NURS 1400 Unit VI Common Childhood Illnesses Metro

NURS 1400 Unit VI Common Childhood Illnesses Metro Community College Nursing Program Nancy Pares, RN, MSN

Integumentary system • Tinea Corporis – Fungal infection; “body ringworm” – Occurs in non terminal, non hairy areas of body – Occurs in children of any age; acquired from animals

Tinea Corporis • Clinical manifestations – Annular, expanding lesion – Raised erythematous border – Scaly, clear center • Treatment – Topical: miconazole, clotrimazole(lotrimin) • Twice daily for 2 -3 wks – Oral: itraconazole, terbinafine

Infestations • Pediculosis: Head lice – Ectoparasites: live on the surface – Most common in 3 -10 years; greater in girls of caucasian origin – Classroom is primary source of infestation

pediculosis • Pathophysiology – Head to head contact: hats, combs, bedding – Lice crawl-do not fly or jump – Eggs(nits) attach to hair shaft with water insoluble glue usually in the auricular or occipital areas of the head – Nymphs emerge in 7 -10 days; lifespan=30 days – Brown in color, size of sesame seed

pediculosis • Clinical manifestations: itching • Diagnosis: identification of nits on scalp • Treatment: – Manual removal: less than 2 years of age – Permethin (Nix): > 2 years of age; kills lice and ova – Lindane (Kwell): > 2 years of age; less potent agent

Pediculosis • Nursing Management – Assessment: careful handwashing; done with hair wet; examine known areas; – Nursing diagnosis • Impaired skin integrity • Low self esteem • Deficient knowledge – Family teaching: treatment of household; notify schools and contacts

Scabies • Ectoparasite; significant world wide • Occurs at any age, most common <2 year old • Pathophysiology – Transmitted by close person to person contact – Burrow into the stratum corneum depositing feces – Females lay eggs in 2 -3 day intervals; hatch in 3 -8 – Adult mites are round, eyeless, life span of female is 2 months; male dies after mating

Scabies • Clinical manifestations – Inflammatory response, generalized pruritus which increases at night – Sites: skin surfaces that are opposing: axillary, cubital, • Diagnosis: microscopic exam of scrapings • Treatment : Permethrine cream(Elimite) – One application is usually sufficient

Scabies • Nursing management – Promotion of comfort – Prevention of secondary infections – Handwashing • Family teaching – All members of household need treatment – All clothes and bedding in hot water – Daycare: no attendance for 24 hours after treatment

Inflammatory disorders Acne Vulgaris • Predominately adolescent skin disease • Chronic condition; 85% of all adolescents • Pathophysiology – Accumulation of sebum in the pilosebaceous follicles which become very cohesive – Comedones are lesions of non inflammatory (white heads); open lesions are black heads

Acne vulgaris • Diagnosis: age and appearance of lesions • Treatment: – Individualized – Topical • Benzoyl peroxide, reinoids, azelaic acid, and abx – Systemic • Anbx, oral contraceptives, accutane

Acne vulgaris • Nursing management – Reduction of severity, supportive care, information about diet, hygiene, rest • Teaching – Educate about misconceptions – Avoid cosmetics

Hearing and Visual disorders • Hearing impairment – See page 1023 table – Congenital vs acquired – Classifications • • Conductive hearing loss Sensoneural hearing loss Mixed conductive sensoneural hearing loss Central hearing loss – Behavioral signs: pg 1025 table

Hearing loss • Diagnosis – Newborn screening – BAER (Brainstem Auditory Evoked Response) • Main test for hearing loss • Treatment: – Dependent on type of hearing impairment – Conductive: hearing aid – Sensoneural: cochlear implants – Sign language, lip reading, cued speech

Hearing loss • Nursing management – Assessment – Nursing diagnosis • Disturbed sensory perception • Delayed growth and development • Ineffective coping

Visual impairment • Binocularity: fixation of 2 ocular images, occurs at 6 months • Visual acuity: clearness of image: changes with age • Etiology – Eyeball mis proportioned – Damage to one or more parts of the eye interfering with visual process – Brain may not process information correctly

Visual impairment • Manifestations based on age: pg 1033 table • Diagnosis: Snellen chart; assessed indirectly with children< 3. . see page 1034

Impairment of muscular efficiency • Strabismus – Condition where the visual lines of each eye do not focus on the same object due to lack of muscle coordination; cross eyed appearance – Clinical manifestations • Clumsy, difficulty picking up objects, crossed eyes – Diagnosis • Hirshberg corneal light reflex, cover test, esotropia, hypertropia

strabismus • Treatment – Medical: • Occlusion dressing (eye patch), glasses, pharmacologic – Surgical • Children < 12 -18 months when medical did not work

strabismus • Nursing management – Early identification • Nursing diagnosis – Delayed growth and development – anxiety

Amblyopia (Lazy eye) • A reduction or loss of vision in one eye unrelated to an organic cause • Pathophysiology – Occurs in first 6 months of life – Brain is trained to compensate – If not corrected by age 7, restoration is minimal • Clinical manifestations; – Rare, child is unaware of any problem • Treatment: glasses

Respiratory disorders: Acute Epiglottitis • • Life threatening bacterial infection Also called ‘croup syndrome’ Can lead to complete airway obstruction Clinical manifestations – Respiratory distress, fever, sore throat, dysphagia, drooling, agitation, and lethargy, • Diagnosis: no spontaneous cough, DO NOT look in throat by depressing tongue

Acute epiglottitis • Nursing management – Anbx, fluids and supportive care – Have emergency equipment on had for tracheotomy.

Bronchiolitis • Acute, typically viral, infection of the bronchioles usually caused by RSV • Usually young children • Causes inflammation of the bronchioles • Wheezing is classic symptom with tachypnea • Complications – Apnea, atelectasis, secondary bacterial infection and respiratory failure

Bronchiolitis • Nursing management/diagnosis – Ineffective airway clearance – Deficient fluid volume – Deficient knowledge of caregivers • Planning /implementation – Family teaching – Acute setting focus on adequate ventilation and fluid balance

Bronchiolitis • Treatment/prevention – Ribuvirin (Virazole) is the only med for RSV bronchiolitis – Prevention drugs • RSV immune globulin (Respi. Gam) • Synagis – Administered monthly as an IM injection – First dose Usually given prior to RSV season

Asthma • Characterized by chronic inflammation, bronchoconstriction, and bronchial hyper responsiveness • Wheezing, coughing and dyspnea • Airways are damaged over time • Classified by severity of symptoms

Asthma • Categories – Mild intermittent – Mild persistent – Moderate persistent – Severe persistent

Asthma • Pharmacologic treatments – Short acting inhaled beta 2 agonists – Long acting inhaled beta 2 agonists – Leukotriene modifiers – Oral anti asthmatics – Methylxanthines – Systemic corticosteroids

asthma • Treatments – Avoid triggers – Regular peak flow monitoring – Medical follow up – Rapid access to medical care • Prevention – Avoid allergen exposure, warm up before exercising, relaxation exercises

Bacterial meningitis • Meningitis is inflammation of meninges • Causative agent is age dependent – Neonates: e coli, group b strep, H influenza, strep pneumoniae – Infants and children: H influenza type b, strep pneumoniae – Adolescent: Neisseria meningitis, strep pneumoniae

Asthma • Nursing management/diagnosis – Risk for suffocation – Ineffective airway clearance – Interrupted family processes

Bacterial meningitis • Clinical manifestation – Infants may have subtle symptoms – Child over 2 may have GI upset and cold like symptoms – Hyperactive reflexes – Kernigs sign: supine with hip flexed. . pain on resistance on extension of leg – Brudzinski sign; supine, flex head. . hip and knees will also flex

Bacterial meningitis • Diagnosis – CSF via lumbar punctures; fluid will be cloudy – Urine for culture, osmolarity, sp. Gravity – Chest x ray – CT/MRI • Treatment – Oxygen – Seizure precautions – Antibiotics/dexamethazone – isolation

Viral meningitis • Inflammatory response of the leptomeninges • Caused by non polio enterovirus; most occur in summer • Often associated with partially treated bacterial infections • Clinical manifestations – Not as ill as bacterial; general malaise, gradual onset, Kernig and Brudzinski signs may be present

Viral meningitis • Diagnosis – CSF • • Less than 500 WBC/cubic mm Glucose increased Protein decreased May do second spinal tap within 6 -8 hrs for confirmation

Viral meningitis • Treatment – Same as bacterial until viral is confirmed • Nursing management – Same as bacterial until viral is confirmed – Comfort measures, – Administer meds as ordered

Encephalitis • Inflammation of the brain caused by bacteria, virus, fungi or protozoa • See page 1085 for table of causes • Pathophysiology – Invasion of pathogen to CNS • Clinical manifestations – Intense HA, s/s of respiratory infection, n/v, slurred speech, seizures, ataxia, personality and behavior changes

Encephalitis • Diagnosis – H&P, – CSF • Initially normal, recheck in 2 days – Leukocytes increase – Protein increase – Nasopharynx swab • Treatment: – Supportive, anbx til bacterial cause r/o

encephalitis • Nursing management/interventions – Vital sign assessment – Neuro checks – PROM – Good skin care

GER ( gastroesophogeal reflux) • Common disorder of infants; improvement seen in 6 -12 months; boys affected more than girls, common in preterm infants • Clinical Manifestations – Vomiting, regurgitation, excessive crying, blood in stools • Diagnosis – Observing feedings, upper GI, endoscopy

GER • Treatment – Dietary modifications – Thicken formula with cereal – Positioning: seated vs prone vs head elevated prone – Pharmacologic intervention • Previcid, reglan • Nursing diagnosis – Risk for aspiration; imbalanced nutrition; deficient knowledge

Parasitic infections • See pages 442 -443 • Pinworms • roundworms

Urinary Tract Infections • Infection of one or more structures of the urinary tract – Cystitis – Urethritis – Pyelonephritis • Pathophysiology – Same as adults

UTI • Clinical manifestations – Infants – Preschoolers – School age and adolescents – See page 626 table • Diagnosis – UA

UTI • Treatment – Eradicating the infection – Preventing re infections – Correcting underlying causes – Preserving renal function – Abx, fluids

Enuresis • Involuntary voiding of urine beyond the expected age • More common in boys • Pathophysiology – Neurologic development delay – Frequent UTI – Structural disorders – Chronic constipation – DM – Sleep arousal problems – Stress and family history

enuresis • Clinical manifestations – Dribbling after voiding – Urgency – Ineffective stream – Infrequent and painful voiding – Incontinence with laughing

Enuresis • Diagnosis – Family history – Neuro exam: reflexes, sphincter tone, spinal defects – Voiding diary – UA, renal ultrasound, urine flow rate

Enuresis • Treatment – Medications: see page 632 – Bed wetting alarms – Motivational therapies: rewards for dry nights – Elimination diets: certain foods may irritate the bladder---sugar, caffeine, dairy , carbonated bev.

Enuresis • Nursing diagnosis – Impaired urinary elimination – Impaired skin integrity – Disturbed sleep pattern – Low self esteem – Impaired social interactions