Week 12 Community Health Clinic

Case 1 – Scoliosis Screening

Scoliosis – abnormal curvature of the spine

Most common in adolescent girls

Check for uneven shoulder & hip levels, asymmetry of scapula

c/o backache & fatigue If severe, can affect respiratory

function

Management of Scoliosis Boston or Milwaukee

brace Surgery – insertion of

rod, fusions Teach management of

brace, skin care Promote positive self-

concept NCP – p. 1815

Legg-Perthes

Aseptic necrosis of femoral head 4 stages: avascular, revascularization,

reparative, regenerative S&S: pain in hip, knee; stiffness, ROM,

limp Important to keep head of femur in

acetabulum until it reforms

Management:

Rest, traction, active non-weight bearing

motion

No weight bearing during early stages

Braces, casts, crutches

Promote comfort, mobility

Teach use of braces, allowable activities

Case 2 – Hip dysplasia, clubfoot

Hip Dysplasia – Abnormal development of head of femur or

acetabulum Subluxed or complete dislocation Tx: maintain hip in flexed abducted position –

Pavlik harness, spica cast, splint Early recognition is important Teaching re: splint care, managing immobility

Clubfoot (talipes)

True or positional Variations

Varus Valgus Equinus Calcanus

Equinovarus most common

Management of clubfoot Serial casting – change q 1-2 wks Denis-Brown splint, Wheaton brace Muscle stretching exercises May require surgery Nursing care:

Neurovascular checks Skin care, cast care Teaching: exercises, cast care

Hypotonia muscle tone – “rag doll”

Sign of disorder – neuromuscular, genetic

Hypothyroidism thyroid hormone – congenital or acquired

Delayed g&d, dry skin, mental sluggishness

Tx: hormone replacement

Case 3 – Tattoos and piercings

Risks: Bleeding Infection – local, systemic (HIV, Hep) Allergic reactions Scarring, keloids Tooth damage (oral piercings)

TATTOO CARE Keep covered for 12

hours – avoid

touching tattoo

Wash with

antibacterial soap &

apply antibiotic cream

Avoid sunlight &

tanning until healed

PIERCING CARE Use antibacterial

soap/cleanser

Avoid harsh

antiseptics

Mouthwash for oral

piercings – check that

piercing is secure (risk

of swallowing)

Case 4 – Grieving in Children

Understanding of death Infant/toddler – no comprehension Pre-school – death is reversible

May experience guilt, fears Many questions

School age – death is permanent Need tangible ways to express grief

Adolescent – death as remote from them Fear of pain & process of dying

Helping Grieving Families Help parents understand child’s reactions Encourage parents to remain with child,

answer questions Encourage child to express feelings, fears Provide outlets for anger, aggression Provide suggestions for concrete ways to

express grief

Ref: www.synspectrum.com/childgrief.doc

Zoonotic Disorders

Transfer of disease from animals to humans Examples:

Insect-borne – West Nile Pets – Cat Scratch Fever Farm animals – Brucellosis Wild animals – TB, rabies

Pregnant women, infants, children at risk

Case 5 – Type 1 Diabetes

Auto-immune disease destroys insulin-producing beta cells of pancreas

S&S: Polyuria, polydipsia, polyphagia Hyperglycemia Weight loss, fatigue May develop DKA – dehydration, acidosis,

ketosis

Management of Type 1 Diabetes

Goal: near-normal BG, avoid hypoglycemia Balance insulin, diet, exercise Frequent monitoring of BG

Type 1 Diabetes (cont’d)

Complications Hypoglycemia Diabetic ketoacidosis (DKA) Long-term

Nursing Care Education** and ongoing support Development of collaborative relationship with

child and family

Case 6 – Foreign Bodies

Nasal Food, beans, crayon pieces, paper, etc. Leads to irritation, infection, obstruction Foul-smelling nasal discharge, difficulty

breathing, discomfort Do NOT probe nose or try to remove if not

visible Have child blow gently through affected nostril

Ear Do NOT attempt to remove by probing

with swab Do NOT reach into ear with tweezers

Prevention Keep small objects out of reach of infants

and toddlers Discourage children from putting things in

body openings

Case 7 – Skin Rashes Possible causes – contact dermatitis,

eczema, allergic reactions, diseases (measles, chickenpox, Kawasaki)

Contact dermatitis (tape)Eczema

Skin Care

Gentle cleansing – avoid irritating

substances – avoid use of soap

Moisturize frequently – use creams/lotions

without added perfumes, etc.

Eliminate newly added soaps, lotions

May require Rx creams - hydrocortisone

Case 8 – Gastro-esophageal Reflux (GER) Gastric contents back up into

esophagus – sphincter dysfunction

Most common < 4 months S&S – regurgitation of

feedings, poor weight gain Risk of aspiration Dx: barium swallow,

endoscopy

Management of GER Feedings – small, frequent feeding with

frequent burping; thicken feeds (controversial)

Positioning – avoid slumping, sitting after feeds; prone, head elevated (controversial)

Medications Surgery in severe cases

- fundoplication

Case 9 – Epistaxis (Nosebleed) Causes: trauma, nose picking, dry air,

irritants, foreign body, cocaine use, bleeding disorders (e.g. von Willebrand)

Emergency Tx: Sit up and lean forward Continuous pressure to nose Cotton into each nostril or cold

cloth to bridge of nose

Case 10 – Obesity, Hyperlipidemia, Hypertension

Obesity – above 95th percentile 22-33% of children Related to genetics, endocrine problems,

lifestyle (nutrition, exercise) Risk for hyperlipidemia,

hypertension, resp.

disorders, cholelithiasis,

Type 2 diabetes

Hyperlipidemia Cholesterol > 5.1 mmol/L; LDL-c - > 3.34 mmol/L Risk factor for CAD Management: dietary, medication

Hypertension Factors: heredity, lifestyle, obesity, renal disease S&S: headaches, vision changes, dizziness Management: lifestyle changes (weight loss, exercise) Medications: ACE inhibitors (e.g. captopril), beta

blockers (e/g. propanolol