Pedia Disorder

pediatric disorders
common problems, disorders and diseases in

infants
a. prematurity:
- birth before 37th week of gestation
1. associated medical problems
maternal
• placenta previa
• abruptio placenta
• cervical incompetence
• hypertensive disease of pregnancy
fetal assessment
- weight - gestational age
- fontanels - multiple gestations
- infections - respiratory distress
- tachypnea - arterial blood gases
- urine integrity - abnormal breath sounds
- skin integrity - vernix caseosa
- apgar scoring - signs of birth trauma
nursing interventions
• feed slowly
• keep infant warm
• maintain clear airway
• rub back or soles of feet to stimulate infant’s
breathing.
• transport infant to special care facility as soon as
possible.
• avoid handling infant more than necessary for
feeding and changing of diapers.
congenital malformations
general nursing care of infant with physical
anomalies
assessment
• determine the child’s immediate physiologic needs
to sustain life
• know the parent’s immediate emotional needs to
promote bonding between child and parents
nursing diagnosis
• anticipated grief related to the loss of “perfect”

child.
• self-esteem disturbance related to interference
with establishing parent-infant bond
• altered nutrition, less than body requirements,
related to malabsorption of necessary nutrients
• prevent infection
• establish extra uterine circulation.
• establish proper waste elimination.
• establish body temperature control.
• expose the child to adequate stimulation.
• establish and maintain adequate respiration.
• ensure ability to take in adequate nourishment.
• foster the development of an infant-parent bond.
• nurses should be familiar with the most frequently
encountered physical anomalies so that they can
make truthful statements regarding the child’s
condition to the parents.
cleft lip
• failure of fusion of the maxillary and median nasal
processes
• occurs between 5 to 8 weeks of intrauterine life
• more common among males than females
• repaired surgically shortly after birth
cleft palate
• an opening of the palate usually found on the
midline due to incomplete development
• may involve the anterior hard palate or the
posterior soft palate
• occurs more frequent in females than in males
• repair is usually postponed until the child is 18 to
24 months old.
cleft lip & palate

nursing interventions:
• preoperatively the child must take an adequate
amount of food. feed the child via commercial cleft
lip nipple to prevent aspiration
• postoperatively the infant is kept on npo status
for at least 4 hours.
• bottle or breast-feeding is contraindicated
following surgery.
cleft lip & palate
• after 3 to 4 days a soft diet is given until healing
is complete.
• when the child begins eating soft food, spoon
should not be used.
• suction if there is the need to remove mucus,
blood and unswallowed saliva.
cleft lip & palate
• after cleft lip surgery, do not lay infants on their
abdomen.
• position child on his/her side as soon as awake.
• clean the suture line with a sterile saline, or 50%
hydrogen peroxide in sterile water and sterile
cotton-tipped applicators after every feeding
cleft lip & palate
• administer acetaminophen as prescribed to make
patient comfortable.
pierre robin syndrome

• a complex of congenital anomalies, including small
mandible, cleft palate, other craniofacial
abnormalities and defects of the eyes and ears
• the infant is positioned on the side or a
gastrostomy tube may be inserted for feeding.
tracheoesophageal atresia and fistula
types
• the esophagus ends in a blind pouch. there is
tracheoesophageal fistula between the distal part
of the esophagus and the trachea.
• the esophagus ends in a blind pouch. there is no
connection to the trachea.
• a fistula is present between an otherwise normal
esophagus and trachea.
types
• the esophagus ends in a blind pouch. a fistula
connects the blind pouch of the proximal
esophagus to the trachea
• there is a blind end portion of the esophagus.
fistulas are present between both widely spaced
segments of the esophagus and the trachea.

characteristic:
• presence of large amounts of amniotic fluid and
large amounts of mucus in the mouth appearing
like blowing bubbles
management:
• immediate surgery is done to prevent pneumonia.
antibiotics are administered as ordered.

preoperative
• give iv therapy
• keep child in an upright position and on the right
side to prevent aspiration
postoperative
• keep infant on npo status for 7-10 days until
suture line heals.
• turn the patient frequently to discourage fluid
from accumulating in the lungs.
• encourage crying to help expand lung tissue.
omphalocele
• the protrusion of the abdominal contents through the
abdominal wall at the point of the junction of the
umblical cord and abdomen.
• the herniated organs are usually the intestines, but may
include the stomach and liver.
• elastic bandaging may be performed as conservative
therapy.
• topical solution such as silver sulfadiazine may be
applied to prevent infection of the sac.
• delayed surgical closure may follow.
intestinal obstruction
• failure of canalization of intestine in utero at some point
in the bowel which results to atresia or stenosis of the
bowel
• the most common site is the duodenal bowel portion.
• anticipated if the mother had duodenal bowel portion.
• anticipated if the mother had hydramnios during
pregnancy or if 30 ml of gastric secretion was aspirated
from the newborn’s stomach
• monitoring body fluid and electrolyte is important until
surgery is done.
meconium ileus
• the obstruction of the intestinal lumen by
hardened meconium
• most commonly found in infants with cystic
fibrosis.
• results in abdominal distention and vomiting of
bile stained fluid
• characterized by the failure to pass meconium
within the first 24 to 48 hours after birth, rapid
dehydration associated with electrolyte imbalance
and abdominal distention
• management includes use of enema or surgery
imperforate anus
• absence of opening in the anus
• managed through surgery
imperforate anus
preoperative
• put the client on npo status.
• attach the nasogastric tube to low intermittent
suction for decompression.
postoperative
• if the bowel sounds are present and the
nasogastric tube is removed, small oral feedings is
advised
• rectal dilation is done once or twice a day to
ensure the proper patency of the rectal sphincter.
diaphragmatic hernia
• the protrusion of the abdominal organ through a
defect in the diaphragm into the chest cavity
which usually involves the stomach and the
intestine
• characterized by the absence of breath sounds on
the affected side of the chest
diaphragmatic hernia
nursing intervention
• elevate head to provide maximum respiratory
space.
• perform gastrostomy to prevent distention of the
herniated intestine.
• use low intermittent suction to avoid injury to the
lining of the stomach.
• after surgery, the infant is kept in a semi-fowler’s
position.
• keep the infant in a warm, humidified environment
to encourage lung fluid drainage.
anomalies of the nervous system
hydrocephalus
• an excess of cerebrospinal fluid in the ventricles
and subarachnoid space of the brain
• the nursing care is same as the child with increase
icp.
neural tube disorders

anencephaly
• the absence of cerebral hemisphere
microcephaly
• characterized by slow brain growth which falls
more than three standard deviations below
normal on growth charts
• results in mental retardation because of the lack
of functioning brain tissue.
spina bifida occulta

• incomplete fusion of spinal cord
• usually occurs in the lubosacral area (l5 and s1)
• there is positive tuft of hair or dimple over the
affected area
• may result to progressive disturbance of gait with
weak foot or bowel and bladder disturbances
meningocele
• hernial protrusion of a saclike cyst of meninges
filled with spinal fluid
• positive cystic swelling beneath the skin which
contains csf
myelomeningocele
• hernial protrusion of a saclike cyst containing
meninges, spinal fluid and a portion of the spinal
cord
• may result to either positive or negative
neurologic deficits
• usually seen with hydrocephalus and arnold chiari
malformation
encephalocele
• cranial meningocele or myelomeningocele
• occurs most often in the occipital area of the skull
neutral tube disorder

preoperative
• the position should be prone or supported on the
side.
• a sterile wet compress of saline, antiseptic or
antibiotic gauze over the lesion may be used to
keep the sac moist.
• maintain body heat
• check any leakage.
• measure head circumstance once a day in the
preoperative period.
• the child must be observed frequently for signs of
increased intracranial pressure
neutral tube disorder
postoperative
• a child is placed on the abdomen until the skin
incision has healed (7-14 days)
• practice careful precautions in preventing urine or
feces to touch the incision
• keep the infant prone or on the side to prevent
pressure on the incision.
nursing care of infants with skeletal
anomalies
finger conditions
polydactyly
• the condition characterized by the presence of one
or more additional fingers
• supernumerary finger is usually amputated in
infancy or early childhood.
syndactyly
• a condition characterized by two fingers which are
fused
• the fusion is usually caused by simple webbing.
• treatment consists of separation of the fingers
into two, which should be functional and
cosmetically appealing.
torticollis (wry neck)

• the head is inclined to one side as a result of the
contraction of muscles on that side of the neck
• occurs as a congenital anomaly when the
congenital muscle is injured and bleeds during
birth
• managed through passive stretching exercises
where the infant is encouraged to look in the
direction of the affected muscles
• surgical correction followed by a neck immobilizer
is necessary if the condition persists after one
year.
craniosynostosis
• the premature closure of the sutures of the skull
which may lead to deformed face and orbits of the
eyes and increased intracranial pressure
• may be associated with cardiac anomalies,
choanal atresia, or defects of the elbows and knee
joints
• if the coronal suture is involved, surgery is
needed.
achondroplasia
• a form of dwarfism inherited as a dominant trait
which involves a defect in the cartilage production
in utero.
• characterized by less than 140 cm in height, and
flattened bridge of the nose
• x-ray films reveal characteristic abnormal flaring
of epiphyseal lines
congenital clubfoot
a. talipes equinovarus
• most common congenital deformity of the foot
• characterized by internal tibial torsion,
plantarflexion, inversion and adduction of the
forefoot
b. calcaneovalgus
• foot turns out and the heel is held lower than the
anterior foot.
• both are managed through serial casting,
corrective surgery or shoe correction
congenital clubfoot
• change diapers frequently
• teach parents on the following:
• how to check the infant’s toes for coldness or
cyanosis
• how to blanch a toenail bed and watch it turn
pink to assess for good circulation
• how to perform passive foot exercises.
developmental hip dysplasia

• flattering of the acetabulum of the pelvis which
results in subluxation and dislocation at the hip
joint
• six times more common in females than in males
because of the flaring of the hips and the hormone
relaxin
• management includes the use of traction (older
children) or surgery.
pavlik harness
• the harness is worn continually.
• teach the parents on how to remove the harness
before bathing and how to reduce the hip again
before using the harness.
• parents should assess the skin under the straps
daily for irritation or redness.
spica cast
• before discharge, teach the parents how to do
neurovascular assessment (check temperature
and circulation in the toes) to prevent circulatory
compression
common prolems in toddlers, preschoolers,

schoolers and adolescents
concept of illness to a child

younger children ( 2 - 7 years )
• the cause of illness is magical or is the
consequence of breaking a rule.
• getting well again is possible only if they follow a
set of rules, such as staying in bed and taking
medicine.

fourth graders (7-10 years)
• generally aware of the role of germs in illness but
may have the misconception that all illnesses are
caused by germs
• see a passive role for them in getting well because
illness comes from outside influences.
eighth graders (13 years and above)
• able to voice an understanding that illness can
occur from several causes
• can take an active role in getting better
nursing process for an ill child
nursing diagnosis 1:
• anxiety of the child
• related factor:
• separation during hospitalization
• nursing priority:
• for the child to actively relate with hospital
personnel and hospital routine in ways
appropriate to child’s age and stage of
development.
nursing process for an iii child

nursing diagnosis 2:
• fear of the child
• related factors:
• diagnosis or therapeutic procedure.
• nursing priority:
• for the child to voice satisfaction with comfort
measures, child describes how he participates in
a procedure.
nursing intervention:
• provide opportunities for parents to participate in
the child’s care.
• promote open parent visiting.
• support sibling and grandparent visitations.
• ample analgesia, including techniques of
distraction or imagery; traditional comforts such
as a change of clothing or positions; and reading
to the child.
• to assure children that their bed is an area that is
safe, all painful procedures should be done in the
treatment room away from the bed.
• offer children a sense of control.
• explain to the children the procedures and give
choices whenever possible to limit their fear of
hospitalization.
• make the children admitted as in-patient feel that
their stay is transient even upon admission.
• allow parents to perform the procedures that need
to be done at home first until they become
comfortable with the techniques.
• be certain that parents/guardian know who to
contact if nursing care plans do not work as
anticipated and that they have a definite return
appointment for follow-up care.
care of a child with muscular-skeletal
disorders
musculoskeletal disorders
nursing diagnosis
• pain related to chronic inflammation of joints.
• impaired physical mobility related to cast on leg.
• self-esteem disturbance related to continued use
of body brace.
• diversional activity deficit related to the need for
imposed activity restriction for weeks.
assessment of musculoskeletal function
diagnostic tests
• x-ray
• bone scan
• arthroscopy
• muscle or bone biopsy
• electromyography
medical/surgical management
casting
• made of plastic or open-woven bandage
impregnated with plaster of paris
• designed to protect a broken bone and to prevent
movement of the aligned bone ends until healing
has progressed sufficiently
casting
• keep the extremity in cast elevated to prevent
edema.
• check circulation frequently (every 15-min. during
the first hour, hourly in the first 24 hours, and
then every 4 hours thereafter).
• assess color, warmth, presence of pedal pulses,
and sensations of numbness or tingling. after
removing the cast, bathe the extremity.
crutches
• prescribed for children for the following reasons:
• to keep weight off both legs
• to support weakened legs
• to maintain balance
• nursing intervention:
• ensure that the crutches are properly fit.
• teach the child to support his weight at the hand
grip not on the axilla
• always assess if the rubber tip is intact.
traction
• involves pulling on a body part in one against a
counter pull exerted in the opposite direction.
• used to reduce dislocations and immobilize
fractures
• provide good skin care on the child’s back,
elbows, and heels.
• provide a trapeze suspended over the bed of the
child to position oneself in using the bedpan.
traction
• do not move the weights or interfere with the
traction when changing the child’s bed linens or
carrying out nursing functions.
• check the extremity in fraction every 15 minutes
during the first hour, hourly for 24 hours, and
every 4 hours, thereafter. monitor for signs of
pallor, lack of warmth, tingling, absent of
paripheral pulse, edema or pain.
traction
• involves the use of an external device to separate
opposing bones to encourage new bone growth.
• used to lengthen the bone when one limb is
shorter than the other
• also used to immobilize fractures or correct
defects when the bone is rotated or angled
open reduction
• a surgical technique used to align and repair bone
• internal fixations, such as use of rods or screws,
are rarely used in children except in those with
scoliosis.
disorders of the skeletal structures
achondroplasia
• the most common form of short limb dwarfism
• transmitted as an autosomal dominant trait
• achodroplastic infants may be stillborn or die in
their first year after birth.
osteogenesis imperfecta
• aka fragilitas ossium, brittle bones
• uncommon hereditary generalized connective
tissue disorder in which the occurrence of multiple
fractures is rendered inevitable by extreme
fragility of the bones
vitamin c (ascorbic acid) deficiency

• interferes with osteoblastic activity resulting in
diminished formation of bone matrix
• clinical manifestation includes hemorrhage which
results from defective capillary walls.
• causes scurvy
scurvy
• an acquired constitutional disease caused by
deficient dietary intake of vitamin c
• manifested by changes in mesenchymal tissue of
the body, especially collagen, bone, teeth, and
blood vessels.
vitamin d deficiency
• produces rickets in the children and osteomalacia
in adults
rickets
• a constitutional disease of infancy and childhood
caused by lack of vitamin d
• evidenced by bone deformities, which may be
striking in degree and widespread in distribution
nursing care for children with congenital hip
dislocation
congenital hip dislocation (chd)
• types
• teratologic (intra-utero)
• typical (unstable, dislocated or subluxated)
• more than 50% of the cases is unilateral
• left hip involvement is more common for unilateral
cases
• occurs more often in girls than in boys (8:1)
• abnormal laxity
• assessed using the ortolani’s test management
varies according to age
knee conditions
chondromalacia patella
• the softening of the articular cartilage of the
patella of diverse origin
• may be progressive and managed conservatively
• has three categories:
• primary idiopathic type
• secondary adolescent type
• adult type
genu varum (bowlegs)

• the lateral bowing of the tibia with the medial
malleoli of the ankles touching and the medial
surfaces of the knees are over 2 inches part
• seen most commonly in 2 years old
• part of normal development in children which is
gradually corrected at age 3 and latest at school
age
• if condition worsens or persists beyond school
age, the child needs referral to an orthopedist.
genu valgum (knock-knee)

• the medial surfaces of the knees touch and the
medial surfaces of the ankle malleoli are
separated by more than 3 inches
• usually seen in children 3 to 4 years
• gradually corrects itself and at the latest by
school age
• if condition worsens or persists beyond school
age, the child needs referral to an orthopedist.
foot and ankle conditions

pes planus (flatfoot)
• a foot without depression or complete loss of the
medial longitudinal arch
• may either be congenital or acquired
• management include arch support, exercises and
shoe modification
pes cavus
• a foot with a usually high arch and synonymous
with clawfoot, pes arcuatus and hollow foot.
• may either be primary (idiopathic) or secondary
(with known cause)
talipes equinovarus or congenital clubfoot

primary deformities
• inversion and adduction of the forefoot
• varus of the calcaneus (heel inversion)
• equinus (plantarflexion)
• internal tibia torsion
talipes equinovarus or congenital clubfoot

secondary deformities:
• contractures of the tissues on the medial side of
the foot
• underdeveloped and contracted calf muscles
• more common in males
• management includes astronomy, arthrodesis and
tendon transfer
osteomyelitis
• an infection of the bone which typically begins at
the metaphysis
• most commonly caused by staphylococcus aureus
in older children and haemophilus influenza in
younger children
• carried to the bone site by septicemia (blood
infection)
osteomyelitis
• children with sickle cell anemia have a special
susceptibility to salmonella invasion in long
bones.
• may also occur directly from an outside invasion
due to a penetrating wound, open fracture, or
contamination during surgery
• characterized by altered bone growth
synovitis
• an acute, nonpurulent inflammation of the
synovial membrane of a joint, which occurs most
commonly in the hip joint of children
• peak age of incidence: between 2 and 10 years
juvenile rheumatoid arthritis (jra)

• inflammatory disease of childhood with an
unknown cause
• characterized by chronic inflammation of the
synovium with joint effusion and eventual erosion
• management includes the use of steroids, nsaids,
slow acting anti-inflammatory drugs; surgery,
bracing or shoe correction.

• exercises
• institute a set of exercises (to preserve and
strengthen muscle and joint functions)
• avoid running, jumping, prolonged walking and
kicking (to prevent strains of the joint)
• apply heat using warm water soaked for 20-30
minutes <to reduce pain and inflammation in
joints and increase comfort and motion>
• hot baths <to eliminate stiffness of joints >
• paraffin soaks <to reduce inflammation in wrist
and fingers
nursing intervention :
• splinting
• encourage client to wear splint continuously even
during sleep during period of achieve
inflammation<to immobilize the joint for faster
recovery>
• instruct the client to use splint until the
inflammation subsides <to prevent contracture
and deformity >
nursing intervention :
• nutrition
• help parents plan mealtime for “best time” of the
day (to prevent malnutrition due to poor appetite
secondary to anorexia, pain and fatigue)
disorders of the spine
scoliosis
• lateral deformity of the spine with vertebral
rotation
• the incidence of thoracic curve is greater than
lumbar curve
• lumbar is the least common pattern.
non-structural scoliosis
• the lateral curvature of vertebral column not
associated with any true structural deformity at
the vertebra
• associated with abnormal posture, by length
discrepancy, muscle spasm (as in lbp of disc
herniation), tumors, inflammation etc.
• non-progressive though may develop to structural
scoliosis, and become progressive if present over
prolonged period of time.
structural scoliosis
• the lateral spine curve that cannot be fully
corrected by lateral flexion
• associated with bony changed and fixed rotatory
deformity of the vertebral bodies toward the
convexity of the curve
• primarily involves bony deformity
• may either be idiopathic (65%) or acquired
• managed through surgery or use of braces
scoliosis
preoperative care
• introduce deep-breathing exercises and
incentive spirometry to increase lung function
postoperatively to children
• explain what they can expect after surgery
(pain, fatigue, and feeling “not themselves”)
scoliosis
preoperative care
• in some instances, a child may receive
postoperative care on a stryker frame. if so,
introduce a frame preoperatively.
• a nasogastric tube is inserted prior to surgery to
prevent abdominal distention. major surgery
may cause paralytic ileus and lack of bowel
tone.
scoliosis
postoperatively care
• do not bend the back once rods are in place and
the spinal fusion has been done.
• tape the hatch of the bed in place or unplug
electric controls so that the bed cannot be raised
by accident by the parent or any uninformed
auxiliary personnel.
• let the child lie flat after surgery.
scoliosis
postoperative care
• position to side lying every two hours to enhance
respiratory status unless segmented rod was used
• perform neurovascular assessment of lower
extremity every 2 hours
• record the vital signs carefully
• keep the child on npo status until bowel sounds
return.
disorders of the skeletal muscles

duchenne muscular dystrophy
• the most common type of muscular dystrophy
characterized by progressive symmetric wasting
of the leg and pelvic muscles
• associated muscle weakness produces a waddling
gait and pronounced lordosis
• the onset of symptoms is at 2-7 years old and on
the average at 4-5 years old.
• young boys are asymptomatic until 3-6 years old.
• male is more affected than females (9:1)
• the primary causes of death are cardiac and
respiratory failure.
• characterized by macroglosia, (+) gower’s sign,
tip-toeing, intellectual impairment in 30% of
cases, wheelchair dependency by 9-10 years old,
lumbar lordosis with protuberant abdomen, (+)
waddling gait, and trendelenburg sign and gait.
stage 1 (patient still ambulatory)
• confirm diagnosis. refer to a genetic counselor
when carrier status is detected.
• do routine nursing care. immunization, dental
care, etc.,
• maximize self-care as long as possible
• encourage social activities, hobbies, education
• encourage ambulation for as long as possible to
prevent contractures
• implement an exercise program
stage ii (patient in wheelchair mobility)
• selection of appropriate wheelchair
• maintain maximum ability for self-care for a s long
as possible
• plastic body jacket (custom made)
• stabilize spine with plastic body jacket
• assist in pulmophysiotherapy
• facilitate ventilation and clearing of secretions.
• assist in postural drainage, chest percussion,
suctioning.
• teach the client and family on the use of assistive
device and equipment
stage iii (totality dependent patient)
• maintain activities that patient are still capable of
doing
• perform general nursing care
• perform assisted ventilation.
injuries of the extremities

fracture
• a traumatic injury to a bone in which the
continuity of the bone tissue is broken
• most common injury in children
• fat embolism may occur as complication
• management include traction, casting, closed
reduction and plaster immobilization
nursing management:
• care of the cast, traction
• reassure and calm the child and parents
sprain and strain

• sprain: an over stretching or tearing of ligaments
or tendons or both secondary to joint trauma
• strain: an injury to the muscle
• r- rest i- ice
• i – ice c- compression
• c- compression e- elevation
• e – elevation s- support
head trauma
skull fractures
• a break in the continuity of the skull caused by
forceful trauma which may occur with or without
damage to the brain
• classified as linear, comminuted, depressed and
basilar
• stabilize the neck with a brace until cervical
trauma has been ruled out.
• assess neurologic function at frequent interval to
detect increased intracranial pressure.
• assess vital signs to detect changes in these areas
and observe the child’s pupils to be certain that
they are equal and they react to light.
concussion
• a temporary injury from a hard jarring shock
types:
• coup injury (direct injury of anterior brain)
• countercoup injury (injury resulting from the recoil
and striking of posterior brain to posterior skull)
manifested by: irrational behavior (frontal lobe),
complete loss of consciousness (if severe),
temporary amnesia (temporal lobe) and temporary
loss of neurologic function without apparent
structural damage
contusion
• a more severe injury in which the brain is bruised,
and with possible surface hemorrhage.
manifested by:
• abnormal motor function, abnormal eye
movements, and elevated icp
subdural hematoma
• venous bleeding into the space between the dura
and the arachnoid membrane
• more often occurs in infants than in older children
• occurs when the head trauma lacerates minute
veins in this area
• symptoms which include anemia, seizures,
vomiting and increased icp may occur three days
after the trauma or for as long as after 20 days
• management: includes subdural puncture in
infants and surgery in older children.
epidural hematoma
• bleeding into the space between the dura and the
skull
• usually results from the rupture of the middle
meningeal artery
• manifested by decorticate posturing, unequal
pupilary dilation or constriction, convulsions,
hemiparesis and loss of consciousness
• management: includes surgical removal of
accumulated blood or cauterization of torn artery.
intracerebral hemorrhage
• bleeding into the substance of the brain
• commonly seen in head injuries due to missile
injuries or bullet wounds, stab injury
• results from intracranial tumors, leukemia,
aplastic anemia, and thrombocytopenia and
complication of anticoagulant therapy.
• onset may be insidious, beginning with the
development of neurologic deficits followed by
headache.
• management: includes control of icp,
administration of fluids and electrolytes and
antihypertensive drugs
abdominal trauma
• generally non-penetrating and occurs from a
direct blow to the abdomen from an object such as
baseball bat or an automobile dashboard.
• the most frequently injured organs are spleen and
liver.
• monitor iv line.
• administer pneumococci vaccine to prevent
pneumococci infections.
• provide post surgical care for the clients after a
splenectomy.
near drowning
• drowning: death due to suffocation from
submersion of liquid
• near drowning: submersion injury requiring
emergency treatment with recovery within 24-
hour post-injury
• management: includes cpr, mechanical
ventilation, administration of 100% 02,
administration of plasma and insertion of
nasogastric tube to decompress the stomach.
poisoning
• intake of a substance that causes illness, injury, or
death
• occurs most commonly in children between 3 and
12 years old
• common agents in childhood poisoning include
soap, detergent or cleaner, and plants.
• before administering an emetic, call a poison
control center to make certain that vomiting is
desirable. unless the poison is caustic, corrosive,
or a hydrocarbon, vomiting is the most effective
way to remove the poison from the body, more
effective than lavage.
poisoning
nursing management
• empty mouth of pills, plant parts, other materials
• flush eyes continuously with normal saline for 15-
20 mins.
• flush skin and wash with soap and soft cloth
• remove contaminated clothes
• bring a victim of an inhalation poisoning into fresh
air
• identify the poison
• be alert to signs and symptoms of potential
poisoning in the absence of other evidence
• call poison control center or other emergency
facility
poisoning
nursing management
• remove poison and prevent absorption
• induce vomiting: administer ipecac if ordered
• 6-12 mos = 10 ml; do not repeat
• 1 -12 yrs =15 ml; rpt dosage once if vomiting
does not occur within 20 min
• do not induce vomiting if:
• victim is comatose, in severe shock, or
convulsing or has lost gag reflex
• poison is a low-viscosity hydrocarbon
• place the child in side-lying, sitting or kneeling
position with head below the chest to avoid
aspiration
frostbite
• a tissue injury caused by extreme cold resulting to
peripheral vasoconstriction
• classified according to the degree of damage (1st
erythematous to 4th –narcotic)
• analgesics may address the pain and epidural
anesthesia is used if the feet are involved.
frostbite
nursing management:
• assess body temperature to diligently defect early
symptoms of infections.
• apply dressing as necessary to avoid secondary
bacterial contamination of a necrotic injury site.
bites
• an injury that is caused by an animal or insect
puncturing or tearing the skin with teeth, fangs,
or mouthparts
management: focuses on the isolation of the extremity
and removal of any venom.
nursing management
• use rubber suction cups to remove venom.
• urge the child to lie quietly to slow circulation
• apply a cold compress to slow the spread of the
venom and to reduce the formation of edema.
burn trauma
burn
thermal
• most common burn, which usually results from
contact with flame or hot liquid chemicals
• infection is the most common cause of death.
• the extent of the injury depends on duration and
intensity of the heat exposure.
• superficial partial thickness burn: heals in 7 to
21 days
• deep partial thickness burn: heals in 3-5 weeks
• full thickness burn: not capable of
reepithelialization and grafting to close the
wounds.
burns
electrical
• the most devastating type of burn which is
associated with systemic complications
• symptoms of cns injury may be late onset within
one month or as late a three years post-injury, so
long term follow-up is needed
• management: includes homograft; debridement,
escharotomy and fasciotomy.
burns
• comfort management
• care of the burn wound (cleansing, debriding, and
applying topical medications and dressings to the
burn wounds)
prevention of complications:
• maintain the body temperature through warmed
solutions, linens, occlusive dressings, heat
shields, radiant warmer and warming blankets
• monitor for symptoms of wound infection,
generalized sepsis or bacterial pneumonia.
• reposition the child frequently.
nursing process
assessment
• weight loss
• dehydration
• poor skin turgor
• metabolic alkalosis
• electrolyte imbalance
• diarrhea and vomiting
• dry mucous membrane
nursing diagnoses
related to interference with establishing parent-
infant bond
• risk for fluid deficit
• altered family process related to chronic illness in
child
• self-esteem disturbance related to feelings of
being different resulting from special dietary
restrictions
• monitor input and output
• determine serum electrolyte levels
• give appropriate nutrition management.
dehydration
• excessive body fluid loss.
• may result from a number of diseases (diabetic
ketoacidosis, gastrointestinal infections) and
extensive burns
• may be classified as isotonic, hypotonic or
hypertonic dehydration
diarrhea
• the frequent passage of loose, watery stools
• major cause of infant mortality
• results from disorders involving digestive,
absorptive, and secretory functions
• caused by abnormal intestinal water and
electrolyte transport
• the most common viral pathogens are rotaviruses
and adenoviruses
• most common bacterial pathogens are
campylobacter jejuni, salmonella, giardia lamblia,
and clostridium difficile
constipation
• alteration in the frequency, consistency and ease
of passing stool
• may arise secondary to a variety of organic
disorders of the g1 tract or wide range of systemic
disorders
• majority of children have idiopathic or functional
constipation
vomiting
• the forcible voluntary or involuntary emptying of
the stomach contents through the mouth
• the primary cause is either viral or bacterial
invasion of the gastrointestinal tract.
• management: includes oral rehydration, iv therapy
and administration of antiemetics.
gastroesophageal reflux (ger)
• backflow of gastric contents into the esophagus as
a result of relaxation or incompetence of the lower
esophageal or cardiac sphincter
• may be associated with hiatal hernia
gastroesophageal reflux (ger)

• place client in head-elevated position following
feedings and at night.
• provide small, frequent feedings to decrease the
amount of regurgitation
• for infants, thicken formula by adding 1 table
spoon of rice cereal per 6 ounces of formula and
crosscut the nipple;
• for toddlers, feed solids first, followed by liquids
• instruct parents to avoid feeding the child fatty
foods, chocolate, tomato products, carbonated
liquids, fruit juices, citrus products, and spicy
foods.
pyloric stenosis
• hypertrophy of the circular muscles of the pylorus
which causes narrowing of the pyloric canal
between the stomach and the duodenum
• usually develops in the first few-weeks of life
preoperative
• administer iv fluid to correct electrolyte
imbalance, dehydration and starvation,
preoperatively
• withheld oral feedings to prevent further
electrolyte depletion
hepatitis
• an acute or chronic inflammation and infection of
her liver
types
• hepatitis a
• mode of transmission: ingestion of locally
contaminated water or shellfish
• hepatitis b
• mode of transmission :transfusion of
contaminated blood and plasma or semen
• inoculation by a contaminated syringe or needle
through intravenous drug use
• spread to fetus if mother has infection in third
trimester of pregnancy
hepatitis
• hepatitis c
• mode of transmission: parenteral route
• hepatitis d
• occurs in children already infected with hbv
• hepatitis e
• uncommon in children
• hepatitis g
• uncommon in children
• blood borne and is similar to hcv
• high-risk groups include transfusion recipients, iv
drug users, and individuals infected with hcv
intussusception
• invagination of one portion of the intestine into
another
• a surgical emergency that occurs between 3
months and 5 years
• preoperative
• keep infants on npo status before surgery or
non-surgical reduction
• monitor laboratory results (cbc, urinalysis)
intussusception
• preoperative
• monitor the stool, inform the physician of the
passage of normal brown stool to allow the
change of therapeutic plan.
• monitor for signs of electrolyte imbalance,
hemorrhage, or peritonitis and manage
accordingly.
• if non-surgical reduction is done, keep child on
npo for a few hours then graduate to regular
feeding
intussusception
• postoperative
• monitor the vital signs, blood pressure, intact
sutures and dressing, and return of bowel
sounds.
• observe the passage of barium or water-soluble
contrast material and stool patterns for 24
hours to know if there is recurrence of
intussusception.
volvulus
• an abnormal twisting of the digestive tract which
leads to partial or complete obstruction and a
reduction in blood supply
• management includes surgery
necrotizing enterocolitis
• acute inflammation of the small and large
intestine caused by clostridium perfringens
• results from ischemia or poor perfusion of blood
vessels in sections
• risk factors: immaturity, history of anorexia or
shock, enteral feedings and infections
• management: includes iv or total parenteral
nutrition and surgery.
appendicitis
• inflammation of the appendix which may lead to
peritonitis and sepsis
• results from obstruction of the lumen of the
appendix by hardened fecal material, foreign
bodies, microorganisms and parasite
• most common cause of abdominal surgery in
children
appendicitis
• preoperative
• keep infants on npo status. use of analgesics,
cathartics and heat are contraindicated
• obtain urine sample for urinalysis and blood
sample for cbc
• initiate iv fluid therapy with electrolytes as
ordered
appendicitis
• postoperative
• observe for possible signs of infection
• maintain the iv fluid until they can take
adequate oral feedings
• for ruptured appendix, iv fluid and antibiotic
therapy are continued until full bowel function is
restored.
meckel’s diverticulum
• a small, naturally occurring, outward profusion of
the inner lining of the small intestine through the
muscular wall
• most common congenital malformation of the gi
tract
• may cause intussusception
celiac disease
• sensitivity or immunologic response to protein,
particularly the gluten factor found in grains
• results in the accumulation of glutamine, which is
toxic in intestinal mucosal cells and the inability to
absorb fats
• occurs most often between the ages of 1 and 5
years
• management includes gluten-free diet and
substituting corn, rice and millet as grain sources
and minerals and vitamin supplements.
hernia
• a protrusion of the bowel through an abnormal
opening in the abdominal wall
• usually occurs at the umbilicus and through the
inguinal canal
• danger occurs when the organ protruding through
the opening is constricted to the extent that
circulation is impaired or the function of other
structures are affected
• managed: through surgery to return the bowel to
the abdominal cavity
hernia
• keep the suture line dry and free from urine or
fecal matter to prevent infection.
• assess circulation in the leg on the side of the
surgical repair
hirschprung’s disease
(congenital aganglionic megacolon)
• absence of ganglionic innervations in the rectum
and upward in the colon leading to absence of
peristaltic waves
• leads to mechanical obstruction from the
inadequate motility in an intestinal segment
• may be familial congenital defect or may be
associated with other anomalies, such as down
syndrome and genital urinary abnormalities
• occurs more often in males than in females
• results to chronic constipation (ribbon-like stools)
• preoperative
• provide a low-residue diet, stool softener and
vitamin supplements to improve the child’s
condition
• administer enemas to achieve bowel
movements. use normal saline not tap water.
• postoperative
• observe for abdominal distention
• assess bowel sounds
• observe for passage of flatus and stools
• administer antibiotic solution or saline, as
prescribed, to reduce the possibility of infection
• offer small frequent feedings of fluid as soon as
nasogastric tube is removed. change diet
gradually from fluid to soft to minimal residue
diet and to normal diet.
inflammatory bowel disease
• involves the development of ulceration of the
mucosa or submucosa layers
• occurs most frequently in young adults and
adolescents
• probable cause is the alteration in immune system
response or autoimmune processes
inflammatory bowel disease
• crohn’s disease: chronic inflammatory disease of
the lower intestinal tract
• ulcerative colitis: inflammation of the walls of the
bowel accompanied by the formation of ulcers
• management: includes enteral or parenteral
nutrition, high protein, carbohydrate and vitamin
diet, anti-inflammatory drugs,
immunosuppressant drugs, colectomy followed by
an ileoanal pull-through, and colostomy or
ileostomy
disorders caused by food, vitamin, and

mineral deficiencies
kwashiorkor
• caused by protein deficiency
• may also occur after weaning, when children
change from breast milk to a diet consisting
mainly of carbohydrate
• management: includes high-protein diet, oral
dehydration, antibiotics and antidiarrheals and iv
fluids and electrolytes
marasmus
• a form of starvation
• caused by deficiency of all food groups
• commonly seen in developing countries
• usually occurs in infants younger than 1 year old
• managed: through adequate nutrition rich in
nutrients, oral dehydration , antibiotics,
antidiarrheals and iv fluids and electrolytes
iodine deficiency
• may lead to hyperplasia of the thyroid gland
(goiter)
• occur most commonly in girls at puberty and
during pregnancy
• management: includes supplemental iodine or
synthetic thyroxine and diet with adequate iodine
content.
cardiovascular disorders
assessment
• chest discomfort (angina pectoris, valvular heart
disease)
• fatigue (earliest symptom associated with several
cardiovascular disease)
• shortness of breath or dyspnea (left ventricular
failure or congestive heart failure)
• edema and weight gain (isolated right ventricular
failure or congestive heart failure)
• dizziness and syncope (postural hypotension,
dysrhythmias< vasovagal effect, cerebrovascular
disorders)
• observe respiratory status
• monitor foe development of rales or crackles
• other nursing care that would answer the nursing
diagnoses
congenital heart diseases
• usually caused by the failure of a heart structure
to progress beyond an early stage of embryonic
development
• conditions such as valvular aortic stenosis,
coarctations of the aorta. tetralogy of fallot, and
transposition of the great vessels occurs more
often in males
• maternal rubella is associated with defects such
as patent ductus arteriosus, pulmonary or aortic
stenosis, atrial septal defects, venticular septal
defect, or pulmonary stenosis.
• atrial septal defect and ventricular septal defect
tend to be familial
old classification
• cyanotic (deoxygenated blood to oxygenated
blood or right-to-left shunt)
• acyanotic (oxygenated to unoxygenated blood or
left-to-right shunt)
• note: this classification system leads to difficulties
because children with acyanotic defects might be
pink in color with manifestations of heart failure.
new classification
defects with increased pulmonary
blood flow
ventricular septal defect (vsd)
• characterized by one or more abnormal openings
in the septum separating the ventricles.
• the most common of all congenital cardiac defects
(25% of all congenital heart disease or about 2 in
every 1000 live births)
• about 60% of small ventricular septal defects
close spontaneously
• management: includes cardiac catheterization and
open heart surgery
atrial septal defect (asd)
• an abnormal communication between the two

atria
• occurs more frequently in girls than in boys
• blood flow is from left to right (oxygenated to
deoxygenated) because of the stronger
contraction of the left side of the heart. this
increases the volume in the right side of the heart
and generally results in ventricular hypertrophy
and increased pulmonary blood flow.
• management: includes open heart surgery and
interventional cardiac catheterization
atrioventricular canal defect

(endocardial cushion defect)
• a cardiac defect resulting from the failure of the
endocardial cushions in the embryonic heart to
fuse and form the atrial septum.
• about 1 in 9 children with down syndrome has this
type of congenital cardiac defect
• blood may flow between all four heart chambers
• managed through surgery and prophylactic
anticoagulation and antibiotic therapy
patent ductus arteriosus (pda)

• an abnormal opening between the pulmonary
artery and the aorta caused by failure of the
ductus arteriosus to close after birth due to
stimulation by prostaglandins
• managed: through the surgical ligation of defect
and indomethacin therapy
obstructive defects
pulmonic stenosis
• the narrowing of the pulmonary valve or the
pulmonary artery just distal to the valve
• accounts for 25% to 35% of congenital heart
anomalies
• inability of the right ventricles to evacuate blood
by way of the pulmonary artery leads to right
ventricular hypertrophy.
• surgery is postponed until 4 to 5 years old.
• managed: through continuous iv infusion of pge1
and cardiac catheterization
aortic stenosis
• the stricture of the aortic valve which prevents
the blood from passing freely from the left
ventricles into the aorta.
• accounts for about 5% of congenital cardiac
abnormalities
• leads to hypertrophy of the left ventricle
• managed: through balloon angioplasty or
replacement
coarctation of the aorta

• narrowing of the lumen of the aorta due to a
constricting band
• may either be infantile or preductal or postductal
• management: includes continued antihypertensive
therapy, graft of transplanted subclavian artery
and angiography.
tricuspid atresia
• the tricuspid valve is completely closed allowing
no blood to flow from the right atrium to the right
ventricles.
• managed: through surgery
tetralogy of fallot
• consists of four defects namely pulmonary
stenosis, ventricular septal defect, dextroposition
of the aorta and hypertrophy of the right ventricle
• occurs in about 10% of children with congenital
cardiac disease
• may cause complications such as embolism,
cerebrovascular accident and thrombophlebitis
clinical consequences of
congenital heart disease
• congenital heart failure (chf)
• inability of the heart to pump an adequate
amount of blood to the systemic circulation at
normal filling pressures
causes:
• secondary to structural abnormalities
• myocardial infarction
• excessive demands on normal heart muscles
acquired heart diseases
rheumatic heart disease
• damage to the heart valves which occurs as a
sequel of rheumatic fever.
• the course of rheumatic is 6-8 weeks.
• often follows an attack of pharyngitis, tonsillitis,
scarlet fever, “step throat” and impetigo.
• occurs most often in children 6 to 15 years of age,
with peak incidence at 8 years
• seen most often in low-socioeconomic, crowded
places,and urban areas
• managed through mitral valve replacement
endocarditis
• the inflammation and infection of the endocardium
or valves of the heart
• occurs as a complication of a congenital heart
disease such as tetralogy of fallot, ventricular
septal defect, or coarctation of the aorta
• caused by streptococci (viridans var)
• vegetative process more commonly occurs on left
side of heart
• managed: with antibiotic therapy and oral surgery
for children with chd
vascular dysfunction
kawasaki disease
• an acute systemic vasculitis caused by a retrovirus
with the cardiovascular system as the primary
area of involvement
• occurs almost exclusively in children before the
age of puberty
• management: focuses on the reduction of the
immune response (gamma globulin) and platelet
aggregation (salicylic acid)
toxic shock syndrome

• characterized by inadequate tissue perfusion to
meet the metabolic demands of the body
• may result to cellular dysfunction and organ
failure
• caused by staphylococcus aureus
• occurs predominantly in previously healthy women
during their menstrual periods
• observed primarily in women who use tampoons
• management includes the use of vasodilators,
catecholamine, corticosteroids, calcium chloride,
and sodium bicarbonate.
cardiopulmonary arrest
• acute emergency
• cessation of the heart function as a result of
anoxia in the heart muscles due to respiratory
failure
• other causes include airway obstruction, trauma,
anaphylactic allergic reactions, cns depression,
drowning and electrocution.
• characterized: by the absence of audible heart
sounds or pulses and blood pressure reading
• management: includes resuscitation,
administration of epinephrine, lidocaine and
atropine via iv or endotracheal tube.
hematologic dysfunction
hematologic disorders
assessment
• skin pallor, petechiae, bruising
• lethargy
• frequent infections
• bleeding that is difficult to control
• diagnostic tests include cbc, test for iron,
coagulation and immune system status
nursing diagnoses:
• knowledge deficit related to cause of illness
• altered nutrition: less than body requirement
• anxiety related to frequent blood sampling
procedures
• pain related to tissue ischemia
• family coping, compromised, ineffective related to
long-term care needs of child with chronic
hematological disorder
hematologic disorders
• use individual distraction techniques to help child
deal with pain and anxiety.
• help with blood sampling, blood or marrow
transfusion
• educate the parents with proper nutrition
specially the need for iron-rich foods.
• manage pain from venipuncture or finger stick
disorders of the red blood cells
anemia
• a condition wherein the number of rbcs and/or
hemoglobin (hgb or hb) concentration is reduced
below normal level
• the oxygen carrying capacity of the blood is
diminished causing a reduction in the oxygen
available to the tissues.
• the most common hematologic disorder of infancy
and childhood
anemia
types:
• normochromic and normocytic anemia
• marked by impaired production of erythrocytes by
the bone marrow or by abnormal or
uncompensated loss of circulating red blood cells
such as in acute hemorrhage
• hypochromic anemias
• inadequate hemoglobin synthesis leading to
hypochromia and reduction in the diameter of the
cells like in iron-deficiency anemia
types:
• macrocytic (megaloblastic anemia)
• characterized by abnormally large, immature and
nucleated rbc
• observed in conditions such as anemia due to folic
acid deficiency and pernicious anemia (vitamin
b12 deficiency)
• hemolytic anemia
• decreased erythrocytes due to increased
destruction resulting from abnormal structure
(sickle-cell anemia) or from extracellular
destructive forces (autoimmune acquired
hemolytic anemia)
thalassemia
• associated with abnormalities of the beta chain of
adult hemoglobin (hgba)
• types:
• thalassemia minor (heterozygous)
• thalassemia major (homozygous)
polycythemia
• an increase in the number of red blood cells that
results as a compensatory response to insufficient
oxygenation of the blood
• may result to cerebrovascular accident or emboli
• the risk increases if the child becomes dehydrated
(fever or during surgery)
disorders of the white blood cells
neutropenia
• reduced number of wbc which may be due to
response to drugs or nonpyogenic infections
• neutrophilia
• increased number of circulating wbc primarily
neutrophil is in response to infection or
inflammation
• leukemia
• uncontrolled proliferation of wbc
• eosinophilia
• increased number of eosinophils associated with
allergic reaction caused by parasitic and atopic
dermatitis
• lymphocytosis
• increased number of lymphocytes
disorders of homeostasis
disseminated intravascular coagulation (dic)
• an imbalance between clotting activity and
fibrinolysis in response to disease or injury
hemophilia - deficiency of a blood coagulation factor
• hemophilia a (factor viii deficiency, von
willebrand’s disease
• hemophilia b (christmas disease, factor ix
deficiency)
• hemophilia c (factor xi deficiency)
disorders of homeostasis
purpuras
• hemorrhagic rashes occuring in the superficial
layer of the skin
• types:
• idiopathic thrombocytopenic purpura
• results from decreased circulating platelets
even in the presence of adequate
megakaryocytes
• henoch-schönlein syndrome
• caused by increased vessel permeability
respiratory disorders
respiratory illness in children
physical assessment:
• cough
• rate and depth of respirations
• retractions
• cyanosis
• clubbing of fingers
• adventitious sounds
• chest diameters
laboratory tests:
• pulse oximetry
• blood gas studies
• nasopharyngeal syncytial virus nasal washings
• sputum analysis
diagnostic procedures:
• chest x-ray
• bronchography
nursing care:
• expectorant therapy
• oral fluid
• liquefying agent
• metered-dose inhalers
• nebulizers
• effective coughing
• chest physiotherapy
• mucus–clearing device
therapy to improve oxygenation:
• oxygen administration
• pharmacologic therapy
• nasal sprays
• corticosteroid
• antihistamines
• expectorants
• bronchodilators
• incentive spirometry
• breathing techniques
• tracheostomy
common upper respiratory tract
disorders
choanal atresia
• a congenital obstruction of the posterior nares by
an obstructing membrane or bony growth
• may be unilateral or bilateral
• presence of signs of respiratory distress at birth
acute nasopharyngitis
(common cold)
• caused by one several viruses, most
predominantly by rhinovirus, coxsackle virus,
respiratory syncytial virus, adenovirus,
parainfluenza and influenza viruses.
• stress factors also appear to play a role in
susceptibility.
• characterized by dehydration, watery rhinitis,
nasal congestion and low grade fever
pharyngitis
• inflammation of the pharynx
• may be caused by virus or group a beta hemolytic
streptococcus
• characterized by fever, sore throat, enlarged
regional lymph nodes and erythematous pharnyx
tonsillitis
• infection and inflammation of the palatine tonsils
• adenitis refers to infection and inflammation of
the adenoid (pharyngeal) tonsils.
• characterized by fever, halitosis, drooling,
lethargy and enlarged and bright red tonsillar
tissues
epistaxis
• bleeding from the nose caused by direct trauma,
mucosal inflammation secondary to allergy or urt
infection
sinusitis
• inflammation of the membrane lining a sinus of
the skull
• occurs as a secondary infection (staphylococcal,
streptococcal, or haemophilus influenza) in older
children
• characterized by fever, headache, purulent nasal
discharge and tenderness over the affected sinus
laryngitis
• inflammation of the larynx
• may occur as a spread of pharyngitis or from
excessive use of the vocal cords
• characterized by brassy voice or inability to make
audible sounds
croup (laryngotracheobronchitis)
• inflammation of the larynx, trachea and major
bronchi
• caused by viruses: parainfluenza (6 months-3
years old) and heamophilus influenza (3-6 years
old)
• characterized by barky/seal cough, inspiratory
stridor and marked retraction at night
epiglottitis
• inflammation of the epiglottitis caused by bacteria
(h. influenzae, streptococci, pneumococci and
staphylococci) and echovirus (rsv)
• occurs most frequently in children from 3 to about
8 years of age
• characterized by high fever, dysphagia, stridor and
drooling
aspiration
• the inhalation of a foreign object into the airway
• characterized by hard, forceful cough and choking
bronchial obstruction
• an aspirated foreign object occludes the bronchi
(right-more common) of children younger than 2
years old
• may cause atelectasis, hyperinflation and
pneumothorax
• characterized by violent cough, dyspnea and
hemoptysis
common lower respiratory tract
disorders
bronchitis
• inflammation of the major bronchi and trachea
• causative agents include influenza viruses,
adenovirus and mycoplasma pneumonia, among
others
• symptoms may last for a week and full recovery
takes as long as 2 weeks
• clinical manifestation: includes nasal
congestation, audible coarse rales, fever, alveolar
hyperinflation and dry, hacking cough
bronchiolitis
• the inflammation of the fine bronchioles and small
bronchi
• occurs most often in children younger than 2 years
of age, with peak incidence at 6 months of age
• precipitates the development of asthma later in
life.
• caused by viruses, such as adenovirus,
parainfluenza virus, respiratory syncytial virus
(rsv)
• clinical manifestations: include mild fever,
atelectasis, nasal flaring and increased respiratory
rate
asthma
• the chronic inflammatory disease of the airways
• an immediate hypersensitivity response
• commonly caused by physical and chemical
irritants such as foods, pollens, dust mites,
cockroaches, smoke, animal dander, temperature,
respiratory infection, activities, and stresses
• can precipitate a late bronchial obstructive
reaction several hours after the initial exposure
asthma
• characterized by: hypoxemia, exacerbations,
ventilatory failure and asphyxia, hacking, irritable,
nonproductive cough, restlessness, apprehension
and diaphoresis, dark red color of lips which may
progress to cyanosis of nail beds, episodes of
wheezing, breathlessness, dyspnea, chest
tightness, and cough at night and/or early
morning
pneumonia
• the inflammation of the pulmonary parenchyma
caused by virus, mycoplasmal agents, bacteria, or
the aspiration of foreign substances
types:
• viral pneumonia
• characterized by diminished breath sounds, low-
grade fever nonproductive cough, fine rales and
diffused infiltrated areas
• primary atypical pneumonia
• characterized by fever, chills, anorexia,
headache, malaise, and muscle pain, rhinitis,
sore throat, and nonproductive cough to
seromucoid sputum then blood-streaked
pneumonia
types:
• bacterial pneumonia
• characterized by acute onset of fever, hacking and
nonproductive cough and diminished breath
sounds or scattered crackles
• viral pneumonia occurs more frequently than
bacterial from.
• primary atypical pneumonia (mycoplasma
pneumoniae) is the most common cause of
pneumonia in children between the ages of 5 and
12 years.
• occurs primarily in the fall and winter months and
is more prevalent in crowded living conditions
tuberculosis
• a chronic granulomatous infection
• caused by mycobacterium tuberculosis and
mycobacterium bovis transmitted through the
inhalation of droplets from an individual with tb or
ingestion of unpasteurized milk.
• usually asymptomatic, but may develop symptoms
such as malaise, fever, cough, weight loss,
anorexia, and lymphadenopathy.
• isoniazid (inh), rifampin (rifadin), ethambutol and
pyrazinamide are used for treatment.
cystic fibrosis
• a chronic multisystem disorder due to autosomal
recessive trait causing exocrine gland dysfunction
• thick mucus produced by the exocrine gland
obstructs small passageways of the affected
organs.
• common symptoms include pancreatic enzyme
deficiency, progressive chronic lung disease
associated with infection, and sweet gland
dysfunction resulting in increased sodium and
chloride sweat concentrations.
atelectasis
• the collapse of lung alveoli which occurs in
children as a primary or a secondary condition
• types: primary (failure of the lungs to expand at
birth) and secondary (developed secondary to rt
obstruction)
• manifested by low apgar score, asymmetry of the
chest, respiratory grunt and cyanosis, decreased
breath sounds on the affected side, irregular
respiration with nasal flaring and apnea and
hypotonic and flaccid pressure in respiratory tract.
pneumothorax
• the presence of atmospheric air in the pleural
space which causes the collapse of alveoli
• characterized by mediastinal shift of apical pulse,
absent or decreased breath sounds, tachypnea,
grunting respiration and cyanosis.
sudden infant death syndrome

• unexpected death of an apparently healthy infant
under 1 year for which a through autopsy fails to
demonstrate an adequate cause of death
• occurs most frequently during winter
• occurs during sleep
• most frequently occurs from 2 to 4 months of life
sudden infant death syndrome
• more observed in males
• the risk factors include maternal smoking and
or/substance abuse, prematurity, fetal cns
problems and sleep risks
• manifestations include frothy, blood-tinged fluid in
the nose and mouth and apneic, blue and lifeless
infant
excretory disorders
children with renal disorders
assessment
• weight loss
• edema
• dehydration and vomiting
• poor skin turgor
• metabolic alkalosis
• electrolyte imbalance
nursing diagnoses:
• risk for fluid and electrolyte imbalance
• altered family process related to chronic illness in
child
• altered parenting related to interference with
establishing parent-infant bond
• self-esteem disturbance related to feelings of
being different resulting from special dietary
restrictions
• give appropriate nutrition management
• compare current weight with past weight
measurements
• other nursing care that would answer the nursing
diagnoses
congenital disorders of the renal or
urinary tract
cryptorchidism
• occurs when one or both testes fail to descent
through the inguinal canal into the scrotal sac
• managed through surgical correction
hypospadias
• congenital defects involving abnormal placement
of the urethral orifice of the penis
• corrected through surgery preferably between 16-
18 months
infections of the urinary system and related

disorders
urinary tract infection (uti)
• an infection of one or more structures in the
urinary system such as urethra, bladder, and
ureters, renal pelvis, calyces and renal
parenchyma
• occurs most often in preschool girls
• most urinary pathogens are gram-negative rods-
escherichia coli
• characterized by hematuria,proteinuria ,painful
,frequent urination with burning sensation, low
grade fever, mild abdominal pain , and enuresis
(cystitis), high fever , abdominal or flank pain ,
vomiting, and malaise (pyelonephritis)
• managed through antibiotic therapy and increased
fluid intake
vesicoureteral reflux
• retrograde flow of urine from the bladder into the
ureters because of defective value that guards
entrance from the bladder to the ureter
• occurs due to scarring from repeated uti’s bladder
pressures or ureters that are implanted at
abnormal sites or angels
• management includes prophylactic antibiotic
therapy and laparoscopic surgery
hydronephrosis
• enlargement of the pelvis of the kidney with urine
as a result of backpressure in the ureter
• occurs at any age, most often in the first 6 months
of life
• surgical correction must be done before
glomerular or tubular destruction occurs
disorder affecting normal urinary

elimination
enuresis
• involuntary discharge of urine especially while
asleep
• usually occurs at 5-7 years
• may be nocturnal, diurnal, or both
disorders of altered kidney function
glomerulonephritis
• an inflammatory disease affecting the clusters of
capillaries in the cortex of a kidney
• destruction, inflammation, and sclerosis of the
glomeruli of both kidneys occur
• usually caused by immunological diseases,
autoimmune diseases, streptococcal infection
(group a beta-hemolytic)
glomerulonephritis
types:
• acute (occur 2-3 weeks after streptococcal
infection)
• chronic (occurs after the acute phase)
management includes administration of

antihypertensive, diuretic, antibiotics and
anticonvulsaant as prescribed
nephrotic syndrome
• a group of symptoms caused by the excretion of
large amount of protein in the urine due to kidney
impairment
• characterized by low levels of albumin and high
levels of cholesterol and lipids in the blood
• management includes antibiotic therapy, loop
diuretics and corticosteroid therapy.
polycystic kidney
• an abnormal condition in which the kidneys are
enlarge and contain many cysts
• inherited as autosomal recessive trait
• management includes surgical removal of affected
kidney and kidney transplant
renal failure
• inability of the kidneys to excrete waste,
concentrate urine and conserve electrolytes
types:
• acute (occurs suddenly due to inadequate
perfusion, kidney disease or urinary tract
obstruction)
• chronic (results from chronic renal disease)
• management includes diuretics, dialysis, and
kidney transplant
neurologic disorders
assessment
• mother’s pregnancy history
• child’s developmental milestones and ability to
perform age-appropriate tasks:
• denver developmental screening test for the
preschool child
• school performance for the older child
neurologic examination
• cerebral function
• general cerebral functions: level of consciousness,
intelligence, performance, mood, and general
behavior.
• specific cerebral functions: stereognosis,
grasphesthesia. kinesthesia.
• cranial nerve function
• assess each pair of cranial nerves separately
• cerebellar function
• test for balance and coordination are romberg
test, tandem walk, finger to nose test, and past
pointing test
neurologic examination
• motor function
• compare the size of the extremities on each side
• feel muscles for tone. move the extremities
through passive range of motion
• evaluate symmetry, spasticity, and flaccidity
bilaterally
• sensory function
• distinguishing light touch, pain, vibration, and
temperature for intact sensory system
• reflex testing (see stages of growth and
development of the child)
diagnoses:
• risk for disuse syndrome related to neurologic
deficit affecting one area of functioning
• altered family processes related to stress
associated with the long-term effects of the
neurologic dysfunction
• let the child’s family discuss fears about the
child’s illness
• provide immediate preoperative and
postoperative care and long-term care
(rehabilitative and home care) if the child
undergoes surgery.
increased intracranial pressure
• a sign that may occur with many neurologic
disorders, such as increased csf volume, cerebral
edema, or space-occupying lesion such as tumors
• etiology
• infection
• brain tumor
• head trauma
• birth trauma or hydrocephalus
• clinical manifestations include increased head

circumstance, changes in the fontanel, eyes, vital
signs; vomiting; pain; and altered consciousness
• management includes barbiturates, osmotic
diuretics and corticosteroids
cerebral palsy
• a group of non-progressive disorders of the upper
motor neuron that results in motor dysfunction
types :
• spastic type: (lesion in pyramidal tract which
accounts for 50-60% of all cp)
• dyskinetic type or athetoid type: (extrapyramidal
tract lesion which accounts for 25-30% of all cp)
• ataxic type: (cerebellar lesion which accounts for
5% of all cp)
• mixed type (characterized by spasticity and
athetoid movements)
cerebral palsy
types (based on topographic classification)
• monoplegia
• hemiplegia
• quadriplegia or tetraplegia
• diplegia
• paraplegia or double hemiplegia
clinical findings: include delayed motor development
skills
management: prevention of further complication and
promote development of posture and movement
control
meningitis
• the inflammation of the meninges due to bacterial
invasion of haemophilus influenzae type b,
neisseria meningitis (meningococcal meningitis),
or group b streptococcus pneumoniae and
diplococcus pneumoniae (pneumococcal
meningitis)
• usually seen in children between 1 month and 5
years
meningitis
• mode of entry: upper respiratory tract to the
meninges
• clinical manifestations: include papilledema,
cranial nerve paralysis, convulsions and shock,
fever, petechial skin rash and bulging fontanels,
positive brudzinski’s and kernig’s sign
• managed through antibiotic therapy
encephalitis
• inflammation of brain tissue
• may arise from protozoan, bacterial, fungal, or
viral invasion; direct csf invasion during lumbar
puncture; mosquito-transmission and complication
of common childhood diseases such as measles,
mumps, and chickenpox
• other viruses: arbovirus (togavirus) st. louis
encephalitis and eastern equine encephalitis
reye’s syndrome
• a combination of acute encephalopathy and fatty
infiltration of the internal organs that may follow
acute viral infections
• associated with the use of aspirin (asa) and nsaids
during viral infection
• usually affects 1 to 18 years of age
reye’s syndrome
• characterized: by lethargy, vomiting, blood
ammonia levels, respiratory arrest and seizures
leading to coma
• management: includes administration of
corticosteroids, mannitol and 10% or 15%
dextrose.
guillain-barre syndrome
• aka inflammatory polyradiculoneuropathy
• a peripheral polyneuritis involving both motor
and sensory nerves which occurs 1 to 3 weeks
after a mild episode of fever
• cause: unknown but suspected to be immune-
mediated
• associated with viral infection
• occurs in school-age children
guillain-barre syndrome
• characterized by impossible spontaneous
respiration, peripheral neuritis after primary
infection, muscle paralysis and paresthesia in leg,
trunk and head, facial weakness and difficulty in
swallowing (cranial nerve involvement), elevated
csf protein level and denervation and decreased
nerve conduction velocity
botulism
• a fetal form of food poisoning caused by an
endotoxin produced by the bacillus clostridium
botulinum
• most common source of toxin: improperly
sterilized home-canned foods
• characterized by constipation, flaccid paralysis if
the bulbar muscles that lead to diminished
respiratory function, generalized weakness,
hypotonia, listlessness, a weak cry, and a
diminished gag reflex
poliomyelitis
• an infectious disease caused by one of the three
polioviruses
• transmitted from person to person through fecal
contamination or oropharyngeal secretions
poliomyelitis
types:
• early/acute
• characterized by fever, upper respiratory tract
infection, g1 manifestations, joints and muscle
pains, asymmetric muscle weakness
• intermediate/convalescent
• characterized by atrophy, contractures and
other complications
• late/residual
seizure disorders
• brief malfunctions of the brain’s electrical system
• results from paroxysmal discharge in cortical
neurons
febrile seizures
• one of the most common neurologic disorders in
children
• boys are more affected than females
• cause is still uncertain
• risk of neurologic deficit, epilepsy, mental
retardation or altered behavior are observed
epilepsy
• a chronic seizure disorder with recurrent and
unprovoked seizures
causes:
• idiopathic
• acquired such as brain injury during prenatal,
perinatal, or postnatal periods
• classification:
• partial
• generalized
special senses
eye disorders
stye (hordeolum)
• a purulent infection of a sebaceous gland of the
eyelid caused by a staphylococcal organism
conjunctivitis
• the inflammation of the conjunctiva caused by
viral or bacterial infections, allergy or
environmental factors
inner keratitis
• inflammatory of the cornea which results when a
foreign body strikes the cornea with an invading
fungal, bacterial, or viral organism
congenital glaucoma
• an abnormal condition of elevated pressure within
an eye caused by obstruction of the outflow of
aqueous humor
• increased eye globe size and pressure ultimately
destroys the optic nerve.
• progressive, usually bilateral
• incidence rate: 1 per 30,000 births
cataract
• an abnormal progressive condition of the lens
characterized by loss of transparency which is
usually caused by trauma from eye injury and
genetic predisposition
• characterized by marked opacity of the lens, which
may be present at birth or may become apparent
in early childhood
cataract
types:
• anterior - due to birth injury
• edge - due to nutritional deficiency in intrauterine
life
• central - familial or due to prenatal rubella
hyperopia (farsightedness)
• inability of the eye to focus on nearby objects due
to errors or refraction, in which light rays that
enter the eye are brought into focus behind the
retina
myopia (nearsightedness)
• inability of the eye to focus on far objects caused
by elongation of the eyeball or by error of
refraction such that parallel light rays are focused
in front of the retina
astigmatism
• an abnormal condition of the eye characterized by
blurring of vision in which the light rays cannot be
focused clearly in a point on the retina and the
spheric curve of the cornea or the lens is not equal
to all meridians
• visual discomfort occurs if the condition is not
corrected
nystagmus
• rapid, irregular eye-movement
• a symptom of an underlying disease condition
• there is a lesion of the cerebellum or a brain stem
amblyopia
• reduced vision in the eye
• no obvious pathological or structural cause
• not correctable by a manifest refraction
color blindness
• inability to distinguish color of the spectrum
clearly
disorder of the ears

otitis media
• infection of the middle ear which occurs as a
result of a blocked eustachian tube that prevents
normal drainage
• a common complication of an acute respiratory
infection
• usually caused by streptococcus pneumoniae and
haemophilus influenzae
endocrine system
disorders
endocrine disorders
assessment:
• health history
• changes is mood
• changes in appetite
• nausea and vomiting
• changes in sleep pattern
• changes in elimination patterns
• changes in growth (significant weight gain or loss)
• increased or decreased sweating; cold or heat
intolerance
• visual disturbances (for pituitary tumors and
pancreatic disorders)
endocrine disorders
assessment:
• changes in activity pattern (inability to keep up
with peers and delayed developmental milestones)
• family risk factors: family history of endocrine
disorders in growth or development or both
• prenatal risk factors: maternal illness, use of
substance or medications, poor nutrition, and
intrauterine growth retardation
• personal risk factors: history of prematurity, viral
illness, central nervous system trauma and
chromosomal abnormalities
endocrine disorders
physical examination:
• hair: brittle (hypothyroidism)
• face: round with hair growth (cushing’s syndrome)
• mouth: delayed dentition (hypocalcemia)
• enlargement of anterior neck (goiter)
• tachycardia (hyperthyroidism)
• fingers: trembling (hyperthyroidism)
• genitals: excessive growth- (adrenogenital
syndrome; early growth- precocious puberty;
delayed growth- hypopituitarism)
• height and weight below 5th percentile
endocrine disorders
nursing diagnoses:
• fear
• altered body image
• grief
• altered family process
• knowledge deficit
• altered nutritional needs
endocrine disorders
• provide comfort measures
• administer medications
• let the required nutritional needs
• let the child’s family discuss fears about the
child’s illness
• provide immediate preoperative and
postoperative care and long-term care
(rehabilitative and home care) if the child
undergoes surgery)
pituitary dysfunction
hypopitutary dwarfism
• may either be due to congenital anomaly or the
destruction of the anterior pituitary gland by
tumor, histiocytosis, or chronic infection leading to
decreased production of growth hormone
growth hormone deficiency
• decreased somatotropin resulting from
nonmalignant cystic tumor or from the increased
intracranial pressure due to other causes
• characterized by high-pitched voice, infantile
appearance of face, small nose and recessed
mandible, delayed onset of genital growth and
pubic, facial, and axillary hair and short but well-
proportioned stature
• managed through injection of growth hormone 2-3
times a week
hyperpituitarism
• gigantism
a skeletal overgrowth due to excessive production
of growth hormone.
associated with acidophil cell hyperplasia or
adenoma
• acromegaly
gradual bony thickening resulting from the
stimulation of periosteal intramembranous
growth.
caused by acidophil adenoma
diabetes insipidus
• a metabolic disorder characterized by deficient
production of anti-diuretic hormone or inability of
the kidney tubules to respond to adh
• may due to either a lesion, tumor or injury to the
posterior pituitary or sex-linked recessive gene
• characterized by polyuria, polydipsia and
polyphagia, hyponatremia
• surgery is performed to remove the tumor.
administration of desmopressin is used to control
idiopathic conditions
thyroid dysfunction
hyperthyroidism
• a condition characterized by hyperactivity of the
thyroid gland, secreting greater than normal
amounts of thyroid hormone
• characterized by tremor, fatigue, diarrhea,
palpitations, weight loss, nervousness,
exopthalmus, constant hunger and heat
intolerance
• may lead to death due to cardiac failure, if
untreated
• management includes surgical ablation,
radioactive iodine and antithyroid drugs.
congenital hypothyroidism (thyroid
dysgenesis)
• condition resulting from a deficiency in the
production of thyroid hormones due to an absent
or nonfunctioning thyroid gland
• becomes apparent during the first 3 months of life
in a formula-fed infant and at about 6 months in
breast-fed infant
congenital hypothyroidism (thyroid
dysgenesis)
• characterized by obesity, umbilical hernia,
enlarged tongue, trouble in feeding, dry and
brittle hair, short and thick neck, respiratory
difficulty chronic constipation, slow deep tendon
reflex, subnormal body temperature, rag-doll
appearance, and elevated thyroid stimulating
factor but low iodine, t3 and t4 levels
• management includes vitamin d supplement,
thyroid hormone and sodium levothyroxine
cretinism (hypothyroidism)
• a form of dwarfism caused by hypofunction of the
thyroid gland which usually manifests in the
second 6 months of life.
• may be caused by a congenital lack of thyroid
tissue or by inability of the gland to synthesize
thyroid hormone
• characterized by impaired mental development,
irregular and delayed ossification of epiphysis
thyroiditis (hashimoto’s disease)
• an autoimmune thyroid disorder characterized by
the production of antibodies in response to
thyroid antigens and the replacement of normal
thyroid structures with lymphocytes and lymphoid
germinal centers
• the most common form of acquired
hypothyroidism in childhood
thyroiditis (hashimoto’s disease)

• age of onset: 10 to 11 years
• - occurs more often in girls then in boys
• characterized by impaired body growth,
hypertrophy of the thyroid, airway obstruction in
infants and obesity, lethargy and delayed sexual
growth in children
• management includes synthetic thyroid hormone
medication
hyperparathyroidism
• aka generalized osteitis fibrosa cystica
• causes generalized osteoporosis on the localized
areas of bone destruction
adrenal dysfunction
androgenital syndrome
(congenital adrenal hyperplasia)
• characterized by increased levels of testosterone
in blood plasma
• in females, it is characterized by deep, masculine
voice and features, no breast development or
menstruation at puberty in females and
precocious development of acne and pubic and
axillary hair
androgenital syndrome
(congenital adrenal hyperplasia)
• in males, development of acne and a deep, mature
voice, advanced bone age and closing of the
epiphysis line, normal size of testes but appear
small in rotation to the size of the penis, and
growth of pubic hair and prostate at age 3 to 4
• oral cortisone is given to the client
cushing’s syndrome
• a metabolic disorder characterized by abnormally
increased secretion of adrenocortical steroids,
particularly cortisol
• characterized by edema, moon face, buffalo hump,
muscular atrophy, increased glucose intolerance,
abnormally pigmented and fragile skin,
hypertension, kidney stones and psychosis

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pediatric disorders

common problems, disorders and diseases in

• anticipated grief related to the loss of “perfect”

cleft lip & palate

pierre robin syndrome

tracheoesophageal atresia and fistula

tracheoesophageal atresia and fistula

neural tube disorders

spina bifida occulta

neutral tube disorder

torticollis (wry neck)

developmental hip dysplasia

common prolems in toddlers, preschoolers,

concept of illness to a child

concept of illness to a child

nursing process for an iii child

vitamin c (ascorbic acid) deficiency

genu varum (bowlegs)

genu valgum (knock-knee)

foot and ankle conditions

talipes equinovarus or congenital clubfoot

talipes equinovarus or congenital clubfoot

juvenile rheumatoid arthritis (jra)

juvenile rheumatoid arthritis (jra)

disorders of the skeletal muscles

injuries of the extremities

sprain and strain

• determine serum electrolyte levels

• give appropriate nutrition management.

gastroesophageal reflux (ger)

disorders caused by food, vitamin, and

atrial septal defect (asd)

• an abnormal communication between the two

atrioventricular canal defect

patent ductus arteriosus (pda)

coarctation of the aorta

toxic shock syndrome

sudden infant death syndrome

infections of the urinary system and related

disorder affecting normal urinary

management includes administration of

• clinical manifestations include increased head

disorder of the ears

thyroiditis (hashimoto’s disease)

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