /linical course is variable and

depends on cause

• !n reversible '(0 there is a

period o severe oliguria0 or a

low+output phase0 ollowed by

an abrupt onset o diuresis0 or

a high+output phase0 and then

a gradual return )or toward-

normal urine volumes

0pe-i%-:

• Fliguria

• nuria uncommon

)e%cept in

obstructive

disorders-

=onspe-i%- (madevelop):

• $ausea

• omiting

• Drowsiness

• Adema

• HT$

ani+estations o+

underlin! disorder

or patholo!i-

-ondition

Compli-ations:

Hper.alemia: $o

e%tra


59/83

=ephroni- 0ndrome ;-ute!lomerulonephritis


60/83

Clini-alani+estation

oE 27$2 p! N1#

• Weight gain

• 1uness o ace)acial edema-

• Aspecially aroundthe eyes

• pparent onarising in themorning

• 6ubside duringthe day

• bdominalswelling )ascites-

• 1leural e2usion

• abial or scrotalswelling

• Adema ointestinal mucosa0possibly causing

• Diarrhea

• nore%ia

• 1oor intestinalabsorption

• n#le or legswelling

• !rritability

• Aasily atigued

• ethargic

• B1 normal orslightly decreased

• 6usceptibility to

oE27$ p! N15

• Adema

• Aspeciallypreorbital

• (acial edemamore prominentin the morning

• 6preads duringthe day toinvolvee%tremities andabdomen

• nore%ia

• :rine

• /loudy0 smo#ybrown)resembles tea orcola-

• 6everely reducedvolume

• 1allor

• !rritability• ethargy

• /hild appearingill

• /hild seldome%pressesspecifccomplaints

• Flder childrencomplaining o

• Headaches


61/83


62/83

=ursin!

ana!ement

$utritional Therapy

• ow+salt diet

• 6evere cases 5 8uid

restriction

• Adema complications 5

diuretic therapy initiated toprovide temporary relie

rom edema

• Due to severe protein loss 5

inusion >@X o albumin is

used

• cute inections 5 t% with

antibiotics

• *st line o therapy 5

corticosteroids

• 6tarting dose or prednisone

is usually > mg;#g;day or O

wee#sI ollowed by *.@

mg;#g every other day or O

wee#s

• 6ide e2ects weight gain0

rounding o ace0 behavior

changes0 and appetite

changes. ong term

• 9oderate sodium

restriction and

8uid i child has

HT$ and edema

• During periods o

oliguria


63/83

n-reasedinter-ranial 4ressure: Chapter 2

Chapter 2: Child ith Cere"ral Ds+un-tion # Questions

Clini-al ani+estations o+ C4 ("oE 2$1)n+ants


64/83

• Tense0 bulging ontanel

• 6eparated cranial sutures+enlarged head Z

• 9acewen )crac#ed+pot- sign

• !rritability and restlessness Z

• Drowsiness

• !ncreased sleeping

• High pitched cry Z

• !ncreased rontoocipital circumerence

• Distended scalp veins

• 1oor eeding Z

• /rying when disturbed

• es: settin!$sun si!n ZChildren

• Headache Z

• $ausea )sometimes- Z

•

(orceul vomiting Z• Diplopia0 blurred vision Z

• 6ei3ures Z

• !ndi2erence0 drowsiness

• Decline in school perormance

• Diminished physical activity and motor

perormance• !ncreased sleeping

• !nability to ollow simple commands

• ethargy

Mate 080 in inants and children

9las!o Coma 0-ale:

• /oma assessment that consists o ,+part assessment eye opening0 verbal response and motor response

• score o *@ is the best Eunaltered level o consciousness )F/-

• score o , is the worse score+ e%tremely decrease F/

=euro Eamination:ital 6igns6#inAyes

Doll Head Maneuver • 'otate the child=s head 7uic#ly to one side and to the other.

• =ormal response eyes move in the opposite directionalori! test "aka o!ulovestibular test#$

• Fnly do when child is unconscious

• !rrigate the e%ternal auditory canal with *Lml o ice water or >L seconds

• Alicited with child=s head up )HFB ,L degrees-

• =ormal response movement o eyes toward the side o stimulation=30=9 ;M3@(0)

• The sudden appearance o a %Eed and dilated pupil(s- is a neurologic emer!en-

• ny tests that re7uire head movement are not attempted until ater cervical spine inury has been ruled out


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• The caloric test is painul and is never perormed on a child who is awa#e or on an individual with a rupturedtympanic membrane

9otor (unction1osturing

• (le%ion

• A%tension'e8e%es=30=9 ;M3@

• , #ey re8e%es that demonstrate neurologic health in young inants are the 9oro0 tonic nec# and withdrawal

re8e%es1rocedures

• Mum"ar pun-ture is -ontraindi-ated when there is a suspicion o !/1

=ursin! Care o the n-ons-ious Child• Amergency measures are directed toward ensuring

o 1atent airway )breathing- and circulationo Treating shoc# )stabili3ing the spine-o 'educe !/1

• /ontinual observation o F/D39 ;M3@• When opioids are used0 bowel elimination must be closely monitored because o the potential constipating e2ect.

6tool soteners should be given with la%atives as needed to prevent constipation

=30=9 ;M3@o 'espiratory obstruction and subse7uent compromise leads to cardiac arrest. 9aintaining an ade7uate0

patent airway is o the utmost importance =30=9 ;M3@:

o The H is elevated to de!rees0 and the child is positioned0 so that the head is maintained inmidline to acilitate venous drainage and avoid ugular compression. Turning side to side is-ontraindi-ated because o the ris# o ugular compression.

• Hypo%ia and the alsalva maneuver can increase !/1

• 6uctioning in contraindicated0 unless it is necessaryI 9a#e sure it is brie and preceded by hyperventilation with*LLX F>. ! suctioning0 o%ygenate prior to suctioning. 6uctioning should be brie. !ncrease in intrathoracicabdominal pressure will be transmitted to the cranium. void nec# vein compression

• 9a#e sure to watch or overhydration0 it can cause cerebral edema


66/83

ntipyretic agents are usually not e2ective0 thereore eEternal -oolin! should "e used, which consists oevaporation )sponge baths-0 conduction )ice pac#s0 cooling blan#ets-0 convection )ans-0 and radiation )s#ine%posure-

9outh care is perormed at least >M a day0 because the mouth tends to get dry coated with mucus. /lean teethwith sot toothbrush or clean with gau3e+saturated saline. /hap stic# or lip )ma#e sure it is not an oil basedproduct.=30=9 ;M3@

o The eyes should be e%amined regularly and careully or early signs o irritation or in8ammation.;rti%-ial tears or a lu"ri-atin! ointment is pla-ed in the ees every *+> hours. Aye dressings maybe necessary to protect the eyes rom possible damage

H;D =R3:

, maor causes (alls0 9otor ehicle !nuries and Bicycle or sports related inuries

/ontrecoup 5 #now that a child can have inury on the opposite side o inury

Clini-al ani+estations (K 2$)

inor nLur:

• 9ay or may not lose consciousness

• Transient period o conusion

• 6omnolence

• istlessness

• !rritability

• 1allor

• omiting )one or more episodes

0i!ns o+ pro!ression:

• ltered mental status )diculty arousingchild-

• 9ounting agitation

• Development o ocal lateral neurologicsigns

• 9ar#ed changes in vital signs0ever nLur:

• 6igns o increased intracranial pressure)bo% >N+*-

• Bulging ontanel )inant-

• 'etinal hemorrhages

• A%traocular palsies )especially /$!!!-

• Hemiparesis

• uadriplegia

• Alevated temperature

• :nsteady gait

• papilledema;sso-iated 0i!ns

• 6calp trauma

• Fther inuries )to e%tremities-

9aor complications o Heady !nury


67/83

• Hemorrhage

• !nection

• /erebral Adema

• Herniation

• Bradycardia

• Decreased motor response to command

• Decreased sensory response to painul stimuli

• lterations in pupil si3e and reactivity

• A%tension or 8e%ion posturing

• /heyne+6tro#es respiration• 1apilledema

• Decreased consciousness

• /omma

=30=9 ;M3@ (0)

• 1osttraumatic meningitis should be suspected in children with increasing drowsiness and ever who also havebasilar s#ull ractures

• /hildren with su"dural hematoma and retina hemorrha!es should be evaluated or the possibility o childabuse0 especially sha.en "a" sndrome

• 0ta"iliGe a child=s spine a+ter head inLur until spinal cord inury is ruled out

• Deep0 rapid0 periodic or intermittent and gasping respirationsI wide 8uctuations or noticeable slowing o thepulse and widening pulse pressure or e%treme 8uctuations in B1 are signs o brainstem involvement.. $ote thatthe mar#ed hypotension may represent internal inuries

• "servation o asmmetri- pupils or one dilated0 nonrea-tive pupil in a -omatose -hild is a neurologicemer!en-

• leedin! +rom the nose or ears needs urther evaluation0 and ater dis-har!e +rom the nose )rhinorrhea- that is positive +or !lu-ose )as tested with De%trosti%- su!!est lea.in! o+ C0F rom s#ullracture


• $1F or restricted to clear li7uids0 until vomiting does not occur

• ! 8uids or comatose child0 or continuously vomiting

• Daily weight

• !&Fs

• 6erum osmolality to detect early s;s o H>F retention0 e%cessive dehydration0 and states o hypertonicity orhypotonicity


68/83

• $eurological assessment0 most important is MC assessment> try to have by one sin!le o"server, so theycan notice any slow changes

• 6aety 9easures side rails up0 sei3ure precautions

• 1rovide a 7uiet environment

• 1rovide sedation and analgesic or child

• 'eport any sei3ure

• Document drainage o any orifce

• 6uture or lacerations

• ntiepileptic or sei3ures

•

ntibiotics i lacerations or /6( lea#age

=30=9 ;M3@:

• 6uctioning through the nares is contraindicated because o the ris# i the catheter entering the brain parenchymathrough a racture in the s#ull

@ea-hin!

• /hec# child every > hours0 i child is asleep wa#e them up

• s;s o increased !/1

• no narcotics or pain medication0 report H/1

• omiting could be a sign o !/10 contact H/1

a-terial enin!itis1revention

• !mmuni3ation o Hib$ursing /onsideration

•


69/83

• maLor priorit o care o a -hild suspe-ted o+ havin! menin!itis is to administer anti"ioti-s ;0;4. Thechild is pla-ed on respirator isolation or at least 2# hours a+ter initiation o+ antimi-ro"ial medi-ation


70/83

ndo-rine 0stem: Chapter 2N (5 questions)

Type * destru-tion o+ pan-reati- "eta -ells0 which produce insulinI this usuallyleads to a"solute insulin de%-ien-.

o brupt onseto C>L years

o ,1s polyuria0 polydipsia0 polyphagia and underweightI others blurred vision andatigue

Type > usually arises because o insulin resistan-e in which the body ails to useinsulin properly combined with relative )rather than absolute- insulin de%-ien-

o Gradual onseto dults0 but increasing in childreno 1resenting symptoms may be r;t long term complications0 overweight


Type * replacement o insulin that the child can not produce

@pes o+ insulin:

o 3apid a-tin!: (=ovolo!, Mispiro)J Fnset 15 minutesJ 1ea# $N minJ Durationo 0hort a-itin! (=ovolin 3')J Fnset minJ 1ea# 2$# hoursJ DurationJ dminister ,L mintues beore mealso ntermediate$a-tin! (=ovolin =4H)J Fnset 2$6 hoursJ 1ea# #$1# hoursJ Duration *?+>L hourso Mon!$a-tin! (Mantus)J Fnset 6$1# hoursJ 1ea# 1$16 hours (no pea.)

J Duration ll day=ursin! Consideration8@reatment:=30=9 ;M3@:

• Hypoglycemic episodes most commonly occur beore meals or when the insulin e2ectis pea#ing

Hpo!l-emi- s8s: pallor0 tremulosness, palpations0 0 sweating0 hunger0 wea#ness0di33iness0 headache4.etc 'A9A9BA' cold and clamy give some candy

o Give a *L+*@ g simple carb )* TB6 o sugar- 0 ollowed by a comple% carb and aprotein )slice o bread or crac#er and protein such as 1B or mil#

Glucagon unctions by releasing stored glycogen rom the liver and re7uires about*@+>L minutes to elevate the blood glucose levels

o@ea-hin!

Timing o ood consumption must be regulated to correspond to the timing and actiono the insulin prescribed

A%tra ood is needed or increased activity

/oncentrated sweets are discouraged

(at is recommended to be reduced to ,LX or less o total caloric re7uirement

!nta#e o dietary fber


71/83

A%ercise lowers blood glucose levels0 i e%ercised is unplanned one can compensateby providing e%tra snac#. ! person is e%ercising consistently then insulin can bereduced

!ntegumentary 6ystem /hapter ,L ), 7uestions-

• 'elie o pruiurits by cooling the a2ected area and increasing the s#in pH withcool baths or compresses and al#aline applications )ba#ing soda baths-

• /lothing and bed linen should be sot and lightweight to decrease the irritantrom riction and stimulation

•


72/83

$euros#eletal 6ystem /hapter ,* )> 7uestions-

mmo"iliGation:• !nactivity leads to a decrease in the unctional capabilities o the whole body

as dramatically as the lac# o physical e%ercise leads to muscle wea#ness

• 9ost o the pathological changes that occur during immobili3ation arise romdecreased muscle strength and mass0 decreased metabolism0 and bonedeminerali3ations

• The daily stress on bone created by motion and weight bearing maintain thebalance between bone ormation and reabsorption

=ursin! Care8 treatment

• 6ystems that can be a2ected secondarily circulatory0 respiratory0 renal0muscular0 G! systems

• With long+term immobili3ation there may be neurological impairment0 andchanges in electrolytes )especially calcium-0 nitrogen balance0 and the

general metabolic rate• 1revent s#in brea#down placed on a pressure+reduction mattress to prevent

s#in brea#down0• /an use the Braden scale in the assessment or pressure ulcer

development or children at ris# or #in brea#down• ntiembolism stoc#ings or intermittent compression devices

• nticoagulant therapy

• Diet high protein0 high caloric oods are encourage to prevent negativenitrogen balance i there is anore%ia due to decrease in G! mobility

• $asogastric or gastrostomy eedings or ! 8uids may be needed to maintainnutrition

• When possible upright position

• Have child associate with others by increasing environmental stimuli andallowing social contact with others

• :se dolls or stu2ed animals to illustrate and e%plain immobili3ation methods

Have them parti-ipate in their on -are

9roth 4late (4hseal) nLuries• !t is the wea#est point o the cartilageI thereore it is a re7uent site o

damage during trauma. !t is important because it may a2ect uture bonegrowth.

Clini-al ani+estation (K 1$2)0i!ns o+ inLur:

• Generali3ed swelling

• 1ain or tenderness

• Deormity

• Diminished unctional use o a2ectedlimb or digit

a also demonstrate:• Bruising

• 6evere muscular[ rigidity

• /repitus )grating sensation ata racture site-

=30=9 ;M3@

• racture should be strongly suspected in a small child who reuses to wal#or crawl


9oal:

o To regain alignment and length o the bony ractures )reduction-


73/83

o To retain alignment and length )immobili3ation-o To restore unction to the inured partso To prevent urther inury and deormity

• (ractures are splinted or casted to immobili3e and protect the inurede%tremity

• 39=C @3;@=@ )pg. *L@U-

o Determine the mechanism o inuryo ssess the O1so 9ove the inured part as little as possibleo /over open wounds with sterile or clean dressingo mmo"iliGe the lim"0 including oints above and below the racture

siteI do not attempt to reduce the racture or push protruding boneunder the s#in.

o :se a sot splint )pillow or olded towel- or rigid splint )rollednewspaper or maga3ine-

o :ninured leg can serve as a splint or leg racture i no splint isavailable

o 'eassess neurovascular statuso pply traction i circulatory compromise is present

o Alevate the inured limb i possibleo pply cold to the inured areao /all emergency medical services or transport to medical acility

=30=9 ;M3@:

• /ompartment syndrome is a serious complication that results romcompression o nerves0 blood vessels0 and muscle inside a closed space. Theinury may be devastating0 resulting in tissue death0 and this re7uiresemergency treatment )asciotomy-. The O1s o ischemia rom a vascular0 sottissue0 nerve0 or bone inury should be included in an assessment o anyinury

o 1ain

o 1ulselessnesso 1alloro 1aresthesiao 1aralysiso 1ressure

@he Child in a CastCast ;ppli-ation:

• /onsider the child=s developmental stage beoreo 1reschool use a plastic doll or stu2ed animal to e%plain procedureo et them #now what to e%pect li#e that it will get warm during

application

o :se distracting methods li#e blowing bubbles0 as#ing them 7uestionsthat ocus on them etc• Turn child every > hours to help dry body cast evenly

• 6upport a plaster cast with a pillow0 and handle with palms o hands

• Hot spots elt or oul smelling odor can indicate inection=30=9 ;M3@0:

• Heated ans or dryers are not used because they cause the cast to dry on theoutside and remain wet beneath or cause burns rom heat conduction by wayo the cast to the underlying tissue


74/83

• Fbservations such as pain )unrelieved by pain medication * hour ateradministration0 especially with passive 'F9-0 swelling0 discoloration )pallor0cyanosis- o the e%posed portions0 decreased temperature0 paresthesia0 orthe inability to move the distal e%posed part)s- should be reported 61.4allor, paralsis, and pulselessness are late si!ns'

• FF< at (amily /entered /are+/ast /are 1G *LO*

•(eeding a child in a hip+spica cast

supine with head elevatedI• /hildren in spica cast usually fnd prone position easier or sel eeding

Cast 3emoval

• A%plain what the child should e%pect0 tic#ling sensation and heat may be elt.

• 'eassurance that it will be o#ay0 let them #eep cast at the end )i they wantto-

• Teach them that they can use mineral oil or lotion to remove particles letbehind.

evelopmental Dsplasia o+ the Hip:

• spectrum o disorders related to abnormal development o the hip that mayoccur at any time during etal lie0 inancy or childhood.

Dia!nosti- @estin! /s (MA at p! 16N):

rtonali

o !nvolves abducting the thighs to test or hip sublu%ation or dislocationo With clun# elicited )inants C ? wee#s-o 1ositive test hip reduced by abduction

arlo @est

o Thighs are adductedo 1ositive test hip is dislocated by adduction


75/83

Clini-al ani+estations:n+ants

• symmetry o gluteal andthigh olds

• imited abduction )as seen in8e%ion-

• pparent shortening o theemur )level o #nee 8e%ion-

• 6hortening o the limb on thea2ected side

• Broadening o the perineum)in a bilateral dislocation-

• Decreased hip abduction

lder n+ants:

•

2ected leg appears shorter than the other• Telescoping or piston mobility o oint+head emur elt to move up and down in

buttoc# when e%tended thigh is pushed frst toward child=s head and then pulleddistally

• @rendelen"ur! si!n+When child stands frst on one oot and then on the other)holding onto a chair0 rail- bearing weight on a2ected hip0 pelvis tilts downward onnormal side instead o upward0 as it would with normal stability

• Greater trochanter prominent and appearing above a line rom anterosuperior iliacspine to tuberosity o ischium


76/83

• 9ar#ed lordosis and waddling gait )bilateral hip dislocation-=ursin! Consideration8@reatment

9aor problem is the maintenance o the device and adaptations with childand;parent

=$6months

• 4avli. Harness0

o Hip in an abducted0 reduced positiono Worn continuously until the hip is proved stable on clinical and ultrasound

e%amination0 usually or O+*> wee#so 6ince inants grow rapidly0 the straps should be chec#ed wee#ly or adustments

)parent=s are not allowed to adust it-o 'emoving depends on the provider=s recommendation0 which will be based on the

deormity and amily level o understandingo 6#in care to prevent brea#down are very !91F'T$T" lways put on undershirts )or a shirt with e%tension that close at the crotch- under

the chest straps and put #nee soc#s under the oot pieces to prevent the straps romsubbing the s#in

" /hec# re7uently )at least >+,M a day- or red areas under the straps and the clothing" Gentle massage healthy s#in under the straps once a day to stimulate circulation0 !n

general avoid lotions and powders0 because they can ca#e and irritate the s#in" lways place the diaper under the straps• Fther devices are used or adduction contracture is present

• When there is diculty maintain stable reduction0 a hip spica cast is used andchanged periodical to accommodate the child=s growth.

• Duration o treatment on the development o the acetabulum0 but is usualla--omplished ithin the 1st ear6$2# months

• 6urgical closed reduction is perormed

• 6pica cast or almost *> wee#s F' a abduction orthosis may be used

• Fpen reduction is perormed i hip remains unstablelder Children

• 9ore dicult to accomplish in this age group0 the older the child gets the harder it isto reconstruct

• 'e7uires several procedures0 and complete reconstruct=30=9 ;M3@:

• The ormer practice o double or triple diapering or DDH is not recommendedbecause there is no evidence to support its ecacy.

Clu"+oot• comple% deormity o the an#le and oot that includes oreoot adduction0

midoot supination0 hindoot varus0 and an#le e7uinus=ursin! Consideration8@reatment

• Goal is to achieve painless0 planti!rade0 & sta"le +oot

• 1onseti methodI 0erial -astin! is stared right ater birth• Wee#ly gentle manipulation and serial long+leg cast allow or gradual

repositioning o the oot.• A%tremities are casted until ma%imum correction is achieved -an ta.e 6$1

ee.s

• Then tenotom is perormed

• Then lon!$le! -ast is perormed and let or ee.s

• 4onseti sandals or strai!ht$la-ed shoes placed in abduction are thenftted to prevent recurrence


77/83

• !nability to achieve normal oot alignment ater casting and tenotomyindicates the need or surgical intervention

4arent @ea-hin!:

• :nderstand the importance o regular cast changes0 and the role they play inthe long+term e2ectiveness o the therapy

• Teach parent care o the cast appliances

steo!enesis mper+e-ta

Fsteoporosis syndrome in children

Heterogeneous inherited disorder o connective tissue

Deective periosteal bone ormation and reduced cortical thic#ness obones


• 1rimarly supportive

• Bisphiosphonate therapy with ! pamidronate to promote increased bone

density and prevent ractures has become standard therapy or manychildren )however0 long bones are wee#end by prolonged treatment

• ightweight braces and splints help support limbs0 prevent ractures and helpto get around

• 1hysical therapy

• 6urgery to treat maniestations

4arent @ea-hin!

• 'e7uire careul handling to prevent ractures supported when being turned0positioned0 moved0 held. $ever hold by the an#les when diapered0 instead litby the buttoc#s or

Child Health Final

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Transcript of Child Health Final