PPN 301 Wk 11: Common childhood illnesses

Nasopharyngitis defined

• “Common cold”, Caused by numerous viruses such as , RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses.

• virus not bacteria

4 major defects in tetralogy of fallot

1. Pulmonary stenosis

2. Right ventricular Hypertrophy

3. Overriding aorta

4. Ventricular septal defect

RSV (respiratory syncytial virus) (Viruses that cause common cold)

• virus that causes serious breathing infections, especially in babies.

• Most common cause of bronchiolitis in infants and toddlers

• If a child is at high risk for serious lung infections, they will need treatment once a month during RSV season – Nov to April

• Spread by touching, living on hard objects for more than 6 hours

• Treatment is mainly to relieve symptoms

• Antibiotics have no effect on viruses, Palivizumab vaccine to prevent RSV from becoming serious

  • use swab to understand what kind of virus it is

Rhinovirus (Viruses that cause common cold)

• the main cause of the common cold

Adenovirus (Viruses that cause common cold)

causes colds, sore throat, bronchitis, or pink eye.

Influenza (Viruses that cause common cold)

• Caused by orthomyxoviruses

  • types A, B, and C

• the flu virus, causes fever, body aches, cough, and fatigue.

Clinical manifestations (Influenza)

• fever* or feeling feverish/chills.

• cough.

• sore throat.

• runny or stuffy nose.

• muscle or body aches.

• headaches.

• fatigue (tiredness)

Therapeutic management/Nursing care (Influenza)

• rest

• fluids, like water

• medication to reduce any fever or aches

Prevention (influenza)

• Yearly vaccination

Parainfluenza (Viruses that cause common cold)

causes croup and other airway infections, especially in young children.

Clinical manifestations (Nasopharyngitis)

• Stuffy, runny nose.

• Scratchy, tickly throat.

• Sneezing.

• Watering eyes.

• Low-grade fever.

• Sore throat.

• Mild hacking cough.

• Achy muscles and bones.

Therapeutic management and nursing care (Nasopharyngitis)

• Treated at home

• Promoting comfort

• Teach families signs of complications

Types of flu vaccines for children

• During the current flu season, CDC recommends annual influenza vaccination during the flu season for everyone 6 months and older with any licensed, age-appropriate flu vaccine.

• Injectable influenza vaccines (IIV4)

• Live attenuated influenza vaccine (LAIV4)

• To create antibodies

Injectable influenza vaccines (IIV4) (types of flu vaccines for children)

• are given as an injection (with a needle) and are approved for use in as young people 6 months and older. (Indications vary by vaccine.)

Live attenuated influenza vaccine (LAIV4) (types of flu vaccines for children)

is given as a nasal spray and is approved for use in non-pregnant, healthy people ages 2-49 years old.

Emergency warning signs of the flu (these signs should be reported to medical care immediately)

• Fast breathing or trouble breathing (can see grunting as well)

• Bluish lips or face

• Ribs pulling in with each breath

• Chest pain

• Severe muscle pain (child refuses to walk)

• Dehydration (no urine for 8 hours, dry mouth, no tears when crying)

• Not alert or interacting when awake

• Seizures (flacid and the child’s eyes would both roll back)

• Fever above 104°F

• In children less than 12 weeks, any fever

• Fever or cough that improve but then return or worsen

• Worsening of chronic medical conditions

Acute Otis Media (AOM)

Inflammation or infection located in the middle ear. Otitis media can occur as a result of a cold, sore throat, or respiratory infection.

Etiology/pathophysiology (Acute Otitis Media-AOM)

happen when bacteria or virus infect and trap fluid behind the eardrum, causing pain and swelling/bulging of the eardrum.

Pharmacological Therapeutic management (acute otitis media-AOM)

• Antibiotics

• Pain-relieving medications

Surgical Therapeutic management (acute otitis media-AOM)

• Placement of ear tubes ( Ear tubes are tiny, hollow cylinders that are surgically inserted into the eardrum to enable drainage of the middle ear, allows air to flow into the middle ear and prevents the buildup of fluids behind the eardrum.

Prevention of Acute otitis media-AOM

• 13-valent conjugate vaccine 

Risk factors for acute otitis media

• exposure to second hand tobacco smoke

• preschool or daycare attendance

• bottle feeding

• pacifier use

• allergies

• esophageal reflux

• siblings with recurrent ear infections

• congenital or acquired autoimmune disease

• chromosomal abnormalities

• craniofacial abnormalities (i.e cleft palate or down syndrome), which may involve oral-palate and eustachian tube defects that can interfere with normal tube ventilation

• lower socioeconomic status. AOM risk may be related to unhealthy diets, poor housing conditions, limited access to medical care

Nursing care (Otitis media)

• Relieving pain

• Facilitating drainage when possible

• Preventing complications or recurrence

• Educating the family in care of the child such as:

  • Positioning. Have the child sit up, raise head on pillows, or lie on unaffected ear.

  • Heat application. Apply heating pad or a warm hot water bottle.

  • Healthy diet/fluid intake

  • Hygiene( hand washing)

  • Monitoring hearing loss.

Bronchitis

• Inflammation of the breathing tubes that causes increased mucus production and narrowing the airway 

Bronchitis is caused by:

• Viral infection

• Bacterial infection

• Physical or chemical agents that are breathed in such as dusts, allergens, and strong fumes, including those from chemical cleaning compounds or tobacco smoke.

• Acute bronchitis may come after a common cold or other viral infections in the upper respiratory tract.. Pneumonia is a complication that can follow bronchitis.

Bronchitis (Clinical manifestations)

• Cough.

• Production of mucus (sputum), which can be clear, white, yellowish-gray or green in color — rarely, it may be streaked with blood.

• Fatigue.

• Shortness of breath.

• Slight fever and chills.

Bronchitis nursing care

• Avoiding exposure to secondhand smoke

• Cough medicine

• Humidifying the air

• Increased fluid intake

• Pain relievers and fever reducers, such as acetaminophen (Tylenol)

• Quitting smoking

• Avoid antihistamines because they dry up the secretions and can make the cough worse. (NO BENNY)

Asthma

• Chronic inflammatory disorder of airways in which the airways narrow and swell and may produce extra mucus(Bronchial hyperresponsiveness) . This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.

Triggers for asthmatic exacerbations:

• Infections like colds and flu.

• Allergies – such as to pollen, dust mites, animal fur or feathers.

• Exercise and weather.

• Smoke, fumes and pollution.

• Medicines – particularly anti-inflammatory painkillers like ibuprofen and aspirin.

• Emotions, including stress, or laughter.

Asthma (Clinical Manifestations)

• Shortness of breath.

• Chest tightness or pain.

• Wheezing when exhaling, which is a common sign of asthma in children.

• Trouble sleeping caused by shortness of breath, coughing or wheezing.

• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.

4 groups of medication (Medication therapy for asthma)

1. Bronchodilators → opens airway (first line of treatment)

2. Anti-Inflammatories (Steroidal) → reduce swelling

3. Leukotriene modifiers → block trigger chemicals

4. Cromolyn sodium → prevents reactions

Bronchodilators (Medication therapy for asthma)

• Opens airway

Anti-inflammatories (steroidal) (Medication therapy for asthma)

• Reduce swelling

Leukotriene modifiers (Medication therapy for asthma)

• block trigger chemicals

Cromolyn sodium (Medication therapy for asthma)

• Prevents reactions

Medication therapy for asthma

• Long-term control medications (controllers or preventer medication) such as, Singulair, Flovent, Advair, Pulmicort, Symbicort and QVAR. 

• Quick-relief medications (reliever medications) such as Albuterol and Ipratropium bromide.  

• Metered-dose inhaler (MDI)

• Corticosteroids (most common)

• Cromolyn sodium (is more fast acting)

• Albuterol

• levalbuterol- commonly inhaled quick relief

• terbutaline- can be inhaled injected, sometimes used in emergencies

• Long-term bronchodilators

• Theophylline: Monitor serum levels

• Leukotriene modifiers

Asthma Nursing care

• Providing acute asthma care

• Long-term asthma care

  • Avoiding allergens

  • Relieving bronchospasm

  • Teaching how to administer medications Supporting the child or adolescent and family

How to use your puffer with a spacer:

1. Shake the inhaler well before use (3-4 shakes)

2. Remove the cap from your inhaler, and from your spacer, if it has one

3. Put the inhaler into the spacer

4. Breathe out, away from the spacer

5. Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it

6. Press the top of your inhaler once

7. Breathe in very slowly until you have taken a full breath. If you hear a whistle sound, you are breathing in too fast.

8. Hold your breath for about ten seconds, then breathe out.

9. If you need to take more than one puff at a time, wait a minimum of 30 seconds between puffs and be sure to shake the puffer (as in step 1) before each puff. Only put one puff of medication into the spacer at a time.

General guidelines for Nursing care/respiratory conditions

• Easing respiratory effort

• Promoting rest

• Promoting comfort

• Reducing the spread of infection

• Reducing temperature

• Promoting hydration

• Providing nutrition

• Encouraging family support and home care

When parents should be instructed to notify primary healthcare provider if they notice (Emergency warning signs for respiratory complications)

• If child is less than 3 months of age:

• Is having trouble breathing,

• Is not eating or is vomiting, or

• Has a fever (temperature of 38.5°C or higher)

In children of all ages (Emergency warning signs for respiratory complications)

• Is breathing rapidly or seems to be working hard to breathe

• Has blue lips

• Is coughing so bad that they are choking or vomiting

• Wakes in the morning with one or both eyes stuck shut with dried yellow pus

• Is much sleepier than usual, doesn’t want to feed or play, or is very fussy and cannot be comforted

• Has thick or coloured (yellow, green) discharge from the nose for more than 10 to 14 days.

Pediatric Gastrointestinal Differences

• Mouth is highly vascular

• Lower esophageal sphincter muscle tone not fully developed until 1 month of age

• Stomach capacity increases with age

• Intestinal growth spurts between 1 and 3 years and between 15 and 16 years of age

• Children are less able than adults to receive and transform the nutrients given to them as they are born with immature

digestive systems.

•  Digestive enzymes are not as plentiful and efficient. 

• Their digestive capacity may be weakened and impaired

due to an early exposure to poor dietary choices and environmental stressors.

• The ingestion of incompletely chewed foods places a stress on a child’s digestive and immune systems

Types of dehydration

• Isotonic

• Hypotonic (diluted)

• Hypertonic

Isotonic (types of dehydration)

Water and salt are lost in equal amounts.

Hypotonic (diluted) (dehydration)

• Electrolyte deficit exceeds water deficit.

Hypertonic (types of dehydration)

Water loss exceeds electrolyte deficit.

Symptoms of dehydration

• dark-colored urine, decreased urination, headaches, fatigue, dry skin, decreased skin turgor.

Therapeutic management of dehydration

• Oral fluid therapy , parenteral fluid therapy (oral rehydration solution)

• Treat the underlying cause of fluid loss

Diarrhea

•  loose, watery and possibly more-frequent bowel movements. 

• Acute diarrhea is a leading cause of illness in children under 5 years of age.

• Acute infectious diarrhea (infectious gastroenteritis)

• Chronic diarrhea is defined as an increase in stool frequency and increased water content for a duration of more than 14 days

Therapeutic management (Diarrhea)

Assess fluid and electrolytes, rehydrate, maintain fluid therapy, and reintroduction of an adequate diet

Vomiting

• Often accompanied by nausea

Therapeutic management of vomiting

• Detect and treat cause

• Prevent complications(dehydration)

• Provide fluids

• Antiemetic in some cases 

Daily maintenance fluid requirements

• 1st 10 kg of body weight: 100ml/kg/day

• 2nd 10kg of bodyweight: 50ml/kg/day

• for each kg over 20kg of bodyweight: 20ml/kg/day

• maximum: 2000ml for females

• maximum: 2500ml for males

Equations (daily maintenance fluid requirements)

• Formula method

• 4/2/1 method

Formula method (Daily maintenance fluid requirements equation)

(100 mL for each of the first 10 kg) + (50 mL for each kg 11–20) + (20 mL for each additional kg)/24 hour

• ask for daily use this method

4/2/1 method (Daily maintenance fluid requirements equation)

• (4 mL/kg for the first 10 kg) + (2 mL/kg for kg 11–20) + (1 mL/kg for every kg above 20) = hourly rate

Cleft lip or cleft palate

• Facial malformations that occur during embryonic development

• May appear separately or together

• long-term care

• Prognosis

Therapeutic management of cleft lip or cleft palate

• Surgical correction of cleft lip

• Surgical correction of cleft palate

Nursing care of cleft lip or cleft palate

• Feeding 

• Pre-operative care

• Post-operative care

Prognosis defined

a prediction of how a disease or condition will progress and the chances of recovery.

Variations in cleft of lip and palate at birth

• Notch in vermillion border

• Unilateral cleft lip and cleft palate

• Bilateral cleft lip and cleft palate

• cleft palate

Notch in vermillion border (Variations in cleft of lip and palate at birth)

Unilateral cleft lip and cleft palate (Variations in cleft of lip and palate at birth)

Bilateral cleft lip and cleft palate (Variations in cleft of lip and palate at birth)

Cleft palate (Variations in cleft of lip and palate at birth)

Breast-feeding (how do I feed my baby with cleft lip?)

• During breast-feeding, the soft breast tissue often will fill the opening

 in the lip and/or gum line. This seals off the mouth and lets your baby create enough suction.

• Sometimes it helps to hold a finger across the cleft while your baby feeds.

• Swallowing noises and normal weight gain are signs that breast-feeding is going well.

• If your baby is "noisy" with feeding, making clicking or kissing noises, they may not have enough suction.

Bottle-feeding (How do I feed my baby with cleft lip?)

• If you bottle-feed your baby, feeding may work better using special bottles or nipples with a wider base.

• When starting a feeding, hold your baby in a slightly upright position.

• Touch the baby's lower lip with the nipple.

• When the baby latches on, direct the nipple slightly downwards.

• Try to keep the nipple in the center of the baby's mouth. Do not let it slip up into the cleft.

Juvenile (Type 1 diabetes

• Autoimmune condition, pancreas cannot produce any insulin

• Exact cause unknown

• If untreated/undetected can lead to ketoacidosis

• Diagnosis:  high blood sugar level symptoms & fasting blood sugar reading of at least 7.0mmol/L or 11mmol/L at any time of day

Early symptoms (Juvenile type 1 diabetes)

• Polyuria

• polydipsia- increased thirst

• Feeling tired or weak

• yeast infection

• increase in appetite

• dry mouth or throat

• unexplained weight loss

Advanced symptoms (Juvenile type 1 diabetes)

• These symptoms appear if diabetes is not treated, or in some cases when it is undiagnosed

  • stomach aches

  • feeling drowsy

  • nausea and vomiting

  • kussmaul breathing- heavy, rapid breathing

Management of Juvenile type 1 diabetes

• Diet & Exercise

• Insulin injections

• Monitoring

Hyperglycemia symptoms

• fatigue

• polyuria

• polydipsia- excessive thirst

• blurry vison

• irritability

Hypoglycemia symptoms

• fatigue

• paleness

• irritability

• increased hunger

• blurry vision

• sweatiness

• headache

• dizziness

• shakiness

Cerebral palsy (CP)

• A group of disorders of movement, muscle tone and posture associated with activity limitations and attributed to nonprogressive, permanent injury or malformation of the developing fetal, infant or young child’s brain 

• Most common permanent physical disability in childhood

• A significant number of children with CP will also have epilepsy

Prenatal brain abnormalities (Cerebral palsy-CP)

• Gross abnormalities of the brain - Brain is formed incorrectly

• Vascular occlusion - blood cannot reach the brain

• Laminar(brains layered structure) degeneration - Brain cells die in layers

• Effects of low birth weight

• Anoxia

• Hypoxic infarction or hemorrhage

Six attributes that require investigation (cerebral palsy-cp)

• Early handedness- use of one hand over the other in a child under 12 months

• Stiffness or tightness in the legs between 6 and 12 months

• Persistent fisting of the hands in children over 4 months

• Persistent head-lag( weak neck muscles can’t support head) in a child over 4 months

• Inability to sit without support in child over 9 months

• Any asymmetry in posture or movement

Therapeutic management (Cerebral palsy)

• Rehabilitation

• Pharmacological

• Neurosurgical

• Orthopedic

• Dental hygiene

• Neuromuscular electrical stimulation (NMES)

Rehabilitation (Therapeutic management-cerebral palsy)

• Physical, occupational & speech-language therapy

Pharmacological (Therapeutic management-cerebral palsy)

• To treat pain related to spasms and seizures

• Botulinum toxin A injections (BoNT-A) is effective for reducing over-activity in muscles in children with cerebral palsy. This results in a reduction in muscle strength and muscle tone with small, short-lived gains in aspects of gait and function

Duchenne muscular dystrophy

• Also called pseudohypertrophic muscular dystrophy

• Most severe and most common of muscular dystrophy in childhood

• X-linked inheritance pattern; one third are fresh mutations (i.e not caused by inheritance)

• Incidence: 1 in 3600 male births

Early onset, usually between 2 and 5 years of age (Duchenne muscular dystrophy)

• Progressive muscular weakness, wasting, and contractures (becomes permanently stiff)

• Calf muscle hypertrophy in most patients

• Loss of independent ambulation by 12 years of age

• Slowly progressive, generalized weakness during teenage years

• Relentless progression until death from respiratory or cardiac failure

Symptoms of Duchenne Muscular dystrophy

• Waddling gait

• Lordosis

• Frequent falls

• Gower sign (child turning onto side or abdomen, flexing knees to assume a kneeling position, then with knees extended gradually pushing torso to an upright position by “walking” the hands up the legs)

• Enlarged muscles (especially thighs and upper arms); feel unusually firm or woody on palpation

Cognitive impairment-Later stages: Profound muscular atrophy (Duchenne Muscular Dystrophy)

• Mild (about 20 IQ points below normal)

• IQ <70 present in 25 to 30% of patients

Complications -Later stages: Profound muscular atrophy (Duchenne Muscular Dystrophy)

• Contracture deformities of hips, knees, and ankles

• Scoliosis

• Risk of fractures

• Respiratory and cardiac compromise

• Obesity

Nursing care (Duchenne muscular dystrophy)

• Help child and family cope with chronic, progressive, incapacitating disease

• Design program to foster independence and activity for as long as possible

• Teach child self-help skills

• Appropriate health care assistance as child’s needs intensify (e.g., home health, skilled nursing facility, respite care for family)

• Often live into adulthood

Congenital heart disease (CHD)

• Incidence: 12 per 1000 live births

  • CHD is a major cause of death in the first year of life (after prematurity).

  • Critical congenital heart disease (CCHD) is more severe and usually requires intervention early in life

• The most common anomaly is ventricular septal defect (VSD).

• Atrial septal defect (ASD)

Altered hemodynamics (congenital heart disease)

Two types

• Acyanotic

• Cyanotic

Acyanotic (Altered hemodynamics- congenital heart disease)

• increased pulmonary blood flow

  • atrial septal defect, ventricular septal defect, patent ductus arteriosus, atrioventricular canal defect

• obstruction to blood flow from ventricles

  • Coarction of aorta, aortic stenosis, pulmonic stenosis

• blood has oxygen so baby does not turn blue

Cyanotic (Altered hemodynamics- congenital heart disease)

• decreased pulmonary blood flow

  • tetralogy of fallout

  • tricuspid atresia

• mixed blood flow

  • Transposition of great arteries, toral anomalous pulmonary venus return, truncus arteriosus, Hypoplastic left heart syndrome

• Oxygen in blood is poor so baby turns blue

Defects with increased pulmonary blood flow (common in)

• Atrial septal defect (ASD)

• Ventricular septal defect (VSD)

• Patent ductus arteriosus (PDA)

Defects with increased pulmonary blood flow

• Abnormal connection between two sides of heart

• Increased blood volume on right side of heart

• Increased pulmonary blood flow

• Decreased systemic blood flow

• In a healthy heart, the wall that separates the right and left chambers (the septum) prevents non-oxygenated blood from mixing with oxygenated blood. A septal defect allows blood to flow back and forth between the right and left sides of the heart.

• “When there’s a hole in the heart, either at the atrial or ventricular level, the heart just can’t work efficiently,”. The lungs end up getting too much oxygen-rich blood. This makes both the heart and lungs work harder. The surgical treatment for atrial septal defect (ASDs) and ventricular septal defect (VSDs) is open-heart surgery.

Most common in (Defects with decreased pulmonary blood flow)

• tetralogy of Fallot and tricuspid atresa

Tetralogy of fallot (Defects with decreased pulmonary blood flow)

• Pressure on right side increases, greater than left-sided pressure which result in desaturated blood in left side of heart and in systemic circulation

Tetralogy of fallout includes four defects (defects with decreased pulmonary blood flow

• Narrowing of the lung valve (pulmonary valve stenosis).

  A hole between the bottom heart chambers (ventricular septal defect).

  Shifting of the body's main artery (aorta).

  Thickening of the right lower heart chamber (right ventricular hypertrophy).

Nursing care of family (Congenital heart disease)

• Helping the family adjust to the disorder.

• Educating the family about the disorder.

• Helping the family manage the illness at home.

• Preparing the child and family for invasive procedures.

• Providing postoperative care:

  • Observing vital signs

  • Maintaining respiratory status

  • monitoring fluids

  • providing rest and progressive activity

  •  providing comfort and emotional support

Plan for discharge and home care (Congenital heart disease)

• Children need at least 3 or 4 more weeks at home and recovery may take 6 to 8 weeks.

• child should not do any activity that could result in a fall or a blow to the chest.

•  keep the child from crying for too long for the first 3 to 4 weeks.

• Do not pull or lift the child by the arms or from their armpit area.

• Limit feeding time to around 30 minutes, add extra calories to formula if it is necessary.  

• Check the wound for signs of infection, such as redness, swelling, tenderness, warmth, or drainage.

• Call the doctor if the child has fever, nausea, or vomiting, chest pain, redness, swelling, or drainage from the wound, Difficulty breathing or shortness of breath, Puffy eyes or face, bluish or grayish skin, dizziness, fainting, or heart palpitations, and feeding problems or reduced appetite

Preoperative preparation for children

Postoperative preparation for children

Sickle cell disease

• Sickle cell disease (SCD) is a group of inherited red blood cell disorders

• In SCD, the hemoglobin is abnormal causing the red blood cells to become hard and sticky and appear crescent or sickle-shaped 

• Sickle or crescent cells die early causing a constant reduction in the number of red blood cells. 

• Sickle or crescent cells, when they travel through small blood vessels, clump together clogging blood flow and depriving organs of blood and oxygen

  • Causing severe pain associated with sickle cell crisis

  • Damage nerves and organs, 

  • Infection, acute chest syndrome, and stroke.

• Sickle cell genotypes influence complication risks and potential disease severity

HbA (sickle cell)

Normal adult hemoglobin.