Professional Documents
Culture Documents
Tere Vanguardia
RESPIRATORY SYSTEM
DISORDERS OF THE LOWER RESPIRATORY SYSTEM
I. Influenza
Influenza involves inflammation and infection of the major airways.
It is caused by the orthomyxovirus influenza type A, B, or C.
Management
II. Bronchitis
Bronchitis, or inflammation of the major bronchi and trachea
one of the more common illnesses affecting preschool and school-age children.
Management
III. Bronchiolitis
Bronchiolitis is inflammation of the fine bronchioles and small bronchi. It is the most
common lower respiratory illness in children younger than 2 years, peaking in
incidence at 6 months of age.
The infection occurs most often in the winter and spring.
Many children who develop asthma later in life have numerous instances of
bronchiolitis during their first year of life.
Viruses, such as adenovirus, parainfluenza virus, and RSV, in particular, appear
to be the pathogens most responsible for this illness
Assessment
Management
IV. Asthma
Asthma, an immediate hypersensitivity (type I) response, is the most common
chronic illness in children, accounting for a large number of days of absenteeism
from school
and many hospital admissions each year. It tends to occur initially before 5 years of
age.
Diagnostic Procedure
Pulmonary Function Studies
Management
anti-inflammatory corticosteroid
bronchodilator
mast cell stabilizer (cromolyn sodium
leukotriene receptor antagonists (montelukast)
Complication
Status Asthmaticus
V. Bronchopulmonary Dysplasia
Bronchopulmonary dysplasia (BPD) is chronic pulmonary involvement that occurs in
10% to 40% of infants who are treated for acute respiratory distress in the first
days of life
Most often occurs in infants who received mechanical ventilation for respiratory
distress syndrome at birth.
It occurs most often in infants born weighting less than 1000 g.
Signs and
Symptoms
Management
MMC
Management
Therapy for children with CF consists of measures to reduce the involvement of
the pancreas, lungs, and sweat glands. Because so many organs are involved,
care works best if it is a collaborative process
Humidified Oxygen
Aerosol Therapy. Three or four times a day, children may be given aerosol
therapy by means of a nebulizer to provide antibiotics or bronchodilators.
Antibiotics are specifically determined by culture.
Mucolytic, such as acetylcysteine (Mucomyst), can be added to the mist to aid in
diluting and liquefying secretions.
Chest Physiotherapy. To aid drainage of secretions, children need chest physiotherapy
frequently, approximately three or four times a day.
Activity. Children with CF need to maintain their usual activities as much as possible. When
in bed, they need frequent position changes so that, at various times of the day, all
lobes of their lungs will be encouraged to drain by being in a superior position.
Respiratory Hygiene. The sputum that a child coughs up may have a disagreeable taste or
odor. Offer frequent mouth care, toothbrushing, and a good-tasting mouthwash to make the
child’s mouth feel fresh.
CARDIOVASCULAR SYSTEM
DISORDERS OF THE CARDIOVASCULAR SYSTEM
Types
Assessment
Diagnosis
Therapeutic Management
Complications
Assessment
Diagnosis
Therapeutic Management
Complications
Assess
ment
The defect leads to the
same symptoms as other ASDs
(right ventricular hypertrophy,
increased pulmonary blood
flow, and fixed S2 splitting).
Diagnosis
An ECG often will reveal first degree heart block as impulse conduction is halted
before the AV node.
Echocardiography will confirm the diagnosis.
Management
Pulmonary artery banding may be done palliatively in selected infants. This
increases pressure in the pulmonary artery and right side of the heart,
reducing the amount of shunting.
Surgery, however, is always necessary for a final repair because these defects
are too large to close spontaneously. Because surgery may involve a valve
repair as well as a septal repair, mitral and tricuspid insufficiency from poor
valve function may occur at a later date.
4. Patent Ductus Arteriosus
The ductus arteriosus is an accessory fetal structure that connects the
pulmonary artery to the aorta. If it fails to close at birth (closure begins with the
first breath, and is usually complete between 7 to 14 days of age, although full
closure may not occur until 3 months of age), blood will shunt from
PDAs are twice as common in girls as boys and occur at a higher incidence at
higher altitudes.
In preterm infants,the incidence may be as high as 20% to 60% and
accounts for about 10% of all heart disease.
Assessment
Diagnosis
Therapeutic Management
1. Pulmonary Stenosis
Pulmonary stenosis is narrowing of the pulmonary valve or the pulmonary
artery just distal to the valve
It accounts for about 10% of congenital heart anomalies
Assessment
asymptomatic
signs of mild (right-sided)
heart failure
severe: cyanosis
thrill may be present in the
upper left sternal area or at the
suprasternal notch
Split S2
Diagnosis
ECG or echocardiography will
reveal right ventricular
hypertrophy
Cardiac catheterization is rarely
necessary for diagnosis but is
used for interventional
enlargement of the stenosed
valve.
Therapeutic Management
Balloon angioplasty by way of cardiac catheterization
2. Aortic Stenosis
Assess
ment
asymptomatic
,
typical
murmur
thrill may be present, particularly at
the suprasternal notch
If severe, decreased cardiac output
evidenced by faint pulses, hypotension,
tachycardia, and inability to suck for long
periods may be present
When the child is active, chest pain
similar to angina
Diagnosis
ECG or echocardiography will reveal left ventricular hypertrophy
Cardiac catheterization is rarely necessary unless interventional therapy by this route is
planned.
Therapeutic Management
beta-blocker or a calcium channel blocker
valvuloplasty
artificial valve replacement for correction
Assessment
headache and vertigo.
exceptional irritability (below 3 years
old)
Epistaxis (nosebleed)
cerebrovascular accident
absence of palpable femoral pulses
leg pain on exertion because of the
diminished blood supply to their lower
extremities
blood pressure in the arms will be at
least 20 mm Hg higher than in the legs
Diagnosis
Echocardiography
ECG
MRI
X-ray examination
Therapeutic Management
Interventional angiography (a balloon catheter)
Surgery
C. Disorders With Mixed Blood Flow
1. Transposition of the great arteries
2. Total anomalous pulmonary venous return
3. Truncus arteriosus
4. Hypoplastic left heart syndrome.
Assessment
cyanotic from birth
Diagnosis
Echocardiography generally reveals an enlarged heart
Cardiac catheterization will reveal the low oxygen saturation resulting from the mixing of
blood in the heart chambers.
Therapeutic Management
Within a few days, ideally 24 hours after birth
PGE1
A balloon atrial septal pull-through operation
Therapeutic Management
Surgery: involves reimplanting the
pulmonary veins into the left atrium.
3. Truncus Arteriosus
In truncus arteriosus, a rare defect
(approximately 1% of initial cardiac lesions),
one major artery or “trunk” arises from the left
and right ventricles in place of separate aorta
and pulmonary artery vessels
Assessment
There is usually an accompanying VSD
cyanotic
typical VSD murmur
Therapeutic Management
Surgery: restructuring the common trunk to
create separate vessels.
1. Tricuspid Atresia
Tricuspid atresia is an extremely serious disorder because the tricuspid valve is
completely closed, allowing no blood to
flow from the right atrium to the right
ventricle
Assessment
extreme cyanosis
tachycardia
dyspnea
Therapeutic Management
2. Tetralogy of Fallot
Tetralogy of Fallot, one of the first
types of congenital heart disease
described
Occurs in about 10% of children with
congenital cardiac disease
It is called a tetralogy because four
anomalies are present:
1. P - pulmonary stenosis
2. O - dextroposition (overriding) of
the aorta
3. V - VSD (usually large)
4. R - right ventricular hypertrophy
Assessment
Diagnosis
History and physical symptoms
Echocardiography
ECG
Cardiac catheterization
Laboratory findings reveal polycythemia, increased hemoglobin, hematocrit, and total
red blood cell count as well as reduced oxygen saturation.
Therapeutic Management
HEMATOLOGIC DISORDERS
GASTROINTESTINAL SYSTEM
DISORDERS OF THE GASTROINTESTINAL SYSTEM
Assessment
Cleft lip may be detected by a sonogram while an infant is in utero.
Cleft palate can be determined by depressing the newborn’s tongue with a tongue blade.
This reveals the total palate and the extent of any cleft present.
Therapeutic Management
Between weeks 4 and 8 of intrauterine life, the laryngotracheal groove develops into the
larynx, trachea, and beginning lung tissue. The esophageal lumen forms parallel to this.
Esophageal atresia is obstruction of the esophagus. Often a fistula (opening) occurs
between the closed esophagus and the trachea.
Therapeutic Management
Emergency surgery
Antibiotics may be prescribed to help prevent infection.
A gastrostomy may be performed (under local anesthesia) and the tube allowed to drain
by gravity to keep the stomach empty of secretions and prevent reflux into the lungs.
It may be necessary to complete the surgery in different stages and to use a portion of
the colon to complete the anastomosis if the esophageal segments are far apart from
each other.
Observe infants closely at postoperative days 7 to 10, when sutures dissolve, because
leaks occurring at anastomosis sites can occur at this time. If this occurs, fluid and air
leak out into the chest cavity, and pneumothorax (collapse of the lung) can occur.
Assessment
Assessment
The diagnosis of pyloric stenosis is made primarily from the history. Whenever parents
say that their baby is vomiting or spitting up, be certain to get a full description:
V. INTUSSUSCEPTION
Ileoileal
Ileocecal
VI. CELIAC DISEASE
Assessment
Hirschsprung’s disease, or
aganglionic megacolon, is absence of
ganglionic innervation to the muscle of a
section of the bowel—in most instances, the
lower portion of the sigmoid colon just above
the anus
Assessment
GENITOURINARY DISORDERS
NEUROMUSCULAR DISORDERS