Transcript REIMBURSEMENT ISSUES

Chapter 31
Care of the Child with a
Physical Disorder
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 1
Disorders of Cardiovascular Function
• Congenital Heart Disease

Etiology/Pathophysiology
• Several environmental and genetic risk factors have
been implicated in the incidence of various types of
defects.
• Types of defects




Increased pulmonary blood flow
Decreased pulmonary blood flow
Obstruction to systemic blood flow
Mixed blood flow
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 2
Disorders of Cardiovascular Function
• Congenital Heart Disease (continued)

Clinical Manifestations
• Cyanosis, pallor
• Cardiomegaly, pericardial rubs, murmurs, additional
heart sounds
• Discrepancies between apical and radial pulses
• Tachypnea
• Dyspnea, grunting, crackles, and wheezes
• Digital clubbing
• Hepatomegaly, splenomegaly
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 3
Disorders of Cardiovascular Function
• Defects with Increased Pulmonary Flow



Patent ductus arterioles
Arial septal defect
Ventricular septal defect
• Defects with Decreased Pulmonary Flow

Tetralogy of Fallot
• Mixed Defects

Transposition of the great vessels
• Defects with Obstruction to Systemic Blood Flow

Coarctation of the aorta
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 4
Figure 31-4
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of infants
and children. [7th ed.]. St. Louis: Mosby.)
Patent ductus arteriosus.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 5
Figure 31-5
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Atrial septal defect.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 6
Figure 31-6
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Ventricular septal defect.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 7
Figure 31-7
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Tetralogy of Fallot.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 8
Figure 31-8
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Transposition of the great vessels.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 9
Figure 31-9
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Coarctation of the aorta.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 10
Disorders of Hematologic Function
• Iron Deficiency Anemia

Etiology/Pathophysiology
• A decrease in red blood cell volume, a decrease in
hemoglobin, or both
• Reduces the oxygen-carrying capacity of the blood

Clinical Manifestations
• Hemoglobin below 10 g/dl
• Fatigue, anorexia, skin pallor, pale mucous membranes,
tachycardia, systolic murmurs
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 11
Disorders of Hematologic Function
• Iron Deficiency Anemia (continued)

Medical Management
• Iron replacement therapy
• Nutritional counseling
• Treatment of underlying conditions

Nursing Interventions
• Dietary counseling
• Oral preparations of iron given three times daily
between meals
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 12
Disorders of Hematologic Function
• Sickle Cell Anemia

Etiology/Pathophysiology
• A genetic disorder characterized by an abnormal form
of hemoglobin within the erythrocyte

Clinical Manifestations
• Pallor, irritability, fatigue, and jaundice
• Joints and surrounding tissue can become edematous
and painful.
• Sickle cell crisis
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 13
Disorders of Hematologic Function
• Sickle Cell Anemia (continued)

Medical Management
• Primarily palliative: analgesics, hydration, oxygen,
transfusions

Nursing Interventions
•
•
•
•
Maintain hydration.
Administer analgesics as ordered.
Provide adequate oxygenation.
Promote comfort measures.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 14
Disorders of Hematologic Function
• Aplastic Anemia



It is due to failure of the cell-generating capacity of the
bone marrow.
All formed elements of the blood are defective,
underdeveloped, or absent, resulting in severe
anemia, leukopenia, and thrombocytopenia.
It may be caused by neoplastic disease of the bone
marrow or, more commonly, by destruction of the
bone marrow through exposure to toxic chemicals,
ionizing radiation, or some antibiotics or other
medications.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 15
Disorders of Hematologic Function
• Hemophilia

Etiology/Pathophysiology
• A serious, lifelong bleeding disorder inherited as an Xlinked recessive disorder
• Transmitted by female carriers; affects male offspring in
1 in 10,000 male births

Clinical Manifestations
• Oral bleeding and bruising
• Persistent bleeding from minor lesions
• Hemarthrosis
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 16
Disorders of Hematologic Function
• Hemophilia (continued)

Medical Management
• Minor external bleeding: pressure and cold packs
• Replacement of factor VIII to control more serious
bleeding; nonopioid or opioid analgesics

Nursing Interventions/Patient Teaching
• Parents taught to protect the child without being
overprotective; techniques to control bleeding; signs of
increased intracranial pressure and need for emergency
medical care
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 17
Disorders of Hematologic Function
• Idiopathic Thrombocytopenic Purpura

Etiology/Pathophysiology
• A marked decrease in the amount of circulating
platelets with resultant bleeding beneath the skin

Clinical Manifestations
•
•
•
•
•
Other than bleeding, the child appears well.
Platelet count drops below 20,000.
Ecchymoses and a pinpoint petechial rash
Bleeding gums, lips, and epistaxis
Intracranial hemorrhage, hematuria, melena,
hematemesis, and menorrhagia
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 18
Disorders of Hematologic Function
• Idiopathic Thrombocytopenic Purpura (continued)

Nursing Interventions and Patient Teaching
• Prevent bruising; control bleeding.
• Teach families to protect the child by restricting activity
and avoiding injury.
• Counsel the family to not use salicylate drugs.

Medical Management
• Transfusions of packed RBCs
• IV gamma globulin and anti-D antibody therapy
• Splenectomy
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 19
Disorders of Hematologic Function
• Leukemia

Etiology/Pathophysiology
• Acute lymphoblastic leukemia (ALL): uncontrollable
proliferation of blast cells, which accumulate in the
marrow, causing crowding and depression of other
healthy cells

Clinical Manifestations
•
•
•
•
Pallor and fatigue
Leukopenia with fever and infection
Thrombocytopenia with bleeding and petechiae.
Bone pain, limping, and joint pain with swelling
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 20
Disorders of Hematologic Function
• Leukemia (continued)

Medical Management
• Highly individualized treatment protocols are instituted
by the physician.

Nursing Interventions and Patient Teaching
• Be available for family, especially in the early phases of
diagnosis and treatment.
• Prevent or manage expected side effects.
• Observe for late effects of treatment.
• Help the child live as normal a life as possible.
• Assist to cope with the emotional aspects.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 21
Disorders of Hematologic Function
• Hodgkin’s Disease

This is a malignant lymphoma distinguished by
painless, progressive enlargement of lymphoid tissue.
 It is believed to occur in one specific site with spread
to nearby lymph nodes.
 It is more common in males and is rare in children
under 5 years of age; incidence increases between 15
and 19 years of age.
 Treatment protocols for children follow the same
protocols established for adults.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 22
Disorders of Immune Function
• Human Immunodeficiency Virus (HIV) and Acquired
Immunodeficiency Syndrome (AIDS)

Etiology/Pathophysiology
• AIDS is a chronic and usually fatal disease due to an
acquired dysfunction of the immune system; it is caused
by HIV.
• HIV has been found in blood and in varying amounts in
body fluids: semen, vaginal secretions, breast milk,
tears, saliva, and urine.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 23
Disorders of Immune Function
• HIV and AIDS (continued)

Clinical Manifestations
•
•
•
•

Failure to thrive
Progressive neurologic disease
Frequent viral and bacterial infections
Greatest threat to an HIV-infected infant under 1 year of
age is Pneumocystis jiroveci (formerly carinii).
Medical Management
• Antiretroviral drugs; often used in combinations
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 24
Disorders of Immune Function
• HIV and AIDS (continued)

Nursing Interventions
• Monitor closely for signs of abnormal growth and
development.
• Support family involvement.
• Encourage social services and home health and
nutritional services, such as WIC.

Patient Teaching
• Educate adolescents by counseling on matters such as
avoiding casual sex and using condoms.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 25
Disorders of Immune Function
• Juvenile Rheumatoid Arthritis

Etiology/Pathophysiology
• A chronic inflammatory, autoimmune disease of
connective tissue; erosion, destruction, and fibrosis of
the articular cartilage

Clinical Manifestations
• Daily afternoon temperature spikes; macular rash on
trunk and extremities; joint involvement

Medical Management
• Nonsteroidal antiinflammatory drugs, antirheumatic
drugs, cytotoxic drugs, corticosteroids
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 26
Disorders of Respiratory Function
• Respiratory Distress Syndrome

Etiology/Pathophysiology
• This is caused by a deficiency of surfactant and occurs
almost exclusively in the preterm, low-birth-weight
infant.
• Without surfactant, the infant is unable to keep the
lungs inflated and the alveoli collapse at the end of
expiration, resulting in hypoxia, atelectasis, and
respiratory acidosis.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 27
Disorders of Respiratory Function
• Respiratory Distress Syndrome (continued)

Clinical Manifestations
•
•
•
•
•
•
•
Nasal flaring
Expiratory grunting
Intercostal, subcostal, or substernal retractions
Dusky color
Tachypnea
Low body temperature
May die within hours of the onset of signs and
symptoms
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 28
Disorders of Respiratory Function
• Respiratory Distress Syndrome (continued)

Medical Management
•
•
•
•
•
Maintaining a neutral thermal environment
Adequate oxygenation
Correction of respiratory and metabolic acidosis
Nutritional support by parenteral therapy
Administration of exogenous pulmonary surfactant
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 29
Disorders of Respiratory Function
• Respiratory Distress Syndrome (continued)

Nursing Interventions
•
•
•
•
Observe and assess response to therapy.
Make frequent respiratory assessments.
Suction as needed.
Position the infant on the side with the head supported
in alignment.
• Assess skin frequently and protect from impairment.
• Provide emotional support for parents.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 30
Disorders of Respiratory Function
• Bronchopulmonary Dysplasia

Etiology/Pathophysiology
• A chronic pulmonary disorder that develops in
premature infants.

Clinical Manifestations
• Respiratory distress; upper respiratory infections

Medical Management
• Precautions are taken to prevent RDS and reduce
ventilation and oxygen requirements.
• Nutritional support is provided initially by total parenteral
nutrition.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 31
Disorders of Respiratory Function
• Bronchopulmonary Dysplasia (continued)

Nursing Interventions and Patient Teaching
• Rest periods are planned to decrease respiratory effort
and conserve energy.
• Small, frequent feedings are given to prevent
overdistention of the stomach.
• Support parents and encourage them to participate.
• Parents are also counseled in ways to reduce the risk of
respiratory infections.
• Teach parents CPR and how to manage other
emergencies.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 32
Disorders of Respiratory Function
• Pneumonia

Etiology/Pathophysiology
• An acute inflammation of the pulmonary parenchyma,
small airways, and alveoli
• Bacterial, viral, mycoplasmal, or foreign body aspiration

Clinical Manifestations
• Cough, wheezes, crackles, respiratory distress
• Chest pain, abdominal pain, myalgia, headache
• Anorexia, irritability, malaise, lethargy, nasal discharge
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 33
Disorders of Respiratory Function
• Pneumonia (continued)

Medical Management
• Antibiotics, bronchodilators, and antipyretics
• Oxygen, chest physiotherapy, suctioning
• Fluid administration

Nursing Interventions and Patient Teaching
• Observation of respiratory and cardiovascular status;
infection control measures
• Provide for adequate rest periods; maintain hydration
by monitoring prescribed IV fluids
• Gentle suctioning with a bulb syringe
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 34
Disorders of Respiratory Function
• Sudden Infant Death Syndrome

Etiology/Pathophysiology
• The sudden, unexpected death of a healthy, normal
infant under 1 year of age in whom a postmortem
examination fails to establish a cause of death

Clinical Manifestations
• Death occurs during sleep, and there is no audible
outcry or sign of distress.

Medical Management
• Directed toward assisting the family
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 35
Disorders of Respiratory Function
• Sudden Infant Death Syndrome (continued)

Nursing Interventions
• Medical personnel should be nonjudgmental, ask few
questions, and provide the family support.
• The nurse should stay with the parent, listening to and
supporting the family.

Prevention
• American Academy of Pediatrics recommend that
infants be placed supine or on the side (nonprone) for
sleeping.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 36
Disorders of Respiratory Function
• Acute Pharyngitis (Sore Throat)

Etiology/Pathophysiology
• An inflammation of the pharynx

Clinical Manifestations
• Low-grade fever, malaise, anorexia, pharyngeal
erythema, and throat soreness
• Headache, cough, hoarseness, rhinitis, and
conjunctivitis
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 37
Disorders of Respiratory Function
• Acute Pharyngitis (Sore Throat) (continued)

Medical Management
• Viral pharyngitis is treated symptomatically with
lozenges, gargles, and acetaminophen.
• Streptococcal pharyngitis must be treated with a 10-day
course of antimicrobial therapy; penicillin is the drug of
choice.

Nursing Interventions and Patient Teaching
• Saline gargles, lozenges, warm compresses to the
neck, and acetaminophen
• Cool liquids; then soft, bland foods
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 38
Disorders of Respiratory Function
• Tonsillitis

Etiology/Pathophysiology
• Usually occurs as a result of pharyngitis and can be
viral or bacterial in origin

Clinical Manifestations
• Sore throat, headache, edematous and tender cervical
lymph glands, fever, hoarseness, and cough
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 39
Disorders of Respiratory Function
• Tonsillitis (continued)

Medical Management
• Comfort measures are provided.
• Bacterial tonsillitis is treated with a 10-day course of
penicillin.
• Tonsillectomy is recommended for children with
hypertrophied tonsils that interfere with eating or
breathing.

Nursing Interventions
• Same as those for pharyngitis
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 40
Disorders of Respiratory Function
• Tonsillitis (continued)

Nursing Interventions
• Preoperative


Provide psychological preparation
Assess for signs of infection and loose teeth.
• Postoperative




Keep in a semiprone position.
Monitor frequently for excessive bleeding; frequent
swallowing.
Give analgesics as ordered.
Provide fluids: no acidic, red, or chocolate drinks.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 41
Disorders of Respiratory Function
• Croup

Etiology/Pathophysiology
• Laryngotracheobronchitis/viral group

Most common form of croup; usually follows upper
respiratory infection
• Acute epiglottitis



A severe, potentially life-threatening bacterial infection of
the epiglottis
Usually caused by H. influenzae type B
Can lead to total airway obstruction
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 42
Disorders of Respiratory Function
• Croup (continued)

Clinical Manifestations
• Hoarseness, inspiratory stridor, tachypnea, nasal
flaring, suprasternal retractions, and barking cough

Medical Management
• High cool mist humidity with low concentration oxygen
by mist tent; epinephrine by aerosol
• Nothing by mouth during acute phase
• IV administration of fluids; antibiotics
• Artificial airway, as needed
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 43
Disorders of Respiratory Function
• Croup (continued)

Nursing Interventions and Patient Teaching
•
•
•
•
•
•
Respond quickly in a calm manner.
Support and reassure parents.
Maintain Fowler’s position.
Monitor vital signs and respiratory status.
Monitor cardiac status.
Provide frequent rest periods.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 44
Disorders of Respiratory Function
• Bronchitis (Tracheobronchitis)

Etiology/Pathophysiology
• An inflammation of the large airways, the trachea, and
the bronchi; usually follows an upper airway infection.

Clinical Manifestations
• Cough, coryza, little or no fever
• After 2 to 3 days, the cough becomes productive.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 45
Disorders of Respiratory Function
• Bronchitis (Tracheobronchitis) (continued)

Medical Management
• Basically palliative: cough drops and cough
preparations; acetaminophen for fever

Patient Teaching
• Suggest use of a cool-mist humidifier to relieve the
child’s cough and help liquefy secretions.
• Encourage fluids.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 46
Disorders of Respiratory Function
• Acute Bronchiolitis

Etiology/Pathophysiology
• A viral inflammation of the smaller airway passages, the
bronchioles.

Clinical Manifestations
• Retractions, tachypnea, nasal flaring, paroxysmal
nonproductive coughing, and wheezing
• Low-grade fever, irritable, fussy, and anxious
• Difficulty eating
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 47
Disorders of Respiratory Function
• Acute Bronchiolitis (continued)

Medical Management
• High humidity via mist tent; oxygen therapy
• IV fluids
• Bronchodilators

Nursing Interventions/Patient Teaching
•
•
•
•
Respiratory isolation precautions
Thorough handwashing.
Frequent monitoring of respiratory condition.
Reassure and support parents.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 48
Disorders of Respiratory Function
• Pulmonary Tuberculosis

Etiology/Pathophysiology
• A chronic bacterial lung infection cause by the bacillus
Mycobacterium tuberculosis

Clinical Manifestations
• Usually none until the disease has significantly
progressed

Patient Teaching
• Instruct parents regarding the importance of giving
medications as ordered.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 49
Disorders of Respiratory Function
• Cystic Fibrosis

Etiology/Pathophysiology
• An inherited disorder of the exocrine glands,
characterized by excessive thick mucus that obstructs
the lungs and GI tract

Clinical Manifestations
• Steatorrhea; growth failure; protruding abdomen; and
thin, wasted extremities
• Chronic coughing, wheezing, sputum production, and
dyspnea
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 50
Disorders of Respiratory Function
• Cystic Fibrosis (continued)

Medical Management
• Chest physiotherapy (CPT) and postural drainage
• Inhalation therapy with bronchodilators
• Expectorants, mucolytic agents, and antibiotics

Nursing Interventions
• Management focuses on improving pulmonary function
and facilitating lung clearing, preventing or managing
respiratory infections, promoting normal growth and
development, and optimizing nutritional status.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 51
Disorders of Respiratory Function
• Bronchial Asthma

Etiology/Pathophysiology
• A reversible obstructive respiratory disorder

Clinical Manifestations
• Tightness in the chest, audible expiratory wheeze,
shortness of breath, tachypnea, dyspnea, restlessness,
anxiety, cyanosis, cough progressing from dry to
productive, fatigue, and diaphoresis
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 52
Figure 31-12
(From Ashwill, J.W., Droske, S.C. [1997]. Nursing care of children: principles and practice. Philadelphia:
Saunders.)
Comparison of a normal bronchial tube and a bronchial tube during an
asthma episode.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 53
Disorders of Respiratory Function
• Bronchial Asthma (continued)

Medical Management
• Long-term control medications
• Quick-relief medications
• Chest physiotherapy

Nursing Interventions
• Monitor vital signs, maintain adequate hydration,
Fowler’s position, provide rest periods, and teach
breathing exercises.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 54
Disorders of Gastrointestinal Function
• Cleft Lip and Cleft Palate

Etiology/Pathophysiology
• Lip: due to failure of the medial nasal and maxillary
processes to join
• Palate: due to failure of the palatal shelves to fuse

Clinical Manifestations
• Feeding difficulties, speech difficulties, recurrent otitis
media
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 55
Figure 31-14, A
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Variations in clefts of lip and palate at birth.
A, Notch in vermilion border.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 56
Figure 31-14, B
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of infants
and children. [7th ed.]. St. Louis: Mosby.)
Variations in clefts of lip and palate at birth.
B, Unilateral cleft lip and palate.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 57
Figure 31-14, C
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Variations in clefts of lip and palate at birth.
C, Bilateral cleft lip and palate.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 58
Figure 31-14, D
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Variations in clefts of lip and palate at birth.
D, Cleft palate.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 59
Disorders of Gastrointestinal Function
• Cleft Lip and Cleft Palate (continued)

Medical Management
• Surgical closure

Nursing Interventions
• Ensure adequate intake of food and fluids without
aspiration.
• Special feeding devices may be used.
• Frequent burping is necessary.
• Assist parents in dealing with the diagnosis.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 60
Disorders of Gastrointestinal Function
• Dehydration

Etiology/Pathophysiology
• May be a result of a number of disease processes that
cause abnormal losses through the skin, respiratory,
renal, and GI systems

Clinical Manifestations
• Loss of skin turgor; dry mucous membranes; sunken
eyes; lethargy; rapid, weak pulse; low blood pressure;
rapid respirations
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 61
Disorders of Gastrointestinal Function
• Dehydration (continued)

Medical Management
• Same as management of diarrhea

Nursing Interventions
• Assess for clinical manifestations of dehydration.
• Observations should include I&O; vital signs; body
weight; skin color, temperature, and turgor; capillary
refill; presence or absence of the sensation of thirst;
and in infants, assessment of the fontanels.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 62
Disorders of Gastrointestinal Function
• Diarrhea and Gastoenteritis

Etiology/Pathophysiology
• A disturbance in intestinal motility characterized by an
increase in frequency, fluid content, and volume of
stools

Clinical Manifestations
• Increased number of stools and increased fluid content
of stools
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 63
Disorders of Gastrointestinal Function
• Diarrhea and Gastoenteritis (continued)

Medical Management
• Treat underlying cause.
• Restore fluid and electrolyte imbalances.

Nursing Interventions
• I&O, promotion of rehydration, correction of electrolyte
imbalances, provision of age-appropriate nutrition,
prevention of the spread of the diarrhea, prevention of
complications, support of the child and family
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 64
Disorders of Gastrointestinal Function
• Constipation

Etiology/Pathophysiology
• The passage of hardened stools; may be associated
with failure of complete evacuation of the colon with
defecation

Clinical Manifestations
• Hard stools, fresh blood in the stools, cramping
abdominal pain, anal fissures, pain on defecation, loss
of appetite, and irritability
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 65
Disorders of Gastrointestinal Function
• Constipation (continued)

Medical Management
• Add fluid or carbohydrate to the formula, add foods with
bulk, and increase fluid intake.
• Manually dilate the sphincter; administer mild
laxatives/enemas.

Nursing Interventions
• Obtain history of bowel patterns; educate on dietary
changes and normal stool patterns.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 66
Disorders of Gastrointestinal Function
• Gastroesophageal Reflux

Etiology/Pathophysiology
• Primarily due to an incompetent lower esophageal
sphincter; gastric contents are allowed to regurgitate
into the esophagus.

Clinical Manifestations
• Vomiting or spitting up
• Aspiration may lead to respiratory signs
• Esophageal ulceration and bleeding
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 67
Disorders of Gastrointestinal Function
• Gastroesophageal Reflux (continued)

Medical Management
• Small, frequent feedings that have been thickened with
infant cereal
• Administration of antacids before meals and at bedtime
• Nissen fundoplication

Nursing Interventions
• Teach parents to thicken formula or breast milk with
cereal and to provide proper positioning after feedings.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 68
Disorders of Gastrointestinal Function
• Hypertrophic Pyloric Stenosis

Etiology/Pathophysiology
• An obstructive disorder in which the gastric outlet is
mechanically obstructed by a congenitally
hypertrophied pyloric muscle

Clinical Manifestations
• The signs begin as regurgitation that progresses to
projectile vomiting.
• Lethargy, weight loss, poor skin turgor, sunken
fontanels, and loss of subcutaneous tissue
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 69
Figure 31-16
(From Ashwill, J.W., Droske, S.C. [1997]. Nursing care of children: principles and practice. Philadelphia:
Saunders.)
Comparison of normal pyloric opening with evidence of pyloric stenosis.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 70
Disorders of Gastrointestinal Function
• Hypertrophic Pyloric Stenosis (continued)

Medical Management
• Surgical relief of the pyloric obstruction;
Fredet-Ramstedt procedure

Nursing Interventions and Patient Teaching
• Provide adequate nutrition.
• Manage preoperative and postoperative care.
• Support the family.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 71
Disorders of Gastrointestinal Function
• Intussusception

Etiology/Pathophysiology
• Result of the telescoping of one portion of the intestine
into another

Clinical Manifestations
• Sudden onset of severe abdominal pain
• Vomiting and lethargy
• “Currant jelly” stool
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 72
Figure 31-17
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Ileocolic intussusception.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 73
Disorders of Gastrointestinal Function
• Intussusception (continued)

Medical Management
• Hydrostatic reduction
• Surgical treatment

Nursing Interventions
• Obtain history from the parents, observe for physical
signs, prepare for procedures, provide postoperative
care.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 74
Disorders of Gastrointestinal Function
• Hirschspung’s Disease

Etiology/Pathophysiology
• An absence of innervation to a segment of the bowel;
no peristaltic waves in the affected portion; causes
intestinal obstruction and distention of the bowel

Clinical Manifestations
• Abdominal distention; vomiting and poor feeding;
ribbonlike, foul-smelling stools
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 75
Figure 31-18
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
The affected bowel in Hirschsprung’s disease.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 76
Disorders of Gastrointestinal Function
• Hirschspung’s Disease (continued)

Medical Management
• Surgical removal of the affected portion of the bowel

Nursing Interventions
• Assist the parents with adjustment to the diagnosis,
promote parent-infant bonding, prepare for surgery, and
educate the parents regarding colostomy care.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 77
Disorders of Gastrointestinal Function
• Hernias

Protrusion of organs or portions of an organ through a
structural defect or weakened muscle wall
 Strangulation: circulation to the protruding organ
impaired
 Incarceration: cannot be manually reduced
 Types: diaphragmatic, hiatal, inguinal, and umbilical
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 78
Figure 31-19
(From Wong, D.L. [1997]. Whaley & Wong's essentials of pediatric nursing. [5th ed.]. St. Louis: Mosby.)
Location of hernias.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 79
Disorders of Genitourinary Function
• Urinary Tract Infection



Infection may affect the upper urinary tract or the
lower urinary tract, or both.
It is primarily caused by bacteria.
Signs and symptoms are fever, weight loss, failure to
thrive, feeding difficulties, vomiting, diarrhea, urinary
frequency, pain during urination, foul-smelling urine,
incontinence, abdominal or flank pain, and hematuria.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 80
Disorders of Genitourinary Function
• Nephrotic Syndrome (Nephrosis)

Etiology/Pathophysiology
• Proteinurea resulting from glomerular damage that
renders the glomerulus permeable to protein.

Clinical Manifestations
• Periorbital edema, abdominal distention, generalized
edema, vomiting, anorexia, diarrhea, irritability,
increased body weight, decreased urine output, and
marked edema
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 81
Figure 31-20
(From Shirkey, H.C. [1980]. Pediatric therapy. [6th ed.]. St. Louis: Mosby.)
Child with nephrotic syndrome.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 82
Disorders of Genitourinary Function
• Nephrotic Syndrome (Nephrosis)

Medical Management
• Adrenocortical steroids, bedrest, and a low-sodium diet

Nursing Interventions and Patient Teaching
• Monitor I&O, body weight, and abdominal girth.
• Provide meticulous skin care, monitor vital signs,
encourage protein intake.
• Instruct parents in testing urine for albumin,
administration of medications, diet restrictions, and side
effects of steroids.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 83
Disorders of Genitourinary Function
• Acute Glomerulonephritis

Etiology/Pathophysiology
• Inflammation of the glomeruli of the kidney; commonly a
postinfection (streptococcal)

Clinical Manifestations
• Sudden onset of hematuria, proteinuria, and oliguria;
urine may be cloudy, smoky brown, or tea-colored
• Edema, abdominal pain, pallor, low-grade fever,
anorexia, vomiting, and headache
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 84
Disorders of Genitourinary Function
• Acute Glomerulonephritis (continued)

Medical Management
• Bedrest; restricted fluids, sodium, potassium, and
phosphate; regular measurement of vital signs, body
weight, and I&O; antibiotic therapy

Nursing Interventions and Patient Teaching
• Promote rest and adequate nutrition, prevent and detect
complications, and support the child and family.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 85
Disorders of Genitourinary Function
• Wilms’ Tumor (Nephroblastoma)

Etiology/Pathophysiology
• Malignant tumor of the kidney; most commonly the left
kidney

Clinical Manifestations
• Enlarging, asymptomatic, and firm abdominal masses
• Abdominal pain, hematuria, fever, hypertension, weight
loss, and fatigue
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 86
Disorders of Genitourinary Function
• Wilms’ Tumor (Nephroblastoma) (continued)

Medical Management
• Surgical resection as soon as possible; radiation and/or
chemotherapy

Nursing Interventions and Patient Teaching
• Prepare child and family for surgery.
• Provide postoperative care.
• Provide discharge planning.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 87
Disorders of Genitourinary Function
• Structural Defects of the Genitourinary Tract

These have serious implications for the psychologic
well-being of the child.
 Prompt correction is necessary to avoid a negative
psychologic impact on the child.
 Nursing Interventions and Patient Teaching
• Prepare the child and family for surgery.
• Provide the child and parents with emotional support.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 88
Disorders of Endocrine Function
• Hypothyroidism

Etiology/Pathophysiology
• Primary: congenital defects or defective synthesis
• Acquired: insufficient stimulation of the pituitary or the
hypothalamus; or systemic resistance to TH

Clinical Manifestations
• Vary according to type of hypothyroidism
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 89
Disorders of Endocrine Function
• Hypothyroidism (continued)

Medical Management
• Oral thyroid hormone replacement therapy

Nursing Interventions and Patient Teaching
• Assist the child and family in compliance with the
medical regimen and periodic monitoring of its effects.
• Importance of compliance and periodic monitoring of
the response to therapy should be stressed.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 90
Disorders of Endocrine Function
• Hyperthyroidism

Etiology/Pathophysiology
• Autoimmune process resulting in the production of
immunoglobulins that have thyroid-stimulating
properties

Clinical Manifestations
• Nervousness; irritability; hyperactive; tremors;
excessive appetite; weight loss; exphthalmos;
tachycardia, tachypnea, hypertension; accelerated
growth; heat intolerance; thyroid storm
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 91
Disorders of Endocrine Function
• Hyperthyroidism (continued)

Medical Management
• Administration of antithyroid medication, subtotal
thyroidectomy, or iodine administration

Nursing Interventions and Patient Teaching
• Promote rest and provide a quiet, nonstimulating
environment; dietary modifications include increased
calories; prepare the child and family for surgery.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 92
Disorders of Endocrine Function
• Diabetes Mellitus

Etiology/Pathophysiology
• A deficiency of insulin resulting in alteration in protein,
carbohydrate, and fat metabolism

Medical Management
• Insulin replacement
• Nutrition
• Exercise

Nursing Interventions
• Educate the child and family on the disease and
treatment and complications.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 93
Disorders of Musculoskeletal Function
• Developmental Dysplasia of the Hip

Etiology/Pathophysiology
• A developmental abnormality of the femoral head, the
acetabulum, or both; subluxation of the hip

Clinical Manifestations
• Shortening of the femur on the affected side; thigh and
gluteal folds are uneven; weight-bearing infant may
have affected leg shorter than the other, a waddling
gait, or limping.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 94
Disorders of Musculoskeletal Function
• Developmental Dysplasia of the Hip (continued)

Medical Management
• Reduction of the hip and application of hip spica cast

Nursing Interventions
• Maintain position of the hip joint, prevent complications,
and provide stimulation necessary for the developing
infant or child.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 95
Disorders of Musculoskeletal Function
• Legg-Calvé-Perthes Disease

Etiology/Pathophysiology
• A disorder caused by decreased blood supply to the
femoral head; results in epiphyseal necrosis and
degeneration

Clinical Manifestations
• Complaints of pain, limp on affected side, and limited
ROM
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 96
Disorders of Musculoskeletal Function
• Legg-Calvé-Perthes Disease (continued)

Medical Management
• Bedrest, traction, casts, braces or harnesses

Nursing Interventions and Patient Teaching
• Neurovascular assessments; teach family care and
management of the appliances
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 97
Disorders of Musculoskeletal Function
• Scoliosis

Etiology/Pathophysiology
• A lateral curvature of the spine

Clinical Manifestations
• Unequal hip height and shoulder height, scapular and
rib prominence, and a posterior rib hump that is visible
when the child bends forward
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 98
Figure 31-24
(From Thompson, J.M., McFarland, G.K., Hirsch, J.E., Tucker, S.M. [1997]. Mosby’s clinical nursing. [4th ed.].
St. Louis: Mosby.)
Scoliosis in children. A, Normal. B, Mild. C, Severe. D, Rotation and
curvature.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 99
Disorders of Musculoskeletal Function
• Scoliosis (continued)

Medical Management
• Less than 20 degrees requires no treatment.
• Bracing is used for moderate curvatures.
• Surgical intervention used in severe scoliosis.

Nursing Interventions and Patient Teaching
• Instruct on maintaining skin integrity; provide
information about the brace, cast, or other device; and
provide emotional support.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 100
Disorders of Musculoskeletal Function
• Osteomyelitis

Infection within the bone
 In children, the metaphysis of the femur, the tibia, and
the humerus are the areas most affected.
 It can occur at any age; the peak incidence in children
is between ages 3 and 15 years, and boys are
affected twice as often as girls.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 101
Disorders of Musculoskeletal Function
• Talipes (Clubfoot)

Etiology/Pathophysiology
• Congenital deformity of the foot and ankle

Clinical Manifestations
• Varies in severity; may involve one foot or both feet

Medical Management
• Manipulation and application of a series of short leg
casts; changed weekly to allow for further manipulation
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 102
Figure 31-26
(From Zitelli, B.J., Davis, H.W. [1997]. Atlas of pediatric physical diagnosis. (3rd ed.). St. Louis: Mosby.)
Bilateral congenital talipes equinovarus (congenital clubfoot) in 2-monthold infant.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 103
Disorders of Musculoskeletal Function
• Talipes (Clubfoot) (continued)

Nursing Interventions and Patient Teaching
• Parents will need support and education.
• Observe toes frequently for coldness, pain, blueness, or
edema.
• Teach passive stretching exercises.
• Teach parents cast care and how to handle the infant.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 104
Disorders of Musculoskeletal Function
• Duchenne’s Muscular Dystrophy

Etiology/Pathophysiology
• A sex-linked inherited disorder characterized by
gradually progressive skeletal muscle wasting and
weakness

Clinical Manifestations
• Child is clumsy; frequent falls, waddling gait, “Gower’s
sign”
• Contractures and deformities
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 105
Disorders of Musculoskeletal Function
• Duchenne’s Muscular Dystrophy (continued)

Medical Management
• No effective treatment; maintain ambulation and
independence as long as possible

Nursing Interventions and Patient Teaching
• Assist the child and family in developing positive coping
strategies to deal with the progressively debilitating
aspects of the illness.
• Exercise program
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 106
Disorders of Musculoskeletal Function
• Septic Arthritis

Etiology/Pathophysiology
• An infection of a joint, which can occur from bacteria in
the blood or as a direct extension of an existing
infection

Clinical Manifestations
• Affected joint is erythematous, edematous, warm, and
exquisitely painful.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 107
Disorders of Musculoskeletal Function
• Septic Arthritis (continued)

Medical Management
• Joint aspiration and surgical irrigation
• Broad-spectrum IV antibiotics

Nursing Interventions
• Same as for osteomyelitis
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 108
Disorders of Musculoskeletal Function
• Fractures


Most common sites in children are long bones,
clavicles, wrists, fingers, and skull.
A fracture can be complete or incomplete.
• Nursing Interventions



Assess injury and soft tissue.
Calm and reassure the child and the parents.
Assess for pain and point of tenderness, color,
sensation, motion, and pulses.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 109
Disorders of Neurologic Function
• Meningitis

Etiology/Pathophysiology
• An infection of the meninges; may be bacterial, viral, or
fungal; bacterial is the most common

Clinical Manifestations
• Fever, vomiting, headache, irritability, photophobia, and
nuchal rigidity
• Progresses to decreased level of consciousness and
seizures
• Positive Kernig’s sign and Brudzinski’s sign
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 110
Disorders of Neurologic Function
• Meningitis (continued)

Medical Management
• Immediate IV administration of appropriate antibiotic
therapy; usually continues for at least 10 days; isolation
until 24 hours after antibiotic therapy began

Nursing Interventions and Patient Teaching
• Rest should be promoted in the initial phase of the
disease and environmental stimuli kept to a minimum.
• Observe vital signs, LOC, I&O, and neurologic signs.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 111
Disorders of Neurologic Function
• Encephalitis

Etiology/Pathophysiology
• An inflammation of the CNS, mainly the brain and spinal
cord

Clinical Manifestations
• Malaise, fever, headache, dizziness, nuchal rigidity,
nausea, vomiting, ataxia, tremors, seizures, and coma;
may proceed to death
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 112
Disorders of Neurologic Function
• Encephalitis (continued)

Medical Management
• Hospitalization for strict observation and supportive
care; control fever, ensure adequate hydration and
nutrition, and monitor vital signs.

Nursing Interventions
• Administer medications; control fever; and monitor
neurologic status and vital signs.
• Provide emotional support to the child and family.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 113
Disorders of Neurologic Function
• Hydrocephalus

Etiology/Pathophysiology
• An excess of fluid within the cranial vault, subarachnoid
space, or both; caused by an imbalance between the
production and absorption of CSF within the ventricular
system

Clinical Manifestations
• Widening and bulging of the fontanels; separation of the
cranial sutures, dilation of scalp veins, thin and shiny
scalp, and rapidly increasing head circumference
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 114
Figure 31-28
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.]. St.
Louis: Mosby.)
Hydrocephalus: an occlusion in flow of cerebrospinal fluid.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 115
Figure 31-29
(From Bowden, V.P., Dickey, S.B., Greenberg, C.S. [1998]. Children and their families: the continuum of
care. Philadelphia: Saunders.)
Child with enlarged head caused by hydrocephalus.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 116
Disorders of Neurologic Function
• Hydrocephalus (continued)

Medical Management
• Surgical removal of tumor, if that is the cause
• Surgical shunting for obstructions

Nursing Interventions
• Observe for complications of the disease and shunt
placement, and provide support and education to the
family.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 117
Figure 31-30
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.]. St. Louis:
Mosby.)
Ventricular peritoneal shunt.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 118
Disorders of Neurologic Function
• Cerebral Palsy

Etiology/Pathophysiology
• Nonprogressive disorders of motor neuron impairment
that result in motor dysfunction

Clinical Manifestations
• Delayed gross motor development, involuntary
movements, hypertonic muscles, poor sucking, feeding
difficulties, persistence of primitive reflexes,
exaggerated deep tendon reflexes, arching of back,
vision and hearing impairments, extension and
scissoring of lower extremities
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 119
Disorders of Neurologic Function
• Cerebral Palsy (continued)

Medical Management
• No specific treatment; benefit from occupational,
physical, and speech/hearing therapist

Nursing Interventions
• Interventions are aimed at providing optimum
development; encourage as much independence as
possible.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 120
Disorders of Neurologic Function
• Seizure Disorders

Etiology/Pathophysiology
• A sudden, excessive, disorderly discharge of abnormal
electrical impulses by the brain’s neurons causing a
temporary alteration in CNS function.

Medical Management
• Anticonvulsants; maintain vital functions during seizure.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 121
Disorders of Neurologic Function
• Seizure Disorders (continued)

Nursing Interventions
• During a seizure, protect the child from injury.
• Do not force an object between the teeth.
• Stay with the child to provide reassurance, emotional
support, and explanations.
• Educate family regarding the nature of the disorder.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 122
Disorders of Neurologic Function
• Spina Bifida (Myelomeningocele)

Etiology/Pathophysiology
• Congenital defects of neural tube closure

Clinical Manifestations
• All motor and sensory function beyond the defect is
usually absent.

Medical Management
• Surgery to replace the neural contents within the sac to
eliminate the possibility of infection
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 123
Disorders of Neurologic Function
• Spina Bifida (Myelomeningocele) (continued)

Nursing Interventions and Patient Teaching
•
•
•
•
Prevent infection.
Prevent complications.
Provide postoperative care.
Support and educate the family.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 124
Disorders of Integumentary Function
• Contact Dermatitis

Etiology/Pathophysiology
• An inflammation, delayed immune response of the skin
resulting from contact with environmental antigens

Clinical Manifestations
• Area becomes erythematous, edematous, and pruritic;
papules and vesicles form and weep and ooze.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 125
Disorders of Integumentary Function
• Contact Dermatitis (continued)

Medical Management
• Identify and eliminate the cause.
• Cool wet dressing dipped in Burow’s solution is applied.
• Antihistamines control pruritus.

Nursing Interventions and Patient Teaching
• Clip fingernails short to prevent infection from
scratching.
• Wash area thoroughly if skin comes into contact with
causative agent.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 126
Disorders of Integumentary Function
• Diaper Dermatitis

Etiology/Pathophysiology
• Form of contact dermatitis; exposure to urine or feces

Clinical Manifestations
• Erythematous papular lesions on the buttocks, labia, or
scrotum

Medical Management
• Keep the diaper area clean and dry; change diapers as
soon as possible cleanse area with mild soap and
water, pat dry.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 127
Disorders of Integumentary Function
• Diaper Dermatitis (continued)

Nursing Interventions
• Protective ointments; keep diaper area clean.
• Teach parents the basics of skin care.
• Use only a thin layer of cornstarch powder.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 128
Disorders of Integumentary Function
• Atopic Dermatitis (Eczema)

Etiology/Pathophysiology
• A pruritic, allergic response

Clinical Manifestations
• Erythema, vesicles, and papules that can ooze and
crust.
• Appear most often on the cheeks, scalp, trunk, and
extensor surfaces of the extremities
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 129
Disorders of Integumentary Function
• Atopic Dermatitis (Eczema) (continued)

Medical Management
• Hydration of the skin; control pruritus; decrease
inflammation; and prevent secondary infections.

Nursing Interventions
• Apply compresses of Burow’s solution; scratching must
be kept to a minimum; provide support to the child and
parents.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 130
Disorders of Integumentary Function
• Seborrheic Dermatitis

Etiology/Pathophysiology
• A chronic inflammatory reaction of the skin commonly
seen in infants; “cradle cap”

Clinical Manifestations
• It most commonly affects the scalp and appears as
thick, white or yellowish, crusty or scaly patches.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 131
Disorders of Integumentary Function
• Seborrheic Dermatitis (continued)

Medical Management
• Remove crusty, scaly patches with mineral oil.
• Brush hair with soft baby brush.
• Daily shampooing with antiseborrheic shampoos.

Nursing Interventions
• Crusts should be soaked with warm water and
compresses until loosened; shampoo and rinse.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 132
Disorders of Integumentary Function
• Acne Vulgaris


An inflammatory process of the skin commonly seen
in adolescents; involves the pilosebaceous follicles of
the face, neck, shoulders, back, and upper chest
Nursing Interventions and Patient Teaching
• Benzoyl peroxide and retinoic acid are incompatible
together; assess the psychosocial impact; meticulous
skin care is emphasized.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 133
Disorders of Integumentary Function
• Psoriasis

A chronic, proliferative skin disorder characterized by
thick, scaly patches and inflammation
• Traumatic Injuries


Animal, insect, and human bites in children account
for a considerable number of visits to clinics and
physicians’ offices.
Dog bites involve lacerations or tissue avulsion
injuries, whereas cats inflict more puncturelike
wounds.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 134
Disorders of Integumentary Function
• Bacterial Infections


Impetigo, folliculitis, and cellulitis are common
bacterial infections in childhood.
The assessment of systemic signs and symptoms,
areas involved, and appearance of lesions are helpful
in establishing the type of infection.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 135
Disorders of Integumentary Function
• Herpes Simplex Virus Type I


A common infection as evidenced by the presence of
HSV-1 antibodies in 30% to 60% of the young
population
Transmitted by direct contact of infected body fluids
with nonintact skin or mucous membranes
• Tinea Capitis, Corporis, Cruris, and Pedis

Common fungal infections of the skin; classified
according to the area of the body that is involved
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 136
Disorders of Integumentary Function
• Candidiasis (Thrush)

Etiology/Pathophysiology
• Caused by the fungus Candida albicans

Clinical Manifestations
• White patches of Candida are frequently found on moist
tissues: tongue, buccal cavity, GI tract, and vagina.
• Generally asymtomatic and easily treated
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 137
Disorders of Integumentary Function
• Candidiasis (Thrush)

Medical Management
• Nystatin suspension; administer after feedings.

Nursing Interventions and Patient Teaching
• Inform parents that the full 7-day course of nystatin is to
be completed.
• Teach parents to sterilize bottles, nipples, pacifiers, and
teethers.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 138
Disorders of Integumentary Function
• Parasitic Infections

Scabies and Pediculosis
• Scabies is an infectious parasitic disorder caused by a
mite; it burrows under the skin and causes papular rash
and intense pruritus.
• Pediculosis captitis (head lice) is a scalp infection that
causes intense pruritus; adult louse attaches to the skin
and feeds by sucking blood; the mature female louse
lays her eggs (nits) on the shaft of the hair.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 139