COMMON HEALTH PROBLEMS

OF INFANCY
 SUDDEN INFANT SYNDROME
 Defined as sudden unexpected death of an
infant under 1 year of age
 Leading cause of death in children between
the ages of 1 month and 1 year
 Death usually occurs during sleep
 Infants at grater risks for SIDS:
 have a family hx of SIDS (esp siblings)
 have a hx of seizure
 are born prematurely
 closely spaced pregnancies
 twins
 Etiology : remains unknown
 Management : Teach parent how to
minimize the risks of SIDS
 avoid smoking during and after
pregnancy
 encourage putting infants to sleep in
supine position unless
contraindicated. Side-lying position
may also be used
 avoid soft, moldable mattress
 avoid use of pillows
LARYNGOTRACHEOBRONCHIT
IS
 Inflammation of the larynx,
trachea and bronchi
 Characterized by a narrowing of
the air passages which causes
edema of the the respiratory
mucosa
 Most often seen in children ages
3 moths to 3 years and usually of
viral origin
 Clinical Manifestation:
 irritability
 “brassy” or barking cough
 hoarseness
 restlessness
 inspiratory stridor
 anorexia
 low-grade fever
 nausea and vomiting
 rales, wheezing, crackles
 Nursing Management:
 Assess for airway obstruction by
evaluating respiratory status
 Keep emergency equipment at
bedside (tracheostomy and
intubation tray
 Administer prescribed medications
which may include bronchodilator
and anti-inflammatory drugs
 Family teaching may include telling
the parents to place the child in the
bathroom and to run hot water to
produce steam.
 EPIGLOTITIS
 Inflammation of the supraglottis
and epiglottis generally caused
by Haaemophilus influenza
bacteria. Echovirus and
respiratory sncytial virus can
also cause this disorder
 Abrupt onset and progresses
rapidly
 ClinicalManifestations:
 sudden onset of fever, lethargy and
dypnea
 restlessness and anxiety
 hyperextension of the neck, drooling
and severe sore throat with refusal to
drink
 stridor and hoarseness
 “tripod position”
 red and inflamed throat with a large,
cherry red, edematous epiglottis
 Nursing Management:
 Closely monitor respiratory status to ensure
airway patency. The throat of a child with
epiglotitis should only be examined by a
trained professional under extreme care
 Emergengency endotracheal or
tracheostomy equipment should be
available.
 Administer prescribed medications which
may include an antibiotic, and anti-
inflammatory such as steroids
 Recommend that all children receive Hib
conjugate vaccine beginning at 2 months of
age
COMMON HEALTH PROBLEMS
OF EARLY CHILDHOOD
 ACUTE OTITIS MEDIA ( AOM )
 Inflammation of the middle ear
 One of the most common health
problems in childhood due to the
short, straight
 eustachian tube of children
aged 6-24 months
 Etiology: usually caused by
Haemophilus inflenzae
 Contributing factors
includes:
 poorly developed cartilage lining
 enlarged lymphoid tissue
 bottle feeding an infant in supine
position
 passive smoking
 ClinicalManifestations:
 Otitis media typically follows an
URTI s/s
Pain
fever
irritability
lossof appetite
nasal congestion
cough
 Nursing Management:
 Assess child for fever and pain level and assess for
possible complications
 Administer prescribed medications. Antibiotic
therapy usually amoxicillin
 If tympanic membrane is ruptured, facilitate
drainage by having the child lie with affected ear in
a dependent position
 Health teaching would include:
 importance of completing the entire course of antibiotic
 discussing preventive measures such as holding the
child upright for feedings, having him blow his nose
gently
 identify the signs of hearing loss and stress the
importance of audiologic test if needed
UPPER RESPIRATORY TRACT
INFECTION
 URTI include nasopharyngitis,
pharyngitis, and tonsillitis
 Also called the common cold,
nasopharyngitis is a viral infection of
the nose and throat
 Pharyngitis and Tonsilitis can be
either viral or bacterial in origin. The
organism common in bacterial
infection is GABS W/C HAS THE
POTENTIAL TO LEAD TO
COMPLICATIONS SUCH AS Rheumatic
Fever and AGN
 Clinical
Manifestations:
 Nasopharyngitis
nasal congestion
watery rhinitis
low grade fever
difficulty breathing secondary to
edema and congestion
enlarged cervical lymph nodes
 Pharyngitis
 Viral pharyngitis manifestations are
generally mild
 s/s include sore throat and general
malaise
 Bacterial pharyngitis manifestations
vary
 s/s include severe sore throat, high
fever and lethargy
 child usually looks sick and may have
difficulty swallowing
 Tonsillitis
 Viral Tonsillitis is characterized
by a gradual onset, low-grade
fever, mild headache, sorethroat,
hoarseness and cough
 Bacterial Tonsillitis is a more
dramatic disorder marked by rapid
onset of high fever, headache
generalized muscles aches and
vomiting
 Nursing Management:
 Assess respiratory status
 Provide liquids and soft foods
 Administer prescribed medications. A 10-
day old course of antibiotic (Penicillin or
Erythromycin if allergic to Penicillin)
 Provide preoperative and postoperative
nursing care if surgery is performed
A. Preoperative nursing care (Tonsillectomy)
 prepare the child according to his developmental
level
 explain that the child will have sore throat after
surgery but he will be able to talk and swallow
B. Postoperative
 observe and report unusual
bleeding
 monitor v/s
 discouraging the child from
coughing and use of straw for
fluids
 position child on his side or the
abdomen to facilitate drainage
 medicate for pain as ordered. Ice
collar may be used.
 Encourage fluids but not with red
 ALTERATIONS IN
RESPIRATORY FUNCTION
 URGENT RESPIRATORY THREATS:
 RESPIRATORY DISTRESS AND
 RESPIRATORY FAILURE

Clinical Manifestations
 Signs of respiratory distress:
tachypnea, retractions, nasal
flaring, inspiratory stridor, and
expiratory grunting.
Signs of respiratory failure include:
 Early signs: restlessness, tachypnea,
tachycardia, and diaphoresis
 Early decompensation: nasal flaring,
retractions, grunting, wheezing,
anxiety and irritability, mood
changes, headache, hypertension
confusion
 Signs of imminent respiratory arrest:
dyspnea, bradycardia, cyanosis,
stupor, and coma
 PNEUMONIA
 Acute inflammation of the lung
parenchyma (bronchioles,
alveolar ducts and sacs and
alveoli) that impairs gas
exchange
Etiology:
 Pneumonia most commonly
results from infection with
bacteria, viruses, or
mycoplasmas, or from aspiration
of foreign substances
Clinical Manifestation:
a. Common findings in bacterial pneumonia
include:
-high fever
-respiratory signs and symptoms, including
cough (nonproductive to productive with
whitish sputum), tachypnea, rhonchi,
crackles, dullness on percussion, chest pain,
retraction nasal flaring and pallor or
cyanosis (depending on severity)
-irritability, restlessness and lethargy
-nausea, vomiting, anorexia, diarrhea, and
abdominal pain
-meningeal signs (meningism)
b. Common findings in viral
pneumonia include:
-variations ranging from mild
fever, slight cough, and malaise
to high fever, severe
cough, and prostration
-nonproductive or productive
cough with whitish sputu
-rhonchi of fine crackles
c. Common findings in mycoplasma
pneumonia include:
-sudden or insidious onset
-fever, chills, malaise, headache,
anorexia, and myalgia
-hacking cough, rhinitis, and sore
throat
-cough progresses from
nonproductive to productive with
seromucoid sputum that later
becomes mucopurulent or blood
streaked
 Laboratory and diagnostic study
findings:
Chest x-rays
Complete blood count
Blood culture, Gram stain, and sputum
culture
Positive antistreptolysin-O titer is
diagnostic of streptococcal pneumonia
Nursing management
 Assess for respiratory distress
 Administer prescribed
medications
 Promote adequate oxygenation
and a normal breathing pattern
 Recommend the pneumococcal
vaccine
 ASTHMA
 Asthma is a chronic, reversible,
obstructive airway disease,
characterized by wheezing. It is
caused by a spasm of the bronchial
tubes or the swelling of the bronchial
mucosa after exposure to various
stimuli
 Asthma is the most common chronic
disease in childhood, most children
experience their first symptoms by 5
years of age.
Etiology: Extrinsic (allergic asthma) -
pollens, dust spores and animal
danders
Intrinsic (Idiopathic asthma) - URTI,
emotional upsets and exercise
Mixed asthma - has characteristics
of both allergic and idiopathic
asthma.
Mixed asthma is the most common
form.
Common irritants:

a. allergen exposure (in sensitized persons). Common

allergens include:
-dust mites
-molds
-animal dander
b. viral infections
c. irritants, which include:
-air pollution
-smoke
-perfumes
-laundry detergents
d. certain foods (especially food additives)
e. rapid changes in environmental temperatures
f. exercise
g. psychological stress
Assessment findings:
Clinical manifestations:
-increased respiratory rate
-wheezing (intensifies as attack
progresses)
-cough (productive)
-use of accessory muscles
-distant breath sounds
-fatigue
-moist skin
-anxiety
Nursing management:
assess respiratory status
administer prescribed medications.
promote adequate oxygenation and
a normal breathing pattern
explain possible use of
desensitization
make the child live a normal life
enroll child in swimming
Diet: High calorie, high protein,
low carbohydrate
Bronchial hygiene measures:
Steam inhalation
Aerosol inhalation
Medimist inhalation
Pharmacotherapy:
 bronchodilators
Epinephrine
Albuterol (Ventolin)
Aminophylline (Theophylline)
Terbutaline (Bricanyl)
Metaproterenol (Allupent)
observe for tachycardia
 corticosteroids - anti-inflammatory
effect
Triamcinolone (Azmacort)
 CYSTIC FIBROSIS
Cystic fibrosis (CF) is a chronic,
multisystem disorder of the exocrine
glands characterized by abnormally
thick pulmonary secretions. CF
affects the pancreas, respiratory
system, GI tract, salivary glands, and
reproductive tract.

Etiology:

-CF is an autosomal recessive

hereditary disorder by a defective
gene.
Assessment findings:
Clinical manifestations:
 Respiratory – wheezing, dyspnea, cough
,cyanosis
 GI - meconium ileus at birth, rectal
prolapse, loose,bulky, frothy, fatty stool
Voracious appetite, wt. loss, ftt,distended
abdomen
 Reproductive - females will have delayed
puberty and decreased fertility
males with few exceptions, are infertile
 Cardiovascular - cor pulmonale, rt-sided
heart enlargement and heart failure,
Hyponatremia
 Integumentary - salty taste,
hypoalbumineria due to ftt
Nursing management:
1. promote adequate oxygenation
and a normal breathing pattern.
2. assess nutritional status
3. promote desired nutritional
intake
4. administer prescribed
medications such as pancreatic
enzymes, bronchodilators,
antibiotic and fat soluble vitamins
 PYLORIC STENOSIS
Pyloric stenosis is the narrowing
of the pyloric sphincter at the
outlet of the
stomach
Congenital hypertrophy of pyloric
sphincter
Etiology:
-Unknown
Assessment findings:
Clinical manifestations:
 regurgitation and non projectile
vomiting
 weight loss
 no sign of anorexia
 upper palpable distention, olive
shape mass in the epigastrium just to
the right of umbilicus
 visible gastric peristalsis wave from
left to right
 decrease frequency and volume of
stools
Laboratory and diagnostic studies:
-ultrasonography and an upper-GI
-Arterial blood gas analysis
-electrolyte studies
Nursing management:
-monitor feeding pattern and the
association between feedings and vomiting
-access the amount, character, and
frequency of vomitus
-promote adequate hydration
-prevent aspiration
-provide postoperative care
(Pyloromyotomy)
 CELIAC DISEASE (GLUTEN-
SENSITIVE ENTEROPATHY
CELIAC SPRUE)
Celiac disease is a malabsorption
syndrome that occurs when the
mucosa of
the proximal is small intestine is
sensitive to, or undergoes an
immunologic
response to gluten
Etiology: inborn error of metabolism to
digest glutenin and gliadin (protein
Assessment findings:
Clinical manifestations:
 diarrhea
 anorexia and abdominal pain
 vomiting
 severe abdominal distention
Laboratory and diagnostic study findings:
 bowel biopsy
Nursing management:
-promote adequate hydration
-promote adherence to dietary guidelines
-provide a gluten-free diet (meat, eggs,
fruit, vegetables,, Vit. ADEK (fat soluble)
AVOID: BROW - barley, rye, oats, wheat
 HIRSCHSPRUNG’S
DISEASE
 congenital absence of
parasympathetic ganglion in
distal colon. Bowel proximal to
aganglionic section becomes
enlarged
 Etiology:
 Hirschsprung’s disease is
believed to be a familial,
congenital effect.
Assessment findings:
Clinical manifestations:
Neonates : failure to pass meconium,
abdominal distention
Infants : FTT, constipation abdominal
distention,
vomiting
Older children : anorexia, chronic constipation, foul
smelling and RIBBON-LIKE
STOOL

Laboratory and diagnostic study findings:

-barium enema
-rectal biopsy
-anorectal manometry
Nursing management:
 Assess for and promptly report signs of enterocolitis
(explosive bloody diarrhea)
 Promote adequate hydration, assess bowel
functioning
 Promote adequate nutrition according to the child’s
age and nutritional requirements
 Administer enemas as prescribed, to relieve
constipation
 Avoid taking temperatures rectally
 Decrease discomfort caused by abdominal distention
 Administer prescribed medication such as, antibiotic
and stool softeners
 Prepare child and parents for procedure and
treatment such as, TEMPORARY COLOSTOMY and
BOWEL RESECTION to remove aganglionic portion.
 Colostomy care same as adult patient
 INTUSSUSCEPTION
Intussusception is an invagination
or telescoping of one portion of
the intestine into an adjacent
portion, causing obstruction
Etiology:
Unknown
Assessment findings:
Clinical manifestations
-severe paroxysmal abdominal pain, causing the
child to
scream and draw his knees to the abdomen
-vomiting of gastric contents
-tender, distended abdomen, possibly with a
palpable
mass
-with continued obstruction, the following occur:
lethargy, “currant jelly”
stools (containing blood and mucus), bile-
stained or
fecal vomitus, and shocklike syndrome, which
may
progress to death
Nursing management:
1. promote adequate hydration
2. promote adequate nutrition
3. monitor bowel elimination
status
4. monitor for inspection
5. support the parents for possible
surgery (Bowel resection)
 HERNIAS
 Protrusion of the bowel through an abdominal
opening in the abdominal wall, in children this occurs
most commonly at the umbilicus and through the
inguinal canal

 Clinical Manifestations:
 Umbilical hernia - swelling or protrusion around the
umbilicus
 Inguinal hernia - usually a painless swelling in the
inguinal area
 Nursing Management:
 Assess for signs of strangulation and incarceration
 Perform postoperative care.
IRON DEFICIENCY ANEMIA
 Inadequate supply of iron for normal red
blood cell formation
 Fe iron from mother is already used up
 Typically occurs between ages 6 mos and 3
years.
 Clinical Manifestations:
 pale skin
 fatique
 pica (eating non food items)
 irritability
 headache, dizziness
 slowed thought processes
Nursing Management:
1. Assess for s/s of impaired tissue
oxygenation
2. Administer prescribed medication or
therapy such as iron prep (Ferrous sulfate)
parenteral iron, transfusions for severe
anemia
3. Promote adequate intake of iron-rich foods
(iron fortified formula, lean meat, fish,
legumes, potatoes, dried fruits
 SICKLE CELL DISEASE
 A group of chronic, severe, genetic
hemolytic disease associated with
hemoglobin S w/c transform RBC into a
sickle shape
 Etiology: autosomal recessive disorder
 Clinical Manifestations:
 enlarged spleen
 enlarged and tender liver from blood stasis
 hematuria
 inability to concentrate urine
 enuresis
 dactilytis (symmetric swelling of the hands and
feet hand –foot syndrome)
 other problems include:
 stroke
 MI
 growth retardation
 delayed sexual maturation
 priapism (unwanted painful erection)
 Nursing Management:
 Promote tissue oxygenation
 Administer appropriate therapeutic
measures
 provide oral and IV hydration
 administer electrolytes replacements
 deliver O2 therapy
 initiate bed rest and careful organization of the
child’s activities
 Relieve pain. Avoid giving Demerol
to avoid seizure
 Apply heat and avoid cold
compresses to prevent
vasoconstriction and sickling
 Position the child for maximum
comfort
 Teach parents to assess early signs
of infection and regular check-up
 Address the significance of genetic
counseling
 THALLASEMIA
 Group of inherited blood disorders
characterized by a deficient synthesis of
specific globulin. Common type is B-
thalassemia also know as “Cooley’s anemia
 Etiology: autosomal recessive disorder
 Clinical Manifestations:
 pallor
 Ftt
 Hepatosplenomegaly
 Severe anemia (hgb of less than 6 g/dL)
 Anorexia
 Chronic hypoxia
 Nursing Management:
 Supportive, involving transfusion of
normal cell q 3-4 weeks
 Treatment of iron overload with
Desferal
 Postoperative care after potential
Splenectomy
 Assist in giving of diet high in folic
acid, high in ascorbic acid and low in
iron
 Address the significance of genetic
counseling
 HEMOPHILIA
 Group of hereditary bleeding disorders resulting from
specific clotting factor deficiencies.
 Two most common include hemophilia A (factor VIII
deficiency) and hemophilia B (factor IX deficiency also
known as Christmas disease)
 Etiology: x-linked recessive disorder transmitted by
females , but common in males
 Clinical Manifestations:
 spontaneous bleeding
 hemarthrosis (bleeding into a joint space)
 limited motion
 pain
 tenderness and joint swelling
 easy bruising
 nosebleeds
 intracranial hemorrhage
 Nursing Management:
 Prevention and control of bleeding
episodes
 Limiting joint movement and
managing pain
 Promotion of normal growth and
development
 Administer the missing clot factor
 Administer desmopressin (DDAVP) for
hemophilia A only
 CONGENITAL HEART
DEFECTS
 Hemodynamics of Fetal
Circulation
 Ductus venosus: carries
oxygenated blood from placenta to
IVC, partially bypasses liver,
closes approximately by 2 mos.
 Ductus arteriosus: bypasses flow
of blood through lungs by
shunting oxygenated and
unoxygenated blood from
pulmonary artery to aorta, closes
7 – 10 days after birth
 Foramen ovale: connects right and and left
atria, allows blood to flow from right atrium to
left atrium thereby bypassing the right ventricle
and pulmonary circuit, closes by 2 – 3 mos.
Transition to newborn circulation:
 At first breath, lungs expand w/c increases
blood flow to pulmonary system
 Pulmonary vascular resistance is decreased and
systemic vascular resistance increases
 These changes lead to the closure of the ductus
venosus, ductus arteriosus and foramen ovale
Diagnostic procedure:
 cardiac catheterization
 echocardiography
 REVIEW OF ACYANOTIC
CONGENITAL HEART
ANOMALIES
ANOMALY DESCRIPTION SYMPTOMS TREATMENT BLOOD
SHUNTING
PATENT DUCTUS Failure of the ductus - recurrent apnea Medical: From
ARTERIOSUS arteriosus to close, often - wide pulse pressure administration of pulmonary
(spontaneous closure at a complication of - machine-like indomethacin artery to aorta
3 wks) respiratory distress murmur (Indocin)
Surgical:
Ligation of patent
ductus
(in infancy)
ATRIAL SEPTAL A communication - systolic murmur Open heart with Left to right
DEFECT between the left and - acyanotic, direct closure or
(A.S.D) right atria asymptomatic suturing with plastic
- thin and asthenic prosthesis
- frequent episodes of (usually done at pre-
pulmonary school age)
inflammatory
diseases
- poor exercise
tolerance
VENTRICULAR A communication - failure to thrive Some small defects Left to right
SEPTAL DEFECT Between the right - frequent may close
and left ventricles spontaneously.
respiratory
(during first year of
infections
life)
- loud, harsh
Open heart with
murmur direct
- systolic thrill closure/suturing
with plastic
prosthesis
(usually at pre-
school age, for
large defects mybe
done in earlier
infancy

COARCTATION OF Preductal - hypertension in Surgical resection Obstruction of

AORTA constriction of the upper extremities of coarctate area blood flow through
aorta bet. with decreased BP with direct the constricted
Subclavian artery in lower extremities anastomosis or with segments
and ductus - weak or absent use of a graft
arteriosus pulsations in lower (correction usually
Postductal extremities done by 2 yrs of age
constriction of aorta to prevent
directly beyond the permanent
ductus hypertension)
 REVIEW OF CYANOTIC
CONGENITAL ANOMALIES
ANOMALY DESCRIPTION SYMPTOMS TREATMENT BLOOD SHUNTING

TETRALOGY OF 1. Pulmonary - acute cyanosis at Surgical: Blalock Right to left

FALLOT stenosis birth Taussig
(T.O.F) 2. Right-sided - clubbing of fingers Repair: open heart
closure of VSD and
hypertrophy and toes
resection of
3. Overriding of - systolic murmur stenosis
the aorta - “tet spell”(acute (usually done
4. Ventricular episodes of during the first two
Septal Defect cyanosis and years of life)
(VSD) hypoxia)
- squatting
- growth retardation
TRANSPOSITION OF The aorta originates - early clubbing of Administration of IV
THE GREAT VESSELS from the right toes and fingers prostaglandin and
(TGV) ventricle and the - poor growth and surgical repair
pulmonary artery development
from the left - rapid respirations,
ventricle fatigue
- failure to thrive
TRUNCUS Failure of normal - severe pulmonary
ARTERIOSUS septation and edema and heart
division of the failure
embryonic bulbar
trunk into the
pulmonary artery
and aorta
 RHEUMATIC FEVER
 systemic inflammatory disease
that occurs as a result of
naturally acquired immunity to
GABHS infection
 Etiology:

usually occurs 2 to 6 weeks after

an untreated upper respiratory
tract infection
 Clinical
manifestations:
 Major characteristics:
 a. subcutaneous nodules
 b. erythema marginatum
 c. polyarthritis
 d. chorea
 e. carditis
 Minor characteristics:
 a. fever
 b. arthralgia
 c. elevated ESR
 d. elevated ASO titer
Nursing management:
 Assess and monitor cardiac, joint,
skin and neurologic status
 Promote compliance with bed rest
and activity restrictions
 Provide adequate nutrition
 Prevent skin breakdown
 Administer prescribed medications.
 Emphasize the importance of
minimizing contact with infected
persons and proper handwashing
technique
 Promote optimal growth and
development
 HYDROCEPHALUS
 Imbalance in either absorption or production of CSF within
the intracranial cavity
 Etiology: often associated with neural tube defect
 Clinical manifestations:
Categorized by age:
Infants: increased head circumference
Bulging anterior fontanel
Distended scalp vein
High pitch cry
Feeding problems
Discomfort when held
Older children:
Headache
Vomiting
Diplopia
Blurred vision
Nursing management:
 Preoperative measurement of head
circumference
 Postoperatively:

Perform frequent neurologic

assessment with daily head
circumference
Position on non-operative site
Institute seizure precautions
 Monitor for s/s of shunt infections
 Give frequent small feedings, planned
rest period after feeding. Daily
weights
 MYELOMENINGOCELE
 Type of Spina Bifida, a fissure in spinal
column leaving meninges and spinal cord
exposed
 Unknown etiology

Clinical manifestation:
 partial to complete paralysis depending
on the location of defect
 clubfoot, scoliosis,
 bowel and bladder problems
 elevated AFP
 visible sac
 Nursingmanagement:
A. Preoperative: main goal is to
prevent rupture of sac
keep infant in prone position
cover sac with gauze moistened
with sterile saline
check sac for tears and cracks
do not cover sac with cloth and
diaper
monitor for s/s of meningitis
B. Postoperative: main goal is to
promote healing and reduce
neurological complications
 place infant in prone position with
head slightly lower than the body
 place protective barrier across
incision to prevent contamination
 be aware of long-term problems of
infection related to urinary
retention reflux, chronic UTI
 Monitor for s/s of IICP
 CEREBRAL PALSY
 Chronic , nonprogressive caused by
malformation of the motor pathways
of the brain
 Clinical manifestations:
 common clinical manifestation in all types of
cerebral palsy is DELAYED GROSS MOTOR
DEVELOPMENT
 infantile reflexes do not go away
 delayed speech development
 lack of head control
 hearing and visual deficits mental retardation
 behavioral problems
 Nursing management:
 Prevent physical injury
 Prevent physical deformity
 Administer prescribed meds:
sedative, muscle relaxants and
anticonvulsants
 Encourage self-care
 Refer to OT and speech therapy
 REYE’S SYNDROME
 acute, multisystem disorder that
follows a mild viral infection,
usually influenza or varicella
 Etiology: salicylates,
acetaminophen toxicity and
antidiarrheals
aspirin toxicity
CONGENITAL DYSPLASIA OF
THE HIP (CDH)
 imperfect development of the
hip of varying degrees
 etiology unknown, females are 8
times more likely to develop
 Clinical manifestations:
 shortening of affected leg
 assymetrical gluteal folds
 limited abduction
 ortolani’s click
 Nursing Management
 Ifdiagnosed within 2-3 mos,
abduction of the hip is
maintained via DOUBLE
DIAPERING and Pavlik harness to
be worn 24 hrs/day
 Frequent CMS checks.
(circulation, motion, sensation)
 Routine cast care (hip spica)
 Routine traction care (Bryant’s)
GASTROINTESTINAL DEFECTS

CLEFT LIP
 Failure of the maxillary
processes to fuse with the nasal
passage
 Etiology unknown but strong
genetic and environmental
factors
 more common in males
 prone to ear, nose and throat
infection
 Nursing management:
 Preoperatively: be aware of sucking
problems and infants swallow a great
deal of air during feeding, burp
frequently and use adaptive feeding
devices: large soft nipples, syringe
with rubber tubing
 Postoperatively: use medicine
dropper
 Elbow restraints, do not position on
abdomen
 Advise parent not to use pacifier
 Apply LOGAN BAR to reduce tension
on the suture line
Cleft Palate
 failure of the palatine processes to
fuse
 more common among females
 repair usually completed by 12-18
mos to prevent speech problem
Nursing management: Postoperatively
 Child is fed through a cup, cannot
use spoon
 Use of elbow restraints
 May position on the abdomen