1 / 159

Maternal child health

Maternal child health. Module 9. Objectives . Discuss systemic infant disorders, child abuse, environmental safety Discuss other common disorders and topics in pediatrics. Introduction: 0-12 months. Depend and relate to parents Interpret illness as general pain and discomfort

fonda
Download Presentation

Maternal child health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related