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Lecture 11 – Unit 3.4

Lecture 11 – Unit 3.4. Nursing Care for Health Problems of Toddlers and Preschool Children Skin Alterations in Children Gail McIlvain-Simpson, MSN, PNP-BC. Topic Areas. Communicable diseases in children, pathology, diagnosis, nursing assessment, and treatment.

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Lecture 11 – Unit 3.4

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  1. Lecture 11 – Unit 3.4 Nursing Care for Health Problems of Toddlers and Preschool Children Skin Alterations in Children Gail McIlvain-Simpson, MSN, PNP-BC

  2. Topic Areas • Communicable diseases in children, pathology, diagnosis, nursing assessment, and treatment. • Screening and treatment for lead poisoning, and poison prevention • Skin alterations in children • Lyme Disease • .

  3. Communicable Diseases • Handouts on Blackboard • Communicable Diseases In Early Childhood • Integumentary Disorders

  4. Communicable Diseases • Why has the incidence of childhood communicable diseases significantly declined? • Why have serious complications resulting from such infections been further reduced? • As nurses what are two key reasons nurses must be familiar with infectious agents?

  5. Nursing Process for the Child with Communicable Disease • Assessment • Diagnosis – Problem ID • Planning • Implementation • Evaluation

  6. What to assess if suspicion of communicable disease? • Recent exposure to known case • Prodromal symptoms • Immunization history • History of having the disease

  7. Components of Prevention Prevention of disease & control of spread to others. • Primary prevention • Prevent complications

  8. A child is admitted with an undiagnosed exanthema – what should be done in this case?

  9. Chicken Pox Varicella Weinberg, S. et al, Color Atlas of Pediatric Dermatology, McGraw-Hill, New York, 1998

  10. Chicken Pox - Varicella Adolescent female • www.vacineinformation.org/photos/variaap002.jpg • Originally from AAP

  11. Chicken Pox - Varicella 4 year old, day 5 • www.vacinneinformation.org/photos/varicdc006a.jpg • Originally from CDC

  12. Shingles or Herpes Zoster • Healthy child • www.vaccineinformation.org/photos/variaap015.jpg • Originally from AAP

  13. DiptheriaCorynebacteriumdiphtheriae • http://www.vaccineinformation.org/photos/diphiac001.jpg

  14. Fifth Disease (Erythema infectiosum) • Weinberg, S. et al, Color Atlas of Pediatric Dermatology, McGraw-Hill, New York, 1998

  15. Roseola (Exanthema Subitum) • http://kidshealth.org/parent/infections/skin/roseola.html

  16. Rubeola (Measles) Koplik Spots • http://lebonheur.adam.com/pages/ency/articleImage.asp?file=2558.jpg&lang=en

  17. Rubeola (Measles)

  18. Mumps • http://www.vaccineinformation.org/photos/mumpcdc001a.jpg

  19. Mumps • http://www.immunize.org/catg.d/iped1861/img0016.htm

  20. Pertussis • http://www.vaccineinformation.org/photos/pertaap002.jpg

  21. Pertussis (Whooping Cough) • http://www.vaccineinformation.org/photos/pertiac001.jpg

  22. Pertussis Deaths • “Whooping cough deaths on rise in infants” • Each year there are an increase of 5000-7000 cases of whooping cough each year and has been steadily rising each year.

  23. German Measlescdn-write.demandstudios.com/.../70/7/238

  24. Rubella • http://www.vaccineinformation.org/photos/rubecdc002a.jpg

  25. Congenital rubella syndrome • http://www.vaccineinformation.org/photos/rubeiac003.jpg

  26. Scarlet Fever • http://www.dermnetnz.org/dna.strept/scarlet.html

  27. White and Red Strawberry Tongue • http://www.dental.mu.edu/oralpath/grad/mucutaneous/sld075.htm

  28. Enterobiasus (Pinworms) • http://ww.dpd.cdc.gov/dpdx/HTML/Enterobiasis.htm

  29. Pinworm Life Cycle Eggs Ingested Hatch in small Intestine Attaches to colon wall Matures in 2-3 weeks Lives in rectum or colon Lays eggs on perianal skin Scratch perianal area

  30. Pinworm - Symptoms • Intense itching of perianal area • No systemic reaction • Unexplained irritability • Restlessness • Poor sleep • Short attention span • Perivaginal itching • www.biosci.ohio~parasite/enterobius.html

  31. Pinworms - Diagnosis • Tape test • Direct visualization with flashlight www.biosci.ohio~parasite/enterobius.html

  32. Pinworms - Treatment • Medications - Anthelmintic • Mebendazole (Vermox) • Pyrantel pamoate (Antiminth)

  33. Pinworms - Treatment • Environmental • good hand washing • daily showers • wash bedding • clean pajamas • snug underwear • fingernails short

  34. Lead Poisoning • Is a major preventable environmental health problem (CDC – 1997) • Brain & nervous system damage • Irreversible health effects • Reduced intelligence • Learning disabilities

  35. Pathophysiology • Lead can affect any part of body • Most concerning – effect on young child’s developing brain & nervous system • Lead disrupts biochemical processes & may have direct effect on release of neurotransmitters, causing alterations in blood brain barrier & may interfere with regulation of synaptic activity • Mild to moderate levels of lead – can affect cognition & behavior in children • Can cause longtermneurocognitive signs

  36. Lead PoisoningDiagnostic Evaluation • Children rarely have symptoms • Venous blood specimen • Lead levels greater than 10mcg/dl (has dropped from 80mcg/dl in 1950’s) • CDC –recommends targeted screening on basis of each state’s determination of need • Universal screening done at ages 1-2 years

  37. Lead Poisoning • Historical perspective • Lead does not decompose • Cultural perspective • Risk factors

  38. Lead Exposure • Lead based paint is the most common source • Ingestion or Inhalation • See Box 14-6 Wong 8th edition page 476

  39. Other sources of Lead • Lead crystal decanters and glasses • Pre-1978 tableware and some imported tableware • Jewelry in vending machines from Jan 2002 to August 2004 • Toys • Chewing on household objects that contain lead: Brass keys, jewelry, fishing sinkers, pre-1970 furniture, pre-1996 mini-blinds

  40. Federal Disclosure Regulations • Must disclose Known Lead-Based Paint & LBP Hazards when sell or lease house • Many pre-1978 homes have lead based paint

  41. Lead Poison Treatment • Chelation therapy • Medications • Succimer • Ca Na2EDT

  42. Nursing Care Management • As nurses what is your primary goal? • ??????? • ???????

  43. Anticipatory Guidance • Hazards of lead based paints in older homes • Ways to control led hazard safety • Hazards accompanying repainteing & renovations of home to houses built before 1978 • Additional exposures (ie dinnerware from other countries)

  44. Ingestion of Injurious Agents

  45. American Association of Poison Control Center • Poison Exposure?Call Your Poison Centerat 1-800-222-1222. •  Free, professional, 24/7/365Don’t guess, be sure… • http://www.1-800-222-1222.info/jingles/engver1.asp

  46. Poison Prevention • Post Poison Control Number (CDC web site)

  47. Poisonings • Significant health concern • Majority occur in children younger than 6 years of age • Can occur with medications & many other substances • Children poisoned by ingestion due to their developmental characteristics

  48. Most Common Poisonings • Cleaning substances • Pain relievers • Cosmetics • Personal care products • Plants • Cough and cold preparations • Improper use causing poisoning

  49. Diffenbachia (Dumb Cane)

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