CARE OF MOTHER, CHILD, AND ADOLESCENT (W/

COMPLICATIONS)
ST. PAUL UNIVERSITY – SURIGAO PROFESSOR: Mrs. Jobelle Teves
COLLEGE OF NURSING TRANSCRIBED BY: Charade P. Mosenabre

LESSON 5: COMMON HEALTH → if necrosis has occurred there would be

o elevated temperature
PROBLEMS o peritoneal irritation
o tender abdomen
TABLE OF CONTENTS
o increased WBC
1. INFANCY o rapid pulse
a. Intussusception
→ confirmed by sonogram
b. Imperforate Anus
NURSING MANAGEMENT
c. Spina Bifida
1. assist in surgery to straighten the
d. Failure to Thrive (FTT)
invaginated portion or reduction (water-
e. Colic
soluble solution, barium enema or
f. Cleft Lip and Palate
pneumatic insufflation)
g. Hirschsprung’s Disease
2. after treatment children are to be observed
h. Hydrocephalus
for 24 hours for reoccurrence
i. Acute Otitis Media
3. provide guidance and support to parents
j. Bacterial Meningitis
2. TODDLER, PRESCHOOL, & ADOLESCENT
IMPERFORATE ANUS
a. Cerebral Palsy
→ occurs in approximately 1 in 5,000 live births;
b. Leukemia
common in boys than in girls
c. Wilm’s Tumor
→ may occur as an additional complication of
d. Asthma
spinal cord defect
e. Urinary Tract Infection
→ initiate wink reflex
f. Scoliosis
→ abdominal distention may be evident
g. Bone Tumors
h. Accident (Trauma/Injury) → x-ray or sonogram will reveal the defect
i. Sexually Transmitted Disease → assess if infant has pass stool 24 hours after
j. Substance Abuse birth
3. ADOLESCENT NURSING MANAGEMENT
a. Dysmenorrhea 1. Collect a urine specimen from infant o assist
b. Obesity in anastomosis
c. Anorexia Nervosa 2. assist in temporary colostomy when repair is
d. Suicide complicated
3. upon repair no rectal temperature taking,
COMMON HEALTH PROBLEMS: INFANCY enema and rectal suppository
INTUSSUSCEPTION 4. do not place infant on the abdomen
→ invagination of one portion of the intestine into 5. after repair infant may need rectal dilatation
another twice a day for few months
6. administer stool softener as prescribed o
→ occurs for idiopathic reasons
provide support to parents
→ developed by most children after
administration of rotavirus vaccine
→ children may draw up legs, cry as if in severe SPINA BIFIDA
pain and may possible vomit at approximately → occurs when the posterior laminae of the
every 15 to 20 minutes vertebrae fail to fuse commonly at the 5th
→ in 12 hours blood in stool may develop lumbar or first sacral
→ caused by congenital defects and folic acid
→ abdomen becomes distended
insufficiency
TYPES:
QUESTIONS TO RECOGNIZE INTUSSUSCEPTION
▪ spina bifida occulta
o duration of pain – it lasts a short time
▪ spina bifida meningocele
with intervals of no crying in between
▪ myelomeningocele
o intensity – severe
o frequency – approximately every 15 to NURSING MANAGEMENT
20 minutes 1. may not need immediate surgery
o description – child pulls up his leg 2. provide support to parents
when crying 3. minimize risk of infection
o other s/s – child vomits, refuses food
and has feeling of full stomach FAILURE TO THRIVE
→ necrosis of invaginated portion must be → a unique syndrome in which an infant falls
prevented below the fifth percentile for weight and high
on standard growth chart

MOSENABRE  2023 1
 → caused by non-organic and organic
→ may lead to cognitive impairment and even
death if allowed to continue
CHARACTERISTICS:
▪ lethargy
▪ inability to resist
▪ rocking on all (4)
▪ reluctant to reach toys
▪ starves for human contact
NURSING MANAGEMENT
1. ensure adequate nutrition
2. nurture the child
3. support and encourage parents
4. ensure evaluation and follow-up
COLIC
→ paroxysmal abdominal pain occurs in infants
under 3 months of age
→ the cause is unclear but may occur from
overfeeding and swallowing
→ formula-fed babies are more likely to have
colic
→ ask parents about duration: 3 hours a day; 3
days a week every after feeding
→ constipation, narrow, ribbon-like stools
→ allergy to milk may cause colic o disappears at
3 months of age
NURSING MANAGEMENT
1. allow infant to burp after feeding
2. determine infant’s feeding pattern
3. place hot water bottle on infant’s abdomen
4. car rides, music boxes
5. maintain upright position in feeding infant
CLEFT LIP AND PALATE
→ the fusion of the maxillary and median nasal
processes normally occurs between weeks 5
and 8 and the palatal process closes at weeks
9 to 12 of intrauterine life
→ occurs approximately 1 in every 700 live births
→ occcurs as a familial tendency or most likely
occurs from transmission of multiple genes
→ cleft palate is a component of many
syndromes
→ cleft lip may be detected by sonogram
NURSING MANAGEMENT
1. assist in cleft lip surgical repair shortly after
birth and sometimes between 2 to 10 weeks
2. reinforce to parents that a revision of the
original repair may be necessary when the
child reaches 4 - 6 years of age
3. inform parents that repair of cleft palate is
usually postponed until child is 6 – 18
months old
4. it will be helpful to show parents
photographs of babies with good repairs to
assure them that their child’s outcome can
be a success
5. assist feeding using specialty feeding
devices
MOSENABRE  2023
HIRSCHSPRUNG’S DISEASE (Aganglionic
Megacolon)
→ absence of ganglionic innervation to the
muscle of a section of the bowel
→ results in chronic constipation or ribbon-like
stools
→ occur at a greater incidence in siblings of a
child with the disorder
→ caused by an abnormal gene on chromosome
→ symptoms in newborn – 6 to 12 months
→ careful history taking to document illness:
o duration of constipation
o what do parents mean by constipation
o consistency of the stool
o is the child ill in any way
NURSING MANAGEMENT
1. assist in anorectal manometry
2. assist in temporary colostomy followed by
bowel repair at 12 to 18 months of age
3. before surgery, the child may be prescribed
daily enemas (using PNSS) to achieve
bowel movements
HYDROCEPHALUS
→ an excessive cerebrospinal fluid (CSF) in the
ventricles and subarachnoid spaces of the
brain
TYPES:
• communicating hydrocephalus
/ extraventricular
• obstructive hydrocephalus /
intraventricular
→ excess in CSF in newborn can result from:
o overproduction by a choroid plexus in
the first or second ventricle
o obstruction of passage of fluid
between point of origin and point of
absorption
o interference with the absorption of the
fluid from subarachnoid space
→ occurs at 3 to 4 per 1,000 live births; it could
be congenital or acquired
→ Signs and Symptoms:
o prominent scalp veins
o bossing of forehead
o enlarged fontanelles
o sunset eyes
o shrill cry
o hyperactive reflexes
o separated suture lines
o increased head circumference
o lethargy or irritability
o signs of increased intracranial
pressure (PTRB)
→ can be demonstrated by sonogram, CT scan,
MRI and Transillumination
NURSING MANAGEMENT
1. administer acetazolamide (Diamox) as
ordered
2. assist in CSF bypass
a. V-P Shunt (ventricle-peritoneum)
b. V-A Shunt (ventricle-artery)
2
 3. administer oxygen as ordered → children may develop papilledema
4. monitor intake and output closely → the infant will be positive for Brudzinski’s or
5. obtain daily weight Kernig’s signs
6. encourage mother to breastfeed → newborn may manifest poor sucking, weak cry,
lethargy, seizures, apnea
ACUTE OTITIS MEDIA → diagnosed with CSF analysis obtained through
→ inflammation of the ear is the most prevalent lumbar puncture
disease among children after RTI → in healthy children, glucose level in the CSF is
→ occurs most often in children 6-36 months of 60%
age and again at 4-6 years NURSING MANAGEMENT
→ seen most frequently in males and children 1. assist intrathecal injections
with cleft palate 2. administer antibiotic as ordered (ampicillin,
→ there is a higher incidence of otitis media in cefotaxime or ceftriaxone)
formula-fed infant rather than those who are 3. administer corticosteroids as ordered
breast-fed 4. place child on respiratory precautions after
→ caused by streptococcus pneumoniae, the start of antibiotic therapy
haemophilus influenzae, group A beta 5. prophylactic antibiotic may be started to
hemolytic streptococci child’s immediate family
→ if not treated, it could lead to hearing 6. assess for cognitive challenges, learning
impairment problems and inability to concentrate urine
→ it generally follows a respiratory infection after the infection
→ Signs and Symptoms:
o fever COMMON HEALTH PROBLEMS: TODDLER,
o sharp or constant pain in one or both PRESCHOOL, ADOLESCENT
ears CEREBRAL PALSY
o irritable, external canal is generally → Cerebral palsy is a disorder of:
free of wax o movement
→ the mastoid process should not be tender to o muscle tone or posture
touch → Caused by:
→ tympanic membrane appears inflamed on o damage that occurs to the developing
otoscopic examination brain
→ tympanocentesis may be performed by a
physician SYMPTOMS:
NURSING MANAGEMENT  Below 6 months
1. Many otitis media infections resolve o head lags when picked up
spontaneously without therapy; o stiff and / or floppy
2. but to avoid the possibility of complications,  Older than 6 months
most children are treated with antibiotics o does not roll over
(ampicillin or amoxicillin) o cannot bring hands together
3. educate S.O. that during the course of otitis o difficulty bringing hands to
media, the child may have a conductive mouth
hearing loss which may last for up to 6  General Symptoms
months after an acute infection o posture / balance problem
4. administer antipyretic, analgesic and nasal o loss of control or coordination
decongestant as ordered o abnormal tone
o Abnormal strength
BACTERIAL MENINGITIS o Abnormal reflexes
→ infection of the meninges, occurring most o Persistent motor delay
often in children under 24 months of age o Cognitive deficit
→ caused by neisseria meningitidis,
streptococcus pneumoniae, group B TYPES OF CEREBRAL PALSY
streptococcus and escherichia coli a. Spastic
→ organisms are spread to meninges through b. Dyskinetic
URTI c. Ataxic
→ brain abscess can result to infection to cranial d. Mixed
nerves which may result to blindness, LEUKEMIA
deafness or facial paralysis → refers to cancers of the white blood cells
→ occurs generally 2 or 3 days of URTI → divided into:
→ Signs and Symptoms: o acute lymphoblastic leukemia (ALL)
o very irritable because of headache, o acute myeloid leukemia (AML)
o seizures or shock, SYMPTOMS
o fontanels are bulging a. pain in the bones or joints

MOSENABRE  2023 3
 b. swollen lymph nodes (groin, neck or → adolescent may have chemotherapy to shrink
elsewhere) the tumor before surgery
c. an abnormally tired feeling
d. poor appetite SYMPTOMS
e. fevers with no other symptoms o chronic cough
f. abdominal pains o dyspnea
o chest pain
WILM’S TUMOR o leg pain
→ also known as nephroblastoma – a rare
kidney cancer that primarily affects children ACCIDENT (Trauma/Injury)
→ adolescents handle trauma differently to
SYMPTOMS younger children or adults
o abdominal mass upon palpitation → adolescents look to their peer group for
o abdominal pain and swelling support
o fever → parents need to understand the ways in which
o blood in the urine teenagers manage distress
o nausea or vomiting or both
o constipation SEXUALLY TRANSMITTED DISEASE
o loss of appetite → may pass from person to person in blood,
o shortness of breath semen, or vaginal and other bodily fluids
o high blood pressure → can be transmitted nonsexually, such as from
mother to infant during pregnancy or childbirth
ASTHMA → “sexually transmitted infections” to “sexually
→ on going (chronic) inflammation of airways in transmitted disease”
the lungs
→ common triggers include allergies, colds and SYMPTOMS
exercise o sores or bumps (genitals/oral/rectal)
→ asthma is managed by controlling inflammation area
with medications o painful/burning urination
o unsual/odd-smelling vaginal discharge
COMMON SIGNS AND SYMPTOMS o unusual vaginal bleeding
o cough o pain during sex
o wheezing o sore/swollen lymph nodeS
o shortness of breath o lower abdominal pain
o worsening symptoms at night o fever
o rash over the trunk, hands or feet
URINARY TRACT INFECTION (UTI)
→ infection in your kidneys, ureters, bladder and SUBSTANCE ABUSE
urethra → also known as substance use disorder
→ girls are at greater risk than boys → inability to control the use of a legal and illegal
→ doctors typically treat UTI with antibiotics drug or medication
SYMPTOMS → includes alcohol, marijuana and nicotine
o fever
o pain on urination SYMPTOMS
o frequency o feeling that you have to use the drug
o blood in urine regularly
o enuresis o intense urges for the drug that block
out any other thoughts
SCOLIOSIS o needing more drug to get the same
→ a spinal disorder in lateral curvature effect
→ five times more common in girls than in boys o taking larger amounts of the drug over
and has a peak incidence at 8 to 15 years of a longer period of time than intended
age o making certain that you maintain a
→ symptoms become most marked at supply of the drug
prepuberty, a time of rapid growth o spending money on the drug, even
though you can’t afford it
BONE TUMORS o not meeting obligations or work
→ osteogenic sarcoma is a malignant tumor of responsibilities
long bone involving rapidly growing bone o failing in your attempts to stop using
tissue the drug
→ often taller than the average age

MOSENABRE  2023 4
 o experiencing withdrawal symptoms
when you attempt to stop taking the
drug
COMMON HEALTH PROBLEMS: ADOLESCENT
DYSMENORRHEA
→ painful menstruation
→ caused by release of prostaglandins
→ can be a preliminary symptom of an underlying
illness
ASSESSMENT
1. Category:
a. mild, moderate and severe
b. primary and secondary
2. Manifestations:
a. bloated feeling and light cramping
24 hours before menstrual flow,
b. colicky (sharp pain),
c. dull and nagging pain,
d. diarrhea,
e. mild breast tenderness,
f. abdominal distention,
g. nausea and vomiting,
h. headache and facial flushing
THERAPEUTIC MANAGEMENT
1. Administer analgesic as prescribed
2. Applying heat to the lower abdomen with a
heating pad or hot water bottle can
significantly reduce pain
3. Exercise seems to reduce menstrual
symptoms, including pain, in some studies
4. There is some evidence that complementary
medicine practices such as yoga or
acupuncture are effective in reducing
painful periods
5. Transcutaneous electrical nerve stimulation
(TENS) is a treatment that involves the use
of electrode patches, which are applied to
the skin near the area of pain
6. At least two surgical procedures have been
developed to treat dysmenorrhea --- cutting
or destroying the uterine nerves, which
prevents the transmission of pain signals
OBESITY
→ both inheritance and environment play a part
in the development of adolescent obesity
THERAPEUTIC MANAGEMENT
1. Treatment of obesity starts with
comprehensive lifestyle management (diet,
physical activity and behavior modification)
which should include the following:
a. Self-monitoring of caloric intake and
physical activity
b. Goal setting
c. Stimulus control
d. Non-food rewards
e. Relapse prevention
COMPLICATIONS
a. Type 2 diabetes
b. heart disease
c. high blood pressure
MOSENABRE  2023
d. certain cancers (breast, colon, and
endometrial)
e. stroke
f. liver and gallbladder disease
g. high cholesterol
h. sleep apnea and other breathing problems
ANOREXIA NERVOSA
→ refusal to maintain a minimally normal body
weight because of a disturbance in perception
of the size or appearance of the body
→ Includes three (3) separate features
1) self-induced starvation to a significant
degree
2) relentless drive for thinness, morbid
fear for fatness or both
3) medical s/s resulting from starvation
such as
▪ dramatic weight loss,
▪ preoccupation with weight,
food, calories, fat grams, and
dieting
▪ refusal to eat certain foods,
progressing to restrictions
against whole categories of
food
▪ frequent comments about
feeling “fat” or overweight
despite weight loss
Specific characteristics of an adolescent
with anorexia nervosa
o BMI < 17.5 or less than 85% of
expected body weight
o intense fear of gaining weight or
becoming fat even though
underweight
o severely distorted body image
o refusal to acknowledge seriousness of
weight loss
o amenorrhea (in girls)
Risk factors
o Body dissatisfaction
o Strict dieting
o Low self-esteem
o Difficulty expressing feelings
o Perfectionism
o Troubled family relationships
o History of physical or sexual abuse
o Family history of eating disorders
THERAPEUTIC MANAGEMENT
1. Steps to anorexia recovery
2. Admit you have a problem
3. Talk to someone
4. Stay away from people, places, and
activities that trigger your obsession with
being thin
5. Seek professional help
5
SUICIDE
→ deliberate self-injury with the intent to end
one’s life

WARNING SIGNS
o Always talking or thinking about death
o Clinical depression (deep sadness, loss of
interest, trouble sleeping and eating that
gets worse)
o Having a "death wish," tempting fate by
taking risks that could lead to death, such
as driving fast or running red lights
o Losing interest in things one used to care
about
o Making comments about being hopeless,
helpless, or worthless
o Putting affairs in order, tying up loose
ends, changing a will
o Saying things like "it would be better if I
wasn't here" or "I want out"
o Sudden, unexpected switch from being
very sad to being very calm or appearing
to be happy
o Talking about suicide or killing one's self
o Visiting or calling people to say goodbye

RISK FACTORS
o One or more prior suicide attempts
o Family history of mental disorder or
substance abuse
o Family history of suicide
o Family violence
o Physical or sexual abuse
o Keeping firearms in the home
o Chronic physical illness, including
chronic pain
o Incarceration
o Exposure to the suicidal behavior of
others
THERAPEUTIC MANAGEMENT
1. Psychotherapy and psychosocial
interventions - can be provided either on a
one-to-one basis by mental health
professionals, or in group settings involving
the patient’s family

MOSENABRE  2023 6