Growing child notes PDF

Preview

Summary

Cebu Doctors’ University College of Nursing Cebu, PhilippinesNCM 109SICK GROWING CHILDGroup DEtable, Hannah Vivien T. Gargar, Nickie C. Goc-ong, Kirstie D. Hemplo, Ma. Kella Patrice E. Hermosa, Claire Diane S. Ko, Daisy Jane G. Layese, Kryss Angelie T. Martinez, Brian Miguel A. Pandong, Joshua Anton...

Description

Cebu Doctors’ University College of Nursing Cebu, Philippines

NCM 109

SICK GROWING CHILD

Group D2 Etable, Hannah Vivien T. Gargar, Nickie C. Goc-ong, Kirstie D. Hemplo, Ma. Kella Patrice E. Hermosa, Claire Diane S. Ko, Daisy Jane G. Layese, Kryss Angelie T. Martinez, Brian Miguel A. Pandong, Joshua Anton R. Po, Drixhen Daniel S. BSN 2-D

Ms. Nikki Rae Cayanan Clinical Teacher

TOPICS Alteration in Hematologic Function 1. Anemias 1.1. Iron deficiency anemias 1.2. Normocytic anemias 1.3. Sickle cell anemias 1.4. B-thalassemia 1.5. Aplastic anemia 2. Clotting factors 2.1. Hemophilia 2.2. Von Willebrand disease 2.3. Disseminated Intravascular Coagulation 2.4. Idiopathic thrombocytopenic purpura Alteration in cellular growth 1. Neuroblastoma 2. Wilms tumor 3. Bone tumors 3.1. Osteosarcoma 3.2. Ewing’s sarcoma 4. Leukemia 5. Soft tissue tumors 5.1. Hodgkin’s disease 5.2. Non-hodgkin's disease 5.3. Rhabdomyosarcoma 5.4. Retinoblastoma Alteration in Gastrointestinal Function 1. Structural defects 1.1. Cleft lip and cleft palate 1.2. Esophageal atresia and traceheo- esophageal fistula 1.3. Pyloric stenosis 1.4. Gastroesophageal reflux 1.5. Omphalocele 1.6. Hirschsprung’s disease 1.7. Anorectal malformations 2. Hernias 2.1. Diaphragmatic hernias 2.2. Umbilical hernias 3. Feeding disorders 3.1. Colic 3.2. Rumination 4. Disorders of malabsorption

4.1. 4.2. 4.3.

Celiac Disease Lactose Intolerance Short Bowel Syndrome

CONTENTS 1.1 Definition/Description of the disease or complication 1.2 Etiology/Causes/risk factors 1.3 Types 1.4 Signs and Symptoms 1.5 Management Medical Pharmacological Surgical 1.6 Pathophysiology 1.7 Nursing Care Plan 1.8 Pictures

Alteration in Hematologic Function 1.

Anemias 1.1. Iron deficiency anemias ● Definition: - It is the most common anemia of infancy and childhood - It occurs whenever the intake of dietary iron is inadequate, thus, hemoglobin cannot be incorporated into RBCs. - A newborn usually has enough iron in reserve to last for the first 6 months of life and afterwards, iron must be incorporated into the diet. ● Etiology/ Causes/ Risk Factors: - Main cause: lack of iron - In children older than 2 years of age, it is commonly caused by chronic blood loss due to GI tract lesions such as polyps, ulcerative colitis, Crohn disease, or frequent epistaxis - Adolescent girls with heavy menstrual periods can become iron deficient when combined with overconsumption of snack foods that are low in iron ● Signs and Symptoms ○ Pallor/ Pale mucous membrane ○ Enlarged heart (possible) ○ Enlarged spleen (possible) ○ Poor muscle tone and decreased activity ○ Pale conjunctiva ○ Spoon-shaped fingernails or depressed in contour ○ Decreased hemoglobin level (less than 11g/100ml of blood) ○ Reduced hematocrit level (below 33%) ○ Low mean corpuscular volume(MCV), mean corpuscular hemoglobin (MCH), and serum iron levels ● Nursing Management ○ Encourage a diet rich in iron and vitamin C to enhance iron absorption. ○ Encourage brushing of teeth thoroughly after ferrous sulfate administration.

○ Instruct parents to administer the drug on an empty stomach with water to enhance absorption. Avoid giving it with milk or tea because these interfere with absorption. ○ If liquid preparation is ordered, have the child drink the medication with water or juice through a straw to avoid staining the teeth. ○ Inform the child and parents that iron may turn stools black. ○ Counsel parents on measures to improve their infant’s nutrition, such as adding iron-rich foods while decreasing formula or breast milk intake. ● Pharmacological Management ○ Iron compounds, such as ferrous sulfate taken for 4 to 6 weeks, is the drug of choice to improve RBC formation and replace iron stores. ● Medical Management ○ After 7 days of iron therapy, a reticulocyte count is usually obtained. If elevated, this means the child is now receiving enough iron that erythrocytes are now proliferating and correcting the anemia. ○ Obtain and monitor RBC count and hemoglobin level. ● Pathophysiology Inadequate iron supply/ Altered iron absorption ↓ Prolonged negative iron balance: there is not enough iron to produce the needed amount of red blood cells ↓ Decrease in red blood cells or amount of hemoglobin in blood ↓ Decrease in oxygen levels ↓ Iron-deficiency anemia

● Nursing Diagnosis ○ Imbalanced nutrition, less than body requirements: weakness r/t inadequate ingestion of iron ○ Activity intolerance: fatigue r/t imbalance between oxygen supply and demand ● Pictures

1.2. Normocytic anemias ● Definition: - Marked by impaired production of erythrocytes by the bone marrow or by abnormal or uncompensated loss of circulating RBCs. RBCs are normal in both color and size, but there are too few of them. ● Types a. Acute blood-loss anemia ❖ Etiology ➢ Due to trauma such as automobile accident with internal bleeding; acute nephritis in which blood is loss in urine; intestinal parasites such as tapeworm ❖ Signs and Symptoms ➢ tachycardia ➢ cyanosis ➢ gasping respirations ❖ Medical Management ➢ Control of bleeding by addressing underlying cause ➢ Blood transfusion b. Anemia of acute infection ❖ Etiology ➢ Due to infection such as osteomyelitis or kidney infection ❖ Signs and Symptoms ➢ extreme fatigue ➢ weakness ➢ pale skin ➢ chest pain, fast heartbeat or shortness of breath. ➢ headaches ➢ cold hands and feet ➢ brittle nails ❖ Medical Management ➢ Treatment of underlying condition c. Anemia of renal disease ❖ Etiology ➢ Renal disease can cause loss of function in kidney cells, which causes decrease in erythropoietin production ❖ Signs and Symptoms ➢ extreme fatigue ➢ weakness ➢ pale skin ➢ chest pain, fast heartbeat or shortness of breath. ➢ headaches

➢ cold hands and feet ➢ brittle nails ❖ Medical Management ➢ Administration of recombinant human erythropoietin d. Anemia of neoplastic disease ❖ Etiology ➢ Malignant growth invades bone marrow and impairs RBC production ❖ Signs and Symptoms ➢ extreme fatigue ➢ weakness ➢ pale skin ➢ chest pain, fast heartbeat or shortness of breath. ➢ headaches ➢ cold hands and feet ➢ brittle nails ❖ Medical Management ➢ Remission of neoplastic process ➢ Transfusion to increase erythrocyte count e. Hypersplenism ❖ Etiology ➢ If spleen is enlarged, blood cells pass more slowly, with more cells being destroyed in the process ❖ Signs and Symptoms ➢ extreme fatigue ➢ weakness ➢ pale skin ➢ chest pain, fast heartbeat or shortness of breath. ➢ headaches ➢ cold hands and feet ➢ brittle nails ❖ Medical Management ➢ Treating underlying splenic disorder including splenectomy ● Nursing Management ○ Supine position to improve circulation ○ Warm child with blanket ○ Help child to use a distraction techniques such as imagery to reduce fear associated with procedures or treatments

● Pathophysiology Excessive blood loss

Loss of kidney function

Malignant growth invades bone marrow ↓

Decrease in level of RBC ↓ Decrease in oxygen levels ↓ Signs & Symptoms ● Extreme fatigue ● Weakness ● Pale skin ● Chest pain, fast heartbeat or shortness of breath. ● Headaches ● Cold hands and feet ● Brittle nails ● Pictures

Spleen is enlarged

1.3. Sickle cell anemias ● Definition: - An inherited red blood cell disorder in which there aren’t enough healthy red blood cells to carry oxygen throughout the body. This disease causes the red blood cells to take an abnormal shape, ultimately causing a blockage in the flow of blood. ● Etiology/ Causes/ Risk Factors: - Genetics: sickle cell anemia is an autosomal recessive pattern, which means that both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition. ● Signs and Symptoms ○ Pain (due to blockage in the blood vessels causes tissue and organ damage) ○ Fatigue ○ Pale appearance ○ Feelings of heart palpitations ○ Heart problems and lung problems ○ Dactylitis (swelling and inflammation of the hands and feet) ○ Bacterial infections ○ Pooling of blood in the spleen and liver congestion ○ Leg ulcers ○ Eye damage ○ Dark urine ● Nursing Management ○ Monitor vitals signs ■ Hypoxia may occur, hyperventilation, tachycardia, and blood pressure levels ○ Assist in the administration of blood products ○ Administer pain medication as prescribed ○ Perform oral rehydration therapy as prescribed ○ Plan and prioritize activities that are to be done to the newborn ○ Encourage rest ○ Provide oxygen therapy as needed ○ Give emotional support to the family

● Pharmacological Management ○ When feeding the baby make sure to only use breast milk (or fortified formula) ○ Provide the infant with dietary supplements to increase the nutrition of their diet (folic acid and vitamin c) ○ Provide all medications prescribed by the doctor. ● Medical Management ○ Prescribe oxygen therapy ○ Prescribe blood transfusion ○ Prescribe dietary supplements ○ Prescribe oral analgesics ○ Prescribe Hydroxyurea (Droxia, Hydrea, Siklos): This is an anti-neoplasticism drug. It is used to increase production of fetal hemoglobin and reduce the frequency of pain crises as well as acute chest syndrome (inflammation of the lungs). It is significantly beneficial for infants, children, and adolescence. ○ Prescribe Antibiotic Prophylaxis before anything that can cause excessive bleeding such as surgery or dental procedures in order to prevent bacterial infection. Pneumococcus or meningococcus. ○ Prescribe L-glutamine oral powder (Endari): in order to reduce the frequency of pain crises. ○ Prescribe Crizanlizumab (Adakveo): administered into the gains in order to reduce the frequency of pain crises. Its side effects may cause nausea, joint pain, back pain, and fever. ○ Prescribe Voxelator (Oxybryta): in order to help fight against anemia. It may cause headache, nausea, diarrhea, fatigue, rash, and fever. ● Pathophysiology Oxygenated erythrocyte containing HbS ↓ Ischemia/Stress ↓ Deoxygenated erythrocyte containing polymerized HbS ↓

Sickle cell formation ↓ Vaso-occlusive crisis Hypoxia Infarction Necrosis of vital organs

Pain

Vasculopathy and endothelial dysfunction Hypercoagul Inflammation opathy

Hemolysis Increased bilirubin

Free plasma HbS

Gallstone

inactivation of NO and increased ROS

↓ Acute pain Hyposplenism Osteonecrosis Nephropathy Acute Chest syndrome ↓ Pulmonary HTM Ulcer Cerebro-vascular disease ● Pictures

1.4. B-thalassemia ● Definition: - Beta thalassemia is a blood disorder that reduces the production of hemoglobin. Due to this low level of hemoglobin there are low levels of oxygen getting lead to the different parts of the body. ● Etiology/ Causes/ Risk Factors: - Beta thalassemia happens when any of the two genes involved in making a beta hemoglobin chain is altered. If one mutated gene is obtained by the individual then they will experience mild signs and symptoms, this is called thalassemia minor or beta-thalassemia. - If the individual contains two mutated genes they will experience signs and symptoms at a moderate to severe level. This is called thalassemia major, or Cooley anemia. - Typically babies born with two defective beta hemoglobin genes seem healthy, but they slowly develop signs and symptoms within the first two years of their life. - A milder form called thalassemia intermedia can occur even if there are two mutated genes. ● Signs and Symptoms ○ Fatigue ○ Weakness ○ Pale or yellowish skin ○ Facial bone deformities (rodent facies) because it causes bone marrow to expand causing the bones to widen, this makes the bones thin and brittle increasing their chances of breaking ○ Slow growth ○ Abnormal swelling ○ Dark urine ● Nursing Management ○ Monitor vitals signs ■ Hypoxia may occur, hyperventilation, tachycardia, and blood pressure levels ○ Assist in the administration of blood products ○ Plan and prioritize activities that are to be done to the newborn ○ Encourage rest ○ Provide oxygen therapy as needed

○ Give emotional support to the family ● Pharmacological Management ○ When feeding the baby make sure to only use breast milk (or fortified formula) ○ Provide the infant with dietary supplements to increase the nutrition of their diet (folic acid and vitamin c) ○ Reduce extra iron in the body using irons chelation therapy ● Medical Management ○ Prescribe oxygen therapy ○ Prescribe blood transfusion ○ Prescribe dietary supplements ● Surgical Management ○ Surgically remove the spleen ○ Surgically remove the gallbladder ○ Bone marrow transplant ● Pathophysiology B-globin chains reduced ↓ Excess unpaired a chains ↓ Precipitated insoluble inclusions ↓ interfere with RBC cell divisions

damage cell membrane

perturb the internal ionic environment

reduced deformability

↓ intramedullary death of euthyroid cells (ineffective erythropoiesis) ↓

Bone changes Skull changes Mellar Prominence

hepatosplenomegal y

persistent progressive anemia

● Pictures

1.5. Aplastic anemia ● Definition: - A deficiency of all types of blood cells caused by failure of bone marrow to develop. It is due to the immune system attacking the stem cells in the bone marrow. It is also the stopping of production. ● Etiology/ Causes/ Risk Factors: - Radiation - Chemotherapy treatments - Stem cells in the bone marrow produce blood cells, in aplastic anemia these stem cells are damaged. This causes the bone marrow to empty (aplastic) or contain few blood cells (hypoplastic). - The most common cause is from the immune system attacking the stem cells in the bone due to: - Radiation and chemotherapy: the treatment kills cancer cells, but it may also damage healthy cells causing the body to see them as a threat - Exposure to toxic chemicals

● Signs and Symptoms ○ Fatigue ○ Shortness of breath ○ Rapid or irregular heart rate ○ Pale skin ○ Frequent or prolonged infections ○ Unexplained or easy bruising ○ Nosebleeds and bleeding gums ○ Prolonged bleeding from cuts ○ Skin rashes ○ Dizziness ○ Headache ○ Fever ● Nursing Management ○ Monitor vitals signs ■ Hypoxia may occur, hyperventilation, tachycardia, and blood pressure levels ○ Assist in the administration of blood products ○ Plan and prioritize activities that are to be done to the newborn ○ Encourage rest ○ Provide oxygen therapy as needed ○ Give emotional support to the family ● Pharmacological Management ○ When feeding the baby make sure to only use breast milk (or fortified formula) ○ Provide the infant with dietary supplements to increase the nutrition of their diet (folic acid and vitamin c) ○ Cyclosporine (gengraf, neoral, sandimmune) and anti-thymocytes in order to suppress the activity of immune cells that are damaging the bone marrow ○ Bone marrow stimulants such as sargramostim (leukine) or filgrastim (neupogen) to help stimulate the bone marrow to produce new blood cells ○ Antibiotics and antiviral to avoid infections ● Medical Management

○ ○ ○ ○

Prescribe oxygen therapy Prescribe blood transfusion Prescribe dietary supplements Stem cell transplant

● Pathophysiology Cytotoxic drugs Radiation Benzene

Idiopathic Seronegative hepatitis Eosinophilic fasciitis Thymoma

Telomere disease Fanconi anemia Other germline gene mutations

↓ chemical and physical damage

immune destruction

constitutional genetic defects

↓ Benzene derivatives serve as toxins to the bone marrow (myelotoxins) ↓ myelotoxins suppress bone marrow function ↓ bone marrow fails to replace senescent blood cells ↓ decreased WBC

decreased RBC

decreased platelets

↓ lowered immune defenses

decreased oxygen supply to

decreased clotting ability

↓ risk for infection

cells and tissues

bleeding tendencies

↓ pallor Fatigue Weakness

heart compensates

epistaxis

↓ ineffective tissue perfusion

heart increases cardiac output by pumping more blood ↓

palpitations (compensatory tachycardia)

● Pictures

Nursing Care Plan for Anemia Needs/Probl ems/Cues

Nursing Diagnosis

Scientific Basis/ Significance

I. Physiologic Deficit A. Activity Intolerance

Activity Intolerance: fatigue r/t imbalance between oxygen supply and demand

Hemoglobin is an After 8 hours of iron-rich protein that nursing helps red blood intervention, the patient will be cells carry oxygen able to: from the lungs to the rest of the body. 1. verbalize reduction of If you have anemia, fatigue, as your body does not evidenced get enough oxygenby reports of rich blood. This can increased energy and cause you to feel ability to tired or weak. You perform may also have desired shortness of breath, activities dizziness, headaches, or an irregular heartbeat.

Subjective cues: ● Fatigue ● Generalized weakness ● Dyspnea Objective cues: ● Pallor

Objectives of Care

Nursing Actions

Rationale

Reduce fatigue:

1.

2.

3.

Source: www.nhlbi.nig.gov/h ealth-topics/anemia 4.

5.

Assist the client/care givers in developin ga schedule for daily activity and rest. Stress the importanc e of frequent rest periods. Monitor hemoglobi n, hematocrit , RBC count, and reticulocyt e counts. Educate energy-co nservation technique s. Administer ferrous sulfate as prescribed by the physician.

1.

To evaluate appropriate ness

2.

To reduce fatigue

3.

To differentiat e any changes from the baseline data

4.

To conserve energy

5.

To increase the body’s iron level

Source: NANDA-I

2.

Clotting factors 2.1. Hemophilia ● Definition: - Hemophilias are inherited disorders of blood coagulation. There are numerous types, each involving a deficiency of a different blood coagulation factor. ● Types of Hemophilia: a. Hemophilia A ( Factor VIII Deficiency) The classic form of hemophilia is caused by deficiency of the coagulation component factor VIII, the antihemophilic factor, and transmitted as a sex linked recessive trait. b. Christmas Disease ( Hemophilia B, Factor IX Deficiency) Christmas disease, first noted in 1952 in a patient by the name of Stephen Christmas, is caused by factor IX deficiency, It is transmitted as a sex linked recessive trait, and only approximtely 15% of people with hemophilia have this form. c. Hemophilia C ( Factor XI Deficiency) Hemophilia C, or plasma thromboplastin antecedent deficiency is caused by factor XI deficiency, is transmitted as an autosomal recessive trait and occurs in both sexes. ● Etiology/ Causes/ Risk Factors: There are several types of hemophilia, and most forms are inherited. However, about 30% of people with hemophilia have no family history of the disorder. In these people, an unexpected change occurs in one of the genes associated with hemophilia. Acquired hemophilia is a rare variety of the condition that occurs when a person's immune system attacks clotting factors in the blood. It can be associated with: ● Pregnancy ● Autoimmune conditions ● Cancer ● Multiple sclerosis

● Signs and Symptoms ○ blood in the urine ○ blood in the stool ○ deep bruises ○ large, unexplained bruises ○ excessive bleeding ○ bleeding gums ○ frequent nosebleeds ○ pain in the joints ● Nursing Management ○ Monitor PTT ( Partial thromboplastin time ) ○ Assess for any pain or swelling over the entire body ○ Monitor Hemoglobin and Hematocrit levels ○ Anticipate or instruct in the need for prophylactic treatment before high-risk situations, such as invasive diagnostic or surgical procedures, or dental work. ○ Encourage the child to avoid rough play ○ First aid...