ncm 102 child continuation

8/3/2019 NCM 102 Child Continuation

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by:

Ma. Fe V. Juen

BSN, RN, MN


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Colic

Clinical Manifestations:

a. loud increase crying

b. Red and flushed face

c. Clenched fistd. Sucks vigorously

e. abdomen becomes tensed

f. Pulls legs against abdomen


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Colic

Causes of Colic:

Assessment:

a. Thorough history b. Duration and its frequency

c. Ask what happens before the attack

d. Description and associated symptoms

e. Number and type of bowel movements

f. Family and medical history

g. Determine babys feeding pattern.


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Colic

Nursing Management:a. Hold the baby upright and allow to burp

after feeding-b. Change maternal diet for breastfeed

baby-c. Frequent small feedings-d. Use of pacifier-e. use of formula bottles with disposablebags

that collapse as the baby sucks-f. Taking for a car rides-g. Music boxes-h. Anti- flatulent agent-


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Otitis Media

Data base:

Most prevalent disease of chidhood-

Most often in children 6 to 36 months old

andagain at 4 to 6 years old

Mostly in males and children with cleftpalate-

Higher incidence in formula fed babies-Associated with constant pacifier use

Highest in winter and spring-


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Otitis Media

Assessment:

Causative Agent:

Therapeutic Management:

a. Analgesics/ Antipyretic-

b. Decongestant

c. Cephalosporin


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Meningitis

An inflammation of the meninges thatdevelops as a result of infection fromeither bacterial or viral agents.

Causes of Bacterial Meningitis:

Secondary Response to a Primary

Infection:

Pathophysiology:


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Meningitis

Clinical Manifestations: Depends on ageand pathogens

Infants Less than 3 Months:

Age Over 2 years:


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Meningitis ( Bacterial ) Diagnostic Examination: a. Microscopic exam and culture of blood, csf

and urineb. Serum electrolyte and Osmolarity-

c. Clotting studies-d. Lumbar puncture-normal opening pressure for infant- 50

mm of H2O.normal opening pressure for a child- 85

mm of H2O

CSF Analysis Results if with Meningitis:


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Meningitis

Therapeutic management:

a. Cardiopulmonary monitor until stable

b. Supplemental O2

c. Management if there is a sign of DICd. Benzodiazepine-

e. Phenytoin-

f. Antibiotics-

g. Dexamethasone-

h. Multidesciplinary approach-


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Meningitis Nursing management:

a. Appropriate protective attire- j. Comfortmeasures

b. Vital signs- k.Observe signs of

c. Inspect skin frequently- complicationsd. Monitor the LOC- I. Health

instructionse. Palpate the fontanelle- to family of ffg:f. Measure head circumference

m.multidesciplanaryg. Monitor signs of seizure- approach.h. Maintain normothemia-i. Medications as presribed-


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Meningitis ( Viral)

An inflammatory response of leptomeninges

Adolescence are usually more at risk-

The Viruses Includes;

Herpes, Adenovirus and Arbovirus-

Others;

Clinical manifestations:

Irritable and Lethargic

General malaise-

Upper resp symptoms

Signs of meningeal irritation

Fever an seizure


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Meningitis ( Viral )

Diagnostic Exam:

a. CSF analysis-

b. WBC count-

c. Glucose- d. Protein-



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Meningitis ( Viral )

Nursing management:

a. Comfort measures

b. Analgesics and Antipyretics as

prescribed. c. Increase fluids both IV and oral

d. Health instructions to family on thefollowing;


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Burns

-Are injuries to body tissue caused byexcssive

excessive heat-

Commonly occur in children 1-4 years of

age and the 3rd greatest cause in children

age

5- 14 years.

Assessment:

The first question to be asked;-


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Burns

Classification According to Criteria ofAmerican Burn Association:

a. Minor- 1st degree lesser than 10% ofbody surface.

Or 3rd degree less than 2% of bodysurface

No area of the face, feet, hands, or

genitalia burned.


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Burns

b. Moderate-2nd degree between 10% to 20%

on the face, hands, feet or genitalia

3rd degree less than 10% of body

surface or smoke inhalation has

occurred.

c. Severe- 2nd degree greater than 20% of

body surface

3rd degree greater than 10% ofbody surface.


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Burns Characteristics:

1st degree- Epidermis, erythematous, dryand painful, Ex. Sunburn

2nd degree - Epidermis and portion of dermis,

blistered, erythematous to white

Ex. Scalds

3rd degree- Entire skin, nerves and blood

vessels in skin.

Leathery, black / white, not sensitive to pain- Ex. Flame


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Burns Nursing Diagnosis: a. Pain R/T trauma to body cells b. Deficient fluid volume R/T to fluid shifts c. Risk for ineffective breathing patterns R/T respiratory edema from burn injury d. Risk for ineffective tissue perfusion R/T cardiovascular adjustments after burn injury. e. Risk for impaired urinary elimination R/T burn injury f. Risk for imbalanced nutrition, less than body req. g. Lowered resistance to infection- h. Social isolation R/T infection control precautions I. Interrupted family processes

J. Deficient diversional activity K. Disturbed body image


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Burns Therapeutic Management:

a. Open Method- Exposed to air used forsuperficial burns or body parts that

are prone to infection

Advantages:

Disadvantages:


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Burns

b. Close Method- burn is covered withnon-

adherent gauze, used formoderate

and severe burn

Advantages:

Disadvantages:


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Burns c. Topical Therapy;

- Silver Sulfadiazine ( Silvadine ) drug of choice

- Antiseptic solution ( Povidone Iodine )

- Nitrofurazone ( Furacin )

d. Escharotomy-

e. Debridement-

f. TENS ( Transcutaneous Electrical Nerve

Stimulation-

g. Grafting ( Homografting/ Allografting-

- Heterografts ( Xenografts )

- Autografting


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6. Poisoning Bacterial infectious diseases that cause diarrhea and

vomiting.

1. Salmonella- most common type of food

poisoning

Inc. period- Period of Com.-

Mode of Transmission-


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Poisoning Clinical Manifestations:

a. Diarrhea, abdominal pain, vomiting, fever,

and headache

b. Diarrhea may contain blood and mucus

Diagnostic exam:



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Poisoning 2. Listeriosis-

Causative Agent: Listeria Monocytogenes Inc. Period:

Mode of Transmission:

Clinical Manifestations:a. Muscle aches, fever, nausea, and diarrheab. Headache, stiff neck, confusion, loss of balancec. Convulsion-

- Therapeutic Management:


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Poisoning

3. Shigellosis ( Dysentery )

Causative Agent- Genus Shegella

Inc. period:

Period of Communicability:

Mode of transmission: Clinical Manifestations:

a. Severe vomiting and diarrhea

b. Abdominal cramping and excessivesalivation

c. Nausea within 2 to 6 hours

Therapeutic management:


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7. Child Abuse Classification:

a. Physical

b. Psychological or Emotional-

Theories of Child Abuse:

a. Special Parents-

b. Special Child-

c. Special circumstances-


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Child Abuse Assessment:

a. Interview- b. Physical exam - Observe the entire body - Plot height and weight - Observe for number of injuries - Higher incidence of hand injury - Burns or scalds, cigarette burns - human bites, head injury or hair pulled off - Broken bones, bruises

- Deliberate poisoning

C. Subjective Symptoms:


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Child Abuse Nursing Diagnosis:

Expected Outcome:

Nursing Interventions:

a. Prevent further abuse-

b. Provide consistent care and support- c. Evaluate and promote family health-

Outcome Evaluation:


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8. Leukemia A distorted and uncontrolled proliferation

of WBCs ( Leukocytes )

a. Acute Lymphocytic Leukemia -( Lymphoblastic )

Involves Lymphoblasts or immature Lymphocytes--- platelets falls and

invasion of increasing WBC elements

begins with continuous proliferation of

immature cells and identify as blast cell

or stem cell.


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Leukemia

Predisposing Factors:

Highest incidence in children 2 and 6 years

Slightly higher in boys than in girls

Radiation and chemical exposure

Genetic-


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Leukemia Clinical ManifestationS:

- Pallor, low grade fever, and lethargy

- Symptoms of Anemia, petechiae & bleeding

- Spleen and liver are enlarged

- Abdominal pain, vomiting and anorexia

- Bone and joint pain

- Headache and unsteady gait

- Painless, generalized swelling of lymph nodes

- Elevated leukocyte count

- hematocrit and platelet count are low

- RBCs are normocytic and normochromic

-


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Leukemia

Diagnostic Exam: a. Bone marrow aspiration-

b. Radiographs of the long bones

c. Lumbar puncture


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9. Asthma An immediate hypersensitivity (type 1) response, with an

excessive antigen-antibody

Response when the invading organism is an allergen.

Pathophysiology: Mast cells are specialized cells found on the

lining of blood vessels, and in connective

tissue, mucous membrane and skin.


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Asthma

-Affects small airways and involves three processess:

1. Bronchospasm

2. Inflammation of bronchial mucosa

3. Increased bronchial secretions-


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Asthma Assessment:

a. After exposure to allergen or trigger an

episode begins with;

1. Dry cough-

2. Dyspnea and wheezing-


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Asthma b. History- Thorough history of the

development of childs symptoms: What to ask?

c. Physical Assessment:

1. Specific symptoms of asthma 2. Auscultation-

3. Percussion-

4. Chest Retractions-


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Asthma

d. Diagnostic exam:

1. Pulse Oximeter-

2. ABG-

3. Pulmonary function test-

4. Peak Expiratory Flow RateMonitoring-

green zone ( 80 to 100% of personalbest)

yellow zone ( 50 to 80% of personalbest)

Red zone ( below 50% )


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Asthma Goal of Management:

1. Avoidance of allergen by environmental control

2. Skin testing and hyposensitization to

identified allergens

3. Relief of symptoms-


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Asthma Therapeutic Management:

1. Inhaled Corticosteroid

2. Long acting bronchodilator

3. Short acting beta-2- agonist bronchodilator

4. Mast cell stabilizer-

5. Leukotriene receptor antagonists

Nursing Dianogsis:


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Asthma Complication:

Status Asthmaticus-Assessment:

1. HR/RR are elevated

2. SAO2 and PO2 is elevated

3. Poor ventilation

4. Pulse Oximeter

5. Culture of sputum



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Rheumatic Fever

Assessment:

Signs and Symptoms of R.F. areDevided into;

1. Minor: With history of previous R.F.

Prolonged P-R and Q- T interval

on the ECG -

Systolic murmur-

FeverAthralgia

Elevated sedimentation rate and

Protein & WBC


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Rheumatic Fever

2. Major: Carditis-

Erythema Marginatum-

Subcutaneous nodules or painlesslumps-

Polyarthritis

Chorea-


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Rheumatic Fever


1. Maintain on bed rest-

2. Vital signs during the acute case-

3. Benzathine Pennicillin-4. Ibufrofen-

5. Corticosteroids-

6. Phenobarbital/ Diazepam-

7. Digoxin and Diuretics-


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Rheumatic Fever

Complication:

1. Permanent valve Dysfunction-

2. Severe Myocarditis-

Nursing Dx:

1.Risk for non- adherence to drug therapy

R/T knowledge deficit about

importance of long therapy2. Situanal low esteem R/T chorea

movements


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Scabies;

Causative Agent: Acarus Scabiei-

Symptoms:

1. Black burrow filled with mite feces, 1-2inches long-

2. Pruritus or itchiness



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Pediculosis/ Pediculosis Capitis

Causativ e Agent:

Symptoms:

1. Small, white flecks on hair shaft orpubic hair

2. Itchiness


Impitigo:


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Impitigo:

Causative Agent:

Inc. period:Period of Communicabilty: From outbreak of

lesions until lesions are healed

Mode of Transmission:

Immunity: None

Assessment :

1. Single papulovesicular lesions-

2. Purulent , oozing, & form honey coloredcrusts-

3. Swollen lymph nodes



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The Family

There are social changes that alters healthcare priorities for maternal and child health

nursing.

Ways in which nurses adapts to this

changes ;

Client Advocacy-

Through ; knowing the health care

services available in the community Establishing relationship with the family

Helping them make informed choicesabout what course of action or service

would be best for them

Current Trends in Maternal and


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Current Trends in Maternal andChild Care and its Implication forNurses

1. Families are not as extended and smaller

than previously.

2. Single parents have become the most

common type of parent most esp. in US3. Ninety percent of women work outside the

home

4. Families are more mobile than previously

and there is an increase in the number ofwomen and children

5. Both child and intimate partner abuse isincreasing in incidence


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Current Trends

6. Families are more health conscious thanever before

7. Health care must respect cost containment


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Care of Couples with Problems ofInfertility

Infertility- the inability to conceive a child orsustain a pregnancy to birth

Subfertility- Couples have potential toconceive but they are just less able to do

this without additional help

Male Subfertility Factors:

1. Disturbance in spermatogenesis-2. Obstruction-

3. Qualitative and quantitative changes in

semensl fluid


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Male Subfertility Factors

4. Development of autoimmunity thatimmobilizes sperm

5. Problems in ejaculation or deposition-

Specific Causes :

a. Inadequate sperm count

Sperm count is the number of sperm

in a single ejaculation or in a ml ofsemen


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Inadequate Sperm count

20 million/ ml of semen- minimum sperm

count or,

50 million/ ejaculation

50% of sperms should be motile30% normal in shape and form

b. Congenital Anomalies:

1. Cryptorchidism-2. Varicocele-

3. Hypospadias/ Epispadias-

4. Congenital Stricture of the tube


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Specific Causes

c. Obstruction or Impaired Sperm Motilitty

1. Orchitis

2. Epididymitis-

3. Tubal Infection-4. Benign Hypertrophy of the Prostate

gland

5. Chang in the composition of semenal

fluid6. Trauma and scarring after surgery

7. Autoimmune response


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Specific Causes

d. Ejaculation Problems / Impotence-

Causes:

1. Psychological problems

2. Cerebrovascular problems

3. Medications

4. Premature ejaculations-


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Female Subfertility

Factors that Causes Subfertility in Females:

1. Anovulation-

a. Genetic Abnormality-

b. Ovarian Tumors-c. Chronic exposure to radiation and

radioactive substances

d. General ill health

e. Poor nutrition/ weight / exercisef. Stress- Physical/ mental-

g. Polycystic ovary syndrome


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Female Subfertility Factors

2. Tubal Transport Problems-a. Sapingitis

b. PID

c. Scarring/ Trauma after surgery

3. Uterine Problems:

a. Tumors- f. Post D & C /

b. Poor secretion of estrogen/Progesterone

c. Endometriosis-

d. Cervical Problems

e. Infection/ Inflammation


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Female Subfertility Factors

4. Vaginal Problems:

a. Infection of the vagina-

b. Sperm- immobilizing or Sperm-Agglutinating Antibodies in BloodPlasma of some women


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Fertility Assessment

Basic Fertility Assessment for a Man:

1. Health History

-General health

-Nutrition

-Radiation

-Past and present occupation

-Past contraceptive use

-Alcohol, drug and tobacco use-Congenital health problems-

-Illnesses-

-Sexual practices-

F tilit A t


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Fertility Assessment for a Woman:

Current and past reproductive tractproblems-

Overall Health-

Abdominal or pelvic operations-

Past history of childhood cancer- Use of douches or intravaginal meds or

sprays-

Exposure to occupational hazards

Nutrition

Menstrual history

History of contraceptives use

History of previous pregnancy/abortions


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2. Physical Assessment:

a. Fertility Testing_

1. Semen Analysis-

2.Sperm penetration assay andantisperm-antibody testing-

3.Ovulation Monitoring-

4. Ovulation Determination by teststrip

F tilit T ti


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Fertility Testing 5. Tubal Patency;

An UTZ and X-ray imaging can beused to determine the patency of the

F.T. and assess the depth andconsistency of the uterine lining. Thisincludes:

a. Sonography- designed to inspect theuterus

b. Hysterosalpingography- a radiologic

exam of the F.T. using a radiopaquemedium introduced into F.T.

F tilit T ti


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Fertility Testing

6. Advanced Surgical Procedures:

a. Uterine Endometrial Biopsy--A thin probe and biopsy forcep are

inserted through the cervix to obtain

specimen-

b. Hysteroscopy- A visual inspection ofthe uterus-

c. Laparoscopy- Introduction of a thin,

hollow, lighted tube through a small

incision in the abdomen just below the

umbilicus-

M t f S bf tilit


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Management of Subfertility1.Increasing sperm count and motility:

a. Changes in lifestyle-

b. Giving of Corticosteroids to a woman

2. Reducing the presence of infection-

Fertility Management


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3. Hormone Therapy:

a. Administration 0f GnRH withClomiphene Citrate ( Clomid,Serophene )-

b. Administration of human menopausal

gonadotropins ( Pergonal )-c. FSH and LH-

d. Bromocriptine ( Parlodel )

e. Low dose Estrogen - Conjugated

Estrogen ( Premarin )-f. Progesterone vaginal suppositories-



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4. Surgery:

a. Correction of obstruction in a mansvas deferens and a womans F.T..

b. Ligation of varecocele-

c. Myomectomy-

d. Lyses by Hysteroscopy-e. Diathermy or Steroid administration-

f. Laparoscopy or Laser surgery-

g. Canalization of F.T. and Plastic Surgical

repair-



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5. Assisted Reproductive Techniques:

a. Therapeutic ManagementThe instillation of sperm into thefemale reproductive tract to aidconception. The sperm is instilled into;

Cervix-Uterus-

Therapeutic insemination byhusband ( use of husbands sperm )

Therapeutic insemination by donor-( donors sperm )

Assisted Reprod cti e


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Assisted ReproductiveTechniques

Uses of Therapeutic Insemination;

1. If the man has an inadequate

sperm count or a woman has a

vaginal or cervical factor-

2. If the man has a known genetic

disorder-


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Therapeutic Insemination

Cryopreserved ( frozen )-

Disadvantage :

Sperm tends to have slower motilitythan unfrozen

Advantage:

-Appears to be no increase in theincedence of congenital anomalies

conceived by this method



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b. Invitrofertilization-

-One or more mature oocytesare removed from a womans ovary by

Laparoscopy and fertilized by exposure to

sperm under laboratory conditions outside

a womans body-

-40 hours after fertilization-

Progesterone and Estrogen-


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c. Gamete Intrafallopian Transfer-

d. Zygote Intrafallopian Transfer-

e. Surrogate Embryo Transfer-

f. Preimplantation Genetic Diagnosis-

ncm 102 child continuation

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