COMMON HEALTH PROBLEMS IN PRESCHOOLERS

LEUKEMIA

Definition:

The word Leukemia comes from the Greek leukos which means "white" and aima which means "blood".

Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones.

Normal function:

White blood cells , which help your body fight infection. Red blood cells , which carry oxygen to all parts of your body. Platelets , which help your blood clot. The total number of white blood cells normally ranges from

4 million to 11 million cells per milliliter of blood.

Experts don't know what causes leukemia. These things are called risk factors.

a) Previous cancer treatment.b) Genetic disorders, such as Down syndrome.c) Certain blood disorders, such as myelodysplastic syndromes. d) Exposure to certain chemicals, such as benzene.e) Smoking.f) Family history of leukemia.

Leukemia is more common in boys than in girls after 1 year of age.

The first type of classification is by how fast the leukemia progresses: I. Acute leukemia -the abnormal blood cells are immature blood cells (blasts). They can't carry out

their normal work, and they multiply rapidly, so the disease worsens quickly.II. Chronic leukemia -this type of leukemia involves more mature blood cells. These blood cells

replicate or accumulate more slowly and can function normally for a period of time.

The second type of classification is by type of white blood cell affected:

I. Lymphocytic leukemia -affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system.

II. Myelogenous leukemia -this type of leukemia affects the myeloid cells (myelocytes). Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells.

Types of leukemia:

I. Acute lymphocytic leukemia (ALL)The most common type of leukemia in young children and can also occur in adults.

II. Acute myelogenous leukemia (AML) Is a common type of leukemia occurs in children and adults. AML is the most common type of acute leukemia in adults.

III. Chronic lymphocytic leukemia (CLL)With CLL, the most common chronic adult leukemia, you may feel well for years without needing treatment.

IV. Chronic myelogenous leukemia (CML)Mainly affects adults. A person with CML may have no symptoms for months or years before entering a phase in which the leukemia cells grow more quickly.

V. Hairy cell leukemiaIs a rarer type of leukemia that is existing.

Signs &Symptoms:

Severe Headaches . Bruising or bleeding easily. Bone or joint pain. A swollen or painful belly from an enlarged spleen. Fever or chills Swollen lymph nodes in the armpit, neck, or groin. Feeling very tired or weak. Losing weight and not feeling hungry. Frequent infections Tiny red spots in your skin (petechiae) Excessive sweating, especially at night

How is leukemia diagnosed?

Review of health history Perform physical exam (swollen lymph nodes spleen or liver is enlarged) blood tests bone marrow biopsy .

How is it treated?

Chemotherapy Radiation treatments Stem cell transplant Biological therapy

Nursing Management:

a) Place in a private room and limit visitors to immediate family for the present to protect patient from potential source of pathogens or infection.

b) Required good hand washing protocol for all personnel and visitors to reduce risk of infection.c) Handle patient gently and keep linens dry or free from wrinkles to prevent sheet burn or skin

excoriation.d) Instruct to perform oral hygiene every 2 to 4 hours, using a soft-bristle toothbrush, sponge or

swab because oral cavity is a medium for growth of organism and is susceptible to ulceration and bleeding.

e) Instruct to avoid foods that may damage oral mucosa, such as very hot, very cold, or highly acidic or spicy foods.

f) Provide for periods of rest alternating with activity to conserve energy for healing and cellular regeneration.

Nephroblastoma (Wilms’ Tumor)

Is a malignant tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney (Melean & Castellino, 2008).

It occurs in association with congenital anomalies such as aniridia (lack of color in the iris), cryptorchidism, hypospadias, pseudohermaphroditism, cystic kidneys, hemangioma & talipes disorders.

Without therapy metastatic spread by the bloodstream is most often to the lungs, regional lymph nodes, liver, bone and eventually, brain.

Usually discovered early in life (6mos to 5 years; peak at 3 to 4 years)

Manifestion:

a) Abdominal massb) Abdominal swellingc) Hematuria d) Low-grade fevere) Anemic from lack of erythropoietin formation by the diseased kidneyf) Hypertension

Diagnostic test:

Abdominal CT scan Chest X-ray Ultrasound Kidney function studies, such as glomerular filtration rate or blood urea nitrogen, will be done to

assess function of the kidney before surgery. MR surveillance in a patient with VHL disease shows hemangioblastomas (arrows) in (A) Brain

and (B) Spine. Ultrasound surveillance in BWS. (A) Typical appearance of Wilms tumor as intrarenal mass with

"claw sign" (arrow) formed by interface with normal renal parenchyma. (B) Typical appearance of hepatoblastoma as intrahepatic mass with dense calcifications (arrow).

Therapeutic Management:

a) Nephrectomy ( excision of the affected kidney)b) Radiation Therapyc) Chemotherapy

Staging NephroblastomaManagement:

Monitor vital signs Perform tepid sponge bath Place a sign reading “ NO Abdominal Palpation” over the child’s crib

Complications:

In girls, radiation related damage to the ovaries may result in sterility. Radiation to lungs may result in interstitial pneumonia. Spine radiation can result to scoliosis.

ASTHMA

Definition:

Asthma attacks all age groups but often starts in childhood. It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in

severity and frequency from person to person. This condition is due to inflammation of the air passages in the lungs and affects the sensitivity

of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs.

Types of asthma

1. Exercise-Induced Asthma Exercise-induced asthma is a type of asthma triggered by exercise or physical exertion. Many people with asthma experience some degree of symptoms with exercise.

However, there are many people without asthma, including Olympic athletes, who develop symptoms only during exercise.

2. Cough-Variant Asthma In the type of asthma called cough-variant asthma, severe coughing is the predominant

symptom. There can be other causes of cough such as postnasal drip, chronic rhinitis, sinusitis, or

GER disease (heartburn). Coughing because of sinusitis with asthma is common.

3. Occupational Asthma This type of asthma is triggered by something in the patient's place of work. Factors such as chemicals, vapors, gases, smoke, dust, fumes, or other particles can

trigger asthma. It can also be caused by a virus (flu), molds, animal products, pollen, humidity and

temperature. Another trigger may be stress. Occupational asthma tends to occur soon after the patients starts a new job and

disappears not long after leaving that job.

Causes:

In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).

Common asthma triggers include:

a) Animals (pet hair or dander) b) Dust c) Changes in weather (most often cold weather) d) Chemicals in the air or in food e) Exercise f) Mold

Symptoms:

Cyanosis to the lips and face Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack Extreme DOB Tachycardia Severe anxiety due to shortness of breath Sweating Cough with or without sputum (phlegm) production Intercostal retractions Shortness of breath that gets worse with exercise or activity Wheezing, which:

Comes in episodes with symptom-free periods in between May be worse at night or in early morning May go away on its own Gets better when using drugs that open the airways (bronchodilators) Gets worse when breathing in cold air Gets worse with exercise Gets worse with heartburn (reflux) Usually begins suddenly

Other symptoms:

Abnormal breathing pattern --breathing out takes more than twice as long as breathing in Breathing temporarily stops Chest pain Tightness in the chest

Factors:

Having a blood relative (such as a parent or sibling) with asthma Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever) Being overweight Being a smoker Exposure to secondhand smoke Having a mother who smoked while pregnant

Exposure to exhaust fumes or other types of pollution Exposure to occupational triggers, such as chemicals used in farming, hairdressing and

manufacturing Low birth weight

Tests:

1. Arterial blood gas 2. Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune

system protein called an immunoglobulin) 3. Chest x-ray 4. Lung function tests

Preventions:

You can reduce asthma symptoms by avoiding known triggers and substances that irritate the airways.

Cover bedding with "allergy-proof" casings to reduce exposure to dust mites. Remove carpets from bedrooms and vacuum regularly. Use only unscented detergents and cleaning materials in the home. Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold. Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the

possibility of cockroaches, which can trigger asthma attacks in some people. If a person is allergic to an animal that cannot be removed from the home, the animal should be

kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes

as much as possible. Eliminate tobacco smoke from the home. This is the single most important thing a family can do

to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair -- this can trigger asthma symptoms.

The goals of treatment are:

Control airway swelling Stay away from substances that trigger your symptoms

Two Basic Kinds of Medication For Treating Asthma:

1. Control drugs to prevent attacks2. Quick-relief (rescue) drugs for use during attacks

1. Control drugs Control drugs for asthma are drugs you take to control your asthma symptoms. Must be taken every day for efficacy. Must take these drugs for at least a month before ones’ start to feel better. Must be taken even when feeling better.

1. Inhaled Corticosteroids- Helps keep your airways from swelling up. ( Aerobid , Asmanex, Azmacort , Flovent , Pulmicort)

2. Long-acting Beta-agonist Inhalers- They relax the muscles of your airways. These medicines can help keep your asthma symptoms away. (Brovana, Foradil, Perforomist , Serevent , Leukotriene modifiers, Accolate ,Singulair , Zyflo )

3. Combination Therapy4. Leukotriene Modifiers - These medicines are used to prevent asthma symptoms. (pill)5. Cromolyn - is a medicine that may prevent asthma symptoms. (aerosol). E.g.Cromolyn Sodium

(Intal), Nedocromil (Tilade)

6. Immunomodulators – These are a new class of asthma medications that are used as an add-on therapy in people who have severe persistent asthma with allergies that has not responded adequately to inhaled steroids. Immunomodulators are a type of antibody. (Xolair )

2. Quick-relief (rescue) drugs: Can be taken when coughing, wheezing, having trouble breathing, or having an asthma attack.

They are also called "rescue" drugs. They also can be used just before exercising to help prevent asthma symptoms that are caused

by exercise. Short-acting bronchodilators (inhalers), such as : Albuterol (Proventil, Ventolin), Metaproterenol (Alupent, Metaprel), Pirbuterol (Maxair), Terbutaline (Brethine, Brethaire, and Bricanyl), Bitolterol (Tornalate), Levalbuterol (Xopenex)

Complications:

a) Death b) Decreased ability to exercise and take part in other activities c) Lack of sleep due to nighttime symptoms d) Permanent changes in the function of the lungs e) Persistent cough f) Trouble breathing that requires breathing assistance (ventilator)

Nursing Intervention

1. Maintain respiratory function and relieve bronchoconstriction while allowing mucus plug expulsion.

2. Control exercise-induced asthma by having the patient sit down, rest, and use diaphragmatic and pulse-lip breathing until shortness of breathsubsides.

3. Supervise the patient’s drug regimen. 4. Demonstrate the proper use of metered doe inhaler properly. 5. Reassure the patient during an asthma attack and stay with him. 6. Place the patient in semi-fowler position and encourage diaphragmatic breathing. 7. Assist him to relax as much as possible.

8. As ordered, administer oxygen by nasal cannula toease breathing and to increase arterial oxygen saturation during an acute asthma attack.

9. Adjust oxygen according to the patient’s vital functions and ABG measurements. 10. Administer drugs and I.V. fluids as ordered. 11. Combat dehydration with I.V. fluids until the patient can tolerate oral fluids, which will help

loosen secretions. 12. Encourage the patient to express his fears and concerns about his illness. 13. Encourage the patient to identify and comply with care measures and activities that promote

relaxation.

URINARY TRACT INFECTION (UTI)

Is an infection that affects the urinary tract.

CAUSES

Microbes including fungi, viruses, and bacteria Bacterium Escherichia coli (E. coli) causes the vast majority of UTIs. The Bacteria are the most

common cause.

RISK FACTORS Throughout childhood, the risk of having a UTI is 2 percent for boys and 8 percent for girls. Having an anomaly of the urinary tract, such as urine reflux from the bladder back into the

ureters, increases the risk of a UTI. Boys who are younger than 6 months old who are not circumcised are at greater risk for a UTI

than circumcised boys the same age.

Other risk factors for developing a UTI include:

An abnormality in the structure or function of the urinary tract (for example, a malformed kidney or a blockage somewhere along the tract of normal urine flow)

An abnormal backward flow (reflux) of urine from the bladder up the ureters and toward the kidneys. This condition, known as vesicoureteral reflux (VUR).

Poor toilet and hygiene habits The use of bubble baths or soaps that irritate the urethra Family history of UTIs

CLINICAL MANIFESTETIONS

Dysuria Frequency Abdominal pain Flank pain unpleasant smelling urine hematuria

Your child could also feel generally unwell with any of the following: Fever

vomiting tiredness irritability not eating well not gaining weight properly jaundice

Types of urinary tract infection

A lower UTI is an infection of the lower part of the urinary tract, which includes the bladder and the urethra. An infection of the bladder is called cystitis, and an infection of the urethra is known as urethritis.

An upper UTI is an infection of the upper part of the urinary tract, which includes the kidneys and the ureters. Upper UTIs are potentially more serious because there is a risk of kidney damage. An infection of the kidneys is known as pyelonephritis.

PREVENTIVE MEASURES

Avoid giving your child bubble baths. Have your child wear loose-fitting underpants and clothing. Increase your child's intake of fluids. Keep your child's genital area clean to prevent bacteria from entering through the urethra. Teach your child to go the bathroom several times every day. Teach your child to wipe the genital area from front to back to reduce the chance of spreading

bacteria from the anus to the urethra.

DIAGNOSIS

URINALYSIS

Findings on examination that may indicate a diagnosis of UTI include:

Raised temperature Dehydration Enlarged or painful bladder upon palpation (child may feel the urge to void) Abdominal or loin tenderness

NURSING INTERVENTION Assess pain, noting location, intensity (scale of o-10), duration. Encourage increase fluid intake. Investigate report of bladder fullness. Observe for changes in mental status, behavior or level of consciousness. Provide comfort measure like back rub, helping patient assume position of comfort. Encourage use of sitz baths, warm soaks to the perineum.

TREATMENT

Empiric antibiotic therapy

Empiric Oral Antibiotic Therapy for UTI in Children

Antibiotic Daily dosageAmoxicillin 20 to 40 mg/kg in 3 dosesCefixime (Suprax) 8 mg/kg in 2 dosesCefpodoxime (Vantin) 10 mg/kg in 2 dosesCefprozil (Cefzil) 30 mg/kg in 2 dosesCephalexin (Keflex) 50 to 100 mg/kg in 4 dosesLoracarbef (Lorabid) 15 to 30 mg/kg in 2 dosesSulfisoxazole(Gantrisin) 120 to 150 mg/kg in 4 doses

NEPHROTIC SYNDROME

DEFINITION

a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine.

It is usually caused by one of the diseases that damage the kidneys’ filtering system.

PATHOPHYSIOLOGY

The underlying problem that leads to nephrotic syndrome would be the damage caused to small blood vessels of the kidneys which will filter out the larger protein elements in the blood which would otherwise be retained within the circulation. Many factors can lead to such damage to the kidney tissues and most often the underlying cause could not be identified.

CAUSES

PRIMARY NEPHROTIC SYNDROME

Result of a disease limited to the kidney.

Minimal Change Disease (MCD)- the most common cause of nephrotic syndrome in children.

Focal Segmental Glomerulosclerosis –the most common cause of nephrotic syndrome in adult

They are considered to be "diagnoses of exclusion", they are diagnosed only after secondary causes have been excluded.

Secondary Nephrotic Syndrome

affects the kidney and other parts of the body.

Secondary causes by histologic pattern:

Membranous nephropathy (MN) :

Hepatitis B & Hepatitis C

Sjögren's syndrome

Systemic lupus erythematosus (SLE)

Diabetes mellitus

Sarcoidosis

Drugs (such as corticosteroids, gold, intravenous heroin)

Malignancy (cancer)

Bacterial infections, e.g. leprosy & syphilis

Protozoal infections, e.g. malaria

Focal Segment Glumerulosclerosis

Hypertensive nephrosclerosis

HIV

obesity

Kidney loss

Minimal change disease (MCD)

Drugs

Malignancy

Allergy

Bee sting

OTHER CAUSES

Changes in immune system

Local inflammation or swelling damages and scars.

CLINICAL MANIFESTATIONS

Edema-The major manifestation of nephrotic syndrome is edema. It is usually soft and pitting, and is most commonly found around the eyes (periorbital), in dependent areas (sacrum, ankles and hands) and in the abdomen (ascites).

Foamy appearance of the urine

High blood pressure

Weight gain from fluid retention

Poor appetite

Malaise

Head ache

Irritability

Fatigue

CHARACTERISTICS

• Excess fluid

• Puffiness around the eyes, characteristically in the morning.

Pitting edema over the legs

Generalized edema throughout the body known as anasarca

Anemic

Dyspnea

DIAGNOSIS

24 hour urine protein measurement

Blood tests

Biopsy

Sometimes further tests may be required. These may include:

Ultrasound

Computed tomography (CT) scan or magnetic resonance imaging (MRI)

Treatment depends on the severity of the condition, this may include:

Specific medications treatment for some of the causes (for example, steroids for minimal change, immunosuppression for membranous nephropathy or focal sclerosis) – this may lead to complete or partial remissions of the nephrotic syndrome

Diuretics to control the swelling tendency

Medication to control high blood pressure

Preventive measures:

Avoid respiratory infections

Control underlying disease conditions such as diabetes and lupus

Dietary modifications-Low salt diet will prevent further accumulation of body fluids and also will prevent the rise of blood pressure at times of a nephrotic episode.

NURSING INTERVENTIONS

Relieve excess fluid by administering steroids or alternative drugs as prescribed.

Offer foods high in potassium, low in sodium, fat and sugar.

Encourage activity as tolerated.

Restrict fluids as ordered. Strictly monitor intake and output.

Weigh patient daily.

Provide meticulous skin care to the edematous parts of the body.

Frequently check the patient’s urine for protein, indicated by frothy appearance.

Monitor and document the location and character of edema assess the patient’s response to prescribed medications

Give emotional support to the child and his parents.

Help child adjust to body image changes by explaining changes ahead of time

Complications

Dehydration

Blood clots

Infection

Kidney failure

TONSILITIS

Tonsillitis

is a term commonly used to refer to infection and inflammation of the palatine tonsils.

S/S

• Fever and sore throat

• Nausea, vomiting, or abdominal pain

• Cough or hoarseness

• Runny or stuffy nose

• Yellow or white patches on the back of the throat

• Bad breath

• Rash on the body or in the mouth

How is it diagnosed

• Throat culture

• Blood tests

treatment

• Ibuprofen: This medicine decreases pain, swelling, and fever.

- . Ibuprofen can cause stomach bleeding and kidney damage if not taken correctly.

• Acetaminophen: This medicine decreases pain and fever.

-. Acetaminophen can cause liver damage if not taken correctly.

• Antibiotics: This medicine is given to fight or prevent an infection caused by bacteria. Give it to your child as directed.

• Tonsillectomy: This is surgery to remove your child's tonsils.

Tonsillectomy

management

• Bed rest.

• Provision of adequate fluids and light diet.

• Giving medications (analgesics and antibiotics).

• If no progress then the alternative measures that can be done is surgery.

• Gargling with warm salt water (8 ounces of warm water mixed with 1 teaspoon salt) will ease sore throat pain. Gargle several times a day.

STRABISMUS

CROSSED EYES/ SQUINT

Definition:

STRABISMUS this is a disorder in which the two eyes do not line up in the same direction, and therefore do not look at the same object at the same time. The condition is more commonly known as “crossed eyes”.

CLASSIFICATION:

Strabismus is classified by the direction the eye turns:

Inward turning is called esotropia

Outward turning is called exotropia

Upward turning is called hypertropia

Downward turning is called hypotropia

Other classifications of strabismus include: ~The frequency w/ which it occurs- either constant or intermittent ~Whether it always involves the same eye- unilateral

~If the turning eye is sometimes the right eye and other times the left eye- alternating

RISK FACTORS:

1. FAMILY HISTORY- individuals w/ parents or siblings who have strabismus are more likely to develop it.

2. REFRACTIVE ERROR- people who have a significant amount of uncorrected farsightedness (hyperopia) may develop strabismus because of the additional amount of eye focusing required to keep objects clear.

3. MEDICAL CONDITIONS- people w/ conditions such as down syndrome and cerebral palsy or who have suffered a stroke or head injury are at a higher risk for developing strabismus.

symptoms:

Symptoms of strabismus may be present all the time, or may come and go. symptoms may include:

Crossed eyes

Double vision

Eyes that do not align in the same direction

Uncoordinated movements (eye do not move together)

Vision or depth perception loss

EXAMS AND TESTS:

A physical examination will include a detailed examination of the eyes. Test will be done to determine how much the eyes are out of alignment.

Eye tests include:

Corneal light reflex

Cover/uncover test

Retinal exam

Standard ophthalmic exam

Visual acuity

TREATMENT:

EYEGLASSES OR CONTACT LENSES- maybe prescribe for patients w/ uncorrected farsightedness. This may be the only treatment for some patients / accommodative esotropia. Once the farsightedness is corrected, the eyes require less focusing effort and my remain straight.

PRISM LENSES- are special lenses that have a prescription for prism power in them. It alter the light entering the eye and assist in reducing the amount of turning the eye has to do to look at objects. Sometimes the prism are able to fully compensate for and eliminate the eye turning.

VISION THERAPY- is a structured program of visual activities prescribe to improve eye coordination and eye focusing abilities. Vision therapy trains the eyes and brain to work together more effectively . These eye exercises help remediate deficiencies in eye movement, eye focusing and eye teaming and reinforce the eye-brain connection. Treatment may include office- based as well as home training procedures.

EYE MUSCLE SURGERY- can change the length or positions of the muscles around the eye in an attempt to better align the eyes. Eye muscle surgery may be able to physically align the eyes so they appear straight. Often a program of vision therapy may also be needed to develop a functional improvement in eye coordination and to keep the eyes from reverting back to their previous condition of misalignment.

Nursing interventions:

Encourage wearing of eyeglasses if prescribed.

Provide postoperative care by protecting the operative site with eye patching.

Apply antibiotic or drops to the affected eye.

Discourage a child from rubbing his eyes, postoperatively.

Teach the parents how to administer eye medications and apply eye patches, if ordered.

Teach the parents or patient eye exercises.

PRE-SCHOOLERSAGE 4-6 YEARS OLD

CONJUNCTIVITIS

DEFINITION:

Conjunctivitis is an infection in the lining over the eyeball and inside the eyelids.

Causes:

Conjunctivitis can be caused by:

~Infection by germs (virus or bacteria); this called infective conjunctivitis.

~Allergies

~Something (foreign body) getting into the eye and irritating.

Signs and symptoms:

~redness of the eye

~irritation (like having sand in the eye)

~discharges (may be clear, milky or pus-like)

~tears

~swelling of the eyelids

~crusts that form on the eyelid overnight

~itching

Treatments:

MEDICATIONS

The treatment for pinkeye depends on the cause:

~BACTERIA. Pinkeye caused by bacteria is treated w/ antibiotics, in the form of eye drops or ointments. Eyes drops or ointments may need to be applied to the inside of the eyelid three to four times a day for five to seven days.

`

VIRUSES. This type of pink eye often results from the viruses that cause a common cold. It usually lasts from four to seven days. Viral conjunctivitis can be highly contagious.

ALLERGIES. Allergy associated conjunctivitis should improve once the allergy is treated and allergen removed.

OTHER HOME REMEDIES:

Apply a compress to your eyes. A cool water compress may help relieve allergic conjunctivitis. If you have viral/bacterial conjunctivitis, you may prefer a warm compress. If pink eye affects only one eye, don’t touch both eyes w/ the same cloth.

Over-the-counter eye drops called artificial tears may relieve symptoms. Do not use the same bottle of drops in an infected eye.

~ Protect your eyes from dirt and other irritating substances.

~ For teens. Avoid the use of makeup and remove contact lenses, if you wear them.

PREVENTION:

~Do not touch/ rub the infected eye(s).

~Perform hand washing

~Use a clean towel

~ Do not share towel, eye cosmetics/ personal eye-care items

Bacterial conjunctivitis

Viral conjunctivitis

Allergic conjunctivitis

MEDICAL MANAGEMENT:

For more severe cases, topical conjunctivitis, eye drops or ointments are prescribe.

Patient w/ allergic conjunctivitis especially recurrent or seasonal conjunctivitis are usually given corticosteroids in ophthalmic preparation

Use of vasoconstrictors such as topical epinephrine solution, cold compresses, ice packs, and cool ventilation usually provide comfort by decreasing swelling.

For conjunctivitis caused chemical irritants, the eye must be irrigated immediately and profusely w/ saline or sterile water.

NURSING INTERVENTIONS:

~May use light cold compresses over the eye for about 10min. 4 to 5 times a day to soothe the pain.

~May use artificial tears for the sandy sensation in the eye and mild pain medications such as acetaminophen.

~Instruct the client to stay at home. Children must not play outside. May return to work or school after 7 days when the redness and discharge have cleared.

~Do not share towels, linens, make up or toys.

~ Wash hands thoroughly w/ soap and water frequently before and after applying the eye drops / cold compresses.

~Use a new tissue every time you wipe the discharge from the eye.

~Discard all make up articles. Must not apply make up until the disease is over.

APPENDICITIS

Appendicitis

is an acute inflammation of the appendix.

causes

obstruction or blockage due to:

• Fecalith presence in the lumen of the appendix

• Appendix tumor

• The presence of foreign objects such as ascariasis worm.

• Appendix mucosal erosion due to parasites such as: E. Histilitica.

S/S

• Lower right abdominal pain

• Low grade fever

• Loss of appetite

• Nausea and vomiting

• Diarrhea

• Swollen or bloated abdomen

Complications:

-If appendicitis goes untreated, the inflamed appendix can burst 24 to 72 hours after the symptoms begin.

-If the appendix has burst, the pain may spread across the whole abdomen, and the child's fever may be very high, reaching 104°F (40°C).

TREATMENT

Appendectomy- Surgical removal of the appendix

Management of Appendicitis

Preoperative Appendectomy, including patients in hospital,

given antibiotics and compress, to reduce the

temperature of the patient

the patient is asked to bed rest and fasted.

Operative action; Appendectomy

Postoperative Appendectomy, one day post surgery

Encouraged to sit upright in bed for 2 x 30 minutes,

the next day soft food and stand upright outside the room,

the seventh day stitches removed, the client's home.

SICKLE CELL DISEASE

Definition:

SCD is a serious disorder in which the body makes sickle-shaped red blood cells. “Sickle-shaped” means that the red blood cells are shaped like a crescent.

Normal Red Blood Cell:

Disc-shaped and look like doughnuts without holes in the center.

They move easily through your blood vessels.

Red blood cells contain an iron-rich protein called hemoglobin. This protein carries oxygen from the lungs to the rest of the body.

Sickled Red Blood cell:

Sickle cells are stiff and sticky.

The sickled red blood cells are fragile and prone to rupture.

The irregular sickled cells can also block blood vessels causing tissue and organ damage and pain.

What causes sickle cell disease?

Sickle cell disease is inherited. To get sickle cell disease, a child has to inherit two sickle cell genes-one from each parent.

When a child inherits the gene from just one parent, that child has sickle cell trait. Having this trait means that you do not have the disease but you are a carrier and could pass the gene on to your children.

Signs & Symptoms:

Fatigue

Anemia

Pale looking

Jaundice

Dactylitis (swelling and inflammation of the hands and/or feet)

Arthritis (inflammation of the joints )

Splenic Sequestration (sudden pooling of blood in the spleen) & Liver Congestion

Lung and Heart Injury

Leg Ulcers

Aseptic Necrosis and Bone Infarcts (death of portions of bone)

Eye Damage

Priapism (abnormally persistent erection of the penis in the absence of sexual desire)

How is sickle cell disease diagnosed?

A simple blood test can show whether a person has sickle cell disease.

How is it treated?

Early treatment includes daily antibiotics from 2 months to 5 years of age to help prevent infections.

Routine childhood immunizations are also important (particularly against the flu and some bacteria).

Blood transfusions

Nursing Management:

Instruct child to avoid physical exertion, emotional stress, low oxygen environments (e.g., airplanes, high altitudes) it increases the need of oxygen.

Encourage the child to take fluids and observe for signs dehydration.

Position carefully. Joints and extremities can be extremely painful.

Isolate the child from possible sources of infection. Instruct parents about signs of infection and encourage them to seek prompt health care.

Restriction of persons with infection decreases the child’s contact with infectious agents. Prompt care for infection reduces the chance of sickle-cell crisis.

Promotion of electrolyte balance and prevention of dehydration.