NR328/NR 328 Exam 2 Study Guide (Latest 2022/2023) Pediatric Nursing - Chamberlain College | Study Guides, Projects, Research Nursing | Docsity (2024)

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NR I328 IEXAM I2 ISTUDY IGUIDE HEMATOLOGIC IDISORDERS: 7-10 Iquestions • Identify Igeneral Inursing Istrategies Iassociated Iwith Ialtered Ianemia • Describe Ithe Imorphology, Ipathophysiology, Iclinical Imanifestations, Itherapeutic Imanagement Iand Inursing Iconsiderations Iof Ithe Ifollowing Ianemias: o ***Laboratory Inorms: I6-12 Iyears Iof Iage ▪ Hemoglobin: • 11.5-15.5 Ig/dl ▪ Hematocrit: • 35-45% ▪ MCV I(mean Icorpuscular Ivolume) • 77-95 IfL • Measure Iof Iaverage Isize Iof IRBC • ↓ I in Imicrocytic; I↑ I in Imacrocytic ▪ MCHC I (mean I corpuscular I Hgb I concentration) • 31–37 Ig/dl • Reflection Iof IHgb Iconcentration • Refer Ito Icolor; Iin Ihypo-, Ivalues Iare I↓ ▪ MCH I(mean Icorpuscular IHgb) • 25–33 Ipg/cell • Reflection Iof IHgb Iconcentration • Refer Ito Icolor; Iin Ihypo-, Ivalues Iare I↓ o Anemia ▪ Condition Iwhere Ithe Ihemoglobin Icontent Iof Ithe Iblood Iis Iinsufficient Ito Isatisfy Ibodily Ineeds ▪ Causes: • Blood Iloss • Accelerated Ihemolysis • Decreased Iproduction ▪ Typical IClinical IManifestations: • Fatigue • Dizziness • Weakness • Pallor • ↑ Iheart Irate • ↑ Ibreathing Irate o Types: ▪ Iron-deficiency Ianemia—MOST ICOMMON I N IPEDS • Nutritional Ianemia • Microcytic-hypochromic—small, I pale IRBC • Who’s Iat Irisk? o Varied o Premature Ibabies Iat I↑ Irisk Ib/c Ithey Idon’t Iget Ithat Iblood Irush Ithe Imom Igives Ithe Ibaby Ilate Iin Ithat I3rd Itrimester, Ib/c Ipremies Iare Iborn Iearly—this Iis Iwhy Ipremature Iinfants Ineed Ithe Iiron Isupplements Iat I2-3 Imonths, Iwhereas Iterm Ibabies Idon’t Ineed Iit Iuntil I4-6 Imonths o Multiples Iand Itwins Iat I↑ Ibecause Ionly Ifinite Iamount Iof Iblood Iavailable Iin Ithat Ilast Irush Iof Iblood; Iso Inot Iall Ithe Ibabies Iget Ienough Iiron o Breast-fed Iexclusively Ibabies Iat I↑ Irisk—breast Imilk Idoesn’t Ihave Isame Iiron Icontent Ias Ifortified Iiron Iformula o Kiddos Iwith Ichronic Iblood Iloss—GI Ibleeders, Ihemophiliacs o Kiddos Iwith Ipoor Idietary Iintake; Iwhole Imilk Idoesn’t Ihave Isame Iiron Iconcentration Ias Iiron Ifortified Iformula • Pathophysiology: o Body Istores Iiron Ithat Iis Iused Ifor Ierythropoiesis o Iron Inecessary Imineral Ifor Ierythropoiesis Ito Ioccur o Not Ienough Iiron Ito Itransport Ito Ithe Ibone Imarrow Ito Imake IRBCs o Bone Imarrow Istill Imakes IRBCs Ibut Ithey Iare Ivery Ismall Iand Ihave Ia Ilower Ihemoglobin Iconcentration • Clinical IManifestations: o Typical Isigns Iof Ianemia Iplus: ▪ Irritability—due Ito Itissue Ihypoxia/O2 Icraving ▪ Pica I(especially Iice, Idirt, Ichalk, Ipowder Ior Ipure Istarch)—eating Iof Isubstances Ithat Iare Inot Itypical Iof Ikiddos Ito Ieat; Ihowever Ithis Icould Ibe Ihard Ito Idistinguish Ifrom Ithis Ioccurring Inormally Iin Itoddlerhood ▪ Poor Imuscle Itone ▪ Growth Iretardation ▪ Headache ▪ Nail Ibed Ideformities Icalled?? ISpoon Inail ▪ Tachycardic; Ipossible Imurmurs • Lab IValues: o Everything Iis I↓↓↓↓ Ib/c Iits Imicrocytic-hypochromic • Implementations: o EDUCATION*** ▪ Prevention* ▪ High Iiron Ifoods* • Foods Ithat Ia Itoddler Iwould Ieat; Ieggs, Ibreads • Whole Imilk Itakes Iup Iroom Iin Ibelly!!! ISo Ikiddo Imay Inot Iintake Ienough Iiron- Irich Ifood Ib/c Ithey’re Inot Ihungry; Iremember Iwhole Imilk Idoes Inot Ihave Isame Iiron Iconcentration Ilike Ifortified Iformula Iso Iif Ikiddo Iis Idrinking Iequal Iamounts Iof Iwhole Imilk Ias Ihe/she Iused Ito Idrink Ithe Iformula Ihe/she Iis Inot Igetting Ienough Iiron ▪ Iron Isupplements • Best Ion Ian Iempty Istomach • Best Iwith IVitamin IC • Don’t Igive Iwith Imilk ▪ Seriousness Idepends Iupon Iwhere Iocclusion Ioccurs; Iex: Ibrain Ivs. Ihand ▪ Manifestations • Severe Ipain I#1 • Tissue Iengorgement • Fever o Sequestration Icrisis ▪ Life-threatening ▪ Blood Ipooling Iwithin Ispleen ▪ Occurs Imore Ioften Iin Iyounger Ikiddos—late Iin Iinfancy I8-10 Imonths Iof Iage Iup Ito I5 Iyears Iof Iage ▪ Manifestations • Profound Ianemia • Hypovolemia • Rupture Iof Ispleen Ipossible o Aplastic Icrisis ▪ Triggered Iby Ifragile IRBC Ileading Ito Ilysing Iof IRBCs ▪ Signals Ito Ibone Imarrow I(BM) Iwe Ineed Imore RBCs, Ileading Ito Icrowding Iout Iof Ibone Imarrow ▪ Crowding Iof IBM Iprevents Inormal Iproduction Iof IWBCs Iand Iplatelets ▪ Pt. Ibecomes Ianemic, Ithrombocytopenic I& neutropenic • Complications: o Acute Ichest Isyndrome ▪ Appears Isimilar Ito Ipneumonia ▪ Pulmonary Iinfiltrate Ipresent Ion ICXR ▪ Are Iin Isevere Irespiratory Idistress ▪ Manifestations: • Acute, Isevere Ionset Iof Ichest Ipain • Fever—high Itemp • Congested Icough • Wheezing • Hypoxic • Dyspnea o Cerebral Ivascular Iaccident ▪ Vaso-occlusive Icrisis Ioccurs Iin Ibrain • Clinical IManifestations: o Anemia o Episodes Iof Ipain o Hand-foot Isyndrome—swelling Ib/c Iof Imicro- Ivasculature Igets Ioccluded Iquickly o Jaundice o Frequent Iinfections o Stunted Igrowth o Vision Iproblems—occlusion Icrisis Iwithin Imicro- Ivasculature Iin Ieyes • Therapeutic IManagement: o Rest o Hydration o Pain I management/analgesics o Oxygenation o Electrolyte Ireplacement o Blood Ireplacement—monitor Iiron Ilevels o Antibiotics—aggressively I treat I infections • Describe Ithe Ietiology, Ipathophysiology, Iclinical Imanifestations, Iand Itherapeutic I management I of I idiopathic I thrombocytopenic I purpura I (ITP) o Disorder Iwith Iincreased Idestruction Iof Iplatelets, Idespite I Inormal Iplatelet Iproduction o Usually Ifollows Ia Iviral Iinfection o Characterized Iby Irapid Idestruction Iof Iplatelets, Idespite Inormal Iplatelet Iproduction Ioccurring o Who’s Iat IRisk? ▪ Children Iwho Ihave Ihad Ia Iviral Iinfection Ipast Icouple Iweeks ▪ 2-5 Iyears, Isome Isay I2-10 Iyears o Types: ▪ Acute: I(focus Ifor IPEDS) • Occurs I1-3 Iweeks Iafter Iviral Iinfection: IURI, Imeasles, Imumps, Ichicken Ipox • Autoimmune Iresponse Icauses Iantibody Ito Icoat Iplatelets Ithat Ithe Ispleen Irecognizes Ias Iforeign—when Iplatelets Icirculate Ithrough Ithe Ispleen Ithey Iare Idestroyed • Decreased Iplatelet Icount—prone Ito Ibleeding ▪ Chronic: • If Iit Ilasts Imore Ithan I6 Imonths—MC Iin Iadults o Pathophysiology: ▪ Autoimmune Iresponse Icauses Iantibodies Ito Icoat Iplatelets ▪ Antibody-coated Iplatelets Iare Iseen Ias Iforeign ▪ Spleen Isees Ithem Ias Iforeign Iand Idestroys Ithem o Clinical IManifestations: ▪ Nosebleeds ▪ Oral Ibleeding—gums ▪ Purpura—big large, purple discoloration/bruising caused by Ibleeding Iunder Ithe Iskin ▪ Petechiae—small, Ipinpoint Ibruising ▪ Internal Ihemorrhaging o Therapeutic IManagement: ▪ Use Isteroids Iand IIVIG—anti-inflammatory Iand Iautoimmune Itreatment ▪ Anti-D Iantibody—causes I Ia I Itransient I Ihemolytic I Ianemia—trying Ito Idestroy Iall Iblood Icells Ihoping Ito Iclear Ithe Iantibody-coated Iplatelets Ito Iessentially I“start Iover Inew” o Nursing IManagement: ▪ SAFETY ▪ Maintain Ikiddo’s Isafety Iwhile Ithey Iare Iin Iactive Iprocess Iof Ithe Idisease ▪ BED IREST ▪ Limitation Iin Iactivity Iwhen Iplatelet Icount Iis Ilow • Limited Iwhen Iplatelet Icount Iis Ibetween I50-100 I(50,000- I100,000) ▪ Avoid I aspirin I and I ibuprofen I products I b/c Iof I blood Ithinning Iaspects • Discuss I the I etiology, I Pathophysiology, I clinical I manifestations I and Imanagement Iof Idisseminated Iintravascular Icoagulopathy I(DIC) o Abnormal simultaneous activation of body’s thrombin (clotting) Imechanisms Iand Ifibrinolytic Isystem o “DEATH IIS ICOMING” I= IDIC o Secondary Idisease Iprocess Imeaning I Ikiddo I Ihas I Isomething I Ielse I Igoing Ion Ito Icause Ithe Ikiddo Ito Igo Iinto Imulti-system Ifailure ▪ Shock, I cancer, I transfusion I reactions, I overwhelmingly I septic, Ispinal Iand Ibrain Iinjuries, Iother Iimmune Idisorders o Who’s Iat IRisk? o Pathophysiology: ▪ Body’s I clotting I mechanisms I are I activated I throughout I the I body Iinstead Iof Ijust Iat Ithe Isite Iof Iinjury ▪ Clotting Ifactors Idepleted ▪ Clot Idissolving Imechanisms Iincreased ▪ Clots Ibeing I inappropriately Iplaced Iwhich Ican Ilead Ito Itissue Iinfarction/ischemia—lead Ito Iorgan Idamage o Clinical IManifestations: ▪ IBP Iand Ipulse ▪ Purpura, Iecchymosis, Ipetechiae ▪ Cyanosis ▪ “Oozing” I to I profound I blood I loss I from I every I opening— eyes, Inose, Iwounds, Ietc. ▪ GI Ibleeding o Lab IValues: ▪ Iplatelet Icount ▪ I serum I fibrinogen ▪ Prolonged IPT/PTT ▪ Fibrin Idegradation Iproducts—increased Iby-products Iof Iclot ▪ **D Idimer—test Ifor Itype Iof Ifibrinogen Ithat Iis Iclassic/indicative Iof IDIC ▪ Iclotting Ifactors o Therapeutic IManagement: ▪ Treat Iunderlying Icause*** ▪ If I underlining I cause Ican’t I be I treated—Cryoprecipitate, I platelets Iand Ifresh Ifrozen Iplasma Iinfusions ▪ IV Iheparin Ito Ideal Iwith Ithe Iclots Ithat Iare Ibeing Ithrown Ito Iavoid Iend-organ Idamage Iand Itissue Iischemia/infarction o Nursing IManagement: ▪ Constant Ivigilance/ Iassessments ▪ Monitor Ibleeding • Compare Iand Icontrast I Ihemophilia I Iand I Ivon I IWillebrand’s I Idisease I Iin Iterms Iof IPathophysiology, Iclinical Imanifestations, Itherapeutic Imanagement Iand Inursing Imanagement o Hemophilia ▪ Hereditary Iclotting Ifactor Idisorders Icharacterized Iby Iprolonged Icoagulation Itimes ▪ Types: • Hemophilia IA I(classic) ▪ o Secondary ▪ B Imemory Icells Irespond Ito Ithe Iantigen Iimmediately ▪ Guided Iby Iyour I gG ▪ Secondary Iexposure Iwe Iusually Itrigger Iwith Ia Ibooster Ishot ▪ Plasma Iantibody Ilevels Irise Iwithin Idays ▪ • Outline Ithe Icurrently Irecommended Iimmunization Ischedule Ifor Iinfants Ithrough Iadolescence Iand Iidentify Ifactors Ithat Icontradict Iadministration Iof Ischeduled Iimmunizations • Demonstrate Ian Iunderstanding Iof Ithe IPathophysiology, Iclinical Imanifestations Iand Itherapeutic Imanagement Iof Isevere Icombined Iimmunodeficiency Idisorder I(SCID) o Congenital Idisorder Ithat Iis Icharacterized Iby Ithe Iabsence Iof Iboth Ihumoral Iand Icell-mediated Iimmunity o Most Isevere—“The Iboy Iin Ithe Ibubble” o Missing Ian Ienzyme Ithat Iprevents Ithe Istem Icell Ifrom Imaturing—means Iyou Ihave Ino Iability Ito Imake Iany Iof Ithe Iimmune Icells o Newborns Ihave Imother’s Iantibodies—last I2-3 Imonths; Ithis Imeans Iyou Iwill INOT Isee Iany Iwarning Isigns Iof ISCID Iinitially ▪ Once Ikiddo Ireached I2-3 Imonths Imom’s Iantibodies Istart Ito Iwear Ioff ▪ Kiddo Iwill Ipresent Iwith Ichronic Iinfections ▪ You’ll Isee Ithrush, Iother Iodd, Inon-typical Iinfections, Inever Iget Iover Ian Iinfection Ibefore Ithey Iget Ianother Iinfection, Ifailure Ito Ithrive ▪ If Igoes Iuntreated Ikiddo Iwill Idie Ibefore Iage Iof I2 Ib/c Ithey Ihave Ino Iimmunity o Pathophysiology: ▪ Missing Ienzyme Iprevents Istem Icell Imaturation ▪ Leads Ito Ino Ior Idecreased Iimmune Iresponse o Clinical IManifestations: ▪ Thrush ▪ Infections Ifrom Iunusual Iagents ▪ Failure Ito Ithrive o Therapeutic I Management ▪ Stem Icell Itransplant—amazingly Ieffective—if Idone Iwithin Ifirst I28 Idays Iof I life, I95% Isurvival Irate—REMEMBER Ithough Ithat Iusually ISCID Igoes Iundiagnosed Iuntil Ilater… • So Iwhat Iare Ithe Ichances Iwe Iwill Idiagnose Iit Iin Ithe Ifirst I28 Idays? IWhat’s Ithe Isurvival Irate Iafter Ithe Ineonate Iperiod? IStill Ipretty Igood!! I • Stem Icell Itransplant Iat I2-5 Imonths Iof Iage Istill Ihave I70- I75% Isurvival Irate ▪ IVIG • Not Ias Ieffective Ias Istem Icell Itransplant • Has Ito Ibe Idone Irepetitively • Goes I in I every I month I for I IVIG I injection • Lots Iof ISA, Ipotential Ifor Ianaphylaxis, Ilot Iof Ihypersensitivity Ireactions ▪ Immunizations • Can Iroutinely Ireceive Iimmunizations IEXCEPT Ifor Ilive Iattenuated—before Igiving Ithese, Iyou Imust Icheck Ithat Ithere Icount Iis Iover I200 • If ICD4 Iis Iover I200, Ithen Ithey Ican Ireceive IMMR Iand Ivaricella ▪ Antibiotics • Aggressive Iwith Itx. Iof Iinfections • However Iwe Idon’t Iwant Ito Iknock Iout Ithe Ikiddo’s Inatural Iimmunity—their Ilittle Igood Ibeastie Ibugs Ithat Ilive Iin Itheir Isystems Ito Ihelp Iprotect Ithem; Inormal Iflora o Nursing IManagement ▪ Hand Ihygiene ▪ Follow Ineutropenic Iprecautions • Wear Imask Iin Iroom • Have Ikiddo Iwear Imask Iwhen Ihe/she Ileaves Iroom • No Ilive Iplants Iin Ithe Iroom Ib/c Iof Iall Ithe Ibeastie Ibugs Ithat Ilive Iin Ithe Isoil • Live Ifruits Iand Iveggies—maybe, Imaybe Inot—depending Ihow Iimmuocompromised Ithey Iare ▪ Proper Iroom Iassignments—shouldn’t Ibe Iwith Ianother Ikiddo Iwho Ihas Ipneumonia Ior IRSV… • Discuss Ithe Iclinical Imanifestations Iand Inursing Icare Iof Ithe Ichild Iwith IHIV/AIDS o Infection Iwith Iretrovirus Ihuman Iinmmunodeficiency Ivirus o MC Imode Iof Itransmission—mom Ito Ibaby! ▪ In ISTL Iwe Ihave Ilowered Ithe Itransmission Ifrom Imom Ito Ibaby— Ivertical Itransmission—to Iless Ithan I0.03% ▪ Adolescents—risk-taking behaviors, unsafe sex, multiple Ipartners, Idrug Iuse o Pathophysiolgy: ▪ HIV Iinfects ICD4 IT Icells • Without IT Icell Iyou Iessentially Ihave Ino I immunity—leads Ito Iwidespread Iimmunodeficiency ▪ Renders ICD4 IT Icell Idysfunctional ▪ Leads Ito Iimmunodeficiency o Clinical IManifestations: ▪ If Iundiagnosed Ior Iyou Idon’t Iknow Iif Ichild Ihas Iit Iyou’ll Isee: • Chronic Idiarrhea* • Failure Ito Ithrive* • Delayed Idevelopment ▪ So Iwhat Iif Imom Iis Iknown Ito Ibe IHIV+? IDoes Ikiddo Ihave IHIV?? • REMEMBER—takes Iup Ito I90+ Idays Iafter Iexposure Ito IHIV Ifor Ia Iperson Ito Itruly Isero-convert Ito Ihaving IHIV • Kiddo Ihas Imom’s Iantibodies Iso Itesting Ikiddo’s Iantibodies Iright Iafter Ibirth Iwould Imost Ilikely Ishow Ia Ipositive Itest Ifor IHIV—THEREFORE Iwe Icannot Idefinitively Isay Ithe Ikiddo Ihas IHIV • So Iwe Ido Iserial Itests Iat I3 Imonths, I6 Imonths, I9 Imonths, I12 Imonths—if Iwe Iget I2 Iconsecutive Ipositive Itests Iin Ia Irow, Ithen Iwe Iwill Imost Ilikely Isay Ithe Ikiddo Iis IHIV+ • BUT Iuntil Ithis Ikiddo Iis I6 Imonths Iof Iage Iwe Iare Itreating Ikiddo Iwith Iall Ianti-retroviral Imedications Ithat Iwe Iwould Igive Imom o Send Imom Ihome Iwith I6 Imonth I Isupply I Iof Imedications Ito Igive Ibaby Iin Ihopes I Iof I Ipreventing Ithat Ibaby Ifrom Isero-converting o Can Ibe Iextremely Ieffective IIF Ithe Ifamily Iis ICOMPLIANT Iwith Imedication Iroutine • When Ikiddo Ireaches I18 Imonths Iof Iage Iwe Ican Ido Idefinitive Itesting—ELISA Iand IWestern Iblot Itests o Opportunistic I infections/Co-conditions: I HOW I WILL I THESE I LOOK I IN I A IKID? ▪ Pneumocystis Icarinii Ipneumonia ▪ Recurrent Ibacterial Iinfections ▪ Wasting Isyndrome o Therapeutic I Management: ▪ AZT, IRetrovir ▪ Routine IIVIG Iinjections o Nursing IManagement: ▪ Typically Iwell Ichild Iuntil Ithe Itrue IAIDS ▪ Normal Ihealth Iprecautions • Avoid Icontact Iwith Iinfected Ipersons • Good Inutrition • Good I skin I care—avoid I skin I breakdown—skin I is I best Ibarrier Ito Iinfection ▪ Incubation Iis I4-8 Iweeks—contagious ▪ Who’s Iat IRisk? • Adolescents Iand Iyoung Iadults • Younger Ikiddos Idon’t Iget Inearly Ias Isick Ifrom Iit Ias Iolder Ikids Ido ▪ Clinical IManifestations: • Fever • Sore Ithroat—unbelievably Isore Ithroat; Iworry Iabout Isevere Idehydration!! • Cervical Iadenopathy—all Ilymph Inodes Iare Ienlarged Iand Iwith Ithat Ian Ienlarged Ispleen—risk Ifor Ispleen Irupture • Fatigue ▪ Therapeutic I Management: • Symptomatic • Analgesic/antipyretic ▪ Nursing IManagement: • Comfort Imeasures • Encourage Irest • Restrict Iphysical Iactivity—for I6-8 Iweeks Ipost-infection Ib/c Iof Ispleen Ienlargement—risk Ifor Ispleen Irupture o Rubella I(German Imeasles Ior I3-day Imeasles) ▪ Contagious Iviral Iinfection Icharacterized Iby Ia Ired Irash ▪ Who’s Iat IRisk? • Not Ia Iproblematic Idisease • Vaccinate Iagainst Iit Ibecause Iof Ithe Ieffects Ion Ian Iunborn Ibaby ▪ Clinical IManifestations: • Rash Iaccompanied Iby Ilow Igrade Ifever • Rash Istarts Ion Iface Iand Ispreads Irapidly Ito Itrunk Ithen Iarms Iand Ilegs • Runny, Istuffy Inose, IHA • Inflamed Ired Ieyes • Enlarged Ilymph Inodes ▪ Therapeutic I Management: • Symptomatic ▪ Nursing IManagement: • Keep Iin Iisolation Iuntil I5 Idays Iafter Irash Istarted— Iextremely Icontagious o Measles I(Rubeola) ▪ Highly Icontagious Iviral Idisease Ithat Icauses Ia Icharacteristic Imaculopapular Irash ▪ EXTREMELY ICONTAGIOUS ▪ Who’s Iat IRisk? • Mortality Ihighest Iin Ikiddos Iunder Ithe Iage Iof I2 Iand Ithose Iwith Iimmune Ideficiency ▪ Clinical IManifestations: • Fever • Dry Icough • Koplik’s I spots—tiny I white I spots I with I bluish I center I found Iinside Imouth Ior Ilining Iof Icheek • Conjunctivitis • Severe IPhotophobia • Skin Irash ▪ Therapeutic IManagement: • Supportive • Antipyretic/analgesia ▪ Nursing IManagement: • Isolate Iuntil I5th Iday Iof Irash • MMR Ivaccine Iis I12-15 Imonths • If Iyou Ihave Ian Iunimmunized Ikiddo, Igive Ithe Ivaccine Iwithin I72 Ihours Iof Iexposure Ito Iprotect Iagainst Idisease o Mumps I(parotitis) ▪ Acute Iinflammation Iof Ione Ior Iboth Iparotid Iglands ▪ Chipmunk Iface—cheeks Ifull ▪ 1 Iin I5 Ippl Iwill Inot Ihave Iany Isymptoms ▪ Who’s Iat IRisk? ▪ Clinical IManifestations: • Swollen, Ipainful Isalivary Iglands • Pain Iwith Ichewing Ior Iswallowing • Fever ▪ Therapeutic I Management: • Symptomatic • Antipyretics/antiinflammatories ▪ Nursing IManagement: • Encourage Ifluids Iand Isoft Ifoods • Avoid Isour Ifoods o Chickenpox ▪ Acute, Ihighly Icontagious Iviral Iinfections Ithat Ican Ioccur Iat Iany Iage ▪ Can Ikill Ikiddos; Ivirus Ican Ilay Idormant Ion Inerve Iroots Iand Iat some Ipoint Iin I50s-70s Ican Ireemerge Ias Ishingles ▪ Highly Icontagious ▪ Who’s Iat IRisk? ▪ Clinical IManifestations: • Stages Iof Irash: o Raised Ired/pink Ibumps I(papules) o Fluid-filled Iblisters I(vesicles) o Crusted Iover/scabbed Ivesicles • Can Ihave Iall I3 Istages Iat Isame Itime • Contagious Iuntil IALL Ibumps Iare Itotally Iscabbed Iover • Fever ▪ Therapeutic I Management: • Symptomatic • Immunocompromised I kiddo o Acyclovir o IVIG ▪ Nursing IManagement: • Isolation o Poliomyelitis ▪ Contagious Iviral Iillness Ithat Iin Iits Imost Isevere Iform Icauses paralysis, Idifficulty Ibreathing Iand Isometimes Ideath ▪ Who’s Iat IRisk? • Anyone Iwho Icomes Iin Icontact Iwith Iit ▪ Clinical IManifestations: • Nonparalytic—fever, Isore Ithroat, IHA, Iv, Ifatigue • Paralytic—less Ithan I1%--started Iwith Isame Isx. Ias Inonparalytic, Ithen Ia Icouple Idays Ilater Iyou Istart Ito Ilose Ireflexes, Imuscle Iaches Iand Ispasms, Iloose Iand Ifloppy Ilimbs Ioften Iworse Ion Ione Iside Iof Ithe Ibody • Post-polio Isyndrome—similar Ito Ishingles; I lays Idormant Iand Ioccurs I30-40 Iyears Ilater; Iprogressive Imuscle Iand Ijoint Iweakness/pain, Iexhausted Iafter Iactivity; Imuscle Iatrophy; Ilife Ithreatening Iwhen Imuscles Iinvolved Iwith Ibreathing Ibecome Iaffected ▪ Therapeutic IManagement: • Supportive ▪ Nursing IManagement: • Try Ito Iprevent Ijoint Ideformity Iand Iextremity Iloss—PT Iand Isplinting; Imaintain Ias Imuch Iuse Iout Iof Ithem Ias Ipossible, Iprevent Icontractures o Diphtheria ▪ Serious Ibacterial Iinfection Iaffecting Ithe Imucous Imembranes Iof Ithe Inose Iand Ithroat ▪ Used Ito Ibe Ileading Icause Iof Ideath Iin Ichildren ▪ Who’s Iat IRisk? ▪ Clinical IManifestations: • Thick, Ipatchy, Igrayish-green Imembrane Iover Ipharynx • Sore Ithroat, Irasping Icough • Airway Iobstruction • Outline Ithe Ibasic Ipathophysiology, Iclinical Imanifestations, Itherapeutic Imanagement Iand Inursing Icare Iof Iparasitic Iinfections o Pin IWorms ▪ Parasitic Iinfection ▪ MC Iin Iwarm Iclimates ▪ Goes Ialong Iwith Ipoor Ihygiene—scratching Iin Ianal Iarea Iand Ithen Iputting Ifingers Iin Imouth ▪ Pin Iworms Ilive Iin Ienvironment—may Iingest Ior Iinhale ▪ Who’s Iat IRisk? ▪ Pathophysiology: • Pinworm Ieggs Iingested/inhaled • Hatch Iin Iupper Iintestines • Travel Ithrough Ithe Iintestines • Come Iout Ithrough Irectal Iarea—when Ithey Iare Imoving Iaround Irectum Iarea IUSUALLY IAT INIGHT Ithey Icause Iintense Ianal Iitching • DIAGNOSE—put Ia Ipiece Iof Itape Iof Ikiddos Irectum, Iwhen Iworms Imove Iout Iof Irectum Ithey Iwill Istick Ito Ithe Itape ▪ Clinical IManifestations: • Intense Inocturnal Ianal Iitching • Insomnia • Vague IGI Isymptoms ▪ Therapeutic IManagement: • Anti-helminth Imedication ▪ Nursing IManagement: • Treat Ientire Ifamily!! • Repeat Imedication Iin I2 Iweeks Ib/c Iwe Ineed Ito Iget Ithe Ieggs Ithat Iare Ipossibly Ilaid Iin Ithe Iupper Iintestines Iand Ihave Inot Ihatched Iyet; Iso Iwait Ithe I2 Iweeks Ifor Ireproductive Icycle Ito Ioccur Iand Ithen Itreat o Lyme’s Idisease ▪ Most Icommon Itick Iborne Idisorder ▪ Who’s Iat IRisk? • Whoever Iis Iexposed Ito Ithe Iticks ▪ Pathophysiology: • Borrelia Iburgdorferi Ienters Ithe Ibloodstream ▪ Stages • Stage I1 o Erythema Imigrans—target Ipattern o 3-31 Idays Iafter Iinitial Itick o Tick Iremoval—place Itick Iin Iplastic Ibag Iand Iin Ifreezer Iso Iif Ikiddo Igets Isick, Iwe Ican Itest Ithat Itick Ito Ifigure Iout Iwhat Iis Igoing Ion Iwith Ikiddo • Stage I2 o Systemic Iinvolvement • Stage I3 o Musculoskeletal Ipain ▪ Therapeutic IManagement: • Prolonged Iantibiotic Itreatment • 14-21 Idays ▪ Nursing IManagement: • Education—how Ito Iprevent o Light Icolored Iclothes o Tuck Ipants Iinto Isocks o Long Isleeves, Ihats o Insect Irepellants Iwith Ideet Iin Iit • Discuss Ithe Ipathophysiology, Iclinical Imanifestations, Itherapeutic Imanagement I and I nursing I strategies Ifor I a I child I with I pediculosis I and Iscabies o Pediculosis ▪ Highly Icommunicable Iparasite Ion Ithe Ihair Iand Iscalp ▪ Very Irarely Iwill Iyou Ihear Ian IAfrican IAmerican Ihas Ilice ▪ We Idon’t Iget Ilice Ifrom Ianimals, Iwe Iget Iit Ifrom Ippl ▪ Lice Ido Inot Ijump—they Irun Iand Icrawl ▪ Lice Ican Ilive Ifor I48 Ihours Ioff Ihost; Inits Ican Ilive I8-10 Idays Ioff Ihost ▪ Who’s Iat IRisk? • Lice Iprefer Ilight, Iblonde, Istraight, Ithin Ihair • Kiddos Iin Iday Icare, Ipreschools Iand Ischool—MC Iis Ischool- Iaged ▪ Pathophysiology: • Lice Ilay Ithe Ieggs I(nit) Ion Ihair Ishaft, Itypically Ivery Iclose Ito Ithe Iscalp—look Iaround Iears, Inape Iof Ineck • Moving Idandruff—not Idandruff Iits Ilice! • Lice Ilive Iand Ireproduce Ionly Ion Ihumans • Bite Ihuman Iand Irelease Itoxin Ifrom Isaliva Ithat Icauses Iitching ▪ Clinical IManifestations: • Intense Iitching ▪ Therapeutic IManagement: • Medicated Ilotion Iand Ishampoo • Do Inot Ileave Ion Iyour Ichild’s Ihead Ifor Iextended Iperiod Iof Itime I(look Iat Ibottle) • Wash Ihair Ivigorously Iand Icomb Ihair Iwith Ifine-tooth Icomb Iinch Iby Iinch; Imay Ibe Imore Ieffective ▪ Nursing IManagement: • Repeat Itreatment Iin I7-12 Idays • Anything Ichild Ihas Ithat Ican Ibe Iwashed Ishould Ibe Iwashed Iin Ia Ihigh, Ihigh Iheat Ito Ikill Inits Iand Ilice • If Iit Ican’t Ibe Iwashed Iplace Iit Iin Ia Isealed Iplastic Ibag Ifor I2 Iweeks Ito Ikill Ilice Iand Inits • Round Inails • Prevent Iitching • Describe Ithe Iclinical Imanifestations Iand Inursing Icare Ifor Ia Ineonate Iwith Isepsis o Sepsis INeonatorum ▪ Generalized Iinfection Ithat Ihas Ispread Irapidly Ithrough Ithe Ibloodstream Iduring Ineonate Itime Iperiod—the Ifirst I28 Idays ▪ Pathophysiology: • Immature Iimmune Isystem • Inability Ito Ilocalize I infection • Lack Iof IIgM Ithat Iprotects Iagainst Ibacterial Iinfections ▪ Causes: • Early IOnset o First I3 Idays Iof Ilife • Late IOnset ▪ Assessment: o Hx. Iof Icomplications Iwith Ilabor—operative Idelivery, Iprolonged Iruptured Imembrane, Ietc. o Have Itemp Iinstability—don’t Ihave Icoordinated Iability Ito Irun Ia Itemp; Igoes Iup Ito I100/101 Ithen Idrops Ito I96 o SO ILOOK IFOR: Iinability Ito Irun Ia Itemp, Iresp. Idifficulty Iand Ilow IBG I(blood Iglucose) o When Iwe Isee Ithis—grab Iblood Icultures Iand Istart Iantibiotics! I“guilty Iuntil Iproven Iinnocent” ▪ Treatment: • Broad Ispectrum Iantibiotics I(gram Ipos. Iand Igram Ineg.) o Gentamycin o Ampicillin o Give Iuntil I48 Ihr. Iread Ion Icultures Icome Iback Inegative • Supportive Itherapies o Resp. Idistress—O2 Ihood, Inasal Icannula ▪ Mortality Irate Iis Iextremely Ihigh Iso Iwe Iare Ivery Iaggressive Iin Itreating Ithis • Discuss Ithe Inursing Imanagement Iof Icradle Icap Iand Idiaper Irash o Cradle Icap ▪ Chronic Irecurrent, Iinflammatory Ireaction Iof Ithe Iskin ▪ Don’t Ireally Iknow Ithe Icause ▪ Lesions Iare Ithick, Iadherent, Iyellowish, Iscaly ▪ Nursing ICare: • Prevent Iwith Iadequate Iscalp Ihygiene • Treatment Idirected Iat Iremoving Ithe Icrusts o Shampoo Idaily Iwith Ia Imild Isoap o Use Ia Ibaby Ishampoo Ib/c Ithey’re Imilder o Allow Ithe Ishampoo Ito Isoak Iin o Use Ia Isoft-bristled Iscrubbing Ibrush Ito Iscrub Iin Ifine Icircular Imotions—thought Iis Ithat Iit Iimproves Icirculation Ito Iscalp Iwhich Iwill Iultimately Iget Irid Iof Icradle Icrap o Use Ifine Itooth Icomb Ito Ihelp Iremove Icrust Ifrom Ihair ▪ May Ihave Icradle Icap Iuo Iuntil Ithe Iage Iof I2 Ior I3; Iothers Iits Ishort- Iterm o Diaper Irash ▪ Keep Iskin Idry!! ▪ Apply Iointment—skin Ibarrier • So Iwhen Ikid Ihas Ia Iwet Idiaper Iyou Idon’t Ineed Ito Iwash/scrub Ioff Idiaper Icream Ievery Itime Iyou Ichange Ithe Idiaper; Ileave Iit Ion Iand Iapply Imore Iif Inecessary ▪ Avoid Ioverwashing ▪ Let Ibaby’s Ibum Iout Ito Iair Idry Iif Ineeded ▪ Do INOT Iuse Ibaby Ipowder!!!! IB/c Iof Irisk Ifor Iinhalation Ipneumonia —has Isuch Ifine Iparticles Ithat Iif Iyou Ishake Iit Ion Ibaby’s Ibottom, Ithe Ibaby Iwill Ibreathe Iin Ithese Iparticles • If Ifamily Iwants Ito Iuse Ibaby Ipowder—away Ifrom Ithe Ibaby, Ishake Isome Iinto Iyour Ihands, Ipat/rub Ihands Itogether Iand Ithen Iput Iit Ion Ibaby’s Ibum SENSORY IALTERATIONS 1-3 Iquestions • Discuss Irefractory Idisorders: o Hyperopia ▪ Far-sighted ▪ Normal Iin Ikids Iup Ito I7 Iyrs. Iof Iage ▪ Don’t Icorrect Iunless Iextremely Isevere Iin Ikiddos Iunder I7 o Myopia ▪ Near-sighted ▪ See Iclearly Iat Iclose Irange ▪ What Ito Ilook Ifor? IA Ilot Iof Ieye Irubbing, Itilting Iof Ihead Ito Ione Iside Ior Ithe Iother, Idifficulty Ireading Iod Iwhiteboard/chalkboard, Iand Ifrequent Iblinking ▪ Corrected Iwith Ilaser Isurgery Ior Ibiconcave Ilenses o Astigmatism ▪ Unequal Icurvatures Iin Irefractive Iapparatus o Nystagmus ▪ Unintentional Ijittery Ieye Imovement ▪ May Ibe Icongenital—how Ichild Iis ▪ Could Ibe Imore Isignificant—is Ithe Inysatgmus Inew? • Can Ibe Icaused Iby Ianother Idisorder Ilike Ia Ibrain Itumor Ior Iclosed Ihead Iinjury • Describe Ithe Icommon Ichildhood Idisorders Iof Ithe Ieye Iand Itheir Isuggested Itreatments: o Ptosis ▪ Inability Ito Iraise Iupper Ieyelid o Strabismus ▪ Cross-eyed ▪ Esotropia-inward Ideviation ▪ Exotropia-outward Ideviation ▪ LOOK IFOR: Isquints Ieyes Itogether Iand Ifrowns, Icloses Ione Ieye Ito Isee Ibetter Iout Iof Ithe Iother, Iinaccurate Ijudgment Iwhen Ipicking Iup Iobjects Ib/c Idepth Iperception Iis Ioff, Idifficulty Ifocusing Ion Iobjects ▪ WANT ITO IPREVENT IPERMANENT IVISON ILOSS ▪ TX: Iocclusion Itherapy—patch Ithe Istronger Ieye Ihoping Ito Iincrease Ithe Imuscle Istrength Iand Iforcing Iweaker Ieye Imuscles Ito Iget Istronger Iso Iit Idoesn’t Iend Iup Ileading Ito Iamblyopia ▪ HESI IHINT: Iif Ithere Iis Ia Iforeign Iobject Iin Ithe Ieye, ILEAVE IIT ITHERE, IPATCH IBOTH IEYES!! • Need Ihigher Ilevel Iof Icare. • **If Iyou Ionly Ipatch Ithe Iinjured Ieye, Iwhen Ithe Iwell-eye Imoves, Iso Iwill Ithe Iinjured Ieye Iwhich Ican Ilead Ito Imore Idamage Ito Ithe Iretina, Imuscles Ior Ithat Ieye o Amblyopia CANCER o Ambulance, Ifire Itrucks Igo Iby—kid Idoesn’t Ieven Iblink Ior Iturn Ito Ithe Inoise o Very Ilittle Ibabbling Ior Ivocalizing o Only Iarouses Ito Itouch; Idoesn’t Irespond Ito Iname • Toddlers/Preschoolers o Hasn’t Ideveloped Igood Ispeech/communication o Communicates Ithrough Igestures; Iwhat Ispeech Ithey Ido Ihave Iis Iunintelligible o May Ihave Idevelopmental Idelay • School-aged/Adolescents o Constantly Isaying I“what” Ior I“huh” o Constantly Iturning Iup Ivolume Iof Iradio, ITV, Icomputer Igames, Ietc. o Continuation Iof Ispeech Iproblems; Ipoor Ischool Iperformance o In Ioperating Iroom—when Iyou Iput Ia Imask Iover Isomeone’s Imouth, Ia Iperson’s Ihearing I(who Ialready Ihas Ihearing Iimpairment) Iis Iimpaired Ifurther Ib/c Ithey Ican’t Iread Ispeakers’ Ilips • Discuss Icancer Icell Icharacteristics Iand Iwhat Icancer Ineeds Ito Ibe Iable Ito Igrow o Characteristics ▪ Vary Iin Isize Iand Ishape ▪ Undergo Iabnormal Imitosis ▪ Function Iabnormally ▪ Don’t Iresemble Ithe Icell Iof Iorigin ▪ Produce Isubstances Inot Iusually Iassociated Iwith Ithe Ioriginal Icell Ior Itissue ▪ Are Inot Iencapsulated ▪ Can Ispread Ito Iother Isites o Need Ito Igrow? ▪ Tumor IGrowth INeeds: • Once Iclump Iof Icells I(forms Ia Itumor) Ibecomes Igreater Ithan I2 Imm Iit Iundergoes Ithe Iprocess Iof Iangiogenesis— Itumor Ibuilds Iits Iown Ivascular Ihighway Iand Inow Ihas Iits Ivery Iown Ibloody Isupply Iof Inutrients Iand Ioxygen—this Iis Iwhy Itumor Igoes Iunnoticed Iin Ithe Ibody • Blood Isupply o Nutrients o Oxygen • Unrecognized Iby Ithe Iimmune Isystem ▪ Effect I of I tumor I characteristics: • Tumor Ilocation • Blood Isupply ▪ Degree Iof Ianaplasia • Effect Iof Ihost Icharacteristics: o Age ▪ Children—rapid Icell Igrowth Iand Idevelopment —perfect Itime Ifor Isomething Ito Igo Iawry Iand Ilead Ito Icancer ▪ Elderly—have Ihad Ia Imutated Igene Iand Ihas Ibeen Iexposes Ito Ithe Ipromoters Iby Inow o Causes ▪ Genetics: o Gender ▪ Sex I hormones I influence I tumor I growth— Ibreast, Iprostate, Iendometrial Ietc. o Overall Ihealth Istatus ▪ Tumors Ineed Inutrients, IO2 Iand Iblood Ito Igrow ▪ If Iindividual Iis Inutritionally Idepleted Isuch Ias Iwith Ifailure Ito Ithrive Ikiddos, Itumor Igrowth Imay Ibe Islowed o Immune Isystem Ifunctions ▪ Immune Isystem Iwill Iaffect Ihow Iquickly Itumors Iwill Igrow Iand Idevelop • Direct: I ISingle Igene Iis Iresponsible o EX: IWilm’s Iand Iretinoblastoma • Indirect: I Associated Iwith Iinherited Iconditions o Children Iwith IDown’s Iare Iprone Ito IALL • Characteristics: o Radiation, Iasbestos, Ismoking Ican Ilead Ito Icancer ▪ Viruses: • Viral IProto-Oncogenes o Contain IDNA Ithat’s Iidentical Ito Ithe Ihuman Iproto- Ioncogenes Ithat Ilook Iand Iacts Ijust Ilike Ia Ihuman Ioncogene • Some Iinfectious Iviruses Ihave Ithe Ipotential Ito Icause Icancer o HPV Iviruses Ican Icause Icervical Icancer—vaccine Iprotects Iagainst I4 Iviruses Ithat Icause I60-90% Iof Icases ▪ Failure Iof IImmunosurveillance • Failure Ito Irecognize Itumor Icells Ias Iforeign • Tumor Icells Isuppress Iimmune Idefenses • Tumor Iantigens Icombine Iwith Iantibodies Ito Ihide Ithe Iantigen • Tumors Imay Ichange Iantigenic Iappearance • Prolonged Iexposure Ito Itumor Iantigen Idepletes Ilymphocytes • Suppressor IT Ilymphocytes Imay Ibe Iinadequate • Discuss Igeneralized Iclinical Imanifestations, Irelevant Inursing Idiagnoses Iand Itreatment Imodalities Iof Icancer o Manifestations: ▪ Pain: I(usually Ihappens Iin Ivery Ilate Istages) • In Iearly Istages Iis Itypically Imild Ior Iabsent • Causes: o Pressure Ior Iobstruction Iof Inerves, Iblood Ivessels Ior Itissues o Viscera Iis Istretched o Cancer Icells Irelease Iproteolytic Ienzymes Ithat Idirectly Iinjure Ior Idestroy Ineighboring Icells ▪ Fatigue: • Feeling Iof Iweakness, Ibeing Itired, Ilacking Ienergy, Iinability Ito Iconcentrate • Underlying Imechanism Iunknown ▪ Cachexia: • Generalized Iwasting Iof Ifat Iand Iprotein • Look Iof Isomeone Istarving • Body Iis Ieating Iitself Itrying Ito Imeet Ithe Ibody’s Imetabolic Ineeds • Characterized Iby: o Anorexia—they Idon’t Iget Ihungry Idue Ito Ithe Icancer Iitself Ior Ib/c Iof Itreatments o Taste Iperception Ialterations—can’t Itaste Isweet, Isalty Iand Isour Isense o Early Isatiety—full Iafter Ionly I2-3 Ibites o Weight Iloss o Anemia o Marked Iweakness o Altered Imetabolism Iof Iproteins, Icarbohydrates Iand Ilipids ▪ Anemia: • Caused Iby Icancer Iof Iblood Iforming Icells, IWBCs Ior IRBCs • Common I in Imetastatic Icancers • Chronic Ibleeding, Isevere Imalnutrition, Ichemo Itreatments ▪ Leukopenia Iand IThrombocytopenia • Result Iwhen Ibone Imarrow Iis Iinvaded • Can Ibe Icaused Iby Ichemo Ior Iradiation • risk Iof Iinfection Iand Ihemorrhage ▪ Infection • Common Iin Ipatients Iwith Iadvanced Icancer • Malnutrition Iand Ianemia Ifurther I Irisk o Therapeutic Imanagement: ▪ Surgery ▪ Radiation Itherapy ▪ Chemotherapy—attacks Icancer Icells Iat Idifferent Ipoints Iin Icell Icycle • Alkylating Iagents • Antimetabolites • Antitumor Iantibiotics • Plant Ialkaloids • Steroid Ihormones ▪ Biotherapy • Interferon—antiviral Iand Ianti-proliferative Ieffect • Interleukins—exert Ieffect Ion IT Ilymphocytes • Monoclonal Iantibodies—bind Ithemselves Ito Itumor Icell’s Isurface; Istop Itumor Icell Ifrom Ibeing Iable Ito Ireplicate ▪ Bone Imarrow Itransplant o Nursing Imanagement: ▪ Anticipate Ineed Ifor Ipain Icontrol—set Ischedule Ito Iprevent Ibreakthrough Ipain ▪ Monitor Ifor Iand Ihelp Ichild Ideal Iwith Iadverse Ieffects Iof chemotherapy • Alopecia—some Ikiddos Ido Iokay Iwith Iit, Iothers Idon’t; Italk Ito Ikiddo Iis Ithey Iwant Ihats, Iwigs, Iscarves ▪ Provide Iemotional Isupport** • Group Iand Ifamily Isupport ▪ Make Isure Iwe Iare Iusing Iall Ichemo Itherapy Iprecautions— Icertification, Iprotective Igear Ior Igloves, I Ihow I Iwe I Idispose I Iof Ichemo, Ihow Iwe Idispose Iof Imaterials I(packed IRBCs), Iwatch Ifor Itransfusion I reactions—stop I immediately, I continue I to I monitor I for Ifirst I20 Iminutes Iof I Ichemo I Itreatment Ifor I Ianaphylaxis, Imanage IN/V, I administer I antiemetic I 30 I mins. I before I chemo, I manage I and Iavoid I anorexia, I give I kiddos I choice I of I food—when I they I want I it I in Ismall Iquantities—high I Inutrient I Idense I Icalories, I Imagic Imouth Iwash, I Igood I Ibody I Ialignment, I Ineuropathy I I(nerve I Ipain)— issues Iwith Iconstipation—stool Isofteners Iand Ilaxatives, Ifoot Iboard Ito Iprevent Ifoot Idrop Iand Ihelp Iwith Iambulation, Ihemorrhagic Istomatitis—irritation Iof Ibladder Ilining—give IMesna Ito Iprovide Iprotective Ibarrier Ialong Ithat Ilining Iand Iencourage Ifrequent Ivoiding, I teach I about I alopecia—hair I that I grows I back I will I be I very Idifferent Ithan Ihair Ibefore, Iget I Imoon I Ifaces—it I Iwill I Igo I Iaway, Imood Ichanges Ifrom Isteroid Itherapy • Differentiate Ibetween Ileukemia Iand Ilymphoma o Painless Ilymph Inode Ienlargement*** • Discuss Ithe Ivarious Itypes Iof Ibrain Itumors Icommon Iin Ipediatrics, Ithe Iclinical Imanifestations, Iand Imanagement o 3rd Ileading Icancer Iin Ipediatric Ipopulation o Abnormal Igrowth Iwithin Ithe Ibrain, Icerebral Ivasculature Ior Imeninges o MC Itype Iof Isolid Itumor Iin Ikiddos o MC Icause Iof Ideath Iin Ikiddos o Types: ▪ Gliomas • Supportive Itissues Iin Ibrain Ior Ispinal Icord • MC Itype • Extremely Ipoor Iprognosis ▪ Meningiomas • Arise Iin Imeninges • Slow Igrowing; Ibetter Iprognosis ▪ Pituitary Iadenomas • Mimic Idiabetes Iinsipidus o Who’s Iat IRisk? ▪ Genetics Imay Iplay Ia Irole ▪ Kiddos Iwho Ihave Ihad Iprior Icranial Iradiation Iexposure o Pathophysiology ▪ Tumor Igrows ▪ Edema Idevelops Iin Isurrounding Itissues ▪ Increased Iintracranial Ipressure o Locations: ▪ Infratentorial—MC; I60% • Ataxia, Ivisual Idisturbances, Idelayed Ior Iprecocious Ipuberty, Iand Igrowth Ifailures ▪ Supratentorial • Personality Ichanges, Iseizures ▪ o Clinical IManifestations: ▪ Headache—MC Isign Ito Ibe Iaware Iof; Ichildren Idon’t Iget IHA Ithe Iway Iadults Ido Iso IHA Iis Ia Igood Itell Ithat Isomething Iis Igoing Ion ▪ Vomiting • Unrelated Ito Iany Ifood Ior Idrink Iconsumption; • Neuro Icause—typically Ichild Iwill Ithrow Iup Iand Iimmediately Iask Ifor Isomething Ito Ieat Iafter Ib/c Iit’s Inot Iassociated Iwith IGI • MC Iin IAM Iwhen Ikiddo Iis Iwaking Iup Isince Ikiddo Iis Igoing Ifrom Ihorizontal Ito Ivertical—change Iof Iposition Iincreases Ithe Iintracranial Ipressure Ifurther ▪ Behavioral Ichanges ▪ S/sx Iof Iincreased Iintracranial Ipressure ▪ Loss Iof Ipreviously Iattained Idevelopmental Iskills • Esp. Iin Iyounger Ikiddos ▪ Decline Iin Ischool Iperformance ▪ Visual Idisturbances, Imuscular Iweakness Ior Iparalysis, Iaphasia, Idysphasia, Icoordination Iissues Iand Iseizures o Therapeutic IManagement: ▪ Surgery* ▪ Radiation ▪ Chemotherapy* • Drugs Iadministered Iintrathecally Iso Iit Ican Ireach ICNS o Nursing IManagement: ▪ Seizure Iprecautions ▪ Monitor ILOC, I CP, I /O I(including Ispecific Igravity) ▪ Post Iop Ipositioning • Infratentorial o Position Ihead Iflat Ion Ieither Iside Iwith Ineck Islightly Iextended • Supratentorial o Elevate Ihead Iabout I30 Idegrees Ito Iensure Ioptimal Idrainage Iand Imaintain Ia Ineutral Iposition Ito Iavoid I ICP o Ventriculoperitoneal Ishunt—goes Ifrom Ibrain Idown Ito Iabdomen Iso Iextra Ifluid Ihas Iplace Ito Igo Iand Ikeeps Iit Ioff Ibrain; Ibody Igets Irid Iof Iit ▪ Maintain Iintegrity Iof Iventriculoperitoneal Ishunt ▪ Eye Icare—keep Ihydrated ▪ Pain Irelief—careful Imedications Idon’t Isedate Ithe Ikiddo—can’t Itruly Iassess Ikiddo’s IICP Iif Isedated ▪ Assess Isensory-perceptual Istatus ▪ Surgical Isite • Outline Ithe Ivarious Itypes Iof Ibone Icancers Iseen Icommonly Iin Ithe Ipediatric Ipopulation Iincluding Ithe Iclinical Imanifestations, Itherapeutic Iand Inursing Imanagement Iincluding Iamputation o Tumor Ior Ineoplasm Iinvolving Ithe Iskeletal tissue o Causes ▪ Primary • Original Isite—15% Iof Icases ▪ Metastatic • Originating Ifrom Ianother Isite o Osteosarcoma: ▪ Most Icommon Iform Iof Iprimary Ibone Itumor ▪ Little Iboys I10-25 Iyears Iof Iage ▪ Originate Iin Ithe Imetaphysis Iof Ilong Ibones • Femur, Itibia, Ihumorous ▪ Rapid Igrowing ▪ 15-20% Ihave Imetastasized Iby Itime Iof Idiagnosis; Iif Idiagnosed Ibefore Imetastasis—75% Isurvival Irate; I30% Isurvival Irate Iafter Imetastasis o Ewing’s ISarcoma: ▪ Rapidly Imetastasizes Ito Ilungs—“lungs Ilook Ilike IeWING’S” ▪ Originates Iin Inerve Itissue Iwithin Ibone Imarrow ▪ 10-25 Iyear Iolds; Imostly Iin Iteens ▪ Pelvis, Ihumorous, Ifemur Iand Iribs ▪ No Imetastasis—prognosis Iis I50-60% ▪ After Imetastasis—prognosis Igoes Idown Ito I25% o Pathophysiology: ▪ Growth Iof Ineoplastic Icells Icauses Iosteolysis ▪ Destruction Iof Inormal Ibone ▪ Bones Ibecome Iweak—pathological Ifractures o Clinical IManifestations: ▪ Pain Iand Iswelling Iat Isite Iof Itumor ▪ IROM ▪ Neuralgia Isecondary Ito Inerve Icompression ▪ Palpable Imass ▪ Pathologic Ifractures o Therapeutic IManagement: ▪ Radiation ▪ Chemotherapy* ▪ Amputation* o Nursing IManagement: ▪ Emotional Isupport ▪ Straight Iforward Iapproach Iwhen Iamputation Iis Iindicated • Elevate Istump Ifor I24 Ihours Ibut Iavoid Iprolonged Ielevation • Maintain Ibody Ialignment • Perform Irange Iof Imotion Ito Ijoint Iabove Iamputation • Assist Iwith Iprosthetic • Encourage Iearly Iinteraction Iwith Ipeers • Outline Inursing Iresponsibilities Iassociated Iwith Ithe Icare Iof Ithe Ichild Iwith Ia neuroblastoma. o Solid Itumor Ioutside Ithe Icranium Ioriginating Iin Iprimitive Ineurocrest Icells o Congenital; Idiagnosed I18-24 Imonths Iof Iage ▪ Explain Iloss Iof Idepth Iperception GASTROINTESTINAL IDISORDERS: • Children Ihave Iincreased Iperistalsis, Iand Iincreased Iemptying Itime. o This Imakes Ithem Imore Iprone Ito Idiarrhea. o I Kids Ido Inot Ineed Ito Ibe INPO Iprior Ito Isurgery Ias Ilong Ias Iadults Ido. o Sphincters Iare Imore Irelaxed, Iwhich Imay Icause Iproblems. ▪ Acidity Iis Ilower Iin Ipediatric Ipatients Ithan Iin Iadults, Iand Isince Isphincters Iare Irelaxed, Iand Ireflux IWILL Ihappen, Ithe Ilower Iacidity Imakes Ifor Ia Iless Ipainful Ireflux Isituation Ithat Iis Iless Idamaging Ito Iesophageal Itissue. o Liver Iis Iimmature, Iso Imetabolism Iof Icertain I Isubstances I Imay I Ibe Idelayed Ior Idifficult, Iand Ithey Ican Ibecome Ijaundice. • Describe Ithe Iprocess Iof Ifluid Ibalance Iwithin Ithe Ibody, Ithe Imanifestation Iof Iimbalance Iand Ithe Inursing Icare Iof Idiarrhea Iand Ivomiting o Fluid IVolume IExcess I(FVE) I-Hypervolemia ▪ Excessive Ifluid Iin Ithe Iextracellular Ispace ▪ Types: • Isotonic: o Gaining Iand/or Ilosing Ithe Isame Iamount Iof Isolutes Ialong Iwith Ithe Iwater. IFluid/solutes Iare Ikept Iin Iproportion, Ior Iat Ithe Isame I%. o No Icell Ishrinkage Ior Iswelling Iin Ian Iisotonic Ichange. o Often Icaused Iby: ▪ Renal Ifailure ▪ Heart Ifailure ▪ Hypersecretion Iof Ialdosterone, Ior Isome Icorticosteroids. • Hypotonic I(AKA IWater Iintoxication) o More Ifluid Iis Igained Ithan Isolutes. o Leads Ito Ia I“relative” Ideficit Iof Isodium o Because Iof Ihypotonic Istate Iof Iextracellular Ispace, Iwater Iis Ibeing Ipulled Iinto Ithe Icells Ito Itry Iand Imaintain Isodium Ibalance. o Causes Icell Iswelling o Caused Iby: ▪ Repeated Iplain Iwater Ienemas, Ibladder Iirrigation, ING Iirrigation. I(NS Iis Iisotonic, Iand Iwouldn’t Icause Ithis) ▪ Too Imuch Iwater Iintake. • Often Iseen Iin Ipeds Ipatients Iwhen Ifamily Idilutes Iformula Iwith Iwater. ▪ Overuse Iof Ihypotonic IIV Ifluid. ▪ Psychogenic Ipolydipsia: I Individuals Iworried Iabout Iweight Ithat Idrink ITONS Iof Iwater Iin Ihopes Ithat Iit Iwill Imake Ithem Ilose Iweight. ▪ SIADH…classic. ▪ Clinical IManifestations: • Rapid Iweight Igain o Not Ias Isignificant Iof Ian Iindicator Iin Ipeds Ibecause Ithey Igain Iweight Irapidly. o Daily Iweights Iare Ithe Ibest Iindicator Iof IF/E Ibalance, Ior II&O Ibalance. o Significant Iweight Igain Iof I2-3lb Iovernight-few Idays. • Bounding Iperipheral Ipulses • Warm Iextremities • Peripheral Iedema • High Icentral Ivenous Ipressure • Pulmonary Iedema • JVD o Fluid IVolume IDeficit I(FVD) I(Mild, Imoderate, Isevere Idehydration Isee ITable I23-5) ▪ Fluid Iintake Iis Iless Ithan Ifluid Ioutput ▪ Types: • Isotonic: IGaining Iand/or Ilosing Ithe Isame Iamount Iof Isolutes Ialong Iwith Ithe Iwater. IFluid/solutes Iare Ikept Iin Iproportion, Ior Iat Ithe Isame I%. o Caused Iby: ▪ Hemorrhage..typical IGI Ilosses Iwill Icause Ithis. • Ex: IVomiting. ▪ Large Iamounts Iof Iwound Idrainage. ▪ Burn Ivictims. • Hypertonic: IMore Iwater Ilost Ithan Isolutes. IFluid Imoves Iout Iof Icells Iinto Iextracellular Ispace. o Caused Iby: ▪ Not Itaking Iin Ienough Iwater I(“Dehydration”)- IMost Icommon! ▪ Diabetes I nsipidus ▪ Increased Isolute Iintake I(too Imuch Isalt, Iprotein, Ietc)…RARE. ▪ Clinical IManifestations: • Moderate: o Flushed Idry Iskin o Dry Imucous Imembranes, Itenting o Concentrated Iurine o Thirst • Severe: o Cold, Iclammy Iskin o Dry Icracked Itongue o Sunken Ieyeballs o Postural Ihypotension o Lethargy o Vomiting ▪ Forceful Iejection Iof Igastric Icontents Ithrough Imouth ▪ Etiology Ican Ibe Idetermined Iby: • Child’s Iage • Pattern Iof Ivomiting o When Idoes Iit Ioccur? IRight Iwhen Ichild Iwakes Iup? IRight Iafter Ithey Ieat? I2 IHours Iafter Ithey Ieat? ▪ If Iit Ioccurs Iwhen Iupon Irising, Igood Ichance Iits Ineurological. ▪ After Ieating, Icould Ibe Iviral Iinfection Ior Ifood poisoning Igoing Ion. • Consistency Iof Ivomitus o Diarrhea o Green, Ibilious Ivomit= ISome Ikind Iof Ibowel Iobstruction ▪ In Iorder Ito Ihave Ibile Iin Ithe Ivomit, Ithen Ifood Isubstances Ior Iparticles Imust Ihave Iat Ileast Ireached Ithe Ismall Ibowel. IThis Iis Iindicative Iof Ia Ibowel Iobstruction. o Curdled Istomach Icontents= Itypically Isome Ikind Iof Iinfection. IViral Iagents Iwill Icause Ieither Iincreased Ior Idelayed Igastric Iemptying. ICould Ialso Imean Igall Ibladder Iissue, Iespecially Iafter Ia Ifatty Imeal. o Coffee Iground Iemesis= IAssociated Iwith Ilower IGI Ibleed, Ipartially Idigested Iblood. o Hematemesis I(bright, Ifrank, Ifresh Iblood) I= IAssociated Iwith Iupper IGI Ibleed. • Associated Isymptoms o Fever I& IDiarrhea Iw/vomiting= IProbably Iinfection. o Vomiting I& IConstipation= IProbably Iobstruction o Vomiting Iw/localized Iabdominal Ipain= IMay Ibe Ipancreatitis, Iappendicitis, Ipeptic Iulcer Idisease. o Vomiting Iw/change Iin ILOC Ior Isevere Iheadache= IOften Ia ICNS Iproblem. o Vomiting Ilarge Iamount Iupon Irising Ifrom Inaptime Ior Ibedtime, Iand Ihungry Iand Iwant Ito Ieat Iright Iafter Iw/no Inauseausness= INeurological Iproblem, Inot IGI Iproblem. o Projectile Ivomiting= IClassic Ipyloric Istenosis. ▪ Leading Icause Iof Ideath Iand Imorbidity Iin Ichildren Iworldwide. ▪ Frequent, Iwatery, Iloose Istools ▪ Increased Iintestinal Imotility Iand Irapid Iemptying Iresults Iin Iimpaired Iabsorption Iof Inutrients Iand Iexcessive Iexcretion Iof Iwater Iand Ielectrolytes o Nursing Icare Ifor IV I& ID ▪ Nursing IDiagnosis: • Altered Inutrition • Fluid Ivolume I deficit • Risk Ifor Iinfection • Altered Iskin Iintegrity ▪ Therapeutic IManagement: • Oral Irehydration Itherapy…just Ias Ieffective Ias IIV Irehydration. IThis Iis Ithe I1st Ioption Inow! IPedialyte Ior Isimilar. • Frequent Ismall Iamounts I– I1-3 Iml IQ I10-15 Iminutes o Gastric Irest Iis Inot Ineeded Iwith Ithis Itype Iof Itherapy. • Antiemetic, Iantidiarrheal, Iantibiotics Ias Iordered • BRAT Idiet Iis Ino Ilonger Ipreferred Imethod Iof Ireintroducing Ifoods. o Let Ithe Ichild Ichoose Iwhat Ithey Iwant Ito Ieat Iand Iadvance Ithemselves. ▪ Nursing IManagement: • Weigh Ichild Ion Iadmission Iand Idaily • Monitor II/O • Good Iskin Icare o Who’s Iat IRisk? ▪ First Iborn Imale ▪ 5 IX IMore Icommon Iin Imales Ithan Ifemales. ▪ Children Iof Iparents Iwho Ihad Ithis Icondition Iare Imore Ilikely Ito Ihave Iit Ialso. ▪ More Icommon Iin Ifull Iterm Ibabies Ithan Ipre-term. ▪ Age Iof Ipresentation Iis I8-12 Iweeks. o Pathophysiology: ▪ Pylorus Inarrows ▪ Obstruction Iat Ipyloric Isphincter ▪ Gastric Idistention, Idilation Iand Ihypertrophy o Clinical IManifestations: ▪ Progressive, Iprojectile, Inon-bilious Ivomiting. • Increasing Ivomiting, Iand Ieventually Ichild Iwill Ieat Iand Iimmediately Ivomit Ibut Iwill Istill Ibe Istarving Ibecause Ino Ifood Iis Imaking Iit Iinto Ithe Iintestines. ▪ Palpable Iolive Iin IRUQ…this Iis Ithe Ipyloric Istenosis. ▪ Vomit Iis Iliterally Iregurgitated Iformula Ior Ibreast Imilk. INo Icurdling, Ino Ibile Icolor. IHasn’t Ibeen Iin Ithe Istomach Ilong Ienough, Iand Ican’t Ireach Ismall Iintestines. ▪ Child Iis Ioften Iso Ithin, Ithat Iyou Ican Isee Ireverse Iperistalsis Ifrom ILUQ Ito IRUQ. ▪ Classic Idehydration Isymptoms, Iand Iwhen I it Igets Isevere Ienough, Ichild Iwill Ibe Iin Imetabolic Ialkalosis. • No Iwet Idiapers, Ican’t Icry Itears, Isunken Ifontanels. o Therapeutic IManagement: ▪ Correct Ifluid Ivolume Ideficit. ▪ Surgery: IPylorotomy Ito Iopen Isphincter. ▪ NG Itube Ito Ilow Icontinuous Isuction Iafter Isurgery. o Nursing IManagement: ▪ Assessing Ihydration Istatus ▪ IVFs Iuntil Itaking IPO Iwell ▪ Start IPO Ifeeding Isoon Iafter Isurgery, Iand Islowly Iincrease. ▪ NG Ipatency o • Discuss Ithe I pathophysiology, I manifestations I and Itherapeutic I management I of Ia Ichild Iwith Iintussusception o Telescoping Iof Ia Ibowel Isegment Iinto Iitself o Who’s Iat IRisk? ▪ Usually Ioccurs Iat I6mo Iof Iage. ▪ More Icommon Iin Iboys ▪ May Ibe Irelated Ito Iviral Iinfection. ISeems Ito Ibe Imore Icommon Iin ISpring Iand ISummer. o Pathophysiology: ▪ Invagin*tion Iof Ibowel ▪ Inflammation Iand Iswelling ▪ Bowel Iobstruction ▪ Necrosis Iis Ipossible o Clinical IManifestations: ▪ Intermittent Iattacks Iof Ivery Icolicky Ipain. ▪ Pain ▪ Emesis Icontaining Ifecal Imaterial ▪ Passage Iof Ired Icurrant Ijelly-like Istools I(Blood Iand Imucous Imixed Itogether) ▪ Palpate Ithe I“sausage Ilink” o Therapeutic IManagement: ▪ NG Itube Ito Idecompress Ithe Iintestines. ▪ Hydrostatic Ireduction. • Air Ibolus Ior Ibarium Ienema Ifrom Ithe Ibottom Iup I(rectum Iup), Ito Itry Iand Ipull Ibowel Iout. IWatch Ito Iensure Ithat Iit Idoes Inot Ihappen Iagain; Ibecause Iwhere Ithe Ibowel Iis Iweakened Iit Imay Ihappen Iagain. ▪ Surgical Ireduction: IIf Iother Ioption Idoes Inot Iwork. IHopefully Ithe Ibowel Ican Ijust Ibe Ipulled Iout, Ibut Iif Inecrosis Ihas Ioccurred Ithen Isome Ibowel Imay Ineed Ito Ibe Iremoved. o Nursing IManagement: ▪ Close Imonitoring Iof IVS Iand II&O ▪ Monitor Istools ▪ Advance Idiet Iwith Ireturn Iof Ibowel Isounds ▪ Manage Iand Imonitor ING Itube ▪ Keeping Ithem Ion Iantibiotics Ibecause Iof Imanipulation Iof Ibowel. • Discuss Ithe Ipathophysiology, Iclinical Imanifestations Iand Itherapeutic Imanagement Iof IHirschsprung’s Idisease. o Congenital Ianomaly Iresulting Iin Ia Ilack Iof Iganglionic Inerve Icells Iin Ipart Iof Ithe Icolon o Who’s Iat IRisk? ▪ More Icommon Iin Iboy Ibabies. ▪ Down Isyndrome. o Pathophysiology: ▪ Lack Iof Iinnervation Ito Ipart Iof Icolon, Itherefore Icolon Icannot Ihave Iperistalsis Ithere. ▪ Accumulation Iof Iintestinal Icontents ▪ Distention Iof Ibowel Iproximal Ito Idefect. ▪ Force Iof Iperistalsis Iproximal Ito Idefect Imay Ieventually Icause Ia Istool Ito Imove Ion Ithru. ▪ Newborn Imay Inever Ipass Imeconium Istool Iif Ithe Iamount Iof Ibowel Iaffected Iis Ilarge; Iand Imay Ibe Ihesitant Ito Ieat Ibecause Ibowel Ihas Inever Ibeen Iemptied. ▪ Abdominal Igirth Iis Imeasured Iat Ibirth Iand Imonitored. o Clinical IManifestations: ▪ Constipation ▪ Liquid Ior Iribbon-like Istools ▪ Distended Iabdomen ▪ FTT/weight Iloss ▪ Episodic Idiarrhea Ibecause Ias Iconstipation Iincreases, Ithe Iperistalsis Iproximal Ito Iobstruction Iincreases, Iand Iwhatever Ican Ibe Ipushed Ipast Ithe Iobstruction Iwill Ibe Ieven Iif Iit Iis Ionly Ifluid. ▪ Classic Istool Iis Ieither: ILiquidy Idiarrhea Ior Iribbon-like Istool I(because Iit Iis Isqueezed Ipast Ithe Iobstruction). ▪ Hyperactive Ibowel Isounds Iproximal Ito Iobstruction Iand hypoactive Ior Iabsent Idistal Ito Iobstruction. o Therapeutic IManagement: ▪ Enemas: IDaily Ito Ikeep Ibowel Iempty, INormal ISaline. ▪ Digital Iexams Ito Ihelp Iexpand Isize Iof Ianus Ito Ideal Iwith Iexpanded Isize Iof Istool. ▪ Surgery Ito Iremove Ideadened Ipiece Iof Ibowel. IOften Ihave Ito Ido Icolostomy, Iand Ithat Imay Ibe Ireversed Iif Ibowel Iis Iworking Icorrectly Iafter Ia Icouple Iyears. o Nursing IManagement: ▪ Assess Ibowel Ifunction ▪ Abdominal Icircumferences ▪ Assess Ihydration Istatus ▪ Colostomy Icare/education ▪ African-American Ibabies o Types: ▪ Umbilical: IAnywhere Iaround Ithe Iumbilicus Idue Ito Ithe Imuscles Ito Inot Iclosing Iat Ibirth. ILeaves Ithe Iability Ifor Ithe Iintestines Ito Ipush Ithru. ITends Ito Iget Iworse Iwhen Ichild Iis Icrying, Icoughing, Istraining Ito Ihave Ia IBM. ▪ Inguinal: IProtrusion Iin Ithe Iarea Iwhere Ithe Itestes Idescend Ifrom Ithe Iabdomen Iinto Ithe Iscrotum I(inguinal Icanal). ITypically Iafter Itestes Idescend, Ithe Icanal Iatrophies. IIf Iit Idoes Inot, Ithen Ithis Imay Ihappen. ▪ Incarcerated: IStrangulated Ibowel Iin Ia Ihernia. o Clinical IManifestations: ▪ Bulge Iat Ithe Iumbilicus ▪ Bulge Ion Ieither Iside Iof Ipelvic Ibone o Therapeutic IManagement: ▪ If Idoes Inot Iclose Ion Iown Iby Ithe Itime Ichild Iis I1yr Iof Iage. ISurgery Iif Iit Idoesn’t Iresolve Iby I3-4 Iyears Iof Iage. ▪ Typically Ihernias Iare Inot Ipainful Iunless Ithey Iare Iincarcerated. DO INOT IMANIPULATE IA ISTRANGULATED IHERNIA. IThis Iis Ia surgical Iemergency, Iso Iprep Ikid Ifor Ipre-op. I(HESI Isays Ito Imanipulate…remember!) o Nursing IManagement: ▪ Educate Ithat Iuse Iof Ibinders Idoes Inot Ihelp ▪ Monitor Ifor Ichange Iin Isize ▪ Monitor Ibowel Isounds Iand Ichange Iin Ibowel Ihabits • Identify Ithe Ietiology Iand Iclinical Imanifestation Iof INEC Iand Idescribe Ithe Icare Iof Ithe Iinfant Iafter Ibowel Iresection. o Necrotic Ilesions Iof Ithe Imucosa Iof Ithe Iintestines o Long-term Icomplication Iof Ifight Ior Iflight Iresponse. IBlood Ishunts Ito Icore Iorgans Iand Iaway Ifrom Iintestines. IIntestines Ibecome Iischemic, Iand Ieven Iif Ithey Ido Inot Ibecome Inecrotic, Ithey Iare Istill Imore Isusceptible Ito Ibacterial Iinfection. IMay Ilead Ito Ibowel Iperforation. o Who’s Iat IRisk? ▪ Premature Ibabies I(micro-preemies, Iborn I25-27 Iweeks Iof Igestation), Ioccurs Iseveral Iweeks Iafter Ibirth. o Pathophysiology: ▪ Intestinal Iischemia Idue Ito Ishunting Iof Iblood o Clinical IManifestations: ▪ Temperature Iinstability ▪ abdominal Igirth ▪ gastric Iresiduals ▪ Ior Iabsent Ibowel Isounds ▪ Grossly Ibloody Istools ▪ Bowel Isounds Ihyperactive Iabove INEC, Iand Iabsent Ibelow INEC. ▪ Palpable Ibowel Iloops Ibecause Ithey Iare Ienlarged. ▪ Bile Imay Ibe Iseen Iin Ivomit. o Therapeutic IManagement: ▪ Antibiotics ▪ Intestinal Irest; Iput Ithem Ion ITPN I& Ilipids. ▪ Surgery o Nursing IManagement: ▪ Early Idetection • Observing Itolerance Iof Ifeeding, Ichecking Ipre-gastric Iaspirates. ▪ Frequent Iabdominal Igirths ▪ Observe Itolerance Iof Ifeedings • Describe I pathophysiology, I manifestations, I management I and I family I teaching Iplan Ifor Ia Ichild Iwith: o Celiac Idisease ▪ Chronic Iinability Ito Itolerate Ifoods Icontaining Igluten ▪ Who’s Iat IRisk? • Inherited Ipre-disposition, Ibut Inot Isure Iif Iits Igenetic. ▪ Pathophysiology: • Intestines Icannot Iprocess Igluten • Intestinal Iwall Iis Idamaged • Absorption Iof Inutrients Iand Ivitamins Iis Iaffected o First: IFat, o Then: IProtein Iabsorption, o Then: ICarbohydrate Iabsorption, o Last: IVitamin Iand IMineral Iabsorption I(Including IADEK-the Ifat Isoluble Ivitamins- Iand IK Iis Iimportant Ifor Iclotting, Iso Ibleeding Imay Ibe Ian Iissue I(like Ibruising).) ▪ Clinical IManifestations: • Steatorrhea • Bloating • Muscle Iwasting • FTT • Bruising, Ianemia, Ibleeding Itendencies. ▪ Celiac ICrisis: • Acute Iepisodes Ior Iflare-ups Ithat Iare Itypically Iprecipitated Iby Iinfection, Iingestion Iof Igluten, Iexposure Ito Icertain Ianticholinergic Idrugs, Istress Ifatigue. IMassive Ielectrolyte Iimbalance, Irapid Idehydration, Iand Iultimately Isevere Imetabolic Iacidosis. IHospitalization Iis Iusually Irequired. ▪ Therapeutic IManagement: • Gluten-free Idiet o No IBROW I(Barley, IRye, IOat, IWheat) o Many Icosmetic Iproducts/hair Iproducts Icontain Igluten…watch Iout Ifor Ithose! • Folate Isupplements • Iron Isupplements • Vitamin IA I& ID Iin Iwater-soluble Iforms ▪ Nursing IManagement: • Small Ifrequent Imeals • Monitor Ifor Isteatorrhea ▪ o Crohn’s Idisease ▪ Chronic Iinflammatory Icondition Iwith Ipatchy Iareas Iof Iinflammation Ianywhere Iin Ithe Ientire IGI Itract ▪ Who’s Iat IRisk? ▪ Pathophysiology: • Inflammatory Ilesions Ioccur I(skip Ilesions) • Granuloma I development o Bowel Iwall Ibecomes Ivery Icongested Iand Ithickened, Iand Imay Iactually Idevelop Iinto Ian Iabscess. o Scar Itissue Imay Ioccur, Iand Ican Iinterfere Iw/movement Iof Igastric Icontents. • Scar Itissue Imay Iinterfere Iwith Imovement Iof Ichyme • Perforation Ior Iobstruction Imay Ioccur • Affects Iall I3 Ilayers Iof Imucosa. ▪ Clinical IManifestations: • Abdominal Ipain • Diarrhea • Decrease Iin Iappetite • Massive Idiarrhea, Istetorrhea Itype, Iup Ito I20x Iper Iday. • N/V