by: Ma. Fe V.

Juen BSN, RN, MN

Colic
Clinical Manifestations: a. loud increase crying b. Red and flushed face c. Clenched fist d. Sucks vigorously e. abdomen becomes tensed f. Pulls legs against abdomen

Colic
Causes of Colic: Assessment: a. Thorough history b. Duration and its frequency c. Ask what happens before the attack d. Description and associated symptoms e. Number and type of bowel movements f. Family and medical history g. Determine babys feeding pattern.

Colic
Nursing Management: a. Hold the baby upright and allow to burp after feedingb. Change maternal diet for breastfeed babyc. Frequent small feedingsd. Use of pacifiere. use of formula bottles with disposable bags that collapse as the baby sucksf. Taking for a car ridesg. Music boxesh. Anti- flatulent agent-

Otitis Media
Data base: Most prevalent disease of chidhood Most often in children 6 to 36 months old and again at 4 to 6 years old Mostly in males and children with cleft palateHigher incidence in formula fed babiesAssociated with constant pacifier use Highest in winter and spring-

Otitis Media
Assessment: Causative Agent:

Therapeutic Management: a. Analgesics/ Antipyreticb. Decongestant c. Cephalosporin

Meningitis
An inflammation of the meninges that develops as a result of infection from either bacterial or viral agents. Causes of Bacterial Meningitis:
Secondary Response to a Primary Infection: Pathophysiology:

Meningitis
Clinical Manifestations: Depends on age and pathogens Infants Less than 3 Months:

Age Over 2 years:

Meningitis ( Bacterial )
Diagnostic Examination: a. Microscopic exam and culture of blood, csf and urine b. Serum electrolyte and Osmolarityc. Clotting studiesd. Lumbar puncturenormal opening pressure for infant- 50 mm of H2O. normal opening pressure for a child- 85 mm of H2O CSF Analysis Results if with Meningitis:

Meningitis
Therapeutic management: a. Cardiopulmonary monitor until stable b. Supplemental O2 c. Management if there is a sign of DIC d. Benzodiazepinee. Phenytoinf. Antibioticsg. Dexamethasoneh. Multidesciplinary approach-

Meningitis
Nursing management: a. Appropriate protective attire- j. Comfort measures b. Vital signsk. Observe signs of c. Inspect skin frequentlycomplications d. Monitor the LOCI. Health instructions e. Palpate the fontanelleto family of ffg: f. Measure head circumference m.multidesciplanary g. Monitor signs of seizureapproach. h. Maintain normothemiai. Medications as presribed-

Meningitis ( Viral)
An inflammatory response of leptomeninges Adolescence are usually more at risk The Viruses Includes; Herpes, Adenovirus and Arbovirus Others; Clinical manifestations: Irritable and Lethargic General malaise Upper resp symptoms Signs of meningeal irritation Fever an seizure

Meningitis ( Viral )
Diagnostic Exam: a. CSF analysis b. WBC count c. Glucose d. Protein Therapeutic Management:

Meningitis ( Viral )
Nursing management: a. Comfort measures b. Analgesics and Antipyretics as prescribed. c. Increase fluids both IV and oral d. Health instructions to family on the following;

Burns
-Are injuries to body tissue caused by excssive excessive heat Commonly occur in children 1-4 years of age and the 3rd greatest cause in children age 5- 14 years.

Assessment: The first question to be asked;-

Burns
Classification According to Criteria of American Burn Association: a. Minor- 1st degree lesser than 10% of body surface. Or 3rd degree less than 2% of body surface No area of the face, feet, hands, or genitalia burned.

Burns
b. Moderate-2nd degree between 10% to 20% on the face, hands, feet or genitalia 3rd degree less than 10% of body surface or smoke inhalation has occurred. c. Severe- 2nd degree greater than 20% of body surface 3rd degree greater than 10% of body surface.

Burns Characteristics:
1st degree- Epidermis, erythematous, dry and painful, Ex. Sunburn 2nd degree - Epidermis and portion of dermis, blistered, erythematous to white Ex. Scalds 3rd degree- Entire skin, nerves and blood vessels in skin. Leathery, black / white, not sensitive to pain- Ex. Flame

Nursing Diagnosis: a. Pain R/T trauma to body cells b. Deficient fluid volume R/T to fluid shifts c. Risk for ineffective breathing patterns R/T respiratory edema from burn injury d. Risk for ineffective tissue perfusion R/T cardiovascular adjustments after burn injury. e. Risk for impaired urinary elimination R/T burn injury f. Risk for imbalanced nutrition, less than body req. g. Lowered resistance to infectionh. Social isolation R/T infection control precautions I. Interrupted family processes J. Deficient diversional activity K. Disturbed body image

Burns

 Therapeutic Management: a. Open Method- Exposed to air used for superficial burns or body parts that are prone to infection Advantages: Disadvantages:

Burns

Burns
b. Close Method- burn is covered with non adherent gauze, used for moderate and severe burn Advantages:

Disadvantages:

 c. Topical Therapy; - Silver Sulfadiazine ( Silvadine ) drug of choice - Antiseptic solution ( Povidone Iodine ) - Nitrofurazone ( Furacin ) d. Escharotomye. Debridementf. TENS ( Transcutaneous Electrical Nerve Stimulationg. Grafting ( Homografting/ Allografting- Heterografts ( Xenografts ) - Autografting

Burns

 Bacterial infectious diseases that cause diarrhea and vomiting. 1. Salmonella- most common type of food poisoning Inc. period Period of Com. Mode of Transmission-

6. Poisoning

 Clinical Manifestations: a. Diarrhea, abdominal pain, vomiting, fever, and headache b. Diarrhea may contain blood and mucus

Poisoning

Diagnostic exam:
Therapeutic Management:

 2. Listeriosis Causative Agent: Inc. Period:

Poisoning
Listeria Monocytogenes

Mode of Transmission: Clinical Manifestations: a. Muscle aches, fever, nausea, and diarrhea b. Headache, stiff neck, confusion, loss of balance c. Convulsion-

- Therapeutic Management:

Poisoning
3. Shigellosis ( Dysentery ) Causative Agent- Genus Shegella Inc. period: Period of Communicability: Mode of transmission: Clinical Manifestations: a. Severe vomiting and diarrhea b. Abdominal cramping and excessive salivation c. Nausea within 2 to 6 hours Therapeutic management:

 Classification: a. Physical

7. Child Abuse

b. Psychological or Emotional-

Theories of Child Abuse: a. Special Parents b. Special Child c. Special circumstances-

 Assessment: a. Interview b. Physical exam - Observe the entire body - Plot height and weight - Observe for number of injuries - Higher incidence of hand injury - Burns or scalds, cigarette burns - human bites, head injury or hair pulled off - Broken bones, bruises - Deliberate poisoning C. Subjective Symptoms:

Child Abuse

 Nursing Diagnosis: Expected Outcome: Nursing Interventions: a. Prevent further abuse b. Provide consistent care and support c. Evaluate and promote family health Outcome Evaluation:

Child Abuse

A distorted and uncontrolled proliferation of WBCs ( Leukocytes ) a. Acute Lymphocytic Leukemia ( Lymphoblastic )

8. Leukemia

Involves Lymphoblasts or immature Lymphocytes--- platelets falls and invasion of increasing WBC elements begins with continuous proliferation of immature cells and identify as blast cell or stem cell.

Leukemia
Predisposing Factors: Highest incidence in children 2 and 6 years Slightly higher in boys than in girls Radiation and chemical exposure Genetic-

Leukemia
Clinical ManifestationS: - Pallor, low grade fever, and lethargy - Symptoms of Anemia, petechiae & bleeding - Spleen and liver are enlarged - Abdominal pain, vomiting and anorexia - Bone and joint pain - Headache and unsteady gait - Painless, generalized swelling of lymph nodes - Elevated leukocyte count - hematocrit and platelet count are low - RBCs are normocytic and normochromic

 Diagnostic Exam: a. Bone marrow aspiration b. Radiographs of the long bones

Leukemia

c. Lumbar puncture

 An immediate hypersensitivity (type 1) response, with an excessive antigen-antibody Response when the invading organism is an allergen. Pathophysiology: Mast cells are specialized cells found on the lining of blood vessels, and in connective tissue, mucous membrane and skin.

9. Asthma

 -Affects small airways and involves three processess: 1. Bronchospasm 2. Inflammation of bronchial mucosa 3. Increased bronchial secretions-

Asthma

 Assessment: a. After exposure to allergen or trigger an episode begins with; 1. Dry cough 2. Dyspnea and wheezing-

Asthma

 b. History- Thorough history of the development of childs symptoms: What to ask? c. Physical Assessment: 1. Specific symptoms of asthma 2. Auscultation 3. Percussion 4. Chest Retractions

Asthma

Asthma
d. Diagnostic exam: 1. Pulse Oximeter 2. ABG 3. Pulmonary function test 4. Peak Expiratory Flow Rate Monitoring green zone ( 80 to 100% of personal best) yellow zone ( 50 to 80% of personal best) Red zone ( below 50% )

 Goal of Management: 1. Avoidance of allergen by environmental control 2. Skin testing and hyposensitization to identified allergens 3. Relief of symptoms-

Asthma

Asthma

Therapeutic Management: 1. Inhaled Corticosteroid 2. Long acting bronchodilator 3. Short acting beta-2- agonist bronchodilator 4. Mast cell stabilizer-

5. Leukotriene receptor antagonists

Nursing Dianogsis:

Asthma

Complication: Status AsthmaticusAssessment: 1. HR/RR are elevated 2. SAO2 and PO2 is elevated 3. Poor ventilation 4. Pulse Oximeter 5. Culture of sputum

Therapeutic Management:

Rheumatic Fever
Assessment: Signs and Symptoms of R.F. are Devided into; 1. Minor: With history of previous R.F. Prolonged P-R and Q- T interval on the ECG Systolic murmurFever Athralgia Elevated sedimentation rate and Protein & WBC

Rheumatic Fever
2. Major: Carditis Erythema Marginatum Subcutaneous nodules or painless lumps Polyarthritis

Chorea-

Rheumatic Fever
Therapeutic Management: 1. Maintain on bed rest2. Vital signs during the acute case3. Benzathine Pennicillin4. Ibufrofen5. Corticosteroids6. Phenobarbital/ Diazepam7. Digoxin and Diuretics-

Rheumatic Fever
Complication: 1. Permanent valve Dysfunction2. Severe Myocarditis-

Nursing Dx: 1.Risk for non- adherence to drug therapy R/T knowledge deficit about importance of long therapy 2. Situanal low esteem R/T chorea movements

Scabies;
Causative Agent: Acarus ScabieiSymptoms: 1. Black burrow filled with mite feces, 1-2 inches long2. Pruritus or itchiness Therapeutic Management:

Pediculosis/ Pediculosis Capitis

Causativ e Agent: Symptoms: 1. Small, white flecks on hair shaft or pubic hair 2. Itchiness Therapeutic Management:

Impitigo:
Causative Agent: Inc. period: Period of Communicabilty: From outbreak of lesions until lesions are healed Mode of Transmission: Immunity: None Assessment : 1. Single papulovesicular lesions2. Purulent , oozing, & form honey colored crusts3. Swollen lymph nodes Therapeutic Management:

The Family
There are social changes that alters health care priorities for maternal and child health nursing. Ways in which nurses adapts to this changes ; Client Advocacy Through ; knowing the health care services available in the community Establishing relationship with the family Helping them make informed choices about what course of action or service would be best for them

Current Trends in Maternal and Child Care and its Implication for Nurses
1. Families are not as extended and smaller than previously. 2. Single parents have become the most common type of parent most esp. in US 3. Ninety percent of women work outside the home 4. Families are more mobile than previously and there is an increase in the number of women and children 5. Both child and intimate partner abuse is increasing in incidence

Current Trends
6. Families are more health conscious than ever before

7. Health care must respect cost containment

Care of Couples with Problems of Infertility

Infertility- the inability to conceive a child or sustain a pregnancy to birth Subfertility- Couples have potential to conceive but they are just less able to do this without additional help Male Subfertility Factors: 1. Disturbance in spermatogenesis2. Obstruction3. Qualitative and quantitative changes in semensl fluid

Male Subfertility Factors

4. Development of autoimmunity that immobilizes sperm 5. Problems in ejaculation or depositionSpecific Causes : a. Inadequate sperm count Sperm count is the number of sperm in a single ejaculation or in a ml of semen

Inadequate Sperm count

20 million/ ml of semen- minimum sperm count or, 50 million/ ejaculation 50% of sperms should be motile 30% normal in shape and form b. Congenital Anomalies: 1. Cryptorchidism2. Varicocele3. Hypospadias/ Epispadias4. Congenital Stricture of the tube

Specific Causes
c. Obstruction or Impaired Sperm Motilitty 1. Orchitis 2. Epididymitis3. Tubal Infection4. Benign Hypertrophy of the Prostate gland 5. Chang in the composition of semenal fluid 6. Trauma and scarring after surgery 7. Autoimmune response

Specific Causes
d. Ejaculation Problems / ImpotenceCauses: 1. Psychological problems 2. Cerebrovascular problems 3. Medications 4. Premature ejaculations-

Female Subfertility
Factors that Causes Subfertility in Females: 1. Anovulationa. Genetic Abnormalityb. Ovarian Tumorsc. Chronic exposure to radiation and radioactive substances d. General ill health e. Poor nutrition/ weight / exercise f. Stress- Physical/ mentalg. Polycystic ovary syndrome

Female Subfertility Factors

2. Tubal Transport Problemsa. Sapingitis b. PID c. Scarring/ Trauma after surgery 3. Uterine Problems: a. Tumorsf. Post D & C / b. Poor secretion of estrogen/ Progesterone c. Endometriosisd. Cervical Problems e. Infection/ Inflammation

Female Subfertility Factors

4. Vaginal Problems: a. Infection of the vaginab. Sperm- immobilizing or SpermAgglutinating Antibodies in Blood Plasma of some women

Fertility Assessment
Basic Fertility Assessment for a Man: 1. Health History -General health -Nutrition -Radiation -Past and present occupation -Past contraceptive use -Alcohol, drug and tobacco use -Congenital health problems-Illnesses-Sexual practices-

Fertility Assessment
Fertility Assessment for a Woman: Current and past reproductive tract problems Overall Health Abdominal or pelvic operations Past history of childhood cancer Use of douches or intravaginal meds or sprays Exposure to occupational hazards Nutrition Menstrual history History of contraceptives use History of previous pregnancy/abortions

Fertility Assessment
2. Physical Assessment: a. Fertility Testing_ 1. Semen Analysis2.Sperm penetration assay and antisperm-antibody testing3.Ovulation Monitoring4. Ovulation Determination by test strip

Fertility Testing
5. Tubal Patency; An UTZ and X-ray imaging can be used to determine the patency of the F.T. and assess the depth and consistency of the uterine lining. This includes: a. Sonography- designed to inspect the uterus b. Hysterosalpingography- a radiologic exam of the F.T. using a radiopaque medium introduced into F.T.

Fertility Testing
6. Advanced Surgical Procedures: a. Uterine Endometrial Biopsy-A thin probe and biopsy forcep are inserted through the cervix to obtain specimenb. Hysteroscopy- A visual inspection of the uterusc. Laparoscopy- Introduction of a thin, hollow, lighted tube through a small incision in the abdomen just below the umbilicus-

Management of Subfertility
1.Increasing sperm count and motility: a. Changes in lifestyleb. Giving of Corticosteroids to a woman 2. Reducing the presence of infection-

Fertility Management
3. Hormone Therapy: a. Administration 0f GnRH with Clomiphene Citrate ( Clomid, Serophene )b. Administration of human menopausal gonadotropins ( Pergonal )c. FSH and LHd. Bromocriptine ( Parlodel ) e. Low dose Estrogen - Conjugated Estrogen ( Premarin )f. Progesterone vaginal suppositories-

Fertility Management
4. Surgery: a. Correction of obstruction in a mans vas deferens and a womans F.T.. b. Ligation of varecocelec. Myomectomyd. Lyses by Hysteroscopye. Diathermy or Steroid administrationf. Laparoscopy or Laser surgeryg. Canalization of F.T. and Plastic Surgical repair-

Fertility Assessment
5. Assisted Reproductive Techniques: a. Therapeutic Management The instillation of sperm into the female reproductive tract to aid conception. The sperm is instilled into; CervixUterusTherapeutic insemination by husband ( use of husbands sperm ) Therapeutic insemination by donor( donors sperm )

Assisted Reproductive Techniques

Uses of Therapeutic Insemination; 1. If the man has an inadequate sperm count or a woman has a vaginal or cervical factor2. If the man has a known genetic disorder-

Therapeutic Insemination
Cryopreserved ( frozen ) Disadvantage : Sperm tends to have slower motility than unfrozen

Advantage: -Appears to be no increase in the incedence of congenital anomalies conceived by this method

Therapeutic Insemination
b. Invitrofertilization-One or more mature oocytes are removed from a womans ovary by Laparoscopy and fertilized by exposure to sperm under laboratory conditions outside a womans body-40 hours after fertilizationProgesterone and Estrogen-

Therapeutic Insemination
c. Gamete Intrafallopian Transferd. Zygote Intrafallopian Transfer-

e. Surrogate Embryo Transferf. Preimplantation Genetic Diagnosis-