NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

● Regurgitation - return of undigested

Chapter 3B: ALTERATIONS IN NUTRITION
AND GASTROINTESTINAL, METABOLISM food from the stomach, accompanied
AND ENDOCRINE by burping
● Spitting up – dribbling of unswallowed
Topic Outline
formula from the infant’s mouth
immediately after a feeding
I. .
II. .
Possible triggering factors
III. .
● Common in infants less than 3yrs old
IV. .
● Infants of mothers who smoke during
V. Hirschsprung’s Disease
pregnancy or after delivery
VI. Failure to Thrive
● Reflux -- heartburn due to stomach acid
VII. .
and milk flowing back into the windpipe
VIII. Diabetes Mellitus
● A growing digestive system with
IX. .
muscles that often spasm.
X. Anorexia Nervosa
● Air intake from feeding or crying
● Hormones that cause stomachaches or
I. Introduction a fussy mood.
● Oversensitivity or over-stimulated by
By secreting hormones that have an impact on a light, noise, etc, A moody baby
variety of organ systems, endocrine glands ● A still-developing nervous system
control homeostasis. A body employs the ● Improper feeding, Overfeeding, rapid
metabolic process to get or produce energy feeding
from food. When a process's normal function is ● Emotional stress or tension between
disrupted, a disorder results. parent and child

II. COLIC Clinical Manifestations

● Infant colic or baby Colic
● paroxysmal abdominal pain or
cramping that is manifested by loud
crying and drawing the legs up to the
abdomen
● Applies to healthy, well fed infants
● It happens to an infant who cries more
than 3 hours, for more than 3 weeks
● Bloating
● Predictable crying episodes
❖ Cries in the same time
everyday, could be afternoon or
evening
❖ episodes may last from a few
minutes to three hours or more
on any given Day
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
❖ Baby may have a bowel
movement or pass gas near the
end of the colic episode
● Intense or inconsolable crying
❖ intense, sounds distressed and
high pitched
❖ baby's face may flush and
extremely difficult to comfort
● Crying that occurs for no apparent
reason
● Curled up legs, clenched fists and
tensed abdominal muscles during colic
episodes
Relieving Colic
● Change infant’s position frequently
❖ with child’s face down and with
body across parent’s arm,
❖ with parents’ hand under
infant’s abdomen, applying
gentle pressure
● Gently massage infant’s abdomen
● Swaddle infant tightly with a soft
stretchy blanket
● Provide smaller, frequent feedings
● Burp infant during and after feeding
● Place infant in an upright seat after
feeding
● Respond immediately to the crying
● Change from one cow's milk formula to
another
● Change from a cow's milk formula to a
soy formula
● Change from a regular formula to a
"predigested," hypoallergenic formula
● If you're breastfeeding, avoid eating
certain foods (such as caffeine, milk,
certain vegetables) and taking herbal
supplements.
● Try giving him more time in a front baby
carrier (the kind you wear over your
chest)
● Take your baby for a ride in the car for a
change in environment (but not when
you are sleepy)
● . Use "white noise" (such as static on
the radio or the vacuum cleaner),
classical music, or a "heartbeat tape"
next to the crib
● Try infant massage.
● Put a warm water bottle on your baby's
belly
● Have him or her suck on a pacifier
● Soak baby in a warm bath
● Try an infant swing.
● Increase or decrease the amount of
stimulation in the environment
● Watch out for over-stimulation or
increased fatigue
● Use of homeopathic drops for colic,
some parents say they have helped
their colicky baby
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
III. CLEFT LIP AND PALATE
When lip or mouth don't form properly, it
happens during pregnancy, could have either
cleft lip, cleft palate or both
During the first six to eight weeks of pregnancy
Five primitive tissue lobes grow:
● one from the top of the head down
towards the future upper
lip(Frontonasal Prominence)
● two from the cheeks, which meet the
first lobe to form the upper lip;
(Maxillar Prominence)
● just below, two additional lobes grow
from each side, which form the chin and
lower lip; (Mandibular Prominence)
If the two tissue failed to join cleft will be form
(fusion failures)
The roof of the mouth is called PALATE
Babies may have both the front and back parts
of the palate open, or they may have only one
part open
Causes:
● Genetics
● Maternal hypoxia (due to maternal
smoking, maternal alcohol or drug
abuse or some forms of maternal
hypertension treatment)
● Seasonal causes (such as pesticide or
Lead exposure)
● Maternal diet and vitamin intake;
retinoids — which are members of the
vitamin A family;
● . Anticonvulsant drug
● Lack of Folic acid
Variations in Clefts of Lip and Palate at Birth
● Unilateral incomplete Cleft Lip
● Unilateral complete Cleft Lip
● Bilateral complete Cleft Lip
● Unilateral complete lip and palate
● Bilateral complete Lip and Cleft Palate
● Complete Cleft Palate (soft and hard
palate, possibly including a gap in the
jaw
● Incomplete Cleft Palate (a 'hole' in the
roof of the mouth, usually as a cleft soft
a. palate)
Diagnostic and Laboratory Procedures
1. Ultrasonography - As early as 14 to 16 weeks
of gestation
2. Determine whether the defect is isolated or
one feature of a broader syndrome
Therapeutic Management
Cheiloplasty
● Surgical Correction of Cleft Lip, Within
the first 2–3 months after birth,
● "Rule of 10s": the child is at least 10
weeks of age; weighs at least 10
pounds,
● If the cleft is bilateral and extensive,
two surgeries may be required to close
the cleft, one side first, and the second
side a few weeks later.
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
● The most common procedure to repair
a cleft lip is the Millard procedure
● If the cleft is bilateral and extensive,
two surgeries may be required to close
the cleft, one side first, and the second
side a few weeks later. The most
common procedure to repair a cleft lip
is the Millard procedure
Palatoplasty
● Surgical Correction of Cleft Palate
● Often a cleft palate is temporarily
covered by a palatal obturator (a
prosthetic device made to fit the roof of
the mouth covering the gap).
● Usually performed between 6 and 12
months.
● Bone tissue can be acquired from the
patients own chin, rib or hip
Insertion of Tympanostomy tube into the
eardrum to aerate the middle ear.
● beneficial for the hearing ability of the
child.
● Hearing impairment is particularly
prevalent in children with cleft palate. T
● The tensor muscle fibres that the
eustachian tubes lack an anchor to
function effectively.
● when the air in the middle ear is
absorbed by the mucous membrane,
the negative pressure is not
compensated, which results in the
secretion of fluid into the middle ear
space from the mucous membrane.
● conductive hearing loss primarily
caused by this middle ear effusion
Speech therapy (/p/, /b/, /t/, /d/, /s/, /z/,
etc)
Prosthetics
Nursing Care Management
● Address the infant’s physical needs as
well as the parents’ emotional needs
● Encourage expression of parental grief
and fears
● Teach the parent how to successfully
feed the child
1. Barium enema demonstrates the
obstruction
2. Abdominal radiograph to detect
intraperitoneal air from a bowel
perforation
3. Rectal examination reveals mucus,
blood and occasionally a low
intussusception
4. Ultrasound
THERAPEUTIC MANAGEMENT
1. Hydrostatic reduction (With barium or
water-soluble contrast)
2. Non-surgical treatment
a. Barium enema (fills the bowel
and allows for visualization of
the bowel by x-ray. The weight
on the barium reduces the
telescoped bowel)
3. Intussusception reduction
a. Laparoscopy (segments of
intestine are pulled apart by
forceps)
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
b. Manual reduction (Milking the
intussusceptum out of the
intussuscipiens)
c. Segmental resection with an
end-to-end anastomosis
d. Medications are limited to pain
control after surgery
NURSING CARE MANAGEMENT
1. Explain the nonsurgical techniques and
possibility of surgery to the parents.
2. Explain the basic defect
intussusceptions and how
intussusceptions is corrected with
contrast enemas.
3. Preserve the parent- child relationship
by encouraging rooming-in or extended
visiting.
4. Frequent v/s and BP monitoring
NURSING CARE MANAGEMENT
1. Perforation during nonoperative
reduction
2. Wound infection
3. Internal hernias and adhesions causing
intestinal obstruction
4. Sepsis from undetected peritonitis
(major complication from a missed
diagnosis)
5. Intestinal hemorrhagE
6. Necrosis and bowel perforation
7. Recurrence
PROGNOSIS
● Outlook for intussusception is excellent
when treated quickly, but when
untreated it can lead to death w/in 2–5
days.
● Most intussusceptions recur within 72
hours of the initial event; however,
recurrences have been reported as long
as 36 months later.
V. Hirschsprung’s Disease
of
● Congenital Aganglionic Megacolon;
Congenital megacolon.
● A developmental disorder of the enteric
nervous system (ENS) and is
characterized by an absence of ganglion
cells in the distal colon thus, poor
muscle movement in the bowel
resulting in blockage of the large
intestine; a congenital condition.
RISKS FACTORS
1. Japanese and American children.
2. 4x more common in males than
females.
3. Sometimes associated with other
inherited or congenital conditions such
as Down syndrome
PATHOPHYSIOLOGY
● Hirschsprung's disease (HD) is a
disorder of the abdomen that occurs
when part or all of the large intestine or
antecedent parts of the gastrointestinal
tract have no ganglion cells and
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
therefore cannot function. During
normal fetal development, cells from
the neural crest migrate into the large
intestine (colon) to form the networks
of nerves called Auerbach's plexus and
Meissner's plexus. In Hirschsprung's
disease, the migration is not complete
and part of the colon lacks these nerve
bodies that regulate the activity of the
colon. The affected segment of the
colon cannot relax and pass stool
through the colon, creating an
obstruction. In most affected people,
the disorder affects the part of the
colon that is nearest the anus. In rare
cases, the lack of nerve bodies involves
more of the colon. In five percent of
cases, the entire colon is affected.
Stomach and esophagus may be
affected too. Muscle contractions in the
gut help digested foods and liquids
move through the intestine. This is
called peristalsis. Nerves between the
muscle layers trigger the contractions.
In Hirschsprung's disease, the nerves
are missing from a part of the bowel.
Areas without these nerves cannot push
material through. This causes a
blockage. Intestinal contents build up
behind the blockage. The bowel and
abdomen swell as a result.
CLINICAL MANIFESTATIONS
1. Abdominal distention (relieved by rectal
stimulation or enema).
2. Green or brown Vomitus.
3. Failure to pass meconium within the
last 48 hours of life
4. Fecal impaction
5. Poor feeding and Failure to thrive
6. Jaundice
7. Chronic constipation with passage of
ribbon like, foul smelling stools
8. Poor weight gain
9. Evidence of previous GI dysfunction
10. Watery diarrhea (in the newborn)
DIAGNOSTIC AND LABORATORY PROCEDURES
1. Abdominal x-ray
2. Anal manometry – a balloon is inflated
in the rectum to measure pressure in
the area
3. Barium enema
4. Rectal biopsy – for histological evidence
of the absence of ganglion cells (Gold
standard)
5. Palpate loops of bowel in the swollen
belly.
6. A rectal exam reveals tight muscle tone
in the rectal muscles.
THERAPEUTIC MANAGEMENT
1. Serial rectal irrigation helps relieve
pressure in (decompress) the bowel.
2. Colostomy is performed first
3. Surgical removal (resection) of the
abnormal section of the colon, followed
by reanastomosis.
NURSING CARE
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
1. Help the parents adjust to the
congenital disorder
a. Foster an infant – parent
bonding.
b. Prepare the parents for
medical surgical intervention
c. Assist them in caring for the
colostomy after discharge
2. Post-operative Care
a. Monitor bowel sounds and
passage of stools will indicate when can
oral feeding be initiated.
3. Home Care
a. Provide instructions about
colostomy care; skin care,
emptying and changing the
ostomy appliance, and
monitoring for problems.
POSSIBLE COMPLICATIONS
1. Inflammation and infection of the
intestines (enterocolitis) may occur
before surgery, and sometimes during
the first 1 - 2 years afterwards.
2. Perforation or rupture of the intestine.
3. Short bowel syndrome, a condition that
can lead to malnourishment and
dehydration
PROGNOSIS
● A small number of children may have
constipation or problems controlling
stools (fecal incontinence).
● Children who get treated early or who
have a shorter segment of bowel
involved have a better outcome.
VI. FAILURE TO THRIVE
● Growth failure; FTT; Feeding disorder;
Poor feeding; faltering weight or weight
faltering.
● Refers to children whose current weight
or rate of weight gain is below the third
or fifth percentiles than that of other
children of similar age and gender.
● Failure to maintain an established
pattern of growth and development
that responds to the provision of
adequate nutritional and emotional
needs of the patient.
CATEGORIES OF FAILURE TO THRIVE
● Endogenous or Organic failure to thrive
(OFTT)
○ Inborn error of metabolism
○ Cystic fibrosis, diarrhea, liver
disease, and celiac disease
○ Gas and acid reflux
○ Physical deformities such as
cleft palate and tongue tie
○ Milk allergies
○ Parasites, asthma, urinary tract
infections, heart disease
● Exogenous or Nonorganic failure to
thrive (NFTT)
○ Caregiver's actions
Factors that lead to inadequate infant caloric
intake:
a. Poverty
b. Family stresS
c. Health or childrearing beliefs
d. Feeding resistance
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
e. Inadequate nutritional
knowledge
f. Insufficient breast milk
● Psychosocial factors
○ Loss of emotional bond
between parent and child
○ Child-caregiver relationship
■ Physical inability to
produce enough
breastmilk.
■ Using only babies' cues
to regulate
breastfeeding so as to
not offer a sufficient
numbers of feeds
(sleepy baby syndrome)
■ Inability to procure
formula when needed.
■ Purposely limiting total
caloric intake
■ Not offering sufficient
age-appropriate solid
foods for babies and
toddlers
■ Over the age of six
months
○ Parents do not understand the
appropriate diet needs for the
child.
○ Exposure to infections,
parasites, or toxins
○ Poor eating habits, such as
eating in front of the television
and not having formal meal
times.
● Idlopathic failure to thrive
CLINICAL MANIFESTATIONS
1. Lack of appropriate weight gain (Weight
is lower than 3rd percentile of standard
growth charts or 20% below the ideal
weight for their height)
2. Growth may have slowed or stopped
3. Delayed motor development
4. Irritability and excessive crying
5. Easy fatigue ability
6. Avoids eye contact
7. Excessive sleepless (lethargy)
8. Skin and hair - Poor hair texture and
amount, nails, alopecia, hygiene, rashes,
birth marks, trauma (eg, bruises, burns,
or scars as signs of physical abuse)
9. Protruding abdomen
10. Constipation
DIAGNOSTIC AND LABORATORY PROCEDURES
1. Anthropometric measurement
2. Physical examination for evidence of
organic causes
3. Denver Developmental Screening Test
to show any delays in development
4. Dietary intake
5. Blood count, urine test and other blood
chemical and electrolyte test to search
for underlying medical problem
6. Create a growth chart outlining all types
of growth since birth is created.
7. Electrolyte balance
8. Hemoglobin electrophoresis to check
for conditions such as sickle cell disease
9. Hormone studies, including thyroid
function tests
10. X-rays to determine bone age knee
studies, wrist studies, or both
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
11. Skeletal survey for occult trauma if
physical abuse is suspected
12. Head CT scanning or MRI studies to
reveal microcephaly, macrocephaly, or
congenital malformation or if abusive
head traua is a concern
13. Urinalysis - Hydration status with
specific gravity, evidence of infection,
renal tubular acidosis
14. Renal function - Serum electrolytes,
BUN, and creatinine levels
15. Liver function – to determine protein
wasting or organomegaly
16. Sweat test for cystic fibrosis
17. Zinc level reported to be low in
malnourished infants and children
18. Metabolic and endocrinology screening
(only as needed)
19. Tuberculosis testing
20. Stool studies
Goal of Management
● Provide sufficient calories to support
“catch up” growth, a rate of growth
greater than the expected rate for age
Nursing Care
1. Accurate assessment of initial weight and
height and daily weight
2. Record all food intake
3. Provide a positive feeding environment
4. Teach the parent successful feeding strategies
5. Support the child and family
Nursing Management
1. Correct nutritional deficiencies and achieve
appropriate weight for height
2. Allow for “catch–up” growth
3. Restore optimum body composition
4. Educate the parents, primary caregivers
regarding child’s nutritional requirements and
appropriate feeding methods
5. Increase the number of calories and amount
of fluid the infant receives
6. Correct any vitamin or mineral deficiencies
7. Identify and treat any other medical
conditions
8. The child may need to stay in the hospital for
a little while
Prevention
Regular checkups can help detect failure to
thrive.
Possible complications
Permanent mental emotional, or physical delay
Possible complications
1. Normal growth and development may
be affected if a child fails to thrive for a
long
2. Normal growth and development may
continue if the child has failed to thrive
for a short time, and the cause is
determined and treated.
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

6. Burns or redness arond the mount and

VII. POISONING
lips from drinking certain poisons
● When a person is exposed to a 7. Breath smells like chemicals(gasoline,
substance that can damage their health paint thinner)
or put their life in danger 8. Difficulty Breathing
Poisons can be: 9. Drowsiness and fainting fits
1. Swallowed
2. Injected Prevention of Poisoning
3. Splashed into the eyes
4. Absorbed through the skin 1. Store medicine, cleaning and laundry
5. Inhaled products, paints/varnishes and pesticides in
their original packaging in locked cabinets or
Type of Poisons containers, out of sight and reach of children.
2. Purchase and keep all medicines in containers
i. Household products (bleach, drain openers, with safety caps. Discard unused medication
toilet bowl 3. Never refer to medicine as “candy” or
ii. Some types of plants and fungi cleaners, rust another appealing name.
removers, and oven cleaners) 4. Check the label each time you give a child
3. Certain types of chemicals and medicine; Use correct dosage
pesticides 5. Never place poisonous products in food or
iii. Cosmetic items (nail polish, nail glue remover drink containers 6. Keep coal, wood or kerosene
and nail primer) stoves in safe working order
2. Carbon Monoxide. 7. Maintain working smoke and carbon
3. Poorly prepared or cooked food, and food monoxide detectors.
that has gone mouldy or been a. contaminated
with bacteria from raw meat Prevention of Poisoning
4. Insect stings
5. Snake bites
6. Alcohol, if an excessive amount is consumed 1. Swallowed poison
in a short period (alcohol poisoning) ♦ Take the item away from the child, and have
the child spit out any remaining substance.
Clinical Manifestations ♦ Do not make your child vomit. Do not use
syrup of ipecac.
1. Vomiting 2. Skin poison:
2. Stomach pains ♦ Remove the child’s clothes and rinse the skin
3. High temperature with lukewarm water for at least 20 minutes.
4. Sleepiness
5. Confusion
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

3. Eye poison: absorbed into the body, having the effect of

♦ Flush the child’s eye by holding the eyelid flushing out the entire GIT
open and pouring a steady stream of room ♦ used following ingestion of sustained release
temperature water into the inner corner for 15 drugs, toxins that are not absorbed by activated
minutes. charcoal (i.e. lithium , iron), and for the removal
4. Poisonous fumes: of ingested packets of drugs (body
♦ Take the child outside or into fresh air packing/smuggling)
immediately. 3. Gastric lavage (Stomach pump)
♦ If the child has stopped breathing, start ♦ insertion of a tube into the stomach, followed
cardiopulmonary resuscitation (CPR) and do not by administration of water or saline down the
stop until the child breathes on his or her own, tube. The liquid is then removed along with the
or until someone can take over. contents of the stomach
5. Injected poisons (e.g. from the sting of ♦ performed within 1 hour of ingestion and the
poisonous animals): exposure is potentially life- threatening.
♦ Bind the affected body part with a pressure 4. Nasogastric aspiration
bandage to make sure the poison is not pumped ♦ involves placement of tube via the nose down
through the body and by placing the affected into the stomach, stomach contents are then
body part in hot water (with a temperature of removed by suction
50 °C) to break down the poison ♦ used for liquid ingestions where activated
6. Take the poison container (or any pill bottles) charcoal is ineffective ( e.g. ethylene glycol
with you to the hospital. poisoning)
7. Don't give ipecac syrup or do anything to
induce vomiting. Enhanced excretion
1. Diuresis
2. Hemodialysis
Gastric decontamination 3. Chelation (for poisonous
4. Hemoperfusion
1. Activated charcoal 5. Hyperbaric medicine
♦ to prevent poison absorption 6. Peritoneal dialysis
♦ ineffective against metals such as sodium, 7. Exchange transfusion
potassium and lithium and alcohols and glycols
♦ not recommended for ingestion of corrosive Antidotes
chemicals such as acids and alkalis
2. Whole bowel irrigation
♦ cleanses the bowel
♦ patient is given large amounts of a
Poison Antidotes
polyethylene glycol solution which is not
Anticholinergics Cholnergics(Vice-vers
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

Antipsychotics(hadol Ropinirole or Methanol Ethanol or

or rispersidone) bromocryptine( fomepizole, and
folinic acid
Atropine and/or Physostigmine
scopolamine Nicotine Bupropion and other
ganglion blockers
Benzodiazepines and Flumazenil
barbiturates Opioids Naloxone

Beta-Blockers Calcium Gluconate Organophosphates Atropin and

(Propranolol, Sotalol, and/or Glucagon. Pralidoxime
etc.) Salbutamol is also
used (and vice-versa Paracetamol N-acetylcysteine
(acetaminophen)
Caffeine and other Adenosine (and
xanthines vice-versa) Thallium Prussian blue

Calcium Channel Calcium gluconate VitaminK Vitamin K

Blockers (Verapamil, anticoagulants e.g.
Diltiazem) warfarin

Cyanide Amyl nitrite/sodium

nitrite/sodium VIII. DIABETES MELLITUS
thiosulfate or
hydroxocobalamin ➢ A chronic disorder of metabolism
characterized by ap partial or complete
Ethylene glycol Ethanol or
deficiency of the hormone insulin
fomepizole, and
because the body does not produce
thiamine
enough insulin
Hydrofluoric acid Calcium Gluconate ➢ In children can occur at any age but has
a peak incidence between age 10 and
Iron (and other heavy Desferrioxamine, 15 years with 75% diagnosed before 18
metals) deferasirox or years of age.
deferiprone ➢ Diabetes fasting blood sugar level is 126
milligrams per deciliter (mg/dL) or
Isoniazid Pyridoxine
higher a sudden.
Magnesium Calcium Gluconate
RISKS FACTORS FOR TYPE 2 DM

1. Overweight
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

2. Having a close relative with type 2 meet its energy needs. The hunger mechanism
diabetes is triggered, but the increased food intake
3. Being Native American, black, Hispanic, (polyphagia) enhances the problem by further
or Asian/Pacific Islander elevating the blood glucose.
4. Having high blood pressure, high blood
levels of lipids (fats), or polycystic ovary CLASSIFICATION
syndrome
1. Insulin – dependent diabetes mellitus
PATHOPHYSIOLOGY (IDDM) or Type I
● can develop at any time during
Insulin is needed to support the metabolism of childhood, even during infancy,
carbohydrates, fats, and proteins primarily by but usually begins between
facilitating the entry of these substances into ages 6 & 13 yrs
the cell, with the exception of nerve cells and 2. Non – insulin – dependent diabetes
vascular tissue. With a deficiency of insulin, mellitus (NIDDM) or Type II
glucose is unable to enter the cell, and its ● occurs mainly in adolescents
concentration in the bloodstream but is becoming increasingly
(hyperglycemia) increases. The increased common among overweight or
concentration of glucose produces an osmotic obese children
gradient that causes the movement of body
fluid from the intracellular space to the COMPARISON CHART
extracellular space; from there, the body fluid is
excreted by the kidneys. When the serum
glucose level exceeds the renal threshold (±180
Type 1 DM Type 2 DM
mg/dl), glucose “spills” into the urine
(glycosuria), along with an osmotic diversion of DEFINITION ▪ Beta cells in ▪ Diet related
water (polyuria), a cardinal sign of diabetes. The pancreas are insulin
urinary fluid losses cause the excessive thirst being attacked release is so
by body's own large and
(polydipsia) observed in diabetes. As might be
cells thus frequent that
expected, this water washout results in a can't produce receptor cells
depletion of other essential chemicals. Protein insulin to take have become
is also wasted during insulin deficiency. Because sugar out of less sensitive
glucose is unable to enter the cells, protein is the blood to the insulin.
broken down and converted to glucose by the stream Thus less
liver (glucogenesis); this glucose then ▪ Insulin is not sugar is being
produced removed
contributes to the hyperglycemia. Without the
from the
use of carbohydrates for energy, fat and protein blood.
stores are depleted as the body attempts to
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

DIAGNOSIS ▪ Genetic, ▪ Genetic, rubella,

environmental obesity cytomegalovir
and (central us)
auto-immune adipose),
factors, physical COMMON ▪ Mostly ▪ Mostly
idiophatic inactivity, PHYSICAL Normal or Overweight
high/low ATTRIBUTES Thin or Obese
birth weight, FOUND
GDM, poor
placental YOU HAVE ▪ Your body ▪ Body can
growth, THIS WHEN makes too still produce
metabolic little or insulin
syndrome no insulin but does not
use it
WARNING ▪ Increased ▪ Feeling tired properly
SIGNS thirst & or ill, (insulin
urination, frequent resistance)
constant urination
hunger, (esp. at AFFECTED ▪ Between 5 - ▪ most
weight loss, night), AGE GROUP 25 (maximum children who
blurred vision unusual numbers in have Type 2
and extreme thirst, weight this age diabetes have
tiredness, loss, blurred group; Type 1 a family
glycosuria vision, can affect at history of
frequent any age) diabetes, are
infections overweight,
and slow and are not
wound very
healing, physically
active.
COMMON ▪ Children/ ▪ Adults, Usually
AFFILIATED teens elderly, develops
GROUPS certain ethnic around
groups puberty

BODILY ▪ Triggered ▪ Appears to GLUCOSE ▪ Open and ▪ Are unable

EFFECTS autoimmune be related to CHANNELS/ absorb to open and
destruction of aging, RECEPTOR glucose into absorb
the beta cells; sedentary cell to be glucose,
autoimmune life-style, utilized by therefore
attack may genetic processes glucose
occur after a influence, but after cannot be
viral infection mostly the induction utilized by
(mumps, obesity of insulin processes; as
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

a result the individual

glucose stays nutrition
in the blood needs
stream
ONSET ▪ Rapid ▪ Slow (years)
CURE ▪ None ▪ There is no (weeks)
cure for type ▪ often
2 diabetes, present
although acutely with
sometimes ketoacidosis
gastric
surgery
and/or CLINICAL MANIFESTATIONS
lifestyle/medi
cation 1. Polyphagia
treatment 2. Polydipsia
can result in 3. Polyuria
remission. 4. Pruritus
5. Paresthesia
▪ Physical
exercise, 6. Weight loss
healthy loss 7. Irritability
of weight & 8. Fatigue
diet control 9. Blurred vision
are advised. 10. Headache
11. Enuresis or nocturia
TREATMENT ▪ Insulin ▪ Diet,
Injections, exercise, 12. Flushed skin
dietary weight loss, 13. Shortened attention span
plan, regular and 14. Poor wound healing
check up of in many 15. Frequent infections
blood sugar cases
levels, daily medication.
DIAGNOSTIC AND LABORATORY PROCEDURES
exercise
▪ Insulin
▪ Goals: Injections 1. 8-hour fasting blood glucose level
optimal may also be Fasting (DM if higher than 126 mg/dL)
glucose, used 2. Random blood glucose (level of 200
prevent/treat mg/dL or higher often means you have
chronic diabetes)
complications,
3. Oral glucose tolerance test (OGTT)
enhance
health
with food/PA,
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
●Between 140 and 200 mg/dL is
called impaired glucose
tolerance
● Before the test begins, a sample
of blood will be taken. You will
then be asked to drink a liquid
containing a certain amount of
glucose (usually 75 grams). Your
blood will be taken again every
30 to 60 minutes after you drink
the solution. The test may take
up to 3 hours.
4. Postprandial blood glucose
NURSING DIAGNOSIS
1. Risk for infection r/t reduced body
defences
2. Altered Nutrition: Less than Body
Requirements
3. Altered Family Process r/t a child with a
life- threatening illness
4. Activity intolerance r/t fatigue
5. Body image Disturbance
6. Individual Coping: Ineffective
THERAPEUTIC MANAGEMENT
● The definitive treatment is replacement
of insulin that the child is unable to
produce.
INSULIN
● Hormone that is released by the
pancreas.
● It controls the amount of sugar
(glucose) in the blood. A child with
diabetes has high blood sugar levels
either because the pancreas produces
little or no insulin (type 1 diabetes,
formerly called juvenile-onset diabetes)
or because the body is insensitive to the
amount of insulin that is produced (type
2 diabetes).
● In either case, the amount of insulin
available is insufficient for the body's
needs.
1. INSULIN THERAPY
The goal is maintaining near – normal blood
glucose values while avoiding too frequent
episodes of hypoglycaemia.
There are four main types of insulin:
a. Rapid acting insulin – used as a bolus
dosage
● Action onset is 15 minutes with
peak actions in 30 to 90
minutes; lasts as long as 5
hours
● Lispro
b. Short acting insulin
● Onset is within 30 minutes with
peak action around 2 to 4
hours; lasts for about 4 to 8
hours
● Regular insulin
c. Intermediate Acting Insulin
● Onset is within 1 to 2 hours
with peak action of 4 to 10
hours; lasts for about 14 to 20
hours
● NPH and Lente insulin
d. Long acting insulin
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
● usually given around bedtime;
onset is 6 to 14 hours; has no
peak or a very small peak; stays
in the blood between 20 to 24
hours
● Ultralente insulin
METHODS OF ADMINISTRATION
1. Daily insulin is administered
subcutaneously by twice–daily
injections, by multiple – dose injections,
or by means of an insulin infusion
pump.
2. Insulin Pump
● An electromechanical device
designed to deliver fixed
amounts of regular or lispro
insulin continuously, thereby
more closely imitating the
release of the hormone by the
islet cells.
MONITORING
a. Daily monitoring of blood glucose levels
(euglycemic/normal range of 80 to 120
mg/dL)
b. Urine testing for glucose is no longer
used for diabetic management;
However, urine testing can be carried
out to detect evidence of ketonuria.
2. DIET
● Plenty of complex carbohydrates, such
as whole-grain breads, pastas, potatoes,
beans, and peas;
● Unprocessed foods, such as bran
cereals, oatmeal, and fresh fruits and
vegetables.
● Snacks are important since children
require frequent feedings to supply
necessary calories for growth.
● Good snack choices include fresh fruit,
dried fruit, cheese crackers, peanut
butter crackers, yogurt, trail mix, vanilla
wafers, grain crackers, or granola bars, if
strenuous exercise is planned.
● Desserts good for all members of the
family include fresh fruit, low-fat yogurt,
pudding, and Jell- O
SEVERAL MEAL PLANNING APPROACHES
a. Exchange system
b. Carbohydrate counting
c. Dietary fiber
3. EXERCISE
● Exercise is encouraged and never
restricted unless indicated by other
health conditions.
● Exercise lowers blood glucose levels and
aids in utilization of food & often results
in reduction of insulin requirements.
● Physical training tends to increase tissue
sensitivity to insulin even in the resting
state.
4. HEALTH TEAM FOR DM:
a. Diabetes educators
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

b. Physician - how many insulin injections expectancy and/or increased health

child need to control his blood sugars problems
and manage his diabetes ● Person is traditionally considered obese
c. Nurse - how to test blood glucose levels if they are more than 20% over their
from a drop of blood from a finger stick ideal weight
and how to give insulin injections ● Obesity has been more precisely
d. Dietitian - food, planning meals and defined by the National Institute of
snacks, and about activity and exercise Health (the NIH) as a BMI of 30 and
above. (A BMI of 30 is about 30 pounds
COMPLICATIONS OF DIABETES MELLITUS: overweight.)
● In the Philippines, 1% of young children
1. Hypoglycemia (0-10 years) and 3% of adolescents
● Hypoglycemic episodes most (11-17 years) were overweight.
commonly occur before meals,
or when the insulin effect is
peaking. RISKS FACTORS
● Common cause: Burst of
physical activity without 1. Genetics / Hereditary
additional food, or delayed, 2. Behavioral Factor
omitted or incompletely 3. Environment
consumed meals.
● Treatment: CAUSES
a. 50% Glucose
administered 1. Sedentary lifestyle
intravenously ● Sedentary people burn fewer
b. Glucagon administered calories than people who are
IM or SC active
a. Large shift towards less
2. Hyperglycemia physically demanding
● Insulin work
● Diet- simple carbohydrates b. Increasing use of
● Fluids mechanized
transportation
c. Greater prevalence of
IX. OBESITY
labor-saving technology
● It is a medical condition in which excess in the home.
body fat has accumulated to the extent
that it may have a negative effect on
health, leading to reduced life
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

2. The balance between calorie intake and similar to forceps) the results
energy expenditure determines: are then used to calculate the
a. Overeating percentage of body fat.
3. … 7. Bioelectric Impedance Analysis (BIA)
There are two methods of the BIA:
(45 - 50) - SAM a. One type involves standing on a
special scale with footpads. A
harmless amount of electrical
current is send through the
body, and then percentage of
body fat is calculated.
b. The other type involves
electrodes that are typically
places on a wrist and an ankle
and on the back of the right
hand and on the top of the foot.
The change in voltage between
the electrodes is measured. The
person’s body fat percentage is
then calculated from the results
of the BIA.
4. Underwater weighing (hydrostatic
weighing)
THERAPEUTIC MANAGEMENT
- Weighs a person underwater
and then calculates lean body
The goal of treatment is achieve and maintain
mass (muscle) and body fat.
a “healthier weight”, not necessarily an ideal
- One of the most accurate ones
weight.
5. DEXA: Dual - Energy X-ray
Absorptiometry
1. Diet
- Used to measure bone density
a. Reduce the consumption of
- Uses X-ray to determine not
energy-dense foods, such as
only the percentage of body fat
those high in fat and sugars.
but also where and how much
b. Increase the intake of dietary
fat is located in the body.
fiber
6. Skin calipers
c. At least 1800 calories per day os
- Measures the skinfold thickness
recommended for adolescents
of the layer of fat just under the
d. Eat fewer calories. One pound is
skin in several parts of the body
equal to 3500 calories
with calipers (a metal tool
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
e. Read food labels and estimating
calories and serving sizes
f. Balance the food you eat with
physical activity
g. Choose a diet with plenty od
grain products, vegetables, and
fruits.
h. Choose a diet low in fat,
saturated fat, and cholesterol,
moderate in sugars, salt and
sodium
2. Physical activity and exercise help burn
calories
3. Medication
a. Anti-obesity drugs to reduce
appetite or decrease fat
absorption
i. Orlistat (Xenical)
ii. Lorcaserin (Belviq)
iii. A combination of
Phentermine and
Topiramate (Qsymia)
4. Surgery
a. Gastric ballon to reduce
stomach and/or bowel length,
leading to feeling full earlier
and a reduced ability to absorb
nutrients from food
b. Bariatric surgery cause weight
los by restricting the amoun of
food the stomach can hold,
causing malabsorption of
nutrients, or by a combination
of both gastric restriction and
malabsortion.
COMPLICATIONS
1. Type 2 diabetes
2. High blood pressure and elevated
cholesterol, especially elevated “bad”
LDL and triglycerides
3. Sleep apnea (obstruction of the airway
in sleep resulting in a serious drop in
blood oxygen levels)
4. Several bone and joint disorders in
childhood
5. Stroke (cerebrovascular accident or CVA
6. Heart attack
7. Cogestive heart failure
8. Cancer
9. Gallstones
X. Anorexia Nervosa
➢ Intense fear of becoming obese
➢ An eating disoreder characterized by
immoderate food restriction,
inappropriate eating habits or rituals,
obsession with having a thin figure, and
an irrational fear of weight gain, as well
as distorted body self-perception. (alter
how the affected individual evaluates
and thinks about their body, food, and
eating.
➢ People with anorexia nervosa often
views themselves as overweight or
“big” even when they are already
underweight.
➢ Occurs most often in girls (90%), usually
at puberty or during adolescence
between 13 - 20 yrs old.
➢ In includes three separate features:
● A self-induced starvation to a
significant degree;
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307
● A relentless drive for thinness, a
morbid fear of fatness, or both
● And medical signs and
symptoms resulting from
starvation.
➢ Anorexia has an average prevalence of
0.3 - 1% in women and 0.1% in men for
the diagnosis in developed countries.
The condition largely affects young
adolescent women, with those between
15 and 19 years old making up 40% of
all cases. Approximately 75% of people
with anorexia are female. Anorexia
nervosa is more prevalent in the upper
social classes and it is thought to be rare
in less-developed countries.
RISK FACTORS
1. Being more worried about, or paying
more attention to, weight and shape
2. Having an anxiety disorder as a child
3. Having a negative self-image
4. Having eating problems during infancy
or early childhood
5. Having certain social or cultural ideas
about health and beauty
6. Trying to be perfect or overly focused
on rules
CAUSES
1. Cultural Pressures
➢ In many societies, being
extremely thin is the standard
of beauty for women and
represents success, happiness,
and self-control
➢ In certain occupation (such as
dancing, modeling, and sports
like gymnastics, figure skating,
running and wrestling), the
pressure maintain a specific
weight and appearance is
strong.
2. Psychological issues/Characteristics
1. Low self-esteem
2. Poor body image
3. Difficulty expressing feelings
4. Need for control
5. Physical or sexual abuse
6. Need to feel special or unique
7. Feeling of ineffectiveness
8. Depression
9. Rigid thinking pattern
10. Perfectionism
11. Avoidance of conflict with
others
3. Family environment
Families of people with the disorder are more
likely to be:
a. Overprotective
b. Rigid - Suffocating in their closeness
c. Develops as a struggle for
independence and individuality.
d. Over valuing appearance and thinness
e. Criticizing a child’s weight or shape
f. Being physical or sexually abusive
g. Life transition can often trigger anorexia
nervosa in someone who is already
vulnerable because of several factors:
● Beginning of adolescence
● Breakup of a relationship
● Genetic factors
● Beginning of failing in school or
at work
 NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Ms. Dhonna Cambe, RN & Ms. Cristina Tianela, RN || September 29, 2023
(SURNAMES) || Sec 307

● Death of a loved one

SUBTYPES OF ANOREXIA NERVOSA

1. Restricting type
➢ Individual does not utilize binge
eating nor displays purging
behavior as their main strategy
for weight loss. Instead, the
individual uses restricting food
intake, fasting, diet pills, and/or
exercise as a means for losing
weight.
2. Binge-eating/ purging type
➢ Individual utilizes binge eating
or displays purging behavior as
a means for losing. weight
(eating a lot of food and then
trying to get rid of the calories
by forcing themselves to vomit,
using laxative or exercising , or
some.