nurs 1400 unit vi common childhood illnesses metro community college nursing program nancy pares,...
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NURS 1400 Unit VICommon Childhood Illnesses
Metro Community CollegeNursing 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 disordersAcne 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• 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
• 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
• 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– CSF via lumbar punctures; fluid will be cloudy– Urine for culture, osmolarity, sp. Gravity– Chest x ray– CT/MRI
• Treatment– 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• 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– 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
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– 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.