1etol Circulotion

placenta provides the exchange of gas and nutrient
four shunts in fetaI circuIation:
Placenta
Ductus venosus
Foramen Ovale
Ductus arteriosus

CONGENITAL HEART DEFECTS

CHD are structural defects of the heart, great vessels, or both that are present at birth.
Children with CHD are more likely to have associated defects such as tracheoesophageal fistula
(TEF)
CHD is second only to prematurity as a cause of death in the first year of life.

CONGENITAL HEART DEFECTS

1.Acyanotic Heart Disease

L R shunt
high pressure to low pressure
oxygenated to unoxygenated blood

2. Cyanotic Heart Disease
R L shunt
low pressure to high pressure

3. Obstructive Defects

. Mixed Oxygenation Defects

Classifications of CHD

1. Defects with increased pulmonary blood flow
-ASD, VSD, PDA

2. Defects with decreased pulmonary blood flow
- TOF, Tricuspid Atresia

3. Obstructive Defects
- COA, Aortic stenosis, Pulmonic stenosis

. Mixed Oxygenation/ defects
-TOGV, Truncus Arteriosus, Hypoplastic left heart syndrome (HLHS)






ACYANOTIC HEART DISEASE

Atrial Septal Defect

-Opening between atria
-late childhood/early adulthood
S/sx: cyanosis(CHF), dyspnea, fatigue, failure to thrive, split S2
x: Abx, surgery 1-3 yo
Cx: endocarditis, heart failure
!ostop: monitor arrhythmia, administer antibiotics
-Atrial septal defect
-Similar to a ventricular septal defect, this is a hole that occurs when the septum separating the
right and left atria doesn't close properly.
-This allows blood from the left atrium to flow into the right atrium, instead of into the left
ventricle and on to the aorta and the rest of the body.
-The defect can cause several complications, including arrhythmias, heart failure, stroke and, in
rare cases, pulmonary hypertension.
-Minor cases may cause no symptoms and may not require treatment.
-Larger defects may require surgical closure or cardiac catheterization

Ventricular Septal Defect

Opening in ventricular septum
S/sx: respi infections, failure to thrive, dyspnea, fatigue, pansystolic murmur
x: close spontaneously otherwise surgery <2 yo
Cx: pulmonary HPN, endocarditis, heart failure
!ostop: monitor arrhythmia, administer antibiotics
-Ventricular septal defect
-Sometimes called a hole in the heart
most common congenital heart defect
occurs when the septum, the muscular wall separating the right and left ventricles, fails to fully
form
-The hole allows oxygen-rich blood to leak from the left ventricle into the right ventricle, instead
of moving into the aorta and on to the body.
-Too much blood may flood the lungs.
-This defect can lead to heart failure, excessive blood pressure in the lungs (pulmonary
hypertension), infections of the heart (endocarditis), irregular heartbeats (arrhythmias) and
delayed growth.
-Small holes may heal on their own or cause no symptoms. Larger holes may require surgical
repair by stitching together or covering with a patch.

Patent Ductus Arteriosus

Aorta to pulmonary artery
Common in prematurity, high altitude, maternal rubella
females
S/sx: clubbing, dyspnea, "machinery like murmur¨ (2nd-3
rd
ÌCS)
Cx: heart failure, endocarditis, pulmonary artery stasis/HPN
x: Ìndomethacin, surgery
-Patent ductus arteriosus
-Before birth, a temporary blood vessel called the ductus arteriosus connects the pulmonary
artery and the aorta.
-This allows blood to bypass the lungs because oxygen is delivered to the fetus through the
placenta and umbilical cord.
-The temporary vessel normally closes within a few hours or days of birth since the lungs take
over.
-Ìf it remains open (patent), some blood that should circulate through the body is misdirected to
the lungs.
-This defect can cause heart failure or endocarditis. Ìn infants, it can be closed with medications.
Ìn older children and adults, plugs, coils or surgery can be used to close the vessel.

CYANOTIC HEART DISEASE

1. TetraIogy of FaIIot (TOF)

S/sx: cyanosis, clubbing, dyspnea, fatigue, squatting, "Tet spells¨, failure to thrive, systolic
murmur, polycythemia
Cx: thromboembolism, CVA
x: O2, knee-chest position, surgery 1-2 yo
!ostop: monitor for arrhythmia

TetraIogy of FaIIot
-This defect is a combination of four (tetralogy) congenital abnormalities.
-The four defects typically are
1. Ventricular septal defect (VSD),
2. Pulmonary stenosis,
3. An aorta overriding both ventricles, and a thickened right ventricular wall
4. (Right ventricular hypertrophy).

-They usually result in an insufficient amount of oxygenated blood reaching the body.
-Complications of tetralogy of Fallot ( fuh-LOE) include cyanosis ÷ sometimes called "blue baby
syndrome," since the lips, fingers and toes may have a bluish tinge from lack of oxygen ,
clubbing of fingers ÷ as well as poor eating, inability to tolerate exercise, arrhythmias, delayed
growth and development, and stroke.
-Surgical repair of the defects is required early in life.
-Tet spells- irritability, pallor and blackouts or convulsions,
-CLUBBÌNG ÌN TETRALOGY OF FALLOT
-CLUBBÌNG OF THE FÌNGERS

1. TetraIogy of FaIIot (TOF)
x:
Blalock Taussig: anastomose SC and pulmo art.
- avoid BP and venipuncture in right arm

2. Transposition of the Great VesseIs

-Aorta from R ventricle
-Pulmonary a. from L ventricle
-Males
S/sx: cyanosis, murmurs
x: PGE for PDA, Balloon catheter to create ASD, definitive surgery 1 wk-3 mos

Transposition of the great vessels/ arteries
-With this defect, the positions of the aorta and the pulmonary artery (the great arteries) are
reversed (transposed).
-The aorta arises from the right ventricle instead of the left and the pulmonary artery arises from
the left ventricle instead of the right.
-This creates a circulatory pattern that prevents nourishing oxygenated blood from reaching the
body.
-This condition would quickly be fatal to a newborn except it's generally accompanied by
another defect ÷ commonly a septal defect or patent ductus arteriosus ÷ that does allow
oxygen-rich blood to get to the body. Surgical repair is usually necessary shortly after birth.

. TotaI AnomaIous !uImonary

Venous Return
Pulmonary vein drain to SVC or R atrium
PDA or foramen ovale essential
S/sx: cyanosis, fatigue
CX: R heart failure
x: PGE, surgery

OBSTRUCTIVE DEFECT

Coarctation of the Aorta
Constriction of aorta
S/sx: asymptomatic HPN, irritability, headache, epistaxis, dyspnea, claudication, higher BP in
upper extremities, dec femoral and distal pulses,systolic murmur
OBSTRUCTÌVE DEFECT
Coarctation of the Aorta
Cx: chronic HPN
x: surgery
!ostop: monitor abdominal pain, antihypertensives

Coarctation of the aorta

This is a narrowing (coarctation), or constriction, in a portion of the aorta.
Coarctation forces the heart to pump harder to get blood through the aorta and on to the rest of
the body.
This defect can cause several life-threatening complications, including severe hypertension,
aortic aneurysm, dissection or rupture, endocarditis, brain hemorrhage, stroke, heart failure and
premature coronary artery disease.
Repair is typically recommended before age 10, either by surgically removing the affected
portion or widening it through balloon angioplasty and placement of a stent.
COARCTATÌON OF THE AORTA
Ndx:
Ìneffective cardiopulmonary and peripheral tissue perfusion related to impaired cardiac function
Proper positioning to maintain respiration
Promote rest to conserve energy
Quiet activities and stimulation
Anticipate needs
Administer prescribed drugs
COARCTATÌON OF THE AORTA
Activity intolerance r/t effects of congenital heart defect and dyspnea
Rest periods
Adequate nutrition
small frequent feedings
iron supplementation

2. !ULONIC STENOSIS
Obstruction of blood flow from the right ventricle to the pulmonary artery
PULMONÌC VALVE
Backflow of blood towards the right ventricle
Right Ventricle has to PUMP HARDER to push the blood to the pulmonary artery for
Oxygenation
RÌGHT VENTRÌCULAR ENLARGEMENT
RÌGHT-SÌDED CONGESTÌVE HEART FAÌLURE


. AORTIC STENOSIS
Ìnvolves an obstruction of the ventricular outflow of the blood
S/SX: faint pulse, hypotension, tachycardia, poor feeding, exercise intolerance, chest pains
DX: ECG, Echocardiography reveals left ventricular hypertrophy.
MX: Surgical aortic valvulotomy or prosthetic valve replacement.
- Balloon Angioplasty to dilate the narrow valve.

. AORTIC STENOSIS
Obstruction of flow to the AORTA
AORTÌC VALVE
Backflow of blood towards the LEFT VENTRÌCLE
Left Ventricle has to PUMP HARDER to push the blood to the AORTA for distribution of
oxygenated blood
LEFT VENTRÌCULAR HYPERTROPHY with Regurgitation of oxygenated blood back to the
LUNGS
LEFT-SÌDED CONGESTÌVE HEART FAÌLURE (Respiratory Signs)
O Truncus arteriosus
-This is a defect in which the normally distinct pulmonary artery and aorta merge into one single
great vessel (truncus) arising from the right and left ventricles.
Ìn addition, there's usually a large ventricular septal defect, essentially turning the right and left
ventricles into a single chamber.
-This allows oxygenated and unoxygenated blood to mix. Too much blood may flow to the
lungs, flooding them and making it difficult to breathe.
-Ìt can also result in life-threatening pulmonary hypertension. Surgery is needed to close the
septal defect with a patch and to separate the pulmonary arteries from the trunk.
-A conduit is placed to connect the right ventricle to the pulmonary artery. Because the conduit
doesn't grow with the child, repeat surgery may be necessary over time.
Truncus arteriosus
HypopIastic Ieft heart syndrome
Ìn this condition, the left side of the heart is underdeveloped (hypoplastic), including the aorta,
aortic valve, left ventricle and mitral valve.
As a result, the body doesn't receive enough oxygenated blood. Ìn the first few days after a
baby is born, the ductus arteriosus remains open (patent), allowing normal circulation, so the
baby may seem fine initially.
But when the ductus arteriosus naturally closes, signs and symptoms begin, including a bluish
cast to the skin from lack of oxygen, difficulty breathing and poor feeding. This condition may be
accompanied by an atrial septal defect.
Treatment options for this life-threatening condition are a heart transplant or a multistage
surgical procedure done during the first few years of life.
Hypoplastic left heart syndrome
AtrioventricuIar canaI defect
This is a combination of defects, including a large hole in the center of the heart and a single
common valve instead of the separate tricuspid and mitral valves.
Also called atrioventricular septal defect, this defect is classified by whether it's only partial,
involving only the upper chambers of the heart, or complete, in which blood can travel freely
among all four chambers of the heart.
Both forms allow extra blood to circulate to the lungs, causing the heart to enlarge.The condition
is often associated with Down syndrome. Ìnfants may also have trouble breathing and not grow
well.
Surgery is often done in infancy to close the hole and reconstruct the valves.

ucocutaneous Lymph Node Syndrome
AtrioventricuIar canaI defect

KAWASAKI DISEASE

Before puberty, peaks 4 yo
EtioIogy: unknown; autoimmune
S/sx: spiking fever x 5 days, bilateral conjunctivitis, reddened pharynx, dry lips, strawberry
tongue, cervical lymphadenopathy, peripheral edema, erythema and desquamation, truncal
rash, arthritis

Mucocutaneous Lymph Node Syndrome
!atho: Respi infection immune complex systemic vasculitis ( coronary artery) > aneurysm and

Dx: clinical
x: Salicylates and Ìmmunoglobulins

KAWASAKÌ DÌSEASE

Risk for
ineffective peripheral tissue perfusion related to inflammation of blood vessels
- Observe for chest pain, color changes, vomiting
Pain r/t swelling of lymph nodes and inflammation of joints
- Comfort measures, administer pain medications
KAWASAKÌ

Nursing easures:Protect edematous areas
Record intake and output
Offer soft food
Administer prescribed medication
Rheumatic Fever
Autoimmune
Grp A Beta hemolytic strep
6-15 yo, peaks 8 yo
1-3 wks after untreated infection

Rheumatic Fever

Dx: 5 major criteria ÷ polyarthritis, carditis, subcutaneous nodules, erytHema marginatum,
sydenham's chorea
minor ÷ fever, polyarthralgia, hx of RF, inc ESR, antecedent strep infection
To diagnose, either 2 major or 1 major and 2 minor present
Cx: mitral valve insufficiency and myocarditis

RHEUMATÌC FEVER

gmt: salicylate, penicillin
Ndx:
Risk for noncompliance r/t knowledge deficit about importance of long term therapy
- prevent initial and recurrent attacks
Decreased cardiac output r/t disease process
- bed rest, comfort and appropriate activities

RHEUMATÌC FEVER

Nursing Care
Monitor vital signs
Provide adequate nutrition
Promote safety to prevent chorea related injuries
Respiratory Anatomy & Physiology
The respiratory system consists of two main parts- the upper and the lower tracts

The UPPER respiratory system consists of:

1. nose
2. sinuses
3. mouth
4. pharynx
5. larynx
6. epiglottis

U!!ER RES!IRATORY TRACT INFECTIONS

ACUTE NASO!HARYNGITIS (CORYZA)

Most frequent infectious disease in children
Average of 10-12 colds/ year
Ìncubation period- 2-3 days

The COMMON COLDS
ACUTE NASOPHARYNGÌTÌS (CORYZA)
Most frequent infectious disease in children
Average of 10-12 colds/ year
Ìncubation period- 2-3 days

The COMMON COLDS

ETIOLOGIC AGENT
1. Rhinovirus - most common cause
2. Parainfluenza virus
3. Respiratory syncitial virus (RSV)
UPPER RESPÌRATORY TRACT ÌNFECTÌONS
4. Adenovirus
5. Ìnfluenza virus
6. Coxsackie virus
SÌGNS AND SYMPTOMS
1. nasal congestion
2. watery rhinitis
3. low grade fever
4. mucus membrane is edematous
5. cervical lymph node may be swollen and palpable
6. body malaise

TREATENT
Common colds is self-limiting
supportive care
relief of nasal obstruction - use of isotonic saline drops and aspiration
antipyretic or analgesic agents
antitussive is sometimes used for persistent cough
Streptococcal
Pharyngitis
Strep throat
Spread by infected nose or throat mucus through coughing or sneezing
S/sx: pain on swallowing, fever, headache, swollen lymph nodes, swollen hyperemic tonsils w/
OR w/out pus
Dx: throat SWAB and culture & sensitivity

TREATENT & ANAGEENT

!HARYNGITIS

1. antibiotics- 10 day-course of oral antibiotics (Pen G or Clindamycin)
2. high fluid intake
3. relief of pain

COMPLÌCATÌONS: Rheumatic Fever, Rheumatic Heart Disease, Acute Glomerulonephritis

TONSÌLLÌTÌS

term commonly used to refer to infection and inflammation of palatine tonsils
palatine tonsils - located on both side of pharynx
Adenitis - refers to infection and inflammation of the adenoids ( pharyngeal) tonsils adenoids -
located in the nasopharynx
%ubal tonsils - located at entrance to the Eustachian tube
Lingual tonsils - located at base of tongue

ETIOLOGY
<3 years old - often viral
-school age children ÷ often bacterial
Signs and Symptoms
-difficulty of swallowing (dysphagia)
painful swallowing (odynophagia)
-fever
- lethargy
-mouth breathing
-difficulty hearing (Eustachian tube)
-halitosis
-sleep apnea

TREATENT

1. antipyretic
2. analgesics
3. Antibiotics ( 10 day course ÷ usually Penicillin but may be Erythromycin if allergic to penicillin)
is prescribed for bacterial infections to prevent the complication of rheumatic fever.
4. Surgical ÷ tonsillectomy with adenoidectomy

INDICATIONS FOR TONSILLECTOY

1. chronic tonsillitis (not done if inflamed because may spread infection)
2. Recurrent tonsillitis (4-6x/year)
3. Peritonsillar Abscess
4. Sleep apnea

Nursing diagnosis: Pain related to Surgical Procedure

TONSILLECTOY
!ost -op Care:

1. Observe for, & report unusual bleeding ( (frequent swallowing)
2. Help prevent bleeding by discouraging the child from coughing & clearing the throat.
3. Position the child on the side or the abdomen (prone) to facilitate drainage from the throat
TONSÌLLECTOMY
4. Provide appropriate teaching . Ìnstruct the child & parents to:
a. Observe activity restrictions, especially upon the child's return to school.
b. Avoid persons with known infections.
c. Avoid acidic & other irritating foods.
d. Monitor the child for bleeding, especially immediately postoperatively & 5 to 10 days
post op when tissue sloughing occurs.
E!ISTAXIS
keep pt in upright position with head tilted slightly forward to minimize the amount of blood
pressure in nasal vessels, keep blood moving forward not back to nasopharynx
apply pressure to the side of the nose with your fingers, may have ice compress
E!ISTAXIS
3. Ask the child to stop crying because crying increases pressure in the blood vessels of the
head and prolonged bleeding
4. control of bleeding, can give epinephrine
(1:1000) to constrict blood vessels
5. can put nasal packing for continuous pressure on the site of the ruptured blood vessel
Epiglottitis
Ìnflammation of epiglottis ("cherry-red")
Hemophilus influenza type B
2-7 yo
Pathophx: upper respiratory infection inflammation of epiglottis

EpigIottitis
>an acute , severe inflammation of the epiglottis.( flap of tissue that covers the opening
to larynx to keep out food and fluids)
> it is considered an emergency because the swollen epiglottis can't rise and allow the
airway to open.
> This emergency situation occurs most commonly in children between 3 and 6 years of age.
Causes:
1. Bacterium H-Ìnfluenza type b
2. pneumococci, streptococci - most common cause
3. echovirus
4.respiratory syncitial virus

E!IGLOTTITIS

Dx: CBC, elevated c-reactive protein (CRP), culture of epiglottis, neck xray
> it is considered an emergency because the swollen epiglottis is not allowing the airway to
open.
- this emergency situation occurs most commonly in children between 3 and 6 years of age.
E ! I G L O T T I T I S
NURSE ALERT!!! " Never illicit gag reflex-may cause complete obstruction¨

Nsg Dx:

Ìneffective breathing pattern r/t inflammation
Ìneffective airway clearance r/t inflammation
Parental anxiety r/t respiratory distress in child
CROUP (LTB)

Acute Laryngotracheobronchitis)

- Ìnflammation & narrowing of the larynx, trachea, and major bronchi. Most common form of
croup & usually affects children younger than 5 years old.
- one of the most frightening diseases of early childhood for both parents and children. Tends
to occur at night & recur with respiratory tract infections.
- common cause is viral infection usually parainfluenza virus, influenza virus.

signs and symptoms

1.Gradual onset from upper respiratory tract infection , which progresses to signs of distress.
2. Hoarseness
3. low grade fever
4. barking cough at night
5. inspiratory stridor
6. Retractions
7.Severe respiratory distress
8. Restlessness& Ìrritability
9. Wheezing, rales, rhonchi, & localized areas of diminished breath sounds

NURSING ANAGEENT
Assess for airway obstruction by evaluating respiratory status. Note color, respiratory effort,
evidence of fatigue, & VS.
provide warm, moist environment-give o2 to alleviate hypoxia
-Keep emergency equipment ( tracheostomy & intubation tray) near the bedside.
give corticosteroids & epinephrine (nebulizer) - reduce inflammation and bronchodilation
intravenous hydration

Nursing dx: Ìneffective airway clearance related to edema

LOWER RES!IRATORY TRACT INFECTION
#espiratory Anatomy & Physiology
%he LOWE# respiratory system consists of:

1. Trachea
2. Bronchus
3. Bronchioles
4. Respiratory unit

%he B#ONCHI
#IGH% B#ONCHUS
Wider
Shorter
More Vertical

LEF% B#ONCHUS
Narrower
Longer
More horizontal
Retraction
Supraclavicular/ Suprasternal retraction - suggest upper airway obstruction
intercostal retraction- suggest lower airway obstruction
Ìnfluenza
> inflammation and infection of the major airway
> caused by orthomyxoviruses, influenza
type A, B, C
Sign and symptoms:
1.cough
2. fever
3.fatique
4.aching pain
5.sore throat
6. GÌT symptoms-diarrhea, vomiting, incubation period: 1-5 days
anagement:
1. antipyretic
2. antiviral drugs( tamiflu)
3. influenza vaccine( yearly given)
CompIication:
1. bronchitis
2. pneumonia

Bronchitis

Ìnflammation of bronchi
Starts as URTÌ
S/sx:
initially low grade fever, colds
3-4 days after, roughening breath sounds, rales, dry, hacking unproductive cough
Cough w/ sputum production - clear to purulent, dyspnea, chest pain
BRONCHITIS
Dx: clinical

gmt:
-rest
-CPT- chest physiotherapy
-Fluids
-antibiotics
-Bronchitis

BronchioIitis

inflammation & swelling of bronchioles w/ mucous in airways
RSV,parainfluenza, Adenovirus, influenza
0-2 yo, peak 6 mos old
transmitted via droplets

BRONCHIOLITIS
Pathophx:
mild upper respiratory infection edema of airway and accumulation of mucus airway
narrowing hypoxemia
S/sx: wheezing, tachypnea, wet hoarse cough, fever, poor appetite, difficulty sucking, restless
sleep, retractions
Dx: cxr, pulse oximetry, throat culture

TubercuIosis
High incidence in infancy and adolescence
Primary Complex ÷ based on xray; first encounter of a child w/ TB; Ghon's tubercle w/
lymphangitis and regional (hilar) lymphadenopathy
Primary Pulmonary TB ÷ clinical TB
d/t Mycobacterium Tuberculosis
Dx: exposure, s/sx (2 or more), PPD, Chest Xray, sputum AFB test
!OSITIVE !!D TEST
Classification of TB
Class Ì TB exposure ÷ (+) exposure
Class ÌÌ TB infection ÷ (+) exposure and PPD
Class ÌÌÌ TB disease ÷ active TB or 3 or more of criteria - Exposure, s/sx, (+) tuberculin
test,xray, sputum exam, culture
Class ÌV TB inactive ÷ (+/-) hx of prev TB, (+/-) hx of prev hx of chemotherapy, (+) xray
evidence of healed lesion and (+) PPD
S/sx: fever, wt loss, cough, anorexia, night sweats, painlesss lymphadenopathy
Treatment:
1.Intensive
ÌNH ( isoniazid), Rifampicin, PZA ( Pyrazinamide) x 2 mos

2.aintenance
ÌNH, Rifampicin x 4 mos

!rimary Anti TB Drugs

Rifampicin =
SE = orange colored urine, GÌ upset, Jaundice, Renal failure, thrombocytopenia
Primary Anti TB Drugs
Isoniazid (INH) = ( Bacteriostatic) inhibits
( Bactericidal ) kills
Used prophylactically to patients (+) of PPD
SE = Rashes (give anti-histamine); Peripheral neuritis ( Give Vit B6- Pyridoxine)50 mg;
Jaundice; Psychosis
Pyrazinamide ( PZA)
SE = Hyperuricemia ( inc uric acid)
Mx: Ìnc fluid intake
4 Ethambutol = 15-20mg/day
SE = Optic neuritis ( dec visual acuity)
Give Vit. B6(Pyrdoxine)
5 Streptomycin
SE = Ototoxicity, 8
th
cranial nerve damage
( Tinnitus, dizziness, N&V)
Respiratory Distress Syndrome
Preterm, infants of diabetic mothers, C/S, hx of asphyxia
S/sx: inc RR, chest retractions, nasal flaring,expiratory grunt, cyanosis, HPN, hypothermia
Dx: ABG, Xray
gmt: surfactant replacement, O2, ventilation, supportive care
Decreased surfactant lungs collapse
-Ìnc pulmonary resistance
-blood shunts through F.O. and D.A.
-poor lung perfusion and gas exchange
-further decrease in surfactant
-hypoxia
-acidosis

BRONCHIAL ASTHA

chronic, reversible , obstructive airway disease, characterized by wheezing. Ìt is caused by
smooth muscle spasm w/ hypertrophy of the bronchial tubes, or swelling of the bronchial
mucosa, after exposure to various stimuli.




Hypersecretion of mucus
Most common chronic disease in childhood. Most children experience their first sx by 5yo
exercise, nocturnal occurrence, seasonal, hx of allergy, stress
Types of Bronchial Asthma
A Extrinsic or Atopic Asthma: r/t external allergens such as:
-contactants: dust, chemicals, soaps, perfumes, lotions, make-up
-inhalants: dust, hay, scents, smoke, sprays
-ingestants: food, milk, chicken, beef, pork, eggs, etc.
-Sudden changes in temperature
Types of Bronchial Asthma
B Intrinsic or Non-Atopic Asthma= not r/t external allergens
Stress
Fatigue
Lack of Sleep
Anxiety
C MIXED type of Asthma= both types present
Pathophysiology of Asthma
Heredity + Allergens &/or Stress

Release of ÌgE from B lymphocytes
ÌgE + Mast cells of respiratory tract = damage to mast cells
Release of: Histamine, Bradykinin, Serotonin, Leukotriennes, Prostaglandins, ECF-A, SRS-A
from damaged mast cells to respiratory membranes
Bronchial Asthma
=S-ecretions: copious, viscous, sticky, stringy, whitish
=S-pasms: laryngo-tracheo-bronchial spasm
=S-welling: edema of the airway

Airway Obstruction
Dyspnea

Signs & Symptoms of Bronchial Asthma
Successive episodes of coughing: dry, hacking, non-productive cough
Ìncreased respiratory secretions: whitish, stringy
Wheezing on expiration
Prolonged expiration
Dry lips and mucous membranes (mouth)
Dyspnea, Tachypnea, Tachycardia
Apprehension and restlessness

Nursing Interventions
Long-term Goal: Patient will achieve an open airway and adequate ventilation as manifested by
normal VS and relief of symptoms
Short-term Goal:
Liquify secretions
Easily expectorate and drain secretions
Relieve spasms
Decrease swelling of airways



Nsg Dx:
Ìmpaired Gas Exchange r/t bronchiolar obstruction, atelectasis and hyperinflation
Parental anxiety r/t respiratory distress in child
Management
nebulization
hydration
O2
positioning
TSB
Monitor VS esp RR
support
Status Asthmaticus
Progression of attack unresponsive to therapy
Preceding upper respiratory tract infection, allergen, cigarette smoke
HR and RR inc, dec breath sounds, cyanosis
x: cont B2 agonist and ÌV steroid, O2, coughing, fluids, monitor Ì and O, ET
ÌT is not enough to have a good mind;

the main thing is to use it well
-Rene Descartes-
Thank you!

GastrointestinaI Disorders

Diagnostic Tests
Barium or Gastrografin Swallow
used to examine the esophagus
Gastrografin and barium facilitate imaging through X-rays, but Gastrografin is less toxic if
it escapes from the GÌ tract

Nursing Interventions:
-Explain the procedure to the child and his parents.
-Maintain the child on NPO starting at midnight before the test.
-Tell the child that he must hold still during the X-ray.
-After the test, monitor bowel movements for excretion of barium. Monitor GÌ function.
-Upper GÌ Ìmaging
-Upper GÌ series
-Swallowed Barium moves into the esophagus, stomach, and duodenum to reveal
abnormalities.
-Barium outlines stomach walls and delineates ulcer craters and filling defects.
-Small bowel series
An extension of the upper GÌ series
Visualizes Barium flowing through the small intestine to the ileocecal valve

Nsg ImpIication:

-Explain the procedure to the child and his parents.
-Tell the child that he must hold still during the X-ray.
-Make sure the lead apron is properly placed around the genital area.
-After the test, monitor bowel movements for excretion of barium.
-Ìncrease fluid intake to allow excretion of barium ( note: chalky bowels )
Monitor GÌ function.
Barium Enema
Allows X-ray visualiztion of the colon.

Nsg ImpIication:
- Explain the procedure to the child and his parents.
-Usually, the child will follow a liquid diet for 24 hours before the test.
-Bowel preparations are administered before the examination.
-Tell the child that X-rays will be taken on a test table and that he must hold still.
-Cover the genital area with a lead apron during X-ray.
-Stool Specimen
-Examined for suspected GÌ bleeding, infection, or malabsorption
-Tests include the Guaiac test for occult blood and microscopic tests for ova, parasites and fat

Nsg ImpIication:
-Obtain the specimen in the correct container.
-Be aware that the specimen may need to be transported to the laboratory immediately or
placed in the refrigerator.

Fiberoptic Testing

Esophagogastroduodenoscopy ÷ a fiber-optic scope is inserted to allow direct visual inspection
of the esophagus, stomach and duodenum
Proctosigmoidoscopy ÷ the rectum and distal sigmoid colon are inspected directly
Colonoscopy ÷ the descending, transverse and ascending colon are inspected directly

Nsg ImpIication:
- Explain the procedure to the child and his parents.
Obtain written, informed consent.
A mild sedative may be administered before the examination.
The child may be kept on NPO starting at midnight before the test.
The child may be placed on a liquid diet for 24 hours before the examination or require enemas
and laxatives until clear.
GI Intubation
To empty the stomach and intestine
To aid in the diagnosis and treatment
To decompress obstructed areas
To detect and treat GÌ bleeding
To administer medications or feedings
NI:
Maintain accurate intake and output records
Record the amount, odor and consistency of gastric drainage every 4 hours.
When irrigating the tube, note the amount of normal saline solution instilled and aspirated
Check for fluid and electrolyte imbalances.
Provide good oral and nasal care. Make sure the tube is secure but that it isn't causing pressure
on the nostrils.





CIeft Lip and !aIate

-Failure of fusion of maxillary and median nasal process
-hereditary
-unilateral/bilateral
Males
x: surgery - Cheiloplasty
Rule of 10's- AGE=10 wks,
WT=10 lbs, HgB=10 gm
CIeft !aIate
-midline opening of palate
-usually w/ Cleft lip
-Female
-surgery 6 - 18 mos - allow anatomic changes <1 yo ie formation of palatine arch and tooth buds

Ndx:

Risk for imbalanced nutrition, less than body requirements r/t feeding problems
Risk for ineffective airway clearance r/t oral surgery
Risk for infection during post op period

Nursing mx:
Adequate nutrition; sips of fluid between feeding in semi-upright position; use rubber tipped
syringe
Direct the formula away from the cleft & toward the side & back of the mouth to prevent
aspiration.
Provide special nipples or feeding devices ( ex. Soft pliable bottle with soft nipple with enlarged
opening)( Breck)
Feed the infant slowly & burp frequently to prevent excessive swallowing of air & regurgitation.
Prevent ear and upper respiratory tract infection

Nursing Care

Preop
Adequate nutrition; sips of fluid btw feeding in upright position; use rubber tipped syringe; Burp
Prevent ear and upper respiratory tract infection
Address body image and speech concern
Nursing Care

Postop
monitor respiratory distress d/t edema, hemorrhage
Use mist tent , if prescribed, to minimize edema, liquefy secretions & minimize distress.
Suction mucus and blood gently
Use cup
Use elbow restraints to maintain suture line integrity. Remove them every 2 hours
Position side lying or back in cleft lip to avoid injury to the operative side; prone in cleft palate to
facilitate drainage.




TracheoesophageaI FistuIa
-Communication of the esophagus and trachea maternal hydramnios and prematurity
S/sx: coughing, choking, cyanosis, dyspnea, excessive secretion, abdominal distention
Dx: Ba swallow
-Gastrointestinal anomalies
-EA is a condition in which the proximal and distal portions of the esophagus do not
communicate.
-TEF is an abnormal communication between the trachea and esophagus
-TEF
Ndx:
-Risk for imbalanced nutrition, less than body requirements r/t inability for oral intake
-Risk for infection r/t aspiration or seepage of stomach contents into lungs
-Risk for impaired skin integrity r/t gastrostomy tube insertion site

Nursing care
!reop
-Suction regularly
-Elevate the head
-Gastrostomy feeding
-hydration
-O2

Nursing care
!ostop
-Observe for respiratory distress
-Proper positioning ÷ avoid hyperextension of neck
-Continue suction
-Prevent wound infection
-Provide pacifier

Hirschsprung's Disease

AgangIionic megacoIon
-Absence of innervation to a bowel segment usually rectosigmoid colon
-No peristaltic activity in affected area

Hirschsprung's Disease
Familial
4x males ( esp w/ down's syndrome)
Dx: Ba enema, biopsy ( pull through )
x: colostomy, surgery
Nursing Care
!re op
1. Daily enemas w/ 0.9% NaCl
*Tap/hypotonic water will cause cardiac congestion or cerebral edema
2. Minimal residue diet w/ vitamin supplementation
3. Position semi fowlers to relieve dyspnea from distended abdomen
4. pacifier



Nursing Care
!ostop
-Observe for abdominal distention
-Small frequent feedings after NGT removal
-Colostomy care
-Assist parents to cope with children's feeding problems

HIRSCHS!RUNG'S DISEASE
Ndx:
Constipation r/t reduced bowel function
Ìmbalanced nutrition, less than body requirements r/t reduced bowel function
Ìntussusception

Ndx:
Pain r/t abnormal abdominal peristalsis
Risk for deficient fluid volume r/t bowel obstruction
DX:
Barium enema for dx & therapeutic treatment tool ( reduction by hydrostatic pressure)
Sonogram reveals " coiled spring "
X: surgery
Nursing Care
-Provide comfort measures - pacifier for infants
-NPO
-Adequate hydration via ÌV therapy
-Promote parent-infant bonding

!yIoric Stenosis

Gastrointestinal anomalies

!yIoric stenosis
Circular muscle surrounding pylorus hypertropies and block gastric emptying .
S/sx : Projectile vomiting( blood tinged ,not bile ) olive- shaped mass in RUQ, visible peristaltic
waves
gt: Surgical [ pyloromyotomy, fredet ramstedt
procedure
Nsg gt : !reop : recognize s/sx
ÌVF, high fowler's
place right side after feeding
!ostop : resumed feeding 4-6H
discharged : within 72H
Ndx:

Risk for deficient fluid volume r/t inability to retain food
Risk for infection at site of surgical incision r/t danger of contamination from feces d/t proximity
of incision to diaper area
Nursing care
Hydration
Pacifier
may give thickened feedings on upright position then NPO just before surgery
Monitor Ì and O, weight, and vomiting
!ostop

1. dropper feeding 4-6 hrs after surgery 45 min- 1 hr duration; oral rehydration soln then half
strength breastmilk/formula at 24 hr interval
2. Side lying position
3. Monitor weight and return of peristalsis
4. Wound care
5. Pacifier for oral needs

CeIiac Disease/GIuten sensitive Enteropathy/CeIiac Sprue

-Malabsorption syndrome that occurs when the mucosa of the proximal small intestine is
sensitive to gluten ( a protein found in BROW wheat, rye, oats, barley)
inability to absorb fat, thus steatorrhea ( fatty stools), deficient fat soluble vitamins, malnutrition
and distended abdomen
S/Sx appears bet 1-5 yo after introduction of gluten in the diet.
S/sx: diarrhea, wt loss, anorexia, irritability, anemia (Fe deficiency)

CeIiac Disease
!athophysioIogy:

-Ìntolerance for or inability to digest gluten >>>accumulation of the amino acid
glutamine>>>toxic to intestinal mucosal cell>>> intestinal villi atrophy >>>reduction of
absorptive surface of the small intestine.
Cx: Lymphoma of the small intestine

CeIiac Disease
CELIAC CRISIS (due to ingestion of gluten, infections, prolonged fasting) = acute vomiting and
diarrhea & may lead to F & E imbalance & rapid dehydration.
Dx: Biopsy of the jejunum reveals the mucosal surface with hyperplastic villus atrophy. (
Definitive diagnosis of celiac disease). This characteristic lesion return to normal after dietary
restriction of gluten which helps confirm the dx.
CeIiac Disease
anagement:
= hydration, gluten free diet, vitamin & Fe supplementation , AVOÌD: cereals, bread, cake,
cookies, spaghetti, pizza, instant soup, some chocolates, some ice cream, donuts, pies,
hotdogs,
CeIiac Disease
Foods aIIowed:
1. Meats: beef, pork, poultry & fish
2. Eggs
3. Milk & dairy products: milk, cheese, cream
4. Fruits & veg: all
5. Grains: rice, corn, gluten free wheat flour, corn flakes, corn meal & gluten free pre-cooked
cereals

Diaphragmatic Hernia
-Herniation of intestinal content into the thoracic cavity
Left side
S/sx: respiratory difficulty, cyanosis, retractions, (-) breath sounds affected side, scaphoid
abdomen
Cx: pulmonary HPN
x: 'E' surgery

DIA!HRAGATIC HERNIA
Ndx:
-Risk for ineffective airway clearance r/t displaced bowel
-Risk for imbalanced nutrition, less than body requirements, r/t NPO status
Nursing Care
Preop:
-Elevate head
-Low intermittent suction
Post op:
SemifowIers
-Maintain warm, humidified envt ÷ lung fluid drainage
-Suction prn
-Chest pptx
-NPO ÷ prevent pressure on diaphragm

Necrotizing EnterocoIitis

-Ìnflammatory disease of the bowel with increased incidence in preterm & other high risk infants
due to intestinal ischemia, colonization of pathogenic bacteria, & substrate( formula feeding) in
the intestinal lumen
!athophysio:
-Mucosal cells lining the bowel wall is damaged >>diminished blood supply to these cells
causes death to the tissue>>( stops secreting protective, lubricating mucus>> thin , unprotected
bowel wall is attacked by proteolytic enzymes>>bowel continues to swell & break down>> gas
forming bacteria invades the damaged areas to produce intestinal penumatosis ( presence of air
in the submucosal surfaces of the bowel
S/sx: abdomen tense and distended, stool (+) for occult blood, > 2 ml gastric residual,
bradycardia, apnea
Dx: abdominal xray
gmt: d/c feeding, ÌV or TPN, Antibiotic, colostomy, surgery for perforation

InguinaI Hernia

-Protrusion of a section of a bowel into the inguinal ring
Males
Cause: when there is an increase in intraabdominal pressure
S/sx: painless lump in the groin
Cx: bowel strangulation
x: surgery <1 yo
!ost op Nursing care:
- wound care
- assess circulation in the leg

uscuIoskeIetaI Disorders
-Clubfoot (Talipes)
-Ankle-foot disorders
Types: Varus ÷ inward rotation
Valgus ÷ outward rotation
Calcaneous ÷ upward rotation or dorsiflexion
Equinus ÷ downward rotation or plantarflexion
-Males
-Unilateral more common

Talipes Equinovarus (plantar flexion and medial deviation) ÷ 95%

S/sx: foot cannot be manipulated by passive exercises into correct position
x: cast and splint, surgery then casting and corrective shoes ( Dennis browne )

CongenitaI Hip DyspIasia
-Ìmperfect hip development affecting femoral head and acetabulum
-Female
-Unilateral more common
-Ìnc frequency w/ breech delivery
S/sx:
-limited abduction of affected hip
-shortening of leg on affected side
( Galeazzi / Allis sign )
-asymmetric thigh and gluteal folds
-buttocks on affected side will flatten on prone
-pelvis dips on normal side when standing on affected leg ( Trendelenburg )
-palpable click ( Ortolani's click)

Endocrine Disorder

Cystic Fibrosis

-Autosomal recessive ( abnormality of the long arm of chromosome 7)
-Chronic multisystem disorder of the exocrine glands characterized by abnormally thick
pulmonary secretions.
-There is a marked electrolyte change in the secretions of the sweat glands ( chloride
concentration of sweat is 2 to 5x above normal )
-Resulting in the inability to transport small molecules across cell membranes leading to
dehydration of cells in the airway & pancreas & dried secretions.
-Affects lungs, pancreas, intestines and sweat glands, salivary glands, reproductive tract.
TerminoIogies:
Exocrine ÷ glands that deliver their secretions to an epithelial surface either directly or through
a duct or to the secretions such glands produce.
Endocrine ÷ ductless glands of the body whose secretions pass directly from the gland into the
interstitial tissues from which they are diffused into the blood or lymph to be carried to other
parts of the body where they affect the functioning of other organs. EX. Pituitary, thyroid,
adrenals, ovaries, testes, & islets of langerhans in the pancreas.
econium iIeus ÷ obstruction in the ileum of the newborn caused by tenacious meconium (
meconium plug syndrome)
Dx: > "Sweat test¨ (Sodium Chloride 2-5x the normal), >absence of pancreatic enzymes,
>immunoreactive trypsinogen in blood
> stool analysis ÷ steatorrhea
> xray ÷ patchy atelectasis & generalized obstructive emphysema.
x: chest physiotherapy, antibiotics, pancreatic enzymes, vitamins, lung or pancreas transplant

CYSTIC FIBROSIS
Ndx:

-Ìmbalanced nutrition, less than body requirements r/t inability to digest fats
Ìneffective airway clearance r/t inability to clear mucus from the respiratory tract
Nursing Care
-Hi calorie, Hi CHON, moderate fat diet
-Nebulization and physiotherapy
-Frequent Position changes when in bed
-Oral care
-Adequate rest and comfort

Genitourinary Disorders
&rinary Tract Infection

-Females
-E coli
-Ascending infection
S/Sx:infants ÷ mimic GÌ d/o; dysuria, frequency, hematuria, low grade fever, abdominal pain
and bedwetting
Dx: urine culture
suprapubic any amount
clean catch > 100,000/ml
x: antibiotic, hydration

Acute GIomeruIonephritis
-Ìnflammation of glomeruli of kidney
Follows infection with streptococcus 10-14 days
5-10 yo
Males
S/sx: sudden onset of edema and hematuria ( urine is tea or cola colored), proteinuria,
hypertension
Dx: urinalysis and 24 hour urine
hypoalbuminemia
inc ESR, BUN, Creatinine, antistreptolysin O ( an inhibitor of streptolysin or grp A
hemolytic streptococci ÷ an inc. in the titer indicates a recent streptococcal infection)
x: semi fowlers, diuretics, antibiotics
O2
antihypertensives
Nsg Care:
quiet play activities
diet ÷ normal CHON, mod salt restriction, fluid restriction
daily weight and output

Nephrotic Syndrome
-Altered glomerular permeability (autoimmune); inc permeability to albumin
-3 yo
-Males syndrome
Nephrotic Syndrome
S/sx: proteinuria, edema - periorbital area, hypoalbuminemia, hyperlipidemia
Dx: urinalysis and 24 hr CHON, inc ESR
x: steroids, immunosupressant
NDx: Risk for decreased fluid volume r/t CHON and fluid loss
Ìmbalanced nutrition: less than BR r/t CHON and fluid loss
Nsg care:
-Adequate nutrition, proper diet ÷ decrease salt
-Weigh daily, monitor Ì and O
-Protect edematous areas
-Administer prescribed drugs
-Health teaching

WiIm's Tumor

-Malignant tumor of the kidney
-Associated with other anomalies
-6 mos-5 yo, peaks 3-4 yo
-Good prognosis
S/sx: abdominal mass, hematuria, low grade fever, anemia, wt loss
Dx: CT scan; Do not palpate
x: Nephrectomy, radiotherapy
avoid abdominal palpation

HematoIogic Disorders

Iron Deficiency Anemia

Ìnfant's iron supply 4-6 mos
Anemia ÷ 9-24 mos
S/sx: pallor, tachycardia, irritability, Hg < 9 g/dl, susceptible to infection
gmt: iron fortified formula, iron rich diet and vitamins
Nsg care: give iron w/ vit c, use w/ dropper at the back of the mouth, expect black stools,
provide iron rich food

HemophiIia A
Ìnherited interference w/ blood coagulation
Factor VÌÌÌ (8)
Sex linked recessive
S/sx: excessive bleeding
NB ÷ apparent ( circumcision)
Pre-school ÷ accidents/falls
School age ÷ bleeding between joints (hemarthroses
Adolescent ÷ ulcers, hematuria
x: factor VÌÌÌ transfusion
Hemophilia A
NDx: Acute pain R/t bleeding into joints
Nursing Care:
Promote safety
Watch out for bleeding ÷ rest area, ice compress, elevate body part
Monitor transfusion reaction
Passive ROM
Assist in gaining control of situation
NDx: Acute pain r/t bleeding into joints
HemophiIia B
-Christmas Factor
-Clotting Factor ÌX (9)
-ACUTE LYMPHOCYTÌC LEUKEMÌA ( ALL)
-Uncontrolled proliferation of WBC
-Lymphoblast ( immature lymphocytes )
-Most frequent CA in children
-2-16 yo
-Males

LEUKEIA

S/sx: pallor, low grade fever, lethargy, petechiae, bleeding, vomiting, anorexia, bone pain,
painless lymphadenopathy
Dx: WBC variable w/ blasts, low platelet and hematocrit, anemia
BMA > 25% blast cells

BONE ARROW AS!IRATION
LEUKEIA

x: chemotherapy
Cx: CNS s/sx, renal failure
NDx: Risk for infection r/t decreased immune function
Activity intolerance r/t reduced oxygen carrying capacity of blood

Nursing Care
!revent infection
-monitor bleeding and transfusion reactions
-Provide comfort and pain alleviation
-Health teaching
-Emotional and psychological support

NeuroIogicaI Disorders

Brain Tumor
-Second most common form of cancer in children
1-10 yo, peak 5 yo
-Usual location - brainstem or cerebellum
TY!ES:
Astrocytoma- glial tissue; 5-8 yo
Medulloblastoma ÷ cerebellum; 5-10 yo; cause compression of 4
th
ventricle; most common
Brain stem tumor ÷ support tissue of neural cells; paralysis of 5
th
-7
th
, 9
th
-10
th
CN
BRAIN TUOR
S/sx: headache, vision changes, vomiting, enlarging head circumference, papilledema,
lethargy, ataxia, nystagmus, personality changes, seizures, lethargy, coma
Dx: skull films, bone scan, CT scan, Lumbar puncture, MRÌ, angiography
x: surgery, chemotherapy




Benign FebriIe Seizure
- 6 mos - 5 years
- fever >/= 38.5C
-generalized tonic-clonic
-rarely persist > 10 minutes
!ostictaI stage
- 30-40 % recurrence
(+) family history


CONVULSION/SEIZURE
Tonic phase (10 secs)
eyes open. Elbows flexed. Arms pronated. Legs extended. Teeth clenched. Pupils
dilated. Breath held- cyanosis. Bowel or bladder control may be lost at the end of this phase
Clonic phase (1-2 min)
tremor gives way to violent generalized shaking. Eyes roll backwards and forwards.
Tongue may be bitten, tachycardia develops.
NURSING CARE
-Turn child to side & allow to drool
-Do not restrain
-Do not put anything in the mouth
-Dec temp
-Refer if:
sx persist
another sx occurs
delirious/difficult to rouse after sx

Status EpiIepticus

-Continual or recurrent seizures lasting 30 minutes or more with no return to normal
consciousness
-Support and maintenance of vital functions
-ÌV administration of diazepam (Valium) or lorazepam (Ativan)
-ÌV phenobarbital
-Monitor closely
-Safety

CerebraI !aIsy

-Damaged motor function d/t anoxic brain injury secondary to infection, perinatal asphyxia,
metabolic disorder
-Nonprogressive
TY!ES:
Spastic- most common (65%); hypertonicity
Athetoid/dyskinetic ÷ worm-like
Ataxic ÷ wide based gait w/ repetitive movement
Mixed - spastic and athetoid
S/sx: spasticity/rigidity, difficulty feeding, delayed speech and motor devt, mood swings,
impulsive, short attention span, irritable
Dx: Clinical
x: antispastics, antibiotics, surgery, nutrition, prevention of injury, PT
NDx: Risk for injury r/t neuromuscular impairment
-Self care deficit r/t neuromuscular impairment
- ensure safety, assist in ADL, ensure adequate nutrition, assist children achieve maximum
potential

HydrocephaIus

-CSF is formed in the first and second ventricles of the brain and then passes through between
the aqueduct of Sylvius and the fourth ventricle to empty into the subarachnoid space of the
spinal cord where it is absorbed.

Hydrocephalus
-Ìmpaired circulation and absorption of CSF
-Excess CSF in the ventricles or the subarachnoid space
2 TY!ES:
-Obstructive / Noncommunicating ÷ there is a block to passage of fluid ( ex: tumor) (
Ìntraventricular)
-Nonobstructive / Communicating ÷ fluid can reach the spinal cord ( extraventricular)

!athophysioIogy
-Congenital, acquired, or unknown etiology
-Obstructive- noncommunicating
(99%)
-Absorption -
communicating
HydrocephaIus
S/sx: head enlargement, anterior fontanel wide and bulging, scalp veins dilated, broad
forehead, sclera shows above iris ( sunset eyes ) , brisk tendon reflexes, spasticity, irritability,
lethargy, poor appetite, cracked pot sound on percussion
HYDROCE!HALUS
Ndx:
Risk for ineffective cerebral tissue perfusion related to increased intracranial pressure
- monitor vs, head circumference, Ì and O
- O2
- position flat or head 30 deg
- do not lie on operative site
HYDROCEPHALUS
Risk for imbalanced nutrition, less than body requirements, related to increased intracranial
pressure
- NPO until bowel sounds return
- position head w/o flexion
- observe for constipation
- note how child sucks
- ÌV fluids
- obtain daily weight
X:
V! shunt: Ventriculoperitoneal shunt
CX:
-Peritonitis
-Meningitis
-Brain abscess
Tx:
-Antibiotic therapy for infections
-Prognosis
-Ìf surgically treated with follow-up, 80% survival rate
-Highest incidence of mortality within 1
st
year of treatment
-Surviving children-1/2 have neurologic disabilities and 1/3 are normal

Spina Bifida
Collective term for all SC disorders
Spina Bifida Occulta ÷ posterior laminae fail to fuse
- dimpling, abnormal tufts of hair
Meningocoele - meninges herniate through unformed vertebrae; protrusion covered by a layer
of skin
- usually occurs in the lumbar region
- protrusion is covered by a skin layer or only the clear dura mater

S!INA BIFIDA

yeIomeningocoeIe ÷ SC and meninges protrude through the vertebrae defect
- absent motor and sensory function
- flaccidity, lack of sensation in LE
- loss of bowel and bladder control
- may be accompanied by hydrocephalus
Dx: sonography
S!INA BIFIDA
Risk for infection r/t rupture or bacterial invasion of the neural tube sac
- position side lying or prone
- keep sac moist
- place under radiant warmer
- post op - prone until site is healed
Risk for ineffective cerebral tissue perfusion r/t increased intracranial pressure
- measure head circumference
- assess for s/sx of inc ÌCP
S!INA BIFIDA
Risk for impaired skin integrity r/t required prone positioning
- reposition head every 2 hrs if w/ hydrocephalus
- change diapers frequently
Impaired physical mobility r/t neural tube d/o
- passive exercises
- may use leg braces, crutches
- inspect lower extremities and buttocks for irritation or possible infection
Risk for impaired elimination r/t neural tube d/o
- intermittent catheterization
- surgery
-Anomalies CNS
-Neural tube defect





S!INABIFIDA ( yeIodyspIasia )
failure of bony spine to close
spinabifida cystica ÷

Meningocele - sac filled with spinal fluid & meninges.( no neurological deficit )
Myelomeningocele - contain meninges , SF & nerve ( with neurological deficit), seen in
lumbosacral

gt : There is no cure for nerve damage due to spina bifida ; Surgery performed within 24
hours after birth to minimize the risk of infection and to preserve existing function in the spinal
cord.
NI : prevent trauma
prevent complication
provide adequate nutrition
provide sensory stimulation
emotional support

Atopic Dermatitis

-2 mos-3 yo
-R/t food allergy
S/sx: papular and vesicular skin eruptions w/ erythema, pruritus, dry,flaky scales upon healing
x: reduce allergen, topical steroids
NDx: Ìmpaired skin integrity r/t eczematous lesion
Nsg care: Reduce allergen
Prevent skin dryness and pruritus

ATO!IC DERATITIS
NURSING ANAGEENT

EDS: ANTÌHÌSTAMÌNES, ANTÌPRURÌTÌCS, STEROÌDAL CREAMS
-Minimize the risk of infection
-Promote skin integrity
-Family Health teaching
-Cotton fabrics, use mild detergents
-Daily baths to hydrate the skin
-Use topical moisturizers
-Protein Energy Malnutrition

arasmus
-Low calorie, low CHON
-0-2 yo
-(-) edema
-"all skin and bone¨
-(+) growth retardation
-Apathetic, quiet
-Good appetite
-Ìnfrequent skin/hair changes
-Anemia uncommon


Kwashiorkor

-Low CHON
-1-3 yo
-(+) edema
-Wasting variable
-Growth retardation variable
-Ìrritable, moaning
-Poor appetite
-(+) skin and hair changes
(+) anemia

!oisoning
-Usually 2-3 yo
-Soap, cosmetics, detergents, drugs
-Males>females ÷ children
-Females>males ÷ adolescent

: x

1.Determine age wt, type of poison swallowed, time of ingestion, route of poisoning, amount
ingested, present condition of child
2.Use syrup of ipecac to induce vomiting except:
corrosive, hydrocarbon, px is comatose
3. Activated charcoal then syrup of ipecac
4. Monitor VS
5. refer to hospital/poison control center

!OISONING
Acetylsalycilic acid (Aspirin)
S/sx: nausea, vomiting, fever, profuse sweating, flushing, hyperthermia, hyperventilation,
convulsions, coma
x: stabilize airway and breathing
-Fluid and electrolyte replacement
-Activated charcoal
-Alkalinization of urine
-hemodialysis

Down's Syndrome
Trisomy
Maternal age >35 yo, paternal age >55
Features: nose is broad and flat, eyelid have an extra fold of tissue at the inner canthus,
palpebral fissure slants upwards, white specks in iris, tongue protrudes, back of the head is flat,
neck is short, extra fat pad, low set ears, poor muscle tone, short thick fingers, simian crease,
cognitively challenged
DOWN'S SYNDROME
-Poor immune function
-Congenital heart diseases ÷ Ventricular Septal Defect
-Cataract
x: early education and play opportunities

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