MCN Transes

TABLE OF CONTENTS
1. Acute Otitis Media 4 32. Peptic Ulcer Disease 60

2. Bronchitis 5 33. Appendicitis 62
3. Iron-Deficiency Anemia 6 34. Celiac Disease 64
4. Pharyngitis 8 35. G6PD 66
5. Variola (Smallpox) 10 36. UTI 68
6. Pre-Eclampsia/Eclampsia 11 37. Chronic Renal Failure 70
7. Tonsillitis 12 38. Aspiration 72
8. Hypothyroidism 13 39. Rubella 74
9. Hydrocele 14 40. Congenital Laryngomalacia 76
10. Pneumonia 15 41. Hyperthyroidism (Grave’s 77
11. Cardiomyopathy 18 Disease)
12. Cystic Fibrosis 20 42. Urticaria And Angioedema 79
13. Cushing’s Syndrome 22 43. Kawasaki Disease 81
14. Tuberculosis 25 44. Fibroadenoma 85
15. PPHN 26 45. Myasthenia Gravis 87
16. Abortion 27 46. Hemophilias 88
17. Dermatitis 29 47. Acute Nasopharyngitis 89
18. Placenta Previa 31 48. Cerebral Palsy 91
19. Abruptio Placentae 32 49. Congestive Heart Failure (CHF) 94
20. Epstein Barr Infectious 34 50. Idiopathic Thrombocytopenic 96
Mononucleosis Purpura
21. Glomerulonephritis 36 51. Syndrome of Inappropriate 98
22. Bronchial Obstruction 38 Antidiuretic Hormone (SIADH)
23. Roseola 40 52. Mumps 99
24. Atelectasis 42 53. Acute Renal Failure 101
25. Endometriosis 44 54. Cryptorchidism 102
26. Rheumatic Fever 46 55. Congenital Glaucoma 104
27. Epiglottitis 48 56. Asthma 106
28. PID 50 57. Sickle Cell Anemia 108
29. Hypertension 52 58. Tetralogy of Fallot 110
30. Gastroesophageal Reflux 54 59. CPR 112
31. Pyloric Stenosis 58 60. 113
C
© All Rights Reserved 2021. Central Mindanao University College of Nursing BSN2 - B
ACUTE OTITIS MEDIA THEAPEUTIC MANAGEMENT
Acute otitis media is a bacterial or viral
infection of the middle ear, usually • wash hands and toys frequently to
accompanying an upper respiratory reduce your chances of getting a
infection. It occurs when the area behind the cold or other respiratory infection
eardrum called the middle ear becomes • avoid cigarette smoke
inflamed and infected. • get seasonal flu shots and
RISK FACTORS pneumococcal vaccines
• being between 6 and 36 months old • breastfeed infants instead of
• using a pacifier bottle feeding them if possible
• attending daycare • avoid giving your infant a pacifier
• being bottle fed instead of breastfed (in • Routine childhood vaccination
infants) against pneumococci
• drinking while laying down (in infants) (with pneumococcal conjugate
• being exposed to cigarette smoke vaccine), H. influenzae type B,
• being exposed to high levels of air and influenza decreases the
pollution incidence of acute otitis media
• experiencing changes in altitude NURSING DIAGNOSIS
• experiencing changes in climate Acute Pain r/t Inflammation and increased
• being in a cold climate pressure in the middle ear aeb rate pain on an
• having had a recent cold, flu, sinus, or appropriate pain scale
ear infection NURSING INTERVENTION
ASSESSMENT AND S/S • Positioning. Have the child sit up,

raise head on pillows, or lie on
Children unaffected ear.
Signs and symptoms common in children • Heat application. Apply heating pad
include: or a warm hot water bottle.
• Diet. Encourage breastfeeding of
• Ear pain, especially when lying infants as breastfeeding affords
down natural immunity to infectious agents;
• Tugging or pulling at an ear position bole-fed infants upright when
• Trouble sleeping feeding.
• Crying more than usual • Hygiene. Teach family members to
• Fussiness cover mouths and noses when
• Trouble hearing or responding to sneezing or coughing and to wash
sounds hands frequently.
• Loss of balance • Monitoring hearing loss. Assess
• Fever of 100 F (38 C) or higher hearing ability frequently
• Drainage of fluid from the ear EMENT
• Headache
• Loss of appetite
Adults
Common signs and symptoms in adults include:
• Ear pain
• Drainage of fluid from the ear
• Trouble hearing
3
BRONCHITIS Avoid cigarette smoke. Cigarette
•
Bronchitis is an inflammation of the lining smoke increases your risk of chronic
of your bronchial tubes, which carry air to bronchitis.
and from your lungs. People who have • Get vaccinated. Many cases of
bronchitis often cough up thickened mucus, acute bronchitis result from
which can be discolored. Bronchitis may be influenza, a virus. Getting a yearly
either acute or chronic. Often developing from a flu vaccine can help protect you
cold or other respiratory infection, acute from getting the flu. You may also
bronchitis is very common. Chronic bronchitis, a want to consider vaccination that
more serious condition, is a constant irritation or protects against some types of
inflammation of the lining of the bronchial tubes, pneumonia.
often due to smoking. • Wash your hands. To reduce your
RISK FACTORS risk of catching a viral infection,
wash your hands frequently and get
Cigarette smoke. People who
• in the habit of using alcohol-based
smoke or who live with a smoker are hand sanitizers.
at higher risk of both acute • Wear a surgical mask. If you
bronchitis and chronic bronchitis. have COPD, you might consider
• Low resistance. This may result wearing a face mask at work if
from another acute illness, such as you're exposed to dust or fumes,
a cold, or from a chronic condition and when you're going to be among
that compromises your immune crowds, such as while traveling.
system. Older adults, infants and NURSING DIAGNOSIS
young children have greater
vulnerability to infection. Ineffective airway clearance r/t excessive,
• Exposure to irritants on the thickened mucous secretions.
job. Your risk of developing
bronchitis is greater if you work NURSING INTERVENTION
around certain lung irritants, such ERAPEUTIC MANAGEMENT
as grains or textiles, or are exposed • Encourage mobilization of secretion
to chemical fumes. through ambulation, coughing, and deep
• Gastric reflux. Repeated bouts of breathing.
severe heartburn can irritate your • Ensure adequate fluid intake to liquefy
throat and make you more prone to secretions and prevent dehydration
developing bronchitis. caused by fever and tachypnea.
ASSESSMENT AND S/S • Encourage rest, avoidance
of bronchial irritant, and a good diet to
• Cough facilitate recovery.
• Production of mucus (sputum),
which can be clear, white,
yellowish-gray or green in color —
rarely, it may be streaked with blood
• Fatigue
• Shortness of breath
• Slight fever and chills
• Chest discomfort
THERAPEUTIC MANAGEMENT
4
• Treatment of underlying cause: lack in
IRON-DEFICIENCY ANEMIA iron.
Iron-Deficiency Anemia is common type of • Breastfed and/or iron fortified formula.
anemia, occurring when the intake of • Introduce iron fortified cereal as a first
dietary iron is inadequate. Your body needs food.
iron to make hemoglobin. When there isn’t • Sources of gastrointestinal bleeding must
enough iron in your blood stream, the rest of be ruled out.
your body can’t get the amount of oxygen it • Diet must be changed to one rich in iron
needs. and vitamin C.
RISK FACTORS NURSING DIAGNOSIS
• between ages 9 months and 3 years • Imbalanced nutrition, less than body
• infants and children, especially those requirements, related to in adequate ingestion
born prematurely or growth spurt of iron.
• when iron requirements increase for girls • Fatigue related to decreased hemoglobin and
who are menstruating diminished oxygen-carrying capacity of the
• women of childbearing age blood.
• pregnant women • Deficient knowledge related to the complexity
• people with poor diet of treatment, lack of resources, or unfamiliarity
• people who donate blood frequently with the disease condition.
• vegetarians who don’t replace meat with • Risk for infection
another iron-rich food • Risk for bleeding
ASSESSMENT AND S/S NURSING INTERVENTION
• Pale conjunctiva and skin Administer prescribed medications, as
• Poor Muscle tone and reduced activity ordered:
• Possibility of an enlarged heart and
spleen Administer IM or IV iron when oral
•
• Spoon-shaped fingernails iron is poorly absorbed.
• Decreased hemoglobin and hematocrit • Perform sensitivity testing of IM iron
levels injection to avoid risk of anaphylaxis.
• Advise patient to take iron
• RBCs are possibly poikilocytic
supplements an hour before meals for
• Possible association with pica
maximum absorption; if gastric
• Extreme fatigue
distress occurs, suggest taking the
• Weakness supplement with meals — resume to
• Chest pain, fast heartbeat or shortness of between-meals schedule if symptoms
breath subside.
• Headache, dizziness, or lightheadedness Reduce fatigue
• Cold hands and feet
• Inflammation or soreness of tongue • Assist the client/caregivers in
• Unusual cravings for non-nutritive developing a schedule for daily activity
substances such as ice, dirt or starch and rest.
• Poor appetite, especially in infants and • Stress the importance of frequent rest
periods.
children
• Monitor hemoglobin, hematocrit, RBC
count, and reticulocyte counts.
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Educate the client and caregivers about
iron deficiency anemia:
•Explain the importance of the

diagnostic procedures (such as
complete blood count), bone marrow
aspiration and a possible referral to a
hematologist.
• Explain the importance of iron
replacement/supplementation.
• Educate the client and the family
regarding foods rich in iron (organ and
other meats, leafy green vegetables,
molasses, beans).
Prevent infection
• Assess for local or systemic signs of

infection, such as fever, chills,
swelling, pain, and body malaise.
• Monitor WBC count; anticipate the
need for antibiotic, antiviral, and
antifungal therapy.
• Prevent bleeding
• Monitor platelet count; instruct the

client/caregivers about bleeding
precautions.
• Anticipate the need for a platelet
transfusion once the platelet count
drops to a very low value.
• Assess the skin for bruises and
petechiae.
6
PHARYNGITIS gather, whether in child care centers,
Pharyngitis is inflammation of the classrooms, offices or airplanes.
mucous membranes that line the back of the • Weakened immunity. You're more
throat, or pharynx. This inflammation can cause
susceptible to infections in general if your
discomfort, dryness, and difficulty swallowing.
resistance is low. Common causes of
Pharyngitis is the medical term for a sore lowered immunity include HIV, diabetes,
throat. Causes of pharyngitis include viral treatment with steroids or chemotherapy
infections, such as common colds, and drugs, stress, fatigue, and poor diet.
bacterial infections, such as group
A Streptococcus. ASSESSMENT AND S/S
Pharyngitis is a common condition and The incubation period is typically two to five
days. Symptoms that accompany pharyngitis
rarely a cause for concern. Viral pharyngitis
vary depending on the underlying condition.
often clears up on its own within a week or so.
In addition to a sore, dry, or scratchy throat, a
However, knowing the cause can help people cold or flu may cause:
narrow down their treatment options. • sneezing
RISK FACTORS • runny nose
• headache
Although anyone can get a sore throat, some
• cough
factors make you more susceptible, including: • fatigue
• Age. Children and teens are most likely to • body aches
develop sore throats. Children ages 3 to 15 • chills
are also more likely to have strep throat, • fever (a low-grade fever with a cold and
higher-grade fever with the flu)
the most common bacterial infection
In addition to a sore throat, the symptoms of
associated with a sore throat. mononucleosis include:
• Exposure to tobacco smoke. Smoking • swollen lymph nodes
and secondhand smoke can irritate the • severe fatigue
throat. The use of tobacco products also • fever
increases the risk of cancers of the mouth, • muscle aches
throat and voice box. • general malaise
• loss of appetite
• Allergies. Seasonal allergies or ongoing
• rash
allergic reactions to dust, molds or pet Strep throat, another type of pharyngitis, can
dander make developing a sore throat also cause:
more likely. • difficulty in swallowing
• Exposure to chemical • red throat with white or gray patches
irritants. Particles in the air from burning • swollen lymph nodes
• fever
fossil fuels and common household
• chills
chemicals can cause throat irritation. • loss of appetite
• Chronic or frequent sinus • nausea
infections. Drainage from your nose can • unusual taste in the mouth
irritate your throat or spread infection. • general malaise
• Close quarters. Viral and bacterial THERAPEUTIC MANAGEMENT
infections spread easily anywhere people If a virus is causing your pharyngitis, home
care can help relieve symptoms. Home care
includes:
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• drinking plenty of fluids to • Instruct the client to apply an ice collar to
prevent dehydration severe sore throats.
• eating warm broth • Instruct the client on proper mouth care.
• gargling with warm salt water (1 • Instruct the client to have a liquid or soft
teaspoon of salt per 8 ounces of water) diet.
• using a humidifier • Encourage the client to increase fluid
• resting until you feel better intake to 2,000 ml/per day
For pain and fever relief, consider taking • Discourage the client from eating spicy
over-the-counter medication such as foods and drinking juices that are acidic.
acetaminophen (Tylenol) or ibuprofen • If the client is unable to drink, fluids may
(Advil). Throat lozenges may also be helpful in be administered IV.
soothing a painful, scratchy throat. • Instruct the client to take all antibiotics,
In some cases, medical treatment is even if he is feeling better.
necessary for pharyngitis. This is especially the • Encourage the client to avoid exposure to
case if it’s caused by a bacterial infection. For irritants, smoking, secondhand smoke,
such instances, your doctor will prescribe and exposure to cold and alcohol.
antibiotics. According to the Centers for • Encourage the client to avoid contact
Disease Control and Prevention Trusted with individuals with upper respiratory
Source (CDC), amoxicillin and penicillin are infections.
the most commonly prescribed treatments for • Encourage the client to use a disposable
strep throat. It’s important that you take the mask when exposed to environmental
entire course of antibiotics to prevent the and occupational pollutants.
infection from returning or worsening. An entire
course of these antibiotics usually lasts 7 to 10
days.
NURSING DIAGNOSIS
1. Acute pain related to inflammation of the
throat.
2. Ineffective airway clearance related to thick
secretions characterized by difficulty in
breathing.
3. Imbalance nutrition less than body
requirements related to difficulty swallowing.
4. Knowledge Deficit related to not familiar with
the sources of information.
NURSING INTERVENTION
• Prepare to administer prescribed
antibiotics, analgesics, antitussives and
decongestants.
• Encourage the client to gargle with warm
saline gargles and use throat lozenges.
• Instruct the client that the temperature
of saline should be sufficiently high to be
effective and should be as hot as the
client can tolerate.
8
VARIOLA (Smallpox) • Vaccine: Vaccination after exposure has
Variola - a highly contagious viral disease been found to reduce severity of disease.
characterized by fever and weakness and skin Nutrition
eruption with pustules that form scabs that Foods to eat:
slough off leaving scars. Variola virus (or variola • Liquid foods such as milk, gruel, broth.
major) is the virus that causes smallpox. The • Baked potato
virus is one of the members of the poxvirus • Bread
group (Poxviridae) and it is one of the most Foods to avoid:
complicated animal viruses. The variola virus is • Coarse vegetables
extremely virulent and is among the most • Fried foods
dangerous of all the potential biological NURSING DIAGNOSIS
weapons. Risk for infection related to open wound
RISK FACTORS NURSING INTERVENTION
Prior to Eradication Isolate Infected Patients from General Patient
• Physical contact with someone with Population
smallpox
Transport the patient safely to an airborne
• Direct contact with infected bodily fluids
infection isolation room (AIIR).
• Direct contact with contaminated
surfaces Take precautions to prevent the spread of
• Exposure to aerosolized particles from disease during transport:
someone with smallpox
Patients will need to remain in an AIIR for the
Present
duration of their illness, which may last 3 to 4
• Laboratory work with the virus
weeks.
ASSESSMENT AND S/S
Following the incubation period, initial If the facility does not have an AIIR:
symptoms developed, lasting between 2 and 4
days. These included: Place the patient in an exam room and close the
• A high fever (38.8-40°C or between 101- door.
104°F) Give the patient a surgical mask or appropriately
• Headache (this could be severe) fitted N95 respirator and instruct them on using
• Body aches (including backache / spinal it.
pain)
• Body weakness Transfer the patient to a healthcare facility that
• A sore throat (pharyngitis) has an AIIR. Disinfect the ambulance after
• Mouth ulcers transporting the patient and before transporting
• Nausea anyone who does not have the disease.
• Vomiting (this could be occasional and
did not affect all infected individuals)
Medication
• Antibiotics: To reduce bacterial infection
associated with the virus.
• Analgesics/Antipyretics: For pain and
fever.
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PRE-ECLAMPSIA/ECLAMPSIA • Antihypertensives: To reduce blood
Preeclampsia is a pregnancy complication pressure.
characterized by high blood pressure and signs • Corticosteroids: This improves liver
of damage to another organ system, most often function and platelet count. It also helps
the liver and kidneys. Eclampsia is a severe in maturation of the baby's lungs.
complication of preeclampsia. It’s a rare but • Anticonvulsants: To prevent seizure,
serious condition where high blood pressure magnesium sulfate is commonly
results in seizures during pregnancy. prescribed.
RISK FACTORS
The following are considered risk factors for Nutrition
eclampsia: Eat a healthy and balanced diet
• Nulliparity Include the following foods:
• Family history of preeclampsia, previous • Calcium rich food: cheese, milk, yogurt,
preeclampsia and eclampsia kale, Chinese cabbage, broccoli, fruit
• Poor outcome of previous pregnancy, juice and cereal
including intrauterine growth retardation, • Eat foods high in vitamin C and E:
abruptio placentae, or fetal death cantaloupe, kiwi, whole grains, cabbage,
• Multifetal gestations, hydatid mole, fetal egg yolks, seeds, sardines, tomatoes and
hydrops, primigravida citrus fruits
• Teen pregnancy Foods to avoid:
• Primigravida • Processed food that contain refined
• Patient older than 35 years sugars, caffeine or alcohol
• Lower socioeconomic status NURSING DIAGNOSIS
High risk of seizures in pregnant women related
ASSESSMENT AND S/S
In addition to swelling (also called edema), to decreased organ function (vasospasm and
protein in the urine, and blood pressure over increased blood pressure)
130/80, preeclampsia symptoms include: NURSING INTERVENTION
• Weight gain over 1 or 2 days because of Monitor blood pressure every 4 hours
a large increase in bodily fluid
Record the patient's level of consciousness
• Shoulder pain
• Belly pain, especially in the upper right Assess signs of eclampsia (hyper active, the
side patellar reflexes, decreased pulse and
• Severe headaches respiration, epigastric pain and oliguria)
• Change in reflexes or mental state
Monitor for signs and symptoms of labor or
• Peeing less or not at all
uterine contractions.
• Dizziness
• Trouble breathing Collaboration with the medical team in the
• Severe vomiting and nausea provision of anti-hypertension
• Vision changes like flashing lights,
floaters, or blurry vision
Medication
10
TONSILLITIS antibiotics. Penicillin taken by mouth for 10 days
Tonsillitis is inflammation of the tonsils, two is the most common antibiotic treatment
oval-shaped pads of tissue at the back of the prescribed for tonsillitis caused by group A
throat — one tonsil on each side. Signs and streptococcus. If your child is allergic to
symptoms of tonsillitis include swollen tonsils, penicillin, your doctor will prescribe an
sore throat, difficulty swallowing and tender alternative antibiotic.
lymph nodes on the sides of the neck. Surgery- Tonsillectomy may be used to treat
frequently recurring tonsillitis, chronic tonsillitis
or bacterial tonsillitis that doesn't respond to
antibiotic treatment.
NURSING DIAGNOSIS
Risk for aspiration related to impaired
swallowing and bleeding at the operative site.
• Prevent aspiration- Place the child in a
RISK FACTORS partially prone position with head turned
• Age- Children tend to get tonsillitis more
to one side until the child is completely
than adults.
awake.
• Germ exposure- Children also spend
more time with other kids their age in • Relieve pain- Apply an ice collar
school or camp, so they can easily spread postoperatively; administer pain
infections that lead to tonsillitis. medication as ordered.
• Encourage fluid intake- When the
ASSESSMENT AND S/S child is fully awake from surgery, give
Tonsillitis is most often caused by common
small amounts of clear fluids or ice chips.
viruses, but bacterial infections also can be the
• Provide family teaching- Instruct the
cause.
caregiver to keep the child relatively
Tonsillitis most commonly affects children quiet for a few days after discharge.
between preschool ages and the midteenage
years. Common signs and symptoms of tonsillitis
include:
• Red, swollen tonsils
• White or yellow coating or patches on
the tonsils
• Sore throat
• Difficult or painful swallowing
• Fever
• Enlarged, tender glands in the neck
• A scratchy, muffled or throaty voice
• Bad breath
• Stomachache
• Neck pain or stiff neck
• Headache
Antibiotics- If tonsillitis is caused by a bacterial
infection, your doctor will prescribe a course of
11
HYPOTHYROIDISM • Irregular menstrual periods
Hypothyroidism, also called underactive thyroid • Thinning hair
disease, is a common disorder. With • Slowed heart rate
hypothyroidism, your thyroid gland does not • Depression
make enough thyroid hormone. • Impaired memory
• Enlarged thyroid gland (goiter)
Standard treatment for hypothyroidism involves
daily use of the synthetic thyroid hormone
levothyroxine (Levo-T, Synthroid, others). This
oral medication restores adequate hormone
levels, reversing the signs and symptoms of
RISK FACTORS
hypothyroidism.
Women, particularly older women, are more
likely to develop hypothyroidism than men. You NURSING DIAGNOSIS
are also more likely to develop hypothyroidism Activity intolerance related to fatigue and
if you have a close family member with an depressed cognitive process.
autoimmune disease. Other risk factors include:
• Race (being white or Asian) • Promote rest- Space activities to
• Age (growing older) promote rest and exercise as tolerated.
• Prematurely graying hair • Protect against coldness- Provide
• Autoimmune disorders such as type 1 extra layer of clothing or extra blanket.
diabetes, multiple sclerosis,
• Avoid external heat exposure-
rheumatoid arthritis, celiac disease,
Discourage and avoid the use of external
Addison's disease, pernicious anemia,
or vitiligo heat source.
• Bipolar disorder • Mind the temperature- Monitor
• Down syndrome patient’s body temperature.
• Turner syndrome • Increase fluid intake- Encourage
increased fluid intake within the limits of
ASSESSMENT AND S/S
fluid restriction.
The signs and symptoms of hypothyroidism
• Provide foods high in fiber.
vary, depending on the severity of the hormone
deficiency. Problems tend to develop slowly, • Manage respiratory symptoms-
often over a number of years. Hypothyroidism Monitor respiratory depth, rate, pattern,
signs and symptoms may include: pulse oximetry, and ABG.
• Pulmonary exercises- Encourage deep
• Fatigue
breathing, coughing, and use of incentive
• Increased sensitivity to cold
spirometry.
• Constipation
• Dry skin • Orient to present surroundings-
• Weight gain Orient patient to time, place, date, and
• Puffy face events around him or her.
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level APEUTIC
• Muscle aches
• Pain, stiffness or swelling in your
joints MANAGEMENT
12
HYDROCELE testicle and not involving the spermatic
A hydrocele is a sac filled with fluid that forms cord is characteristic of a hydrocele.
around a testicle. Hydroceles are most common
Symptoms
in babies. Nearly 10 percent of males are born
with a hydrocele. However, they can affect Usually, the only indication of a hydrocele is a
males of any age. Hydroceles generally don’t painless swelling of one or both testicles.
pose any threat to the testicles.
Adult men with a hydrocele might experience
Hydrocele Causes discomfort from the heaviness of a swollen
scrotum. Pain generally increases with the size
A hydrocele can start before your baby is born.
of the inflammation. Sometimes, the swollen
The testicles grow inside their belly and then
area might be smaller in the morning and larger
move down into their scrotum through a short
later in the day.
tunnel. A sac of fluid goes with each testicle.
Usually, the tunnel and the sac seal off before Hydroceles typically manifest as the
birth, and the baby’s body absorbs the fluid following:
inside. When this process doesn’t go as it
• Palpable fullness. Hydroceles typically
should, they can get a hydrocele.
manifest as a soft nontender fullness
There are two types of hydrocele: within the hemiscrotum.
A noncommunicating hydrocele happens when • Transillumination. When the scrotum
the sac closes like normal, but the boy’s body is investigated with a focused beam of
doesn’t absorb the fluid inside it. light, the scrotum transilluminates,
revealing a homogeneous glow without
A communicating hydrocele happens when the
internal shadows.
sac doesn’t seal. With this type, their scrotum
may swell more over time. • Swelling. Hydroceles of the canal of
Nuck in female patients typically present
Babies born prematurely are more likely to have
as soft, nontender inguinal or labial
a hydrocele.
swelling.
RISK FACTORS
Most hydroceles are present at birth. Babies THERAPEUTIC MANAGEMENT
There are no medications available to treat
who are born prematurely have a higher risk of
a hydrocele. A hydrocele usually does not need
having a hydrocele.
to be surgically repaired. A hydrocele typically
Risk factors for developing a hydrocele later in goes away on its own within six to 12 months of
life include: age. If the hydrocele does not resolve on its
own, then it needs to be surgically repaired to
• Injury or inflammation to the scrotum
prevent further complications.
• Infection, including a sexually
transmitted infection (STI) Surgical Management
ASSESSMENT AND S/S • Inguinal. The inguinal approach, with
Assessment of a child with hydrocele includes: ligation of the processus vaginalis high
• Physical examination. The scrotum is within the internal inguinal ring, is the
enlarged on both sides; a smooth, cystic procedure of choice for pediatric
hydroceles.
feeling mass completely surrounding the
• Scrotal. The scrotal approach, with
excision or eversion and suturing of the
13
tunica vaginalis, is recommended for • Acute pain related to the presence of
chronic noncommunicating hydroceles postoperative wound.
• Sclerotherapy. An additional • Risk for infection related to surgical
adjunctive, if not definitive, procedure, is incision.
scrotal aspiration and sclerotherapy of • Impaired urinary elimination related
the hemiscrotum using tetracycline or to postoperative wound.
doxycycline solutions • Fear/Anxiety related to the surgical
procedure.
NURSING DIAGNOSIS
• Excess fluid volume related to the
collection of fluid in the scrotal sac.
• Health education. Provide
• preoperative education, including visit blood pressure, heart rate and rhythm,
with OR personnel before surgery when and respirations; and resume oral intake
possible; discuss anticipated things that gradually as indicated.
may concern patient: masks, lights, IVs,
• Relief from pain. Evaluate pain
BP cuff, electrodes, bovie pad, feel of
regularly (every 2 hrs noting
oxygen cannula or mask on nose or face,
characteristics, location, and intensity
autoclave and suction noises, child
(0–10 scale); note presence of anxiety or
crying.
fear, and relate with nature of and
• Reduce risk for infection. Verify that preparation for procedure; assess causes
preoperative skin, vaginal, and bowel of possible discomfort other than
cleansing procedures have been done as operative procedure; and provide
needed depending on specific surgical additional comfort measures: backrub,
procedure; apply sterile dressing to heat or cold applications.
prevent environmental contamination of
fresh wound; and administer antibiotics
as indicated.
• Monitor fluid volume. Measure and
record I&O (including tubes and drains);
monitor vital signs noting changes in
14
PNEUMONIA • Difficulty coughing: Not being able to cough
Definition: Pneumonia is a lung infection that properly or often enough can lead to
can range from mild to severe. It happens when pneumonia.
an infection causes the air sacs in your lungs
Lifestyle risk factors:
(alveoli) to fill with fluid or pus; this can make it
hard for you to breathe in enough oxygen to • Smoking: If you smoke, your risk of
reach your bloodstream. Anyone can get this contracting pneumonia is higher than that of
lung infection. You can get pneumonia in one or the general population because smoking
both lungs. You can also have it and not know compromises your immune system's ability
it (walking pneumonia). to defend itself from the organisms that
make you sick.
Causes: Bacteria, viruses, or fungi can cause
• Drug or excessive alcohol use: Drinking
pneumonia. Common causes include:
too much alcohol or using drugs may cause
• Flu viruses you to aspirate food, drink, or vomit into
• Cold viruses your lungs while you're under the influence.
• RSV virus (the top cause of pneumonia in • Malnutrition: Being undernourished
babies age 1 or younger) contributes to a higher risk of developing
• Bacteria called Streptococcus pneumoniae pneumonia and of it being more severe,
and Mycoplasma pneumoniae especially in young children and older adults.
• Poor dental health: Poor oral hygiene can
RISK FACTORS
contribute to pneumonia, especially if you
Health risk factors:
have dentures.
• Pneumonia can affect anyone at any age, but • Exposure to animals, chemicals, or
the two age groups at the highest risk are environmental toxins
children under age 2 and adults over age 65.
ASSESSMENT AND S/S
• Being in the hospital: Because your immune
Symptoms: Common pneumonia symptoms
system is already weakened, your risk of
include:
developing pneumonia is higher if you're
hospitalized in the ICU; it’s even higher if • Chest pain when you breathe or cough
you're on a ventilator to help you breathe. • Cough that produces phlegm or mucus
• Having a chronic disease: If you have COPD, • Fatigue and loss of appetite
asthma, heart disease, bronchiectasis, cystic • Fever, sweating, and chills
fibrosis, diabetes, celiac disease, or sickle cell • Nausea, vomiting, and diarrhea
disease. • Shortness of breath
• Suppressed immune system: If you have HIV
Assessment findings include:
or AIDS, have had an organ or bone marrow
transplant, are receiving chemotherapy or Inspection:
long-term steroids, or have an autoimmune • Increased respiratory rate
disorder. • Increased pulse rate
• Difficulty swallowing: (Parkinson's disease, • Guarding and lag on expansion on the
stroke), you're at a higher risk of aspirating affected side
food, drink, saliva, or vomit and, thus, • Children with pneumonia may have nasal
developing aspiration pneumonia. flaring and/or intercostal and sternal
• Reduced consciousness: Whether you're retractions
sedated, prone to generalized seizures, or Palpation:
have had anesthesia, these episodes of • Chest expansion decreased on involved side
reduced consciousness can contribute to • Tactile fremitus is increased
aspiration pneumonia. Percussion:
• Dull over affected area
16
Auscultation: Interventions:
• Breath sounds louder than normal
To improve airway patency:
• Bronchophony, egophony, whispered
pectoriloquy present • Secretions should be removed because
• Crackles, fine to medium retained secretions interfere with gas
THERAPEUTIC MANAGEMENT exchange and may slow recovery.
• Blood culture. Blood culture is performed • Adequate hydration of 2 to 3 liters per day
for identification of the causal pathogen and thins and loosens pulmonary secretions.
prompt administration of antibiotics in • Humidification may loosen secretions and
patients in whom CAP is strongly suspected. improve ventilation.
• Administration of macrolides. • Coughing exercises. An effective, directed
Macrolides are recommended for people cough can also improve airway patency.
with drug-resistant S. pneumoniae. • Chest physiotherapy is important because it
• Hydration is an important part of the loosens and mobilizes secretions.
regimen because fever and tachypnea may
result in insensible fluid losses. To promote rest and conserve energy:
• Administration of antipyretics. • Encourage avoidance of overexertion and
Antipyretics are used to treat fever and possible exacerbation of symptoms.
headache. • Semi-Fowler’s position. The patient should
• Administration of antitussives. assume a comfortable position to promote
Antitussives are used for treatment of the rest and breathing and should change
associated cough. positions frequently to enhance secretion
• Bed rest. Complete rest is prescribed until clearance and pulmonary ventilation and
signs of infection are diminished. perfusion.
• Oxygen administration. Oxygen can be
given if hypoxemia develops. To promote fluid intake:
• Pulse oximetry. Pulse oximetry is used to • Increase in fluid intake to at least 2L per day
determine the need for oxygen and to to replace insensible fluid losses.
evaluate the effectiveness of the therapy.
• Aggressive respiratory measures. Other To maintain nutrition:
measures include administration of high • Fluids with electrolytes. This may help
concentrations of oxygen, endotracheal provide fluid, calories, and electrolytes.
intubation, and mechanical ventilation. • Nutrition-enriched beverages. Nutritionally
NURSING DIAGNOSIS enhanced drinks and shakes can also help
• Ineffective airway clearance related to restore proper nutrition.
copious tracheobronchial secretions. • Instruct patient and family about the cause
• Activity intolerance related to impaired of pneumonia, management of symptoms,
respiratory function. signs, and symptoms, and the need for
• Risk for deficient fluid volume related to follow-up.
fever and a rapid respiratory.
• Instruct patient about the factors that may
NURSING INTERVENTION have contributed to the development of the
Nursing Priorities: disease.
• Maintain/improve respiratory function.
• Prevent complications.
• Support recuperative process.
• Provide information about disease process,
prognosis, and treatment.
17
CARDIOMYOPATHY ASSESSMENT AND S/S
➢ Obtain vital signs every 15 minutes
during acute phase.
➢ Assess the patient for changes in
neurological function hourly and as
clinically indicated.
➢ Observe for signs of decreasing
peripheral tissue perfusion such as low
capillary refill, facial pallor, cyanosis, and
cool, clammy skin.
➢ is a heart muscle disease associated with ➢ Assess for chest discomfort because
cardiac dysfunction that makes it harder myocardial ischemia may result from
for the heart to pump blood to the rest of poor perfusion.
the body. ➢ Assess heart and lung sounds to evaluate
➢ The term “cardiomyopathy” refers to a the degree in heart failure.
structural or functional abnormality of
the ventricular myocardium that occurs ➢ Signs and Symptoms
following an infection such as o Fast or irregular heart rate
adenovirus, cytomegalovirus, or o Fast breathing or trouble breathing
HIV/AIDS infection and results in severe o In infants, difficulty feeding and poor
dilation of the left or both ventricles. weight gain (also known as “failure to
➢ This impairs systolic function and leads to thrive”)
heart failure. o Bloating
➢ Types of cardiomyopathy include: o Swelling from fluid buildup or peripheral
o Idiopathic Dilated cardiomyopathy edema
(IDC) (the most common type in o Heart Murmurs
children): The heart muscle gets thinner THERAPEUTIC MANAGEMENT
and is not as strong as normal. ➢ Therapy is directed at controlling the
o Hypertrophic cardiomyopathy: The heart failure by bedrest, fluid restriction,
heart muscle gets thicker which can and pharmacologic agents to decrease
cause the ventricle to become smaller the cardiac load, improve myocardial
and not eject blood the way it should. contractility, and decrease afterload.
o Restrictive cardiomyopathy (rare in Immune globulin may help reverse the
children): The heart muscle gets stiff. It process. If a child fails to respond to
can't expand and fill with blood between medical therapy, the prognosis is poor
heartbeats. unless the child is eligible for cardiac
RISK FACTORS transplantation.
➢ Family History (IDC) ➢ Pharmacologic agents:
➢ Infections o Diuretics to reduce abnormal fluid
➢ Metabolic disorders retention by promoting the production
➢ Nutritional deficiencies such as thiamine and excretion of urine.
deficiencies o Beta-blockers to reduce the workload of
➢ Coronary artery disease the heart by blocking certain substances
➢ Drug and alcohol abuse from binding to structures within the
➢ Exposure to toxins heart
18
o Digitalis medications such as digoxin,
which increase the efficiency of heart
muscle contractions and produce a more
regular heartbeat.
o Angiotensin-converting enzyme (ACE)
inhibitors are a type of vasodilator which
relax blood vessels, thereby lowering the
blood pressure and minimizing the effort
needed by the heart to pump blood
throughout the body.
➢ Children with a more serious dilated
cardiomyopathy may need surgery to
implant a device that helps maintain
normal heart rhythm through electrical
stimulation (pacemakers or defibrillators.
NURSING DIAGNOSIS
➢ Decreased cardiac output related to
damaged heart muscle as evidenced by
irregular heartbeat, dyspnea upon
exertion, and fatigue.
➢ Activity Intolerance related to decreased
cardiac output or excessive fluid volume
➢ Impaired gas exchange related to
alveolar edema due to increased left
ventricular pressure as evidenced by
shortness of breath.
➢ Excess fluid volume
➢ Elevate the head of the bed. Assist the
patient to assume semi-fowler’s position.
➢ Provide oxygen at 2 to 4 L/min to
maintain or improve oxygenation.
➢ Minimize oxygen demand by maintaining
the patient at bed rest.
➢ Provide liquid diet on acute phase,
➢ Administer diuretic as prescribed to
reduce preload and afterload.
➢ Monitor serum potassium before and
after administration of loop diuretics.
➢ Prophylactic heparin may be ordered to
prevent thromboembolus formation
secondary to venous poisoning.
➢ Institute pressure ulcer prevention
strategies secondary to hypoperfusion or
vasoconstriction agents.
19
CYSTIC FIBROSIS CF’s obstruction of the lungs increases the risk
Cystic fibrosis (CF) is a serious genetic condition of lung infections such
that causes severe damage to the respiratory as bronchitis and pneumonia, as it creates
and digestive systems. This damage often optimal conditions for the growth of pathogens.
results from a buildup of thick, sticky mucus in Obstruction in the pancreas can lead to
the organs. malnutrition and poor growth. It has also been
associated with an increased risk of diabetes
The most commonly affected organs include and osteoporosis.
the:
- Lungs THERAPEUTIC MANAGEMENT
Antibiotics may be prescribed to get rid of a
- Pancreas
lung infection and to prevent another infection
- Liver
from occurring in the future. They’re usually
- intestines given as liquids, tablets, or capsules. In more
Cystic fibrosis affects the cells that produce severe cases, injections or infusions of
sweat, mucus, and digestive enzymes. antibiotics can be given intravenously (through
Normally, these secreted fluids are thin and a vein).
smooth like olive oil. They lubricate various Mucus-thinning medications make the
organs and tissues, preventing them from mucus thinner and less sticky. They also help
getting too dry or infected. you to cough up the mucus so it leaves the
lungs. This significantly improves lung function.
In people with cystic fibrosis, however, a faulty
gene causes the fluids to become thick and Nonsteroidal anti-inflammatory drugs
sticky. Instead of acting as a lubricant, the fluids (NSAIDs), such as ibuprofen (Advil), have a
clog the ducts, tubes, and passageways in the limited role as an agent to reduce airway
inflammation. The Cystic Fibrosis Foundation
body.
suggests the use of high-dose ibuprofen in
RISK FACTORS children 6 through 17 years of ageTrusted
• Because cystic fibrosis is an inherited Source who have good lung function. Ibuprofen
disorder, it runs in families, so family isn’t recommended for patients with more
history is a risk factor. severe lung function abnormalities or those who
Although CF occurs in all races, it's most are older than 18 years of age.
common in white people of Northern
Bronchodilators relax the muscles around the
European ancestry.
tubes that carry air to the lungs, which helps
ASSESSMENT AND S/S increase airflow. You can take this medication
through an inhaler or a nebulizer.
The most common symptoms of CF are: Cystic fibrosis transmembrane
conductance regulator (CFTR) modulators
- salty-tasting skin are a class of drugs that act by improving the
- persistent coughing function of the defective CFTR gene. These
- shortness of breath drugs represent an important advance in
- wheezing management of cystic fibrosis because they
- poor weight gain in spite of excessive target the function of the mutant CFTR gene
appetite rather than its clinical consequences. All patients
with cystic fibrosis should undergo CFTR gene
- greasy, bulky stools
studies to determine if they carry one of the
- nasal polyps, or small, fleshy growths
mutations approved for CFTR modulator drugs.
found in the nose
Most of the available data are in patients who
20
are less than 12 years old and in patients with oximetry; maintain oxygen saturation
mild or moderate CF lung disease. higher than 90%; administer oxygen as
ordered; administer mouth care every 2
Pancreatic enzymes. These agents aid
to 4 hours; perform chest physiotherapy
digestion when the pancreas is malfunctioning;
every 2 to 4 hours as ordered; plan
current pancreatic enzyme preparations are
nursing and therapeutic activities and
derived from porcine extracts and contain
diversional activities; and teach them to
various proportions of lipase, amylase, and
exercise to help loosen the thick mucus.
protease.
- Prevent infection. Good handwashing
Vitamins. Vitamins are organic substances techniques should be practiced by all;
required by the body in small amounts for practice and teach other good hygiene
various metabolic processes; they may be habits; monitor vital signs every 4 hours;
synthesized in small or insufficient amounts in restrict people with an infection from
the body or not synthesized at all, thus requiring contact with the child; and administer
supplementation; vitamins A, D, E, and K are fat antibiotics as prescribed.
soluble while biotin, folic acid, niacin, - Maintain adequate nutrition. Greatly
pantothenic acid, B vitamins (ie, B-1, B-2, B-6, increase the child’s caloric intake; provide
B-12), and vitamin C are generally water the child with high-calorie, high protein
soluble. snacks, such as peanut butter and
cheese; administer pancreatic enzymes
NURSING DIAGNOSIS with all meals and snacks; encourage the
child to eat salty snacks; report any
- Ineffective airway clearance related changes in bowel movements; and weigh
to thick, tenacious mucus production. and measure the child.
- Ineffective breathing pattern related - Reducing the child’s anxiety. Provide
to tracheobronchial obstruction. age-appropriate activities to help
- Risk for infection related to bacterial alleviate anxiety and boredom;
growth medium provided by pulmonary encourage the family caregiver to stay
mucus and impaired body defenses. with the child; allow the child to have
- Imbalanced nutrition:less than familiar toys or mementos from home.
body requirements related to impaired - Provide family support. Give the
absorption of nutrients. family and the child opportunities to
- Anxiety related to hospitalization. voice fears and anxiety; respond with
- Compromised family coping related active listening techniques; and provide
to child’s chronic illness and its demands emotional support throughout the entire
on caregivers. hospital stay.
- Deficient knowledge of the
caregiver related to illness, treatment,
and home care.
- Improve airway clearance. Monitor

the child for signs of respiratory distress;
teach the child to cough effectively;
examine and document the mucus
produced; increase fluid intake; and
encourage the child to drink extra fluids.
- Improve breathing. Maintain the child
in a semi-Fowler’s position; use pulse
21
CUSHING’S SYNDROME shoulders and the upper back (causing
Cushing’s syndrome is a disorder of the a buffalo hump)
endocrine system. - purple stretch marks on the breasts,
arms, abdomen, and thighs
- Cushing’s syndrome (Cushing’s disease,
- thinning skin that bruises easily
Hypercortisolism, Adrenal Hyperfunction)
- skin injuries that are slow to heal
is a cluster of clinical abnormalities
- acne
caused by excessive levels of
- fatigue
adrenocortical hormones (particularly
- muscle weakness
cortisol) or related corticosteroids and, to
a lesser extent, androgens and In addition to the common symptoms above,
aldosterone. there are other symptoms that may
- The prognosis depends on the underlying sometimes be observed in people with
cause; it’s poor in untreated people and Cushing’s syndrome.
in those with untreatable ectopic
corticotropin-producing carcinoma
These can include:
RISK FACTORS
- high blood sugar
The main risk factor for developing Cushing’s - increased thirst
syndrome is taking high-dose corticosteroids - increased urination
over a long period of time. If your healthcare - osteoporosis
provider has prescribed corticosteroids to treat - high blood pressure (hypertension)
a health condition, ask them about the dosage - a headache
and how long you’ll be taking them. - mood swings
- anxiety
Other risk factors can include: - irritability
- depression
- an increased incidence of infections
- type-2 diabetes that isn’t properly
managed
In children
- high blood pressure (hypertension)
- obesity
Children can have Cushing’s syndrome too,
Some cases of Cushing’s syndrome are due to although they develop it less frequently than
tumor formation. Although there can be a adults. According to a 2019 study, about 10
genetic predisposition to develop endocrine percent of new Cushing’s syndrome cases each
tumors (familial Cushing’s syndrome), there’s no year occur in children.
way to prevent tumors from forming.
ASSESSMENT AND S/S In addition to the symptoms above, children
with Cushing’s syndrome may also have:
The most common symptoms of this condition
are: - obesity
- slower rate of growth
- high blood pressure (hypertension)
- weight gain
- fatty deposits, especially in the
midsection, the face (causing a round, In women
moon-shaped face), and between the
22
Cushing’s syndrome is more prevalent in women stress imposed by the removal of the
than in men. According to the National Institutes pituitary or adrenals.
of Health (NIH), three times as many women
develop Cushing’s syndrome compared to men.
NURSING DIAGNOSIS
Women with Cushing’s syndrome may - Risk for injury related to weakness.
develop extra facial and body hair. - Risk for infection related to altered
protein metabolism and inflammatory
This most often occurs on the: response.
- Self-care deficit related to weakness,
- face and neck fatigue, muscle wasting, and altered
- chest sleep patterns.
- abdomen - Impaired skin integrity related to
- thighs edema, impaired healing, and thin and
fragile skin.
- Disturbed body image related to
Additionally, women with Cushing’s syndrome altered physical appearance, impaired
may also experience irregular menstruation. In sexual functioning, and decreased
some cases, menstruation is absent altogether. activity level.
Untreated Cushing’s syndrome in women can - Disturbed thought processes related
lead to difficulties becoming pregnant. to mood swings, irritability, and
depression.
In men
• Decreasing Risk of Injury. Provide
As is the case with women and children, men a protective environment to prevent
with Cushing’s syndrome can also experience falls, fractures, and other injuries to
some additional symptoms. bones and soft tissues.
Men with Cushing’s syndrome may have: • Decreasing Risk of Infection.

Avoid unnecessary exposure to people
with infections.
- erectile dysfunction
- a loss of sexual interest • Preparing Patient for Surgery.
- decreased fertility Monitor blood glucose levels, and
assess stools for blood because
diabetes mellitus and peptic ulcer are
THERAPEUTIC MANAGEMENT common problems
- Adrenal enzyme • Encouraging Rest and Activity.

inhibitors. Metyrapone, aminoglute Encourage moderate activity to
thimide, mitotane, prevent complications of immobility
and ketoconazole may be used to and promote self-esteem.
reduce hyperadrenalism if the syndrome • Promoting Skin Integrity. Use
is caused by ectopic ACTH secretion by a meticulous skin care to avoid
tumor that cannot be eradicated. traumatizing fragile skin.
- Cortisol therapy. Cortisol therapy is
essential during and after surgery, to • Improving Body Image. Discuss
help the patient tolerate the physiologic the impact that changes have had on
patient’s self-concept and
23
relationships with others. Major
physical changes will disappear in
time if the cause of Cushing syndrome
can be treated.
• Improving Thought Processes.
Explain to patient and family the cause
of emotional instability, and help them
cope with mood swings, irritability,
and depression.
• Monitoring and Managing

Complications. Adrenal
hypofunction and addisonian
crisis: Monitor for hypotension; rapid,
weak pulse; rapid respiratory rate;
pallor; and extreme weakness. Note
factors that may have led to crisis (eg,
stress, trauma, surgery).
• Teaching Patients Self-Care.
Present information about Cushing
syndrome verbally and in writing to
patient and family. If indicated, stress
to patient and family that stopping
corticosteroid use abruptly and
without medical supervision can result
in adrenal insufficiency and
reappearance of symptoms.
24
TUBERCULOSIS homes, homeless shelters, overcrowded
Definition : Tuberculosis (TB) is a contagious places), and living with someone infected with
infection that usually attacks the lungs but could TB.
spread to other parts of body like the kidney,
spine and brain. It is caused by a bacteria called ASSESSMENT AND S/S
Mycobacterium tuberculosis and is spread Latent TB cause no symptoms.
through droplets. Signs and Symptoms of Active TB include:
Two forms of TB • Coughing for 3 or more weeks
1. Latent TB: no symptoms and not • Coughing up blood or mucus
contagious. The germs are in the body • Chest pain/ pain with breathing
but the immune system keeps them from • Unintentional weight loss
spreading however, the infection is still • Fatigue
alive and can one day be active. • Fever, night sweats, chills
2. Active TB: The germs multiply and make • Loss of appetite
you sick. You can spread the disease to
others. Ninety percent of active cases in THERAPEUTIC MANAGEMENT
adults come from a latent TB infection. If you have latent TB, your doctor will give you
medication to kill the bacteria so the infection
Classification
doesn’t become active. You might get isoniazid,
Data from the history, physical examination, TB
rifapentine, or rifampin, either alone or
test, chest xray, and microbiologic studies are
combined. You’ll have to take the drugs for up
used to classify TB into one of five classes.
to 9 months.
Class 0. There is no exposure or no infection. A combination of medicines also treats active

Class 1. There is an exposure but no evidence TB. The most common are ethambutol,
of infection. isoniazid, pyrazinamide, and rifampin. You’ll
Class 2. There is latent infection but no disease. take them for 6 to 12 months.
Class 3. There is a disease and is clinically
If you have drug-resistant TB, your doctor might
active.
give you one or more different medicines. You
Class 4. There is a disease but not clinically
may have to take them for much longer, up to
active.
30 months, and they can cause more side
Class 5. There is a suspected disease but the
effects.
diagnosis is pending.
Weakened Immune System: conditions such Risk for Infection
as HIV/AIDS, Diabetes, Severe Kidney Disease, Ineffective Airway Clearance
Cancer, ongoing chemotherapy, taking drugs to Risk for Impaired Gas Exchange
prevent rejection of transplanted organs,
malnutrition/ low body weight, very young or
• Promoting Airway clearance
very advanced age.
• Adherence to treatment regimen
Traveling in certain areas with high TB • Promoting activity and adequate nutrition
rates. (plan a progressive activity schedule)
• Preventing spread of infection (hygienic
Other Factors: Using substances, using
measures)
tobacco, working in health care, living or
• Acid Fast Bacillus Isolation
working in a residential care facility (e.g. nursing
• Monitor Adverse effects
25
PPHN • Respiratory acidosis
Persistent Pulmonary Hypertension of • Loud, single second heart sound (S2) or
the Newborn (PPHN) - is a dangerous a harsh systolic murmur (secondary to
condition that may cause a baby not to get tricuspid regurgitation)
enough oxygen after birth. • Low Apgar scores
• Meconium staining
During pregnancy, a baby gets all of the oxygen
• Cyanosis; poor cardiac function and
he or she needs from the mother through the
perfusion
placenta. The baby’s blood mostly skips over its
• Systemic hypotension
lungs. The blood vessels going to the baby’s
• Symptoms of shock
lungs (pulmonary vessels) are closed.
When the baby is born and takes the first
• supportive therapy such as oxygen,
breath, the pulmonary vessels should open up
ventilation, IV glucose to provide
and start flowing blood through the lungs. This
calories, antibiotics to combat infection,
allows the baby to get oxygen for the brain and
medications to reduce pulmonary
the rest of the body.
resistance, and other drugs, such as low-
With PPHN, the blood vessels to the baby’s dose dopamine, to elevate systemic
lungs do not open up fully. The closed blood blood pressure
vessels cause too much blood to skip the lungs. • surfactant administration
This means that the brain and the body may not • inhaled nitric oxide
get enough oxygen. There is too much pressure • ECMO
in the blood vessels to the lungs (pulmonary
NURSING DIAGNOSIS
hypertension).
• Risk for Decreased Cardiac Output
RISK FACTORS • Ineffective Coping
• Meconium aspiration: This happens • Deficient Knowledge in the disease
when the baby breathes in its own sticky process
poop (meconium).
• Infection.
• Continuous monitoring of oxygenation,
• Respiratory distress syndrome
blood pressure, and perfusion
(RDS): This breathing difficulty happens
• Maintaining a normal body temperature
in infants who do not have fully
• Correction of electrolytes/glucose
developed lungs.
abnormalities and metabolic acidosis
• Lack of oxygen before or during
• Nutritional support
birth.
• Minimal stimulation/handling of the
• Diaphragmatic hernia: This refers to a
newborn
hole in the diaphragm, which is the
• Minimal use of invasive procedures (eg,
muscle that keeps the chest separate
suctioning)
from the abdomen. A hernia is when
organs from one side push through the
hole--in this case, organs from the
abdomen intrude on the chest
ASSESSMENT AND S/S
• Asphyxia
• Tachypnea, respiratory distress
26
ABORTION Undernutrition. Lack of nutrients would cause
Abortion is a disruption of a pregnancy before undernourishment to both the mother and the
the fetus reaches its viable age of more than 20 fetus, leading to abortion.
to 24 weeks of gestation or weighs at least
Drugs. There are drugs which are
500g.
contraindicated for pregnant women. Ingestion
Types of abortion might compromise the fetus and lead to
abortion.
Threatened abortion- PV bleeding <20
weeks of gestation; with/without pain; closed Infection. In infection, the fetus would fail to
cervical os grow and estrogen and progesterone production
would fall. This would lead to endometrial
• no product of conception in the vagina
sloughing, then prostaglandins would be
Inevitable abortion- is an early pregnancy released leading to uterine contractions and
with vaginal bleeding and dilatation of the cervical dilatation along with expulsion of the
cervix. Typically, the vaginal bleeding is worse products of pregnancy.
than with a threatened abortion
ASSESSMENT AND S/S
• PV bleeding; pain; cervix os is open The presenting symptom of an abortion is
always vaginal spotting, and once this is noticed
Incomplete abortion- PV bleeding; pain;
by the pregnant woman, she should
cervix os is open; some of the product of
immediately notify her healthcare provider
conception remain in the uterus but some come
into the vagina As nurses, we are always the first to receive the
initial information so we should be aware of the
Complete abortion- PV bleeding; pain; cervix
guidelines in assessing bleeding during
os is closed; product of conception come out in
pregnancy.
the vagina
Ask of the pregnant woman’s actions before the
Missed abortion- fetus didn't form or has died,
spotting or bleeding occurred and identifies the
but the placenta and embryonic tissues are still
measures she did when she first noticed the
in your uterus
bleeding.
• no pain, no bleeding, no symptoms;
Inquire of the duration and intensity of the
closed cervical os
bleeding or pain felt. Lastly, identify the client’s
RISK FACTORS blood type for cases of Rh incompatibility
Congenital Structural Defect. This structural
Vaginal spotting. Vaginal spotting appears as
defect may be due to chromosomal aberration
small brownish to reddish spots of blood coming
or a serious physical defect.
out of the woman’s vaginal opening. This usually
Low Progesterone. Progesterone maintains occurs when the cervix slightly dilates because
the decidua basalis. If the corpus luteum fails to the woman may have tried to lift heavy objects
produce enough progesterone, it would risk the or mild trauma to the abdomen occurred.
life of the fetus inside the uterus.
Vaginal bleeding. Bleeding is a serious
Rh Incompatibility. The fetus could get occurrence during pregnancy because it might
rejected from a mother’s body if they have an indicate that the cervix has opened and
incompatible Rh. products of conception might be expelled.
27
Cramping/sharp/dull pain in the Measure the maternal blood loss by saving and
symphysis pubis. This could occur on both weighing the used pads.
sides and could be caused by trauma or
Save any tissue found in the pads because this
premature contractions that might cause
might be a part of the products of conception
cervical dilation.
Uterine contractions felt by the mother.
Uterine contractions can be false or true, but
either of the two could be alarming during the
early stages of pregnancy because it could expel
the contents of the uterus thereby leading to
abortion.
• Administration of intravenous
fluids. Such as Lactated Ringer’s, IV
therapy should be anticipated by the
nurse as well as administration of oxygen
regulated at 6-10L/minute by a face
mask to replace intravascular fluid loss
and provide adequate fetal oxygenation.
• Avoid vaginal examinations. The
physician would also avoid further
vaginal examinations to avoid disturbing
the products of conception or triggering
cervical dilatation.
• The physician might also order an
ultrasound examination to glean more
information about the fetal and also
maternal well-being.
NURSING DIAGNOSIS
• Risk for deficient fluid volume related to
bleeding during pregnancy
• Risk For Maternal Injury
• Acute Pain
If bleeding is profuse, place the woman flat in
bed on her side and monitor uterine
contractions and fetal heart rate through an
external monitor.
Also measure intake and output to establish
renal function and assess the woman’s vital
signs to establish maternal response to blood
loss.
28
DERMATITIS inside the elbows, behind the knees and
Atopic dermatitis (eczema)- Atopic in front of the neck. The rash may leak
dermatitis happens when there is damage to the fluid when scratched and crust over.
skin barrier. This causes the skin to become People with atopic dermatitis may
inflamed, red, dry, bumpy and itchy. experience improvement and then
Contact dermatitis- Contact dermatitis is an seasonal flare-ups.
allergic or irritant reaction that causes a painful
• Contact dermatitis. This red, itchy
or itchy skin rash. As the name suggests, you
stinging rash occurs where your skin has
get contact dermatitis from coming into contact
with an allergen. Examples include an allergen come into contact with substances that
like poison ivy and an irritant like a chemical. irritate the skin or cause an allergic
reaction. You may develop blisters.
RISK FACTORS
Atopic dermatitis risk factors include:
• A family history of dermatitis, hay fever THERAPEUTIC MANAGEMENT
or asthma. The most important step in the medical
• Being female. management of dermatitis is to recognize the
• Being African-American. causative factor so that it could be avoided.
Contact dermatitis risk factors include: • Avoiding the irritant. The key is to
• If you work around chemicals such as in identify the substance that causes the
a factory, restaurant or garden. rash so that it could be avoided.
• Water. You may be surprised, but water • Phototherapy. There are patients
can aggravate contact dermatitis, that need light therapy to calm their
through frequent hand washing and immune system, and the method is
prolonged contact with water. called phototherapy.
• Soaps. All kinds of soaps, detergents, • Medicated baths. Medicated baths
shampoos and other cleaning agents are prescribed for larger areas of
have harmful substances that could dermatitis.
possibly irritate the skin.
• Solvents. Solvents such as turpentine,
Pharmacologic Therapy
kerosene, fuel, and thinners are strong
substances that are harmful to the Drug therapy for contact dermatitis usually
sensitive skin. consists of lotion, creams, and oral medications.
• Extremes of temperature. There are
people who are really sensitive even • Hydrocortisone, a corticosteroid,
when exposed to extremes of may be prescribed to combat
temperature and could cause contact inflammation in a localized area.
dermatitis.
• Antihistamines. Prescription
ASSESSMENT AND S/S antihistamines may be given if non-
prescription strength is inadequate.
• Atopic dermatitis (eczema). Usually • Barrier cream. These products can
beginning in infancy, this red, itchy rash provide a protective layer for the skin.
usually occurs where the skin flexes —
29
• Antibiotics. Topical or oral
antibiotics may be used to treat
secondary infection.
NURSING DIAGNOSIS
• Impaired skin integrity related to contact
with irritants or allergens. (Contact
Dermatitis)
• Disturbed body image related to visible
skin lesions.
• Risk for infection related to excoriations
and breaks in the skin.
• Risk for impaired skin integrity related to
frequent scratching and dry skin.H
Nursing interventions appropriate for the patient
include:
• Skin care. Encourage the patient to
bathe in warm water using a mild soap,
then air dry the skin and gently pat to
dry.
• Topical application. Usual application
of topical steroid creams and ointments
is twice a day, spread thinly and
sparingly.
• Phototherapy preparation. Prepare
the patient for phototherapy, because
this method uses ultraviolet A or B light
waves to promote healing of the skin.
• Acknowledge patient’s feelings.
Allow patient to verbalize feelings
regarding their skin condition.
• Proper hygiene. Encourage the patient
to keep the skin clean, dry, and well
lubricated to reduce skin trauma and risk
for infection.
30
PLACENTA PREVIA THERAPEUTIC MANAGEMENT
Placenta Previa is an attachment issue, It is the Medical interventions are necessary to ensure
abnormal attachment of the placenta in the that the safety of both mother and fetus are still
uterus near or over the cervical opening. It intact.
should attach either to the top or side of the ➢ Intravenous therapy. This would be
uterus…. NOT in the lower parts of the uterus, prescribed by the physician to replace the
near or over the cervical opening. blood that was lost during bleeding.
Different types of placenta previa: ➢ Avoid vaginal examinations. This may
• Total previa: placenta completely covers initiate hemorrhage that is fatal for both
the cervical opening the mother and the baby.
• Partial previa: placenta partially covers ➢ Attach external monitoring equipment.
the cervical opening (not fully covered) To monitor the uterine contractions and
• Marginal previa: placenta is near the record fetal heart sounds, an external
edge of the cervical opening equipment is preferred than the internal
monitoring equipment.
RISK FACTORS ➢ Cesarean delivery. Although the best way
• Maternal age >35 years old to deliver a baby is through normal
• Multiples delivery, if the placenta has obstructed
• Already had a baby more than 30% of the cervical os it would
• Drug use: cocaine or smoking be hard for the fetus to get past the
• Scarring in the uterus from surgery: placenta through normal delivery.
fibroid removal, c-section etc. Cesarean birth is then recommended by
ASSESSMENT AND S/S the physician.
➢ Painless vaginal bright RED bleeding NURSING DIAGNOSIS

(mild to profuse) Fear related to outcome of pregnancy due
to bleeding.
➢ Relaxed soft uterus NON-tender NURSING INTERVENTION
ERAPEUTIC MANAGEMENT
➢ Episodes of bleeding (not spotting) most
likely during 3rd trimester…as the body • Assess fetal heart sounds so the mother
prepares for the baby with the cervix would be aware of the health of her baby.
thinning it causes bleeding from where it • Allow the mother to vent out her feelings
is tearing the vessels in the placenta. to lessen her emotional stress.
• Assess any bleeding or spotting that
➢ Visible bleeding (not concealed as in might occur to give adequate measures.
some cases with abruptio placentae) • Answer the mother’s questions honestly
to establish a trusting environment.
➢ Intercourse post bleeding (spontaneous • Include the mother in the planning of the
or during labor) care plan for both the mother and the
baby.
➢ Abnormal fetal position breech (bottom
first) or transverse lie (sideways)…baby’s
head should normally be down but the
placenta is in the way…fetal heart rate
normal
31
ABRUPTIO PLACENTAE ➢ Extended fundal height from
A detachment issue, There is detachment of the concealed bleeding
placenta from the uterine wall BEFORE the birth ➢ Tender uterus
of the baby. ➢ Abdominal pain/contractions
The types of abruption placenta are measured ➢ Concealed bleeding that can stay
according to the degree of placental separation inside the uterus and back flow
that has occurred. into the fallopian tubes. The
patient can enter shock without
• Grade 0. No indication of placental seeing the amount of blood loss.
separation and diagnosis of slight ➢ Hard abdomen
separation is made after birth. ➢ Experiences DIC (disseminated
• Grade 1. There is minimal separation intravascular coagulation): a
which causes vaginal bleeding, but no super event of clotting in the body
changes in fetal vital signs occur. followed by a depletion of clotting
• Grade 2. Moderate separation occurs and factors that leads to uncontrolled
fetal distress is already evident. The bleeding and possibly death.
uterus is also hard and painful upon ➢ Distressed baby (heart rate
palpation. tone abnormalities)
• Grade 3. Extreme separation; maternal THERAPEUTIC MANAGEMENT
shock and fetal death is imminent if no
interventions are done. • Intravenous therapy. Once the
woman starts to bleed, the physician
RISK FACTORS
would order a large gauge catheter to
Risk Factors include:
replace the fluid losses.
• chronic hypertension • Oxygen inhalation. Delivered via
face mask, this would prevent fetal
• development of preeclampsia
anoxia.
• previous placental abruption
• Fibrinogen determination. This
• trauma to abdomen test would be taken several times
before birth to detect DIC.
• cocaine or smoking
• PROM (premature rupture of the
membranes) Once the condition has reached a stage that
mightily endangers the life of both patients,
• multiples
then surgical management is put into action.
• many pregnancies in the past
• Short umbilical cord. A short umbilical • Cesarean delivery. If birth is
cord could cause the separation of the imminent, it is safest to deliver the
baby via caesarean delivery.
placenta especially if trauma occurs.
• Chorioamnionitis. This is an infection of • Hysterectomy. The worst outcome
the fetal membranes and fluid that could would be for the woman to develop
predispose the woman to premature DIC, and to prevent exsanguinations,
placental separation. hysterectomy must be performed.
NURSING DIAGNOSIS
ASSESSMENT AND S/S Deficient fluid volume related to bleeding during
➢ Dark red bleeding premature placental separation.
32
PEUTIC MANAGEMENT
• Place the woman in a lateral, not supine
position to avoid pressure in the vena
cava.
• Monitor fetal heart sounds.
• Monitor maternal vital signs to establish
baseline data.
• Avoid performing any vaginal or
abdominal examinations to prevent
further injury to the placenta.
33
EPSTEIN BARR INFECTIOUS On a blood smear, atypical lymphocytosis
MONONUCLEOSIS is seen with elevation of the lymphocyte counts
Definition: the most infectious disease caused peak between 2 and 3 weeks of illness.
by the Epstein-Barr virus, also known as the
glandular fever or because it was first A positive Monospot test, which can be
discovered as a disease transmitted by kissing, reported in minutes, or
the kissing disease due to the presence of virus Heterophile Antibody Test is positive in
in the saliva. 80% of children older than 4 years of age and
RISK FACTORS are more accurate in older adolescents.
Highest incidence of Epstein Barr Virus is A positive IgM antibody against a viral capsid
between 15 and 24 years old, but 50% of antigen (VCA) is diagnostic of primary infection.
children seroconvert before 5 years of age.
Typically, these viruses spread most commonly Children with infectious mononucleosis should
through bodily fluids, especially saliva. However, be treated for pain and fever with
these viruses can also spread through blood and acetaminophen, or nonsteroidal inflammatory
semen during sexual contact, blood agents in cases of severe inflammation and
transfusions, and organ transplantations. obstruction of airway to prevent the need of
ASSESSMENT AND S/S tracheostomy.
Classic symptoms of Epstein - Barr virus Infectious mononucleosis should not be taken
includes: with penicillin antibiotics like ampicillin or
Several days of prodromal symptoms of amoxicillin.
anorexia, chills and malaise with fever in 90% Symptoms of infectious mononucleosis can be
and enlargement of the cervical nodes and relieved by drinking fluids to stay hydrated and
tonsils. getting plenty of rest.
Pharyngitis with palatal petechial and
About 20% of patients also have a streptococcal
periorbital edema and found with splenomegaly
infection and need antibiotic therapy for at least
is present in 5%.
10 days.
If the mesenteric lymph nodes enlarge,
NURSING DIAGNOSIS
children may experience abdominal pain so Risk for ineffective airway clearance related to
sharp that it simulates appendicitis. oropharyngeal swelling.
Risk for ineffective adolescent eating dynamics
related to oropharyngeal swelling
Spleen may become enlarged as a result of
infectious mononucleosis, encourage patient, to
avoid contact sports until full recovery.
Participating in contact sports can be strenuous
and may cause the spleen to rupture.
Don’t give aspirin to children because of its
association with Reye’s syndrome, a serious
DIAGNOSTIC TEST: illness that can lead to death.
34
Encourage not sharing food or personal care
items
Encourage patient not to kiss.
Encourage the patient to use anesthetic
lozenges or warm saline gargles for pharyngitis.
A soft diet such as milkshakes, sherbets, soups,
and puddings provides additional liquid and
nutritional supplements.
35
GLOMERULONEPHRITIS • Vascular disorders. Vasculitis, or the
disorder of the blood vessels, may also
Glomerulonephritis (GN) is inflammation of the lead to glomerulonephritis.
glomeruli, which are structures in your kidneys • Risk factors. Having hypertension can
that are made up of tiny blood vessels. These damage the ability of the kidneys to filter
knots of vessels help filter your blood and the blood. Poorly controlled diabetes can
remove excess fluids. If your glomeruli are lead to diabetic nephropathy, which is
damaged, your kidneys will stop working the damage of the kidneys due to both
properly, and you can go into kidney failure. high blood pressure levels and high
glucose levels. Glomerulonephritis can
also be inherited – a condition known as
Sometimes called nephritis, GN is a serious Alport syndrome. Having lung cancer,
illness that can be life-threatening and requires
leukemia, or myeloma increases the risk
immediate treatment. GN can be both acute, or for developing glomerulonephritis.
sudden, and chronic, or long-term. This
condition used to be known as Bright’s disease.
ASSESSMENT AND S/S
Signs and Symptoms of • Blood test – to perform kidney function
Glomerulonephritis tests, which include measuring the levels
of blood waste products like blood urea
nitrogen (BUN) and creatinine.
• Hematuria – blood in urine; appears
• Urinalysis – to check for the presence
pink or brown-colored urine indicating
of protein and red blood cells in the urine,
presence of red blood cells.
this may indicate damage of the
• Proteinuria – presence of protein in the
glomeruli.
urine; may appear foamy
• Imaging – kidney X-ray, ultrasound
• Azotemia – increased presence of waste
and/or CT scan, to visualize the kidneys
products such as creatinine and blood
and check for the extent of damage.
urea nitrogen (BUN) in the blood
• Kidney biopsy – to collect samples of
• Hypertension or high blood pressure
kidney tissues in order to identify the
• Swelling or edema – indicates fluid
cause of kidney inflammation.
retention that is usually seen in the face,
hands, feet, and abdomen THERAPEUTIC MANAGEMENT
• Weight gain 1. Blood pressure and fluid volume
control. One of the most common
RISK FACTORS causes of glomerulonephritis is
Causes and Risk Factors of hypertension or high blood pressure;
Glomerulonephritis therefore it needs to be controlled
effectively. The physician may prescribe
• Infections. Glomerulonephritis can
angiotensin-converting enzyme inhibitors
occur after recovering from a strep throat
(ACE) inhibitors, or angiotensin receptor
infection. It can also happen when a
blockers (ARBs). Diuretics may also be
patient has a viral infection such as HIV,
given to reduce plasma volume and treat
or a bacterial infection, such as
edema.
endocarditis.
2. Corticosteroids or Plasmapheresis.
• Immune disorders. Lupus is an
If the glomerulonephritis is caused by an
inflammatory disease that is long-term
immune disorder, then corticosteroids
and can affect different parts of the body,
can help reduce the inflammation.
including the kidneys.
Another option is to remove the
36
antibodies from the patient’s plasma, a • Encourage progressive activity through
procedure known as plasmapheresis. self-care and exercise as tolerated.
3. Dietary changes. The dietitian may Explain the need to reduce sedentary
advise to reduce salt, protein, and activities such as watching television and
potassium in the patient’s diet. using social media in long periods.
4. Dialysis or Kidney Transplant. If Alternate periods of physical activity with
severe or chronic glomerulonephritis rest and sleep.
results to end-stage kidney disease, the
patient may need a kidney transplant or • Teach deep breathing exercises and
a long-term dialysis treatment to filter the relaxation techniques. Provide adequate
blood. ventilation in the room.
• Encourage the next of kin, relative, or
NURSING DIAGNOSIS caregiver of the patient to participate in
Excess Fluid Volume related to decreased his/her care, such as monitoring
renal function secondary to glomerulonephritis, hydration and diet, and activities of daily
as evidenced by facial and leg edema, azotemia, living where the patients require a
proteinuria, weight gain, and blood pressure helping hand.
level of 190/100.
Activity Intolerance related to anemia and
edema secondary to glomerulonephritis as
evidenced by fatigue, HB level of 82,
overwhelming lack of energy, swollen feet,
unsteady gait, and verbalization of tiredness.
• Monitor vital signs every 4 hours,
especially the patient’s blood pressure
level.
• Monitor the urine for presence of protein
and blood in the urine using urine dipstick
and urinalysis, as ordered by the
physician.
• Administer antihypertensive, diuretics,
and/or corticosteroids as prescribed.
• Place the patient in fluid restriction, as
ordered by the physician. Monitor the
input and output (I&O) strictly using daily
chart.
• Assess the patient’s activities of daily

living, as well as actual and perceived
limitations to physical activity. Ask for
any form of exercise that he/she used to
do or wants to try. Ensure that the
exercise is safe to perform during the
patient’s current stage of
glomerulonephritis.
37
BRONCHIAL OBSTRUCTION and mouths or fail to chew food well before
Bronchial obstruction occurs when a foreign swallowing. Other risks factors include:
object blocks the air pathway inside the main • Severe allergies to insect stings such as
bronchus. The right main bronchus is straighter those from bees or to foods such as peanuts
and has a larger lumen than the left bronchus in • Birth defects or inherited diseases that can
children older than 2 years of age, making the cause airway problems
right bronchus an easier site for blockage. • Neuromuscular disorders and other
conditions that cause people to have a
difficult time swallowing food properly
ASSESSMENT AND S/S
After the aspiration of the foreign body:
• Child generally coughs violently
• Becomes dyspneic (not breathing or able to
breathe except with difficulty).
If the foreign body is not expelled:

When the foreign object is not large enough to • Hemoptysis (coughing up of blood, a.k.a
block the trachea, it often lodges itself within the airway bleeding)
right bronchus, resulting in the obstruction of a • Fever
portion or the entire right lung. Obstruction is • Purulent Sputum
often caused by the objects such as buttons, • Leukocytosis ( white cell count is above the
bones, popcorn, nuts, their own tooth, peanuts, normal range)
small toys and etc. ^ These are the general result as an
infection may develop
There are three (3) Phases of Bronchial • Localized wheezing
Foreign Body Obstruction: • Obstruction may lodge into the esophagus
and cause respiratory distress
X-ray results will reveal what is causing the

obstruction, if it is radiopaque.
*Note that articles like plastic, nuts
or popcorn cannot be visualized well
on X-ray film, making X-ray
inconclusive.
• Partial Obstruction: occurs when air is still
able to pass through the blockage, Patients with any airway obstructions require
• Obstructive Emphysema: occurs when the immediate medical attention and typically are
blockage serves as a block/check valve that aphonic and unable to breathe. When a child is
lets air in, but traps the exiting air, and found out to have Bronchial Obstruction:
• Obstructive Atelectasis: occurs when the • A bronchoscopy may be necessary to
blockage does not allow air from exiting and remove the foreign body in the operating
entering around it.
room.
Children have a much higher risk of obstruction • Ineffective airway clearance related to
by foreign objects than adults since they are foreign body in airway
more likely to stick small objects in their noses
38
• Impaired gas exchange related to altered
oxygen supply
• Risk for infection related to foreign object
obstruction
• Ineffective breathing pattern related to
ineffective inspiration and expiration
occurring with chronic airflow constraints
• Activity Intolerance related to imbalance
between oxygen supply/demand
Post operative nursing intervention includes:
• Assess the child closely. Observe for any
signs of bronchial edema and airway
obstruction that occurred from mucus
accumulation because of the bronchus
manipulation.
• Assess the vital signs frequently. Vital
signs like increasing pulse and respiratory
rates suggest increased edema and
obstruction.
• Have the child NPO for at least an hour.
This is to avoid infection and additional
aspiration in the bronchus.
• Offer fluid cautiously. Once a gag reflex
present, be cautious when offering the first
fluid to prevent additional aspiration.
• Offer cool fluids. Cool fluids may feel more
soothing than warm fluids which can also
reduce soreness of the throat.
• Use an Ice Collar. Breathing cool, moist air
or using an ice collar may reduce edema.
39
ROSEOLA ● Older infants are at greatest risk of acquiring
● Roseola Infantum is a common disease of roseola because they haven't had time yet to
childhood caused by a primary infection with develop their own antibodies against many
human herpesvirus 6 (HHV-6) and less viruses. While in the uterus, babies receive
frequently, by human herpesvirus 7 (HHV-7). It antibodies from their mothers that protect them
is a generally mild infection that usually affects as newborns from contracting infections, such
children by age 2. It occasionally affects adults. as roseola. But this immunity decreases with
Roseola is so common that most children have time. The most common age for a child to
been infected with roseola by the time they contract roseola is between 6 and 15
enter kindergarten. months.
● Two common strains of the herpes virus cause ASSESSMENT AND S/S
roseola. The condition typically causes several Symptoms of roseola appear about ten days
days of fever, followed by a rash. after infection. The first sign of illness is a high
fever (often above 103° F or 39.5° C). This
● Roseola typically isn't serious. Rarely, a very
fever can last from three to seven days. Once
high fever can result in complications.
the fever goes away, a rash often appears on
Treatment of roseola includes bed rest, fluids
their stomach that may spread to their back,
and medications to reduce fever.
neck and arms. It is made of pink or red spots
Causative agent: human herpes virus 6 (HHV- and not itchy or painful. The rash can fade after
6) a few hours but may be noticeable for one to
two days.
Incubation period: 9 to 10 days
Children with roseola may also develop cold- or
Period of communicability: during febrile
flu-like symptoms, including:
period
• Runny nose.
Mode of transmission: unknown
• Slight cough.
Immunity: Contracting the disease offers • Sore throat.
lasting natural immunity; no vaccine is available • Swollen lymph nodes.
(American Academy of Pediatrics [AAP], 2015). • Upset stomach or diarrhea.
• Seizure. This is generally a febrile
seizure, or a seizure that is brought on by
a quick rise in body temperature. This
type of seizure is rarely harmful.
However, you should call your doctor or
seek emergency care if you believe that
your child has had a seizure.
Treatment focuses on measures to reduce the
fever with acetaminophen (Tylenol) or
ibuprofen (Motrin) if the child is over 6 months.
There are no long-term effects of roseola. If an
infant should develop this exanthema in the
hospital, follow standard infection precautions.
RISK FACTORS
40
There's no specific treatment for roseola,
although some doctors may prescribe the
antiviral medication ganciclovir (Cytovene) to
treat the infection in people with weakened
immunity. Antibiotics aren't effective in treating
viral illnesses, such as roseola.
NURSING DIAGNOSIS
• Risk for deficient fluid volume related to
dehydration due to fever as evidenced by
increased temperature.
• Hyperthermia related to infection as
evidence by increased temperature
• Risk for Injury related to altered level of
consciousness resulting from febrile seizure
episode
• Assess the child by doing a physical exam in
order to know the symptoms that may
indicate the presence of Roseola
• Explain the disorder and treatment to the
family.
• Monitor vital signs.
• Monitor for febrile seizure
• Provide extra fluids to replace fluid lost
through increased metabolism
• Give medications like acetaminophen and
ibuprofen to reduce fever.
• Provide tepid sponge bath to the patient's
skin surface to promote dispersal of body
heat when the body temperature is 39.5°C
and over.
41
ATELECTASIS ▪ Medications (may cause shallow
Also known as, “imperfect expansion”, and breathing)
is characterized as the incomplete expansion of ▪ Pain or injury that may make it painful to
the lung. This cough or cause shallow breathing, including
can happen to stomach pain or rib fracture
both or one ▪ Smoking
portion only. ASSESSMENT AND S/S
▪ Tachypnea
When present at
– Abnormal rapid breathing as the
birth, it is
patient tries to compensate the difficulty
normally
in breathing.
primary
▪ Tachycardia
atelectasis, and
– Increased heart rate over 100
it is acquired
beats/minute due to rapid bronchial
during neonatal period or later in life, it is
blockage.
acquired or secondary atelectasis.
▪ Dyspnea
ETIOLOGY – Shortness of breath due to low
amount of air in the lungs
▪ Airway obstruction
▪ Cyanosis
▪ Lung compression (occurs in pneumothorax
– Bluish discoloration due to low
or pleural effusion or increased recoil of the
oxygen levels
lung due to loss of pulmonary surfactant)
▪ Diminished chest expansion
▪ Injury
– Due to obstruction or injury that
▪ Tumour
makes it painful to fully expand the chest.
TYPES ▪ Absence of breath sounds
– Also due to obstruction
▪ Compression atelectasis – caused by
▪ Intercostal retractions
external pressure by tumour, fluid, or
– Happens during inspiration
air putting pressure on a part of the lung-
where intercostal spaces are pulled due
causing the alveoli to collapse.
to difficulty in lung expansion.
▪ Absorption atelectasis – caused by air
being removed from obstructed alveoli ASSESSMENT FINDINGS:
or inhalation of anaesthetic agents.
Inspection:
▪ Surfactant atelectasis – caused by
▪ Increased respiratory rate
decreased production of surfactant ▪ Increased pulse rate
which is necessary to preventing the lung ▪ Intercostal and sternal retractions
to collapse during expiration. Palpation:
▪ Decreased chest expansion on affected area
RISK FACTORS
▪ Tactile fremitus decreased or absent
▪ Older age
▪ Deviation of trachea (severe lung collapse)
▪ Difficulty swallowing
Percussion:
▪ Infrequent changes of position
• Dull note
(bedridden)
Auscultation:
▪ Lung disease (Asthma, COPD,
• Diminished breath sounds
Bronchiectasis or Cystic fibrosis)
• Absent adventitious sound (obstructed
▪ Recent abdominal or chest surgery
bronchus)
▪ Recent general anaesthesia
• Occasional fine crackles (patent bronchus)
▪ Weak breathing
42
THERAPEUTIC MANAGEMENT ▪ Humidify inspired air and monitor pulse
▪ Chest Radiograph is used to confirm the oximetry, and ABG values.
diagnosis. Relief:
▪ Computed Tomography scan can be ▪ Monitor vital signs for any indication of
used to show the actual location of the infection.
blockage. ▪ Provide analgesics for management of pain
▪ Utilization of Incentive spirometer ▪ Assist patient in semi-fowler’s position and
should be taught to manage lung expansion. repositioning. Assist ambulation to prevent
▪ Continuous airway pressure is provided injury.
for patients who are not intubated and does Nutrition and Water Intake:
not have excessive secretions. ▪ Provide adequate nutrition that is composed
▪ Administration of Opioid analgesics is of 20 to 30 grams of fibre as well as fruits
usually prescribed by physicians to relieve and vegetables. Protein is also great for
pain. strong respiratory muscle function.
▪ Nebulized dornase alfa and - Avoid too much salt, fried foods, acidic
bronchodilators are used to mitigate beverages and foods that cause bloating.
persistent mucous plugging. ▪ Give adequate fluid intake with the exception
▪ Prevention of consistent position in of antidiuretic medications to avoid fluid
bed to avoid accumulation of fluid and overload.
prevent difficulty in breathing.
NURSING DIAGNOSIS
▪ Ineffective Airway Clearance related to
increased mucus production, tenacious
secretions, and bronchospasm
▪ Acute pain related to thermal injury
treatments and immobility.
▪ Fear related to the nature of the situation
▪ Risk for Ineffective Respiratory Function
related to immobility secondary to post-
anaesthesia state and pain.
▪ Risk for Infection related to disruption of skin
layer secondary to tracheostomy
Nursing Priorities:
▪ Educate patient on disease process,
treatment, and complications.
▪ Improve respiratory function.
▪ Avoid aggravation of disease.
▪ Provide health teaching for continuative
care.
INTERVENTIONS:
Airway clearance:
▪ Encourage coughing and breathing exercises
every 1 to 2 hours.
▪ Utilize incentive spirometer for deep
breathing.
43
ENDOMETRIOSIS ▪ Fixed and tender retroverted uterus (bi-
Endometriosis is an often-painful disorder in manual examination
which tissue similar to the tissue that normally THERAPEUTIC MANAGEMENT
lines the inside of your uterus — the ▪ Laparoscopy is the least invasive surgery
endometrium — grows outside your uterus. for detection of endometrial lesions in the
pelvic area.
▪ Imaging techniques. This is used to
determine deep endometriosis.
▪ Hormonal treatment used to mimic
pregnancy
▪ Administration of analgesics. NSAIDs
are used in patients with endometriosis for
the management of pain.
▪ Endometrial suppression treatment.
The use of oral contraceptives, Danazol
(androgenic agents), progesterone therapy,
and GnRH that can suppress ovulation,
limiting the possible accumulation of tissue.
▪ Possible surgery. Hysterectomy and
ETIOLOGY bilateral salpingo-oophorectomy or removal
of the uterus, ovaries, and fallopian tubes,
▪ Retrograde menstruation
are introduced when the symptoms are
▪ Immunologic disorders unbearable.
▪ Endometrial cell transport ▪ Monitor lab values. Sodium, potassium,
▪ Transformation of peritoneal cells into and magnesium are important electrolytes
endometrial cells. because these lab values can indicate muscle
weakness.
RISK FACTORS
▪ Monitor vital signs to check any signs of
▪ Age
alteration in body function. This may also
▪ Early Menarche
indication infection.
▪ Heavy Bleeding during menstruation
▪ Ambulation should be encouraged to have
▪ Stimulation of hormones during
proper urinary elimination and promote the
menstruation
slow return of bowel.
ASSESSMENT AND S/S
NURSING DIAGNOSIS
▪ Dysmenorrhea – Pain in the lower abdomen
▪ Acute/ Chronic pain related to shedding of
during menstruation
endometrial tissue outside the cervical cavity
▪ Dyschezia – Pain during defecation
▪ Acute pain related to post-operative incision
▪ Dyspareunia – Pain during intercourse
as evidenced by pain, grimacing, guarding
▪ Dysurea – Pain during urinating
movements.
ASSESSMENT FINDINGS: ▪ Activity intolerance related to pain as
evidenced by post-operative incision.
Inspection:
▪ Risk for surgical infection as evidenced by
▪ Pallor
▪ Increased presence of drainage in left lower quadrant
▪ Increased pulse rate NURSING INTERVENTION
▪ Intercostal and sternal retractions Nursing Priorities:
Palpation:
▪ Lower abdominal tenderness ▪ Educate patient on disease process,
44
▪ Improve urination and reduce verbalized
pain.
▪ Avoid aggravation of disease.
▪ Provide health teaching for continuative
care.
INTERVENTIONS:
Health education and Monitoring:
▪ Educate patient on the disease process and
what to expect on possible treatment.
▪ Educate patient about pain felt and the need
for verbalizing its severity.
▪ Educate and instruct strict wound care
techniques to avoid sepsis.
▪ Assess for any allergy to any medication,
especially ones used for pain relief.
▪ Assess for signs of infection and urine
profile.
Relief:
▪ Monitor vital signs for any indication of
infection.
▪ Provide pain relief drugs and teach patient
about ways to manage pain such as music
therapy and cold compress.
▪ Assist patient in semi-fowler’s position and
monitor as ambulation can be impaired due
to severe pain.
Nutrition and Water Intake:
▪ Provide adequate nutrition that is composed
of fibrous foods such as fruits, vegetables,
legumes; and iron-rich foods and essential
fatty acids such as salmon, sardines, and flax
seeds.
▪ At least 8 to 10 glasses of water. Administer
necessary fluids if instructed.
45
RHEUMATIC FEVER ▪ Increased respiratory rate
A febrile disease that is characterized by ▪ Increased temperature
inflammation of the joints, skin, nervous system, ▪ Inspect for any presence of edema and
and heart. It can also develop into a delayed swelling of peripheral extremities
immune response to a group A β-hemolytic ▪ Inspect for hyperextended joints and
streptococcus in genetically predisposed extremities.
individuals. This will eventually lead to scarring Palpation:
▪ Erythema nodosum
of the cardiac structures and its deformity.
Percussion:
• Increased cardiac dullness
Auscultation:
• New or changing murmurs in the apical or
mid-left sternal border
• Muffled heart sound
• Pericardial friction rub
▪ Specific, prescribed medications to either
reduce the manifestations of the disease or
eliminate remaining strep bacteria.
Salicylates and steroids (for inflammation);
Corticosteroids (for severe carditis); Valporic
ETIOLOGY
acid or Carbamazepine (for severe
▪ Untreated infection involuntary movements); Penicillin (for
▪ Molecular Mimicry is produced through an eliminating remaining bacteria.
autoimmune response where the M protein ▪ Surgical care. To decrease valve
of certain strains of streptococci cross-react insufficiency when heart failure persists after
antigens in the heart, joints, and other medical therapy.
tissues.
RISK FACTORS ▪ Bed rest
▪ Age and sex ▪ Diet. Patients with CHF should follow fluid-
▪ Family history of the disease restricted and sodium-restricted diet;
▪ Type of Strep Bacteria
patients taking corticosteroid or diuretics
▪ Environmental factors (housing and
should follow Potassium supplementation.
socioeconomic status)
ASSESSMENT AND S/S ▪ Activity. Gradual increase in activity level
▪ Fever (>38.5 C) until patient returns to normal functioning.
▪ Red, swollen, tender, and extremely painful
joints (knees, ankles, elbows, wrists) NURSING DIAGNOSIS
▪ Nodules (lumps) ▪ Acute Pain related to joint pain when
▪ Red, raised, lattice-like rash (rash, back, and extremities are touched or moved
abdomen) ▪ Deficient diversional activity related to
▪ Shortness of breath prescribed bed rest
▪ Uncontrolled movement of arms, legs, and ▪ Activity intolerance related to carditis or
facial muscles arthralgia
▪ Weakness ▪ Risk for injury related to chorea
▪ Risk for noncompliance with prophylactic
ASSESSMENT FINDINGS: drug therapy related to financial or
Inspection: emotional burden of lifelong therapy.
46
Nursing Priorities:
▪ Educate patient on disease process,
▪ Symptomatic relief of the disease indications
▪ Eradicate infection
▪ Avoid prophylaxis
INTERVENTIONS:
Health education and Monitoring:

▪ Educate patient on the disease process and
what to expect on possible treatment.
▪ Educate patient about pain felt and the need
for verbalizing its severity.
▪ Educate and instruct strict wound care
techniques and prevent
▪ Assess for any allergy to any medication,
especially ones used for pain relief.
▪ Assess for signs of infection and blood
profile.
Relief:
▪ Assist patient in bed rest. Provide clean and
non-irritating beddings/linens to prevent a
trigger for rashes
▪ Administer inflammatory drugs such as
Salicylates, and Aspirin that is commonly
used for fever and inflammation
▪ Prednisone for conventional therapy of heart
failure.
Nutrition and Water Intake:
▪ Provide adequate nutrition that is composed
of fruits and vegetables, and a handful of
protein. Add legumes and grains as well.
▪ Emphasize on antioxidant foods that can
fight free radicals. Vit K-rich foods are also
acceptable as it can increase blood clot.
▪ At least 8 to 10 glasses of water. Administer
necessary fluids if instructed.
▪ Limit sodium up to less than 1 teaspoon/day
as it can cause fluid retention.
47
EPIGLOTTITIS been weakened by illness or
Epiglottitis is inflammation and swelling of the medication, you're more susceptible
epiglottis, the thin cartilage structure at the root to the bacterial infections that may
of the tongue that closes off the windpipe
cause epiglottitis.
(trachea) when foods or liquids are being
swallowed. Epiglottitis is a medical emergency. If • Lacking adequate
not treated quickly, it can be fatal. vaccination. Delayed or skipped
immunizations can leave a child
vulnerable to Hib and increases the
risk of epiglottitis.
ASSESSMENT AND S/S
• Always remember – ADD Air Nurse
Abnormal position to breathe….tripod
position
Dysphagia (difficulty swallowing)….lead
to drooling
Difficultly talking…voice soft or
muffled….sore throat
Epiglottitis usually begins as an inflammation and
swelling between the base of the tongue and the
epiglottis. With continued inflammation and
swelling of the epiglottis, complete blockage of
Apprehension
the airway may occur, leading to suffocation and Increased Temperature (HIGH fever)
death. Even a little narrowing of the windpipe can RAPID onset
dramatically increase the resistance of an airway,
making breathing much more difficult.
Nasal flaring
The pediatric population (ages 2-5 years) tend Uses accessory muscles to
to struggle with epiglottitis more than adults breathe…airway restriction
(but adults can get this condition). Retractions of chest
Stridor (inspiratory)
Epiglottitis is spread via droplets, which harbors Epiglottis enlarged or swollen on x-ray of
an infectious agent like bacteria. the neck
The most common cause of epiglottitis is caused THERAPEUTIC MANAGEMENT

by a bacteria that attacks the epiglottis • There are a variety of adjuvant therapies
called: Haemophilus influenza type B available that can be utilized on a case-
by-case basis. Administration of
RISK FACTORS supplemental humidified oxygen along
Certain factors increase the risk of developing with IV hydration can help to limit the risk
epiglottitis, including: of sudden airway obstruction.
• Patients should be monitored in the ICU
• Being male. Epiglottitis affects more regardless of the placement of an airway,
males than females. such as their natural airway, intubation,
or tracheostomy, so they can be
• Having a weakened immune monitored more closely for airway
system. If your immune system has deterioration.
48
• Ideally, daily examination of the • assess respiratory effort and rate: >60
supraglottic structures should be breaths per minute abnormal for all age
performed with fiberoptic groups
nasolaryngoscopy to assess the patient's • Keep emergency equipment at bedside
response to therapy and evaluate for any and have trained staff readily available
complications such as epiglottic for possible intubation.
abscesses. • Monitor temperature not orally, but other
• For patients in whom the airway has routes like rectal, tympanic, temporal or
been secured, care must be taken to axillary
avoid dislodgement of the endotracheal • Keep child calm. When a child cries
tube or tracheostomy, as reintubation or becomes very anxious this
may not be feasible leading to significant increases the chances of an airway
morbidity or mortality depending upon obstruction.
the severity of the clinical situation. • Allow the child to be in a comfortable
position that allows them to breathe (NO
SUPINE because it impedes respiratory
NURSING DIAGNOSIS
effort)
•Ineffective Airway Clearance related
to Obstruction associated with edema
and excessive mucus production in
the upper airways as evidenced by
sudden high fever and drooling
• Hyperthermia related to inflammation
of epiglottis
• Anxiety related to change in the
environment as evidenced by
verbalization and extreme expression
of fear by crying
• Risk for suffocation related to disease
process as evidenced by extreme
anxiety leading to struggle to breathe
• As the nurse, do NOT insert
ANYTHING in the patient’s mouth to
assess it
• Don’t use a tongue blade, oral
thermometer, obtain a throat culture as
this may cause spasm
• NEVER leave the patient alone since the
patient is at risk for a SUDDEN airway
obstruction
• maintain airway (most patients with
severe cases of epiglottitis will need to be
intubated)
49
PID ASSESSMENT AND S/S
PID
Signs and symptoms of PID vary depending
upon the severity of the infection and the
infectious organism. Chlamydia is often
responsible for mild symptoms, even though the
infection can cause severe damage to
reproductive structures. Often, infections aren't
recognized because chlamydial infections may
be asymptomatic.
Pelvic inflammatory disease is an infection of a When symptoms occur, they're most often in
woman’s reproductive organs. It is a the form of lower abdominal and/or pelvic pain.
complication often caused by some STDs, like Other signs and symptoms include:
chlamydia and gonorrhea. Untreated PID can
• change in vaginal discharge including
cause scar tissue and pockets of infected fluid
color, amount, and odor
(abscesses) to develop in the reproductive tract,
• dysuria
which can cause permanent damage. • pain with intercourse
RISK FACTORS • irregular menses.
A number of factors might increase your risk of
Depending on the severity of the infection, fever
pelvic inflammatory disease, including:
and chills, nausea and vomiting, painful
defecation, and dehydration may also occur.
• Being a sexually active woman younger
than 25 years old Complications of PID can include infertility from
blocked fallopian tubes, ectopic pregnancy,
• Having multiple sexual partners tuboovarian abscess, chronic pelvic pain, and
infection, including sepsis, of a vaginally
• Being in a sexual relationship with a person
delivered newborn.
who has more than one sex partner
• Having sex without a condom
Several types of antibiotics can cure PID.
• Douching regularly, which upsets the Antibiotic treatment does not, however, reverse
balance of good versus harmful bacteria in any scarring caused by the infection. For this
the vagina and might mask symptoms reason, it is critical that a woman receive care
immediately if she has pelvic pain or other
• Having a history of pelvic inflammatory symptoms of PID. Prompt antibiotic treatment
disease or a sexually transmitted infection can prevent severe damage to the reproductive
organs.
There is a small increased risk of PID after the
insertion of an intrauterine device (IUD). This The longer a woman delays treatment for PID,
risk is generally confined to the first three weeks the more likely she is to become infertile or to
after insertion. have a future ectopic pregnancy because of
damage to the fallopian tubes.
Additionally, a woman’s sex partner(s) should
be treated to decrease the risk of re-infection,
even if the partner(s) has no symptoms.
50
Although sex partners may have no symptoms,
they may still be infected with the organisms
that can cause PID.
In certain cases, clinicians may recommend
hospitalization to treat PID. This decision should
be based on the judgment of the health care
provider and the use of suggested criteria found
in the 2015 STD Treatment Guidelines. If a
woman’s symptoms continue, or if an abscess
does not resolve, surgery may be needed.
(Additional)
Mild infections can be managed on an outpatient
basis. If symptoms don't improve or if the
patient's clinical status is worsening,
hospitalization and I.V. therapy as well as
further diagnostic studies such as ultrasound
and laparoscopy may be indicated. Reinfection
rates are high; all women diagnosed with
chlamydia or gonorrhea should have repeat
testing done in 3 to 6 months.3
NURSING DIAGNOSIS
Alteration of comfort, related to inflammation,
edema, secondary to pelvic inflammatory
disease.
- Determine / document presence of possible
pathophysiological causesof pain.
- Encourage adequate rest periods to prevent
fatigue.
- Discuss impact of pain on lifestyle
/independence and ways to maximize level of
functioning.
- Identify specific signs /symptoms and changes
in pain characteristics requiring medical follow
up.
51
HYPERTENSION 3. Lifestyle choices can increase your risk
for high blood pressure.
4. Unhealthy Diet- A diet that is too high in

sodium and too low in potassium puts
you at risk for high blood pressure.
5. Physical Inactivity- Getting regular

physical activity helps your heart and
blood vessels stay strong and healthy,
which may help lower your blood
pressure.
High blood pressure, also called hypertension, is
blood pressure that is higher than normal. Your 6. Obesity- Having obesity or overweight
blood pressure changes throughout the day also means your heart must work harder
to pump blood and oxygen around your
based on your activities. Having blood pressure
body.
measures consistently above normal may result
in a diagnosis of high blood pressure (or
7. Too Much Alcohol- Drinking too much
hypertension)
alcohol can raise your blood pressure.
• Normal. The normal range for blood
pressure is between, less than 120 8. Tobacco Use- Nicotine raises blood
mmHg and less than 80 mmHg. pressure, and breathing in carbon
• Elevated. Elevated stage starts from monoxide—which is produced from
smoking tobacco—reduces the amount of
120 mmHg to 129 mmHg for systolic
oxygen that your blood can carry.
blood pressure and less than 80 mmHg
for diastolic pressure.
9. Genetics and Family History- People with
• Stage 1 Hypertension. Stage 1 starts a family history of high blood pressure
when the patient has a systolic pressure share common environments and other
of 130 to 139 mmHg and a diastolic potential factors that increase their risk.
pressure of 80 to 89 mmHg.
• Stage 2 Hypertension. Stage 2 starts • Family health history
when the systolic pressure is already • Age
more than or equal than 140 mmHg and • Sex.
the diastolic is more than or equal than • Race or ethnicity
90 mmHg.
ASSESSMENT AND S/S
RISK FACTORS Nursing assessment must involve careful
monitoring of the blood pressure at frequent
1. Elevated Blood Pressure- Elevated blood and routinely scheduled intervals.
pressure is blood pressure that is slightly
higher than normal
• If patient is on antihypertensive
2. Diabetes- Diabetes causes sugars to build medications, blood pressure is
up in the blood and also increases the assessed to determine the
risk for heart disease. effectiveness and detect changes in
the blood pressure.
52
• Complete history should be obtained support the patient’s efforts to control
to assess for signs and symptoms that hypertension.
indicate target organ damage. • Provide written information about
• Pay attention to the rate, rhythm, and expected effects and side effects.
character of the apical and peripheral • Encourage and teach patients to measure
pulses. their blood pressures at home.
• Assess the patient’s health history • Emphasize strict compliance of follow-up
• Perform physical examination as check-up.
appropriate.
NURSING DIAGNOSIS
Based on the assessment data, nursing
diagnoses may include the following:
SIGNS AND SYMPTOMS
If your blood pressure is extremely high, there • Deficient knowledge regarding the
may be certain symptoms to look out for, relation between the treatment
including: regimen and control of the disease
process.
• Severe headaches
• Nosebleed • Noncompliance with the
• Fatigue or confusion therapeutic regimen related to side
• Vision problems effects of the prescribed therapy.
• Chest pain
• Risk for activity
• Difficulty breathing
intolerance related to imbalance
• Irregular heartbeat
between oxygen supply and demand.
• Blood in the urine
• Pounding in your chest, neck, or ears Risk-prone
• health
• behavior related to condition
People sometimes feel that other symptoms requiring change in lifestyle.
may be related to high blood pressure, but they NAGEMEN
may not be: NURSING INTERVENTION
• Dizziness The objective of nursing care focuses on
• Nervousness lowering and controlling the blood pressure
• Sweating without adverse effects and without undue cost.
• Trouble sleeping
• Encourage the patient to consult a
• Facial flushing
• Blood spots in eyes dietician to help develop a plan for
improving nutrient intake or for weight
THERAPEUTIC MANAGEMENT loss.
The nurse can help the patient achieve blood • Encourage restriction of sodium and fat
pressure control through education about • Emphasize increase intake of fruits and
managing blood pressure. vegetables.
• Implement regular physical activity.
• Assist the patient in setting goal blood • Advise patient to limit alcohol
pressures. consumption and avoidance of tobacco.
• Provide assistance with social support. • Assist the patient to develop and adhere
• Encourage the involvement of family to an appropriate exercise regimen.
members in the education program to
53
GASTROESOPHAGEAL REFLUX gastric contents into the esophagus. It is very
The regurgitation of stomach secretions into the common during infancy, with about 70% of
esophagus through the lower esophageal infants affected, and it usually requires no
(cardiac) sphincter. It is a normal physiologic treatment. It usually starts within 1 week after
process that occurs throughout the day in birth and may be associated with a hiatal hernia.
infants, children, and adults. The emesis occurs after eating, is effortless, and
most often consists of 1 to 2 oz of undigested
milk.
Children with cerebral palsy or other neurologic
involvement are at particular risk. Reflux is
occasionally due to cow’s milk protein
intolerance.
ASSESSMENT
• Irritability
• Failure to thrive
• Esophagitis
• Aspiration pneumonia
• Wheezing
RISK FACTORS • Apnea
Conditions that can increase your risk of
GERD include: In patients with GERD, diagnostic workup may
include the following:
• Obesity
• Hiatal hernia (bulging of the top of the • Upper GI series to look for anatomical
stomach up into the diaphragm) abnormalities such as intestinal
• Pregnancy malrotation
• Connective tissue disorders, such as • pH probe (catheter inserted through
scleroderma the nose into the lower esophagus) to
• Delayed stomach emptying calculate the amount of acidic reflux
into the esophagus in a 24-hour period
Factors that can aggravate acid reflux
• Esophageal manometry to assess
include:
esophageal motility to ensure there is
• Smoking normal esophageal peristalsis
• Eating large meals or eating late at night • Endoscopy to obtain biopsies to assess
• Eating certain foods (triggers) such as the degree of esophagitis
fatty or fried foods
• Drinking certain beverages, such as Conservative/Traditional Treatment
alcohol or coffee
• Taking nonsteroidal anti-inflammatory • Feed infants small frequent feedings of
drugs (NSAIDS), such as aspirin formula thickened with rice cereal (1
tablespoon of cereal per 1 oz of breast
GASTROESOPHAGEAL REFLUX IN milk or formula).
INFANTS
• The infant should be held in an upright
Gastroesophageal reflux in infants occurs due
position for 30 minutes after feedings if
to the immaturity of the lower esophageal
possible.
sphincter, which allows easy regurgitation of
54
• The infant should not be placed in the car esophagus as readily as it previously
seat at home as this puts pressure on the could. As the stomach adjusts, however,
stomach, making emesis more likely. symptoms will fade.
• Tight clothing and diapers should be
GASTROINTESTINAL REFLUX IN
avoided.
CHILDREN AND ADOLESCENTS
• Cigarette smoke should be avoided as Certain groups of children are at higher risk for
exposure to nicotine worsens reflux. reflux. These include children with:
Asking the breastfeeding mother to
eliminate dairy from her diet or a trial of • Cerebral palsy
a hypoallergenic formula for 2 weeks may • Down syndrome
be indicated. • Cystic fibrosis
• Obesity
Medication
Chronic reflux is potentially dangerous because
Medication is not indicated for uncomplicated
it can lead to erosion of the esophagus with
reflux, but for infants experiencing irritability perforation or stricture and is associated with
and poor feeding due to esophagitis, prescribe the development of esophageal cancer in later
• H2 -receptor antagonist such as life.
ranitidine (Zantac)
ASSESSMENT
• Proton pump inhibitor such as • Heartburn that occurs 30-60 minutes
omeprazole (Prilosec) may be prescribed • Regurgitation
daily to reduce the possibility of the • Esophagitis (irritated esophagus)
stomach acid contents irritating the
esophagus. THERAPEUTIC TREATMENT
Prevent Reflux
Surgery
• Avoid lying down until 3 hours after a
If such medical therapy is ineffective, a meal
laparoscopic or surgical fundoplication • Sleep at night with their upper body
may be performed. elevated on a foam wedge or extra pillow
• Wrapping the upper portion of the • Avoid acidic foods
stomach (fundus) around the lower ➢ Tomato products, citrus fruits, or
esophagus to prevent regurgitation of spicy foods
stomach contents • Avoid foods that delay gastric emptying
• After this procedure, the child will ➢ Fatty foods, chocolate, or alcohol
temporarily have a nasogastric tube Helpful and recommended tips:
attached to intermittent low suction.
• Assess nasogastric tube drainage and • Losing some weight if overweight
any vomitus for coffee-colored drainage • Avoid bending after meals
after the first 24 hours (it is a normal • Remove tight belts
finding in the first 24 hours), which would Medications to take:
indicate bleeding from the surgical site.
• When infants are first fed after surgery, • Over-the-counter antacid relieves pain
they may display signs of abdominal • H2 –receptor antagonists prescription
discomfort, such as gagging, that prevents heartburn
retching, and distention, because ➢ Famotidine (Pepcid)
food can no longer reflux into the ➢ Ranitidine (Zantac)
55
• Proton pump inhibitors (PPIs) that halt establish a dietary plan for weekly goals
the release of stomach acids of weight loss of one pound; encourage
➢ Omeprazole (Prilosec) – both patient to make gradual changes in
over-the-counter and prescription dietary habits; provide activities for the
➢ Rabeprazole (AcipHex) – patient that do not center around or are
prescription associated with meals or snacks.
➢ Best long-term relief • Relieve pain. Assess for heartburn, and
➢ Best taken 30 minutes before carefully assess pain location and discern
breakfast and prescribed 8 to 12 pain from GERD and angina pectoris.
weeks • Prevent aspiration. Avoid placing the
patient in supine position, have the
Some adults require surgery in later life to
patient sit upright after meals; instruct
relieve esophageal strictures or to prevent
patient to avoid highly seasoned food,
persistent esophagitis, which can lead to cancer
acidic juices, alcoholic drinks, bedtime
if untreated.
snacks, and foods high in fat; elevate
NURSING DIAGNOSIS HOB while in bed.
• Imbalanced nutrition: less than • Enforce health education. Provide
body requirements related to inability patient and folks with information
to intake enough food because of reflux. regarding disease process, health
• Acute pain related to irritated practices that can be changed, and
esophageal mucosa. medications to be utilized; instruct
• Imbalanced nutrition: more than patient and folks in medications, effects,
body requirements related to eating side effects, and to report to physician if
symptoms persist despite medical
to try to assuage pain.
treatment.
• Risk for aspiration related
• Relieve anxiety. Allow verbalization of
to esophageal compromise affecting the
concerns and to ask inquiries about
lower esophageal sphincter. illness, treatment, surgery, recovery by
• Deficient knowledge related to lack of parents; encourage parents to stay with
information regarding condition/disease the child
process. ➢ and to assist in care; communicate
• Anxiety related to change in the health frequently with parents and
status of the infant (possible surgical provide easy to understand and
intervention). truthful answers to questions;
• Risk for injury related to abnormal utilize pictures, drawings, and
blood profile. models for explanations.
NURSING INTERVENTIONS • Prevent injury. Inform parents that
• Improve nutrition. Accurately infant usually outgrows the disorder and
measure the patient’s weight and height; attains normal function by 6 weeks of age
encourage small frequent meals of high and those with a persistent reflux
calories and high protein foods; instruct problem usually resolve by 6 months of
to remain in upright position at least 2 age; assist and prepare parents and
hours after meals; avoiding eating 3 infant for diagnostic examination and
hours before bedtime; instruct patient to possible surgical procedure; educate and
eat slowly and masticate foods well; instruct to do Guaiac test on stool and
56
vomitus and allow to return
demonstration.
57
PYLORIC STENOSIS who took certain antibiotics in late pregnancy
The pyloric sphincter is the opening between the may have an increased risk of pyloric stenosis.
lower portion of the stomach and the beginning
Bottle-feeding. Some studies suggest that
portion of the intestine (the duodenum). If
bottle-feeding rather than breast-feeding can
hypertrophy or hyperplasia of the muscle
increase the risk of pyloric stenosis. Most of the
surrounding the sphincter occurs, it is difficult
people who participated in these studies used
for the stomach to empty, a condition called
formula rather than breast milk, so it isn't clear
pyloric stenosis.
whether the increased risk is related to formula
The exact cause is unknown, but multifactorial or the mechanism of bottle-feeding.
inheritance is the likely cause.
ASSESSMENT
• At 4 to 6 weeks of age, infants typically
begin to vomit almost immediately after
each feeding
• Vomiting grows increasingly forceful until
it is projectile, possibly projecting as
much as 3 to 4 ft
• Pyloric stenosis occurs less frequently in
breastfed infants than in formula-fed
infants
• Vomitus usually smells sour
• There will never be bile in the vomitus
RISK FACTORS
• Infants are usually hungry immediately
Sex. Pyloric stenosis is seen more often in boys
after vomiting
— especially firstborn children — than in girls.
Nausea is present if infants show signs of:
Race. Pyloric stenosis is more common in
whites of northern European ancestry, less ➢ Disinterest in eating
common in Black people and rare in Asians. ➢ Excessive drooling
➢ Chewing on the tongue
Premature birth. Pyloric stenosis is more
common in babies born prematurely than in full- Signs of dehydration in infants:
term babies.
➢ Dry mucous membrane of the
Family history. Studies found higher rates of mouth
this disorder among certain families. Pyloric ➢ Sunken fontanelles
stenosis develops in about 20% of male ➢ Fever
descendants and 10% of female descendants of ➢ Decreased urine output
mothers who had the condition. ➢ Poor skin turgor
➢ Weight loss
Smoking during pregnancy. This behavior
can nearly double the risk of pyloric stenosis. Alkalosis may be present accompanying:
Early antibiotic use. Babies given certain ➢ Hypochloremia
antibiotics in the first weeks of life — ➢ Hypokalemia
erythromycin to treat whooping cough, for ➢ Starvation
example — have an increased risk of pyloric • Hypopnea (slowed respirations) occurs
stenosis. In addition, babies born to mothers • HCO3 level is above 30 mEq/L
• Tetany may occur with alkalosis
58
A definitive diagnosis can be made by watching • Impaired oral mucous membrane
the infant drink. If a pyloric stenosis is related to NPO status.
present, the sphincter feels round and firm, • Risk for impaired skin integrity
approximately the size of an olive in the right related to fluid and nutritional deficit.
abdomen. As the infant drinks, gastric peristaltic • Compromised family coping related
waves pass from left to right across the to seriousness of illness and impending
abdomen. surgery.
The olive-size lump becomes more prominent, NURSING INTERVENTIONS
and the infant vomits with projectile emesis. • Maintain adequate nutrition and
fluid intake. If the infant is severely
If the diagnosis is still in doubt, an ultrasound
dehydrated and malnourished,
will show a hypertrophied sphincter
rehydration with intravenous fluid and
An endoscopy also may be used for diagnosis by electrolytes is necessary; feedings of
directly visualizing the hypertrophied sphincter. formula thickened with infant cereal and
fed through a large-holed nipple may be
given to improve nutrition; feed the
infant slowly while he or she is sitting in
an infant seat or being held upright.
THERAPEUTIC MANAGEMENT • Provide mouth care. The infant needs
• Surgical or laparoscopic correction (a
good mouth care as the mucous
pyloromyotomy) – performed before
membranes of the mouth may be dry
electrolyte imbalance occurs
because of dehydration and omission of
• IV administration (isotonic saline or 5%
oral fluids before surgery; a pacifier can
glucose saline)
satisfy the baby’s need for sucking
• An infant who is receiving only IV fluid
because of the interruption in normal
generally needs a pacifier to meet
feeding and sucking habits.
nonnutritive sucking needs and be
• Promote skin integrity. The infant is
comfortable
repositioned, the diaper is changed, and
• If tetany is present, administer calcium
lanolin or A and D ointment is applied to
• Give potassium containing solutions but
dry skin areas.
only until renal failure is confirmed –
• Promote family coping. Include the
otherwise, potassium buildup causes
caregivers in the preparation for surgery
cardiac arrythmias
and explain the importance of added IV
Surgical correction – muscle of pylorus is split fluids, the reason for ultrasonographic or
down to the mucosa barium swallow examination, and the
function of the NG tube and saline
• Sounds simple but technically difficult to
lavage; describe the surgical procedure
perform
to be performed; and explain what to
• At risk for infection
expect and how long the operation will
NURSING DIAGNOSIS last.
• Imbalanced nutrition: less than body
requirements related to inability to retain
food.
• Deficient fluid volume related to
frequent vomiting.
59
PEPTIC ULCER DISEASE Toddler Symptoms:
Peptic Ulcer – a shallow excavation formed in
• Anorexia
the mucosal wall of the stomach, the pylorus, or
• Vomiting
the duodenum
• Bleeding follows in several weeks
• 1% to 2% in children; frequently in males
School-age children and adolescents
• Includes gastritis (irritation of the lining
Symptoms
of the stomach or duodenum)
• In infants, ulcers tend to occur in the • Gnawing
stomach; in adolescents, they are usually • Aching pain in the epigastric area before
duodenal. meals that is relieved by eating
• Caused by H. pylori bacteria • Epigastric tenderness
• Leads to pain, blood in the stool, and
vomiting (with blood)
Combination of medications
• If left uncorrected, can lead to bowel or
stomach perforation with acute • Amoxicillin and Clarithromycin (Biaxin) –
hemorrhage or pyloric obstruction. antibiotics
• Chronic ulcer condition may lead to • Omeprazole (Prilosec) – proton pump
anemia from the constant, gradual blood inhibitor (PPI)
loss. • Bismuth subsalicylate (Pepto-Bismol) is
soothing and mildly antibiotic and so may
be prescribed concurrently
Children with stress ulcers can be treated with a
PPI alone.
NURSING DIAGNOSIS
• Acute pain related to the effect of
gastric acid secretion on damaged tissue.
RISK FACTORS • Anxiety related to an acute illness.
In addition to having risks related to taking • Imbalanced nutrition related to
NSAIDs, you may have an increased risk of changes in the diet.
peptic ulcers if you: • Deficient knowledge about prevention
of symptoms and management of the
• Smoke. Smoking may increase the risk of
condition.
peptic ulcers in people who are infected
with H. pylori. NURSING INTERVENTIONS
• Drink alcohol. Alcohol can irritate and Relieving Pain and Improving Nutrition
erode the mucous lining of your stomach, • Administer prescribed medications.
and it increases the amount of stomach • Avoid aspirin, which is an anticoagulant,
acid that's produced. and foods and beverages that contain
• Have untreated stress. acid-enhancing caffeine (colas, tea,
• Eat spicy foods. coffee, chocolate), along with
ASSESSMENT decaffeinated coffee.
An ulcer occurring in a neonate usually presents • Encourage patient to eat regularly
with hematemesis (blood in vomitus) or spaced meals in a relaxed atmosphere;
melena (blood in the stool).
60
obtain regular weights and encourage • Note and report symptoms of penetration
dietary modifications. (back and epigastric pain not relieved by
• Encourage relaxation techniques. medications that were effective in the
past).
Reducing Anxiety
• Note and report symptoms of perforation
• Assess what patient wants to know about (sudden abdominal pain, referred pain to
the disease, and evaluate level of shoulders, vomiting and collapse,
anxiety; encourage patient to express extremely tender and rigid abdomen,
fears openly and without criticism. hypotension and tachycardia, or other
• Explain diagnostic tests and signs of shock).
administering medications on schedule.
Home Management and Teaching Self-
• Interact in a relaxing manner, help in
Care
identifying stressors, and explain
effective coping techniques and • Assist the patient in understanding the
relaxation methods. condition and factors that help or
• Encourage family to participate in care, aggravate it.
and give emotional support. • Teach patient about prescribed
medications, including name, dosage,
frequency, and possible side effects. Also
Monitoring and Managing Complications
identify medications such as aspirin that
If hemorrhage is a concern: patient should avoid.
• Instruct patient about particular foods
• Assess for faintness or dizziness and
that will upset the gastric mucosa, such
nausea, before or with bleeding; test
as coffee, tea, colas, and alcohol, which
stool for occult or gross blood; monitor
have acid-producing potential.
vital signs frequently (tachycardia,
• Encourage patient to eat regular meals in
hypotension, and tachypnea).
a relaxed setting and to avoid overeating.
• Insert an indwelling urinary catheter and
• Explain that smoking may interfere with
monitor intake and output; insert and
ulcer healing; refer patient to programs
maintain an IV line for infusing fluid and
to assist with smoking cessation.
blood.
• Alert patient to signs and symptoms of
• Monitor laboratory values (hemoglobin
complications to be reported. These
and hematocrit).
complications include hemorrhage (cool
• Insert and maintain a nasogastric tube
skin, confusion, increased heart rate,
and monitor drainage; provide lavage as
labored breathing, and blood in the
ordered.
stool), penetration and perforation
• Monitor oxygen saturation and
(severe abdominal pain, rigid and tender
administering oxygen therapy.
abdomen, vomiting, elevated
• Place the patient in the recumbent
temperature, and increased heart rate),
position with the legs elevated to prevent
and pyloric obstruction (nausea,
hypotension, or place the patient on the
vomiting, distended abdomen, and
left side to prevent aspiration from
abdominal pain). To identify obstruction,
vomiting.
insert and monitor nasogastric tube;
• Treat hypovolemic shock as indicated.
more than 400 mL residual suggests
If perforation and penetration are concerns: obstruction.
61
APPENDICITIS symptoms for some time as simple
The appendix, a blind-ended pouch attached to gastroenteritis.
the cecum, may become inflamed because of an
• But pain is a late symptom
upper respiratory or other body infection, but
• Anorexia
the cause of appendicitis is generally obscure.
• Tenderness in the right lower quadrant
• Appendicitis is the inflammation of the • Nausea or vomiting
appendix • Elevation of temperature
• Most common cause of abdominal • Leukocytosis
surgery in children
• Fecal material enters the appendix,
Disease Process
hardens, and obstructs the appendiceal
lumen • The history typically begins with
• Inflammation and edema develop anorexia for 12 to 24 hours. Children
• Necrosis and pain result do not eat and do not act like their
usual selves.
If the condition is not discovered early enough,
• Nausea and vomiting may then occur.
the necrotic area will rupture and fecal material
• The abdominal pain, when it does start,
will spill into the abdomen, causing peritonitis, a
is at first diffuse.
potentially fatal condition.
• Gradually, it becomes localized to the
right lower quadrant.
• The point of sharpest pain is often one
third of the way between the
anterior superior iliac crest and
the umbilicus
• Until the pain becomes localized,
appendicitis is difficult to distinguish
from acute gastroenteritis.
• Although this interferes with an
abdominal examination, it is in itself an
important sign that children have
abdominal pain.
• To assist in a diagnosis of a painful
RISK FACTORS abdomen, always palpate the
• Appendicitis is more common in men and anticipated tender area last.
teenagers.
• You are at increased risk of developing Therapy for appendicitis is surgical removal of
appendicitis if you have family members the appendix by laparoscopy before it ruptures.
who have had appendicitis.
• For a child, having cystic fibrosis also Achieving this is easier in older than younger
seems to raise the risk of getting children because they are more capable of
appendicitis relating the progression of symptoms.
ASSESSMENT Also, the wall of the appendix is thinner and

Most parents assume appendicitis begins with perforates more readily in young children.
sharp pain, so they may dismiss a child’s early
NURSING DIAGNOSIS
62
• Acute pain related to obstructed
appendix.
• Risk for deficient fluid volume
related to preoperative vomiting,
postoperative restrictions.
• Risk for infection related to ruptured
appendix.
NURSING INTERVENTIONS
The nurse prepares the patient for surgery.
• IV infusion. An IV infusion is made to
replace fluid loss and promote adequate
renal functioning.
• Antibiotic therapy. Antibiotic therapy
is given to prevent infection.
• Positioning. After the surgery, the
nurse places the patient on a High-
fowler’s position to reduce the tension on
the incision and abdominal organs,
thereby reducing pain.
• Oral fluids. When tolerated, oral fluids
could be administered.
63
CELIAC DISEASE • The diagnosis is based on the history;
Celiac disease is an immune-mediated abnormal clinical symptoms such as
response to gluten, the protein in wheat, and ➢ Poor growth
related proteins in rye, barley and possibly oats, ➢ Bulky stools
in a genetically susceptible individual. ➢ Malnutrition
➢ Distended abdomen
When children with the disorder ingest gluten,
➢ Anemia
flattening of the fingerlike projections (villi) of
which usually become noticeable
the small intestine occurs, preventing the
between 6 and 18 months of age, after
absorption of foods, especially fat, into the
the introduction of gluten into the diet.
body. If the disease goes undiagnosed, children
However, celiac disease can be
develop steatorrhea (bulky, foul-smelling, fatty
diagnosed at any age.
stools), failure to thrive, and malnutrition.
• Serum analysis of antibodies against

gluten (endomysial antibody, tissue
transglutaminase is obtained)
• Biopsies of the small intestinal mucosa
(done by endoscopy), which are the gold
standards, establish the typical changes
in intestinal villi
Treatment is to continue the gluten-free diet for
life because there is an associated slightly
The illness occurs most frequently in children of
increased risk of malignancy in those who are
• Northern European background diagnosed with celiac disease as adults.
• Those with a first-degree relative with Correction of any vitamin and mineral
celiac disease deficiencies may be necessary.
• Those who have type 1 diabetes
NURSING DIAGNOSIS
mellitus
• Diarrhea related to intestinal
• IgA deficiency
inflammation secondary to Celiac Disease
• Down syndrome
as evidenced by loose, water stools,
RISK FACTORS abdominal cramping and pain, increased
Celiac disease tends to be more common in urgency to defecate, and increased
people who have: bowel sounds.
• Imbalanced Nutrition: Less than
• A family member with celiac disease or
body requirements related to reduced
dermatitis herpetiformis
absorption of nutrients secondary to
• Type 1 diabetes
Celiac Disease, as evidenced by diarrhea,
• Down syndrome or Turner syndrome
abdominal pain and cramping, weight
• Autoimmune thyroid disease
loss, nausea and vomiting, and loss of
• Microscopic colitis (lymphocytic or
appetite.
collagenous colitis)
• Addison's disease NURSING INTERVENTIONS
ASSESSMENT
64
• Monitor dietary intake, fluid intake and
output, weight, serum electrolytes, and
hydration status.
• Make sure that the diet is free from
causative agent, but inclusive of essential
nutrients, such as protein, fats, vitamins,
and minerals.
• Maintain NPO status during initial
treatment of celiac crisis or during
diagnostic testing.
• Provide parenteral nutrition as
prescribed.
• Provide meticulous skin care after each
loose stool and apply lubricant to prevent
skin breakdown.
• Encourage small frequent meals, but do
not force eating if the child has anorexia.
• Use meticulous hand washing technique
and other procedures to prevent
transmission of infection.
• Assess for fever, cough, irritability, or
other signs of infection.
• Teach the parents to develop awareness
of the child’s condition and behavior;
recognize changes and care for child
accordingly.
• Explain that the toddler may cling to
infantile habits for security. Allow this
behavior, it may disappear as physical
condition improves.
• Stress that the disorder is lifelong;
however, changes in the mucosal lining
of the intestine and in general clinical
conditions are reversible when dietary
gluten is avoided.
65
G6PD • Trouble with physical activity
Glucose-6-phosphate dehydrogenase (G6PD) • Enlarged spleen and liver
deficiency is a hereditary condition as an X- • Increased heart rate
linked recessive disorder, and thus most often • Heart murmur
affects males. G6PD deficiency is polymorphic,
The symptoms of hemolytic anemia may look
with more than 300 variants.
like other health problems. Always see your
G6PD deficiency occurs when a person is healthcare provider for a diagnosis.
missing or does not have enough of an enzyme
called glucose-6-phosphate dehydrogenase.
Treatment will depend on your symptoms, age,
This enzyme helps red blood cells work properly.
and general health. It will also depend on how
Too little G6PD leads to the destruction of red severe the condition is.
blood cells. This process is called hemolysis that Treatment may include:
causes hemolytic anemia. • Staying away from certain medicines,
Fact: G6PD deficiency protects people from foods, and environmental exposures
• Telling your healthcare providers that
being infected with malaria, so it is more
you have G6PD deficiency
commonly seen in areas with high malaria
• Checking with your provider before
infection rates, such as Africa, the
taking any medicine
Mediterranean region, and Asia.
If you have this condition, you will need to stay
RISK FACTORS
• G6PD deficiency occurs most often in away from things that can trigger hemolytic
men. It is rare in women anemia. These include:
• The disorder affects about 10 to 14 out • Aspirin, and products that have aspirin
of 100 African-American men in the U.S. • Certain antibiotics
It is also common in people from the • Fava beans
Mediterranean area, Africa, or Asia. • Moth balls
• The severity of the disorder varies,
depending on the group. In African- The ultimate treatment for G6PD deficiency is
Americans, the problem is mild. It mainly gene therapy (replacing a defective gene with a
affects older red blood cells. In whites, good one), but this is not yet available at the
the disorder is often more serious. present time.
ASSESSMENT NURSING DIAGNOSIS

G6PD can cause hemolytic anemia. This is when • Fatigue related to decreased
the red blood cells break down faster than they hemoglobin and diminished oxygen-
are made. Symptoms of hemolytic anemia carrying capacity of the blood.
include: • Altered nutrition, less than body
requirements, related to inadequate
• Pale skin intake of essential nutrients.
• Yellowing of the skin, eyes, and mouth • Altered tissue perfusion related to
(jaundice) insufficient hemoglobin and hematocrit.
• Dark-colored urine
• Fever NURSING INTERVENTIONS
To manage fatigue:
• Weakness
• Dizziness • Prioritize activities. Assist the patient in
• Confusion prioritizing activities and establishing
66
balance between activity and rest that
would be acceptable to the patient.
• Exercise and physical activity. Patients
with chronic anemia need to maintain
some physical activity and exercise to
prevent the deconditioning that results
from inactivity.
To maintain adequate nutrition:
• Diet. The nurse should encourage a
healthy diet that is packed with essential
nutrients.
• Alcohol intake. The nurse should inform
the patient that alcohol interferes with
the utilization of essential nutrients and
should advise the patient to avoid or limit
his or her intake of alcoholic beverages.
• Dietary teaching. Sessions should be
individualized and involve the family
members and include cultural aspects
related to food preference and
preparation.
To maintain adequate perfusion:
• Blood transfusion monitoring. The nurse
should monitor the patient’s vital signs
and pulse oximeter readings closely.
To promote compliance with prescribed
therapy:
• Enhance compliance. The nurse should
assist the patient to develop ways to
incorporate the therapeutic plan into
everyday activities.
• Medication intake. Patients receiving
high-dose corticosteroids may need
assistance to obtain needed insurance
coverage or to explore alternative ways
to obtain these medications.
67
URINARY TRACT INFECTION • A recent urinary procedure
A urinary tract infection (UTI) is an infection of
the urinary system. This type of infection can ASSESSMENT AND S/S
involve your urethra (a condition called Urinary tract infection causes the lining of the
urethritis), kidneys (a condition urinary tract to become red and irritated
called pyelonephritis) or bladder, (a condition (inflammation), which may produce some of the
called cystitis). following symptoms:
⚫ Pain in the side (flank), abdomen or
Causes of UTI pelvic area.
UTIs are primarily caused by bacteria that have ⚫ Pressure in the lower pelvis.
invaded the urinary tract. ⚫ Frequent need to urinate (frequency),
urgent need to urinate (urgency) and
⚫ Inability or failure to empty the Incontinence (urine leakage).
bladder completely. Stasis of urine inside ⚫ Painful urination (dysuria) and blood in
the urinary bladder attracts bacteria into the urine.
entering the tract. ⚫ The need to urinate at night.
⚫ Instrumentation of the urinary tract. ⚫ Abnormal urine color (cloudy urine) and
Catheterization or cystoscopy procedures c strong or foul-smelling urine.
ould introduce bacteria into the urinary Other symptoms that may be associated with a
tract. urinary tract infection include:
⚫ Pain during sex.
⚫ Obstructed urinary flow. Abnormalities ⚫ Penis pain.
in the structure of the urinary tract could ⚫ Flank (side of the body) pain or lower
obstruct the flow of the urine and result in back pain.
inability to empty the bladder completely. ⚫ Fatigue.
⚫ Decreased natural host defenses. ⚫ Fever (temperature above 100 degrees
Immunosuppression or inability of the body Fahrenheit) and chills.
to produce the body’s defenses predisposes ⚫ Vomiting.
⚫ Mental changes or confusion
the patient to UTI.
RISK FACTORS DIAGNOSTIC TESTS
⚫ Urinalysis.This test will examine the urine
Urinary tract infections are common in women,
and many women experience more than one for red blood cells, white blood cells and
infection during their lifetimes. Risk factors bacteria. The number of white and red blood
specific to women for UTIs include: cells found in your urine can actually
indicate an infection.
• Female anatomy
⚫ Urine cultures. Urine cultures are useful in
• Sexual activity
• Certain types of birth control identifying the organism present and are the
• Menopause definitive diagnostic test for UTI.
⚫ STD tests. Tests for STDs may be
Other risk factors for UTIs include:
performed because there are UTIs
transmitted sexually.
• Urinary tract abnormalities
• Blockages in the urinary tract ⚫ CT scan. A CT scan may detect
• A suppressed immune system pyelonephritis or abscesses.
• Catheter use
68
⚫ Ultrasonography. Ultrasound is extremely Relieve pain. Antispasmodic agents
•
sensitive for detecting obstruction, may relieve bladder irritability and
abscesses, tumors, and cyst. analgesics and application of heat
help relieve pain and spasm.
• Fluids. The nurse should encourage
Antibiotics are typically used to treat urinary
the patient to drink liberal amounts of
tract infections.
fluids to promote renal blood flow and
⚫ Nitrofurantoin.
to flush bacteria from the urinary
⚫ Sulfonamides (sulfa drugs).
tract.
⚫ Amoxicillin.
• Voiding. Encourage frequent voiding
⚫ Cephalosporins.
every 2 to 3 hours to empty the
⚫ Trimethoprim/sulfamethoxazole
bladder completely because this can
(Bactrim®).
significantly lower urine bacterial
⚫ Doxycycline.
counts, reduce urinary stasis, and
⚫ Quinolones (such as ciprofloxacin
prevent reinfection.
[Cipro®]).
• Irritants. Avoid urinary irritants such
Lifestyle and home remedies
as coffee, tea, colas, and alcohol.
Urinary tract infections can be painful, but you RAPEUTIC MANAGEMENT
can take steps to ease your discomfort until
antibiotics treat the infection. Follow these tips:
• Drink plenty of water. Water helps to
dilute your urine and flush out bacteria.
• Avoid drinks that may irritate your
bladder. Avoid coffee, alcohol, and soft
drinks containing citrus juices or caffeine
until your infection has cleared. They can
irritate your bladder and tend to aggravate
your frequent or urgent need to urinate.
• Use a heating pad. Apply a warm, but
not hot, heating pad to your abdomen to
minimize bladder pressure or discomfort.
NURSING DIAGNOSIS
Based on the assessment data, the nursing
diagnoses may include the following:
Acute pain related to infection within
•
the urinary tract.
• Deficient knowledge related to lack of
information regarding predisposing
factors and prevention of the disease.
Nurses care for patients with urinary tract
infection in all settings.
69
CHRONIC RENAL FAILURE • Hypocalcemia and hyperphosphatemia –
Also termed chronic kidney disease (CKD), is occurs drom kidney’s inability to excrete
defined as the presence of kidney damage or an phosphate
estimated glomerular filtration rate (eGFR) less • Osteodystrophy – occurs as calcium is
than 60 ml/min/1.73 mt2, persisting for 3 withdrawn from bones to compensate for
months or more, irrespective of the cause. low calcium levels
• Impaired Vitamin D synthesis – because
CKD results from developmental abnormalities,
kidneys are responsible for synthesizing
when acute failure becomes long term, or when
vitamin D to its active form, leads to
chronic kidney disease has caused extensive
calcium malabsorption from GI tract
nephron destruction. The nephrons that are not
• Renal rickets – growth is halted and
destroyed appear to function as usual but are
bones lose strength due to calcium
inadequate in number to sustain kidney function.
depletion
Begins approximately when 50% of nephrons are • Anemia – due to decreased
destroyed. Kidney function then diminishes by erythropoietin production which
degree until child develops end-stage kidney stimulates RBC production
disease, where kidneys no longer effectively • Pruritus – may be present from skin
evacuate waste products from the body. irritation due to excretion of nitrogenous
wastes
RISK FACTORS
Non-modifiable risk factors include:
• Age
• Gender (usually in males)
• Non-Caucasian ethnicity (African
Americans, Afro-Caribbean, Hispanics,
and South and Pacific Asians)
• Genetics
Modifiable risk factors include:
• Systemic Hypertension
• Proteinuria
• Metabolic Factors
• Children are generally placed on a low-
ASSESSMENT AND S/S protein, low-phosphorous, low-
Early CKD stages are asymptomatic, and potassium diet to prevent rapid urea
symptoms manifest in stages 4 or 5. It is and phosphate buildup.
commonly detected by routine blood or urine • Children may be placed prescribed
testing. aluminum hydroxide gel to take with
meals to bind phosphorous in the
• Polyuria – due to a halt in the nephron’s
intestines and prevent absorption.
ability to concentrate urine
• Milk usually is not given because it is
• Dehydration – due to inability to reabsorb
high sodium, potassium, and phosphate
enough sodium to maintain a functioning
which may be difficult for children to
serum level of body fluid
clear.
• Oliguria and anuria – occurs as additional
• Meat is restricted, even beans
nephrons are lost
• Acidosis – results from inability to secrete
H+ ions
70
• Good instructions on selecting low- and psychological aspects of the illness and
protein foods to whoever will be long-term care.
preparing meals at home.
• Low-electrolyte, low-protein formulas are
• Help patient stay as active as possible to
commercially available for infants with
discourage boredom by suggesting age-
renal failure.
appropriate activities.
• Total daily fluid intake may need to
• Ask teenagers if they are using a
be restricted, but as minimal as
recreational drug as a method to relieve
possible.
anxiety or boredom.
• Sodium intake may need to be
• Provide parents with opportunities at
restricted or kept normal but no
periodic health assessments to voice
excessively salty foods, or added due to
their frustrations, fears, and anxieties.
poor tubular reabsorption resulting in
• Ask parents if they have time to do things
dump of sodium in urine.
important to them as individuals, this
• Low-sodium formulas are
ultimately improves children’s care
recommended for children with heart
because it improves the lives and mental
failure who need a low-sodium intake,
attitudes of those around them.
but should be used cautiously in
children with renal insufficiency In addition, nurses may also:
because high potassium content can lead • Monitor intake and output
to toxic potassium blood levels. • Watch for nephrotoxic medications-
• Diuretics may be prescribed to statins, aminoglycosides
regulate sodium and fluid levels and • Listen to the lungs
prevent edema. • Assess edema
• Supplemental calcium to prevent • Observe mental status
muscle cramping, rickets, tetany, or • Administer diuretics as prescribed
seizures. • Monitor potassium levels
• Daily hypertensive drug may be • Obtain a 12 lead ECG
prescribed as hypertension becomes • Ensure a low protein diet
more and more acute from the • Ensure a low salt diet
accumulating blood volume. • Educate patient on renal failure
• Recombinant human erythropoietin • Check BUN and creatinine levels
to stimulate RBC production or packed
RBC to correct anemia.
• Administer blood transfusions and
all fluids cautiously so that volume
overload does not occur.
• Dialysis to effectively excrete urea for
children waiting for a kidney transplant
NURSING DIAGNOSIS
Risk for interrupted family process r/t chronically
ill family member
Nursing diagnoses with chronic or end-stage
kidney disease must address both the physical
71
ASPIRATION Treatment for aspiration depends on the
Definition: This is when something enters your severity of a person’s symptoms and the
airway or lungs by accident. It may be food, material they inhaled. In some instances,
liquid, or some other material. This can cause treatment is unnecessary.
serious health problems, such as pneumonia.
Bronchoscopy may be ordered if an object,
Causes: such as a piece of food, is still in the lungs.
During this procedure, a tube with a camera will
• Accidentally passage of foreign
be inserted down a person’s throat and into the
substances into the windpipe and lungs
lungs to remove the foreign material.
instead of the esophagus
• Use of tube feedings’ artificial airway Antibiotics (ampicillin-sulbactam, or a
devices (e.g. tracheostomy tube) combination of metronidazole and amoxicillin) –
• Acid reflux prescribed to people with aspiration
• Post-surgery and use of anesthesia pneumonia to help clear the infection.
(Anesthesia reduces a person’s level of
Speech therapy may help to improve a
consciousness and ability to protect their
person’s swallowing reflex and lower their risk
airways, which increases the risk of
of aspiration, especially in patients with stroke.
aspiration.
• Inhalation/ ingestion of household/ Dietary and lifestyle changes can also help
industrial chemicals treat chronic aspiration.
1. Dysphagia (difficulty swallowing) • Activity intolerance related to ineffective
2. Impaired/ absent gag reflex respiratory function
3. Reduced physical mobility • Impaired spontaneous ventilation as
4. Neurological disorders (e.g. Parkinson’s evidenced by breathing difficulty
disease) • Impaired verbal communication related to
5. Intoxication from drugs or alcohol, this leads pain as evidenced by facial grimace
to impaired consciousness and reflexes
6. Dementia NURSING INTERVENTION
7. Gastroesophageal reflux disease (GERD) Monitor respiratory rate, depth, and effort. Note
any signs of aspiration such as dyspnea, cough,
ASSESSMENT AND S/S cyanosis, wheezing, or fever.
Symptoms:
Evaluate swallowing ability by assessing
1. Coughing
for the following:
2. A feeling that something is stuck in the throat
3. Painful swallowing
- Coughing, choking, throat clearing,
4. Wheezing
gurgling or “wet” voice during or after
5. Trouble breathing
swallowing
6. A hoarse voice
- Residual food in mouth after eating
7. Gagging
- Regurgitation of food or fluid through the
8. Crying (infants/ children)
snares
9. Cyanosis
10. Facial grimace
Inform the physician or other health care
11. Excessive salivation
provider instantly of noted decrease in
12. Heartburn
cough/gag reflexes or difficulty in swallowing.
13. Inability to chew
THERAPEUTIC MANAGEMENT Keep head of bed elevated when feeding and for
at least a half hour afterward.
72
Position patients with a decreased level of
consciousness on their side.
Establish emergency and contingency plans for

care of patient.
In patients with artificial airways:

Perform oral suctioning as needed.
In patients with NG or gastrostomy tubes:

Elevate the head of bed to 30 to 45 degrees
while feeding the patient and for 30 to 45
minutes afterward if feeding is intermittent.
Family health teaching:

Educate the patient and family the need for
proper positioning.
Instruct in signs and symptoms of aspiration.
73
RUBELLA • Lack of immunization against Rubella or
Rubella is sometimes called German measles. It immunosuppression; and
is a viral infection. It usually causes a mild illness • Exposure to an active case of rubella.
in children. Adults have a slightly more severe
ASSESSMENT AND S/S
illness. The disease is spread person-to-person
• Affects older school-age and adolescent
through droplets coughed or sneezed into the
children
air by an infected person. Most outbreaks of
• Occurs most commonly during the
rubella happen among young adults and adults
spring.
who have not been vaccinated and have not had
• The symptoms begin with a 1- to 5-day
the disease before. It takes 2 to 3 weeks after
prodromal period, during which children
exposure for symptoms to develop. The illness
or adolescents have a low-grade fever,
is mostly mild. But the virus can cause serious
headache, malaise, anorexia, mild
birth defects in pregnant women. A vaccine is
conjunctivitis, possibly a sore throat, a
effective in preventing rubella.
mild cough, and swollen lymph nodes
Causative agent: Rubella virus such as those in the suboccipital,
postauricular, and cervical chains (Levin
Incubation period: 14 to 21 days
& Weinberg, 2008).
Period of communicability: 7 days before to • After the 1 to 5 days of prodromal signs,
approximately 5 days after the rash appears a discrete pink-red maculopapular rash
begins on the face, then spreads
Mode of transmission: Direct and indirect
downward to the trunk and extremities.
contact with droplets
• On the third day, the rash disappears.
Immunity: Contracting the disease offers There is generally no desquamation
lasting natural immunity; a high rubella titer (peeling); if present, it is primarily fine
reveals infection has occurred. flaking of the skin.
Active artificial immunity: Attenuated live Fever with rubella is not marked, although
virus vaccine arthritis (joint pain) with effusion into the joints
occurs in some children on the second or third
Passive artificial immunity: Immune serum
day, lasting as long as 5 to 10 days.
globulin is considered for pregnant women
RISK FACTORS
• Children need comfort measures for the
Rubella is caused by a virus that is spread
rash and an antipyretic such as
through the air or by close contact. Rubella can
acetaminophen (Tylenol) or ibuprofen
also be transmitted to a fetus by a mother with
(Motrin) for fever or joint pain.
an active infection, causing severe disease in the
• If a child develops rubella while in the
fetus. A person can transmit the disease from 1
hospital, follow droplet precautions for 7
week before the onset of the Rubella rash, until
days after the onset of the rash in
1-2 weeks after the rash disappears. Rubella is
addition to standard infection
less contagious than rubeola (measles). Lifelong
precautions.
immunity to Rubella follows infection. The
• If rubella occurs during pregnancy, it can
Rubella vaccine is safe and effective in
cause extensive congenital malformation
preventing rubella.
in the fetus. Because of this, it can never
Rubella Risk factors: be considered a simple disease.
74
• It is important that girls be immunized
against it before they reach child-bearing
age.
NURSING DIAGNOSIS
1. High risk of infection related to the host
and infectious agents. Expected results:
2. Pain related to skin lesions, malaise
Identify high-risk children
Rational: to ensure children avoid
exposure
Make a referral to a community health
nurse if necessary.
• Rational: to ensure proper procedures
at home.
Monitor temperature
• Rational: increased body temperature is
not expected to indicate an infection.
Maintain good body hygiene.
• Rational: to reduce the risk of
secondary infection from the lesions.
• Give a little water absorption, but often a
child or a favorite drink and fine food.
Use a cool mist vaporiser, mouthwash,
and tablets suck.
Rational: to keep mucous membranes
moist.
Clean the eye with physiological saline
solution
Rational: to remove secretions or
leprosy
Keep your child cool.
Rational: because the air is too hot can
increase itching.
Give a coldwater bath and give a lotion
such as calamine
Rational: to reduce itching.
Give analgesic, antipyretic, and

antipruritus according to the needs and
requirements.
Rational: to reduce pain, lower body
temperature, and reduce the itching.
75
CONGENITAL LARYNGOMALACIA beginning of an upper respiratory tract
➢ The infant’s laryngealstructure is weaker infection.
than normal and collapses more than usual on
As parents become more accustomed to the
inspiration
sound their infant makes while breathing, they
➢ This produces laryngeal stridor (a high- will become astute reporters of change in their
pitched crowing sound on inspiration) infant’s condition; listen to them carefully
present from birth, possibly intensified when the when they report a change to prevent
infant is in a supine position or when sucking. overlooking this important information.
RISK FACTORS TH
➢ Relaxation or a lack of muscle tone in
the upper airway may be a factor ERAPEUTIC MANAGEMENT
ASSESSMENT AND S/S

➢ Stridor, High pitched sound, Difficulty
feeding, Poor weight gain, Choking while
feeding, Apnea, Pulling in neck and chest
with each breath, Cyanosis,
Gastroesophageal reflux, Aspiration
➢ The infant’s sternum and intercostal spaces
may retract on inspiration because of the
increased effort needed to pull air into the
trachea past the collapsed cartilage rings.
➢ Many infants with this condition must stop
sucking frequently during a feeding to
maintain adequate ventilation and to rest
from their respiratory effort, which is
exhausting.
Most children with congenital laryngomalacia
need no routine therapy other than to have
parents feed them slowly, providing rest
periods as needed.
The condition improves as infants mature and
cartilage in the larynx becomes stronger at
about 1 year of age.
Showing them a weight chart that
demonstrates their child is growing and thriving
despite this problem can be reassuring.
If stridor becomes more intense, advise parents
to have the infant seen by their primary care
provider, because generally this indicates
beginning obstruction and probably the
76
HYPERTHYROIDISM (GRAVE’S heat, Changes in bowel patterns, An
DISEASE) enlarged thyroid gland (goiter), Fatigue,
➢ Oversecretion of thyroid hormones by muscle weakness, Difficulty sleeping, Skin
the thyroid gland. thinning, Fine brittle hair
➢ In children, it usually occurs at the time of ➢ Graves’ disease often follows a viral illness
puberty or during adolescence or a period of stress. Some children may
➢ More common in girls than in boys. have a genetic predisposition to
development of the disorder.
➢ Overactivity of the thyroid gland can occur
from the gland’s being overstimulated by ➢ With overproduction of T3 and T4, children
TSH from the pituitary gland due to a gradually experience nervousness, loss of
pituitary tumor. muscle strength, and easy fatigue.
➢ Hyperthyroidism in children is caused by an ➢ Their basal metabolic rate is high; blood

autoimmune reaction that results in pressure and pulse are increased. They
overproduction of immunoglobulin G (IgG), perspire freely. They are always hungry,
which stimulates the thyroid gland to and, although they eat constantly, they do
overproduce thyroxine. not gain weight and may even lose weight
because of the increased basal metabolic
➢ An exophthalmos-producing pituitary rate.
substance causes the prominent-appearing
eyes that accompany hyperthyroidism in ➢ On radiography, bone age appears
some children. advanced beyond the chronologic age of the
child.
RISK FACTORS
➢ Being female ➢ Unless the condition is treated, the child will
not be able to reach normal adult height,
➢ Being over age 60 because epiphyseal lines of long bones will
➢ Recent pregnancy close before normal height is attained.
➢ Having an autoimmune disease (such ➢ The thyroid gland, which usually is not
as type 1 diabetes) prominent in children, appears as a swelling
on the anterior neck (goiter).
➢ Family history of thyroid disease or
autoimmune disease ➢ This enlargement can be confifirmed by
ultrasound.
➢ Personal history of thyroid problems,
like goiter (an abnormally large thyroid ➢ When the child protrudes the tongue or
gland) or having had thyroid surgery extends the hands, fine tremors are
noticeable.
➢ Consuming significant amounts of iodine
through food or medication ➢ In a few children, the eye globes are
prominent (exophthalmos), giving the child
ASSESSMENT AND S/S a wide-eyed, staring appearance.
➢ Unintentional weight loss, Tachycardia or
Arrhythmia, Palpitations, Increased ➢ Laboratory tests show elevated T4 and T3
appetite, Nervousness, anxiety and levels and increased radioactive iodine
irritability, Tremor, Sweating, menstrual uptake.
pattern changes, Increased sensitivity to
77
➢ TSH is low or absent because the thyroid is necessary in a young adult, also can be
being stimulated by antibodies, not by the completed safely.
pituitary gland.
➢ After both radioiodine ablative therapy and
THERAPEUTIC MANAGEMENT thyroidectomy, supplemental thyroid
➢ Therapy consists first of a course of a beta- hormone therapy may be needed
adrenergic blocking agent: propranolol, indefinitely because the gland is no longer
to decrease the antibody response able to produce an adequate amount.
➢ After this, the child is placed on an NURSING DIAGNOSIS
antithyroid drug: propylthiouracil (PTU) ➢ Situational low self-esteem related to lack of
or methimazole (Tapazole) to suppress the coordination and presence of prominent
formation of thyroxine. goiter
➢ While the child is taking these drugs, the NURSING INTERVENTION
blood is monitored for leukopenia ➢ Offer parents support to supervise
(decreased white blood cell count) and medication administration, so that they
thrombocytopenia (decreased platelet can be certain the child takes their medicine
count), side effects of the drugs. every day.
➢ If either of these results, the drug is ➢ Caution children not to stop taking the
discontinued until the white blood cell medicine abruptly or a thyroxine crisis
or platelet count returns to normal, so (sudden onset of extreme symptoms of
the child does not develop an infection or hyperthyroidism) can occur.
experience spontaneous bleeding.
➢ Help them understand that surgery
➢ Because the thyroid stores considerable may not dispel the need for
thyroid hormone that must be used up first, medication; if a large portion of the
it takes about 2 weeks for these drugs thyroid gland is removed, it may be
to have an effect. necessary to give medicine indefinitely to
make up for the missing gland.
➢ The child usually has to take the drug for 2
to 3 years before the condition “burns ➢ In any event, it is preferable to try a course
itself out.” of medical management before resorting to
surgery.
➢ The exophthalmos may not recede, but it
will not become worse after therapy is ➢ After therapy, encourage children to
instituted. return to activities that require fine
coordination or social interaction and
➢ If the child has a toxic reaction to medical
to think of themselves as well again.
management (severely lowered white blood
cell count or platelet count) or is MANAGEMENT
noncompliant about taking the medicine,
radioiodine ablative therapy with 131I
to reduce the size of the thyroid gland can
be accomplished
➢ Surgical removal of part or almost all
of the thyroid gland, which may be
78
URTICARIA AND ANGIOEDEMA RISK FACTORS
Definition : Hives and angioedema are common. You may
be at increased risk of hives and angioedema if
you:
• Have had hives or angioedema before
• Have had other allergic reactions
• Have a family history of hives,
angioedema or hereditary angioedema
ASSESSMENT AND S/S

Urticaria, or hives, refers to macular wheals Symptoms
surrounded by erythema arising from the
Hives
chorion layer of skin; they are intensely pruritic
(often described as having a burning sensation). The welts associated with hives can be:
Hives may occur so closely that they tend to
• Reddish
blend together; dilatation of capillaries and
• Itchy ranging from mild to intense
venules with increased permeability occurs
• Round, oval or worm-shaped
around the lesions. The cause of urticaria is a
• As small as a pea or as large as a dinner
type I or immediate hypersensitivity reaction
plate
created by histamine released from an antibody-
antigen response, similar to but of lesser Most hives appear quickly and go away within
intensity than anaphylaxis. 24 hours. Chronic hives can last for months or
years.
Angioedema is an
edema of the skin Angioedema
and subcutaneous
Angioedema is a reaction similar to hives that
tissue. It occurs
affects deeper layers of your skin. It can appear
most frequently on
with hives or alone. Signs and symptoms
the eyelids, hands,
include:
feet, genitalia, and
lips, where the skin is loosely bound by • Puffiness of the face, eyelids, ears,
subcutaneous tissue. Angioedema can be mouth, hands, feet, and genitalia
distinguished from other edemas because it is • Swelling that usually affects one side of
not dependent, generally asymmetrically the body or affects one side more than
distributed, and usually occurs in conjunction the other
with urticaria. With severe angioedema, the • A sensation of fullness or discomfort in
larynx may be involved, which is a serious the area of the swelling
problem because laryngeal edema could be so • Slight redness of the skin, although the
extreme that it leads to airway obstruction and, skin may also be normal in color
subsequently, asphyxiation and death.
The allergens that most frequently cause THERAPEUTIC MANAGEMENT
urticaria and angioedema include drugs, foods, If your symptoms are mild, you may not need
and insect stings. In some children, exposure to treatment. Hives and angioedema often clear up
hot or cold can also cause these reactions. on their own. But treatment can offer relief for
79
intense itching, serious discomfort or symptoms NURSING INTERVENTION
that persist. • Administer injection of epinephrine if it is
a severe attack of hives or angioedema.
Medications
Patient Education
Treatments for hives and angioedema may
include prescription drugs, including: • Avoid triggers. These can include
foods, medications, pollen, pet dander,
• Anti-itch drugs. The standard
latex and insect stings. If you think a
treatment for hives and angioedema are
medication caused your rash, stop using
antihistamines that don't make you
it and contact your primary care provider.
drowsy. These medications reduce
• Use an over-the-counter anti-itch
itching, swelling and other allergy
drug. A nonprescription oral
symptoms. They're available over-the-
antihistamine, such as loratadine
counter or by prescription.
(Claritin), cetirizine (Zyrtec Allergy) or
• Anti-inflammatory drugs. For severe
diphenhydramine (Benadryl Allergy,
hives or angioedema, doctors may
others), may help relieve itching.
sometimes prescribe an oral
Consider whether you might prefer a type
corticosteroid drug — such as prednisone
that doesn't cause drowsiness. Ask your
— to reduce swelling, redness and
pharmacist about options.
itching.
• Apply cold washcloth. Covering the
• Drugs that suppress the immune
affected area with a cold washcloth can
system. If antihistamines and
help soothe the skin and prevent
corticosteroids are ineffective, your
scratching.
doctor might prescribe a drug capable of
• Take a comfortably cool bath. Find
calming an overactive immune system.
relief from itching in a cool shower or
Emergency situations bath. Some people may also benefit from
bathing in cool water sprinkled with
For a severe attack of hives or angioedema, you
baking soda or oatmeal powder (Aveeno,
may need a trip to the emergency room and an
others), but this isn't a solution for long-
emergency injection of epinephrine — a type of
term control of chronic itching.
adrenaline. If you have had a severe attack or
• Wear loose, smooth-textured cotton
your attacks recur, despite treatment, your
clothing. Avoid wearing clothing that's
doctor may have you carry a pen-like device that
rough, tight, scratchy or made from wool.
will allow you to self-inject epinephrine in
This will help you avoid skin irritation.
emergencies.
• Avoid the sun. When outdoors, seek
shade to help relieve discomfort.
NURSING DIAGNOSIS
• Risk for allergy reaction related to
exposure to allergens.
• Impaired spontaneous ventilation,
associated with metabolic factors
(angioedema), presents as less
cooperation.
80
KAWASAKI DISEASE • Urine proteins. More recently, 2 urine
proteins hold promise as biomarkers of
Kawasaki disease: meprin A or
filamin C; these 2 biomarkers were
diagnostically superior to ESR or CRP;
investigators identified more than 190
proteins that were present only in
children with Kawasaki disease,
including the proteins associated with
endothelial and myocardial cell
injury (filamin C) and immune regulators
(meprin A).
• CBC. On complete blood counts (CBCs),
mild-to-moderate normochromic anemia
is observed in the acute stage; the
white blood cell count (WBC) is moderate
to high (50% of patients have a WBC
Kawasaki disease (KD), or greater than 15,000/µL), with a left shift,
mucocutaneous lymph node syndrome, is an which is a predominant sign of
illness that causes inflammation in arteries, immature and mature
veins, and capillaries. It also affects your lymph granulocytes.
nodes and causes symptoms in your nose, • Platelet count. During the subacute
mouth, and throat. It’s the most common cause stage, thrombocytosis is the outstanding
of heart disease in children. marker; the platelet count begins to rise
The good news is that Kawasaki in the second week and continues to rise
disease is usually treatable, and most children during the third week; platelet
recover from the disease within a few days of counts average 700,000/μL, but levels as
treatment without any serious problems high as 2 million have been
Recurrences are uncommon. If left untreated, observed.
KD can lead to serious heart disease. • Cholesterol. Serum cholesterol, high-
density lipoprotein, and apolipoprotein A
A rare but serious illness. levels are decreased; these values
tend to persist beyond clinical resolution
RISK FACTORS of the disease.
Three things are known to increase your • Echocardiography. Echocardiography
child's risk of developing Kawasaki disease. is the study of choice to evaluate for
• Age. Children under 5 years old are most coronary artery aneurysms (CAAs),
at risk of Kawasaki disease. in both fully manifested and suspected
• Sex. Boys are slightly more likely than girls incomplete cases of Kawasaki
are to develop Kawasaki disease. disease.
• Ethnicity. Children of Asian or Pacific • Imaging studies. Magnetic resonance
Island descent, such as Japanese or imaging (MRI), magnetic resonance
Korean, have higher rates angiography (MRA), and ultrafast
of Kawasaki disease. computed tomography (CT) scanning are
other noninvasive tests that can be
ASSESSMENT AND S/S used to evaluate coronary artery
No specific laboratory test is used to abnormalities.
diagnose Kawasaki disease; however, certain • Electrocardiography. On
abnormalities coincide with various stages. electrocardiography (ECG), tachycardia,
81
prolonged PR interval, ST- T wave
changes, and decreased voltage of R
waves may indicate myocarditis; Q waves
or ST-T wave changes may
indicate myocardial infarction.
• Cardiac enzymes. Cardiac enzyme
levels (eg, creatine kinase [CK], creatine
kinase myocardial band [CK-MB],
cardiac troponin, lactate dehydrogenase
[LD-1 >LD-2]) are elevated during
a myocardial infarction.
• high fever that is often higher than 102.2
The child should be assessed in every
F (39 C) and persists for five or more
phase of the disease:
days
• Acute febrile phase. The child appears
• rash on the torso and groin
severely ill and irritable; there is high,
• bloodshot eyes, without crusting
spiking fever for 5 or more days, bilateral
• bright red, swollen lips
conjuctival injection, oropharyngeal
erythema, strawberry tongue, or • “strawberry” tongue, which appears
red and dry lips, erythema and edema of shiny and bright with red spots
hands and feet, periungual • swollen lymph nodes
desquamation, erythematous • swollen hands and feet
generalized rash, and cervical • red palms and soles of the feet
lymphadenopathy greater than 0.6 inch • irritability
(1.5 cm). Heart problems may also appear
during this time.
• Subacute phase. Acute symptoms of
the acute stage subside; temperature Later symptoms begin within two
returns to normal. The child remains weeks of the fever. The skin on the hands and
irritable and anorectic. feet of your child may start to peel and come off
in sheets. Some children may also develop
• Convalescent phase. Check the child’s
temporary arthritis, or joint pain.
new set of diagnostic results to establish
the disease’s status. Other signs and symptoms include:
• abdominal pain
• vomiting
• diarrhea
• enlarged gallbladder
The condition tends to appear during late • temporary hearing loss
winter and spring. In some Asian countries, Call your doctor if your child is showing
cases of KD peak during the middle of summer. any of these symptoms. Children who are
Early symptoms, which can last up to younger than 1 or older than 5 are more likely
two weeks, may include: to present incomplete symptoms. These
children make up the 25 percent of KD cases
that are at a heightened risk of experiencing
heart disease complications.
82
THERAPEUTIC MANAGEMENT warfarin and low molecular weight
The principal goal of treatment for heparin are used in patients with
Kawasaki disease is to prevent coronary artery large aneurysms in whom the risk of
disease and to relieve symptoms. thrombosis is high. The goal is to
Full doses of intravenous immunoglobulin maintain an international normalized
(IVIG) are the mainstay of treatment, along with ratio (INR) of 2-2.5.
other drugs.
• Intravenous immunoglobulin NURSING DIAGNOSIS
reduces the immune response. IVIG Based on the assessment data, the major
relieves acute inflammation and nursing diagnoses are:
has been shown to reduce the rate of • Chronic pain related to inflammation of
coronary aneurysms from greater the myocardium or pericardium.
than 25% in untreated patients to • Risk for decreased cardiac
1-5% in treated patients; maximal output related to accumulation of fluid
benefits are seen when IVIG is given in the pericardial sac.
within the first 10 days of the illness. • Activity intolerance related to
• Aspirin decreases inflammation and inflammation and degeneration of
blocks platelet aggregation. Aspirin myocardial muscle cells.
has a synergistic effect with IVIG and • Impaired skin integrity related to
has long been a standard part of therapy inflammatory process, altered circulation,
for Kawasaki disease; patients on and edema formation.
prolonged aspirin therapy must be • Impaired oral mucous
instructed that concomitant use of membrane related to inflammatory
ibuprofen antagonizes the irreversible process, dehydration, and mouth
effect of platelet inhibition by aspirin and breathing.
should be avoided during therapy;
additionally, the risks of developing Reye The doctor will do a physical examination
syndrome during an active and order blood and urine tests to help in the
infection with influenza or varicella diagnosis. Tests may include:
should be addressed. • Blood tests. Blood tests help rule out
• Other adjunctive agents. In addition other diseases and check your child's
to their use in treatment of IVIG-resistant blood cell count. A high white blood cell
Kawasaki disease, corticosteroids count and the presence of anemia and
have been proposed as part of primary inflammation are signs of Kawasaki
therapy; the roles of other adjunctive disease.
therapies, including pentoxifylline and Testing for a substance
abciximab, have not yet been called B-type natriuretic peptide (BNP)
definitively determined; that's released when the
pentoxifylline acts as an anti- heart is under stress may be helpful in
inflammatory agent by inhibiting tumor diagnosing Kawasaki disease. However,
necrosis factor-alpha and may reduce the more research is needed to confirm this
incidence of aneurysms; abciximab is a finding.
platelet glycoprotein IIb/IIIa • Electrocardiogram. Electrodes are
receptor inhibitor and has been used in attached to the skin to measure the
conjunction with standard therapies electrical impulses of your child's
in patients with Kawasaki disease and heartbeat. Kawasaki disease can cause
giant aneurysms. heart rhythm problems.
• Anticoagulant • Echocardiogram. This test uses
therapy. Anticoagulants such as ultrasound images to show how well the
83
heart is working and can
help identify problems with the coronary
arteries.
• Chest X-ray. A chest X-ray creates black
and white images of the heart and lungs.
A doctor may order
this test to look for signs of heart failure
and inflammation.
Nursing interventions for the patient with
Kawasaki disease are:
• Monitor pain. Monitor pain level and
child’s response to analgesia.
• Cardiac monitoring and
assessment. Take vital signs as
directed by conditions; assess for
signs of mycocarditis (tachycardia,
gallop rhythm, chest pain); and monitor
for heart failure.
• Monitor I&O. Closely monitor intake
and output, and monitor hydration status
by checking skin turgor, weight, urinary
output, specific gravity, and presence of
tears.
• Plan periods of rest and
activities. Allow the child periods of
uninterrupted rest; encourage the
child to move about freely under
supervision; provide soft toys and quiet
play and encourage use of hands
and fingers; and provide quiet, peaceful
environment with diversional
activities.
• Provide oral care. Offer cool liquids
(ice chips and ice pops); progress to soft,
bland foods; and give mouth care every
1 to 4 hours with special mouth swabs;
use soft toothbrush only after healing
has occurred.
84
FIBROADENOMA ⚫ Race: It is more common in African and
Definition : A fibroadenoma is a benign, or American women.
noncancerous, breast tumor. Unlike a breast
⚫ Family History: Fibroadenomas like breast
cancer, which grows larger over time and can
cancers may also run in families.
spread to other organs, a fibroadenoma remains
in the breast tissue. ⚫ Obesity: It is associated with higher
incidences of Fibroadenoma Breast.
They’re pretty small, too. Most are only 1 or 2
centimeters in size. It’s very rare for them to get ⚫ Oral Contraceptive pills (OCP): Women who
larger than 5 centimeters across. consume OCP at very early age are also at
high risk
Usually, a fibroadenoma won’t cause any pain.
It will feel like a marble that moves around ⚫ Pregnancy: Fibroadenoma of breast grow in
beneath your skin. You may describe the texture size during pregnancy while shrink after
as firm, smooth, or rubbery. In some cases, menopause
though, you won’t even be able to feel it at all.
ASSESSMENT AND S/S
Since they’re usually painless, you might not
notice one until you feel a lump while you’re in
the shower or during a self breast exam.
Other times, a doctor might find it on a
mammogram or ultrasound.
In many cases, fibroadenomas require no
⚫ Simple fibroadenomas. They look the treatment. However, some women choose
same all over when you view them under a surgical removal for their peace of mind.
microscope. ⚫ Nonsurgical management
⚫ Complex fibroadenomas. These are it's important to monitor the fibroadenoma with
bigger and tend to affect older women. They
follow-up visits to your doctor for breast
might have cells that grow rapidly. ultrasounds to detect changes in the
⚫ Juvenile fibroadenomas. These are the appearance or size of the lump. If you later
most common type of breast lump found in become worried about the fibroadenoma, you
girls and adolescents between the ages of can reconsider surgery to remove it.
10 and 18. They can grow large, but most
shrink over time. Some disappear.
⚫ Surgery
⚫ Giant fibroadenomas. They can grow to
larger than 2 inches. They may need to be ✓ Lumpectomy or excisional biopsy. In
removed if they press on or replace other this procedure, a surgeon removes breast
breast tissue. tissue and sends it to a lab to check for
cancer.
RISK FACTORS
⚫ Age: Fibroadenomas of breast are ✓ Cryoablation. Your doctor inserts a thin,
commonly seen under the age group of 30. wand-like device (cryoprobe) through your
Most common in age of 15 to 25. But they skin to the fibroadenoma. A gas is used to
can be found to affect women of any age. freeze and destroy the tissue.
85
After a fibroadenoma is removed, it's possible
for one or more new fibroadenomas to develop.
New breast lumps need to be assessed with a
mammogram, ultrasound and possibly biopsy —
to determine if the lump is a fibroadenoma or
might become cancerous.
NURSING DIAGNOSIS
⚫ Impaired Physical Mobility
⚫ Acute Pain
⚫ Anxiety
⚫ Disturbed Body Image
⚫ Perform a comprehensive assessment of
pain to include location, characteristics,
onset/duration, frequency, quality, and
intensity or severity of pain to plan
appropriate interventions
⚫ Support the use of appropriate defense
mechanisms to relieve anxiety.
⚫ Encourage an attitude of realistic hope as a
way of dealing with feelings of helplessness
because hope is associated with better
physical health.
⚫ Assist patient to discuss changes caused by
illness and surgery to promote grief work
and maintain support from family/friends.
86
MYASTHENIA GRAVIS • Monitor pulse oximetry and report O2
Definition: is characterized by weakness and saturation
rapid fatigue of any of the muscles under your • Monitor the patients pulse oximetry every
voluntary control. 4-6 hours
• Administer oxygen if indicated
Causes:
B
• It is an auto -immune disorder. • Assess sign of activity intolerance
• Few are congenital, that is, present at • Monitor pulse oximetry and report 02
birth. saturation <92%
• In rare cases, mother will pass antibodies
that cause the disease onto the child.
However, this is curable in the child.
• Abnormal enlargement or tumor of
thymus gland is associated with
myasthenia gravis and might trigger the
production of antibodies which cause the
condition.
RISK FACTORS
• There are no known risk factors for
myasthenia gravis. People who have a
family history of myasthenia gravis
may be at greater risk to get the
disease
ASSESSMENT AND S/S
• The newborn appears “floppy,” sucks
poorly, and has weak respiratory effort.
• Ptosis (drooping eyelids) may be present
• Diplopia
• Difficulty holding head up from causing
weakness in neck
• Myasthenia gravis is treated by the
administration of neostigmine
(Prostigmin) or pyridostigmine bromide
(Mestinon), acetylcholinesterase
inhibitors that prolong the action of ACh
NURSING DIAGNOSIS
A. Ineffective Breathing pattern related to
neurovascular weakness of the
respiratory muscles and throat
B. Risk for aspiration related to difficulty
swallowing
A
• Assess for signs of activity intolerance.
87
HEMOPHILIAS
Definition: Hemophilia is an inherited disorder
NURSING DIAGNOSIS
of blood coagulation
C. Parental health-seeking behaviors related
There are two types of Hemophilia to strategies for protecting child from
injury
1. Hemophilia A
D. Pain related to joint infiltration by blood
2. von Willebrand’s Disease
E. Risk for interrupted family processes
3. Hemophilia B or Christmas Disease
related to fears regarding child’s
4. Hemophilia C
prognosis and long term nature of illness
Causes:
• Hemophilia A was caused by deficiency of A.
the coagulation component factor VIII, • Parents need information about how to
the antihemophilic factor. prevent bleeding episodes and also how
• Along with a factor VIII defect, there is to respond when one occurs.
also an inability of the platelets to • Prevention of injury is the most important
aggregate (von Willebrand’s Disease) intervention with these children. Help
• Factor IX Deficiency (Hemophilia B) parents to set appropriate limits. An
• Hemophilia C caused by factor XI active infant may need to have crib sides
deficiency padded; all toys need to be inspected for
sharp edges or parts
RISK FACTORS B.
• Autoimmune disorders (SLE, • Immobilization of the affected joint helps
rheumatoid arthritis) to decrease bleeding and also helps
• Infections (Hepatitis C, AIDS) provide relief.
• Drugs (Interferon-alpha) • As soon as the acute bleeding episode
• Dermatological conditions has halted (approximately 48 hours),
(Pemphigus, psoriasis) perform passive range of motion as
ordered to maintain function
ASSESSMENT AND S/S
C.
• Hemophilia often is recognized first in the
• Be certain to give them a chance to
infant who bleeds excessively after
talk about how the bleeding began
circumcision
• Assist them with measures that offer
• Suddenly the lower extremities (where
them a sense of control over the
the child bumps things) become heavily
situation. As children reach school
bruised
age, they must learn to monitor their
• Nosebleeds are common but are not as
own activities to prevent bleeding
severe as with the platelet deficiency
episodes.
syndromes
• With even small abrasion, bleeding must
be controlled by the administration of
factor VIII This may be supplied by fresh
whole blood or by fresh or frozen plasma,
but it is best supplied by a concentrate of
factor VIII.
• administration of desmopressin (DDAVP),
which stimulates the release of factor
VIII, may be helpful
88
ACUTE NASOPHARYNGITIS (Common • Low fever
Cold) • Post-nasal drip
Definition
NURSING CONSIDERATION
The common cold is a contagious viral infection • Wash your hands often with soap
of the upper-respiratory tract. This includes the and water. Wash them for 20 seconds,
nose, throat, and sinuses. A cold also affects the and help young children do the same. If
ears and lungs. Colds are the most common soap and water are not available, use an
disease in the world. Colds affect all ages (often alcohol-based hand sanitizer. Viruses
infants and children) and may occur 2 to 10 that causes colds can live on your hands,
times in a year in an individual. and regular handwashing can help
protect you from getting sick.
ETIOLOGY
Although many types of viruses • Avoid touching your eyes, nose, and
can cause a common cold, rhinoviruses are mouth with unwashed hands.
the most common culprit. A cold virus enters Viruses that causes colds can enter your
your body through your mouth, eyes or nose. body this way and make you sick.
• Make sure to wear mask and gloves
INCUBATION PERIOD when dealing with a patient that
Symptoms will usually appear within one to has colds. PPE’s can lessen your risk
three days of getting infected. Symptoms from getting infected by the virus.
may last from one week to 10 days, but they
can last longer. TREATMENT
There's no cure for the common cold. Antibiotics
COMMUNICABILITY PERIOD are of no use against cold viruses and shouldn't
For colds, most individuals become contagious be used unless there's a bacterial infection.
about a day before cold symptoms Treatment is directed at relieving signs and
develop and remain contagious for about symptoms.
five to seven days. Some children may pass
the flu viruses for longer than seven days • Pain relievers. For a fever, sore throat
(occasionally for two weeks). and headache, many people turn to
acetaminophen (Tylenol, others) or other
MODE OF TRANSMISSION mild pain relievers. Use acetaminophen
The common cold virus is typically transmitted for the shortest time possible and follow
via airborne droplets (aerosols), direct label directions to avoid side effects.
contact with infected nasal secretions, or Use caution when giving aspirin to
fomites (contaminated objects). children or teenagers. Children and
NURSING ASSESSMENT (SIGNS & teenagers recovering from chickenpox or
SYMPTOMS) flu-like symptoms should never take
Common symptoms of nasopharyngitis include: aspirin. This is because aspirin has been
linked to Reye's syndrome, a rare but
• Runny or stuffy nose
potentially life-threatening condition, in
• Sneezing
such children.
• Coughing
Consider giving your child over-the-
• Sore or scratchy throat
counter (OTC) pain medications designed
• Watery or itchy eyes
for infants or children. These include
• Headache
acetaminophen (Children's Tylenol,
• Tiredness
FeverAll, others) or ibuprofen (Children's
• Body aches
89
Advil, Children's Motrin, others) to ease they have touched, and after blowing
symptoms. your nose. If a child has a cold, wash his
• Decongestant nasal sprays. Adults or her toys after play.
can use decongestant drops or sprays for • Keep fingers away from your nose
up to five days. Prolonged use can cause and eyes to avoid infecting yourself with
rebound symptoms. Children younger cold virus particles you may have been
than 6 shouldn't use decongestant drops picked up.
or sprays. • Put up a second hand towel in the
• Cough syrups. The Food and Drug bathroom for healthy people to use.
Administration (FDA) and the American • Keep an eye on the humidity of your
Academy of Pediatrics strongly environment so that sinuses do not dry
recommends against giving OTC cough out.
and cold medicines to children younger
COMPLICATION
than age 4 as they may be harmful.
Post-infectious cough, usually without phlegm,
There's no good evidence that these
may last for weeks to months after the cold goes
remedies are beneficial or safe for
away and may keep a person up at night. This
children.
cough has been associated with asthma-like
It isn't typically recommended that you
symptoms, and can be treated with asthma
give cough or cold medicines to an older
medications. Consult a healthcare provider if
child, but if you do, follow the label
you have this kind of cough.
directions. Don't give your child two
medicines with the same active Talk to a healthcare provider if you experience
ingredient, such as an antihistamine, any of the following:
decongestant or pain reliever. Too much
• Unusually severe cold symptoms
of a single ingredient could lead to an
• High fever
accidental overdose.
• Ear pain
Lifestyle and Home Remedies • Sinus type headache
• Cough that gets worse while other cold
• Drinking plenty of fluids. Water, juice,
symptoms improve
clear broth or warm lemon water are
• Flare-up of any chronic lung problem,
good choices. Avoid caffeine and alcohol,
such as asthma.
which can dehydrate you.
• Resting. If possible, stay home from
work or school if you have a fever or a
bad cough or are drowsy after taking
medications. This will give you a chance
to rest as well as reduce the chances that
you'll infect others.
PREVENTION
• Avoid close contact with people who
have a cold, especially during the first
few days when they are most likely to
spread the infection.
• Wash hands after touching someone
who has a cold, after touching an object
90
CEREBRAL PALSY Toddlers/ Children
Definition
Although the brain of toddlers/children with
Cerebral palsy (CP) is a group of disorders that cerebral palsy remains injured, the injury does
affect a person's ability to move and maintain not get worse as they develop.
balance and posture. CP is the most common
Depending on the level of severity of their
motor disability in childhood. Cerebral means
cerebral palsy, toddlers and children may
having to do with the brain. Palsy means
experience difficulties with their physical
weakness or problems with using the muscles.
development such as:
RISK FACTORS
Some things increase the chance that a child will • not walking by 12-18 months
have CP. These are called risk factors. It is • not speaking simple sentences by 24
important to remember that having a risk factor months
does not mean that a child will have CP. If your child is not reaching these milestones or
• Infection―Infections of the brain, for they display some of the signs of cerebral palsy,
example, meningitis or encephalitis you may need to speak to your early childhood
during infancy. nurse, general practitioner or pediatrician.
• Injury―Injuries to the brain, for THERAPEUTIC MANAGEMENT
example, head injuries caused by motor Children and adults with cerebral palsy require
vehicle crashes or child abuse. long-term care with a medical care team.
• Problem with blood flow to the Besides a pediatrician or physiatrist and possibly
brain―Cerebrovascular accidents, for a pediatric neurologist to oversee your child's
example, stroke or bleeding in the brain medical care, the team might include a variety
associated with a blood clotting problem, of therapists and mental health specialists.
blood vessels that didn’t form properly, a
MEDICATIONS
heart defect that was present at birth, or
sickle cell disease. Medications that can lessen muscle tightness
might be used to improve functional abilities,
ASSESSMENT AND S/S
There are some signs that may indicate a child treat pain and manage complications related to
has cerebral palsy. Not all signs are visible at spasticity or other cerebral palsy symptoms.
birth and may become more obvious as babies Muscle of nerve injections
develop.
To treat tightening of a specific muscle, your
Infants doctor might recommend injections of
• Low muscle tone (baby feels ‘floppy’ onabotulinumtoxinA (Botox, Dysport) or another
when picked up) agent. Your child will need injections about
• Unable to hold up its own head while every three months.
lying on their stomach or in a supported Side effects can include pain at the injection site
sitting position and mild flu-like symptoms. Other more-serious
• Muscle spasms or feeling stiff side effects include difficulty breathing and
• Poor muscle control, reflexes and posture swallowing.
• Delayed development (can’t sit up or
independently roll over by 6 months) Oral muscle relaxants
• Feeding or swallowing difficulties Drugs such as diazepam (Valium), dantrolene
• Preference to use one side of their body (Dantrium), baclofen (Gablofen, Lioresal) and
91
tizanidine (Zanaflex) are often used to relax improve your child's ability to speak
muscles. clearly or to communicate using sign
language. They can also teach the use of
Diazepam carries some dependency risk, so it's
communication devices, such as a
not recommended for long-term use. Side
computer and voice synthesizer, if
effects of these drugs include drowsiness, blood
communication is difficult.
pressure changes and risk of liver damage that
Speech therapists can also address
requires monitoring.
difficulties with eating and swallowing.
In some cases, baclofen is pumped into the • Recreational therapy. Some children
spinal cord with a tube. The pump is surgically benefit from regular or adaptive
implanted under the skin of the abdomen. recreational or competitive sports
activities, such as therapeutic horseback
Your child might also be prescribed medication
riding or skiing. This type of therapy can
to reduce drooling — possibly Botox injections
help improve your child's motor skills,
into the salivary glands.
speech and emotional well-being.
THERAPIES
SURGICAL PROCEDURES
A variety of therapies play an important role in
Surgery may be needed to lessen muscle
treating cerebral palsy:
tightness or correct bone abnormalities caused
• Physical therapy. Muscle training and by spasticity. These treatments include:
exercises can help your child's strength,
• Orthopedic surgery. Children with
flexibility, balance, motor development
severe contractures or deformities might
and mobility. You'll also learn how to
need surgery on bones or joints to place
safely care for your child's everyday
their arms, hips or legs in their correct
needs at home, such as bathing and
positions.
feeding your child.
Surgical procedures can also lengthen
For the first one to two years after birth,
muscles and tendons that are shortened
both physical and occupational therapists
by contractures. These corrections can
provide support with issues such as head
lessen pain and improve mobility. The
and trunk control, rolling, and grasping.
procedures can also make it easier to use
Later, both types of therapists are
a walker, braces or crutches.
involved in wheelchair assessments.
• Cutting nerve fibers (selective
Braces or splints might be recommended
dorsal rhizotomy). In some severe
for your child to help with function, such
cases, when other treatments haven't
as improved walking, and stretching stiff
helped, surgeons might cut the nerves
muscles.
serving the spastic muscles in a
• Occupational therapy. Occupational
procedure called selective dorsal
therapists work to help your child gain
rhizotomy. This relaxes the muscle and
independence in daily activities and
reduces pain, but can cause numbness.
routines in the home, the school and the
community. Adaptive equipment NURSING DIAGNOSIS
recommended for your child can include • Impaired Physical Mobility
walkers, quadrupedal canes, seating • Imbalanced Nutrition: Less than Body
systems or electric wheelchairs. Requirements
• Speech and language therapy. • Impaired Verbal Communication
Speech-language pathologists can help
92
• Ineffective Therapeutic Regimen • Facilitate communication. Talk to the
Management child deliberately and slowly, using
• Risk for Injury pictures to reinforce speech when
• Risk for Delayed Growth and needed; encourage early speech therapy
Development to prevent poor or maladaptive
• Risk for Self-care Deficit communication habits; and provide
means of articulate speech such as sign
language or a picture board.
• Ensure therapeutic communication.
• Enforce therapeutic measures. Assist
To ease the change of environment, the
in multidisciplinary therapeutic measures
nurse needs to communicate with the
designed to establish locomotion,
family to learn as much as possible about
communication, and self-help, gain
the child’s activities at home.
optimal appearance and integration of
• Enhance self-esteem. Assist the
motor functions.
patient to increase his/her personal
judgment of self-worth.
• Provide emotional support. Provision
of reassurance, acceptance, and
encouragement during times of stress.
• Strengthen family support. Utilize the
family’s strengths to influence patient’s
health in a positive direction.
• Prevent injury. Prevent physical injury
by providing the child with a safe
environment, appropriate toys, and
protective gear (helmet, kneepads) if
needed.
• Prevent deformity. Prevent physical
deformity by ensuring the correct use of
prescribed braces and other devices and
by performing ROM exercises.
• Encourage mobility. Promote mobility
by encouraging the child to perform age-
and condition-appropriate motor
activities.
• Increase oral fluid intake. Promote
adequate fluid and nutritional intake.
• Manage sleep and rest periods.
Foster relaxation and general health by
providing rest periods.
• Enhance self-care. Encourage self-
care by urging the child to participate in
activities of daily living (ADLs) (e.g. using
utensils and implements that are
appropriate for the child’s age and
condition).
93
CONGESTIVE HEART FAILURE pressure). A child may appear cyanotic from
Congestive heart failure (CHF) usually interference with gas exchange in the
occurs as a result of a congenital heart disorder alveoli, which begin to fill with fluid (pulmonary
or a disease such as rheumatic fever, Kawasaki edema). Left-sided heart failure can
disease, or infectious endocarditis. ultimately lead to right-sided heart failure
as extensive pressure in the pulmonary
This occurs when the myocardium of the heart system prevents blood from leaving the
cannot pump and circulate enough blood to right ventricle.
supply oxygen and nutrients to body cells
RISK FACTORS
Blood pools in the heart (excessive preload) or
in the pulmonary or venous systems. This may
result from a congenital disorder that lessens
the effectiveness of the heart’s pumping action,
or it may occur after cardiac surgery or
rheumatic fever, when the myocardium is
weakened
Severe anemia, hypocalcemia, and myocarditis

may contribute to the heart’s inability to
function effectively.
ASSESSMENT AND S/S

One of the first signs of CHF is tachycardia
as the heart attempts to beat faster to move
blood forward more effectively; this is quickly
followed by tachypnea or rapid breathing
When a child has primary right heart failure,

increased venous pressure and
hepatomegaly (enlarged liver) occur from
back-pressure in the portal circulation.
The child may feel irritable and restless from
the abdominal pain caused by the liver • The infant becomes breathless from
distention. Lower extremity edema, usually a rapid respirations, tires easily, and has
primary sign in adults, is often a late sign difficulty feeding because of the
of heart failure in children exhaustion and dyspnea present.
• Then diaphoretic from the effort of
Left-sided heart failure, back-pressure feeding. If edema is present, it is
causes blood to accumulate in the generalized rather than dependent and
pulmonary system. Dyspnea is usually the often is first noticed as periorbital edema.
dominant symptom, especially when a child • An abrupt gain in weight may be the
lies flat (this is orthopnea or difficulty breathing most obvious indication that extra fluid is
except in an upright position; it occurs due to accumulating. On physical examination,
increased pulmonary congestion). A child may an infant will have an enlarged liver (a
have rales and may produce bloody liver palpable more than
sputum on coughing (from lung capillaries • The apical heartbeat is displaced laterally
broken under increased pulmonary blood
94
and downward.
• A galloping heart rhythm or an
accentuated third heart sound may be
heard because of the sudden distention
of the ventricle during the rapid filling
phase.
Commonly used diuretics include furosemide
(Lasix) and spironolactone (Aldactone). The
most common drug used to increase
contractility and slow tachycardia is digoxin.
Drugs that decrease afterload include
hydralazine, an arterial side, a direct-acting
vasodilator; and captopril, an angiotensin-
converting enzyme (ACE) inhibitor (Karch,
2009)
TNURSING DIAGNOSIS
Nursing Diagnosis: Ineffective
cardiopulmonary and peripheral tissue perfusion
related to inadequate heart function
Outcome Evaluation: Child’s pulse, blood

pressure, and respiratory rate are within
acceptable parameters for age group; abnormal
heart sounds, edema, and ascites are absent
ENT
• Provide for Rest Periods.
• Provide Oxygen as Necessary.
• Administer Drugs as Prescribed to
Improve Heart Action.
• Assess child’s intake and output for
adequacy.
• Assess parents’ understanding of
child’s condition
• Assess whether parents feel they
have enough emotional support to
care for an ill infant
• Assess whether parents have any
further questions about child’s
condition or needs.
95
IDIOPATHIC THROMBOCYTOPENIC • Intravenous immunoglobulin (IVIg) - If
PURPURA your bleeding has reached a critical level
Idiopathic thrombocytopenic purpura is an or you’re going to have surgery and need
immune disorder in which the blood doesn’t clot to increase your platelet count quickly,
normally. This condition is now more commonly you may be given intravenous
referred to as immune thrombocytopenia (ITP). immunoglobulin (IVIg).
Anti-D immunoglobulin - This is for
ITP can cause excessive bruising and bleeding. people who have Rh-positive blood. Like
An unusually low level of platelets, or IVIg therapy, it can quickly increase the
thrombocytes, in the blood results in ITP. platelet count, and it may work even
faster than IVIg. However, it can have
serious side effects, so individuals should
be carefully chosen for this treatment.
• Rituximab (Rituxan) - This is an antibody
therapy that targets the immune cells
responsible for producing the proteins
that attack platelets.
• Thrombopoietin receptor agonists -
including romiplostim (Nplate) and
eltrombopag (Promacta), help prevent
bruising and bleeding by causing your
bone marrow to produce more platelets.
• General immunosuppressants - inhibit
the overall activity of the immune
system. They don’t target specific
components of the immune system
RISK FACTORS
related to ITP. These include:
ITP is more common among young women. The
o cyclophosphamide (Cytoxan)
risk appears to be higher in people who also
o azathioprine (Imuran, Azasan)
have diseases such as rheumatoid arthritis,
o mycophenolate (CellCept)
lupus and antiphospholipid syndrome.
• Antibiotics - Helicobacter pylori, which is
the bacteria that causes most peptic
ASSESSMENT AND S/S
ulcers, has been associated with ITP in
Immune thrombocytopenia may have no signs
some people. Antibiotic therapy to
and symptoms. When they do occur, they may
eliminate H. pylori has been shown to
include:
help increase platelet counts in certain
• Easy or excessive bruising
individuals.
• Superficial bleeding into the skin that
appears as pinpoint-sized reddish-purple
Surgery
spots (petechiae) that look like a rash,
Splenectomy - If you have severe ITP and
usually on the lower legs
medication doesn’t improve your symptoms or
• Bleeding from the gums or nose
platelet count, your doctor may advise surgery
• Blood in urine or stools
to remove your spleen.
• Unusually heavy menstrual flow
Emergency Treatment
Medications
Severe or widespread ITP requires emergency
• Corticosteroids - such as prednisone
treatment. This usually includes transfusions of
(Rayos), which can increase your platelet
concentrated platelets and intravenous
count by decreasing the activity of your
administration of a corticosteroid such as
immune system.
96
methylprednisolone (Medrol), IVIg, or anti-D immediately; avoid use of restraints;
treatments. obtain a physician’s order if restraints are
needed; and eliminate or drop all
Lifestyle Changes possible hazards in the room such as
• Avoid certain over-the-counter drugs that razors, medications, and matches.
can affect platelet function, including • Prevent infection. Wash hands and
aspirin, ibuprofen (Advil, Motrin), and the teach patient and SO to wash hands
blood-thinning medication warfarin before contact with patients and between
(Coumadin). procedures with the patient; encourage
• Limit your intake of alcohol because fluid intake of 2,000 to 3,000 mL of water
consuming alcohol can adversely affect per day, unless contraindicated;
blood clotting. recommend the use of soft-bristled
• Choose low-impact activities instead of toothbrushes and stool softeners to
competitive sports or other high-impact protect mucous membranes; and if
activities to decrease your risk of injury infection occurs, teach the patient to take
and bleeding. antibiotics as prescribed; instruct patient
T to take the full course of antibiotics even
NURSING DIAGNOSIS if symptoms improve or disappear.
Based on the assessment data, the major
nursing diagnoses for idiopathic References:
thrombocytopenic purpura are: Donohue, M. (2018, February 15). Idiopathic
• Risk for bleeding related to decreased Thrombocytopenic Purpura (ITP).
platelet count. Healthline.
• Risk for injury related to abnormal blood https://www.healthline.com/health/idiop
profile. athic- thrombocytopenic-purpura-
• Risk for ineffective protection related to itp#treatments.
altered kinesthetic perception. Mayo Foundation for Medical Education and
• Risk for infection related to suppression Research. (2019, April 30). Immune
of the immune system by steroids. thrombocytopenia (ITP). Mayo Clinic.
https://www.mayoclinic.org/diseases
TH conditions/idiopathic- thrombocytopenic
NURSING INTERVENTION purpura/symptoms-causes/syc-20352325.
• Prevent bleeding. Review laboratory Belleza, M., By, -, Belleza, M., &
results for coagulation status as Marianne is a staff nurse during the
appropriate: platelet count, prothrombin day and a Nurseslabs writer at night. She is
time/international normalized ratio a registered nurse since 2015 and is
(PT/INR), activated partial currently working in a regional tertiary
thromboplastin time (aPTT), fibrinogen, hospital and is finishing her Master's in
bleeding time, fibrin degradation Nursing this June. As an outpatient
products, vitamin K, activated department nurse. (2021, February 11).
coagulation time (ACT); and educate the Idiopathic Thrombocytopenic Purpura
at-risk patient and caregivers about Nursing Care Management. Nurseslabs.
precautionary measures to prevent tissue https://nurseslabs.com/idiopathic-
trauma or disruption of the normal thrombocytopenic- purpura/.
clotting mechanisms.
• Prevent injury. Thoroughly conform
patient to surroundings; put call light
within reach and teach how to call for
assistance; respond to call light
97
SYNDROME OF INAPPROPRIATE • Monitor intake and output. Note
ANTIDIURETIC HORMONE (SIADH) decreased urinary output and positive
The SIADH is a rare condition in which there is fluid balance on 24-hour calculations.
overproduction of ADH by the posterior pituitary • Assess for presence and location of
gland. edema formation.
• Monitor infusion rate of parenteral fluids
RISK FACTORS closely; May use infusion pump, as
• Central nervous system infections (such necessary.
as bacterial meningitis) • Administer oral fluids with caution. Do a
• Long-term positive pressure ventilation, 24-hour schedule fluid intake if fluids are
or pituitary compression (such as from restricted.
edema or tumor) • Assess level of consciousness and
neuromuscular response.
ASSESSMENT AND S/S • Provide safety and seizure precautions.
Mild symptoms of hyponatremia Maintain a calm, quiet environment.
• Weight gain • Encourage fluids and foods high in
• Concentrated urine (increased specific sodium such as meat, milk, beets, celery,
gravity) eggs, and carrots. Use fruit juices and
• Nausea bouillon instead of water.
• Vomiting • Monitor serum and urine electrolytes and
osmolality.
Severe hyponatremia
• Coma or seizures occur from brain edema References
Pillitteri, A. (n.d.). Chapter 48: Nursing Care of
THERAPEUTIC MANAGEMENT a Family When a Child Has an Endocrine or
• Fluid restriction a Metabolic Disorder. In Maternal &
• Supplementation of sodium by IV fluid (if Child Health Nursing (Seventh Edition,
needed) Vol. Volume 2, p. 1407). essay, C&E
• Demeclocycline (Declomycin) - a Publishing, Inc.
tetracycline antibiotic that has the side Martin, P., By, -, Martin, P., & Paul Martin
effect of blocking the action of ADH in is a registered nurse with a bachelor of
renal tubules and reducing resorption of science in nursing since 2007. Having worked as
water, may be prescribed a medical-surgical nurse for five years.
(2020, December 5). 10 Fluid And
NURSING DIAGNOSIS Electrolyte Imbalances Nursing Care Plans.
• Excess fluid volume Nurseslabs.
• Electrolyte imbalance (hyponatremia) https://nurseslabs.com/fluid-electrolyte-
imbalances-nursing-care-plans/.
• Monitor vital signs as well as central
venous pressure, if available.
• Weigh client daily. Observe for sudden EASE
weight gain.
• Note presence of neck and peripheral
vein distention, along with pitting edema,
and dyspnea.
• Auscultate lung and heart sounds.
98
MUMPS • Hygienic practices. Assess the
Definition: Mumps is a viral infection that family’s hygienic practices to prevent
primarily affects saliva-producing (salivary) the spread of the disease.
glands that are located near your ears. Mumps
can cause swelling in one or both of these
glands.
Symptoms
ETIOLOGIC AGENT
It is a viral illness caused by a paramyxovirus, a
member of the Rubulavirus family. Some people infected with the mumps virus
have either no signs or symptoms or very mild
INCUBATION PERIOD ones. When signs and symptoms do develop,
The average incubation period for mumps is 16 they usually appear about two to three weeks
to 18 days, with a range of 12 to 25 days. after exposure to the virus.
COMMUNICABILITY PERIOD The primary sign of mumps is swollen salivary
Mumps is communicable from 6–7 days before glands that cause the cheeks to puff out. Other
to 9 days after the onset of parotitis (a painful signs and symptoms may include:
swelling of your parotid glands). Asymptomatic
and inapparent cases can also be infectious. Pain in the swollen salivary glands on one or
both sides of your face
MODE OF TRANSMISSION
The mumps virus replicates in the upper • Pain while chewing or swallowing
respiratory tract and is transmitted person to • Fever
person through direct contact with saliva or • Headache
respiratory droplets of a person infected with • Muscle aches
mumps • Weakness and fatigue
• Loss of appetite
ASSESSMENT AND S/S
NURSING CONSIDERATION
Nursing Assessment
Nursing Diagnosis
• Physical exam. Assess the child for • Impaired social interaction related to
symptoms that may indicate the isolation from friends.
presence of measles. • Risk for impaired skin integrity related to
• Knowledge of the disease. Assess raking pruritus.
the patient’s or significant other’s • High risk of infection related to the host
knowledge regarding the disease. and infectious agents.
99
• Acute pain related to skin lesions and • Eat a soft diet of soup, yogurt, and other
irritated mucous membranes. foods that aren’t hard to chew (chewing
may be painful when your glands are
Nursing Interventions
swollen).
• Isolation. Patients will need to be on • Avoid acidic foods and beverages that
isolation precautions to decrease may cause more pain in your salivary
transmission within the community; glands.
emphasize the need for immediate PREVENTION
isolation when early catarrhal symptoms The best way to prevent mumps is to be
appear. vaccinated against the disease.
• Skin care. Measles causes The mumps vaccine is usually given as a
extreme pruritus; nursing interventions combined measles-mumps-rubella (MMR)
include keeping the patient’s nails short, inoculation, which contains the safest and most
encourage long pants and sleeves to effective form of each vaccine. RAPEUTIC ENT
prevent scratching, keeping skin moist
with health care provider recommended COMPLICATION
lotions, and avoiding sunlight and heat. Mumps complications include orchitis,
oophoritis, mastitis, meningitis, encephalitis,
• Eye care. Treat conjunctivitis with warm
pancreatitis, and hearing loss. Complications
saline when removing eye secretions and
can occur in the absence of parotitis and occur
encourage patient not to rub eyes;
less frequently in vaccinated patients. Some
protect the eyes from the glare of strong
light. complications are known to occur more
frequently among adults than children.
• Hydration.
• Temperature control. Antipyretics
should be administered to the patient as
ordered for a temperature greater than
100.4 Fahrenheit unless directed
elsewise by a healthcare provider; be
sure to remind parents not to administer
aspirin due to the risk of Reye’s
syndrome.
TREATMENT
Because mumps is a virus, it doesn’t respond to
antibiotics or other medications. Treatment is
based on alleviating symptoms, these include:
• Rest when you feel weak or tired.

• Take over-the-counter pain relievers,
such as acetaminophen and ibuprofen, to
bring down your fever.
• Soothe swollen glands by applying ice
packs.
• Drink plenty of fluids to
avoid dehydration due to fever.
100
ACUTE RENAL FAILURE • Administering sodium bicarbonate
Acute renal failure most often occurs because of may cause a shift of potassium
a sudden body insult, such as severe from the bloodstream into cells,
dehydration. The chronic form results from temporarily reducing the
extensive kidney disease, such as hemolytic- circulating potassium level.
uremic syndrome or glomerulonephritis. This • Administration of a combination of
develops rapidly, usually in less than a few days. IV glucose and insulin may also be
RISK FACTORS effective (insulin helps glucose
• prolonged anesthesia, hemorrhage, move into cells).
shock, severe diarrhea, or sudden • Diet should be low in protein,
traumatic injury potassium, and sodium and high
• occur in children who are placed on in carbohydrate to supply enough
cardiopulmonary bypass while calories for metabolism yet limit
undergoing heart surgery urea production and control serum
• children who receive common antibiotics potassium levels.
(aminoglycosides, penicillin, • A diuretic such as furosemide
cephalosporins, and sulfonamides) (Lasix) may be ordered in an
• who swallow a poison such as arsenic attempt to increase urine
(found in rat poison), or who are exposed production.
to industrial wastes such as mercury • Fluid intake may be limited to
ASSESSMENT AND S/S prevent heart failure due to
• Oliguria,a urine output of less than 1 accumulating fluid that cannot be
mL/kg of the child’s body weight/hour excreted.
• Azotemia (accumulation of nitrogen NURSING DIAGNOSIS
waste in the bloodstream) will occur Excess fluid volume r/t compromised regulatory
because of the oliguria mechanism as evidenced by intake greater than
• Uremia (extra accumulation of nitrogen output, oliguria
wastes in the blood, with additional toxic NURSING INTERVENTION
symptoms such as cerebral irritation)
also may occur • Weigh children daily (same scale, same
• the BUN rises clothing, same time of day) and maintain
• Hyperkalemia (elevated potassium level) accurate intake and output recordings to
may occur if potassium cannot be evaluate fluid status.
excreted
• Acidosis will occur • Parents and children should be given
THEAPEUTIC MANAGEMENT support during IVP or radioactive uptake
scan, because the results may be
• A BUN level greater than 80 to 100 disappointing and so different from what
mg/100 mL is toxic and needs they hoped they would be.
correction, usually by dialysis • If the child is dehydrated (as with
• An IVP or radioactive uptake scan diarrhea or hemorrhage), IV fluid is
may be ordered to substantiate needed to replace plasma volume.
the lack of kidney function.
• If children are so ill that they cannot eat,
• Potassium levels greater than 6
total parenteral nutrition may be
mEq/L are corrected by the IV
necessary. Regulate amounts carefully to
administration of calcium
prevent fluid overload.
gluconate (as the glucose moves
into cells, it carries potassium with
it)
101
CRYPTORCHIDISM • Physical examination. Physical
examination is the most important
Occurs when one or both of the testicles do not tool in the diagnostic evaluation of
descend into the scrotum while the fetus is cryptorchidism; the patient must be
developing. During gestation, the testicles form examined in a warm, relaxed
in the abdomen and gradually drop through the environment; closely observing the
inguinal canal into the scrotum at around month scrotum before manipulation is
8 of pregnancy. Occasionally one or both of the important; the frog-leg or catcher
testes do not descend, which is a condition position may be used to facilitate
called cryptorchidism. palpation of the testis.
• Hormonal therapy. Hormonal

therapy should be considered for
patients in whom the diagnosis of
retractile testis is not certain;
hormonal therapy has been employed
in Europe for many years as a primary
SYMPTOMS therapy for cryptorchidism; the main
Undescended testicles may be palpable or hormones used are human chorionic
unpalpable. gonadotropin (hCG) and luteinizing
hormone (LH)-releasing hormone
• Abdominal: The least common location (LHRH); in Europe, these two
for an undescended testicle is in the hormones have been given in
abdomen. combination, with initial success rates
• Inguinal: The testicle has moved into the
of 14-65%; however, some long-term
inguinal canal, but not far enough to be studies have shown lower success
detectable by touch. rates.
• Atrophic or absent: The testicle is either
very small, or it has never formed. • Orchiopexy. A surgical procedure
RISK FACTORS called orchiopexy is used to bring the
testis down into the scrotum and
• premature birth, with an earlier delivery anchor it there; surgery is usually
carrying a greater risk performed when the child is 1 to 2
• a low birth weight, which may double or years old; prognosis for a normal
triple the risk functioning testicle is good when the
• Down’s syndrome and other conditions surgery is performed at this young age
that slow fetal growth and no degenerative action has taken
• a family history of issues with genital place before treatment.
development
• tobacco consumption by a mother during NURSING DIAGNOSIS
pregnancy
• Impaired urinary
ASSESSMENT AND S/S elimination related to the condition
and surgical intervention.
• History. Obtain history from prenatal
• Disturbed body image related to
and birth records, and through
appearance of the genitalia.
interviews from family caregivers.
102
• Risk for infection related to surgical technique, and inspect incision for
incision and drainage tubes. drainage or signs of infection.
• Deficient knowledge related to the • Maintaining fluid
condition and surgery. volume. Administer fluids as
ordered; monitor vital signs for
hypotension or tachycardia; assess
NURSING INTERVENTION patient’s skin turgor and mucous
• Understanding the surgical membranes for signs of dehydration;
treatment. Determine the child’s measure and record accurate intake
expectation regarding illness and and output.
hospitalization through discussion and • Promoting comfort. Administer
play therapy; explain the anatomy and analgesics as ordered and according
physiology of the urinary system in to the assessment of complaints of
terms the child can understand; use a pain, restlessness, crying, or
body outline appropriate for the age withdrawal; administer
of the child, and explain all diagnostic antispasmodics as ordered for bladder
tests before their occurrence. spasm, and provide distraction and
• Promoting normal urine comfort measures.
output. Monitor daily intake and
output; encourage adequate fluids
and monitor daily weights; care for all
catheters and urinary tubes according
to facility policy; maintain appropriate
position of tubes; observe and record
amount and appearance of urinary
drainage, occurrence of bladder
spasms, symptoms of urinary or
incisional infection.
• Providing emotional support
regarding body image. Continue
reassurance about appearance of
genitalia; maintain discussions
regarding reactions; this may need to
be done with patient and family alone
as well as a family unit; discuss plans
for interim period from initial surgery
until secondary or reconstructive
procedures can be performed; initiate
independence of care; and focus on
activities the child can perform and
accomplish.
• Preventing infection. Administer
antibiotics and I.V. fluids as ordered;
maintain patency of catheters;
provide catheter care as directed;
administer wound care using aseptic
103
CONGENITAL GLAUCOMA test, the ophthalmologist applies some
In congenital glaucoma, the intraocular drops to numb the eyes and then places
pressure increases because there is a birth an instrument on the eye to measure the
defect in the development of the angle of the pressure. Normal ocular pressure is
eye as a result of poor development of the eye. between 10 and 20 mm of mercury.
This means that the aqueous humour cannot
flow out normally, so the intraocular pressure
increases and leads to optic nerve damage. THERAPEUTIC MANAGEMENT
1. Eye drops. The eye drops help
improve fluid drainage or decrease
amount of fluid produced by the eye.
Depending on the target eye pressure,
the patient may be prescribed one or
more of the following:
2. Prostaglandins – increase outflow of
fluid in the eyes; side effects include
mild eye reddening and stinging, iris
darkening, eyelashes or eyelid skin
RISK FACTORS darkening, and blurred vision
The only known risk factors are genetic -
3. Beta blockers – reduce eye fluid
consanguinity and affected siblings. Parents
production; side effects include
of PCG patients should be aware that the
difficulty of breathing, hypotension,
chance of a second child with PCG is a small
bradycardia, impotence, and fatigue
but real risk that usually is no more than 3%.
If two children have the disease, then the 4. Alpha adrenergic agonists – increase
risk of subsequent children increases to as outflow of fluid in the eye and reduce
high as 25%, with the assumption of aqueous humour production; side
autosomal recessive inheritance. In 2018, effects include irregular heart rate,
Yu-Wai-Man et al compiled the clinical utility hypertension, fatigue, red, itchy or
gene card for PCG which describes situations swollen eyes, and dry mouth
for which gene testing may be useful. 5. Carbonic anhydrase inhibitors – reduce
ASSESSMENT AND fluid production; side effects include
metallic taste, urinary frequency, and
• Examination of the front part of the tingling in fingers and toes
eye: This aims to assess the condition of 6. Rho kinase inhibitors –reduce fluid
the cornea and the angle and then build-up; side effects include eye
determine the most appropriate surgical redness, or eye discomfort
procedure for each case.
• Examination of the fundus: After 7. Mitotic or cholinergic agents -increase
dilating the pupils with eye drops, the fluid outflow; side effects include
ophthalmologist looks through a special headache, eye ache, smaller pupils,
magnifying lens to examine the retina blurred vision, and near-sightedness
and optic nerve and identify any signs of Oral medications. If eye drops are insufficient,
damage. Glaucoma causes a progressive oral medications like a carbonic anhydrase
loss of nerve fibres from the optic nerve, inhibitor will be prescribed.
resulting in a gap (excavation) that
increases in size as the disease develops.
• Tonometry: This is performed to NURSING DIAGNOSIS
measure eye pressure. To perform this
104
• Disturbed Visual Sensory Perception
related to altered status of the eyes and
vision secondary to glaucoma, as
evidenced by blurry vision, eye pain, eye
redness, and patchy blind spots on the
peripheral and central visual fields on
both eyes
• Deficient Knowledge related to new
diagnosis of glaucoma as evidenced by
patient’s verbalization of “I want to know
more about my new diagnosis and care”
• Anxiety
• Risk for Injury
• Eye Pain
• Powerlessness
• Assess the patient’s current visual
acuity and visual field.
• Discuss the possibility of loss of vision
and allow the patient to express
his/her feelings towards it.
• Administer the eye drops as
prescribed.
• Teach the patient on how to properly
administer them and educate him/her
the right schedule to administer the
drops daily as prescribed. Allow the
patient to demonstrate the procedure
• Prepare for surgical intervention
intended for glaucoma. Surgical
interventions to treat glaucoma
include:Laser TherapyIridectomy
Filtering surgery Drainage tubes
Minimally invasive glaucoma surgery
105
ASTHMA • Obesity
Asthma is a chronic disease that causes the Children and adults who are overweight
airways of the lungs to swell and narrow. It or obese are at a greater risk of asthma.
leads to breathing difficulty such as wheezing, Although the reasons are unclear, some
shortness of breath, chest tightness, and experts point to low-grade inflammation
coughing. in the body that occurs with extra weight.
Obese patients often use more
RISK FACTORS
• Family history medications, suffer worse symptoms and
If you have a parent with asthma, you are less able to control their asthma than
are three to six times more likely to patients in a healthy weight range.
develop asthma than someone who does ASSESSMENT AND S/S
not have a parent with asthma. Medical history
• Viral respiratory infections The first step in diagnosing asthma is talking to
Respiratory problems during infancy and the doctor about the symptoms and the health.
childhood can cause wheezing. Some This can provide clues as to whether asthma or
children who experience viral respiratory something else is causing the symptoms. The
infections go on to develop chronic doctor will likely ask about the symptoms and
asthma. the exposure to substances that have been
linked to asthma.
• Allergies
Having an allergic condition, such as Physical exam
atopic dermatitis (eczema) or allergic Your doctor may:
rhinitis (hay fever), is a risk factor for • Examine your nose, throat and upper
developing asthma. airways.
• Use a stethoscope to listen to your
• Occupational exposures breathing. Wheezing — high-pitched
If you have asthma, exposures to certain whistling sounds when you breathe out
elements in the workplace can cause — is one of the main signs of asthma.
asthma symptoms. And, for some • Examine your skin for signs of allergic
people, exposure to certain dusts conditions such as eczema and hives.
(industrial or wood dusts), chemical Your doctor will want to know whether you have
fumes and vapors, and molds can cause common signs and symptoms of asthma, such
asthma to develop for the very first time. as:
• Recurrent wheezing
• Smoking • Coughing
Cigarette smoke irritates the airways. • Trouble breathing
Smokers have a high risk of asthma. • Chest tightness
Those whose mothers smoked during • Symptoms that occur or worsen at night
pregnancy or who were exposed to • Symptoms that are triggered by cold air,
secondhand smoke are also more likely exercise or exposure to allergens
Asthma signs and symptoms in children
to have asthma.
In children, additional signs and symptoms may
• Air Pollution signal asthma. These may include:
Exposure to the main component of
smog (ozone) raises the risk for asthma. • Louder or faster than normal breathing
Those who grew up or live in urban areas • Frequent coughing or coughing that
have a higher risk for asthma. worsens after active play
106
• Coughing, clear mucus and a runny nose
caused by hay fever
• Frequent missed school days
• Limited participation in physical activities
Patients with persistent asthma require
medications that provide long-term control of
their disease and medications that provide quick
relief of symptoms. Medications for long-term
control of asthma include inhaled
corticosteroids, cromolyn, nedocromil,
leukotriene modifiers and long-acting
bronchodilators.
NURSING DIAGNOSIS
Here are eight (8) nursing care plans and
nursing diagnosis for asthma:
• Ineffective Breathing Pattern
• Ineffective Airway Clearance
• Deficient Knowledge
• Anxiety
• Activity Intolerance
• Health-Seeking Behaviors: Prevention of
Asthma Attack
• Interrupted Family Processes
• Fatigue
The nurse generally performs the following
interventions:
• Assess history. Obtain a history of

allergic reactions to medications
before administering medications.
• Assess respiratory status. Assess
the patient’s respiratory status by
monitoring the severity of symptoms,
breath sounds, peak flow, pulse
oximetry, and vital signs.
• Assess medications. Identify
medications that the patient is
currently taking. Administer
107
SICKLE CELL ANEMIA •Stroke
Sickle cell anemia, or sickle cell disease (SCD), •Stunted growth
is a genetic disease of the red blood cells •Frequent pain episodes
(RBCs). Normally, RBCs are shaped like discs, THERAPEUTIC MANAGEMENT
which gives them the flexibility to travel through Management of sickle cell anemia is usually
even the smallest blood vessels. However, with aimed at avoiding pain episodes, relieving
this disease, the RBCs have an abnormal symptoms and preventing complications.
crescent shape resembling a sickle. This makes Treatments might include medications and
them sticky and rigid and prone to getting blood transfusions. For some children and
trapped in small vessels, which blocks blood teenagers, a stem cell transplant might cure the
from reaching different parts of the body. This disease.
can cause pain and tissue damage.
• Hydroxyurea (Droxia, Hydrea,
The sickle hemoglobin (HbS) gene is Siklos). Daily hydroxyurea reduces the
inherited in people of African descent and to a frequency of painful crises and might
lesser extent in people from the Middle East, the reduce the need for blood transfusions and
Mediterranean area, and the aboriginal tribes in hospitalizations. It can also increase the
India. risk of infections. This drug is
contraindicated to pregnant women.
Sickle cell anemia is the most severe form of
sickle cell disease. • L-glutamine oral powder
RISK FACTORS (Endari). The FDA recently approved this
Sickle cell disease is more common in certain drug for treatment of sickle cell anemia. It
ethnic groups, including: helps in reducing the frequency of pain
crises.
• People of African descent, including
African – Americans (among whom 1 in • Crizanlizumab (Adakveo). Given
12 carriers a sickle gene) through a vein, it helps reduce the
• Hispanic – Americans from Central and frequency of pain crises. Side effects can
South America include nausea, joint pain, back pain and
• People of Middle Eastern, Asian, indian, fever.
and Mediterranean descent
• Pain-relieving medications. Doctor
ASSESSMENT AND S/S might prescribe narcotics to help relieve
pain during sickle cell pain crises.
• Anemia. Anemia is always present;
usually, hemoglobin values are 7 to • Voxelotor (Oxbryta). The Food and
10g/dl. Drug Administration (FDA) recently
approved this oral drug to improve anemia
• Jaundice. Jaundice is characteristic in people with sickle cell disease. Side
and usually obvious in the sclerae. effects can include headache, nausea,
• Dysrhythmias. Dysrhythmias and diarrhea, fatigue, rash and fever.T
heart failure may occur in adults. NURSING DIAGNOSIS
• Enlargement of the bones. The
bone marrow expands in childhood in • Acute pain related to tissue hypoxia
a compensatory effort to offset due to agglutination of sickled cells
anemia, sometimes leading to within blood vessels.
enlargement of the bones of the face • Risk for infection.
and skull.
• Dark urine
108
• Risk for powerlessness related to steps to take to prevent or
illness-induced helplessness. diminish such crises (eg, keep warm,
maintain adequate hydration, avoid
Deficient
• knowledge regarding
stressful situations).
sickle cell crisis prevention.
NURSING INTERVENTION If hydroxyurea is prescribed for a
•
MANAGING PAIN: woman of childbearing age, inform
her that the drug can cause congenital
• Use patient’s subjective description of harm to unborn children and advice
pain and pain rating on a pain scale to about pregnancy prevention.
guide the use of analgesic agents. PROMOTING HOME AND COMMUNITY
• Support and elevate any joint that is BASED CARE
acutely swollen until swelling diminishes.
• Teach patient relaxation techniques, • Involve the patient and his or her
breathing exercises, and distraction to family in teaching about the disease,
ease pain. treatment, assessment, and
• When acute painful episode has monitoring needed to detect
diminished, implement aggressive complications. Also teach about
measures to preserve function (eg, vascular access device management
physical therapy, whirlpool baths, and and chelation therapy.
transcutaneous nerve stimulation). • Advise health care providers, patients,
and families to communicate
PREVENTING & MANAGING INFECTION: regularly.
• Provide guidelines regarding when to
• Monitor patient for signs and
seek urgent care.
symptoms of infection.
• Provide follow up care for patients
• Initiate prescribed antibiotics
with vascular access devices, if
promptly.
necessary medications as prescribed
• Assess patient for signs of
and monitor the patient’s responses to
dehydration.
those medications; medications may
• Teach patient to take prescribed oral
include an antibiotic if the patient has
antibiotics at home, if indicated,
an underlying respiratory infection.
emphasizing the need to complete the
entire course of antibiotic therapy. • Pharmacologic
therapy. Administer medications as
PROMOTING COPING SKILLS
prescribed and monitor patient’s
responses to medications.
• Enhance pain management to promote a
therapeutic relationship based on mutual Fluid therapy. Administer fluids if
•
trust. the patient is dehydrated.
• Focus on patient’s strengths rather than PEUTIC MANAGEMENT
deficits to enhance effective coping skills.
• Provide opportunities for patient to make
decisions about daily care to increase
feelings of control.
INCREASING KNOWLEDGE
• Teach patient about situations that

can precipitate a sickle cell crisis and
109
TETRALOGY OF FALLOT • postures such as bending at knees
or fetal position.
1. Narrowing (stenosis) of the
An echocardiography may divulge right
pulmonary artery. The pulmonary
artery carries blood from the heart to the ventricular hypertrophy, reduction in size of the
pulmonary artery and decrease in pulmonary
lungs for oxygen.
blood flow. Electrocardiogram may point out
2. Ventricular septal defect. This is an
right ventricular hypertrophy.
opening in the wall between the 2 lower
chambers of the heart (right and left Once a cardiac catheterization is performed it
ventricles). will expose the degree of structural defects.
3. Overriding aorta. The artery that
carries oxygen-rich blood to the body The term “TET spell” is cyanosis that is
(aorta) is shifted toward the right side of caused by activity intolerance such as feeding,
the heart. It should be on the left side. In crying or playing.
this condition, the aorta sits over the THERAPEUTIC MANAGEMENT
ventricular septal defect. Medically managed by prescribing:
4. Hypertrophy (enlargement) of the
right ventricle. The right lower 1. propranolol for infants who are
chamber of the heart (ventricle) is bigger hypercyanotic. In cases of severe
than normal. Tetralogy of Fallot
2. prostaglandin E1 is used to sustain
RISK FACTORS patency of the ductus arteriosus while
While the exact cause of tetralogy of Fallot is waiting for the pediatric patient to
unknown, various factors might increase the risk undergo surgery. Once the patient is able
of a baby being born with this condition. These to undergo
risk factors include: 3. corrective surgery the surgeon will
close the ventricular septal defect with a
• A viral illness during pregnancy, such patch and the pulmonary stenosis will be
as rubella (German measles) eradicated by resection. Enlargement of
pulmonary outflow tract is also achieved
• Alcoholism during pregnancy
by use of a patch. Cardiopulmonary
• Poor nutrition during pregnancy bypass is used during corrective surgery
to maintain circulation of blood and
• A mother older than age 40 oxygen to the body. It is preferable for
• A parent who has tetralogy of Fallot the patient to undergo surgery to correct
the defects prior to 6 months of age,
• The presence of Down syndrome or however, if the patient has severe
DiGeorge syndrome pulmonary stenosis or atresia the
Blalock-Taussig procedure is usually
ASSESSMENT AND S/S performed and a full correction is done at
• murmur, a later date. The Blalock-Taussig
• cyanosis, procedure divides the left subclavian
• hypoxemia, artery and connects to the left pulmonary
• dyspnea, artery which allows blood flow to the
• sleepiness, lungs to uptake oxygen.
• decreased oxygen saturation,
• agitation,
• adventitious lung sounds
110
TNURSING DIAGNOSIS Monitor height and weight; draw on a
• Decreased Cardiac Output related to growth chart to determine the trend of
ineffective circulation, secondary to the growth.
presence of cardiac malformations Can provide iron supplements to treat
• Altered Growth and Development related anemia, if recommended.
to inadequate oxygen and nutrients to Encourage age-appropriate activities.
the tissues Emphasize that the child has the same
• Activity intolerance related to imbalance needs as other children socialization.
in the fulfillment of oxygen to the body Allow the child to organize his own space
needs as evidenced by cyanosis of the and limitation of activity because the
body. child will rest when tired.
• Altered family processes related to 3. Monitor vital signs ; respiration rate,
having children with heart disease pulse rate and blood pressure to obtain
as baseline data to detect any change.
• Risk for infection related to poor physical Assess patient’s general condition to note
status. for any abnormalities and deformities
H present within the body.
Limit the activities and/or procedure to
be done on the patient to prevent strain
1. Monitor vital signs, peripheral pulses,
and overexertion.
capillary refill by comparing
Manage the time and procedures to be
measurements at both extremities while
done on the patient at one time to
standing, sitting and lying down if
provide enough rest for the patient.
possible.
Provide patient with calm and quiet
• Assess and record the apical pulse environment for relaxation
for 1 full minute.
4. Encourage the family to participate in the
• Observation of cyanotic attacks. care process.
• Give a knee-chest position in Educate the family about the disease
children.
process.
• Observe for signs of decreased 5. Provide frequent rest periods and periods
sensory: lethargy, confusion, and of uninterrupted sleep.
disorientation. Give a balanced diet high in nutrients, to
• Monitor intake and output
achieve adequate growth.
adequately. Encourage the family to participate in the
• Provide adequate rest time for care process.
children and accompany children Teach families to recognize the signs of
during activity. complications.
• Serve foods that are easily
digestible and reduce the
consumption of caffeine.
• Collaboration in the examination
serial ECGs, chest radiographs,
administration of anti GEMENT
dysrhythmias.
• Collaboration of oxygen
• Collaboration IV fluid
administration.
2. Give a balanced diet high in nutrients to
achieve adequate growth.
111
CARDIOPULMONARY RESUSCITATION • Perform 30 chest compressions. (One hand
(CPR) for children and two fingers for Infants)
Cardiopulmonary resuscitation (CPR) is a • Perform two rescue breaths.
lifesaving technique that's useful in many • Repeat until an ambulance or automated
emergencies, such as a heart attack or near external defibrillator (AED) arrives.
drowning, in which someone's breathing or NURSING DIAGNOSIS
heartbeat has stopped. • Recognize signals of any emergency that
may require CPR
RISK FACTORS
• Heredity • Stop activity, rest, lay down
• Sex • If pain lasts more than two minutes, call for
• Race help
• Age • Patient’s having early signs often deny
• Smoking having a heart attack
• Hypertension • Be prepared to do CPR, if alone do CPR for
• Diet one minute, then call 9-1-1.ERAPEUTIC
• Obesity MANAGEMENT
• Lack of exercise NURSING INTERVENTION
• Stress Nurses are responsible for initiating and
ASSESSMENT AND S/S performing CPR in case the situation arises. It
• Chest pain – can be an uncomfortable also the nurses’ responsibility to attend to the
pressure, tightness or feeling of indigestion, patient requiring care until the emergency
heavy squeezing pain like a weight on the services or physician arrives.
chest, can radiate to left arm and neck
• Nausea/vomiting
• Shortness of breath
• Pale, sweaty cold skin
• May have no signs or symptoms (silent
Myocardial infarction)
For Adults:
• Call 911 or ask someone else to.
• Lay the person on their back and open their
airway.
• Check for breathing. If they are not
breathing, start CPR.
• Perform 30 chest compressions.
• Perform two rescue breaths.
• Repeat until an ambulance or automated
external defibrillator (AED) arrives.
For Infants and Children:
• Call 911 or ask someone else to.
• Lay the person on their back and open their
airway.
• Check for breathing. If they are not
breathing, start CPR.
112
DIABETES MELLITUS TYPE 1 AND 2 - Race or Ethnicity (Black, Hispanic,
Diabetes refers to a group of condition, Indian-American, Asian-American are at
characterized by a high level of blood sugar. Too higher risk)
much sugar in the blood can cause serious, - Age
sometimes life-threatening health problems. - History of Gestational Diabetes
- Having Polycystic Ovary Syndrome
Prediabetes is when the blood sugar is in the
- High blood pressure
borderline. Higher than normal, but lower than
- Abnormal cholesterol and triglyceride
diabetics. It may or may not progress into
levels.
diabetes.
ASSESSMENT AND S/S
Type 1 Diabetes
For Type 1 Diabetes:
- also called as insulin-dependent diabetes.
- Unplanned weight loss
It used to be called as juvenile-onset
- Nausea and vomiting
diabetes, because it often begins in
childhood. For Type 2 Diabetes:
- it is an autoimmune condition where your - Yeast infections
body attacks the beta cells in the - Slow-healing of sores or wounds
pancreas with antibodies. The reason of - Pain or numbness in your feet or legs
this is still unclear, but genetic factors are
Common Symptoms for both types:
believed to play a major role. The organ
- Hunger
is then damaged and is unable to
- Fatigue
produce enough insulin.
- Peeing more often
Type 2 Diabetes - Thirst
- it is also called as non-insulin-dependent - Dry mouth
diabetes. The body produces insulin, but - Itchy skin
it is unable to use it effectively. The exact - Blurred vision
reason why the body does not respond to
insulin is not yet fully understood.
Insulin therapy via different method such as
- Insulin resistance is when the body does
insulin pump, needle and syringe, and insulin
not respond to insulin.
pens.
RISK FACTORS
Medications that manage blood sugar levels
such as Metformin. Should also monitor blood
- Family History
sugar levels.
- Presence of damaging immune system
cells Physical activity is vital for using up spare
- Medical conditions such as cystic fibrosis glucose in the body making the muscles more
or hemochromatosis sensitive to insulin. It can also help reverse
- Exposure to viral illness diabetes in its early stages and prevent heart-
- Geography (prevalence is high in related complications.
countries away from the equator)
Diet management should avoid fried foods,
salty foods, sugary foods, and drinks that
- Weight
contain too much sugar.
- Inactivity
- Family history
113
NURSING DIAGNOSIS - Review type of insulin used. Note the
- Risk for unstable blood glucose type of insulin to be administered
level related to insulin resistance, together with the method of delivery and
impaired insulin secretion, and time of administration. This affects timing
destruction of beta cells. of effects and provides clues to potential
- Risk for infection related to delayed timing of glucose instability.
healing of open wounds. - Check injection sites
- Deficient knowledge related to periodically. Insulin absorption can
unfamiliarity with information, lack of vary day to day in healthy sites and is less
recall, or misinterpretation. absorbable in lipohypertrophic tissues.
- Risk for disturbed sensory
perception related to endogenous
chemical alterations.
- Impaired skin integrity related to
delayed wound healing.
- Ineffective peripheral tissue
perfusion related to too much glucose
in the bloodstream
- Educate about home glucose
monitoring. Discuss glucose monitoring
at home with the patient according to
individual parameters to identify and
manage glucose variations.
- Review factors in glucose
instability. Review client’s common
situations that contribute to glucose
instability because there are multiple
factors that can play a role at any time
like missing meals, infection, or other
illnesses.
- Encourage client to read labels. The
client must choose foods described as
having a low glycemic index, higher fiber,
and low-fat content.
- Discuss how client’s antidiabetic
medications work. Educate client on
the functions of his or her medications
because there are combinations of drugs
that work in different ways with different
blood glucose control and side effects.
- Check viability of insulin. Emphasize
the importance of checking expiration
dates of medications, inspecting insulin
for cloudiness if it is normally clear, and
monitoring proper storage and
preparation because this affect insulin
absorbability.
114

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TABLE OF CONTENTS

1. Acute Otitis Media 4 32. Peptic Ulcer Disease 60

ASSESSMENT AND S/S • Positioning. Have the child sit up,

•Explain the importance of the

• Assess for local or systemic signs of

• Monitor platelet count; instruct the

- Improve airway clearance. Monitor

Men with Cushing’s syndrome may have: • Decreasing Risk of Infection.

- Adrenal enzyme • Encouraging Rest and Activity.

• Monitoring and Managing

Class 0. There is no exposure or no infection. A combination of medicines also treats active

➢ Painless vaginal bright RED bleeding NURSING DIAGNOSIS

• Assess the patient’s activities of daily

If the foreign body is not expelled:

X-ray results will reveal what is causing the

Health education and Monitoring:

The most common cause of epiglottitis is caused THERAPEUTIC MANAGEMENT

4. Unhealthy Diet- A diet that is too high in

5. Physical Inactivity- Getting regular

ASSESSMENT Also, the wall of the appendix is thinner and

• Serum analysis of antibodies against

ASSESSMENT NURSING DIAGNOSIS

Establish emergency and contingency plans for

In patients with artificial airways:

In patients with NG or gastrostomy tubes:

Family health teaching:

Give analgesic, antipyretic, and

ASSESSMENT AND S/S

➢ Hyperthyroidism in children is caused by an ➢ Their basal metabolic rate is high; blood

ASSESSMENT AND S/S

Severe anemia, hypocalcemia, and myocarditis

ASSESSMENT AND S/S

When a child has primary right heart failure,

Outcome Evaluation: Child’s pulse, blood

• Rest when you feel weak or tired.

• Hormonal therapy. Hormonal

• Assess history. Obtain a history of

• Teach patient about situations that

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