Studied by 5 peoplePrematurity
birth before 37th week of gestation
Maternal
Associated Medical Problems to Prematurity
(______________)
Placenta previa
Abruptio placenta
Cervical incompetence
Hypertensive disease of pregnancy
Placenta previa
A pregnancy problem when the placenta covers the cervix, causing bleeding
Abruptio placenta
A pregnancy problem that occurs when the placenta separates from the inner wall of the uterus before birth
Hypertensive disease of pregnancy
A type of high blood pressure that usually begins after 20 weeks of pregnancy and ends after childbirth.
Cervical incompetence
A pregnancy problem that happens when weak cervical tissue causes or plays a part in a premature birth or the loss of a healthy 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
Prematurity
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.
These are nursing interventions for?
Physical Anomalies
Determine the child’s immediate physiologic needs to sustain life
Know the parent’s immediate emotional needs to promote bonding between child and parents
These are assessments for?
Anticipated grief
_____ _____ related to the loss of “perfect” child.
Clue: Physical Anomalies diagnosis
Self-esteem disturbance
_____________________ related to interference with establishing parent-infant bond
Clue: Physical Anomalies diagnosis
nutrition
Altered ________, less than body requirements, related to malabsorption of necessary nutrients
Clue: Physical Anomalies diagnosis
Physical Anomalies
Prevent infection
Establish extra uterine circulation.
Establish proper waste elimination.
Establish body temperature control.
Expose the child to adequate stimulation.
These are nursing interventions for?
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 nipple, NPO, contraindicated
Nursing interventions for Cleft lip & palate:
Preoperatively the child must take an adequate amount of food. Feed the child via commercial ___________ to prevent aspiration
Postoperatively the infant is kept on ___ status for at least 4 hours.
Bottle or breast-feeding is ____________ following surgery.
soft diet, spoon, suction
Nursing interventions for Cleft lip & palate:
After 3 to 4 days a _______ is given until healing is complete.
When the child begins eating soft food, ______ should not be used.
_____ if there is the need to remove mucus, blood and unswallowed saliva.
abdomen, suture line, 50%, acetaminophen
Nursing interventions for Cleft lip & palate:
After cleft lip surgery, do not lay infants on their ________
Position child on his/her side as soon as awake.
Clean the _______ with a sterile saline, or ___ hydrogen peroxide in sterile water and sterile cotton-tipped applicators after every feeding
Administer _________ 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.
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.
Antibiotics
Tracheoesophageal Atresia and Fistula
Management:
Immediate surgery is done to prevent pneumonia. _________ are administered as ordered.
amniotic fluid
Tracheoesophageal Atresia and Fistula
Characteristic:
Presence of large amounts of ________ and large amounts of mucus in the mouth appearing like blowing bubbles
IV , right
Tracheoesophageal Atresia and Fistula
Nursing Interventions:
Preoperative
Give __ Therapy
Keep child in an upright position and on the _____ side to prevent aspiration
NPO, turn, crying
Tracheoesophageal Atresia and Fistula
Postoperative
Keep infant on ___ status for 7-10 days until suture line heals.
____ the patient frequently to discourage fluid from accumulating in the lungs.
Encourage ______ 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
Monitoring body fluid and electrolyte is important until surgery is done.
duodenal bowel portion
The most common site for Intestinal Obstruction
30
Intestinal Obstruction is anticipated if the mother had hydramnios during pregnancy or if __ ml of gastric secretion was aspirated from the newborn’s stomach
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
NPO, bowel sounds, Rectal dilation
Imperforate Anus
Preoperative
Put the client on ___ status.
Attach the nasogastric tube to low intermittent suction for decompression.
Postoperative
If the _________ are present and the nasogastric tube is removed, small oral feedings is advised
_________ 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
Managed through surgery
Elevate, gastrostomy, semi-fowler
Diaphragmatic Hernia Nursing Intervention
_______ head to provide maximum respiratory space.
Perform _______ 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 ________’s position.
Keep the infant in a warm, humidified environment to encourage lung fluid drainage.
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.
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 lumbosacral 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
prone, wet compress, intracranial pressure
Neural Tube Disorder Preoperative
The position should be _____ or supported on the side.
A sterile ______ 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
7-14,
Neural Tube Disorder Postoperative
A child is placed on the abdomen until the skin incision has healed (_____ 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.
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
Talipes Equinovarus
Most common congenital deformity of the foot
Characterized by internal tibial torsion, plantarflexion, inversion and adduction of the forefoot
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
The following are interventions for?
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
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.
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.
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
Anxiety
Nursing Process for an ill Child
Nursing Diagnosis 1:
_______ 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.
Fear
Nursing Process for an Ill Child
Nursing Diagnosis 2:
____ 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.
Ample analgesia
Nursing Intervention for an Ill Child is _________, including techniques of distraction or imagery; traditional comforts such as a change of clothing or positions; and reading to the child.
Pain, Impaired physical mobility, Self-esteem disturbance
Diagnosis for musculoskeletal disorders
____ related to chronic inflammation of joints.
________ related to cast on leg.
_______ related to continued use of body brace.
Diversional activity deficit related to the need for imposed activity restriction for weeks.
Musculoskeletal Function
X-ray
Bone Scan
Arthroscopy
Muscle or Bone Biopsy
Electromyography
Diagnostics for assessment of?
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
elevated, circulation, extremity
Keep the extremity in cast _____ to prevent edema.
Check ______ 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 ______.
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.
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 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.
Achondroplasia
The most common form of short limb dwarfism
Transmitted as an autosomal dominant trait
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
Congenital Hip Dislocation (CHD)
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
Teratologic and Typical
Two types of CHD
Teratologic
(intra-utero) CHD
Typical
(unstable, dislocated or subluxated) CHD
Chondromalacia Patella
The softening of the articular cartilage of the patella of diverse origin
May be progressive and managed conservatively
Primary Idiopathic Type
Secondary Adolescent Type
Adult Type
Categories of Chondromalacia Patella
Genu Varum (Bowleg)
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.
Gena 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.
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
AKA Congenital Clubfoot
Primary deformities
Inversion and adduction of the forefoot
Varus of the calcaneus (heel inversion)
Equinus (plantarflexion)
Internal tibia torsion
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)
sickle cell, Salmonella, altered bone growth
Osteomyelitis
Children with _________ anemia have a special susceptibility to _______ 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 __________
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
JRA Interventions
_______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, Hot baths, Paraffin soaks
JRA Interventions
_________ using warm water soaked for 20-30 minutes <To reduce pain and inflammation in joints and increase comfort and motion>
_______ <To eliminate stiffness of joints >
_________ <To reduce inflammation in wrist and fingers
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 >
Nutrition - Help parents plan mealtime for “best time” of the day (To prevent malnutrition due to poor appetite secondary to anorexia, pain and fatigue)
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
deep-breathing, Stryker frame, nasogastric tube
Scoliosis
Preoperative Care
Introduce __________ exercises and incentive spirometry to increase lung function postoperatively to children
Explain what they can expect after surgery (pain, fatigue, and feeling “not themselves”)
In some instances, a child may receive postoperative care on a ______. If so, introduce a frame preoperatively.
A _________ is inserted prior to surgery to prevent abdominal distention. Major surgery may cause paralytic ileus and lack of bowel tone.
back, side lying, NPO
Scoliosis
Postoperatively Care
Do not bend the ____ 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.
Position to ________ 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 _____ status until bowel sounds return.
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.
Duchenne Muscular Dystrophy
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)
Duchenne Muscular Dystrophy
_____________
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
Note
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