NCLEX and CGFNS - PEDIATRIC NURSING

TUBERCULOSIS

2009-07-01T08:10:00.003+03:00

Tuberculosis is a contagious disease caused by an acid-fast bacillus, Mycobacterium tuberculosis. The transmission of tuberculosis is through inhalation of droplets from a person with active tuberculosis.

Children are more common infected than adult in family. They can be infected from family member or by another individual with whom they have frequent contact such as babysitter.

Sign and Symptoms:

May be asymptomatic
Malaise
Fever
Cough
Weigh loss
Anorexia
Lymphadenopathy

Diagnose:

Mantoux Test
Sputum Culture

Medical Interventions:

Isoniazid (INH), rifampin (rifadin), and pyrazinamide
A 9 month course of INH is prescribed to prevent a latent infection from progressing to clinically active tuberculosis and to prevent initial infection in children in high risk situations
A 12 month course is prescribed to the HIV infected child
For child with active tuberculosis: INH, rifampin, and pyrazinamide daily for 2 months and then INH and rifampin twice weekly for 4 months

Nursing Interventions:

Wear a mask if the child is coughing and does not cover his or her mouth
Place children on airborne precautions until medications have been initiated, sputum cultures demonstrate a diminished number of organisms, and cough is improving
Maintain airborne precaution with family members
Adequate rest and diet
Advice the child and family to prevent transmission of tuberculosis

Mantoux Test:

Positive reaction to the mantoux test will appear 2-10 weeks after the initial infections
The test is done to determine whether the child has been infected and has developed a sensitivity to the protein of the tubercle bacillus
A positive reaction does not confirm the presence of active disease
Once the child reacts a positively, the child will always react positively
A positive reaction in a previously negative test indicates that the child has been infected since the last test
The test should not be done at the same time as measles immunization since it may cause false-negative reaction

Measuring of Mantoux Test:

The result of the test is measured by indurations:
15 cm or more = positive in child 4 years or older who do not have any risk factor
10 cm or more = positive in children younger than 4 years and in those with chronic illness or at high risk for exposure to tuberculosis
5 cm or more = positive for the highest risk groups such as children with immunusuppressive conditions or human immunodeficiency virus

Sputum Culture:

The test is positive if it demonstrates the presence of mycobacteria in a culture
Gastric washing (aspiration of lavaged contents from the fasting stomach) is done to obtain specimen from an infant or young child since they often swallow sputum rather than expectorate it
The specimen is obtained in the early morning before breakfast

Pneumonia

2009-03-30T09:18:00.002+03:00

Pneumonia is an inflammation of the alveoli. It can be cause by a virus, mycoplasmal agents, bacteria, or the foreign substances aspiration. The causative agents are usually come to the lung through inhalation or from the bloodstream.

There are types of pneumonia:

Viral pneumonia
Primary atypical pneumonia (Mycoplasma pneumonia)
Bacterial pneumonia
Aspiration pneumonia

Aspiration Pneumonia

2009-03-30T09:13:00.002+03:00

Aspiration pneumonia may occur when food, secretions, liquids, or other materials enter the lung and cause inflammation and a chemical pneumonitis.

Signs and Symptoms of Aspiration Pneumonia:

Cough or fever with foul-smelling sputum
Deteriorating results on chest x-rays

Bacterial Pneumonia

2009-03-30T09:11:00.001+03:00

Bacterial pneumonia is a serious infection that sometimes need for hospitalization when pleural effusion or empyema accompanies the disease and is mandatory for children with staphylococcal pneumonia.

Signs and Symptoms of Bacterial Pneumonia:

Acute onset, fever, toxic appearance
In infant: irritability, poor feeding, lethargy, abrupt fever, respiratory distress
In older child: chills, headache, abdominal pain, chest pain, and meningeal symptoms
Diminished breath sound or scattered crackles
Hacking, nonproductive cough
Coarse crackles and wheezing are heard as the infections resolves

Nursing Interventions for Bacterial Pneumonia:

Administer oxygen as prescribed
Place the child in a mist tent as prescribed
Administer antimicrobial, antipyretic, antitussives as prescribed
Suction mucus if the infant is unable to handle secretions
Chest physiotherapy and postural drainage every 4 hours as prescribed
Encourage child to lie on the affected side to splint the chest and reduce the discomfort caused by pleural rubbing
Provide fluid intake and take caution to prevent aspiration
Institute isolation precautions according to the agency policy
Continuous closed chest drainage may be instituted if purulent fluid is present
Thoracentesis may be done to remove fluid accumulation in the pleural cavity

Primary Atypical Pneumonia

2009-03-30T09:10:00.002+03:00

Primary atypical pneumonia is the most common cause of pneumonia in children between 5-12 years of age. Primarily it occurs in the fall and winter season and in crowded living conditions.

Signs and Symptoms of Primary Atypical

Anorexia, headache, fever, chills, muscle pain, and malaise
Rhinitis, sore throat, and dry-hacking cough
Initially non productive cough, then production of seromucoid sputum that becomes mucopurulent or blood streaked

Nursing Intervention:

Nursing interventions for patient with primary atypical pneumonia are symptomatic.

Viral Pneumonia

2009-03-30T09:06:00.002+03:00

Viral pneumonia occurs more frequently than bacterial pneumonia. It is also associated with upper respiratory infection caused by viruses.

Signs and Symptoms of Viral Pneumonia:

Slight cough, malaise, and mild fever, to severe cough, prostration, and high fever
Non productive or productive cough with small amounts of whitish sputum
Wheezing or fine crackles

Nursing Interventions for Patient with Viral Pneumonia:

Oxygenation with cool mist as prescribed
Encourage to increase fluid intake
Administer antipyretics and antimicrobials as prescribed
Chest physiotherapy and postural drainage as prescribed

Bronchiolitis / Respiratory Syncytial Virus (RSV)

2009-03-30T09:00:00.002+03:00

Bronchiolitis is defined as an inflammation of the bronchioles. It causes production of tick mucus that occludes bronchiole tubes and small bronchi. The common cause of bronchiolitis is respiratory syncytial virus that is higly communicable and usually transferred by the hands.

Signs and Symptoms:

Upper respiratory infection symptoms: rhinorrhea and low-grad fever
Tachypnea
Lethargy, poor feeding and irritability
Increased difficulty in breathing
Expiratory wheeze and grunt
Nasal flaring and retractions
Diminished breath sounds

Nursing Interventions:

Maintain patent airway
Place child at a 30-50 degree angle with the neck is slightly extended to maintain an open airway as well as decrease pressure on diaphragm
Provide cool and humidified oxygen
Assess for any signs of dehydration
Encourage fluid intakes

Special Consideration in Giving Care Child with RSV:

Isolate the child in a single room or in a room with another child with RSV

Good hand washing procedures

The nurses who care for these children do not care for other high-risk children

Wear gowns when soiling of clothing may occur during care

Administer ribavirin (Virazole) as prescribed

Prepare for the administration of respiratory syncitial virus immune globulin ((RSV-IGIV or RespiGam or palivizumav)

Key Concept in Administration of Ribavirin (Virazole)

Administer Ribavirin via aerosol by hood, tent, mask, or through ventilator tubing
Pregnant health care providers should not care for a child receiving ribavirin
The nurse who wear contact lenses should wear goggles when coming in contact with ribavirin since the mist may dissolve soft lenses

Respiratory Syncytial Virus Immune Globulin

The immune globulin is used prophylactically to prevent respiratory syncytial virus infection in high-risk child
The immune globulin is not administered to infants or children with congenital heart disease or with cyanotic congenital heart disease

Bronchitis

2009-03-30T08:54:00.002+03:00

Bronchitis is an infection of the major bronchi that may be referred to as tracheobronchitis.

Signs and Symptoms:

Fever
Dry, hacking, and nonproductive cough that is worse at night and becomes productive in 2-3 days

Nursing Interventions:

Monitor for respiratory distress
Provide cool and humidified air
Monitor for any signs of dehydration
Increased fluid intake
Administer acetaminophen (Tylenol) for fever as prescribed

Laryngotracheobronchitis

2009-03-14T22:38:00.002+03:00

Laryngotracheobronchitis is gradual inflammation of the larynx, trachea and bronchi. It is a most common type of croup and may be caused by virus or bacteria.

Sign and Symptoms:

Irritability and restlessness
Fever at low to high grade
Hoarse voice
Inspiratory striddor and suprasternal retraction
Seal bark and brassy cough
Crackles and wheezing
Use of accessory muscles for breathing
Anorexia, nausea, and vomiting
Signs of anoxia and carbon dioxide retention
Cyanosis

Nursing Interventions:

Keep a paten airway
Assess respiratory status (nasal flaring, inspiratory stridor, sternal retraction)
Monitor for pallor or cyanosis
Elevate the head of the bed and provide bed rest
Provide humidified oxygen
Encourage fluid intake
Administer medication as prescribed (antibiotics, analgetics, bronchodilators, corticosteroids)
Epinephrine nebulizer may be given for children with severe disease, stridor at rest, retractions, or difficulty breathing
Have resuscitation equipment available

Epiglottitis

2009-03-14T22:33:00.002+03:00

Epiglottitis is an inflammation on the epiglottitis. It mah be caused by Haemophilus influenzae type B or Streptococcus pneumoniae.

Epiglottitis most frequently occurs in winter in child between age 2 and 5 years. If it is happened, it is consideres as an emergency situation.

Signs and Symptoms:

High fever
Sore, red, and inflamed throat
Drooling
Absence of spontaneous cough
Muffled voice
Difficulty swallowing
Inspiratory stridor
Agitation
Tripod positioning

Nursing Interventions:

Maintain a patent airway
Assess respiratory status and breath sounds (nasal flaring, stridor, using accessory muscles)
Avoid assess body temperature by oral route
To prevent spasm of the epiglottis and airway occlusion, no attempts should be made to visualize the posterior pharynx or to obtain a throat culture
Prepare for lateral neck films to confirm the diagnosis
Keep NPO
Do not restrain the child
Do not leave the child unattended
Do not force the child to lie down
Administer fluids and antibiotic intravenously as prescribed
Administer analgesics and antipyretics as prescribed
Provide high humidification to cool the airway and decrease swelling
Provide cool-mist oxygen therapy as prescribed
Have resuscitation equipment available
Prepare for endotracheal intubation or tracheotomy if there is severe respiratory distress
Ensure that the child has up-to-date immunization schedule

Tonsilitis and Adenoiditis

2009-03-14T22:25:00.003+03:00

Tonsillitis is an inflammation and infection of the tonsils, while adenoiditis is inflammation and infection of the adenoids. Both of them are usually manage by tonsillectomy and adenoidectomy.

Signs and Symptoms:

Enlarged, bright red tonsils (may be covered by white exudates)
Persistent or recurrent sore throat
Swallowing difficulties
Fever
Cough
Mouth breathing and unpleasant mouth odor
Enlarge adenoids lead to nasal quality of speech, mouth breathing, hearing difficulties, snoring, or obstructive sleep apnea

Pre-operative Interventions:

Observe for sign of active infection
Assess bleeding and clotting studies
Assess for any loose teeth to decrease the risk of aspiration during surgery

Post-operative Interventions:

Place patient in prone or side-lying position to facilitate drainage
Keep suction equipment in reach, however do not suction unless if there is any airway obstruction

Discourage coughing or clearing the throat

Avoid milk products initially

Provide clear, cool, noncitrus and noncarbonated fluid

Avoid red liquids since will stimulate the appearance of blood if the child vomits

Do not give child any straws, forks, or sharp objects that can be put in the mouth

Administer acetaminophen (Tylenol) for sore throat as prescribed

Notify physician if bleeding, persistent earache, or fever occur

Instruct parent to keep child away from crowds until heal

Otitis Media

2009-03-14T22:19:00.002+03:00

Otitis media is an infection in the middle ear as a result of a blocked Eustachian tube which prevent normal drainage. It is more prone to infants and children because their Eustachian tubes are shorter, wider and straighter. Otitis media also is common complication from an acute respiratory infections.

Signs and Symptoms of Otitis Media:

Fever
Irritability and restlessness
Loss of appetite
Rolling of head from side to side
Earache or pain
Puling on or rubbing the ear
Signs of hearing loss
Red, opaque, bulging, or retracting tympanic membrane
Purulent ear drainage

Nursing Interventions:

Encourage fluid intake
Teach parent to feed infants in upright position
Teach parent about administering ear medication. In a child younger than age 3, pull the pinna down and back, while in a child older than 3 years, pull the pinna up and back
Instruct child not to chew during acute episode since it increases pain
Provide local heat and have the child lie with the affected ear down
Instruct and teach the parent how to clean drainage from the ear with sterile cotton swabs
Instruct the parents that screening for hearing loss may be necessary

Myringotomy:
Myringotomy is in insertion of tympanoplasty tubes into the middle ear to equalize pressure and keep the ear aerated.

Post-operative Nursing Intervention for Child with Myringotomy:

Keep the ear dry
Instruct patient to wear earplugs when bathing, shampooing, and swimming
Avoid diving and submerging under water

Conjunctivitis

2009-03-14T22:04:00.002+03:00

Conjunctivitis is an inflammation of the conjunctiva and it is usually caused by allergy, infection, or trauma. Conjunctivitis that is caused by bacteria or virus is extremely contagious.

Signs and Symptoms of Conjunctivitis:

Redness
Itching, burning, or scratchy eyelids
Edema
Discharge

Nursing Interventions:

Instruct patient in infection control: good hand washing, not sharing towels, and washcloth
Administer antibiotic, antiviral eye drops or ointments or antihistamines as prescribed
The child should be kept home from school or day care until antibiotic eye drops have been given for 24 hours
Cool compresses can be used to lessen irritation and dark glasses can be worn for photophobia
Discontinue wearing contact lenses (if any) and obtain new lenses to eliminate the reinfection
Discharge eye makeup (if any)

Strabismus

2009-03-11T09:34:00.003+03:00

Strabismus is defined as a condition when the eyes are not aligned because of lack of coordination of the extraocular muscles. It is sometimes called as "squint" or "lazy eyes". Strabismus is normal in the young infant but should disappear after around age 4 months.

The most cause of strabismus come from the muscle imbalance or paralysis of extraocular muscles, however it also may result from brain tumor, myasthenia gravis, or infection.

Signs and Symptoms of Strabismus:
Amblyopia (it comes if not treated early)
Loss of binocular vision
Permanent loss of vision if not treated early
Impairment of depth perception
Squinting or tilting of the head to see
Frequent headaches

Nursing Interventions:
Instruct the parents regarding occlusion therapy (patching) of the good eye to strengthen the weak eye
Corrective lenses may be indicated
Inform the parent that the injection of botulinum toxin wears off in about 2 months, and if successful, the correction will occur
Prepare for surgery. The surgery is performed to realign the weak muscles if non-surgical interventions are unsuccessful. It is performed usually before 2 years
Instruct and encourage parents in regarding the need of follow-up visits

Child Abuse

2009-03-11T09:29:00.002+03:00

The term of child abuse is involved emotional or physical abuse or neglect, sexual exploitation or molestation by caretakers or other individuals.

Signs and Symptoms of Physical Abuse:

Bald spots on the scalp
Unexplained bruises, burns, or fracture
Apprehensive child
Fear of parent
Extreme aggressiveness or withdrawal
Lack of crying when approached by a stranger

Signs and Symptoms of Physical Neglect:

Poor hygiene
Consistent hunger
Inadequate weight gain
Constant fatigue
Inconsistent school attendance
Delinquency
Reports of lack of child supervision

Signs and Symptoms of Emotional Abuse:

Speech disorders
Psychoneurotic reactions
Learning disorder
Suicide attempts
Habit disorders: sucking, biting, and rocking

Signs and Symptoms of Sexual Abuse:

Difficulty walking or sitting
Torn, stained or bloody under-clothing
Pain swelling or itching of the genitalia
Poor peer relations
Bruises, bleeding, or lacerations in the genital or anal area
Unwillingness to change clothes

Shaken Baby Syndrome:

Intracranial hemorrhage
Full bulging fontanelles and head circumference greater than expected

Nursing Interventions:

Assess any possible injuries
Support the child during a physical assessment
Report case of suspected abuse
Place the child in an environment that is safe
Document the objective manner information
Assess parent's strength and weakness in dealing with stress
Assist the family in identifying stressor, support systems, and resources
Refer the family to appropriate support groups

Tourette's Disorder

2009-03-11T09:25:00.002+03:00

Tourette's Disorder is a disorder that is characterized by recurrent involuntary and rapid movement affecting various parts of the body, accompanied by vocal noises such as barks, grunts, or profanities. It appears between ages 2 and 5.

Nursing Interventions:

One-to-one relationship
Protect the child from harm
Allow the child to have a favorite toy or other object
Maintain eye contact
Provide positive reinforcement for appropriate behaviors
Assess suicide potential
Remove dangerous objects from the environment
Limit on socially inappropriate or manipulative behaviors
Provide non-competitive group situations.

Attention-Deficit Hyperactivity Disorder

2009-03-11T09:15:00.002+03:00

Attention-Deficit Hyperactivity Disorder (ADHD) is a disorder in child that is characterized by developmentally inappropriate degrees of inattention, overactivity, and impulsivity. The diagnosis is established base on self-reports, parent, and teacher report, and psychological assessments.

The child with Attention-Deficit Hyperactivity Disorder may probably has childhood problems such as lowered intellectual development, some minor physical abnormalities, sleeping disturbances, behavioral or emotional disorders, and difficulty in social relationships.

Signs and Symptoms:

Easily distracted with external or internal stimuli
Difficulty with following the instructions
Poor attention span
Talking excessively
Shifting from one uncompleted activity to another
Interrupting or intruding on others
Engaging in physically dangerous activities

Nursing Interventions:

Encourage support group for parent
Provide environmental and physical safety measures
Enhance capabilities and self-esteem
Administer medications as prescribed such as methylphenidate hydrochloride (Ritalin), pemoline (Cylert), and dextroamphetamine sulfate (Dexedrine)
Inform the child and parent that the effects medication may come with in 1-2 weeks if taken as prescribed

Autism

2009-03-08T20:46:00.003+03:00

Autism is a severe mental disorder begins in infancy or toddler-hood. It is characterized by impairment of reciprocal social interaction and in verbal and non-verbal communication. The cause of autism is unknown and the prognosis is poor, however, the diagnosis can be established through the symptoms and specialized autism assessment tools

Signs and Symptoms of Autism:

Abnormal responses of body sensations
Disturbance in the rate ad appearance of physical, social, and language skills
Abnormal ways in relating to persons, objects, and events
Self-absorbed and unable to relate to others
The child may play happily alone for hours but have temper tantrums if interrupted
Repetition of previously heard speech meaninglessly and reversal of the pronouns "I" and "you"
Unusual attachment to a significant object and display frequent rocking, spinning, twirling, or other bizarre behaviors

Nursing Interventions:

Identify the child routines, habits, and preferences, and maintain consistency as much as possible
Observe the specific ways in which the child communicates
Encourage communication through the use of picture boards
Provide safety environment and safety precautions
Observe for stress and anxiety
Avoid placing demands on child
Initiate referrals to special programs as required
Provide support for child's parents

Mental Retardation

2009-03-08T20:37:00.002+03:00

Mental retardation is a condition that is characterized by a below-average score on a test of mental ability or intelligence and limitations in the ability to function in daily life, such as communication, self-care, and getting along in social situations and school activities.

Signs and Symptoms of Mental Retardation:

Cognitive skills and level of adaptive functioning are in under level of normal
Speech delays
Fine-motor and gross-motor are delayed
Decreased spontaneous activity
Irritability
Non-responsiveness
Poor eye contact during feeding

Nursing Interventions:

Promote care skills as much as possible
Facilitate appropriate playtime
Assist the child in communication and socialization skills
Provide safety precaution as necessary
Assist the family with decisions in relation to care
Provide information about support services and community agencies

Cerebral Palsy

2009-03-08T20:31:00.002+03:00

Cerebral palsy is a condition that is characterized by impaired movement and posture due to an abnormality in the extra-pyramidal or pyramidal motor system.

Signs and Symptoms of Cerebral Palsy:

Feeding difficulties
Extreme irritability and crying
Stiff and rigid arms or legs
Abnormal motor performance
Delayed gross development
Muscles tones alterations
Abnormal posturing (such as episthotonic)
Persistent of primitive infantile reflexes

Nursing Interventions:

Assess the child's developmental level and intelligence
Encourage the child in early intervention and participation in school programs
Communicate and interact with the child on his/her developmental level
Prepare for using mobilizing devices
Provide a safe environmental
Provide safe and appropriate toys for age and developmental levels
Place the child upright after meals
Administer medication as prescribed

Seizure Disorder

2009-03-08T20:24:00.002+03:00

Seizure is defined as a sudden, transient alteration in brain function due to excessive levels of electrical activity in the brain. It can be classified as partial or generalized, or unclassified, that is depended on the area of the brain involved.

Nursing Assessment of Seizure in Child

Obtain information from the parent about the onset time, precipitating events, and behavior before and after the seizure.
Assess the child's history in relation to seizures.

Seizure Precautions:

Raise the side rails when the child is sleeping or resting
Place a waterproof mattress or pad on the bed or crib
Pad the side rails and other hard object
Instruct child to wear medical identification
Instruct the child about precaution during potentially hazardous activities
Instruct the child not to swim without a companion
Instruct the child to wear a helmet and padding during bicycle riding, skateboarding, and inline skating
Alert caregivers to the need for any special precautions

Emergency Treatment for Seizures:

Ensure airway patency
Identify time of seizure episode
If the child is in sitting or standing position, ease the child down to the floor, placing the child in a side-lying position
Place a pillow or folded blanket under the child's head, or place your own hands under the child's head, or place the child's head in your own lap
Loose the child's clothes
Remove eye glasses if present
Clear area from any hazard or hard objects
Allow seizure to proceed and end without interference
Turn child to one side (as a unit) if vomiting
Do not restrain the child, place anything in the child's mouth or give any food or liquid to the child
Remain with the child until the child fully recovers
Prepare to administration some medication as prescribed
Observe for incontinence
Document the occurrence

Bladder Exstrophy

2009-03-02T07:08:00.002+03:00

Bladder exstrophy is a congenital anomaly characterized by extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause of bladder exstrophy is unknown.

Bladder exstrophy needs a surgical management and a series of staged reconstructions. The initial surgery is to close the abdominal defect, and it should be done within the first few day of life. However, the subsequent operation is done to reconstruct the bladder and genitalia and enable child to achieve urinary continence.

Signs and Symptoms of Bladder Exstrophy:

Esposed bladder mucose
Widened symphysis pubis
Defects of the external genitalia

Nursing Interventions:

Monitor urinary output
Monitor for signs of urinary tract or wound infections
Maintain the integrity of the exposed bladder mucose
Prevent the bladder tissue from drying, while allowing the drainage of urine until surgical closure is done.
Cover the bladder with sterile, nonadherent clear plastic wrap or a sterile thin film dressing without adhesive
Petroleum jelly is avoided because it tends to dry out, adhere to the bladder mucose, and damage the delicate tissues when the dressing is remove
Administer antibiotics as prescribed
Emotional support to the parents and encourage verbalization of their fears and concerns

Epispadias and Hypospadias

2009-03-02T07:01:00.001+03:00

Epispadias is a condition in which the urethral orifice is located on the dorsal surface of the penis (often occurs with exstrophy or the bladder). In hypospadias the urethral orifice is located below the glans penis along the ventral surface.

Surgical intervention is done before the age of toilet training (preferably between 16 and 18 months of age) and the child should not be circumcised because the foreskin may be used in surgical reconstructions.

After surgery, the child will have a pressure dressing and may have some type of urinary diversion or a urinary stent that is used to maintain patency of the urethral opening while healing of the meatus occurs.

Postoperative Nursing Interventions:

Monitor vital signs
Encourage child fluid intake to maintain urine output and to maintain patency of the stent
Monitor intake and output and the urine for cloudiness or a foul odor
Notify the physician if there is no urinary drainage for 1 hour because it may indicate kinks in the system or obstruction by sediment
Administer pain killer, anticholinergic and antibiotic as prescribed
Instruct the parent to avoid giving the child a tub bath until the stent is removed (if any)

Cryptorchidism

2009-03-02T06:57:00.002+03:00

Cryptorchidism is a condition in which one or both testes fail to descent through the inguinal canal into the scrotal sac.

Sign of cyptorchidism:
Testes are not palpable or easily guided into the scrotum

Nursing Interventions:

Observe during the first 12 month of life to determine whether spontaneous descent occurs.
After age of one year, medical or surgical treatment may be instituted
Human chorionic gonadotropin may be prescribed
Surgical corrections (if needed) is done by orchiopexy between 1 and 2 years of age

Enuresis

2009-03-02T06:52:00.003+03:00

Enuresis is a condition in which the child is unable to control bladder function even though the child has reached an age at which control of bladder is expected. There are two types of enuresis: primary and secondary (acquired)

Primary Nocturnal Enuresis

Bed wetting in a child who has never been dry for extended periods
The child is unable to sense a full bladder and does not awaken to void
The child may have delayed maturation of the central nervous system

Secondary or Acquired Enuresis

Bed wetting occurs after a period of established urinary continence
It may occur during nighttime sleep (nocturnal), only during the waking hours (diurnal), or during both times of the day

Nursing Interventions:

Obtain urinalysis and urine culture as prescribed
Limit fluid intake at night, and encourage the child to void just before going to bed
Involve the child in caring for the wet sheets and changing the bed to assist the child to take ownership of the problems
Give child rewards as appropriate

Nephrotic Syndrome in Children

2009-03-02T06:47:00.002+03:00

Nephrotic syndrome is a kidney disorder that characterized by massive proteinuria, hypoalbuminemia, and edema. The primary treatments are to reduce the excretion of urinary and maintain protein-free urine.

Signs and Symptoms:

Child body weight is increased
Periorbital and facial edema (mostly in the morning)
Urine output is decreased
Urine is dark and frothy
Leg, ankle, labial or scrotal edema
Abdominal swelling
Blood pressure is normal or slightly decreased

Nursing Interventions:

Monitor vital signs, intake and output, and daily weights
Monitor urine for specific gravity and albumin
Monitor for edema
A regular diet without added salt is prescribed during remission
A sodium restriction diet is prescribed during massive edema
Administer corticosteroid and immunosuppressant as prescribed
Administer diuretics as prescribed

Glomerulonephritis in Children

2009-03-01T04:53:00.004+03:00

Glomerulonephritis is an inflammation of the internal kidney structures (glomeruli). Glomeruli itself has functions to help filter waste and fluids from the blood. This disease leads to proliferative and inflammatory changes within glomerular structure, as well as, destruction, inflammation and sclerosis of the glomeruli of both kidneys.

Inflammation in glumeruli due to an antigen-antibody reaction produced by an infection elsewhere in the body.

Casuse of glomerulonephritis:

Autoimmune disease
Immunological disease
Streptococcal infection, group A beta-hemolytic
History of pharyngitis or tonsillitis 2-3 week before the symptoms

Complication of Glomerulonephritis:

Hypertensive encephalopathy
Renal failure
Heart failure
Pulmonary edema

Signs and Symptoms:

Periorbital and facial edema (more prominent in the morning)
Decreased urinary output
Cloudy, smoky, and brown-colored urine
Anorexia
Pallor, irritability and lethargy

Headaches, abdominal or flank pain, dysuria
Hypertension
Proteinuria
Azotemia
Blood urea nitrogen and creatinine levels are increased
Antistreptolysin O titer is increase

Nursing Intervention:

Monitor vital signs, weight, intake and output, and observe characteristic of urine
Limit activity and provide safety
In uncomplicated disease, a regular diet is permitted but sodium is restricted
For child with hypertension or edema, moderate sodium restriction is prescribed
During oliguria period, foods high in potassium are restricted
If child has severe azotemia, protein restricted is prescribed
Observe the complication of glumerulonephritis
Administer diuretics, antihypertensives, and antibiotics as prescribed
Initiate seizure precaution and administer anticonvulsant as prescribed
Instruct parent to report signs of bloody urine, headache, or edema
Inform parent that child needs to obtain treatment for infection

Meningitis in Children

2008-12-03T10:17:00.005+03:00

Meningitis is an infection in the nervous system. It can be caused by bacteria and virus or complication from neurosurgery, trauma, and infection in sinus or ears.

Meningococcal meningitis occurs in epidemic form and transmitted by droplet infection from nasopharyngeal sections. Viral meningitis is associated with viruses such as mumps, paramyxovirus, herpes virus, and enterovirus.

The diagnoses of meningitis is made by testing cerebrospinal fluid that shows increased pressure, cloudy, high of protein, and low glucose.

Signs and Symptoms:

There are no classic signs and symptoms. It depends on the type, child age, and duration of illness.
Vomiting and diarrhea
Fever, chills
Nuchal rigidity
Poor feeding or anorexia
Alter level of consciousness
Bulging anterior fontanel in infant
Muscle or joint pain
Kernig's sign and Brudzinski's sign

Nursing Intervention:

Isolation for at least 24 hours after antibiotic initiated
Administer antibiotics as prescribed
Assess neurological and cardiovascular system
Monitor intake and output

Reye's Syndrome

2008-12-03T10:12:00.003+03:00

Reye's syndrome is acute encephalopathy follows a viral illness. It is characterized by cerebral edema and fatty changes in the liver. The disease is associated with administration of aspirin. The main goal of treatment is to maintain effective cerebral perfusion and control increasing Intra Cranial Pressure.

Signs and Symptoms:

History of viral illness 4-7 days before the onset of symptoms
Nausea and vomiting
Progressive neurological deterioration
Malaise

Nursing Intervention:

Assess and monitor neurological status
Monitor LOC and signs of increased ICP
Provide rest and decrease stimulation
Monitor intake and output
Monitor liver function
Monitor for signs of bleeding and impaired coagulation

Spina Bifida

2008-12-03T10:01:00.004+03:00

Spina bifida is a defect in central nervous system. It occurs as a result from neural tube failure to close during embryonic development.

Type of Spina Bifida
1. Spina Bifida Occulta:
Posterior vertebral arches fail to close in the lumbosacral area. Spinal cord remains intact and usually is not visible. Meninges are not exposed on the skin surface and neurological deficit are not usually present.

2. Spina Bifida Cystica
The vertebra and neural tube close incomplete resulting in a saclike protrusion in the lumbar or sacral area. The defect includes meningocele, myelomeningocele, lipomeningocele, and lipomeningomyelocele.

3. Meningocele
The protrusion involves meninges and a saclike cyst that contains CSF in the midline of the back. Spinal cord is not involved and neurological deficits are usually not present.

4. Myelomeningocel
The protrusion involves meninges, CSF, nerve roots, and spinal cord. The sac is covered by a thin membrane that is prone to leakage or rupture. Neurological deficit are evident.

Signs and Symptoms:

Visible spinal defect
Flaccid paralysis of the legs
Hip and joint deformities
Altered bladder and bowel function
Specific signs and symptoms depend on the spinal cord involvement

Nursing Intervention:

Assess the sac and measure the lesion
Assess neurological system
Assess and monitor for increasing ICP
Measure head circumferences
Protect the sac, cover with a sterile, moist (normal saline), nonadherent dressing and change the dressing every 2-4 hours
Place patient in prone position and head to one side
Use antiseptic technique
Assess and monitor the sac for redness, clear or purulent drainage, abrasions, irritation, and signs of infection
Assess for hip and joint deformities
Administer medication: antibiotics, anticholinergics, and laxatives as prescribed

Hydrocephalus

2008-11-29T00:07:00.002+03:00

Hydrocephalus is a condition marked by an excessive accumulation of cerebrospinal fluid resulting in dilation of the cerebral ventricles and raised intracranial pressure; may also result in enlargement of the cranium and atrophy of the brain.

There are two types of hydrocephalus: communicating and non-communicating.

Communicating Hydrocephalus:

It occurs as a result of impaired absorption within the subarachnoid space
Interference of the cerebrospinal fluid within the ventricular system does not occur

Non-communicating Hydrocephalus:

It is an obstruction of cerebrospinal flow within the ventricular system.

Signs and Symptoms Hydrocephalus in Infant:

Increased head circumference
Macewen’s sign: thin, widely separated bones of the head that produce a cracked-pot sound on percussion
Dilated scalp vein
Frontal bossing
Sunsetting eyes
Anterior fontanel tense, bulging, and non pulsating

Signs and Symptoms Hydrocephalus in Child:

Changes of behavior: irritability and lethargy
Nausea and vomiting
Headache on awakening
Ataxia
Nystagmus

Surgical Intervention:
Surgical intervention of Hydrocephalus is to prevent further CSF accumulation by bypassing the blockage and draining the fluid from the ventricles to a location where it can be reabsorbed. There are two types of surgical intervention: Ventriculoperitoneal Shunt and Atrioventricular Shunt.

Ventriculoperitoneal Shunt: the CSF drains from the lateral ventricles into the peritoneal cavity.
Atrioventricular Shunt: the CSF drains into the right atrium of the heart from the lateral ventricle, bypassing the obstruction. It is mostly used in older children and in children with pathological conditions of the abdomen.

Nursing Intervention (post-op)

Monitor and assess vital signs and neurological signs
Position client on the un-operated side to prevent pressure on the shunt valve
Keep the child flat: to avoid rapid reduction of intracranial fluid
Observe for increased ICP, if ICP is increased, elevate the head of the bed to 15-30 degrees
Monitor for signs of infections
Assess dressings for drainage
Monitor intake and output
Measure head circumference
Administer medications as prescribed
Teach parents how to recognize shunt infection and shunt malfunction

Head Injury in Children

2008-11-27T06:43:00.004+03:00

Head injury is pathological result of any mechanical force to the skull, scalp, meninges, or brain. The manifestations of head injury depend on the type of injury and the amount of increased intracranial pressure (ICP).

Sign and Symptoms of Head Injury:

Early Signs:

Headache
Nausea and vomiting
Visual disturbances and diplopia
Slight changes in vital signs
Dizziness or vertigo
Change in pupillary response and equality
Slight change in level of consciousness
Signs in infants: bulging fontanel, wide sutures, increased head circumference, high pitched cry, and dilated scalp vein

Late Signs:

Cushing’s triad: increased systolic blood pressure and widened pulse pressure, bradycardia, and irregular respiration
Significant decrease in level of consciousness
Decorticate posturing (see picture)
Decerebrate posturing (see picture)
Fixed and dilated pupils

Nursing Intervention in Head Injury:

Monitor and assess the airway, breathing, and circulations
Assess the injury and immobilize the neck if a cervical injury is suspected
Monitor vital signs and neurological function
Monitor level of consciousness
Initiate seizure precaution
Keep patient a nothing by mouth status until determined that vomiting will not occur
Administer oxygen and intravenous fluid as prescribed
Elevate the head of bed at 15-30 degrees if not contraindicated
Keep head in midline position to facilitate venous drainage and avoid jugular vein compression
Monitor for nose or ear drainage which could indicate leakage of cerebrospinal fluid (CSF) as a sign of skull fracture
Avoid suctioning through the nares
Administers acetaminophen (Tylenol) for headache, anticonvulsants for seizures, antibiotic, and tetanus toxoid as prescribed
Monitor for signs of brainstem involvement: deep, rapid, or intermittent and gasping respirations; wide fluctuations or noticeable slowing of the pulse; widening pulse pressure or extreme fluctuations in blood pressure
Monitor for epidural hematoma: asymmetric pupils

Children's Fear of Hospitalization

2008-07-20T22:32:00.003+03:00

Children's Reaction to Hospitalization may vary depend on child growth and development.

5 month – 3 years

Fear of separation from mother or usual caregiver.

Nursing Intervention:
Encourage rooming in and bring familiar object from home e.g. toys and blanket.

3-6 years

A toddler views hospitalization as punishment.
A school age or adolescent will fear of harm and mutilation

Nursing Intervention:

Kindly explain nursing procedure in simple terms and do not inform child of painful far in advance.
Nurse can demonstrate procedures with dolls.
Do not discourage crying and allow parents to be with child during painful procedures.
Nurse should be honest regarding pain experienced during procedures.

6-18 years

Separation from parents, peers and lost of control

Nursing Intervention:

Allow child to be visited by family and friends.
Allow child to use the telephone to maintain family and peer contact.
Give child choices when it is possible.
Explain procedures in simple terms.
Do not discourage child to cry.
Restrain can be applied for a procedure if necessary and tell that this will help him / her hold still.

Immunization Schedule

2008-07-07T20:03:00.003+03:00

Immunization is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen).

Recommendations of immunization schedules are issued by the Center for Disease Control (CDC) and are subject to change. The schedule may vary from state to state, so please always check current recommendations of the CDS and your local board of health.

The current recommended routine administration of immunization licensed childhood vaccines as of December 2007 for children age ) through 6 years may be accessed HERE.
For adolescent and adult immunization schedule may be accessed HERE.

Just to be remembered for nurses giving immunization schedule that :

Moderate or severe acute illness, with or without fever, is a contraindication to immunization.
Previous severe reaction to the vaccine or any of its components is a contraindication to immunization
The common cold without fever is NOT a contraindication to immunization

Pediatric : Deciduous Teeth

2008-06-21T02:22:00.000+03:00

Deciduous teeth also known as milk teeth, baby teeth, temporary teeth, primary teeth, lacteal dentition are the first set of teeth in the growth development of humans. They develop during the embryonic stage of development and erupt during infancy. They are usually lost and replaced by permanent teeth, but in the absence of permanent replacements, they can remain functional for many years. (www.wikipedia.org)

Deciduous teeth will continue to form until they erupt at age of 6 – 24 months or 33 months of age.

Please click image above to enlarge.

Pediatric : Developmental Milestones (15 months – adolescent)

2008-06-07T14:38:00.000+03:00

As a previous post I mentioned pediatric developmental milestones from 0 month till 12 months, here now I continue with pediatric developmental milestone from 15 months till adolescent.

15 Months :

Can pull or push a toy
Can walk without assistance
Can build tower of 2 blocks
Can throw ball overhanded
Can scribble with crayon or pencil

18 Months :

Can run clumsily
Can build tower of 3-4 blocks
Can jump in lace with both feet
Can control anal and urinary sphincter
Can control about 10 words

2 Years :

Climbs stair
Runs with wide stance
Says names some familiar objects
Says combine 2-3 words meaningful
Can attain bladder and bowel control
Weight about 4 times birth weight
Average weight gain is 4-6 lb/year during ages 2-6 years
Attains about a half of expected adult height

2.5 Years :

Able to jump from chair or step, and
Can stand on one foot briefly

3 Years :

Climbs stairs by alternating feet on steps
Can ride tricycle
Turn doorknobs
Can dress self
Says or speaks in short sentences
All 20 deciduous teeth have erupted

4 Years :

Catches ball
Recognizes colors
Hops on one foot
At this time, birth length has doubled

5 Years :

Can skip well and jump rope
Says contain all parts of speech
Maintain balances with eyes closes
Vocabulary of 2100 words can be built

6-12 years :

Can tie shoes
Can learn to how to swim, skate, and ride bicycle
Forms clubs or gangs
Uses pencil and crayon well
Strong sense of what is fair
Can read and count
At this time, average weight gain will be 4-6 lb/year during age 6-12 years

Adolescent :
At this time, he/she can learn to care for self independently while learning to effectively interact with society.

As mentioned on previous post that Pediatric developmental milestones are difficult to memorize, but at least as a Nurse should have knowledge about that. NCLEX - CGFNS examination will ask some questions in relation with pediatric developmental milestones.

Pediatric : Developmental Milestones ( 0 - 12 Months)

2008-06-03T19:45:00.000+03:00

Pediatric developmental milestones are based on averages, means that each child progresses at his or her own rate.

Birth - 1st month :

* Maintains eye contact
* Demonstrates reflex activities
* Lies in flexed position
* Using communication technique by crying
* Average weight gains is 3-5 oz weekly during first 6 month

2 Months :

* Can lifts head for short periods when prone
* Smiles and frowns
* Coos
* Will visually follows moving objects

3 Months :

* Sits with support
* Will turn from back to side
* Can recognizes parent
* Demonstrates pleasure by squealing
* Focusing on win hands

4 Months :

* Can lift head and chest about 90 degrees and bearing weight on forearms
* Turning from back to prone position
* Holing head erect while in siting position
* Can reach for objects and grasps objects with both hands
* Plays with fingers
* Carries objects to mouth
* Makes consonant sounds and laughs aloud

5 Months :

* Turning from abdomen to back
* Playing with toes and puts feet into mouth
* Can hold objects in one hand and reaches for another objects with other hand

6 Months :

* Can sit alone leaning forward on both hands
* Reaches for and grasps objects
* Extends arm when he or she wishes to be picked up
* Briefly looks for dropped objects
* Fear to strangers
* Enjoying to play peekaboo
* Begins to produce world like sound
* Birth weight has doubled
* Weekly weight gain is 3-5 oz during 6-18 months

7 Months :

* Bears weight on feet
* Transfers object from one hand to other hand
* Begins to crawl

8 Months :

* Sits alone without support
* Pull to standing position
* Can release object intentionally
* Uses pincer grasp
* Say "DADA" without meaning
* Stranger anxiety

9 Months :

* Can crawl well
* Will walk sideways while holding on
* Bangs 2 blocks together
* Searches for hidden object
* Can drink from cup and attempts to feed self

10 Months :

* Begins to walk and climb
* Neat pincer grasp
* Playing pat-a-cake and initiates peekaboo game
* May say 1-2 words with meaning

11 Months :

* Will cooperate with dressing activities
* Attempts to feed self with spoon
* Follows simple direction
* Will understand "no" and shakes head to indicate "no"

12 Months :

* Will walk alone or with one hand held
* Frequently falls while walking
* Can drink well from a cup
* Can pull off socks
* Points with one finger
* Birth weight has tripled
* Birth length has increased by 50%
* Head and chest circumference are equal

Pediatric developmental milestones are difficult to memorize, but at least as a Nurse should have knowledge about that. NCLEX - CGFNS examination will ask some questions in relation with pediatric developmental milestones.

NCLEX-CGFNS : Developmental Theories

2008-05-22T01:03:00.000+03:00

There are common Development theories always come in NCLEX - CGFNS test.

ERIKSON'S PSYCHOSOCIAL DEVELOPMENT
This theory is based on the belief that each stage is the result of the child's need to adapt to the social environment and must be resolved before the next stage can be successfully achieved. As the nurse, you should know pediatric developmental theories well.

Erikson's Psychosocial Developments are :

Birth - 1 years : Trust vs mistrust
1-3 years : Autonomy vs shame and doubt
4-5 years : Initiative vs guilt
6-11 years : Industry vs inferiority
12-18 years : Identity vs identity confusion

FREUD'S PSYCHOSEXUAL DEVELOPMENT
Freud's psychosexual development emphasize the importance of sex and control over aggresive impulses in the child's development. These are :

Birth-2 years : Oral Stage
2-3 years : Anal Stage
3-6 years : Phallic Stage
6-12 years : Latent Stage
12-18 years : Genital Stage

PIAGET'S COGNITIVE DEVELOPMENT THEORY
This is a Intellectual thought development.

Birth-2 years : Sensorimotor, senses and motor activity
2-7 years : Preoperational or preconceptual, Intellectual development
7-11 years : Concrete operation, reasoning and organizing thoughts
11 years - adulthood : Formal operation, abstract thinking and deductive reasoning