NCM 109: Care of Mother & Child at Risk w/ Problems

Lesson 10: Care of Pediatric Client w/

Thalassemia ! fatigue
! Jaundice
→ The thalassemias are autosomal recessive ! swollen abdomen
anemias associated with abnormalities of ! Hepatosplenomegaly
the b chain of adult hemoglobin ! diabetes mellitus
(hemoglobin A).
→ Although these anemias occur most
frequently in the Mediterranean population,
they also occur in children of African and
Asian heritage

DIAGNOSIS
→ Generally, starts with a regular blood test
that reveals low hemoglobin levels,
decreased MCV, and a high RDW, all of
which show that there are many distinct
sizes of RBC.

Beta Thalassemia Minor

→ If a person has just one altered gene that
results in either a decreased or nonexistent
production of beta globin, they are said to
have beta thalassemia minor.
SIGNS AND SYMPTOMS
! Beta Thalassemia minor is normally
asymptomatic
→ The red blood cells in the peripheral blood
smear are microcytic and hypochromic.
Another type of cell called a target cell is a
little red blood cell that has excess cell
membrane scrunched up so that it
resembles a bull's eye.

Thalassemia Major (HOMOZYGOUS B-

THALASSEMIA)

→ Also called Cooley anemia or Mediterranean

anemia.
→ There is total absence of beta chains.
→ Symptoms do not develop until the first 3 to
6 months of life.
SIGNS AND SYMPTOMS
! anemic
! Pallor
! Shortness of breath

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
→ Additionally, laboratory results may reveal
elevated levels of ferritin, transfer and
saturation factors, and serum iron.
→ Hemoglobin electrophoresis is the last step
in the diagnosis, revealing low levels of HbA
but rising levels of HbF and Hba2, which are
produced when too many extra alpha
chains begin binding to gamma and delta
chains.
TREATMENT
o Stem cell transplantation is the ultimate
cure for the disorder.
o Beta thalassemia does not always require
treatment.
o When needed Blood transfusion are given.
o regular blood transfusion might lead to iron
overload and worsen hemochromotosis.
(Deforoxamine is given.)
NON-TRANSFUSION DEPENDENT
• Beta thalassemia minor
• Intermediate beta- thalassemia with mild
symptoms
TRANSFUSION DEPENDENT
• Beta thalassemia major
• Intermediate beta- thalassemia with
severely reduced beta chain synthesis.
Hemophilia
→ Hemophilia is usually an inherited bleeding
disorder in which the blood does not clot
properly. It is a rare disorder in which the
blood doesn't clot in a typical way because
it doesn't have enough blood-clotting
proteins (clotting factors).
SIGNS AND SYMPTOMS
! Bleeding into the joints. This can cause
swelling and pain or tightness in the joints;
it often affects the knees, elbows, and
ankles.
! Bleeding into the skin (which is bruising) or
muscle and soft tissue causing a build-up of
blood in the area (called a hematoma).
! Bleeding of the mouth and gums, and
bleeding that is hard to stop after losing a
tooth.
! Bleeding after circumcision (surgery
performed on male babies to remove the
hood of skin, called the foreskin, covering
the head of the penis).
! Bleeding after having shots, such as
vaccinations.
DIAGNOSIS
→ Screening tests and clotting factor tests.
Screening tests are blood tests that show if
the blood is clotting properly. Clotting
factor tests, also called factor assays, are
required to diagnose a bleeding disorder.
This blood test shows the type of
hemophilia and the severity.
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
TREATMENT The symptoms are generally mild compared
with those in children with factor VIII or
o The best way to treat hemophilia is to
factor IX deficiencies. Bleeding episodes are
replace the missing blood clotting factor so
treated with administration of
that the blood can clot properly. This is
desmopressin (DDAVP) or transfusion of
typically done by injecting treatment
fresh blood or plasma.
products, called clotting factor
concentrates, into a person's vein. ASSESSMENT
Hemophilia A (Factor VIII Deficiency) ❖ Hemophilia often is recognized first in the
infant who bleeds excessively after
➢ The classic form of hemophilia is caused by
circumcision. If the disease has not shown
deficiency of the coagulation component
itself for several generations in a family, the
factor VIII, the antihemophilic factor, and
parents may be unaware of its existence.
transmitted as a sex-linked recessive trait.
For this reason, all infants need careful and
In the United States, the incidence is
thoughtful observation after circumcision.
approximately 1 in 5,000 White males. A
Because infants do not receive many
female carrier may have slightly lowered
injuries, children’s bleeding tendencies may
but sufficient levels of the factor VIII
not become apparent until they become
component so that she does not manifest a
active (e.g., crawling, climbing, or walking).
bleeding disorder. The baseline level of
Suddenly, the lower extremities (where the
factor determines the occurrence of
child bumps things) become heavily
bleeding episodes and can range from mild
bruised. There is soft tissue bleeding and
to severe (Gupta, Garg, & Singh, 2015).
painful hemorrhage into joints, which
➢ Factor VIII is an intrinsic factor of
become swollen and warm. Repeated
coagulation; its absence causes the intrinsic
bleeding into a joint this way causes
system for manufacturing thromboplastin
damage to the synovial membrane
to be incomplete. The child’s coagulation
(hemarthrosis), possibly resulting in severe
ability is not totally absent because the
loss of joint mobility (Merono-Gallut &
extrinsic or tissue system remains intact.
Cuesta-Barriuso, 2016).
Because of this system, the child’s blood
will eventually coagulate after an injury. THERAPEUTIC MANAGEMENT
Christmas Disease (Hemophilia B, Factor IX ❖ With even minor abrasions, bleeding can be
Deficiency) controlled by the administration of factor
VIII supplied by fresh whole blood, fresh or
➢ Christmas disease, first noted in 1952 in a
frozen plasma, or a concentrate of factor
patient by the name of Stephen Christmas,
VIII. The concentrate is supplied as a
is caused by factor IX deficiency. It is
powdered form that can be stored at home
transmitted as a sex-linked recessive trait,
and reconstituted as needed. For most
and only approximately 15% of people with
bleeding episodes, one bag of concentrate
hemophilia have this form. Treatment is
per 5 kg of body weight is usually sufficient
with a concentrate of factor IX, which is
to provide protection for approximately 12
available for home administration
hours; another transfusion may be
(Ambruso et al., 2016).
necessary after that time.
Hemophilia C (Factor XI Deficiency)
Disseminated Intravascular Coagulation
➢ Hemophilia C, or plasma thromboplastin
❖ Disseminated intravascular coagulation
antecedent deficiency, is caused by factor XI
(DIC) is an acquired disorder of blood
deficiency, is transmitted as an autosomal
clotting that results from excessive trauma
recessive trait, and occurs in both sexes.
or some similar underlying stimulus, such

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
as an acute infection or trauma. A child SIGNS AND SYMPTOMS
begins to develop petechiae or have
→ In hypospadias, the opening of the urethra
uncontrolled bleeding from puncture sites
is located on the underside of the penis
from injections or intravenous therapy.
instead of at the tip. In most cases, the
Ecchymoses and petechiae form on the skin.
opening of the urethra is within the head of
Observe all children with a serious illness
the penis. Less often, the opening is at the
carefully for signs such as these of
middle or the base of the penis. Rarely, the
increased bleeding to help identify that this
opening is in or beneath the scrotum.
is happening. DIC is also discussed in
Chapter 21 as a frequent complication of Signs and symptoms of hypospadias may
bleeding disorders in pregnancy. include:

Hypospadias ! Opening of the urethra at a location other

than the tip of the penis
→ Hypospadias is a urethral defect in which ! Downward curve of the penis (chordee)
the urethral opening is not at the end of the ! Hooded appearance of the penis because
penis but on the ventral (lower) aspect of only the top half of the penis is covered by
the penis. The meatus may be near the foreskin
glans, midway back, or at the base of the ! Abnormal spraying during urination
penis (Hutton & Babu, 2007).
→ In boys with hypospadias, the urethra
forms abnormally during weeks 8–14 of
pregnancy. This anomaly is fairly common,
occurring in approximately 1 in 300 male
newborns. It tends to be familial or may
occur from a multifactorial genetic focus.

DIAGNOSIS

» Hypospadias is usually diagnosed during a

physical examination after the baby is born.
RISK FACTORS » Hypospadias can be diagnosed with
ultrasound as a “blunt tip” appearance of
 Mothers over 35 years of age and with high the penis on ultrasound, which indicates
body mass index (BMI). abnormal tapering of the distal phallus.
 Women pregnant through assisted Ventral shortening and curvature of the
reproduction techniques. penis represents chordee
 Administration of certain hormones before » A “buried” appearance of the penis has been
and during pregnancy. described, in which the penis is significantly
foreshortened. The “tulip sign” describes
severe hypospadias, in which there is
penoscrotal transposition, and the penis is
curved and located between the folds of a
bifid scrotum.

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
MANAGEMENT & TREATMENT
o Treatment for hypospadias depends on the
type of defect the boy has. Most cases of
hypospadias will need surgery to correct
the defect.
o If surgery is needed, it is usually done when
the boy is between the ages of 6–18 months
old.
o Children with hypospadias should not be
circumcised because, at the time of the
repair, the surgeon may wish to use a
portion of the foreskin for the repair.
o In the newborn, the surgical procedure may
be a meatotomy—a procedure in which the
urethra is extended to a usual position—to
establish better urinary function.
urine output without putting tension
against the urethral sutures.
o The child may notice painful bladder
spasms as long as the catheter is in place (3
to 7 days), so an analgesic such as
acetaminophen (Tylenol) and an
anticholinergic medication such as
oxybutynin (Ditropan) may be prescribed
for pain relief.
o After hypospadias repair, children can be
expected to have usual urinary and
reproductive function unless accompanying
anomalies of the penis are present.
Epispadias
→ Epispadias refers to a rare urogenital birth
defect of the urethra found in both males
and, more rarely, females assigned at birth
in which the urethral tube fails to tabularize
as usual. Epispadias happens at 6th weeks
of gestations. As a result, the urethral
opening is found on the dorsal side rather
than the tip of the penis in those assigned
male at birth and towards or above the
clitoris in those assigned female at birth. In
epispadias, the space between the expected
and the actual urethral opening remains
open.

Hypospadias repair is a surgery that

corrects the position of the urethra on your
penis. It may be a one- or two-stage
procedure, depending on severity.
o If the repair will be extensive, all surgery
→ Epispadias in male is part of the bladder
may be delayed until the child is 3 to 4
exstrophy-epispadias-complex (BEEC) may
years of age. To encourage penis growth
involve the urinary system, musculoskeletal
and make the procedure easier, the child
system; pelvis; abdominal wall; genitalia;
may have testosterone cream applied to the
and sometimes, the spine and anus.
penis or receive testosterone injections
→ Epispadias in female associated with
until surgery.
BIFIDCLIORIS which clitoris divided into 2
o After surgical repair, a urethral urinary
parts
drainage catheter will be inserted to allow

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
CLASSIFICATION:
In boys, types of epispadias include:
□ Glanular epispadias: The meatus is on top
of the glans (head of the penis).
□ Penile epispadias: The meatus is along the
penis shaft.
□ Penopubic epispadias: The meatus is near
the pubic bone.

SIGNS AND SYMPTOMS

MALE GENITALS
! difficulty in urination
! UTI
FEMALE GENITALS
! Frequent and painful urination.
! UTI
FOR BOTH INDIVIDUALS WITH MALE OR
FEMALE GENITALS
! sexual dysfunction
! Infertility
In girls, types of epispadias include: ! Insecurities
□ Vesicular epispadias - urethra mainly MANAGEMENT & TREATMENT
normal but relation to clitoris altered
1. CLOSE DEFECT
□ Subsymphyseal epispadias - defect in
2. RECONSTRUCT URETHRA
anterior wall of urethra for about one half
3. HORMONAL THERAPY
its length.
□ Retrosymphyseal epispadias - defect in Surgery options for boys include:
anterior wall of entire urethra, and
sphincter is usually involved. • Modified Cantwell-Ransley technique -
involves "rebuilding" the penis. It takes
some of the penis apart to move the urethra
to a more normal position.

DIAGNOSIS
» Epispadias is most often noticed at birth.
Providers notice a boy's unusually shaped
penis or a girl's clitoris and labia. If a
pediatrician discovers epispadias, they'll be
taken to a pediatric urologist for treatment.

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
• Mitchell technique completely reconstructs
the penis. This ensures the urethra is in the
best position and corrects chordee.
Surgery options for girls include:
→ Reconstruction in girls is less complex than
in boys.
If epispadias is diagnosed at birth,
Healthcare providers can:
• Connect the two parts of the clitoris.
• Place the urethra in the correct location.
If the problem isn’t diagnosed or treated
until later, girls may need surgery to:
• Correct incontinence (lack of urine control).
• Reconstruct a narrow vaginal opening.
NURSING INTERVENTION
Nursing interventions for the child are:
 Relief from pain
 Improve urinary elimination
 Lessen anxiety
 Prevent infection
Glomerulonephritis
→ Glomerulonephritis is a medical condition
characterized by inflammation of the
glomeruli, which are tiny filtering units in
the kidneys responsible for removing waste
products and excess fluid from the blood. It
is also known as glomerular nephritis.
→ Glomerular diseases can be classified by
the injury mechanism or glomerular cell
target, by the presence or absence of
systemic disease, and by the appearance of
nephritic syndrome or nephrotic syndrome.
→ There are several types of
glomerulonephritis, and the exact cause
can vary depending on the specific type.
The condition can be categorized as either
acute (developing suddenly) or chronic
(developing gradually and persisting over
time).
Common causes of glomerulonephritis
include:
• Infections: Certain infections, such as strep
throat or staphylococcus infections, can
trigger an immune response that affects the
glomeruli.
• Autoimmune diseases: Conditions like
systemic lupus erythematosus (SLE) or
vasculitis can cause the immune system to
mistakenly attack the glomeruli.
• Antibody-related disorders: Some types
of glomerulonephritis are caused by
abnormal deposits of antibodies in the
glomeruli, leading to inflammation.
SIGNS AND SYMPTOMS
Symptoms of glomerulonephritis may
include:
Hematuria: Blood in the urine can make it
appear pink or cola-colored.
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
Proteinuria: Protein leakage into the urine,
resulting in foamy urine.
Edema: Swelling, particularly in the face,
hands, feet, and abdomen, due to fluid
retention.
High blood pressure: Hypertension is a
common finding in glomerulonephritis.
Decreased urine output: The kidneys may not
be able to produce an adequate amount of
urine.
DIAGNOSIS
Diagnosis of glomerulonephritis typically
involves a combination of urine tests, blood
tests, imaging studies, and kidney biopsy to
determine the underlying cause and severity of
the condition.
MANAGEMENT & TREATMENT
Treatment for glomerulonephritis depends on
the specific type and severity of the disease. It
may include medications to control blood
pressure and reduce inflammation,
immunosuppressive drugs to modulate the
immune response, and dietary changes to
manage fluid and salt intake. In severe cases,
dialysis or kidney transplantation may be
necessary.
 It's important for individuals with
glomerulonephritis to work closely with
their healthcare providers to monitor their
kidney function, manage symptoms, and
prevent complications.
Nephrotic Syndrome (Nephrosis)
→ Nephrosis is altered glomerular
permeability apparently due to fusion of the
glomeruli membrane surfaces, causes
abnormal loss of protein in urine.
Immunologic mechanisms are involved in
instigating the process. A T-lymphocyte
dysfunction may be responsible. The
highest incidence is at 3 years of age, and it
occurs more often in boys than in girls.
CLASSIFICATIONS
A. Congenital – occurs as an autosomal
recessive disorder (rare in children)
B. Secondary – progression of
glomerulonephritis or in connection with
systemic diseases such as sickle cell anemia or
systemic lupus erythematosus (SLE)
C. Idiopathic – primary (most common)
SIGNS AND SYMPTOMS
• Proteinuria
• Edema
• Hypoalbuminemia
• Hyperlipidemia
→ Proteinuria occurs because there is the
increased glomerular permeability leads to
protein loss in the urine and leads to
hypoalbuminemia. With low level of protein
in the bloodstream, osmotic pressure
causes fluid to shift from the bloodstream
into interstitial tissue causing edema.
→ As blood volume decreases, kidneys begin
to conserve sodium and water adding to the
potential edema. Hyperlipidemia occurs
due to liver that increases its production of
lipoproteins to try compensating for
protein loss. Lipids are too large to be lost
in urine, so they rise to high levels in blood
serum. There are cases where some
children have high lipid levels that when
blood is drawn and placed into test tube, it
forms a circle of white fat on the top of it.
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
CAUSES
COMMON PRIMARY CAUSES
• Hypersensitivity to an antigen–antibody
reaction or an autoimmune process.
• Minimal change nephrotic syndrome
(MCNS)
• Focal glomerulosclerosis (FGS)
• Membranoproliferative
glomerulonephritis (MPGN)
SECONDARY CAUSES INCLUDE SYSTEMIC
DISEASE:
• Systemic lupus erythematosus (SLE)
• Diabetes mellitus
• amyloidosis
* MCNS is the type most often seen in children
(80%). As the name implies, with this type,
little scarring of glomeruli occurs. Children
with this degree of scarring respond well to
therapy. Other types are focal
glomerulosclerosis (FGS) and
membranoproliferative glomerulonephritis
(MPGN).
Both of these types involve scarring of
glomeruli, and these children will have a
poorer response to therapy.
RISKS
Medical conditions that can damage the kidney
→ Certain diseases such as diabetes, lupus,
amyloidosis, reflux nephropathy, and other
kidney diseases
Certain medications
→ Nonsteroidal anti-inflammatory drugs or
drugs that fights infection
Certain infections
→ HIV, Hepatitis B and C, Malaria
DIAGNOSIS
Urinalysis (Urine Test)
1. During a dipstick test, you’ll pee into a
special container at your healthcare
provider’s office or a hospital. Then, a
healthcare provider will place a strip of
paper coated with special chemicals
(dipstick) into the container. The dipstick
will change color if there’s albumin in your
pee.
2. If your healthcare provider needs a more
precise measurement, they may
recommend urine protein tests. Urine
protein tests may include a single urine
sample or a 24-hour collection of urine.
3. In a single urine sample, your container is
sent to a lab. Lab technicians compare how
much albumin and creatinine are in your
pee (albumin-to-creatinine ratio). If your
urine sample has more than 30 milligrams
(mg) of albumin for each gram of creatinine,
it may signal a problem.
4. In a 24-hour urine collection, your
healthcare provider will give you a
container to collect your pee from home. On
the day of the test, you’ll:
·Pee in the toilet as usual when you first wake
up.
·Pee in the container the rest of the day until
you go to sleep.
·Pee in the container one last time when you
first wake up the following day.
5. You’ll then drop your sample off at your
healthcare provider’s office or a lab. Lab
technicians will only measure the amount
of albumin in your sample.
Blood Tests
1. During an albumin blood test, your
healthcare provider will use a thin needle to
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NCM 109: Care of Mother & Child at Risk w/ Problems
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withdraw a small amount of blood from a
vein in your arm.
2. The blood sample goes to a lab for testing. A
low level of albumin or other proteins may
indicate nephrotic syndrome.
3. Lab technicians may also test your blood
cholesterol and blood triglyceride levels.
Those levels may increase if your blood
albumin level is low.
Renal biopsy/Kidney biopsy
1. May be done to determine whether there is
scarring of the glomerular membrane and
document the type of nephrotic syndrome
present.
2. During a kidney biopsy, your healthcare
provider will remove a small piece of your
kidney tissue to examine at a lab under a
microscope.
3. Your healthcare provider will first numb
the area with a local anesthetic so you won’t
feel any pain. They’ll also give you a light
sedative to help you relax. Then, they’ll
insert a needle through your skin and into
your kidney to collect the tissue sample.
4. If you have diabetes and your healthcare
provider suspects you have nephrotic
syndrome, you likely won’t need a kidney
biopsy. Your medical history, urine tests
and blood tests are often enough to help
them diagnose nephrotic syndrome as a
result of your diabetes.
COMPLICATIONS
Blood Clots
→ Inability of glomeruli to filter blood
properly leads to the loss of blood proteins
that help in preventing clotting. As a result,
it increases the risk to develop blood clot in
veins.
High Blood Cholesterol and Elevated Blood
Triglycerides
→ By the time that the level of protein
albumin in your blood falls, liver makes
more albumin at the same time the it
releases more cholesterol and triglycerides.
Chronic Kidney Diseases
→ Later on, it can cause the kidneys to lose
their function over time and when the
kidney functions fall enough there will be
the need for dialysis and kidney transplant.
MANAGEMENT & TREATMENT
Blood Thinners (Anticoagulants)
It's prescribed to decrease blood's ability to
clot, especially if you've had a blood clot.
(Heparin, Warfarin (Coumadin, Jantoven),
Dabigatran (Pradaxa), Apixaban (Eliquis) and
Rivaroxaban (Xarelto).
Cholesterol-Reducing Medications
Statins can help lower cholesterol levels, its
examples include Atorvastatin (Lipitor),
Fluvastatin (Lescol XL), Lovastatin (Altoprev),
Pravastatin (Pravachol), Rosuvastatin (Crestor,
Ezallor) and Simvastatin (Zocor). However,
taking this medication is not clear if it can
improve such outcome like avoiding heart
attacks or decreasing the risk of early death.
Therapy
Therapy for a child with nephrotic syndrome is
directed toward reducing the proteinuria and
subsequently the edema with a course of
corticosteroids, such as IV
methylprednisolone/oral prednisone, and
keeping the child free of infection while the
immune system is suppressed. An initial dose
of prednisone is given until diuresis without
protein loss is accomplished; the dosage is then
reduced for maintenance and continued for as
long as 1 to 2 months
Diuretic Therapy
Children who respond poorly to prednisone
alone, however, may need diuretic therapy
with a drug such as furosemide. When children
are taking furosemide for extended periods,
there is always a danger that too much
potassium will be excreted, causing
hypokalemia.
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Lesson 10: Care of Pediatric Client w/
Nephroblastoma (WILM’S TUMOR)
→ Wilms tumor is a rare kidney cancer that
mainly affects children. Also known as
nephroblastoma, it's the most common
cancer of the kidneys in children. Wilms
tumor most often affects children ages 3 to
4. It becomes much less common after age
5, but it can affect older children and even
adults.
→ Wilms tumor mostly occurs in just one
kidney. But it can sometimes be in both
kidneys at the same time.
SIGNS AND SYMPTOMS
Children with Wilms tumor (also known as
nephroblastoma) usually have a swelling or
bump in their belly. Often, there are no other
symptoms. But some children may also have:
CAUSES
→ It's not clear what causes Wilms tumor.
→ Cancer begins when cells develop changes
in their DNA. Cells' DNA holds the
instructions that tell the cells what to do.
The changes tell the cells to grow and
multiply quickly. The cancer cells live while
healthy cells die as part of their natural life
cycle. With Wilms tumor, the changes make
extra cells in the kidney that form the
tumor.
Rarely, DNA changes passed from parents to
children can increase the risk of Wilms tumor.
DIAGNOSIS
Wilms tumor is sometimes diagnosed after a
parent notices a smooth lump in their child’s
belly. Doctors do an exam and order tests such
as:
» an ultrasound
» X-rays
» an MRI
» a CT scan
» bone scans
» blood tests and urine tests
» genetic testing
RISK FACTORS
Wilms tumor occurs more often in children
who have certain conditions present at
birth, including:
Aniridia. In aniridia, the colored portion of the
eye, known as the iris, forms only in part or not
at all.
Hemihypertrophy. Hemihypertrophy means
one side of the body or a part of the body is
larger than the other side.
Wilms tumor can occur as part of rare
syndromes, including:
WAGR syndrome. This syndrome includes
Wilms tumor, aniridia, genital and urinary
system problems, and intellectual disabilities.
Denys-Drash syndrome. This syndrome
includes Wilms tumor, kidney disease and male
pseudohermaphroditism). In male
pseudohermaphroditism, a boy's genitals
aren't clearly male.
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Lesson 10: Care of Pediatric Client w/
Beckwith-Wiedemann syndrome. Children MANAGEMENT & TREATMENT
with this syndrome tend to be much larger
The common types of treatments used for a
than what is typical, known as macrosomia.
Wilms tumor are described below:
→ This syndrome might cause organs in the
1. Surgery
stomach area to jut into the base of the
2. Chemotherapy
umbilical cord, a large tongue, large internal
3. Radiation therapy
organs and ears that are formed unusually.
4. Physical, emotional, and social effects of
Surgery cancer
→ Surgery is the removal of the tumor and Chemotherapy
some surrounding healthy tissue during an
→ Chemotherapy may be given through
operation.
the bloodstream to reach cancer cells
→ Surgery is a common treatment for all
throughout the body. When a drug is
stages of a Wilms tumor. It is important that
given this way, it is called systemic
your child's surgeon has experience with
therapy. Chemotherapy for a Wilms
removing Wilms tumors and, in some cases,
tumor is usually given through an
experience with saving part of the kidney.
intravenous (IV) tube placed into a vein
→ Surgery is usually performed by either a
using a needle. Chemotherapy may also
pediatric surgeon with experience in
be given locally, which is when the
removing cancer in children or a pediatric
medication is applied directly to the
urologist. A pediatric urologist is a doctor
cancer or kept in a single part of the
who specializes in treating urinary tract
body.
problems in children.
→ A chemotherapy regimen, or schedule,
The types of surgery used to treat a Wilms usually consists of a specific number of
tumor include: cycles given over a set period of time. A
person may receive 1 drug at a time or
Radical nephrectomy. A radical nephrectomy
combinations of different drugs given at
is the removal of the whole kidney and some
the same time. A Wilms tumor with a
surrounding tissue, as well as nearby lymph
favorable histology is often treated with
nodes. The surgical removal of the lymph nodes
dactinomycin (Cosmegen) and
is called a lymph node dissection.
vincristine (Vincasar PFS, Oncovin). In
Partial nephrectomy. A partial nephrectomy is some cases, doxorubicin (Adriamycin)
the removal of the tumor and some of the will also be added. Other drugs used to
surrounding healthy tissue, leaving as much of treat Wilms tumors include
the kidney as possible. A partial nephrectomy cyclophosphamide (Cytoxan, Neosar),
is performed when the other kidney is etoposide (Toposar, VePesid), and
damaged, also contains a tumor, or has already irinotecan (Camptosar).
been removed. → Chemotherapy can be given after
surgery to eliminate any remaining
→ When 1 kidney is removed, the other
cancer cells. When this is done, it is
kidney takes over the full job of filtering
called adjuvant chemotherapy.
waste from the body. Dialysis may also be
→ Sometimes, chemotherapy is given
used if preserving 1 functioning kidney is
before surgery to shrink a tumor that is
not possible. Dialysis is when a machine
too large to remove or a tumor that is
does the filtering work of the kidneys.
growing into blood vessels or other
organs, making it too risky to remove.
When this is done, it is called
neoadjuvant chemotherapy.

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
→ The side effects of chemotherapy non-medical needs. Any person,
depend on the individual and the type of regardless of age or type and stage of
chemotherapy and dose used, but they cancer, may receive this type of care.
can include fatigue, risk of infection, And it often works best when it is
nausea and vomiting, hair loss, loss of started right after a cancer diagnosis.
appetite, and diarrhea. These side People who receive palliative care along
effects usually go away after treatment with treatment for the cancer often have
is finished. less severe symptoms, better quality of
life, and report that they are more
Radiation Therapy
satisfied with treatment.
→ The most common type of radiation
NURSING INTERVENTION
treatment is called external-beam
radiation therapy, which is radiation 1. Preventing Infections
therapy given from a machine outside
The body’s natural defense mechanisms or
the body.
protective barriers is compromised in patients
→ When radiation treatment is given using
with Wilms Tumor (Nephroblastoma) due to
implants, it is called internal radiation
the risk of infection and bleeding, which can
therapy or brachytherapy. A radiation
occur as a result of cancer itself or as a side
therapy regimen, or schedule, usually
effect of a treatment such as chemotherapy or
consists of a specific number of
surgery. This can lead to a weakened immune
treatments given over a set period of
system, anemia, and other health problems,
time.
which require nursing care plans that prioritize
→ Radiation therapy may be used to treat a
infection control, wound care, and symptom
large tumor or a tumor that has spread
management to improve patient outcomes.
to other parts of the body. It may also be
Moreover, impaired oral mucous membrane
used to shrink a tumor before surgery
can also be a concern for patients with Wilms
or to destroy cancer cells that remain
Tumor (Nephroblastoma) which can damage
after surgery. Radiation therapy is
the lining of the mouth and cause pain,
usually part of the treatment plan for
inflammation, and sores. This can lead to
children with a stage III or IV Wilms
difficulty in eating, drinking, and speaking,
tumor with a favorable histology and for
which can affect the patient’s nutritional status
all children who have a tumor with an
and overall well-being, necessitating nursing
anaplastic histology
care plans that focus on oral care, pain
Physical, emotional and Social effects of management, and nutritional support to
Cancer improve patient comfort and quality of life.
 Cancer and its treatment cause physical 2. Preventing Injuries
symptoms and side effects, as well as
Risk for Injury may be a concern for patients
emotional, social, and financial effects.
with Wilms Tumor (Nephroblastoma) due to
Managing all of these effects is called
the potential for physical injury and harm from
palliative care or supportive care. It is
falls, due to the effects of treatment such as
an important part of your child’s care
surgery and chemotherapy, and due to the
that is included along with treatments
effects of the tumor itself. Additionally, patients
intended to slow, stop, or eliminate the
with Wilms Tumor may be at risk for injury due
cancer.
to their weakened immune system and
 Palliative care focuses on improving
susceptibility to infection, necessitating
how your child feels during treatment
nursing care plans that prioritize fall
by managing symptoms and supporting
prevention, infection control, and medication
patients and their families with other,

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
management to improve patient safety and
outcomes.
3. Reducing Anxiety
Anxiety may be a concern for patients or
parents of children with Wilms Tumor
(Nephroblastoma) due to the stress of the
diagnosis, the uncertainty of treatment
outcomes, and the potential for physical and
emotional discomfort associated with the
disease and its management. This can lead to
feelings of fear, worry, and unease,
necessitating nursing care plans that focus on
emotional support, coping strategies, and
education to help patients and their families
manage anxiety and improve their overall well-
being.
Pediculosis
→ Etiology: lice
→ Pediculosis refers to an infestation of
parasitic lice on the human body. Lice are
tiny insects that live on the scalp, body, or
pubic area and feed on human blood.
Pediculosis can occur in three forms:
• Head lice (Pediculus humanus capitis)
• Body lice (Pediculus humanus corporis)
• Pubic lice (Pthirus pubis)
Head Lice (Pediculus humanus capitis):
← Characteristics: Head lice infest the hair
and scalp, particularly in children. The lice
are small, wingless insects that feed on
human blood. They lay their eggs (nits)
close to the scalp and attach them to the
hair shafts.
← Transmission: Head lice are primarily
spread through direct head-to-head contact
with an infested person. They can also be
transmitted by sharing personal items such
as combs, brushes, hats, headphones, or
pillows.
Body Lice (Pediculus humanus corporis):
← Characteristics: Body lice infest clothing
and bedding rather than living directly on
the body. They move onto the skin to feed
on blood and then return to the clothing.
Body lice are slightly larger than head lice
and can survive away from the body for a
limited time.
← Transmission: Body lice infestations are
typically associated with unhygienic and
crowded living conditions. They are usually
spread through close contact with infested
clothing, bedding, or other personal items
such as towels or blankets.
Pubic Lice (Pthirus pubis):
← Characteristics: Pubic lice, commonly
known as "crabs," infest the pubic hair, as
well as other areas with coarse hair such as
the armpits or eyebrows. They are small,
crab-shaped insects that attach their eggs to
hair shafts.
← Transmission: Pubic lice are primarily
transmitted through sexual contact,
including intimate or close body contact.
They can also spread through sharing
infested clothing, bedding, or towels.
Occasionally, pubic lice may spread through
non-sexual close personal contact.
SIGNS AND SYMPTOMS
The common symptoms of pediculosis
include:
• Intense itching, especially in the infested
area.
• Visible lice or nits on the hair, clothing,
or bedding.
• Irritated or red skin in the affected area.
• Sores or small red bumps caused by
scratching.
• Difficulty sleeping due to itching.
PREDISPOSING FACTORS
→ Anyone may become louse infested under
suitable conditions of exposure but most
common in children between the ages 3 and
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
→ Pediculosis is easily transmitted from
person to person during direct contact. It
may take as long as two to three weeks or
longer for a person to notice the intense
itching associated with this infestation.
PREVENTION
• Physical contact should be avoided.
• Avoid sharing head equipment and clothing.
• Health education on the life history of lice,
proper treatment and the importance of
laundering clothing and bedding in hot water
or dry cleaning to destroy lice and eggs is
extremely valuable.
MANAGEMENT & TREATMENT
• Medicated shampoos or cream rinses
containing pyrethrins, permethrin, lindane, or
malathion are preferred for treating people
with head lice.
• Retreatment after 7 to 10 days is often
recommended to ensure that no eggs have
survived.
• Nit combs are available to help remove nits
from hair.
• Dose and duration of shampoo treatment
should be followed carefully according to label DIAGNOSIS
instructions.
» Finding a lice or adult louse on the scalp
• Historically, head lice have been removed by or in the hair of a person.
hand, by shaving affected areas, or by physical » Finding numerous nits within 6 mm of
removal with a lice comb. Wet combing the scalp is highly suggestive of active
involves moistening the hair and combing the infestation.
hair root-to-tip with a lice comb. » Finding nits only more than 6 mm from
• Regular direct inspection of children for head the scalp is only indicative of previous
lice, and when indicated, of body and clothing, infestation.
particularly of children in schools, institutions, » Small red papules under hairline at nape
nursing homes and summer camps, is of neck
important.

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
Scabies
→ Scabies is an infestation of tiny mites on the
skin. It causes a small red rash and intense
itching. This infection is very contagious. It
often spreads from child to child while
children are sleeping together in the same
bed or have close personal contact.
CAUSES
• Scabies is caused by very tiny mites that
burrow into the upper layers of the skin.
The mites live there and lay eggs that hatch
a few days later.
RISKS
• Anyone can get scabies, but it happens
mostly in children and young adults. The
greatest risk factor for getting scabies is
coming in close contact with a person who
has it. Other risk factors are overcrowded
living conditions and poor hygiene.
DIAGNOSIS
» Doctors usually diagnose scabies based on
symptoms and how the rash looks. The
doctor may scrape the skin to look for mites
or eggs under a microscope.
SIGNS AND SYMPTOMS
! It may take between 4 to 6 weeks for a child
to get symptoms of scabies after coming in
contact with an infected person.
! In children younger than age 2, the rash
caused by the mites tends to show up on
the head, neck, palms, and soles of the feet.
In older children, the rash is usually located on
any of the following places:
• Hands
• Between the fingers
• Wrists
• Belt Line
• Thighs
• Belly button
• Groin area
• Chest area
• Armpits
These are the most common symptoms of
scabies. But each child may experience
symptoms differently. Symptoms may
include:
• Severe itching
• Rash with small pimples or red bumps.
Sometimes burrows can be seen.
• Scaly or crusty skin in the worst cases
MANAGEMENT & TREATMENT
Treatment will depend on your child’s
symptoms, age, and general health. It will also
depend on how severe the condition is.
Treatment may include:
• Using prescription creams and lotions, such
as permethrin
• Taking medicines by mouth to kill the mites
• Taking antihistamine medicine by mouth to
help relieve itching
• Using other medicines on the skin as needed
How is scabies treated in a child?
Cut your child's fingernails to help prevent
infection. In addition, it is important to wash all
clothes and bedding in hot water and dry them
in a hot dryer. Clothing and other objects that
can’t be washed should be placed in a plastic
bag for at least 1 week. These items can include
things like pillows and stuffed animals. People
with crusted scabies are considered very
infectious. Careful vacuuming of furniture and
carpets is recommended.
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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
Impetigo * It can spread to other areas of the body
through:
- Clothing
- Fingers
- Towels

BULLOUS IMPETIGO
- A toxin-mediated erythroderma in which the
epidermal layer of the skin, resulting in large
areas of skin loss.
- After the blister break, they form yellow
scabs.
→ Impetigo is a common and highly
contagious skin infection that causes sores
and blisters. It's not usually serious and
often improves within a week of treatment
or within a few weeks without treatment.
CLASSIFICATION
Impetigo can be classified as either primary
or secondary.
•Primary impetigo involves previously normal ECTHYMA
skin affected by direct bacterial invasion. - A more serious form of impetigo that
penetrates deeper into the skin than other
•Secondary impetigo involves infection forms of impetigo.
forming at a previous skin wound site. - It sometimes accompanied by swollen glands.
TYPES The blister that accompanied by this form of
NON-BULLOUS impetigo is painful and can develop into larger
- Or Crusted impetigo is the most common. It and bigger sores.
begins as tiny blisters that eventually burst and
leave small wet patches of red skin that may Appears on the:
weep fluid. Gradually, a yellowish-brown or tan - Buttocks
crust covers the area, making it look like it has - Legs
been coated with honey or brown sugar. - Ankles
- Feet

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NCM 109: Care of Mother & Child at Risk w/ Problems
Lesson 10: Care of Pediatric Client w/
The three types of Impetigo are Be sure to finish the entire course of
distinguished by the bacteria that cause medication even if the sores are healed.
them;
PREVENTION
1-2 Non- bullous and bullous impetigo are
primary caused by Staphylococcus Aureus. To help prevent skin infections, you should:
3- Ecthyma is caused by streptococcus • Clean and care for wounds
pyogenes, Staphylococcus Aureus or both. • Wash your hands and laundry often
If you have an open wound or skin infection,
FACTORS THAT INCREASE RISK avoid spending time in:
* Poor Hygiene • Hot tubs
* Age • Swimming pools
* Crowded Places such as schools • Natural bodies of water (e.g., lakes,
* Broken skin rivers, oceans)
* Certain sports that involved skin to skin
contact ex. Football & Wrestling
* Hot, Humid weather - Disease causing
bacteria thrive in this weather
* Diabetes
* A compromised immune system such as from
HIV
SIGNS AND SYMPTOMS
- Red sore near the mouth and face
- Blisters that occur on the trunk, diaper area,
or neck folds in infants and children
- Painful pus-filled sore
DIAGNOSIS
A dermatologist can often diagnose impetigo by
looking at your skin. Sometimes, lab tests are
necessary to give you the diagnosis, or to get
information necessary to treat you. If you need
a lab test, a dermatologist often takes a sample
from a blister on your skin.
MANAGEMENT & TREATMENT
→ Impetigo is treated with prescription
mupirocin antibiotic ointment or cream
applied directly to the sores two to three
times a day for five to 10 days.
→ Before applying the medicine, soak the area
in warm water or apply a wet cloth
compress for a few minutes. Then pat dry
and gently remove any scabs so the
antibiotic can get into the skin. Place a
nonstick bandage over the area to help
prevent the sores from spreading.
→ For ecthyma or if more than just a few
impetigo sores are present, your doctor
might prescribe antibiotics taken by mouth.

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