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NURS 1400 Unit VI Common Childhood Illnesses

NURS 1400 Unit VI Common Childhood Illnesses. Metro Community College Nursing Program Nancy Pares, RN, MSN. Integumentary system. Tinea Corporis Fungal infection; “body ringworm” Occurs in non terminal, non hairy areas of body Occurs in children of any age; acquired from animals.

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NURS 1400 Unit VI Common Childhood Illnesses

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  1. NURS 1400 Unit VICommon Childhood Illnesses Metro Community College Nursing Program Nancy Pares, RN, MSN

  2. Integumentary system • Tinea Corporis • Fungal infection; “body ringworm” • Occurs in non terminal, non hairy areas of body • Occurs in children of any age; acquired from animals

  3. Tinea Corporis • Clinical manifestations • Annular, expanding lesion • Raised erythematous border • Scaly, clear center • Treatment • Topical: miconazole, clotrimazole(lotrimin) • Twice daily for 2-3 wks • Oral: itraconazole, terbinafine

  4. Infestations • Pediculosis: Head lice • Ectoparasites: live on the surface • Most common in 3-10 years; greater in girls of caucasian origin • Classroom is primary source of infestation

  5. pediculosis • Pathophysiology • Head to head contact: hats, combs, bedding • Lice crawl-do not fly or jump • Eggs(nits) attach to hair shaft with water insoluble glue usually in the auricular or occipital areas of the head • Nymphs emerge in 7-10 days; lifespan=30 days • Brown in color, size of sesame seed

  6. pediculosis • Clinical manifestations: itching • Diagnosis: identification of nits on scalp • Treatment: • Manual removal: less than 2 years of age • Permethin (Nix): > 2 years of age; kills lice and ova • Lindane (Kwell): > 2 years of age; less potent agent

  7. Pediculosis • Nursing Management • Assessment: careful handwashing; done with hair wet; examine known areas; • Nursing diagnosis • Impaired skin integrity • Low self esteem • Deficient knowledge • Family teaching: treatment of household; notify schools and contacts

  8. Scabies • Ectoparasite; significant world wide • Occurs at any age, most common <2 year old • Pathophysiology • Transmitted by close person to person contact • Burrow into the stratum corneum depositing feces • Females lay eggs in 2-3 day intervals; hatch in 3-8 • Adult mites are round, eyeless, life span of female is 2 months; male dies after mating

  9. Scabies • Clinical manifestations • Inflammatory response, generalized pruritus which increases at night • Sites: skin surfaces that are opposing: axillary, cubital, • Diagnosis: microscopic exam of scrapings • Treatment : Permethrine cream(Elimite) • One application is usually sufficient

  10. Scabies • Nursing management • Promotion of comfort • Prevention of secondary infections • Handwashing • Family teaching • All members of household need treatment • All clothes and bedding in hot water • Daycare: no attendance for 24 hours after treatment

  11. Inflammatory disordersAcne Vulgaris • Predominately adolescent skin disease • Chronic condition; 85% of all adolescents • Pathophysiology • Accumulation of sebum in the pilosebaceous follicles which become very cohesive • Comedones are lesions of non inflammatory (white heads); open lesions are black heads

  12. Acne vulgaris • Diagnosis: age and appearance of lesions • Treatment: • Individualized • Topical • Benzoyl peroxide, reinoids, azelaic acid, and abx • Systemic • Anbx, oral contraceptives, accutane

  13. Acne vulgaris • Nursing management • Reduction of severity, supportive care, information about diet, hygiene, rest • Teaching • Educate about misconceptions • Avoid cosmetics

  14. Hearing and Visual disorders • Hearing impairment • See page 1023 table • Congenital vs acquired • Classifications • Conductive hearing loss • Sensoneural hearing loss • Mixed conductive sensoneural hearing loss • Central hearing loss • Behavioral signs: pg 1025 table

  15. Hearing loss • Diagnosis • Newborn screening • BAER (Brainstem Auditory Evoked Response) • Main test for hearing loss • Treatment: • Dependent on type of hearing impairment • Conductive: hearing aid • Sensoneural: cochlear implants • Sign language, lip reading, cued speech

  16. Hearing loss • Nursing management • Assessment • Nursing diagnosis • Disturbed sensory perception • Delayed growth and development • Ineffective coping

  17. Visual impairment • Binocularity: fixation of 2 ocular images, occurs at 6 months • Visual acuity: clearness of image: changes with age • Etiology • Eyeball mis proportioned • Damage to one or more parts of the eye interfering with visual process • Brain may not process information correctly

  18. Visual impairment • Manifestations based on age: pg 1033 table • Diagnosis: Snellen chart; assessed indirectly with children< 3..see page 1034

  19. Impairment of muscular efficiency • Strabismus • Condition where the visual lines of each eye do not focus on the same object due to lack of muscle coordination; cross eyed appearance • Clinical manifestations • Clumsy, difficulty picking up objects, crossed eyes • Diagnosis • Hirshberg corneal light reflex, cover test, esotropia, hypertropia

  20. strabismus • Treatment • Medical: • Occlusion dressing (eye patch), glasses, pharmacologic • Surgical • Children < 12-18 months when medical did not work

  21. strabismus • Nursing management • Early identification • Nursing diagnosis • Delayed growth and development • anxiety

  22. Amblyopia (Lazy eye) • A reduction or loss of vision in one eye unrelated to an organic cause • Pathophysiology • Occurs in first 6 months of life • Brain is trained to compensate • If not corrected by age 7, restoration is minimal • Clinical manifestations; • Rare, child is unaware of any problem • Treatment: glasses

  23. Respiratory disorders: Acute Epiglottitis • Life threatening bacterial infection • Also called ‘croup syndrome’ • Can lead to complete airway obstruction • Clinical manifestations • Respiratory distress, fever, sore throat, dysphagia, drooling, agitation, and lethargy, • Diagnosis: no spontaneous cough,DO NOT look in throat by depressing tongue

  24. Acute epiglottitis • Nursing management • Anbx, fluids and supportive care • Have emergency equipment on had for tracheotomy.

  25. Bronchiolitis • Acute, typically viral, infection of the bronchioles usually caused by RSV • Usually young children • Causes inflammation of the bronchioles • Wheezing is classic symptom with tachypnea • Complications • Apnea, atelectasis, secondary bacterial infection and respiratory failure

  26. Bronchiolitis • Nursing management/diagnosis • Ineffective airway clearance • Deficient fluid volume • Deficient knowledge of caregivers • Planning /implementation • Family teaching • Acute setting focus on adequate ventilation and fluid balance

  27. Bronchiolitis • Treatment/prevention • Ribuvirin (Virazole) is the only med for RSV bronchiolitis • Prevention drugs • RSV immune globulin (RespiGam) • Synagis • Administered monthly as an IM injection • First dose Usually given prior to RSV season

  28. Asthma • Characterized by chronic inflammation, bronchoconstriction, and bronchial hyper responsiveness • Wheezing, coughing and dyspnea • Airways are damaged over time • Classified by severity of symptoms

  29. Asthma • Categories • Mild intermittent • Mild persistent • Moderate persistent • Severe persistent

  30. Asthma • Pharmacologic treatments • Short acting inhaled beta 2 agonists • Long acting inhaled beta 2 agonists • Leukotriene modifiers • Oral anti asthmatics • Methylxanthines • Systemic corticosteroids

  31. asthma • Treatments • Avoid triggers • Regular peak flow monitoring • Medical follow up • Rapid access to medical care • Prevention • Avoid allergen exposure, warm up before exercising, relaxation exercises

  32. Bacterial meningitis • Meningitis is inflammation of meninges • Causative agent is age dependent • Neonates: e coli, group b strep, H influenza, strep pneumoniae • Infants and children: H influenza type b, strep pneumoniae • Adolescent: Neisseria meningitis, strep pneumoniae

  33. Asthma • Nursing management/diagnosis • Risk for suffocation • Ineffective airway clearance • Interrupted family processes

  34. Bacterial meningitis • Clinical manifestation • Infants may have subtle symptoms • Child over 2 may have GI upset and cold like symptoms • Hyperactive reflexes • Kernigs sign: supine with hip flexed..pain on resistance on extension of leg • Brudzinski sign; supine, flex head..hip and knees will also flex

  35. Bacterial meningitis • Diagnosis • CSF via lumbar punctures; fluid will be cloudy • Urine for culture, osmolarity, sp. Gravity • Chest x ray • CT/MRI • Treatment • Oxygen • Seizure precautions • Antibiotics/dexamethazone • isolation

  36. Viral meningitis • Inflammatory response of the leptomeninges • Caused by non polio enterovirus; most occur in summer • Often associated with partially treated bacterial infections • Clinical manifestations • Not as ill as bacterial; general malaise, gradual onset, Kernig and Brudzinski signs may be present

  37. Viral meningitis • Diagnosis • CSF • Less than 500 WBC/cubic mm • Glucose increased • Protein decreased • May do second spinal tap within 6-8 hrs for confirmation

  38. Viral meningitis • Treatment • Same as bacterial until viral is confirmed • Nursing management • Same as bacterial until viral is confirmed • Comfort measures, • Administer meds as ordered

  39. Encephalitis • Inflammation of the brain caused by bacteria, virus, fungi or protozoa • See page 1085 for table of causes • Pathophysiology • Invasion of pathogen to CNS • Clinical manifestations • Intense HA, s/s of respiratory infection, n/v, slurred speech, seizures, ataxia, personality and behavior changes

  40. Encephalitis • Diagnosis • H&P, • CSF • Initially normal, recheck in 2 days • Leukocytes increase • Protein increase • Nasopharynx swab • Treatment: • Supportive, anbx til bacterial cause r/o

  41. encephalitis • Nursing management/interventions • Vital sign assessment • Neuro checks • PROM • Good skin care

  42. GER ( gastroesophogeal reflux) • Common disorder of infants; improvement seen in 6-12 months; boys affected more than girls, common in preterm infants • Clinical Manifestations • Vomiting, regurgitation, excessive crying, blood in stools • Diagnosis • Observing feedings, upper GI, endoscopy

  43. GER • Treatment • Dietary modifications • Thicken formula with cereal • Positioning: seated vs prone vs head elevated prone • Pharmacologic intervention • Previcid, reglan • Nursing diagnosis • Risk for aspiration; imbalanced nutrition; deficient knowledge

  44. Parasitic infections • See pages 442-443 • Pinworms • roundworms

  45. Urinary Tract Infections • Infection of one or more structures of the urinary tract • Cystitis • Urethritis • Pyelonephritis • Pathophysiology • Same as adults

  46. UTI • Clinical manifestations • Infants • Preschoolers • School age and adolescents • See page 626 table • Diagnosis • UA

  47. UTI • Treatment • Eradicating the infection • Preventing re infections • Correcting underlying causes • Preserving renal function • Abx, fluids

  48. Enuresis • Involuntary voiding of urine beyond the expected age • More common in boys • Pathophysiology • Neurologic development delay • Frequent UTI • Structural disorders • Chronic constipation • DM • Sleep arousal problems • Stress and family history

  49. enuresis • Clinical manifestations • Dribbling after voiding • Urgency • Ineffective stream • Infrequent and painful voiding • Incontinence with laughing

  50. Enuresis • Diagnosis • Family history • Neuro exam: reflexes, sphincter tone, spinal defects • Voiding diary • UA, renal ultrasound, urine flow rate

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