Infant and Toddler Acute/Long Term Illness
Infant and Toddler Acute/Long Term Illness NUR 349
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This 9 page Class Notes was uploaded by Nicole Raynor on Thursday August 25, 2016. The Class Notes belongs to NUR 349 at Molloy College taught by Paraszczuk in Fall 2016. Since its upload, it has received 4 views. For similar materials see HumanistChldFam in Nursing and Health Sciences at Molloy College.
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Date Created: 08/25/16
Toddler with Acute or LongTerm Illness Urinary Tract Infection o Common in males – uncircumcised o Females and young children have shorter urethras o Cause: Infrequent voiding (Toddler’s that are potty training have that sense of autonomy – they want control) o Important to identify and treat to prevent systemic spread and preserve renal function – urinary tract is short can quickly travel to kidneys and cause pyelonephritis o Presentation of symptoms changes when children mature Lower UTI symptoms: Younger children: Fever, irritability, foulsmelling urine (easy to detect when they wear diapers and are assisted to the bathroom) Older children: enuresis (bedwetting), dysuria (painful urination), urgency, frequency, incontinence if toilet trained Urgency and frequency are hard to see in younger kids because they are not potty trained and do not have the verbal skills to communicate that there is burning when they urinate o Upper UTI Signs (kidneys involved) High fever, chills, abdominal pain Flank pain Costoverebralangle tenderness o Nursing Management: Clean urine collection (privacy needs) – can be challenging in younger kids Culture and sensitivity test Monitor I&O Encourage fluids and frequent voiding Patient Education (Prevention): Wipe front to back Hand washing Discourage holding urine Cotton underwear – less moisture, more breathable Shower instead of tub Incomplete Emptying/ Vesicoureteral Reflux o Associated with recurring kidney infections o Contraction of bladder allows some amount of urine to flow up into ureters o If it is mild – it is usually outgrown o Reimplantation surgery if severe Treatment: Low dose antibiotics Treatment of infection (high fever) Surgical repair o Teach: importance of taking prophylactic antibiotics Nephrotic Syndrome o Glomerular membrane change (filtering system is under attack causing changes Massive proteinuria – permeable to proteins Protein is eliminate through urine Hypoalbuminemia – serum albumin decreases Edema – fluid shifts and water is retained Fluid goes into tissues Hyperlipidemia Decrease immunity – immunoglobulin’s are excreted with protein Clinical Manifestations: Rapid weight gain Edema in the face Fluid is in the tissues decreased urine output Ascites Parents might complain that the clothing on child is tight fitting Prognosis: Edema Remission without long lasting effects Considered in remission when the urine is up to trace for protein for 5 – 7 days Management: Aim at cause Sodium restrictions if edema is present or on a steroid (don’t want to retain more fluid) Medications: Prednisone – for tapering the immune system Immunosuppressant therapy (Cytoxan) Diuretics, antibiotics (prevent infections because immune system is compromised) Nursing Management: Monitor: I&O VS – heart rate and respirations elevated, BP not Proteinuria Daily weights Edema – change position q 2 hr Abdominal girth Skin – breakdown b/c of edema Signs of infection Promote rest, nutrition – stress reduction, quiet activities Family Issues: Social isolation – separated from pears Lack of energy, immunosuppressed, change in appearance (body image) due to edema Kawasaki Disease o Acute systemic vasculitis – blood vessels are inflamed o 3 distinct phases: acute, subacute, convalescent o Diagnosed by symptoms: Fever (> 102.2) & 1 of these: Conjunctivitis Change in oral mucous (strawberry tongue) Edema –then peeling of hands and feet Rash, enlarged lymph nodes Alterations in blood values (increase in platelets, ESR and CRP) – not used alone to diagnose – used in addition to others o FEBRILE Fever Extermity changes/edema Bulbar conjunctivitis Rash Internal organ involvement Lymphadenopathy (enlarged lymph nodes) Enanthem (alteration of mucose internally) Nursing Management: Cardiac sequelae can occur formation of coronary artery dilation or aneurysm Treatment: high dose IV gamma globulin If not effective or given fast enough – damage can occur Aspirin regular than lose dose will be continued Used only because of antiplatelet action Later on – narrowing of vessels can lead to heart attack! Communicable Diseases: Incidences have declines with immunizations These are childhood diseases – get them once and never again Give supportive care – treatment is not the focus Nursing Care: o Assess for symptoms o When suspected – important to assess Recent exposure Symptoms Constitutional symptoms (fever, rash) Immunity status (did the child have the vaccine?) o Incubation period – point of exposure until child develops signs and symptoms o Contagious communicability – right before rash occurs and until they are dry and crusted o Primary prevention – immunize o Control spread of disease to others Isolate unknown rash Hand washing Care of the Infant and Toddler with Acute and Long Term Illness Neurologic Development o Infant Brain 2/3 adult size at birth develops rapidly until age 4 growth complete by age 15 o Myelination Coordination Motor skills o Primitive Reflexes Assessment of Cerebral Function o Infants and young children: observe spontaneous and elicited reflex responses o Family hx, health history, physical examination Modified Glasglow Coma Scale o Assessment of eye opening, verbal, and motor responses o Maximum score of 15; minimum is 3 – indicating brain dead Intracranial Pressure (ICP) o Can cause damage when increased Early Signs: Child: headache/ change in normal behavior pattern Infant: bulging fontanel, increased head circumference Late Signs: Significant decrease in LOC Posturing Increased systolic BP and pulse pressure Bradycardia Irregular respirations (tachypnea) – CheyneStokes Fixed, dilated pupils Febrile Seizures o Transient disorder 3 months – 5 years old o More frequent in males o See in roseola, otitis, pharyngitis, adnenitis o Temp is usually > 101.8 o Seizure occur as temp is rising Treatment: Fever reduction Avoid tepid baths Vigorous use of antipyretics Protect child from injury during seizure Call 911 if seizure > 5 min duration Evaluate history (episodic and family) Anticonvulsants only if needed Nursing Care: Protect from injury Suction after seizure Protect the head – put something small like a folded towel under head Document CNS Infections o Lab studies require to identify causative agent – give antibiotic right away o Inflammation can affect meninges, brain or spinal cord – swelling Swelling of the meninges in a small enclosed space – increased ICP and decreased blood supply – pressure is forced downward Bacterial Meningitis o Acute inflammation of CNS o Caused by: streptococcus, meningicoccus, e. coli Clinical Manifestations (Children): Fever, chills, headache, dizziness, lethargy, vomiting, seizures, photophobia, nuchal rigidity, ataxia, tremors, As worsens: altered mental status, petechial or purpuric rash, +Kernig’s and Brudzinki signs As ICP increase vomiting, seizures, photophobia Amputation following because blood supply is compromised Toxins that bacteria produce cause periphery to constrict o Kernig’s and Brudzinki are not reliable ways of determining if they have meningitis – because it occurs less than 50% of the time Clinical Manifestations (Infants): Fever (or hypothermia) – may not have a high fever – will be come hypothermia because body can’t maintain body temperature while fighting off infection Poor feeding, vomiting, marked irritability, or lethargic, seizures, opisthotonic position (arching of back from irritation of spinal cord), bulging fontanel (b/c increased ICP) Transmission and Treatment: Droplet infection – if been with patient, then you have been exposed Infection in kidneys and through blood or septicemia that can spread to meninges Diagnosed by Lumbar Puncture Cerebrospinal fluid appears cloudy/milky or yellowish in color Treat infection (antibiotics), inflammation (steroids), and shock, maintain ventilation, reduce ICP, control seizure, fever and pain (b/c it increases ICP) Nursing Management: Patients are usually sedated because it helps decrease the ICP Culture and proteins Started on broad spectrum antibiotics FIRST Administer antibiotic ASAP after cultures are drawn and place on respiratory isolation until 24 hours after that first dose Good communication and maintaining patient isolation precautions Young children may have neuro sequela – hearing loss and vision impairment – cranial nerves can be impaired permanently Nursing Care: LOC is impaired safety and airway!! Reduce ICP: Frequent neuro checks – pupils Continuous ICP/BP monitoring o Do not want to see big swings Measure head circumference if under 2 Reduce stimuli (quiet room) Elevate the HOB – no pillow – lay flat, midline head b/c want to get blood down through the large veins in the neck If the patient is not alert – NPO Treatment of shock – monitor BP, vasopressor to keep adequate Sepsis Caused by bacteria, virus, fungal Kids can get neuro sequela – monitor – younger kids are more at risk Septicemia – kids ability to fight infection is harder Management: o Early identification: check for risk factors Bloodstream infection can lead to meningitis Work up infants who don’t “look good” o Antibiotics 710 days of IV antibiotics Pyloric Stenosis construction of pyloric sphincter with obstruction of gastric outlet seen when infants are older than 15 months st not evident in 1 couple of days sphincter over grows and gradually starts to obstruct infants are not happy because they are hungry and want to eat Diagnostic Evaluation: o Projectile vomiting – stomach full spasms o Olive like mass palpable – over where stomach meets intestines o Parent is going to complain of vomiting after every feeding Ask mother: any fever?, activity? If seems hungry, agitated, eat? Hydration status? Treatment: o Pyloromyotomy – prognosis is good Nursing Considerations: o PreOp: Fluid and electrolyte imbalance, weight loss – depending on how long this has been going on for Maintain NPO – IV therapy o PostOp Initiate feedings – make sure they can tolerate it Intussusception Intestine is folding on itself Compromise in blood supply necrotic tissue Distention very quickly can lead to perforation Early identification! Diagnosis: o Contrast enema – can be therapeutic because of hydrostatic pressure – can cause it to straighten out Helps to identify using air or normal saline may be helpful to diagnosis Nursing Considerations: Symptoms: Colicky pain (parent reports) abdominal mass currant jelly stools (blood dark red color) ask parent to save diapers, so you can inspect them vomiting Assess: hydration status – IV fluids bowel function – passage of normal brown stool – problem is solved Gastroesophageal Reflux (GER) transfer of gastric contents into the esophagus common in young infants because cardiac sphincter is not fully developed at rick because infants are on fluid diet usually will outgrow as get older if baby is thriving we don’t need to do that much about it frequency and persistency make it abnormal – if causing damage – then needs to be treated Diagnosed: o Upper GI Series – fluoroscopy o Endoscopy – if concerned about esophagus Management: o Change or thicken feeds – thickening food with rice cereal * o Positioning o Meds to reduce acid – ranitidine (zantac) Nursing: Parent teaching: Elevate head after feeding No pressure on abdomen after feeding Small and frequent feedings / burping Failure to Thrive (FTT) Growth delay Diagnosis: weight below 5% or failure to grow as expected Etiology o Organic – child has condition o Inorganic – neglect Careful interviewing – what are they eating etc. Therapeutic Management: o Aim at cause: Catchup growth Multidisciplinary approach – nutrition, social worker, etc. Hospitalize – abuse, dehydrated, severely malnourished We can hospitalize if we suspect abuse/neglect – in order to protect the child Nursing interventions for inorganic failure to thrive: o Observe parentchild interactions o Administer daily multivitamin supplements o Role model appropriate adultchild interactions
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