Notes for NCM 109: Final Term
absorption.
Hydrocephalus
 Cause is unknown
 Overproduction of fluid
 Obstruction of the passage of fluid.
 Interference with the absorption of CSF
from the subarachnoid space if the portion is
removed
Function of Cerebrospinal Fluid:
 It acts as “shock absorber” (absorbing the
energy of sudden impulse) for the brain and
spinal cord.
 It acts as a vehicle for delivering nutrients to
the brain and removing waste from it.
 It flows between the cranium and spine to
regulate changes in pressure.
Congenital Hydrocephalus – present at birth that
occur during fetal development or as a result of
genetic abnormalities.
Acquired Hydrocephalus – develops at birth or in
adulthood and is typically caused by injury or
disease.
Assessment:
 Excessive fluid accumulates and dilates the
system above the point of obstruction.
 The infant’s fontanelles widen and appear
tense, the suture lines on the skull separate
and the head diameter enlarges.
 The scalp becomes shiny and scalp veins
become prominent.
 Brow bulges in a typical appearance
(bossing) and the eyes become sunset
Communicating Hydrocephalus or Extra ventricular
Hydrocephalus
 this type of hydrocephalus occurs when
there is no obstruction to the flow of CSF
within the ventricular system.
 The condition arises either due to inadequate
Obstructive Hydrocephalus or Intraventricular
Hydrocephalus
 it occurs when the flow of CSF is blocked in
the passages connecting the ventricles
causing enlargement of the pathways leading
to an increase in pressure within the skull.
 Can be demonstrated by sonogram,
computed tomography, magnetic resonance
imaging
 Transillumination (holding a bright light
against the skull with the child in the
darkened room) revealed the skull is filled
with fluid.
Hydrocephalus
 Is the build up of fluid or excess of fluid in
the cavities or ventricles of the brain
 The excess fluid increased the size of the
ventricles and puts pressure on the brain.
 Cerebrospinal Fluid normally flows through
the ventricles and bathes the brain and spinal
column.
 Too much CSF associated with
hydrocephalus can damage brain tissues and
cause brain function problems.
 Cerebrospinal Fluid (CSF) is formed in the
first and second ventricles of the brain and
passes through the aqueduct of Sylvius and
the fourth ventricle to empty into the
subarachnoid space of the spinal cord where
the it absorbed.
 Total volume 150ml
 Color: colorless, clear
 All children under 2 years should have their
head circumference recorded.
 Measure head circumference of all infants
within an hour of birth and before discharge
 The infant’s motor function becomes
impaired as the head enlarges.
Signs:
 Signs of increased intracranial pressure such
as decreased pulse and respiration, increased
temperature and blood pressure, hyperactive
reflexes, strabismus and optic atrophy.
  Irritable or lethargic, fail to thrive. Nursing Management of Child with Burns
 High pitched cry.
Burns
Therapeutic Management:
 Burns are tissue damage that results from
 Overproduction of fluid = Acetazolamide heat, overexposure to the sun, or other
(Diamox) to promote excretion of fluid radiation, chemical or electrical contact.
 Obstruction = removal Top Causes of Injury
 Laser surgery to reopen of flow or bypassing
the point of obstruction by shunting the fluid Children (to age 15)
to another point of absorption
1. Scalding (hot liquids
 Shunting procedure to divert the excess CSF
2. Contact with embers
away from the brain to another cavity such
3. Flams (fires/lighters)
as peritoneal cavity.
4. Friction (mostly involving treadmill
 Fluid drains by this route into the mishaps)
peritoneum and is absorbed by the peritoneal
membrane and into the body circulation.
Imperforate Anus Adults

 Is stricture of the anus 1. Flames

 There may be accompanying fistula to the 2. Scalding
bladder in boys and to the vagina in girls 3. Contact with embers
 It may occur as an additional complication 4. Chemicals
of the spinal cord disorders because both the Risk Factors:
external canal and the spinal cord arise from
the same germ layer.  Water heaters with temperature set too high
 Access to very hot liquids (coffee, soup etc.)
Assessment:
 Room heaters with pans of water for
 No anus is present humidity
 The condition may be revealed because a  Children with access to stovetops for
membrane filled with black meconium can electrical appliances
be seen protruding from the anus. A wink  Unguarded bathroom faucets
reflex (touching the skin near the rectum  Young children left unattended in bathtubs
should make it contract) will not be present or shoers
if present. If sensory nerve endings in the  Cooking without supervision
rectum are not intact.  Playing with fire or matches
 Inability to insert a rubber catheter into the  Child abuse
rectum.
 No stool will be passed and abdominal
distention become evident. 2seconds of exposure to 148F liquid causes burns
Therapeutic Management serious enough to require surgery

 Surgery – anastomosis of the separated
bowel segments.
Alteration in Fluid and Electrolytes and Acid-Base
Balance
Coffee is often served at 175F, making it high-risk
for causing severe burns.
Burns in children are considered a preventable
accident. Education is directed toward removing
risks.
Types of Burns:
 1. Thermal Burns
Burns due to external heat sources which
raise the temperature of the skin and tissues
and cause tissue cell death. Hot metals,
scalding liquids, steam and flames when
coming in contact with the skin, can cause
thermal burns.
These are most common type pf burn
Children are particularly at risk to accident
thermal burns
Result from any heated source (flame, scald,
contact from a hot object)
Frequently because of fires, car accidents,
matches/lighter, improperly stored gasoline
and kitchen accidents
Range from superficial damage to all layers
of the skin and underlying tissue.
2. Radiation Burns
Burns caused by prolonged exposure to
ultraviolet rays of the sun or other sources of
radiation such as x-ray.
3. Chemical Burns
Burns caused by strong acids, alkalies,
detergents or solvents coming into contact
with the skin and/or eyes.
4. Electrical Burns
Burns from electrical current, either
alternating current (AC) or direct current
(DC).
Nursing Diagnosis
 Impaired tissue integrity
 Fluid volume deficit
 Altered nutrition less than body
requirements
 Risk for injury
 Pain management
 Body image disturbance
 Altered growth and development
 Altered family process
 Caregiver role strain
 Activity intolerance
Clinical overview:
 Extensive or severe burn injuries account for
some of the most difficult nursing care in the
pediatric age group.
 Children who have suffered serious burn
trauma must undergo prolonged, painful and
often restrictive hospitalizations. Thermal,
electrical and chemical agents cause burns.
 Burns occur in children of all ages after
infancy and are the second leading cause of
injury to children 1-4 years old.
 Typically, toddlers sustain hot water scalds,
while older children are most likely to suffer
flame-related burns.
 Approximately, 10% of burn injuries can be
attributed to child abuse, most frequently by
submersion in hot water.
 Children with severe burns have rapid fluid
and electrolyte shifts in the first 24hours
resulting in hypovolemia and
hypoproteinemia, hyponatremia, and
hyperkalemia. Because of the high risk for
hypovolemia and electrolyte imbalance,
once the client has an airway, establsing and
maintaining intravenous access is a priority.
 Other priorities should be given to
prevention of infection, maintenance of the
airways and proactive administration of pain
medications to decrease the suffering of the
child (pain is more difficult to control once
it peaks)
 Early and continuous administration iof pain
medications – (following orders-is essential)
BURN TYPE DESCRIPTION
Superficial 1st degree Involves epidermis,
tender, slightly
swollen, red, like a
sunburn.
Partial Thickness 2nd involves epidermis
degree and dermis. Blister
formation or
reddened
discoloration with
moist weeping
surface.
Full Thickness 3rd Involves entire
degree dermis and portions
of subcutaneous
tissue. leathery brown
with little surface
moisture.
 Full Thickness 4th Involves
degree subcutaneous, fascia,
muscle and bone.
Minor Burns Superficial and
partial thickness first-
and second-degree,
covering15% of body
surface area (BSA)
and not
involving face,
hands, feet, or
genitalia.
Moderate Burns Partial thickness
second degree
covering15% but 30
BSA or full thickness
involving <10% BSA
Major (severe) Burns Partial thickness
second-degree
involving 30% BSA
or full thickness
involving>10% BSA
or face, hands, fact,
or
genitalia
1ST DEGREE  EPIDERMIS
2ND DEGREE  DERMIS
3RD DEGREE  SUBCUTANEOUS TISSUE
When to see a doctor
 Seek emergency medical assistance for:
 Burns that cover the hands, feet, face, groin,
buttocks, a major joint or
 a large area of the body
 Deep burns, which means burns affecting all
layers of the skin or even deeper tissues
 Burns that cause the skin to look leathery
 Burns that appear charred or have patches of
black, brown or white
 Burns caused by chemicals or electricity
 Difficulty breathing or burns to the airway
Therapeutic Nursing Management of the Child with
Burns:
Emergency Care
a. Stop the burning process
b. Assess the victim's condition
c. Cover the burn with clean dressing
d. Transport the victim to medical facility
e. Provide analgesia if possible
f. Reassure and comfort the child
Minor Burns
a. Immerse area in cold water to reduce pain
and
b. Cleanse with mild soap and water
(iodophor)
c. Cover with fine mesh gauze lightly
lubricated with water-soluble antimicrobial
ointment
d. Update tetanus if indicated
e. Provide analgesia as needed
Wound Care
1. Shave hair adjacent to wound.
2. Cleanse wound with soap and iodophor soap
or saline.
3. Apply silver nitrate 0.5%(AgN04) or silver
sulfadiazine 1% (Silvadene topical
preparation.
4. Apply topical antibiotic ointment for
bactericidal and bacteriostatic properties.
5. Apply dressing using sterile technique.
Rehabilitation
1. Splinting. traction, and frequent position changes
2. Plastic surgery.
Educate the family on the importance of having
working smoke detectors in the home. New batteries
should be put in annually and the batteries should be
checked each month.
Prevention:
To Reduce the Risk of Common Household Burns:
 Never leave items cooking on the stove
unattended.
  Turn pot handles toward the rear of the sum total of these parts is equal to the total body
stove. surface area injured.
 Don't carry or hold a child while cooking at
the stove.
 Keep hot liquids out of the reach of children
and pets.
 Keep electrical appliances away from water.
 Check the temperature of food before
serving it to a child. Don't heat a baby's
bottle in the microwave.
 Never cook while wearing loose-fitting
clothes that could catch fire over the stove.
 If a small child is present, block his or her
access to heat sources such as stoves,
outdoor grills, fireplaces and space heaters.
 Before placing a child in a car seat, check
for hot straps or buckles.
 Unplug irons and similar devices when not PARKLAND FORMULA:
in use. Store them out of reach of small 4ml x BSA (%) x Body Weight (kg)
children.
 Cover unused electrical outlets with safety
caps. Keep electrical cords and wires out of
The Child with Burns: Pharmacology
the way so that children can't chew on them
 If you smoke, never smoke in bed.  Analgesics
 Be sure you have working smoke detectors  Antibiotics (1V)
on each floor of your home. Check them and  Antibiotics (topical)
change their batteries at least once a year. 1. Mafenide cream 10% Sulfamylon
 Keep a fire extinguisher on every floor of 2. Silver sulfadiazine 1% 5ilvadene
your house.  Cimetidine (Tagamet)
 When using chemicals, always wear  Antacids
protective eyewear and clothing.
 Keep chemicals, lighters and matches out of Child with Burns: Complications
the reach of children. Use safety latches.  Mucosal erosion resulting in gastrointestinal
And don't use lighters that look like toys. bleeding
 Set your water heater's thermostat to below  Anemia due to cell destruction and
120 F (48.9 C) to prevent scalding. Test bath hemolysis
water before placing a child in it.  Metabolic acidosis
 Scarring
 Body image changes
RULE OF NINES  Shock
The Rule of Nines is a quick way to estimate the  Third spacing
extent of  Fluid and electrolyte imbalance
burns in
adults through
dividing the
body into
multiples of
nine and the
  Respiratory injury secondary to smoke  Congenital heart disorders esp.
inhalation or carbon monoxide atrioventricular disorders
 Pulmonary edema  Stenosis or atresia of the duodenum
 Infection/pneumonia  Strabismus and cataract disorders
 Stress ulcer  Their lifespan generally is only 50 to 60
 Contracture deformities years.
Therapeutic Management:

Down Syndrome  Need to be exposed to early educational and

play opportunities
 The most common chromosomal
 Sensible precautions such as handwashing
abnormality
technique because they are prone to
 Seen as frequently as 1 in 800 live births infection
 Most frequently in the pregnancies of  In infancy the enlarged tongue may interfere
women who are over 35 years of age. The with swallowing and cause choking unless
incidence is high 1 in 100 live births the child is fed slowly
 Paternal age (over 55) may also contribute to  Need physical examination at birth so that
the increased incidence genetic disorder can be detected and
 Even in the newborn, the tongue may counseling and support for parents and
protrude from the mouth because the oral siblings can begin
cavity is smaller than normal
 The back of the head is flat
 The neck is short and an extra pad of fat at REACTIVE ATTACHMENT DISORDER:
the base of the head causes the skin to be
loose and can be lifted up (like a puppy’s Failure to Thrive
neck)
 Is a unique syndrome in which an infant fall
 The ears may be low set
below that 5th percentile for weight and
 Muscle tone is poor, giving the baby a rag-
height on a standard growth chart or is
doll appearance
falling in percentiles on a growth chart.
 Fingers are short and thick and the little
finger is often curved inward Two Categories:
 There may be a wide space between the first
1. Severe loss of weight – organic causes e.g.,
and second toes and the first and second
Cardiac Disease
fingers
2. Disturbance in the parent – child
 The palm of the hand shows a peculiar
relationship resulting in maternal role
crease (a simian line) or a horizontal palm
insufficiency (a non-organic cause)
crease rather than the normal 3 creases in the
 Syndrome can lead to cognitive impairment
palm.
in the child and even death if allowed to
 Have some degree of cognitive challenge the
continue.
degree can range from that of less
involvement (IQ 50 to 70) to one requiring Assessment:
total care (IQ less than 20)
 Take a detailed pregnancy history of
 Appear to have altered immune function,
children at routine health assessments
making them prone to respiratory infections.
 Always weigh children at routine
Common in Down Syndrome: assessments and plot and compare their
weight with standard growth curves
 Lymphocytic leukemia
Typical Characteristics:
  Lethargy with poor muscle tone
 Lack of resistance to the examiner’s
manipulation
 rocking in all fours excessively, as if seeking
stimulation
 possibly greater reluctance to reach for toys
or initiate human contact
 diminished or non-existent crying
 staring hungrily at people who approach
them as if they are starved for human
contact
 little cuddling or conforming to being held
 delays in sitting, pulling to standard
position, crawling and walking because the
child spends so much time alone
 delayed or absent speech because of the lack
of interaction
Therapeutic Management:
 need to be removed from parents’ care for
evaluation and therapy
 studies other than routine blood work and
urinalysis and are usually delayed
 placed on diet appropriate for ideal weight
PERVASIVE DEVELOPMENT DISORDER:
Autism Spectrum Disorder
 attachment to odd objects such as always
carrying a string or a shoe
 repetitive hand movements (clapping or
flapping) and constant body rocking are
often observed
 difficult to gain the child’s attention as the
child becomes intensely preoccupied by
music or objects that revolve, such as fan,
the swirling water in the toilet bowl or a
spinning top
 characterized by impairment in social and
communication skills and the display of
stereotypical behaviors
 marked by deficits in language, perceptual,
motor development and the inability to
function well in social settings
 most often diagnosed when the child is 2 to
3 years old
 aggressive actions such as shitting, head
banging and biting, inability to feel pain
may also be present
 labile mood (crying occurs suddenly and is
followed immediately by giggling or
laughing)
 react with over responsiveness to sensory
stimuli such as light or sound, but unaware
of the major event in the room e.g., sound of
fire alarm
 long term memory and “savant” skills (e.g.,
Virtuoso piano playing)
 excellent memory and able to recall dates
and spoken words
Therapeutic Management:
 need intensive therapeutic to learn
improved communication techniques
 parental support to learn self-care and
proceed with therapy
Assessment:
 impairment in communication both verbal
and nonverbal skills and communication
may be totally absent
 echolalia repetition of words or phrases
spoken by others)
 bizarre responses to the environment may
include intense reactions to minor changes
in the environment
Essential Intrapartum and Newborn Care Practice
 Millennium Development Goal (MIDG) our
Commitment by 2015
 MIDG 4 = reduce child mortality
 MDG 5 = improve maternal health
Antennal Care
1. Have at least 4 antennal visits with the
skilled health provider.
 To detect diseases which may
complicate pregnancy
  To educate women in danger and
emergency signs and symptoms
 To prepare the woman and her
family for childbirth.
Recommended Practices during labor:
 Admit when the parturient is already in
active labor
 Continuous maternal support by a
companion of her choice, during labor and
delivery
 Mobility during labor
 Position of choice during labor and delivery
 Episiotomy will not be done, unless
necessary
 Active Management of the Third Stage of
Labor (AMSL)
 Monitoring the progress of labor with use of
Partograph
1. Immediate and thorough drying of the
newborn
Unnecessary Interventions Eliminated:
 Enemas and perineal shavings
 Fluid and food intake restrictions
 Routine insertion of Intravenous fluids
 Fundal pressure to facilitate second stage of
labor
Unnecessary Intervention in Newborn Care:
 Routine suctioning
 Early bathing
 Routine separation from the mother
 Foot printing
 Application of various substances to the
cord
 Giving prelacteals or artificial infant milk
formula or other breastmilk substitutes
Prior to Woman’s Transfer to the Delivery Room
 Ensure that mother is in her position of
choice while in labor
 Asks mother if she wishes to eat/drink or
void
 Communicate with the mother-informed her
of the progress of labor, give reassurance
and encouragement.
Woman already in the Delivery Room (preparing for
delivery)
 Check temperature in the DR area to be 25 –
28 Celsius; eliminate airdraft
 Asks woman if she is comfortable in the
semi-upright position
 Ensure the woman’s privacy
 Removed all jewelries then wash hands
thoroughly observing the WHO 1-2-3-4-5
procedure
 Prepare a clear, clean newborn resuscitation
area. Checked the equipment if clean,
functional and within easy reach.
 Arrange materials/supplies in a linear
sequence: gloves, dry linen, bonnet,
oxytocin injection, plastic clamp, scissors 2
kidney basins
In a separate sequence, for after the 1st
breastfeed:
 Eye ointment, stethoscope, vit K,
hepatitis B and BGC vaccines (cotton
balls)
 Clean the perineum with antiseptic
solution
 Wash hands and put on 2 pairs of sterile
gloves aseptically (if same worker
handles perineum and cord)
At the time of Delivery:
 Encourage woman to push as desired
 Drape the clean, dry linen over the mother’s
abdomen or arms in preparation for drying
the baby
 Apply perineal support and do not control
the delivery of the head
 Call out time of birth and sex of baby
 Inform the mother of the outcome
First 30 secs:
 Thoroughly dry the baby for at least 30
seconds, starting from the face and head,
going down to the trunk and extremities
 while performing a quick check for
breathing
1-3 minutes
 Remove the wet cloth
 Place baby in skin to skin contact on the
mother’s abdomen or chest
 Cover baby with dry cloth and the baby’s
head with a bonnet
 Exclude a 2nd baby by palpating the
abdomen in preparation for giving Oxytocin
 Used wet cloth to wipe the soiled gloves.
 Give IM oxytocin within one minute of
baby’s birth. Dispose wet cloth properly
 Remove first set of gloves and
decontaminate for at least 10 minutes
 Palpate the umbilical cord to check for
positions
 After pulsations stopped, clamp cord using
the plastic clamp or cord tie 2cm from the
base
 Place the instrument clamp 5cm from the
base
 Cut near plastic cord clamp (not midway)
 Perform the remaining steps of the delivery
of placenta
 Wait for strong uterine contractions then
apply controlled cord traction and counter
traction on the uterus, continuing until the
placenta is delivered
 Massage the uterus until firm
 Inspect the lower vagina and perineum for
lacerations/tears and repair lacerations/tears
as necessary
 Examine the placenta for completeness and
abnormalities
 Clean the mother, flush perineum and apply
perineal pad/napkin/cloth
 Check the baby’s color and breathing, check
if the mother is comfortable, check if uterus
contracts
 Dispose the placenta in a leak-proof
container or plastic bag
 Decontaminate (soaked in 0.5% chlorine
solution) instruments before cleaning:
Decontaminate 2nd pair of gloves before
disposal for 10 minutes
 Advise mother to maintain skin-to-skin
contact. Baby should be positioned in prone
on mother’s chest/in between the breast with
head turned to one side
NEWBORN SCREENING
Newborn screening (NBS) is an essential public
health strategy that enables the early detection and
management of several congenital disorders, which
if left untreated, may lead to mental retardation
and/or death.
How do you do a newborn screening?
 Touch the first cycle on the newborn
screening card gently against the large blood
drop and in one step allow the blood to soak
through the filter paper and fill the circle. Do
not press the paper directly against the
baby’s heel. Each of the five circles need to
be filled and saturated through.
 Newborn screening (NBS) is an essential
public health strategy that enables the early
detection and management of several
congenital disorders, which if left untreated,
may lead to mental retardation and/or death.
The Newborn Screening Test is done by collecting a
few drops of blood from the baby’s heel. Ideally,
newborn screening should be done two days after
birth or before discharge from the hospital. The
blood sample is placed on a special filter paper card.
What are the most common newborn screening
disorders?
 The most common screening tests in the US
include those for hypothyroidism
(underactivity of the thyroid gland) PKU
(phenylketonuria), galactosemia and sickle
cell disease.
 Early diagnosis and initiation of treatment
along with appropriate long-term care help
 ensure normal growth and development of
the affected individual. It has been an
integral part of routine newborn care in most
developed countries for five decades
 It ensures that all babies are screened for
certain serious conditions at birth, and for
those babies with the condition, it allows
doctors to start treatment before some of the
harmful effects happen.
There are three parts to newborn screening
 The heel stick to collect a small blood
sample, pulsetoximetry to look at the
amount of oxygen in baby’s blood, and a
hearing screen.
 The blood test is generally performed when
a baby is 24 to 48 hours old. This timing is
important because certain conditions may go
undetected if the blood sample is drawn
before 24 hours of age.
PKU
 Phenylketonuria also called PKU, is a rare
inherited disorder that causes an amino acid
called phenylalanine to build up in the body.
PKU is caused by a defect in the gene that
helps create the enzyme needed to break
down phenylalanine
 For the rest of their lives, people with PKU
babies, children and adults – need to follow
a diet that limits phenylalanine, which is
found mostly in foods that contains protein.
How does PKU affects the body?
 Phenylketonuria (PKU) is a treatable
disorder that affects the way the body
processes protein
 Children with PKU cannot use a part of
the protein called phenylalanine. If left
untreated, phenylalanine builds up in the
bloodstream and causes brain damage.
 Without the enzyme necessary to
process phenylalanine, a dangerous
buildup can develop when a person with
PKU eats foods that contain protein or
eats aspartame, an artificial sweetener.
 This can eventually lead to serious
health problems.
PKU signs and symptoms can be mild or severe and
may include:
 A musty order in the breath, skin or urine,
caused by too much phenylalanine in the
body.
 Neurological problems that may include
seizures
 Skin rashes (eczema)
 Fair skin and blue eyes, because
phenylalanine can’t transform into melanin –
the pigment responsible for hair and skin
tone
 Abnormally small head (microcephaly)
 Hyperactivity
 Intellectual disability
 Delayed development
 Behavioral, emotional and social problems
 Psychiatric disorders
Galactosemia
 Is a disorder that affects how the body
processes a simple sugar called galactose.
 A small amount of galactose is present in
many foods. It is primarily parts if a larger
sugar called lactose, which is found in all
dairy products and many baby formulas.
What causes galactosemia?
 If your body has this condition, it means the
genes that produce the enzymes to break
down galactose into glucose (a sugar) are
missing key parts. Without these parts, the
genes can’t tell the enzymes to do their job.
This causes galactose to build in the blood,
creating problems, especially for newborns.
Is there a cure for galactosemia?
 There is no cure for galactosemia or
approved medication to replace the
enzymes, although a low-galactose diet can
prevent or reduce the risk of some
complications, it may not stop all of them. In
some cases, children still develop problems
such as speech delays learning disabilities
and reproductive issues.

What happens if you have galactosemia?
 Galactosemia happens when there’s a
change (mutation) in the genes that make an
enzyme that breaks down galactose.
 To have galactosemia, a child must inherit
two galactosemia genes, one from each
parent. In galactosemia, galactose and its by-
products build up in the blood. This can
damage cells and parts of the body.
What foods should be avoided with galactosemia?
 Food ingredients which are unacceptable in
the diet for galactosemia:
- Butter
- Buttermilk
- Buttermilk solids
- Cheese (exceptions: Jarlsberg, Gruyere,
Emmentaler, Swiss, Tilster, grater 100%
parmesan aged >10 months and sharp
Cheddar cheeses aged >12 months)
- Cream
- Dry milk
- Dry milk protein
- Dry milk solids
What are the symptoms of galactosemia in adults?
 Initial signs/symptoms may include poor
feeding, vomiting, diarrhea, jaundice,
bleeding tendencies, lethargy, abdominal
distension with liver swelling and increased
risks of sepsis (a reaction from a blood
infection). Later symptoms can include liver
failure cataracts and brain damage.
 Sickle cell anemia is one of a group of
inherited disorders known as sickle cell
disease. It affects the shape of cred blood
cells, which carry oxygen to all parts of the
body. Red blood cells are usually round and
flexible, so they move easily through blood
vessel.
Hypospadias
 Hypospadias is a birth defects in the boys
where the opening of the urethra (the tube
that carries urine from the bladder to the
outside of the body) is not located at the tip
of the penis.
 The urethra is the tube through which urine
drains from your bladder and exits your
body.
Causes:
 Hypospadias is present at birth (congenital).
As the penis develops in a male fetus,
certain hormones stimulate the formation of
the urethra and foreskin.
 Hypospadias results when a malfunction
occurs in the action of these hormones,
causing the urethra to develop abnormally.
Risk Factors:
 Family history – this condition is more
common in infants with a family history of
hypospadias.
 Genetics – certain gene variations may play
a role in disruption of the hormones that
stimulate formation of male genitals.
 Maternal age over 35 – some research
suggests that there may be an increased risk
of hypospadias in infant males born to
women older than 35 years.
 Exposure to certain substances during
pregnancy – there is some speculation about
an association between hypospadias and a
mother’s exposure to certain hormones or
certain compounds such as pesticides or
industrial chemicals, but further studies are
needed to confirm this.
Signs and Symptoms may include:
 Opening of the urethra at a location other
than the tip of the penis.
 Downward curve of the penis (chordee)
 Hooded appearance of the penis because
only the top half of the penis is covered by
foreskin
 Abnormal spraying during urination.
Complication:
If hypospadias is not treated, it can result in:
 Abnormal appearance of the penis
 Problems learning to use a toilet
 Abnormal curvature of the penis with
laceration
 Problems with impaired ejaculation
Hypospadias repair is surgery to correct a defect in
the opening of the penis that is present at birth. The
urethra (the tube that carries urine from the bladder
to outside the body) dose not end at the tip of the
penis)
When should hypospadias be corrected?
 In some cases, the repair is done in stages.
These are often proximal cases with severe
chordee the pediatric urologists often want
to straighten the penis before making the
urinary channel. Surgeons prefer to do
hypospadias surgery in full term and
otherwise healthy boys between the ages of
6 and 12 months.
Can baby with hypospadias be circumcised?
 Babies with hypospadias should not be
circumcised.
 The surgeon may use extra skin from the
uncircumcised foreskin to do the repair.
 Epispadias is a rare birth defect located at
the opening of the urethra. In this condition,
the urethra does not develop into a full tube,
and the urine exits the body from an
abnormal location.
 The causes of epispadias are unknown. It
may be related to improper development of
the pubic bone.
Scabies
 Is an itchy skin condition caused by a tiny
burrowing mite called Sarcoptes scabiei.
 Intense itching occurs in the area where the
mote burrows. The urge to scratch may be
especially strong at night.
 Scabies is a contagious and can spread
quickly through close physical contact in a
family, child care group, school class,
nursing home or prison. Because scabies is
so contagious, doctors often recommend
treatment for entire families or contact
groups.
Signs and symptoms:
 Itching often severe and usually worse at
night.
 Thin, irregular burrow tracks made up of
tiny blisters or bumps on your skin.
Prevention:
To prevent re-infestation and to prevent the mites
from spreading to other people take these steps:
 Clean all clothes and linens – use hot, soapy
water to wash all clothing, towels and
bedding used within three days before
beginning treatment. Dry with high heat.
Dry-clean items you can’t wash at home.
 Starve the mites – consider placing items
you can’t wash in a sealed plastic bag and
leaving it in an out-of-the-way place, such as
in your garage, for a couple of weeks. Mites
die after a few days without food.
Pediculosis
 Head lice (pediculosis capitis) is a common,
highly contagious infection the often occurs
in nurseries, day care centers and schools.
 It is caused by infestation with the human
head louse. Pediculus humanus capitis and it
is usually very itchy.
 Lice are very small insects that feed on
human blood. The female louse attaches her
eggs (nits) to the base of the hair near the
scalp and the nits hatch 7-10 days later.
While the adult louse cannot survive for
 more than 2 days off the human head. A nit  Vacuum floors and furniture.
can stay alive for up to 10 days off the body  Examine the hair and scalp of household
(for example) on clothes, hairbrushes or members and treat them if they are infested.
carpets). Lice are spread from child to child  Notify the school nurse, teacher or day care
by close contact and by sharing belongings provider if your child is diagnosed with head
that are infested with lice. lice. Your child can return to school after
proper treatment.
 Do not share combs, hairbrushes, hats,
Signs and symptoms: towels, bedding, clothing, headphones,
stuffed toys or other items with someone
 Moving lice or nonmoving nits may be seen
who has head lice.
on the scalp and hair. Each louse is
approximately 1-3 mm long and is whitish
gray in color. Lice crawls they do not jump
or fly. Nits are smaller, about 0.5-1 mm
white and are firmly attached to the hair
very close to the scalp.
 Small red bumps or sores may be seen on
the scalp, neck and shoulders. Occasionally,
the lymph nodes behind the ears or in the
neck may be swollen and tender
 Lice may sometimes be seen on the
eyelashes causing the eyes to become red
and irritated.
Management:

 Over-the-counter medications for head lice

are effective and should be the first
treatment you use. These includes pyrethrin
and permethrin lotion 1%.
 Both medicines kill only live lice, not the
eggs, so they should be reapplied in 7-10
days to kills newly hatched lice.
 These treatments are only minimally
absorbed through the skin.
 These treatments are only minimally
absorbed through the skin.
 Before applying the over-the-counter
lotions, do not use conditioner on the hair, as
this will coat the hair and protect the lice
from the medicine. Also do not wash the
hair for 1-2 days after treatment.
 Wash any object that your child has come
into contact with during the past 48 hours in
hot water for at least 5 minutes.
 Seal potentially contaminated but non
washable objects in plastic bags for 2 weeks.
(the lice will die within 2 days and the nits
will hatch and die within 2 weeks)