COMMON HEALTH PROBLEMS DURING INFANCY

FAILURE TO THRIVE
1. A condition in which a child fails to gain weight and is persistently less than 5th percentile on growth charts. 2. When related to non organic cause: disrupted maternal-child relationship. It is maternalimportant to rule out other pathology first ( absorption or hormonal problems) before a disorder can be diagnosed as FTT. 3. Assessment Finding: - sleep disturbances - rumination
2

FAILURE TO THRIVE
- history of parental isolation and social crisis with inadequate support system -PE: delayed growth (decreased vocalization, decreased interest in environment), characteristic postures (floppy or stiff, resist cuddling) -disturbed maternal-infant interaction maternal(feeding techniques, amount of stimulation, ability to respond to infants cues.

4. Nursing Intervention:

FAILURE TO THRIVE

1. Provide consistent care. 2. Teach parents positive feeding techniques: - provide a quiet environment - follow childs rhythm of feeding - maintain face to face posture with child - talk to child encouragingly during feeding 3. Involve parents in care 4. Refer to appropriate community agencies.

CLEFT LIP & PALATE

non-union of nontissue & bone of upper lip & hard / soft palate during embryologic development

CLINICAL FINDINGS
facial deformity visible at birth difficulty sucking / swallowing abdominal distention milk escapes thru nose predisposition to infection infection

MEDICAL MANAGEMENT speech therapist dentist & orthodontist audiologist / otolaryngologist pediatrician surgeon

SURGICAL CORRECTION cheiloplasty palatoplasty

PREPRE-OP NURSING CARE

feed in upright position; burp frequently use large-holed nipples / largerubberrubber-tipped syringes provide SFF, or gavage feeding finish feeding with water

POSTPOST-OP NURSING CARE

maintain patent airway assess color; monitor amount of swallowing provide pain control / relief avoid tension on suture line resume feedings; keep suture line clean

SIDS
Sudden Infant Death Syndrome Known as CRIB death CRIB Causes: Hypoxemia theory and Apnea theory Assessment: Autopsy: mottled complexion and extremely cyanotic lips and fingertips Diagnostic: (autopsy) petechiae over the visceral surfaces of the pleura, edematous pulmonary artery , congested lungs fully expanded , stomach curd inside the stomach

SIDS
Nursing mgt.: provide emotional support Other measures to prevent SIDS :  infant on his back when sleeping  No smoking anywhere near the infant  Remove pillows, stuffed toys in crib  Use a firm mattress with a snug-fitting snugsheet  Make sure the infants head remains uncovered

 A common chromosomal abnormality char. by an extra chromosome 21 (trisomy (trisomy 21) Incidence increases with maternal age Assessment findings: A. Physical characteristics Head: small in size; face has flat profile Eyes: inner epicanthal folds Nose: small and depressed nasal bridge Ears: small and sometimes low-set low-

DOWN SYNDROME

Mouth: Protruding tongue Neck: short and broad Abdomen: protruding Genitalia: small penis; cryptorchidism Hands: short, stubby fingers Muscles: hypotonic B. Mental characteristics Mental retardation Slow development

NURSING INTERVENTION: Promote self-care skills self Encourage parents to enroll child in special day care programs and education. Prevent respiratory infections. Stress importance of changing infants position frequently. Explain to parents about feeding difficulties

 A condition caused by an imbalance in the production and absorption of CSF in the ventricles of the brain. Usually the result of a congenital malformation Classification: Non-communicating circulation of CSF is Nonblocked within the ventricular system of the brain. Communicating CSF flows freely within the ventricular system but is not adequately absorbed.

HYDROCEPHALUS

Clinical findings:
Head enlargement Separation of cranial suture lines Fontanel becomes tense and bulging Frontal enlargement; bulging sunset eyes Dilated scalp veins

Treatment: placing a drainage

tube(shunt) from the ventricles to the abdominal cavity to eliminate the high internal pressure.

HYDROCEPHALUS
Nursing interventions: Daily measurement of the frontalfrontaloccipital of the head in infants Provide small frequent feedings Monitor for signs of infection Encourage parents to ventilate feelings Have parents participate in care of the shunt prior to clients discharge.

 An acute inflammatory condition of the meningeal tissue covering the brain. Inflammatory process results in the development of cerebral edema Infectious process increases permeability of protective membrane , results in a increased protein in the CSF. Etiologic factors pathogenic organism gains entry from an infection elsewhere in the body

MENINGITIS

 Meningococcal meningitis is the only form readily contagious Increased mortality in infants Clinical findings: bulging fontanel Apneic episodes Fever; seizures Opisthotonous positioning Poor sucking Poor muscle tone

Diagnostic procedure: Lumbar puncture Examination of spinal fluid for bacteria Nursing Interventions: Maintain respiratory precautions Begin IV antibiotics Maintain adequate hydration Decrease environment stimuli Avoid movement or positioning that increases discomfort

OTITIS MEDIA
Inflammation of the middle ear characterized by fluid in the middle ear with signs and symptoms of: Ear pain, drainage, decreased hearing, fever, irritability, tinnitus About one third have symptoms lasting 2 weeks or less

EAR DRUM

NORMAL

INFLAMMED

SECRETORY OTITIS MEDIA

more commonly known as glue ear. ear. caused by blockage of the eustachian tube as a result of allergies, swollen adenoids or other infections of the nose & throat, that dampens down the conduction of sound and reduces hearing

ACUTE OTITIS MEDIA

also known as bacterial otitis media acute infection of the middle ear usually started by an infection in the URT is the most frequent diagnosis of children in clinical practice

CHRONIC OTITIS MEDIA

is the result of a prolong middle ear infection with perforation of the eardrum. affects 20-40% 20of all children under the age 6

OTITIS MEDIA
Nursing interventions: Antibiotic administration Relief of pain Facilitate drainage when possible Prevent recurrence and complications Provide anticipatory guidance to parents Provide emotional support to the child and family

FEBRILE SEIZURES
A seizure in assoc. with a febrile illness in the absence of CNS infxn. or acute infxn. electrolyte imbalance. Occurs after 6 mos. and usually before 3 years Most common neurologic condition of childhood Cause is unknown Boys are affected as twice as often as girls

FEBRILE SEIZURES
Clinical findings: Fever >38.8 C Seizure during the temperature rise rather than a prolonged elevation. Nursing interventions: IV or rectal diazepam Acetaminophen administration Provide parental education and emotional support

 Attention deficit hyperactivity disorder A developmental disorder char. by inappropriate inattention and impulsivity Usually appears by age 3 Clinical findings: I. Inattention
Fails to finish things he/she starts Often doesnt seem to listen Easily distracted Has difficulty concentrating

ADHD

ADHD
Has difficulty sticking to play activity

II.Impulsivity
Often acts before thinking Shifts excessively from one activity to another Has difficulty organizing work Needs a lot of supervision Frequently calls out in class Has difficulty awaiting turn in games or group activities

III. Hyperactivity
Runs about or climbs on things excessively Has difficulty sitting still or fidgets excessively Has difficulty staying seated Moves about excessively during sleep Is always on the go Other characteristics:
Negativism Low frustration tolerance Soft neurological signs obstinacy

Nursing interventions: Assist child to recognize when anger occurs and to accept feelings Teach child appropriate expression of angry feelings Redirect violent behavior Make environment safe Provide frequent nutritious snacks Confront child, withdraw attention when interactions are manipulative or exploitative Ritalin administration CNS stimulant

AUTISM
Lack of responsiveness to other people Lack of involvement with others Lack of verbal communication Preoccupation with inanimate objects Ritualistic behavior Onset before 30 mos. of age

Nursing interventions: Encourage a significant 1 to 1 relationship with an adult

 Promote and engage in peer interactions Do not force interactions. Respond to nonverbal cues with verbal interpretation Use en face approach Encourage child to recognize and respond with own physiologic needs and urges. Offer fluids and encourage exercise Offer bathroom at appropriate intervals Prevent child from hurting self

COMMON HEALTH PROBLEMS IN TODDLERS

CEREBRAL PALSY
Damage to the motor centers of the brain; nerve impulses are not correctly sent or received; results in impairment of muscle control Cause is unknown Most have congenital malformation of the brain that existed at birth. Not all of these malformations can be seen by the physician, even with todays sophisticated scans, but when CP is recognized in a newborn, a congenital malformations is suspected.

 Clinical findings: Abnormal posture Increased or decreased resistance to passive movement Delayed achievement of developmental milestones Presence of infantile reflexes Associated disabilities:
Mental retardation Seizures Attention-deficit problems Attention Vision or hearing sensory impairments

CEREBRAL PALSY
Nursing interventions: Maintain and promote mobility with orthopedic devices and PT Maintain adequate nutrition Maintain safety precautions Encourage recreation and educational activities Assist parents to set realistic goals

POISONING
General principles (SIRES) S tabilize the clients condition
1.initiate the ABCs of CPR 2. terminate the exposure of the toxic substance

I - dentify the toxic substance

1. Obtain accurate hx and retrieve any available poison 2. notify local poison control center, emergency facility, or physician of immediate care

 R- everse the substance effect

1. shower or wash-off substance wash 2. antidotes for heroin or drug overdose 3. emesis, lavage, cathartics ingested subs. lavage,

E liminate the substance from the body

1. induce emesis by administering syrup of ipecac or apomorphine Emesis is contraindicated:
In comatose pt., severe shock, convulsing, has lost the gag reflex Has ingested strong corrosive (acid or alkaloid) substances

POISONING
S upport client both physically and psychologically
1. if intentional overdose or suicide attempt, refer for psychiatric evaluation 2. if accidental poisoning with a child, parents often demonstrate guilt, offer positive emotional support

CHILD ABUSE
A. Child neglect failure to provide the basic necessities.
1. failure to thrive 2. infant or child does not appear to be physically cared for. 3. evidence of malnutrition 4. lack of adequate supervision 5. Language development may be delayed 6. Withdrawal; inappropriate fearfulness 7. Parents may be uninterested and unresponsive to the childs needs.

 B. Physical abuse
1. Symptoms
A. bruises and welts from being beaten with a belt, stick, etc. B. Rope burns from being tied up or beaten C. human bite marks D. burns
Buttocks from being immersed in hot water Pattern of burns round, small burns from cigars Burns are frequently in the buttocks, genital area

E. evidence of various fractures in different stages of healing F. internal injuries from being hit repeatedly in the abdomen Head injuries skull, facial fractures

CHILD ABUSE
2. Behavior symptoms
Withdrawal from physical contact with adults Inappropriate response to pain or injury; failure to cry or seek comfort from parents Infant may stiffen when held; child may stiffen when approached by adult or parent Very little eye contact with adults Child may try to protect abusing parent for fear of punishment if abuse is discovered.

CHILD ABUSE
3. parent or caretakers
Conflicting stories regarding accident or injury Explanation of accident is inconsistent with sustained injuries Initial complaint is not associated with childs injury Refusal to allow further tests or additional medical care Lack of nurturing response to injured or ill child; no cuddling, touching, or comforting child in distress Repeated visits to various emergency facilities Do not understand stages of G& D

 Nursing intervention: it is important for the nurse to be knowledgeable of the legal responsibilities in regard to child abuse law Remove child immediately from the abusive environment Educate parents in regard to normal G&D of children, the role of discipline and the necessity for having realistic expectations Become familiar with available community resources such as crisis centers, crisis hotlines, etc.

COMMON HEALTH PROBLEMS IN PRESCHOOLERS

A. Acute Myeloid Leukemia (AML) - Results from defect in the hematopoietic stem cell that differentiates into all myeloid cells. Signs and Symptoms: -fever , weakness , fatigue , bleeding tendencies , presence of bruises Diagnostic: -CBC , bone marrow aspiration Management: -Chemotherapy , Bone marrow transplantation

LEUKEMIAS

 Results from uncontrolled proliferation of immature cells derived from the lymphoid cells Most common in young children , with boys more than girls , peak incidence at 4 years of age Signs and symptoms: - Leukocyte count may either be increased or decreased , but always in high proportion of immature cells - Pain from enlarged liver , spleen , headache Management: - Chemotherapy

B. Acute Lymphocytic Leukemia

C. Chronic Lymphocytic Leukemia

Common malignancy of older adults Derives from a malignant clone of B lymphocytes Signs and Symptoms: - Increased lymphocyte count , enlargement of the lymph nodes , splenomegaly , fever , weight loss , diaphoresis Management: - Chemotherapy

Acute lymphoid leukemia (ALL); bone marrow smear (control); There is a marked proliferation Normal granulocytes and erythroblasts of small lymphoblasts

Acute myeloid leukemia (AML); There is a marked proliferation of large myeloblasts

Chronic myeloid leukemia (CML); There is a marked proliferation of granulocytes at various stages of maturation

ASTHMA
1. Obstructive disease of the lower respiratory tract. 2. Most common chronic respiratory disease in children. 3. Caused by allergic reaction to environment allergen ( seasonal or year round ) 4. Immunologic and allergic reaction results in histamine release which produces 3 main airway responses. a. Edema of Mucous Membranes b. Spasm of Smooth Muscles of Bronchi and Bronchioles c. Auscultation of Tenacious Secretions. 5. Status Asthmaticus : Little response to treatment and symptoms.

Normal Lungs

Asthma

Source: What You and Your Family Can Do About Asthma by the Global Initiative For Asthma Created and funded by NIH/NHLBI

ASSESSMENT FINDINGS
1. Family History of Allergies 2. Client history of eczema 3. Respiratory Distress a. SOB b. Expiratory Wheeze c. Air Trapping ( Barrel Chest ) d. Use of Accessory Muscles e. Irritability f. Diaphoresis g. Change in sensorium in severe attack. h. ABG : Respiratory Acidosis

MEDICAL TREATMENT
6. Medical Treatment a. Drug Therapy 1. Bronchodilators : Relieve Bronchospasms 2. Corticosteroids : Relieve inflammation and edema 3. Antibiotics : Secondary Infections b. Physical Therapy c. Exercise

Medications to Treat Asthma: QuickQuick-Relief

Used in acute asthma episodes Generally they are shortshort-acting beta2-agonists

How to Use a Spray Inhaler

HealthHealth-care provider should evaluate inhaler technique at each visit.

Inhalers and Spacers

Spacers can help patients who have difficulty with technique and can reduce potential side effects.
Spacers

Inhalers

Nebulizers
Uses compressed air machine to deliver medicine as a mist Good for small children or for severe asthma episodes

1.Nursing Diagnosis a. Ineffective Breathing Pattern related to impaired inhalation and anxiety. b. Ineffective airway clearance related to increase production of secretions and bronchospasms. bronchospasms. c. Impaired Gas Exchange related to air trapping. d. Anxiety related to fear of suffocation, bronchospasm, bronchospasm, death. 2. Nursing Interventions a. Place patient in high-fowlers position. highb. Administer oxygen as ordered. c. Monitor ABG and oxygen saturation levels to determine effectively of treatment. d. Administer medications as ordered. e. Provide humidification and hydration to loosen secretions.

NURSING DIAGNOSIS AND INTERVENTIONS

f. Provide chest percussion and postural drainage when bronchodilation improves. g. Monitor respiratory distress. h. Provide patient teaching and discharge planning concerning : 1. Modification of Environment a. Well ventilated b. Damp dusting c. Avoid rugs, draperies or curtains , stuffed animals. d. Avoid natural fibers ( wool feathers ). 2. Importance of Moderate Exercise 3. Purpose of Breathing Exercises

NURSING INTERVENTIONS

COMMON HEALTH PROBLEMS IN SCHOOLSCHOOL-AGED CHILDREN

DIABETES MELLITUS
1.1 Heterogenous group of chronic disorders characterized by hyperglycemia. 1.2 Hyperglycemia is due to total or partial insulin deficiency or insensitivity of the cell to insulin. 1.3 Characterized by disorders in the metabolism of carbohydrate, fat and protein as well as changes in the structure and function of blood vessels. 1.4 Exact etiology unknown. Causative Factors : a. Genetics or Autoimmune Response in Type 1 b. Genetics and Obesity in Type 2

5. Types of Diabetes Mellitus a. Type 1 ( Insulin-Dependent Diabetes Mellitus or InsulinIDDM) 1. Secondary destruction of beta cells in the or Islets of Langerhans in the pancreas resulting in little or no insulin production requires insulin injections. 2. Occurs in children or nonobese adults b. Type 2 ( Non-Insulin Dependent Diabetes Mellitus NonNIDDM ) 1. Results from a partial deficiency of cells to insulin production or insensitivity of cells to insulin. 2. Occurs in obese adults over 40 years old c. Diabetes Mellitus associated with Other Conditions or Syndromes

DIABETES MELLITUS

1.Altered Nutrition : More than body requirements related to intake in excess of activity expenditure. 2. Risk for injury ( Hypoglycemia ) related to effects of insulin or inability to eat. 3. Activity Intolerane related to poor glucose control. 4. Knowledge Deficit related to use of oral hypoglycemic agents. 5. Risk for impaired skin integrity related to decreased sensation and circulation to lower extremities. 6. Ineffective coping related to chronic disease and complex selfself-care regimen.

NURSING DIAGNOSIS

NURSING CARE MANAGEMENT

1.Administer insulin and oral hypoglycemic agents. Monitor side effects during the period of drugs peak action. 1.1 Rapid Acting ( Regular Insulin ) a. Clear, Immediate Onset, Peak : 30-40 mins, Duration : 2-4 hours 30- mins, 21.2 Intermediate Acting ( NPH Insulin ) a. Cloudy, 2-4 hours onset, Peak : 4-10 hours, Duration : 10-16 2410hours 1.3 Long Acting ( Ultralente Insulin ) a. Cloudy, Onset:6-10 hours; Peak : none, Duration : 18-20 hours Onset:6182. Provide special diet as ordered. a. Ensure patient is eating all meals. b. If all food is not ingested, provide appropriate substitute according to the exchange list or give measured amount of orange juice to substitute for left over food. Provide snack later in the day.

9. Observe for chronic complications. complications. 10. Provide Client teaching and discharge planning.

NURSING INTERVENTIONS

10.1 Disease Process 10.2 Diet a. Plan meals in accordance to exchange list. b. Emphasize importance of regularity of meals. Never skip meals. meals. 10.3 Insulin a. How to draw up insulin. b. Injection Techniques 10.4 Oral hypoglycemic Agents a. Stress importance of taking drug regularly. b. Avoid Alcohol intake while on medication.

1O. Provide Client Teaching and Discharge Planning 10.5 Blood Glucose Monitoring a. Use for Type 1 Diabetes Mellitus since it gives exact blood glucose levels and detects hypoglycemia. b. Instruct client in finer-stick technique, use of finermonitor device recording utilization of test results. results. 10.6 General Care a. Perform good oral hygiene and regular dental exams. b. Regular eye exams. c. Care for sick days 1. Do not omit insulin or oral hypoglycemic agents. agents. 2. Notify physician 3. Monitor urine or blood glucose levels and urine ketones frequently. 4. If nausea and vomiting occurs, sips of clear liquids with simple sugars.

NURSING INTERVENTIONS

10. Provide client teaching and discharge planning 10.7 Foot Care a. Wash feet with mild soap and water and pat dry. b. Apply lanolin to feet to prevent drying and cracking. c. Cut toe nails straight across. d. Avoid constricting garments such as garters. e. Wear clean, absorbent socks ( cotton or wool ). f. Purchase properly fitting shoes and break shoes gradually. g. Never go barefoot. Inspect feet and notify physician if with cuts and blisters. blisters. 10.8 Exercise a. Undertake regular exercise. b. Food intake may need to be increased before exercise. c. Exercise is best performed after meals when the blood sugar is rising 10.9 Complications a. Recognize signs and symptoms of hypo/hyperglycemia. b. eat candy or drink juice with sugar added for insulin reaction.

ASSESSMENT FINDINGS AND INTERVENTIONS FOR DIABETIC KETOACIDOSIS

e. Assessment Findings 1. Polydipsia, polyphagia and polyuria ( 3 Ps ) Polydipsia, 2. Nausea, vomiting, abdominal pain 3. Skin warm , dry and flushed 4. Dry mucous membranes and soft eyeballs 5. Kussmaul Respirations or tachypnea, acetone breath tachypnea, 6. Alteration in LOC 7. Hypotension, Tachycardia 8. Diagnostic Tests : Elevated serum glucose and ketones Elevated BUN, creatinine and Hct f. Nursing Interventions 1. Maintain patent airway. 2. Administer IV fluids and electrolytes as ordered. Assess for imbalance. 3. Administer insulin as ordered. 4. Check urine output hourly. 5. Monitor vital signs 6. Provide patient teaching instructions

INSULIN REACTIONS
1.Abnormally low blood sugar below 50mg/dl. 2. Precipitating Factors a. Insulin Overdosage b. Too little food c. Nutritional and Fluid Imbalances d. Excessive Exercise 3. Assessment Findings a. Headache, dizziness, difficulty problem solving, restlessness, hunger, visual disturbances b. Slurred speech, alteration in gait, decreasing LOC, pallor, cold and clammy skin, diaphoresis skin, 4. Nursing Interventions a. Administer oral sugar (candy or orange juice ) with sugar added if patient is alert. alert. b. Explore with patient reasons for hypoglycemia and provide additional diabetic teaching as indicated.

1.Complication of diabetes characterized by hyperglycemia and a hyperosmolar state without ketosis 2. Occurs in NIDDM or Nondiabetic (Elderly ) 3. Precipitating Factors a. Undiagnosed Diabetes b. Infections and Stress c. Medications d. Dialysis e. Major Burns f. Pancreatic Disease 4. Assessment Findings a. Similar to Ketoacidosis but with Kussmual breathing and acetone breath. b. Diagnostic Tests : Extremely elevated blood glucose level Elevated BUN, creatinine and Hct Urine (+) for sugar 5. Nursing Interventions : Similar to Ketoacidosis

HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC COMA

 Insulin Administration What You Need: Need:  MD order  Insulins  Insulin syringe  Alcohol pads  Gloves

Materials for Insulin Injection

Other Ways of Insulin Injection

 Insulin Pen Injectors  The insulin pen looks like an ink pen with a cartridge. On one end cartridge. is a small needle, on the other is a plunger that you press to deliver the insulin under the skin. A dial on the cartridge allows you to skin. select your desired dosage of insulin. Although it can cost more insulin. than a regular needle and syringe, the pen injector is a convenient and accurate device for using insulin. It can be a good choice for insulin. people who do not feel comfortable using a needle and syringe in public or at school or work Insulin Jet Injectors  This device releases a fine spray of insulin at such a fast speed that the insulin passes directly through the skin. Jet injectors are skin. great for people who don't like to use needles, but they can be costly and may cause bruising, especially in thin people. people.

 Insulin Pumps  The insulin pump is a small device about the size of a pager that contains a supply of insulin. A person with diabetes can wear insulin. it in a pocket or on a belt. Thin plastic tubing leads from the belt. device and ends with a needle that inserts just under the skin, usually around the abdomen. The pump delivers a small, steady abdomen. amount of insulin all the time -- this is called the "basal" dose. In dose. addition, you give an extra dose (a "bolus") before meals. A pump meals. has programming and data tracking capabilities. capabilities.

INSULIN PUMP

 How to Administer Insulin

Insulin Preparation  Mixing insulins requires care and skill to avoid inaccurate dosage  Always be sure to have another nurse double check as you mix the insulins  NOTE: NOTE: When mixing insulin, if one is cloudy, the clear insulin is drawn up first, and the cloudy one second. second. Here's How: How: 1. With your double-check nurse present, check the MD order doubleand the medication sheet for previous dose and site 2. Wash your hands and assemble your equipment 3. Double check the order. If giving any cloudy insulin such as order. NPH, roll the vial between your hands to mix. DO NOT SHAKE. mix. SHAKE. This will cause air bubbles which will displace insulin and cause inaccurate dosing. dosing.

4. Wipe the top of each vial with alcohol sponges. sponges. 5. Pull back on the plunger of the insulin syringe to fill with air equal to the combined volume of insulin. insulin. 6. With the bottle still sitting on the counter, insert the needle into the rubber stopper. stopper. If giving NPH, or any other cloudy insulin, this is the first bottle you use. use. Without touching the insulin with the needle, pressurize this bottle by inserting air equal to the volume of insulin in this dose. Remove the needle. dose. needle. 7. Insert the needle into the clear insulin's rubber stopper and invert the bottle. bottle. Pressurize with the remaining air. Then slowly withdraw the required dose of air. this insulin. Remove and expel any air bubbles. Have your second nurse insulin. bubbles. double check this dose. Ask her to TELL you what dose she sees in the dose. syringe. syringe. This should correspond to the dose prescribed. If not, adjust as prescribed. needed 8. Reinsert the needle into the first bottle, invert and withdraw the required dose. dose. (Since it was previously pressurized, there is no need to insert anymore air. air.) Be very careful not to push any of the previous insulin into this bottle. bottle. (If you do, discard this bottle and start over.) Withdraw the needle. Have over. needle. your second nurse again double check the dose. Again, ask her to tell you dose. what dose she sees. If it is not accurate, begin again. sees. again.

 Injection sites  Rotate the injection sites to give the skin time to recover at each spot. spot. Always inject into fatty tissue, never muscle. muscle.  Depending on the type of insulin, injections need to be done 15 to 30 minutes before mealtime as directed by the doctor. doctor. 9. Identify your patient. Don gloves, explain the procedure and administer patient. the dose. Observe reaction to injection. Document dose, site, time, how dose. injection. tolerated, and any additional information required by your institution to indicate the medication was double-checked for accuracy. doubleaccuracy.

 Types of Insulin 1. REGULAR INSULIN Rapid-acting insulin Rapid Fastest insulin of all  Starts to work within 15 minutes  Peaks at about an hour or so after injection  Usually used up in four or five hours  Designed so it can be injected right before meals  Starts to work about the time the patient starts to eat. eat. 2. NPH  Mixed with a substance that makes the body absorb the insulin more slowly  This type of insulin looks cloudy and has to be mixed before injected  Takes longer to start to work, and it stays in the body for a longer time  Usually begins to work about two to four hours after injection  Peaks four to 10 hours after injection, and keeps working for 10 to 16 hours  Lente lasts even longer. It peaks at four to 12 hours after injection and longer. stays in the body from 12 to 18 hours  IntermediateIntermediate-acting insulin works all day if it is taken in the morning  A shot of intermediate-acting insulin in the evening keeps insulin in the intermediatepatients body during the night. night.

INSULIN REACTION a. Abnormally low blood sugar below 50mg/dl. 50mg/dl. b. Precipitating Factors  Insulin Overdosage  Too little food c. Nutritional and fluid imbalances d. Excessive Exercise Assessment Findings a. Headache, dizziness, difficulty with problem solving, restlessness, Headache, hunger, visual disturbances. disturbances. b. Slurred speech, alteration in gait, decreasing LOC, pallor, cold and clammy skin, diaphoresis Nursing Interventions a. Administer oral sugar in the form of candy or orange juice with sugar added if the patient is alert. alert. b. Explore with the patient reasons for hypoglycemia and provide additional diabetic teaching as indicated. indicated. c. Iatrogenic Hypothyroidism 1. Surgical removal of the gland or overtreatment of hyperthyroidism with drugs or radioactive iodine. iodine.
1.

JUVENILE RHEUMATOID ARTHRITIS

Causes are unknown Thought to be associated with an autoimmune problem. Not regarded as hereditary. Most common symptom: persistent joint swelling, pain & stiffness that are typically worse in the morning or after a nap. Difference with the adult RA: children with JRA outgrow the illness while adults have lifelong symptoms.

RHEUMATIC FEVER
1. An inflammatory disorder that may involve the heart, joints, connective tissue and CNS 2. Peaks in school age children linked to environmental factors and family history of disorder. 3. Thought to be an autoimmune disorder ( Infection of Group A beta hemolytic streptococcus) 4. Prognosis depends on the degree of heart damage.

A. Major Symptoms (JonesCriteria) JonesCriteria) 1. Carditis a. 50% of patients b. Aschoff bodies c. Valvular insufficiency of mitral and aortic valves d. Cardiomegaly e. SOB, Hepatomegaly and Edema 2. Polyarthritis ( Painful Migratory Joints) 3. Chorea 4. Subcutaneous Nodules 5. Erythema Marginatum

ASSESSMENT FINDINGS
B. Minor Symptoms 1. Reliable History of Rheumatic Fever 2. Recent History of Streptococcus Infection C. Diagnostic Tests 1. Elevated ESR, ASO titer 2. ECG Changes

 Carditis a. Administer penicillin as ordered. b. Promote bedrest until ESR returns to normal. Arthritis a. Administer aspirin as ordered. b. Change position frequently. Chorea a. Decrease stimulation b. Provide safe environment. No forks with meals , assistance with mobility. c. Provide small frequent meals. Alleviate childs anxiety about the ability of the heart to function. Prevent recurrent infection. Minimize boredom with age-appropriate sedentary play.

NURSING INTERVENTIONS

COMMON HEALTH PROBLEMS IN ADOLESCENT

 Lateral or sideways curve in the spine that is apparent when viewing the spine from behind. Occurs in thoracic or thoraco-lumbar regions. thoraco2 types: * Structural: the mechanics of the curve are such that rotation of the vertebrae occurs in combination with lateral curvature that usually produces a protruberance of one side of the rib cage. *Functional: fixed rotation does not occur & the curvature is usually non-progresive. non-progresive. Unknown or idiopathic.

SCOLIOSIS

Anorexia Nervosa
Main sign: Morbid fear of gaining weight Other signs: Sensitivity to cold temperatures Amenorrhea Deliberate self-starvation with selfweight loss Denial of hunger Obvious thinness but feels fat Lanugo all over the body Loss of scalp hair

Bulimia Nervosa
Extreme measures to lose weight
Uses diet pills, diuretics or laxatives Purges after eating Extreme exercise

Signs of purging
swelling of the cheeks or jaw area cuts and calluses on the back of the hands and knuckles teeth that look clear

Peculiar signs
depression loss of interests in activities

Findings:

Weight loss of 15% or more of original body weight Amenorrhea Social withdrawal and poor family and individual coping History of high activity and achievement in academics, athletics Electrolyte imbalance Depression / distorted body image

Nursing Diagnosis: Body image disturbance/selfdisturbance/selfesteem disturbance Ineffective individual coping

Nursing Interventions: Establish a trusting relationship Monitor vital signs Reinforce: dieticians prescription to accomplish realistic weight gain treatment plan that establishes privileges and restrictions based on compliance Decrease emphasis on foods, eating, weight loss or gain Weigh client daily at the same time Remain with the client after meal and for 1st four hours

Nursing Interventions:
Set limit on time allotted for eating Encourage client to express feelings Promote feeling of control by participation in treatment independent decision making

MENSTRUAL DISORDERS
1. Dysmenorrhea a. Characterized by crampy pain that begins before or shortly after onset of menstrual flow and continues 48-72 hours. 48b. Results from excessive production of prostaglandins which causes painful contraction of the uterus and arteriolar vasospasm. c. Psychological Factors ( anxiety and tension ) contribute to dysmenorrhea. But resolves dysmenorrhea. after childbirth. d. Types of Dysmenorrhea 1. Primary: painful menstruation without identifiable pelvic pathology

Dysmenorrhea
2. Secondary : with pelvic pathology ( pain occurs before menses, with ovulation and at times with sexual intercourse). e. Treatment 1. Application of Heat, Rest, Distraction, Exercise, Analgesia for Primary Dysmenorrhea 2. Secondary : depends on the underlying cause

What are the symptoms of dysmenorrhea ? Aching pain in the abdomen (pain may be severe at times) Feeling of pressure in the abdomen Pain in the hips, lower back, and inner thighs When cramps are severe, symptoms may include: Upset stomach, sometimes with vomiting Loose stool

What causes common menstrual cramps? -Menstrual cramps are caused by contractions in the uterus (which is a muscle). -The uterus, the hollow, pear-shaped pearorgan where a baby grows, contracts throughout a woman's menstrual cycle. -During menstruation, the uterus contracts more strongly. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus. -Pain results when part of the muscle briefly loses its supply of oxygen.

How does secondary dysmenorrhea causes menstrual cramps?

Menstrual pain from secondary dysmenorrhea is caused by a disease in the woman's reproductive organs. Conditions that can cause secondary dysmenorrhea include: Endometriosis - A condition in which the tissue lining the uterus (the endometrium) is endometrium) found outside of the uterus. Pelvic inflammatory disease - An infection caused by bacteria (a type of germ) that starts in the uterus and can spread to other reproductive organs. Cervical stenosis - Narrowing of the opening to the uterus Tumors (also called "fibroids" ) - Growths on the inner wall of the uterus

How can I relieve mild menstrual cramps? Take aspirin or other pain reliever such as acetaminophen or ibuprofen. Place a heating pad or hot water bottle on lower back or abdomen. Rest when needed. Avoid foods that contain caffeine. Avoid smoking and drinking alcohol. Massage lower back and abdomen. Women who exercise regularly often have less menstrual pain. To help prevent cramps, make exercise a part of your weekly routine. If these steps do not relieve pain, your health care provider can order medications including ibuprofen and oral contraceptives (women who take oral contraceptives have less menstrual pain.)

a. Absence of menstrual flow. b. Types of Amenorrhea 1. Primary ( delayed menarche ) : variations in body build, heredity, environmental, physical, mental and emotional development 2. Secondary : absences of menses for 3 cycles or 6 months after a normal menarche caused by pregnancy, tension, emotional upset, stress and nutritional factors c. Management 1. Verbalization of concerns and anxiety about the problem. 2. Complete physical examination, health history and simple laboratory test

Amenorrhea

SEXUALLY TRANSMITTED DISEASES (STDs)

y transmitted by sexual activity; include traditional venereal disease as well as nonspecific urethral and genital infection, enteric infections, and parasitic infection y The only effective way to prevent acquiring STD is to abstain from all forms of sexual contact. y To reduce the risk of STD y Avoid multiple partners, anonymous partners, prostitutes, and other persons with multiple sexual partners. y Avoid sexual contact with persons who have a genital discharge, genital warts, genital herpes lesions or other suspicious genital lesions, or laboratory evidence of infection. y Avoid oral-anal sex to prevent enteric infections. oraly Avoid genital contact with oral cold sores. y Use condoms in combination with spermicides. spermicides. y Have periodic examination for STD if at high risk. y Secure active and passive HepaB virus immunization.

STDs

GONORRHEA
Infection involving the mucosal surface of the genitourinary tract, rectum and pharynx NEISSERIA GONORRHEA Incubation period- 1-14 days period Can be passed from mother to her baby at birth SIGNS AND SYMPTOMS: WOMEN strong smelling vaginal discharge that may be thin and watery or thick and yellow/green; irritation or discharge from the anus; abnormal vaginal bleeding; some low abdominal or pelvic tenderness; pain or burning sensation when passing urine; low abdominal pain sometimes with nausea MEN white, yellow or green thick discharge from the tip of penis; inflammation of the testicles and prostate gland; irritation or discharge from the anus; urethral itch and pain or burning sensation when passing urine

DIAGNOSTIC TESTS y Urinalysis ,SWAB TEST from cervix, urethra, throat or rectum; IE in women TREATMENT: y treat Chlamydia at the same time y CIPRO,LEVAQUIN,TEQUIN CEFTRIAXONE WITH DOXYCYCLINE y to avoid reinfection- Treat reinfectionsexual partner

y CHLAMYDIA TRACHOMATIS y usually infects the genitals of both men and women, as well as the eyes, rectum, and throat y Most common STD bec. >50% who have bec. chlamydia have no symptoms at allallchlamydia infxn usually gets untreated y Incubation period: 7-21 days 7SIGNS AND SYMPTOMS y usually asymptomatic but others may have mild symptoms like y WOMEN:an unusual vaginal discharge; pain or a burning sensation when passing urine, bleeding between periods, pain during sex or bleeding after sex; low abdominal pain, sometimes nausea

CHLAMYDIA

 MEN: WHITE/CLOUDY, WATERY

DISCHARGE from the tip of the penis; pain or burning sensation when passing urine; testicular pain and/ or swelling

DIAGNOSTIC TEST: Urine test and a SWAB TEST TREATMENT: DOXYCYCLINE AND AZITHROMAX (treat gonorrhea at the same time) y Once treated successfully, it will not come back unless a new infxn is picked-up picked-

 herpes simplex type II may also be caused by type I, which is often associated with lesions (cold sores) of the mouth transmitted through sex, or by kissing or touching any affected area. Lesions occur 3 to 7 days after infection and may lasts for weeks When symptoms resolve, virus lies dormant in spinal root ganglia and is capable of repeatedly causing lesions Newborn may be infected during vaginal delivery May cause aseptic meningitis and prostatitis; prostatitis; associated with higher rates of cervical cancer

GENITAL HERPES

GENITAL HERPES
CLINICAL FINDINGS: y 1. Subjective: dysuria; dysuria; fluflu-like symptoms; tingling sensation before vesicles appear; genital itching and pain y 2. Objective: leukorrhea; leukorrhea; vaginal bleeding, vesicles and papules on genitalia; urinary retention, culture reveals herpesvirus type II

NURSING INTERVENTIONS: 1. Provide emotional support to deal with incurable, THERAPEUTIC contagious nature of disease INTERVENTIONS: 2. Help client develop stressstressreducing strategies; stress y No cure; acyclovir precipitates recurrences sodium (ZOVIRAX) 3. Encourage increase oral reduces healing time fluid intake and severity of 4. Relieve local discomfort as symptoms, not as ordered: analgesics, topical anesthetic agents, sitz baths, effective in application of heat or cold subsequent episodes 5. Stress the need to avoid y Sedation for severe sexual contact when lesion pain exist; avoid intercourse y Alcohol may be used during the last 6 weeks of pregnancy to dry lesions 6. Advise client to have annual Papsmear

SYPHILIS
y TREPONEMA PALLIDUM y oral, anal, or vaginal sex, or via intimate touching or kissing. *Mothers can pass it to their babies by touching syphilis sores (chancres) and then touching the baby. y Incubation Period: 1 weekweek- 3 months

1. Primary syphilis a. Chancre on genitalia, mouth, or anus; serous drainage from chancre b. Enlarged lymph nodes c. Positive test for syphilis; 2. Secondary syphilis a. skin rash on palms and soles of feet, alopecia b. erosions of oral mucous membrane c. fever, enlarged lymph nodes 3. Latent syphilis: asymptomatic

CLINICAL FINDINGS

4. Tertiary syphilis a. cardiovascular changes; aortitis, aortitis, aortic aneurysm, stroke b. neurologic changes: personality changes, ataxia, blindness

y Testing: Diagnosis of syphilis is done through a blood test and/or examination of secretions from chancres. y Treatment: Antibiotics -Benzathine penicillin G 2.4 mU intramuscular injection or Doxycycline 100 mg by mouth 2-3 times 2a days for 14 days. y If not treated: can lead to serious damage to the brain and the nervous system; mental deterioration; a loss of balance, vision, and sensation; leg pain; and heart disease. y Chances for stillbirth and serious birth defects, including blindness, are very high.

BACTERIAL VAGINOSIS
y results from overgrowth of one of several organisms that are normally present in the vagina, upsetting the natural balance of vaginal bacteria. y spread during sexual intercourse y Women with new or multiple sex partners, y women who douche y use an intrauterine device (IUD) for birth control y incubation period: Anywhere from 12 hours to five days

BACTERIAL VAGINOSIS

Symptoms y a grayish-white, foul-smelling discharge. grayishfoulThe odor, often described as fish-like, may fishbe more obvious after sexual intercourse. Treatment : Antibiotics - Metronidazole 500mg 2-3 times a day for 7-10 days . 27y If not treated: usually not serious. In some cases, can cause infections in the uterus and fallopian tubes. y It is important to treat bacterial vaginosis, vaginosis, especially before having an IUD inserted, an abortion, or tests done on the uterine lining. y Both trichomoniasis and bacterial vaginosis have been linked to an increased risk of transmission of human immunodeficiency virus (HIV) and other sexually transmitted (HIV) diseases.

 protozoan parasite TRICHOMONAS VAGINALIS Women contract trichomoniasis from infected male or female partners while men usually contract it only from female partners Using condoms and/or dental dams provide some protection. can also survive on infected objects like sheets, towels, and underwear and could be transmitted by sharing them. Incubation Period: If symptoms appear, it usually takes from 3 to 28 days for them to develop.

TRICHOMONIASIS

 Symptoms: Many people are asymptomatic; however, some common trichomoniasis symptoms women may experience include: Genital itching and/or burning, vaginal or vulvar redness, frothy yellowyellow-green vaginal discharge with a strong odor, blood spotting, discomfort during intercourse, abdominal pain symptoms worsen after menstruation and that the symptoms may be confused with an yeast infection.

TRICHOMONIASIS
Men are usually asymptomatic, but if a man has symptoms, they can include: Unusual penile discharge, painful urination, burning sensation after ejaculation, tingling inside the penis Testing: SWAB TEST:swab of fluid from a male's urethra or from a female's vagina Treatment: Antibiotics - Metronidazole It is especially important that both partners are treated at the same time because an infected man, even a man who has never had symptoms or whose symptoms have stopped, can continue to infect a female partner until he has been treated.

CANDIDIASIS
y Candida Albicans y Caused by yeast transmitted from GI tract to vagina y Overgrowth with pregnancy, diabetes and with steroid and antibiotic therapy y Vaginal examination : Thick, white, cheesy patches on vaginal walls y Causes oral thrush in the newborn thru direct contact n the birth canal. y Treatment : topical application of clotrimazole and nystatin

QUESTIONS?