By: Daryl Joel C. Dumdum, RN

Growth and Development
‡ Growth
± Increase in size of a structure.

‡ Development
± Maturation of structures

‡ Cephalocaudal
± Head to Toe

‡ Proximo-Distal
± Trunk to Peripheries

‡ Phylogeny
± Development or evolution of a species or group

‡ Ontogeny
± Development of an individual within a species

Rates of Development
‡ Fast Growth Periods

‡ Slow Growth Periods

± The Head and neurologic tissue grow faster than other tissues

± The trunk grows more rapidly than other tissues

‡ The limbs Grow most during School age periods ‡ The trunk grows faster than other tissue during adolescence

LATENCY STAGE 12 and Above .GENITAL SAGE .Theorists Sigmund Freud ( Psychosexual Theory) 0-1 .ORAL STAGE 1-3 .ANAL STAGE 3-6 .PHALLIC STAGE 6-12.

ERIK ERIKSON (PSYCHOSOCIAL) ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ 0-1 INFANCY 1-3 TODDLER 3-6 PRESCHOOL 6-12 SCHOOL AGE 12-18 ADOLESCENT 18-35 Early Adult 35-60 Middle Adult 60 and above Late Adult ‡ ‡ ‡ ‡ ‡ Trust vs mistrust Autonomy vs shame Initiative vs guilt Industry vs inferiority Identity vs role confusion ‡ Intimacy vs Isolation ‡ Generativity vs stagnation ‡ Ego Integrity vs Despair .

repetition of acts ‡ 2-4 Preconceptual ± Egocentrism.Jean Piaget (COGNITIVE) ‡ 0-2 Sensorimotor ± Reflexes. magical thinking ‡ 4-7 intuitive/ preoperational ± Cause and effect ‡ 7-11 Concrete operations ‡ 11-15 Formal Operations ± Reality & Abstract thought . use of symbols.

language. and personalsocial development from newborn to 6 yrs ± Does not measure intelligence ‡ Growth Parameters ± Bone Age: x-ray of tarsals and carpals ± Growth charts . fine motor.MEASUREMENT TOOLS ‡ Chronological Age -Assessment of developmental tasks related to birth date ‡ Mental age-assessment of cognitive development ± IQ ‡ Denver Developmental age ± Generalized assessment tool. Measures gross motor.

grows 1 inch monthly for the first 6months ‡ Head Growth: equal to or slightly larger than the chest. Increases by ½ inch monthly for the first 6moths ‡ Brain Growth: Increase in size about 2/3 adult size at 1year and 90% adult size at 2 years .Neonate Birth to 1 month ‡ Weight increases weekly by 5-7oz (142198g)for first 6 months ‡ Length.

Neonate Birth to 1 month ‡ ‡ ‡ ‡ ‡ Behavior is reflex controlled Flexed extremities Can lift head slightly off bed when in prone Hearing and touch are well developed at birth Sight not fully developed until 6 years ± Differentiate darkness from light at birth ± Rapidly develops clarity of vision within 1 foot ± Fixates on moving objects .

Neonate Birth to 1 month ‡ Cries to express displeasure ‡ Smiles indiscriminately ‡ Receives gratification through sucking ‡ Makes throaty sounds .

1-4 months ‡ Posterior fontanel closes ‡ Moro Reflex and Tonic neck reflex begins to fade ‡ Gains Head control: Balances head in sitting position ‡ Rolls from back to side ‡ Begins voluntary hand-mouth activity ‡ Begins to be able to coordinate stimuli from various sense organs ‡ Hearing: locates sound by turning and visually searching .

vocalizes when smiling .1-4 months ‡ ‡ ‡ ‡ ‡ Vision: beginning hand eye coordination Prefers human face Follows objects at 180° Accommodation is equal to adult Crying becomes differentiated at 1 month ± Decreased during awake periods ± Ceases when parent is in view ‡ Vocalization distinct from crying at 1 month ± Squeals to show pleasure at 3 moths ± Coos. laughs. babbles.

musical toys. different sizes and textures ± Hang mobiles within 8-10 inches of infant¶s face ± Expose to various environmental sounds. .SOLITARY PLAY ‡ BIRTH to 4 months ± Provide variety of brightly colored objects. use rattles.

5-6 months ‡ Birth weight doubles at 6 months ‡ Eruption of teeth begins ± Lower incisor first ± Causes increased saliva and drooling ± Enzyme released during teething causes diarrhea. facial skin irritation ± Slight fever ‡ ‡ ‡ ‡ ‡ Intentional rolling over Supports weight on arms Creeping Can grasp and let go voluntarily Transfers toys from one hand to another .

biting and taste preference begin to develop ‡ Vocalization: begins to imitate sounds ‡ Socialization: recognizes parents.5-6 months ‡ Sits with support ‡ Hearing: can localize sounds above and below the ear ‡ Vision: smiles at own mirror image and responds to facial expressions of others ‡ Taste: sucking needs have decreased and cup weaning can begin. chewing. stranger anxiety begins to develop .

5-6 months ‡ SOLITARY PLAY ± Provide brightly colored toys to hold and squeeze ± Allow infant to splash in bath ± Provide crib mirror ‡ Begins to imitate ‡ Can find partially hidden objects .

goes from prone to sitting position ‡ Crawls ‡ Pulls self to standing position ‡ Develops finger-thumb opposition (pincer grasp) ‡ Preference for dominant hand evident ‡ Can fixate on small objects ‡ Beginning to develop depth perception .7-9 months ‡ Teething continues ± 7 months: upper central incisor ± 9 months: upper lateral incisor ‡ Sits unsupported.

cries when scolded ‡ Imitates simple acts and noises ‡ Responds to simple commands ‡ Vocalization: verbalizes all vowels and most consonants ‡ Socialization: increased stranger anxiety and anxiety over separation from parent ‡ Exhibits aggressiveness by biting at times ‡ Understands the word ³NO´ .7-9 months ‡ Begins to understand object permanence. searches for dropped objects ‡ Reacts to adult anger.

1010-12 months ‡ ‡ ‡ ‡ Birth weight triples Length: 50% increase over birth length Head and chest circumference equal Teething ± Lower lateral incisors erupt ± Average of 8 deciduous teeth ‡ ‡ ‡ ‡ ‡ Creeps with abdomen off floor Walks with help or cruises May attempt stand alone Can sit down from upright position Weans from bottle to cup .

1010-12 months ‡ Able to discriminate simple geometric forms ‡ Able to follow rapidly moving objects ‡ Vocalization: imitates animal sounds. peek-a-boo ‡ Shows emotions such as jealousy. affection. anger. can say 4-5 words but understands many more (ma. fear ‡ Recognizes objects by name ‡ Looks and follows pictures in book ‡ Shows more goal-directed actions . da) ‡ Socialization: begins to explore surroundings ‡ Play games such as pat-a-cake.

1-3 years ‡ Slow growth ‡ Primary dentition (20 teeth) completed by 2 ½ years ‡ Develops sphincter control necessary for bowel and bladder control ‡ Walks alone by 18 months ‡ Climbs stairs and furniture by 18 months ‡ Runs fairly well by 2 years ‡ Jumps from chair or step by 2 ½ years ‡ Balances on one foot ‡ Rides tricycle .

3-5 years ‡ Permanent teeth may appear late in preschool ± Molars behind last temporary teeth ‡ Walks upstairs with alternating feet by 3 yrs ‡ Walks downstairs using alternate feet by 4 years ‡ Stands on 1 foot by 3 years ‡ Hops on 1 foot by 4 yrs .

print letters and numbers at 5 ‡ Handles scissors well at 5 years old. traces a diamond by 4 yrs Copies a diamond and triangle . ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ .3-5 years Skips and hops on alternate feet by 5 years Balances on 1 foot with eyes closed by 5 years Throws and catches ball by 5 years Jumps off 1 step by 3 years Jumps rope by 5 years Hands dominance is established by 5 years Builds a tower of blocks by 3 years Ties shoes at 5 Copies a circle by 3 yrs Copies squares.

develops greater strength ‡ Develops smoothness and speed in fine motor control .6-12 years ‡ Slow growth continues ‡ Dentition ± Loses first primary teeth at about 6 years ± By 12 years has all permanent teeth except final molars ‡ Vision completely mature ‡ Gross motor skills: children are very energetic.

12 yrs old ± Girls ‡ Increase in size of breast & genitalia ‡ Appearance of axillary & pubic hair ‡ Menarche ± Boys ‡ Deepening of voice ‡ Development of muscle ‡ Increase in size of penis & testes ‡ Production of viable sperm .

continuation of competitive play ± Fear .1212-18 ‡ Adolescence ± Play .of replacement from friends .of acne ± Significant Development ‡ They have distinctive odor .of death .of obesity .

‡ Nocturnal emission/ wet dreams are present ‡ Sperm is viable by the age of 17 ‡ Testes & scrotum increases at age 17 ‡ Breast & female genitalia increases until the age of 18 ± Characteristics ‡ Idealistic ‡ Rebellions ‡ Performance ‡ Conscious of body image .

‡ Adventure some ‡ Smoking ‡ Alcoholism ‡ Drug addiction ‡ Premarital sex .

do not lie about whether something will hurt Do not make a promise you know you cant make Do not threaten. if necessary.Interventions for the ill or hospitalized Child ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Speak in quiet. pleasant tones Use words appropriate to age Do not explain more than necessary Always explain what you are going to do and its purpose Be honest. punish the act not the child Never shame the child by using terms like baby or sissy .

Interventions for the ill or hospitalized Child ‡ Involve parents in child care ‡ Promote independence ‡ Allow choices where possible. encourage them to bring in a favorite toy. pictures of family members. or to make a tape to be played for the child . but do not use yes/no questions unless you can accept a ³no ³ answer ‡ Teach parents to anticipate next stage of development ‡ If parents cannot stay with the child.

sublimate sensations. enhance fine and gross motor development as well as social development ± Make play appropriate for mental age and physical disease ± Use multisensory stimulation .Interventions for the ill or hospitalized Child ‡ PLAY ± Is a way to solve problems. decreases stress in the environment. becomes enculturated. express creativity. prepare for different situations.

Interventions for the ill or hospitalized Child ‡ Provide toys safe for mental age ‡ Offer play specific to age groups ± Infants and Toddler: enjoys repetition. Associative play ± School age: likes groups. group goals with interaction . organized activities (to enhance sharing) cooperative play. solitary play. parallel play ± Preschooler: likes to role play and make believe play.

uncooperativeness. or acting out . but needs to be prepared as well ‡ Inadequate preparation results in heightened anxiety that may result in regressive behavior.Preparation for procedures ‡ Allow the child to play with the equipments to be used but provide safety ‡ Demonstrate procedure first on a doll ‡ Teach the child skills that will be needed after the procedure and provide time for practice ‡ Desensitize the child ‡ Describe sensations to be felt by the child postprocedure ‡ Parents can often be helpful in preparing the child for the procedure.

Failure to Thrive (FTT)
‡ A condition in which a child fails to gain weight and is persistently less than the 5th percentile on growth charts ‡ When related to inorganic cause it is usually due to disrupted maternal - child relationship ‡ Other pathology especially absorption and hormonal dysfunctions must be ruled out first before a diagnosis of FTT can be obtained

Failure to Thrive (FTT)
‡ Growth and development delay usually improve with appropriate stimulation ‡ S/S
± Sleep disturbances: voluntary regurgitation and reswallowing ± History of parental isolation and social crisis with inadequate support systems ± Delayed growth and development ± Disturbed maternal and- infant interaction

Failure to Thrive (FTT)
‡ Nursing Interventions: ± Provide consistent care ± Teach parents positive feeding techniques. ± Maintain face to face posture with the child ± Talk to child encouragingly during feeding ± Involve parents in care ‡ Provide supportive environment ‡ Give positive feedback ‡ Demonstrate and reinforce responding to child¶s cues

emotional. may result from intentional and nonaccidental actions or may be from intentional and nonaccidental acts of omission (neglect) ‡ In sexual abuse 80% of children know their abuser ‡ Adults who abuse are more likely victims of abuse also ‡ Only 10 % of abusers have serious psychologic disturbance.Child Abuse ‡ Physical. little confidence and low tolerance to frustrations . but most have low self-esteem. or sexual abuse of children.

lacerations) .Child Abuse ‡ Abuse is most common among toddlers as they exercise autonomy and parents may sense loss of power ‡ Assessment findings: ± No history to explain injury ± Delay in seeking medical attention ± History changes with repetition ± Injury not consistent with injury ± Skin injuries (bruises. burns.

ruptured spleen ± Observation of parents and child may reveal interactional problem . retinal hemorrhage ± Abdominal Injuries may include lacerated liver.Child Abuse ± Injury may show outline of instruments use and may be in varying stages of healing ± Musculoskeletal injuries. ± CNS injuries like subdural hematoma. sprains. dislocations. fractures.

and home situation ± Provide education ± Initiate referrals for long term follow-up (community agencies. hospitalization. pediatric and mental heath clinics) .Child Abuse ‡ NURSING INTERVENTIONS: ± Attend to physical needs of the child first ± Report suspected child abuse to appropriate agency ± Encourage parents to express feelings concerning abuse.

90% by 6 months ‡ Usually occurs during sleep. cannot be prevented ‡ Peak age: 3 months . there is no struggle and death is silent ‡ Diagnosis made at autopsy .SIDS (Sudden Infant Death Syndrome) ‡ Sudden death of any young child that is unexpected by history and in which thorough postmortem examination fails to demonstrate adequate cause of death ‡ Cannot be predicted.

SIDS (Sudden Infant Death Syndrome) ‡ Although cause is unknown. chronic hypoxemia and apnea are suggested factors ‡ ASSESSMENT: ± Incidence higher in preterm infants. or other neurologic symptoms at higher risk . feeding. low birth weight infants ± Infants with abnormalities in respiration. twins or triplets.

also cold) ± Let parents say goodbye to the baby (hold.SIDS (Sudden Infant Death Syndrome) ‡ NURSING INTERVENTIONS: ± Nursing care is directed at supporting parents/family ± Provide a room for the family to be alone if possible. Stay with them. prepare them for how infant will look and feel ( baby will be bruised and blanched due to pooling of blood until death was discovered. rock) .

clergy. . significant others ± Explain how parents can receive autopsy results ± Notify Family physician or pediatrician.SIDS (Sudden Infant Death Syndrome) ± Reinforce that death was not their fault ± Provide appropriate support referrals.

Death and Dying ‡ Parental Response ± Major life stress event ± Initially parents experience grief in response to potential loss of child ± Responses might include shock and disbelief. guilt. denial. and depression ± May have long term disruptive effects on family system ‡ Stress may result to divorce ‡ Behavioral problems .

a type of sleep or separation .Death and Dying ‡ Child¶s Response ± Child concepts to death depends on mental age ± Infants and toddler ‡ Live only in present ‡ Are concerned only with separation from mother and being alone and abandoned ± Preschooler ‡ See death as temporary.

causality. and irreversibility (but still questions it) ± Adolescents ‡ Are thinking about the future and knowing that they can not participate ‡ May express anger at impending death ‡ May find it difficult to talk about death ‡ May wish to plan own funeral ‡ May wish to write something for friends and family .Death and Dying ± School age ‡ Have a concept of time.

NURSING IMPLICATIONS ‡ Communicating with dying child ± Use the child's own language ± Do not use euphemisms ± Do not expect an immediate response ± Never give up hope ± Do not leave the child ± Do not whisper in the room ± Touch is therapeutic ± Continue reading favorite stories of the child ± Lat parents participate .

which one requires further evaluation? 1. A 4 year old who talks to an imaginary playmate 3. A 9 yr old with enuresis 4. A 16 yr old who had nocturnal emissions .Who ha! ‡ The nurse has assessed four children of varying ages. a 7-month old who is afraid of strangers 2.

The nurse µs response should be based on which of the following understanding of the child¶s behavior? 1. 4. ³will you take care of me when I am dead the way you do now?´ The childs mother asks the nurse how to respond. 2. 3. The child is denying that he has a terminal problem The child may be hallucinating Children of this stage do not understand the finality of death Most 5 yr old children have a great fear of mutilation .All right! ‡ The nurse is caring for a 5 year old child who has leukemia and is now out of remission and not expected to survive. The child says to his mother.

4.Grabeh na to! ‡ When Child abuse is suspected. Have a number of scars Have identifiable shapes Display an erratic pattern Be on one side of the body . the nurse knows that abusive burns will 1. 3. 2.

I put all medicines on the highest shelf in the kitchen 3. My husbund put the gates up at the top and bottom of the stairs .Todo na talaga! ‡ The Nurse is talking with a mother of a one year-old child in a well baby clinic. I have some syrup of ipecac at home in case my child ever needs it 2. We have moved all the valuable vases and figurines out of the family room 4. Which statement the mother makes indicates a need for more instruction in keeping the child safe? 1.

Allergy to eggs Immunosuppression Congenital defects Mental Retardation .YEYE! BONEL! ‡ The presence of what condition would necessitate a change in the standard immunization schedule for a child? 1. 4. 2. 3.

± Examples: ‡ Huntington¶s chorea ‡ Myotonic muscular dystrophy ‡ Night blindness ± Genetic Counselling: 50% chance with each pregnancy that the child will have the disease or disorder .Common Pediatric Disorders ‡ Autosomal Dominant ± Allele responsible for the disease is dominant ± Only one parent needs to pass on the gene.

Common Pediatric Disorders ‡ Autosomal Recessive ± Allele responsible for disease will not result ihn expression if the other allele in the pair is dominant ± Both parents must pass on the genes ± Examples: ‡ ‡ ‡ ‡ ‡ Cystic fibrosis PKU Sicke cell anemia Albinism Tay.Sachs .

‡ 25% chance with each pregnancy of having a child will neither have the disease nor be a carrier. .Common Pediatric Disorders ± Genetic Counselling: ‡ 25% chance with each pregnancy of haing a child with the disorder ‡ 50% chance with each pregnancy of having a child who is a carrier of the disease but will not manifest the symptoms.

‡ Sex .linked ( X-linked) Inheritance ±Inheritance of characteristics located on X and Y chromosomes ±Examples: ‡Color blindness ‡Baldness ‡Hemophillia A and B ±Genetic Counselling ‡If a woman is a carrier and her partner does not have the disorder ± 50% chance that her son will have the disorder .

all his daughters will be carriers but none will manifest the disease.±50% chance her daugther will become a carrier ±If a man has a sex-linked disorder. .

normal. broad flat nose ‡ Small mouth.size protruding tongue ‡ Low Set ears ± Extremities ‡ Short Thick Fingers and hands . flat facial profile.Chormosome Disorders ‡ Down Syndrome ± Caused by an extra chromosome 21 ( total of 47) ‡ Assessment Findings ± Head and Face ‡ Small head.

Chormosome Disorders ± Simian creases ( Single crease along palms) ± Muscle weakness. lax joints ‡ Associated anomalies and disorders ± Congenital heart defects ± GI structural defects ± Increase incidence of leukemia ± Increased Incidence of Respiratory infection ± Visual defects ‡ Mental Retardation .

Chormosome Disorders ‡ Nursing Interventions ± Provide parent education concerning ‡ Increased susceptibility to respiratory infection ‡ Nutritional Needs ‡ Medication Administration if necessary ± Promote developmental progress ± Provide genetic counselling .

Fluid And Electrolyte. Acid Base Balance ‡ Dehydration ± Isotonic Dehydration ‡ Water and electrolytes loss are proportionate ± Hypotonic dehydration ‡ Electrolytes deficit exceeds water loss ± Hypertonic Dehydration ‡ Water loss exceeds electrolyte loss .

etc ‡ Leads to metabolic acidosis ‡ Also causes loss of bicarbonate and potassium . malabsorption.Diarrhea ‡ A change in consistency and frequency of stools ‡ Caused by bacteria and viruses. inflammation. parasites. poisons. allergies.

decreased tears and saliva. Depressed anterior fontanel ± Increased Pulse Rate and decreased BP ± Sunken Eyes ± High pitched cry . dry skin with poor turgor ± In children less than 18 mos. dry mucous membranes.Diarrhea ‡ Signs/ Symptoms ± Frequent stools with abdominal cramping ± Decreased urine output.

Diarrhea ‡ Nursing Interventions ± NPO to rest bowel if ordered ± Administer IV Fluids as ordered ± Resume Oral feeding slowly ± Provide skin care ± Monitor lab results ± Isolation if infectious ± Anti .diarrheal drugs .

often with burping) ‡ If prolonged may result in metabolic alkalosis or aspiration ‡ Nursing Interventions: ± Treat the underlying cause ± Hydration ± Assess amount of vomitus.Vomiting ‡ Differs from spitting up (dribbling of undigested formula. frequency. and nature .

Vomiting ± Prevent complications ± Administer anti-emetic Medications ‡ Trimethobenzamine HCl ( Tigan) ‡ Promethazine HCl (Phenargan) .

Nuerologic Disorder .

trauma. or obstruction by thick arachnoid membrane or meninges . neoplasm. or hematoma ± COMMUNICATING/CONGENITAL ‡ inadequate absorption of cerebrospinal fluid (CSF) resulting from infection.HYDROCEPHALUS ‡ Increased amount of CSF within the ventricles of the brain ‡ May be caused by obstruction of CSF flow or by overproduction or inadequate reabsorption of CSF ‡ Classification ± NONCOMMUNICATING/OBSTRUCTIVE ‡ obstruction within the ventricles such as congenital malformation.

Increased intracranial pressure: projectile vomiting not associated with feeding. anorexia. seizures ‡ 6. especially important after 4 to 6 months ‡ 5. and papilledema of retina ‡ 4. "Sunset" eyes (sclera visible above iris). irritability. Increasing head size in the infant because of open sutures and bulging fontanels ‡ 2. Head lag. causing necrosis . bulging eyes. Prominent scalp veins and taut. shiny skin ‡ 3. high shrill cry. Damage to the brain because increased pressure decreases blood flow to the cells.Clinical findings ‡ 1.

Relief of hydrocephalus ± a.Therapeutic interventions ‡ 1. revised as necessary ‡ 2. Treatment of complications ‡ 3. Mechanical shunting of fluid to another area of the body-ventricular peritoneal shunt: catheter passed subcutaneously to the peritoneal cavity. Removal of the obstruction if that is the cause ± b. Management of problems related to effect on psychomotor problems .

Risk for skin breakdown related to immobility . Assessment ‡ 1. Signs of increased intracranial pressure B. Risk for injury related to increased intracranial pressure ‡ 4. Altered family process related to having a seriously ill child ‡ 2. Head circumference/fontanels ‡ 2. Analysis/Nursing Diagnoses ‡ 1. Risk for infection related to shunt ‡ 3.Nursing Care of Infants and Children with Hydrocephalus A.

Carefully observe neurologic signs ± b. Check the valve frequently for patency . Observe shunt site (abdominal site in peritoneal procedure) for infection ‡ 2. which can mask symptoms ± d. Monitor for increasing intracranial pressure ± a. Measure head circumference ± c. and damage to spinal cord ± a. Place the infant in a Fowler's position to facilitate draining of fluid. infection. infant should be positioned flat postoperatively with no pressure on shunted side ± b. When holding the infant. Prevent breakdown of scalp. Use minimal sedatives or analgesics.Planning/Implementation ‡ 1. support the neck and head ± c.

Promote adequate nutrition ± a. irritability. hold infant if possible ± c. lethargy. Observe for signs of dehydration 4. Keep eyes moist and free of irritation if eyelids incompletely cover corneas . and anorexia. because these will decrease the intake of nutrients ± b. Perform all care before feeding to prevent vomiting. Monitor for vomiting.

Support parents ± (1) Continued shunt revisions are usually necessary as growth occurs ± (2) Usually very concerned about developmental delay ‡ c. with minimal handling to prevent damage to shunt ‡ b. if indicated. Postoperative nursing care: similar to that for cardiac surgery with the addition of: ‡ a. to maintain patency ± (2) Signs of increasing intracranial pressure and infection ± (3) Evidence of dehydration .5. Place the infant or child on bed rest after surgery. Observe for brain damage by recording milestones during infancy ‡ d. Teach parents ± (1) Pumping of the shunt.

MENINGOCELE 2. Failure of posterior vertebral arches to fuse during embryonic development 2. 85%= lower thoracic lumber or sacral area. 15% = upper thoracic & cervical regions TYPES 1. Causes: idiopathic.2. viral. SPINA BIFIDA OCCULTA 2. radiation. SPINA BIFIDA CYSTICA 2. environmental factors 3.1.SPINA BIFIDA 1. MYELOMENINGOCELE . sibling with neural tube defect.


Examine the defect for size. tissue covering & CSF leakage 2. SURGERY: CLOSURE OF SAC. Motor/sensory involvement 3. Bowel & bladder function: NEUROGENIC BLADDER . DRUG THERAPY: Antibiotics 3. ORTHOPEDIC PROCEDURES 2. Immobilization ASSESSMENT FINDINGS 1.SPINA BIFIDA ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ MEDICAL MANAGEMENT 1. SHUNT. level.

neurogenic bladder. positioning. Prevent trauma to the sac: covering. antibiotics ) 2. immobilization ) . PRENATAL: ALPHAFETOPROTEIN NURSING INTERVENTIONS 1.SPINA BIFIDA DIAGNOSTIC TEST 1. keeping dryness. Prevent complications ( hydrocephalus.

2. 2. POST NATAL: kernicterus or head trauma . precipitate delivery.1. PERINATAL: drugs at delivery.CEREBRAL PALSY 1. PRENATAL: genetic.3. Causes 3. breech deliveries with delay 2.Neuromuscular disorders resulting from damage to or altered structure of the part of the brain responsible for motor function 2. trauma or anoxia to mother 2. fetal distress.

skeletal muscle relaxants. Surgery ASSESSMENT FINDINGS ± ± ± ± ± Spasticity Athetosis Ataxia Tremors Rigidity . PT/OT 3. Speech/audiology therapy 4.CEREBRAL PALSY MEDICAL MANAGEMENT 1. local nerve blocks 2. DRUG therapy: anti-anxiety.

Defective speech touch. padded crib ) 5. Assist in ADL.CEREBRAL PALSY ASSOCIATED PROBLEMS a. Limit stimulation 3. Disturbances of body image. demonstration of procedure is essential 4. Obtain a careful pregnancy. Provide a safe environment ( safety helmet. Mental retardation b. Dental anomalies e. and childhood history 2. h. Visual disabilities g. Orthopedic problems f. PT . perception d. Hearing loss c. birth. Feelings of worthlessness NURSING INTERVENTIONS 1.

‡ A. Most common CNS infection of infants and children ‡ B. Inflammation of the meninges by viral or bacteria that travel via the cerebrospinal fluid

Classification: culture of cerebrospinal fluid used to help identify organism ‡ 1. Bacterial: caused by pus-forming bacteria, especially meningococcus, pneumococcus, and influenza bacillus ‡ 2. Tuberculous: caused by tubercle bacillus ‡ 3. Viral or aseptic: caused by a wide variety of viral agents

Clinical findings ‡ 1. Opisthotonos: rigidity and hyperextension of the neck ‡ 2. Headache ‡ 3. Irritability and high-pitched cry ‡ 4. Signs of increased intracranial pressure ‡ 5. Fever, nausea, and vomiting ‡ 6. Meningococcal meningitis: petechiae and purpuric skin rash Therapeutic intervention - massive doses of intravenous antibiotics

Vomiting ‡ 4. Assessment ‡ 1. Seizures ‡ 5. irritability ‡ 3. Fever ‡ 2. Nuchal rigidity .Nursing Care of Infants and Children with Meningitis A. Headache.

B. Risk for injury related to presence of infection . Analysis/Nursing Diagnoses ‡ 1. Altered family processes related to having a child with a serious illness ‡ 2. Risk for infection related to presence of infective organisms ‡ 3.

Record intake and output carefully b. Daily weights ‡ 6. since child usually becomes ill suddenly ‡ 7. Planning/Implementation ‡ 1. Provide for rest ‡ 2. Correct any deficits c. Monitor IV fluid d. Observe for complications such as septic shock and circulatory collapse . Position on the side with head gently supported in extension ‡ 4.C. Decrease stimuli from the environment (control light and noise) ‡ 3. Maintain fluid balance because of meningeal edema a. Administer antibiotic therapy as prescribed ‡ 8. Provide emotional support for parents. Institute respiratory isolation ‡ 5.

Family verbalizes fears regarding child's prognosis . Evaluation/Outcomes ‡ 1.D. Child shows decreasing severity of illness ‡ 2.

CardioVascular Disorder .

CONGENITAL HEART DEFECTS ‡ Acyanotic Heart Defects ± Oxygenated blood is shunted from the systemic to pulmonary circulation ( left to right shunt) and blood leaving the aorta is completely oxygenated ‡ Cyanotic Heart Defects ± Unoxygenated blood is shunted from the right to the left side of the heart where it mixes with oxygenated blood .

causing a left . causing a left to right shunt ‡ Ventricular Septal Defect (VSD) ± Opening in the septum between ventricles.right shunt ‡ Patent Ductus Arteriosus (PDA): Failure to close at birth .to .Acyanotic Heart Defects ‡ Atrial Septal Defect ( ASD ) ± Abnormal opening in the septum between left and right atria.

Acyanotic Heart Defects ‡ Coarctation of the Aorta ± Narrowing of the Aorta usually just beyond the left subclavian artery ‡ Pulmonary Stenosis ‡ Aortic Stenosis ‡ Endocardial Cushion defects .

ATRIAL SEPTAL DEFECT ‡ Four types ± Ostium secundum defect ± Ostium primum defect ± Sinus venosus defect ± Coronary sinus septal defect .

an apical holosystolic or late systolic murmur often is heard radiating to the axilla.Manifestations ‡ prominent right ventricular cardiac impulse ‡ palpable pulmonary artery pulsations ‡ Mitral valve prolapse ± In patients with mitral valve prolapse. .

Management ‡ Cardiac catheterization ‡ surgical closure NURSING: Oxygenation Emotional Support Education .

may occur as a primary anomaly with or without additional major associated cardiac defects ‡ VSD is a developmental defect of the interventricular septum whereby a communication exists between the cavities of the two ventricles. . which is a hole between the 2 lower chambers of the heart.Ventricular Septal Defect ‡ A ventricular septal defect (VSD).


which is well localized at the left sternal border. or edema ± Mildly hyperactive precordial impulse ± Second heart sound (S2): S2 may be obscured entirely by the holosystolic murmur. hepatomegaly.Manifestations ‡ Infants with small defects ± Normal vital signs ± Clear lungs ± Absence of jugular venous distension (JVD). .

it occurs in 100% of patients by age 40 years and contributes to cause of death. .May be present Squatting in 15% of patients ‡ Hemoptysis: Hemoptysis occurs in 33% of patients (never in patients <24 y). palpable.Manifestations ‡ Infants with large VSDs ± ± ± ± ± ± ± ± Cyanosis Clubbing Erythrocytosis Prominent RV lift. revealed on palpation Very short or no systolic murmur S2 .Loud. maximal in xiphoid region. or closely split S3 of right ventricular origin . single.

Management ± Furosemide in a dosage of 1-3 mg/kg/d in 2 or 3 divided doses is used. Increase the caloric density of the feedings.1-0. ± Digoxin in a dosage of 5-10 mcg/kg/d may be indicated if diuresis and afterload reduction do not relieve symptoms adequately . Long-term furosemide treatment results in hypercalcemia and renal damage and electrolyte disturbances. ± Captopril in a dosage of 0.3 mg/kg 3 times daily can be useful to reduce systemic afterload.

Patent Ductus Arteriosus ‡ The ductus arteriosus is normally patent during fetal life. This occurs by abrupt contraction of the muscular wall of the ductus arteriosus. ‡ Normally. Prostaglandin antagonism. This patency is promoted by continual production of prostaglandin E2 (PGE2) by the ductus. This can be associated with severe fetal cardiovascular compromise. functional closure of the ductus arteriosus occurs by about 15 hours of life in healthy infants born at term. which is associated with increases in the partial pressure of oxygen (PO2) coincident with the first breath. such as maternal use of nonsteroidal anti-inflammatory medications. can cause fetal closure of the ductus arteriosus. .

The second heart sound (S2) often is obscured by the murmur ‡ MANAGEMENT ± Surgical ligation . A thrill may be present in the suprasternal notch or in the left infraclavicular region. ± The first heart sound (S1) is typically normal.Manifestations ± The apical impulse is laterally displaced.

Cyanotic Heart Defects ‡ Tetralogy of fallot ± Pulmonary stenosis ± Coarctation of the Aorta ± Ventricular Septal Defect ± Right Ventricular Hypertrophy ‡ Symptoms Depends on the degree of pulmonary stenosis .

6. risk for blood clots. poor growth. Meet needs quickly a.3. Use soft nipple for feeding a.3. Organize care a.3. Don¶t interfere when squatting a.5. Provide careful skin care a. squatting.Cyanotic Heart Defects ASSESSMENT S/SX= CYANOSIS.4. Administer oxygen a. NURSING INTERVENTIONS a.1.3.3. Antibiotic prophylaxis . Polycythemia.3. CHF( LEFT SIDE ) A. clubbing of digits.2.


RHD ‡ Caused by GABHS ‡ Signs and symptoms ± Fever ± Migratory poly arthritis ± Malnourished ‡ Treatment: ± Aspirin ± Sumapen ± Supportive .

Disorder of the Hematologic System .

ANALGESIC/NARCOTICS( avoid aspirin ). Hydration b. Exchange/blood transfusion b. Drug therapy: UREA. Bed rest b.2. initially fetal hemoglobin prevents sickling MEDICAL MANAGEMENT b. Surgery . Autosomal disorder affecting hemoglobin B.4.1.5.SICKLE CELL ANEMIA ‡ ‡ A. ANTIBIOTICS b.3. Defective hemoglobin causes red blood cells to become sickle shaped and clump together under reduced oxygen tension.

Kidneys ( infarts. Bones ( osteoporosis ) 5. Heart ( Heart failure = hemosiderosis ) 8. Abdomen ( first sign: colic ) 2. Genitals (impotence) .SICKLE CELL ANEMIA ASSESSMENT FINDINGS 1. Lower extremities ( hand-foot syndrome. enuresis ) 7. ulcers) 3. Nervous system ( CVA ) 6. Spleen ( splenomegaly ) 4.

Vasoocclusive crisis (pain episode): most common and non±lifethreatening
± a. Results from sickled cells obstructing blood vessels, causing occlusion, ischemia, and potential necrosis ± b. Symptoms include fever, acute abdominal pain (visceral hypoxia), hand-foot syndrome, priapism, and arthralgia without an exacerbation of anemia

2. Splenic sequestration crisis ‡ a. Results from the spleen pooling large quantities of blood, which causes a precipitous drop in blood pressure and ultimately shock ‡ b. Acute episode occurs most commonly in children between 8 months and 5 years of age; can result in death from anemia and cardiovascular collapse ‡ c. Chronic manifestation is termed functional asplenia

3. Aplastic crisis: diminished red blood cell production ‡ a. May be triggered by a viral or other infection ‡ b. Profound anemia results due to rapid destruction of red blood cells combined with a decreased production 4. Hyperhemolytic crisis: increased rate of red blood cell destruction ‡ a. Characterized by anemia, jaundice, and reticulcytosis ‡ b. Rare complication that frequently suggests a coexisting abnormality such as glucose-6phosphate dehydrogenase deficiency

Streptococcus pneumonia ‡ b. Repeat strokes in 60% of children who have experienced previous one 6. Overwhelming infection ‡ a.SICKLE CELL ANEMIA 5. Haemophilus influenzae type B . Stroke: sudden and severe complication with no related illnesses ‡ a. Chest syndrome: clinically similiar to pneumonia 7. Sickled cells block the major blood vessels in the brain ‡ b.

Correct metabolic acidosis 5.2. Sickle cell test d.1. Hgb electrophoresis NURSING INTERVENTIONS 1. Hydration & oxygenation 2. Bed rest 4. Decrease emotional stress . Avoid tight clothing 3. Sickledex d.SICKLE CELL ANEMIA DIAGNOSTIC TEST d.3.

Hydration/electrolyte replacement c. Antibiotic therapy e. Administration of hydroxyurea to limit sickling a. Adequate oxygenation b. Treatment of crisis ± ± ± ± ± . Rest b. Adequate hydration c.SICKLE CELL ANEMIA Therapeutic interventions ‡ 1. Prevention of sickling phenomenon ± ± ± a. Blood products ‡ 2. Pain management d.

Vision/hearing ‡ 4. Vital signs ‡ 2. Neurologic signs ‡ 3.SICKLE CELL ANEMIA Assessment ‡ 1. Location and intensity of pain .

Limited activity tolerance ± c. Analysis/Nursing ‡ 1. Separation from support system ‡ 3. Body image disturbance related to: ± a. Altered tissue perfusion (cardiovascular) related to decreased oxygen tension . Chronic illness ‡ 2. Retarded growth and maturation ± b. Fear related to: ± a. Pain related to tissue ischemia ‡ 4.SICKLE Diagnoses CELL ANEMIA . Unfamiliar environment ± b.

fluid needs to be increased. prophylactic use of pneumococcal. especially if the child is febrile . meningococcal. Prevent crisis ± a.SICKLE CELL ANEMIA Planning/Implementation ‡ 1. Avoid hypoxia: treat respiratory tract infections immediately ± c. and Haemophilus flu vaccines ± b. Avoid infection. which precipitates a crisis. dehydration. and other conditions causing strain on body. Avoid dehydration ‡ (1) May cause a rapid thrombus formation ‡ (2) Daily fluid intake should be calculated according to body weight (130 to 200 ml per kilogram [2 to 3 oz per pound]) ‡ (3) During crisis.

Blood transfusions for severe anemia .SICKLE CELL ANEMIA ‡ 2. Proper positioning. Exercise as tolerated (immobility promotes thrombus formation and respiratory problems) ± d. schedule to prevent pain ± f. Control of pain. careful handling ± c. use narcotics. During crisis provide for: ± a. Adequate hydration (may need IV therapy) ± b. Adequate ventilation ± e.

can be found in Mediterranean people ± b. Provide for genetic counseling ± a. since clinical manifestations usually do not appear before 6 months of age . each pregnancy has 25% chance of producing a child with the disease ± d. Parents need to know the risk of having other children with trait or disease ± c.SICKLE CELL ANEMIA ‡ 3. Disorder mostly of blacks. If both parents are carriers. Screen young children for the disorder.

Child demonstrates positive body image ‡ 4.SICKLE CELL ANEMIA . Evaluation/Outcomes ‡ 1. Child does not exhibit signs of sickling . Child verbalizes feelings about disease process ‡ 3. Child reports minimal pain ‡ 2.

hematomas. Hemophilia C: Factor XI deficiency ASSESSMENT FINDINGS 1. Bruising. Prolonged PTT. Hemarthrosis 4. Peripheral neuropathies 5. Hemophilia B: Christmas disease/factor IX deficiency b. no petechiae 3. Hemophilia A: Factor VIII b.2.HEMOPHILIA ‡ TYPES ± ± ± ± ± ± ± ± ± ± b.1. anemia . Prolonged bleeding after minor injury 2.3.

Provide client teaching: prevention of trauma & genetic counselling . Provide care for hemarthrosis 3. Control acute bleeding episode ( I-C-E ) 2. Administer cryoprecipitate 4.HEMOPHILIA NURSING INTERVENTIONS 1.

Dengue Hemorrhagic Fever /Dengue Shock Syndrome ‡ Caused by Dengue Virus (I.IV) ‡ Vector: Aedes Aegyptii ‡ MOT: Mosquito bite ‡ Signs/ Symptoms: ± Petechial rash ± Epistaxis ± Hematemesis ± Melena ± DHN .II.III.

Disorder of the Respiratory System .

Respiratory involvement: chest physiotherapy.CYSTIC FIBROSIS GENERAL INFORMATION 1. ( 2 ) RESPIRATORY. ( 3 ) REPRODUCTIVE. high protein 1. Fatal disease: average age at death is 20 years MEDICAL MANAGEMENT 1. Pancreatic involvement: promote absorption of nutrients 1. Dysfunction of the exocrine glands ( respiratory.a. Autosomal recessive inheritance 3. ( 4 ) LIVER 4. GIT. high calorie/low fat. Diet modification: predigested formula. sweat. Affected organs: ( 1 ) PANCREAS.b. antibiotic . Pancreatic enzyme supplementation 2. pancreas ) 2. salivary.

productive cough. RESPIRATORY INVOLVEMENT ( 1 ) S/SX of respiratory distress. pseudomonas infection. clubbing of digits . steatorrhea.CYSTIC FIBROSIS ASSESSMENT FINDINGS 1. FECAL FAT increase 2. rectal prolapse. protruding abdomen. voracious appetite. meconium ileus. vit ADEK deficiencies. barrel chest. anemia ( 2 ) Diagnostic test: DECREASE TRYPSIN. PANCREATIC INVOLVEMENT ( 1 ) FTT.

low fat . ELECTROLYTE INVOLVEMENT ‡ ( 1 ) HYPONATREMIA. Provide highcalorie.2. Salty taste of sweat ‡ ( 2 ) PILOCARPINE IONTOPHORESIS SWEAT TEST = 2-5 x normal amount NURSING INTERVENTIONS 1. high carbohydrate & protein. Pancreatic enzymes with meals 1.1. PANCREATIC INVOLVEMENT 1.CYSTIC FIBROSIS 3.

mucolytic 2.1. High sodium intake . Administer expectorants.2.3. Breathing exercises. mist tent 3. Provide aerosol treatments. ELECTROLYTE IMBALANCE 3. postural drainage 4 times/day 2.CYSTIC FIBROSIS 2. Administer antibiotics RESPIRATORY INVOLVEMENT 2. Avoid cough suppressants 2.

Disorder of the GIT .

audiologist.1.2. Surgical correction 2. PALATOPLASTY ( 18 . Speech therapist.otolaryngologist. on one or both sides ‡ ‡ ‡ ‡ ‡ MEDICAL MANAGEMENT 1.CLEFT LIP AND PALATE ‡ GENERAL INFORMATION ± Failure of merging between the medial nasal and maxillary processes at the fifth week of embryonic development. pediatrician 2. CHEILOPLASTY( 2 months ) 2. dentist/orthodontist.



Gavage feeding 6. Use a large-holed nipple 4. Burp frequently 3. Use a rubber-tipped syringe 5. Proper positioning in feeding 2. Finish feeding with water 7.CLEFT LIP AND PALATE ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ NURSING INTERVENTIONS D.1 Pre-operative CHEILOPLASTY 1. Provide SFF .

Anticipating child¶s needs ‡ 5. Assess color. DO NOT PLACE IN PRONE POSITION ‡ 4. Provide pain control relief .2 Post-operative CHEILOPLASTY ‡ 1. monitor amount of swallowing ‡ 3. Use elbow restraints ‡ 6.‡ D. Keep suture line clean ‡ 7. Maintain patent aiway ‡ 2.

3. Have suction available ‡ 3.4. Prevent injury or trauma to suture line( use CUP. Post-operative PALATOPLASTY ‡ 1. utensils ) .no bottles. Pre-operative PALATOPLASTY ‡ 1. POSITION ON SIDE ‡ 2. straw.‡ D. Infant should be weaned to cup before surgery ‡ D.

Olive-size bulge under right rib cage 2. FTT 3. DIAGNOSTIC TEST: UGIS. ‡ ‡ ‡ ‡ MEDICAL MANAGEMENT b. Noninvasive: thickened feedings b. Projectile vomiting 4.PYLORIC STENOSIS ‡ ± GENERAL INFORMATION also known as infantile hypertrophic pyloric stenosis (IHPS). It occurs secondary to hypertrophy and hyperplasia of the muscular layers of the pylorus.2. Dehydration 5. Surgery: Pyloroplasty ASSESSMENT FINDINGS 1. is the most common cause of intestinal obstruction in infancy.1. Hematocrit ‡ . Serum electrolytes.


signs of infection ‡ ‡ ‡ ‡ ‡ . PRE-OPERATIVE 1.2. Advance DAT 2. Prevent aspiration D. POST-OPERATIVE 1.1. Place on right side after feeding 3. place on right side after feeding ) 3. Prevent vomiting ( give thickened feeding. Administer replacement fluids 2.PYLORIC STENOSIS ‡ ‡ ‡ ‡ NURSING INTERVENTIONS D. Monitor I & O. high fowler¶s position.

INTUSSUSCEPTION GENERAL INFORMATION ± a segment of intestine invaginates into the adjoining intestinal lumen. Males affected two times more frequently than females ‡ C. occurs most frequently at the ileocecal valve ‡ B. causing a bowel obstruction. ‡ A. Usually occurs between 3 to 12 months of age . Telescoping of one portion of the intestine into another.


Classification ‡ 1. Ileocecal: invagination at the ileocecal valve; most common type ‡ 2. Ileoileal: one part of ileum invaginates on another section of the ileum ‡ 3. Colocolic: one part of the colon invaginates on another section of the colon

Clinical findings ‡ 1. Healthy, well-nourished infant or child who wakes up with severe paroxysmal abdominal pain, evidenced by kicking and drawing legs up to the abdomen ‡ 2. One or two normal stools, then bloody mucus stool ("currant jellylike³ stool) ‡ 3. Palpation of sausage-shaped mass ‡ 4. Other signs of intestinal obstruction usually present


‡ 1. Barium enema to reduce telescoping ‡ 2. Surgery ( if with Peritonitis )
± Medical reduction by hydrostatic pressure (barium enema) ± Surgical reduction; sometimes with intestinal resection

intermittent abdominal pain ‡ 2. Tender. Vomiting ‡ 3. distended abdomen . acute. Sudden.Nursing Care of Infants and Children with Intussusception Assessment ‡ 1. Red "currant jelly-like" stools ‡ 4.

INTUSSUSCEPTION Planning/Implementation ‡ 1. Same as for any abdominal surgery ‡ 2. Make provisions for frequent parental visits because the problem usually occurs when the child is 6 to 8 months of age and separation anxiety is acute .

Evaluation/Outcomes ‡ 1. Child consumes sufficient nutrients for growth ‡ 4. Family can verbalize feelings about the illness ‡ 3. Child does not exhibit signs of dehydration . Child does not show physiologic manifestation of pain ‡ 2.

Pain related to invaginating bowel ‡ 2. Diarrhea .Analysis/Nursing Diagnoses ‡ 1. Increased peristalsis ‡ 4. Vomiting ± b. Decreased intake ± b. Altered nutrition: less than body requirements related to: ± a. Risk for fluid volume deficit related to: ± a. Altered family processes related to having a child with life-threatening illness ‡ 3.

TPN ASSESSMENT FINDINGS 1 Steatorrhea 2. Chronic diarrhea 3. FTT .CELIAC DISEASE ± Absorptive disorder of the GI tract ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ MEDICAL MANAGEMENT 1. Diet therapy: BROW free/glutenfree 2.

Abdominal pain. listlessness 6.CELIAC DISEASE ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ 4.D. Monitor gluten-free diet 2.E. Vit A. Distended abdomen. muscle wasting 5. Diagnostic test: ( 1 ) PANCREATIC ENZYMES & SWEAT CHLORIDE TEST ( 2 ) Jejunal & duodenal biopsy: ATROPHY OF MUCOSA NURSING INTERVENTIONS 1.K deficiency 7. Provide fat-soluble vitamins fat- .

same as pyloric stenosis ‡ Management: ± Resection of the colon ± Colostomy .Hirschsprung Disease ‡ Absence of aganglionic nerve in the portion of the colon ‡ Characteristic sign: ± Ribbon-like stool ± Symptoms.

Disorder of the Renal System .


vomiting. diarrhea. Diet 5. Pallor. Hepatomegaly NURSING INTERVENTIONS 1. I & O and weight monitoring 2. Anorexia. lethargy 3.NEPHROSIS/NEPHROTIC SYNDROME ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ASSESSMENT FINDINGS 1. Provide scrotal support . malnutrition 2. Maintain skin integrity 6. Protect from known sources of infection 3. Bed rest 4.

Pediatric Oncology .

Induction: intense & potentially life threatening b. Diagnosis: blood studies.2. CNS prophylaxis c. Treatment stages a.LEUKEMIA ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ GENERAL INFORMATION TYPES b. bone marrow biopsy 2. ACUTE LYMPHOCYTIC LEUKEMIA ( ALL ) b. ACUTE NONLYMPHOCYTIC LEUKEMIA ( ANLL ) MEDICAL MANAGEMENT 1.1. Maintenance: 2 to 3 years .

LEUKEMIA ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ASSESSMENT FINDINGS 1. Support for family & child . Abdominal pain with weight loss & anorexia 5. Enlarged spleen & liver 4. Provide care for client receiving chemotherapy. Enlarged lymph nodes 3. INFECTION 2. Bone pain NURSING INTERVENTIONS 1. radiation therapy 2. BLEEDING. BLOOD: ANEMIA.

Mother notices MASS while bathing or dressing child. hematuria. Daunorubicin. nontender. Chemotherapy: Vincristine. Radiation therapy 3. About 90% of kidney cancers in children are Wilms tumors.WILM·S TUMOR/NEPHROBLASTOMA ‡ ± GENERAL INFORMATION is the most common type of kidney cancer in children. ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ MEDICAL MANAGEMENT 1. midline near liver 2. anemia 3. Hypertension. Diagnostic test: IVP . Doxorubicin ASSESSMENT FINDINGS 1. Nephrectomy( 24-48 hours of diagnosis ) 2.

Provide care for a client post nephrectomy ‡ 4. DO NOT PALPATE ABDOMEN ‡ 2. Handle carefully when bathing ‡ 3. radiation therapy . Provide care for a client receiving chemotherapy.WILM·S TUMOR/NEPHROBLASTOMA ‡ NURSING INTERVENTIONS ‡ 1.

intermittent fever . MEDICAL MANAGEMENT ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ 1. FIRM & MOVABLE 2. DIAGNOSIS: Lymphangiogram. splenectomy 2. RADIATION THERAPY. CHEMOTHERAPY ASSESSMENT FINDINGS 1. nodes are NONTENDER. biopsy( REEDSTERNBERG CELLS ). Enlarged nodes in lower cervical region.HODGKIN·S LYMPHOMA ‡ ± GENERAL INFORMATION is a cancer that starts in lymphatic tissue. PAINLESS. Recurrent. Lymphatic tissue includes the lymph nodes and related organs that are part of the body's immune and blood-forming systems.

HODGKIN·S LYMPHOMA ‡ ‡ ‡ ‡ ‡ ‡ ‡ 3. radiation therapy 2. Night sweats 4. lethargy 5. Weight loss. Provide care for child on chemotherapy. Protect from infection if splenectomy is performed 3. Provide support for child/adolescent parents . malaise. Pruritus NURSING INTERVENTIONS 1.


Poisoning ‡ A. Improper storage is the major contributing factor to poisonings . Ingestion of a toxic substance or an excessive amount of a substance ‡ B. Highest incidence occurs in children under 4 ‡ D. More than 90% of poisonings occur in the home ‡ C.

See Clinical Findings under type of poisoning . Assessment ‡ 1. Need for respiratory or cardiac support ‡ 3. Vital signs ‡ 2.Poisoning A. Treat other symptoms such as seizures ‡ 4.

Altered family processes related to sudden hospitalization and emergency aspects of illness ‡ 2. Fear related to sudden hospitalization and treatment (multiple injections for lead poisoning) ‡ 3. Risk for injury related to presence of toxic substance in the body ‡ 5. Risk for injury related to sources of toxic substances in the environment ‡ 4.Poisoning Analysis/Nursing Diagnoses ‡ 1. Risk for poisoning related to immature judgment of child .

Terminate the exposure ± a. plant parts. Planning/Implementation ‡ 1. Thoroughly flush eyes with tap water if they were involved ± c. Bring the victim into fresh air if an inhalation poisoning ± f. Flush skin and wash with soap and soft cloth ± d. Give water to dilute ingested . or other material ± b. acid. Empty the mouth of pills. or hydrocarbon involved ± e. especially if pesticide.Poisoning C. Remove clothing. alkali.

Poisoning ‡ 2. vomitus. etc. Be alert to signs and symptoms of potential poisoning in absence of other evidence . Identify that a poisoning has occurred ± a. emergency facility. urine. Call the local poison control center. Save all evidence of poison (container. or physician for immediate advice regarding treatment ± b.) ± c.

Poisoning ‡ 3. emesis of the corrosive redamages the mucosa of the esophagus and pharynx . If the poison is a strong corrosive (acid or alkali). or convulsing or has lost the gag reflex. If the poison is a low-viscosity can cause a severe chemical pneumonitis ± c. If the person is comatose. Do not induce vomiting ± a. these conditions can increase the risk of aspiration ± b. once aspirated. in severe shock.

Induce vomiting except as contraindicated by administering ipecac syrup (for 12month-olds give 10 ml of ipecac syrup with 8 to 12 oz of water. for 1.Poisoning ‡ 4. Dilute with water ± b. Remove the poison ± a. over 12 years of age give 30 ml of ipecac syrup with 16 ounces of water).to 2-year-olds give 15 ml of ipecac syrup with 8 to 16 ounces of water. if vomiting does not occur repeat once in 20 minutes for those over 12 months of age. for those under 12 months of age ipecac is not repeated .

± c. Whether vomiting is spontaneous or induced. prevent aspiration ± a. When unconscious. Administer activated charcoal 1 g per Poisoning inducing kg 30 to 60 minutes after vomiting ± d. position on the side . Keep the child's head lower than the chest ± b. Prepare appropriate equipment for potential medical use. When alert. such as gastric lavage 5. place the head between the legs ± c.

Monitor vital signs ± b. Treat as appropriate (e. Support the child and parent ± a.g. keep warm and position correctly in case of shock.. reduce temperature if hyperpyretic) ‡ 7. Do not admonish or accuse the child or parent of wrongdoing . Keep calm and quiet ± b. Observe for latent symptoms and complications of poisoning ± a. institute seizure precautions.Poisoning ‡ 6.

Institute anticipatory guidance for possible future accidents based on the child's age and maturational level ± c. and behavior problems ± b. environmental factors. Provide assistance with environmental manipulation when necessary .Poisoning ‡ 8. parent-child relationship. Refer to a visiting nurse agency for evaluation of the home environment and the need for safety measures ± d. developmental ability. Assess possible contributing factors in the occurrence of an accident. such as discipline. Teach prevention of poisoning ± a.

especially children's varieties ± h. Caution against keeping large amounts of drugs on hand. Discourage transferring drugs to containers without safety caps ± i. Discuss problems of discipline and children's noncompliance . Teach children the hazards of ingesting nonfood items without supervision ± g. Educate the parents regarding safe storage of all substances ± f.Poisoning ± e.

Parents and child have knowledge concerning prevention of future poisoning . Child recognizes and does not ingest harmful substances ‡ 2. Child is treated without complications ‡ 3. Child expresses feelings and concerns ‡ 6. Child receives medication with minimal distress ‡ 4. Evaluation/Outcomes ‡ 1. Parents express confidence in care ‡ 7. Toxin is eliminated from body ‡ 5.Poisoning .

Toxic dose 150 mg/kg body weight ±2. Therapeutic use of 150 mg/kg/day for several days has resulted in toxicity . One of the most common drugs taken by children ±1.Acetaminophen Poisoning ‡ A.

Slow. Pallor ± 4. Profuse diaphoresis ± 2. Pain in right upper quadrant ± 6. Nausea and vomiting ± 3.‡ Clinical findings . Decreased urine output ± 9. Coma ± 12. weak pulse ± 7. Coagulation abnormality ± 11. Jaundice ± 10.symptoms of overdose ± 1. Confusion ± 8. Weakness ± 5. Liver failure Acetaminophen Poisoning .

lavage ±2. Administer IV fluid ±3. Induce vomiting with ipecac syrup.Acetaminophen Poisoning ‡ Therapeutic interventions ±1. Administer an antidote (acetylcysteine) .

Obtain blood for hepatic and renal function tests ‡ F. Support the child and family . Identify ingested substance and amount ‡ B. Monitor the electrocardiograph ‡ C. Measure and record the vital signs frequently ‡ E. Measure intake and output ‡ D.Acetaminophen Poisoning Specific Nursing Care of Children with Acetaminophen Poisoning ‡ A.

Salicylate Toxicity and Poisoning ‡ Toxic dose: 300 to 500 mg per kilogram of body weight or 7 adult aspirins (28 baby aspirin) for a 9-kg (20-lb) child .

Vomiting d. Hyperpnea h. Hyperpyrexia i. Mild salicylate toxicity (items i to k are of little value in small children) ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ a. Dizziness k. Oliguria g. Disturbances of hearing and vision . Delirium f.Salicylate Toxicity and Poisoning ‡ Clinical findings ± 1. Dehydration e. Nausea c. Diaphoresis b. Ringing in the ears j.

sweating.Salicylate Toxicity and Poisoning ± 2. Hyperventilation: confusion. especially if chronic ingestion . increased temperature ‡ c. Bleeding. coma ‡ b. Salicylate poisoning ‡ a. Metabolic acidosis: anorexia.

Vitamin K if bleeding ±4. IV fluids ±3. Peritoneal dialysis in severe cases . Therapeutic interventions ±1. saline cathartics ±2. activated charcoal. gastric lavage. Induce vomiting.‡ C.

Soil. or drinking water with lead ± 3. significant. A prevalent. preventable health problem that causes neurologic and intellectual damage from even low levels of lead ‡ B. hobbies . Parental occupations. Blood lead concentration should be less than 10 mg per 100 ml of blood ‡ C. Associated with increased levels of lead in the environment and pica ± 1. dust. Most common source is lead-based paint ± 2.Lead Poisoning (Plumbism) Data Base ‡ A.

irritability. Abdominal pain. Loss of weight. pallor. fatigue ± 5. listlessness. convulsions. Brain damage. Anemia. Clinical findings (chronic ingestion) ± 1. or lethargy) ± 8.Lead Poisoning (Plumbism) ‡ D. Constipation ± 4. Lead line on teeth and long bones ± 6. Protein in urine as a result of proximal tubular damage ± 7. hyperactivity. Headache. vomiting ± 3. Behavioral changes (impulsiveness. insomnia. death . anorexia ± 2. joint pains ± 9.

fatigue. GI disturbances. malaise. calcium EDTA) ± (1) Urine lead content monitored. Objective: reduce concentration of lead in the blood and soft tissue by promoting its excretion and deposition in bones ‡ a. numbness of extremities. may cause persistent fever in children receiving therapy.‡ E. Dimercaprol (BAL) ± (1) Generally used in conjunction with calcium disodium edetate ± (2) Adverse effects: local pain at the site of injection. rise in blood pressure accompanied by tachycardia after injection . Calcium disodium edetate (Calcium Disodium Versenate. Therapeutic interventions ± 1. peak excretion in 24 to 48 hours ± (2) Adverse effects: acute tubular necrosis. fever. pain in muscles and joints ‡ b.

‡ c. d-penicillamine ± (1) Oral chelating agent ± (2) Increases urinary excretion. rash. abdominal pain ± 2. enuresis. but less effective than calcium EDTA ± (3) Adverse effects: transient decrease in white blood cells and platelets. Prevention of further ingestion .

Screen children at risk by recognizing clinical findings. warm moist applications may relieve discomfort of injections ‡ D. appropriate environment. Prevent future lead poisoning by parental and child education. Observe child carefully and closely ‡ E.Specific Nursing Care of Children with Lead Poisoning ‡ A. Plan preparation of the child and rotation of injection sites if therapeutic intervention includes IM chelating agents. Plan discharge and follow-up care of the child ‡ F. Determine environmental exposure ‡ B. and supervision of child and siblings . especially behavior changes ‡ C.

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