NUR 2310 Pediatric Nursing       Concepts  ANDREA STORRIE,MSN, CPNP
GROWTH AND DEVELOPMENT              Unit 1 Developmental influences on child        health promotion
One hundred years from now              it will not matter          What kind of car I drove.       What kind of house I l...
CHILDREN’S HEALTH           A CHANGING PARADIGM• Sixty years ago leading causes of death  were infections and catastrophic...
GROWTH AND DEVELOPMENTGROWTH – Increase in the size and number of cells resulting in   increased size and/or weight of a p...
GROWTH AND                  DEVELOPMENTDEVELOPMENT• Gradual change and expansion progressing from lower  to advanced compl...
G & D CONTINUEDMATURATION  – An increase in competence and adaptabilityDIFFERENTIATION  – Process by which early cell stru...
BASIC ASSUMPTIONS ABOUT CHILD                DEVELOPMENT•   Development is orderly•   Development has direction•   Develop...
BASIC ASSUMPTIONS CON’T•   Development requires energy to be expended•   Children develop through conflict and adaptation•...
DEVELOPMENTAL INFLUENCESPATTERNS OF GROWTH & DEVELOPMENT:DIRECTIONAL TRENDS  –   CEPHALOCAUDAL  –   PROXIMODISTAL (NEAR TO...
FACTORS INFLUENCING GROWTH AND                 DEVELOPMENT• Heredity         • Disease• Neuroendocrine   • Environmental  ...
ERIKSON’S STAGES OF PERSONALITY                    DEVELOPMENT•   Involves a specific conflict or developmental task•   In...
Piaget’s Stages of Cognitive Development• Sensorimotor (Birth to 2 years)  progress from reflex to sense of cause and effe...
FREUD - PSYCHOSEXUAL DEVELOPMENT•   Oral stage - birth to one year•   Anal stage - one to three years•   Phallic stage - t...
PLAY• Universal medium for learning• Children learn what no one  else can teach them• Play is the work of childrenhttp://w...
CLASSIFICATION OF PLAYPractice play  referred to as functional  or sensorimotor playSymbolic playGames
SOCIAL ASPECTS OF PLAY•   Solitary play•   Onlooker play•   Parallel play•   Associative play•   Cooperative play
FUNCTIONS OF PLAY   • Physical development     •   Cognitive development     •   Emotional         development     •   Soc...
Anticipatory Guidance• Parents need to know how to a provide safe  environment for their child• Need to know what to expec...
SAFETY PRECAUTIONS WITH INFANT TOYS• Select toys that are smooth and rounded and made of  wood or plastic• Plastic toys sh...
PEDIATRIC UNIT SAFETY PRECAUTIONS• Baby proof room• Provide only age appropriate toys• Remove all medical equipment except...
CHILDREN’S RESPONSE TO HOSPITALIZATION• Separation Anxiety:   – Protest: crying, screaming, wrongly     viewed as misbehav...
CHILDREN’S RESPONSE CON’T•   Fear of the unknown•   Fear of pain or mutilation•   Loss of control•   Anger•   Guilt•   Reg...
PARENTAL STRESSORS•   Fear of the unknown•   New environment•   Separation from child•   Guilt•   Financial burden•   Fear...
COMMUNICATING WITH CHILDREN• Allow time to feel comfortable• Avoid rapid advance or other threatening  gestures• Talk with...
COMMUNICATION CON’T.– Speak in a quiet, unhurried, confident tone of voice– Speak clearly, be specific, and use simple wor...
GUIDELINES FOR ADMISSION•   Introductions•   Orient child and family•   Apply identification•   Explain hospital rules•   ...
HEALTH HISTORY•   Immunizations current?•   Well Child Care?•   Sick Care only?•   Who is the provider?•   What routines a...
IMMUNIZATIONShttp://www.cdc.gov/vaccines/recs/schedules/child  -schedule.htm#printablehttp://www.cdc.gov/vaccines/pubs/pin...
ASSESSMENT GUIDELINES•   Perform in an appropriate, nonthreatening area•   Provide time for play & getting acquainted•   O...
Pediatric Assessment• Toddlers are the most challenging to examine   – Sequence is flexible• What are some differences of ...
PLAGIOCEPHALY (POSITIONAL)• Misshapen head• Back of head is flattened due to constantly being  placed in supine position• ...
PLAGIOCEPHALY (POSITIONAL)
PLAGIOCEPHALY (POSITIONAL)
PERFORMING A PEDIATRIC PROCEDUREBefore the procedure  – Offer ways to cope with pain or discomfort  – Use developmentally ...
PERFORMING A PEDIATRIC     PROCEDURE          During the procedure      Talk to the child if he/she desires     Keep the c...
PED PROCEDURES CON’TAfter the procedure  – Praise the child for attempting to cooperate  – Provide an opportunity to vent ...
MEDICATION ADMINISTRATION“8”   rights      – Patient, Order, med., dose, time, route, documentation, &         attitude   ...
ADDITIONAL PROCEDURES WITH VARIATIONS•   Measurement of I & O•   Parenteral fluid therapy•   Inhalation therapy•   Chest p...
BIOLOGICAL DEVELOPMENT• GAINS 5-7 OUNCES WEEKLY FOR 1ST 5-6 MO.• DOUBLES BIRTH WEIGHT BY 6 MO.• TRIPLES BIRTH WEIGHT BY 12...
BIOLOGICAL DEVELOPMENT• BRAIN INCREASES IN WEIGHT BY 2 ½ TIMES• ORGAN SYSTEMS BEGIN TO MATURE• GROWTH CHARTS ARE MOST ACCU...
BIOLOGICAL DEVELOPMENT• BRAIN INCREASES IN WEIGHT BY 2 ½ TIMES• ORGAN SYSTEMS BEGIN TO MATURE• GROWTH CHARTS ARE MOST ACCU...
GROSS MOTOR MILESTONES•   HEAD CONTROL ESTABLISHED @ 4-6 MONTHS•   TURNS ABD. TO BACK @ 4-5 MONTHS•   TURNS BACK TO ABD. @...
FINE MOTOR MILESTONES• 1 MONTH - HANDS FISTED – PALMAR GRASP• 3 MONTHS - CAN HOLD RATTLE• 4-5 MONTHS – BEGINS REACHING & G...
FINE MOTOR MILESTONES• 8-9 MONTHS - PINCER GRASP DEVELOPS,  REACHES FOR TOYS, RAKES FOR OBJECTS• 10-12 MONTHS – RELEASES C...
SOCIAL MILESTONES• SMILES RESPONSIVELY TO STIMULI @ 6-8 weeks.• SHOWS FEAR AND ANGER @ 4-8 MO.• SMILES AT SELF IN MIRROR @...
SOCIAL MILESTONES• STRANGER ANXIETY HEIGHTENS @ 6-8 MO.• QUIETS SELF AND QUIETED BY MUSIC @ 10-12  MO.• HAS MOOD CHANGES @...
LANGUAGE MILESTONES•   RESPONDS TO SOUNDS @ BIRTH•   COOS, BABBLES- 3 MOS•   BABBLING COMMON @ 4-5 MONTHS•   MAKES VOWEL S...
LANGUAGE MILESTONES•   BELLY LAUGHS & TALKS TO TOYS 6-7 MO.•   First few words have meaning- 8-9 mos “mama, dada”     – Un...
PSYCHOSOCIAL DEVELOPMENT-ERIKSON• TRUST VS. MISTRUST – THE BASIC DEVELOPMENTAL TASK OF  INFANCY   – TRUST OF SELF, OTHERS ...
COGNITIVE DEVELOPMENT                      PIAGET• SENSORIMOTOR  – INITIALLY RELATES TO WORLD THROUGH REFLEXES  – Realize ...
COGNITIVE DEVELOPMENT                     PIAGET– FOUR STAGES DURING INFANCY   • USE OF REFLEXES       – Sucking, rooting,...
Development of Body Image• Parallels sensorimotor development• As physical needs are met they feel comfort and satisfactio...
IMMUNIZATIONS REQUIRED FIRST 6 MONTHS•   DTaP SERIES•   HEPATITIS B SERIES•   POLIO SERIES•   STREP PNUEMOCOCCUS SERIES (P...
IMMUNIZATIONS REQUIRED@ 12-15 MONTHS• BOOSTERS  – DTAP  – PNUEMOCOCCUS  – HIB• MMR• VARICELLA
INFANT NUTRITION•   HUMAN MILK MOST DESIRABLE COMPLETE DIET FOR THE FIRST 6 MONTHS•   BREAST MILK OR FORMULA UNTIL 12 MONT...
ADDITION OF SOLID FOODS• IRON FORTIFIED RICE CEREAL USUALLY FIRST• FRUIT JUICES CAN BE ADDED AFTER 6 MONTHS• STRAINED VEGE...
INTRODUCING SOLID FOODS TO INFANTS• INTRODUCE WHEN INFANT IS HUNGRY• BEGIN BY PUSHING FOOD TO BACK OF TONGUE BECAUSE OF  E...
• AS AMOUNT OF SOLID FOOD INCREASES, DECREASE  AMOUNT OF FORMULA TO PREVENT OVERFEEDING• DO NOT INTRODUCE FOODS BY MIXING ...
PLAY• SOLITARY OR ONE-SIDED PLAY• OVER THE YEAR BECOMES MORE SOPHISTICATED AND  INTERDEPENDENT• SENSORY STIMULATION IS VER...
CLEFT LIP & CLEFT PALATE•   MULTIFACTOR ETIOLOGY•   TENDS TO RUN IN FAMILIES•   ENVIRONMENTAL TERATOGENS MAY PLAY A ROLE• ...
CLEFT LIP & CLEFT PALATE•   PATHOPHYSIOLOGY- FAILURE OF THE MAXILLARY AND PREMAXILLARY    PROCESSES TO MEET AND FUSE. NOTH...
CLEFT LIP & CLEFT PALATE• SURGICAL TREATMENT   – CLEFT LIP REPAIRED BY AGE 3 TO 6 MO   – CLEFT PALATE REPAIRED AT 6-24 MO....
CLEFT LIP & CLEFT PALATE• NURSING CARE- CLEFT LIP REPAIR   – PREOP- DEAL WITH FEEDING PROBLEMS   – ENCOURAGE PARENT/INFANT...
Mosby items and derived items ©                                  73 of 602006 by Mosby, Inc.
Cleft Lip Repair
CLEFT LIP & CLEFT PALATE•   NURSING CARE- CLEFT PALATE REPAIR     – PERFORMED BEFORE FAULTY SPEECH HABITS OCCUR     – PREO...
ESOPHAGEAL ATRESIA WITH       TRACHEAL-ESOPHAGEAL FISTULA• PATHOPHYSIOLOGY:• FAILURE OF THE ESOPHAGUS TO FORM AS A CONTINU...
Mosby items and derived items ©                                  78 of 602006 by Mosby, Inc.
CLINICAL MANIFESTATIONS– EXCESSIVE SALIVATION AND DROOLING– THE THREE “C’s”= COUGH, CHOKING AND CYANOSIS– APNEA– RESPIRATO...
ESOPHAGEAL ATRESIA WITH        TRACHEAL-ESOPHAGEAL FISTULA• THERAPEUTIC MANAGEMENT  – PREVENTION OF ASPIRATION AND PNEUMON...
ESOPHAGEAL ATRESIA WITH         TRACHEAL-ESOPHAGEAL FISTULA• NURSING CARE – PREOP  – IF SUSPECTED MAKE INFANT NPO  – ELEVA...
ESOPHAGEAL ATRESIA WITH          TRACHEAL-ESOPHAGEAL FISTULA• NURSING CARE- POST OP  – MAINTAIN GASTROSTOMY TUBE  – If a s...
DIAPHRAGMATIC HERNIA• FAILURE OF DIAPHRAGM TO CLOSE PRENATALLY  ALLOWING ABDOMINAL ORGANS TO BE  DISPLACED INTO THE ABDOMEN
Diaphragmatic Hernia
DIAPHRAGMATIC HERNIA• DEFECT ON IS USUALLY ON THE LEFT SIDE. BOWEL  ENTERS THE CHEST CAVITY AND PUSHES HEART TO THE  RIGHT...
DIAPHRAGMATIC HERNIA• CLINICAL MANIFESTATIONS   – HEART SOUNDS LOUDER ON THE RIGHT   – SCAPHOID ABDOMEN   – BOWEL SOUNDS I...
HYDROCEPHALUS• IMBALANCE BETWEEN PRODUCTION AND ABSORPTION OF CSF  CAUSING ACCUMULATION IN VENTRICLES   – Communicating   ...
HYDROCEPHALUS• EARLY PHYSICAL SIGNS  – BULGING FONTANELS  – DILATED SCALP VEINS  – SEPARATED SUTURE LINES• LATE PHYSICAL S...
HYDROCEPHALUS•   VENTRICULAR-PERITONEAL SHUNT USUALLY NEEDED (VP shunt)•   Infection is greatest hazard•   Monitor closely...
NEURAL TUBE DEFECTS• SPINAL BIFIDA OCCULTA  – DEFECT PRESENT IN VERTEBRA  – NO SAC PRESENT  – NO OBVIOUS DEFICITS BUT “SOF...
Spina Bifida Cystica• Meningocele• Sac contains meninges and spinal fluid but no  neural elements• Not associated with neu...
Spinal Bifida Cystica• Myelomeningocele• Sac contains meninges, spinal fluid, and nerves• Manifestations relate to degree ...
NEURAL TUBE DEFECTS• CAN BE DETECTED BY ULTRASOUND• CAN BE DETECTED BY AFP• INITIAL CARE  – PREVENTION OF INFECTION  – NEU...
NEURAL TUBE DEFECTS• MULTIDISCIPLINARY APPROACH  – NEUROLOGICAL AND NEUROSURGICAL EVALUATION  – ORTHOPEDIC EVALUATION  – G...
Nursing Considerations• After birth:  – Prone positioning  – Radiant warmer to maintain temp without clothing  – Applicati...
Nursing Considerations•   Post op care same as any surgical procedure•   Latex allergy precautions•   Family support•   Ed...
DEVELOPMENTAL DYPLASIA OF THE HIP• HIP JOINT INSTABILITY• MULTIFACTORAL ETIOLOGY• FRANK BREECH PRESENTATION HAS HIGH  ASSO...
DEVELOPMENTAL DYPLASIA OF THE HIP• DIAGNOSTIC EVALUATION  – POSITIVE BARLOW OR ORTOLANI MANEUVERS    DURING ASSESSMENTS  –...
DEVELOPMENTAL DYPLASIA OF THE HIP• THERAPEUTIC MANAGEMENT  – “DOUBLE DIAPER”  – PAVLIK HARNESS  – HIP SPICA CAST    • AVOI...
Pavlik Harness
Spica Cast
CLUB FOOT• FOOT TWISTED OUT OF THE NORMAL POSITION• EXACT CAUSE NOT KNOWN• UNILATERAL CLUB FOOT IS MORE COMMON• IF MILD TR...
CLUB FOOT• Serial casting is begun immediately• Correction usually takes 8 to 12 weeks• Severe case or cases in which cast...
Care of child with a cast• Assessments  – Circulation  – Sensation  – Movement• Interventions  – Elevate limb  – Avoid ind...
IRON DEFICIENCY ANEMIA ANEMIA CAUSED BY INADEQUATE SUPPLY OF DIETARY IRON MATERNAL IRON STORES ADEQUATE FOR 4-6 MONTHS (...
IRON DEFICIENCY ANEMIA ANEMIA CAUSED BY INADEQUATE SUPPLY OF DIETARY  IRON MATERNAL IRON STORES ADEQUATE FOR 4-6 MONTHS ...
Fe Deficiency Lab Values• RBC- low• Hgb/HCT- low• MCV/MCH- low- microcytic anemia• Ferritin levels (iron storage) low
Anemia: Lab Evaluation– Normal Peripheral Smear   • Iron Deficiency Anemia
• ATOPIC DERMATITIS ATOPIC DERMATITIS       ECZEMA / IS PROBABLY GENETICALLY  DETERMINED WITH CONTRIBUTING FACTORS• A PRUR...
ECZEMA / ATOPIC DERMATITIS
ECZEMA/ATOPIC DERMATITIS THERAPEUTIC MANAGEMENT  MOISTURIZE SKIN  REDUCE INFLAMMATION (TOPICAL OR ORAL   STEROIDS)  RE...
ECZEMA/ATOPIC DERMATITIS• TREATMENT METHODS  – AVOID ENVIRONMENTAL TRIGGERS SUCH AS    OVERHEATING, SOAPS, WOOL, ETC.  – O...
FAILURE TO THRIVE (FTT)• PERSISTENT DEVIATION FROM NORMAL  GROWTH CURVE (GROWTH < 5TH  PERCENTILE)• ORGANIC FTT- THERE IS ...
FAILURE TO THRIVE (FTT)• NON-ORGANIC FTT  – CAUSES     •   DISTURBED PARENT-CHILD RELATIONSHIP     •   POVERTY     •   HEA...
FAILURE TO THRIVE (FTT)CLINICAL MANIFESTATIONS  •   GROWTH FAILURE  •   DEVELOPMENT DELAY  •   APATHY  •   POOR EYE CONTAC...
FAILURE TO THRIVE (FTT)• MANAGEMENT – Reversal of malnutrition – Treat any underlying medical conditions – Multidisciplina...
Nursing Considerations• Accurate assessment of initial weight and  height• Record of all food intake and eating  behaviors...
SUDDEN INFANT DEATH SYNDROME (SIDS)• UNEXPLAINED DEATH AFTER POST MORTEM  EVALUATION OF A CHILD LESS THAN 1 YR. OLD• EPISO...
SUDDEN INFANT DEATH SYNDROME - SIDS• MANY THEORIES BUT NO KNOWN ETIOLOGY• SLEEP APNEA NOT THE CAUSE OF SIDS• MONITORING OF...
Risk factors• Infants born weighing less than 3.5 pounds.• Infants exposed to cocaine, heroin, or  methadone during the pr...
Reducing the risks Supine position only   No more side lying (AAP, 2005) No blankets, soft, bedding, bumpers, toys etc ...
SUDDEN INFANT DEATH SYNDROME - SIDS CARE OF FAMILY AFTER SIDS EVENT   COMFORT FAMILY AND ALLOW OPPORTUNITY TO SAY    GOO...
Cystic Fibrosis Pathophysiology:    Increased viscosity of mucous gland secretions    Elevation of sweat electrolytes (...
CYSTIC FIBROSIS• AUTOSOMAL RECESSIVE• MULTISYSTEM DISEASE  – RESPIRATORY SYSTEM  – DIGESTIVE SYSTEM  – INTEGUMENTARY SYSTE...
CYSTIC FIBROSIS DIAGNOSIS   FAMILY HISTORY   ABSENT PANCREATIC ENZYMES   INCREASE SWEAT CHLORIDE - >60 mEq/L   CHRONI...
CYSTIC FIBROSIS• PULMONARY CARE   – CLEAR AIRWAY (CHEST PT, FLUTTER     DEVICE, PERCUSSION VEST)   – THIN MUCUS THROUGH NE...
CYSTIC FIBROSIS• GASTROINTESTINAL CARE  – PANCREATIC ENZYMES-IF CAN NOT SWALLOW    PILLS MAY BE MIXED WITH A LITTLE FOOD  ...
Cystic Fibrosis Related Diabetes• Shares features of Type I and Type II• Unique an distinct form that requires special  ma...
GASTORENTERITIS• CAUSES ARE VIRAL, BACTERIAL, METABOLIC  AND PARASITIC• MOST PEDIATRIC CASES ARE VIRAL• EVEN VIRAL GASTROE...
GASTORENTERITIS• DEHYDRATION AND KIDS  – ASSOCIATED WITH METABOLIC ACIDOSIS  – KIDS HAVE A GREATER EXTRA CELLULAR    FLUID...
WATER BALANCE DIFFERENCESInfants and young children have a greater need for waterMore vulnerable to alterations in fluid...
EXTRACELLULAR FLUID                    COMPARTMENTConstitutes more than half total body water at birth Has greater ECF u...
WATER LOSS 2/3 of insensible water loss is through skin 1/3 through respiratory tract Insensible fluid loss is increase...
Dehydration• Sodium is the main solute in the ECF• When ECF volume is reduced in acute  dehydration, total body sodium is ...
Types of DehydrationIsotonicHypotonic (hyponatremic)Hypertonic (hypernatremic, hyperosmotic) ISOTONIC DEHYDRATION Primar...
Lab ValuesK+ normal to lowNA initially normal but then may be lowBUN and Creatinine – HighCO2- low (indicator of sever...
Signs and Symptoms                    of Dehydration   Fewer wet diapers than usual   No tears when crying; inside of mo...
GASTORENTERITIS ORAL REHYDRATION THERAPY MAY AVOID  HOSPITALIZATION CHOICE OF IV FLUID REPLACEMENT IS  BASED ON THE CHIL...
Concept of Oral Rehydration       • Rehydration solution of 75 to 90 mEq of         Na+ per liter       • Give 40 to 50 ml...
Prevention of Diarrhea•    Most diarrhea is spread by the fecal-oral route•    Teach personal hygiene•    Clean water supp...
PYLORIC STENOSIS PYLORUS MUSCLE INCREASES IN SIZE AND MASS OBSTRUCTS FOOD FROM LEAVING THE STOMACH IF UNTREATED DEATH F...
PYLORIC STENOSIS CLINICAL MANIFESTATIONS  –   VOMITING BEGINS BETWEEN 1 TO 10 WEEKS OF AGE  –   VOMITING BECOMES PROJECTI...
PYLORIC STENOSIS NURSING CARE  – PREOP MANAGE FLUIDS &    ELECTROLYTES    • DECOMPRESSION OF STOMACH BY NG TUBE    • IV F...
INTUSSUSCEPTION TELESCOPING OF INTESTINE USUALLY AT THE  ILEOCECAL VALVE  – Terminal ileum telescopes into the ascending ...
INTUSSUSCEPTION CLINICAL MANIFESTATIONS     WAVES OF COLICKY SEVERE PAIN     VOMITING     CURRANT JELLY STOOLS     LE...
IntussusceptionBARIUM ENEMA IS PRIMARILY DONE AS A DIAGNOSTICPROCEDURETHE BARIUM ENEMA MAY REDUCE THE OBSTRUCTION BYHYDR...
Clinical Manifestations                            of Hirschsprung  • Cogenital aganglionic megacolon  • Aganglionic segme...
Mosby items and derived items ©                                  163 of 602006 by Mosby, Inc.
Therapeutic Management• Surgery• Two stages  – Temporary ostomy  – Second stage—“pull-through”    procedure               ...
Vesicoureteral Reflux -VUR• Retrograde of urine into ureters  – Reservoir for bacteria• Primary – congential abnormal inse...
Complications• Associated with recurring kidney infections  – Pyelonephritis – high fever, vomiting, chills  – Can cause r...
Management• Prevent bacteria from entering the kidney  – Low dose antibiotic therapy  – Urine culture every 2-3 months and...
Prognosis• Usually excellent with prompt treatment at time  of diagnosis• Early diagnosis essential to prevent long term  ...
Nursing education• Wipe from front to back• Observe frequently for signs of pain, difficulty  voiding
Short Bowel Syndrome (SBS)• A malabsorptive disorder• Results from decreased mucosal surface area,  usually as result of s...
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
Infant spring 12 without graphics
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Nursing Buddies.... No graphic PPT

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  • Whether this is true in our own lives or the lives of those that we have the privilege to interact with and help this is so true. We can and do make a difference
  • This paradigm certainly is changing. What we saw in PPEC is the direct result of being able to save those tiny preterm babies. Peds nurses: Patient teaching to educate and empower the family to care for the child in the home setting. Opportunities for education: Your child’s schoolChurch groupsYouth groupsGirl scoutsSportsYou will always be on duty! But you won’t mind.
  • Something you can measure When reading journals for EBP talk about q/q changes.
  • This occurs through growth, maturation and learning Give child opportunities pos or negSome children that we see with have developmental delays. They need greater opportunities to explore. Causes of Delay - lack of knowledge, child been very ill, family stress, other children, substance abuse. Overuse of TV***All stages dependent upon environmental, genetic, nutritional factors. Nathan
  • Baby girls are born with eggs in their ovaries, but they don’t mature until pubertyOrgan transplant/regeneration of islet cells/stem cell transplantNeural cells are modified. Synapses have to learn to communicate with each other.
  • Have to give opportunities Role model. Have to see. How many have kid? Do your kids do what you tell them to do or do they do what they see you do. Er kids modeling language of parent.
  • Opportunities give children a chance to developSensitive periods reflected on ranges seen on G &amp;D matrix.Change not expected in one day but over several weeks.
  • HEREDITY - Inherited characteristics, sex, body size and shape, hair colorNEUROENDOCRINE - hormones affect heredity – PKU test or now called infant screening – able to assess thyroid disease, CFNUTRITION Single most important influence on growth. INTERPERSONAL relationships critical role in emotional, intelligence, and personality development. EX: Romanian babies.SOCIOECONOMIC – Lack the knowledge or resources for a safe, stimulating environmentDISEASE – Ethan/KendraENVIRONMENT – injuries r/t consequences of environmental dangers. – chemicals, labeling, new cleaner FABULOSO – looks like a sports drink. Tobacco – passive smoking, nicotine and drugs from breast feeding. Lead paint older homes, cribs-retardationSTRESS – age of occurrence is a factor, duration - how long, &gt; # stress at one time, health, temperament. May have a change in behavior. Need to help kids cope and how to solve problems. Staged cardiac surgery, critical illness (ICU stay)MEDIA- technology opened up our world. + and - OL courses, face book, TV, violence, promiscuity seen on TV. Identify with media. TV on for &gt; 6 hrs day ½ American families. Watch 21-28 hours per week. AAP - Powerful influence on the dev of unhealthy beh and neg attitudes in kids Development does occur in order, but each child progresses at their own rate. Sensitive periods. First three months of PN life are sensitive periods for later G&amp;D. Need loving and warm relationship with caregiver
  • What do children learn through play? Write on boardGet along with others.Large muscle coordination and developmentCardiovascular healthFine motor skillsPersonality developmentCooperation and problem solvingEmpathySelf confidenceBrain developmentInspire them Learn to manipulate objects - textures, shapes, colorsAssociate words with objects Expand knowledge
  • Practice play doing what ever their attention is focused to. What ever….Symbolic play – pretend play Begins 11-13 monthsAct out roles that they see in role models, Imitate you, parents, telephone, Burger King, store, school, nurse etc Games – Young pat a cake, older cooperative (tea time) and competitive play (T-ball)
  • Muscle development Release of excess energyHow children explore their world. Problem solvingHow they feel about themselvesInteract with others Practice skills Right from wrong Creativity Provides for a release of tension and stress. Medium to try out fearful situations . Learn they can do it. Learn to communicate Code of conduct for the group if they are to be accepted. Learn to conform to the standards of the group.
  • Some parents are aware of safety. Others need your help. Teaching the parent. One of the things that I try to talk about with all of my families is…. To help to avoid some of the bumps and bruises along the way. If in doubt, just talk about safety in a non threatening way. Don’t accuse, parents become defensive. On a road trip…. Good gas prices, good hotels etc. Many parents just haven’t thought about safety. Car seat and seat belt safety. Electric plugs, cabinet locks, cleaners out of reach, water in mop buckets, toilet lids closed, sharp edges, water heaters, more mobility at the various stages. Toys – loose parts, strings, cords, items they will put in their mouth, loud noises that might damage ears. IPODS, music too loud. Older generation HOH, new generation will be HOH too. Need for constant supervision. Education of older siblings. Need to keep toys out of reach. Bicycle helmets, knee pads, Lead - old furniture, plastic bags. Seat belt survey
  • Injuries are a major cause of death during infancy. Aspiration (hot dog)Clothes for buttons Mobiles inspected Plastic eyes on stuffed animalsBalloons Syringe capsbandaids
  • Children are separated from normal environment. Don’t have the ability for abstract thinking. EX: Clinic – children playing in the garbage can. Parents weren’t watching the child.
  • Loss of control can increases the perception of threat and decreases coping skills. Give choices. Look at facial expression of distress. Cry, grimace. Toddlers /preschoolers like autonomy – Like rituals. Routine is upset.
  • Rituals from home Include family Minimize loss of control I liked the style of the nurse in the video. Taking the child for a ride in the wagon and orienting the mom at the same time. Bonding with the mom and child. FunEducationalInformativeMany parts of your assessment are completed.
  • Barriers to immunizations? Nutrition – amount of formula, table foods, food groups underweight or overweight SiblingsFactors affecting immunizations: Cost, transportation, distance to clinics, communication, long wait times, lack of education regarding efficacy. Fear of dangers Pertussis. Autism ASSESSMENT Asking direct and indirect questions. You ask/parent provides on form. Chief complaint – open ended questions. What brings you here? The matter? How can I help you? Present IllnessPast historyMedicationsG and Dev
  • Florida Shots?
  • Have toys for distractionPrivacyDevelop therapeutic relationship, but separate enough to distinguish own feelings and fears
  • Child – Life
  • Immokalee Study: Looked at Farm Workers and any potential correlation between chemicals/pesticides and CLEnvironmental Factors: Maternal infectionRadiation exposureAlcohol ingestionCorticosteroidsTranquilersAntiepilepticssmoking
  • ELMO PAGE 856
  • Parents need support due to being both a cosmetic and functional defectCan interfere with bonding. Sometimes surgery done within days. Palate in stages. Support: Show before and after pictures Teach feeding techniques Preemie nipples Increase size of opening, long tubing, extra long nipple that goes beyond the cleft, Syringe with an extension tubingDropperFeed upright Burp frequentlyExplain need for longterm followup. Clear milk from mouth to prevent infection
  • Page 858Esophagus ends in a blind pouch or narrows into a thin cord and no continuous pathway to the stomach TEF is an abnormal connection between the trachea and the esophagusMaternal hydramnios is a common finding. SGA. Other embryonic defects = cardiac, cleft lip and or palate, vertebral, UY abdominal wall defect
  • Significant respiratory difficulty .Excessive oral secretions drooling/feeding intolerance Cough and gag with feeding through nose/mouthAnd cause aspiration
  • Page 877
  • Left because that is the side of the diaphram that fuses last. Dx PN on US. Can have fetal surgery. – poor outcomes due to PT labor Decreased breath sounds. Bowel sounds are heard in the chest Heart sounds heard on the right side – heart displaced by abd contentsFlat or scaphoid abdomenGastric tube to decompress stomach Symptomatic within the first few hours = poor survival rate (50 %) Technology improving outcomes.
  • Tx shuntSurgery to relieve obstruction – tumor Unidirectional flow valve that drains fluid from the ventricle to the peritoneum Open when the pressure reaches a certain point, and closes when not needed. Hazards = infection and malfunction. &gt; risk 1-2 wks after placement Septicemia, bacterial endocarditis, wound infection, menengitis, venticulitisKinking, plugging, separation or migration ABX first, then if no improvement removal of shunt HC measurement s/sx icp:Widening sutures, and fontanels, distended scalp veins, lethargy, poor feeding, vomiting, irritability, opisthotonic, high pitched cry.
  • Distortion of the spinal cord and the nerve roots coming from the spine by fibrous bands or adhesions Fatty tumours in the spine, under the skin or in surrounding tissues Cysts in the skin or just under it Cysts filled with cerebrospinal fluid in the spine (syrinxes) Divisions in the spinal cord Spinal cord tethered or held down at the site (unable to move freely in the spinal canal) To avoid confusion, the term often used to for spina bifida occulta with these associated problems is occult spinal dysraphism (OSD).In addition to these structures which are usually hidden from view, there are a number of signs which may appear on the skin (cutaneous signatures) and give a clue to the underlying problems with the central nervous system. These signs can appear on their own but quite often they appear in combination. Some common ones are:An abnormal hair growth over the thoracic or lumbar spine A dermal sinus or small tract which leads from the skin surface down through to the spinal cord. Blind sinuses or pits which do not lead into the spine are common in newborns especially in the crease of the bottom and do not indicate underlying problems. A fatty mass (lipoma) just under the skin A rudimentary tail A capillary haemangioma (stork bite) over the lower spine. Haemangioma over the back of the head are more common and do not indicate underlying problems.
  • Cord not involved
  • Child has motor and sensory deficits below the deficit.Visible at birth Usually in the lumbosacral areaUsually covered with a very fragile, thin membrane.Can tear easily, allowing the CSF to flow out. Infection in.
  • Use the palms, not the fingers when the cast is wet. Cast care 1809Plaster casts 10-72 hours to drySynthetic – 5-30 minutes Synthetic don’t mold to body parts as well.
  • Use of non-well water for infant formula
  • No Bubble Bath
  • Often secondary to NEC
  • Infant spring 12 without graphics

    1. 1. NUR 2310 Pediatric Nursing Concepts ANDREA STORRIE,MSN, CPNP
    2. 2. GROWTH AND DEVELOPMENT Unit 1 Developmental influences on child health promotion
    3. 3. One hundred years from now it will not matter What kind of car I drove. What kind of house I lived in. How much money I had in my bank account. Nor what my clothes looked like. But the world may be a little betterBecause I was important in the life of a child.
    4. 4. CHILDREN’S HEALTH A CHANGING PARADIGM• Sixty years ago leading causes of death were infections and catastrophic disease• Today’s leading causes are complications of low birth weight, congenital anomalies and injury• Antibiotics, immunizations and cancer advances changed the paradigm• How do pediatric nurses function now and how will the future change pediatric nsg.?
    5. 5. GROWTH AND DEVELOPMENTGROWTH – Increase in the size and number of cells resulting in increased size and/or weight of a part – Quantitative change
    6. 6. GROWTH AND DEVELOPMENTDEVELOPMENT• Gradual change and expansion progressing from lower to advanced complexity. The emerging and expanding of individual capacities• Qualitative change
    7. 7. G & D CONTINUEDMATURATION – An increase in competence and adaptabilityDIFFERENTIATION – Process by which early cell structures are systemically modified to achieve specific properties. – A development from simple to more complex activities and functions. – All four of these processes are interrelated simultaneously. – None occur without the other.
    8. 8. BASIC ASSUMPTIONS ABOUT CHILD DEVELOPMENT• Development is orderly• Development has direction• Development is complex• Each child is unique• Development necessitates practice• Development requires a role model
    9. 9. BASIC ASSUMPTIONS CON’T• Development requires energy to be expended• Children develop through conflict and adaptation• Development goes through cycles• Development has sensitive periods
    10. 10. DEVELOPMENTAL INFLUENCESPATTERNS OF GROWTH & DEVELOPMENT:DIRECTIONAL TRENDS – CEPHALOCAUDAL – PROXIMODISTAL (NEAR TO FAR) – DIFFERENTIATION – GENERAL (MASS) TO SPECIFIC
    11. 11. FACTORS INFLUENCING GROWTH AND DEVELOPMENT• Heredity • Disease• Neuroendocrine • Environmental factors hazards• Nutrition • Stress• Interpersonal • Mass media relationships – AAP• Socioeconomic factors
    12. 12. ERIKSON’S STAGES OF PERSONALITY DEVELOPMENT• Involves a specific conflict or developmental task• Infant - Trust vs. Mistrust• Toddler - Autonomy vs. Shame and Doubt• Preschooler - Initiative vs. Guilt• Schoolager - Industry vs. Inferiority• Adolescent - Identity vs. Role Confusion• Adulthood- Intimacy vs. Isolation
    13. 13. Piaget’s Stages of Cognitive Development• Sensorimotor (Birth to 2 years) progress from reflex to sense of cause and effect• Preoperational (2 to 7 years) egocentric - thinking is concrete and tangible• Concrete operational (7 to 11 years) increasingly logical and coherent - develop conservation• Formal operations (11 to adulthood) think abstractly - adaptable and flexible
    14. 14. FREUD - PSYCHOSEXUAL DEVELOPMENT• Oral stage - birth to one year• Anal stage - one to three years• Phallic stage - three to six years• Latency period - six to twelve years• Genital period - age twelve and over DURING CHILDHOOD, CERTAIN REGIONS OF THE BODY ASSUME A PROMINENT PSYCHOLOGIC SIGNIFICANCE WHICH SHIFTS FROM ONE PART OF THE BODY TO ANOTHER
    15. 15. PLAY• Universal medium for learning• Children learn what no one else can teach them• Play is the work of childrenhttp://www.brightcove.tv/title.jsp ?title=894297564&channel=82 5544798
    16. 16. CLASSIFICATION OF PLAYPractice play referred to as functional or sensorimotor playSymbolic playGames
    17. 17. SOCIAL ASPECTS OF PLAY• Solitary play• Onlooker play• Parallel play• Associative play• Cooperative play
    18. 18. FUNCTIONS OF PLAY • Physical development • Cognitive development • Emotional development • Social development • Moral development • Therapeutic value
    19. 19. Anticipatory Guidance• Parents need to know how to a provide safe environment for their child• Need to know what to expect before it happens• Based on childs developmental level• Awareness of the child’s changing capabilities allows the parents to be more alert and reactive to safety hazards the child is likely to encounter
    20. 20. SAFETY PRECAUTIONS WITH INFANT TOYS• Select toys that are smooth and rounded and made of wood or plastic• Plastic toys should be made of tough and resilient material• Avoid fuzzy and furry stuffed animals• Inspect toys for small removable parts• Check toys for toxic paint• Supervise infants if playing with paper, string, or cloth
    21. 21. PEDIATRIC UNIT SAFETY PRECAUTIONS• Baby proof room• Provide only age appropriate toys• Remove all medical equipment except when used for treatments• Cords out of reach• Outlets covered• Crib rails up to highest adjustment• Maintain physical contact if infant or toddler is on an unguarded surface such as a scale or treatment table• NEVER LEAVE UNATTENDED NEAR WATER !
    22. 22. CHILDREN’S RESPONSE TO HOSPITALIZATION• Separation Anxiety: – Protest: crying, screaming, wrongly viewed as misbehavior – Despair: decreased activity or withdrawal, often viewed as a good thing or “settling in” – Denial or detachment: starts to play & form other attachments, resigned not content
    23. 23. CHILDREN’S RESPONSE CON’T• Fear of the unknown• Fear of pain or mutilation• Loss of control• Anger• Guilt• Regression
    24. 24. PARENTAL STRESSORS• Fear of the unknown• New environment• Separation from child• Guilt• Financial burden• Fear that child will suffer or even die• Fatigue• work, care of other children, distance to hospital
    25. 25. COMMUNICATING WITH CHILDREN• Allow time to feel comfortable• Avoid rapid advance or other threatening gestures• Talk with parent if child is initially shy• Communicate through transition objects such as dolls or puppets• Assume an eye level position
    26. 26. COMMUNICATION CON’T.– Speak in a quiet, unhurried, confident tone of voice– Speak clearly, be specific, and use simple words and short sentences– State directions and suggestions positively– Offer a choice only if one exists– Be honest– Allow time to express concerns and fears– Give older child the chance to talk without parents present
    27. 27. GUIDELINES FOR ADMISSION• Introductions• Orient child and family• Apply identification• Explain hospital rules• Perform nursing admission history• Take baseline vital signs & obtain specimens• Support child and parents as necessary
    28. 28. HEALTH HISTORY• Immunizations current?• Well Child Care?• Sick Care only?• Who is the provider?• What routines are normal for the child? – Bedtime ritual? Read a story? Rock?
    29. 29. IMMUNIZATIONShttp://www.cdc.gov/vaccines/recs/schedules/child -schedule.htm#printablehttp://www.cdc.gov/vaccines/pubs/pinkbook/pink -chapters.htmhttp://www.flshots.com/
    30. 30. ASSESSMENT GUIDELINES• Perform in an appropriate, nonthreatening area• Provide time for play & getting acquainted• Observe for readiness to cooperate• Avoid prolonged explanations about procedures• Involve child and parent in exam process• Use a firm, direct approach• Proceed with exam in an organized sequence• Reassure child throughout exam & use praise• Discuss findings with the family
    31. 31. Pediatric Assessment• Toddlers are the most challenging to examine – Sequence is flexible• What are some differences of a pediatric assessment vs. the assessment of an adult?• Lymph nodes are often palpable in healthy infants and children up to 12 years or age (cervical, axillary, inguinal, and occipital areas)
    32. 32. PLAGIOCEPHALY (POSITIONAL)• Misshapen head• Back of head is flattened due to constantly being placed in supine position• Infants need belly time• Treatment – DOC band – Need to be worn 23 hours a day – Frequent adjustments
    33. 33. PLAGIOCEPHALY (POSITIONAL)
    34. 34. PLAGIOCEPHALY (POSITIONAL)
    35. 35. PERFORMING A PEDIATRIC PROCEDUREBefore the procedure – Offer ways to cope with pain or discomfort – Use developmentally appropriate words – Give choices when possible – Be sure consent form is signed – Always wash hands thoroughly
    36. 36. PERFORMING A PEDIATRIC PROCEDURE During the procedure Talk to the child if he/she desires Keep the child informed of progress Tell the child when the ”worst is over”
    37. 37. PED PROCEDURES CON’TAfter the procedure – Praise the child for attempting to cooperate – Provide an opportunity to vent feelings – Reunite the child with parents – Reward the child in an age-appropriate way – Record the process and it’s outcomes
    38. 38. MEDICATION ADMINISTRATION“8” rights – Patient, Order, med., dose, time, route, documentation, & attitude – Oral medications – Intramuscular administration – Vastus lateralis – Intravenous administration – NG, OG, or Gastrostomy administration – Rectal Administration
    39. 39. ADDITIONAL PROCEDURES WITH VARIATIONS• Measurement of I & O• Parenteral fluid therapy• Inhalation therapy• Chest physiotherapy• Postural drainage• Gavage or gastrostomy feeding• Ostomies
    40. 40. BIOLOGICAL DEVELOPMENT• GAINS 5-7 OUNCES WEEKLY FOR 1ST 5-6 MO.• DOUBLES BIRTH WEIGHT BY 6 MO.• TRIPLES BIRTH WEIGHT BY 12 MO• BIRTH LENGTH INCREASES 50% BY 12 MO.• HEAD SIZE INCREASES 33% BY 12 MO.
    41. 41. BIOLOGICAL DEVELOPMENT• BRAIN INCREASES IN WEIGHT BY 2 ½ TIMES• ORGAN SYSTEMS BEGIN TO MATURE• GROWTH CHARTS ARE MOST ACCURATE ASSESSMENT OF CHILD’S GROWTH
    42. 42. BIOLOGICAL DEVELOPMENT• BRAIN INCREASES IN WEIGHT BY 2 ½ TIMES• ORGAN SYSTEMS BEGIN TO MATURE• GROWTH CHARTS ARE MOST ACCURATE ASSESSMENT OF CHILD’S GROWTH
    43. 43. GROSS MOTOR MILESTONES• HEAD CONTROL ESTABLISHED @ 4-6 MONTHS• TURNS ABD. TO BACK @ 4-5 MONTHS• TURNS BACK TO ABD. @ 6-7 MONTHS• SITS WITHOUT SUPPORT @ 8-9 MO.• CRAWLS AND PULLS UP @ 8-9 MO.• STANDS ALONE @ 10-12 MO.• WALKS W/ ONE HAND HELD 10-12 M• WALKS INDEPENDENTLY 12-15 MO.
    44. 44. FINE MOTOR MILESTONES• 1 MONTH - HANDS FISTED – PALMAR GRASP• 3 MONTHS - CAN HOLD RATTLE• 4-5 MONTHS – BEGINS REACHING & GRASPING WITH PALMS• 6-7 MONTHS – PICKS UP OBJECT WELL -TRANSFERS OBJECTS FROM HAND TO HAND
    45. 45. FINE MOTOR MILESTONES• 8-9 MONTHS - PINCER GRASP DEVELOPS, REACHES FOR TOYS, RAKES FOR OBJECTS• 10-12 MONTHS – RELEASES CUBE INTO CUP AFTER DEMO. – PINCER GRASP COMPLETE – FEED SELF WITH SPOON
    46. 46. SOCIAL MILESTONES• SMILES RESPONSIVELY TO STIMULI @ 6-8 weeks.• SHOWS FEAR AND ANGER @ 4-8 MO.• SMILES AT SELF IN MIRROR @ 6-7 MO – PLAYS PEEK- A -BOO
    47. 47. SOCIAL MILESTONES• STRANGER ANXIETY HEIGHTENS @ 6-8 MO.• QUIETS SELF AND QUIETED BY MUSIC @ 10-12 MO.• HAS MOOD CHANGES @ 10-12 MO.
    48. 48. LANGUAGE MILESTONES• RESPONDS TO SOUNDS @ BIRTH• COOS, BABBLES- 3 MOS• BABBLING COMMON @ 4-5 MONTHS• MAKES VOWEL SOUNDS “ee, ah, ooh”- 4-5 months
    49. 49. LANGUAGE MILESTONES• BELLY LAUGHS & TALKS TO TOYS 6-7 MO.• First few words have meaning- 8-9 mos “mama, dada” – Understands simple demands- “wave bye bye” – Comprehends –”No,no”• 10 -12 months says “mama or dada”• By 1 year recognizes objects by names• CAN SAY 3-5 WORDS WITH MEANING BY 1 YEAR – Knows own name – Enjoys jabbering
    50. 50. PSYCHOSOCIAL DEVELOPMENT-ERIKSON• TRUST VS. MISTRUST – THE BASIC DEVELOPMENTAL TASK OF INFANCY – TRUST OF SELF, OTHERS , AND THE WORLD – TRUST DEVELOPS WHEN INFANT’S NEEDS ARE CONSISTENTLY MET – IF NEEDS NOT CONSISTENTLY MET MISTRUST OF WORLD DEVELOPS
    51. 51. COGNITIVE DEVELOPMENT PIAGET• SENSORIMOTOR – INITIALLY RELATES TO WORLD THROUGH REFLEXES – Realize others besides themselves control the environment – Object permanence by 9 months • One of the key tasks of this stage • Seen in the development of separation anxiety
    52. 52. COGNITIVE DEVELOPMENT PIAGET– FOUR STAGES DURING INFANCY • USE OF REFLEXES – Sucking, rooting, grasping • PRIMARY CIRCULAR RESPONSE (1-4 months) – Replacement of reflexive behaviors with voluntary acts • SECONDARY CIRCULAR RESPONSE -Continuation of primary lasts until 8 months - Primary circular reactions are repeated and prolonged for the response that results • COORDINATION OF SECONDARY SCHEMAS – Use previous behavioral achievements primarily as the foundation for adding new intellectual skills – Object permanence
    53. 53. Development of Body Image• Parallels sensorimotor development• As physical needs are met they feel comfort and satisfaction with their body• Messages convey by caregivers reinforce these feelings• Object permanence is basic to development of self image• By the end of the first year they realize they are distinct from their parents – At the same time is increased interest in their image – Smile at themselves in the mirror
    54. 54. IMMUNIZATIONS REQUIRED FIRST 6 MONTHS• DTaP SERIES• HEPATITIS B SERIES• POLIO SERIES• STREP PNUEMOCOCCUS SERIES (Prevnar)• H. INFLUENZA B- HIB SERIES• Rotavirus vaccine
    55. 55. IMMUNIZATIONS REQUIRED@ 12-15 MONTHS• BOOSTERS – DTAP – PNUEMOCOCCUS – HIB• MMR• VARICELLA
    56. 56. INFANT NUTRITION• HUMAN MILK MOST DESIRABLE COMPLETE DIET FOR THE FIRST 6 MONTHS• BREAST MILK OR FORMULA UNTIL 12 MONTHS• IRON SUPPLEMENTS @ 4-6MO FOR BREAST FED BABIES D/T DEPLETED IRON STORES• FORMULA BABIES MAY HAVE ENOUGH FROM DIET• NO BOTTLES IN MICROWAVE TO HEAT• NO SOLIDS UNTIL 4-6 MONTHS – EARLY EXPOSURE TO SOLIDS CAN PRODUCE ALLERGIES – EXTRUSION REFLEX IS STRONG IN YOUNG INFANTS
    57. 57. ADDITION OF SOLID FOODS• IRON FORTIFIED RICE CEREAL USUALLY FIRST• FRUIT JUICES CAN BE ADDED AFTER 6 MONTHS• STRAINED VEGETABLES USUALLY NEXT• FOLLOWED BY STRAINED FRUITS, THEN MEATS• EGGS, COW’S MILK, AND CITRUS ARE THE MOST COMMON INFANT ALLERGENS. DELAY INTRODUCTION UNTIL INFANT 12 MONTHS OLD
    58. 58. INTRODUCING SOLID FOODS TO INFANTS• INTRODUCE WHEN INFANT IS HUNGRY• BEGIN BY PUSHING FOOD TO BACK OF TONGUE BECAUSE OF EXTRUSION REFLEX• USE A SMALL SPOON WITH A STRAIGHT HANDLE• BEGIN WITH 1-2 TEASPOONS OF FOOD, INCREASE GRADUALLY• INTRODUCE FOODS ONE AT A TIME WITH 4-7 DAYS BETWEEN ADDING NEW FOODS
    59. 59. • AS AMOUNT OF SOLID FOOD INCREASES, DECREASE AMOUNT OF FORMULA TO PREVENT OVERFEEDING• DO NOT INTRODUCE FOODS BY MIXING WITH FORMULA IN THE BOTTLE• EARLY FEEDING EXPERIENCES ARE SLOPPY• CHILDREN CAN’T BE PRESSURED INTO EATING NEATLY UNTIL THEY HAVE MANIPULATIVE SKILLS
    60. 60. PLAY• SOLITARY OR ONE-SIDED PLAY• OVER THE YEAR BECOMES MORE SOPHISTICATED AND INTERDEPENDENT• SENSORY STIMULATION IS VERY IMPORTANT• INFANTS NEED TO BE PLAYED WITH, NOT MERELY ALLOWED TO PLAY
    61. 61. CLEFT LIP & CLEFT PALATE• MULTIFACTOR ETIOLOGY• TENDS TO RUN IN FAMILIES• ENVIRONMENTAL TERATOGENS MAY PLAY A ROLE• CHROMOSOMAL ANOMALIES OFTEN HAVE CLEFTS AS A FEATURE• MATERNAL SMOKING IN 1ST TRIMESTER ASSOCIATED WITH 10 % OF CASES• APPEARS MOST OFTEN IN ASIAN AND NATIVE AMERICAN INFANTS - LEAST IN AFRICAN-AMERICAN• Maternal intake of folic acid may prevent (NIH, 2007)
    62. 62. CLEFT LIP & CLEFT PALATE• PATHOPHYSIOLOGY- FAILURE OF THE MAXILLARY AND PREMAXILLARY PROCESSES TO MEET AND FUSE. NOTHING IS MISSING, ALL THE PIECES ARE THERE.• CAN BE INCOMPLETE OR COMPLETE• CLEFT PALATE CAN BE MISSED. FULL VISUALIZATION AND PALPATION OF THE PALATE NEEDED DURING NEWBORN EXAMINATIONS• CLEFT LIP CAN BE UNILATERAL OR BILATERAL – EXTENT OF CLEFT AND NASAL DEFORMITY IS VARIABLE
    63. 63. CLEFT LIP & CLEFT PALATE• SURGICAL TREATMENT – CLEFT LIP REPAIRED BY AGE 3 TO 6 MO – CLEFT PALATE REPAIRED AT 6-24 MO.• MULTIDISCIPLINARY TEAM APPROACH D/T PROBLEMS WITH SPEECH, ORTHODONTIA AND EARS/SINUSES
    64. 64. CLEFT LIP & CLEFT PALATE• NURSING CARE- CLEFT LIP REPAIR – PREOP- DEAL WITH FEEDING PROBLEMS – ENCOURAGE PARENT/INFANT BONDING – Z-PLASTY REPAIR OF LIP MINIMIZES NOTCHING – POST OP- PREVENT INFANT CRYING, CLEAN SUTURE LINE, MAINTAIN SUPINE POSITIONING, MAINTAIN ELBOW RESTRAINTS AND LIP BOW (LOGAN BOW)
    65. 65. Mosby items and derived items © 73 of 602006 by Mosby, Inc.
    66. 66. Cleft Lip Repair
    67. 67. CLEFT LIP & CLEFT PALATE• NURSING CARE- CLEFT PALATE REPAIR – PERFORMED BEFORE FAULTY SPEECH HABITS OCCUR – PREOP- DEAL WITH FEEDING PROBLEMS – POST OP- PREVENT INFANT CRYING, ASSESS FOR PAIN, PREVENT CHILD FROM INSERTING HARD OR POINTED OBJECTS IN MOUTH AND AVOID HARD FOODS – NEED TO MONITOR RESPIRATORY STATUS CLOSELY – OBSERVE FEEDING ONCE RESUMED- I & O • Liquids to soft diet within 48 hours
    68. 68. ESOPHAGEAL ATRESIA WITH TRACHEAL-ESOPHAGEAL FISTULA• PATHOPHYSIOLOGY:• FAILURE OF THE ESOPHAGUS TO FORM AS A CONTINUOUS PASSAGE• THE PROXIMAL SEGMENT TERMINATES INTO A BLIND POUCH• THE DISTAL SEGMENT IS CONNECTED TO THE TRACHEA OR THE PRIMARY BRONCHUS BY A SHORT FISTULA
    69. 69. Mosby items and derived items © 78 of 602006 by Mosby, Inc.
    70. 70. CLINICAL MANIFESTATIONS– EXCESSIVE SALIVATION AND DROOLING– THE THREE “C’s”= COUGH, CHOKING AND CYANOSIS– APNEA– RESPIRATORY DISTRESS WITH FEEDS– ABDOMINAL DISTENTION
    71. 71. ESOPHAGEAL ATRESIA WITH TRACHEAL-ESOPHAGEAL FISTULA• THERAPEUTIC MANAGEMENT – PREVENTION OF ASPIRATION AND PNEUMONIA • NPO AND IV FLUIDS • “POUCH TUBE” TO REMOVE SECRETIONS • ELEVATE HEAD • GASTROSTOMY TO DRAIN STOMACH CONTENTS (decompression) - SURGICAL CORRECTION
    72. 72. ESOPHAGEAL ATRESIA WITH TRACHEAL-ESOPHAGEAL FISTULA• NURSING CARE – PREOP – IF SUSPECTED MAKE INFANT NPO – ELEVATE HEAD – CLEAR SECRETIONS WITH CONTINUOUS SUCTION – OXYGEN FOR RESPIRATORY DISTRESS
    73. 73. ESOPHAGEAL ATRESIA WITH TRACHEAL-ESOPHAGEAL FISTULA• NURSING CARE- POST OP – MAINTAIN GASTROSTOMY TUBE – If a staged repair- care of cervical esphagostomy – SLOW RETURN OF ORAL FEEDS – DISCHARGE AFTER ORAL FEEDINGS RESUMED AND G-TUBE REMOVED
    74. 74. DIAPHRAGMATIC HERNIA• FAILURE OF DIAPHRAGM TO CLOSE PRENATALLY ALLOWING ABDOMINAL ORGANS TO BE DISPLACED INTO THE ABDOMEN
    75. 75. Diaphragmatic Hernia
    76. 76. DIAPHRAGMATIC HERNIA• DEFECT ON IS USUALLY ON THE LEFT SIDE. BOWEL ENTERS THE CHEST CAVITY AND PUSHES HEART TO THE RIGHT. IMPEDES GROWTH OF THE LUNG• AFTER BIRTH THE BOWEL FILLS WITH AIR WHICH FURTHER COMPROMISES BREATHING AND CIRCULATION
    77. 77. DIAPHRAGMATIC HERNIA• CLINICAL MANIFESTATIONS – HEART SOUNDS LOUDER ON THE RIGHT – SCAPHOID ABDOMEN – BOWEL SOUNDS IN CHEST – INCREASING RESPIRATORY DISTRESS• STABILIZATION PRE-OP – RESUSCITATED WITH ET TUBE NOT MASK – ELEVATE HEAD OF BED – AFFECTED SIDE DOWN – NPO AND GASTRIC DECOMPRESSION (NG TUBE)
    78. 78. HYDROCEPHALUS• IMBALANCE BETWEEN PRODUCTION AND ABSORPTION OF CSF CAUSING ACCUMULATION IN VENTRICLES – Communicating – Noncommunicating• FOUND EARLY ON WELL EXAMS BY SERIALLY MEASURING AND GRAPHING HEAD CIRCUMFERENCES• VERY OFTEN ASSOCIATED WITH MYELOMENINGOCELE
    79. 79. HYDROCEPHALUS• EARLY PHYSICAL SIGNS – BULGING FONTANELS – DILATED SCALP VEINS – SEPARATED SUTURE LINES• LATE PHYSICAL SIGNS – SETTING SUN SIGN- SCLERA VISIBLE ABOVE IRIS – SHRILL HIGH PITCHED CRY DUE TO ICP – OPISTHOTONOS
    80. 80. HYDROCEPHALUS• VENTRICULAR-PERITONEAL SHUNT USUALLY NEEDED (VP shunt)• Infection is greatest hazard• Monitor closely for signs of infection and ICP• Pain management• Educate parents on signs of infection and increases ICP• Teach parents how to change dressing
    81. 81. NEURAL TUBE DEFECTS• SPINAL BIFIDA OCCULTA – DEFECT PRESENT IN VERTEBRA – NO SAC PRESENT – NO OBVIOUS DEFICITS BUT “SOFT” SIGNS MAY BE PRESENT
    82. 82. Spina Bifida Cystica• Meningocele• Sac contains meninges and spinal fluid but no neural elements• Not associated with neurological defect
    83. 83. Spinal Bifida Cystica• Myelomeningocele• Sac contains meninges, spinal fluid, and nerves• Manifestations relate to degree of defect, which is determined by the level of the lesion
    84. 84. NEURAL TUBE DEFECTS• CAN BE DETECTED BY ULTRASOUND• CAN BE DETECTED BY AFP• INITIAL CARE – PREVENTION OF INFECTION – NEUROLOGIC ASSESSMENT – DEALING WITH IMPACT ON FAMILY
    85. 85. NEURAL TUBE DEFECTS• MULTIDISCIPLINARY APPROACH – NEUROLOGICAL AND NEUROSURGICAL EVALUATION – ORTHOPEDIC EVALUATION – GENITOURINARY EVALUATION – GASTROINTESTINAL (BOWEL CONTROL) EVALUATION
    86. 86. Nursing Considerations• After birth: – Prone positioning – Radiant warmer to maintain temp without clothing – Application of moist, nonadherent sterile dressing over sac – Prevent infection
    87. 87. Nursing Considerations• Post op care same as any surgical procedure• Latex allergy precautions• Family support• Education
    88. 88. DEVELOPMENTAL DYPLASIA OF THE HIP• HIP JOINT INSTABILITY• MULTIFACTORAL ETIOLOGY• FRANK BREECH PRESENTATION HAS HIGH ASSOCIATION WITH D.D.H.
    89. 89. DEVELOPMENTAL DYPLASIA OF THE HIP• DIAGNOSTIC EVALUATION – POSITIVE BARLOW OR ORTOLANI MANEUVERS DURING ASSESSMENTS – RESTRICTED ABDUCTION – ASYMMETRICAL SKIN FOLDS ON POSTERIOR THIGHS – APPARENT FEMUR SHORTENING – DDH
    90. 90. DEVELOPMENTAL DYPLASIA OF THE HIP• THERAPEUTIC MANAGEMENT – “DOUBLE DIAPER” – PAVLIK HARNESS – HIP SPICA CAST • AVOID INDENTING WET CAST WITH FINGERS. USE FLATS OF HANDS • DO NOT PULL ON ABDUCTION BAR • PROTECT CAST FROM SOILING
    91. 91. Pavlik Harness
    92. 92. Spica Cast
    93. 93. CLUB FOOT• FOOT TWISTED OUT OF THE NORMAL POSITION• EXACT CAUSE NOT KNOWN• UNILATERAL CLUB FOOT IS MORE COMMON• IF MILD TREATED WITH EXERCISES• IF MORE INVOLVED SERIAL CASTING IS PERFORMED• IF MAXIMUM CORRECTION IS NOT ACHIEVED 3-6 MO., SURGERY FOLLOWS• LONG-TERM FOLLOW UP INDICATED
    94. 94. CLUB FOOT• Serial casting is begun immediately• Correction usually takes 8 to 12 weeks• Severe case or cases in which casting does not correct deformity require surgery – Done between 4 months and 1 year of age
    95. 95. Care of child with a cast• Assessments – Circulation – Sensation – Movement• Interventions – Elevate limb – Avoid indenting the cast while it is drying – Parent education
    96. 96. IRON DEFICIENCY ANEMIA ANEMIA CAUSED BY INADEQUATE SUPPLY OF DIETARY IRON MATERNAL IRON STORES ADEQUATE FOR 4-6 MONTHS (FULL- TERM) AND 2-3 MONTHS (PREEMIE) TREATMENT  IRON FORTIFIED FORMULA  ORAL IRON SUPPLEMENT  VITAMIN C  DECREASE WHOLE MILK AND ADD Iron Fortified CEREALS, VEGETABLES, AND MEATS
    97. 97. IRON DEFICIENCY ANEMIA ANEMIA CAUSED BY INADEQUATE SUPPLY OF DIETARY IRON MATERNAL IRON STORES ADEQUATE FOR 4-6 MONTHS (FULL-TERM) AND 2-3 MONTHS (PREEMIE) TREATMENT  IRON FORTIFIED FORMULA  ORAL IRON SUPPLEMENT  VITAMIN C  DECREASE WHOLE MILK AND ADD Iron Fortified CEREALS, VEGETABLES, AND MEATS
    98. 98. Fe Deficiency Lab Values• RBC- low• Hgb/HCT- low• MCV/MCH- low- microcytic anemia• Ferritin levels (iron storage) low
    99. 99. Anemia: Lab Evaluation– Normal Peripheral Smear • Iron Deficiency Anemia
    100. 100. • ATOPIC DERMATITIS ATOPIC DERMATITIS ECZEMA / IS PROBABLY GENETICALLY DETERMINED WITH CONTRIBUTING FACTORS• A PRURITIC ECZEMA ASSOCIATED WITH DRY SKIN, ALLERGY, AND EMOTIONAL STRESS WHICH STARTS IN INFANCY & MAY CLEAR BY 2-3 YRS.• AFFECTS 9-12% OF YOUNG CHILDREN
    101. 101. ECZEMA / ATOPIC DERMATITIS
    102. 102. ECZEMA/ATOPIC DERMATITIS THERAPEUTIC MANAGEMENT  MOISTURIZE SKIN  REDUCE INFLAMMATION (TOPICAL OR ORAL STEROIDS)  RELIEVE ITCH (MEDS AND LUBRICATION)  PREVENT SECONDARY INFECTION  REMOVE IRRITANTS AND ALLERGENS  IDENTIFY AND AVOID POTENTIAL FOOD TRIGGERS
    103. 103. ECZEMA/ATOPIC DERMATITIS• TREATMENT METHODS – AVOID ENVIRONMENTAL TRIGGERS SUCH AS OVERHEATING, SOAPS, WOOL, ETC. – ORAL ANTIHISTAMINES (Atarax, Benadryl, Claritin) – INFREQUENT TEPID BATHING, WET COMPRESSES, OCCLUSIVE CREAMS AND COOL COMPRESSES – LOW POTENCY ANTI-INFLAMMATORY CREAMS (Elocon, Cutivate)
    104. 104. FAILURE TO THRIVE (FTT)• PERSISTENT DEVIATION FROM NORMAL GROWTH CURVE (GROWTH < 5TH PERCENTILE)• ORGANIC FTT- THERE IS A PHYSICAL PATHOLOGICAL PROCESS PRESENT. THE FTT MAY OR MAY NOT BE CORRECTABLE DEPENDING ON THE UNDERLYING CAUSE.
    105. 105. FAILURE TO THRIVE (FTT)• NON-ORGANIC FTT – CAUSES • DISTURBED PARENT-CHILD RELATIONSHIP • POVERTY • HEALTH BELIEFS • INADEQUATE NUTRITIONAL KNOWLEDGE • FAMILY STRESS• MIXED FTT – Combination of organic and inorganic etiologies
    106. 106. FAILURE TO THRIVE (FTT)CLINICAL MANIFESTATIONS • GROWTH FAILURE • DEVELOPMENT DELAY • APATHY • POOR EYE CONTACT/RADAR GAZE • STIFF POSTURE • NO FEAR OF STRANGERS
    107. 107. FAILURE TO THRIVE (FTT)• MANAGEMENT – Reversal of malnutrition – Treat any underlying medical conditions – Multidisciplinary approach
    108. 108. Nursing Considerations• Accurate assessment of initial weight and height• Record of all food intake and eating behaviors• Assessment of parent child relationship
    109. 109. SUDDEN INFANT DEATH SYNDROME (SIDS)• UNEXPLAINED DEATH AFTER POST MORTEM EVALUATION OF A CHILD LESS THAN 1 YR. OLD• EPISODES HAVE DECREASED 40% SINCE THE “BACK TO SLEEP” CAMPAIGN• INCIDENCE NOW 0.6 IN 1000 LIVE BIRTHS• PEAK AGE 2-4 MONTHS• 95% OF DEATHS OCCUR BY 6 MONTHS
    110. 110. SUDDEN INFANT DEATH SYNDROME - SIDS• MANY THEORIES BUT NO KNOWN ETIOLOGY• SLEEP APNEA NOT THE CAUSE OF SIDS• MONITORING OF SUBSEQUENT SIBLINGS NOT RECOMMENDED - 99% CHANCE OTHER INFANTS WILL NOT DIE OF SIDS
    111. 111. Risk factors• Infants born weighing less than 3.5 pounds.• Infants exposed to cocaine, heroin, or methadone during the pregnancy.• Infants who have had an apparent life- threatening event.
    112. 112. Reducing the risks Supine position only  No more side lying (AAP, 2005) No blankets, soft, bedding, bumpers, toys etc in the crib Do not over clothe the infant Pacifiers use at time of sleep (controversial) No co-sleeping
    113. 113. SUDDEN INFANT DEATH SYNDROME - SIDS CARE OF FAMILY AFTER SIDS EVENT  COMFORT FAMILY AND ALLOW OPPORTUNITY TO SAY GOODBYE  PROVIDE WRITTEN MATERIAL  ARRANGE FOR F/U HOME VISIT WHEN FAMILY IS READY  REFER TO SIDS SUPPORT GROUP
    114. 114. Cystic Fibrosis Pathophysiology:  Increased viscosity of mucous gland secretions  Elevation of sweat electrolytes (NA)  Mechanical obstruction as a result of thick secretions  Small passages in organs become obstructed (lungs and pancreas)  Meconium ileus  Pancreatic fibrosis
    115. 115. CYSTIC FIBROSIS• AUTOSOMAL RECESSIVE• MULTISYSTEM DISEASE – RESPIRATORY SYSTEM – DIGESTIVE SYSTEM – INTEGUMENTARY SYSTEM – REPRODUCTIVE SYSTEM
    116. 116. CYSTIC FIBROSIS DIAGNOSIS  FAMILY HISTORY  ABSENT PANCREATIC ENZYMES  INCREASE SWEAT CHLORIDE - >60 mEq/L  CHRONIC PULMONARY INVOLVEMENT THERAPEUTIC MANAGEMENT  PREVENT/MINIMIZE PULMONARY COMPLICATIONS  ENSURE ADEQUATE NUTRITION  ASSIST CHILD/FAMILY TO ADAPT TO ILLNESS
    117. 117. CYSTIC FIBROSIS• PULMONARY CARE – CLEAR AIRWAY (CHEST PT, FLUTTER DEVICE, PERCUSSION VEST) – THIN MUCUS THROUGH NEBULIZED MEDS (PULMOZYME) – INHALED BRONCHODILATORS – PROMPT ANTIBIOTIC TREATMENT OF INFECTIONS – DAILY PHYSICAL EXERCISE
    118. 118. CYSTIC FIBROSIS• GASTROINTESTINAL CARE – PANCREATIC ENZYMES-IF CAN NOT SWALLOW PILLS MAY BE MIXED WITH A LITTLE FOOD – HIGH PROTEIN, HIGH CARB, HIGH CALORIE DIET – VITAMINS A,D,E AND K, IN WATER SOLUBLE FORM
    119. 119. Cystic Fibrosis Related Diabetes• Shares features of Type I and Type II• Unique an distinct form that requires special management• Average age of onset is 18- 21 years of age
    120. 120. GASTORENTERITIS• CAUSES ARE VIRAL, BACTERIAL, METABOLIC AND PARASITIC• MOST PEDIATRIC CASES ARE VIRAL• EVEN VIRAL GASTROENTERITIS CAN KILL A CHILD THROUGH DEHYDRATION• Approximately 400 children aged 1 month to 4 years die annually as a result of volume depletion
    121. 121. GASTORENTERITIS• DEHYDRATION AND KIDS – ASSOCIATED WITH METABOLIC ACIDOSIS – KIDS HAVE A GREATER EXTRA CELLULAR FLUID TO INTRACELLULAR FLUID RATIO THAN ADULTS WHICH RESULTS IN GREATER AND MORE RAPID LOSS OF FLUID – CHILDREN EXPERIENCE GREATER INSENSIBLE WATER LOSS
    122. 122. WATER BALANCE DIFFERENCESInfants and young children have a greater need for waterMore vulnerable to alterations in fluid and electrolyte balanceGreater I & O relative to sizeHigher basal metabolic rateGreater production of metabolic wasteImmature kidney function
    123. 123. EXTRACELLULAR FLUID COMPARTMENTConstitutes more than half total body water at birth Has greater ECF until about age 2 Greater and more rapid water loss during this age
    124. 124. WATER LOSS 2/3 of insensible water loss is through skin 1/3 through respiratory tract Insensible fluid loss is increased by heat, humidity, temperature and respiratory rate Infants and toddlers tend to be more highly febrile
    125. 125. Dehydration• Sodium is the main solute in the ECF• When ECF volume is reduced in acute dehydration, total body sodium is almost always reduced, regardless of serum values
    126. 126. Types of DehydrationIsotonicHypotonic (hyponatremic)Hypertonic (hypernatremic, hyperosmotic) ISOTONIC DEHYDRATION Primary form of dehydration in children Water and salt are lost in equal amounts Major loss is from ECF Reduction in plasma volume, circulating volume, Shock is greatest threat to life Child will display characteristic symptoms of hypovolemic shock Serum sodium remains normal (130-150 meq/L)
    127. 127. Lab ValuesK+ normal to lowNA initially normal but then may be lowBUN and Creatinine – HighCO2- low (indicator of severity of dehydration)
    128. 128. Signs and Symptoms of Dehydration Fewer wet diapers than usual No tears when crying; inside of mouth dry and sticky Irritability, high-pitched cry Difficulty in awakening Increased respiratory rate or difficulty breathing Sunken fontanel, sunken eyes with dark circles Abnormal skin color, temperature, or dryness Slow cap refill Decreased turgor
    129. 129. GASTORENTERITIS ORAL REHYDRATION THERAPY MAY AVOID HOSPITALIZATION CHOICE OF IV FLUID REPLACEMENT IS BASED ON THE CHILD’S TYPE OF DEHYDRATION (ISOTONIC, HYPOTONIC OR HYPERTONIC). MAKE SURE THE CHILD IS VOIDING BEFORE ADDING K+ TO ANY IV FLUID.
    130. 130. Concept of Oral Rehydration • Rehydration solution of 75 to 90 mEq of Na+ per liter • Give 40 to 50 ml/kg over first 4 hours • Maintain hydration with solution of 40 to 60 mEq Na+ per liter • Daily volume of maintenance hydration 150 ml/kg/dayMosby items and derived items © 152 of 602006 by Mosby, Inc.
    131. 131. Prevention of Diarrhea• Most diarrhea is spread by the fecal-oral route• Teach personal hygiene• Clean water supply/protect from contamination• Careful food preparation• HandwashingMosby items and derived items © 153 of 602006 by Mosby, Inc.
    132. 132. PYLORIC STENOSIS PYLORUS MUSCLE INCREASES IN SIZE AND MASS OBSTRUCTS FOOD FROM LEAVING THE STOMACH IF UNTREATED DEATH FROM DEHYDRATION AND ELECTROLYTE IMBALANCES REQUIRES SURGICAL CORRECTION (PYLOROMYOTOMY)
    133. 133. PYLORIC STENOSIS CLINICAL MANIFESTATIONS – VOMITING BEGINS BETWEEN 1 TO 10 WEEKS OF AGE – VOMITING BECOMES PROJECTILE – PALPABLE PYLORIC MASS (OLIVE SHAPED) – VISIBLE GASTRIC PERISTALTIC WAVES – IRRITABLE AND HUNGRY INFANT DIAGNOSTIC PROCEDURES – ULTRASOUND – BARIUM SWALLOW
    134. 134. PYLORIC STENOSIS NURSING CARE – PREOP MANAGE FLUIDS & ELECTROLYTES • DECOMPRESSION OF STOMACH BY NG TUBE • IV FLUIDS AND ELECTROLYTES – MAY HAVE K, Na, & Cl DEPLETION – POST OP - MONITOR FEEDINGS • CLEAR LIQUIDS 4-6 HR. AFTER SURGERY • STEP WISE PROGRESSION TO FULL FORMULA OR BREAST MILK OVER 48 HOUR PERIOD
    135. 135. INTUSSUSCEPTION TELESCOPING OF INTESTINE USUALLY AT THE ILEOCECAL VALVE – Terminal ileum telescopes into the ascending colon OCCURS BETWEEN AGES OF 3 MONTHS AND 5 YEARS - HALF IN INFANTS UNDER 1 YEAR SYMPTOMS DEVELOP BECAUSE BLOOD SUPPLY TO COLON IS COMPROMISED
    136. 136. INTUSSUSCEPTION CLINICAL MANIFESTATIONS  WAVES OF COLICKY SEVERE PAIN  VOMITING  CURRANT JELLY STOOLS  LETHARGY (LATE IN COURSE) COMPLICATIONS  ISCHEMIA  PERFORATION AND PERITONITIS  SHOCK
    137. 137. IntussusceptionBARIUM ENEMA IS PRIMARILY DONE AS A DIAGNOSTICPROCEDURETHE BARIUM ENEMA MAY REDUCE THE OBSTRUCTION BYHYDROSTATIC PRESSURE.NONOPERATIVE REDUCTION SUCCESSFUL IN 80-90% OF CASESBARIUM ENEMA IS NOT DONE IF SIGNS OF SHOCK ORPERFORATION ARE PRESENT
    138. 138. Clinical Manifestations of Hirschsprung • Cogenital aganglionic megacolon • Aganglionic segment usually includes the rectum and proximal colon • Accumulation of stool with distention • Failure of internal anal sphincter to relax • Enterocolitis may occurMosby items and derived items © 162 of 602006 by Mosby, Inc.
    139. 139. Mosby items and derived items © 163 of 602006 by Mosby, Inc.
    140. 140. Therapeutic Management• Surgery• Two stages – Temporary ostomy – Second stage—“pull-through” procedure Mosby items and derived items © 2006 by 165 of 60 Mosby, Inc.
    141. 141. Vesicoureteral Reflux -VUR• Retrograde of urine into ureters – Reservoir for bacteria• Primary – congential abnormal insertion of the ureters into the bladder• Secondary – due to an acquired condition
    142. 142. Complications• Associated with recurring kidney infections – Pyelonephritis – high fever, vomiting, chills – Can cause renal scarring in children • Can occur with the first episode of febrile UTI
    143. 143. Management• Prevent bacteria from entering the kidney – Low dose antibiotic therapy – Urine culture every 2-3 months and prn fever – Many will outgrow – Annual cystourethrogram – Surgery if significant anatomic abnormality , UTI’S, non compliance with meds, VUR after puberty especially in females
    144. 144. Prognosis• Usually excellent with prompt treatment at time of diagnosis• Early diagnosis essential to prevent long term complications
    145. 145. Nursing education• Wipe from front to back• Observe frequently for signs of pain, difficulty voiding
    146. 146. Short Bowel Syndrome (SBS)• A malabsorptive disorder• Results from decreased mucosal surface area, usually as result of small bowel resection• Therapeutic management• Nursing considerationsMosby items and derived items © 171 of 602006 by Mosby, Inc.

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