Transcript Childhood communicable Diseases Alteration in Cellular Growth

CHILDHOOD COMMUNICABLE DISEASES
ALTERATION IN CELLULAR GROWTH
ENDOCRINE SYSTEM
2013
Objectives
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Summarize information on immunizations and
communicable diseases
Describe incidence, etiologies, and manifestations of
pediatric cancers
Recognize Wilms’ Tumor in children, the treatment, and
required nursing care
Develop a plan of care for a child or adolescent with
Leukemia
Recognize endocrine disorders in children
Compose a plan of care for a child with diabetes
Childhood Communicable Diseases
Selected Disorders
Immunizations
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Antigen
 Foreign
substance
 Natural immunity
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Antibodies
 Passive
immunity
Infant Vulnerability to Infection
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Immune system not fully developed
 Prenatal,
perinatal, postnatal exposures to infection
from medical procedures or complications
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Maternal Antibodies Offer Limited Protection
 Diminishes
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with time
Immunization Protection Incomplete
Children’s Vulnerability to Infection
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Developing Immune System
Exposure to Infections from Other
 Close
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contact with adults & other children
Poor Hygiene Habits
 Encourage
handwashing
 Use disposable tissues
 Educate adult caregivers.
Disease Transmission
Infectious
Agent
Mode of
Transmission
Susceptible
Host
Disease Transmission
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Infectious Agents
 Bacterial,
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Mode of Transmission
 Vector:
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viral, fungal, protozoan
animal, human, object
Portal of Entry
 Membranes:
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eyes, nose, skin, blood
Portal of Exit
 Excretions,
secretions
Infectious Process
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Organisms in Body
 Multiply
within body
 Bacteria,
fungus, protozoa
 Production of toxin
 Infect
cells
 Virus
forces cells to replicate virus
Body’s Response to Infection
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Neutrophils, Complement System Proteins,
Macrophages to Invaders
Fever
 Macrophages
release endogenous pyrogens
 Hypothalamus releases prostaglandins
 Body temperature rises
 Heat speeds immune response
Immunizations/Vaccines
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Introduce Antigen
 Trigger
antibody formation
 Generate active immunity
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Introduce Antibodies
 Produce
passive immunity
Immunizations
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Types of immunizations
 Killed
virus
 Toxiod
 Live attenuated
 Recombinant
 Conjugated
Immunizations
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Facts & Figures
 Developed
late 1800
 Successful public health
 Save thousands from death and injury
 Does not harm Immune System
 No
links to autism, inflammatory bowel disease, multiple
sclerosis, asthma, or diabetes
 Reduce
 Does
risk of infection
not eliminate risk
Schedule
Immunizations
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Nursing Care
 Assess
immunization record, current health
 Mild
illness (fever not contraindicated)
 Past reactions
 Interventions
 Advocate
 Information:
benefits, risks, side effects
 Consent
 Longer
needles
 Don’t delay
Immunization Documentation
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Date of Immunization
Vaccine Given
Manufacturer
Lot number
 Expiration date
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Site and Route of administration
Information provided to parents
Immunization record, instructions for home
 Adverse effects
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Type
 response
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Infectious/Communicable Diseases
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Pathophysiology
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Symptoms
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Cultures
Treatment
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Fever
Diagnosis
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Dependent on illness
Supportive
Nursing Interventions
Assess hydration
 Look for signs of infection
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Communicable Diseases
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Vaccines Reduces Incidence
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Initial Symptoms
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Fatigue, weakness, rash, fever, irritability, tachycardia,
vomiting, diarrhea, respiratory difficulties
Routes
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Many diseases no vaccine available
Human, animal, polluted water
Acquired
Contaminated equipment
 Nonsterile technique
 Contact with other children in clinical setting
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Infection
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Management
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Diagnostic tests
Culture and sensitivity
 Radiographs
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Treatment
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Drugs: antibiotics, antifungals, antivirals
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Antibiotic overuse encourages resistant strains
Fever management
 Isolation precautions
 Hydration
 Skin/oral
 Family support
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Lice
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Pathophysiology
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Symptoms
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Itching
Diagnosis
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Transmitted by direct contact
Visual assessment
Treatment
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Pediculicide Shampoo
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Pyrethrum
1%Permethrin
Nursing Interventions
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Education
Treatment
Scabies
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Pathophysiology
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Symptom
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examination
Treatment
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Pruritus
Diagnosis
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Skin to skin contact
5% Permethrin
Nursing Interventions
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Education
Impetigo
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Pathophysiology
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Symptoms
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Gram stain
Bacterial culture
Treatment
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pustules
Diagnosis
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Streptococcus
Staph aureus
Amoxicillin
Erythromycin
Nursing Interventions
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Education
Varicella
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Pathophysiology
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Symptoms
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Exam
Treatment
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Lesions
Fever
Diagnosis
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Viral – direct contact
Supportive
Acyclovir
Nursing Interventions
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Non-aspirin
Airborne/Contact precautions
Measles
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Pathophysiology
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Viral
Symptoms
Fever
 Rash
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Diagnosis
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Treatment
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Serology for Ig measles
Supportive
Nursing Interventions
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Fluids and soft foods
Mumps
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Pathophysiology
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Symptoms
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Throat swab
Treatment
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Parotid swelling
Diagnosis
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Rubula virus
Supportive
Nursing Interventions
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Standard & Droplet precautions
Rubella
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Pathophysiology
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RNA virus
Symptoms
Rash
 Fever
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Diagnosis
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Treatment
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Nasal swab
Support
Nursing Interventions
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Isolation precautions
Fungal infection (candidiasis)
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Pathophysiology
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Symptoms
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White patches on tongue
Diagnosis
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Direct contact
exam
Treatment
Nystatin
 Amphotericin B
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Nursing Interventions
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Education
Fungal Infection (Ringworm)
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Pathophysiology
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Symptoms
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Rash, itchy
Diagnosis
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Fungal infection on skin surface
Exam, skin scrapings
Treatment
Griseofulvin
 Terbinafine
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Nursing Interventions
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Education
Alterations in Cellular Growth
Selected Disorders
Alterations in Cellular Growth
Pediatric Cancers
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Neoplasm
 New
Growth
 Benign
 Malignant

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Metastasis
Approximately 9,500 new cases
 Approximately
1,500 deaths per year
 Overall survival rate is greater than 80%
Cancer Causes
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External stimuli
 Chemical,
radiation
 Causes of more adult cancers
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Immune or Gene Abnormalities
 Congenital
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or triggered by virus
Chromosomal Abnormalities
 Congenital
 Leukemia
risk for specific cancers
and Down syndrome link
Pediatric versus Adult
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Pediatric Cancers
 Rarer
 Faster
growing
 Nonepithelial cell origin
Pediatric Cancer Signs
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Pain
Cachexia
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Anemia
Infections
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Bacterial, Viral, Fungal
Bruising
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Fatigue, weakness , loss of appetite
Without consistent injury
Neurologic changes
Palpable Mass
Cancer Diagnostic Tests
Cell Visualization
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Direct biopsy
CBC
Bone marrow
aspiration
Lumbar puncture
Internal Imaging
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Radiograph
Ultrasound
MRI
CT
Treatment Goal
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Remove the Cancer
 Surgery
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Inhibit Growth
 Chemotherapy
 Radiation
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Assist Immune system
 Biotherapy
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Replace Cancerous Bone Marrow
 Hematopoietic
stem cell transplant
Oncologic Emergencies
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Metabolic
 Electrolyte
imbalances from tumor lysis
 Septic shock due to infections toxins
 Hypercalcemia from bone breakdown
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Space occupying Lesions
 Pressure
 Spinal
on
cord
 Circulation
 Nerves
 organs
Retinoblastoma
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Pathophysiology
 Genetic
 Embryonic
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retinal cells
Symptoms
 Leukokoria
(white pupil)
 Different color
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Diagnosis
 Full
ocular exam
 CT/MRI
Retinoblastoma
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Treatment
 Surgery
 Radiation
 Laser
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Therapy
Nursing Interventions
 Family
history
 Assess color and position of eye
 Post surgical care
Wilms’ Tumor
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Pathophysiology
 Intra-renal
tumor
 ? Genetic link
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Symptoms
 Asymptomatic
 Firm

lobulated mass
Diagnosis
 Parent
 Ultrasound
 Labs
Wilms’ Tumor
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Treatment
 Surgery
 Chemotherapy
 Radiation
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Nursing Interventions
 Monitor
B/P
 DO NOT PALPATE
Leukemia
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Pathophysiology
 Most
frequent type of cancer
 Peak onset 2-4 years
 Boys > girls
 Affects bone marrow
 Anemia
 Neutropenia
 Decreased platelet production
Symptoms
Fever
 Fatigue
 Anorexia
 Petechiae
 Bone/joint pain
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Common symptoms of Leukemia
Diagnosis
WBC – up/down
 H/H - drop
 Leukemic blast Phase cells
 Bun Creatine
 CXR
 Platelet count - drop
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Leukemia
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Treatment
 Radiation
 Chemotherapy
4
stages
Nursing Interventions
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Infection control
Skin
 Respiratory
 IV contamination
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Bleeding control
Platelet transfusion
 Packed RBC’s
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Nutrition
NG
 TPN/IL
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Family support
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Education
Endocrine System
Selected disorders
Endocrine System
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Releases Hormones
 Hormones
affect cellular activity
 Cell response
 Quantity
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+ timing of hormones
Responsible for Fetal Development
Regulates Central Nervous system
Responsible for Maturation of Reproductive Organs
Maintain Homeostasis
Childhood Hormone importance
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Growth & Maturation
 Growth
(metabolic)
 Thyroid
 Growth
& Development
 Metabolizing nutrients and energy
 Adrenal
 Glucocorticoids
 Androgens
 Gonadal
 Androgens
males
 Progesterone females
Childhood Hormone importance
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Metabolic Function
 Antidiuretic
 Parathyroid
 Insulin
Hormone (ADH)
Endocrine Disorder Signs
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Changes in
 Growth
rate
 Cognitive Development
 Sexual Development
 Metabolic Regulation
 Fluids
 Electrolytes
 glucose
Growth Disorders
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Causes of Short Stature
Growth Hormone Deficiency
 Hypopituitarism
 Hypothalamus

GH – growth, bone density, glucose uptake
 Infarctions
 Tumors
 Trauma
 Genetic
 Growth
disorders
hormone replacement (SQ Qd)
 Focus on appropriate developmental age
Hypothyroid
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Pathophysiology
 Congenital
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Symptoms
 Decreased
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appetite, hair loss, sensitivity to cold
Diagnosis
 Newborn
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or acquired
screening T4 with increase TSH
Treatment
 Levothyroxine
 Synthyroid
Nursing Interventions
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Routine neonatal screening
Nutritional balance
Education
 Sleep
disturbances related to therapy
 Medication administration
 Signs and symptoms of to much medication
Diabetes
Type 1


Insulin insufficiency
Requires insulin
replacement
Type 2
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Insulin resistance
May have low
average or high insulin
levels
Nursing Interventions

Type 1
 Teaching
 Pathophysiology
of insulin insufficiency
 Glucose monitoring
 Insulin injection
 Diet modification
 Complication prevention and response
 Support
Nursing Intervention

Type 2
 Teaching
 Weight
reduction
 Diet changes
 Exercise
 Medications

Glycemic control
 Support
MNEMONIC
HOT & DRY = SUGAR HIGH
COLD & CLAMMY = NEED SOME CANDY