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MLNG CELESTE,RN, MD 1
Respiratory Disorders
Anatomy and physiology of respiratory tract
MLNG CELESTE,RN, MD 3
> at birth the bifurcation is located at the 3rd
or 4th thoracic vertebra
> at 4 years, it is at the level of T5
> at 12 years, it is located between T5 to T6
> ethmoidal and maxillary sinuses are present
at birth
> Frontal and sphenoidal sinuses do not develop
until 6-8 years of age
MLNG CELESTE,RN, MD 4
>after 2 years of age the R bronchus is shorter
and more vertical than the left
> change in thoracic breathing begins at 2-3
years of age and is complete at 7
> in infants, the wall of the airway has less
cartilage (advantageous in an infant – an
infant does not develop bronchospasm- less
smooth muscle in the airway), therefore
wheezing cannot be a prominent finding
MLNG CELESTE,RN, MD 5
Adult vs Pediatric Airway
• Smaller airway diameter 4mm
• Distance between structures is shorter
• Organisms move faster, usually viral
• Infants obligate nose breathers
• “Little finger”=trachea size
MLNG CELESTE,RN, MD 6
• Respiratory system is divided into 2 divisions:
1. upper respiratory tract
a. nose
b. Para nasal sinuses
c. pharynx
d. larynx
e. epiglottis
MLNG CELESTE,RN, MD 7
MLNG CELESTE,RN, MD 8
• Inspiration :
- delivers warm and moistened air to the alveoli
transports O2 across the alveolar
membrane to hgb –laden RBC allows CO2
to diffuse from RBC back to alveoli thru
expiration , CO2 filled air is discharged to
outside
MLNG CELESTE,RN, MD 9
Respiratory center > medulla of the brain
receptors:
1. peripheral receptor-aortic arch and
carotid arteries( stimulated by
decrease PO2)
2. central respiratory receptor- stimulated
by:
a. increased PCO2 b. decreased temp.
c. body acidity d. increased BP
MLNG CELESTE,RN, MD 10
Assessment of respiratory illness in children
• Physical assessment:
A. cough- a reflex initiated by stimulation of
nerve of respiratory tract mucosa by the
presence of dust chemicals, mucus or
inflammation
- useful procedure to clear excess mucus
MLNG CELESTE,RN, MD 11
B. rate and depth of respiration:
tachypnea > increased RR, 1st indicator of
airway obstruction in young
children
MLNG CELESTE,RN, MD 12
• Supraclavicular or
Suprasternal retraction
Suggests upper airway
obstruction
• intercostal retractions
suggest lower airway
obstruction
MLNG CELESTE,RN, MD 13
D. Restlessness :
- when infantS or children have decreased
O2,
they become anxious and restless
MLNG CELESTE,RN, MD 14
F. Clubbing of fingers:
- change in the angle between the
fingernail and nailbed because of increased
capillary growth in the fingertips
G. Adventitious sounds:
- extra or abnormal breathing sounds
- I/E ratio is reversed (bronchial or tubular
breathing)
MLNG CELESTE,RN, MD 15
MLNG CELESTE,RN, MD 16
types of adventitious sounds:
1.rhonchi- obstruction at the level of nose
or pharynx
2.stridor- obstruction at the level of larynx
(best heard in supine position)
3. wheezing – obstruction is in the lower
trachea or bronchioles (expiration)
4.rales –when alveoli are filled with fluids,
fine crackling sounds
MLNG CELESTE,RN, MD 17
H. Chest diameter:
- in children with COPD unable to
exhale completely air trapped in
lung - - alveoli (hyperinflation) ,
produces
elongated A-P diameter of the chest
( pigeon chest)
MLNG CELESTE,RN, MD 18
MLNG CELESTE,RN, MD 19
• Laboratory tests:
A. blood gas analysis > an invasive method
for determining the effectiveness
of ventilation acid-base status
> provides information about
oxygenation of the blood as well as
O2 saturation of Hgb
MLNG CELESTE,RN, MD 20
causes of decreased O2 saturation
1. pt with respiratory distress (O2 cannot
reach the bloodstream)
2.Hgb is defective, cannot carry a full
complement of O2
PCO2 - measures efficiency of ventilation
PCO2 - seen in children who are
hyperventilating (breathing deeply) -
blowing off to much PCO2
PCO2- seen in children who are
hypoventilating (breathing very shallow) -
can’t blow off the CO2
MLNG CELESTE,RN, MD 21
CO2 retention( due to obstruction/
or hypoventilation)
partial pressure of CO2 rises and
concentration of CO2 in the plasma
increases
respiratory acidosis
( the body compensates by increased kidney
tubular reabsorption of HCO3 (bicarbonate)
respiratory alkalosis
( bicarbonate exceeds the
amount of acid in the blood)
MLNG CELESTE,RN, MD 22
in doing ABG- we need arterial blood (reflects
how the lungs are oxygenating the blood)
How to use:
1. sensor and photo detectors are placed
around vascular bed
2. infrared light is directed through the
finger from the sensor to the photo
detector( hgb absorbs light wave differently
when bound to O2 )
MLNG CELESTE,RN, MD 26
Advantages: 1. non-invasive
2.continuous monitoring by pulse
oximeter allows you to
modify the care
MLNG CELESTE,RN, MD 27
MLNG CELESTE,RN, MD 28
ABG values:
PH- 7.35-7.45 < 7.35 - acidosis,
> 7.45 - alkalosis
PO2 – 80-100 mm Hg
60 -80 mmHg- mild hypoxemia
40-60 mmHg - moderate hypoxemia
< 40
MLNG mmHg
CELESTE,RN, MD - severe 29
explanation:
> ph, pco2 - alkalosis
> ph, pco2 - acidosis
MLNG CELESTE,RN, MD 30
C. Nasopharyngeal culture
E. Sputum analysis:
>rare in children younger than school
age
MLNG CELESTE,RN, MD 31
• Diagnostic tests:
1. chest X-ray
2. bronchography
3.pulmonary function test - measures the
forces of inertia, elasticity, and
flow resistance
measured by the use of spirometry-
device that records the force of
air exchange
MLNG CELESTE,RN, MD 32
MLNG CELESTE,RN, MD 33
Therapeutic techniques
Expectorant therapy
1.Coughing
2.Chest physiotherapy
- 3 technique are involved
1. postural drainage
2.percussion
3. vibration
3.Mucus clearing devices- by use of flutter
device- stainless steel ball inside the device
moves when the child breathes out -causing
vibration in the lung -helps loosen the
mucus
MLNG CELESTE,RN, MD 34
Therapy to improve oxygenation
MLNG CELESTE,RN, MD 35
MLNG CELESTE,RN, MD 36
3. expectorant- helps raise mucus
4. bronchodilator- used to open lower
airway
5. metered dose inhaler- route of
medication
MLNG CELESTE,RN, MD 37
MLNG CELESTE,RN, MD 38
Disorders of upper respiratory tract
• Choanal atresia
• Acute nasopharyingitis
• Pharyngitis
• Tonsillitis
• Epistaxis
• Sinusitis
MLNG CELESTE,RN, MD 39
• Laryngitis
• Congenital laryngomalacia/tracheomalacia
• Croup
• Epiglottitis
• Aspiration
• Bronchial obstruction
MLNG CELESTE,RN, MD 40
Choanal atresia
> congenital obstruction of the posterior
nares by an obstructing membrane or
bony growth, preventing newborn from
drawing air through the nose into the
nasopharynx
> either unilateral/bilateral
MLNG CELESTE,RN, MD 41
• Sign: cyanosis
• Treatment:1. local piercing of the
obstructing membrane
2. surgical removal of the bony
growth
MLNG CELESTE,RN, MD 42
Acute nasopharyngitis (common colds-coryza)
MLNG CELESTE,RN, MD 43
• Signs and symptoms:
1.nasal congestion
2.watery rhinitis
3.low grade fever
4. mucus membrane is edematous
5.cervical lymph nodes may be swollen and
palpable
6. body malaise
MLNG CELESTE,RN, MD 44
• Pathophysiology:
> initial pathology is submucosal
edema of nasal mucosa by shedding of
ciliated epithelial cells (5th day) nasal
mucopurulent discharge
> interferon ( plays major role in recovery)
MLNG CELESTE,RN, MD 45
• Treatment: Common colds is self-limiting
> supportive care
> relief of nasal obstruction- use of
isotonic saline drops and aspiration
> antipyretic or analgesic agents
> antitussive is sometime used for
persistent cough
MLNG CELESTE,RN, MD 46
• Nursing diagnosis: parental health-seeking
behaviors related to management
of child’s cold symptoms
MLNG CELESTE,RN, MD 47
Pharyngitis
MLNG CELESTE,RN, MD 48
• Viral pharyngitis:
> causative agent is virus
Physical examination:
1. enlarged lymph nodes
2. erythema on the back of the pharynx
MLNG CELESTE,RN, MD 49
• Treatment:
1. antipyretic
2. gargle with warm water- school age
3. provide liquid foods- (+) difficulty of
swallowing
Nursing diagnosis:
> risk for fluid volume deficit
MLNG CELESTE,RN, MD 50
Streptococcal pharyngitis:
> caused by group A beta-hemolytic
streptococcus
> can lead to cardiac and kidney damage
> more severe than viral infection
MLNG CELESTE,RN, MD 51
- Spread by infected nose or throat
mucus through coughing or sneezing
MLNG CELESTE,RN, MD 52
treatment:
1. antibiotics- 10 days course of oral
antibiotics( pen G or clindamycin)
2. high fluid intakes
3.relief of pain
Complications:
1. Rheumatic fever
2. Glomerulonephritis
MLNG CELESTE,RN, MD 53
Retropharyngeal abscess
MLNG CELESTE,RN, MD 54
laboratory findings:
leukocytosis- increased WBC count
treatments:
1. antibiotics( benzathine pen G.
penicillin V
2. abscesses resolve on their own
if not - can do incision
3.adequate fluid intakes
MLNG CELESTE,RN, MD 55
Tonsillitis
> term commonly used to refer to infection
and inflammation of palatine tonsils
MLNG CELESTE,RN, MD 56
Signs and symptoms:
1. difficulty of swallowing
2.fever
3.lethargy
4.mouth breathing- (posterior pharyngeal
obstruction)
5.difficulty hearing- (Eustachian tube
obstruction)
6.halitosis
7. sleep apnea
MLNG CELESTE,RN, MD 57
Causes:
> child <3 years old-often viral
> school age children- group A beta-
hemolytic
Treatment: 1. antipyretic
2. analgesics
3. antibiotics
4. if recurrent onset of tonsillitis -
can do tonsillectomy
MLNG CELESTE,RN, MD 58
Tonsillectomy-removal of palatine tonsils
Adenoidectomy- removal of pharyngeal
tonsils-can be done in
children having sleep apnea
MLNG CELESTE,RN, MD 59
Epistaxis (nosebleed)
Management:
1. keep patient 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
MLNG CELESTE,RN, MD 60
2. apply pressure to the side of the nose with
your fingers
3. keep the child quiet and 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 continued
pressure
MLNG CELESTE,RN, MD 61
Sinusitis
Causes: streptococcal
staphylococcal
H- Influenza
MLNG CELESTE,RN, MD 62
signs and symptoms:
1. fever
2. purulent nasal discharge
3. headache
4.tenderness over the affected sinus
MLNG CELESTE,RN, MD 63
treatment:
1. antipyretic
2.analgesic
3. antibiotic for specific infection
4. nasal spray- Oxymetazoline HCl
(afrin) shrinks the edematous mucus
membrane and allows infected material to
drain
5. warm compress
MLNG CELESTE,RN, MD 64
Laryngitis
>inflammation of larynx
> occurs as complication of pharyngitis
or from excessive use of voice
Management :
1.sips of fluid offer relief from annoying tickling
sensation
2. rest the voice for at least 24 hrs
MLNG CELESTE,RN, MD 65
Congenital laryngomalacia/tracheomalacia
MLNG CELESTE,RN, MD 66
management: no routine treatment
-instruct parents to feed the child
slowly
MLNG CELESTE,RN, MD 67
Croup ( laryngotracheobronchitis)
MLNG CELESTE,RN, MD 68
signs and symptoms:
1. low grade fever
2. barking cough at night
3. inspiratory stridor
4.retractions
Management:
> provide warm, moist environment- as
an emergency measure
> give corticosteroids (nebulizer)-
reduces inflammation and bronchodilation
> intravenous hydration
MLNG CELESTE,RN, MD 69
Epiglottitis
MLNG CELESTE,RN, MD 70
causes:
1. H-Influenza type b
2. pneumococci, streptococci - most
common cause
3. echovirus
4.respiratory syncitial virus
MLNG CELESTE,RN, MD 71
never illicit gag reflex- may cause complete
obstruction
Laboratory findings:
1. leukocytosis ( 20,000-30,000 mm3)
with the proportion of neutrophils
Management:
1. provide warm moist environment
2. O2 administration
3. antibiotic therapy
4. intravenous therapy
MLNG CELESTE,RN, MD 72
MLNG CELESTE,RN, MD 73
Aspiration
MLNG CELESTE,RN, MD 74
*if the child is lying on his back at the
time of aspiration, stand at the head of
the table or bed, place hand under child
diaphragm and exert inward and upward
thrust*
MLNG CELESTE,RN, MD 75
MLNG CELESTE,RN, MD 76
MLNG CELESTE,RN, MD 77
Bronchial obstruction
MLNG CELESTE,RN, MD 78
Laboratory findings:
1.radioopaque finding on chest X-ray
2.leukocytosis
Complications:
1. pneumothorax
2.atelectasis
3. lipid pneumonia
MLNG CELESTE,RN, MD 79
management:
MLNG CELESTE,RN, MD 80
Disorders of lower respiratory tract
MLNG CELESTE,RN, MD 81
Influenza
> inflammation and infection of the
major airway
> caused by orthomyxoviruses, influenza
type A, B, C
MLNG CELESTE,RN, MD 82
incubation period: 1-5 days
Management:
1. antipyretic
2. antiviral drugs( tamiflu)
3. influenza vaccine( yearly given)
Complication:1. bronchitis
2. pneumonia
MLNG CELESTE,RN, MD 83
Bronchitis
MLNG CELESTE,RN, MD 84
causes:1. influenza virus
2. adenovirus
3. mycoplasma pneumoniae
Course of disease: 1-2 weeks
Sign and symptoms:
1.fever
2. dry hacking cough
3. on auscultation can hear rhonchi and
rales
4. On chest x-ray finding-diffuse alveolar
` hyperinflation and some marking on
hilus of lungs
MLNG CELESTE,RN, MD 85
Management:-1. aim in relieving the
respiratory symptoms
2. antipyretic
3. adequate hydration
4. antibiotic therapy
MLNG CELESTE,RN, MD 86
Bronchitis
Viral Bacterial
Etio Rhinovirus,Influenza, S. pneumoniae,
RSV, Parainfluenza S. aureus,
adenovirus, H. Influenzae,
paramyxovirus M. Catarrhalis
Causes: 1. adenovirus
2. parainfluenza
3. respiratory syncytial virus
MLNG CELESTE,RN, MD 88
sign and symptoms:
1. nasal flaring
2.intercostal/subcostal retarction
on inspiration
3. tachypnea
4. mild fever
5. expiratory wheezing
6. tachycardia
7. chest x-ray –pulmonary
infiltrates or collapse of alveoli
MLNG CELESTE,RN, MD 89
Management:1. antipyretic
2. adequate hydration
3. if in respiratory distress can
hospitalized the pt.
4. O2 administration
5. nebulized with
bronchodilators
nursing diagnosis:
> parental anxiety related to respiratory
distress in child
MLNG CELESTE,RN, MD 90
Respiratory syncytial virus
> an RNA virus, common cause of
bronchiolitis in young children.
> can cause apnea/periodic halt of
respiration
> peak in severity between 48 to 72 hrs
Sign and Symptoms:
-lethargic, cyanosis, nasal flaring
retraction, grunting, rales/ rhonchi
Diagnosis: throat or nasal culture
MLNG CELESTE,RN, MD 91
management: therapy is supportive
1. O2 administration
2.antiviral drugs( ribavirin)
3. isolate the patient
4. vaccination-RSV-IGIV and
palivizumab
MLNG CELESTE,RN, MD 92
asthma
MLNG CELESTE,RN, MD 93
Mechanism of disease:
> primarily affect the small airways and
involve 3 processes:
1. bronchospasm-happen because of
stimulation of PSNS (smooth
muscle constriction)
2. inflammation bec. of mast cell
3. mucus production activation this will
release histamine,
leukotrienes &
prostaglandin
MLNG CELESTE,RN, MD 94
Signs and symptoms:
1. dry cough
2. expiratory wheezing
3. cyanosis
4. retractions
MLNG CELESTE,RN, MD 95
Clinical Assessment of Asthma
MLNG CELESTE,RN, MD 97
Ndx:
• Ineffective breathing pattern r/t
bronchospasm, edema and accumulation of
mucus
• Fear r/t sudden onset of Asthma attack
• Activity intolerance r/t imbalance between O2
supply and demand
• Health seeking behaviors r/t prevention and
treatment for asthma attack
MLNG CELESTE,RN, MD 98
Management
• B2 agonists, Theophylline, Steroids, Cromolyn
Na, O2
• Orthopneic position
• Monitor VS, hydration
• Adequate nutrition and non allergenic diet
• Environmental modification
• Health education
MLNG CELESTE,RN, MD 99
Status Asthmaticus
Tx: SCC
Intensive
INH, Rifampicin, PZA x 2 mos
Maintenance
INH, Rifampicin x 4 mos
lungs collapse
acidosis
• placenta provides
the exchange of gas
and nutrient
umbilical vein
right atrium
right atrium
right ventricle
pulmonary arteries
( ductus arteriosus)
aorta
• Aorta from R
ventricle
• Pulmonary a. from L
ventricle
• Males
• S/sx:cyanosis,
murmurs
• Mx:PGE for PDA,
Balloon catheter to
create ASD,
definitive surgery 1
wk-3 mos
MLNG CELESTE,RN, MD 136
3. Total Anomalous Pulmonary
Venous Return
• Pulmonary vein
drains to SVC or R
atrium
• PDA or foramen
ovale essential
• S/sx:cyanosis,
fatigue
• CX: R heart failure
• Mx:PGE, surgery
• Constriction of aorta
• males
• S/sx: asymptomatic HPN,
irritability, headache,
epistaxis, dyspnea,
claudication, higher BP in
upper extremities, dec femoral
and distal pulses,systolic
murmur
• Cx:chronic HPN
• Mx:surgery 2 yo
• Postop: monitor abdominal
pain, antihypertensives
• Rest periods
• Adequate nutrition
small frequent feedings
iron supplementation
• Dx:clinical
Ndx:
Risk for noncompliance r/t knowledge deficit
about importance of long term therapy
- prevent initial and recurrent attacks
• Upper GI series
- Swallowed Barium moves into the esophagus,
stomach, and duodenum to reveal
abnormalities.
- Barium outlines stomach walls and delineates
ulcer craters and filling defects.
NI:
- 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.
• Esophagogastroduodenoscopy – a fiber-optic
scope is inserted to allow direct visual
inspection of the esophagus, stomach and
duodenum
• Aganglionic megacolon
• Absence of
parasympathetic
ganglionic cells in a
segment of the colon
(usually at the distal end
of the large intestine:
rectosigmoid colon)
• Lack of innervation to a
bowel segment causes a
lack of, or alteration in,
peristalsis in the affected
part
• Male predominance
MLNG CELESTE,RN, MD 188
• Causes
Familial, congenital defect
Commonly exists with other congenital
anomalies, particularly Down’s syndrome
(trisomy 21) and anomalies of the urinary tract
• Pathophysiology
As stool enters the affected part, it remains
there until additional stool pushes it through.
• The affected part of the colon dilates; a
mechanical obstruction may result.
S/sx:
Constipation
Ribbonlike stools
Failure to pass meconium or stool
abdominal distention
Bile stained or fecal vomiting
Nursing Care
Preop
8. Administer isotonic enemas: Normal saline solution or
mineral oil to evacuate the bowel
Daily enemas with 0.9% NaCl
Don’t administer tap water.
*Tap/hypotonic water will cause cardiac
congestion or cerebral edema
2. Minimal residue diet with vitamin supplementation
3. Position semi fowlers to relieve dyspnea from distended
abdomen
4. pacifier
Postop
9. Observe for abdominal distention
10. Small frequent feedings after NGT removal
11. Colostomy care
5. Assist parents to cope with children’s feeding
problems
MLNG CELESTE,RN, MD 194
Intussusception
• 2-6 mos
• Invagination of intestine
• S/sx:intense abdominal pain,
vomiting, blood in stool
“currant jelly”, abdominal
distention (sausage shaped
mass)
• NECROSIS: fever, tachycardia,
rigid abdomen
• Dx:sonogram “coiled spring”
• Mx:Ba enema (reduction by
hydrostatic pressure), surgery
2. NPO
• Hydration
• Pacifier
• may give thickened feedings on upright position then NPO
just before surgery
• Monitor I and O, weight, and vomiting
Postop
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
MLNG CELESTE,RN, MDneeds 200
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
Mx:’E’ surgery
Postop
6. Semi-fowlers
7. Maintain warm, humidified envt – lung fluid drainage
8. Suction prn
9. Chest pptx
10. NPO – prev pressure on diaphragm
• Causes:
Gluten intolerance
Immunoglobulin deficiency
MLNG CELESTE,RN, MD 205
• Pathophysiology
A decrease in the amount and activity of
enzymes in the intestinal mucosal cells causes
the villi of the proximal small intestine to
atrophy and decreases intestinal absorption.
• Complications
Lymphoma of the small intestine
Give the child: corn and rice products, soy and potato
flour, breast milk or soy- based formula, and fresh fruits.
• Ankle-foot disorders
• Types: Varus – inward
rotation
Valgus – outward
rotation
Calcaneous –
upward rotation or
dorsiflexion
Equinas –
downward rotation or
plantarflexion
Nursing Care
• Exercise
• Cast and brace care
• Skin care
• Restraints if necessary
• Diversional activities
• Health teaching
• Imperfect hip
development affecting
femoral head and
acetabulum
• Female
• Unilateral more
common
• Inc frequency w/
breech delivery
A. Lower right leg
B. asymmetric skin
MLNG CELESTE,RN, MD
fold 219
A. Normal hip
B. subluxated hip
C.Dislocated Hip
MLNG CELESTE,RN, MD 220
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)
• Mx: maintaining hip in abduction
traction and casting
A. Frejka splint
B. Pavlik Harness
C. Hip abduction for
subluxation
MLNG CELESTE,RN, MD 222
NDx: Impaired physical mobility r/t
immobilization device
Nursing Care
• Maintain proper positioning-keep legs abducted
• Adequate nutrition
• Diversional activities
• Regular exercise
• Ensure adequate circulation
• Provide comfort
• Maintain cast, traction, splint
• 6 mos - 5 years
• fever >/= 38.5C
• generalized tonic-clonic
• rarely persist > 10 minutes
• Postictal stage
• 30-40 % recurrence
• (+) family history
• Nonprogressive
• TYPES:
Spastic Dysphagia – most common; hypertonicity
Athetoid/dyskinetic – worm-like
Ataxic – wide based gait w/ repetitive mvmt
Mixed
• Dx: Clinical
Dx: sonography
• Inflammation of meninges
• Bacterial, Tuberculous, viral
S/sx: opisthotonus, neck rigidity, irritability, high
pitched cry
Dx: Lumbar puncture, Bld C/S, Ct scan, MRI
NDx: Risk for infection r/t presence of infective
organism
Tx: Abx
• Factor VIII
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
• Lymphoblast
• 2-16 yo
• Males
• Prevent infection
• monitor bleeding and transfusion reactions
• Provide comfort and pain alleviation
• Health teaching
• Emotional and psychological support
• B chain defect
• Heterozygous – Thalassemia minor
• Homozygous – Thalassemia major
• 4-6 mos old
S/sx: anemia
Dx: peripheral blood smear
Tx: blood transfusion - pRBC
• Females
• E coli
• Ascending infection
• S/Sx:infants – mimic GI d/o; dysuria, frequency,
hematuria, low grade fever, abdominal pain and
bedwetting
• Dx: urine culture
suprapubic any amount
clean catch > 100,000/ml
• Mx: antibiotic
hydration
MLNG CELESTE,RN, MD 263
Acute Glomerulonephritis
Nsg Care:
quiet play activities
diet – normal CHON, mod salt restriction, fluid
restriction
daily weight and output
• Altered glomerular
permeability(autoimmune);
inc permeability to albumin
• 3 yo
• Males
• Minimal change syndrome
Dx:urinalysis and
24 hr CHON, inc ESR
MLNG CELESTE,RN, MD 267
Mx:steroids, immunosupressant
Nsg care:
Adequate nutrition, proper diet – dec salt
Weigh daily, monitor I and O
Protect edematous areas
Administer prescribed drugs
Health teaching
A. Hypospadia B. Epispadia
C. Hypospadia w/ chordee
• Epispadias
-Urethral opening on
the dorsal surface of
the penis
• Surgical correction
Mx: surgery
Nsg care:
Post op – pain relief
assist parents in coping
• 2 mos-3 yo
• R/t food allergy
S/sx: papular and vesicular
skin eruptions w/ erythema,
pruritus, dry,flaky scales
upon healing
Mx: reduce allergen, topical
steroids
NDx: Impaired skin integrity r/t
eczematous lesion
Nsg care: Reduce allergen
Prevent skin dryness and
pruritus
• Protrusion of a bowel
through the inguinal ring
• males
• S/sx:painless lump in the
groin
• Cx:bowel strangulation
• Mx:surgery <1 yo
• Post op Nursing care:
wound care
assess circulation in
the leg
• TYPES:
• Mild: fever, irritable, 2-10 episodes/day, dry
mucous membranes, tachycardia
• - 2.5-5% wt loss
• Mx: oral rehydration
• Cx:dehydration
• Mx:fluid and electrolyte replacement
• Dx:Stool exam and culture
Electrolyte determination
Mx:
7. Determine age & wt, type of poison swallowed,
time of ingestion, route of poisoning, amt
ingested, present condition of child
< 1 yo – scalding
Pre school – reaches up a stove, spills coffee
Older children – flame burns
Trisomy 21
Maternal age >35 yo, paternal age >55
Features:nose is broad and flat, eyelids 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
• Use of chemicals
• Improve mental state
• Induce euphoria
• Peer pressure
• Feel more confident
• Adolescent rebellion