Professional Documents
Culture Documents
I. Psychosocial problems:
Poverty or financial stressors
leading to food shortage
Parental neglect
Behavior problems in the child,
e.g. misbehavior at meal times,
which can lead to power
conflicts and tension resulting in
inadequate feeding
Food phobia, perhaps following
a choking episode
Parental mental health
problems, e.g. postpartum
depression
Parental eating disorders, such
as anorexia nervosa
II. Anatomic problems causing
mechanical feeding
difficulties:
I.Malabsorption:
Cow's milk protein allergy
Cystic fibrosis
Other causes of pancreatic
insufficiency
Celiac disease
Biliary atresia
Inflammatory bowel disease
Liver disease
Chronic diarrhea
II. Improper utilization:
Prematurity
Recurrent infections
Chronic infections, such as
HIV or PTB
Endocrine disorders, such as
hyperthyroidism or growth
hormone deficiency
Cardiac disorders, such as
congenital heart defects or CHF
Pulmonary disorders, such as
chronic lung disease,
bronchopulmonary dysplasia, or
poorly controlled asthma
Malignancy
Chronic liver disease
Rare causes
Child abuse
Diabetes insipidus
Rickets
Contributory or predisposing
factors
Constipation
Excessive crying
Excessive sleepiness (lethargy)
Irritability
EXAM and TEST
CBC
Electrolyte balance
Hemoglobin electrophoresis
Hormone studies (thyroid
function tests)
X-rays to determine bone age
Urinalysis
Treatment
Gas-relief medication -
Simethicone
Probiotics - substances that
help maintain the natural
balance of "good" bacteria in
the digestive tract can soothe
colic.
COLIC REMEDIES
Feed the baby.
The baby may be hungry, try a feeding.
Hold the baby as upright as possible,
and burp the baby often. Sometimes
more frequent but smaller
feedings are helpful. If breast-feeding,
it may help to empty one breast
completely before switching sides. This
will give the baby more hindmilk, which
is richer and potentially more satisfying
than the foremilk, which is present at
the beginning of a feeding.
Offer a pacifier.
Trisonomy 21 is caused by
a random error in cell
division that results in the
presence of an extra copy of
chromosome 21.
This cell division errors occurs:
Defects involve
abnormal openings in
the lip/palate that
may occur unilaterally
or bilaterally and are
readily apparent at
birth.
Cleft lip (with or without cleft
palate) occurs more frequently
in males,
Cleft palate is more frequent in
females.
Combination of cleft lip and
palate occurs in approximately
50% of cases
Cleft lip alone occurs in about
25% of cases
and cleft palate alone occurs in
about 25% of cases.
CLASSIFICATION:
Cleft lip / pre alveolar cleft :
Varies from a notch in the lip
to complete separation of the
lip into the nose
Failure of maxillary process to
fuse with nasal elevations on
frontal prominence; normally
occurs during fifth and sixth
weeks of gestation
Isolated cleft palate / postalveolar
cleft:
Cleft of uvula
Cleft of soft palate
Cleft of both soft and hard palate
through roof of mouth
Failure of mesodermal masses of
lateral palatine process to meet
and fuse; normally occurs
between seventh and 12th weeks
of gestation
Submucous cleft:
Muscles of soft palate not
joined
Not recognized until child
talks; cannot be seen at birth
Cleft of hard and soft palate
CAUSES
1. Hereditary
A. chromosomal abnormalities
2. Environmental factors
A. Exposure to radiation
B. Rubella virus
C. Teratogenic factors
Pierre Robin syndrome cleft palate,
glossoptosis (tongue lays back on
pharynx), and micrognathia
(underdeveloped mandible):
This causes feeding difficulties,
potential airway obstruction by
tongue, slow weight gain, and ear
infections.
By age 3 to 4 months, the
mandible has grown enough to
accommodate the tongue, and
respiratory difficulty is greatly
diminished.
Clinical Manifestations
General management is
focused on closure of the clefts,
prevention of complications,
habilitation, and facilitation of
normal growth and development
of the child.
The cleft lip is generally repaired
before the palate defect.
Immediate repair several
hours to several weeks after
birth.
Intraoral or extraoral
prosthesis to prevent maxillary
collapse, stimulate body
growth, and aid in feeding and
speech development; may be
used before surgical repair.
Later repair when infant is 6 to
12 weeks old, hemoglobin 10
g/dL, steady weight gain seen
10 lb (4.5 kg) or white blood cell
(WBC) count normal.
Cleft palate repair may be done
any time between ages 6 months
and 5 years; it is based on degree
of deformity, width of oropharynx,
neuromuscular function of palate
and pharynx, and surgeon's
preference.
Repair at age 9 to 18 months
may be preferred because
speech patterns have not been
set, yet growth of involved
structures allows for improved
surgical repair.
If repair is delayed to age 4 or
5, a special denture palate is
used to help occlude the cleft
and aid in establishing speech
patterns.
SURGERY
CHEILOPLASTY surgery to close cleft
lip; done as early as possible, using the
RULE OF 10
a. At least 10 weeks old
b. Weighing at least 10 lbs
c. Having at least 10 grms hemoglobin
9. Administer an antibiotic as
prescribed because the
mouth and suture line are
constantly contaminated.
IMPERFORATE ANUS
An arrest in embryologic development of the anus at the
eighth week of embryonic life.
cause is UNKNOWN.
Imperforate anus occurs when the anal
opening is absent or not in a normal
position.
4) Overflow-type diarrhea
Constipation - unresponsive to
conventional remedies
A. ASSESSMENT
3. Abdominal distention
3. Myelomeningocele or Meningomyelocele
The spinal cord and cord membranes protrude through
the defect in the laminae of the vertebral column. And
are covered by a thin membrane. Most serious type
SPINA BIFIDA
Associated defects include weakness or paralysis below
the defect, bowel and bladder dysfunction, clubfeet,
dislocated hip, and hydrocephalus
Is a condition of altered
production, flow, or
absorption of
cerebrospinal fluid (CSF).
from the Greek words meaning hydro- water and
cephalo - head, is caused by excess cerebrospinal fluid
(CSF) in the spaces within and surrounding the brain.
X-ray
MRI
CT scan
TREATMENT
Goal :to reduce the pressure in the baby's head and to
properly drain the cerebral spinal fluid (CSF).
Occasionally, medications or procedures to draw off the
extra CSF may be used.
Ventriculoperitoneal (VP) shunt - removes excessive
cerebrospinal fluid from the ventricles and shunts it to
the peritoneum. A one-way valve is present in the tubing
behind the ear.
The shunt consists of three
parts:
a tube that is placed
inside of the ventricular
space
a reservoir and valve to
control the flow of CSF
tubing that is directed
under the skin to the
abdomen, or less
commonly to the heart or
lung area
The shunt redirects the CSF out of
the head through the tubing to a
location elsewhere in the body where
it can absorbed. The shunt is usually
placed behind the ear and the tubing
is threaded from behind the ear,
under the skin to the area of the
abdomen, heart, or lung.
Components :
Ventricular tubing.
A one-way or unidirectional
pressure-sensitive flow valve.
A pumping chamber.
Distal tubing.
Shunt Complications
Infection
Bleeding
Complications
Seizures
Herniation of the brain.
Spontaneous arrest due to
naturalcompensatory mechanisms,
persistent increased ICP, and brain
herniation.
Developmental delays.
Depression in adolescents is common.
NURSING INTERVENTIONS
Otoscopic examination.
Tympanometry --- quick and simple way
to assess tympanic membrane mobility
Acoustic reflectometry --- useful in infants
older than age 3 months.
measures reflected sound waves from
the middle ear.
TREATMENT
Ampicillin
Penicillin G
Cefotaxime
Gentamicin
RISK FACTORS
Brain damage
Deafness
Hydrocephalus
Epilepsy
LABORATORY TEST
A complex febrile
seizure is characterized by
longer duration, recurrence,
or focus on only one side of
the body.
Signs and Symptoms
During simple febrile seizures
the body will become stiff and the arms and legs
will begin twitching.
The patient loses consciousness, although their eyes
remain open.
Breathing can be irregular.
They may become incontinent (wet or soil
themselves); t
hey may also vomit or have increased secretions
(foam at the mouth).
The seizure normally lasts for less than five minutes.
Risk factors
Young age
Family history
Treatment
Educational/behavioral
interventions: Therapists use highly structured
and intensive skill-oriented training sessions to help
children develop social and language skills, such
as Applied Behavioral Analysis. Family counseling
for the parents and siblings of children with an ASD
often helps families cope with the particular
challenges of living with a child with an ASD.
Family therapies. Parents and family members can
learn how to play and interact with their children in
ways that promote social interaction skills, manage
problem behaviors, and teach daily living skills and
communication.
Treatments includes:
Medication
-ADHD drugs sometimes have side effects. But these
usually occur when treatment is started and are usually
mild and short-lived. The most common side effects of
stimulants for ADHD include: decreased appetite/weight
loss, sleep problems, headaches, Jitteriness, social
withdrawal, stomachaches.
Various types of psychotherapy
-A type of talking therapy, which means you or
your child will be encouraged to discuss ADHD and
how it affects you. It can help children, teenagers and
adults make sense of being diagnosed with ADHD,
and can help you to cope and live with the condition.
(eg. Family therapy, body psychotherapy)
or a combination of treatments.
All in all, although both conditions are
classified as developmental disorders they
still differ in the following aspects:
1. Autism is a more complex problem
compared to ADHD.