Download NURS 1400 Unit VI Common Childhood Illnesses

NURS 1400 Unit VI
Common Childhood Illnesses
Metro Community College
Nursing Program
Nancy Pares, RN, MSN
Integumentary system
• Tinea Corporis
– Fungal infection; “body ringworm”
– Occurs in non terminal, non hairy areas of body
– Occurs in children of any age; acquired from
animals
Tinea Corporis
• Clinical manifestations
– Annular, expanding lesion
– Raised erythematous border
– Scaly, clear center
• Treatment
– Topical: miconazole, clotrimazole(lotrimin)
• Twice daily for 2-3 wks
– Oral: itraconazole, terbinafine
Infestations
• Pediculosis: Head lice
– Ectoparasites: live on the surface
– Most common in 3-10 years; greater in girls of
caucasian origin
– Classroom is primary source of infestation
pediculosis
• Pathophysiology
– Head to head contact: hats, combs, bedding
– Lice crawl-do not fly or jump
– Eggs(nits) attach to hair shaft with water insoluble
glue usually in the auricular or occipital areas of
the head
– Nymphs emerge in 7-10 days; lifespan=30 days
– Brown in color, size of sesame seed
pediculosis
• Clinical manifestations: itching
• Diagnosis: identification of nits on scalp
• Treatment:
– Manual removal: less than 2 years of age
– Permethin (Nix): > 2 years of age; kills lice and ova
– Lindane (Kwell): > 2 years of age; less potent agent
Pediculosis
• Nursing Management
– Assessment: careful handwashing; done with hair
wet; examine known areas;
– Nursing diagnosis
• Impaired skin integrity
• Low self esteem
• Deficient knowledge
– Family teaching: treatment of household; notify
schools and contacts
Scabies
• Ectoparasite; significant world wide
• Occurs at any age, most common <2 year old
• Pathophysiology
– Transmitted by close person to person contact
– Burrow into the stratum corneum depositing feces
– Females lay eggs in 2-3 day intervals; hatch in 3-8
– Adult mites are round, eyeless, life span of female
is 2 months; male dies after mating
Scabies
• Clinical manifestations
– Inflammatory response, generalized pruritus
which increases at night
– Sites: skin surfaces that are opposing: axillary,
cubital,
• Diagnosis: microscopic exam of scrapings
• Treatment : Permethrine cream(Elimite)
– One application is usually sufficient
Scabies
• Nursing management
– Promotion of comfort
– Prevention of secondary infections
– Handwashing
• Family teaching
– All members of household need treatment
– All clothes and bedding in hot water
– Daycare: no attendance for 24 hours after
treatment
Inflammatory disorders
Acne Vulgaris
• Predominately adolescent skin disease
• Chronic condition; 85% of all adolescents
• Pathophysiology
– Accumulation of sebum in the pilosebaceous
follicles which become very cohesive
– Comedones are lesions of non inflammatory
(white heads); open lesions are black heads
Acne vulgaris
• Diagnosis: age and appearance of lesions
• Treatment:
– Individualized
– Topical
• Benzoyl peroxide, reinoids, azelaic acid, and abx
– Systemic
• Anbx, oral contraceptives, accutane
Acne vulgaris
• Nursing management
– Reduction of severity, supportive care,
information about diet, hygiene, rest
• Teaching
– Educate about misconceptions
– Avoid cosmetics
Hearing and Visual disorders
• Hearing impairment
– See page 1023 table
– Congenital vs acquired
– Classifications
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•
•
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Conductive hearing loss
Sensoneural hearing loss
Mixed conductive sensoneural hearing loss
Central hearing loss
– Behavioral signs: pg 1025 table
Hearing loss
• Diagnosis
– Newborn screening
– BAER (Brainstem Auditory Evoked Response)
• Main test for hearing loss
• Treatment:
– Dependent on type of hearing impairment
– Conductive: hearing aid
– Sensoneural: cochlear implants
– Sign language, lip reading, cued speech
Hearing loss
• Nursing management
– Assessment
– Nursing diagnosis
• Disturbed sensory perception
• Delayed growth and development
• Ineffective coping
Visual impairment
• Binocularity: fixation of 2 ocular images,
occurs at 6 months
• Visual acuity: clearness of image: changes
with age
• Etiology
– Eyeball mis proportioned
– Damage to one or more parts of the eye
interfering with visual process
– Brain may not process information correctly
Visual impairment
• Manifestations based on age: pg 1033 table
• Diagnosis: Snellen chart; assessed indirectly
with children< 3..see page 1034
Impairment of muscular efficiency
• Strabismus
– Condition where the visual lines of each eye do
not focus on the same object due to lack of
muscle coordination; cross eyed appearance
– Clinical manifestations
• Clumsy, difficulty picking up objects, crossed eyes
– Diagnosis
• Hirshberg corneal light reflex, cover test, esotropia,
hypertropia
strabismus
• Treatment
– Medical:
• Occlusion dressing (eye patch), glasses, pharmacologic
– Surgical
• Children < 12-18 months when medical did not work
strabismus
• Nursing management
– Early identification
• Nursing diagnosis
– Delayed growth and development
– anxiety
Amblyopia (Lazy eye)
• A reduction or loss of vision in one eye
unrelated to an organic cause
• Pathophysiology
– Occurs in first 6 months of life
– Brain is trained to compensate
– If not corrected by age 7, restoration is minimal
• Clinical manifestations;
– Rare, child is unaware of any problem
• Treatment: glasses
Respiratory disorders: Acute
Epiglottitis
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•
•
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Life threatening bacterial infection
Also called ‘croup syndrome’
Can lead to complete airway obstruction
Clinical manifestations
– Respiratory distress, fever, sore throat, dysphagia,
drooling, agitation, and lethargy,
• Diagnosis: no spontaneous cough,DO NOT
look in throat by depressing tongue
Acute epiglottitis
• Nursing management
– Anbx, fluids and supportive care
– Have emergency equipment on had for
tracheotomy.
Bronchiolitis
• Acute, typically viral, infection of the
bronchioles usually caused by RSV
• Usually young children
• Causes inflammation of the bronchioles
• Wheezing is classic symptom with tachypnea
• Complications
– Apnea, atelectasis, secondary bacterial infection
and respiratory failure
Bronchiolitis
• Nursing management/diagnosis
– Ineffective airway clearance
– Deficient fluid volume
– Deficient knowledge of caregivers
• Planning /implementation
– Family teaching
– Acute setting focus on adequate ventilation and
fluid balance
Bronchiolitis
• Treatment/prevention
– Ribuvirin (Virazole) is the only med for RSV
bronchiolitis
– Prevention drugs
• RSV immune globulin (RespiGam)
• Synagis
– Administered monthly as an IM injection
– First dose Usually given prior to RSV season
Asthma
• Characterized by chronic inflammation,
bronchoconstriction, and bronchial hyper
responsiveness
• Wheezing, coughing and dyspnea
• Airways are damaged over time
• Classified by severity of symptoms
Asthma
• Categories
– Mild intermittent
– Mild persistent
– Moderate persistent
– Severe persistent
Asthma
• Pharmacologic treatments
– Short acting inhaled beta 2 agonists
– Long acting inhaled beta 2 agonists
– Leukotriene modifiers
– Oral anti asthmatics
– Methylxanthines
– Systemic corticosteroids
asthma
• Treatments
– Avoid triggers
– Regular peak flow monitoring
– Medical follow up
– Rapid access to medical care
• Prevention
– Avoid allergen exposure, warm up before
exercising, relaxation exercises
Bacterial meningitis
• Meningitis is inflammation of meninges
• Causative agent is age dependent
– Neonates: e coli, group b strep, H influenza, strep
pneumoniae
– Infants and children: H influenza type b, strep
pneumoniae
– Adolescent: Neisseria meningitis, strep
pneumoniae
Asthma
• Nursing management/diagnosis
– Risk for suffocation
– Ineffective airway clearance
– Interrupted family processes
Bacterial meningitis
• Clinical manifestation
– Infants may have subtle symptoms
– Child over 2 may have GI upset and cold like
symptoms
– Hyperactive reflexes
– Kernigs sign: supine with hip flexed..pain on
resistance on extension of leg
– Brudzinski sign; supine, flex head..hip and knees
will also flex
Bacterial meningitis
• Diagnosis
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CSF via lumbar punctures; fluid will be cloudy
Urine for culture, osmolarity, sp. Gravity
Chest x ray
CT/MRI
• Treatment
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Oxygen
Seizure precautions
Antibiotics/dexamethazone
isolation
Viral meningitis
• Inflammatory response of the leptomeninges
• Caused by non polio enterovirus; most occur
in summer
• Often associated with partially treated
bacterial infections
• Clinical manifestations
– Not as ill as bacterial; general malaise, gradual
onset, Kernig and Brudzinski signs may be present
Viral meningitis
• Diagnosis
– CSF
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•
Less than 500 WBC/cubic mm
Glucose increased
Protein decreased
May do second spinal tap within 6-8 hrs for
confirmation
Viral meningitis
• Treatment
– Same as bacterial until viral is confirmed
• Nursing management
– Same as bacterial until viral is confirmed
– Comfort measures,
– Administer meds as ordered
Encephalitis
• Inflammation of the brain caused by bacteria,
virus, fungi or protozoa
• See page 1085 for table of causes
• Pathophysiology
– Invasion of pathogen to CNS
• Clinical manifestations
– Intense HA, s/s of respiratory infection, n/v,
slurred speech, seizures, ataxia, personality and
behavior changes
Encephalitis
• Diagnosis
– H&P,
– CSF
• Initially normal, recheck in 2 days
– Leukocytes increase
– Protein increase
– Nasopharynx swab
• Treatment:
– Supportive, anbx til bacterial cause r/o
encephalitis
• Nursing management/interventions
– Vital sign assessment
– Neuro checks
– PROM
– Good skin care
GER ( gastroesophogeal reflux)
• Common disorder of infants; improvement
seen in 6-12 months; boys affected more than
girls, common in preterm infants
• Clinical Manifestations
– Vomiting, regurgitation, excessive crying, blood in
stools
• Diagnosis
– Observing feedings, upper GI, endoscopy
GER
• Treatment
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Dietary modifications
Thicken formula with cereal
Positioning: seated vs prone vs head elevated prone
Pharmacologic intervention
• Previcid, reglan
• Nursing diagnosis
– Risk for aspiration; imbalanced nutrition; deficient
knowledge
Parasitic infections
• See pages 442-443
• Pinworms
• roundworms
Urinary Tract Infections
• Infection of one or more structures of the
urinary tract
– Cystitis
– Urethritis
– Pyelonephritis
• Pathophysiology
– Same as adults
UTI
• Clinical manifestations
– Infants
– Preschoolers
– School age and adolescents
– See page 626 table
• Diagnosis
– UA
UTI
• Treatment
– Eradicating the infection
– Preventing re infections
– Correcting underlying causes
– Preserving renal function
– Abx, fluids
Enuresis
• Involuntary voiding of urine beyond the expected
age
• More common in boys
• Pathophysiology
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Neurologic development delay
Frequent UTI
Structural disorders
Chronic constipation
DM
Sleep arousal problems
Stress and family history
enuresis
• Clinical manifestations
– Dribbling after voiding
– Urgency
– Ineffective stream
– Infrequent and painful voiding
– Incontinence with laughing
Enuresis
• Diagnosis
– Family history
– Neuro exam: reflexes, sphincter tone, spinal
defects
– Voiding diary
– UA, renal ultrasound, urine flow rate
Enuresis
• Treatment
– Medications: see page 632
– Bed wetting alarms
– Motivational therapies: rewards for dry nights
– Elimination diets: certain foods may irritate the
bladder---sugar, caffeine, dairy , carbonated bev.
Enuresis
• Nursing diagnosis
– Impaired urinary elimination
– Impaired skin integrity
– Disturbed sleep pattern
– Low self esteem
– Impaired social interactions