NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM

(ACUTE OR CHRONIC)
LGA AND SGA COMPLICATIONS
A. FETAL
Large for Gestational Age
1. Shoulder Dystocia
➢ LGA babies are those whose birth weight
2. Hypoglycemia
is above the 90th percentile for their
3. Hypothermia
gestational age, meaning that they weigh
4. Meconium Aspiration
more than 90% of babies at the same
B. MATERNAL
gestational age.
1.Uterine Rupture
➢ Does not correlate with an increased risk
2.Uterine Atony
of mortality.
3.Birth Injury
Small for Gestational Age
SGA
➢ SGA babies are those whose birth weight 1. Reduced Body Fat
is below the 10th percentile for their 2. Reduced Body Muscle
gestational age, meaning that they weigh 3. Dry and Loose Skin
less than 90% of babies at the same 4. Thin and Dry Umbilical Cord
gestational age. 5. Wide Skull Suture

➢ Increased chance of infant mortality. COMPLICATIONS

➢ LBW -Low Birth Weight; < 2,500 g A. FETAL

1. Hypoglycemia
➢ VLBW -Very Low Birth Weight; < 1,500 g
2. Hypothermia
➢ ELBW -Extremely Low Birth Weight; < 3. Hypocalcemia
1,000 g 4. Polycythemia
5. Perinatal Asphyxia
CAUSE AND RISK FACTORS
NURSING MANAGEMENTS
LGA
LGA
• GDM
- Preventive care: Includes maternal
• Maternal Obesity
nutrition education to prevent excessive
• Genetics
weight gain and strict control of
• Post-term
gestational diabetes to avoid fetal
• Baby Boy
impact.
SGA
- Assist laboring mother into the lithotomy
• IUGR
position to increase pelvic outlet.
• Genetics
- Assess the newborn to detect birth
• Multiple Gestation
trauma (i.e., clavicle fracture or
• Pre-term
paralysis).
SIGNS, SYMPTOMS & COMPLICATIONS
- Monitor temperature. Provide warmth if
LGA needed.
1. Increased Body Fat
2. Lethargic

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
- Monitor glucose level. IV glucose may be
needed if glucose level can’t be
maintained.
SGA
- Preventive care: Includes maternal
nutrition education to prevent inadequate
weight gain and nutrition, and maintain
resting in a proper position.
- Provide family teaching regarding the
need for ongoing monitoring of growth
and development with appropriate support
for the family and infant if developmental
delay is noted.
- Monitor temperature and maintain warm
environment to prevent cold stress.
Incubator post birth for temperature
control if hypothermia is noted.
- Monitor for skin breakdown.
- Monitor glucose level. IV glucose maybe
be administered if glucose level can’t be
maintained.
- Monitor calcium level.
PRETERM AND POSTTERM
PRETERM
- refers to a baby born before 37 weeks of
pregnancy, which can cause health
problems due to underdevelopment.
Signs and Symptoms of Preterm Newborn
- Low birth weight
- Weak muscle tone
- Less body fat
- Increase Lanugo
- Jaundice
- Small size
PATHOPHYSIOLOGY
✓ Multiple pregnancy
✓ Fertility treatment
EDITED BY: ANTONETH & JOYCE
✓ Smoking
✓ Ascending infection
✓ PROM
✓ Previous miscarriage
✓ Decidual hemorrhage
✓ Maternal stress
✓ Previous preterm labor
Nursing Interventions
➢ Respiratory support: Providing support
to help the baby breathe, such as
oxygen therapy or mechanical
ventilation.
➢ Nutritional support: Providing
specialized nutrition to meet the
baby's growth and development needs,
such as parenteral nutrition or enteral
feeding.
➢ Maintaining warm environment:
Preterm babies have difficulty
regulating their body temperature.
➢ Educating parents on how to care for
their preterm baby, including feeding,
bathing, and monitoring for signs of
complications.
➢ Prevent infection
Treatment
- Preterm infants often need specialized
medical care in a neonatal intensive care
unit (NICU). This is a specific part of the
hospital for babies in critical condition.
Neonatologists are healthcare providers
who specialize in newborn care. Some
babies stay in the NICU for weeks or
months.
- Preterm infants often need help with:
➢ Breathing.
➢ Feeding.
➢ Gaining weight.
➢ Maintaining their own body
temperature.
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
POSTTERM
- is a newborn who is born after 42 weeks
of gestation, which is two weeks or more
beyond the expected due date.
Signs and Symptoms of Postterm Baby
- Decreased fetal movement
- Meconium-stained amniotic fluid
- Excessive weight
- Dry, peeling skin
- Low amniotic fluid levels
Pathophysiology
✓ No Ultrasound
✓ No LMP
✓ Wrong calculations of AOG
✓ Genetics
✓ Maternal Age >35 yrs. Old
✓ Maternal obesity
✓ Baby boy
Nursing Management
➢ Monitor the newborn's vital signs,
including temperature, heart rate, and
respiratory rate, and report any
abnormalities to the healthcare provider
➢ Ensure that the newborn is kept warm
and dry.
➢ Monitor blood glucose levels and provide
appropriate feeding or glucose
supplementation as needed.
➢ Provide emotional support to parents, who
may be anxious or worried about their
postterm baby's health and well-being.
➢ Encourage parents to spend time with
their newborn and provide support and
education on infant care and development.
TREATMENT
1. Monitoring: Postterm babies are typically
monitored closely for signs of distress or
complications. This may involve frequent
checks of the baby's heart rate,
breathing, and oxygen levels.
EDITED BY: ANTONETH & JOYCE
2. Induction of labor: If a postterm baby
has not been born by 42 weeks, induction
of labor may be recommended to reduce
the risk of complications.
3. Cesarean delivery: In some cases, a
cesarean delivery may be necessary to
ensure the safe delivery of a postterm
baby.
4. Meconium aspiration syndrome treatment:
If a postterm baby has aspirated
meconium (a baby's first bowel
movement), treatment may involve
suctioning the baby's airways to remove
any meconium and provide oxygen support.
5. Hypoglycemia management: Postterm
babies may be at risk of low blood sugar
levels (hypoglycemia), which can be
managed with frequent feedings and/or
glucose monitoring.
SUDDEN INFANT DEATH SYNDROME
(SIDS)
SUDDEN INFANT DEATH SYNDROME
(SIDS)
- Sudden infant death syndrome (SIDS) is
a sudden unexplained death in infancy. It
tends to occur at a higher than usual rate
in infants of adolescent mothers, infants
of closely spaced pregnancies, and
underweight and preterm infants.
- The peak age of incidence is 2 to 4
months of age.
- SIDS also tends to be slightly more
common in baby boys.
POSSIBLE CONTRIBUTING FACTORS
• Sleeping prone rather than supine
• Viral respiratory or botulism infection
• Exposure to secondary smoke
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
• Pulmonary edema ➢ avoidance of soft bedding, overheating,
• Brainstem abnormalities and exposure to tobacco smoke, alcohol,
• Neurotransmitter deficiencies and illicit drugs
• Heart rate abnormalities
• Distorted familial breathing patterns
• Decreased arousal responses
• Possible lack of surfactant in alveoli
• Sleeping in a room without moving air
currents (the infant rebreathes expired
carbon dioxide)
PATHOPHYSIOLOGY

SIGNS AND SYMPTOMS

• SIDS has no symptoms or warning signs.
Babies who die of SIDS seem healthy
before being put to bed. They show no
signs of struggle and are often found in
the same position as when they were
placed in the bed.
NURSING MANAGEMENT HOW CAN A FAMILY COPE AFTER LOSING
(based on AAP recommendation) A BABY TO SIDS?
➢ Put newborns to sleep on their back, the • Ask the family to join a grief support
incidence of SIDS has declined almost group.
50% to 60%. • Advise them to get help from a
➢ use of a firm sleep surface counsellor, a psychologist, or a
➢ breastfeeding; room sharing without bed psychiatrist.
sharing • Advise them to talk with a close family
➢ routine immunizations member, a friend, or a spiritual adviser.
➢ consideration of using a pacifier
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
• Autopsy reports should be given to CAUSES OF APNEA
parents as soon as they are available.
- Bleeding in or damage to the brain
• They need support to see them through
- Lung problems, infections, and changes in
the first few months of the second
body temperature
child’s life, particularly until past the
- Digestive problems and heart or blood
point at which the first child died.
vessel problems
• A new baby born to a family in which a
- Too low or too high levels of chemicals in
SIDS infant died can be screened using a
the body and triggering reflexes
sleep assessment as a precaution
MEDICAL MANAGEMENT

APNEA OF PREMATURITY ➢ Blood oxygen level

➢ Blood test
APNEA ➢ Laboratory test
- Absence of breathing ➢ X-ray, ultrasounds, or other imaging
- Apnea of prematurity refers to what studies
happens when a child doesn’t breathe for NURSING MANAGEMENT
more than 20 secs.
- More common on premature ✓ Position the infant's head and neck in a
- Causes bradycardia neutral position.
- Begin after 2 days of life and last up to ✓ Avoid prolonged suctioning; Discourage
2-3mons after Birth taking rectal temperatures and tube
feedings.
PATHOPHYSIOLOGY ✓ Administer methylxanthines (e.g.,
- Disorder caused by immaturity of (theophylline, caffeine) as prescribed.
neurologic and mechanical of the ✓ Anticipate the use of nasal Continuous
respiratory positive airway pressure (CPAP).
✓ Administer continuous nasal airflow or
3 TYPES OF APNEA CPAP via a nasal mask, or a face mask.
CENTRAL APNEA- caused by immaturity ✓ Prepare the infant for assisted
of medullary respiratory control centers mechanical ventilation as indicated.
OBSTRUCTIVE APNEA- caused by ✓ Maintaining fluid and electrolyte balance
obstructed airflow ✓ Skin-to-skin care
MIXED APNEA- combination of central ✓ Regulating temperature
and obstructive apnea ✓ Educate the parents on the use of apnea
monitor and allow for a return
SIGNS AND SYMPTOMS
demonstration of the application, to
- Cyanosis setting, alarms, power source, inform of
- Decreased heart rate when and how to respond to changes
- Low oxygen level in respiration and heart rate.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
MECONIUM ASPIRATION SYNDROME → Risk of injury (brain injury) related to
hypoxemia.
MECONIUM → Ineffective thermoregulation related to
immature temperature regulation
→ Is present in the fetal bowel as early as 10
weeks of gestation. mechanism.
→ Baby born breech → Risk of infection related to deficient
→ Meconium staining occurs in approximately immunological defence.
10% to 20% of all births; in 2% to 4% of these
births, infants will aspirate enough
meconium to cause meconium aspiration
syndrome (MAS).
→ Does not occur in ELBW
→ Aspirate either in utero or with the first
breath at birth.

SIGNS & SYMTOMPS (Causes: severe respiratory

distress)

1. Tachypnea - Rapid breathing.

2. Retractions - Area between the ribs and neck
sinks attemps to inhale.
3. Grunting - body’s way to keep air in the lungs
so they will stay open.
4. Pneumothorax - A collapsed lung occurs when
air escapes from the lungs.
5. Pneumomediastinum - A condition in which air
is present in the mediastinum.
6. Pulmonary interstitial emphysema (PIE) - When
air gets trapped in the tissue outside air sacs in
the lungs.
Nursing Diagnosis
→ Ineffective breathing pattern related to
surfactant deficiency, alveolar instability.
→ Impaired gas exchange related to immature
pulmonary function.
Nursing Management
→ Thorough oropharyngeal suctioning
→ If no severe risk, keep under warmer.
Oxygen and observe for vital signs.
→ If depressed baby, intubation to be
initiated. PPV should be avoided. Do
thorough laryngotracheal toileting.
→ Thorough stomach wash with Normal
saline.
→ Nurse the baby in a thermoneutral
environment with oxygen.
→ Restricted IV fluids to prevent pulmonary
edema.
→ Prophylactic antibiotics after taking blood
culture sample.
→ Assisted ventilation to be provided if
respiratory failure occurs.
→ Chest drainage if pneumothorax occurs.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
Medication
→ Using light or little sedation, administering the
smallest dose necessary to manage pain, and
monitoring for managing posible delirium
symptoms Risk Factors
Rehabilitation Maternal
→ Due to the high prevalence of respiratory and
cardiovascular problems in patients after ICU
release, pulmonary or cardiovascular
rehabilitation is recommended
TRANSIENT TACHYPNEA OF THE Fetal
NEWBORN (TTN)
- wet lungs
- self-limiting
- transient (short-lived) within 2 hours
after birth
- faster than normal breathing rate > 60
cpm
- in the lungs, not the airways
- a breathing disorder seen shortly after
delivery, most often in early term or late
preterm babies
Management
Clinical Features
● At the time of birth & within 2 h. after
delivery
● Tachypnea (RR > 60 b/min.)
● Flaring nostrils or movements between
the ribs or breastbone known as
retractions
● Increased anterior-posterior diameter
● Breath sounds typically are clear
● Bluish skin color (cyanosis)
● Rapid breathing, which may occur with
noises such as grunting
✓ delivery before completion of 39 weeks
gestation
✓ cesarean section without labor
✓ gestational diabetes
✓ maternal asthma
✓ male gender
✓ perinatal asphyxia
✓ prematurity
✓ small for gestational age
✓ large for gestational age infants
✓ Differential Diagnosis
✓ Congenital Pneumonia
✓ Meconium Aspiration Syndrome
✓ Respiratory Distress Syndrome (RDS)
✓ Neonatal Sepsis
✓ Pneumomediastinum
✓ Pneumothorax
✓ Persistent Pulmonary Hypertension
✓ Congenital heart disease
✓ Polycythemia
✓ Anemia/hypovolemia
➢ Given TTN is a self-limited condition,
supportive care is the mainstay of
treatment.
➢ Medical care of transient tachypnea of
the newborn (TTN) is supportive. As the
retained lung fluid is absorbed by the
infant's lymphatic system, the pulmonary
status improves. Supportive care includes
intravenous fluids and gavage feedings
until the respiratory rate has decreased
enough to allow oral feedings.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
➢ Rule of 2 hours: Two hours after onset ACUTE RESPIARTORY DISTRESS
of respiratory distress, if an infant’s SYNDROME (ARDS)
condition has not improved or has
worsened, consider transferring infant RDS

to a center with a higher level of - occurs in babies born early (premature)

neonatal care. whose lungs are not fully developed.
Respiratory Management: - The earlier the infant is born, the more
- Oxygenation , CPAP likely it is for them to have RDS and need
Nutrition: extra oxygen and help breathing.
- NPO, IV fluids, Tube feeding - The pathologic feature of RDS is a
Infection: hyaline like (fibrous) membrane formed
- Antibiotics such as ampicillin and from an exudate of an infant’s blood that
gentamicin begins to line the terminal bronchioles,
Medications: alveolar ducts, and alveoli. This membrane
- Furosemide and epi prevents the exchange of oxygen and
- Salbutamol carbon dioxide at the alveolar-capillary
Prognosis membrane, interfering with effective
● Overall prognosis is excellent with most oxygenation.
of the symptoms resolving within 48
Causes RDS of the New Born
hours of onset. In some case reports,
malignant TTN has been reported in  RDS is caused by a lack of surfactant in
which affected newborns develop the lungs. The lungs of a fetus start
persistent pulmonary hypertension due to making surfactant during the third
a possible elevation of pulmonary vascular trimester, which starts after the 26th
resistance due to retained lung fluid. week of pregnancy. Surfactant is a foamy
substance that keeps the lungs fully
expanded so that newborns can breathe
in air once they are born. This surfactant
does not form until the 34th week of
gestation.

 Other causes include:

1. Meconium Aspiration Syndrome

2. Sepsis
3. Slow transition to extrauterine life
4. Pneumonia

RISK FACTORS

- Siblings that had RDS.

- Twin or multiple births.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
- C-section (cesarean) delivery. 2. Oxygen Administration
- Mother that has diabetes.
 The administration of oxygen is often
- Infection.
necessary to maintain correct PO2 and
- Baby that is sick at the time of
pH levels following surfactant
delivery.
administration.
- Cold, stress, or hypothermia. Baby
cannot keep body temperature warm HYPERBILIRUBINEMIA
at birth.
HYPERBILIRUBINEMIA
SIGNS AND SYMPTOMS - Hemolytic disease of the newborn
- The term “hemolytic” is Latin for
1. Subtle signs that may appear include:
“destruction” of red blood cells.
2. Low body temperature
- Hemolytic disease is present when there
3. Nasal flaring
is an excessive destructions of red blood
4. Sternal and subcostal retractions
cells, which lead to elevated bilirubin
5. Tachypnea
levels (hyperbilirubinemia)
6. Cyanotic mucous membranes
Signs and Symptoms
PATHOPHYSIOLOGY ● Yellowing of your baby’s skin and the
whites of his or her eyes. This often
 Neonatal respiratory distress syndrome
starts on a baby’s face and moves down
(RDS) occurs from a deficiency of
his or her body. (JAUNDICE)
surfactant, due to either:
● Poor feeding
1. inadequate surfactant production ● Lack of energy
2. surfactant inactivation in the context
of immature lungs

Prematurity affects both these factors,

thereby directly contributing to RDS.

THERAPEUTIC MANAGEMENT

1. Surfactant Replacement

 RDS can be largely prevented by the

administration of surfactant at birth for
an infant at risk because of low
gestational age. Immediately after birth,
synthetic surfactant is administered into
an endotracheal tube by using a syringe
or catheter (lung lavage).
PHYSIOLOGIC JAUNDICE
• Most common
• After 24 hours of age
• More common in LPI (late preterm)
and preterm infants
• Rapid breakdown of RBC

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
• Immature liver
• Dehydration
PATHOLOGIC JAUNDICE
• Before 24 hours of age
• Greater than 14 days of life
• Associated with bilirubin
encephalopathy or kernicterus
• Causes:
• ABO incompatibilities
• Maternal infections
• Maternal diabetes
• Maternal ingestion of
sulfonamides, diazepam or
salicylates near term
ABO Incompatibility
● Most common cause of hemolytic disease
● Of the 20% with ABO incompatibility,
only 5% with clinical effects
● Risk factors:
○ Occurs with Maternal type O
blood & fetal type A, B, or AB
● Mothers immune system may react ->
forms antibodies against baby’s RBC
● Diagnosed by: Coombs’ test/ Direct
antiglobulin test (DAT)
● Can cause:
○ Mild Anemia
○ Hyperbilirubinemia
● Treatment: Phototherapy, fluids, IVIG,
occasionally exchange transfusion
Rh Incompatibility
● - Occurs when maternal antibodies are
present or develop in response to
exposure to an antigen (different blood
type)
- Maternal sensitization
- Maternal antibodies cross the placenta
● - Causes hemolysis of fetal RBC’s
● - Isoimmunization – leading to fetal
anemia
EDITED BY: ANTONETH & JOYCE
● - Erythroblastosis Fetalis – immature
erythrocytes
● - Worst with consecutive pregnancies
● - RhoGam (immunoprophylaxis) given for
Rh - mothers
● - Significant decrease in incidence of Rh
incompatibility
● - Given at 28 weeks and if any incidence
of bleeding
Nursing Care Priorities
• Increase PO intake
• Phototherapy-position light at least 10 cm
from infant
• Protect eyes
• Skin care – frequent stools
• Make sure no ointments or creams applied
to body when receiving phototherapy
• Reposition frequently
• Discharge Teaching
• Feed frequently
• Observe for lethargy
• Count number of diapers (bilirubin is
excreted through urine & stool)
wet – 6-8/day
soiled diapers 1/day
• Follow up appointments
How is hyperbilirubinemia in a newborn
diagnosed?
The timing of when your child’s jaundice first
starts matters. It may help his or her
healthcare provider make a diagnosis.
• First 24 hours. This type of jaundice is often
serious. Your child will likely need treatment
right away.
• Second or third day. This is often physiologic
jaundice. Sometimes it can be a more serious
type of jaundice. It's important to be sure the
baby is getting enough milk at this point.
• Toward the end of the first week. This type
of jaundice may be from breastmilk jaundice
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
but may be due to an infection or other rare
serious problems.
• In the second week. This is often caused by
breastmilk jaundice but may be caused by rare
liver problems.
MEDICAL MANAGEMENT
PHOTOTHERAPY
- Bilirubin absorbs light. High bilirubin
levels often decrease when a baby is put
under special blue spectrum lights
Fiber optic blanket
- A fiber optic blanket is another form of
phototherapy. The blanket is usually put
under your baby. It may be used alone or
with regular phototherapy.
Exchange transfusion
- This treatment removes your baby’s blood
that has a high bilirubin level. It replaces
it with fresh blood that has a normal
bilirubin level.
Feeding with breastmilk
- The American Academy of Pediatrics says
that you should keep breastfeeding a
baby with jaundice. If your baby has not
been getting enough milk at the
breast, you may need to supplement with
pumped breastmilk or formula.
NECROTIZING ENTEROCOLITIS (NEC)
NECROTIZING ENTEROCOLITIS (NEC)
▪ "NECROTIZING" means the DEATH OF
TISSUE
▪ "ENTERO" refers to SMALL
INTESTINE
▪ "COLO" refers to the LARGE
INTESTINE
▪ "ITIS" means inflammation
EDITED BY: ANTONETH & JOYCE
DEFINITION
• Is a serious gastrointestinal problem that
mostly affects PREMATURE BABIES.
• The condition inflames intestinal tissue,
causing it to die.
• A HOLE may form in baby's intestine.
• -Bacteria can leak into the abdomen
(belly) or bloodstream through the hole.
• -Usually develops within 2-6 weeks after
birth.
WHO MIGHT GET NECROTIZING
ENTEROCOLITIS?
- Born before 37th week of pregnancy
- Fed through a tube in the stomach
• Weighing less than 5 1/2 pounds at
- birth
- •Rarely, affects in full term infants
DIAGNOSIS
- Client's history
- Physical assessment
- Abdominal X-ray
- Blood Test
- Fecal Test
SIGNS & SYMPTOMS
✓ Abdominal pain and swelling
✓ Red or tender belly
✓ Change in HR, BP, BT and breathing
✓ Diarrhea with Bloody Stool
✓ Green or yellow vomit
✓ . Lethargy
✓ -Refusing to eat and weight loss
4 TYPES OF (NEC)
➢ Classic
- This most common type of NEC tends
to affect infants born before 28
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
weeks of pregnancy. Classic NEC RETINOPATHY OF PREMATURITY (ROP)
occurs three to six weeks after birth.
→ an acquired ocular disease that leads to partial
➢ Transfusion-associated
or total blindness in children, is caused by
- An infant may need a blood vasoconstriction of immature retinal blood
transfusion to treat anemia (lack red vessels.
blood cells). About 1 in 3 premature
→ Originally it was called retrolental fibroplasias
babies develop NEC within three days
(RLF), named for the end-stage of the disease
of getting a blood transfusion. in which a white, vascularized plaque could be
➢ Atypical seen behind the lens in an eye that was often
- Rarely, an infant develops NEC in the completely blind.
first week of life or before the first
feeding.
➢ Term infant
- Full-term babies who get NEC usually
have a birth defect. Possible causes
include congenital heart condition,
gastroschisis (intestines that form
outside of the body) and low oxygen
levels at birth.

MANAGEMENT

01

- Stopping all regular feedings. The

baby receives nutrients through an
intravenous (IV) catheter.
02
- Checking stools for blood.
03
- If abdominal swelling interferes with
breathing, providing oxygen or
mechanically assisted breathing.
04
- Starting antibiotic therapy.
Signs and symptoms
Subtle changes in a baby's retina aren't easily detected
and can't be seen by parents or pediatric doctors and
nurses. Only a pediatric ophthalmologist, a doctor who
specializes in eye care, can detect signs of retinopathy
of prematurity by using special instruments to examine
the baby's retina.
Severe and untreated ROP may cause some of the
following symptoms:
→ White pupils, called leukocoria
→ Abnormal eye movements, called nystagmus
→ Crossed eyes, called strabismus
→ Severe nearsightedness, called myopia

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
Risk factors for ROP telemedicine purposes. The advantages of this
method are that fewer screening
ROP is essentially a disease of prematurity.
ophthalmologists would be needed, making it
The emergence of retinopathy of prematurity depends ideal for more remote or rural areas.
on the interaction of multiple factors, such as:
Surgical & Medical Management
→ gestational age
1. Cryotherapy
→ low birth weight
2. Laser photocoagulation
→ Hypoxia
→ duration of oxygen supplementation Treatment modalities after retinal detachment:
→ respiratory distress syndrome
→ Open-sky vitrectomy,
→ twin pregnancy
→ Scleral buckling procedures (SBPs),
→ Anemia
→ Closed vitrectomy and lensectomy with or
→ blood transfusions
without SBPs.
→ Sepsis
→ intraventricular haemorrhage The success rate for surgery to reattach the retina in
→ Hypotension infants with ROP is poor as there is rapid degeneration
→ hypothermia of the photoreceptor cells after retinal detachment.
Infants who are most immature and most ill (and Other Modalities of Treatment:
consequently receive the most oxygen) are at the
highest risk for developing ROP → Anti-VEGF therapies ( bevacizumab)

Diagnosis Nursing Management

The only way to determine if babies have ROP is to 1. Nursing interventions can reduce the risk
examine the inside of their eyes for abnormalities in the regarding oxygen and light. Currently, our best
retina. nursing efforts include support and education
for the family and developmental-based nursing
Ophthalmologists trained in the diagnosis and interventions for the infant or child blinded or
treatment of ROP will examine your baby's eyes. visually impaired by ROP.
2. Careful control of oxygen saturation,
Current recommendation for a screening eye
normalisation of serum IGF-1 concentrations
examination is for all infants born at less than or equal
3. Provision of adequate nutrition
to 32 weeks gestation, and/or weighing less than 1500 g
4. Curbing the negative effects of infection and
at birth. This is to ensure that all infants at significant
inflammation
potential risk are screened.
5. Judicious use of oxygen in delivery room and the
1. Indirect Ophthalmoscopy: Examination of the NICU
retina is performed using the binocular indirect 6. A reduction in blood transfusion in the NICU
ophthalmoscope (a head-mounted scope with could promote adequate postnatal growth and
light source) and a lens for focusing. improve neural and vascular development of the
retina.
2. Use of RetCam and telemedicine : The RetCam is
a camera used to photograph the retina of
infants. This camera do not require a dilated
pupil or contact with the eye. Retinal images
taken by the camera can be stored, transmitted
to expert, reviewed, analyzed and sequentially
compared over time and are useful for
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
→ signs of infection around the time of labor or
delivery (such as fever in the mother)
→ prolonged labor

TREATMENT/MANAGEMENT

HIGHEST PRIORITY

→ The most common antibiotic to treat group B

strep is penicillin or ampicillin.
→ PROVIDE SUPPORT AND EDUCATION

BETA-HEMOLYTIC AND GROUP B

STREPTOCOCCUS INFECTION OPHTHALMIA NEONATORUM
DEFINITION OPHTHALMIA NEONATORUM
→ KNOWN AS "GBS" - Neonatal conjunctivitis, also known as
→ It is a bacterial infection babies can get during
ophthalmia neonatorum, is a type of eye
delivery or in their first weeks of life.
infection that affects newborn babies,
→ It is caused by bacteria typically found in a
person's vagina or rectal area or the GI tract. specifically in their first month of life.
→ It can cause serious complications.
SIGNS AND SYMPTOMS
→ Pregnant people are screened for group B strep
during pregnancy. • Edema of the eyelids
→ Antibiotics can treat the infection if tested • Redness and chemosis of the
positive.
conjunctiva
SIGNS AND SYMPTOMS • Purulent discharge
CAUSES/ETIOLOGY
1. EARLY-ONSET
→ Tachypnea Chemical
→ Apnea
• silver nitrate (90% infants)
→ Extreme paleness
• povidone-iodine solution,
→ Hypotension/hypotonia
• erythromycin 0.5%, or tetracycline
2. LATE-ONSET 1%
→ Lethargy Bacterial
→ Fever • Chlamydia trachomatis,
→ Loss of appetite • Neisseria gonorrhoeae
→ Bulging fontanelles from increased intracranial
• Staphylococcus aureus,
pressure
• Streptococcus pneumoniae,
RISK FACTORS • Escherichia coli,
→ a GBS-positive swab in a previous pregnancy • and other gram-negative bacteria
→ a previous baby with GBS infection Viral
→ pre-term labor • Herpes simplex virus
→ rupturing of the membranes well before the
onset of labor (18 hours or more)

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
COMPLICATIONS

- Corneal complications
- HSV: Keratitis, keratouveitis
- Vision impairment

DIAGNOSIS

MICROBE IDENTIFICATION

• N. gonorrhoeae and Chlamydia:

Swab drainage for culture and
sensitivity

• HSV: Giemsa stain, PCR

CBC - Eosinophil count

TREATMENT/MANAGEMENT

Medical Management
CARE OF NEWBORN WITH MOTHER
POSITIVE WITH HEPATITIS B
• Gonococcal disease: IV/IM
ceftriaxone What is Hepatitis B?

→ Hepatitis B is a viral infection that attacks the

• Chlamydial disease: Oral
erythromycin, azithromycin
• HSV: Acyclovir
PREVENTION
- Routine neonatal prophylaxis with
erythromycin 0.5 % ointment
liver and can cause both acute and chronic
disease
→ The virus is most commonly transmitted from
mother to child during birth and delivery, as
well as through contact with blood or other
body fluids during sex with an infected partner,
unsafe injections or exposures to sharp
instruments.

Nursing Management ACUTE VS. CHRONIC HEPATITIS B

• Treat neonate's mother, sexual Acute hepatitis B infection - lasts less than six months.
partner Your immune system likely can clear acute hepatitis B
from your body, and you should recover completely
• Maternal prenatal screening within a few months.

Chronic hepatitis B infection - lasts six months or

longer. It lingers because your immune system can't
fight off the infection. Chronic hepatitis B infection may
last a lifetime, possibly leading to serious illnesses such
as cirrhosis and liver cancer

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
Hepatitis B is In → HBV DNA testing for HBsAg-positive pregnant
persons at 26-28 weeks to guide the use of
→ Blood
maternal antiviral therapy during pregnancy.
→ Semen
→ Routine vaccination of all infants with the
→ Vaginal fluid
hepatitis B vaccine series, with the first dose
→ Anal fluid
administered within 24 hours of birth
HBV is spread by → Providing hepatitis B immune globulin and
hepatitis B vaccine to their infants within 12
→ Mother to child hours of birth
→ Sex w/out condoms
→ Sharing drug injecting equipment How to protect baby from hepatitis B?
→ Unsterilized tattoo and piercing equipment
→ Baby should get the first dose of hepatitis B
→ Sharing razors, toothbrush and ceremonial
vaccine and a shot called hepatitis B immune
tools
globulin (HBIG) within 12 hours of being born.
Risk for perinatal complications and poor maternal/ → All the hepatitis B shots are necessary to help
fetal outcomes such as ; keep the baby from getting hepatitis B. –
Infants receive 3–4 doses of HBV vaccine
→ Intrauterine Infection → Make sure the baby gets tested after
→ IUGR completing the series of shots.
→ Premature Delivery
→ Intrauterine Fetal Demise Nursing Management – maternal

Mother to Newborn Transmission → Provide dietary education: high-carbohydrate,

high-calorie, low- to moderate-fat and low- to
→ Transplacental transmission of HBV in utero moderate-protein diet and small, frequent
→ Natal transmission during delivery meals to promote nutrition and healing
→ Postnatal transmission during care or through → Educate the mother and family regarding
breast milk measures to prevent transmission of disease
Signs and Symptoms with others at home Provide comfort
measures.
→ Rash → Warn the patient to avoid trauma that may
→ Low grade fever cause bruising.
→ Joint Pain → Encourage gradual resumption of activities and
→ Abdominal pain mild exercise during convalescent period
→ Dark urine and light colored stool → Limit client activity (bedrest) in order to
→ Sucking will be poor promote hepatic healing.
→ Yellowing skin and white eyes ( jaundice)
→ Weakness and fatigue

Physiologic Jaundice - Usually appears between 3–4

days after delivery.

If jaundice occurs within 24 hrs after birth - It' s

presence could indicate a blood incompatibility
between the infant and a mother

Prevention of mother to child transmission

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
NEWBORN GENITAL HERPES
SIMPLEX VIRUS INFECTION
What is herpes simplex in newborn?
 Neonatal herpes is a herpes infection in a
young baby. The younger the baby, the
more vulnerable they are to the harmful
effects of infection.
 Herpes can be very serious for a young
baby, whose immune system will not have
fully developed to fight off the virus.
 Neonatal herpes, which is rare in the UK,
is caused by the herpes simplex virus.
This virus is very common and causes cold
sores and genital ulcers in adults.
How does a newborn baby catch herpes?
 During pregnancy and labor
 If you had Genital herpes for the first
time within the last 6 weeks of your
pregnancy, your newborn baby is at risk
of catching herpes.
 There's a risk you will have passed the
infection on to your baby if you had a
vaginal delivery.
After birth
 The herpes simplex virus can be passed
to a baby through a cold sore if a person
has a cold sore and kisses the baby.
 The herpes virus can also be spread to
your baby if you have a blister caused by
herpes on your breast and you feed your
baby with the affected breast or
expressed breast milk from the affected
breast.
 A baby is most at risk of getting a herpes
infection in the first 4 weeks after birth
You should not kiss a baby if you have a cold
sore to reduce the risk of spreading infection.
What are the warning signs in babies?
EDITED BY: ANTONETH & JOYCE
 Because newborn babies have
underdeveloped immune systems, they
can quickly become
seriously ill after catching the virus.
• is lethargic or irritable
• is not feeding
• has a high temperature (fever)
• has a rash or sores on the skin, eyes and
inside the mouth
 These are early warning signs that your
baby may be unwell.
• is lacking in energy (listless)
• is becoming floppy and unresponsive
• is difficult to wake up from sleep
• has breathing difficulties or starts
grunting
• breathes rapidly
• has a blue tongue and skin (cyanosis) –
• if they have brown or black skin this may
be easier to see on their lips, tongue and
gums, under their nails and around their
eyes
How is neonatal herpes treated?
 Neonatal herpes is usually treated with
antiviral medicines given directly into the
baby's vein (intravenously).
 This treatment may be needed for
several weeks.
 Any related complications, such as fits
(seizures), will also need to be treated.
 You can breastfeed your baby while
they're receiving treatment,
unless you have herpes sores around your
nipples.
How serious is herpes for a baby?
 Sometimes neonatal herpes will only
affect the baby's eyes, mouth or skin.
 In these cases, most babies will make a
complete recovery with antiviral
treatment.
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
 But the condition is much more serious if
it has spread to the baby's organs.
 Many infants with this type of neonatal
herpes will die, even after they have been
treated.
 If widespread herpes is not treated
immediately, there's a high chance the
baby will die.

How can neonatal herpes be prevented?

 If you're pregnant and have a history of
genital herpes, tell your doctor or
midwife.
 You may need to take medicine during
the last month of pregnancy to prevent
an outbreak of vaginal sores during
labour.
 Delivery by caesarean section is
recommended if the genital herpes has
occurred for the first time in the last 6
weeks of your pregnancy.
If you develop a cold sore or have any signs
of a herpes infection, take these precautions:
• do not kiss any babies
• wash your hands before contact with a
baby
• wash your hands before breastfeeding
• cover up any cold sores, lesions or signs
of a herpes infection anywhere on your
body to avoid passing on the virus
CARE OF NEWBORN AND MOTHER
POSITIVE ON HIV
What is HIV?
→ HIV (human immunodeficiency virus) is a virus
that attacks cells that help the body fight
infection, making a person more vulnerable to
other infections and diseases.
→ It is spread by contact with certain bodily fluids
of a person with HIV, most commonly during
unprotected sex.
→ HIV enters the bloodstream by way of body
fluids, such as blood or semen. Once in the
blood, the virus invades and kills CD4 cells. CD4
cells are key cells of the immune system.
HIV is transmitted in three routes:
→ sexual contact
→ exposure to infected body fluids or tissues
→ from mother to child during pregnancy,
delivery or breastfeeding

Signs and Symptoms:

→ Some develop flue like symptoms days-weeks

after exposure
→ Early HIV symptoms
- Fever
- Headache
- Enlarged lymph nodes
- Abdominal cramping
- Skin rash

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
- Weight loss → Breastfeeding is absolutely contraindicated for
mothers who are HIV positive.
→ Pregnant women should be offered screening
for HIV early in pregnancy because appropriate
antenatal interventions can reduce MTCT of
HIV infection.

INFANT OF A DIABETIC MOTHER

Infant of a Diabetic Mother

- Infants of mothers with diabetes

(IDMs), have a higher risk of
developing fetal and neonatal
complications, including growth
MEDICAL MANANGEMENT:

→ All pregnant women with HIV should take

HIV medicines throughout pregnancy for
their own health and to prevent perinatal
transmission of HIV.
→ Most HIV medicines are safe to use during
pregnancy.
→ Generally, pregnant women with HIV can
use the same HIV treatment regimens
recommended for non-pregnant adults—
unless the risk of any known side effects to
a pregnant woman or her baby outweighs
the benefits of a treatment regimen.
→ All pregnant women with HIV should start
taking HIV medicines as soon as possible
during pregnancy. In most cases, women who abnormalities, respiratory
are already on an effective HIV treatment
distress, and metabolic
regimen when they become pregnant should
complications, in addition to
continue using the same regimen throughout
their pregnancies. preterm delivery.
→ A scheduled cesarean delivery (sometimes Causes and risk factors:
called a C-section) to prevent perinatal
transmission of HIV is recommended for Diabetes occurs when the body’s ability to
women who have high or unknown viral loads produce or respond to the hormone insulin is
near the time of delivery impaired, resulting in higher blood glucose levels.
NURSING MANAGEMENT 2 types of diabetes in pregnancy:
→ Educate the HIV positive mother on methods to 1. Pregestational- which is where diabetes is
reduce the risk of transmission to her diagnosed before pregnancy;
developing fetus/infant.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
2. Gestational - which is where mothers Diagnosis:
without previously
Starts with prenatal history and physical
diagnosed diabetes have high blood
assessment of both mother and baby. During
glucose levels during pregnancy, especially
pregnancy, maternal blood glucose levels and
during their third trimester.
intrauterine fetal growth is part of the diagnosis.

Newborn assessment
Clinical manifestations: Identifying any problems that may require
• most infants of mothers with diabetes immediate attention, including:
have a macrosomic appearance, with a • measuring blood glucose levels - to screen
round puffy face, plethoric or ruddy for hypoglycemia;
skin, a larger body, and a higher than
normal birth weight. • hematocrit levels - to check
for polycythemia;
• On the other hand, infants with IUGR
typically present with low birthweight, • measuring bilirubin levels;
decreased subcutaneous fat and muscle • assessing for any electrolyte imbalances,
mass, and a thin umbilical cord. such
Newborn with: as hypocalcemia and hypomagnesemia.

Hypoglycemia: • Chest X-ray - to identify birth trauma

• Irritability • echocardiogram – to identify congenital

heart anomalies.
• jitteriness
Treatment:
• lethargy
- In cases where preterm birth is expected,
• difficulty feeding treatment includes giving maternal
• seizures steroids before birth to help the fetal
lungs mature and reduce the risk of
Hyperbilirubinemia: respiratory distress.
• the infant’s skin and mucous membranes - In cases of fetal macrosomia, plans are put
can take on a yellowish color (neonatal in place for cesarean birth if vaginal
jaundice). delivery is not possible.
Impaired lung development: - Newborns with hypoglycemia are given
(may exhibit signs of respiratory distress) glucose orally, by gavage tube, or by IV

• tachypnea - If no other significant complications are

found, then routine newborn care should
• respiratory retractions be provided
• nasal flaring shortly after birth

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
Nursing Management:
Priority goals:
1. maintain stable blood glucose levels
2. provide supportive care
➢ Once the infant has been stabilized after
delivery:
- quickly check the glucose level
➢ If the infant is asymptomatic with
glucose levels within normal limits:
- place the infant skin-to-skin with the
mother, cover them with a warm blanket,
assist with breastfeeding, and continue to
closely monitor the infant.
➢ If glucose levels are low, but the infant
is asymptomatic:
- follow your facility’s protocol for feeding
and glucose monitoring.
➢ If the infant’s blood glucose is low and the
infant is also symptomatic:
- immediately report these findings to the
healthcare provider, and administer IV
glucose, as prescribed.
➢ Support thermoregulation to prevent
cold stress
- by placing a hat on the infant’s head
- swaddling them in a warm blanket.
- Check their temperature frequently and
report signs of cold stress, including
an axillary temperature of less than 96.8°
F or 36° C, pallor,
cyanosis, lethargy, tachypnea, or poor
feeding.
- Place the infant under a radiant warmer
and slowly rewarm the infant according to
your facility’s protocol.
EDITED BY: ANTONETH & JOYCE
- Continue to monitor their temperature
until thermal stability is achieved, and
begin the process of weaning the infant to
an open crib.
➢ Provide client and family teaching
- Begin by explaining to the infant’s parents
or caregivers how diabetes can affect the
fetus and newborn. Explain that
hypoglycemia, respiratory difficulties, and
other problems are temporary and can
resolve with treatment.
- Review the plan of care for their baby,
including the frequency of glucose
measurements and feedings, and stress
the importance of keeping their infant
warm to avoid chilling and hypoglycemia
- Teach them to recognize signs of
hypoglycemia, and to call for assistance if
their infant is lethargic, jittery, having
trouble feeding, or increased respirations.
➢ When the baby is ready for discharge:
- Review teaching for newborn care,
including their baby’s feeding schedule.
- Emphasize the importance of keeping all
follow up appointments with their
pediatrician to monitor their
child’s growth and development.
- Teach them about postpartum care at
home, including diabetes self-care,
especially during future pregnancies.
FETAL ALCOHOL SYNDROME (FAS)
WHAT IS FETAL ALCOHOL
SYNDROME(FAS)?
- Fetal alcohol syndrome (FAS) is a
condition that develops in a fetus
(developing baby) when a pregnant person
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
drinks alcohol during pregnancy. Alcohol • Undergoing behavior and education
use during pregnancy can interfere with therapy for emotional and learning
the baby’s development, causing physical concerns.
and mental defects. • Training you as a parent to best help your
child.
SYMPTOMS OF FAS:
INFANT
- Abnormal facial features, including a
smooth ridge between the nose and upper
INTUSSUSCEPTION
lip, a thin upper lip, and small eyes.
- Low body weight. What is intussusception?
- Short height.
✓ Intussusception refers to the
- Sleep and sucking difficulties.
invagination of a part of the intestine
- Small head size.
into itself, like a telescope causing bowel
- Vision or hearing problems.
obstruction.
ETIOLOGY ✓ Intussusception is the most common
cause of intestinal blockage in children
- Fetal Alcohol Syndrome (FAS) is caused by a
between ages 6 months and 3 years.
woman consuming alcohol while pregnant.
Alcohol enters the bloodstream and crosses the ✓ Most common in males than females.
placenta to the growing fetus, resulting in a
much higher concentration in the baby’s blood. ✓ It occurs most often near the ileocecal
junction
NURSING INTERVENTIONS

• Perform complete assessment of systems

including heart and lung auscultation
• Assess infant for signs of withdrawal
• Obtain history of pregnancy from
patient’s mother
• Measure head and abdominal
circumference of infant
• Minimize external stimuli
• Provide education and counseling for SIGNS AND SYMPTOMS
parents/caregivers
VOMITING
TREATMENT - Initially, vomiting is nonbilious and
reflexive, but when the intestinal
• Using medications to treat some
obstruction occurs, vomiting becomes
symptoms like attention and behavior
bilious.
issues.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
ABDOMINAL PAIN
- Pain in intussusception is colicky, severe,
and intermittent. Episode may occur in
15-20-minute intervals. Sudden crying,
draw their knees up to their chest.
BLOODY STOOL
- Stool is described as having a “red
currant jelly” appearance due to the
blood and mucus it contains.
Pathologic
- Meckel’s Diverticulum
- Polyp
- Bowel tumors
- Hypertrophy of Peyer patches
Cause
- Most cases are considered idiopathic.
Risk Factors
- Most common < 24 months old
- Previous intussusception
- Intussusception in sibling
- Intestinal malrotation
DIAGNOSIS AND TREATMENT
DIAGNOSTIC IMAGING
1. Ultrasound, abdominal X-ray, CT scan
- Telescoped intestine: visualized as “bull’s
eye” image
- Intestinal obstruction signs
TREATMENT
1. Air or contrast enema
2. Surgery
EDITED BY: ANTONETH & JOYCE
COMPLICATIONS
- Ischemic Bowel
- Sepsis
- Bowel Perforation
- Peritonitis
NURSING MANAGEMENT
➢ Administer IV fluids. Infants with
intussusception may become
dehydrated due to vomiting and
diarrhea. IV fluids are necessary to
replace lost fluids and maintain
adequate hydration.
➢ Monitor I&O. Replace volume lost as
ordered, and monitor the intake and
output accordingly.
➢ Provide post-procedure care. After
the procedure, the infant may
experience discomfort and abdominal
distension. The nurse should provide
post-procedure care, such as pain
management and monitoring of vital
signs, to ensure the infant is stable
and comfortable.
➢ Education. Educate the family
caregivers on what happens during
intussusception and about the
surgery, and answer questions to
reduce the anxiety.
FAILURE TO THRIVE
Failure to thrive
- is a unique syndrome in which an
infant fall below the 5th percentile
for weight and height on a standard
growth chart or is falling in
percentiles on a growth chart.
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
The condition is usually divided into two
categories:
Organic Cause: refers to growth failure that is
due to an acute or chronic medical condition that
interferes with normal food intake, absorption
or digestion of food, or is due to increased
calorie need to keep up or help growth.
Nonorganic Cause: up to 80% of all children with
FTT have Non-organic type FTT and occurs when
there is inadequate food intake or there is a lack
of environmental stimuli.
Assessment
✓ On physical examination, these infants
usually demonstrate typical
characteristics such as:
✓ Lethargy with poor muscle tone, a loss of
subcutaneous fat, or skin breakdown
✓ Lack of resistance to the examiner's
manipulation, unlike the response of the
average infant
✓ Rocking on all fours excessively, as if
seeking stimulation
✓ Possibly a greater reluctance to reach for
toys or initiate human contact than is
demonstrated by the average infant;
diminished or nonexistent crying
✓ Staring hungrily at people who approach
them as if they are starved for human
contact
✓ Little cuddling or conforming to being
held
✓ Delays in sitting, pulling to a standing
position, crawl-ing, and walking because
the child spends so much time alone
✓ Markedly delayed or absent speech
because of the lack of interaction
Management for Organic Causes
1. Identifying and treating the underlying
medical condition: This may involve
EDITED BY: ANTONETH & JOYCE
diagnostic testing such as blood work,
imaging studies, or other medical
interventions.
2. Nutritional support: To promote growth
and development.
3. Parent education and support: To help
them manage their child's condition.
4. Monitoring and follow-up: Require
ongoing monitoring and follow-up to
ensure that they are growing and
developing properly.
Management for Nonorganic Causes
1. Family therapy: May be necessary to
address the underlying psychosocial
factors contributing to the child's failure
to thrive. This may involve working with a
mental health professional to identify and
address issues within the family system
that may be contributing to the child's
lack of growth and development.
2. Parenting education and support: To
help them better meet their child's
needs and provide a nurturing
environment.
3. Early intervention: To provide the child
with additional stimulation and support to
promote growth and development.
4. Nutritional support: To promote growth
and development.
5. Child protective services: In cases
where neglect or abuse is suspected, to
ensure the child’s safety and well-being.
6. Monitoring and follow-up: To ensure
that they are growing and developing
properly.
Failure to Thrive is not a specific
medical condition, but rather a term
used to describe a pattern of
inadequate growth and development in
infants and children. It can be caused
by a wide range of factors, including
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
medical conditions, nutritional → Facial discoloring, such as skin flushing or
deficiencies, and psychosocial factors blushing
such as neglect or abuse. → Body tension, such as pulled up or
It is important to identify the stiffened legs, stiffened arms, clenched
underlying cause of failure to thrive in fists, arched back, or tense abdomen
order to provide appropriate CAUSES:
management and support. Failure to → Digestive system is not fully developed
thrive can have long-term consequences → Incomplete or no burping after feeding
for a child's physical, cognitive, and → Overfeeding and Underfeeding
emotional development, so early → Food allergy or intollerances
intervention is crucial. → Early form of childhood migraine
COLIC → Imbalance of healthy bacteria in the
digestive tract
COLIC
Risk factors for colic are not well-
→ Colic is frequent, prolonged and intense
understood. Research has not shown
crying or fussiness in a healthy infant.
differences in risk when the following factors
→ Colic can be particularly frustrating for
were considered:
parents because the baby's distress
→ Sex of the child
occurs for no apparent reason and no
→ Preterm and full-term pregnancies
amount of consoling seems to bring any
→ Formula-fed and breast-fed babies
relief.
→ Infants born to mothers who smoked
→ These episodes often occur in the
during pregnancy or after delivery have
evening, when parents themselves are
an increased risk of developing colic.
often tired.
Complications
→ Episodes of colic usually peak when an
Colic does not cause short-term or long-term
infant is about 6 weeks old and decline
medical problems for a child. Research has
significantly after 3 to 4 months of age
shown an association between colic and the
Colic is a poorly understood phenomenon;
following problems with parent well-being:
it is equally likely to occur in both
→ Increased risk of postpartum depression
breastfed and formula-fed infants.
in mothers
→ This condition is encountered in male and
→ Early cessation of breast-feeding
female infants with equal frequency.
→ Feelings of guilt, exhaustion, helplessness
Signs & symptoms:
or anger
→ Intense crying that may seem more like
SHAKEN BABY SYNDROME
screaming or an expression of pain
→ The stress of calming a crying baby has
→ Crying for no apparent reason, unlike
sometimes prompted parents to shake or
crying to express hunger or the need for
otherwise harm their child. Shaking a
a diaper change
baby can cause serious damage to the
→ Extreme fussiness even after crying has
brain and death. The risk of these
diminished Predictable timing, with
uncontrolled reactions is greater if
episodes often occurring in the evening
parents don't have information about
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
soothing a crying child, education about
colic and the support needed for caring
for an infant with colic.
NURSING MANAGEMENT:
ASSESSMENT:
→ History
→ Physical exam
INTERVENTIONS:
→ Reduce or relieve pain
→ Introduce herbal remedies
→ Soothing strategies
→ Feeding practices
→ Changes in the diet (Formula change &
Maternal diet)
→ Educate parents about colic and how to
manage colic
→ Educate parents on how to enhance
parenting skills and knowledge
TRISOMY 21
TRISOMY 21
→ Also known as Down syndrome, trisomy 21
is a genetic condition caused by an extra
chromosome. Most babies inherit 23
chromosomes from each parent, for a
total of 46 chromosomes. Babies with
Down syndrome however, end up with
three chromosomes at position 21,
instead of the usual pair.
SIGNS & SYMPTOMS
→ Distinctive facial features
→ Mild to moderate intellectual disabilities
→ Heart, kidney and thyroid issues
→ Skeletal abnormalities, including spine,
hip, foot and hand disorders
→ Less responsive to stimuli
→ Vision and hearing impairment
→ Inwardly curved little finger
EDITED BY: ANTONETH & JOYCE
→ Wide space between the great and
second toe
→ Single, deep crease on the soles of the
feet and one or both hands
CAUSES & RISK FACTORS
→ One factor that increases the risk for
having a baby with Down syndrome is the
mother’s age.
→ Women who are 35 years or older when
they become pregnant are more likely to
have a pregnancy affected by Down
syndrome than women who become
pregnant at a younger age.
COMPLICATIONS
Potentially serious complications — The most
serious complications of Down syndrome include:
→ Heart defects
→ Blood disorders
→ Immune system problems
→ Stomach and digestive system
→ Hormonal disorders
→ Skeletal problems
Other complications (Less serious complications)
include:
→ Intellectual disability
→ Height and weight
→ Vision
→ Hearing loss
→ Skin
→ Behavior
DIAGNOSTIC TESTS FOR NEWBORNS
→ After birth, the initial diagnosis of Down
syndrome is often based on the baby's
appearance. But the features associated
with Down syndrome can be found in
babies without Down syndrome, so your
health care provider will likely order a
test called a chromosomal karyotype to
confirm diagnosis
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
TREATMENT & MANAGEMENT Class 2- Involving soft palate and hard palate
There is no cure for Down syndrome. But a child but not the alveolus.
with Down syndrome may need treatment for Class 3- Soft palate, Hard palate and alveolus on
problems such as: one side
Heart defects Class 4- Soft and hard palate and alveolus on
→ There are some Minor defects can be both side of premaxilla
treated with medicines or they will fix
themselves on their own. Others may
need surgery. All babies with Down
syndrome should have an echocardiogram
(heart ultrasound) and be looked at by a
pediatric cardiologist. This exam and test
should be done shortly after birth. This
is so that any heart defects can be found
and treated correctly.
Intestinal problems
→ Some babies with Down syndrome are
born with intestinal problems that need
surgery.
Vision problems
→ Common problems include crossed eyes,
nearsightedness or farsightedness, and
cataracts. Most eyesight problems can be
made better with eyeglasses, surgery, or
other treatments. Your child should see
an eye doctor (pediatric ophthalmologist)
before they turn 1 year old.
CLEFT PALATE
CLEFT PALATE
→ is a split or opening in the roof of your
mouth that forms during fetal
development. SIGNS & SYMPTOMS
→ it occurs when the palatal process does → Aspiration
not close as usual at approximately 9 to → Difficulty with feedings
12 weeks of intrauterine life. → Vomiting
→ a cleft palate can be on one or both sides → Excessive air swallowing
of the roof of the mouth. It may go the → Escape of food in to the nose
full length of the palate. → Chronic ear infections
→ more common in females. → Fatigue
Class 1- Invoving only soft palate → Irritability

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
→ Poor weight gain - Use of specialy nipples or feeding bottle
→ Coughing or choking to allow the baby to latch properly
→ Nasal regurgitation - Baby must be given essential care
RISK FACTORS including immunization, warmth, and
→ Lack of folic acid during pregnancy hygiene.
→ Genetics/ Hereditary IMPORPHERATED ANUS
→ Smoking or drinking alcohol during
IMPERFORATED ANUS
pregnancy
→ A stricture or the absence of the anus.
→ Nutritional disturbances during
→ A congenital defect in which the opening to the
development
anus is either blocked or missing.
→ Defective vascular supply
→ Fecal elimination may be impossible until surgery is
→ Effects of certain drugs such as anti-
performed.
seizure medications and steroids.
→ PATHOPHYSIOLOGY
DIAGNOSIS
WHY ARE BABIES BORN WITH AN
→ Physical Examination at birth
IMPERFORATED ANUS?
→ Ultrasound
- CAUSE: underdevelopment of fetus
- Can be associated with other birth
MEDICAL & SURGICAL MANAGEMENT
defects
Management of Cleft palate involves the care of
- Present in approximately 1 in 5,000 live
a multidisciplinary health care team to provide
births, more
optimum results, this includes: Pediatrics,
common in boys than in girls.
Orthodontics, Speech Pathology, Audiology and
IN WEEK 7 OF INTRAUTERINE LIFE…
Surgeon.
→ upper bowel elongates to pouch and
Surgery - soft palate repair at 3-6 months of
combine with pouch invaginating from the
age, hard palate repair at 6-18 months of age.
perineum. These two sections of bowel
→ Speech theraphy
meet, the membranes between them are
→ Dental Care
absorbed.
→ Palatal Obturator
→ HOWEVER, if these motion toward each
NURSING MANAGEMENT
other does not occur/membrane between
- Encourage genetic counseling to the
2 surfaces does not dissolve, an
parents
imperforate anus occurs.
- the defect evokes negative reaction and
→ The disorder can be relatively minor,
shock to the parents, the nurse must
requiring just surgical incision of the
explain about the possibility of defect
persistent membrane, or much more
correction.
severe, involving sections of the bowel
- Promote family coping
that are many inches apart with no anus.
- Mother and are family should be
demonstrated the various techniques of
There may be an accompanying fistula to the
feeding the baby
bladder in boys and to the vagina in girls
- Explain to parents about the risk of
aspiration
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
(retrovaginal fistula), further complicating a
surgical repair.
COMPLEX (rare defects)
■ Rectovaginal fistula
■ Persistent cloaca
NON-COMPLEX (common defects)
■ Rectovestibular fistula
■ Rectoperineal fistula
SIGNS AND SYMPTOMS
→ Opening of anus is missing or not in the
right/usual place. In girls, it may be close
to the vagina.
→ No passage of poop within 24 hours of
birth.
→ Poop passes through another opening.
→ (such as in Urethra for boys, Vagina for
girls)
→ Abdominal distention/swollen belly.
RISK FACTORS
■ Increased in incidence of Trisomy 13,
18, and 21.
■ Associated anomalies
–(Genitourinary, Vertebral/Spinal Cord,
Craniofacial, Cardiovascular, Gastrointestinal.)
■ Paternal smoking, maternal overweight,
obesity, and diabetes.
EDITED BY: ANTONETH & JOYCE
■ VACTERL Syndrome
→ -Vertebral defects
→ -Anal defects
→ -Cardiac defects
→ -Tracheoesophageal fistula
→ -Renal defects
COMPLICATIONS
→ Bowel control problems.
→ Bladder control problems.
→ Stool incontinence.
→ Constipation.
→ Problems with sexual function.
ASSESSMENT
→ Condition can be detected with/by a
prenatal sonogram.
→ Meconium-filled black membrane
protrudes from the anus/anal region
if inspection at birth reveals no anus
in a newborn.
→ Wink reflex
→ Through X-ray sonogram –
positioning the baby slightly head-
down to allow swallowed air to rise at
the end of the blind pouch of the
bowel.
DIAGNOSIS
→ Diagnosis is made through Physical
exams and Imaging tests
→ Doctors conduct head to toe
assessment, after which, diagnosis is
made.
→ Imaging tests include: Ultrasound, X-
ray, and MRI.
NURSING MANAGEMENT
→ Follow-up care by parents to assess
whether infant is defecating.
→ Ask parents to collect a urine specimen to
examine for presence of meconium to
help determine whether the infant has a
rectal-bladder fistula.
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
→ Placing a urine collector bag over the
vagina in girls may reveal meconium-
stained discharge, revealing the presence
of a rectovaginal fistula.
→ Administration of fluids and nutrition
through an IV line.
→ NGT or Orogastric feeding.
→ Maintaining adequate hydration with
moist mucous membrane, skin turgor, and
capillary refill good.
→ Maintaining normal vital signs.
TREATMENT
→ The degree of difficulty of repair in an
imperforated anus depends on the extent
of the problem.
→ If the baby’s rectum ends very near the
normal site of the anus, your baby may
need only 1 operation within their first
few days of life: Laparoscopy with
anastomosis
→ Surgery may be more complex if the
rectum ends higher.
→ Your baby may also need surgery to
repair any channels that connect their
rectum to other body structures, such as
the urinary or genital tract. In this case,
your baby will need other operations
before anal repair.
HIRSCHSPRUNG’S DISEASE
Hirschsprung's Disease
- Absence of ganglionic innervation to
the muscle of a section of the bowel.
- A congenital condition where nerve
cells of the myenteric plexus are
absent in the distal bowel and rectum.
- It is characterized by persistent
constipation resulting from partial or
complete obstruction of mechanical
origin
EDITED BY: ANTONETH & JOYCE
Myenteric Plexus
- principally responsible for the
peristaltic movement of the bowels.
TWO MAIN TYPES:
1. Short-segment HD - nerve cells missing from
only the last segment of the large intestine most
common four times more common in men than
women
2. Long-segment HD - nerve cells are missing
from most of the large intestine affects’ men
and women equally
What causes Hirschsprung's Disease?
1. Mutation of genes (RET, EDNRB,
EDN3)
2. Inheritance
3. Associated conditions: Downs
syndrome, Neurofibromatosis.
Waardenburg Syndrome, Multiple
endocrine neoplasia
Risk factors:
- Having a sibling who has
Hirschsprung's disease.
Hirschsprung's disease can be
inherited. If you have one child who
has the condition, future biological
siblings could be at risk
- Being male. Hirschsprung's disease is
more common in males
- Having other inherited conditions.
Hirschsprung's disease is associated
can be inherited. If you have one child
who has the condition, future
biological siblings could be at risk.
with certain inherited conditions, such
as Down syndrome and other
abnormalities present at birth, such
as congenital heart disease.
Signs and symptoms
1. Abdominal distention - Infants with
aganglionic megacolon show tympanitic abdominal
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
distention and symptoms of intestinal
obstruction.
2. Chronic constipation - Older infants and
children with Hirschsprung's disease usually
present with chronic constipation
3. Palpable intestinal loops - Upon abdominal
examination, these children may demonstrate
marked abdominal distention with palpable
dilated loops of colon.
4. Absence/delayed passage of meconium -
During the newborn period, infants affected
with Hirschsprung's disease may present with
failure of passage of meconium.
5. Vomiting - Repeated vomiting is present due
to intestinal obstruction.
6. Malnourishment - Poor nutrition results from
the early satiety, abdominal discomfort, and
distention associated with chronic constipation
Diagnosis and Tests
1. PLAIN ABDOMINAL RADIOGRAPHY -
performed when signs and symptoms of
abdominal obstruction arise
2. CONTRAST ENEMA - use of xray images
and enema solution with a contrast
solution also called barium enema
3. ANORECTAL MANOMETRY - checks how
well a child's rectum is working done
ONLY ON OLDER CHILDREN
4. RECTAL BIOPSY - used to confirm or
rule out a diagnosis of Hirschsprung
Disease
2 types of rectal Biopsy
- 1. Rectal suction biopsy
- 2. Full thickness rectal biopsy
Management & Treatment
Medical Management
- Initial therapy
- Decompression Diet
Pharmacologic management
- Drug therapy currently is not a
component of the standard of care
EDITED BY: ANTONETH & JOYCE
for this disease itself; however, some
medications may be used to treat
complications of Hirschsprung disease
like antibiotics
Surgical treatment
- The surgical options vary according to
the patient’s age, mental status,
ability to perform activities of daily
living, length of the ganglionic
segment, degree of colonic dilation,
and presence of enterocolitis.
- > Ostomy surgery
- > Pull-through procedure
Nursing care
- Promote adequate bowel elimination
monitor for complications
- Provide supportive care, including the
psychosocial need of the child's
parents or caregivers
Postoperative:
- NPO
- Maintain nasogastric tube, or NG
tube, at low-intermittent suction.
- Administer IV fluids, antibiotics, and
pain meds as ordered closely monitor
clients' V/S, fluid intake and output,
measure abdominal circumference
- Report signs of enterocolitis, including
fever, abd. pain, distension, or
explosive, foul smelling diarrhea
In cases of temporary colostomy:
- Assess site, noting normal findings,
such as pink or rosy red stoma with
minimal swelling or bleeding, stoma
that stays above the level of skin with
the colostomy bag securely in place,
and intact skin surrounding the stoma.
- REPORT IMMEDIATELY to HCP if
you noticed increased bleeding or
swelling, signs of ischemia, signs of
retraction, and flattening of stoma
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
if peristalsis returns: debilitating incontinence requiring a
- d/c the NG tube and start client on permanent colostomy.
clear liquids SPINA BIFIDA
- -closely monitor the color,
What is Spina Bifida?
consistency, and amount of stool
SPINA- “spine” BIFIDA- “split”
- report if client presents signs of
• Is a birth defect that occurs when the
obstruction, including vomiting,
spine and spinal cord don’t form properly.
abdominal distention, or an absence of
• A type of neural tube defect
gas or stool
• Most common in baby girls
- attend to psychosocial need of the
3 TYPES OF SPINA BIFIDA
child's parents or caregivers
1. SPINA BIFIDA OCCULTA
- encourage them to participate in
- OCCULTA- means “hidden”
child's care, to ask questions, and
- Mildest and most common
express their feelings about the
- Spina bifida occulta results in a small
diagnosis
separation or gap in one or more of
Prognosis
the bones of the spine (vertebrae).
- about 90% of children with
2. MENINGOCELE
Hirschsprung’s have no major
- Least common type/rare type of spina
complications or difficulties. Of the
bifida
10% who do have problems, most
- Characterized by a sac of spinal fluid
eventually get better with help from
bulging through an opening in the
their doctor and other health
spine.
professionals and go on to live a
- Babies with meningocele may have
perfectly normal life
some minor problems with functioning,
- Reports of long-term outcomes after
including those affecting the bladder
definitive repair for Hirschsprung
and bowels.
disease are conflicting. Some
3. MYELOMENINGOCELE
investigators report a high degree of
- Also known as “open spina bifida”
satisfaction, whereas others report a
- Most severe type
significant incidence of constipation
- This makes the baby prone to life-
and incontinence. Ingeneral, more
threatening infections and may also
than 90% of patients with
cause paralysis and bladder and bowel
Hirschsprung disease report
dysfunction.
satisfactory outcomes; however, many
SIGNS AND SYMPTOMS
patients experience disturbances of
● Tuft of hair
bowel function for several years
● Small dimple or a birthmark
before normal continence is
● Movement problems
established
CAUSES:
- Approximately 1% of patients with
• Lack of folic acid intake
Hirschsprung disease have
• Certain medication

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
• Genetics
TREATMENT:
• Initial surgery to repair the spine
• Physiotherapy
Nursing Management:
• Physical examination. When collecting
date during the examination, observe the
movement and response to stimuli of the
lower extremities; carefully measure the
head circumference and examine the
fontanelles.
• Assessment of knowledge regarding the
defect. Determine the family’s
knowledge and understanding of the
defect, as well as their attitude
concerning the birth of a newborn with
such serious problems.
• Prevent infection. Monitor the newborn’s
vital signs, neurologic signs, and behavior
frequently; administer prophylactic
antibiotic as ordered; carry out routine
aseptic technique; cover the sac with a
sterile dressing moistened in a warm
sterile solution and change it every 2
hours; the dressings may be covered with
a plastic protective covering.
• Promote skin integrity. Placing a
protective barrier between the anus and
the sac may prevent contamination with
fecal material, and diapering is not
advisable with a low defect.
• Prevent contractures of lower
extremities. Newborns with spina bifida
often have talipes equinovarus (clubfoot)
and congenital hip dysplasia (dislocation
of the hips); if there is loss of motion in
the lower limbs because of the defect
conduct range-of-motion exercises to
prevent contractures; position the
newborn so that the hips are abducted
and the feet are in a neutral position;
EDITED BY: ANTONETH & JOYCE
massage the knees and other bony
prominences with lotion regularly, then
pad them, and protect them from
irritation.
• Proper positioning of the newborn.
Maintain the newborn in a prone position
so that no pressure is placed on the sac;
after surgery, continue this positioning
until the surgical site is well healed.
HYDROCEPHALUS
Hydrocephalus
- Derived from the Greek word “Hydro”
meaning “water”, and “Cephalus”
meaning “Head”.
- Excessive accumulation of
cerebrospinal fluid (CSF) resulting in
abnormal widening of the spaces in
the brain.
Two main types of hydrocephalus in Infants:
➢ Communicating or Extraventricular
Hydrocephalus
- The Fluid is able to reach the spinal
cord.
➢ Obstructive or Intraventricular
- There is a block to CSF so it
cannot circulate into the subarachnoid space.
Who gets Hydrocephalus?
➢ congenital hydrocephalus (present at
birth)
➢ acquired hydrocephalus
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
(occurs following birth).
Signs and Symptoms
Changes in the Head
• An unusually large head
• A rapid increase in the size of the head
• A bulging or tense soft spot (fontanel) on
the top of the head
• Prominent scalp veins
Physical signs and symptoms
• Nausea and vomiting
• Sleepiness or sluggishness (lethargy)
• Irritability
• Poor eating
• Seizures
• Eyes fixed downward (sun setting of the
eyes)
• Problems with muscle tone and strength
Risk Factors
In many cases, the cause of hydrocephalus is
unknown. However, a number of developmental
or medical problems can contribute to or trigger
hydrocephalus.
Newborns
Hydrocephalus present at birth (congenital) or
shortly after birth can occur because of any of
the following:
● Abnormal development of the central
nervous system that can obstruct the
flow of cerebrospinal fluid
● Bleeding within the ventricles, a possible
complication of premature birth
● Infection in the uterus — such as rubella
or syphilis — during pregnancy, which can
cause inflammation in fetal brain tissues
Pathophysiology
EDITED BY: ANTONETH & JOYCE
Diagnostic Findings
Examination in infants may include the following:
➢ Computed tomography (CT) scanning.
➢ Magnetic resonance imaging (MRI).
➢ Ultrasonography through anterior
fontanelle in infants.
➢ Skull radiography.
Surgical Management
SHUNT - a passage that is made to allow blood
or other fluid to move from one part of the body
to another. It consists of a long, flexible tube
with a valve that keeps fluid from the brain,
flowing in the right direction and at the proper
rate.
Ventriculoperitoneal (VP) Shunt
- One end of the upstream catheter is in a
ventricle. The other end of the
downstream catheter is in the peritoneal
cavity
Ventriculoatrial (VA) Shunt
- Ventriculoatrial shunt placement enables
cerebrospinal fluid (CSF) to flow from the
cerebral ventricular system to the atrium of the
heart.
Medical Management
➢ Diuretics. Acetazolamide (ACZ) and
furosemide (FUR) treat posthemorrhagic
hydrocephalus in neonates.
➢ Anticonvulsants. Helps to prevent
seizures.
➢ Antibiotics. For shunt infections such as
septicemia, ventriculitis, meningitis, or
given as a prophylactic treatment.
Nursing Assessment
➢ Head circumference.
➢ Neurologic and vital signs.
➢ Check the fontanelles.
➢ Monitor increase in intracranial pressure.
➢ History taking.
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
OTITIS MEDIA Pathophysiology

OTITIS MEDIA

✓ •Otitis Media is the inflammation or

infection located in the middle ear and is
the second most common pediatric
diagnosis in the emergency department
following upper respiratory infection. It
occurs most often in children 6 to 36
months of age and again at 4 to 6 years.
✓ •Children most susceptible to it are
NURSING MANAGEMENT
males, Alaskan and native children, those
with cleft palate, and infants who are ✓ •Positioning, Have the child sit up, raise
formula-fed rather than breastfed. head on pillows , or lie on unaffected ear.
✓ •Otitis media with effusion occurs when ✓ •Provide a smoke free environment.
otitis media becomes chronic. The ✓ •Diet, Encourage breastfeeding of infants
condition most frequently occurs in as breastfeeding affords natural
children 3 to 10 years of age. immunity to infectious agents; position
✓ •Children will notice a feeling of fullness bole fed infants upright when feeding.
or the sound of popping or ringing in their ✓ •Hygiene
ears. ✓ •Monitor hearing loss

Signs and Symptoms MEDICAL MANAGEMENT

Otitis media: Otitis media:

• Fever • •ANTIBIOTIC THERAPHY

• Ear pain • •ANALGESIC
• Unusual irritability • •ANTIPYRETIC
• Fluid draining from ears
Otitis media with effusion:
• Hearing difficulties
• Loss of balance •Myringotomy with tympanostomy tube insertion

Otitis media with effusion:

• Hearing difficulties
• Tugging or pulling at one or both ears
• Loss of balance
• Delayed speech development

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
MENIGGITIS - (also called aseptic meningitis) is more
common than bacterial meningitis and
MENINGITIS
usually less serious
- is a swelling (inflammation) of the thin
- Many of the viruses that cause meningitis
membranes that cover the brain and the
are common, such as those that cause
spinal cord caused by bacteria or viruses.
colds, diarrhea, cold sores, and the flu.
These membranes are called the
TREATMENT
meninges.
The treatment by type includes:
- it can affect anyone, but is most common
Bacterial Meningitis
in babies, young children, teenagers and
- this treatment will start as quickly as
young adults.
possible
SIGNS & SYMPTOMS:
- the healthcare provider will give IV
- cranky
(intravenous) antibiotics
- feed poorly
- also get a corticosteroid medicine
- sleepy or hard to wake up
Viral Meningitis
- fever
- treatment may be done to help ease
- bulging fontanelle
symptoms
OTHER SYMPTOMS:
- no medicines to treat the viruses
- jaundice
- herpes simplex virus - which is treated
- stiffness of the body and neck
with IV antiviral medicine
- a lower than normal temperature
PREVENTION
- weak suck
Vaccines to prevent infections that can lead to
- high-pitched cry
bacterial meningitis in babies are:
CAUSES OF MENINGITIS
- Haemophilus influenzae type b (Hib)
- Most cases are caused by bacteria or
vaccine.
viruses, but some can be due to certain
- Pneumococcal (PCV13) vaccine.
medicines or illnesses.
- Meningococcal vaccine
- It is most often caused by bacterial or
Vaccines against viruses that can lead to
viral infection that moves into the
meningitis are:
cerebral spinal fluid (CSF).
- Influenza.
- A fungus or parasite may also cause
- Varicella.
meningitis.
- Measles, mumps, rubella (MMR).
2 types of Meningitis:
NURSING MANAGEMENT
1. BACTERIAL MENINGITIS
- Monitoring and recording vital signs.
- is rare, but is usually serious and can be
- Assess the patient's mental status and
life-threatening if not treated right away
provide psychological support if the
- . In newborns, the most common causes
patient is conscious.
are group B strep, E. coli,and less
- Elevate the head of the bed to 30
commonly, Listeria monocytogenes.
degrees with a straight neck for venous
2. VIRAL MENINGITIS
drainage from the brain.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
- Ensure the patient has an IV line for - This most common type lasts from a few
fluids and medications. seconds to 15 minutes. Simple febrile
- Administer antibiotics as prescribed. seizures do not recur within a 24-hour
- period and are not specific to one part of
FEBRILE SEIZURE the body.
2. Complex febrile seizures.
What is Febrile Seizure?
- This type lasts longer than 15 minutes,
- A febrile seizure is a convulsion in a child
occurs more than once within 24 hours, or
that's caused by a fever. The fever is
is confined to one side of your child's
often from an infection. Febrile seizures
body.
occur in young, healthy children who have
Prevention of Febrile Seizure
normal development and haven't had any
- -Administer ibuprofen or acetaminophen
neurological symptoms before.
- -Educate parents about the occurrence
- Associated with high fever (38 to 40
of fever at night.
degrees Celsius)
- -Educate parents to read bottle label
- -Most common type is seen in preschool
carefully before administration to ensure
children, although it can occur as late as
the correct dosage.
7 years of age
- -Teach parents that every child who has a
- Most serious if occur under 6 months of
febrile seizure must be seen by a
age
healthcare provider.
Causes
Therapeutic management
1. A sudden spike in temperature, not a
- -TSB
gradual incline
- -Advise parents not to put the child in a
2. Immunization
bathtub of water.
3. Infection
- Suppositories may be given at the
4. History of other family members having
appropriate dose.
had similar seizures.
- -Caution parents not to apply alcohol or
Symptoms
cold water
- Usually, a child having a febrile seizure
- -Parents should not temp to give oral
shakes all over and loses consciousness.
medication during the seizure.
Sometimes, the child may get very stiff
- -At the healthcare facility, a lumbar
or twitch in just one area of the body
puncture will be performed to rule out
. A child having a febrile seizure may:
meningitis. If warranted, antipyretic
- Have a fever higher than 100.4 F (38.0 C) drugs to reduce fever below seizure
- Lose consciousness levels will be administered.
- Shake or jerk the arms and legs - -Appropriate antibiotic therapy will be
prescribed if infection is documented.
Classification
1. Simple febrile seizures.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
AUTISM • Meet childs basic human needs
• Utilizes and teaches certain “behavior
Autism
modification technique”, formulate
- is a developmental disorder that appears
schedule and fix up activities
in the first 3 years of life, and affects
• Encourage child to do activities on his
the brain’s normal development of social
own
and communication skills.
• Provide moral support to parents
• Teach child signs, symbol, eye contact
(non verbal)
• Demontrate “communication skills”, “social
skills”. Teach importance of establishing
and maintaining good interpersonal
relationship.
• Encourages, appreciates child, ensures
positive and social reinforcementto the
child fo exhibition of desirable behaviors
Common symptoms in the child with Autism • Motivate child to express or to
spectrum disorder: communicate his needs verbally
• Failure to develop social relations • Clarify and make child to interpret
• Stereotyped behaviors such as hand his/her behavior
gestures • Provide the language training to the child
• Extreme resistance to change in routine • Help child to learn creative activities
• Abnormal responses to sensory stimuli • Give familiar objects to the child
• Decreased sensitivity to pain • Assist child to learn their own body parts
• Inappropriate or decreased emotional • Make the child adjust socially to the
expression environment
• Specific, limited intellectual problem
solving abilities
• Stereotyped or repetitive used of
language
• Impaired ability to initiate or sustain a
conversation
Causes and Risk Factors
• Having a sibling with ASD
• Having older parents
• Having certain genetic conditions
• Being born with a very low birth weight
• Males are 4-5 times more likely to have
ASD than females
Nursing Management
• Serve child one to one basis
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
COMMON PROBLEMS WITH TODDLER - Do not apply any ointments, oils, or sprays
to the burned area.
BURN - Use child-strength over-the-counter pain
reliever such as acetaminophen (Tylenol)
BURN
PREVENTION:
- IS AN INJURY TO THE SKIN OR
OTHER ORGANIC TISSUE PRIMARILY - -Turn handles and pots toward back of
CAUSED BY HEAT DUE TO THERMAL, stove
RADIATION, CHEMICAL, AND - -keep screen in front of fireplace or
ELECTRICAL CONTACT heater
- -Do not leave toddlers unsupervised near
3 TYPES OF DEGREE BURN
hot waters or near lit candles
1. First degree burns - -Never drink hot beverages when a child
2. Second degree burns is sitting on your lap
3. Third degree burns - -Do not allow toddlers to play matches
- -Keep electric wires and cords out of
SIGNS / SYMPTOMS
reach
- RED PEELING SKIN - -Cover electrical outlets with safety
- Swelling plugs
- White charred skin
POISONING
- Blisters
Poisoning in Toddler
PATHOPHYSIOLOGY
• Poisoning is when cells are injured or
HEAT-> DAMAGED TISSUE-> INCREASED destroyed by the inhalation, ingestion,
CAPILLARY PERMIABLITY -> EDEMA injection, or absorption of a toxic
substances.
COMPLICATIONS:
• Poisoning occurs in all socioeconomics
- -dehydration groups, and 90% of the time it occurs in
- -organ failure the child’s home.
- -low blood pressure • The substances most frequently ingested
- -severe infection in children 5 years younger include
cosmetics/personal care products,
NURSING MANAGEMENT:
household cleaning products, analgesics,
- Cool the affected area with cold water or foreign bodies such as toys and topical
cold compresses until the pain is reduced preparations.
or relieved. ACETAMINOPHEN POISONING
- If a blister has formed, do not break it. ● is an over-the-counter medication that is
- Protect the burn with a dry, sterile, frequently involved in childhood poisoning
gauze bandage or with a clean bed sheet today.
or cloth.

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
● Parents use acetaminophen to treat
childhood fevers and have it readily
available in the home.
● It can cause extreme permanent liver
destruction.
Symptoms:
-Anorexia
-nausea
-vomiting
CAUSTIC POISONING
● Ingestion of a strong alkali, such as lye,
which is contained in certain toilet bowl
cleaners or hair care products.
● Causes burns and tissue necrosis in the
mouth, esophagus, and stomach.
Signs and symptoms:
-Oral pain
-ulceration
-Drooling
-Vomiting
-Abdominal Pain
IRON POISONING
● Is frequently swallowed by small children
because it is an ingredient in vitamin
prepations, praticularly in prenatal
vitamins.
● When ingested, a large amount of iron is
corrosive to the gastric mucosa and leads
to signs and symptoms of severe gastric
irritation in the child.
● The immediate effects include nausea and
vomiting, diarrhea and abdominal pain.
Lead Poisoning
● Is a medical condition caused by
increased level of the heavy metal lead in
the body and this can interfere with a
variety of body processes and causes of
toxicity to many organs and tissues.
● It also called plumbism
● When lead enters the body , it interferes
with red blood cell function by blocking
EDITED BY: ANTONETH & JOYCE
the incorporation of iron into the
protoporphyrin in red blood cells and
leads to hypochromic, microcytic anemia.
Preventions
• Keep medicines and toxic products locked
and away from children.
• Add the poison control number (1-800-
222-1222) in your cell phone and make
sure all caretakers do the same.
• Call the poison control center if you think
your child has ingested anything that may
be poisonous. Keep in mind that the child
may be awake and alert and acting
normally.
• If your child has ingested a poisonous
product and colapses or stops breathing,
call 911.
• When administering medications, be sure
to read the labels carefully and to
administer the appropriate amount.
• Safely dispose unused, uneeded, or
expired medications and vitamins.
Emergency management of poisoning at home:
● What was swallowed; if the name of a
medicine is not known, what it was
prescribed for and a description of it
● The child’s weight and age and how long
ago the poisoning occured.
● The route of poisoning
● An estimation of how much of the poison
the child took.
● The child’s present condition.
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
Managements - PSYCOLOGICAL/ EMOTIONAL (to feel
ACETAMINOPHEN POISONING unintelligent or inadequate)
● Activated charcoal- is an antidote for - SEXUAL (being sexually touch)
poisoning - NEGLECT (deprived with basic needs)
● Acetylcysteine Physical Abuse
Therapeutic management: - Physical abuse involves physical
CAUSTIC POISONING aggression directed at a child by an adult.
● Advocate for a strong analgesic, such as A non-accidental physical injury
IV morphine to achieve pain relief for Harming a child w/ hands orfeet,stick, or
this level of injury. other object;
● A chest X-ray may be prescribed • Puching
● A laryngiscopy and esophagoscopy under • beating
conscious sedation or general anesthesia • kicking
may be done to assess the lungs and • throwing
esophagus. • burning
● Assess Vital Signs
IRON POISONING ASSESSMENT
● Stomach lavage - Bruises
● Administration of chelating agent such as - Burns
IV or IM deferoxamine - Bald spot
● Exchange Transfusion - Fracture
LEAD POISONING - Human bites
● Oral chelating agent such as EFFECTS OF CHILDABUSE
dimercaptosuccinic acids (DMSA) • Depression & Anxiety disorder
● Chelation theraphy such as dimercaprol • Trauma/Fear
• Delay speech
• Poor health
CHILD ABUSED
• Low Self-esteem
What is Child Abuse/Maltreatment? • More likely involve in such activities;
- - Is a form of violence or maltreatment when growing up.
directed at a child, by an adult. It is • Child maltreatment
violent or threatening for the child, which NURSING MANAGEMENT
includes being neglected. 1. Create a relationship with the child
FACTORS 2. Listen and observe
1. Special Parent: Parent who Maltreat 3. Examine the child for abuse
2. Special Child: Who are Maltreated 4. Aid physical injuries; includes giving
3. Special Circumstance: Stress medication.
FORMS OF ABUSE 5. Assess behavior/mood
- PHYSICAL ( beaten or burned) 6. Provide comfort and understanding
7. Speak to the social worker and CPS
8. Refer for Psychologists
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
9. Refer parents to a therapist/parenting - Hopping on their knees when trying to
class walk
MED/SURGMANAGEMENT - Inability to stand
1. Imaging studies - Uncontrollable muscle movement
2. Orthopedic Surgery; bone fracture - Scooting around on their buttocks
fixation - Speech problems
Reporting suspected Child Abuse - Stiff muscles, joints, or tendons
- Permissive reporters - report suspected
Types of of Cerebral Palsy
child abuse but not required by the law.
- Mandatory reporters - Nurses: must 1. Spastic type
report suspected child abuse; if failure to - Spastic diplegia
report may result to: Fine, Jail Time, or - Spastic quadriplegia.
worst Loss of License. - Spastic hemiplegia
- Spastic double hemiplegia.
CEREBRAL PALSY 2. Athetoid type
3. Ataxic type
What Is Cerebral Palsy?
4. Mixed type
- Cerebral palsy (CP) is a group of
nonprogressive disorders of upper motor
neuron impairment that result in motor
dysfunction. Affected children also may
have speech or ocular difficulties,
seizures, cognitive challenges, or
hyperactivity.

Risk Factors:

- Two important risk factors associated

with CP are prematurity (delivery before
37 weeks) and low birth weight (less than
2.5 kg). Other factors can also increase
risk such as multiple gestation, maternal
and foetal infections, malformation of
the brain and genetic causes.

What Are The Signs And Symptoms Of CP In

A toddler?

- Abnormal posture
- Crawling in a lopsided manner
- Difficulty with fine motor skills such as
eating, brushing teeth, or coloring
- Hearing loss or blindness
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
How Is CP Diagnosed In A Toddler? COMMON PROBLEMS WITH PRE-SCHOOL

- Nervous system exam

- MRI
LEUKEMIA
- Feeding studies WHAT IS LEUKEMIA?
- Electroencephalogram (EEG)
- Leukemia is the distorted and
- Gait lab analysis
uncontrolled proliferation of white blood
- CT scan
cells (WBCs) and is the most frequently
- Genetic studies
occurring type of cancer in children
- Metabolic tests
- The disease develops in the bone marrow.
Nursing Management:
TYPES OF LEUKEMIA
- Prevent physical injury by providing the
1. ACUTE LYMPOCYTIC
child with a safe environment,
(LYMPHONBLASTIC) LEUKEMIA (ALL)
appropriate toys, and protective gear
- highest incidence of ALL is children
(helmet, kneepads) if needed.
between 2- and 6-year age ALL is slightly
- Prevent physical deformity by ensuring
higher in boys than girls
correct use of prescribed braces and
- see more often in Hispanic and white
other devices and by performing ROM
children than in children of other races.
exercises.
2. ACUTE MYELOID LEUKEMIA (AML)
- Promote mobility by encouraging the child
- It is the most common type of acute
to perform age-and condition appropriate
leukemia in adults. This type of cancer
motor activities.
usually gets worse quickly if it is not
- Promote adequate fluid and nutritional
treated.
intake.
- Foster relaxation and general health by SIGNS AND SYMPTOMS
providing rest periods.
- Anemia
- Administer prescribed medications which
- Palor
may include sedatives, muscle relaxants
- Low grade fever
and anticonvulsants.
- Unsteady gait
- Encourage self-care by urging the child
• Shortness of breath
to participate in activities of daily living
• Frequent or long-term infections
(ADLs) (e.g. using utensils and implements
• Easy bruising or bleeding
that are appropriate for the child’s age
- Bone or joint pain
and condition).
• Poor appetite
- Facilitated communication
• Weight loss
Medical Management - Swollen lymph nodes
• Petechiae
- Physical therapy
• Anorexia
- Orthopedic management
- Technological aids

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
RISK FACTORS
• Family history
• Radiation
• Exposure to chemicals
• Genetic factor
TREATMENT
- Chemotherapy- is the most common form
of leukemia treatment. It involves using
chemicals to kill leukemia cells or keep
them from multiplying. During treatment
may receive the chemicals (medication) as
a pill, an injection into a vein or a shot
under your skin. Usually, you receive a
combination of chemotherapy drugs
- Medicine-Drugs to prevent or treat side
effects of leukemia treatment may be
given.
- Blood transfusions-These may be used to
replaced blood cells and/or platelets.
- Follow-up care-Follow-up is needed to
gauge how well treatment is working. It
can also help doctors know if the disease
is coming back and help them to manage
any late effects of treatment.
- Hematopoietic cell transplant (stem cell
or bone marrow transplant) - This
treatment replaces the cancerous blood-
forming cells killed by chemotherapy
and/or radiation therapy with new,
healthy hematopoietic cells.
NURSING MGT.
• Education. The nurse should explain the
disease course, treatment and adverse
effects. Infection. The nurse should
teach the patient and his family how to
recognize symptoms of infection such as
fever, chills, cough, and sore throat.
EDITED BY: ANTONETH & JOYCE
• Bleeding. The nurse should educate the
patient and the family how to recognize
abnormal bleeding through bruising and
petechiae and now to stop it with direct
pressure and ice application
• Promote good nutrition. The nurse should
explain that chemotherapy causes weight
loss and anorexia, so the patient must be
encouraged to eat and drink high-calorie
and high-protein foods and beverages.
• Rehabilitation. The pee should help
establish and appropriate rehabilitation
program for the patient during remission
NEPHROBLASTOMA (WILM’S
TUMOR)
WILM’S TUMOR
• A type of rare childhood cancer starts in
the kidney
• Also known as nephroblastoma
• The most common kidney cancer in
children and fourth most common type of
childhood cancer
• It affects children between 3 to 5 years
old and becomes much less common after
age 5
SIGNS AND SYMPTOMS
- Swelling in the abdomen
- fever
- Mass in the abdomen which can be felt
- Pain in the abdomen
- Hematuria
- Weakness and fatigue
- Unexplained weight loss
- Nausea and vomiting
- constipation
- High blood pressure
PATHOPHYSIOLOGY
- Mostly Wilms’ tumor is unilateral but it
can be bilateral in 5% of cases
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
- Nephroblastoma are generally large and
rapidly growing
- Tumor generally start growing in renal
parenchyma or at the tip of kidney.
- It causes suppression of normal tissue
remaining
- Majority of tumors present as a single
encapsulated mass, that separates the
normal kidney and tumor
- Although the tumor is encapsulated but
the membrane may be very thin and get
easily torn
- Rupture of tumor put patient at the risk
of hemorrhage and dissemination of
tumor
CAUSES
• It’s not clear what causes Wilms’ tumor,
but in rare cases, heredity may play a
role.
• Cancer begins when cells develop errors
in their DNA
• The errors allow the cells to grow and
divide uncontrollably and to go on living
when other cells would die.
• The accumulating cells form a tumor. In
Wilms’ tumor, this process occur in the
kidney cells.
TREATMENT AND STAGES
Treatment of Wilms tumor is based mainly on
the stages of the cancer:
Stage 1- These tumor are still only in the kidney.
Stage 2- Tumor extend beyond kidney, into
nearby fatty tissue.
Stage 3- Tumor isn’t able to be removed
completely and some tissue remains in child’s
abdominal area
Stage 4- These tumors are already spread to
distant parts of the body at the time of
diagnosis.
Stage 5- In this stage usually tumor is
bilaterally present.
EDITED BY: ANTONETH & JOYCE
Wilms tumor is curable in more than 9 out of 10
children(90%), the main treatment include:
• Chemotherapy
• Radiation
• Nephrectomy
NURSING MANAGEMENT
PREOPERATIVE CARE
• Prepare the parents and child for surgery
• Explain not to palpate the abdomen of the
child
• Caution should be taken while turning and
handling the child
POST OPERATIVE CARE
• Monitor vital signs
• Monitor renal functioning by monitoring
weight, intake and output
• Explain parents about follow up and
continuing treatment at the time of
discharge
ASTHMA
What is asthma?
- The word ASTHMA is derived from the
Greek word for "panting" a description of
childs distress. Typically, an episode
begins with a dry cough. Asthma is a
chronic inflammatory disorder of
respiratory tract and is the most common
chronic illness in children (NHLBI,2007)
Typically, asthma presents before 5
years of age, although it may be difficult
to make a definitive diagnosis in these
early years l. Many Viral illness can
present with symptoms that are similar
and asthma and viral illnesses can trigger
asthma symptoms.
Signs and symptoms
1. Dyspnea
2. Chest tightness
3. A whistling sound (Wheezing)
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
4. Retraction
5. Feelings of weakness or tiredness
6. Less energy during play
7. Frequent coughing spells
WHAT CAUSES ASTHMA?
- Researchers don’t know the exact cause
of asthma, but it often develops during
childhood when your child’s immune
system is still developing. Many factors
may affect how your child’s lungs develop
or how their body fights germs.
These include:
-Genetics
-Allergens
-Viral infections at a young age
Is asthma contagious?
- No, asthma isn’t contagious. Germs such
as bacteria and viruses don’t cause the
condition, so it can’t spread from person
to person
If your child has any of the following warning
signs of a severe attack, you should get medical
help right away:
- Severe coughing.
- Rapid worsening of shortness of breath
or wheezing.
- Serious breathing problems. -Increase in
respiratory rate at rest.
- Turning pale or bluish in their face, lips
and/or fingernails.
- Trouble speaking, inability to speak in
sentences or not being able to speak at all
What are the complications of asthma?
-If asthma isn’t well-managed, it can cause a
variety of issues and complications. These may
include:
- -Severe asthma attacks.
EDITED BY: ANTONETH & JOYCE
- -Missed school or other activities.
- -Frequent hospitalizations and/or
emergency department visits.
- -Permanent lung damage.
What tests will be done to diagnose asthma?
- -Lung (pulmonary) function tests
- Peak Expiratory Flow Rate Monitoring
- -Allergy skin testing and blood tests
- Chest X-ray
THERAPEUTIC MANAGEMENT
Four components:
a. measure of asthma assessment
and monitoring, which involves
history and physical examination
and objective testing to determine
asthma severity and control
b. education for home self-
management
c. control of environmental factors
that contribute to symptoms
d. pharmacological therapy, defined
as quick relief and long acting
medications. - continuous
nebulization with an inhaled B2
agonist and IV corticosteroids may
necessary to reduce symptoms.
MEDICATIONS
Quick relief medication:
Short-acting beta2-agonists (SABAs): SABAs,
such as albuterol. SABAs used to be called
“rescue” medicine or inhalers. Providers now
prefer the term “quick-relief” because you can
and should use the medicine for any asthma
symptom, not just for asthma attacks.
Long acting medication:
- -Salbutamol is used to relieve symptoms
of asthma and chronic obstructive
pulmonary disease (COPD) such as
coughing, wheezing and feeling
breathless.
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
- -Systemic corticosteroids: • Soiled toilet paper comes into contact
Corticosteroids can help reduce the with their genitals.
swelling (inflammation) in your child’s SIGNS AND SYMPTOMS
airways caused by asthma symptoms. Your
child can take these medicines by mouth - FEVER
(orally) or by injection - LACK OF ENERGY
- CLOUDY PEE
- BLOOD IN PEE
URINARY TRACT INFECTION - NOT GAINING WEIGHT PROPERLY
What is Urinary Tract Infection? - ABDOMINAL PAIN
- LOWER BACK PAIN
- When germs (called bacteria) get into the
- BURNING SENSATION
urinary tract, they can cause an
- SMELLING PEE
infection. UTI refers to a bacterial
- POOR FEEDING
infection of the bladder (cystitis) or the
- VOMITING
kidneys (pyelonephritis).
- TIREDNESS
CAUSES OF UTI
PATHOPHYSIOLOGY
➢ Caused by bacteria that get into the
Infection within the urinary system caused by
bladder from the skin surface
either a BACTERIA, VIRAL or FUNGUS.
surrounding the urethra.
BACTERIA is Most common specifically E.COLI
➢ Germs that live in the large intestine and
are in stool can get in the urethra. MEDICAL MANAGEMENT

➢ Constipation - Children with febrile UTI should be

treated with antibiotics for seven to 10
UTI IN FEMALE
days.
- A UTI is much more common in girls
LABORATORY
because they have a shorter urethra and
their bottoms are much nearer the - URINALYSIS
urethra. - KIDNEY ULTRASOUND
- VOIDING CYSTOURETHROGRAM
WHY UTI ARE PRONE IN CHILDREN?
NURSING MANAGEMENT
• Children hold their urine too long.
● Administer antibiotic as ordered
• Don’t relax fully when urinating.
● Encourage patient to void frequently
• Don’t empty their bladder completely.
● Educate patient on proper wiping (from
• When a child wipe their ganitals from
front to the back)
back to front.
● Assess the symptoms of UTI

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
● Instruct the patient’s mother to increase
fluid intake.
● Educate patient on drinking acidic juices
which help deter growth of bacteria
HOW TO PREVENT UTI?
✓ Let your child empty his/her bladder
regularly at least once in 3 to 4 hours
✓ Wipe from front to back
✓ Constipation and pinworms can also put a
child at risk of a UTI (treat them
immediately if present)
✓ Periodic urine cultures during the first
year after a child’s first UTI helps
prevent it
✓ Early diagnosis and early treatment are
the most important steps in preventing
UTI
EDITED BY: ANTONETH & JOYCE
COMMON PROBLEMS WITH SCHOOL- AGED
School-age children with diabetes mellitus
Definition
-Diabetes mellitus is an endocrine disorder in
which the pancreas cannot produce adequate
insulin to regulate body glucose level.
-Glucose is an important source of energy for
the cells that make up the muscles and tissues.
It's also the brain's main source of fuel.
-The main cause of diabetes varies by type.
PATHOPHYSIOLOGY
Forms of diabetes mellitus
1. TYPE 1 DM
2. TYPE 2 DM
Type 1 dm
- Type 1 diabetes in children is a condition
in which child's body no longer produces
an important hormone (insulin). Child
needs insulin to survive, so the missing
insulin needs to be replaced with
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
injections or with an insulin pump. Type 1 Type 2 DM
diabetes in children used to be known as
- Type 2 diabetes in children is a chronic
juvenile diabetes or insulin-dependent
disease that affects the
diabetes.
way the child's body processes sugar
Key symptoms: (glucose) for fuel. Without treatment,
the disorder causes sugar to build up in
- Increased thirst
the bloodstream, which can lead to
- Fatigue
serious long-term consequences. Type 2
- Losing weight
diabetes occurs more commonly in adults.
- Increased appetite
In fact, it used to be called adult-onset
Risk factors diabetes. But the increasing number of
children with obesity has led to more
Type 1 diabetes most often occurs in children
cases of type 2 diabetes in younger
but can occur at any age. Risk factors for type 1
people.
diabetes in children include:
Key symptoms:
• Family history
• Genetics • Increased thirst
• Race • Fatigue
• Certain viruses • Losing weight
• Increased appetite
Complications
• Darkened areas of skin, especially around
Type 1 diabetes can affect the major organs in the neck or in the armpits
your body. Complications can include:

• Heart and blood vessel disease

• Nerve damage
• Kidney damage
• Eye damage
• Osteoporosis

ACCEPTABLE BLOOD GLUCOSE RANGES

FOR CHILDREN WITH TYPE 1 DIABETES

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
Risk factors NURSING MANAGEMENT

- Researchers don't fully understand why Nurses should provide accurate and up-to-date
some children develop type 2 diabetes information about the patient’s condition so that
and others don't, even if they have the healthcare team can come up with
similar risk factors. However, it's clear appropriate interventions and management.
that certain factors increase the risk, Nursing Assessment The nurse should assess the
including: following for patients with Diabetes Mellitus:
• Weight
• Assess the patient’s history. To
• Inactivity
determine if there is presence of
• Diet
diabetes, assessment of history of
• Family History
symptoms related to the diagnosis of
• Race or ethnicity
diabetes, results of blood glucose
• Age and sex
monitoring, adherence to prescribed
• Maternal gestational diabetes
dietary, pharmacologic, and exercise
• Low birth weight or preterm birth
regimen, the patient’s lifestyle, cultural,
Complications psychosocial, and economic factors, and
effects of diabetes on functional status
Complications of type 2 diabetes are related to
should be performed.
high blood sugar and include:
• Assess physical condition. Assess the
• High cholesterol patient’s blood pressure while sitting and
• Heart and blood vessel disease standing to detect orthostatic changes.
• Stroke • Assess the body mass index and visual
• Nerve damage acuity of the patient.
• Kidney disease • Perform examination of foot, skin,
• Eye disease, including blindness nervous system and mouth.
• Laboratory examinations. HgbA1C,
Signs and symptoms:
fasting blood glucose, lipid profile,
microalbuminuria test, serum creatinine
level, urinalysis, and ECG must be
requested and performed.

Therapeutic management

Although there is no cure for diabetes, children

with this disease can lead normal lives if it's
kept under control. Managing the disease
focuses on blood sugar monitoring, treatment
such as insulin therapy, given as multiple
injections per day or through an insulin pump,
and maintaining a healthy diet. Keeping blood
sugars within a normal range reduces is
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
important and lowers the risk of long-term
health problems related to poor diabetes
control. In addition to a healthy diet, at least
thirty minutes of exercise a day can help
children manage their disease as well. Regular
check-ups are especially important to identify
and treat diabetes in children as early as
possible.
EDITED BY: ANTONETH & JOYCE
What parents of children with diabetes can
do:
As the child becomes more independent, you can
help them learn to take more responsibility for
caring for their diabetes. Children above the age
of 7 typically have the fine motor skills to be
able to start giving themselves insulin injections
with adult supervision. They can also check the
sugar in their blood several times per day, using
simple, chemically treated test strips and a
blood sugar meter. However, these self-care
tasks need supervision to make certain their
diabetes stays under control according to the
doctor 's guidelines.
- If the child takes too much insulin: their
blood sugar can become too low
(hypoglycemia). This can lead to
trembling, a rapid heartbeat, nausea,
fatigue, weakness, and even loss of
consciousness.
- If the child takes too little insulin: the
major symptoms of diabetes (weight loss,
increased urination, thirst, and appetite),
can return
Developing good diabetes management habits
when a child is young can have a dramatic impact
on their management habits as they get older.
Many communities also have active parent groups
that share and discuss common concerns. Ask
the doctor for a recommendation
RHEUMATIC FEVER FOR SCHOOL-AGED
CHILDREN
- It is an autoimmune disease that occurs
as a reaction to a group A β-hemolytic
streptococcal infection, specifically, a
pharyngitis.
- Happens approximately 10 days after
recovery from pharyngitis.
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
- It occurs most often in children 6 to 15 Signs and Symptoms
years of age, with a peak incidence at 8
(Minor)
years.
- In some cases rheumatic fever causes 1. CRP increased (≥3 mg/dl)
long-term damage to the heart and its
2. Arthralgia
valves. This is called rheumatic heart
disease. 3. Fever (≥38.5°C)

Cause: 4. ESR (≥60mm/h)

• Rheumatic fever can occur after a 5. Prolonged PR interval

throat infection from a bacteria
called group A streptococcus. Group A
streptococcus infections of the
throat cause strep throat or, less
commonly, scarlet fever. The link
between strep infection and
rheumatic fever isn't clear. It
appears that the bacteria trick the
immune system into attacking
otherwise healthy tissue.
• The body's immune system typically
targets infection-causing bacteria.
However, in rheumatic fever, the
immune system mistakenly attacks
healthy tissue, particularly in the
heart, joints, skin and central nervous
system. This faulty immune system
reaction results in swelling of the
tissues (inflammation).
Risk Factors
● Inadequate or lack of antibiotic treatment of
streptococcal pharyngitis.
● Individuals with a history of acute rheumatic
fever.
● Children from ages 6 to 15 years.
● Crowding, such as found in schools, military
barracks, and daycare centers.
6. Anamnesis Suggestive of
Rheumatism
(MAJOR)
1. Joint Pain
2. Carditis
3. Nodules (subcutaneous)
4. Erythema Marginatum
5. Sydenham’s Chorea
TOTALS
● We can conclude that a patient has Rheumatic
Fever if the patient possesses:
2 major criteria or 1 major criterion and 2 minor
criteria.
● However, a patient that has chorea doesn’t
require GAS evidence.
Nursing Management
1. Provide comfort and reduce pain. Position
the child to reduce joint pain; warm baths and
gentle range-of-motion exercises help to
alleviate some of the joint discomforts; use pain
indicator scales with children so they are able to
express the level of their pain.

● Family history
EDITED BY: ANTONETH & JOYCE
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
2. Provide diversional activities and sensory
stimulation. For those who do not feel very ill,
bed rest can cause distress or resentment; be
creative in finding diversional activities that
allow
bed rest but prevent restlessness and boredom,
such as a good book; quiet games can provide
some entertainment, and plan all activities with
the child’s developmental stage in mind.
3. Promote energy conservation. Provide rest
periods between activities to help pace the
child’s energies and provide for maximum
comfort; if the child has chorea, inform visitors
that the child cannot control these movements,
which are as upsetting to the child as they are
to others.
4. Prevent injury. Protect the child from injury
by keeping the side rails up and padding them; do
not leave a child with chorea unattended in a
wheelchair, and use all appropriate safety
measures.
Therapeutic Treatment
● Penicillin therapy is immediately begun once
throat cultures and blood work have been
obtained. Intramuscular (IM) or oral penicillin is
prescribed for a full 10-day course.
● Oral nonsteroidal anti-inflammatory agents
may be prescribed to reduce inflammation or
joint pain.
● Steroids for severe carditis and valve damage.
● Phenobarbital and diazepam (Valium) are
both effective in reducing the purposeless
movements of chorea.
EDITED BY: ANTONETH & JOYCE
Juvenile idiopathic Arthritis
- also called juvenile arthritis (JA) or
juvenile rheumatoid arthritis (JRA).
- is a form of arthritis in children which
affects one or more joints for at least 6
weeks in a child age 16 or younger.
- It is an autoimmune disease
Cause:
The cause of JA is unknown, although it is
thought to be an autoimmune process in which a
child develops circulating antibodies
(immunoglobulins) against body cells. A genetic
predisposition may also be present and increases
the risk in some children.
Complications:
- Eye problems
- Growth problems
Signs and symptoms
• Swollen, stiff, and painful joints
• Eye inflammation
• Warmth and redness in a joint
• Less ability to use one or more joints
• Fatigue
• Decreased appetite, poor weight gain, and slow
growth
• High fever and rash (in systemic JIA)
• Swollen lymph nodes (in systemic JIA)
Three groups who developed sets of criteria
to classify children with arthritis:
• American College of Rheumatology (ACR)
• European League Against Rheumatism
(EULAR)
• International League of Associations for
Rheumatology (ILAR)
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
Types of JIA
Polyarticular
- five or more inflamed joints, often
involving weight-bearing joints.
Rheumatoid nodules be seen in patients
with positive rheumatoid factor (RF).
- Same joint on both sides in the body
- More girls than boys are diagnosed.
Pauciarticular (oligoarticular)
- less than five inflamed joints. Large,
weight-bearing joints, such as the knees
and ankles, are typically affected.
- Usually one joint on one side of the body
- More girls than boys.
Systemic
- Any joint in the body. Characterized by
spiking fevers, typically occurring once or
twice each day, at about the same time of
day.
- Macular rash on chest, thighs,
Infammaion of heart and lungs, Anemia
Enlarged lymph nodes, liver and spleen
Enthesitis-related arthritis
- frequently presents on evening and
postexercise pain. Attention should be
given to buttock pain and back pain.
Psoriatic arthritis
- usually mild. Onset of arthritis precedes that
of psoriasis in approximately half of children.
Undifferentiated arthritis
- diagnosed if the patient's manifestations
either do not fulfill the criteria for
anyone category or fulfill the criteria for
more than one.
EDITED BY: ANTONETH & JOYCE
Psoriatic arthritis
- usually mild. Onset of arthritis precedes
that of psoriasis in approximately half of
children.
NURSING MANAGEMENT
ASSESSMENT
- Assess children for self-care.
- Assess the child's and parents'
understanding of the illness and the
therapy planned.
- Children with pauciarticular arthritis
need screening with a slit-lamp
examination every 6 months for uveitis.
Daily Activities and Exercise
- to improve and maintain muscle and joint
function and to improve ability to do
activities of daily living
Medication
• Nonsteroidal anti-inflammatory medicines
(NSAIDs)- to reduce pain and inflammation
• Slow-acting antirheumatic drugs (SAARDs)-
also called disease-modifying antirheumatic
drugs (DMARDs) can be used if NSAIDs are
ineffective.
• Corticosteroid medicines- to reduce
inflammation and severe symptoms.
Heat Application
- Heat reduces pain and inflammation in joints
and so increases
comfort and motion.
Nutrition
- Children with JA, like those with other
chronic diseases, may eat poorly because
of joint pain and fatigue. Help parents
 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
plan mealtimes at the "best times" of the
day to over-come these problems.

Scabies

● Scabies is a skin infestation caused by a

mite known as Sarcoptes scabiei. This
causes an itchy, red rash to form on your
skin.

● It’s a highly contagious condition that can

easily be passed from one person to
another through direct skin contact.

● Infestation site: Armpits, knees,

buttocks, around fingernails, in between
fingers or soles of the feet, palms of the
hand, neck, and face.
Types of Scabies:
Classic Scabies - It is the most common type
of form, involving infestation with a low
number of mites approximately 10-15 mites.
Nodular Scabies - It is characterized by
inflammatory nodules in skin folds and genital
areas.
Crusted Scabies - It is the severe type of
scabies. It is due to hyper-infestation with
thousands to millions of mites. It is common
in person with weak immune system.
Signs and symptoms
❖ Severe itching (Pruritus)
❖ Crusting and scaling in HIV clients
❖ Appears as burrows or fine grayish-red
lines
❖ Blisters like in soles of feet
❖ Itchiness persist up to 2 weeks
❖ Exfoliating crust in face
❖ Sores secondary to infections
PRIORITY NURSING INTERVENTIONS
❑ Gloves and gowns in the care of the
clients

Etiology and Risk Factors ❑ Avoid prolonged skin to skin contacts

1. Most common in pre-schoolers and ❑ Linens, towels, and beddings

school-age children decontamination
2. Crowded living conditions ❑ Isolate the child up to 24 hours after
3. Sharing of towels, beddings, and clothes treatment is initiated
4. Malnutrition
❑ Simultaneously treat all household
members

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
Treatment Pathophysiology

Administration of scabicidal agents:

- Permithrin
- Lindane
- Ivermictin

Follow-up care is a key part of your child's

treatment and safety.

Impetigo

IMPETIGO

• Bacterial infection in the skin.

• Common in Young Children and possible for SIGNS AND SYPTOMS

Young Adult.
• COLLECTION OF REDDISH LESION OR
Causative agents; GAS, S. aureus BLISTER
Incubation period; 7-10 days • CLEAR FLUID THAT PUS FOR FEW
DAYS
Mode of transmission; DIRECT CONTACT
• CRUSTY YELLOW LESSION
2 Types of Impetigo • YELLOWISH BIG BLISTER
• SCABS DRIES AND FALL OFF
Non-bullous
• ITCHY OR IRRITATING
A yellow crust like lesion • PAINFUL ( BULLOUS)
• HEALS AFTER FEW DAYS
Superficial part of skin
Nursing Management
Not painful
MANAGEMENT
Bullous
EDUCATING ABOUT RIGHT HYGIENE
Yellow Big blister
PHARMACOLOGIC MANAGEMENT
Bulla in the epidermis
MUPIROCIN (BACTROBAN)
Painful & itchy
TOPICAL ANTIBIOTIC (3X A DAY FOR 10
RISK FACTORS
DAYS)
- Poor personal hygiene
RETAPAMULIN OINTMENT 1%
- Broken skin
- Weakened immune system TOPICAL ANTIBIOTIC (2X A DAY FOR 5
DAYS)

EDITED BY: ANTONETH & JOYCE

 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)
PENICILLIN OR AMOXICILLIN

- SUMMARY
- A SUPERFICIAL BARTERIAL
INFECTION IN THE SKIN INVOLVING
EPIDERMIS
- (YOUNG CHILDREN)
- CAUSE BY S. aureus and GAS or S.
pyogenes, transmitted through DIRECT How does it affect children?
- CONTACT
Causes and Risk Factors of PEDICULOSIS
- POOR PERSONAL HYGIENE, BROKEN
SKIN, WEAKENED IMMUNE SYSTEM • Head to head contact.
- FROM THE CAUSATIVE AGENT- • Closely stored belongings.
BROKEN SKIN AND INVASION- • Items share among
INFLAMMATORY friends or families.
• Contact with
- REACTION-OUTBREAK
furniture that has
- SIGNS AND SYMPTOMS
lice on it.
- NURSING AND PHARMACOLOGIC
MANAGEMENT

PEDICULOSIS CAPITIS

Pediculosis

• is an infestation of the hair and scalp 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.

EDITED BY: ANTONETH & JOYCE

NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
(ACUTE OR CHRONIC)

EDITED BY: ANTONETH & JOYCE