Pediatric Nursing

LEYCEL F. MARZAN, RN, MSN

COMMON HEALTH PROBLEMS THAT
DEVELOP DURING INFANCY.
 Objectives
After the discussion the students should be able to:
✓Describe illnesses common to infants
✓Point out the signs and symptoms of the most common
illnesses during infancy
✓Discuss the therapeutic management of the common
illnesses during infancy
✓Discuss the nursing interventions of the common
illnesses during infancy
✓Ba able to apply these nursing intervention into actual/
simulated nursing practice.
✓Uphold Marian values as they apply nursing
interventions to clients in actual settings in the future.
 INTUSSUSCEPTION
✓ The invagination of one portion of the intestine into
another (one segment of the bowel telescopes into the
lumen of an adjacent segment of intestine)
✓ most frequently occurs in the second half of the first
year of life with 90% of cases occurring by 2 years of
age.
ASSESSMENT
✓Red currant jelly
stools containing
blood and mucus
✓Acute
episodic/colicky
abdominal pain
✓Sausage –shaped
mass palpated a the
right upper quadrant
 Therapeutic Management
• Reduction of the intussusception
✓Through instillation of a water soluble
solution, Barium enema, or air
pneumatic insufflation) into the
bowel.
✓Surgery to reduce the invagination
before necrosis of the affected part
occurs
 Medical or surgical treatment

• The purpose of hydrostatic reduction procedure

is to pull the invaginated bowel out from another
section of bowel, allowing normal fecal material
to pass.
• Sonography has now been accepted as a method
for guiding hydrostatic reduction of
intussusception with tap water, normal saline or
Ringer's lactate solution.
• The currant jelly stools will stop when the bowel
is no longer irritated.
 Nursing intervention ✓ Water or clear liquids will be allowed
for the Barium Enema for the child to take in.
✓ Parents /caregivers are advised to put
the child on NPO status after
midnight.
✓ Laxative is given to the child as
ordered the night before the exam. A
laxative, in a pill or liquid form, will
help empty the colon.
✓ Check if child has allergies to
medicines iodinated contrast
material
✓ Inform parents what to expect after
the procedure: like chalky white
stools 1 to 2 days after; and child may
have constipation
 NURSING INTERVENTION
PRE-SURGERY
❖Infants are kept NPO status before surgery or non-
surgical reduction
❖Provide pacifier to control pain
❖IV therapy as ordered to hydrate patient
❖Pre-operation interventions like documents and
communication, pre-op drugs like antibiotics,
materials needed
❖Information and emotional support to parents
and family
 NURSING INTERVENTION
POST- SURGERY:
✓ Infants are kept on NPO status for few hours and then
introduced gradually to regular feedings
✓ Care of nasogastric tube which is attached to low
intermittent suction—it will remain in place until the
suture line is healed and peristaltic function has
returned. Monitor for occurrence of bowel movement.
✓ Ensure that IV is infusing in place
✓ Encourage the participation of family to regain
confidence in this type of care. Urge them to continue
to hold and be with the child as recovery proceeds
✓ Care of the wound/incision site
✓ Pain control mechanisms
✓ Document properly
 Failure To Thrive (FTT)
(Reactive Attachment Disorder)

• A unique syndrome in which an

infant falls below the 5th percentile for
weight and height on a standard
growth chart and is divided into 2
categories:
❖ORGANIC TYPE: severe loss of weight can be
explained by organic causes like diseases of the
heart, digestive or metabolism

❖NON-ORGANIC: is due to disturbance in parent-

child relationship resulting to maternal
insufficiency. The parent feels little emotional
attachment to the child, which leads to the
neglect of the biological and emotional needs of
the child. If these syndrome continues , it may
lead to cognitive impairment of the child and even
death. It is considered a form of child-neglect
 ASSESSMENT
✓ Maternal claims of unintended pregnancy; A partner
left during the pregnancy; An experience of economic
catastrophe like loss of job; A long distance move that
left the support people behind
✓ Lethargy with poor muscle tone, loss of subcutaneous
fat, or skin breakdown; Lack of resistance to the
examiner’s manipulation
✓ Rocking on all fours excessively as if seeking stimulation
✓ greater reluctance to reach for toys or initiate human
contact
 ASSESSMENT
✓ Staring hungrily at people who approach them as
if starved for human contact
✓ Little cuddling or conforming to being held
✓ Delays in crawling, sitting, pulling to standing
position and walking because the child spend so
much time alone; delayed or absent speech
because of the lack of interaction
✓ With advanced FTT , the nutritional status is
extremely poor that the infant is near acidosis
due to starvation; may have poor immunity and
may result to death due to secondary infections
like pneumonia
 Therapeutic Management
❖Infants are immediately placed on a diet
appropriate for their ideal weight
❖The child is removed from the parent’s care
and hospitalized for evaluation and therapy or
the need for foster homes
❖Unnecessary pain stimulation (like injections/
needle pricks during laboratory studies) is
delayed for this under stimulated children
 Nursing Intervention
ENSURE ADEQUATE NUTRITION
❑Keep careful record of intake and output
❑Assess stools for pH and reducing substances
such as glucose to be certain that child is
absorbing nutrients effectively
❑Evaluate the sucking and other reflexes of the
baby
❑Evaluate feeding abilities of baby to be certain
that reflexes are intact
❑Assess for symptoms such as pulling up of legs;
crying after eating which suggests
gastrointestinal discomfort
 Nursing intervention
• Nurture the Child
❑Provide effective nurturing to child like
one member of the nursing team should
be chosen to care for the child during the
hospital stay primary nursing or case
management pattern of assignment).
❑Reserve time for providing interactions
with the child such as rocking, talking,
giving a leisurely bath, offering toys
• Support and Encourage parents
❑Encouraging them to visit as much as possible while
the child is hospitalized
❑During visits, encourage them to interact more with
the infant
❑Give suggestions on how to communicate with the
baby is important
❑Give time for the parent to realize what has been
happening since feelings does not change overnight
❑A follow-up home visit is recommended to see if the
parenting bond is maintained and further evaluation if
the baby needs to be transferred to the care of foster
homes
• Help Prevent poor parenting
❑Parents who may be risk for lacking adequate
parenting skills and support systems need to be
identified during pregnancy, so they can receive
counseling and close follow-up in the postnatal
period
 Colic
• Paroxysmal abdominal pain that generally
occurs in infants under 3 months of age
and it is marked by loud, intense crying.
Infant will pull their legs up against their
abdomen, and faces become red and
flushed, their fists clench and their
abdomen becomes tense. Child stops
crying for a while then begins to cry again
as another wave of intestinal pain occurs.
• This may occur children for overfeeding or
formula fed.
• Occurs 3 days every week lasting for 3
hours a day, bowel movements are normal
 Nursing Intervention
• Take a thorough history of an infant with signs of colic because intestinal
obstruction or infection can mimic an attack of colic and be misinterpreted by the
casual interviewer
• Burp child after feeding
• Small frequent feedings to prevent distention and discomfort
• Offer pacifiers to infant may be effective and reduce stimuli to infant distract
child’s attention with play (listening to music box or listening to heartbeat)
• Discourage placing hot water bottle because of risk of rupture of appendicitis if
there is a developing case of appendicitis, aside from the risk of scald and burns
• Caution parents from the use of herbs and home remedies
• Contact nurse practitioner to do physical exam to ensure infant is healthy
• Review formula preparation, bottle holding and burping as needed
• Educate parents about common characteristics of colic including duration timing
and intensity of crying
• Help plan respite time if necessary to reduce stress of parents due to infant's
constant crying
• Advise parent to contact clinic if measures are ineffective by 1 week
 CLEFT LIP
• . Failure of maxillary and median nasal
process to fuse
• Child is prone to ear, nose and throat
infections; prone to hearing and speech
problems.
• Surgical treatment: Cheiloplasty which is
best done during first weeks of life; Z –
shaped suture is done to minimize
scarring
• Care for the child after Cheiloplasty
• Feeding: use large, soft nipples with cross
cut holes (however, this may not be
tolerated by some infants); Breck feeder;
Habermann feeder; medicine dropper—
okay for infants with poor sucking
• Breck feeder=
syringe with
rubber tubing
• Medicine dropper
• Watch out for presence of edema in the oral mucosa,
mouth including the tongue, we would not like the
airway to be blocked by the edema.
• Elbow restraint should be applied to the child after
surgery to prevent the hands of child reach for the
surgical site which may result to trauma to the suture
line
• Logan bar is applied in the area to reduce tension on
suture line
• Child is placed in side-lying or supine position, to
prevent trauma on the operative site.
• Cleanse suture line of formula and serosanguinous
drainage with cotton tipped swab dipped in saline or half
strength hydrogen peroxide--To avoid crusting and to
minimize scarring and uneven closure of the
incision=this is priority to include in care by parents
• Crying should be prevented to avoid stress on
suture Keep baby quiet and peaceful always
as much as possible. Advise the parents,
caregivers to carry baby immediately as soon
as he/she starts to cry to calm him/her
• No prone position; and do NOT use pacifiers
• B. CLEFT PALATE: a midline fissure of the palate that
results from failure of the two sides to fuse
• Uranoplasty (cleft palate repair) best done at 12 to 18
months of age. This is to allow palatal changes with
growth and to prevent speech problems
• Care of the child after cleft palate repair
• Feed the child with liquefied diet through a paper cup
• Do not insert spoon into the mouth. Allow the child to
sip from the side of the spoon to prevent trauma to the
operated area
• Soft diet is maintained until operated area is healed.
• Child may be positioned on abdomen or prone (if
palate only) supine and side-lying to promote drainage
• Provide oral hygiene to prevent infection
IMPERFORATE ANUS
• Is a stricture or the absence of
the anus
• More common in boys than in
girls
• May occur as an additional
complication of spinal cord
disorders.
 Assessment
• “wink reflex” (touching the skin near the rectum
should make the anus contract) cannot be elicited
because sensory nerve endings may not be intact
• no passing of meconium within 24 hours and
abdominal distention is evident
• Follow-up care by parents include an assessment of
whether infant is defecating or not
• Observe for the urine collected for the presence of
meconium—this will suggest rectal –bladder fistula
• An x-ray will reveal that the lower bowel ends in a blind
pouch
 Therapeutic Management
• Simple laparoscopy with anastomosis for
uncomplicated simple imperforate anus
• Creation of temporary colostomy then
followed by final repair at 6 to 12 months if
conditions is complicated (like bladder or
vagina fistula is present)
 Nursing Intervention
• Preoperative Care:
• Keep the infant on NPO status to avoid further
bowel distention
• A nasogastric tube attached to low intermittent
suction for decompression will be inserted, as
ordered by physician, to relieve vomiting and
prevent pressure on other abdominal organs or
the diaphragm from the distended intestine
• IV therapy or total parenteral Nutrition will be
started, as ordered by physician, to maintain fluid
and electrolyte balance
 Nursing Intervention
• Postoperative care
• Position after repair of imperforate anus: supine with the
legs suspended at 90 degree angle or on either side with
the hips elevated to prevent pressure on the perineum
• Monitor for bowel sounds, if bowel movement is already
evident NGT can be removed and small oral feedings of
glucose water, formula or breastmilk can be started
• Infants who are scheduled for 2nd stage repair and with
colostomy are not allowed to eat high residue foods. Advise
parents to offer infant with low residue diet like rice
cereals, strained fruits and vegetables
 Nursing Intervention
• If rectal repair was completed, take axillary or tympanic
temperature rather than rectal temperatures to avoid
trauma to suture line which may lead to loosening of suture
• No enemas, suppositories or any other intrusive rectal
procedures. Hang a sign above the infant’s crib cautioning
against these procedures.
• Give stool softeners daily as prescribed by physician. Teach
parents regarding the dose and time and emphasize its
importance.
• Place a diaper under the infants buttocks, instead of being
worn by infant)– so stool may be cleansed away as soon as
they occur.
 Nursing Intervention
• Clean the suture line well after each bowel movement by
irrigating it with normal saline or other prescribed solution
to prevent infection.
• Do not position infant on the abdomen—because this may
cause tension on the perineal area ad the suture line– SIDE-
LYING POSITION IS BEST
• Rectal dilatation is done once or twice a day for a few
months after surgery to ensure proper patency of the rectal
sphincter. Gently insert a lubricated cot-covered finger into
the rectum. Review the procedure with the parents and
document that they are able to perform this procedure
before the child is discharged from the hospital.
 Nursing Intervention
• Emphasize to parents that manual rectal dilatation is
very important so that constriction of the anal
sphincter will not occur.
• Give emotional support following the diagnosis of the
disorder by giving correct information and up-dates.
• Make self-available for any queries from the parents
• Assure parents that the child will have a relatively
normal bowel function thereafter.
• If child should have permanent ostomies, assure
parents that the child will accept this well as they grow
older because they have never known any other
method of defecation.
 Hirschsprung's Disease
(Congenital Aganglionic Megacolon)
• it is an absence of ganglionic innervation to
the muscle of a section of the bowel (in
most instances, the lower portion of the
sigmoid colon just above the anus)—thus
there is no peristalsis in that section to
move fecal material through the segment of
the intestine, resulting to chronic
constipation or passing of thin, ribbon-like
stools (the stools pass through small and
narrow segment of the intestine and
evacuated out through the anus and look
like ribbons).

• The portion of the bowel proximal to the

obstruction dilates, thus distending the
abdomen.
 Assessment
• Characterized by absence of meconium within 24 hours after birth and
bile-stained emesis
• If ever the child passes stool, it is in the form of explosive diarrhea
• Signs and symptoms of HD becomes apparent when child reaches 6 to 12
months of age. By this time the child appears thin and undernourished
however with large distended abdomen, and have a history of not having
bowel movement for more than a week– if ever child passes stools, it
appears to be loose, watery and thin like ribbons.
• Through rectal examination, the examining finger will touch hard and
caked stool
• Through rectal biopsy , a definitive diagnosis, will show aganglionic cell in
the bowel
• Through Barium enema or ultrasound will outline narrow, nerveless
portion and the large distended proximal portion of the bowel
• Through anorectal manometry, that tests the strength or innervation of
the internal rectal sphincter,--reveals rectal muscles and sphincter do not
relax when the balloon is inflated suggesting paralysis of the colon
 Therapeutic Management
• Pull-through operation, it is the dissection and
removal of the affected section, with
anastomosis of the intestine
– Two-stage surgery: 1st stage is the creation of the
temporary colostomy, then 2nd stage follows with
the repair of the bowel at 12 to 18 months of age
 Nursing Interventions
• Pre-operatively
– Patient may be placed on a minimal-residue diet,
stool-softeners daily, vitamin supplements and
perhaps daily enemas with normal saline
(0.9%%NaCl) until their condition improves
– Total parenteral nutrition can offer another source
of nutrition
– Fried foods and highly seasoned foods are omitted
– Advise parents to refrain from introducing new
feeding methods
 Nursing Intervention
• Post-operatively (Infant returns from operating room with a
nasogastric tube in place attached to a low suction, an IV infusion
and perhaps a Foley catheter)
– Observe the infant for abdominal distention. Ensure that the
nasogastric tube is intact and in place
– Assess bowel sounds and observe also passage of flatus and
stools
– As soon as peristalsis has returned the nasogastric tube can be
removed, and the child can be offered small frequent feedings
of fluids, such as water or gelatin.
– Gradually introduce full fluids, soft diet and minimal residue
diet, then finally normal diet of age
– Ensure that IVF is infusing well
– Care for indwelling Foley catheter
– NO ENEMA
–Caution parents that the child may still
remain a “fussy eater” for few months
because feeding problems that begin
for physical reasons can continue for
emotional or psychological reasons.
–Help parents to diminish food
gradually: to schedule periods during
the day when they give their full
positive attention to the child
 SURGICAL PROCEDURE FOR
HIRSCHSPRUNG’S DISEASE
• The endorectal pull-through procedure
described by Soave and subsequently
modified by Boley to include primary colo-
anal anastomosis is one of the most
commonly performed procedures for
Hirschsprung's disease.
• Soave-boley endorectal pull-through and
colo-anal anastmosis
 COLOSTOMY CARE
• A colostomy is an operation that creates an opening
for the colon, or large intestine, through the
abdomen. A colostomy may be temporary or
permanent. It is usually done after bowel surgery or
injury.
• Check the skin around the stoma for redness or
irritation. The skin around the stoma should not be
red, raw, swollen or burning
• Keep the surrounding area of the stoma always dry
and clean
• Observe for any foul odour coming from the stoma
as well
 CONGENITAL HEART ANOMALIES
• A. CONGENITAL HEART DISEASES
• Review the Fetal Circulation
• Ductus venosus: carries oxygenated blood from the
placenta to the inferior vena cava; it by passes the
liver; it closes at 8-weeks of life
• Ductus Arteriosus: bypasses flow of blood through
lungs by shunting oxygenated blood from pulmonary
artery to aorta; it closes at 7-10 days after birth
• Foramen ovale: connects right and left atria; allows
blood flow from right atrium (RA) to left atrium (LA);
bypasses the right ventricle (RV) and pulmonary
circuit; closes by 2 to 3 months
The normal human circulation
• superior vena cava and inferior
vena cava
• Right Atrium
• Tricuspid valve
• Right Ventricle
• Pulmonary valve
• Pulmonary Artery
• Lungs for oxygenation
• Pulmonary veins
• Left Atrium
• Mitral valves
• Left ventricle
• Aortic valve
• Aorta
• To different parts of the body
 • Oxygenated blood from the
The Fetal Circulation •
placenta
Umbilical vein
• Ductus venosus
• Inferior vena cava
• Right atrium
• Foramen ovale
• Left atrium
• Left ventricle
• Aorta (Coronary, Cerebral,
Upper limb)

• Deoxygenated blood through

SVC and IVC
• Right Atrium
• Tricuspid valve
• Right Ventricle
• Pulmonary Artery
• Ductus Arteriosus
• Descending Aorta
• Continues to internal iliac
arteries to supply the lower
half of body
• Umbilical arteries back to
placenta
A. DEFECTS WITH INCREASED
PULMONARY BLOOD FLOW
 • PATENT DUCTUS
ARTERIOSUS (PDA)= This
is the failure of the
Ductus Arteriosus to
close; characterized by
machinery murmurs and
wide pulse pressure.
• this allows a portion of
oxygenated blood from
the left heart to flow back
to the lungs by flowing
from the aorta, which has
a higher pressure, to the
pulmonary artery
Pulmonary vascular congestion • It causes Congestive
is the risk. Heart Failure (CHF)
Indomethacin is the drug of • acyanotic
choice for closing the PDA
 Pulmonary vascular congestion
is the risk.
Indomethacin is the drug of
choice for closing the PDA

• PATENT DUCTUS
ARTERIOSUS (PDA)
• inhibition of
prostaglandin
synthesis by
Indomethacin results
in constriction of the
Ductus Arteriosus
• VENTRICULAR SEPTAL
DEFECT(VSD)= most
common CHD
characterized by
abnormal opening
between the left and the
right ventricles. This
results to right sided CHF
because the blood shunts
from the left side of the
heart (higher pressure) to
the right side of the heart
(lower pressure). This
results to failure to thrive
(FTT) due to decreased
oxygenation and
metabolism
• VENTRICULAR
SEPTAL
DEFECT(VSD)=
Patient will have
increased RR
(Tachypnea); and
Dyspnea (difficulty
breathing) easy
fatigability== these
are signs that patient
is developing CHF
• ATRIAL SEPTAL DEFECT
(ASD)= This is characterized
by abnormal opening
between the left atria and
right atria. This results to
right-sided CHF (shunting of
blood from the left to the
right side of the heart
• Prepare child for x-ray and
echo cardiogram –these are
generally performed to
demonstrate if there is an
increase in the heart size
and location and size of the
defect
B. OBSTRUCTIVE DEFECTS
OBSTRUCTIVE DEFECTS
• COARCTATION OF
AORTA= This is presence
of narrowing in the Aorta.
It is characterized by the
following: hypertension
in the upper extremities;
lower blood pressure in
the lower extremities;
weak or absent pulse in
the lower extremities
• Surgical treatment:
Removal of the
coarctation or balloon
angioplasty
• acyanotic
• AORTIC
STENOSIS=This is
narrowing of the
aortic valve. It
leads to left-side
congestive heart
failure
 PULMONIC
STENOSIS

• = this
narrowing of
pulmonic valve.
It leads to right-
sided
congestive hear
failure
C. DEFECT WITH DECREASED
PULMONARY BLOOD FLOW
 ❖ TETRALOGY OF FALLOT: 4
defects namely,
❖ 1. Pulmonic Stenosis
❖ 2. Ventricular Septal Defect
❖ 3. Overriding Aorta ( the Aorta is
located in the right ventricle
together with the pulmonary
artery. The Aorta transports a
combination of oxygenated and
unoxygenated blood
❖ 4. Right Ventricular
Hypertrophy. The right ventricle
The child with TOF experiences “Tet spell” or
enlarges to accommodate
hypoxic episode. The child should be put into
increased workload caused by
“knee-chest” position to improve return of
shunting of blood from the left to
blood from lower extremities to the heart—
the right ventricle due to the
thereby improving the cardiac output and
presence of VSD.
tissue oxygenation. To older children the
“squatting” position is typical to compensate
for hypoxemia
• Primary
clinical
manifestatio
n of acute
cyanosis or
Tet spell in
Tetralogy of
Fallot is
Anxiousness
and
irritability
• TRANSPOSITION OF THE
GREAT VESSELS
• This is characterized by
exchange of position of
the aorta ad the
pulmonary artery. The
aorta is located in the
right ventricle, and the
pulmonary artery is
located in the left
ventricle. This is a mixed
defect.
• Two- non communicating
circulations
• There is severe cyanosis
upon birth
 Collaborative Management for Children with
Cardiovascular Defects

• Monitor: VS, respiratory status, intake and

output, and weight
• Administer O2 therapy (100% oxygen by face
mask). To improve tissue oxygenation
• During hypercyanotic spells, place the infant in
knee-chest position
• Administer Morphine Sulfate as prescribed to
reduce cardiac workload
• Indomethacin to close PDA as prescribed
 Collaborative Management for Children with
Cardiovascular Defects

• Provide adequate nutrition. Malnutrition occurs due

to decreased metabolism that results from
inadequate tissue oxygenation
• Administer IV fluids as prescribed
• Provide adequate rest. To reduce Oxygen demands
of tissues.
• Poor feeding and activity intolerance are common
in children with congenital heart disease
• Surgery to correct the defects. This is the most
definitive treatment.
 Care of child before cardiac surgery
• Vital signs for baseline values
• Accurate height and weight are also recorded
• Laboratory values must be checked specially chemistry hematology and
coagulation values
• Blood products must be typed and cross-matched
• Pregnancy test for girls who are menstruating
• Informed consent must be secured for anesthesia and surgery
• Prepare parents for the amount of equipment that will surround the child
after the surgery such as cardiac monitor Oxygen tanks, IV equipment,
chest tube, ventilator and the noise these machines may bring.
• Discuss the surgical procedure to parents and with the child to lessen
worries and answer misconceptions
• Discuss coughing and deep breathing exercise and use of spiromentry
during post op should be discussed preoperatively
• Take parents and older children to the ICU where they will return after
surgery and show the equipment that will surround them
 Care of child after cardiac surgery
• Taking accurate vital signs is essential in the
immediate post operative period
• Continuous cardiac monitoring and assisted
ventilation with endotracheal intubation is
frequently necessary
• Hemodynamic monitoring through the central
venous catheter to carefully evaluate the preload
will help determine which type of therapy is
necessary
• IV fluids monitored
 Nursing intervention
• Endotracheal suctioning is necessary to prevent obstruction
of the tube
• Assist with the chest physiotherapy to help lung secretion
mobile
• As soon as the ET tube and ventilator are removed
encourage the child to cough and breath deeply and use
and incentive spirometer at hourly interval to mobilize
secretions.
• Coughing and Deep breathing may be painful post-op so
pain relievers are given as prescribed
• Teach children how to use pillow as splint while coughing
and deep breathing
• Be certain parents understand that games blowing cotton
or bubbles using the incentive spirometer as important
exercises to help achieve lung expansion
 Nursing intervention
• Chest tube drainage is attached to allow the drainage
and collection of fluid or air from the chest but also to
prevent air or fluid from returning to the chest
– Keep the system closed and below chest level
– Ensuring the suction control chambers are filled or set for
the ordered amount of suctioning. If a fluid filled system,
ensure bubble are in the chamber
– Ensure the water seal chamber is filled to manufacturer’s
recommended level
– Monitoring for bubbles in the water seal chamber which
can indicate either a leak in the drainage system or an air
leak from the patient’s lungs.
– Assessing and documenting the amount color and
consistency in the drainage system routinely and
as ordered. Report any drainage that changes in
volume color or bloodiness
– Keep tubes freely draining, do NOT milk or rub the
tubes
– Ensure adequate pain control that allows the child
to be awake and interactive
Nursing interventions when infant is in
the Routine care unit
• Watch out for blood loss
• Prevent infection
• Maintain lung expansion
• Encourage mobility
• Encourage healthy eating
• Include family in care
 Nursing Intervention
• PREVENT INFECTION
– Antibiotic therapy for 24 to 48 hours after chest
closure
– Check the surgical incision site and the points of
insertion for possible beginning infection
– Let infant wear shirts and bibs when feeding to
prevent formula from dropping into the incision
site
• MANAGE PARENTAL ANXIETY
– Encourage child to be out of bed and ambulate once they
are hemodynamically stable and free from cumbersome
equipment
– Encourage parents to participate in the care of their child
(feeding breathing exercises and ambulating)
– Show to parents how to pick up child properly by placing
hand behind the neck and scooping under the buttocks.
– To prevent pain, do not pull the child’s arms when
attempting to carry an older child
– Use seatbelts at car seats to ensure safety
– Do not place child on prone
 Care of the child after
cardiac surgery

• The child should avoid the following:

– Outside play or activities for 6 weeks. To prevent trauma
and healing of the incision.
– Crowd for 2 weeks. To prevent development of infections
– Activities that could cause fall (e.g. bike-riding) for 4 to 6
weeks
– Creams, lotions, or powders on the incision until healed.
To prevent infection
– Submersion underwater in tub or pool
 Care of the child after
cardiac surgery

• The child usually allowed to return to school after 3 weeks

• Advise parents to discipline child normally and avoid over
protectiveness. This allows normal growth and development
of the child.
• Dental visit should be done every 3 months after age 3 years. To
prevent dental caries which may harbor microorganisms
especially streptococcus (Group A beta-hemolitic streptococcus
may trigger autoimmune response that causes rheumatic
heart disease
• Emphasize to parents the importance of regular follow-up care
for the child
• Assistance with dressing and bathing for several weeks buti will
soon independent again.
 Cardiac catheterization
• is a procedure used to diagnose and treat certain cardiovascular
conditions.
• A long thin tube called a catheter is inserted in an artery or vein in
groin, neck or arm and threaded through blood vessels to heart
• Assess puncture site 30 minutely for 4 hours then hourly until
ambulation. Ensure that the dressing is snug and intact and no
bleeding is present.
• Reassess site after first ambulation and then a minimum of 4
hourly prior to discharge.
• Patients should be kept lying flat for several hours after the
procedure so that any serious bleeding can be avoided and that the
artery can heal.
• It is advised that diagnostic catheterisation patients are kept on bed
rest for four hours, and interventional catheterisation patients stay
on bed rest for six hours.
 Nursing Intervention
• Priority nursing intervention here is to prevent
bleeding at the puncture site. Apply direct
pressure to the catheterization site for at least 15
minutes, IF bleeding should occur at the insertion
site.
• Distal pulses will be checked to ensure peripheral
tissue perfusion. If a pulse cannot be palpated a
Doppler should be used. Notify physician for any
loss of pulses
• An anticoagulant maybe initiated as ordered
 Nursing Intervention
• Provide detailed education regarding the
symptoms of an infection to the family.
• Sponge bath is recommended or quick
shower. Submersion to tub baths or pools are
strictly prohibited.
Congestive heart failure (CHF)
• Congestive heart failure (CHF) is a
condition in which the heart does not
pump as well as it should. The most
common symptoms in young children
are difficulty feeding, sweating and
poor weight gain. Older children may
present with fatigue and exercise
intolerance
• Clinical manifestations of CHF is
tachypnea, dyspnea, fatigue
• Edema due to poor circulation of
blood secondary to heart failure,
edema increases weight
 Priority Nursing diagnosis

• Decreased Cardiac Output: Inadequate

blood pumped by the heart to meet
metabolic demands of the body
– Administer Digoxin (Lanoxin) Increases
contractility of the heart and force of
contraction
– provide optimum rest and good
Oxygenation
• The child may tire easily:
– Provide nipples of their bottles with easy-to suck
nipples
– Eating may tire the child easily, so its should be not
more than 45 minutes
– Do not give large meals at feeding time
– Organize nursing interventions in such a way that the
child will have an uninterrupted rest and sleep
periods to reduce cardiac demands and workloads
– Diet is low sodium, high calorie
• Digoxin therapy: stronger heart contraction, edema is
gradually resolved because of better circulation
• Digoxin increases the force of contraction of the muscle of
the heart by inhibiting the activity of an enzyme (ATPase)
that controls movement of calcium, sodium, and
potassium into heart muscle. Inhibiting ATPase increases
calcium in heart muscle and therefore increases the force
of heart contractions.
• Digoxin toxicity: Early signs: lack of appetite, nausea,
vomiting, or diarrhea; headache, confusion, anxiety, or
hallucinations, halos around bright objects; (fast, forceful
heartbeats in an irregular rhythm) weakness
• INSTRUCTION OF CARDIOPULMONARY RESUSCITATION
(CPR) INCREASES PARENTAL CONFIDENC AND PRAPARE
THENTO HANDLE EMERGENCY
 HYDROCEPHALUS.
• It is caused by an imbalance in the production and
absorption of CSF in the ventricular system. When
production is greater than the absorption, CSF
accumulates within the ventricular system, usually under
increased pressure producing passive dilatation of the
ventricles. It is detected through prenatal sonogram
• Two types:
– COMMUNICATING hydrocephalus (Extraventricular)
• This is due to impaired absorption of CSF within the subarachnoid
space (due to malformations, tumors, hemorrhage, infection, trauma) .
Ventricles communicate
– NON-COMMUNICATING hydrocephalus (Intraventricular)
• This is due to obstruction of CSF flow within the ventricular system.
The ventricles do not communicate
3 main reasons why CSF accumulates:
• 1. Overproduction of fluid by the choroid plexus in the
first or second ventricle as could occur from a growing
tumor (rare).
• 2. Obstruction of the passage of fluid in the narrow
aqueduct of Sylvius (most common) or the foramina of
Magendie and Luschka, the openings that allow fluid to
leave the 4th ventricle.
• Interference with the absorption of CSF from the
subarachnoid space if a portion of the subarachnoid
membrane has been removed (like surgery of
meningocele or extensive subarachnoid hemorrhage)
Assessment of Hydrocephalus

• Rapid head growth

• Bulging fontanels
• Dilated scalp veins
• Separated sutures
• MacEwan sign (cracked
pot sound on
percussion
• Thinning of skull bones
• Frontal enlargement
(bossing)
• “sunset eyes”
 Assessment
• Child shows signs of increased intracranial
pressure such as decrease pulse and
respiration, increased temperature and blood
pressure, hyperactive reflexes, strabismus and
optic atrophy
• Irritable or lethargic with typical shrill, high
pitched cry
• MacEwen's sign or Macewen sign= is a sign used to
help to diagnose hydrocephalus] (accumulation of
excess cerebrospinal fluid) and brain abscesses.
Tapping (percussion) the skull near the junction of
the frontal, temporal and parietal bones will
produce cracked pot sound. Positive test is
indication of separated sutures. This is due to raised
intracranial tension.
• The “setting sun” sign is an ophthalmologic
phenomenon where the eyes appear driven
downward bilaterally. The inferior border of the
pupil is often covered by the lower eyelid, creating
the “sunset” appearance. This finding is classically
associated with hydrocephalus in infants and
children
• Papilledema is a serious medical condition where
the optic nerve at the back of the eye becomes
swollen. Symptoms can include visual disturbances,
headaches, and nausea. Papilledema occurs when
there is a build-up of pressure in or around the
brain, which causes the optic nerve to swell; Late
sign of increased ICP

If surgery is anticipated, IV infusion should not be

placed in a scalp vein in a child with hydrocephalus.
• As the head continues to enlarge the child’s
motor function becomes impaired because of
both neurologic impairment and atrophy
caused by the inability to move such a heavy
head.
• Skull x-ray will reveal the separating sutures
and thinning of the skull
• Transillumination will reveal that the skull is
filled with fluid rather than solid brain tissue
 Therapeutic Management
• IF CAUSED BY OVERPRODUCTION OF CSF:
– Acetazolamide (Diamox) a diuretic may be
prescribed to promote the excretion of the excess
fluid
– Destruction of a portion of the choroid plexus
may be attempted by ventricular endoscopy; if a
tumor is responsible for the overproduction of CSF
the tumor should be removed
• IF CAUSED BY OBSTRUCTION
– Shunting procedure
 Nursing Intervention
Pre-operatively
• Assess if infant is able to turn freely because
of increased head size
• Provide an environment for child that is
stimulating yet not tiring
• Arrange for consultation for mother with
neurosurgeon to discuss surgery and child’s
prognosis
 VENTRICULOPERITONEAL SHUNT (VP
SHUNT) INSERTION
• Involves threading a thin polyethylene catheter under the
skin from the ventricles to the peritoneum. Fluid drains by
this route from the ventricles to the peritoneum where it is
absorbed across the peritoneal membrane into the body
circulation--eventually reduces intracranial pressure.
• After VP shunt insertion, place the child in supine position
with head of bed flat for the first 24 hours to prevent too
rapid reduction in CSF pressure. A rapid decrease in the
size of the ventricles may cause subdural hematoma
• After 24 hours, the child may be turned to the unaffected
side; may be put in semi-fowler’s position 10-20degree
angle if there is sustained increase in ICP
 Ventriculoperitoneal (VP) shunt complications

• include blockage and infection – early and prompt detection of

shunt dysfunction is vital as delay can lead to markedly raised
intracranial pressure, which may result to death.
• signs of shunt malfunction: (there is decreased absorption of CSF—
due to blockage of VP or infection/swelling
– Headaches.
– Vomiting.
– Lethargy (sleepiness)
– Irritability.
– Swelling or redness along the shunt tract.
– Decreased school performance.
– Periods of confusion.
– Seizures
• Monitor abdominal girth, enlargement of abdominal girth signifies
that the CSF is NOT adequately absorbed in the abdominal cavity
 Nursing Intervention
Postoperatively
• Assess infant’s neurologic status postoperatively including response
to sound pupillary response increasing irritability or lethargy
• Position infant with head of bed slightly elevated; prevent flexion or
rotation of the head. Record cerebral perfusion pressure as
prescribed.
• Assess head circumference and anterior fontanelles for tenseness
every 4 hours as prescribed.
• Document head circumference and appearance of anterior
fontanelles.
• Observe how mother feeds the baby. Assist mother and teach how
to position the baby during feeding
• Monitor intake and output closely
• Administer osmotic diuretic and corticosteroid as prescribed
 Nursing Intervention
• Psychosocial/Spiritual/ Emotional Need
– Observe mother’s interaction with infant and remind
her that congenital disorders occur in a proportion of
all births for unknown reasons
– Review care of child and assure parents healthcare
providers can be contacted anytime if they have
questions.
– Establish a convenient follow up care appointment
– Make referral for home care if needed. Also refer
parents to support group of other parents of children
with hydrocephalus
SPINAL CORD ANOMALIES.
• It is the failure of the neural tube to close
• detected through amniocentesis and prenatal
sonogram; characterized by elevated alpha-feto
protein (AFP).
• Degrees of Spinal cord anomalies: 1) Spina Bifida,
2) Meningocele , and 3) Meningomyelocele
• 1. Spina bifida occulta
• The posterior portion of the lamina failed to
close but the spinal cord or the meninges do NOT
protrude through the defect. The defect is not
visible externally. It is characterized by skin
depression or dimple; port-wine angiomatous
nevi, dark tufts of hair, soft subcutaneous
lipomas. It is simply a surface of bone is missing,
and the spinal cord is intact
• 2. Meningocele– the external sac (the three
layers of meninges: pia mater arachnoid and
the dura mater) protrude as a circular mass,
about the size of an orange through the defect
in the vertebral column. The protrusion
generally occurs I the lower lumbar and
lumbosacral region, although it might be
present anywhere along the spinal canal. The
protrusion is either covered y a layer of skin or
ore frequently only the clear dura mater. No
sensory or motor deficits accompany the
disorder unless the membrane sack should
rupture.
• Meningomyelocele--most common
birth defect affecting the central
nervous system and is viewed as the
most complicated birth defect
• Not only the meninges protrude
through the vertebrae, but the spinal
cord usually ends at the point of
protrusion
• Motor and sensory function is
decreased or absent beyond this point.
• The higher the defect is along the
spine, the greater the degree of
paralysis
• The child may have partial or complete
paralysis, partial or complete lack of sensation
of the lower extremities as well as loss of
bowel and bladder control
• Legs appear lax because infant cannot move
them
• Urine and stools continually dribble because
of lack of sphincter control
• Infant ay have accompanying Talipes disorder
and developmental dysplasia of the hip
• A hydrocephalus may also develop in
• Many as 90% of these infants because of the
lack of sub arachnoid membrane
• Encephalocele– is a cranial
meningocele, most often in the
occipital area of the skull but may
occur as a nasal or nasopharyngeal
disorder. Generally covered by the
skin.
• Transillumination of the sac will reveal
whether brain tissue is in the sac. A CT
scan MRI or ultrasound will reveal the
size of the skull disorder and help
predict the extent of surgery needed.
 Assessment
• Discovery of increased AFP (alpha feto-protein) in
amniotic fluid
• Observe and record whether an infant born with
neural tube disorder has spontaneous movement
of the lower extremities
• Asses the nature and pattern of voiding (whether
wet every 2-3 hours or continually wet). Infants
without motor or sphincter control void
continually. This pattern is same for defecation.
• Differentiation is further established by CT scan
ultrasound or MRI.
 Therapeutic Management
• No surgical correction for Spina bifida occulta. Just inform parents
of the defect. They should receive patient education so that they
can recognize more serious symptoms as the child grows such as
numbness weakness or pain which may indicate a need for
reevaluation.
• Immediate surgery is needed for Meningocele and encephalocele
to replace the meninges and to close the gap in the skin. This is
done soon after birth if possible (within 24-48 hours) to prevent
infection. Surgical risk: the child’s cognitive potential may be
impaired; and if a large portion of the meninges have to be
removed by the surgery—this could limit the rate of absorption of
CSF which could lead to build up of CSF and hydrocephalus.
• Children with meningomyelocele have the same surgery to return
the meninges and close the gap in the skin surface—however
complete or partial paralysis of the lower extremities and loss of
bladder and bowel function will not be resolved
 Nursing intervention
• Preoperative
– Use sterile gloves and sterile linens when caring for infants
with either meningocele or meningomyelocele
– Use a sterile, wet, warm compress of saline, antiseptic, or
antibiotic gauze over the lesion to keep the sac moist. Add
additional warm fluid as needed.
– Position infants carefully to prevent pressure on the
exposed meninges either in a prone position or supported
on their side. Use rolled blankets or diapers to support the
back and prevent pressure on the lesion. Place folded
diapers between legs to prevent skin surfaces from
touching and rubbing in this position and to prevent hips
from internally rotating.
 Nursing Intervention
• Position infants on their abdomen will prevent urine and feces from
flowing onto the lesion as well as keeping the protruding meninges
free from pressure.
• Place a piece of plastic wrap below the protruding membranes on
the child’s back to prevent feces from touching the open lesion.
• Place a folded towel under the infants abdomen to help flex the
infant’s hip while on prone position to reduce pressure on the sac ,
and ensure good leg position. Check if the infant’s leg is
comfortable in that position.
• Make certain that the child is adequately warm. However do not
put child under radiant heat source because it may dry the lesion
and cause cracking. Use of incubator is advised for a better heat
source and allows the nurse to assess and monitor the lesion.
• Watch out for any seepage of clear fluid from the defect and
should be reported promptly because that is probably
escaping CSF. If in doubt if fluid is urine or CSF check it against
a glucose test strip: CSF will test positive for glucose whereas
urine or mucus will not.
• Monitor for any increase in head size, measure head
circumference as prescribed in the preoperative to set a
baseline to be used after surgery. Mark with an indelible pen
the scalp above and below the tape measure over both ears
and on the back of the scalp.
 Nursing Intervention
• Post-operative.
– Baby is placed on cardiorespiratory monitor and
positioned on the abdomen until the skin incision has
healed (about 7 days)
– Continue same careful precautions against allowing urine
or feces to touch the incision area
– If defect repair is large and the risk of picking up the infant
is great, the infant may be fed while lying on the side in an
incubator or prone on a specialized bed frame.
– Raise infant’s head slightly by slipping a folded diaper
under it.
– Do not pat/touch/stroke the incision area at anytime.
• Continue to observe the child as well for signs of increased
intracranial pressure such as bulging fontanelles, variations
in vital signs, neurologic signs such as pupillary changes or
behavioral changes such as irritability or lethargy
• Preserve skin integrity during preoperative and
postoperative
– Reposition patient every 2 hours to prevent pressure ulcers
– Use paper tape or stockinette for dressing changes or place a
protective dressing such as Stomahesive on the skin under the
area where the tape will touch.
– Change diaper frequently to prevent excessive contact of acidic
urine with skin
 Nursing Intervention
• Encourage parents to take infants to the places children normally
accompany parents such as home relatives shopping or the zoo,
because encouraging children to be as independent as possible as
they grow helps them lead an active life as possible
• Teach parents how to perform passive exercises to prevent muscle
atrophy and formation of contractures if a child has impaired lower
extremity motor control.
• Prepare parents emotionally for the possibility of use of crutches.
Provide patient education regarding the use of crutches
• Teach parents to do a daily inspection of child’s lower extremities
and buttocks for any area of irritation or possible infection
• When in use of wheelchair teach the patient to press with their
arms on the armrests to raise their buttocks off the wheelchair seat
at least once every hour to help provide adequate circulation to the
lower extremities.
 Nursing Intervention
• To ensure bladder emptying, an intermittent
clean urinary catheterization technique may be
taught to parents (inserting a clean catheter
through the urethra into the bladder every 4
hours to drain urine)
• On early school age, the child can learn to do self-
catheterization
• A drug such as oxybutynin chloride (Ditropan)
may improve bladder capacity and allow a child
to need less frequent catheterization
Acute Otitis media
• Inflammation of the middle ear is one of
the most prevalent diseases of childhood
• Causative organism: Streptococcus
pnuemoniae; Haemophillus influezae;
Streptococcus pyogens
• Occurs in children 6 to 36 months and then
again at 4 to 6 years
• Most susceptible groups: male children;
Alaskan and native American; those with
cleft palate, and infants who are formula-
fed
• Potentially serious disease of childhood
because permanent damage can occur to
middle ear structures, leading to
permanent hearing impairment
 Assessment
• Child have cold or rhinitis and low grade fever for several days,
the fever peaks to about 102F (38C) and sharp constant pain
begins in one or both ears
• Infant become extremely irritable and frequently tug or pull
affected ear in an attempt to gain relief from pain
• External ear is usually free of wax because the warmth of
inflammation and fever melts the wax and moves it more readily
out of the canal
• Tympanic membrane appears inflamed and reddened and may
bulge forward into the external canal
• Otoscopic examination may show a level of fluid behind the
tympanic membrane and the malleus becomes prominent
• No movement of tympanic membrane (as there would be
normally)
 Therapeutic Management
• Analgesic, antipyretic, decongestants are
prescribed
 Otitis Media with Effusion
• This occurs if Otitis Media become chronic
usually occurs to children 3 to 10 years old
• Epithelial cells of the middle ear begin to
secret a thin watery mucus, becomes glue-like
thick and tenacious
• Some children claim a feeling of fullness or the
sound of popping or ringing in the ears; partial
loss of hearing 20 to 40dB because of the
inability of the ossicles to function well
 Therapeutic Management
• Control of allergy : antihistamine of
decongestant
• Tympanocentesis
• Tubal Myringotomy and insertion of
myringotomy tubes for aeration
 Nursing Intervention
• Suggest to mother to give prescribed antihistamine at
bedtime. Urge child to sleep with affected ear up.
• Meet with EENT service to consult on cause of frequent
otitis media
• Instruct mother to administer acetaminophen every 4
hours or ibuprofen every 8 hours and how to instill saline
nose drops
• Encourage mother to offer liquids and soft foods
• Educate the mother about the common characteristics of
otitis media; reassure mother the infection will resolve
without an antibiotic
• Instruct mother to contact the clinic or healthcare provider
if there is no improvement within 24 to 48 hours or if the
child exhibits increased pain
Bacterial Meningitis
• Infection of the cerebral meninges
• Common to children younger than 24months
of age and most often in winter
• Causative agents: Streptocccus pneumoniae
or group B Streptococcus
• Pathologic organism usually spread to the
meninges fro the upper respiratory tract
infections by lymphatic drainage possibly
through the mastoid or frontal sinuses or by
direct introduction through lumbar puncture
or skull fracture. Once organisms enter the
meningeal space they multiply rapidly and
then spread through the CSF to invade the
brain tissue through the meningeal folds.
• Brain abscess or invasion of the infection into
the cranial nerves can result in blindness,
hearing impairment or facial paralysis
• If a thick exudate accumulates in the narrow
aqueduct of Sylvius it can cause obstruction
leading to hydrocephalus. Brain tissue
edema can put pressure o the pituitary
gland, causing increased production of
antidiuretic hormone, resulting in the
syndrome of inappropriate antidiuretic
hormone secretion causing hyponatremia
 Assessment
✓ 2-3 days of upper respiratory tract infection
✓ Infant become increasingly irritable because of intense headache
✓ Experience sharp pain when they bend their head forward
✓ weak cry and lethargy in newborn
✓ As the disease progresses signs of meningeal irritation occur as
evidenced by positive Brudzinski and Kernig’s sign.
✓ Children may hold their back arched and their neck hyperextended
opisthotonus position
✓ May not follow light through visual fields due to 3rd and 6th cranial
nerve paralysis
✓ If Fontanelles are open= bulged and feel tense, if closed fontanelle
=papilledema may develop
✓ Cardiovascular shock, seizure nuchal rigidity apnoea
✓ CSF analysis confirms the diagnosis: presence of increased WBC,
glucose level
 Therapeutic Management
• Antibiotic therapy (intrathecal injections)
• Dexamethasone or mannitol may be
administered to reduce ICP and prevent
hearing loss
• Respiratory precautions for 4 hours to prevent
transmission to other members of the family
and health care providers
 Nursing Intervention
• Position child flat on bed (no pillow) minimize pain
• Monitor for signs of increased intracranial pressure
• Be certain that parents receive a good explanation of everything that is
happening so that child and parents may feel secure
• Explain to parents that irritability of their chid is part of the disease
process so they continue to interact with child
• Assure that child will recover eventually and irritability will lessen and
the child will begin to show ore interest in communicating feelings.
• Promote rest by keeping stimulation in the room to a minimum.
• Monitor the rate of all IV infusion to prevent over hydration ad
increased ICP.
• Measure urine specific gravity to detect over secretion or under
secretion of antidiuretic hormone because of pituitary pressure
• Measure head circumference and weigh the child daily
• Minor hearing acuity (this is reduced if there is pressure on the 8th
cranial nerve.
FEBRILE SEIZURE
• Seizures associated with high fever 102F
to 104F (38. 9C to40C) are the most
common type seen in pre school
children although these can occur as
late as 7 years of age
• Usually generalized tonic-clonic pattern,
which lasts for 15 to 20 seconds
• The seizure is due to sudden spike of
temperature, not a gradual incline; may
last 1 to 2 minutes or less
• Every child who has occurrence of this
type of fever should be re-evaluated to
rule out other neurologic disorder.
 Therapeutic management
• After seizure subsides, parents should sponge the child with
tepid water to reduce the fever quickly. Do not put child in a
bathtub of water to do this because of risk of drowning in
case a second seizure occurs. Do not use alcohol.
• Do not give antipyretic by mouth after seizure because of risk
of aspiration. Suppositories are given at an appropriate dose.
• If fever does not subside with these measures. The child is
transferred to healthcare facility for further evaluation.
• Lumbar puncture is done to rule out meningitis.
• Antibiotic therapy is prescribed if infection is present
• Assure parent that febrile seizure do not lead to brain damage
and that the child is almost always completely well afterward.
Autism/ASD
• Autism Spectrum Disorder (ASD) is
marked by difficulties in three main
areas: social deficits, communication
issues and restricted behaviors with
onset at the early developmental
stage, that impair everyday
functioning.
• Within the first 36 months of life
• Lack responsiveness to people around
them, display gross communication
skills impairment; produce bizarre
responses to various aspect of the
environment
 Assessment
• Failure to develop social relations
• Stereotyped behaviors such as hand gestures
• Extreme resistance to change in routine
• Abnormal responses to sensory stimuli
• Decreased sensitivity to pain
• Inappropriate or decreased emotional expression
• Limited intellectual problem-solving abilities
• Stereotyped or repetitive use of language
• Impaired ability to initiate or sustain a
conversation
 Therapeutic Management
• Applied Behaviour analysis (ABA) treatment
based on the association between behaviour and
learning
• Risperidone (Risperdal) and aripiprazole (Abilify)
are approved for children and teens with ASD–
improve sociability while decreasing tantrums,
aggressive outbursts, and self-injurious behaviour
• Selective Serotonin Reuptake Inhibitors alpha 2
agonists antipsychotics mood stabilizers and
Selective norepinephrine reuptake inhibitors
 Nursing Intervention
• Assess what self-care activities the child completes for himself. Allow
child to wear own clothes until under conscious sedation to avoid
confrontation.
• Consult with childcare specialist about what activities would be best for
child who is easily distracted
• Begin IV line in non-dominant hand. Document medication given at home.
• Discuss a diet with mother that doesn’t involve so many fatty foods
because child is overweight
• Talk to mother about techniques to make brushing teeth a game not a
chore
• Educate parents that autism is a disorder not a normal boyish behaviour.
Explore whether the family is aware of respite services in community
• Assess whether child can take favourite toy to operating room. Respect
that toy dog is favourite toy and important to child
• Discuss that child will be sleepy for remainder of day after conscious
sedation
Chromosomal defects
• DOWN SYNDROME . IT IS A
CHORMOSOMAL ABNORMALITY
CHARACTERIZED BY AN EXTRA
CHOROSOME 21, THUS THE NAME
TRISOMY 21
– With oblique palpebral fissure
more commonly known as the
“Mongolian slant”
– Have small nose, wide bridge; large
protruding tongue and high arched
palate
– The goal in working with mentally
challenged children is to train them
to be independent as much as
possible
• the child is mentally retarded, can not cope
with biological age can not cope with fast and
dynamic pace
• Parents should be consistent and firm with
rules to promote discipline
• They learn through repetition and drills
• PATAU SYNDROME : TRISOMY 13
• EDWARD’S SYNDROME: TRISOMY 18
• TRISOMY 13 AN 18 BOTH HAVEPOOR
PROGNOSIS, AND MOST AFFECTED CHILDREN
DIE FROM CARDIAC OR REPIRATOYR
COMPLICATIOS BY WITHIN SIX MOTHS Old
 Nursing Intervention
• Provide parents the opportunity to discuss the
challenges they have in meeting their child’s need
in a non-judgmental manner and discuss options
available to the family if they are unable to care
for a child at home.
• Connect families with children with intellectual
disabilities to community supports and resources
• Reinforce and review precautions against
unintentional injuries.
• Remind parents to treat their child according to
their child’s intellectual age.
 Nursing intervention
• Encourage parents to let child join regular classes
to provide access to important educational and
social experiences because this offers maximum
stimulation for the child.
• Promote self care activities
• Provide age appropriate play.
• Refer to speech therapy
• Enrol child to classes
• Prepare to Adulthood: Orient the child about
sexuality; menstruation; contraception
 Reference
• Maternal and Child Health Nursing Care of the
Childbearing and childrearing family, 8th
edition by JoAnne ilbert –Flagg; Adele Pillitteri