Chpt.32- Care of the child with a physical/mental & cognitive disorder

Cystic fibrosis etiology-

Disorder characterized by excessive thick mucus that obstructs the lungs and GI tract

In Cystic Fibrosis, sodium chloride concentrations in the sweat and saliva are-

Elevated due to abnormal reabsorption of chloride be epithelial cells

Cystic fibrosis s/s-

*Steatorrhea (bulky, foul smelling, fatty stools)*Chromic coughing, wheezing, sputum production, and dyspnea*Child may taste salty when kissed

Croup/ Epiglottis etiology-

Laryngotracheobronchitis and acute epiglottis

Croup/ Epiglottis can lead to-

Total airway obstruction*put child in upright position

Croup/ Epiglottis s/s-

*Stridor*Barking cough*Epiglottis- drooling

Croup medical management-

High cool mist humidity w/ low concentration oxygen by mist tent; epinephrine by aerosol*Never examine mouth and throat (will cause spasm)*Artificial airway; as needed

Epiglottis medical management-

Apply oxygen *cool mist tent-humidifies air and decreases stridor

Nursing interventions for Croup/ Epiglottis-

Maintain Fowlers position

Hypertrophic Pyloric Stenosis etiology-

Gastric outlet obstructed by a congenitally hypertrophied (enlarged) pyloric muscle

Hypertrophic Pyloric Stenosis s/s-

Projectile vomiting after feedings - hallmark sign*Olive shaped mass in the epigastrium

Intussusception etiology-

Results of telescoping of one portion of the intestine into another

Intussusception s/s-

Vomiting and lethary*Jelly stool (Mixed with blood and mucus)- hallmark sign

Intussusception medical management-

Surgical; after surgery give infants oral electrolyte solution (contains glucose and electrolyte)

Hischsprung's disease etiology-

No peristaltic waves in the affected portion*Causes intestinal obstruction and distention of the bowel

Hischsprung's disease s/s-

Ribbonlike, foul-smelling stools

Hischsprung's disease medical management-

Surgical removal of the affected portion of the bowel

Hischsprung's disease nursing interventions-

May require a temp ostomy to relieve obstructed area and allows the bowel distal to the ostomy to rest

Cleft lip/Cleft palate for nursing interventions-

*Special feeding devices may be used*Minimize crying- pulls incision line causing inflammation and risk for scar formation- rock infant with favorite planet

Gastroesophageal reflux etiology-

Gastric contents are allowed to regurgitate into the esophagus

Gastroesophageal reflux s/s-

*Vomiting or spitting up*Weight loss

Gastroesophageal reflux medical management-

*Small, frequent feedings that have been thickened with infant cereal *Child placed in upright position after feeding

Gastroesophageal reflux nursing interventions-

Teach parents to provide proper positioning after feedings; upright position in infant seat*Nissen fundoplication


Candidiasis (opportunistic infection)

HIV/AIDS; Greatest threat to an HIV infected infant under 1 year of age is-

Pneumocystis jiroveci (formally carinii)

Sudden Infant Death Syndrome (SIDS) etiology-

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

SIDS s/s-

Death occurs during sleep, and there is no audible outcry or signs of distress

SIDS prevention-

American Academy of Pediatrics recommend that infants be placed supine or on the side (nonprime) for sleeping

Dehydration s/s-

Loss of skin tumor; dry mucus membranes; sunken eyes; lethargy; rapid, weak pulse; low BP; rapid respirations

Dehydration medical management-

*Same management as diarrhea*Check specific gravity*Potassium (3.6 to 5.2 mol/L)*Report to MD if abnormal

Dehydration nursing interventions-

Assess the fontanels (sunken)

Urine specific gravity-

1.010 (hydration)1.030 (dehydration)

Child maltreatment etiology; Child factors (Age, disabilities)-

These factors may increase the potential for maltreatment by a parent or caretaker

Child maltreatment s/s-

Children who have been abused or neglected may manifest certain physical and/or behavioral indicators that suggest maltreatment

Child maltreatment/ Child abuse nursing interventions-

*Special attention should be paid to injuries inconsistent w. the parents or caregivers explanation *All states have regulations for mandatory reporting if HCP suspects

Nurse is collecting data and noticed a bruise-

Obtain a detailed history then report the abuse