Maternal Notes (FINALS).pdf

Inadequate sperm count: - N-40 M/ml; 125M/ejaculation NURSING CARE OF MALE AND FEMALE CLIENT WITH Causes: GE...

Inadequate sperm count: - N-40 M/ml; 125M/ejaculation NURSING CARE OF MALE AND FEMALE CLIENT WITH Causes: GENERAL AND SPECIFIC PROBLEMS IN SEXUALITY - Chronic diseases: TB, sinusitis, hi temp-lead to: decreased spermatozoa production. MALE SEXUAL DYSFUNCTION - men-desk job-increases scrotal heat - orchitis due to mumps-damage sperm cells ERECTILE DYSFUNCTION - radiation, x-rays-impairs spermatozoa Inadequate sperm count: inability of man to attain or maintain erection-> no Causes: satisfactory intercourse. - excessive use drugs /alcohol lead to malnutrition Causes: - endocrine imbalance-thyroid, pituitary pre-existing illnesses and its management, personal inhibition-spermatogenesis. low vit intake advise vit E-aid anxieties. fertility and quality sexual process Management: - surgery near testes...herniorrhaphy - impair circulation to increase excitement phase in sexualcycle. testes. desensitization stimulate erection and let it subside several times before OBSTRUCTION OF SPERM MOTILITY coitus. Causes: PREMATURE EJACULATION Tubal infection Std consistently reaches ejaculation or orgasm before or very Ascending bladder infection soon after entering the vagina Adhesions partner no sexual gratification Occlusions Management: Congenital stricture of spermatic duct Seman's procedure: stimulating the penis. Modified: the man or his partner squeeze the penis below CHANGES IN SEMINAL FLUID the prepuce. Causes: RETARDED EJACULATION Infection of prostate gland and seminal vesicles Pooling of sperm change composition of seminal fluid ejaculatory incompetence: inability to ejaculate into the Reduced sperm motility vagina or delayed intravaginal ejaculation Causes: DIFFICULTY WITH EJACULATION same W/ impotence Causes: interpersonal problems frequent intercourse Management: anomalies of penis: improve interpersonal problems. - hypospadias-urethral opening at FEMALE SEXUAL DYSFUNCTION - ventral surface. - epispadias-urethral opening at dorsal surtace FRIGIDITY - psychological problems. - debilitating disease inhibition sexual arousal, congestion and vaginal lubrication absent or minimal. MALE FERTILITY STUDIES Causes: Management: anxiety, negative emotions associated w/ sexual arousal, History: Contents : fear, interpersonal probs. - congenital problems. (hypospadias, epispadias, Management: cryptorchidism), illnesses(mumps ,STDs ) herniorrhaphy, identify and develop sensual and erotic feelings before present illnesses, man's job-desk all day, x-ray exposure, proceeding to intercourse. frequency of intercourse & masturbation, impotence, ORGASMIC DYSFUNCTION premature ejaculation, coital position, contraceptive measures, fathered children previous marriage or inability to reach orgasm. relationship. Causes: same w/ frigidity. Physical assessment: Management: - observation of 2nd sex charac. and genital abnormalities ( eliminate sexual anxieties and enhance erotic sensitivity. absence vas deferens or undescended testes) masturbation. Semen analysis: - procedure and normal values DYSPAREUNIA painful intercourse Laboratory tests: Causes: - U/A, CBC,blood typing, Rh factor, serological test for Organic factor, psychological problem, fear syphilis, sedimentation rate, protein-bound iodine test,cholesterol diet,bioassay of urine for gonadotropin and VAGINISMUS 17 ketosteroid, testicular biopsy Psychological assessment: vaginal opening closes tightly and prevent penile penetration - discuss w/physician/nurse-attitude on sexual relations, Causes: pregnancy, raising children, sexual activity before marriage. Involuntary spastic contraction of muscles at and around vaginal opening and levator ani muscles MANAGEMENT OF MALE INFERTILITY AROUSING SEXUAL DESIRES treat chronic disease or current infection. surgery-obstructed vas deferens. Cunnilingus: sexual desire by kissing, sucking and licking between low sperm count-abstain intercourse. labia, clitoris and vagina. artificial insemination Fellatio: kissing, sucking and licking the penis.69-88 sperm banks (soixante neuf) Anal stimulation: CAUSES OF FEMALE INFERTILITY Sodomy: penis enter the rectum sexual taboo: sodomy in animals. ANOVULATION Sadism: watching or inflicting discomfort on others. Masochism: infliction of discomfort on oneself. Causes: Sadomasochism: practiced together. pituitary/thyroid disturbance,immature and disease ovaries paraphernalia-saloon in US endometriosis, exposure to x-rays and radioactive subs. Fetishism: sexual arousal using inanimate objects Management: like fur, leather, rubber and women's underclothing. Tests for ovulation: Transvestism: wearing clothing of opposite sex. - BBT - Fern test-arborization SEXUAL ABUSE - Spinnbarkeit test-height of estrogen-cervical mucus thin and Rape water ability- 10-13 cm Incest: practicing sexual behavior bet. persons who are closely Uterine endometrial biopsy: corkscrew appearance of related. endometrium (typical progesterone dominated endometrium) Voyeurism: peeping tom: interest in viewing others having sexual suggest ovulation relationship or viewing nude woman. Culdoscopy: presence of graafian follicle,corpus Sexual harassment luteum/albicans in ovaries. Making obscene telephone calls or smart phone messages TUBAL FACTORS INFERTILITY MALE INFERTILITY PROBLEMS Causes: Chronic salphingitis - due to PID, ruptured MALE INFERTILITY appendix/abdominal surgery congenital webbing or strictures of fallopian tube Predisposing Factors: Management: intermenstrual interval is shortened due to: hormonal, Test of tubal patency: diseased pelvic organ,dietary deficiencies - Rubin test : CO2 instilled into cervix under pressure 1. Over 100 mmHG - stricture HYPERMENORRHEA 2. 200 mmHG - occlusion excessive flow for prolonged no. of days due to glandular 3. CO2 diffused into peritoneum -> under diaphragm effects function,approaching menopause,cervical endometrial pain in both shoulders polyps,uterine fibroids, CA of cervix or endometrium. - Uterosalpingography: x-ray of uterus using radiopaque medium - to be perform same month of Rubin test. METRORRHAGIA UTERINE FACTORS INFERTILITY intermenstrual bleeding due to: CA of cervix, extrauterine preg,threatened abortion,disturbance of glands Causes: of internal secretions. fibromas congenitally deformed uterine cavity MENORRHAGIA inadequate endometrium formation due to poor secretion of estrogen or progesterone. Heavy uterine bleeding that occurs at regular intervals CERVICAL FACTORS INFERTILITY MASTALGIA Causes: painful breasts-w/ increase in size and tenderness. Erosions of cervix - change cervical mucus - spermatozoa GENITAL ANOMALIES don’t penetrate Management: variation in size of labia minora Sim’s Huhner Test: determine ovulation-thin, watery cervical Fusion from one side of labia to the other. mucus buried clitoris VAGINAL FACTORS INFERTILITY PREMENSTRUAL SYNDROME Cause: group of symptoms experienced in varying degrees by Infection of vagina women of reproductive age in the week before menstruation. Change pH of vagina Tests: PREMENSTRUAL SYNDROME Pelvic exam and culture of vaginal discharges group of symptoms experienced by women on their FEMALE FERTILITY STUDIES menopausal stage. Management: PRE-MENSTRUAL DYSMORPHIC DISORDER (PDD) History: menstrual, menarche, douches,use of intravaginal Depressive disorder characterized by mood and physical meds and sprays, radioactive exposures. symptoms that cause significant distress in menstruating Physical assessment: investigate secondary women during the luteal phase of the menstrual cycle characteristics,rule out anatomical defects. Symptoms occur three days prior to menstruation and Lab Tests:U/A,CBC, sedimentation rate, serology tests, pbi improve within a few days after the onset of menses. det, BMR, urine assay, 17 ketosteroids ,FSH, estriol, PMDD has a profound impact on a person's quality of life pregnanediol and dramatically increases the risk of suicidal ideation and Psychological assessment: discuss attitudes towards even suicide attempts. sexual intercourse, raising children. Most women of reproductive age experience discomfort or TREATMENT OF FEMALE INFERTILITY mood changes prior to menstruation. exact cause of PMDD is currently unknown. Infection: treat according to causative org. symptoms are only present during ovulatory cycles and Tumor: surgical removal resolve after menses, tubal insufficiency: diathermy or steroid ad Caused by fluctuations in gonadal sex hormones or disturbance of ovulation: variations in sensitivity to sex hormones. - Fertility medication: First line treatment for PMDD is with selective serotonin 1. clomid (chlomephine citrate) induce oogenesis. reuptake inhibitors (SSRIs). - Anovulation: Hormonal therapy with oral contraceptives containing 1. Parlodel-bromocryptine mesylate-anti-hyperprolactenemia drospirenone have demonstrated efficiency in reducing 2. clomid-induce oogenesis PMDD symptoms as well. Artificial Insemination Cognitive behavioral therapy whether in combination with - IVF - done first in England sRI's or alone has shown to be effective in reducing - Use of donor egg and or sperm in IVF impairment. - ICSI: intracytoplasmic sperm injection - sperm injected Exercise, and dietary modifications, may be helpful directly to egg - ZIFT: zygote intrafallopian transfer ANOMALIES OF PELVIC GIRDLE - GIFT: gamete intrafallopian transfer Spina Bifida - ART: assisted reproductive technology - assistive fertility Meningocele preservation, cryopreservation, frozen embryo hatching. Syringomyelocele Alternative and complementary treatments: Spina bifida oculta - acupuncture Meningomyelocele - Diet and supplements - Healthy lifestyle ANOMALIES OF THE URINARY TRACT MENSTRUAL DYSFUNCTION Hypospadias Epispadias AMENORRHEA Horseshoe kidney: fusion of 2 kidneys Androgenital syndrome physiologic: due to pregnancy, uterine or tubal, lactation. primary : when normal menstrual cycle not established even HERMAPHRODITISM after age of puberty due to: developmental anomaly of existence in same person of both female and male sex generative organs. gonads. secondary: absence of menses anytime after menstrual Pseudohermaphrodite: cycle well established up to menopause. female pseudohermaphrodite: PSEUDOMENORRHEA/CRYPTOMENORRHEA - external resemble male organ: - hypertrophied clitoris resembles male phallus. Occurs W/ congenital anomalies or mechanical obstructions - secondary sex characteristics: male:voice, development of preventing flow of menstrual blood. breasts. - vagina- hematocolpos male pseudohermaphrodite: - uterus- hematometra - essential organ testes - tubes- hematosalphinx - secondary sex characteristics: females: hi-pitched voice, fullness of breasts. SURGICAL AMENORRHEA HOMOSEXUALITY due to removal of ovaries congruent w/ behavioral sex and sexual partner preference POST RADIATION AMENORRHEA TRANSEXUALISM destruction of ovary and uterus due to radiation desiring body, sexual organs, and sex of opposite sex OLIGOMENORRHEA/HYPOMENORRHEA CARE OF CHILD AT RISK OR WITH PROBLEMS scanty menstrual flow due to ovarian deficiency (ACUTE AND CHRONIC) POLYMENORRHEA CARE OF HOSPITALIZED CHILD 3 Focus in Caring for a Hospitalized Child: Alleviating the anxieties of children GESTATIONAL AGE-RELATED PROBLEMS Major Factors in Support of Coping during Illness and Hospitalization PRETERM INFANT Preparation of Children and Families for Hospitalization A preterm infant is traditionally defined as a live-born infant PAIN MANAGEMENT IN CHILDREN born before the end of week 37 of gestation; another criterion used is a weight of less than 2500 g (5 lb 8 oz). Pain in Children is not only a hurting sensation, but it can CAUSES: also be a confusing one because a child did not anticipate Multiple pregnancy the pain, does not have words to explain how it feels, and Abnormalities of the uterus cannot always understand its cause. Adolescent pregnancy PAIN PHYSIOLOGY Cervical incompetence Premature rupture of Nociceptors: free nerve endings w/specific receptors found Lack of prenatal care in tissue throughout the body Substance abuse membranes Four reasons: Smoking - reduced oxygen in tissues from impaired circulation Placenta previa - pressure on tissue Previous preterm delivery - external injury PIH - overstretching of body cavities with fluid or air. High, unexplained alpha fetoprotein level in 2nd trimester CLINICAL MANIFESTATION: PAIN IMPULSES STIMULATED BY THE NEUROTRANSMITTERS Respiratory manifestations WILL BE CONDUCTED BY Cardiovascular manifestations A-alpha and A-beta fibers - large fibers that are myelinated Gastrointestinal manifestations and conduct the response at a rapid rate, transmits sharp, Altered fluid status (fluid excess, deficit) well localized pain. Latrogenic anemia A-delta nerve - fibers that are smaller and conduct at a Infection slower rate like light pressure and vibration Hypoglycemia or hyperglycemia C-nerve - fibers-slowly conducting un-myelinated axons that Ineffective temperature control transmit diffuse, dull, burning and chronic pain. Neuromuscular system Pain impulses join central nervous system (CNS) fibers in Hyperbilirubinemia the dorsal horn of the spinal cord and the impulses are ASSESSMENT: projected upward to the brain, where they will be perceived as pai Pain will be classified as: Acute pain is sharp pain. Chronic pain is pain that lasts for a prolonged period (often defined as 6 months). Cutaneous pain is pain that arises from superficial structures such as the skin and mucous membrane. Somatic pain is pain that originates from deep body structures such as muscles or blood vessels. Visceral pain involves sensations that arise from internal organs Referred pain is pain that is perceived at a site distant from its point of origin. PAIN MECHANISM/FLOW Pain impulse--stimulated noxious stimuli(mechanical, chemical, thermal) electrical activity, transduction, transmission, pain impulse moves along peripheral - sensory DIAGNOSTIC TEST FINDINGS: nerves, spinal column, brain. Chest x-ray Gate Control Theory: pain impulses travel and interpreted Serum glucose in the body. ABG analysis Serum calcium PAIN ASSESSMENT Head ultrasounds A. Pain Interview and History: Serum bilirubin PQRST: Echocardiography - P - Presence of pain "Are you hurting today?" Euglobulin lysis time - Q - Quality "What words describe your pain?" (i.e.sharp, Eye examination by a retinal specialist burning, tingling). CBC - R - Radiation or location “Where is your pain?” “Does it shoot MEDICAL MANAGEMENT: or radiate anywhere else?” - S-Severity “Give me a number between 0-10 for your pain” - T - Timing “How long have you had this pain? How long does it last when the pain comes?” B. Assessment Measures Objective Measures: used by observer to score client behavior or physiologic parameters associated w/ painful response, HR ,BP, and self reporting instruments Subjective (Self-Rating ) Measures: when children measure the pain themselves. PAIN MANAGEMENT: Nonpharmacologic: distraction, preparation, relaxation, cutaneous stimulation, self-exercises, hypnosis Pharmacologic: - Analgesics-NSAIDS - Local or regional anesthesia NURSING CARE OF A HIGH-RISK NEWBORN NURSING MANAGEMENT: Provide respiratory support LBW infants: weigh less than 2,500 grams or less at birth Perform the following assessments. regardless of gestational age - Assess heart sounds for presence of murmurs. Categories : - Assess pulse and perfusion. - SGA: small for gestational age - have intrauterine growth - Monitor blood pressure, heart rate, and pulse pressures. retardation (IUGR) Provide adequate fluids and electrolytes and nutrition. - SFD : small for date-birth weight fall below 10% percentile on Maintain a neutral thermal environment. intrauterine growth charts Prevent infection. - AGA: appropriate in weight for gestational age Assess for readiness for selected interventions. - LGA: large for gestational age - weight above 90% on - Provide stimulation when appropriate to infant state and intrauterine growth chart readiness. Premature (preterm) infants: regardless of birth weight are - Encourage flexion in the supine position by using blanket those delivered before 37 weeks from 1st day of LMP. rolls. Full term infants: those born between 37 and 42 weeks - Provide the newborn with body boundaries through gestation. swaddling or using blanket rolls against the newborn's body Postmature infants: those born after a prolonged gestation ( and feet after 42nd weeks) regardless of birth weight. Promote parent-newborn attachment.  Initiate phototherapy as required. Obesity COMPLICATIONS: Postdatism (GA >42 weeks) Respiratory distress syndrome (RDS) Multiparity Retinopathy of prematurity (ROP) Advanced age Patent ductus arteriosus Previous LGA infant Necrotizing enterocolitis (NEC) Large stature Bronchopulmonary dysplasia (BPD) FETAL FACTORS: Apnea of prematurity Genetic or congenital disorders Male gender POSTMATURE INFANT Congenital heart disease esp TGA (happy chubby blue male A post term infant is one born after the 42nd seek of a infant) pregnancy PATHOPHYSIOLOGY: 3 STAGES OF FETAL DYSMATURITY SYNDROME: Infants who are large for gestational age have been Stage 1: Chronic Placental Insufficiency subjected to an overproduction of growth hormone in utero. - Dry, cracked, peeling, loose, and wrinkles skin This most frequently happens with infants of diabetic - Malnourished appearance mothers who are poorly controlled. It may also occur in Stage 2: Acute Placental Insufficiency multiparous pregnancies because with each pregnancy - All features of stage 1 except plint iii babies tend to grow larger. - Meconium staining CLINICAL MANIFESTATIONS: - Perinatal depression Complications associated with maternal diabetes Stage 3: Subacute placental insufficiency Birth injuries due to disproportionate size of newborn to birth - Findings of stage 1 and 2 except point passageway - Green staining of skin, nails, cord, and placental membrane NURSING MANAGEMENT: - A higher risk of fetal intrapartum or neonatal death If IDM, observe for potential complication ASSESSMENT FINDINGS: Monitor for, and manage, birth injuries and complications of A long, thin newborn with wasted appearance, birth injuries. parchment-like skin, and meconium-stained skin, nails, and - Clavicle fracture umbilical cord. BIRTH INJURIES Fingernails are long and lanugo is absent. Meconium aspiration syndrome is manifested by fetal hypoxia ( blue or pale skin, low HR, weak muscle tone, weak INTRACRANIAL HEMORRHAGE cry, no cry, difficulty breathing) trauma or anoxia congenital vascular anomaly or Meconium staining of amniotic fluid, respiratory distress at hemorrhagic problem. delivery, and meconium-stained vocal cords. CAUSES: DIAGNOSTIC TEST FINDINGS: trauma, CPD, prolonged labor, precipitate delivery, breech Hematocrit may be elevated presentation, mechanical interference. Sonogram ASSESSMENT: A non-stress test or complete biophysical profile cyanosis, pallor, apnea, difficult respiration, irregular NURSING MANAGEMENT: breathing without other signs of respiratory distress Manage meconium aspiration syndrome. lethargy, somnolence with absent or diminished moro reflex, Obtain serial blood glucose measurements. poor response to stimuli, exaggerated reflex, tremors, Provide early feeding to prevent hypoglycemia, if not convulsions, tensed or bulging fontanels contraindicated by respiratory status. MANAGEMENT: Maintain skin integrity. Diagnostics : UTZ, CT scan, hct determination small dose of vit K, BT, sedative, subdural tap (to remove collection of fluid and reduce ICP Nursing management: provide warmth and rest: place in incubator infant's head elevated, measure head circumference daily feed with care: gavage if can't tolerate IVF FACIAL NERVE INJURY Assess for symmetry of mouth while crying. Wrinkles are deeper on the unaffected side. The paralyzed side is smooth with a swollen appearance. The nasolabial fold is absent GESTATIONAL WEIGHT-RELATED PROBLEMS If the eye is affected, protect it with patches and artificial tears SMALL FOR GESTATIONAL AGE MANAGEMENT: An SGA infant is one whose length, weight, and head X-ray studies of the shoulder and upper arm to rule out bony circumference are below the 10th percentile of the normal injury variation for gestational age as determined by neonatal Examination of the chest to rule out phrenic examination. nerve injury ETIOLOGY: Delay of passive movement to maintain range of motion of Maternal conditions associated with SGA babies the affected joints until the nerve edema resolves (7 to 10 include: days) - Hypertension (chronic or pregnancy- induced) Splints may be useful to prevent wrist and digit contractures - Cardiac, pulmonary, or renal disease on the affected side - Diabetes mellitus ERB-DUCHENNE PALSY AND KLUMPKE PARALYSIS - Poor nutrition - Use of alcohol, tobacco, or drugs Erb-Duchenne palsy - paralysis of the arm causes injury to - Age the trunk (C5-C6) - Multiple gestation Assess for adduction of the affected arm with internal - Placental insufficiency rotation and elbow extension. - Placental fetal abnormalities The Moro reflex is absent on the affected side. Fetal conditions associated with SGA infants include: The grasp reflex is intact. - Normal genetically small infant Klumpke paralysis. - Chromosomal abnormality Assess for absent grasp on the affected side. - Malformations The hand appears claw-shaped. - Congenital infections, especially rubella and cytomegalovirus PHRENIC NERVE PALSY The effect of these factors upon the fetus is dependent on the stage of fetal development. Assess for respiratory distress with diminished breath ASSESSMENT FINDINGS: sounds. Soft tissue wasting X-ray usually shows elevation of the diaphragm on the Loose, dry, and scaling skin affected side Perinatal asphyxia (due to a small placenta that is less efficient in gas exchange) SKULL FRACTURE Respiratory distress, and central nervous system (CNS) Assess for soft-tissue swelling over fracture site, visible aberrations (if the infant has polycythemia) indentation in scalp, cephalhematoma, positive skull x-ray, Congenital anomalies (occurring in as many as 35% and CNS signs with intracranial hemorrhage (e.g., lethargy, LARGE FOR GESTATIONAL AGE seizures, apnea, and hypotonia). A LGA newborn is one weighs more than 4,000 g, is above ACUTE CONDITIONS OF THE NEONATE the 90th percentile PREDISPOSING FACTORS: RESPIRATORY DISTRESS SYNDROME MATERNAL FACTORS: Diabetes Formerly termed hyaline membrane disease  Most often occurs in preterm infants, infants of diabetic Hypothermia mothers, infants born by CS birth, or those who for any DIAGNOSTIC FINDINGS: reason have decreased blood perfusion of the lungs Blood gases will reveal a poor gas exchange evidenced by PATHOPHYSIOLOGY: decreased oxygen and increase carbon dioxide levels; High pressure is required to fill the lungs with air for the 1st acidosis time and overcome the pressure of lung fluid Chest x-ray will show patches or streaks of meconium in the Deficient surfactant → alveoli collapse with each lung, with spaces of hyperaeration (honeycomb effect). The expiration → takes forceful inspiration to inflate them → with diaphragm will be pushed downward deficient surfactant, areas of hypoinflation occur and TREATMENT: pulmonary resistance is increased → blood then shunts Suctioning before the first breath through the foramen ovale and the ductus arteriosus as Respiratory assistance with mechanical ventilation it did during fetal life → lungs are poorly perfused, thus Neutral thermal environment affecting gas exchange → alveoli is no longer adequate to Surfactant sustain life without ventilator support. Antibiotic ASSESSMENT FINDINGS: Monitoring of Vital signs, lung status, respiratory rate and Increase distress: character Seesaw respirations (on inspiration, the anterior chest wall retracts and the abdomen protrudes, on expiration the SUDDEN INFANT DEATH SYNDROME (SIDS) sternum rises) PATHOPHYSIOLOGY: Heart failure evidenced by decreased urine output and Sudden unexplained death in infancy edema of the extremities Usually during sleep Pale gray skin color Usually related to immature Periods of apnea CNS Bradycardia CAUSE: Diagnosis of RDS is made on the clinical signs of grunting, Unknown cyanosis in room air, tachypnea, nasal flaring, retractions, Possible Contributing Factors: and shock - Exposure to secondary smoke DIAGNOSTIC TEST FINDINGS: - Sleeping prone rather than supine Chest x-ray film will reveal a diffuse pattern of radiopaque - Pulmonary edema areas that look like ground glass - Heart rate abnormalities Blood gas studies will reveal respiratory acidosis - Distorted familial breathing patterns Grp B beta hemolytic, streptococcal infection may mimic RECOMMENDATIONS: RDS. This infection is so severe in newborns that the insult Supine sleeping position to the lungs is intense enough to stop surfactant production. Use of firm sleep surface Cultures of blood, CSF, skin may be done to rule out this Room sharing without bed sharing condition Routine immunization MEDICAL MANAGEMENT: Breastfeeding Surfactant replacement and rescue - synthetic surfactant Consideration of using pacifier is sprayed into the lungs by a syringe or catheter through Avoidance of soft bedding, overheating, and exposure to endotracheal tube at birth while the infant is positioned with tobacco smoke, alcohol, and illicit drugs the head upright and then tilted downward Parents must be counseled at the time of the infant's death Oxygen administration - is necessary to correct oxygen. A and periodically possible complication of oxygen therapy in the very Autopsy result must be given to parents as soon as they are immature or very ill infant is retinopathy of prematurity. available Ventilation - normally, on a ventilator, inspiration is shorter WARNING SIGNS: than expiration, or there is an inspiratory/expiratory ratio of Fast breathing (more than sixty breaths in one minute,, 1:2 although keep in mind that babies normally breathe more - Limiting fluid intake may help decrease pulmonary rapidly than adults congestion Retractions (sucking in the muscles between the ribs with - Indomethacin may be used to cause closure of the patent each breath, so that her ribs stick out) ductus arteriosus, thus making ventilation more efficient Flaring of her nose PREVENTION: Grunting while breathing Dating a pregnancy by sonogram or the Persistent blue skin coloring lecithin/sphingomyelin ratio of amniotic fluid is an important way to be certain that an infant born by CS or HYPERBILIRUBINEMIA induced is mature enough the RDS is not apt to occur. excessive concentration of bilirubin in blood which results to function or blood group incompatibility leading to increased erythrocyte destruction. TWO TYPES OF BILIRUBIN: Direct (conjugated) - water-soluble - easier for the body to eliminate Indirect (unconjugated) - fat-soluble; easily cross the blood-brain barrier - hard for the body to eliminate PHYSIOLOGIC JAUNDICE: begins after 24 hours of life (common 3rd-4th day) Result of neonatal hepatic immaturity MECONIUM ASPIRATION SYNDROME Bilirubin > 5-14 mg/di PATHOLOGIC JAUNDICE: Appearance of the fluid is green to greenish black from the Jaundice begins within the first 24 hours of life staining Usually related to hemolytic disease of the newborn PATHOPHYSIOLOGY: Rh incompatibility Risk factors for meconium aspiration syndrome include: ABO incompatibility - Maternal diabetes Other Causes: - Maternal hypertension - infection, polycythemia,biliary atresia - Difficult delivery PREDISPOSING FACTORS: - Fetal distress Prematurity - Intrauterine hypoxia Cephalhematoma- is a hemorrhage, collection of blood - Advanced gestational age (greater than 40 weeks) between the skull and periosteum - Poor intrauterine growth ASSESSMENT: Meconium can cause severe respiratory distress in three Assessment includes blanching of the skin specifically ways: forehead and cheeks - It can bring inflammation of bronchioles because it is a CLINICAL MANIFESTATION: foreign substance Jaundice all over - can block small bronchioles by mechanical plugging Yellow discoloration of the sclera - It can cause a decrease in surfactant production through Lethargy lung cell trauma Dark amber concentrated urine ASSESSMENT FINDINGS: Poor feeding Obvious presence of meconium in the amniotic fluid Dark stool (dark greenish staining or streaking of the amniotic acid) COMPLICATIONS: - skin with greenish stain KERNICTERUS - Limp appearance at birth bilirubin is deposited in the brain causing destruction of brain - Cyanosis cells - Difficulty respirations at birth causes permanent impaired neurological function - APGAR score is apt to be low MANAGEMENT: - Tachypnea, retractions, apnea Early and frequent feedings to stimulate Increased RR peristalsis Chest retractions (barrel chest) Exchange transfusion Phototherapy  Photo-oxidation by the use of artificial blue light in order to injury to sternocleidomastoid muscle on one side. convert bilirubin into an excretable form. occurs in neonate with wide shoulder when pressure exerted NURSING MANAGEMENT: on shoulder during delivery. ASSESSMENT: head tilted to affected side head rotated to opposite side asymmetry of face, eyes, ears and skull NURSING MANAGEMENT: exercise head supported with sandbags CRANIO-FACIAL MALFORMATIONS CRANIOSYNOSTOSIS: Premature closure of 1 or more sutures NURSING RESPONSIBILITIES IN PHOTOTHERAPY CARE: Deformity of head Expose all areas of the body to light turn the infant every 2 Damage to brain and eye hours. CLASSIFICATION: Cover eyes(prevent retinal injury) and genitalia. Scaphocephaly Give plenty of fluids to prevent dehydration. Oxycephaly (acrocephaly) Check for loose stools which would mean dehydration SCAPHOCEPHALY Check vital signs every 2 hours for possible hyperthermia Monitor Intake and output every 8 hours sagittal sutures closes prematurely head long ,narrow and Weigh infant daily bony ridge often marks obliterated sutures giving head Increase fluid intake shaped of inverted boat Monitor skin and provide skin care Monitor bilirubin levels OXYCEPHALY (ACROCEPHALY) NEONATAL SEPSIS/SEPSIS NEONATORUM closure of coronal and lambdoid suture--=-> deformity of face and orbit. Generalized infection that has spread rapidly through the Management : bloodstream Surgical : cutting one cm strip of bone involved. TYPES: Early Onset: BRANCHIAL ARCH DEFORMITIES - Begins within 24 hours - More rapid progression HEMIFACIAL MICROSOMIA - Often causes pneumonia or meningitis undersized one side of infant's face Late Onset: S/S :ear on affected side malformed or absent - Develops after 48 hrs to 1st week Tx :construction of external ear by autologous costal - Usually involve CNS cartilage graft or silicone prosthesis used as framework. ETIOLOGY: Split-ribs to reconstruct malformed mandible on affected site. Group B streptococci(GBS) and Escherichia Coli(E. Coli) Staphylococcus epidermidis, Staphylococcus Aureus, MANDIBULAR FACIAL DYSTOSIS Haemophilus influenza (TREACHER COLLINS SYNDROME) Candida albicans - common cause of nosocomial infections of hospitalized low birth weight(LBW) infants affects both side of face, inherited abnormal dominant Vertical Infection manner Horizontal Infection S/S : absence of cheekbone,small chin,underlying jaw PREDISPOSING FACTORS: apparent Prolonged rupture of membranes - anti-mongoloid slant to palpebral fissure. Long, difficult labor - congenital fissure in lateral one third of lower eyelids, cleft Resuscitation and other invasive procedures palate, deformities of external ear absent exterior canal Maternal infection deafness. Vaginosis - most common cause of neonatal sepsis Aspiration of amniotic fluid bacteria, virus, fungus, Nursing management: Escherichia coli Pre-op, post-op care, psychosocial support ASSESSMENT FINDINGS: Surgical management: surgical release of prematurely Hypotonia, Lethargy closed cranial suture done during infancy. Temperature instability SPINA BIFIDA Feeding intolerance (poor sucking vomiting, hyperglycemia, hypoglycemia) failure of the posterior laminae of the vertebrae to close; this Mottling, pallor, cyanosis leaves an opening through which the spinal meninges and Respiratory distress(nasal flaring, retractions, grunting) spinal cord may protrude. taphea acid bradycardia PATHOPHYSIOLOGY: (Initially which is followed by periods Neural tube defects due: teratogenic process that causes Hypotension failed closure and abnormal differentiation of the embryonic Abdominal distension and diarrhea neural tube. THERAPEUTIC MANAGEMENT: CAUSES: Culture of the blood, urine, skin lesions, CSF Low folic acid intake Blood analysis Genetics Lumbar puncture to rule out meningitis Certain Medications Gastric aspiration Diabetes Antibiotic administration (Ampicillin, Gentamicin) Obesity Neutral thermal environment CLINICAL MANIFESTATION: Vital signs frequently Paralysis Collect specimens to identify causative organism Cognitive symptoms Chest radiograph Arnold-Chiari malformation NURSING MANAGEMENT: CLASSIFICATION: Identify infants at risk Spina bifida oculta Emphasize hand washing Meningocele Use of medical asepsis Myelomeningocele On time medications administration Maintain fluid balance and hourly urine output SPINA BIFIDA OCULTA Monitor vital signs Spinal cord, meninges are normal defect only of vertebrae a Observe for complications dimple in skin mark opening of dermal sinus tract originating Gavage feeding PRN in subarachnoid space, subcutaneous lipoma, growth of tufts Parental support of hair over site. NURSING DIAGNOSIS: simplest and commonly asymptomatic in L5, S1 Impaired gas exchange NEUROLOGIC SX: Ineffective thermoregulation skin discoloration, hair, lump or dermal sinus overlying the Risk for imbalanced nutrition, less than body requirements abnormality. Risk for deficient fluid volume myelodysplasia: malformation of spinal cord and or nerve Risk for infection roots which may cause neurologic symptoms: Risk for impaired parenting - weakness,gait difficulties,foot deformities NURSING CARE OF A CHILD WITH - sensory symptoms,urinary retention, NEUROLOGIC DISORDER - repeated UTI, enuresis NURSING CARE: no need for tx unless neurological s/s occur INJURIES TO BONE AND MUSCLES If spinal cord is involved:surgical procedure is indicated. TORTICOLLIS:  if dermal sinus tract connects with subarachnoid is CAUSES: present,surgically explored and closed to prevent infection. Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one SPINA BIFIDA CYSTICA ventricle to another or from the ventricles to other spaces MENINGOCELE: meninges protrude through opening in around the brain. spinal canal, forming cyst-protrusion filled with CSF and Poor absorption. Less common is a problem with the covered with skin sac covered by thin transparent membrane mechanisms that enable the blood vessels to absorb CSF; or it maybe completely covered with skin,spinal cord not this is often related to inflammation of brain tissues. from involved, no neurologic impairment in legs or sphincter disease or injury MENINGOMYELOCELE/MYELOMENINGOCELE: Overproduction. Rarely, the mechanisms for producing - congenital failure of arches of one or more vertebrae to unite CSF create more than normal and more quickly than it can at center of back,bony wall normally surrounding spinal canal be absorbed. at place is missing. CLINICAL MANIFESTATION: - external protrusion through a transparent sac more severe Poor feeding. The infant with hydrocephalus has trouble in sac contains neural tissue, spinal fluid feeding due to the difficulty of his condition. ASSESSMENT AND DIAGNOSTIC FINDINGS: Large head. An excessively large head at birth is suggestive AFP levels of hydrocephalus. Ultrasonography Bulging of the anterior fontanelles. The anterior fontanelle Clinical examination becomes tense and bulging, the skull enlarges in all MTI diameters, and the scalp becomes shiny and its veins dilate. CT Setting sun sign. If pressure continues to increase without SURGERY MANAGEMENT: intervention, the eyes appear to be pushed downward Prenatal surgery: To be done before the 26th week of slightly with the sclera visible above the iris- the so-called pregnancy — a pregnant mother's uterus surgically open setting sun sign. and repair the baby's spinal cord. High-pitched cry. The intracranial pressure may increase NURSING ASSESSMENT: and the infant's cry could become high-pitched. Physical examination Irritability. Irritability is also caused by an increase in the Assessment intracranial pressure. Projectile vomiting. An increase in the intracranial pressure NURSING INTERVENTIONS: can cause projectile vomiting. Prevent infection. SIGN OF INCREASED INTRACRANIAL PRESSURE: Promote skin integrity. vomiting,restlessness irritability,high-pitched shrill Prevent contractures of lower extremities. cry,alteration of v/s(systolic BP, PR, and irregular Proper positioning of the newborn. resp),forehead prominent, pupillary changes,seizures Promote family coping. (possible), lethargy or coma, stupor) Provide family teaching. ASSESSMENT AND DIAGNOSTIC FINDINGS: Computed tomography (CT) scanning: CT scan is used to ENCEPHALOCELE assess the size of ventricles and other structures. Magnetic resonance imaging (MRI): MRI is used to assess sac like protrusion of meninges, CSF, brain substance for Chiari Malformation or cerebellar or periaqueductal through a congenital defect in skull tumors. cranial meningocele: contains only meninges Skull radiography: detect erosion of sella turcica; (after 75% occurs in the occipital area shunt insertion) to confirm correct positioning of installed NURSING MANAGEMENT: hardware. extreme care in handling the head. MEDICAL MANAGEMENT: ARNOLD-CHIARI MALFORMATION Goal of treatment: to reduce or prevent brain damage by improving the flow of CSF which may include surgery to occipito - cervical region with displacement of cerebral provide shunting for drainage of the excess fluid from the tonsils and adjacent structure into a funnel shaped ventricles to an extracranial space such as the peritoneum or enlargement of upper cervical canal, swelling, displacement right atrium (in older children) or management with of medulla against upper portion of spinal cord. medications to reduce ICP if progression is slow or surgery ASSESSMENT: is contraindicated. running nose, PHARMACOLOGIC THERAPY: crowing Diuretics. Acetazolamide (ACZ) and furosemide (FUR) treat respiration, post hemorrhagic hydrocephalus in neonates; both are increased size of head due to obstruction of CSF flow. diuretics that also appear to decrease secretion of CSF at MANAGEMENT: the level of the choroid plexus. Surgery Anticonvulsants:interfere impulse transmission of cerebral cortex and prevent seizures. ANENCEPHALY Antibiotics: after culture and sensitivity dependent for shunt Severe defect involving absence entire brain or cerebral infections such as septicemia, ventriculitis, meningitis, or hemispheres given as a prophylactic treatment. SURGICAL MANAGEMENT: Surgical intervention: effective means of relieving brain pressure and preventing additional damage to the brain tissue. Surgery: preferred therapeutic option in patients with hydrocephalus. Ventriculoperitoneal (VP) shunt: medical device that relieves pressure on the brain caused by fluid accumulation. Ventriculoatrial (VA) shunt placement enables cerebrospinal fluid (CSF) to flow from the cerebral ventricular system to the atrium of the heart. HYDROCEPHALUS Lumboperitoneal shunt. Only used for communicating hydrocephalus, CS fistula, or pseudotumor cerebri). imbalance between production of CSF and its absorption Torkildsen shunt (rarely). Effective only in acquired over surface of brain into circulatory system. obstructive hydrocephalus. Formation flow and absorption of CSF: Ventriculopleural shunt (second-line therapy). Used if other production of CSF dependent mostly on active transport of shunt types contraindicated. ions (Na) across epithelial NURSING ASSESSMENT: membrane of choroid plexus into cavities of ventricles. Head circumference. Measurement of the newborn's head osmotic equilibrium re-established through passive addition is essential. of H2O and fluid accumulates within cerebral ventricle Neurologic and vital signs. Obtaining accurate vital and themselves. neurologic signs is necessary before and after surgery. CSF Circulation: Check the fontanelles. If the fontanelles are not closed, Pathway: carefully observe them for any signs of bulging. lateral ventricles, foramen of Monro, third ventricle, aqueduct Monitor increase in intracranial pressure. Observe, of Sylvius, fourth ventricle, foramina of Magendie and report, and documentall signs of IICP. Luschka; subarachnoid space over brain and spinal cord; History taking. If the child has returned for revision of an reabsorption into venous sinus blood via arachnoid existing shunt, obtain a complete history before surgery from granulations. the family caregiver to provide a baseline of the child's TWO TYPES OF HYDROCEPHALUS: behavior. Noncommunicating. In the noncommunicating type of NURSING DIAGNOSIS: congenital hydrocephalus, an obstruction occurs in the free Risk for Injury related to increased ICP. circulation of CSF. Risk for Impaired Skin Integrity related to pressure from Communicating. In the communicating type of physical immobility. hydroçephalus, no obstruction of the free flow of the CSF Risk for Infection related to the presence of a shunt. exists between the ventricles and the spinal theca; rather, Risk for Delayed Growth and Development related to the condition is caused by defective absorption of CSF, impaired ability to achieve developmental tasks. thus causing increased pressure on the brain or spinal cord.  Anxiety related to the family caregiver's fear of the surgical It is caused by an injury to the developing brain, which outcome. mostly happens before birth Deficient Knowledge related to the family's understanding of There is no single cause but researchers can identify a the child's condition and home care. number of factors that may lead to the brain injury NURSING INTERVENTIONS: Babies can now be diagnosed as at 'high risk of CP' at three Preventing injury. months of age - At least every 2 to 4 hours, monitor the newborn's level of There are many evidence-based interventions for CP and consciousness; new international clinical guidelines will soon be available. - check the pupils for equality and reaction; Cerebral palsy (CP) is a physical disability that affects - monitor the neurologic status, and observe for a shrill cry, movement and posture lethargy, or irritability; CP is an umbrella term for a group of disorders that affects a - measure and record the head circumference daily, and keep person's ability to move suction and oxygen equipment convenient at the bedside. CP is due to damage to the developing brain before, during or after birth CP affects people in different ways. It can affect body movement, muscle control, muscle coordination, muscle tone, reflex, posture and balance. Although CP is a permanent life-long condition, some of these signs of cerebral palsy can improve or worsen over time CAUSES OF CEREBRAL PALSY: Cerebral palsy (CP) is the result of a combination of events either before, during, or after birth that can lead to an injury in a baby's developing brain There are multiple causes of CP - but a series of 'causal pathways', i.e. a sequence of events that combine to cause or accelerate injury to the developing brain. About 45% of children diagnosed with CP are born prematurely For most babies born at term with CP, the cause remains unknown Promoting skin integrity. RISK FACTORS: - After a shunting procedure, keep the newborn's head turned Risk factors do not cause CP. However, the presence of away from the operative site until the physician allows a some risk factors may lead to an increased chance of a child change in position; being born with CP. - reposition the newborn at least every 2 hours, as permitted; Some risk factors for cerebral palsy have been identified. - inspect the dressings over the shunt site immediately after These include: the surgery, every hour for the first 3 to 4 hours, and then at - premature birth (less than 37 weeks) least every 4 hours - low birth weight (small for gestational age) Preventing infection. - blood clotting problems (thrombophilia) - Closely observe for and promptly report any signs of - an inability of the placenta to provide the developing fetus infection; with oxygen and nutrients - perform wound care thoroughly as ordered, and administer - bacterial or viral infection of the mother, fetus or baby that antibiotics as prescribed. directly or indirectly attacks the infant's central nervous Promoting growth and development. system - The newborn needs social interaction and needs to be talked DIAGNOSIS: to, played with, and given CP can sometimes now be diagnosed early, so - the opportunity for activity; interventions can start as soon as possible - provide toys appropriate for his mental and physical capacity. Babies can now be assessed as being at 'high risk of Reducing family anxiety. cerebral palsy' as early as 3-5 months of age. - Explain to the family the condition and the anatomy of the The most sensitive tools are: surgical procedure in terms they can understand; - General Movements Assessment in babies hip spica cast providing optimal TYPES: nutrition. standard trisomy :most common encourage normal physical, emotional, social dev't.: provide translocation occurs when extra number 21 chromosomes playthings. becomes attached to a number 14, 5, or another 21 educating parents chromosomes providing follow-up care: involve parents on planning. mosaic : very rare: cells of these individual contains both normal, abnormal chromosome components. OSTEOGENESIS IMPERFECTA CAUSES OF DOWN SYNDROME: (OI, BRITTLE BONES) Caused by extra genetic material from chromosome 21 generalized disorder of connective tissue PRENATAL TESTING: FORMS: Amniocentesis: procedure in which a small sample of Osteogenesis imperfecta congeneta: multiple amniotic fluid is drawn out of the uterus through a needle fracture:caused by mild trauma in utero or during inserted in the abdomen delivery,extremities shortened ,deformed :due to intrauterine Chorionic Villus Sampling (CVS): prenatal test to detect fractures that healed in abnormal position, blue sclera, birth defects that is performed at an early stage of pregnancy protruding eyes,flat feet, frequent dislocation of joints, Percutaneous Umbilical Blood Sampling (PUBS): a structural scoliosis, kyphosis. genetic test that examines blood from the umbilical cord to Osteogenesis imperfecta tarda: onset after first year of life detect fetal abnormalities progressive deafness, hyperextensibility of joint, thin skin, Alpha-fetoprotein Test (AFP): Alpha fetoprotein (AFP) is a hyperpyrexia with excessive sweating protein normally produced by the liver and yolk sac of a NURSING MANAGEMENT: developing baby during pregnancy in adults. nurse, parents must do all procedures gently being certain Sonogram: It is a picture taken of the baby during an that arm, legs are always supported. ultrasound test. provide stimulation, education PHYSICAL TRAITS: oral magnesium oxide supplement, vit. & fluoride calcitonin A flattened facial profile injection. Eyes that slant upward surgery. A small mouth, making the tongue appear large Dental anomalies ACHONDROPLASIA Small and arched palate failure of cartilage cell proliferation, premature closure of Short nose growth plates of bone. Flat back of head ASSESSMENT: Abnormal ears enlarge head, short extremities (evident esp. in shortness of HEALTH PROBLEMS: the femur and humerus) pooling of secretions. Congenital Heart defects NURSING MANAGEMENT: Intestinal defects assisted ventilation or tracheostomy or both frequent rest Vision problems periods, avoidance of stress. Hearing loss Infections DEVELOPMENTAL MALFORMATION Thyroid problems OF EXTREMITIES Memory loss AUTISM ABNORMAL POSITION OF THE FEET Autistic people often have difficulty in accessing community Metatarsus valgus: deformity of the foot in which the activities, leisure facilities and other services. Everyone forepart rotates outward away from the midline of the body having a better understanding of autism has the power to and the heel remains straight.duck walk,toeing out change lives. The following information is provided to help METATARSUS VARUS: PIGEON TOE :INVERSION OF you to gain a better understanding of autism and suggests FORE PART OF FOOT ways in which you can support autistic people. CLUBFOOT Autism is also known by other names, including: - Autism Spectrum Disorder (ASD) most common orthopedic deformities - Autism Spectrum Condition (ASC) foot twisted out of its normal shape or position in utero, - Asperger’s Syndrome cannot be moved to an over corrected position. - Pervasive Developmental Disorder NURSING MANAGEMENT: Autism is a lifelong condition and affects-people from-all Short term :correct deformity,maintain body part in normal backgrounds. position. Currently more males than females are diagnosed with Long term: prevent recurrence of deformity. autism. - manipulation of foot: parents should be taught properly, done It is estimated that 1 in every 100 people in the several times a day. UK have an Autism Spectrum Disorder (ASD). Many people are unaware that they are autistic.  - care of an infant in Denis Browne splint (made of two ❖ Speech therapy footplates attached to crossbar) ❖ Surgery - when splint is fitted to feet, varying position angulation can ❖ Muscular dystrophy complications be maintained) - care of an infant/child in a cast: encourages gradual stretching of tight muscle, contraction of previously relaxed NURSING CARE OF A CHILD WITH UPPER AND LOWER muscle. RESPIRATORY PROBLEMS - parent education NASOPHARYNGITIS POLYDACTYLY: supernumerary digits (fingers or toes) on hands or feet ❖ “Cold” ❖ “upper respiratory infection or rhinitis” SYNDACTYLY: webbing between adjacent digits ❖ swelling of the nasal passages and the back of the throat ❖ Sneezes Reduction deformities of extremities: ❖ coughs - 3.1 amelia: absence of limb or limbs ❖ blows their nose - 3.2 hemimelia: absence all or part of distal half of limb such ❖ talks as forearm,hand or lower leg,foot - 3.3 phocomelia: absence of proximal portion of limb, hands CAUSES: or feet being attached to trunk of body by an irregularly - VIRUS/ BACTERIA shaped bone. - Rhinovirus is the most common coldcausing virus. It’s highly contagious. Cause : ingestion of thalidomide Nursing management : habilitation : prosthetic device SYMPTOMS OF VIRAL NASOPHARYNGITIS ❖ runny or stuffy nose ❖ sneezing ❖ coughing MUSCULAR DYSTROPHY ❖ sore or scratchy throat ❖ watery or itchy eyes (MD) group of inherited diseases in which the muscles ❖ headache that control movement (called voluntary muscles) ❖ tiredness progressively weaken. In some forms of this disease, the ❖ body aches heart and other organs are also affected. ❖ low fever can appear in infancy up to middle age or later, and its ❖ post-nasal drip form and severity are determined in part by the age at which it occurs. Some types of muscular dystrophy typically affect only males; some people with MD enjoy a HOW IS VIRAL NASOPHARYNGITIS TREATED? normal life span with mild symptoms that progress very slowly; others experience swift and severe muscle weakness and wasting, dying in their late teens to early ❖ vapor run, such as Vicks VapoRub 20s. ❖ saline nasal spray ❖ zinc sulfate syrup ❖ Ask your child’s pediatrician about dosage. DUCHENNE ❖ Use a humidifier or vaporizer, or breathe in steam from hot water or a shower, to help relieve congestion. most common form of muscular dystrophy in children, ❖ Eat chicken soup. Duchenne muscular dystrophy typically affects only ❖ Dissolve ½ teaspoon of salt in warm water and gargle it. males. It appears between the ages of 2 and 6. The This can help relieve the pain from a sore throat. muscles decrease in size and grow weaker over time yet ❖ Add honey to warm water to help soothe a sore throat. may appear larger. Disease progression varies, but many Don’t give honey to children under 1 year old. people with Duchenne (1 in 3,500 boys) need a ❖ Don’t smoke and avoid secondhand smoke. wheelchair by the age of 12. In most cases, the arms, legs, and spine become progressively deformed, and HOW DOES A DOCTOR DIAGNOSE VIRAL there may be some cognitive impairment. Severe NASOPHARYNGITIS? breathing and heart problems mark the later stages of the disease ❖ physical examination (nose, throat, and ears) CAUSES: ❖ Swab test ❖ swollen lymph node ❖ defects in certain genes, with type determined by the abnormal gene. ❖ Duchenne muscular dystrophy occurs when that gene fails to TONSILLITIS make dystrophin. ❖ Most of the muscular dystrophies are a form of inherited disease called X-linked disorders or genetic diseases that - Tonsillitis is inflammation of the tonsils, two mothers can transmit to their sons even though the mothers oval-shaped pads of tissue at the back of the throat themselves are unaffected by the disease. one tonsil on each side. Signs and symptoms of ❖ Men carry one X chromosome and one Y chromosome. tonsillitis include swollen tonsils, sore throat, difficulty Females carry two X chromosomes. Thus, in order for a girl swallowing and tender lymph nodes on the sides of to become affected by muscular dystrophy, both their X the neck chromosomes would have to carry the defective gene -- an extremely rare occurrence, since their mother would have to CAUSES: be a carrier (one defective X chromosome) and their father ❖ Most cases of tonsillitis are caused by infection with a would have to have muscular dystrophy (since men carry common virus, but bacterial infections also may cause just one X chromosome, the other is a Y chromosome). tonsillitis. ❖ A female who carries the defective X chromosome can pass ❖ viruses the disease to their son (whose other chromosome is a Y, ❖ bacteria (streptococcus pyogenes) from the father) RISK FACTORS DIAGNOSIS: - Risk factors for tonsillitis include: Young age. Tonsillitis most often affects ❖ Muscle Biopsy children, and tonsillitis caused by bacteria is ❖ Genetic (DNA) testing most common in children ages 5 to 15. ❖ Neurologic tests Frequent exposure to germs. School-age ❖ Enzyme tests children are in close contact with their peers ❖ Heart monitoring and frequently exposed to viruses or bacteria ❖ MRI or Ultrasound that can cause tonsillitis. MANAGEMENT: SYMPTOMS: ❖ Tonsillitis most commonly affects children between ❖ Steroids ( Corticosteriod) preschool ages and the midteenage years. Common ❖ Medicines targeting gene mutations signs and symptoms of tonsillitis include: ❖ Anticonvulsants (for epilepsy) ❖ Red, swollen tonsils ❖ Immunosuppressants ( for lupus and other autoimmune ❖ White or yellow coating or patches on the tonsils disease) ❖ Sore throat ❖ Antibiotics (for lung infection) ❖ Difficult or painful swallowing ❖ Physical therapy ❖ Fever ❖ Stretching ❖ Enlarged, tender glands (lymph nodes) in the neck ❖ Aquatic therapy ❖ A scratchy, muffled or throaty voice ❖ Respiratory care ❖ Bad breath ❖ Mobility and positioning aids  ❖ Stomachache TREATMENT ❖ Neck pain or stiff neck - Decongestant ❖ Headache - Saline nasal wash - Antibiotics COMPLICATIONS: - Warm, moist air - Inflammation or swelling of the tonsils from frequent or ongoing (chronic) tonsillitis can cause complications such as: LARYNGITIS - Disrupted breathing during sleep (obstructive sleep apnea) ❖ Laryngitis is an inflammation of your voice box (larynx) - Infection that spreads deep into surrounding tissue from overuse, irritation or infection (tonsillar cellulitis) - Infection that results in a collection of pus behind a tonsil (peritonsillar abscess) STREP INFECTION - Rheumatic fever - Scarlet fever - Inflammation of the kidney - Poststreptococcal reactive arthritis CAUSES: EPISTAXIS ACUTE LARYNGITIS - Most cases of laryngitis are temporary and improve after ❖ Nosebleeds (also called epistaxis) can occur easily the underlying cause gets better. Causes of acute because of the location of the nose and the laryngitis include: close-tothe-surface location of blood vessels in the lining - Viral infections similar to those that cause a cold of your nose - Vocal strain, caused by yelling or overusing your voice - Bacterial infections, although these are less common CAUSES: CHRONIC LARYNGITIS Nose picking. - Inhaled irritants, such as chemical fumes, allergens or Colds (upper respiratory infections) and sinusitis, smoke especially episodes that cause repeated sneezing, - Acid reflux, also called gastroesophageal reflux disease coughing and nose blowing. (GERD) Blowing your nose with force.