Week 12 Community Health Clinic

1. Week 12 Community Health Clinic

2. Case 1 – Scoliosis Screening • Scoliosis – abnormal curvature of the spine • Most common in adolescent girls • Check for uneven shoulder & hip levels, asymmetry of scapula • c/o backache & fatigue • If severe, can affect respiratory function

3. Boston or Milwaukee brace Surgery – insertion of rod, fusions Teach management of brace, skin care Promote positive self-concept NCP – p. 1815 Management of Scoliosis

4. Legg-Perthes • Aseptic necrosis of femoral head • 4 stages: avascular, revascularization, reparative, regenerative • S&S: pain in hip, knee; stiffness,  ROM, limp • Important to keep head of femur in acetabulum until it reforms

5. Management: • Rest, traction, active non-weight bearing motion • No weight bearing during early stages • Braces, casts, crutches • Promote comfort, mobility • Teach use of braces, allowable activities

6. Case 2 – Hip dysplasia, clubfoot Hip Dysplasia – • Abnormal development of head of femur or acetabulum • Subluxed or complete dislocation • Tx: maintain hip in flexed abducted position – Pavlik harness, spica cast, splint • Early recognition is important • Teaching re: splint care, managing immobility

9. True or positional Variations Varus Valgus Equinus Calcanus Equinovarus most common Clubfoot (talipes)

10. Management of clubfoot • Serial casting – change q 1-2 wks • Denis-Brown splint, Wheaton brace • Muscle stretching exercises • May require surgery • Nursing care: • Neurovascular checks • Skin care, cast care • Teaching: exercises, cast care

11. Hypotonia •  muscle tone – “rag doll” • Sign of disorder – neuromuscular, genetic • Hypothyroidism •  thyroid hormone – congenital or acquired • Delayed g&d, dry skin, mental sluggishness • Tx: hormone replacement

12. Case 3 – Tattoos and piercings • Risks: • Bleeding • Infection – local, systemic (HIV, Hep) • Allergic reactions • Scarring, keloids • Tooth damage (oral piercings)

13. TATTOO CARE Keep covered for 12 hours – avoid touching tattoo Wash with antibacterial soap & apply antibiotic cream Avoid sunlight & tanning until healed PIERCING CARE Use antibacterial soap/cleanser Avoid harsh antiseptics Mouthwash for oral piercings – check that piercing is secure (risk of swallowing)

14. Case 4 – Grieving in Children • Understanding of death • Infant/toddler – no comprehension • Pre-school – death is reversible • May experience guilt, fears • Many questions • School age – death is permanent • Need tangible ways to express grief • Adolescent – death as remote from them • Fear of pain & process of dying

15. Helping Grieving Families • Help parents understand child’s reactions • Encourage parents to remain with child, answer questions • Encourage child to express feelings, fears • Provide outlets for anger, aggression • Provide suggestions for concrete ways to express grief Ref: www.synspectrum.com/childgrief.doc

16. Zoonotic Disorders • Transfer of disease from animals to humans • Examples: • Insect-borne – West Nile • Pets – Cat Scratch Fever • Farm animals – Brucellosis • Wild animals – TB, rabies • Pregnant women, infants, children at risk

17. Case 5 – Type 1 Diabetes • Auto-immune disease destroys insulin-producing beta cells of pancreas • S&S: • Polyuria, polydipsia, polyphagia • Hyperglycemia • Weight loss, fatigue • May develop DKA – dehydration, acidosis, ketosis

18. Management of Type 1 Diabetes • Goal: near-normal BG, avoid hypoglycemia • Balance insulin, diet, exercise • Frequent monitoring of BG

19. Type 1 Diabetes (cont’d) • Complications • Hypoglycemia • Diabetic ketoacidosis (DKA) • Long-term • Nursing Care • Education** and ongoing support • Development of collaborative relationship with child and family

20. Case 6 – Foreign Bodies Nasal • Food, beans, crayon pieces, paper, etc. • Leads to irritation, infection, obstruction • Foul-smelling nasal discharge, difficulty breathing, discomfort • Do NOT probe nose or try to remove if not visible • Have child blow gently through affected nostril

21. Ear • Do NOT attempt to remove by probing with swab • Do NOT reach into ear with tweezers Prevention • Keep small objects out of reach of infants and toddlers • Discourage children from putting things in body openings

22. Case 7 – Skin Rashes • Possible causes – contact dermatitis, eczema, allergic reactions, diseases (measles, chickenpox, Kawasaki) Contact dermatitis (tape) Eczema

23. Skin Care • Gentle cleansing – avoid irritating substances – avoid use of soap • Moisturize frequently – use creams/lotions without added perfumes, etc. • Eliminate newly added soaps, lotions • May require Rx creams - hydrocortisone

24. Case 8 – Gastro-esophageal Reflux (GER) • Gastric contents back up into esophagus – sphincter dysfunction • Most common < 4 months • S&S – regurgitation of feedings, poor weight gain • Risk of aspiration • Dx: barium swallow, endoscopy

25. Management of GER • Feedings – small, frequent feeding with frequent burping; thicken feeds (controversial) • Positioning – avoid slumping, sitting after feeds; prone, head elevated (controversial) • Medications • Surgery in severe cases - fundoplication

26. Case 9 – Epistaxis (Nosebleed) • Causes: trauma, nose picking, dry air, irritants, foreign body, cocaine use, bleeding disorders (e.g. von Willebrand) • Emergency Tx: • Sit up and lean forward • Continuous pressure to nose • Cotton into each nostril or cold cloth to bridge of nose

27. Case 10 – Obesity, Hyperlipidemia, Hypertension Obesity – above 95th percentile • 22-33% of children • Related to genetics, endocrine problems, lifestyle (nutrition, exercise) • Risk for hyperlipidemia, hypertension, resp. disorders, cholelithiasis, Type 2 diabetes

28. Hyperlipidemia • Cholesterol > 5.1 mmol/L; LDL-c - > 3.34 mmol/L • Risk factor for CAD • Management: dietary, medication Hypertension • Factors: heredity, lifestyle, obesity, renal disease • S&S: headaches, vision changes, dizziness • Management: lifestyle changes (weight loss, exercise) • Medications: ACE inhibitors (e.g. captopril), beta blockers (e/g. propanolol