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Maternal child health

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  1. Maternal child health Module 9

  2. Objectives • Discuss systemic infant disorders, child abuse, environmental safety • Discuss other common disorders and topics in pediatrics

  3. Introduction: 0-12 months • Depend and relate to parents • Interpret illness as general pain and discomfort • Interventions should be considered with developmental age in mind

  4. Infants: GI • Thrush • Fungal infection of mouth, throat • Candida albicans; common < 6 months age • Sources: Hands, nipples, pacifiers, vaginal canal • Teaching: • Carefully clean hands, bottles and nipples, may need to apply antifungal to breast between feedings – teach how to wash before offering to baby • Baby may require antifungal applied to mouth

  5. Infants: GI • Diarrhea • disturbed GI motility -> diarrhea • Acute gastroenteritis • Caused by infection • Other common causes: juices, formulas, allergens • Dehydration, electrolyte imbalance • Labs: serum sodium, serum glucose, serum bicarbonate, blood urea nitrogen (BUN) help determine severity

  6. Infants: GI • diarrhea • Avoid concentrated juices and medications not approved by pediatrician • Frozen liquids (popsicles), Pedialyte may help rehydrate • Keep skin clean, dry

  7. Infants: GI • Colic • 3 x3 x 3 • Crying > 3 hours daily • Starts about 3 weeks, lasting about 3 weeks • No discernible physical cause • Overly sensitive to stimulation • Dehydration

  8. Infants: GI • Colic • Infants may be more at risk for injuries like shaken baby, abuse, neglect • Educate parents and caregivers • Encourage parents to take breaks • Assess parents’ coping

  9. Infants: GI • Failure to thrive • May indicate feeding or nutritional problems • May indicate abuse, neglect • Must be assessed carefully • Growth chart should be appropriate to race, feeding style • Growth charts: tool • Development should be assessed • Care plan: nutrition, medical hx, psychosocial

  10. Infants: GI • Cleft lip/palate • Malformation of hard and/or soft tissues of mouth, palate • May interfere with feeding • Predisposed to thrush -> GI infection • May require speech therapy and nutritional therapy • Prevent aspiration: hold upright to feed • ESSR feed techniques: Enlarge nipple, Stimulate suck reflex, Swallow fluid appropriately, Rest

  11. Infants: GI • Cleft lip/palate • Allow frequent burping d/t extra air swallowed • Requires surgical repair: photos, expectations • Promote bonding • Post-op feeds: avoid suture line • Clean suture line with saline after feeds • Have baby lie on stomach to drain surgical area • Monitor for dehydration

  12. Types of cleft lip/palate

  13. Cleft palate: before/after surgery

  14. Cleft lip before/after surgery

  15. Infants: GI • Esophageal atresia with tracheoesophageal fistula • Esophagus not connected to stomach • Hole between esophagus/trachea • Requires surgery • Requires IV nutrition until healed • s/s: coughing/choking with swallowing, breathing problems

  16. Infants/children: GI • Pyloric stenosis • Valve between stomach and duodenum enlarged • Projectile vomiting • Malnutrition/dehydration • Visible peristaltic waves from left to right across the epigastric region may be seen • May require surgery

  17. Infants: GI • Megacolon (Hirschsprung’s) • Nerves defective along portion of colon • No peristalsis -> intestinal obstruction • Enlarged colon • Surgery: temporary colostomy and removal of dead tissues, then restructuring GI tract • Pre-op diet: low fiber, high-protein/calorie

  18. Hirschsprung’s Disease/megacolon

  19. Infants/children: GI • Gastroesophageal reflux (GER) • Effortless regurgitation • Most common cause vomiting term/preterm infants • Incompetent lower esophageal sphincter • Intussusception • Part of intestine pulls up inside itself • Most common cause intestinal obstruction ages 3 months- 6 years • Unknown cause

  20. Nursing care: infants GI • Assess nutrition, hydration • Provide age-appropriate education, pre/post-op care • Teach parents how to help their child eat, drink • Teach ostomy, incision care • Provide support for families

  21. Infant musculoskeletal disorders • Congenital talipes equinovarus • Clubbed foot • Developmental dysplasia of the hip • Partial or full dislocation of femoral head from hip • Treatment: • spica cast • Pavlik harness

  22. Hip immobilization Spica cast Pavlik harness

  23. Nursing care: musculoskeletal • Keep case in proper shape until dry • Assess, protect skin • Assess CMS, report changes • Encourage growth/development • Activities • Learning • social

  24. infant: integumentary system • Milia rubra • Diaper rash: diaper dermatitis • Cradle cap: seborrheic dermatitis • Atopic dermatitis • Newborn rash: erythema toxicum neonatorum • Stork bite: telangiectatic nevi • Port-wine stain: nevus flammeus • Strawberry birthmarks: nevus vasculosus

  25. Cradle cap

  26. Nursing care: infant skin • reassure parents • teach preventive care for rashes • Show how to apply and remove creams • Caution against drying soaps, teaching thorough rinsing of skin – avoid overdrying! • provide support of worries over appearance

  27. infant: nervous system • Spina bifida • Failure of neural tube to close • May be result of low folic acid in mom’s diet during pregnancy • Sensorineural deficit below site • Elimination, ambulation problems • Treatment: surgery to close • Variation :myelomeningocele: portion of spinal cord, meninges, spinal fluid, nerves protrude

  28. infant: nervous sytem • Hydrocephalus • Too much CSF in/around brain • Shunt from brain to peritoneal cavity • May require surgery series during growth • “Sunset sign” • S/S (infants): Frontal bossing of forehead, sunset eyes, slow pupil response to light, irritability, high-pitched cry, difficulty consoling, lethargy, altered LOC, difficulty sucking/feeding

  29. Nursing care: infant nervous system • Education: disease, surgery, recovery • Pre/post operative nursing care • Monitor baseline and changes in motor, sensory, circulation • Monitor level of consciousness • Assess for failure to thrive d/t malnutrition, dehydration r/t poor feeding

  30. Sunset sign

  31. Infant: nervous system • Seizure disorders • Partial or generalized • Fever, infection, trauma, hypoxia, poisons, tumors, metabolic disturbances • birth-2 years most common • Assess for safety and interruption of age-related tasks • Promote safe behaviors • Bed rail pads, helmets

  32. Types of seizure protection

  33. Infant: nervous system • Meningitis • Inflammation of meninges (central nervous system) • <5 years old • Usually follows an URI, skull fracture, lumbar puncture • S/S (infants): bulging fontanelle, high-pitched cry • Kernig’s, Brudzinski’s signs • Haemophilus influenzae type b vaccine

  34. Exam for meningitis Kernig’s sign Brudzinski’s sign

  35. Infants: nervous system • Cerebral palsy • Nonprogressive disorders -> motor dysfunction • No specific treatment – care given to treat disabilities: occupational, physical, speech and hearing specialists • Many implicated causes: maternal, perinatal, infancy/childhood • Careful history taking important to find causes • Botox may be used to treat spastic muscles – can help avoid contractures and surgeries later

  36. Child with cerebral palsy

  37. Nursing care: infants: neuro • Assist with use and learning of adaptive devices for ADLs: eating utensils, ambulation devices, protective headgear • Teach new ways to do ADLs independently • Encourage mobility and age-appropriate activities • Help families adjust to multiple therapies • Direct to support services • Assess family adaptation

  38. Infants : genitourinary system • Hypospadias • Urethra opening on underside of penis • Hydrocele • Fluid in scrotum • Phimosis • Foreskin too tight • Cryptorchidism • Undescended testes

  39. Hypospadias repair

  40. Infants: GU system • Inguinal hernia • Abdominal organ(s) protrude into groin • More often in boys than girls • Present at birth or developed later • May be put into place by pressure – done by pediatrician – or surgery • If blood supply to organ cuts off, infant may show signs of severe abdominal pain and vomit – requires emergency bowel resection

  41. Inguinal hernias

  42. Nursing care: infants GU • Educate parents: cause of defect, risks and benefits of surgery, post-surgical home care, address reproductive concerns • Monitor I&O, hydration status, pain • Anti-infectives in underlying infection

  43. infants: cognitive/sensory • Down syndrome • Extra chromosome on pair 21 • Distinct head/face/hand characteristics: simian crease, low-set ears at birth • Some degree of cognitive impairment • May have URIs, cardiac and thyroid problems

  44. Infants: cognitive/sensory • Visual or hearing impairment • Deficit or loss of sight or hearing • May be related to illness , injury or congenital • Early assessment, correction to prevent learning problems

  45. Nursing care: cognitive/sensory • refer to appropriate support services and developmental specialists • Assess adaptation: infant and family • Help families develop appropriate stimuli for child • Assess adaptation and age-appropriate development

  46. Assessing child abuse: all ages • Physical neglect • Failure to thrive • Hunger • Poor hygiene • Clothes too heavy or too light for season • Unattended medical needs • Abandonment • Extended stays at school • Delinquency • Alcohol, drugs

  47. Assessing child abuse • Physical abuse • Injuries explained away as “accidents” • Injuries don’t fit explanation, conflicting stories • Symmetrical burns without splash marks • Bruises, welts, human bite marks • Multiple, spiral fractures in various stages healing • Fractures to skull, nose, face • Unreported injuries discovered by exam • Apprehension when other children cry • Concealing clothing worn to hide injuries • Object-shaped marks: belt buckle, iron, cords

  48. Assessing child abuse • Emotional abuse • Withdrawal, inappropriate fearfulness • Emotional/intellectual development lag • Language difficulties • Suicide attempts • Failure to thrive • Feeding problems • Bedwetting • Disturbed sleep

  49. Assessing child abuse • Sexual abuse • Promiscuous behaviors • Age-inappropriate sexual knowledge • Forcing sexual acts on other children • Fear of being touched • Difficulty walking, sitting • Adolescent pregnancy • Vaginal/penile discharge • Bruising in genital area, hard/soft palate • Recurrent UTIs