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NURSING OF CHILDREN

NURSING OF CHILDREN. UNIT 3 Respiratory & Cardiovascular Blood & Lymphatics. Whooping Cough. Pertussis Communicable childhood disease Incubation 7-10 days Direct contact or airborne. Whooping Cough. Assessment. Treatment. Vaccinate Symptomatic care Cool mist tent Antibiotics

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NURSING OF CHILDREN

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  1. NURSING OF CHILDREN UNIT 3 Respiratory & Cardiovascular Blood & Lymphatics

  2. Whooping Cough • Pertussis • Communicable childhood disease • Incubation 7-10 days • Direct contact or airborne

  3. Whooping Cough Assessment Treatment Vaccinate Symptomatic care Cool mist tent Antibiotics Isolation Positioning Observe respiratory distress Frequent small feedings • Fever • Coryza • Dry cough; Paroxysms • “whoop” sound

  4. Croup • Acute Laryngotracheobronchitis (LTB) • Severe inflammation & obstruction of the upper airway • Usually viral but may be bacterial origin • Usually preceded by URI which proceeds to laryngitis & then descends into trachea & sometimes bronchi • Flexible larynx susceptible to spasms = airway obstruction • Profound airway edema = obstruction

  5. Croup ASSESSMENT TREATMENT Assess resp. status; keep emergency equip. @ bedside ↑ humidity O2 therapy Maintain hydration Adm. meds. Reduce anxiety Support parents Education • URI • Inspiratory stridor • Retractions • Barking cough • Hoarseness • Pallor, cyanosis • Restless, irritable • Low grade fever • Adventious lung sounds or absent breath sounds

  6. Epiglottitis • Acute inflammation of epiglottis • Progressive obstruction = hypoxia, hypercapnia, acidosis, altered LOC • Untreated may rapidly progress to complete airway obstruction

  7. Epiglottitis • Maintain patent airway • Endotracheal intubation / tracheostomy • Swelling ↓ usually after 24 hrs. • Infection tx’d with AB’s 7-10 days • IV’s to maintain hydration

  8. EpiglottitisAssessment • Sudden onset & preceded by URI • Sore throat, dysphagia, High fever • Characteristic positioning • Sitting upright, leaning forward with chin outthrust, mouth open, & tongue protruding (tripod position) • Drooling • Irritable, restless • Wheezy inspiratory stridor, snoring expiratory sound • Retractions • Tachycardia, thready pulse

  9. EpiglottitisAssessment • Signs of hypoxia • Throat is red & inflammed with lg. cherry red edematous epiglottis • Only examined by experienced personal & have emergency equip @ BS d/t exam may precipitate complete airway obstruction

  10. Epiglottitis Diagnostic Results • Lateral neck x-ray = epiglottal enlargement • ↑ WBC’s • Blood cultures

  11. EpiglottitisPlanning & Care

  12. Bronchitis • Infection of the major bronchi • Assessment • Fever • Hacky, productive cough • Rhonchi & crackles

  13. BronchitisNursing Responsibilities • Monitor resp. distress • Monitor VS • Provide humidified air • Monitor s/s dehydration • ↑ fld. Intake • Monitor weight • Adm. Acetaminophen for fever • Adm. resp. treatmets as ordered

  14. Respiratory Syncytial Virus (RSV) • Causative organism to bronchiolitis – inflammation of the bronchioles • Results in thick production of mucus that occludes the bronchiole tubes & small bronchi • Not airborne but by direct contact

  15. (RSV) - Assessment • URI symptoms • Fever • Nasal drainage • Tachypnea • ↑ dyspnea • Nasal flaring • Retractions • Espiratory wheeze • Grunting • Harsh cough

  16. (RSV) – Nursing Care • Patent airway • VS • Cool humidified O₂ • s/s dehydration • Isolation • Good handwashing

  17. Asthma • Chronic, episodic, obstructive disorder characterized by airway narrowing d/t bronchospasms & mucosal edema • Most commonly results from allergic hyper responsiveness of trachea & bronchi to irritants • Familial • Most common chronic lung disease • Obstruction d/t edema of resp. mucosa = bronchiolar narrowing & smooth muscle spasm & secretion accumulation • Leads to air trapping, wheezing & resp. distress • Status asthmaticus • Acute, severe, prolonged asthma attack that does not respond to usual tx.; hospitalization

  18. Asthma Assessment • Dyspnea, air hunger • Anxiety • Coughing • Wheezing, particularly exp. • Fatigue • Tachypnea • c/o chest tightness • Retractions • Cyanosis • Diaphoresis

  19. Asthma Planning & Care • ↑ resp. effectiveness • Assess resp. status • Maintain oxygenation • Promote rest • Prevent dehydration • Assist with ID precipitating factors & ways to limit exposure • Education • Stay hydrated • No cold fluids • Adm. meds • Bronchodilators • Theophylline (restlessness) • Aminophylline (urinary retention & fatigue) • Beta-adrenergics • Corticosteriods: ↓ airway inflammation • Antihistamines: ↓ postnasal drip • Antibiotics • Epinephrine & albuterol

  20. Cystic Fibrosis • Chronic inherited disorder of the exocrine glands • Characterized by abnormally thick respiratory secretions & other multisystem effects • Inherited recessive trait • Underlying defect likely r/t protein or enzyme alteration • Viscous secretions effect many organ systems • Salivary & sweat glands will ↑ Na⁺ & Cl⁻ excretion = salty taste when kissed

  21. Cystic FibrosisAssessment • Respiratory • Wheezing, dyspnea, dry nonproductive cough • As disease progresses & mucous obstruction in small airways: • Barrel shaped chest, cyanosis, clubbing of fingers & toes • GI due to obstruction of pancreatic ducts & absence of pancreatic enzymes • Chronic diarrhea with large, frothy, foul smelling stools; weight loss despite increased appetite

  22. Cystic FibrosisLab Studies • ↑ Na⁺ & Cl⁻ levels detected on a sweat test • Absence of pancreatic enzymes • Steatorrhea • Generalized obstructive emphysema per CXR

  23. Cystic FibrosisPlanning & Care • Pulmonary hygiene before meals • Resp. status • Encourage adequate nutrition / assess nutritional status • ↑ calories, ↑ protein, moderate fat • Medications • Aminoglycosides (penicillins) • Pancreatic enzymes (pancrease) • Vitamin & iron supplements • Monitor s/s infection • Promote adequate rest • Help child maintain positive self image

  24. Congenital Heart Disease • S/S • Growth abnormalities • Cyanosis • Clubbing of fingers & toes • Periorbital & peripheral edema • Tachypnea • Engorged neck veins • Tachycardia or bradycardia, thready pulse • ↓ BP or unequal BP in arms & legs • Murmurs, bruits • Abd. distention • Hepatomegaly, splenomegaly

  25. Patent Ductus Arteriosus – PDA • Fetal ductus arteriosus between aorta & pulmonary artery remains open • Lg. PDA may result in L. atrial & L. ventricular enlargement, pulm. edema, d/t ↑ pulmonary pressure & CHF

  26. Atrial Septal Defect - ASD • Septum opening between L & R atria • Oxygenated blood flows L to R & mixes with systemic venous blood • ↑ in total blood flow to lungs from vol overload to R ventricle = R-sided heart enlargement = pulm edema & CHF

  27. Ventricular Septal Defect - VSD • Septum opening between R & L ventricles • Oxygenated blood flows L to R & mixes with systemic venous blood • ↑ pulmonary circulation = R-sided heart enlargement = pulmonary vascular disease • Has characteristic loud harsh murmur developing usually 1st few days after birth; best heard @ lower left sternal border

  28. Coarctation of Aorta • Narrowing of aorta • Restricted blood flow through narrowed aorta = L ventricular failure • Characteristic finding = ↑ systolic pressure in arms with ↓ pressure in legs • Most common cyanotic heart defect in which deoxygenated blood enters systemic arterial circulation • Cyanosis results from R to L shunting of blood, mixing of blood in a common chamber, & abnormal blood vessel development

  29. Tetralogy of Fallot • 4 abnormalities • VSD, overriding of the aorta, pulmonic stenosis, right ventricular hypertrophy • Characteristic finding • Squatting = ↓ venous return of low O₂ content from lower extremities & ↑ systemic vascular resistance = pulmonary blood flow

  30. Heart DefectsPlanning & Care • Maintain optimal nutrition • Small freq. meals spaced 3-4 hrs apart • ↓ cardiac workload • Manage CHF • Manage resp. distress • Prevent hypokalemia secondary to diuretic therapy • Prevent anemia • Enhance self-concept • Manage hypoxia • Observe for s/s of infection • Monitor s/s of thrombosis • To reduce risk – keep hydrated • Preventive handwashing, ensure immunizations, provide adequate rest • Education about the defect & management • Tetralogy surgical repair 18-36 months

  31. CHF • Severe circulatory congestion d/t ↓myocardial contractility = heart’s inability to pump sufficient blood to meet body’s needs. • Congenital heart disease - primary cause of CHF in 1st 3 yrs. of life

  32. CHF Assessment • Rapid resp • Rapid pulse • Feeding difficulties • Poor wt. gain • Edema • Freq resp tract infections

  33. CHF Interventions • Reduce workload of heart • Improve resp • Maintain nutrition • Prevent infections • Reduce patient anxiety • Support parents • Educate parents

  34. CHF Medications • Lanoxin (digoxin): Antiarrhythmic • Slows & strengthens heart • AP pulse taken 1 full min. • Newborn HR < 100 = hold med & call MD • Older children <70 = hold med & call MD • Toxicity = N/V, anorexia, irreg pulse, sudden change in pulse • Lasix (furesomide): Diuretic • Reduce edema • Monitor electrolytes, esp K+

  35. Rheumatic Fever • Systemic disease involving joints, heart, CNS, skin & subq tissue • Collagen disease = destruction of connective tissue • Effects heart, scars mitral valve • Throat infection caused by Group A beta hemolytic streptococci

  36. Assessment • s/s may not occur for 1-3 wks after throat infection • Migratory polyarthritis • Skin eruptions • Rheumatic carditis • Sydenham’s Chorea • Abd. pains • Fever • Pallor • Unexplained epistaxis • Fatigue • Anorexia

  37. Treatment & Care • Penicillin to treat strep infection • Acetaminophen (pain/fever) or steroids for relief of pain • Manage cardiac failure if occurring • Safety if chorea present • Chemoprophylaxis • Complete physical & mental rest

  38. Iron Deficiency Anemia • Most common nutritional deficiency of children in US • Causes: Severe hemorrhage, inability to absorb iron , excessive growth requirements, inadequate diet, feeding infants cow’s milk too early leads to GI bleeding

  39. Iron Deficiency Anemia • Pallor • Irritability • Anorexia • ↓ in activity • Longstanding anemia • Growth retardation & cognitive changes

  40. Treatment & Care • Oral iron supplements • Between meals with OJ (absorption) • If liq. form → use a straw (discoloration) • IM → Z-track method (discoloration)

  41. Sickle Cell Disease • Inherited defect in the formation of hemoglobin termed hemoglobin S • Crescent shape → difficulty passing through capillaries = clumping of cells in small vessels = thrombosis & obstruction = infarcts especially in spleen & joints = PAIN

  42. Sickle Cell Disease • Treatment • Hospitalized when in crisis • Supportive & symptomatic • Bedrest • Analgesics • Blood transfusions

  43. Leukemia • Malignant disease of the blood forming organs of the body • Uncontrolled growth of immature WBC’s (stem cells or blasts) • 50,000 – 100,000

  44. Classifications of Leukemia • Based on which blood cell affected • Acute lymphocytic (ALL); 75% of childhood cases • Acute nonlymphocytic (ANLL); less responsive to therapy • Acute myelocytic (AML); more common in adults

  45. Leukemia Symptoms • Gradual to immediate onset • Low grade temp, pallor, tendency to bruise, leg & joint pain, lymph node enlargement • Progresses to liver & spleen enlargement • Oral mucosa ulcerations • Anemia • Death within 6 months if not tx’d or from a secondary infection

  46. Treatment & Care • Protective isolation • Handle gently & position frequently • Good skin & hair care • Good oral hygiene • Fingernails & toenails short • Maintain hydration • Monitor blood transfusions

  47. Hemophilia • Blood does not clot normally • Primarily affects males but is transmitted by symptom free females who are carriers • 3 types

  48. Hemophilia A • Inherited, sex linked, female (x) chromosome, recessive trait • Coagulation factor VIII deficiency • Goal - ↑ amt of factor to assure clotting • Level determined by Partial Thromboplastin Time (PTT)

  49. Symptoms • Extensive bleeding from slight cut or extensive bruising • Clotting time extend > 1 hr. • Anemia & mod. ↑ in platelets • Signs of shock • Hematuria • Hemarthrosis (classic sign); ankylosis

  50. Nursing Care • Open wounds tx’d with cold & pressure • Nosebleeds – gelfoam packs with topical thrombin & pressure • Ice packs to knees • Bed cradle

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