Common Health Challenges & Hospitalization PDF

COMMON HEALTH CHALLENGES & HOSPITALIZATION BY THE END OF THIS SESSION, YOU WILL BE ABLE TO: 1. Identify common illnesses and describe manifestations, treatment and nursing care 2. Identify developmental milestones relevant to unwell/hospitalized children 3. Consider the role of...

COMMON HEALTH CHALLENGES & HOSPITALIZATION BY THE END OF THIS SESSION, YOU WILL BE ABLE TO: 1. Identify common illnesses and describe manifestations, treatment and nursing care 2. Identify developmental milestones relevant to unwell/hospitalized children 3. Consider the role of the pediatric nurse  EXCELLENT RESOURCES Ministry of Child and Youth Ontario http://www.children.gov.on.ca/htdocs/English/inde x.aspx Safe Kids Canada http://www.safekidscanada.ca/Professionals/Safet y-Information/About-Injuries/Index.aspx  MORE RESOURCES Sick Kids Hospital Health resources http://www.aboutkidshealth.ca/En/HealthAZ/Pages /default.aspx?name=a  COMMON ILLNESSES INFANT TODDLER/ Hyperbilirubinemia PRESCHOOL Febrile Seizures Acute Otitis Media Acute Gastro RSV Tonsillitis SCHOOL-AGE ADOLESCENT Pneumonia Eating Disorders Depression/Suicide Autism Substance Abuse Asthma  HYPERBILIRUBINEMIA Excess bilirubin; Deposits in tissues, causing jaundice Related to breakdown of fetal RBC’s after delivery = Physiologic jaundice Pathologic jaundice = jaundice presenting within the first 24 hours, usually a result of blood incompatibility Risk factors for jaundice include: Prematurity Infant of a diabetic mother Polycythemia “many cells in the blood” Incompatibility with a component of mom’s blood (Rh+/-, blood type) Treatment: maintain hydration, phototherapy treatment  ACUTE OTITIS MEDIA Inflammation of middle ear Occurs most often after a respiratory infection Affects children between 6 and 24 months and early childhood Eustachian tube Pain, irritability, fever, pulling at ear, diarrhea Surgical Management: Myringotomy (surgical incision of the eardrum) Tympanostomy (tube inserted to drain fluid from the middle ear)  OTITIS MEDIA An ear infection happens when mucus from a cold blocks the eustachian tube. When the tube is blocked, infected fluid builds up in the middle ear. This puts pressure on the eardrum and makes it bulge, which causes pain. Most children will have at least 1 ear infection, and about 1 in 4 of these children will have many ear infections. Ear infections are most common in children between the ages of 6 months and 2 years, but they can occur throughout childhood Symptoms of an ear infection Your child may have one or more of these symptoms: ear pain crying not sleeping well fluid draining from the ear fever In 1 out of every 10 to 20 cases, the pressure in the middle ear causes the eardrum to burst (rupture). This causes a hole in the eardrum. The ear then drains a yellow or cloudy fluid. Pain and fever relief Give your child acetaminophen (Tylenol or Tempra) or ibuprofen (Motrin or Advil) to help with the earache or fever. These medicines usually begin to work within 1 hour. You may need to give them during the first few days until the antibiotic has time to take effect. The pain medicines do not affect the antibiotic. Do not give your child Aspirin (ASA or acetylsalicylic acid). NORMAL EARDRUM OTITIS MEDIA  RSV Respiratory Syncytial Virus – easily spread virus that causes “common cold” in healthy older children, but can cause severe disease in infants Causes bronchiolitis and pneumonia in children Common, seasonal (usually Nov – April) Runny nose Cough, sneezing, mucous Fever Synagis (Palivizumab) An injection of antibodies that can be given to high-risk infants to protect from severe disease Given monthly during RSV season  RSV TREATMENT Supportive care, aimed at managing symptoms Adherence to infection prevention & control techniques Oxygen Suctioning Maintain hydration Monitor for significant (or changes in) tachypnea & tachycardia Frequent assessment of work-of-breathing, chest sounds and oxygenation IV is frequently necessary in severe disease – infants with significant tachypnea will not be able to feed adequately, in addition to increased insensible losses with increased WOB  HOSPITALIZED INFANT Attempt to prevent/minimize frustrations Regression is common Support parent-infant attachment Promote sensorimotor activities Regression – for eg, a child who previously drank from a cup PROVIDING COMFORT  TODDLER/PRESCHOOLER Examining a toddler: -Involve caregivers -down to their level -minimal physical contact at first Preschooler: -may demo use of equipment Explain to their level of understanding  FEBRILE SEIZURES A seizure (or convulsion) involves involuntary muscle contraction and relaxation Febrile seizures accompany infections such as: Otitis media, Upper respiratory tract infection, Meningitis Presentation: sudden onset of seizure, involving arms, legs & facial muscles usually early in the course of a high fever  FEBRILE SEIZURES (CONTINUED) Treatment: Diazepam (if seizure persists) Antipyretics (Tylenol and/or ibuprofen) Family education  ACUTE GASTROENTERITIS Inflammation of the stomach and intestines, usually accompanied by diarrhea & vomiting Can be caused by malnutrition, lactose intolerance Viruses- rotavirus, norwalk, adenovirus Bacteria – Shigella, salmonella, campylobactor, e- coli, clostridium diificile, yersinio Parasites – Giardia lambia, crytosporidium, Entamoeba histolytica  ACUTE GASTROENTERITIS (CONTINUED) The organism, time of year, and transmission route play a role in the occurrence of infective gastro Often very high transmission in daycare centres Diagnosis: History & exam Symptoms Fever Nausea Vomiting Diarrhea(liquid, green stools with mucus or blood) Dehydration Electrolyte imbalance  ACUTE GASTROENTERITIS (CONTINUED) Dehydration prevention & management is key! Symptoms include: weight loss, Rapid, thready pulse Hypotension (late) Decreased peripheral circulation Dry mucous membranes Decreased urine output Depressed (sunken) fontanel Skin turgor Loss of tears  TONSILLITIS Inflammation of the tonsils (two masses of lymphoid tissue at the back of the mouth), resulting from pharyngitis Normally enlarge progressively from age 2-10; reduce during preadolescence Infection can cause them to become enlarged enough to interfere with breathing & swallowing Symptoms include: enlarged, bright-red tonsils, recurrent sore throat, mouth breathing, halitosis, nasal speech, fever, difficulty swallowing, snoring  TONSILLITIS (CONTINUED) TREATMENT: Medical Analgesics Antipyretics Antibiotics (if streptococcal infection) Surgical T & A (tonsillectomy & adenoidectomy) Preparation for surgery is important for children Post-op monitoring of VS, intake & output, signs of bleeding Encourage intake of cool/cold fluid (clear initially) Avoid straws, and red or brown liquids  TONSILLITIS (CONTINUED) http://www.youtube.com/watch?v=dbfLvripF00&f eature=fvst  HOSPITALIZED TODDLER Separation anxiety can be intense Reassure parents Maintain a sense of trust with toddler Allow child to work through experiences via play, and soothing techniques Support home schedules/habits Repetitive games are helpful Toddler’s world revolves around parents/caregiver; Mothers in particular SEPARATION ANXIETY  SEPARATION ANXIETY - STAGES Protest Despair Denial/Detachment I GIVE UP  HOSPITALIZED PRESCHOOLER Concrete thinkers Often feel guilty/blame self Understand time relationships Afraid of bodily harm Role play can be beneficial PREPARATION THROUGH ROLE PLAY SCHOOL-AGE  PNEUMONIA Causitive organism depends on age Inflammation of the lungs Alveoli become filled with exudate; surfactant may be reduced Gas exchange is impaired Cough (dry initially, then productive) Fever Tachypnea  AUTISM SPECTRUM DISORDER When using the term Autism Spectrum Disorders, most professionals are referring to the subset of Pervasive Developmental Disorders (PDD) that includes: Autistic Disorder (usually referred to as autism) PPD-NOS (Pervasive Development Disorders Not Otherwise Specified), and Asperger's Disorder. Autistic Disorder is considered to be at the more severe end of the spectrum.  Children that have difficulty with social skills, language, and behavior are said to have a pervasive developmental disorder (PDD). Most children with problems in development have only one or two areas of disability. Children with PDD, however, have problems in many areas, such as social interaction, communication, and imagination. Thus, the term "pervasive" was chosen to describe this disorder. The name of this disorder has changed to Autistic Spectrum Disorder (ASD).  WHAT IS AUTISM SPECTRUM DISORDER A group of neurodevelopmental disorders, characterized by the following: Difficulties with social interaction Challenges with communication Repetitive behaviors  WHAT IS ASD? Cause is unknown; there is a genetic link Most children with autism are found to have normal health and no medical reason for the symptoms. Red-flags to report: No babbling or pointing by 12 months No 2-word spontaneous phrases by 24-months Loss of social skill or language previous attained  Symptom Social skills resists being cuddled; may scream to be put down when held remains withdrawn from parents and others and fails to form relationships avoids eye-to-eye contact prefers to play alone is indifferent to the feelings of others and to social norms Use of language and imagination speaks later than other children of the same age cannot understand or copy speech or gestures rate, pitch, tone, or rhythm of speech is abnormal unable to start a conversation or keep one going unable to engage in fantasy or imaginative play such as role playing and storytelling responds inappropriately to sounds acquired speech is immature and unimaginative; he makes up words and echoes what someone says Behaviour, activities, and interests develops habit behaviour and compulsive routines greatly resists even the slightest change; becomes enraged if his obsessive routine is altered or activities are disrupted hyperactive obsessed with one topic or idea; may become attached to unusual objects walks on tiptoe and/or flicks or twiddles fingers for long periods bangs head, rocks, or stares has sudden screaming spells injuries himself on purpose has trouble learning manual tasks  HOW IS IT DIAGNOSED? Because autism is a complex condition, assessments are usually done by a team of professionals, such as a speech-language pathologist, development pediatrician, clinical psychologist or psychiatrist. To diagnose autism, they watch the child's behaviour and ask parents about the child's development.  AUTISM http://www.autismspeaks.ca/ 1478 children province wide waiting for Intensive behavioural therapy, another 362 waiting for assessments Longer young children wait for therapy the less likely they are to lead independent productive lives Big issue is imaging the devastation of knowing a treatment exists to help your sick child and because of government indifference your child is going to suffer and deteriorate. March 30, 2012 Toronto Star – new research shows rate of diagnosis almost twice as prevalent as was to believed only 10 years ago 1 in 88 compared to 1 in 155 2002, ? Some increase due to better identification /diagnosis. Happening world wide five times more common in boys than girls  ASTHMA 80% occur before age 5 Symptoms in children, coughing, wheezing expiration, SOB, c/o of itchiness in neck, chin & chest Fear especially night attacks Air hunger- flaring of nostrils, use of accessory muscles, orthopnea, perspiration  ASTHMA TREATMENTS Medications – bronchodilators, ant inflammatory drugs Nursing care – avoid triggers, decrease excessive humidity, dust & dander Activity tolerance  HOSPITALIZED SCHOOL-AGE Most tolerate brief separations from parents Forced dependency can be difficult Provide a sense of continuity with the outside world Observe body language carefully Can participate in their own care Encourage children to draw, act out their feelings, play board games COMFORTING SCHOOL AGED ADOLESCENCE  EATING DISORDERS Anorexia Nervosa Bulimia https://www.canada.ca/en/public-health/services/ publications/healthy-living/eating-disorders-teens- information-parents-caregivers.html  MOOD DISORDERS Depression Not as easy to identify in children Major depressive or mood disorder: Prolonged behavioral change from baseline Interferes with school, family, activities What are some symptoms? Often “act out” their concerns; sadness/depression is a common emotion r/t moving, grades, diff w/ friends, but resolve in a short time Symptoms include loss of appetite, sleep problems, lethargy, social withdrawl, sudden drop in grades Can lead to substance abuse/suicide Treatment? Treatment includes education, antidepressants, and monitoring for side effects of medications  WARNING SIGNS OF SUICIDE Major life changes, feelings of hostility or hopelessness Suicidal clues – giving away possessions, writing/talking about Decreased performance at school or work Mood swings, flat affect Withdrawal from family and friends loss of interest in personal appearance  Boys complete suicide 4 times more often than girls but girls attempt suicide 5 times more often Males tend to use lethal methods such as guns, hanging, jumping off high elevations Girls more often overdose or slit their wrists 2008 9 to 14 years 16 males 9 females Stat Canada 15 to 19 years 140 males 68 females OFTEN ARE A CRY FOR HELP  SUBSTANCE ABUSE =use of drugs, alcohol or tobacco for the purpose of producing an altered state of consciousness Frequency may be an indication of increased dependence The developing brain of a child may suffer more injury than an adult  ATTITUDE starts missing more classes than usual without a good reason seems to care less about marks or school activities has an unexplained drop in grades  BEHAVIOUR major change in behaviour major change in how he interacts with family members preventing family members from knowing about their friends or where they are going Change in Cash Another sign of substance abuse is the unexplained need for extra cash. Your child might not be able to explain where he is spending the money. You may notice cash missing from home or valuable items disappearing  SUBSTANCE ABUSE (SYMPTOMS) Changed attitude or success in school Behavioural changes Change in the need for cash Change in self-care and appearance Change in level of energy Physical signs and symptoms CHANGE IN SELF-CARE AND APPEARANCE Normally, teenagers are very concerned with the way they look. They strive to look their best. If your child lacks interest in clothing, hygiene, grooming, or looks, this may be a sign of substance abuse. Energy poor energy levels getting too much or too little sleep decrease in motivation Physical Signs delayed reaction time red eyes poor concentration and memory increased appetite paranoid thinking (also a sign of mental health disease)  HOSPITALIZED ADOLESCENT Early Adolescence – Illness/hospitalization is a threat to body image Intense relationships with same-sex peers are prevalent Anxious about how illness will affect physical appearance, functioning and mobility Middle Adolescence – Anxious about ability to appeal to opposite sex & meet gender role expectations Incorporating choice, privacy & peer visitors Late Adolescence – Hospitalization may threaten career & future plans Dating partner is often the person of primary importance Able to think abstractly and solve problems; can understand diagnosis & participate in decision-making  CHILD ABUSE (P. 572) Emotional abuse: Intentional verbal acts that result in a destruction of self-esteem in the child; can include rejection or threatening the child Emotional neglect: An intentional omission of verbal or behavioral actions that are necessary for development of a healthy self-esteem; can include social or emotional isolation of a child Sexual abuse: Involves an act that is performed on a child for the sexual gratification of the adult Physical neglect: The failure to provide for the basic physical needs of the child, including food, clothing, shelter, and basic cleanliness Physical abuse: The deliberate infliction of injury on a child; suspected when an injury is not consistent with the history or developmental level of the child  Risk Factors for Abuse Suspected Abuse Professional Responsibility https://durhamcas.ca/reporting-abuse/child-family -services-act/  REPORTING ABUSE In Ontario, it is the law to report suspected child abuse and neglect to a Children’s Aid Society, or if someone is in immediate danger, to call the police. It is not necessary for you to be certain a child or youth is or may be in need of protection to make a report to a Children’s Aid Society. “Reasonable grounds” refers to information that an average person, using normal and honest judgement, would need in order to decide to report. The duty to report applies to any child who is or appears to be, under the age of 16. On January 1, 2018, Ontario raised the age of protection from 16 to 18 years of age. A professional, or member of the public who is concerned that a 16 or 17 year old is or may be in need of protection may, but is not required to, make a report to a Children’s Aid Society, who is required to assess the reported information.