HEALTH PROBLEMS MOST COMMON IN THERAPEUTIC MANAGEMENT

SCHOOL AGED CHILDREN • Antibiotic broad spectrum such as sulfamethoxazole-

trimethoprim (Bactri) or amoxicillin, or an antibiotic.
UTI Specific to causative organism that is cultured.
→ Occurs more often in females than in males at a ratio of • Drink a large quantity of fluid to flush the infection out
about 8% in girls to 3 % in boys of the urinary tract.
→ More common in uncircumcised boys • Sit in a bathtub of warm water and void into the water if
with moderate to severe pain on urination that
ETIOLOGY interferes with voiding,
• Bacterial infections are the most common. • Analgesic acetaminophen (tylenol), reduce pain
• Escherichia coli is the most common causing 75-90% of enough to allow voiding.
UTI episodes. • Remind parents UTI treatment with antibiotics must be
o enter an ascending infection from the perineum continued for the full prescription for the infection will
and are gram-negative. return.
o also occur as healthcare acquired infection and • Repeat clean catch urine sample is usually obtained at
children who have urinary catheter. 72 hours to assess effectiveness of the antibiotic
o occur more often in girls than boys because the treatment and to be certain that bacteria count is being
urethra is shorter in girls and because it is located reduced.
close to the vagina and anus
PREVENTION
SIGNS & SYMPTOMS • In women who experience ≥ 3 UTIs/yr, behavioral
• Typical symptoms that occur in older children or in adults measures are recommended:
o pain on urination o increasing fluid intake
o frequency o not delaying urination
o burning o wiping front to back after defecation
o hematuria • Changing diapers frequently can help reduce the risk
• May not be present in young children so UTI is for infection and infants.
suspected when a child has a fever with no • Girls should be thought early when they are toilet
demonstrable cause on physical examination. trained to wipe themselves from front to back after
• If the infection is confined to the bladder that child may voiding and defecating to avoid contaminating the
have a low-grade fever, mild abdominal pain and urethra.
enuresis (Bed wetting) • Discourage use of bubble baths, feminine hygiene
• If the infection is a pyelonephritis* the symptoms spray, and hot tubs and girls.
generally are more acute with high fever, abdominal or
flank pain, vomiting and malaise. ACUTE RHEUMATIC FEVER
→ Autoimmune consequence of infection with Group A
* a type of urinary tract infection where one or both kidneys streptococcal infection
become infected → Results in a generalized inflammatory response affecting
subcutaneous tissues and the heart.
CAUSES
• Pathogenic microorganism in the urinary tract (kidney, ASSESSMENT
bladder, urethra) The diagnosis of acute rheumatic fever requires:
• Bacteria (Escherichia coli) E. coli - bacteria in the • 2 major, or
digestive system • 1 major and 2 minor manifestations, AND
• evidence of group A streptococcal infection
3 BASIC TYPES OF UTIs
→ Bladder infection (cystitis) Jones criteria, 2015 revision, high-risk populations
→ Kidney infections (pyelonephritis) (Oceania, Africa, South Asia, other lower-income areas)
→ Urethritis (inflammation of urethra) Major criteria are as follows:
• Carditis (clinical or echocardiographic diagnosis)
TWO COMMON ABNORMALITIES • Polyarthritis or monoarthritis: Polyarthralgia can also be
→ Vesicoureteral reflux* considered but only after careful consideration of the
→ Urinary obstruction differential diagnoses
• Chorea (rare in adults)
* urine flows backward from the bladder to one or both ureters • Erythema marginatum (uncommon; rare in adults)
and sometimes to the kidneys • Subcutaneous nodules (uncommon; rare in adults)
CAN UTI BE PREVENTED IN CHILDREN? Minor criteria are as follows:
• Drink more fluids • Polyarthralgia (cannot count arthritis as a major
• Draining the bladder more often criterion and arthralgia as a minor criterion
• Treatment of constipation • Fever exceeding 38°C (note lower cutoff)
• Changing diaper more often • Elevated ESR (>30 mm/hr; note lower ESR standard)
• Teach good bathroom habits or CRP level (>3 mg/L)
• Wipe from front to back • Prolonged PR interval
• Avoid "holding it"
ASSESSMENT
HOW ARE UTI'S DIAGNOSED IN CHILDREN? o Polyarthritis
o Urine test (midstream clean catch method) o Apical systolic murmur
o Urine culture o Sydenham chorea
o Erythema marginatum
o Subcutaneous nodule
LABORATORY FINDINGS CAUSE
• Anti-streptolysin O (ASO) titer • unknown
• Fever > 38.5 degree C • Autoimmune process (ANA)
• ESR & CRP elevation • Genetic Predisposition
• Echocardiogram • Increase in Young Children
• Throat culture-GABH streptococci

PREDISPOSING FACTORS
• Family history of rheumatic fever
• Low socioeconomic status
• Age: 5-15 years

PATHOGENESIS
1. Group A streptococcal infection
2. Production of extracellular toxin of GAS
3. Abnormal immune response to streptococcal
components (molecular mimcry)
4. Immune response fails to differentiate between
epitopes of the streptococcal pathogen and certain host
tissues = inflammation to local sites

TREATMENT
• Penicillin therapy (IM or Oral) for 10-day course
• Oral Nonsteroidal anti-inflammatory agents
• Steroids is utilized only in children with severe carditis
and valve damage ASSESSMENT
• Phenobarbital and Diazepam (valium)
PREVENTIVE MAINTAINANCE DOSES OF PENICILLIN
• monthly IM injection of penicillin G benzathine
• twice daily oral tablets of penicillin V potassium
o preventive therapy continues until the child is at least
21 years of age
o if the child concurred valve damage preventive
therapy will continue until at least 40 years of age
THERAPEUTIC MANAGEMENT
NURSING INTERVENTIONS
• Monitor temp frequently
• Monitor the patient's pulse frequently after activity
• Auscultation of the heart periodically
• Observe for adverse effects of salicylate
• Restrict sodium and fluids and obtain daily weights as
indicated
PROGNOSIS
• Good prognosis for older age group and if no carditis
during the initial attack
• Bad prognosis for the younger children & those with
carditis with valvar lesions
→ Polyarticular, Pauciarticular, Systemic Onset
• persistent fever and Rash
• pain and stiffness of joint involvement
• assess effect their disease is having on self-care
• assess the child's and parents understanding of
• the illness
• child w/ Pauciarticular arthritis need screening with a
slip lamp examination every six months for uveitis
(severe uveitis can lead to blindness)
• Daily activities and exercises
→ using an elevated toilet seat
→ using loops or velco strips
→ set program of daily ROM exercise
→ dance routine or game
→ incorporated into a dance routine or a game
(Simon says)
→ swimming and bicycle or tricycle riding
encourage children to do us much self-care
→ warm bath in the morning
• Heat Lamp Application
→ heating pad or a warm water
→ Paraffin

RHEUMATIC ARTHRITIS • Medication

→ NSAIDs : Ibuprofen, Naproxen
Disorders of the joints and tendons : Collagen Vascular o 4x a day for at least 6 to 8 weeks given
Disease with food
• Collagen is compound of bundles of protein rich fibers o slow acting anti rheumatic drugs
that form the connective tissues of the tendons, (SAARDs), Disease Modifying Anti
ligaments, and bones Rheumatic Drugs (DMARDs)
• Tissue is found throughout the body. → Methotrexate : Steroids
• Collagen diseases are systemic.
• Nutrition
JUVENILE RHEUMATIC ARTHRITIS → plan mealtimes at the best times of the day
• Juvenile Arthritis
• Juvenile Idiopathic Arthritis (JIA)
• Affects blood vessels & other connective tissues
• Classified symptoms - before 16 yrs (3 months)
• Peak incidence - 1 to 3 yrs / 8 to 12 yrs
• Slightly common in girls than boys
• Rarely continue past 19 years of age.