Problems during School Aged.pptx

Definition:
• Type 1 diabetes (juvenile diabetes
or insulin-dependent diabetes)
– is a chronic condition in which the
pancreas produces little or no insulin,
a hormone needed to allow sugar
(glucose) to enter cells to produce
energy.
– The far more common type 2 diabetes
occurs when the body becomes
resistant to insulin or doesn't make
enough insulin.

• Common in childhood or
adolescence, it also can begin in
adults.

DIABETES TERMINOLOGY
Preferred Name Former Names
Type 1 diabetes
mellitus
Juvenile diabetes,
insulin-dependent
diabetes mellitus
(IDDM)
Type 2 diabetes
mellitus
Adult-onset
diabetes,
noninsulin-
dependent diabetes
mellitus (NIDDM)

COMPARISON OF T1DM AND T2DM
Characteristic
Diabetes Mellitus
Type 1
Diabetes Mellitus
Type 2
Time of onset
Primarily in
childhood and
adolescence
Predominantly after
40 years of age
Body type
Often thin or normal
weight
Often obese
Insulin
requirement
Insulin
administration
required for survival
Insulin
administration not
required for survival
Pathophysiolo
gy
Insulin deficiency;
pancreas is usually
damaged by an
autoimmune attack
Insulin resistance;
pancreas is not
damaged by an
autoimmune attack

Difference:
Difference between the child and the
adult is that of a child is being
“BRITTLE DIABETICS”
 onset is more rapid
harder to control because children
are more active physically.
may be precipitated by illness, injury
or stress

Cause:
• Family history
• Genetics - the body's own immune
system — which normally fights
harmful bacteria and viruses —
mistakenly destroys the insulin-
producing (islet) cells in the
pancreas. Human leukocyte
antigen (HLA) genes
• Exposure to certain viruses.

Physiology
• Insulin is essential to process
carbohydrates, fat, and protein.
• Insulin reduces blood glucose levels
by allowing glucose to enter muscle
cells and by stimulating the
conversion of glucose to glycogen
(glycogenesis) as a carbohydrate
store.

Pathophysiology
• T1DM is caused by destruction of the
insulin-producing pancreatic islet cells.
• Because this destruction is typically
caused by the body’s immune system,
T1DM (unlike T2DM) is considered an
autoimmune disorder.
• The exact cause of this autoimmune
reaction is unclear but is likely due to one
or more of several factors, including
genetics, environmental triggers,
pathogens (i.e., viruses), and diet.

Pathophysiology
• Damaged pancreatic islet cells, the
body’s insulin levels begin to drop.
Eventually, the body no longer is
capable of producing enough insulin
to properly manage blood glucose
regulation, resulting in
hyperglycemia.

Pathophysiology
:
• In type 1 diabetes, there's no insulin
to let glucose into the cells, so sugar
builds up in the bloodstream, where
it can cause life-threatening
complications.
• In type 2 diabetes, the islet cells are
still functioning, but the body
becomes resistant to insulin or the
pancreas doesn't produce enough
insulin or both.

The role of insulin
• Once a significant number of islet cells are
destroyed, will produce little or no insulin.
Insulin is a hormone that comes from the
pancreas, a gland situated behind and below
the stomach.
– The pancreas secretes insulin into the
bloodstream.
– Insulin circulates, enabling sugar to enter
your cells.
– Insulin lowers the amount of sugar in the
bloodstream.
– As the blood sugar level drops, so does the
secretion of insulin from the pancreas.

The role of glucose
• Glucose — a sugar — is a main source of
energy for the cells that make up muscles and
other tissues.
– Glucose comes from two major sources:
food and the liver.
– Sugar is absorbed into the bloodstream,
where it enters cells with the help of insulin.
– The liver stores glucose as glycogen.
– When the glucose levels are low, such as
hunger , the liver converts stored glycogen
into glucose to keep the glucose level
within a normal range.

S & Sx
• Hyperglycemia
• Polyuria is due to osmotic diuresis, this
increase changes the osmotic pressure
within the tubules, thus inducing water
retention. The excess volume is then
excreted as urine. In patients with T1DM,
hyperglycemia causes glucose to
accumulate in the kidney tubules, and
thus osmotic diuresis occurs secondary
to hyperglycemia. In young children
especially, night time enuresis (bed-
wetting) may be present.

S & Sx
• Polydipsia, or excessive thirst, often
accompanies polyuria.
• Polyphagia, or excessive hunger, is a
result of both dehydration and the
catabolic state (due to insulin depletion
and the reduced availability of glycogen,
proteins, and triglycerides).
• Fatigue and weakness due to catabolic
muscle wasting.

S & Sx
• Muscle cramps due to imbalance in
electrolytes, including sodium, chloride,
and potassium
• Gastrointestinal symptoms such as
nausea, abdominal discomfort or pain,
and changes in bowel movements can
be caused by diabetic ketoacidosis
(DKA)

S & Sx
• Peripheral neuropathy, or nerve
damage occurring in the extremities. This
is due to the build up of sorbitol, a
product of glucose conversion in the
sensory nerves of the periphery.
• Blurred vision resulting from glucose-
induced swelling of the lens.

Risk factors:
• Family history
• Genetics.
• Geography. The incidence of type
1 diabetes tends to increase as you
travel away from the equator.
People living in Finland and
Sardinia have the highest incidence
of type 1 diabetes

Risk factors:
• Age. Although type 1 diabetes can
appear at any age, it appears at two
noticeable peaks. The first peak
occurs in children between 4 and 7
years old, and the second is in
children between 10 and 14 years
old.

Possible risk
factors
• Exposure to certain viruses, such as
the Epstein-Barr virus, Coxsackie
virus, mumps virus and
cytomegalovirus
• Early exposure to cow's milk
• Low vitamin D levels
• Drinking water that contains nitrates

Possible risk
factors
• Early (before 4 months) or late (after
7 months) introduction of cereal and
gluten into a baby's diet
• Having a mother who had
preeclampsia during pregnancy
• Being born with jaundice

Complications:
Acute complications:
• Hypoglycemia
• Hyperglycemia
• DKA

Complications:
Long term complications:
• Retinopathy, Cataracts
• Gastroparesis
• Hypertension, atherosclorosis
• Progressive renal failure
• Peripheral vascular disease
• Peripheral and autonomic
neuropathy
• Increased risk of infection

DIAGNOSIS
• BLOOD GLUCOSE test--- methods for
monitoring day-to-day diabetes control.
– FASTING PLASMA GLUCOSE (FPG) TEST
• The FPG test is a measure of the blood glucose
levels in an individual following a period of fasting
INTERPRETING FPG TEST RESULTS
Plasma Glucose Level (mg/dL) Diagnosis
Source: NIDDK, 2012.
≤99 Normal
100–125 Prediabetes
≥126 Diabetes*
* Confirmed by repeating the test on a different day.

DIAGNOSIS
– ORAL GLUCOSE TOLERANCE TEST
(OGTT)
• The OGTT measures blood glucose levels in an
individual who has fasted for a period of at least 8
hours and is administered 2 hours after that person
has consumed a glucose-containing liquid.
INTERPRETING OGTT TEST RESULTS
2-Hour Plasma Glucose Level
(mg/dL)
Diagnosis
Source: NIDDK, 2012.
≤139 Normal
140–199 Prediabetes
≥200 Diabetes*
* Confirmed by repeating the test on a different day.

DIAGNOSIS
• GLYCATED HEMOGLOBIN ---
Measurement of HbA1c--- is a form
of hemoglobin that is measured
primarily to identify the
average plasma glucose
concentration over prolonged
periods of time

DIAGNOSIS
• RANDOM PLASMA GLUCOSE
TEST
– A test is an informal measure of the
blood glucose level. This method is
performed at random, with no fasting
requirement. Using this test, a blood
glucose level of ≥200 mg/dL in the
presence of other symptoms may
indicate that a patient has diabetes.

Management
• PRIMARY GOALS OF T1DM
THERAPY
–Reduce the frequency and
severity of symptoms
–Prevent the development of
diabetes-related
complications

Management
• Frequent monitoring of blood
glucose levels
• Taking regular doses of insulin,
• Following a diet designed to
manage blood sugar levels,
• And participating in an active
exercise routine.

Management
INSULIN THERAPY
• All children with type 1 diabetes
mellitus require insulin therapy.
• Most require 2 or more injections
of insulin daily, with doses
adjusted on the basis of self-
monitoring of blood glucose
levels.

Management
• GLYCEMIC CONTROL
– self-monitoring of blood glucose
(SMBG)
– HbA1C monitoring at least 2x a year.

Management
INSULIN THERAPY
• Insulin replacement is
accomplished by giving basal
insulin and a preprandial
(premeal) insulin.
The basal insulin:
– long-acting (glargine (Lantus) and
detemir (Levemir)
– or intermediate-acting (NPH).

Management
INSULIN THERAPY
The pre-prandial insulin:
– rapid-acting (lispro, aspart, or
glulisine)
– short-acting (regular)
(Humulin 70/30, Novolin 70/30)

Management
• Diet
– Diet should be adequate enough to
support growth and development
and satisfy appetite and insulin
requirements.

Management
• Diet
• Recent dietary recommendations
– Carbohydrates - Should provide 50-
55% of daily energy intake; no more
than 10% of carbohydrates should
be from sucrose or other refined
carbohydrates
– Fat - Should provide 30-35% of
daily energy intake
– Protein - Should provide 10-15% of
daily energy intake

Nursing
interventions:
• Educate about lifestyle
modification and health promotion
activities.
• Prescribe and tailor an
appropriate therapeutic exercise
program, instruct patients with
peripheral neuropathy to optimize
mobility safety, and address
issues of impaired balance and
proprioception

Nursing
interventions:
• Instruct patients on how to optimize day-
to-day activities such as
– organizing and tracking medications,
– using low-vision and nonvisual
devices to draw up and measure
insulin doses,
– and incorporating protective
techniques and compensating for
peripheral sensory loss in activities
that involve the use of hot, cold, or
sharp objects.

Nursing
interventions:
• Physical Activity
– Exercise is one of the cornerstones
of a comprehensive program for the
management of T1DM.
– Patients should therefore be
encouraged to maintain a regular
exercise routine, typically lasting for
30 minutes 3 to 5 times per week
(NIDDK, 2012).

Nursing
interventions:
• RECOMMENDED PHYSICAL
ACTIVITIES
– Daily activity
– Aerobic exercises
– Strength training
– Stretching

RHEUMATIC FEVER
RF- is a generalized systemic disease
affecting principally the connective
tissues of the body. Primarily affecting
the heart and joints.
CAUSE= group A beta hemolytic
streptococci
INCIDENCE= common in children who
belong to low socio economic status
and who are malnourished.
DIAGNOSIS=elevated ASO titer

ASSESSMENT
• History of streptococcal pharyngitis
or upper respiratory infection 2 to 6
weeks before onset of illness.
• Jones criteria (requirement to
establish diagnosis)
– presence of two major manifestations,
– or one major and two minor
manifestations, plus evidence of
preceding streptococcal infection,

S & Sx
Major signs
1.Migratory polyarthritis -most
common complain, usually affecting
large joints, of the body, become
swollen, hot, red, tender, and
accompanied by fever and intense
pain.
2. Carditis - mitral valve is most often
affected, manifested by heart
murmurs.

S & Sx
Major signs
3. Sydenham’s chorea or St. Vitus
dance - involving g nerve tissues,
characterized by:
purposeless movements,
muscular weakness,, emotional
instability, indistinct speech.

S & Sx
4. Erythema marginatum- skin
rashes that begin as small pink,
slightly raised macules over the
trunk and inner of arms and thighs.
5. Subcutaneous nodules- hard
painless nonproritic ficely movable
elevations on the joints of the scalp
and along the spines.

S & Sx
MINOR SIGNS:
• Previous strep infection
• Fever, epistaxis, arthritis
• Leucocytosis
• Elevated ESR-erythrocyte
sedimentation rate
• C – reactive protein – positive.

S & Sx
MINOR SIGNS:
• History of previous rheumatic fever or
evidence of pre-existing rheumatic
disease.
• Arthralgia: pain in one or more joints
without evidence of inflammation,
tenderness to touch, or limitation of
motion.
• Electrocardiogram (ECG) changes –
mainly pulse rate interval prolongation.

RISK FACTORS
• Family history.
• Type of strep bacteria. Certain
strains of strep bacteria are more
likely to contribute to rheumatic
fever than are other strains.
• Environmental factors. A greater risk
of rheumatic fever is associated with
overcrowding, poor sanitation and
other

Complications:
• Rheumatic heart disease

TESTS AND
DIAGNOSIS
1. Physical exam
– Checking the joints for signs of inflammation
– Checking for fever
– Examining the skin for nodules under the
skin or a rash
– Listening to the heart for abnormal rhythms,
murmurs or muffled sounds that may
indicate inflammation of the heart
– Conducting a series of simple movement
tests to detect indirect evidence of
inflammation of the central nervous system

TESTS AND
DIAGNOSIS
2. Tests for strep infection
– Throat culture for group A beta-
hemolytic streptococci and blood
sample for titter of streptococcal
antibodies ( antistreptolysin O, or ASO
titer) to support evidence of recent
streptococcal infection.
– Complete blood count, ESR, and C-
reactive protein for changes described
above.

TESTS AND
DIAGNOSIS
3. Electrocardiogram (ECG or
EKG)
– records electrical signals as they
travel through the child's heart.
There would be patterns among
these signals that indicate
inflammation of the heart or poor
heart function.

TESTS AND
DIAGNOSIS
4. Echocardiography
– uses sound waves to produce live-
action images of the heart. This
common test may enable to detect
altered structures within the heart.

TREATMENTS AND
DRUGS
• The goals of treatment for rheumatic
fever are:
– to destroy any remaining group A
streptococcal bacteria
– relieve symptoms, control
inflammation
– and prevent recurring episodes of
rheumatic fever

TREATMENTS AND
DRUGS
2. Anti-inflammatory treatment.
–Aspirin or naproxen (Anaprox,
Naprosyn, others) --- to reduce
inflammation, fever and pain.
–Corticosteroid (prednisone) --- for
severe cases/not responding to
NSAID’s.

TREATMENTS AND
DRUGS
3. Anticonvulsant medications.
–Valproic acid (Depakene) or
carbamazepine (Carbatrol,
Equetro, others) --- for severe
involuntary movements of
Sydenham chorea
–Phenobarbital, diazepam

MANAGEMEN
T:
1. Bed rest
2. Diet- high protein,caloric,
vitamins,and rouphage, low
sodium.
3. Maintain body alignment- support
painful joints with pillow*use bed
cradles, to protect painful joints
from weight of bed covers , *avoid
sudden, unexpected moves.

MANAGEMEN
T:
4. Drugs
 Diuretics
 Digitalis
 Steroids
 anti-inflammatory agents
 Penicillin
 aspirin
SIDEEFFECTS - ringing in the ears,
nausea and vomiting, bleeding

Nursing
interventions
• Monitor temperature frequently, and
patient’s response to antipyretics.
• Monitor the patient’s pulse
frequently, especially after activity to
determine degree of cardiac
compensation.
• Auscultate the hear periodically for
development of new heart murmur
or pericardial or pleural friction rub.

Nursing
interventions
• Observe for adverse effects of
salicylate or nonsteroidal anti-
inflammatory drug (NSAID) therapy,
such as stomach upset, tinnitus,
headache, GI bleeding, and altered
mental status.
• Monitor the patient’s response to
long-term activity restriction.
• Restrict sodium and fluids and
obtain daily weights as indicated.

Nursing
interventions
• Administer medications punctually
and at regular intervals to achieve
constant therapeutic blood levels.
• Explain the need to rest (usually
prescribed for 4 to 12 weeks,
depending on the severity of the
disease and health care provider’s
preference) and assure the patient
that bed rest will be imposed no
longer than necessary.

Nursing
interventions
• Assist the patient to resume activity
very gradually once asymptomatic
at rest and indicators of acute
inflammation have become normal.
• Provide comfort measures.
• Provide safe, supportive
environment for the child with
chorea.

Nursing
interventions
• Observe for the disappearance or
any major or minor manifestations
of the disease and report signs of
increased rheumatic activity as
salicylates or steroids are being
tampered.
• Encourage continuous prophylactic
antimicrobial therapy to prevent
recurrence.

PROGNOSIS
Depends primarily on the extent of
cardiac damage, then termed.
(RHEUMATIC HEART DISEASE)

JUVENILE RHEUMATOID
ARTHRITIS
Childhood arthritis, JRA, Juvenile
idiopathic arthritis, Still's disease

JUVENILE RHEUMATOID
ARTHRITIS
 Juvenile rheumatoid arthritis (JRA)
is the most common type of arthritis
that persists for months or years at
a time.
 It is an autoimmune disorder. The
disease commonly occurs in
children from the ages of 7 to 12,
but it may occur in adolescents as
old as 15 years of age, as well as in
infants.

Cause
 The cause is unknown.
• AUTOIMMUNE DISORDER(body's
immune system attacks its own cells
and tissues).
• Hereditary
• Environmental factors.
• Certain gene mutations may make a
person more susceptible to
environmental factors — such as
viruses — that may trigger the disease.

Signs and
Symptoms
1. Pain - Limping
2. Swelling of the joints (Large bones)
3. Stiffness particularly in the morning
or after naps.
4. Other symptoms are:
– Joint Deformity (swollen lymph nodes)
– Rashes
– Fever

TYPES OF JRA
1. Systemic (bodywide) JRA
2. Polyarticular JRA
3. Pauciarticular JRA

Systemic JRA
• Least common type of JRA
• Symptoms are body wide affects the
body system other than the joints.
• Symptoms:
– Fever and rash
– Enlarged lymph nodes, liver, and
spleen
– Pericarditis and plueritis

Systemic JRA
Blood test:
• Decreased RBC
• Increased WBC
Treatment:
• NSAIDs

Polyarticular JRA
 Affects 5 or more joints in the first 6
months of disease.
 This subtype can include the neck and
jaw as well as the small joints usually
affected.
 This type of JRA is more common in
girls than in boys.
 Early childhood onset are at risk for
developing a chronic iridocyclitis or
an anterior uveitis, which is
inflammation of the eye.

Polyarticular JRA
• Two types: They are defined
whether or not the child has a
positive rheumatoid factor.
– seronegative - negative Rf factor
– seropositive - positive test

Pauciarticular or
Oligoarticular JRA
 Affects 4 or fewer joints in the first 6
months of illness.
• This is the most common form of
JRA, accounting for about half of all
children with JRA.
• The average onset is 3 years, but it
is not unusual for a child to be as
young as 1 year older. Girls are
affected more than boys.

Pauciarticular or
Oligoarticular JRA
• This type of arthritis is often
asymmetrical
• It usually affects the large joints and
the most frequently affected joint is
the knee, although an ankle, elbow,
wrist or a small joint in the hand can
also be affected.

Pauciarticular or
Oligoarticular JRA
• Oftentimes developed acutely
• They do not have fever, skin rash or
other systemic symptoms that affect
all parts of the body.
• Some children with this type of arthritis
have surprisingly little pain despite the
presence of a large joint swelling or
inability to move the joint properly.
Some children may refuse to walk.

Pauciarticular or
Oligoarticular JRA
• Susceptible to developing a form of
eye inflammation called iritis.
• Children with pauciarticular JRA
have their eyes examined by an
ophthalmologist every 3 months.

Diagnosis
1. Blood tests
– Elevated Erythrocyte sedimentation
rate (ESR) to help classify the type of
juvenile rheumatoid arthritis and to
determine the degree of inflammation.
– Increased C-reactive protein also
measures levels of general
inflammation in the body

Diagnosis
1. Blood tests
– Elevated Anti-nuclear antibody. Anti-
nuclear antibodies are proteins
commonly produced by the immune
systems of people with certain
autoimmune diseases, including
arthritis.
– CBC: Usually reveals moderate
anemia. WBC is elevated when
inflammatory processes are present.

Diagnosis
– Rheumatoid factor (RF): Positive in
more than 80% of cases (Rose-Waaler
test).
– Latex fixation: Positive in 75% of
typical cases.
– Agglutination reactions: Positive in
more than 50% of typical cases.
– Immunoglobulin (Ig) (IgM and
IgG): Elevation strongly suggests
autoimmune process as cause for RA.

Diagnosis
2. Imaging scans
– X-rays may be taken to exclude other
conditions, such as:
• Fractures
• Tumors
• Infection
• Congenital defects
• X-rays may also be used from time to time
after the diagnosis to monitor bone
development and to detect joint damage.

Treatment/Management
1. Therapies
2. Non-steroidal anti-inflammatory
drugs and intra-
articular corticosteroid injections.
3. Surgery

NURSING MANAGEMENT
• The most common issues for the
patient with RA include pain, sleep
disturbance, fatigue, altered mood,
and limited mobility.

NURSING MANAGEMENT
• The patient with newly diagnosed RA
needs information about the disease
to make daily self management
decisions and to cope with having a
chronic disease.
– Relieving pain and discomfort
– Increasing mobility
– Facilitating self care
– Improving body image and coping skills
– Monitoring complications
– Health education

Self-care Techniques that Help Limit
the Effects of Juvenile Rheumatoid
Arthritis
1. Getting regular exercise.
• Exercise is important because it
promotes both muscle strength and
joint flexibility
• Swimming is an excellent choice
because it places minimal stress on
joints.

2. Applying cold or heat.
Stiffness affects many children with
juvenile rheumatoid arthritis,
particularly in the morning.
Although some children respond well
to cold packs, most children prefer a
hot pack or a hot bath or shower.

3. Eating well.
Some children with arthritis have poor
appetites.
Others may gain excess weight due to
medications or physical inactivity. A
healthy diet can help maintain an
appropriate body weight.
Adequate calcium in the diet is important
because children with juvenile
rheumatoid arthritis are at risk of
developing weak bones (osteoporosis)
due to the disease, the use of
corticosteroids, and decreased physical
activity and weight bearing.

Definition
• Scabies is an intensely pruritic, highly
contagious infestation of the itch mite
Sarcoptes scabiei in the skin.
• (from Latin: scabere, "to scratch")
• classified by the World Health
Organization as a water-related disease.
• Like syphilis, scabies has come to be
known as the great imitator.

cause
:• Sarcoptes scabiei-
a tiny and usually
not directly visible
parasite, which
burrows under the
host's skin,
causing intense
allergic itching.

Modeof transmission:
• most often transmitted by direct skin-
to-skin contact
• Scabies can also be spread by sharing
towels, bed sheets, and other personal
belongings.
• Sexual contact is the most common form
of transmission and scabies has been
considered by many to be a sexually
transmitted disease (STD).
• Scabies often affects several family
members at the same time. Can be
transmitted before manifestations
ofsymptoms.

signs and symptoms
• A person can be
infected for up to 2
to 6 weeks before
the rash or itching
occurs
• intense itching
(pruritus)
• pimple-like (papular)
itchy rash
• Crustiness

signs and symptoms
• Classical sites of
scabies rash...
• between fingers
• wrists
• auxiliary areas
• female breasts (particularly
the skin of the nipples)
• the umbilical area
• penis and scrotum
• buttocks
• inside of legs
• ankles

signs and symptoms
In children, common sites of
infestation include the:
• Scalp
• Face
• Neck
• Palms of the hands
• Soles of the feet

DIAGNOSIS
• Definite diagnosis - a definite
diagnosis is made by taking skin
scrapings from burrows and
identifying the mites, their eggs
or faeces by microscopy
• Presumptive diagnosis - it is
often difficult to find burrows
and obtain suitable specimens,
therefore presumptive diagnosis
relies on history and clinical
appearance

TREATMENT
• Use a scabicide for the treatment of
scabies
• Permethrin (Elimite) -- In 5% cream
• Ivermectin (Mectizan, Stromectol) --
Binds selectively with glutamate-
gated chloride ion channels in
invertebrate nerve and muscle
cells, causing cell death.

TREATMENT
application of lotion or cream

TREATMENT
• Don’t apply treatment after a hot bath as this
increases systemic absorption and removes the drug
from its treatment site
• Apply to the whole body
• Nails should be short and clean
• If the hands are washed, reapply the treatment
• If using cream - rub it in lightly to the skin
• If using a lotion - pour it into a bowl for ease of
application, then use a sponge for even coverage
• Re-examine the person to confirm that the diagnosis is
correct
• Itching can last up to 3 weeks after successful
treatment

OUTBREAKS prevention
• Promote good surveillance of new residents
• Observe for rashes on arrival at the home,
then at
3 weeks and at 6 weeks
• Maintain a high level of suspicion if patients
present with undiagnosed skin rashes
• Educate staff on presentation and transmission
of scabies
• Encourage staff to report rashes (including on
themselves and their family)

Nursing Interventions
• Instruct patient to apply the cream at
bedtime, from neck down to toes, covering the
entire body.
• Advise patient to report any skin irritation.
• Suggest the family members and other close
contact of the patient be checked for possible
symptoms and be treated if necessary.
• If patient is hospitalized, practice good
handwashing technique, or use gloves while
performing nursing procedure.
• Terminal disinfection should be carried out
after discharge of patient.

Nursing Interventions
• soaking in cool water or applying a
cool, wet washcloth to irritated areas of
the skin may minimize itching.
• Trim finger nails short
• Isolate the child until tx is completed
• application of soothing lotion
• Administer antihistamine as prescribed

Definition
• Pediculosis is an infestation
of the hairy parts of the
body or clothing with the
eggs, larvae or adults of
lice. The crawling stages of
this insect feed on human
blood, which can result in
severe itching

Types:
-HEAD LICE
(Pediculus humanus capitis)
-BODY LICE
(Pediculus humanus
corporis)
-PUBIC LICE (Phthirus
pubis)

HEAD LICE
(PEDICULOSIS
CAPITIS)

• “Pediculosis capitis”) is a
human medical condition
caused by the colonization
of the hair and skin by the
parasitic insect Pediculus
humanus capitis—the head
louse.

Head lice feed on human blood
(hematophagy), and itching from
louse bites is a common symptom
of this condition.

Signs and symptoms
• pruritus (itching) on the head which
normally intensifies 3 to 4 weeks
after the initial infestation.
• Skin excoriation in affected area.
• Erythematous macules or wheals
may appear at puncture sites.
• Lice and nits may be seen clinging
to hairs

Cause
• Head lice are generally spread through
direct head-to-head contact with an
infested person;
• transmission by sharing bedding or
clothing such as head wear is much
less common.
• Head lice occur on the head hair.
Human lice do not occur on pets or
other animals. Lice do not have wings
and cannot jump.

Diagnosis
• The condition is diagnosed by the
presence of lice or eggs in the hair,
which is facilitated by using a
magnifying glass or running a comb
through the child’s hair.
• In questionable cases, a child can
be referred to a health professional.

• The use of a louse comb is the most
effective way to detect living lice. In
cases of children with dirty, long
and/or curly/frizzy hair, an alternative
method of diagnosis is examination
by parting the hair at 2 cm intervals to
look for moving lice near the scalp.
• With both methods, special attention
should be paid to the area near the
ears and the nape of the neck.
• The examiner should examine the
scalp for at least 5 minutes.

• The use of a magnifying glass to
examine the material collected between
the teeth of the comb could prevent
misdiagnosis.
• The presence of nits alone however,
is not an accurate indicator of an
active head louse infestation.
Children with nits on their hair have a
35-40% chance of also being infested
with living lice and eggs. If lice are
detected, the entire family needs to be
checked (especially children up to the
age of 13 years).

BODY LICE
(PEDICULOSIS CORPORIS)

symptoms:
• Sores (lesions) in the body due to
bites and scratching
• Lice and nits may be seen in seams
of clothing
• Skin excoriation in affected area.
• Erythematous macules or wheals
may appear at puncture sites

Causes:
• Body lice are spread through
direct contact with the body,
clothing or other personal
items or such, of a person
already carrying lice.

Pubic Lice
(pediculosis pubis)

• Pubic lice are small, six-legged
creatures that infect the pubic
hair area and lay eggs. These
lice can also be found in armpit
hair and eyebrows.

CAUSE
• Sexual contact
• Sometimes, pubic lice can spread
through contact with objects such as
toilet seats, sheets, blankets, or
bathing suits at a store.

Risk factors for pubic lice
include:
• Having multiple sexual partners
• Having sexual contact with an
infected person
• Sharing bedding or clothing with an
infected person

Symptoms of pubic lice:
• itching in the area covered by pubic
hair (it often gets worse at night).
This itching may start soon after
getting infected with lice, or it may
not start for up to 2 - 4 weeks after
contact.
• Gray-blue macules may appear on
trunk or inner thighs

Exams and Tests
• An examination of the outer
genital area shows small gray-
white oval eggs (nits) attached
to the hair shaft. It may also
reveal adult lice. The health
care provider might also see
scratch marks or signs of an
infection, such as impetigo.

• Because pubic lice may cause an eye
infection (blepharitis) in young
children, their eyelashes should be
examined for evidence of lice with a
high-powered magnifying glass.
• Adult lice may be easily identified
under the microscope. Their crab-like
appearance is the reason that pubic
lice are referred to as "the crabs."
• Teenagers with pubic lice may need
to be tested for other sexually
transmitted infections (STIs).

Management:
• Treatment for pediculosis corporis
involves washing with soap and
water and washing all infested
clothing and linens with hot water.
Alternatively, clothes may be dry-
cleaned or ironed, paying close
attention to the seams.

Management:
• Pediculosis capitis and pubis are
treated with a topical antiparasitic
preparation, such as lindane (Kwell)
or permethrin (Nix).
• Manual removal of nits (eggs) may
be performed; retreatment with
topical antiparasitic in 3-7 days is
recommended.

Management:
• Petroleum may be applied to
eyelashes, then lice and nits
removed with swab or tweezers, or
pilocarpine drops can be used to
paralyze the lice.
• Items that cannot be washed or dry-
cleaned can be stored for 30 days
without use.

Nursing consideration:
• Advise patient that pediculosis
pubis is considered a sexually
transmitted disease; partners must
be examined and treated.

• Teach patient the proper use of
medication:
– Apply lotion or cream after bathing to
affected hairy and adjacent areas;
wash off after 8-12 hours.
– Alternatively, apply shampoo to
affected hairy areas and lather for 4-5
minutes, rinse, and let hair dry.
– Use fine-tooth comb to remove nits.

• Urge patient to wash all clothing,
towels, linens, combs, and hair
items by soaking in hot water for 10
minutes.
• Advise patient not to use
antiparasitic preparations more
frequently than recommended.

Impetigo?
• Bacterial infectious disease
affecting the superficial layers of
the skin and characterized by the
formation of vesicles, crusts, or
bullae

Etiology and incidence:
• Caused by Staphylococcus aureus
and Streptococcus pyogenes.
• Occurs most commonly when
personal hygiene is poor.
• Is common in children younger than
age 10.
• Is spread by close contact .Is highly
contagious.
• An abrasion of skin may serve as a
portal of entry.

How do you get impetigo?
• impetigo or boils
– impetigo begins out of blue without
any visible source of infection.
• Commonly found around the hands and
face

Clinical manifestation:
• Incubation period is 1-10 days.
• Lesion first appears as pink-red
macules that quickly change to
vesicles which, in turn, rupture,
develop crusts, and leave a
temporary superficial erythematous
area.

• Bullous (neonate and older
child)large, thin-roofed blisters
break to form thin, light-brown
crusts. Lesions may occur
anywhere on the body but are more
common on the face, axillae, and
groin.

• Crusted (preschool-age,seen more
commonly in summer on exposed
body parts)lesions appear with
thick, yellow crusts; skin around
crusts is red and weeping with
satellite lesions.

• Regional lymphadenopathy is
common with secondary infection of
insect bites, eczema, poison ivy,
and scabies.
• Autoinoculation is major cause of
spreading.
• Pruritus may occur.

Treatment/ prevention:
Based on etiology and type of
infection.
• Gently wash affected area with soap
and water three times per day.
• Crusts and debris can be removed
from the affected area by gentle
soaking or wet compresses. Use tap
water, normal saline or 1:20
Burrow's solution.

• Apply topical antibacterial
medication, such as Bacitracin or
mupirocin ointment (Bactroban).
• Systemic antibiotics
(cephalosporins, erythromycin, or
dicloxacillin) if widespread or
recurrent.

• Consider methicillin-resistant S.
aureus in patients who do not
respond to the above treatment.
• Prevention : close contact with other
children should be avoided until 24
hours after treatment is initiated.
– Regular handwashing.

Nursing considertion:
• Assess the child's skin condition
and document the location and
appearance of lesions. Note new
lesions.

• Initiate and teach measures to
prevent the spread of infection.
– Engage in frequent hand washing. Use
separate towels.
– Daily bathing with soap and water.
Regular laundering for contaminated
bed linens, towels, and clothing.

– Observe drainage and secretion
precautions for 24 hours after the start
of therapy.
– Isolate the child from direct contact
with other children (school or day care)
until 24 hours after treatment has
started.

– Trim fingernails and toenails. Apply
small amount of Bacitracin or
mupirocin ointment under the
fingernails to prevent the spread of
infection.
– Engage the child in diversional
activities to discourage scratching.

• Be aware that the patient with
streptococcal impetigo has an
increased risk for acute
glomerulonephritis

Pictures
(Step 1)
(Step 2)
(Step 3)

•Kawasaki disease
is a frightening and
rare condition in
children.

What is Kawasaki
Disease?
• Kawasaki disease is a group of
specific symptoms and physical
signs.
• Kawasaki disease is associated with
swelling and damage of the blood
vessels, or arteries. This swelling
and damage is called inflammation.
• Kawasaki disease often affects the
arteries that supply the heart with
blood. These are called the
coronary arteries.

What is Kawasaki
Disease?
• Children who get the disease are
usually less than 5 years old.
• It is very rare to get the disease
after a child is 10 years old.
• The risk of other children in the
same family getting Kawasaki
disease is very low.
• The risk of a child getting Kawasaki
disease for the second time is very
rare.

What Causes Kawasaki
Disease?
• At present, no one actually knows what
causes Kawasaki disease. Research is
being done into the possible causes.
• Researchers now think that the disease
may be caused by an infection. Normally,
the body's immune system quickly
recognizes germs and destroys them.
• But in the case of Kawasaki disease, a
poison or toxin may be formed by the
infection. This poison, or toxin, or
perhaps the infection itself, makes
certain individuals have an unusual, or
abnormal reaction from the immunity
system to the infection. However, we do
not know what the infection or toxin is.

• We also do not know what makes
some individuals more likely to get
this disease than others. There is a
slight chance that the brothers and
sisters of a child with Kawasaki
disease may also get the disease.
But this is very rare. Unfortunately,
there is no way we know of to
prevent a child from getting the
disease.

Kawasaki Disease: Symptoms
and Diagnosis
• All patients have a continuous fever
lasting 5 days or more.
• 4 out of 5 of the following symptoms
are also necessary before the
doctor can know for sure, if a child
has this disease.

Symptoms
• Red eyes
• Redness of the lips, tongue or
mouth
• Redness or swelling of the hands
and feet
• A body rash
• Swelling of the glands in the neck

Kawasaki Disease Symptoms:
Red Eyes
• The below photo shows what the
child’s eyes look like with Kawasaki
disease.

Changes in the Lips, Tongue
and Mouth
• Some changes which occur in the
mouth and lips may be seen in the
pictures below.

These changes of the mouth
and lips include such things
as:
• redness,
• drying with cracking of the
lips, and
• a red strawberry-like tongue.

Changes to the Hands and
Feet
• The palms, or inside flat part of the
hands, and the soles, or bottoms of
the feet may turn red in colour. They
may also appear swollen.

• About a week after the fever breaks, the
skin from the fingers and toes may peel
off, sometimes in large pieces. When this
happens, new, normal skin shows below
the peeling skin.

Body Rash
• A body rash usually first appears
with the fever. The skin appears red
and will feel 'bumpy' to the touch.

• A red rash can be seen in the
groin or diaper area, particularly
in young infants. This can also
peel off later.

Swelling of the Glands in the
Neck
• The picture below shows a child with
swollen lymph nodes. You can
sometimes feel these, just under the skin
in the neck. Usually, they are soft,
painless and about the size of a pea.

• In a child with Kawasaki disease,
these lymph nodes may become
swollen or enlarged. They become
easier to feel.

What is the Treatment for a
Child with Kawasaki Disease?
• There is no single medicine, which
can treat or cure Kawasaki disease.

There are two medicines,
which can be given to reduce
the effects of Kawasaki
disease
• Aspirin. To reduce the risk of
heart problems.
• Gamma Globulin. (purified
antibodies), an ingredient of
blood that helps the body fight
infection

What are the Possible Serious
Problems for a Child with
Kawasaki Disease?
1. Changes in the Coronary Arteries:
• The most serious problems from
Kawasaki disease have to do with its
effects on the heart. During the
disease, the arteries, which supply
the heart with blood, called coronary
arteries, can become inflamed and
damaged

2. Formation of Aneurysms:
• Inflammation and damage to the
coronary arteries could weaken their
walls and cause the walls to develop
pouches or sacs, called aneurysms.
This is just like a weak spot in a tire
or hose, that swells up with water or
air.

What is an Aneurysm?
• Normally, the walls of blood vessels
are smooth and even. In Kawasaki
disease, the muscular walls of the
coronary arteries may become
weakened.
• The pressure of the blood flowing
through the arteries may cause
these weak spots to balloon-out,
just like a weak spot in a tire or
inner tube.

Abnormal Angiogram:
Aneurysm
• This is an angiogram of a heart with
abnormal coronary arteries. The
arrows point to some of the
abnormalities. Here, the blood
vessels are not smooth; they have
ballooned out to form aneurysms.
This can happen to a few children
who have had Kawasaki disease.

Tests to Monitor Heart
Complications
• The following tests are used by a
cardiologist to find out what possible
effects Kawasaki disease has had
on the heart and coronary arteries:
• 1. Echocardiography
• 2. Electrocardiography
• 3. Angiography

Long Term Effects of
Kawasaki Disease
• About 95 out of every 100 children
who have had Kawasaki disease
recover completely. If no damage in
the coronary arteries is seen on the
echo tests, then complete recovery
is most likely. This means that there
is little chance of future problems.

• If small aneurysms or dilations of
the coronary artery are found, this is
not serious. Small aneurysms tend
to go away in about a year or two.
Large or giant aneurysms do not
tend to go away, and may lead to
clots or narrowings. Although these
children with severe coronary
damage need to be followed
closely, even these children tend to
lead relatively normal lives

LABORATORY FINDINGS
• Laboratory findings include
neutrophilia, anaemia, thrombocytosis,
elevated erythrocyte sedimentation
rate, elevated serum transaminase
levels, hypoalbuminemia and an
elevated serum alpha1-antitrypsin
level.
• Unlike atherosclerosis, no fatty streaks
or macrophage accumulations occur.

Other Significant Clinical and
Laboratory Findings
• Cardiovascular:
– On auscultation, gallop rhythm or distant heart
sounds;
– ECG changes
– (chest X-ray abnormalities (cardiomegaly);
– echocardiographic changes (pericardial effusion,
coronary aneurysms, or decreased contractility);
– mitral and/or aortic valvular insufficiency; and
rarely,
– aneurysms of peripheral arteries (e.g., axillary),
angina pectoris, or myocardial infarction

• Gastrointestinal: Diarrhea,
vomiting, abdominal pain, hydrops
of gallbladder, paralytic ileus, mild
jaundice, and mild increase of
serum transaminase levels

• Blood: Increased erythrocyte
sedimentation rate, leukocytosis
with left shift, positive C-reactive
protein, hypoalbuminemia, and mild
anemia in acute phase of illness
(thrombocytosis in subacute phase)

• Urine: Sterile pyuria of urethral
origin and occasional proteinuria
• Skin: Perineal rash and
desquamation in subacute phase
and transverse furrows of fingernails
(Beau's lines) during convalescence

• Respiratory: Cough, rhinorrhea,
and pulmonary infiltrate
• Joint: Arthralgia and arthritis
• Neurological: Mononuclear
pleocytosis in cerebrospinal fluid,
striking irritability, and rarely, facial
palsy

NURSING MANAGEMENT
1 Allow the child period of uninterrupted rest.
2. Perform comfort measures related to the eyes
3. Monitor temperature every 4 hours
4.Perform passive motion exercises
5. Provide quite and peaceful environment
6. Provide care measures
7.Provide skin measures
8. Offer clear fluids, every 4 hrs, when awake.
9. Encourage child to eat.
10.Infuse IV fluids
11Explain all procedures to child and family
12Encourage parents and child to express their concern
13.Practice relaxation techniques
14.Prepare child for cardiac surgery
15.Keep family informed about progress

Congestive heart failure (CHF) occurs when
the heart is not able to pump blood effectively.
Fluid can build up in the tissues of the body as
a result of congestive heart failure. This type of
heart failure could be due to a number of heart
conditions. Symptoms include congested
lungs, shortness of breath, water retention,
dizziness, and weakness. Treating CHF may
include medications, fluid restriction, exercise,
surgery, and more. Follow the links below to
find WebMD's comprehensive coverage about
how congestive heart failure is caused, how to
treat it, and much more.

• (+) Lightheadedness, dizziness,
headaches, nausea
• (+) abdominal bloating, decreased
appetite
• (+) fatigue and weakness as
described previously
• (-) fever, vomiting, wheezing,
diarrhea, focal weakness, syncope
Signs and symptoms

Past Medical History
• Hypertension
• Hyperlipidemia
• Diabetes Type II
• Chronic renal insufficiency
• Bi-Ventricular pacemaker/ Automatic
implantable cardioverter defibrillator
(BIV/ICD) implanted 3 year ago for low
ejection fraction and episodes of non-
sustained ventricular tachycardia
• Previous heavy alcohol use
• Gout
• Depression

Medications
• Allergies: penicillin
• Beta blocker - Toprol XL 50mg po daily
• ACE- Inhibitor - Lisinopril 40mg po daily
• Digoxin 0.125mg po daily
• Loop Diuretic - Lasix 40mg po bid
• Aldosterone antagonist - Spironolactone 25mg po daily
• Anticoagulant - Coumadin as directed for INR 2-3
• NPH insulin 20 Units in AM, 25 Units in PM
• Aspirin 81mg po daily
• HMG CoA Reductase inhibitors (Statin) Atorvastatin 40mg po daily
• Selective Serotonin Re-uptake Inhibitor - Paxil 10mg po daily

Family History
• Mother  history of diabetes, died
from stroke at age 58
• Father  does not know
• One sister  died at age 57 from
breast cancer
• Patient does not have any children

Social History
• Previous heavy alcohol for
approximately 20 years, quit alcohol
6 years ago
• Previous cocaine use but quit at age
25
• Denies ever smoking cigarettes
• Currently unemployed on disability
secondary to chronic medical illness
• Unmarried

Physical Exam
• Vitals upon presentation to emergency
room:
– Temperature: 99.0 F
– Pulse: 104 beats per minute
– Blood Pressure: 104/62 mm Hg
– Respiratory rate: 28 respirations per minute
and labored
– Oxygen saturation: 89% on room air, 94% on
3 Lit O2
– Weight: 132 lbs (increased from 115 lbs
documented in clinic 1 month ago)

Physical Exam
• Abdomen: mildly distended, normo-
active bowel sounds, minimal
diffuse tenderness, liver edge
palpable 2 cm below costal margin,
palpable splenomegaly, there is
also a suggestion of shifting
dullness to percussion and a
positive fluid wave (indicative of
ascites)
• Genito-Urinary: Not assessed

Physical Exam
• Extremities: 3+ bilateral pitting lower extremity edema to
level of the lower thighs
• Skin: cool, dry, discoloration of lower extremities
suggestive of chronic venous insufficiency
• Musculoskeletal: full range of motion of all extremities
but states heaviness of lower limbs
• Neurologic: alert and oriented x 3 with some anxiety,
otherwise grossly normal with no focal sensory or motor
deficits.
• Psych: anxiety secondary to moderate respiratory
distress

Electrocardiogram
• Electronic ventricular Pacemaker
• Premature ventricular contraction

Chest X-Ray
• Enlarged cardiac silhouette
• Pulmonary vascular distention and
redistribution, suggesting pulmonary
venous hypertension
• Bilateral blunting of the costophrenic
angles suggestive of pleural
effusion
• No focal consolidation or
pneumothroax
• + pacemaker/defibrillator

Transthoracic
Echocardiogram
• Left Ventricle moderate to markedly dilated
• Severely reduced systolic function. Ejection fraction 5-
10%
• Doppler evidence for decreased left ventricular diastolic
compliance and increased left atrial pressure
• Severe mitral regurgitation and tethering of the anterior
and posterior leaflets and reduced mobility
• Moderately dilated left and right atrium
• Dilated right ventricle
• Severe tricuspid regurgitation
• Mild aortic insufficiency
• Moderate pulmonic regurgitation
• Markedly dilated inferior vena cava

Dehydration
- Dehydration is a condition that occurs when
the loss of body fluids, mostly water, exceeds
the amount that is taken in. With
dehydration, more water is moving out of our
cells and then out of our bodies than the
amount of water we take in through drinking.
- We lose water every day in the form of water
vapour in the breath we exhale and as water
in our sweat, urine, and stool. Along with the
water, small amounts of salts are also lost.
- When we lose too much water, our bodies may
become out of balance or dehydrated. Severe
dehydration can lead to death

Three types of dehydration based on
serum sodium levels:
hypotonic or hyponatremic
- referring to this as primarily
a loss of electrolytes, sodium in
particular.
hypertonic or hypernatremic
-referring to this as primarily a
loss of water.
isotonic or isonatremic
- referring to this as equal loss
of water and electrolytes.

Causes of dehydration
Diarrhea
Diarrhea is the most common reason for a person to lose excess amounts of water.
A significant amount of water can be lost with each bowel movement. Worldwide,
more than four million children die each year because of dehydration from
diarrhea.

Vomiting
Vomiting can also be a cause of fluid loss. Not only can an individual lose fluid
in the vomitus, but it may be difficult to replace water by drinking because of
that same nausea and vomiting

Sweat
The body can lose significant amounts of water in the form of sweat when it
tries to cool itself. Whether the body temperature is increased because of
working or exercising in a hot environment or because a fever is present
due to an infection; the body uses water in the form of sweat to cool itself.

Inability to drink fluids
The inability to drink adequately is the other potential cause of dehydration. Whether it is
the lack of availability of water, intense nausea with or without vomiting, or the lack of
strength to drink, this, coupled with routine or extraordinary water losses can
compound the degree of dehydration.

Burns
Burn victims become dehydrated because the damaged skin cannot prevent
fluid from seeping out of the body. Other inflammatory diseases of the skin
such as toxic epidermal necrolysis, also may be associated with significant
fluid loss

signs and symptoms
- The body's initial responses to dehydration are thirst to increase
water intake, and decreased urine output to try to conserve water
loss. The urine will become concentrated and more yellow in color.
- As the level of water loss increases, more symptoms can become
apparent. The following are further signs and symptoms of
dehydration.
- Dry mouth
- The eyes stop making tears
- Sweating may stop
- Muscle cramps
- Nausea and vomiting
- Heart palpitations
- Light headedness (especially when standing)
- Weakness
- Decreased urine output
- Sleepiness or tiredness

Complications
Heat injury. If you don't drink enough fluids when you're
exercising vigorously and perspiring heavily, you may
end up with a heat injury, ranging in severity from mild
heat cramps to heat exhaustion to potentially life-
threatening heatstroke.
Swelling of the brain (cerebral edema). Sometimes,
when you're getting fluids again after being
dehydrated, the body tries to pull too much water
back into your cells. This can cause some cells to swell
and rupture. The consequences are especially grave
when brain cells are affected.
Seizures. Electrolytes — such as potassium and sodium
— help carry electrical signals from cell to cell. If your
electrolytes are out of balance, the normal electrical
messages can become mixed up, which can lead to
involuntary muscle contractions and sometimes to a

Complications
Kidney failure. This potentially life-
threatening problem occurs when your kidneys
are no longer able to remove excess fluids and
waste from your blood.
Low blood volume shock (hypovolemic shock).
This is one of the most serious, and
sometimes life-threatening, complications of
dehydration. It occurs when low blood volume
causes a drop in blood pressure and a drop in
the amount of oxygen in your body.
Coma and death. When not treated promptly
and appropriately, severe dehydration can be
fatal.

Treatments and drugs
Clear fluids include:
water (note that water alone is not
necessarily safe to use in infants and can
lead to significant electrolyte problems,
for this reason, Pedialyte or other
balanced electrolyte solutions should be
used.
clear broths,
popsicles,
Jell-O, and
other replacement fluids that may
contain electrolytes (Pedialyte, Gatorade,
Powerade, etc.)

The only effective treatment for
dehydration is to replace lost fluids and
lost electrolytes. The best approach to
dehydration treatment depends on your
age, the severity of your dehydration and
its cause.
- Oral rehydration solution (ORS)
- Fluid replacement through intravenous
therapy
-Treating the cause of dehydration

Loperamide (Imodium) may be considered to
control diarrhea. If the affected individual
has a fever, or if there is blood in the
diarrhea, medical advice should be obtained
before administering medications to control
diarrhea.
Acetaminophen or ibuprofen may be used to
control fever. Ibuprofen may irritate the
stomach and cause nausea and vomiting, so it
should be used with caution in patients who
already have these symptoms.

Prevention
To prevent dehydration, drink plenty of fluids and eat
foods high in water such as fruits and vegetables.
Letting thirst be your guide is an adequate daily
guideline for most healthy people. Fluids can be
obtained not just from water but also from other
beverages and foods.
Under certain circumstances, you may need to take in
more fluids than usual:
Environment: Dehydration due to the weather is a
preventable condition. If possible, activities should
not be scheduled in the heat of the day. If they are,
adequate fluids should be available, and cooler,
shaded areas should be used if possible. Of course,
people should be monitored to make certain they are
safe. Those working in hot environments need to take
care to rehydrate often. In heat waves, it is
important to routinely check on neighbours, especially
the elderly or those that do not have air conditioning.

Prevention
Environment: People exercising and
working in a hot environment need to
drink adequate amounts of water.
People can become dehydrated in the
ocean, lakes, or pools if the water and
environmental temperatures are warm
enough.
Heat related conditions: Know the signs
and symptoms of heat cramps, heat
rash, heat exhaustion, and heat
stroke. Preventing dehydration is one
step to avoid these conditions.

Nursing Considerations
- Assess vital signs, noting peripheral
pulses.
- Monitor blood pressure and invasive
hemodynamic parameters.
- Strictly monitor intake and output.
Observe the physical properties of
the urine.
- Correctly infuse the right amount of
IVF.
- Encourage small, frequent feedings.
- Provide frequent, oral care.
- Administer medications as prescribe

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