copyright © 2008 wolters kluwer health | lippincott williams & wilkins the infant with a major...
TRANSCRIPT
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Infant With a Major Illness
Chapter 17
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Factors That Determine Manifestations of Health Problems in Infants
• Pathogenic agent
• The environment
• The infant
Most acute health problems result from a respiratory or gastrointestinal (GI) infection or from a congenital deviation
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Sensory Disorders: Otitis Media• Any disorder related to the senses can significantly
impact the infant’s development
• Symptoms are repeated shaking of head and rubbing or pulling at one ear; fever, irritability, and hearing impairment
• Diagnosis is bright-red, bulging eardrum and drainage; rupture may occur
• Treatment is with antibiotics; amoxicillin is common
• Repeated otitis media is treated with prophylactic oral penicillin or sulfonamide
• Mastoiditis is a complication of untreated otitis media
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Neurologic Disorders: Acute or Nonrecurrent Seizures
• In children between 6 months and 3 years of age, febrile seizures are most common
– May occur suddenly without warning
– Treatment based on presenting symptoms
– Treatment: protection; diazepam (Valium) for continuous seizure activity; acetaminophen
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Monitoring for Complications of Seizures
• Signs of increased intracranial pressure (IICP)
• Preventing aspiration
• Keeping child safe
• Monitoring intake and output
• Supporting the child’s family
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Nursing Process for the Child at Risk for Seizures
• Assessment: family caregiver interview, ask about history of seizures and presence of fever
• Baseline temperature and physical exam
• Nursing diagnoses: risk for aspiration, risk for injury, compromised family coping, deficient knowledge of caregivers
• Outcome identification and planning: prevent aspiration and prevent injury
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Nursing Process for the Child at Risk for Seizures (cont.)
• Implementation
– Prevention of aspiration
– Safety
– Family coping
– Family teaching
• Evaluation
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Neurologic Disorders: Haemophilus Influenzae Meningitis
• Peaks between ages 6 and 12
• Spread by droplet infection from an infected person
• HIB vaccine at 2, 4, 6, and 12 months of age
• High-pitched cry, irritability, fever, headache, nuchal rigidity, projectile vomiting
• Lumbar puncture
•Complications:
– Hydrocephalus
– Nerve deafness
– Mental retardation
– Paralysis
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Two Positions for a Lumbar Puncture
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Treatment of Haemophilus Influenzae Meningitis
• IV antibiotics, based on sensitivity studies
• IV steroid early in the course has decreased the incidence of deafness as a complication
• If seizures occur, anticonvulsants are often given
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Nursing Process for the Child With Meningitis
• Assessment
• Nursing diagnoses
• Outcome identification and planning
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Nursing Process for the Child With Meningitis (cont.)
• Implementation
– Monitoring for complications
– Prevention of aspiration
– Safety
– Fluid balance
– Family teaching
– Family coping
• Evaluation
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Respiratory Disorders
• Acute nasopharyngitis (common cold)
• Most common complication is otitis media
• Illness of viral origin
– Fever: older than 3 months, congested nasal passages, vomiting, diarrhea
– May be first symptom of childhood contagious diseases, such as measles
• Treatment and nursing care
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Acute Bronchiolitis/Respiratory Syncytial Virus Infection
• Most common during first 6 months of life; rare after age 2
• Viral infection
• Causative agent in 50% is RSV
• Dyspnea, cough, nasal drainage, shallow respirations, marked cyanosis, sternal retraction, respiration rate 60-80 breaths per minute, fever, dehydration
• Diagnosis: clinical findings and ELISA of mucus by nasal aspiration or nasopharyngeal washing
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Treatment of Acute Bronchiolitis/Respiratory Syncytial Virus Infection
• Mist tent, rest, increased fluids, oxygen
• Antibiotics are not prescribed because the causative organism is a virus
• IV fluids
• Contact transmission precautions
• Ribavirin (Virazole): category X drug for severe or complicated RSV
– Women who are pregnant should stay out of the room where ribavirin is being administered
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Respiratory Disorders (cont.)
• Bacterial pneumonia: occurs secondary to upper respiratory viral infection
– Clinical manifestations: follows mild upper respiratory illness, fever, respiratory distress, flaring nostrils, circumoral cyanosis, chest retractions, convulsions
– Diagnosis: symptoms, chest x-ray, culture
– Treatment: penicillin or ampicillin; if penicillin allergy, use cephalosporin anti-infectives
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Nursing Process for the Child With Pneumonia
• Assessment
• Nursing diagnoses
• Outcome identification and planning
See Nursing Care Plan 17.1
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Implementation of Nursing Process for Child with Pneumonia
• Implementation
– Maintaining airway clearance
– Monitoring respiratory function
– Promoting adequate fluid intake
– Maintaining body temperature
– Promoting energy conservation
- Preventing additional infections
- Reducing the child’s anxiety
- Promoting family coping
- Providing family teaching
• Evaluation
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Cardiovascular Disorders: Congestive Heart Failure
• Occurs when blood and fluids accumulate in the organs and body tissues
• Heart loses ability to pump and circulate
• Fatigue, feeding problems, failure to gain weight; pale, mottled, or cyanotic color; tachycardia, rapid respirations; dyspnea; flaring nostrils; use of accessory muscles
• Based on clinical symptoms; chest radiograph reveals enlarged heart; ECG; echocardiogram
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Treatment of Congestive Heart Failure
• Cardiac glycosides: Lanoxin
• ACE inhibitors: Capoten, Vasotec
• Diuretics: Lasix, Aldactone
• Fluid restriction
• Physical activity limitation
• Improving tissue oxygenation
Nursing process:
• Assessment
• Nursing diagnoses
• Outcome identification and planning
• Implementation
• Evaluation
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Hematologic Disorders: Iron Deficiency Anemia
• Below-average body weight, pale mucous membranes, anorexia, growth retardation, and listlessness
• Hemoglobin lower than 11 g/dL or a hematocrit lower than 33%
• Stool tested for occult blood to rule out GI bleed
• Treatment: ferrous sulfate administration between meals with juice (vitamin C aids in iron absorption)
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Sickle Cell Disease
• Hereditary trait most common in African Americans
• Production of abnormal hemoglobin that causes the red blood cells to assume a sickle shape
• Chronic anemia
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Sickle Cell Crisis
• Viscosity of blood increases
• Impaired circulation results in tissue damage and infarction
• Acute abdominal pain, fever, severe leg pain; hot, swollen joints; board-like abdomen with absent bowel sounds
• Several days after a crisis: jaundice from hemolysis
• Diagnosis: Sickledex screening
• Prevention of crises: hydration, avoid strenuous activity, small blood transfusions; iron preparations have no effect on sickle cell disease
• Nursing process for the child with sickle cell crisis
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Thalassemia
• Mild to severe anemias: hemoglobin production is abnormal
• Thalassemia major (Cooley’s anemia): presents in childhood and is the most common of the thalassemia blood disorders; often occurs in people of Mediterranean descent
• Anemia, fatigue, pallor, irritability, anorexia; bone pain and fractures
• Treatment: blood transfusions; diet and medications to prevent heart failure; splenectomy or bone marrow transplant; deferral to treat iron overload
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Gastrointestinal Disorders: Malnutrition and Nutritional Problems
• Protein malnutrition
– Kwashiorkor
o Marasmus
• Vitamin deficiency disease
– Vitamin D
– Vitamin C
– Thiamine
– Riboflavin
– Niacin
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Gastrointestinal Disorders: Malnutrition and Nutritional Problems (cont.)
• Mineral insufficiencies
• Food allergies
– Milk allergy
– Lactose intolerance
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Nursing Process for the Child With Nutritional Problems
• Assessment
• Nursing diagnoses: imbalanced nutrition; less than body requirements; deficient fluid volume; constipation; impaired skin integrity
• Outcome identification and planning
• Implementation
• Evaluation
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Gastrointestinal Disorders: Gastroesophageal Reflux (GER)
• Occurs when the sphincter in the lower portion of esophagus is relaxed and allows gastric contents to be regurgitated back into the esophagus
• Usually noted within first week of life; resolved within first 18 months
• Effortless vomiting, irritable, hungry; possible aspiration
• Diagnostics: endoscopy
• Treatment: Zantac, Prilosec, Nissan fundoplication
• Nursing care
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Gastrointestinal Disorders:Diarrhea and Gastroenteritis
• Diarrhea can be mild or severe
• Severe diarrhea can cause the child to become severely dehydrated and gravely ill
• Infectious diarrhea-gastroenteritis
• Stool specimen for culture and sensitivity; antibiotics if indicated
• Treatment: oral rehydration therapy; breast-fed or formula fed; IV fluids
• Nursing process
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Other Gastrointestinal Disorders
• Colic: recurrent paroxysmal abdominal pain; disappears at about 3 months of age
• Pyloric stenosis: hypertrophy of the circular muscle fibers of the pylorus, with a severe narrowing of its lumen
• Congenital aganglionic megacolon (Hirschsprung disease): persistent constipation resulting from partial or complete intestinal obstruction of mechanical origin
• Intussusception: telescoping of one portion of the bowel into a distal portion
• Nursing process
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Genitourinary Disorders
• Hydrocele: collection of peritoneal fluid that accumulates in the scrotum through a small passage (processus vaginalis)
• Cryptorchidism: occurs when one or both testes do not descend into the scrotum
• Urinary tract infections: Escherichia coli accounts for about 80% of acute episodes
• Wilms’ tumor (nephroblastoma): adenosarcoma in the kidney region
• Nursing process
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Integumentary Disorders
• Seborrheic dermatitis (cradle cap)
• Miliaria rubra (prickly heat)
• Diaper rash
• Candidiasis: Candida albicans
• Impetigo: superficial bacterial skin infection
• Atopic dermatitis (infantile eczema)
– Hereditary predisposition
– Hypersensitivity
– Allergens
• Nursing process
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Psychosocial Disorders: Nonorganic Failure to Thrive
• Infants who fail to gain weight and who show signs of delayed development
– Organic failure to thrive: result of a disease condition
– Nonorganic failure to thrive (NFTT): has no apparent physical cause
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Nursing Process for the Child With Nonorganic Failure to Thrive
• Assessment
• Nursing diagnoses
• Outcome identification and planning
• Implementation
• Evaluation