Pediatric Disorders

Childhood Disorders
MLNG CELESTE,RN, MD 1
Respiratory Disorders
Anatomy and physiology of respiratory tract
• Origin of respiratory system:

> arises as an out pouching from the
pharyngeal pouch; this gradually migrates
to the thoracic area ( completed by the
3rd fetal month)
> right primary bronchus is slightly larger
than the left and form obtuse angle (FB)
> larynx is 1/8 the adult size at birth
> trachea is 4cm long in newborn, 1/2 of adult’s
> at birth the bifurcation is located at the 3rd
or 4th thoracic vertebra
> at 4 years, it is at the level of T5
> at 12 years, it is located between T5 to T6
> ethmoidal and maxillary sinuses are present
at birth
> Frontal and sphenoidal sinuses do not develop
until 6-8 years of age
>after 2 years of age the R bronchus is shorter
and more vertical than the left
> change in thoracic breathing begins at 2-3
years of age and is complete at 7
> in infants, the wall of the airway has less
cartilage (advantageous in an infant – an
infant does not develop bronchospasm- less
smooth muscle in the airway), therefore
wheezing cannot be a prominent finding
Adult vs Pediatric Airway
• Smaller airway diameter 4mm
• Distance between structures is shorter
• Organisms move faster, usually viral
• Infants obligate nose breathers
• “Little finger”=trachea size
• Respiratory system is divided into 2 divisions:
1. upper respiratory tract
a. nose
b. Para nasal sinuses
c. pharynx
d. larynx
e. epiglottis
2. lower respiratory tract

a. bronchi
b. bronchioles
c. alveoli
• Inspiration :
- delivers warm and moistened air to the alveoli
transports O2 across the alveolar
membrane to hgb –laden RBC allows CO2
to diffuse from RBC back to alveoli thru
expiration , CO2 filled air is discharged to
outside
Respiratory center > medulla of the brain
receptors:
1. peripheral receptor-aortic arch and
carotid arteries( stimulated by
decrease PO2)
2. central respiratory receptor- stimulated
by:
a. increased PCO2 b. decreased temp.
c. body acidity d. increased BP
Assessment of respiratory illness in children
• Physical assessment:
A. cough- a reflex initiated by stimulation of
nerve of respiratory tract mucosa by the
presence of dust chemicals, mucus or
inflammation
- useful procedure to clear excess mucus
paroxysmal cough- refers to series of

expiratory cough after deep expiration
( seen in whooping cough, aspiration )
B. rate and depth of respiration:
tachypnea > increased RR, 1st indicator of
airway obstruction in young
children
C. Retraction> inward drawing of the chest

causes: airway obstruction, stiff lungs
non compliant lung
> commonly seen in infant and
newborn because intercostal
tissue is weaker and less
developed
• Supraclavicular or
Suprasternal retraction
Suggests upper airway
obstruction
• intercostal retractions
suggest lower airway
obstruction
D. Restlessness :
- when infantS or children have decreased
O2,
they become anxious and restless
E. Cyanosis – blue tinge to the skin

- becomes apparent when PO2 is <
40mmhg resulting to increased RR
F. Clubbing of fingers:
- change in the angle between the
fingernail and nailbed because of increased
capillary growth in the fingertips
G. Adventitious sounds:
- extra or abnormal breathing sounds
- I/E ratio is reversed (bronchial or tubular
breathing)
types of adventitious sounds:
1.rhonchi- obstruction at the level of nose
or pharynx
2.stridor- obstruction at the level of larynx
(best heard in supine position)
3. wheezing – obstruction is in the lower
trachea or bronchioles (expiration)
4.rales –when alveoli are filled with fluids,
fine crackling sounds
H. Chest diameter:
- in children with COPD unable to
exhale completely air trapped in
lung - - alveoli (hyperinflation) ,
produces
elongated A-P diameter of the chest
( pigeon chest)
• Laboratory tests:
A. blood gas analysis > an invasive method
for determining the effectiveness
of ventilation acid-base status
> provides information about
oxygenation of the blood as well as
O2 saturation of Hgb
causes of decreased O2 saturation
1. pt with respiratory distress (O2 cannot
reach the bloodstream)
2.Hgb is defective, cannot carry a full
complement of O2
PCO2 - measures efficiency of ventilation
PCO2 - seen in children who are
hyperventilating (breathing deeply) -
blowing off to much PCO2
PCO2- seen in children who are
hypoventilating (breathing very shallow) -
can’t blow off the CO2
CO2 retention( due to obstruction/
or hypoventilation)
partial pressure of CO2 rises and
concentration of CO2 in the plasma
increases
respiratory acidosis
( the body compensates by increased kidney
tubular reabsorption of HCO3 (bicarbonate)
respiratory alkalosis
( bicarbonate exceeds the
amount of acid in the blood)
in doing ABG- we need arterial blood (reflects
how the lungs are oxygenating the blood)
if venous blood : only reflects oxygenation of

particular extremity from which blood is
drawn
SITES commonly used for ABG:

1. temporal artery- young infant
2.umbilical artery- newborn
3.radial artery- older children
Other sites: (small infant) if impossible to obtain
arterial blood directly, heel or finger stick
may be used (just warm the area for about 20
minutes)
B. Pulse oximetry - continuous ,non invasive
technique for measuring O2 saturation
How to use:
1. sensor and photo detectors are placed
around vascular bed
2. infrared light is directed through the
finger from the sensor to the photo
detector( hgb absorbs light wave differently
when bound to O2 )
Advantages: 1. non-invasive
2.continuous monitoring by pulse
oximeter allows you to
modify the care
Disadvantages: 1. sensor is small ( needs

frequent checking)
2. excess light may distort the
reading
ABG values:
PH- 7.35-7.45 < 7.35 - acidosis,
> 7.45 - alkalosis
PCO2- 35-45 mmHg

< 35 - alveolar hyperventilation and
respiratory alkalosis
> 45 means ventilatory failure and
respiratory acidosis
PO2 – 80-100 mm Hg
60 -80 mmHg- mild hypoxemia
40-60 mmHg - moderate hypoxemia
< 40
MLNG mmHg
CELESTE,RN, MD - severe 29
explanation:
> ph, pco2 - alkalosis
> ph, pco2 - acidosis
how to know if metabolic or respiratory?

>references are ph and HCO3
 if ph and HCO3 - both elevated it
is metabolic
 If ph and HCO3 is - opposite direction
(one is increased, the other is decreased) it
is respiratory ( SMOR)
C. Nasopharyngeal culture
D. Respiratory syncytial virus nasal washing

> pt is placed in supine position and 1-2 ml
of sterile saline is dropped with sterile needle-
less syringe into one nose, then nose is
aspirated using small, sterile bulb syringe
E. Sputum analysis:
>rare in children younger than school
age
• Diagnostic tests:
1. chest X-ray
2. bronchography
3.pulmonary function test - measures the
forces of inertia, elasticity, and
flow resistance
measured by the use of spirometry-
device that records the force of
air exchange
Therapeutic techniques
Expectorant therapy
1.Coughing
2.Chest physiotherapy
- 3 technique are involved
1. postural drainage
2.percussion
3. vibration
3.Mucus clearing devices- by use of flutter
device- stainless steel ball inside the device
moves when the child breathes out -causing
vibration in the lung -helps loosen the
mucus
Therapy to improve oxygenation
• O2 administration: via hood, nasal cannula,

and O2 mask
• Pharmacologic therapy:
1.antihistamine
2.decongestant-causes vasoconstriction
leading to shrinkage of mucous
membrane - expands breathing space
3. expectorant- helps raise mucus
4. bronchodilator- used to open lower
airway
5. metered dose inhaler- route of
medication
• Incentive spirometry - device that encourages

children to inhale deeply to aerate
the lung
• Breathing technique- blowing ball, blowing
out with purse lips
• Tracheostomy -opening in the trachea to
create an artificial airway to relieve
respiratory obstruction
• Endotracheal tube intubation
Disorders of upper respiratory tract
• Choanal atresia
• Acute nasopharyingitis
• Pharyngitis
• Tonsillitis
• Epistaxis
• Sinusitis
• Laryngitis
• Congenital laryngomalacia/tracheomalacia
• Croup
• Epiglottitis
• Aspiration
• Bronchial obstruction
Choanal atresia
> congenital obstruction of the posterior
nares by an obstructing membrane or
bony growth, preventing newborn from
drawing air through the nose into the
nasopharynx
> either unilateral/bilateral
Dx. Can be assessed by holding the newborn’s

mouth closed, then gently compressing 1st
nostril, then the other
• Sign: cyanosis
• Treatment:1. local piercing of the
obstructing membrane
2. surgical removal of the bony
growth
Acute nasopharyngitis (common colds-coryza)
• Most frequent infectious disease in children

• Average of 10-12 colds/ year
• Incubation period- 2-3 days
• Causes: 1. rhinovirus-most common cause
2.coxsackie virus-most common cause
3.respiratory syncitial virus
(major etiologic agent)
4.adenovirus
5. parainfluenza /influenza virus
• Signs and symptoms:
1.nasal congestion
2.watery rhinitis
3.low grade fever
4. mucus membrane is edematous
5.cervical lymph nodes may be swollen and
palpable
6. body malaise
• Pathophysiology:
> initial pathology is submucosal
edema of nasal mucosa by shedding of
ciliated epithelial cells (5th day) nasal
mucopurulent discharge
> interferon ( plays major role in recovery)
• Treatment: Common colds is self-limiting
> supportive care
> relief of nasal obstruction- use of
isotonic saline drops and aspiration
> antipyretic or analgesic agents
> antitussive is sometime used for
persistent cough
• Nursing diagnosis: parental health-seeking
behaviors related to management
of child’s cold symptoms
Pharyngitis
> it is an inflammation of mucous

membrane of the throat and involves the
nasopharynx, uvula and soft palate
> peak incidence occurs between 4 to 7
years of age
> either bacteria or viral, occurs as a result of
a chronic allergy
• Viral pharyngitis:
> causative agent is virus
signs and symptoms:

1. sore throat
2. fever
3.general malaise
Physical examination:
1. enlarged lymph nodes
2. erythema on the back of the pharynx
• Treatment:
1. antipyretic
2. gargle with warm water- school age
3. provide liquid foods- (+) difficulty of
swallowing
Nursing diagnosis:
> risk for fluid volume deficit
Streptococcal pharyngitis:
> caused by group A beta-hemolytic
streptococcus
> can lead to cardiac and kidney damage
> more severe than viral infection
Signs and symptoms:

1. marked erythema of the back of throat and palatine
tonsils
2. tonsils are enlarged and (+) white exudates in
the tonsillar crypts
3. high grade fever
4. difficulty swallowing
- Spread by infected nose or throat
mucus through coughing or sneezing
- Dx: throat swab and culture
treatment:
1. antibiotics- 10 days course of oral
antibiotics( pen G or clindamycin)
2. high fluid intakes
3.relief of pain
Complications:
1. Rheumatic fever
2. Glomerulonephritis
Retropharyngeal abscess
> limited to young infants

> infected lymph nodes that drain the
nasopharynx located behind the posterior
pharyngeal wall
Signs and symptoms:

1. sore throat
2. fever
3. enlargement of regional lymph nodes
laboratory findings:
leukocytosis- increased WBC count
treatments:
1. antibiotics( benzathine pen G.
penicillin V
2. abscesses resolve on their own
if not - can do incision
3.adequate fluid intakes
Tonsillitis
> term commonly used to refer to infection
and inflammation of palatine tonsils
palatine tonsils- located on both sides of

pharynx
Adenitis- refers to infection and inflammation of

the adenoids ( pharyngeal) tonsils
Adenoids- located in the nasopharynx

Tubal tonsils- located at entrance to the
eustachian tube
Lingual tonsils-located at base of tongue
Signs and symptoms:
1. difficulty of swallowing
2.fever
3.lethargy
4.mouth breathing- (posterior pharyngeal
obstruction)
5.difficulty hearing- (Eustachian tube
obstruction)
6.halitosis
7. sleep apnea
Causes:
> child <3 years old-often viral
> school age children- group A beta-
hemolytic
Treatment: 1. antipyretic
2. analgesics
3. antibiotics
4. if recurrent onset of tonsillitis -
can do tonsillectomy
Tonsillectomy-removal of palatine tonsils
Adenoidectomy- removal of pharyngeal
tonsils-can be done in
children having sleep apnea
Indication for tonsillectomy:

> chronic tonsillitis (not done if inflamed-
because may spread infection)
Nursing diagnosis: pain related to surgical

procedure
Epistaxis (nosebleed)
> extremely common in children and usually

occurs in trauma
> occurs during respiratory illness, after
strenuous activity
Management:
1. keep patient in upright position with head
tilted slightly forward to minimize the amount
of blood pressure in nasal vessels , keep blood
moving forward not back to nasopharynx
2. apply pressure to the side of the nose with
your fingers
3. keep the child quiet and stop crying
because crying increases pressure in the
blood vessels of the head and prolonged
bleeding
4. control of bleeding, can give epinephrine
( 1:1000) to constrict blood vessels
5. can put nasal packing for continued
pressure
Sinusitis
> rare in children younger than 6 years of

age because frontal sinuses do not develop
fully until 6 years of age
> occurs as secondary infection in older
children
Causes: streptococcal
staphylococcal
H- Influenza
signs and symptoms:
1. fever
2. purulent nasal discharge
3. headache
4.tenderness over the affected sinus
treatment:
1. antipyretic
2.analgesic
3. antibiotic for specific infection
4. nasal spray- Oxymetazoline HCl
(afrin) shrinks the edematous mucus
membrane and allows infected material to
drain
5. warm compress
Complication if untreated: otitis media and

osteomyelitis ( involves
facial bone)
Laryngitis
>inflammation of larynx
> occurs as complication of pharyngitis
or from excessive use of voice
Management :
1.sips of fluid offer relief from annoying tickling
sensation
2. rest the voice for at least 24 hrs
Congenital laryngomalacia/tracheomalacia
>means laryngeal structure is weaker than

normal and collapses more than usual in
inspiration
> produces laryngeal stridor present from
birth, intensified when infant is in supine
or sucking
Sign and symptoms:
1. stridor
2.retraction- on inspiration because of
increased effort needed to pull the air into
trachea from collapse cartilage ring
management: no routine treatment
-instruct parents to feed the child
slowly
Croup ( laryngotracheobronchitis)
> inflammation of the larynx, trachea, and

major bronchi
> one of the most frightening diseases of
early childhood for both parents and
children
> common cause organism is viral infection
usually parainfluenza virus
signs and symptoms:
1. low grade fever
2. barking cough at night
3. inspiratory stridor
4.retractions
Management:
> provide warm, moist environment- as
an emergency measure
> give corticosteroids (nebulizer)-
reduces inflammation and bronchodilation
> intravenous hydration
Nursing dx.: Ineffective airway clearance related

to edema
Epiglottitis
> inflammation of the epiglottis( flap of

tissue that covers the opening to larynx to
keep out food and fluids
> its an emergency because the swollen
epiglottis can’t rise and allow the airway to
open
causes:
1. H-Influenza type b
2. pneumococci, streptococci - most
common cause
3. echovirus
4.respiratory syncitial virus
Signs and symptoms:

1. begins as mild URTI
2. 1 to 2 days (+) severe inspiratory
stridor
3. high fever
4. hoarseness
5. sore throat
6. dysphagia
never illicit gag reflex- may cause complete
obstruction
Laboratory findings:
1. leukocytosis ( 20,000-30,000 mm3)
with the proportion of neutrophils
Management:
1. provide warm moist environment
2. O2 administration
3. antibiotic therapy
4. intravenous therapy
Aspiration
> inhalation of foreign objects into the airway

> common in infant and toddlers
Management: Heimlich subdiaphragmatic

abdominal thrust
( stand behind the child and place a fist
just under the child diaphragm)
*if the child is lying on his back at the
time of aspiration, stand at the head of
the table or bed, place hand under child
diaphragm and exert inward and upward
thrust*
* for infant, use back thrust to dislodge

an aspirated object-turn the infant prone
over your arm and administer up to 5
quick back blows forcefully bet. The infants
shoulder blades using the heel of the
hands*
Bronchial obstruction
> obstruction on the bronchus (commonly on

the right)
> common in child younger than school-age
Sign and symptoms:

1.violent cough
2.hemoptysis
3.fever
4. purulent sputum
5.localized wheezing
6.dyspnea
Laboratory findings:
1.radioopaque finding on chest X-ray
2.leukocytosis
Complications:
1. pneumothorax
2.atelectasis
3. lipid pneumonia
management:
1. bronchoscopy –removal of foreign body

2. close observation after bronchoscopy,
frequent V/S monitoring
3. maintain on NPO after procedure, assess for
gag reflex
Disorders of lower respiratory tract
Influenza
> inflammation and infection of the
major airway
> caused by orthomyxoviruses, influenza
type A, B, C
Sign and symptoms:

1.cough
2. fever
3.fatique
4.achings pain
5.sore throat
6. GIT symptoms-diarrhea, vomiting
incubation period: 1-5 days
Management:
1. antipyretic
2. antiviral drugs( tamiflu)
3. influenza vaccine( yearly given)
Complication:1. bronchitis
2. pneumonia
Bronchitis
> inflammation of major bronchi and

trachea
> affect preschool and school age
Sign and symptoms:

1. fever
2. cough
3.nasal congestion
causes:1. influenza virus
2. adenovirus
3. mycoplasma pneumoniae
Course of disease: 1-2 weeks
Sign and symptoms:
1.fever
2. dry hacking cough
3. on auscultation can hear rhonchi and
rales
4. On chest x-ray finding-diffuse alveolar
` hyperinflation and some marking on
hilus of lungs
Management:-1. aim in relieving the
respiratory symptoms
2. antipyretic
3. adequate hydration
4. antibiotic therapy
Bronchitis
Viral Bacterial
Etio Rhinovirus,Influenza, S. pneumoniae,
RSV, Parainfluenza S. aureus,
adenovirus, H. Influenzae,
paramyxovirus M. Catarrhalis
S/sx Rhinitis, cough, higher fever and a more

malaise, chills, mild prod cough
fever, sore throat
Dx Clinical Elev c-reactive CHON
Xray – normal
Course Mild & self-limiting Up to 2 weeks
Rx supportive empirical; amox-
tetracycline,
Bronchiolitis
> inflammation of the fine bronchioles and

small bronchi
> common lower respiratory illness in
children younger than 2 years of age , peak
in 6 mos of age
Causes: 1. adenovirus
2. parainfluenza
3. respiratory syncytial virus
sign and symptoms:
1. nasal flaring
2.intercostal/subcostal retarction
on inspiration
3. tachypnea
4. mild fever
5. expiratory wheezing
6. tachycardia
7. chest x-ray –pulmonary
infiltrates or collapse of alveoli
Management:1. antipyretic
2. adequate hydration
3. if in respiratory distress can
hospitalized the pt.
5. nebulized with
bronchodilators
nursing diagnosis:
> parental anxiety related to respiratory
distress in child
Respiratory syncytial virus
> an RNA virus, common cause of
bronchiolitis in young children.
> can cause apnea/periodic halt of
respiration
> peak in severity between 48 to 72 hrs
Sign and Symptoms:
-lethargic, cyanosis, nasal flaring
retraction, grunting, rales/ rhonchi
Diagnosis: throat or nasal culture
management: therapy is supportive
2.antiviral drugs( ribavirin)
3. isolate the patient
4. vaccination-RSV-IGIV and
palivizumab
asthma
> an immediate hypersensitivity ( type 1)

response, most common illness in
children
> condition may be intermittent, symptom-
free period
> common seen in children with atopy or
tend to be hypersensitivity to allergens
Mechanism of disease:
> primarily affect the small airways and
involve 3 processes:
1. bronchospasm-happen because of
stimulation of PSNS (smooth
muscle constriction)
2. inflammation bec. of mast cell
3. mucus production activation this will
release histamine,
leukotrienes &
prostaglandin
Signs and symptoms:
1. dry cough
2. expiratory wheezing
3. cyanosis
4. retractions
Clinical Assessment of Asthma
MILD MOD SEVERE

breathless walking talking at rest
talks in sentences Phrases words
Alertness may be usually agitated
agitated agitated
RR Inc inc >30
accessory (-) (+) (+)
wheeze audible audible audible w/o
steth
pulse <100 100-120 >120
Intermittent Mild ModerateP Severe
Persistent ersistent Persistent
Am sx < 1x/wk >1x/wk Daily; aff Daily; dec
activ activ
Pm sx </= 2x/mo >/= 2x/mo >1x/wk > 1x/wk
PEFR 80% </= 80% 60-79% <60%
PEFR var < 20% 20-30% 30% >30%
Ndx:
• Ineffective breathing pattern r/t
bronchospasm, edema and accumulation of
mucus
• Fear r/t sudden onset of Asthma attack
• Activity intolerance r/t imbalance between O2
supply and demand
• Health seeking behaviors r/t prevention and
treatment for asthma attack
Management
• B2 agonists, Theophylline, Steroids, Cromolyn
Na, O2
• Orthopneic position
• Monitor VS, hydration
• Adequate nutrition and non allergenic diet
• Environmental modification
• Health education
Status Asthmaticus
• Progression of attack unresponsive to therapy

• Preceding upper respiratory tract infection,
allergen, cigarette smoke
• HR and RR inc, dec breath sounds, cyanosis
Mx: cont B2 agonist and IV steroid, O2, coughing,

fluids, monitor I and O, ET

Pneumonia
• Inflammation of lung parenchyma
Bacterial and atypical pathogens:

NB – GBS, Gr (-) bacilli, chlamydia
Children – S. pneumoniae, H. Influenzae, M.
catarrhalis
Adolescents – S and M Pneumoniae, M.
catarrhalis
Hospital acquired – Pseudomonas, Klebsiella, E.
Coli, Enterobacter sp
Viral Pneumonia - RSV, Parainfluenza,

Adenovirus, Influenza

Pathophx: aspiration/hematogenous/inhalation
Alveoli inflammation hypoxemia
S/sx: fever, chills, cough, irritability, poor

feeding, restlessness, headache, GI sx,
tachypnea, use of accessory muscles,
decreased BS, crackles, dullness on
percussion, chest retractions
Dx: cxr, blood and sputum c/s

Parameter Bacterial Viral Atypical
Age Any Any 5-15 yo
Onset Abrupt Variable Insidious
Fever High Variable Low-grade
Toxicity Toxic Variable Non-toxic
Inc RR Common Common Uncommon

Perimeter Bacterial Viral Atypical
Cough Productive Non prod Non prod
Assoc sx Mild coryza Mild coryza Bullous

myringitis,
pharyngitis
PE (+) variable Fine

consolidation crackles,
few crackles wheezing
Inc WBC common variable Uncommon

• Nsg Dx:
• Ineffective breathing pattern r/t physiologic
effects of Pneumonia
• - O2, monitor VS, CPT, encourage coughing
and deep breathing
• Risk for deficient fluid volume r/t diminished

oral intake and increased insensible fluid
losses sec to diaphoresis, dyspnea and fever
• - weigh and monitor daily, sips of fluid,
temp control, monitor I and O

• Activity Intolerance r/t effects of Pneumonia
and Tachypnea
- rest periods, O2, small frequent feedings,
gradual increase in activity, support and
contact with family

Tuberculosis
• High incidence in infancy and adolescence
• Primary Complex – based on xray; first

encounter of a child w/ TB; Ghon’s tubercle w/
lymphangitis and regional (hilar)
lymphadenopathy
• Primary Pulmonary TB – clinical TB
• d/t Mycobacterium Tuberculosis
Dx: exposure, s/sx (2 or more), PPD, cxr

Classification of TB
Class I TB exposure – (+) exposure

Class II TB infection – (+) exposure and PPD
Class III TB disease – active TB or 3 or more
of criteria - Exposure, s/sx, (+) tuberculin test,
xray, sputum exam, culture

Class IV TB inactive – (+/-) hx of prev TB,
(+/-) hx of prev hx of chemotherapy, (+) xray
evidence of healed lesion and (+) PPD

S/sx: fever, weight loss, cough, anorexia, night
sweats, painless lymphadenopathy
Tx: SCC
Intensive
INH, Rifampicin, PZA x 2 mos
Maintenance
INH, Rifampicin x 4 mos

Respiratory Distress Syndrome
• Preterm, infants of diabetic mothers, C/S, hx

of asphyxia
S/sx: inc RR, chest retractions, nasal flaring,

expiratory grunt, cyanosis, HPN, hypothermia
Dx: ABG, Xray
Mgmt: surfactant replacement, O2, ventilation,

supportive care

Decreased surfactant
lungs collapse
Inc pulmonary resistance
blood shunts through F.O. and D.A.
poor lung perfusion and gas exchange
further decrease in surfactant hypoxia
acidosis

Cardiovascular Disorders
Fetal Circulation
• placenta provides
the exchange of gas
and nutrient
• four shunts in fetal

circulation:
– Placenta
– Ductus venosus
– Foramen Ovale
– Ductus arteriosus

Special Structures:
Foramen Ovale
Connects the left and right atrium
Bypassing fetal lungs
Obliterated after birth to become fossa ovalis
Umbilical Vein
Brings oxygenated blood coming from the placenta to the heart an
liver
Becomes ligamentum teres
Umbilical arteries
Carry unoxygenated blood from the fetus to placenta
Become umbilical ligaments after birth
Ductus venosus
Carry oxygenated blood from umbilical vein to IVC
Bypassing fetal liver
Becomes ligamentum venosum after birth
Ductus arteriosus
Carry oxygenated blood from pulmonary artery to aorta
Bypassing fetal lungs
Becomes ligamentum arteriosum; closes after birth
Fetal
Circulation

Fetal circulation:
oxygenated blood (placenta)
umbilical vein
liver ductus venosus
inferior vena cava
right atrium
foramen ovale (flap opening in the atrial

septum
that allow only R-L movement
of blood)

• Continuation:
left atrium
left ventricle right ventricles

(small
amount)
aorta pulmonary arteries

ductus
arteriosus
supply the body aorta
supply blood to the

body
• Continuation:
superior vena cava
right atrium
right ventricle
pulmonary arteries
( ductus arteriosus)
aorta
supply blood to the body

Common Congenital Heart
Defects
• abnormalities that develop before birth
• can occur in the heart's chambers,
valves or blood vessels
• A baby may be born with only one
defect or several that tend to occur in
combination.
• Of the dozens of heart defects, some
are mild and may need minimal or no
medical treatment even through
adulthood, while others are life-
threatening, either immediately to the
newborn or over time.

1.Acyanotic Heart Disease
L R shunt
high pressure to low pressure
oxygenated to unoxygenated blood
2. Cyanotic Heart Disease

R L shunt

Classifications of CHD
1. Defects with increased pulmonary blood flow

-ASD, VSD, PDA
2. Defects with decreased pulmonary blood flow
- TOF, Tricuspid Atresia
3. Obstructive Defects
- COA, Aortic stenosis, Pulmonic stenosis
4. Mixed Oxygenation/ defects
-TOGV, Truncus Arteriosus, Hypoplastic left
heart syndrome (HLHS)

ACYANOTIC HEART DISEASES

Atrial septal defect
• Similar to a ventricular septal defect, this
is a hole that occurs when the septum
separating the right and left atria doesn't
close properly.
• This allows blood from the left atrium to
flow into the right atrium, instead of into
the left ventricle and on to the aorta and
the rest of the body.
• The defect can cause several
complications, including arrhythmias,
heart failure, stroke and, in rare cases,
pulmonary hypertension.
• Minor cases may cause no symptoms and
may not require treatment.
• Larger defects may require surgical
closure or cardiac catheterization
1. Atrial Septal Defect
• Opening between atria

• females
• late childhood/early adulthood
• S/sx: cyanosis (CHF), dyspnea,
fatigue, failure to thrive, split
S2
• Mx: Antibiotics,
surgery 1-3 yo
• Cx: endocarditis, heart failure
• Postop: monitor
arrhythmia, administer
antibiotics

Ventricular septal defect
• Sometimes called a hole in the heart
• most common congenital heart defect
• occurs when the septum, the muscular wall separating the
right and left ventricles, fails to fully form
• The hole allows oxygen-rich blood to leak from the left
ventricle into the right ventricle, instead of moving into the
aorta and on to the body.
• Too much blood may flood the lungs.
• This defect can lead to heart failure, excessive blood pressure
in the lungs (pulmonary hypertension), infections of the heart
(endocarditis), irregular heartbeats (arrhythmias) and delayed
growth.
• Small holes may heal on their own or cause no symptoms.
Larger holes may require surgical repair by stitching together
or covering with a patch.

2. Ventricular Septal Defect
• Opening in ventricular
septum
• Most common
• S/sx: respiratory infections,
failure to thrive, dyspnea,
fatigue, pansystolic murmur
• Mx:closes spontaneously
otherwise surgery <2 yo
failure
• Postop: monitor
• Cx:pulmonary HPN,
endocarditis, heart
arrhythmia, administer
antibiotics

Patent ductus arteriosus
• Before birth, a temporary blood vessel called the ductus
arteriosus connects the pulmonary artery and the aorta.
• This allows blood to bypass the lungs because oxygen is
delivered to the fetus through the placenta and
umbilical cord.
• The temporary vessel normally closes within a few
hours or days of birth since the lungs take over.
• If it remains open (patent), some blood that should
circulate through the body is misdirected to the lungs.
• This defect can cause heart failure or endocarditis. In
infants, it can be closed with medications. In older
children and adults, plugs, coils or surgery can be used
to close the vessel.

3. Patent Ductus Arteriosus
• Aorta to pulmonary artery

• Common in prematurity, high
altitude, maternal rubella
• females
• S/sx:clubbing, dyspnea,
“machinery murmur” (2nd-3rd
ICS)
• Cx:heart failure, endocarditis,
pulmonary artery stasis/HPN
• Mx:Indomethacin, surgery

Aortic stenosis
• defect that narrows or
obstructs the aortic valve
opening, making it difficult
for the heart to pump blood
into the aorta.
• Mild cases may not have
symptoms initially, but they
can worsen over time.
• The defect can cause heart
enlargement, left-sided
heart failure, arrhythmias,
endocarditis and fainting.
• Treatment includes surgical
repair or replacement of the
valve or, in young children,
widening through balloon
valvuloplasty
Tetralogy of Fallot
• This defect is a combination of four (tetralogy)
congenital abnormalities. The four defects typically are
ventricular septal defect (VSD), pulmonary stenosis, a
misplaced aorta and a thickened right ventricular wall
(right ventricular hypertrophy).
• They usually result in an insufficient amount of
oxygenated blood reaching the body.
• Complications of tetralogy of Fallot (fuh-LOE) include
cyanosis — sometimes called "blue baby syndrome,"
since the lips, fingers and toes may have a bluish tinge
from lack of oxygen — as well as poor eating, inability to
tolerate exercise, arrhythmias, delayed growth and
development, and stroke.
• Surgical repair of the defects is required early in life.
• Tet spells- irritability, pallor and blackouts or

convulsions,

CYANOTIC HEART DISEASE
1. Tetralogy of Fallot
• S/sx: cyanosis, clubbing,

dyspnea, fatigue, squatting,
“Tet spells”, failure to thrive,
systolic murmur, polycythemia
• Cx:thromboembolism,CVA
• Mx: O2, knee-chest position,
surgery 1-2 yo
• Postop:monitor for arrhythmia
Blalock Taussig: anastomose
subclavian art. and pulmo art.
- avoid BP and venipuncture in
right arm

Transposition of the great vessels/ arteries
• With this defect, the positions of the aorta and the
pulmonary artery (the great arteries) are reversed
(transposed).
• The aorta arises from the right ventricle instead of the
left and the pulmonary artery arises from the left
ventricle instead of the right.
• This creates a circulatory pattern that prevents
nourishing oxygenated blood from reaching the body.
• This condition would quickly be fatal to a newborn
except it's generally accompanied by another defect —
commonly a septal defect or patent ductus arteriosus —
that does allow oxygen-rich blood to get to the body.
Surgical repair is usually necessary shortly after birth.

2. Transposition of the Great Vessels
• Aorta from R
ventricle
• Pulmonary a. from L
ventricle
• Males
• S/sx:cyanosis,
murmurs
• Mx:PGE for PDA,
Balloon catheter to
create ASD,
definitive surgery 1
wk-3 mos
3. Total Anomalous Pulmonary
Venous Return
• Pulmonary vein
drains to SVC or R
atrium
• PDA or foramen
ovale essential
• S/sx:cyanosis,
fatigue
• CX: R heart failure
• Mx:PGE, surgery

Coarctation of the aorta
• This is a narrowing (coarctation), or constriction, in a
portion of the aorta.
• Coarctation forces the heart to pump harder to get
blood through the aorta and on to the rest of the body.
• This defect can cause several life-threatening
complications, including severe hypertension, aortic
aneurysm, dissection or rupture, endocarditis, brain
hemorrhage, stroke, heart failure and premature
coronary artery disease.
• Repair is typically recommended before age 10, either
by surgically removing the affected portion or widening
it through balloon angioplasty and placement of a stent.

Coarctation of the Aorta
• Constriction of aorta
• males
• S/sx: asymptomatic HPN,
irritability, headache,
epistaxis, dyspnea,
claudication, higher BP in
upper extremities, dec femoral
and distal pulses,systolic
murmur
• Cx:chronic HPN
• Mx:surgery 2 yo
• Postop: monitor abdominal
pain, antihypertensives

Ndx:
Ineffective cardiopulmonary and peripheral tissue
perfusion related to impaired cardiac function
• Proper positioning to maintain respiration
• Conserve energy to promote rest
• Quiet activities and stimulation
• Anticipate needs
• Administer prescribed drugs

Activity intolerance r/t effects of congenital heart
defect and dyspnea
• Rest periods
• Adequate nutrition
small frequent feedings
iron supplementation

Pulmonary stenosis
• the flow of blood from the right
ventricle to the pulmonary artery is
obstructed by narrowing at the
pulmonary valve.
• When there's an obstruction
(stenosis), the right ventricle must
pump harder to get blood into the
pulmonary artery.
• The defect may occur along with
other defects, such as thickening of
the muscle of the right ventricle
immediately below the valve.

• in many cases, pulmonary stenosis is mild and doesn't
require treatment. But because it can cause heart
failure, arrhythmias or enlargement of the right heart
chambers, surgery may be necessary to repair the
stenosis or replace the valve.
• Special balloons to widen the valve (balloon
valvuloplasty) may also be used.

Truncus arteriosus
• This is a defect in which the normally distinct pulmonary
artery and aorta merge into one single great vessel
(truncus) arising from the right and left ventricles.
• In addition, there's usually a large ventricular septal
defect, essentially turning the right and left ventricles
into a single chamber.
• This allows oxygenated and unoxygenated blood to mix.
Too much blood may flow to the lungs, flooding them
and making it difficult to breathe.
• It can also result in life-threatening pulmonary
hypertension.Surgery is needed to close the septal
defect with a patch and to separate the pulmonary
arteries from the trunk.
• A conduit is placed to connect the right ventricle to the
pulmonary artery. Because the conduit doesn't grow
with the child, repeat surgery may be necessary over
time.

Truncus arteriosus

Hypoplastic left heart syndrome
• In this condition, the left side of the heart is
underdeveloped (hypoplastic), including the
aorta, aortic valve, left ventricle and mitral valve.
• As a result, the body doesn't receive enough
oxygenated blood. In the first few days after a
baby is born, the ductus arteriosus remains open
(patent), allowing normal circulation, so the baby
may seem fine initially.
• But when the ductus arteriosus naturally closes,
signs and symptoms begin, including a bluish cast
to the skin from lack of oxygen, difficulty
breathing and poor feeding. This condition may
be accompanied by an atrial septal defect.
• Treatment options for this life-threatening
condition are a heart transplant or a multistage
surgical procedure done during the first few
years of life.

Hypoplastic left heart syndrome

Atrioventricular canal defect
• This is a combination of defects,
including a large hole in the center of the
heart and a single common valve instead
of the separate tricuspid and mitral
valves.
• Also called atrioventricular septal defect,
this defect is classified by whether it's
only partial, involving only the upper
chambers of the heart, or complete, in
which blood can travel freely among all
four chambers of the heart.
• Both forms allow extra blood to circulate
to the lungs, causing the heart to
enlarge.The condition is often associated
with Down syndrome. Infants may also
have trouble breathing and not grow
well.
• Surgery is often done in infancy to close
the hole and reconstruct the valves.
Atrioventricular canal defect

Other Cardiovascular
Problems

Kawasaki Disease/
Mucocutaneous Lymph Node Syndrome
• Before puberty, peaks 4 yo
• S/sx:spiking fever x 5 days, bilateral conjunctivitis,

reddened pharynx, dry lips, strawberry tongue, cervical
lymphadenopathy, peripheral edema, erythema and
desquammation, truncal rash, arthritis
• Patho: Respi infection immune complex systemic

vasculitis aneurysm and MI
• Dx:clinical
• Mx: Salicylates and Immunoglobulins

• Risk for ineffective peripheral tissue perfusion
related to inflammation of blood vessels
- Observe for chest pain, color changes,
vomiting
• Pain r/t swelling of lymph nodes and

inflammation of joints
- Comfort measures, administer pain
medications

Other Measures:
Protect edematous areas
Record intake and output
Offer soft food
Administer prescribed medication

Rheumatic Fever
• Autoimmune J. N. E. S.
• Grp A Beta hemolytic strep
• 6-15 yo, peaks 8 yo
• 1-3 wks after untreated infection
• Dx: 5 major criteria – polyarthritis,
carditis, subcutaneous nodules,
erytHema marginatum,
sydenham’s chorea
minor – fever, polyarthralgia, hx
of RF, inc ESR, antecedent strep
infection
• To diagnose, either 2 major or 1
major and 2 minor present
• Cx:mitral valve insufficiency and
myocarditis

Mgmt: salicylate, penicillin
Ndx:
Risk for noncompliance r/t knowledge deficit
about importance of long term therapy
- prevent initial and recurrent attacks
Decreased cardiac output r/t disease process

- bed rest, comfort and appropriate activities

Nursing Care
• Monitor vital signs
• Provide adequate nutrition
• Promote safety to prevent chorea related
injuries

Gastrointestinal Disorders
Altered Gastrointestinal Functioning
Acquired and congenital conditions

of the GI tract can result in altered
GI functioning.
A thorough assessment is necessary

for prompt treatment.

Interventions are geared toward:
• controlling and correcting the problem
• promoting adequate nutrition and
normal function and
• preventing complications

Characteristics of the pediatric GI System
• Peristalsis occurs within 2 ½ to 3 hours

in the neonate and extends to 3 t0 6
hours in older infants and children.
• The stomach capacity of the neonate is

30 to 60 ml, which gradually increases
to 200 to 350 ml by age 12 months and
1,500 ml in the adolescent.

• Up until 4 to 8 weeks, the neonatal abdomen is
larger than the chest and the musculature is
poorly developed.
• The sucking and extrusion reflexes persist until

3 to 4 months.
• Saliva production begins at age 4 months and

aids in the process of digestion.

• Spit-ups are frequent in the neonate because
of the immature muscle tone of the lower
esophageal sphincter (LES) and the low
volume capacity of the stomach.
• Increased myelination of nerves to the anal

sphincter allows for physiologic control of
bowel function, usually at about age 2.

• The liver’s slow development of glycogen
storage capacity makes the infant prone to
hypoglycemia.
• From ages 1 to 3, the composition of intestinal

flora becomes more adultlike and stomach
acidity increases, reducing the number of GI
infections.

Diagnostic Tests

Barium or Gastrografin Swallow
Primarily used to examine the esophagus
Gastrografin and barium facilitate imaging through X-
rays, but Gastrografin is less toxic if it escapes from the
GI tract
Nursing Interventions:
- Explain the procedure to the child and his parents.
- Maintain the child on NPO starting at midnight before
the test.
- Tell the child that he must hold still during the X-ray.
- After the test, monitor bowel movements for
excretion of barium. Monitor GI function.

Upper GI Imaging
• Upper GI series
- Swallowed Barium moves into the esophagus,
stomach, and duodenum to reveal
abnormalities.
- Barium outlines stomach walls and delineates
ulcer craters and filling defects.

• Small bowel series
- An extension of the upper GI series
- Visualizes Barium flowing through the small
intestine to the ileocecal valve

NI:
- Explain the procedure to the child and his
parents.
- Tell the child that he must hold still during the
X-ray.
- Make sure the lead apron is properly placed
around the genital area.
- After the test, monitor bowel movements for
excretion of barium.
- Monitor GI function.

Barium Enema
• Allows X-ray visualiztion of the colon.
NI:
parents.
- Usually, the child will follow a liquid diet for 24
hours before the test.
- Bowel preparations are administered before
the examination.
- Tell the child that X-rays will be taken on a test
table and that he must hold still.
- Cover the genital area with a lead apron
during X-ray.
Stool Specimen
Examined for suspected GI bleeding, infection,
or malabsorption
Tests include the Guaiac test for occult blood and
microscopic tests for ova, parasites and fat
NI:
- Obtain the specimen in the correct container.
- Be aware that the specimen may need to be
transported to the laboratory immediately or
placed in the refrigerator.

Fiber-optic Testing
• Esophagogastroduodenoscopy – a fiber-optic
scope is inserted to allow direct visual
inspection of the esophagus, stomach and
duodenum
• Proctosigmoidoscopy – the rectum and distal

sigmoid colon are inspected directly
• Colonoscopy – the descending, transverse and

ascending colon are inspected directly

• NI:
parents.
- Obtain written, informed consent.
- A mild sedative may be administered before
the examination.
- The child may be kept on NPO starting at
midnight before the test.
- The child may be placed on a liquid diet for 24
hours before the examination or require
enemas and laxatives until clear.

Endoscopic Retrograde
Cholangiopancreatography (ERCP)
Contrast media is injected into the duodenal papilla to
allow radiographic examination of the pancreatic ducts
and hepatobiliary tree
NI:
- Before the procedure:
Explain the procedure to the child and his parents.
Obtain written, informed consent.
Check the child’s history for allergies to cholinergics and
iodine.
Administer a sedative and monitor the child for the
drug’s effect.

- After the procedure:
Monitor the child’s gag reflex (the child
remains on NPO status until his gag reflex
returns)
Protect the child from aspiration of mucus by
positioning the child on his side.
Monitor the child for urine retention.

GI Intubation
To empty the stomach and intestine

To aid in the diagnosis and treatment
To decompress obstructed areas
To detect and treat GI bleeding
To administer medications or feedings

NI:
Maintain accurate intake and output records
- Record the amount, odor and consistency of
gastric drainage every 4 hours.
- When irrigating the tube, note the amount of
normal saline solution instilled and aspirated
Check for fluid and electrolyte imbalances.

Provide good oral and nasal care. Make sure the
tube is secure but that it isn’t causing pressure
on the nostrils.

To support the tube’s weight and prevent its
accidental removal, anchor the tube to the
child’s clothing.
After removing the tube from a child with GI
bleeding, watch out for signs and symptoms of
recurrent bleeding.
Maintain a calm and reassuring manner and
provide emotional support because many
children panic at the sight of the tube.

Cleft Lip and Palate
• failure of fusion of maxillary

and median nasal process
• hereditary
• unilateral/bilateral
• males
Mx: surgery – Cheiloplasty;
usually 1-3 mos
• Rule of 10’s-10 wks,
10 lbs, Hgb 10 gm

Cleft Palate
• midline opening of palate

• usually w/ Cleft lip
• Female
• surgery 6-18 mos - allows
anatomic changes; <1
y/o (ie, formation of
palatine arch and tooth
buds)

Ndx:
• Risk for imbalanced nutrition, less than body
requirements r/t feeding problems
• Risk for ineffective airway clearance r/t oral
surgery
• Risk for infection during post op period

Nursing Care
Preop
• Adequate nutrition; sips of fluid btw feeding in upright
position; use rubber tipped syringe; Burp
• Prevent ear and upper respiratory tract infection
• Address body image and speech concerns
• Reassurance to parents
Postop
• monitor respiratory distress d/t edema, hemorrhage
• Suction mucus and blood gently
• dropper feeding 1st 3 weeks; regular feeding after
• Anticipate needs and position to prevent tension on
sutures
• Position side lying in cleft lip; prone in cleft palate

Tracheoesophageal Fistula
• Communication of the esophagus and trachea

• maternal hydramnios and prematurity
• S/sx:coughing, choking, cyanosis, dyspnea,
excessive secretion, abdominal distention
• Dx: Ba swallow

Ndx:
• Risk for imbalanced nutrition, less than body
requirements r/t inability for oral intake
• Risk for infection r/t aspiration or seepage of
stomach contents into lungs
• Risk for impaired skin integrity r/t gastrostomy
tube insertion site

Nursing care
Preop
• Suction regularly
• Elevate the head
• Gastrostomy feeding
• hydration
• O2
Postop
8. Observe for respiratory distress
9. Proper positioning –avoid hyperextension
of neck
11. Continue suction
12. Prevent wound infection
13. Provide pacifier

Hirschprung’s Disease
• Aganglionic megacolon
• Absence of
parasympathetic
ganglionic cells in a
segment of the colon
(usually at the distal end
of the large intestine:
rectosigmoid colon)
• Lack of innervation to a
bowel segment causes a
lack of, or alteration in,
peristalsis in the affected
part
• Male predominance
• Causes
Familial, congenital defect
Commonly exists with other congenital
anomalies, particularly Down’s syndrome
(trisomy 21) and anomalies of the urinary tract
• Pathophysiology
As stool enters the affected part, it remains
there until additional stool pushes it through.
• The affected part of the colon dilates; a
mechanical obstruction may result.

• Complications
Severe Constipation
Enterocolitis – severe diarrhea, Hypovolemic
shock, Death
S/sx:
Constipation
Ribbonlike stools
Failure to pass meconium or stool
abdominal distention
Bile stained or fecal vomiting

• Dx:
Rectal biopsy provides definitive diagnosis by
showing the absence of ganglion cells
Ba enema – shows distention of the colon;
spasm and a narrowed lumen in the affected
bowel
Abdominal X-rays show distention of the colon
and air-fluid levels; No air is seen in the
rectum
• Mx:
colostomy, surgery: To decompress the colon,
a temporary colostomy or ileostomy may be
necessary

Ndx:
• Constipation r/t reduced bowel function
• Imbalanced nutrition, less than body requirements r/t
reduced bowel function
Nursing Care
Preop
8. Administer isotonic enemas: Normal saline solution or
mineral oil to evacuate the bowel
Daily enemas with 0.9% NaCl
Don’t administer tap water.
*Tap/hypotonic water will cause cardiac
congestion or cerebral edema
2. Minimal residue diet with vitamin supplementation
3. Position semi fowlers to relieve dyspnea from distended
abdomen
4. pacifier

After colostomy or Ileostomy
2. Monitor fluid intake and output (ileostomy will likely
cause excessive electrolyte loss)
2. Keep the area around the stoma clean and dry; use
colostomy or ileostomy appliances to collect drainage
3. Monitor for return of bowel sounds to begin diet
Postop
9. Observe for abdominal distention
10. Small frequent feedings after NGT removal
11. Colostomy care
5. Assist parents to cope with children’s feeding
problems
Intussusception
• 2-6 mos
• Invagination of intestine
• S/sx:intense abdominal pain,
vomiting, blood in stool
“currant jelly”, abdominal
distention (sausage shaped
mass)
• NECROSIS: fever, tachycardia,
rigid abdomen
• Dx:sonogram “coiled spring”
• Mx:Ba enema (reduction by
hydrostatic pressure), surgery

Ndx:
• Pain r/t abnormal abdominal peristalsis
• Risk for deficient fluid volume r/t bowel
obstruction

Nursing Care
1. Provide comfort measures - pacifier for

infants
2. NPO
3. Adequate hydration via IV therapy
4. Promote parent-infant bonding

Pyloric Stenosis
• Hypertophy/hyperplasia
of pyloric sphincter
• Males
• S/sx:nonbillous
vomiting, s/sx of of
dehydration and wt loss,
abdominal distention,
“olive” sized mass RUQ,
visible peristalsis
• Dx:xray-”string sign”,
USG, endoscopy
• Mx: surgery
Ndx:
• Risk for deficient fluid volume r/t inability to
retain food
• Risk for infection at site of surgical incision r/t
danger of contamination from feces d/t
proximity of incision to diaper area

Nursing care
• Hydration
• Pacifier
• may give thickened feedings on upright position then NPO
just before surgery
• Monitor I and O, weight, and vomiting
Postop
1. dropper feeding 4-6 hrs after surgery 45 min- 1 hr duration;
oral rehydration soln then half strength breastmilk/formula
at 24 hr interval
2. Side lying position
3. Monitor weight and return of peristalsis
4. Wound care
5. Pacifier for oral
MLNG CELESTE,RN, MDneeds 200
Diaphragmatic Hernia
• Herniation of intestinal
content into the thoracic
cavity
• Left side
• S/sx:respiratory
difficulty, cyanosis,
retractions, (-) breath
sounds affected side,
scaphoid abdomen
• Cx: pulmonary HPN
Mx:’E’ surgery

Ndx:
Risk for ineffective airway clearance r/t displaced
bowel
Risk for imbalanced nutrition, less than body
requirements, r/t NPO status

Nursing Care
Preop
• Elevate head
• Low intermittent suction
Postop
6. Semi-fowlers
7. Maintain warm, humidified envt – lung fluid drainage
8. Suction prn
9. Chest pptx
10. NPO – prev pressure on diaphragm

Necrotizing Enterocolitis
- Bowel develops necrotic patches, interfere w/

digestion, lead to paralytic ileus, peritonitis and
perforation
- D/t ischemia sec shock or hypoxia, infection,
immature GIT immune protection
S/sx: abdomen tense and distended, stool (+) for
occult blood, > 2 ml gastric residual, bradycardia,
apnea
Dx: abdominal xray
Mgmt: d/c feeding, IV or TPN, Antibiotic, colostomy,
surgery for perforation
Celiac Disease/Gluten sensitive
enteropathy/Celiac sprue
• Characterized by poor food absorption and

sensitivity or intolerance to gluten (a protein found
in grains : wheat, rye, oats, barley)
• Usually becomes apparent between ages 6-18

months
• Causes:
Gluten intolerance
Immunoglobulin deficiency
• Pathophysiology
A decrease in the amount and activity of
enzymes in the intestinal mucosal cells causes
the villi of the proximal small intestine to
atrophy and decreases intestinal absorption.
• Complications
Lymphoma of the small intestine

• S/sx:
steatorrhea (fatty stools) because of inability to
absorb fat
chronic diarrhea
anorexia
malnutrition; weight loss
failure to thrive
coagulation difficulty from the malabsorption of fat-
soluble vitamins
irritability
anemic (Fe deficiency)
abdominal pain and distention

• CELIAC CRISIS: acute vomiting and diarrhea
• Dx:clinical; IgA antigliadin Ab, gluten free diet
• Mx: gluten free diet, vitamin & Fe

supplementation
• NDx: Imbalance nutrition: Less than body

requirements r/t impaired absorption

NI:
- nutrition counseling
Eliminate gluten from the diet:
avoid cereals, bread, cake, cookies, spaghetti, pizza,
instant soup, some chocolates
Give the child: corn and rice products, soy and potato
flour, breast milk or soy- based formula, and fresh fruits.
Replace vitamins and calories; give small, frequent

meals.
Monitor for steatorrhea- its disappearance is a good

indicator that the child’s ability to absorb nutrients is
improving.
Endocrine Disorders
Cystic Fibrosis
• Autosomal recessive
• Dysfunction of exocrine glands; inc viscosity of
mucous glands
• Affects lungs, pancreas, intestines and sweat
glands
• Cystic fibrosis (multiple organ disease; the
primary pathophysiologic mechanism in cystic
fibrosis mucus buildup in the lungs and pancreas;
steatorrhea; azotorrhea)
• S/sx: GI - meconium ileus, rectal prolapse,
steatorrhea, malnutrition, failure to thrive
Respiratory – recurrent infection,cough,
dyspnea, clubbing, cyanosis

Sweat Gland – ”salty taste”
Other – males infertile, abnormal glucose tolerance
Dx: history, sweat test (Cl 2-5x the normal),
absence of pancreatic enzymes, immunoreactive
trypsinogen in blood and pulmonary involvement
Mx: chest physiotherapy, antibiotics, pancreatic
enzymes, vitamins, lung or pancreas transplant

Ndx:
• Imbalanced nutrition, less than body
requirements r/t inability to digest fats
• Ineffective airway clearance r/t inability to
clear mucus from the respiratory tract

Nursing Care
1. Hi calorie, Hi CHON, moderate fat diet

2. Nebulization and physiotherapy
3. Frequent Position changes when in bed
4. Oral care
5. Adequate rest and comfort

Musculoskeletal Disorders

Clubfoot (Talipes)
• Ankle-foot disorders
• Types: Varus – inward
rotation
Valgus – outward
rotation
Calcaneous –
upward rotation or
dorsiflexion
Equinas –
downward rotation or
plantarflexion

• Males
• Unilateral more common
• Talipes Equinovarus (plantar flexion and medial

deviation) – 95%
• S/sx: foot cannot be manipulated by passive

exercises into correct position
• Mx: cast and splint, surgery then casting and

corrective shoes

NDx: Risk for impaired skin integrity r/t
corrective devices
Nursing Care
• Exercise
• Cast and brace care
• Skin care
• Restraints if necessary
• Diversional activities
• Health teaching

Congenital Hip Dysplasia
• Imperfect hip
development affecting
femoral head and
acetabulum
• Female
• Unilateral more
common
• Inc frequency w/
breech delivery
A. Lower right leg
B. asymmetric skin
MLNG CELESTE,RN, MD
fold 219
A. Normal hip
B. subluxated hip
C.Dislocated Hip
S/sx:
• limited abduction of affected hip
• shortening of leg on affected side
(Galeazzi/Allis sign)
• asymmetric thigh and gluteal folds
• buttocks on affected side will flatten on prone
• pelvis dips on normal side when standing on
affected leg (Trendelenburg)
• palpable click (Ortolani’s click)
• Mx: maintaining hip in abduction
traction and casting

A. Ortolani’s test
B. Barlow’s Test
A. Frejka splint
B. Pavlik Harness
C. Hip abduction for
subluxation
NDx: Impaired physical mobility r/t
immobilization device
Nursing Care
• Maintain proper positioning-keep legs abducted
• Adequate nutrition
• Diversional activities
• Regular exercise
• Ensure adequate circulation
• Provide comfort
• Maintain cast, traction, splint

Neurological Disorders

Brain Tumor
• Second most common form of cancer in children

• 1-10 yo, peak 5 yo
• Usual location - brainstem or cerebellum
• TYPES:
Astrocytoma- glial tissue; 5-8 yo
Medulloblastoma – cerebellum; 5-10 yo; cause
compression of 4th ventricle; most common
Brain stem tumor – support tissue of neural cells;
paralysis of 5th-7th, 9th-10th CN

S/sx: headache, vision changes, vomiting, enlarging
head circumference, papilledema, lethargy,
ataxia, nystagmus, personality changes, seizures,
lethargy, coma
Dx: skull films, bone scan, CT scan, Lumbar
puncture, MRI, angiography
Mx: surgery, chemotx

Preop
2. Stool softeners
3. Dexamethasone
4. Dilantin
5. Shave head
6. Prepare patient and family psychologically

Postop
2. Proper position – low fowler’s
3. Anticipate needs
4. Saline eye drops as needed
5. Monitor VS and NVS
6. Regulate IV
7. Observe head dressings
8. Provide comfort and opportunity for self
expression

Benign Febrile Seizure
• 6 mos - 5 years
• fever >/= 38.5C
• generalized tonic-clonic
• rarely persist > 10 minutes
• Postictal stage
• 30-40 % recurrence
• (+) family history

NURSING CARE
• Turn child to side & allow to drool

• Do not restrain
• Do not put anything in the mouth
• Dec temp
• Refer if:
sx persist
another sx occurs
delirious/difficult to rouse after sx

Seizure
• Paroxysmal involuntary disturbance of brain

function
Epilepsy: recurrent seizures unrelated to

fever or to acute cerebral insult

Generalized Seizures
• Absence Seizures/Petit Mal:

- staring spell that lasts a few seconds
- 100x a day
- appear as if daydreaming
• Generalized/Grand Mal/Tonic-Clonic 4 stages

Prodrome: mood or behavioral changes; precede
attack by hours
Aura: immediately before seizure and will localize the
attack to its point of origin within the nervous
system
Tonic phase (10 secs)
eyes open. Elbows flexed. Arms pronated. Legs
extended. Teeth clenched. Pupils dilated.
Breath held- cyanosis. Bowel or bladder control
may be lost at the end of this phase
Clonic phase (1-2 min)

tremor gives way to violent generalized
shaking. Eyes roll backwards and forwards.
Tongue may be bitten, tachycardia develops.
Breathing commences at the end of phase.

• Partial Seizures
Simple partial: with motor and sensory symptoms

Complex partial/psychomotor: simple partial
developing into a complex seizure, consciousness
impaired at onset
Partial seizure with secondary generalization
discharges spread from their point of origin and
excite other structures

Mx: Acute Attack
• Provide O2
• Position properly
• Turn head to side
• Promote safety
• Do not restrain

Prevention
• Health teaching
• Supervise activities
• Antiepileptics
Generalized Tonic-Clonic, Focal – Phenobarbital,
Phenytoin
Absence – Ethosuximide, Valproate

Erb Duchenne’s Paralysis
• Damage on C5-C6 due to birth trauma

• Unilateral
• S/sx: shoulder adducted, internally rotated,
elbow extended, forearm pronated and the
wrist flexed “waiter’s tip”, (-) moro reflex
• Mx: PT, surgery
• Nsg care: advise exercise and frequent follow
up

Cerebral Palsy
• Damaged motor function d/t anoxic brain injury
secondary to infection, perinatal asphyxia,
metabolic disorder
• Nonprogressive
• TYPES:
Spastic Dysphagia – most common; hypertonicity
Athetoid/dyskinetic – worm-like
Ataxic – wide based gait w/ repetitive mvmt
Mixed

• S/sx: spasticity/rigidity, difficulty feeding, delayed
speech and motor devt, mood swings, impulsive,
short attention span, irritable
• Dx: Clinical
• Mx: antispastics, antibiotics, surgery, nutrition,

prevention of injury, PT
NDx: Risk for injury r/t neuromuscular impairment

Self care deficit r/t neuromuscular impairment
- ensure safety, assist in ADL, ensure
adequate nutrition, assist children achieve
maximum potential
Hydrocephalus
• Impaired circulation and absorption of CSF
2 TYPES:
3. Obstructive/Noncommunicating – w/n
ventricular system
4. Nonobstructive/Communicating – obliteration of
SA cisterns or malfunction of arachnoid villi
S/sx: head enlargement, ant fontanel wide and

bulging, scalp veins dilated, broad forehead,
sclera shows above iris, brisk tendon reflexes,
spasticity, irritability, lethargy, poor appetite,
cracked pot sound on percussion
Ndx:
Risk for ineffective cerebral tissue perfusion related

to increased intracranial pressure
- monitor vs, head circumference, I and O
- O2
- position flat or head 30 deg
- do not lie on operative site

Risk for imbalanced nutrition, less than body
requirements, related to increased intracranial
pressure
- NPO until bowel sounds return
- position head w/o flexion
- observe for constipation
- note how child sucks
- IV fluids
- obtain daily weight

Spina Bifida
• Collective term for all SC disorders
Spina Bifida Occulta – posterior laminae fail to fuse

- dimpling, abnormal tufts of hair
Meningocoele - meninges herniate through

unformed vertebrae; protrusion covered by a
layer of skin
- usually occurs in the lumbar region
- protrusion is covered by a skin layer or only the
clear dura mater
Myelomeningocoele – SC and meninges protrude
through the vertebrae defect
- absent motor and sensory function
- flaccidity, lack of sensation in LE
- loss of bowel and bladder control
- may be accompanied by hydrocephalus
Dx: sonography

• Risk for infection r/t rupture or bacterial invasion
of the neural tube sac
- position side lying or prone
- keep sac moist
- place under radiant warmer
- post op – prone until site is healed
• Risk for ineffective cerebral tissue perfusion r/t
increased intracranial pressure
- measure head circumference
- assess for s/sx of inc ICP

• Risk for impaired skin integrity r/t required prone
positioning
- reposition head every 2 hrs if w/ hydrocephalus
- change diapers frequently
• Impaired physical mobility r/t neural tube d/o
- passive exercises
- may use leg braces, crutches
- inspect lower extremities and buttocks for
irritation or possible infection
• Risk for impaired elimination r/t neural tube d/o
- intermittent catheterization
- surgery

Meningitis
• Inflammation of meninges
• Bacterial, Tuberculous, viral
S/sx: opisthotonus, neck rigidity, irritability, high
pitched cry
Dx: Lumbar puncture, Bld C/S, Ct scan, MRI
NDx: Risk for infection r/t presence of infective
organism
Tx: Abx

Hematologic Disorders

Iron Deficiency Anemia
Infant’s iron supply 4-6 mos

Anemia – 9-24 mos
S/sx: pallor, tachycardia, irritability, Hg < 9

g/dl, susceptible to infection
Mgmt: iron fortified formula, iron rich diet

and vitamins
Nsg care: give iron w/ vit c, use w/ dropper

at the back of the mouth, expect black
stools, provide iron rich food
Hemophilia A
• Inherited interference w/ blood coagulation
• Factor VIII
• Sex linked recessive
• S/sx: excessive bleeding

NB – apparent
Pre-school – accidents/falls
School age – bleeding between joints
Adolescent – ulcers, hematuria
» Mx:factor 8
NDx: Acute pain r/t bleeding into joints
Nursing Care
• Promote safety
• Watch out for bleeding – rest area, ice
compress, elevate body part
• Monitor transfusion reaction
• Passive ROM
• Assist in gaining control of situation

Acute Lymphocytic Leukemia
• Uncontrolled proliferation of WBC
• Lymphoblast
• Most frequent CA in children
• 2-16 yo
• Males

S/sx: pallor, low grade fever, lethargy, petechiae,
bleeding, vomiting, anorexia, bone pain, painless
lymphadenopathy
Dx:WBC variable w/ blasts, low platelet and

hematocrit, anemia
BMA > 25% blast cells

Mx: chemotherapy
Cx: CNS s/sx, renal failure
NDx: Risk for infection r/t decreased immune

function
Activity intolerance r/t reduced oxygen carrying
capacity of blood

Nursing Care
• Prevent infection
• monitor bleeding and transfusion reactions
• Provide comfort and pain alleviation
• Health teaching
• Emotional and psychological support

Beta Thalassemia
• B chain defect
• Heterozygous – Thalassemia minor
• Homozygous – Thalassemia major
• 4-6 mos old
S/sx: anemia
Dx: peripheral blood smear
Tx: blood transfusion - pRBC

Genitourinary Disorders

Urinary Tract Infection
• Females
• E coli
• Ascending infection
• S/Sx:infants – mimic GI d/o; dysuria, frequency,
hematuria, low grade fever, abdominal pain and
bedwetting
• Dx: urine culture
suprapubic any amount
clean catch > 100,000/ml
• Mx: antibiotic
hydration
Acute Glomerulonephritis
• Inflammation of glomeruli or kidney

• Follows infection with strep10-14 days
• 5-10 yo
• Males

S/sx:sudden onset of edema and hematuria,
proteinuria, hypertension
Dx: urinalysis and 24 hour urine

hypoalbuminemia
inc ESR, BUN, Crea, antistreptolysin O

Mx: semi fowlers
diuretics, antibiotics
O2
antihypertensives
Nsg Care:
quiet play activities
diet – normal CHON, mod salt restriction, fluid
restriction
daily weight and output

Nephrotic Syndrome
• Altered glomerular
permeability(autoimmune);
inc permeability to albumin
• 3 yo
• Males
• Minimal change syndrome
S/sx: proteinuria, edema-

periorbital area,
hypoalbuminemia,
hyperlipidemia
Dx:urinalysis and
24 hr CHON, inc ESR
Mx:steroids, immunosupressant
NDx: Risk for decreased fluid volume r/t CHON and

fluid loss
Imbalanced nutrition: less than BR r/t CHON
and fluid loss
Nsg care:
Adequate nutrition, proper diet – dec salt
Weigh daily, monitor I and O
Protect edematous areas
Administer prescribed drugs
Health teaching

Wilm’s Tumor
• Malignant tumor of the kidney

• Associated with other anomalies
• 6 mos-5 yo, peaks 3-4 yo
• Good prognosis
• S/sx:abdominal mass, hematuria, low grade fever,
anemia, wt loss
• Dx: CT scan
• Mx: Nephrectomy, radiotherapy
avoid abdominal palpation

Hypospadia/Epispadia
A. Hypospadia B. Epispadia
C. Hypospadia w/ chordee

CONGENITAL MALFORMATIONS OF THE
URINARY TRACT
• Epispadias
-Urethral opening on
the dorsal surface of
the penis
• Surgical correction

• Hypospadias
-Male urethral
opening on the
ventral surface of
penis, or female
urethral opening in
vagina
• Surgical
reconstruction

Hypospadia - common
- chordee - fibrous band
Mx: surgery
Nsg care:
Post op – pain relief
assist parents in coping

Cryptorchidism
• Failure of one or both

testes to descend
• Descend up to 6 weeks
at birth
• May be d/t dec
testosterone
• S/sx:right testis more
common
• Mx:chorionic
gonadotrophin hormone
Orchiopexy 1 yo

Other Diseases

Atopic Dermatitis
• 2 mos-3 yo
• R/t food allergy
S/sx: papular and vesicular
skin eruptions w/ erythema,
pruritus, dry,flaky scales
upon healing
Mx: reduce allergen, topical
steroids
NDx: Impaired skin integrity r/t
eczematous lesion
Nsg care: Reduce allergen
Prevent skin dryness and
pruritus

Otitis Media
• Inflammation of the middle ear

• 6-36 mos, 4-6 yo
• S. Pneumoniae, H. Influenzae, M. Catarrhalis
• Follows URTI
S/sx:pain in affected ear, fever
Cx:hearing impairment
Mx: antibiotics, analgesics, antipyretics
NDx: Acute pain r/t inflammatory process
- provide comfort, reinforce completion of
antibiotic, offer liquids and finger food (prevent
pain when chewing)
Inguinal Hernia
• Protrusion of a bowel
through the inguinal ring
• males
• S/sx:painless lump in the
groin
• Cx:bowel strangulation
• Mx:surgery <1 yo
• Post op Nursing care:
wound care
assess circulation in
the leg

diarrhea
• Viral – Rotavirus, Adenovirus
• Bacterial – Shigella, Salmonella, Cholera
• Protozoan – Amoeba
• TYPES:
• Mild: fever, irritable, 2-10 episodes/day, dry
mucous membranes, tachycardia
• - 2.5-5% wt loss
• Mx: oral rehydration

Severe: fever, tachycardia, tachypnea, pale and cool skin,
apprehensive/lethargic, obvious s/sx of dehydration, UO
scanty, several episodes of loose stools
-5-15% wt loss
• Cx:dehydration
• Mx:fluid and electrolyte replacement
• Dx:Stool exam and culture
Electrolyte determination
NDx: deficient fluid volume r/t fluid losses in stools

- promote hydration and comfort, Record I and O

Protein Energy Malnutrition
Marasmus
• Low calorie, low
CHON
• 0-2 yo
• (-) edema
• “all skin and bone”
• (+) growth
retardation
• Apathetic, quiet
• Good appetite
• Infrequent skin/hair
changes
• Anemia uncommon
Kwashiorkor
Low CHON
1-3 yo
(+) edema
Wasting variable
Growth retardation variable
Irritable, moaning
Poor appetite
(+) skin and hair changes
(+) anemia

Poisoning
Usually 2-3 yo
Soap, cosmetics, detergents, drugs
Males>females – children
Females>males – adolescent
Mx:
7. Determine age & wt, type of poison swallowed,
time of ingestion, route of poisoning, amt
ingested, present condition of child

2.Use syrup of ipecac to induce vomiting except:
caustic, corrosive, hydrocarbon, px is comatose
3. Activated charcoal then syrup of ipecac
4. Monitor VS
5.refer to hospital/poison control center

POISONING
Acetylsalicilic acid (Aspirin)

S/sx:nausea, vomiting, fever, profuse sweating,
flushing, hyperthermia, hyperventilation,
convulsions, coma
Mx:stabilize airway and breathing

Fluid and electrolyte replacement
Activated charcoal
Alkalinization of urine
hemodialysis

Burns
Assessment
A airway - check nose, face and neck (priority)
singed and sooty hair of the nose, give high flow
02
B breathing
C circulation - if there is no breathing and
circulation start CPR
D check for disability and manage accordingly
E expose or determine extent of injury

Kinds of Burn:
Flame – gasoline, kerosene, petroleum
Chemical – acid or alkali
Electrical – most fatal
Radiation – sunlight
< 1 yo – scalding
Pre school – reaches up a stove, spills coffee
Older children – flame burns

TBSA
Parkland Formula (4ml x TBSA x BWkg) 1st
8H give ½, 2nd 8H give ¼ and for the 3rd 8H
give the last part)

0-1 yo 1-4 yo 5-9 yo 10-14 15 yo
yo
Head 19 17 13 11 9
Neck 2 2 2 2 2
Ant trunk 13 13 13 13 13
Post trunk 13 13 13 13 13
r. Buttock 2.5 2.5 2.5 2.5 2.5
L buttock 2.5 2.5 2.5 2.5 2.5
Genitalia 1 1 1 1 1
r. Upper 4 4 4 4 4
arm
l. Upper 4 4 4 4 4
arm MLNG CELESTE,RN, MD 289
0-1 yo 1-4 yo 5-9 yo 10-14 yo 15 yo
r. Lower arm 3 3 3 3 3
l. Lower arm 3 3 3 3 3
r. Hand 2.5 2.5 2.5 2.5 2.5
l. Hand 2.5 2.5 2.5 2.5 2.5
r. Thigh 5.5 6.5 8 8.5 9
l. thigh 5.5 6.5 8 8.5 9
r. Leg 5 5 5.5 6 6.5
l. leg 5 5 5.5 6 6.5
r. Foot 3.5 3.5 3.5 3.5 3.5
l. foot 3.5 3.5 3.5
MLNG CELESTE,RN, MD
3.5 3.5
290
Classification
1st degree – partial thickness (painful,
no blisters, erythematous); epidermis
2nd degree – deep partial thickness
(painless, with blister, blanch); epidermis and
dermis
3rd degree – full thickness (painless,
leathery, whitish/charred)
4th degree – bones and visceral organs
are affected

Hospitalization recommended
- Total burns > 10% of BSA or > 2% FTB
*halved if < 2 yrs old
- Hands, feet, face or genitalia involved
- Inhalation injury
- Associated injuries present
- Burn is inflicted
- Infected burn
- Prior medical illness
- comatose

Management:
- 1st 24 hrs - D5LR
- 8-24 hrs post burn - colloid
- Give TIG or TAT and TT
- Prophylactic antibiotic
- Sterile dressing for wound
Small minor burns – dressings, soap and water

More extensive burns – antibacterial
cream/ointment, thick/thin dressings and
cleansing bath

Down’s Syndrome
Trisomy 21
Maternal age >35 yo, paternal age >55
Features:nose is broad and flat, eyelids have an
extra fold of tissue at the inner canthus, palpebral
fissure slants upwards, white specks in iris,
tongue protrudes, back of the head is flat, neck is
short, extra fat pad, low set ears, poor muscle
tone, short thick fingers, simian crease,
cognitively challenged

Poor immune function
Congenital heart diseases
Cataract
ALL occurs 20x more
Mx: early education and play opportunities

prevention of infection
counseling and support

Child Abuse
• Non accidental injury
inflicted by an adult
• Physical, emotional,
sexual
• Children grow up to
be abusers
themselves and are
violent
• Nsg Resp: treat
injury, report to
DSWD, NGO, Bantay
Bata

Substance Abuse
• Use of chemicals
• Improve mental state
• Induce euphoria
• Peer pressure
• Feel more confident
• Adolescent rebellion

TYPES OF ABUSED SUBSTANCES
Tobacco - sign of maturity
Alcohol - most frequent

- no stigma
Amphetamines – sense of well being, alertness,

self esteem and wt loss

Anabolic steroids – improves athletic ability
Marijuana – stress reliever bec gives a sense of

well being, altered sensory perception

Hallucinogens – distortions in vision, smell or

hearing
Opiates – physiologic craving
Cocaine – inc VS, dec appetite,

cardiovascular arrest, euphoria,
excitement, hallucinations

ASSESSMENT OF SUBSTANCE ABUSE
• Failure to complete homework

• Poor reasoning ability
• Decreased school attendance
• Frequent mood swings
• Deteriorating physical appearance
• Recent change in peer group
• Negative perception of parents

Nursing Intervention
• Caution against drug abuse

• Provide counseling
• refer to rehab facilities

Thank you!

Pediatric Disorders

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Pediatric Disorders

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Childhood Disorders

• Origin of respiratory system:

2. lower respiratory tract

paroxysmal cough- refers to series of

C. Retraction> inward drawing of the chest

E. Cyanosis – blue tinge to the skin

if venous blood : only reflects oxygenation of

SITES commonly used for ABG:

Disadvantages: 1. sensor is small ( needs

PCO2- 35-45 mmHg

how to know if metabolic or respiratory?

D. Respiratory syncytial virus nasal washing

• O2 administration: via hood, nasal cannula,

• Incentive spirometry - device that encourages

Dx. Can be assessed by holding the newborn’s

• Most frequent infectious disease in children

> it is an inflammation of mucous

signs and symptoms:

Signs and symptoms:

- Dx: throat swab and culture

> limited to young infants

Signs and symptoms:

palatine tonsils- located on both sides of

Adenitis- refers to infection and inflammation of

Adenoids- located in the nasopharynx

Indication for tonsillectomy:

Nursing diagnosis: pain related to surgical

> extremely common in children and usually

> rare in children younger than 6 years of

Complication if untreated: otitis media and

>means laryngeal structure is weaker than

> inflammation of the larynx, trachea, and

Nursing dx.: Ineffective airway clearance related

> inflammation of the epiglottis( flap of

Signs and symptoms:

> inhalation of foreign objects into the airway

Management: Heimlich subdiaphragmatic

* for infant, use back thrust to dislodge

> obstruction on the bronchus (commonly on

Sign and symptoms:

1. bronchoscopy –removal of foreign body

Sign and symptoms:

> inflammation of major bronchi and

Sign and symptoms:

S/sx Rhinitis, cough, higher fever and a more

> inflammation of the fine bronchioles and

> an immediate hypersensitivity ( type 1)

MILD MOD SEVERE

PEFR 80% </= 80% 60-79% <60%

PEFR var < 20% 20-30% 30% >30%

• Progression of attack unresponsive to therapy

Mx: cont B2 agonist and IV steroid, O2, coughing,

MLNG CELESTE,RN, MD 100

Bacterial and atypical pathogens:

Viral Pneumonia - RSV, Parainfluenza,

MLNG CELESTE,RN, MD 102

S/sx: fever, chills, cough, irritability, poor

Dx: cxr, blood and sputum c/s

MLNG CELESTE,RN, MD 103

Onset Abrupt Variable Insidious

Fever High Variable Low-grade

Toxicity Toxic Variable Non-toxic

Inc RR Common Common Uncommon