Children With Altered Cardiac and Tissue Perfusion Related to Oxygenation Responses (Mat Review)

**CHILDREN WITH ALTERED CARDIAC AND TISSUE PERFUSION RELATED TO OXYGENATION EXIBIT VARIOUS RESPONSES:** 1. **CARDIOVASCULAR RESPONSES:** 1. Tachycardia: increased heart rate (greater than 160 bpm in infants, greater than 120 bpm in children. 2. Bradycardia: Decreased heart rate (less than...

**CHILDREN WITH ALTERED CARDIAC AND TISSUE PERFUSION RELATED TO OXYGENATION EXIBIT VARIOUS RESPONSES:** 1. **CARDIOVASCULAR RESPONSES:** 1. Tachycardia: increased heart rate (greater than 160 bpm in infants, greater than 120 bpm in children. 2. Bradycardia: Decreased heart rate (less than 80 bpm in infants, less than 60 bpm in children). 3. Hypotension: Low blood pressure. 4. Cardiac arrhythmias: abnormal heart rhythms. 5. Decreased cardiac output: Reduced blood flow. 2. **RESPIRATORY RESPONSES**: 1. Tachypnea: Rapid breathing rate (greater than 40 breaths/minute in infants, greater than 20 breaths/minute in children. 2. Dyspnea: Difficulty breathing. 3. Grunting: Inspiratory effort. 4. Retractions: Chest wall indrawing. 5. Apnea: pauses in breathing. 3. **Neurological Responses:** 1. Altered mental status: Confusion, lethargy, or coma. 2. Seizures: Convulsions. 3. Decreased consciousness: Reduced responsiveness. 4. Irritability: Restlessness or agitation. **4. Hemodynamic Responses:** 1. Vasoconstriction: decreased peripheral blood flow. 2. Vasodilation: Increased peripheral blood flow. 3. Increased systemic vascular resistance: Elevated blood pressure. **5. Renal Responses:** 1. Oliguria: Decreased urine output (less than1 ml/kg/h). 2. Anuria: Absent urine output. 3. Fluid overload: Excess fluid accumulation. **6. Metabolic Responses:** 1. Metabolic acidosis: Increased lactic production, 2. Hypoglycemia: Low blood glucose. 3. Hyperglycemia: Elevated blood glucose. 7\. **Integumentary Responses:** 1. Cool or clammy skin: Decreased peripheral perfusion. 2. Cyanosis: Blue discoloration of skin and mucous membranes. 3. Pallor: Pale skin. **8**. **Gastrointestinal Responses:** 1. Nausea and vomiting. 2. Abdominal distension. 3. Diarrhea or constipation. **Nursing Considerations:** 1. Monitor vital signs and oxygen saturation. 2. Assess respiratory and cardiac function. 3. Provide oxygen therapy and respiratory support. 4. Administer medications to support cardiac function. 5. Maintain fluid and electrolyte balance. 6. Provide emotional support and comfort measures. **Diagnostic Tests:** 1. Arterial blood gas (ABG) analysis. 2. Electrocardiogram. 3. Echocardiogram. 4. Chest radiograph. 5. Pulse oximetry. **Nursing Diagnoses:** 1. Impaired gas exchange. 2. Decreased cardiac output. 3. Ineffective tissue perfusion. 4. Anxiety. 5. Fear. II. **ALTERATIONS IN FLUID AND ELECTROLYTE AND ACID-BASED BALANCE IN CHILDREN:** **1.FLUID IMBALANCE**: - **Etiology:** 1. Diarrhea and vomiting: Gastroenteritis, food poisoning. 2. Fever: increased fluid loss through sweating. 3. Inadequate fluid intake: Poor oral hydration, neglect. 4. Excessive urine output: Diabetes insipidus, kidney disease. 5. Excessive sweating: Heat exhaustion, strenuous exercise. 6. Medications: Diuretics, laxatives. 7. Underlying medical conditions: Diabetes, kidney disease, heart failure. - **Disease Process:** 1. Fluid loss exceeds fluid intake. 2. Electrolyte imbalance (sodium, potassium, chloride). 3. Decreased blood volume (hypovolemia). 4. Decreased blood pressure (hypotension). 5. Impaired kidney function. 6. Potential organ failure (kidney, liver, brain). - **Signs and Symptoms:** 1. **Mild dehydration:** 2. **Moderate dehydration:** 3. **Severe dehydration:** - **Nursing Interventions** 1. Assessment: Monitor fluid intake/output, vital signs, and electrolyte levels. 2. Fluid replacement: Oral rehydration therapy (ORT) or intravenous fluids. 3. Electrolyte Management: Administer electrolyte supplements. 4. Medication management: Adjust medications contributing to dehydration. 5. Vital Signs monitoring: Continuously monitor vital signs. 6. Supportive care: provide emotional support and comfort measures. - **Health Teaching:** 1. Fluid intake: Encourage adequate fluid consumption. 2. Electrolyte balance: Educate on electrolyte-rich foods. 3. Fever management: Teach fever reduction techniques. 4. Medications management: Instruct on proper medication use. 5. Follow-up care: Schedule regular check-ups - **Nursing Diagnoses:** 1. Fluid volume deficit: related to inadequate fluid intake. 2. Electrolyte Imbalance: related to excessive loss. 3. Risk for complications: related to untreated dehydration. 4. Anxiety: related to uncertainty, fear. 5. Deficient knowledge: related to inadequate fluid management. **2. FLUID OVERLOAD:** also known as hypervolemia, occurs when excess fluid accumulates in the body, leading to an imbalance in fluid and electrolyte levels. - **Etiology:** 1. Excessive fluid administration: IV fluids, blood transfusions. 2. Heart failure: Decreased cardiac output, increased fluid retention. 3. Kidney disease: Impaired fluid regulation, electrolyte imbalance. 4. Liver disease: Cirrhosis, ascites. 5. Nephrotic syndrome: Excessive fluid retention. 6. Medications: Steroids, NSAIDs. 7. Respiratory distress syndrome: Pulmonary edema. - **Disease Process:** 1. Excess fluid accumulates in tissues and organs. 2. Increased blood volume and cardiac workload. 3. Pulmonary congestion and edema. 4. Decreased oxygenation and perfusion. 5. Potential organ failure (heart, lungs, kidneys). - **Signs and Symptoms:** 1. **Mild Fluid Overload** 2. **Moderate Fluid Overload** 3. **Severe Fluid Overload** - **Nursing Interventions:** 1. Monitor fluid intake/output and vital signs. 2. Restrict fluid intake. 3. Administer diuretics. 4. Provide oxygen therapy. 5. Elevate head of bed. 6. Monitor electrolyte levels. 7. Supportive care (comfort measures). - **Health Teaching:** 1. Fluid management techniques. 2. Medication management. 3. Monitoring weight and blood pressure. 4. Recognizing signs of fluid overload. 5. Follow-up care. - **Nursing Diagnoses:** 1. Excess fluid volume: related to excessive fluid administration. 2. Impaired gas exchange: related to pulmonary congestion. 3. Decreased cardiac output: related to fluid overload. 4. Anxiety. 5. Deficient Knowledge: related to fluid management. **3. EDEMA:** Is the accumulation of excess fluid in body tissues, leading to swelling. - **Etiology:** 1. Fluid overload: Excessive IV fluids, blood transfusions. 2. Heart failure: Decreased cardiac output, increased fluid retention. 3. Kidney disease: Nephrotic syndrome, acute kidney injury. 4. Liver disease: Cirrhosis, ascites. 5. Medications: Steroids, INSAIDs. 6. Infections: Cellulitis, abscesses. 7. Allergic reactions: Anaphylaxis. 8. Genetic disorders: Turner syndrome. - **Disease Process:** 1. Fluid accumulation in tissues. 2. Increased hydrostatic pressure. 3. Decreased oncotic pressure. 4. Capillary leakage. 5. Swelling and tissue damage. - **Signs and Symptoms:** 1. **Mild Edema:** 2. **Moderate Edema:** 3. **Sever Edema:** - **Nursing Interventions**: 1. Monitor fluid intake/output and vital signs. 2. Elevate affected limbs. 3. Administer diuretics (as prescribed). 4. Provide comfort measures (Ex. Positioning) 5. Monitor electrolyte levels. 6. Supportive care (oxygen therapy). 7. Document changes in swelling. - **Health Teaching:** 1. Fluid management techniques. 2. Medication management. 3. Monitoring weight and blood pressure. 4. Recognizing signs of edema. 5. Elevation techniques. 6. Compression bandaging (if applicable). - **Nursing Diagnoses:** 1. Excess Fluid Volume: related to fluid overload. 2. Impaired Skin Integrity: related to edema. 3. Decreased cardiac Output: related to fluid overload. 4. Anxiety. 5. Deficient Knowledge: related to edema management. 1. **ELECTROLYTE IMBALANCE:** - **Normal Values of common electrolytes in children:** 1. **Sodium (Na+): 135-145 mmol/L** 2. **Potassium (K+): 3.5-145 mmol/L** 3. **Chloride (Cl-): 95-110 mmol/L** 4. **Calcium (Ca2+): 8.5-10.5 mg/dL** 5. **Magnesium (Mg2+): 1.6-2.4 mg/dL** 6. **Phosphate (PO42-): 4.5-6.5 mg/dL** 7. **Bicarbonate (HCO3-): 22-28 mmol/L** - **Age-Specific Variations:** 1. **Neonates (0-28 days):** - **Sodium: 130-140 mmol/L** - **Potassium: 3.5-5.50 mmol/L** 2. **Infants: (29 days-1 year):** - **Sodium: 135-145 mmol/L** - **Potassium: 4.0-5.5 mmol/L** 3. **Children (1-18 years)** - **Sodium: 135-145 mmol/L** - **Potassium: 3.5-5.5 mm/L** **2. Sodium Imbalance:** or dysnatremia, occurs when sodium levels in the blood are abnormal, affecting fluid balance and nerve/muscle function. - **Etiology:** 1. **Hyponatremia (low sodium):** Dehydration, diarrhea, vomiting, and excessive fluid administration, kidney disease, heart failure, syndrome of inappropriate antidiuretic hormone secretion (SIADH). 2. **Hypernatremia (high sodium):** Dehydration, diabetes insipidus, excessive sodium intake, kidney disease, certain medications. - **Disease Process:** 1. **Hyponatremia:** Excess water dilutes sodium levels, causing swelling of brain and nerve cells. 2. **Hypernatremia:** Excess sodium draws water out of cells, causing dehydration. - **Signs and Symptoms:** 1. Hyponatremia: - Headache - Nausea/Vomiting - Seizures - Muscle weakness - Confusion - Respiratory Distress 2. **Hypernatremia:** - Thirst - Dry mouth - Dark urine - Confusion - Seizures - Muscle weakness - **Nursing Intervention:** 1. Monitor sodium levels and vital signs. 2. Administer fluids (oral/IV) as prescribed. 3. Restrict sodium intake (hypernatremia) or provide sodium supplements. 4. Provide supportive care (oxygen therapy, pain management). 5. Monitor urine output and electrolyte levels. 6. Educate parents on sodium management. - **Treatment:** 1. **Hyponatremia:** Fluid restriction, sodium supplements, medication adjustment. 2. **Hypernatremia:** Fluid administration, sodium restriction, medication adjustment. - **Nursing Diagnoses:** 1. Electrolyte Imbalance: related to Sodium imbalance. 2. Fluid volume deficit: related to dehydration. 3. Risk for seizures: related to electrolyte imbalance. 4. Anxiety 5. Deficient knowledge: related to sodium management. **3. Potassium Imbalance:** or **[dyskalemia]**, occurs when potassium levels in the blood are abnormal, affecting heart function, muscle contraction, and nerve transmission. - **Etiology:** 1. **Hypokalemia (low potassium**): diarrhea, vomiting, excessive urine output, certain medications (diuretics), kidney disease, metabolic alkalosis. 2. **Hyperkalemia (high Potassium):** kidney disease, excessive potassium intake, certain medications (ACE inhibitors), metabolic acidosis, cell destruction (hemolysis). - **Disease Process:** 1. **Hypokalemia:** Potassium deficiency affects muscle contractions, leading to weakness, fatigue, and cardiac arrhythmias. 2. **Hyperkalemia:** Excess potassium affects heart function, leading to arrhythmias cardiac arrest. - **Signs and Symptoms:** 1. **Hypokalemia** - Muscle weakness - Fatigue - Abdominal cramps - Constipation - Cardiac Arrhythmias - Respiratory Distress 2. **Hyperkalemia:** - Muscle weakness - Abdominal Cramps - Numbness/Tingling - Confusion - Cardiac arrhythmias - Respiratory arrest - **Nursing Intervention:** 1. Monitor Potassium levels and vital signs. 2. Administer potassium supplements(hypokalemia) or potassium-bbinding medications (hyperkalemia). 3. Provide supportive care (oxygen therapy, pain management). 4. Monitor urine output and electrolyte levels. 5. Educate parents on Potassium management. 6. Encourage dietary modifications (bananas, avocados for hypokalemia; Low potassium diet for hyperkalemia. - **Health Teaching:** 1. Potassium-rich foods (bananas, avocados). 2. Potassium supplement administration. 3. Medication management 4. Monitoring Potassium levels. 5. Recognizing signs of imbalance. - **Nursing Diagnoses:** 1. Electrolyte Imbalance: related to Potassium imbalance. 2. Activity Intolerance: related to muscle weakness. 3. Risk for Cardiac Dysfunction: related to Potassium Imbalance. 4. Anxiety 5. Deficient knowledge: related to Potassium management. **4. Calcium Imbalance:** or dyscalcemia (low calcium), occurs when calcium levels in the blood are abnormal, affecting bone health, muscle function, and nerve transmission. - **Etiology:** 1. **Hypocalcemia (low calcium):** Vitamin D deficiency, kidney disease, hypoparathyroidism, magnesium deficiency, certain medications. 2. **Hypercalcemia (high calcium):** Vitamin D toxicity, hyperparathyroidism, kidney disease, certain medications, malignancies. - **Disease Process:** 1. **Hypocalcemia:** Calcium deficiency affects muscle contractions, leading to weakness, tetany, and cardiac arrhythmias. 2. **Hypercalcemia:** Excess calcium affects kidney function, leading to nephrocalcinosis, kidney stones, and bone demineralization. - **Signs and Symptoms:** 1. **Hypocalcemia:** -. Muscle cramps -. Tetany -. Seizures -. Weakness -. Fatigue -. Cardiac arrhythmias 2. **Hypercalcemia:** -. Weakness -. Fatigue -. Nausea/Vomiting -. Abdominal pain -. Kidney stones -. Bone pain - **Nursing Interventions:** 1. Monitor calcium levels and vital signs. 2. Administer calcium supplements (hypocalcemia) or calcium-lowering medications (hypercalcemia). 3. Provide supportive care (oxygen therapy), pain management). 4. Monitor urine output and electrolyte levels. 5. Educate parents on calcium management. 6. Encourage dietary modifications (dairy products, leafy green for hypocalcemia; low-calcium diet for hypercalcemia. - **Health Teaching:** 1. Calcium-rich foods (dairy products, leafy greens). 2. Vitamin D supplementation. 3. Medication management. 4. Monitoring calcium levels. 5. Recognizing signs of imbalance. - **Nursing Diagnoses:** 1. Electrolyte Imbalance: related to calcium imbalance. 2. Activity Intolerance: related to muscle weakness. 3. Risk for cardiac Dysfunction: related to calcium imbalance. 4. Anxiety 5. Deficient knowledge: related to calcium management. **5. Magnesium Imbalance in children:** or ***[dysmagnesemia,]*** occurs when magnesium levels in the blood are abnormal, affecting muscle function, nerve transmission and heart rhythm. - **Etiology:** 1. **Hypomagnesemia (low magnesium):** Diarrhea, vomiting, inadequate dietary intake, kidney disease, certain medications (diuretics, antibiotics). 2. **Hypermagnesemia (High Magnesium) :** Excessive intake, kidney disease, certain medications (laxatives, antacids). - **Disease Process:** 1. **Hypomagnesemia:** Magnesium deficiency affects muscle contractions, leading to weakness, cramps, and cardiac arrhythmias. 2. **Hypermagnesemia:** Excess magnesium affects heart function, leading to bradycardia, respiratory depression. - **Signs and Symptoms:** 1. **Hypomagnesemia** -. Muscle cramps -. Weakness -. Fatigue -. Seizures -. Cardiac arrhythmias -. Tetany 2. **Hypermagnesemia** -. Respiratory depression -. Bradycardia -. Hypotension -. Muscle weakness -. Nausea and vomiting -. Diarrhea - **Nursing Interventions**: 1. Monitor magnesium levels and vital signs. 2. Administer magnesium supplements (hypomagnesemia) or magnesium --lowering medications (hypermegnesemia). 3. Provide supportive care (oxygen therapy, pain management). 4. Monitor urine output and electrolyte levels. 5. Educate parents on magnesium management. 6. Encourage dietary modifications (dark leafy greens, nuts for hypomagnesemia; low magnesium diet for hypermagnesemia. - **Health Teaching:** 1. Magnesium --rich foods (dark leafy greens, nuts). 2. Medications Management. 3. Monitoring magnesium levels. 4. Recognizing signs of imbalance. 5. Avoiding excessive magnesium intake. - **Nursing Diagnoses:** 1. Electrolyte Imbalance: related magnesium imbalance. 2. Activity Intolerance: related to muscle weakness. 3. Risk for cardiac Dysfunction: related to magnesium imbalance. 4. Anxiety 5. Deficient knowledge: related to magnesium management. **6. Chloride Imbalance in Children:** or **dyschloremia,** occurs when chloride levels in the blood are abnormal, affecting fluid balance, acid -base balance and muscle function. - **Etiology:** 1. **Hypochloremia (low chloride):** Diarrhea, vomiting, excessive sweating, cystic fibrosis, certain medications (diuretics). 2. **Hyperchloremia (high Chloride):** Dehydration, excessive chloride intake, kidney disease. Metabolic acidosis. - **Disease Process:** 1. **Hypochloremia**: Chloride deficiency affects fluid balance, leading to metabolic alkalosis, respiratory alkalosis. 2. **Hyperchloremia:** Excess chloride affects acid-base balance, leading to metabolic acidosis. - **Signs and Symptoms:** 1. **Hypochloremia;** -. Respiratory alkalosis -. Metabolic alkalosis -. Muscle weakness -. Fatigue -. Seizures -. Tetany 2. **Hyperchloremia:** -. Metabolic acidosis -. Respiratory depression -. Cardiac arrhythmias -. Muscle weakness -. Confusion - **Nursing Interventions:** 1. Monitor chloride level and vital signs. 2. Administer chloride supplements (hypochloremia) or Chloride-lowering medications (hyperchloremia). 3. Provide supportive care (oxygen therapy, pain management). 4. Monitor urine output and electrolyte levels. 5. Educate parents on chloride management. 6. Encourage dietary modifications (bananas, avocados for hypochloremia; low chloride diet for hyperchloremia). - **Health Teaching:** 1. Chloride-rich foods (bananas, avocados). 2. Medications management. 3. Monitoring chloride levels. 4. Recognizing signs of imbalance. 5. Avoiding excessive chloride intake. - **Nursing Diagnoses:** 1. Electrolyte Imbalance: related to chloride imbalance. 2. Acid-base imbalance: related to metabolic alkalosis/acidosis. 3. Activity intolerance: related muscle weakness. 4. Anxiety 5. Deficient Knowledge: related to chloride management. **1. ACID-BASE IMBALANCE IN CHILDREN:** 1. **Metabolic Acidosis in children:** is a condition where the body produces excessive acid or cannot effectively remove excess acid, leading to an imbalance in the body's acid-base balance. - **Etiology:** 1. Diabetic ketoacidosis: High blood pressure levels, dehydration. 2. Lactic acidosis: Infection, sepsis, liver disease. 3. Renal failure: Kidney disease, acute kidney injury. 4. Respiratory disorders: Respiratory distress syndrome. 5. Medications: Salicylates, acetaminophen overdose. 6. Gastrointestinal disorders: Diarrhea, vomiting. - **Disease Process:** 1. Excess acid production (ketoacids, lactic acid). 2. Impaired acid secretion (kidney disease). 3. Buffering mechanisms overwhelmed. 4. pH imbalance (acidosis). - **Signs and Symptoms:** 1. **Mild:** -. Fatigue -. Weakness -. Headache -. Nausea/vomiting -. Rapid breathing 2. **Moderate:** -. Confusion -. Disorientation -. Seizures -. Coma -. Cardiac arrhythmias 3. **Severe:** -. Respiratory failure -. Cardiac arrest -. Death - **Nursing Interventions:** 1. Monitor vital signs, pH and electrolyte levels. 2. Administer IV fluids and electrolytes. 3. Provide oxygen therapy. 4. Manage pain and discomfort. 5. Supportive care (nutrition, hydration). 6. Monitor urine output and kidney function. 7. Collaborate with healthcare team for medication management. - **Health Teaching:** 1. Recognizing signs of metabolic acidosis. 2. Managing underlying conditions (diabetes, kidney disease). 3. Medication Management. 4. Hydration and nutrition strategies. 5. Follow-up care and monitoring. - **Nursing Diagnoses:** 1. Acid-Base Imbalance: related to metabolic acidosis. 2. Respiratory Distress: related compensatory mechanisms. 3. Anxiety. 4. Deficient Knowledge: related to acid-base management. 5. Risk for Cardiac Dysfunction: related to acidosis. **2. METABOLIC ALKALOSIS IN CHILDREN:** is a condition where body's pH balance becomes too alkaline due to excessive bicarbonate levels. - **Etiology:** 1. Vomiting or nasogastric suction: Loss of hydrochloric acid. 2. Diuretics: Excessive Potassium and chloride loss. 3. Cystic fibrosis: Respiratory alkalosis and metabolic alkalosis. 4. Hypokalemia: Potassium depletion. 5. Hypocalcemia: Calcium depletion. 6. Milk- alkali syndrome: Excessive calcium intake. 7. Respiratory alkalosis: Hyperventilation. 8. Kidney disease: Impaired acid excretion. - **Disease Process:** 1. Excess bicarbonate production or retention. 2. Hydrogen ion loss or depletion. 3. pH imbalance (alkalosis). 4. Compensatory mechanisms (hyperventilation). - **Signs and Symptoms:** 1. **Mild:** -. Fatigue -. Weakness -. Headache -. Nausea/Vomiting -. Muscle cramps 2. **Moderate:** -. confusion -. Disorientation -. Seizures -. Tetany -. Cardiac arrhythmias 3. **Severe:** -. Respiratory failure -. Cardiac arrest -. Coma - **Nursing Interventions**: 1. Monitor vital signs, pH, and electrolyte levels. 2. Administer IV fluids and electrolytes (potassium, Chloride). 3. Provide supportive care (nutrition, hydration). 4. Manage pain and discomfort. 5. Encourage deep breathing exercises. 6. Collaborate with healthcare team for medication management. - **Health Teaching:** 1. Recognizing signs of metabolic alkalosis. 2. Managing underlying conditions (cystic fibrosis, kidney disease). 3. Medication management. 4. Hydration and nutrition strategies. 5. Avoiding excessive calcium intake. - **Nursing Diagnoses:** 1. Acid-Base Imbalance: related to metabolic alkalosis. 2. Respiratory Distress: related to compensatory mechanisms. 3. Anxiety. 4. Deficient knowledge: related to acid-base management. 5. Risk for cardiac Dysfunction: related to alkalosis. **RESPIRATORY ACIDOSIS in children:** occurs when the lungs cannot remove carbon dioxide effectively, leading to acid buildup in the blood. - **Etiology:** 1. Respiratory disorders: Asthma, Chronic Obstructive Pulmonary Disease (COPD), cystic fibrosis, pneumonia. 2. Neuromuscular disorders: Muscular dystrophy, spinal cord injuries. 3. Airway obstruction: Foreign body aspiration, tracheal stenosis. 4. Ventilatory Failure: Respiratory muscle fatigue, sedation. 5. Congenital anomalies: Diaphragmatic hernia, tracheoesophageal fistula. - **Disease Process:** 1. Impaired gas exchange (oxygen, carbon dioxide). 2. Carbon dioxide accumulation. 3. Blood pH decrease (acidosis). 4. Compensatory mechanism (kidney retention of bicarbonate). - **Signs and Symptoms** 1. **Mild:** -. Respiratory rate increase -. Depth of breathing increase. -. Confusion. -. Headache -. Fatigue 2. **Moderate:** -. Dyspnea -. Tachypnea -. Hypercapnia -. Acidotic breathing pattern -. Cardiac arrhythmias 3. **Severe:** -. Respiratory failure -. Cardiac arrest -. Coma -. Seizures - **Nursing Management:** 1. Assess respiratory status: Monitor vital signs, oxygen saturation. 2. Maintain airway patency: Suction, intubation (if necessary). 3. Provide oxygen therapy: Nasal cannula, mask, or ventilator. 4. Support ventilation: Mechanical ventilation (if necessary). 5. Monitor electrolyte levels: Potassium, sodium, chloride. 6. Administer medications: Bronchodilators. Sedatives (as prescribed). 7. Encourage deep breathing exercises: Incentive spirometry. - **Health Teaching:** 1. Recognize signs of respiratory acidosis. 2. Manage underlying conditions (asthma, COPD). 3. Medications management. 4. Breathing techniques. 5. Importance of follow-up care. - **Nursing Diagnoses:** 1. Respiratory Distress: related to impaired gas exchange. 2. Acid-base Imbalance: related to respiratory acidosis. 3. Anxiety. 4. Deficient knowledge: related to respiratory acidosis management. 5. Risk for cardiac Dysfunction: related to acidosis. **RESPIRATORY ALKALOSIS in Children:** occurs when the lungs eliminate excessive carbon dioxide, leading to alkalosis (elevated blood pH). - **Etiology:** 1. Hyperventilation: Anxiety, panic, stress. 2. Respiratory disorders: Asthma, cystic fibrosis, pneumonia. 3. Central nervous system disorders: Meningitis, encephalitis. 4. Medications: Salicylates, stimulants. 5. High-altitude environment: Overventilation. - **Disease Process:** 1. Excessive carbon dioxide elimination. 2. Blood pH increase (alkalosis). 3. Decreased bicarbonate levels. 4. Compensatory mechanism (kidney retention of hydrogen ions). - **Signs and Symptoms:** 1. **Mild:** -. Rapid breathing -. Lightheadedness -. Dizziness -. Tingling fingers/toes. -. Headache 2. **Moderate:** -. Muscle cramps -. Tetany -. Confusion -. Disorientation -. Cardiac arrhythmias 3. **Severe:** -. Seizures -. Respiratory failure -. cardiac arrest -. Coma - **Nursing Interventions:** 1. Monitor vital signs and respiratory status. 2. Assess oxygen saturation and pH levels. 3. Provide reassurance and relaxation techniques. 4. Administer oxygen therapy (if necessary). 5. Encourage slow, deep breathing exercises. 6. Manage pain and discomfort. 7. Collaborate with healthcare team for medication management. - **Health Teaching:** 1. Recognize signs of respiratory alkalosis. 2. Manage anxiety and stress. 3. Breathing techniques. 4. Importance of follow-up care. 5. Avoiding excessive altitude exposure. - **Nursing Diagnoses:** 1. Respiratory Distress: related to hyperventilation. 2. Acid-Base Imbalance: related to respiratory alkalosis. 3. Anxiety 4. Deficient knowledge: related to respiratory alkalosis management. 5. Risk for cardiac Dysfunction: related to alkalosis. III. **ALTERATIONS WITH INFECTIOUS, INFLAMMATORY, AND IMMUNOLOGIC RESPONSES:** I. **COMMON INFECTIOUS DISEASES IN CHILDREN:** 1. **RESPIRATORY TRACT INFECTIONS:** 1. **PNEUMONIA**: is an acute inflammatory infection of the lungs, primarily affecting the alveoli. - **Etiology:** 1. **Bacterial: *Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus.*** 2. **Viral: *Respiratory syncytial virus (RSV), Influenza, Adenovirus.*** - **Disease Process:** 1. Pathogen invasion of lung tissue. 2. Inflammation and edema. 3. Alveolar consolidation. 4. Impaired gas exchange. 5. Hypoxemia and respiratory distress. - **Signs and Symptoms:** 1. **Mild:** -. Cough -. Fever -. Runny nose -. Fatigue 2. **Moderate:** -. Difficulty breathing -. Chest pain -. Wheezing -. Vomiting 3. **Severe:** -. Seizures. -. Coma -. Cardiac arrest - **Nursing Interventions:** 1. Assess respiratory status. 2. Monitor oxygen saturation. 3. Administer oxygen therapy. 4. Provide hydration and nutrition. 5. Manage pain and comfort. 6. Encourage deep breathing exercises. 7. Administer medications (antibiotics, bronchodilators). 8. Maintain infection control measures. - **Health Teaching:** 1. Recognize signs of Pneumonia. 2. Practice good hygiene (handwashing). 3. Vaccination (pneumococcal influenza). 4. Avoid close contact with infected individuals. 5. Mange underlying conditions (asthma, diabetes). - **Nursing Diagnoses:** 1. Impaired gas exchange: related to alveolar consolidation. 2. Respiratory Distress: related to inflammation and edema. 3. Pain: related to chest pain and discomfort. 4. Anxiety. 5. Deficient knowledge related to Pneumonia management. 2. **BRONCHIOLITIS:** is a viral respiratory illness characterized by inflammation, edema and obstruction of small airways (bronchioles) in infants and young children. - **Etiology:** 1. Viral: Respiratory syncytial virus (RSV) (70-80% cases), adenovirus, influenza, Parainfluenza. 2. Other factors: Premature birth, low birth weight, congenital heart disease, immunodeficiency. - **Disease Process:** 1. Viral replication in respiratory epithelium. 2. Inflammation and edema of bronchioles. 3. Mucus production and airway obstruction. 4. Impaired gas exchange and respiratory distress. - **Signs and Symptoms:** 1. **Mild**: -. Runny nose -. Cough -. Fever -. Wheezing 2. **Moderate**: -. Respiratory distress -. Tachypnea -. Retractions -. Nasal flaring 3. **Severe**: -. Apnea -. Bradycardia - **Nursing Interventions:** 1. Assess respiratory status. 2. Monitor oxygen saturation. 3. Provide oxygen therapy. 4. Maintain hydration and nutrition. 5. Manage fever. 6. Encourage breast feeding. 7. Administer medications (bronchodilators, antipyretics). 8. Implement infection control measures. - **Health Teaching:** 1. Recognize signs of bronchiolitis. 2. Practice good hygiene (handwashing). 3. Avoid close contact with infected individual. 4. Vaccination (Influenza, RSV) 5. Manage underlying conditions (asthma, heart disease). - **Nursing Diagnoses:** 1. Respiratory Distress: related to airway obstruction. 2. Impaired gas exchange: related to inflammation and edema. 3. Anxiety. 4. Deficient knowledge: related to Bronchiolitis management. 5. Risk for infection: related to viral transmission. **3. CROUP OR Laryngotracheobroncholitis:** is an acute viral respiratory illness characterized by inflammation of the larynx, trachea, and bronchi, leading to hoarseness, cough, and respiratory distress. - **Etiology:** 1. **Viral**: ***Parainfluenza virus (50-70%), Influenza, Adenovirus, Respiratory syncytial virus (RSV).*** 2. **Other factors**: ***Allergies, environmental irritants, bacterial superinfection.*** - **Disease Process:** 1. Viral replication in respiratory epithelium. 2. Inflammation and edema of larynx, trachea, and bronchi. 3. Narrowing of airway diameter. 4. Impaired gas exchange and respiratory distress. - **Signs and Symptoms:** 1. **Mild:** 2. **Moderate:** 3. **Severe:** - **Nursing Interventions:** 1. Assess respiratory status. 2. Monitor oxygen saturation. 3. Provide oxygen therapy. 4. Maintain hydration and nutrition. 5. Manage fever. 6. Administer medications (corticosteroids, bronchodilators). 7. Implement infection control measures. 8. Provide comfort measures (positioning, suctioning). - **Health Teaching:** 1. Recognize signs of croup. 2. Practice good hygiene (handwashing). 3. Avoid close contact with infected individuals. 4. Vaccination (Influenza). 5. Manage underlying conditions (asthma). - **Nursing Diagnoses:** 1. Respiratory Distress: related to airway obstruction. 2. Impaired gas exchange: related to inflammation and edema. 3. Anxiety. 4. Deficient Knowledge: related to croup management. 5. Risk for infection: related to viral infection. **4. INFLUENZA OR FLU:** is a highly contagious respiratory illness caused by influenza viruses (A, B, C). - **Etiology:** 1. Viral: Influenza A (H1N1, H3H2), Influenza B, Influenza C. 2. Transmission: Droplet spread, contact with contaminated surfaces, close contact with infected individuals. 3. Risk factors: Age (less than 5 years), Chronic medical conditions, immunodeficiency, pregnancy. - **Disease Process:** 1. Viral replication in respiratory epithelium. 2. Inflammation and edema of upper and lower respiratory tract. 3. Impaired gas exchange and respiratory distress. - **Signs and Symptoms:** 1. **Mild:** 2. **Moderate:** 3. **Severe:** - **Nursing Interventions:** 1. Assess respiratory status. 2. Monitor oxygen saturation. 3. Provide oxygen therapy 4. Maintain hydration and nutrition. 5. Manage fever. 6. Administer medications (antivirals, analgesics). 7. Implement infection control measures. 8. Encourage rest. - **Health Teaching:** 1. Recognize flu symptoms. 2. Practice good hygiene (handwashing). 3. Avoid close contact with infected individuals. 4. Vaccination (annual influenza vaccine) 5. Manage underlying conditions (asthma, diabetes). 6. Use antiviral medications as prescribed. - **Nursing Diagnoses:** 1. Respiratory Distress: related to airway obstruction. 2. Hyperthermia: related to fever. 3. Anxiety 4. Deficient knowledge: related to flu management. 5. Risk for infection: related to viral transmission. II. **GASTROINTESTINAL INFECTIONS IN CHILDREN**: 1. **Gastroenteritis:** is an acute inflammatory process of the gastrointestinal (GI) tract, primarily affecting the stomach and intestines. - **Etiology:** 1. Viral: Rotavirus, Norovirus,Adenovirus, Astrovirus. 2. Bacterial: Escherichia coli (E-COLI), Salmonella, Shigella. 3. Parasitic: Giardia, Cryptosporiduim. 4. Food poisoning: Contaminated food or water. - **Disease Process:** 1. Pathogen invasion of GI tract. 2. Inflammation and irritation of mucosal lining. 3. Increased secretion of fluids and electrolytes. 4. Impaired absorption and digestion. - **Signs and Symptoms:** 1. **Mild:** 2. **Moderate:** 3. **Severe:** - **Nursing Interventions:** 1. Assess hydration status. 2. Monitor electrolyte levels. 3. Provide fluid replacement (oral rehydration therapy). 4. Administer anti-diarrheal medications (if prescribed). 5. Manage nausea and vomiting 6. Implement infection control measures. 7. Encourage rest. - **Health Teaching**: 1. Practice good hygiene(handwashing). 2. Avoid contaminated food and water. 3. Vaccination (rotavirus). 4. Breastfeeding (protects against gastroenteritis). 5. Manage underlying conditions (diabetes, immunodeficiency). - **Nursing Diagnoses:** 1. Fluid volume Deficit: related to dehydration. 2. Diarrhea: related to gastrointestinal inflammation. 3. Nausea: related to gastrointestinal irritation. 4. Anxiety. 5. Deficient knowledge. 2. **FOOD POISONING:** is an acute illness caused by consuming contaminated food or drinks, leading to gastrointestinal and systemic symptoms in children. - **Etiology:** 1. **Bacterial*: Salmonella, Staphylococcus aureus, E-coli.*** 2. **Viral*: Norovirus, Rotavirus.*** 3. **Parasitic: *Giardia, Cryptosporidium.*** 4. **Fungal*: Aspergillus*** 5. **Chemical: Food additives, pesticides.** 6. **Toxins: *shellfish toxins.*** - **Disease Process:** 1. Ingestion of contaminated food/drink. 2. Pathogen/toxin absorption into blood stream. 3. Gastrointestinal inflammations and irritation. 4. Systemic symptoms (fever, headache). - **Signs and Symptoms:** 1. **Mild:** 2. **Moderate:** 3. **Severe:** - **Nursing Interventions:** 1. Assess vital signs. 2. Monitor hydration status. 3. Provide fluid replacement (oral rehydration therapy). 4. Administer anti-emetics (if prescribed). 5. Manage pain and discomfort. 6. Implement infection control measures. 7. Encourage rest 8. Monitor electrolyte levels. 9. Provide nutritional support. - **Health Teaching:** 1. Handle food safely (storage preparation). 2. Cook food thoroughly. 3. Avoid-cross contamination. 4. Refrigerate perishable foods promptly. 5. Avoid raw/undercooked meat, eggs, fish. 6. Wash hands frequently. 7. Avoid close contact with infected individuals. 8. Vaccination (hepatitis, Typhoid). - **Nursing Diagnoses:** 1. Fluid volume Deficit: related to dehydration. 2. Nausea: related to gastrointestinal irritation. 3. Diarrhea: related to gastrointestinal inflammation. 4. Anxiety. 5. Deficient knowledge: related to food poisoning prevention. 6. Risk for infection: related to viral/bacterial transmission. **3. INTUSSUSCEPTION in Children:** is a medical emergency where a portion of the intestine's telescopes into another, causing bowel obstruction, ischemia, and potentially life- threatening complications. - **Etiology:** 1. **Idiopathic (9o%):** Unknown cause, typically affecting children 3-6 months. 2. **Secondary (10%):** Underlying conditions, such as: - **Disease Process:** 1. Intestinal segment invaginates into adjacent segment. 2. Blood supply compromised leading to ischemia. 3. Obstruction causes abdominal distention, pain, and vomiting. 4. Potential perforation, peritonitis, and sepsis. - **Signs and Symptoms:** 1. **Classic triad (30%)** **Other symptoms:**. Abdominal distention. fever. Lethargy. Weight loss. Diarrhea - **Nursing Interventions:** 1. Assess vital signs and abdominal status. 2. Monitor for signs of shock, perforation, or peritonitis. 3. Provide pain management. 4. Administer IV fluids and electrolytes. 5. Prepare for diagnostic tests (ultrasound, X-rays) 6. Assist with enema reduction or surgical intervention. 7. Monitor for complications (infection, bowel necrosis) 8. Provide emotional support to child and family, - **Health Teaching:** 1. Recognize early signs and symptoms. 2. Seek immediate medical attention if suspected. 3. Explain diagnostic tests and treatment options. 4. Discuss importance of vaccination (rotavirus). 5. Provide guidance on managing pain, hydration, and nutrition. - **Nursing Diagnoses:** 1. Acute pain: related to intestinal obstruction. 2. Fluid volume deficit: related to vomiting and dehydration. 3. Anxiety. 4. Deficient knowledge: related to intussusception. 5. Risk for infection: related to perforation. 4\. **NEUROLOGICAL INFECTION IN CHILDREN:** 1. **MENINGITIS:** is an acute inflammation of the meninges (protective membranes) surrounding the brain and spinal cord, potentially life-threatening. - **Etiology:** 1. **Bacterial: *Streptococcus pneumonia, Haemophilus influenza type b (Hib), Neisseria meningitis, E-coli.*** 2. **Viral: *Enteroviruses, Herpes simplex virus.*** 3. **Fungal: *Cryptococcus neoformans.*** - **Disease Process:** 1. Pathogen invasion of meninges. 2. Inflammation and edema. 3. Increased intracranial pressure (ICP). 4. Impaired cerebral blood flow. 5. Potential brain damage, seizures, and death. - **Signs and Symptoms:** 1. Infants (0-6 months): fever, irritability, refusal to feed, vomiting. 2. Children (6 months-2 years): fever, headache, stiff neck, vomiting. 3. Older children: Severe headache, stiff neck, fever, confusion, seizures. 4. Classic triad: Fever, headache, stiff neck. - **Nursing Interventions:** 1. Assess vital signs and neurological status. 2. Monitor ICP and cerebral perfusion pressure. 3. Provide oxygen therapy. 4. Administer antibiotics/antivirals/antifungals as prescribed. 5. Mange pain, fever and seizures. 6. Maintain fluid and electrolyte balance. 7. Implement infection control measures. 8. Provide emotional support. - **Treatment:** 1. Antibiotics (bacterial meningitis): Ceftriaxone, cefotaxime. 2. Antivirals (viral meningitis); Acyclovir. 3. Antifungals (fungal meningitis): Amphotericin B, 4. Supportive care: fluids, oxygen, pain management. 5. Surgery (if necessary): Relive ICP, drain abscesses. - **Nursing Diagnoses:** 1. Acute pain: related to headache, fever. 2. Anxiety: 3. Deficient knowledge: related to meningitis management. 4. Risk for neurological Dysfunction: related to inflammation, edema. 5. Fluid volume deficit: related to dehydration.