U World Child Health final PDF

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Fecal incontinence refers to the repeated passage of stool in inappropriate places by children age ≥4 years. In more than 80% of cases, it is due to functional constipation (retentive type); in about 20% of cases, it may be caused by psychosocial triggers (nonretentive type). A reward system is one of the behavioral strategies used in the treatment of functional incontinence (due to constipation). The reward is given to encourage the child's involvement in the treatment to restore normal bowel function. Rewards are given for the child's effort and participation, not for having bowel movements while sitting on the toilet. Intussusception an intestinal obstruction that occurs when a segment of the bowel folds (ie, telescopes) into another segment The classic symptom triad of intussusception is abdominal pain, "currant jelly" stools, and a sausage-shaped abdominal mass. However, it is more common for clients to have episodes of sudden abdominal pain, inconsolable crying, and vomiting followed by periods of normal behavior. Reduction of intussusception is often performed with a saline or air enema. The nurse will monitor for passage of normal brown stool, indicating reduction of intussusception. If this occurs, the HCP should be notified immediately to modify the plan of care and stop all plans for surgery. If perforation occurs, the client could develop peritonitis in which the peritoneum in the abdomen becomes inflamed due to infection. This can quickly lead to sepsis and multiple organ failure. Peritonitis is characterized by fever, abdominal rigidity, guarding, and rebound tenderness. This condition can be fatal if it is not treated quickly. Pyloric stenosis results in recurrent projectile vomiting, which leads to dehydration and hypokalemic metabolic alkalosis. Dehydration is manifested by hemoconcentration (elevated hematocrit) and elevated blood urea nitrogen. Infants will be hungry constantly despite regular feedings, a palpable oliveshaped mass in the epigastrium to the right of the umbilicus, and projectile vomiting (can be up to 3 feet). The amount of milk consumed (particularly with bottle feedings) along with the mother's technique (mainly adequate burping) should be assessed to ensure there is no excessive air swallowing or overfeeding as an etiology. Melena (dark red or black, sticky stool) is an indication of an upper gastrointestinal (UGI) bleed. Gastritis is a common cause of UGI bleeding in infants and toddlers. Hypercyanotic episode, or "tet spell," an exacerbation of tetralogy of Fallot that can happen when a child cries, becomes upset, or is feeding. The child should first be placed in a knee-to-chest position. Flexion of the legs provides relief of dyspnea as this angle improves oxygenation by reducing the volume of blood that is shunted through the overriding aorta and the ventricular septal defect. Polycythemia (elevated hemoglobin levels) Infants with cyanotic cardiac defects can develop polycythemia as a compensatory mechanism due to prolonged tissue hypoxia. Polycythemia will increase blood viscosity, placing an infant at risk for stroke or thromboembolism. Clubbing is another manifestation of prolonged hypoxia.

Poor oxygenation can cause elevated levels of hemoglobin (polycythemia), which increase blood viscosity. Thickened serum puts infants at risk for stroke or thromboembolism. An infant with polycythemia must stay hydrated.

Epistaxis, or nosebleed Rarely serious and is usually due to mucosal irritation from dryness, local injury (eg, nosepicking), a foreign body, or rhinitis. Most bleeding arises from a highly vascular network on the anterior nasal septum. Epistaxis generally resolves spontaneously or with simple home management. The initial step in treatment is to tilt the client's head forward and apply direct, continuous pressure to the nose for 5-10 minutes Keeping the child quiet and calm may help provide the adequate time and pressure necessary for clotting Epistaxis can often be prevented by avoiding local trauma and maintaining hydration of the mucosa with saline nasal spray or a humidifier.

Hemophilia A bleeding disorder caused by a deficiency in coagulation proteins. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention. Clients with hemophilia who are injured should be monitored closely for bleeding (eg, intracranial bleeds, bleeding into joints). Signs of an intracranial bleed include lethargy, headache, irritability, and vomiting. An intracranial bleed is lethal if unchecked, so administration of factor VIII to a client with hemophilia A is the first order of action, followed by a CT scan. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention, including:  Avoid medications such as ibuprofen and aspirin that have platelet inhibition properties  Avoid intramuscular injections; subcutaneous injections are preferred.  Avoid contact sports and safety hazards; noncontact activities (eg, swimming, jogging, tennis) and use of protective equipment (eg, helmets, padding) are encouraged  Dental hygiene is necessary to prevent gum bleeding, and soft toothbrushes should be used.  MedicAlert bracelets should be worn at all times  The smallest gauge needle is used, and firm, continuous pressure is applied at the site for 5 minutes Clients with hemophilia are at risk for permanent joint destruction due to frequent bleeds into the joint spaces. Assisting clients with decreasing the incidence of bleeding episodes and prompt treatment when bleeding occurs can help minimize joint destruction. Celiac disease (celiac sprue) An autoimmune disorder in which the body is unable to process gluten, a protein found in most grains. Gluten consumption will damage the villi of the small intestine; this results in malabsorption of fats (steatorrhea, foul-smelling stools) and other nutrients, which can lead to malnutrition and failure to thrive. The child will need to adhere to a gluten-free diet for life. Rice, corn, and potatoes are gluten free and are allowed in the diet A child with celiac disease cannot eat barley, rye, oats, or wheat (mnemonic - BROW). Oily or bulky, foul-smelling stool is an indication of excess fat in the stool (steatorrhea) from malabsorption. This is characteristic of pancreatic insufficiency, cystic fibrosis, or celiac disease.

Kawasaki disease a childhood condition that causes inflammation of arterial walls (vasculitis). The coronary arteries are affected in KD, and some children develop coronary aneurysms. The etiology of KD is unknown; there are no diagnostic tests to confirm the disease, and it is not contagious. Kawasaki disease (KD) is a systemic vasculitis of childhood that presents with ≥5 days of fever, nonexudative conjunctivitis, lymphadenopathy, mucositis, hand and foot swelling, and a rash. KD has 3 phases: 1. Acute - sudden onset of high fever that does not respond to antibiotics or antipyretics. The child becomes very irritable and develops swollen red feet and hands. The lips become swollen and cracked, and the tongue can also become red (strawberry tongue). 2. Subacute - skin begins to peel from the hands and feet. The child remains very irritable. 3. Convalescent - symptoms disappear slowly. The child's temperament returns to normal. Initial treatment consists of IV gamma globulin (IVIG) and aspirin. IVIG creates high plasma oncotic pressure, and signs of fluid overload and pulmonary edema develop if it is given in large quantities. Therefore, the child should be monitored for symptoms of heart failure (eg, decreased urinary output, additional heart sounds, tachycardia, difficulty breathing). treated with aspirin and IVIG to prevent coronary artery aneurysms. Once children with KD are discharged home, parents should be instructed to check their temperature every 6 hours for the first 48 hours following the last fever and then daily until the follow-up visit. The health care provider should be notified if the child has fever as this may indicate a need for further treatment. Phenylketonuria (PKU) one of a few genetic inborn errors of metabolism. Individuals with PKU lack the enzyme (phenylalanine hydroxylase) required for converting the amino acid phenylalanine into the amino acid tyrosine. As unconverted phenylalanine accumulates, irreversible neurologic damage can occur. A low-phenylalanine diet is essential in the treatment of PKU. Phenylalanine cannot be entirely eliminated from the diet as it is an essential amino acid and necessary for normal development. The diet must meet nutritional needs while maintaining phenylalanine levels within a safe range (2-6 mg/dL for clients age 5-10 mL/kg in 1 hour should be reported immediately to the health care provider. This could indicate postoperative hemorrhage and requires immediate intervention. Cardiac tamponade can develop rapidly in children and can be life-threatening. Urine output should be 1-2 mL/kg/hr. ** Solid foods are introduced at age 4-6 months, beginning with iron-fortified cereal and progressing to soft fruits and vegetables. Five to 7 days should elapse before a new food is introduced to observe for allergies. Simple finger foods may be introduced at age 6-9 months. Cow's milk should not be introduced until after age 1 year.

Bacterial meningitis inflammation of the meninges of the brain and spinal cord caused by infection. General manifestations in infants and children age...