Download Basic Nursing: Foundations of Skills and Concepts Chapter 24

SECTION III MATERNAL & PEDIATRIC NURSING
UNIT 18 NURSING CARE OF THE CLIENT:
CHILDREARING
CHAPTER 56
INFANTS WITH
SPECIAL NEEDS:
BIRTH TO 12 MONTHS
L. Lehmkuhl, RN 2008
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OTITIS MEDIA




Inflammation of the
middle ear.
Eustachian tubes in
infants are shorter, wider
and more horizontal than
in adults.
Drainage from middle ear
to nasopharnyx is often
impaired.
Secretions and air
become trapped as
bacteria moves up from
pharnyx to the middle ear



Irritability, pulling at the
infected ear, diarrhea,
vomiting, fever, hearing
loss.
Treatment includes
medications or
myringotomy for
recurrent infections.
Prevention: proper
positioning when feeding
(upright), smoke-free
environment (to prevent
respiratory congestion).
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Infant
Adult
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Middle Ear Infection (Otitis
Media)

Otitis media is an
inflammation and/or infection
of the middle ear. Acute otitis
media (acute ear infection)
occurs when there is
bacterial or viral infection of
the fluid of the middle ear,
which causes production of
fluid or pus. Chronic otitis
media occurs when the
eustachian tube becomes
blocked repeatedly due to
allergies, multiple infections,
ear trauma, or swelling of the
adenoids.
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Eustachian tube
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LARYNGOTRACHEOBRONCHITIS
Viral illness–swelling of the upper airway.
 Symptoms include stridor, “barking”
cough, hoarseness.
 Treat to maintain a patent airway and
improve respiratory effort.
 Cool mist and medications.

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Edema in airways
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• Profuse nasal
drainage
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PNEUMONIA
Often preceded by an upper respiratory
infection.
 Onset is abrupt, fever, flaring nostrils,
circumoral cyanosis, chest retractions,
increased pulse and respirations, cough.
 Oxygen, cool mist hydration, respiratory
therapy, and medications.

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RESPIRATORY
DISTRESS SYNDROME



Most often found in pre-term
infants.
Lungs are deficient in
surfactant (a slippery,
protective substance, which
helps the lungs inflate with air
and keeps the air sacs from
collapsing).
When lungs collapse after
each breath O2 supply
reduced



Symptoms include tachypnea,
retractions, grunting, crackles,
pallor, cyanosis, hypothermia,
edema, flaccid muscle tone,
GI shutdown (no voiding),
jaundice, acidosis.
First 96 hours are critical to
recovery.
Treatment: surfactant through
endotracheal tube, supportive
care (e.g. CPAP).
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CYSTIC FIBROSIS


Affects lungs,
pancreas, liver,
and reproductive
organs.
Autosomalrecessive trait
(both parents are
carriers)


Meconium ileus (impacted
feces in NB causing Bowel
obstruction),
intussusception, problems
gaining and maintaining
weight, pulmonary
problems, salty taste on
skin.
Treat to manage pulmonary
complications, postural
drainage, high calorie diet
(CF asorb only 50% of
ingested foods).
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Cystic Fibrosis
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Cystic Fibrosis/Clubbed Fingers

Clubbed fingers is a
symptom of disease,
often of the heart or
lungs which cause
chronically low blood
levels of oxygen.
Diseases which cause
malabsorption, such
as cystic fibrosis or
celiac disease can
also cause clubbing.
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Clubbing
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Postural Drainage

There are 6 to 12 positions a
person with pulmonary disease
may take to drain mucus from
a certain part of the lungs.
Another person may tap in
certain areas to help loosen
the mucus and allow it to be
coughed out. Other ways to
relieve the lung congestion of
cystic fibrosis include
percussion vests and inhaled
aerosols.
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*
(often the earliest manifestation)*
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SUDDEN INFANT
DEATH SYNDROME (SIDS)
“Crib death.”
 Sudden unexpected death of apparently
healthy infant.
 No single cause has been identified.
 Provide empathic support to the family.
 Inform family that autopsy must be done.

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CONGENITAL
CARDIOVASCULAR DISEASE







Increased pulmonary blood flow.
Decreased pulmonary blood flow.
Obstructed blood flow out of heart.
Mixed blood flow.
Symptoms vary with type of disease.
Infants with sever defects often exhibit S/S CHF
(fatigue, orthopnea, failure to thrive, pale,
mottled or cyanotic skin, tachy,)
Treatment includes medications (dig to increase
heart contractibility), surgery.
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*
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HYPERBILIRUBINEMIA
Also known as jaundice, yellow
discoloration of the skin, sclera, mucous
membranes, and body fluids.
 Treat to reduce the amount of
unconjugated bilirubin.
 Treatment is usually phototherapy with a
bililight.

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IRON-DEFICIENCY ANEMIA
Full-term infants have iron stores that last
for 5 to 6 months.
 Surfaces between 9 and 24 months.
 Symptoms: pallor, tachycardia, lethargy,
irritability, and below-normal hemoglobin,
hematocrit, and iron levels.
 Treatment is iron replacement (foods,
formula, supplements, IM Fe).

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SICKLE-CELL ANEMIA


Genetic disorder
characterized by the
production of abnormal
hemoglobin.
Symptoms not until 6
months of age:
abdominal pain, fever,
growth retardation,
anemia.



Prevent crises with
hydration. During: bed
rest, oxygen, analgesics,
fluids.
Immunizations for
children with this disease
include: influenza,
pneumococcal,
meninggococcal, and
hep B.
Prophalatic po pcn til 5-6
y/o
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THRUSH
Oral fungal infection often acquired after
atb treatment of another illness.
 Symptoms include painless, white
patches that look like curdled milk on the
oral mucosa.
 Topical nystatin is the most commonly
used treatment.

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ACUTE GASTROENTERITIS
Inflammation of the stomach and
intestines with diarrhea and vomiting.
 The infant may become dehydrated and
gravely ill.
 Adequate fluids to replace fluid loss
(rehydration) is the goal of treatment.

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COLIC
Sudden, periodic attack of abdominal
pain, cramping; usually ends by 3 months.
 Infant cries for several hours and draws
the legs up to the abdomen.
 Usually occurs at the same time of day.
 Treatment includes medications and
exploration of ways to comfort the infant.

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FAILURE TO THRIVE
Infant failing to gain weight and showing
signs of delayed development.
 Sustained growth failure, developmental
delays, poor feeding, sleeping patterns.
 Treatment: provide nutrition, promote
growth and development, and assist
parents to develop skills.

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CLEFT LIP/PALATE


May occur separately
or together.
Infants with cleft
palate are at risk for
aspiration, feeding
difficulties, and
respiratory infections.


Treat to close defects
Surgical lip closure @
6-12 weeks, followed
by palate closure 1218 months.
Maintain nutrition,
prevent
complications, and
foster normal growth
and development.
*

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ESOPHAGEAL ATRESIA WITH
TRACHEOESOPHAGEAL FISTULA


Failure of the esophagus to
develop as a continuous
passage and/or an unnatural
connection between
esophagus and the trachea.
S/S excessive salivation,
drooling, coughing, choking
during fdg’s, cyanosis, hx of
polyhydraminos (excessive
production of amniotic fkluid)
durting prenatal period

Prognosis is usually good with
surgery
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PYLORIC STENOSIS




Occurs when circular muscle
surrounding the pylorus
hypertrophies and blocks
gastric emptying.
The main symptom is projectile
vomiting (ejection up to three
feet).
Other S/S: hunger, visible
peristalic waves,
Hyperbowelsounds, irritable,
olive shape mass on RUQ
Complete recovery with surgery
treatment.
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HIRSCHSPRUNG’S
MEGACOLON



Congenital anomaly
manifested as partial or
complete mechanical
obstruction resulting from
inadequate colon motility.
Failure to have a stool in
the first 24 hours may be
indicative of this defect.
Surgical intervention is
usually necessary.
*
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GASTROESOPHAGEAL REFLUX
Return of abdominal contents into the
esophagus.
 Symptoms include hunger, irritability, FTT,
vomiting, and frequent upper respiratory
infections.
 Often resolves with dietary modifications,
medication and positioning.

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INTUSSUSCEPTION
Telescoping of one portion of the bowel into a
distal portion (part of the intestine being pulled
inward into itself)
 This can block the passage of food through the
intestine. If the blood supply is cut off, the
segment of intestine pulled inside can die.
 The infant will suddenly become pale, cry out
sharply, and draw up the legs in a severe
colicky spasm of pain, vomiting and “currentjelly” stool occur.
 Barium enema is the main treatment.
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
CONGENITAL TALIPES
EQUINOVARUS (CLUB FOOT)



Foot has clublike
appearance with entire
foot inverted, apparent at
birth.
Treatment includes
manipulation and casting
of the foot and surgery.
Even with aggressive
therapy/surgery the club
foot may recur.
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DEVELOPMENTAL
DYSPLASIA OF THE HIP
Dysplasia–refers to a variety of conditions
wherein the femoral head and the
acetabulum are improperly aligned.
 Limited abduction, asymmetry of the
gluteal and thigh fat folds, and telescoping
of the thigh.
 Treatment: casting, bracing and surgery.

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POSITIONAL PLAGIOCEPHALY


Flattened head
syndrome.
Occurs when the
infant is put to sleep
in the same position
repeatedly or by neck
muscle problems.



Not self-correcting.
Light-weight plastic
helmet to redirect
symmetrical growth
of infant’s head.
Prevention is
key…teach parents
to alternate sleeping
positions.
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MILIA RUBRA
Prickly heat.
 Rash appears as pinhead-sized
erythematous papules.
 Often found in folds of skin from being
overdressed in Summer heat.
 Infants may be irritable because of
itching.
 Treatment is primarily preventative.

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DIAPER DERMATITIS
Diaper rash.
 Erythema, edema, vesicles, papules, and
scaling on the perineum, genitals,
buttocks, and skin folds.
 Treatment: change diapers regularly and
keep the infant’s skin clean and dry.

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SEBORRHEIC DERMATITIS




Cradle cap.
Characterized by yellowish, scaly, or crusted
patches on the scalp.
Caused by overactive sebaceous gland activity.
Crusting can usually be prevented by washing
infant’s head with a washcloth and using a finetoothed comb. Mineral oil will help loosen
crusty sebum prior to washing.
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ATOPIC DERMATITIS



Eczema–chronic
superficial inflammatory
skin disorder
characterized by intense
pruritis.
Treat to relieve pruritis,
hydrate skin, reduce
inflammation, and
prevent secondary
infections.
Baths, compresses give
temporary relief.

Control allergens:



Smoking outside
Family pets kept outside *
Removing dust
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Dermatitis, Atopic in an Infant

Atopic dermatitis is
quite often seen on the
cheeks of infants. It
consists of red
(erythematous), scaling
plaques that are
diffusely scattered over
the infant's body and
face.
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SPINA BIFIDA
Neural tube defect
 Surgery is required to
wherein incomplete
close the defect.
closure of vertebrae
and neural tube results
in an opening through
which meninges and
spinal cord may
protrude.
 Caused by maternal
folic acid deficiency
during pregnancy
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
HYDROCEPHALUS
Results when the balance between the
rate of cerebrospinal fluid formation and
absorption is disturbed.
 Abnormally large head at birth, bulging
anterior fontanels, and eyes appear to be
pushed downward (sunset eyes ).
 Surgical insertion of a shunt is required to
drain CSF into body cavity.

*
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FEBRILE CONVULSIONS
(seizures)



Involuntary muscle
contraction and
relaxation.
Usually occur early in
the course of a high
fever and carry little
risk of neurological
damage.
Last less than 3
minutes

Usually self resolved
and no treatment is
necessary
If continues treatment
includes:
anticonvulsants and
antipyretics
*

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MENINGITIS
The organs of the central
nervous system (brain and
spinal cord) are covered by  Monitor neurological
3 connective tissue layers
status
q
4hours.
collectively called the
 Treatment includes
meninges.
spinal tap, isolation,
 The three main types are
bacterial, tubercular, and
and medications.
viral.
 Symptoms sudden or
gradual: high-pitched cry,
fever, seizures, irritability,
vomiting, bulging fontanel,
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poor feeding

CEREBRAL PALSY


Cerebral palsy is caused
by injuries to the
cerebrum (the largest
part of the brain), which
occur as the baby grows
in the womb or near the
time of birth. Results
from damage to the
motor centers of the
brain.


Symptoms vary in severity
but include motor disorders
seizures, impaired vision,
difficulty swallowing and
speaking.
Multidisciplinary team
treatment to assist child in
developing maximum
potential.
To improve ambulation
surgical intervention such a
lengthening the Achilles’
tendon and releasing
hamstrings .
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HYPOSPADIAS

Urethral opening is on the ventral surface
of the penis often associated with
undesended testicles and inguinal hernia

Surgically corrected during the first year
of life.
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HYDROCELE



Palpable, round, nontender mass in the
scrotum. The mass
is a collection of fluid.
Most close by 1 year
of age without
intervention.
Surgery may be
required.
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CRYPTORCHIDISM
Failure of the testicles to descend into
scrotal sac.
 Most descend spontaneously by 1 year of
age.
 Surgery may be required.

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VESICOURETERAL REFLUX
Backflow of urine from bladder into
ureters and possibly the kidneys.
 The primary symptom is recurrent UTIs.
 Treatment involves preventing UTIs and
may require surgery.

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WILMS’ TUMOR


Nephroblastoma is one
of the most common
early childhood cancers
found in kidney region.
Symptoms may include
an abdominal mass to
the side of midline,
abdominal pain,
malaise, anemia, and
fever.



When palpate
abdominal if mass if
felt stop immediately
to prevent dislodging
tumor cells.
Surgery is the
treatment of choice.
Chemotherapy,
radiation also used.
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Wilms Tumor
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DOWN SYNDROME
Chromosomal anomaly resulting in
moderate to severe mental retardation.
 Almond-shaped eyes, depressed nasal
bridge; protruding tongue; low-set ears;
short, broad neck; transverse palmar
crease, broad, short hands with stubby
fingers; and protruding abdomen.

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VISUAL IMPAIRMENT
Refractory disorders.
 Strabismus.
 Corrective lenses, patching, and surgery
may be required.

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Crossed Eyes

eyes that are not looking in
the same direction, which is
referred to as crossed eyes
(strabismus). Other more
specific medical terms refer to
eyes turned either outward or
inward, or that are abnormally
rotated. Any appearance of
crossed eyes in young
children should be
immediately evaluated, as
should recent onset of
crossed eyes in an adult.
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HEARING IMPAIRMENT





Conductive loss: Transmission of sound is
interrupted to middle ear
Sensorineural loss: r/t auditory nerves
Mixed hearing loss: combo of conductive and
sensorineural
Central hearing loss: reoccurring otitis media
when brain stem and cerebral cortex impairs
sound conduction
Treatment depends on the cause and type of
loss.
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Hearing Test

Newborns are routinely
screened for their hearing
shortly after birth to prevent
delays in normal language
skills. In one test, a small
earpiece is placed in the
outer part of the baby's ear.
The earpiece emits clicking
sounds into the baby's ear
and the microphone in the
earpiece detects nearby
sounds. The sounds should
echo in the ear canal. If there
is no echo, it is a sign of
hearing loss.
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ABUSE AND NEGLECT

Abuse–any intentional
act of physical neglect
or physical, emotional,
or sexual abuse
committed by a
person responsible for
the care of a child.



If parent and child
explanations do not
match…
Document verbatim
(“in quotient marks”)
both parent and child
subjective data
All cases of suspected
child abuse must be
reported.
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ENVIRONMENTAL SAFETY
Poisoning.
 Trauma.
 Suffocation.
 Drowning.
 Prevention is of utmost importance.

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