MCN2 PEDIA CONCEPT TRANSES - PDF

By: Balana, Jessey S. ❖ PROBLEMS RELATED TO MATURITY: PRETERM INFANT: NUR 1210 – NCM 109 CARE OF THE Delivered before 37 weeks of development in the MOTHER AN...

By: Balana, Jessey S. ❖ PROBLEMS RELATED TO MATURITY: PRETERM INFANT: NUR 1210 – NCM 109 CARE OF THE Delivered before 37 weeks of development in the MOTHER AND CHILD AT RISK OR uterus Weigh less than 5 ½ pounds (2.5kg) WITH PROBLEMS 11% of live births nationwide Early Preterm (born between 24 to 34 weeks) Module 1: Pedia Concept Late Preterm (born between 34 to 37 weeks) NURSING CARE OF AT RISK/HIGH Appears immature and has a low birth weight, but is well proportioned for age because the baby appears RISK/SICK CLIENT - NEWBORN to have been doing well in utero Even a newborn from a “perfect” pregnancy may More prone to Hypoglycemia, Infections, and require specialized care or develop a problem over Intracranial Hemorrhage the first few days of life necessitating special Lack of Lung Surfactant – not form until about 34th interventions. week of pregnancy, also makes them extremely Any infant who is born dysmature vulnerable to respiratory distress syndrome (RDS) (before term or post term, or who is underweight or Determining the Maturity of the Newborn: overweight for gestational age) is also at Neonates Assessment risk for complications at birth or in the first few days of life. Inspection of sole creases Birth weight is normally plotted on a growth chart Skull firmness such as the Colorado (Lubchenco) Intrauterine Ear cartilage Growth Chart – special chart for newborns (available Neurologic Development at ThePoint) Mother’s report of LMP Term neonates – born after the beginning of week Physical findings (Ballard’s Maturity Testing) 38 and week 42 of pregnancy Sonographic estimation of gestation age ❖ The High-Risk Newborn: Newborn regardless of the gestational age or birth Gestational Age – major determinant of neonatal death weight, who has a greater- than- average chance of rates. morbidity or mortality because of conditions or circumstances superimposed on the normal course Etiology/Factors associated with Preterm Birth: of events associated with birth and adjustments to Low Race Pregnancy Unwanted of extrauterine life. socioeconomic complications unintended level pregnancies Poor nutritional Age of mother Early Unmarried mothers status and order of induction of birth labor Lack of prenatal Closely spaced Elective Women with care pregnancies cesarean birth abnormal amounts of amniotic fluid Multiple Abnormalities Type of work Mental status of pregnancies of the and physical women mother’s activity of reproductive mother system APGAR Scoring: Previous early Infections History of Use of tobacco birth (UTI) spontaneous products The 1-minute score determines how well the baby or surgical abortion tolerated the birthing process Age – highest incidence is in birthing parents The 5-minute score tells the doctor how well the younger than 20 years baby is doing outside the mother’s womb. Order of Birth – early birth is highest in first Interpretation: pregnancies and those beyond fourth pregnancy 0-3 severely depressed Characteristics of a Preterm Infant: 4-6 moderately depressed Very small and appear scrawny 7-10 good/healthy Have a proportionately large head in relation to the Silverman-Andersen Index – Neonatal Respiratory body, with scant hair Distress Grading: Skin - bright pink, smooth, and shiny, with small blood vessels clearly visible underneath the thin 0 No respiratory Distress epidermis 4-6 Moderate Distress Fine lanugo - abundant over the body but is sparse, 7-10 Severe Distress fine, and fuzzy on the head Ear cartilage - soft and pliable Ballard Maturational Assessment – the sum of all Skin - bright pink, smooth, and shiny, with small 12 criteria represents the neuromuscular and physical blood vessels clearly visible underneath the thin maturation of the fetus. epidermis Soles and palms - minimum creases  Bones of the skull and the ribs - feel soft Apnea of Prematurity: Eyes may be fused. - Short episodes of stopped breathing in babies who Sleeping for most of the time were born before they were due. Inactive and listless - Cessation in respirations lasting longer than 20 Underdeveloped breast tissue seconds is sometimes accompanied by bradycardia Male infants - few scrotal rugae, testes are and/or cyanosis. undescended. - As a result of fatigue or the immaturity of their Females - labia minora and clitoris are prominent respiratory mechanisms. Extremities - maintain an attitude of extension and remain in any position in which they are placed Causes: Unable to maintain body temperature, have limited Brain is not fully Feeding problems Low oxygen levels ability to excrete solutes in the urine, and have developed increased susceptibility to infection. Muscles that keep the Heart or lung Overstimulation A pliable thorax, immature lung tissue, and an airway open are weak problems Anemia Infection Temperature problems immature regulatory center Treatment: More susceptible to biochemical alterations Higher extracellular water content Slower feeding time Change position Use bag and mask, Preterm infants exchange fully half their administer oxygen extracellular fluid volume every 24hours Gently stimulate when Suction if with Give caffeine preparation apnea apnea Soft cranium - subject to characteristic unintentional deformation, or "preemie head, caused by Retinopathy of Prematurity (ROP) positioning from one side to the other on a mattress - Acquired ocular disease that leads to partial or total Head - looks disproportionately longer from front to blindness in children, is caused by vasoconstriction back, is flattened on both sides, and lacks the usual of immature retinal blood vessels. convexity seen at the temporal and parietal areas. - High concentrations of oxygen - causative agent - This positional molding is often a concern to parents - blood vessels to grow abnormally and randomly in and may influence their perception of the infant’s the eye. attractiveness and their responsiveness to the - These abnormal vessels tend to leak or bleed, which infant. leads to scarring of the retina. Frequent repositioning of the infant and positioning - When the scars shrink, they pull on the retina, on a gel mattress can reduce or minimize cranial causing it to detach from the back of the eye which molding. can cause blindness Problems due to Prematurity: - Caused by disorganized growth of retinal blood vessels Anemia of Prematurity: - Immature retinal blood vessels constrict when Low Birth Weight infants at age 1-3 months exposed to high oxygen concentrations. Clinical Features: apnea, poor weight gain, - In addition, endothelial cells in the layer of nerve tachypnea, feeding problem. fibers in the periphery of the retina proliferate, Erythropoiesis decreases after birth as a result of leading to retinal detachment and blindness. increased tissue oxygenation due to the onset of - Infants who are most immature and most ill (and breathing and closure of the ductus arteriosus, and consequently receive the most oxygen) are at a reduced production of erythropoietin. highest risk. Low Hb and Reticulocyte count - A preterm infant who is receiving oxygen must have Many preterm infants develop a normochromic, blood PO2 levels monitored by pulse oximeter, normocytic anemia (normal cells, just few in transcutaneous oxygen saturation, or blood gas number), which can make the infant appear pale, monitoring. lethargic, and anorectic. - Keeping blood PO2 levels within normal limits lowers Occurs from a combination of immaturity of the the risk. hematopoietic system (effective production of red - When blood PO2 levels rise to higher than 100 mm cells with an elevated reticulocyte count may not Hg, the risk of the disease increases greatly. In the begin until 32 weeks of pregnancy) past, once ROP occurred, there was no reversing it. Maturity of baby at birth Hemoglobin level at Times of Nadir nadir (weeks) Periventricular/Intraventricular Hemorrhage: Term babies 9.5-11 6-12 - Neurodevelopmental problems have been linked to Premature babies (1200- 8.0-10 5-10 lack of maternal thyroid hormones at a time when 2500gm) their own thyroid is unable to meet postnatal needs. Small premature babies 6.5-9.0 4-8 (100 beats/min) Clear secretions and Administration of TPN meconium from the mouth and nose with a bulb Nosocomial exposure syringe or a large-bore suction catheter. Dry, stimulate, reposition, and administer oxygen as Pathophysiology of Sepsis: necessary. Premature withdrawal of the placental barrier leaves Maintain an optimal thermal environment to the infant vulnerable to most common viral, minimize oxygen consumption. bacterial, fungal, and parasitic infections. Minimal handling because these infants are easily Immunoglobulin G (IgG) - are normally acquired agitated. from the maternal system and stored in fetal tissues - Agitation can increase pulmonary hypertension and during the final weeks of gestation to provide NBs right-to-left shunting, leading to additional hypoxia with passive immunity to a variety of infectious and acidosis. agents. Early birth (interrupts) ➔ *transplacental a. Sedation to decrease agitation. b. Umbilical artery catheter be inserted to monitor transmission➔ preterm infants have a low level of blood pH and blood gases without agitating circulating IgG. infant. IgA- against viral infections, and IgM – against Oxygen therapy via hood or positive pressure to gram-negative organisms, are not transferred to the maintain adequate arterial oxygenation. fetus. ➔ highly vulnerable to invasion by these Mechanical ventilation to minimize mean airway organisms Defense mechanisms of neonates are pressure and tidal volume if pulmonary interstitial further hampered by: emphysema or a pneumothorax is present a. low level of complement Oxygen saturations should be maintained at 90-95% b. diminished opsonization ability Surfactant therapy to replace displaced or c. monocyte dysfunction inactivated surfactant and as a detergent to remove d. reduced number and inefficient function of meconium. circulating leukocytes are unable to concentrate Volume expansion, transfusion therapy, and their limited numbers at the site systemic vasopressors (Dopamine) to maintain e. A hypofunctioning adrenal gland contributes only a systemic blood pressure greater than pulmonary meager anti-inflammatory response ➔These blood pressure, thereby decreasing the right-to-left deficiencies permit rapid invasion, spread, and shunt through the patent ductus arteriosus. multiplication of organisms. Ensure adequate oxygen carrying capacity by Types of Sepsis: maintaining the hemoglobin concentration of at least 13 g/dL. Congenital Infection: - Present at birth SEPSIS NEONATORUM (SEPTICIMEA) - Infection direct from mother - Generalized bacterial infection in the bloodstream Early-onset sepsis that occurs in an infant younger than 90 days old - (less than 3 days after birth) - Infant’s poor response to pathogenic agents, ➔ - acquired in the perinatal period usually no local inflammatory reaction at the portal - Infection can occur from direct contact with of entry to signal an infection, ➔ symptoms tend to organisms from the maternal GI and genitourinary be vague and nonspecific ➔ Delayed diagnosis and tracts. treatment. Late-onset sepsis - (1 to 3 weeks after birth or Day 8 and 9 of NB) Sources of Infection: - primarily nosocomial - Offending organisms are usually: Transplacental transfer from maternal bloodstream a. Staphylococci or during labor from ingestion or aspiration of b. E. Coli infected amniotic fluid. c. Klebsiella organisms  d. Pseudomonas or Candida species Risk Factors of Hyperbilirubinemia: e. Enterococci f. Coagulase-negative staphylococci Postnatal age Total Serum Bilirubin Value Clinical Manifestation of Sepsis: Prematurity Health of the neonate Hypothermia Swollen belly area Poor sucking SGA Diarrhea Vomiting Sudden episodes of apnea Pathophysiology: Low blood Jaundice Unexplained sugar desaturation Bilirubin is one of the breakdown products of the hemoglobin that results from red blood cell Unexplained Desaturation - A few neonatal infections destruction (RBC) when RBCs are destroyed, the (e.g., pyoderma, conjunctivitis, omphalitis, and breakdown products are released into the mastitis) are easily recognized. circulation, where the hemoglobin splits into two Diagnostic Evaluation of Sepsis: fractions: heme and globin. The globin (protein) portion is used by the body, and Radiographic examination the heme portion is converted to unconjugated Cultures of blood, urine, and CSF bilirubin, an insoluble substance bound to albumin. CBC C-Reactive Protein serial measurements Symptoms of Hyperbilirubinemia: Prevention of Sepsis: Jaundice causes a yellow color of the skin. The color begins on the head to feet fashion Screen pregnant women for GBS Lethargy Screening other maternal infections Poor sucking Handwashing techniques Isolation precautions Diagnostic Evaluation: Standards for spacing of infant beds (3 feet spacing) Signs of jaundice Therapeutic Management of Sepsis: Blood exams Serum Bilirubin Prompt initiation of antibiotic therapy a. Preterm infants > 10 mg/dL (> 170 μmol/L) Supportive therapy b. Term infants > 18 mg/dL in term infants Blood transfusion Blood, urine and CSF culture Electronic monitoring of vital signs Regulation of thermal environment Jaundice in Breastfeeding Infant: Development of Sepsis: Breast-feeding is associated with an increased incidence of jaundice. 1. The initial respiratory infection spreads from the chest into the body Two types: 2. The infection eventually enters and surrounds the Breast-feeding—associated jaundice (early-onset spinal cord jaundice) 3. Finally, the infection spreads up to the brain where - begins at 2 to 4 days of age and occurs in it becomes fatal approximately 12% to 13% of breast-fed newborns. HYPERBILIRUBINEMIA: Therapeutic Management of Hyperbilirubinemia: Jaundice of the newborn Neonatal hyperbilirubinemia Early feeding Bili lights – jaundice Pharmacologic: Phenobarbital Hemolytic disease of the newborn Fiberoptic panel / blanket Hemolytic – Latin “Destruction” (lysis) of red blood Intravenous immunoglobulin cells Phototherapy In the past, often caused by an Rh blood type Exchange transfusion incompatibility. Now, often caused by an ABO incompatibility Phototherapy: 1. The infants’ eyes are shielded by an opaque mask to Causes of Jaundice: prevent exposure to the light – protective Plexiglas shield. ABO Incompatibility Rh Incompatibility a. infant's eyelids are closed Sepsis b. checked at least every 4 to 6 hours Extensive bruising c. Eye shields are removed during feedings Cephalhematoma 2. Temperature is closely monitored 3. Flexed position with rolled blankets along the sides of the body 4. Minimal clothing and turn patient to sides 5. An overhead phototherapy unit may be combined with a Bili blanket that can be placed under the infant. 6. Accurate charting includes: a. Time b. Shielding of the eyes c. Type of fluorescent lamp d. Number of lamps e. Distance between surface of lamps and infant f. Use of phototherapy + incubator or bassinet g. Occurrence of side effects. Maximize phototherapy: Distance between the lamps and the infant, no less than 18 inches. Increasing the skin surface area exposed to phototherapy will also maximize treatment. An overhead phototherapy unit is combined with a bili blanket that can be place under the infant. Lining the sides of the bassinet with white blankets or aluminum foil can increase effectiveness of therapy Minor Side Effects of Phototherapy: Loose, greenish stools - Frequent stooling can cause perianal irritation; therefore, meticulous skin care, keeping the skin clean and dry, is essential. Bronze baby syndrome - Infants develop a dark, gray-brown discoloration of skin, urine, and serum due to the accumulation of porphyrins and other metabolites Frying effect - Increased tanning due to use of oily lubricants or lotions on the skin Purpura or bullae - In infants with cholestatic jaundice or congenital erythropoietic porphyria Exchange Transfusion Serum Bilirubin levels greater than 20-25 mg/dL Using an estimate of 80-90 mL/kg total blood volume X 2 is usually removed and replaced sequentially in aliquots (10-15 mL in term babies; 5- 10 mL in smaller preterm babies) over several hours. Using O negative blood rather than the baby's blood type is important because not all circulating antibodies may be removed. Packed RBCs resuspended in fresh frozen plasma must be used for this procedure. COMPLICATIONS OF HYPERBILIRUBINEMIA Kernicterus - indirect bilirubin levels as high as 20 mg/100ml a. Decreased activity b. Fever c. Lethargy d. Seizures e. Irritability f. Opisthotonus g. Rigid extension of all four extremities h. Loss of interest in feeding By: Balana, Jessey S. - But a problem with the arcuate nucleus could deprive the baby of this involuntary reaction and put NUR 1210 – NCM 109 CARE OF THE him or her at greater risk for SIDS. MOTHER AND CHILD AT RISK OR Stomach sleeping a. Puts pressure on a child's jaw, therefore narrowing WITH PROBLEMS the airway and hampering breathing. b. Can increase an infant's risk of "rebreathing" his or Module 2: Pedia Concept her own exhaled air, particularly if the infant is Respiratory disorders are among the most common sleeping on a soft mattress or with bedding, causes of illness and hospitalization stuffed toys, or a pillow near the face. in children. - The soft surface could create a small enclosure Respiratory disorders range from minor illnesses around the baby's mouth and trap exhaled air. As such as a viral upper respiratory tract infection (a the baby breathes exhaled air, the oxygen level in common cold), to life-threatening respiratory the body drops and carbon dioxide accumulates. tract disease. - Eventually, this lack of oxygen could Because the level of acuity can change quickly, contribute to SIDS. respiratory deterioration or Causes of SIDS: compromise must be recognized and be responded to immediately. Problems with the baby's ability to wake up (sleep arousal) ❖ SUDDEN INFANT DEATH SYNDROME (SIDS) Inability for the baby's body to detect a build-up of - sudden unexplained death in infancy. carbon dioxide in the blood. - Occur at a higher than usual rate in infants of adolescent parents, infants of closely spaced Diagnostic and Laboratory Procedures: pregnancies, and underweight and preterm infants. - Peak age of incidence is 2 to 4 months ECG (electrocardiogram) test. - SDS; cot death, Crib Death - To detect if the baby is already dead - Sudden, unexpected death of an infant younger than History of any young sudden deaths in the family, or 1 year old (2 to 4 months) which may occur during if a young person is suffering from symptoms of: sleep, whilst awake, or just after exercise a. Chest Pain (Exercise related) - Occur between the hours of 10pm at night and b. Dizziness 10am in the morning c. Breathlessness d. Fainting Risks of SIDS: e. Palpitations Affect boys more often than girls Therapeutic Management: Rates are highest for African Americans, Alaska natives and American Indians and lowest for Asians Educate the family about the risk of prone sleeping and Hispanics position in infants from birth – 6months of age Increased incidence during cold weather Communicate to parents or care giver about the risk Being around cigarette smoke while in the womb or factors for SIDS after being born - How to avoid SIDS Sleeping in the same bed as their parents (co Avoid any remarks that may suggest responsibility sleeping) Allow the parents to say goodbye to their child Multiple birth babies (being a twin, triplet, etc.) - Give time for grieving Prematurity or low birth weight Encourage the parents to express their emotions Having a brother or sister who had SIDS Family counseling may be recommended to help Mothers who smoke or use illegal drugs siblings and all family members cope with the loss of Being born to a teen mother an infant Short time period between pregnancies Prevention: Late or no prenatal care Soft bedding in the crib Screening family members where there has been a Living in poverty situations heart condition or a previous sudden death Lack of breastfeeding Infants younger than 1 year old should be placed on Overheating from excessive sleepwear and bedding their backs to sleep — never face-down on their Infant has an underlying cardiac abnormality stomachs or on their sides Infants with an abnormality in the arcuate nucleus, Place your baby on a firm mattress to sleep, never a part of the brain that may help control breathing & on a pillow, waterbed, sheepskin, couch, chair, or awakening during sleep. other soft surface - If a baby is breathing stale air and not getting To prevent rebreathing, do not put blankets, enough oxygen, the brain usually triggers the baby comforters, stuffed toys, or pillows near the baby to wake up and cry. - To avoid suffocation - That movement changes the breathing and heart Make sure your baby receives all recommended rate, making up for the lack of oxygen. immunizations  Make sure your baby does not get too warm while Results from complex interactions & automatic sleeping. neural regulation of the airways, where the - A baby who gets too warm could go into a deeper following occurs: sleep, making it more difficult to awaken Do not smoke, drink, or use drugs while pregnant Bronchial smooth muscle contraction. and do not expose your baby to secondhand smoke Bronchospasm Receive early and regular prenatal care Mucosal edema from inflammatory cells in the Make sure your baby has regular well-baby checkups airways with injury to the epithelium. Breastfeed, if possible Increased mucus production Put your baby to sleep with a pacifier during the first Mucus plugging year of life Air trapped behind occluded or narrowed airways Keep the cribs and bassinets in the room where Insufficient oxygenation & ventilation. parents' sleep. Air hunger responses, resulting in anxious behavior Classification: ❖ ASTHMA Greek word “panting” 1. Atopic (extrinsic) Episode begins with a dry cough and then develop Occupational asthma - when a person develop increasing difficulty exhaling as it becomes more and asthma because of contact with certain chemical more difficult for them to force air through the irritants or industrial dusts in the workplace narrowed lumen of the bronchioles that are not only 2. Non-atopic (intrinsic) inflamed and swollen but also filled with mucus. Chronic lung disease in which there is airway Clinical Manifestations: obstruction, airway inflammation & airway hyper responsiveness or spasm of the bronchial smooth Dyspnea with prolonged expiration muscle. Expiratory wheeze (a whistling sound when you Chronic inflammatory disease of the respiratory tract breathe), progressing to inspiratory & expiratory and is the most common illness in children. wheezing, progressing to breath sounds becoming Present before 5 years of age audible Primarily affects the small airways Grunting respirations in infancy Typical dyspnea and wheezing (sound caused by air Chest tightness (may feel like something is being pushed forcibly past obstructed bronchioles) squeezing or sitting on your chest) associated with the disorder begin. Shortness of breath (can't catch their breath or feel Wheezing is primarily heard upon expiration because out of breath; may feel like can't get air out of the lumen of the bronchioles are narrower during lungs) exhalation than inhalation, but it may be absent with Nasal flaring severe asthma exacerbations. Cough occurring at night or early in the morning Accessory muscle use Risk Factors: Anxiety, irritability, to decreasing level of consciousness Among children, more boys have asthma than girls. Cyanosis - But after 15 years of age, more women have asthma Reversible airflow obstruction and bronchospasm than men. The airways are so swollen that air can’t get through Smoking during pregnancy and after delivery client stops wheezing and breath sounds aren’t Low air quality from factors such as traffic pollution audible. or high ozone levels Use of antibiotics in early life Exacerbation of Asthma: Exposure to bacterial endotoxin in early childhood Dust Runny nose Psychological stress from environmental sources including tobacco Mold Sinus infections Cockroach allergens smoke, dogs, and farms Pollen Reflux disease Exercise or emotional factors Delivery via caesarean section Foods Sleep apnea Animal dander (cat and dog hair) Having allergies, eczema (an allergic skin condition), Perfumes Weather changes Both viral and bacterial infections of the upper respiratory tract or parents who have asthma. Diagnostic and Laboratory Procedures: Causes: Pattern of symptoms Genetic factors - Wheezing, a runny nose or swollen nasal passages, - Atopy is an inherited tendency to develop allergies and allergic skin conditions (such as eczema) - Parents who have asthma Allergy testing Environmental factors - to find out which allergens affect you, if any. - Allergens, air pollution, dust mites, cockroaches, a. Bronchoprovocation test - to measure how animal dander, and mold sensitive the airways are - Exposure to some viral infections in infancy or in b. Spirometry - forced expiratory volume in one early childhood when the immune system is second (FEV1), and peak expiratory flow rate) developing. - to check how the lungs are working. This test measures how much air a person can breathe in and out. It also measures how fast you can blow air out Chest x ray or an EKG (electrocardiogram) - to help find out whether a foreign object in the airways or another disease might be causing the Oral corticosteroid - recommended with five symptoms days of prednisone being the same 2 days of Response to therapy over time dexamethasone. Arterial blood gas Magnesium sulfate intravenous treatment - Initially mild respiratory alkalosis from shown to provide a bronchodilating effect when hyperventilation then subsequently respiratory used in addition to other treatment in severe acute acidosis asthma attacks. Eosinophil count – increased in blood, sputum Heliox, a mixture of helium and oxygen, may also be considered in severe unresponsive cases. Therapeutic Management 3. Exercise is advantageous for children with The goal of asthma treatment is to control the asthma (B-adrenergic or cromolyn sodium disease before exercise) 1. Prevent and control asthma symptoms, reduce 4. Oxygen is used to alleviate hypoxia if frequency and severity of asthma saturations fall below 92%. exacerbations, and reverse airflow obstruction. 5. Bronchial thermoplasty 2. Drug Therapy - involves the delivery of controlled thermal energy to General Categories of Asthma Medications: the airway wall during a series of bronchoscopies. Long term control medications (Preventor Nursing Management medicines) Management is targeted at preventing asthma - To achieve and maintain control of inflammation exacerbations by avoiding asthma triggers by ✓ Long acting B2 agonist (to open the airways) decreasing airway obstruction, inflammation & ✓ Leukotriene modifiers (help block the chain reactivity with medications. reaction that increases inflammation in the airways) Promote pulmonary functions ✓ Methylxanthines (Therapeutic range 5-15 mcg/ml) Assess & monitor child’s hydration status Avoid milk and milk products Side effects: Alleviate or minimize child’s & parents’ anxiety, Nausea & Vomiting using development level Headache Assess child’s & parents’ feelings about having Irritability asthma & taking medications. Insomnia Assess willingness to participate in education programs & refer family to support groups as Early sign of toxicity greater than 20 mcg/ml: needed. Emergency Setting: establish IV line for fluid Distractibility therapy and route for emergency drugs Poor school performance Nausea Prevention: Tachycardia and Irritability 1. Avoid triggers Theophylline levels greater than 30 mcg/ml - Allergens (helps open the airways): a. dust mites, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers Seizure - Irritants Arrhythmia a. cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home décor Quick relief medications (Rescue products, and sprays (such as hairspray) Medications) 2. Medicines such as aspirin or other nonsteroidal - To treat symptoms and exacerbations anti-inflammatory drugs and nonselective beta- ✓ Inhaled corticosteroid blockers and use of inhaled corticosteroids ✓ Cromolyn sodium and nedorcomil (helps prevent 3. Sulfites in foods and drinks airway inflammation) 4. Viral upper respiratory infections, such as colds ✓ Omalizumab (anti-IgE) (helps prevent body from 5. Physical activity, including exercise reacting to asthma triggers) 6. Limiting smoke exposure both in utero and after delivery Asthma medications are given by inhalation 7. Breastfeeding by: 8. Dietary restrictions during pregnancy Metered dose Inhaler 9. Smoking ban Nebulizer Prognosis: Hyposensitization - To identify allergens The prognosis for asthma is generally good. - Used for treatment of seasonal allergy and when Early treatment with corticosteroids seems to single substance was identified as offending allergen prevent or ameliorates a decline in lung function.  Asthma has no cure. Even when you feel fine, you WBC Increased still have the disease, and it can flare up at any time Pa02 decreased ❖ PNEUMONIA Management: - Infection and inflammation of alveoli Assess for respiratory distress - Often has bacterial or viral origin and is recognized Administer prescribed meds – antibiotics (penicillin, as a hospital or community-acquired infection macrolides) - Occurs most often in late winter and early spring. Supportive care – viral - Inflammation of lung parenchyma Promote adequate oxygenation - Classified according to etiologic agent - Classified according to location and extent of ❖ PERSISTENT PATENT DUCTUS ARTERIOSUS pulmonary involvement - From the failure of the ductus arteriosus to close Etiologic Agent: after birth Less than 3 mos - GBS, g (-) bacilli, chlamydia, S. Therapeutic Management: pneumonia Administer IV therapy cautiously 3 mos – 5y – S. pneumoniae, staphylococcus, H Indomethacin or Ibuprofen to close the PDA infuenzae, M.catarrhalis - Prostaglandin inhibitor Adolescents – S and M pneumoniae, M. catarrhalis Monitor Urine Output (Side effect of indomethacin is Hospital acquired – Pseudomonas, Klebsiella, E.Coli, oliguria) Enterobacter sp Corrective surgery: Ligation of PDA (closed heart Viral Pneumonia -RSV, Parainfluenza, Adenovirus, procedure) Influenza Mycoplasma pneumonia – common in more than 5y Comparison of Bronchiolitis, Pneumonia, and Asthma Signs and Symptoms: BACTERIAL Assessment Bronchiolitis Pneumonia Asthma High fever, chills Cause Usually, Possibly bacterial Hypersensitivity type Irritability, restlessness, lethargy respiratory (pneumococcal, or 1 immune response Nausea, vomiting, Diarrhea, poor feeding syncytial virus Haemophilus influenzae) viral or Respiratory symptoms – cough, restlessness, mycoplasma; possibly tachypnea, retractions, crackles, dullness on secondary to percussion, cyanosis aspiration Age of child Under 2 years All through childhood Onset: 1-5 years Signs and Symptoms: VIRAL Onset Follows an Often follows an upper Often triggered by pattern upper respiratory infection respiratory respiratory infections; follows Mild fever, slight cough infection initiation by an High fever, malaise, severe cough and prostration allergen Non- productive cough – productive cough with Appearance Fatigued, Fatigued, anxious, Wheezing, whitish phlegm anxious, shallow respirations exhausted, shallow frightened Rhonchi and fine crackles respirations, increasing Signs and Symptoms: MYCOPLASMA anteroposterior PNEUMONIAE diameter of chest Sudden and insidious onset Cough Paroxysmal, Productive, harsh Paroxysmal, with dry cough thick mucus Fever, chills, malaise, headache, anorexia, and production myalgia Fever Low grade Elevated None Hacking cough, rhinitis, anorexia Auscultatory Barely audible Decreased breath Wheezing, Nonproductive to productive with semi mucoid Sounds breath sounds, sounds, rales decreased breath rales, sounds sputum to mucopurulent or blood streaked. wheezing Location and Extent Lobar Pneumonia – involve segment of one or more lobe Bronchopneumonia – terminal bronchioles and involve nearby lobules Interstitial pneumonia – confined to alveolar walls, peribronchial and interlobular tissues. Laboratory/ Diagnostic Tests: CXR – diffuse patchy infiltrates, consolidation or disseminated infiltration CBC Blood and sputum C/S Positive ASO titer By: Balana, Jessey S. Dehydration: Excessive Body Fluid Loss Pediatric dehydration – is common complication of NUR 1210 – NCM 109 CARE OF THE illness. Volume depletion in children is caused by MOTHER AND CHILD AT RISK OR fluid losses from vomiting or diarrhea. WITH PROBLEMS Developmental and Biological: Module 3A – Pedia Concept Smaller the child the greater proportion of body water to weight and proportion of extracellular fluid Fluids and Electrolytes balance are a crucial in to intracellular fluid maintaining homeostasis within the body. Infants larger proportional surface area of GI tract A temporary disturbance in body’s level of fluid and than adults electrolytes can be a serious illness to children. Infants greater body surface area and higher Fluids are vital to all forms of life. metabolic rate than adults. - They help maintain body temperature and cell shape, and they help transport nutrients, gases, and General Appearance: wastes. - Normally obtained by the body through oral 1. Skin – a. Check for dry skin and their mucous ingestion of fluid and by the water formed in the membrane metabolic breakdown of food. Poor skin turgor, tenting, dough- like feel Primarily, fluid is lost from the body in URINE and Temperature increase FECES. Sunken eyeballs, no tears - Minor losses (insensible losses) – occurs from Pale, ashen, cyanotic nail beds or mucous evaporation from skin and lungs and from membranes saliva, which is of little importance except in Delayed capillary refill >3 seconds children with tracheostomies or those requiring Maintenance Fluid for Capillary Fluid: nasopharyngeal suction, Infants do not concentrate urine as well as adults 4mL per kilo for 1st 10kg/hour because their kidneys are IMMATURE. 2mL per kilo for next 10kg/hour - Greater loss of fluid in their urine. 1mL per kilo for next 5kg/hour To maintain fluid balance, the amount of fluid gained 2. Cardiovascular: throughout the day must equal the amount lost Pulse rate change-rapid, weak, or thready, bounding - Some can be measured some are not. or arrythmias, rate and quality increase Electrolytes works with fluids to maintain health and Blood Pressure – take note on the increase or well-being. decrease BP Electrolytes are crucial for nearly all cellular 3. Respiratory rate: reactions and functions. Change in rate or quality Urinary system maintains the proper balance of fluid Dehydration of hypovolemia- shows tachypnea, and electrolytes in the blood. apnea, or deep shallow respirations - When disease occur such as abnormal kidney Fluid overload – shows moist breath sounds and function, excessive amounts of fluid may occur. may have presence of cough Gastrointestinal System – can be a major source of fluid and electrolyte loss if vomiting or diarrhea Treatment Modalities: occurs. Severe Some No Dehydration In adolescence, body water accounts for 60% of Dehydration Dehydration (No signs of severe total weight. or some dehydration - In infants, 70% of total weight Mental Lethargic or Restless or Normal Status unconscious irritable - In children, 65% of total weight Radial Pulse Weak or absent Palpable Easily palpable Eyes Sunken Sunken Normal Fluid is distributed in 3 bodily compartments: Skin Pinch Goes back very Goes back Goes back quickly slowly slowly (2 seconds) (< 2 seconds) body weight. Thirst Drinks poorly or Thirst, drinks No thirst, drinks 2. Interstitial (surrounding cells), 20% body weight not able to drink quickly quickly 3. Intravascular (Blood Plasma), 5% of body weight. Severe Dehydration: Extracellular Fluid - Interstitial and Intravascular Fluid, Treat Shock if present totaling of 25% of body weight. - If able to drink administer oral rehydration solution (ORS)while with IV access Method to Calculate Fluid Requirement: - Insert peripheral IV line using large IV catheter g24 - Administer Lactated Ringer and monitor infusion Body Weight Fluid Requirement per 24 hours rate. Up to 10 kg 100 mL/kg 11-20 kg 1,000 mL + 50 mL/kg for each - Monitor if presence of peri orbital edema, this means additional kg over 10kg over hydration, regulate flow rate accurately More than 20 kg 1,500 mL +20 mL/kg for each Observe child within 2 hours, continue giving ORS if additional kg over 20 kg able to drink  Monitor ongoing losses closely. Strict monitoring - Glomeruli remove excess fluid, electrolytes and regularly waste from the bloodstream and pass out through If remains lethargic check blood glucose and treat if urine. This may come sudden or gradually chronic. hypoglycemic or low sugar level - Most common in children ages 5-10 years old. One stabilized reassess degree of dehydration and - Boys appear to develop the disease more often than continue IV rehydration if still needed. If IV girls. rehydration not anymore required ORS maybe given. - A child with history of streptococci infection like respiratory tract infection, otitis media, tonsillitis, Some Dehydration: streptococcus throat infection should have urinalysis test 2 weeks after the infection to evaluate Administer ORS for 4 hours specially for every loss glomerulonephritis. stool or vomiting - Blood analysis will indicate a lowered blood protein Encourage additional age- appropriate fluid intake level (hypoalbuminemia) caused by the massive including breastfeeding proteinuria. Monitor ongoing losses closely. Assess clinical - Erythrocyte sedimentation rate increase condition and degree of dehydration at regular - Concentration of Urea, Nonprotein Nitrogen (BUN), intervals to ensure continuation of appropriate Creatinine in blood will increase. treatment. Immunoglobulin G (IgG) – antibodies against NO Dehydration: streptococci, can be detected in the blood stream with Prevent dehydration –Encourage age-appropriate acute glomerulonephritis. fluid intake, including breastfeeding in young Symptoms: children. If with Diarrhea – administer zinc sulfate to children Pink or cola colored urine from RBC (hematuria) under 5 years of age Foamy urine due to excess protein (Proteinuria) High blood pressure Diet: may give banana, rice apple and toast (BRAT) Fluid retention (Edema) with swelling in the face, Teaching/Parent Instruction: hands, feet and abdomen Things to watch out for go to hospital for consult Treatment Management: and treatment: - If diarrhea or vomiting increases. Antibiotic will be prescribed for 1-2 weeks - No improvement seen in child’s hydration status Diuretics may be given - Child appear wore pr weak If with heart failure- keep the child in semi-fowler’s - Child will not take fluids position, give digitalis and oxygen - No urine output If with hypertension – an anti-hypertensive medication be given. Isotonic Dehydration – child’s body loses more water Diet – restricting salt to avoid edema and low than it absorbs (as with diarrhea) or absorbs less fluid protein intake to reduce protein in the urine than it excretes (as with nausea or vomiting). Weigh the child every day. Best time early morning - Decrease in the volume of blood serum upon waking up. Monitor intake and output Hypertonic Dehydration – When water in a greater Bed rest maybe advised. proportion than electrolytes hypertonic dehydration occurs. URINARY TRACT INFECTIONS: - Occur in a child with nausea (thus preventing fluid clinical condition that may involve the intake) and fever (which increases fluid loss through perspiration) Urethra Bladder Ureters Renal pelvis - RBC and Hematocrit increase Calyces Renal parenchyma Hypotonic Dehydration – disproportionately high loss of Risk Factors: electrolytes in proportion to fluid loss. Common in kids 5 years old; During the first few - Plasma concentration of sodium and chloride are low months of life, incidence in boys exceeds that in - Result from excessive loss of electrolytes by girls. By the end of the first year and thereafter, vomiting from an increased loss of salt from first-time and recurrent UTIs are most common in diuresis, or from diseases such as adrenocortical girls. insufficiency or diabetic acidosis. Alteration of the peri urethral flora by antibiotic therapy ACUTE GLUMERONEPHRITIS: Genetic factors Inflammation of the glomerulus of the kidney, may Local inflammation occur as a separate entity but usually occurs in a. Cystitis - An infection of the urethra and bladder children as an immune complex disease after b. Pyelonephritis - infection of the ureters up to the infection with nephritogenic streptococci. kidneys - Inflammation of tiny filters in the kidneys(glomeruli)  Anatomical abnormality of the urinary tract - Urosepsis – febrile UTI coexisting with systemic (malformed kidney or a blockage somewhere along signs of bacterial illness; blood culture reveals the tract of normal urine flow) presence of urinary pathogen. Vesicoureteral reflux (VUR) - an abnormal backward flow (reflux) of urine from the bladder up the ureters Clinical Manifestations: and toward the kidneys. Pain, burning, or a stinging sensation when peeing Poor toilet and hygiene habits Increased urge to urinate or frequent urination Use of bubble baths or soaps that irritate the urethra Fever (though this is not always present) Family history of UTIs Frequent night waking to go to the bathroom Infrequent urination (Enuresis) Incomplete emptying of the bladder (permit Wetting problems, even though the child is toilet incubation of bacteria in the bladder) taught Constipation (rectum chronically dilated by feces) Low back pain or abdominal pain in the bladder Catheterization (generally below the navel) Previous UTIs Foul-smelling urine that may look cloudy or contain Children who receive antibiotics - These agents may blood alter gastrointestinal (GI) and peri urethral flora, Jaundice disturbing the urinary tract's natural defense against Hematuria (may not be present) colonization by pathogenic bacteria. Poor feeding Tight clothing or diapers Sexual intercourse Diagnostic and Laboratory Procedures: Altered urine and bladder chemistry Urinalysis Etiology: - (+) for proteinuria – presence of bacteria - (+) RBC or hematuria – mucosal irritation Bacterial infections - pH elevated – presence of RBCs or WBCs and - E coli bacteria make urine more alkaline - Streptococcus group B, especially among neonates Urine culture collected by: - Enterococcus species - Midstream clean - catch technique - Proteus species - Suprapubic aspiration - Pseudomonas aeruginosa - Catheterization - Klebsiella species Ultrasound of the kidneys and bladder - Staphylococcus saprophyticus, especially among Voiding Cystourethrogram (VCUG) X-rays taken female adolescents & sexually active females during urination Fungi (Candida species Therapeutic Management: Pathophysiology: Complete oral antibiotics specific causative organism In a urinary tract infection (UTI), bacteria usually enter Increase Fluid Intake to flush the infection out of the the urinary tract through the urethra. Typically, UTIs urinary system develop when uropathogens that have colonized the Cranberry juice to acidify the urine periurethral area ascend to the bladder via the urethra. Suggest child to sit and void in the bathtub of warm From the bladder, pathogens can spread up the urinary water tract to the kidneys (pyelonephritis) and possibly to Acetaminophen (Tylenol) to reduce pain enough to the bloodstream (bacteremia). Poor containment of allow voiding infection, including bacteremia, is more often seen in Encourage child to drink extra fluids as soon as infants younger than 2 months. symptoms are noticed and for the next 24 hours Classifications of UTI Encourage child to urinate often and to empty his or her bladder each time Bacteriuria - bacteria in the urine Teach preventive measures - Asymptomatic bacteriuria – significant bacteriuria with no evidence of clinical infection. Prevention: - Symptomatic bacteriuria – accompanied by physical Frequent diaper changes signs of UTI. Teach children not to "hold it" when they have to go - Recurrent UTI – repeated episode of bacteriuria or Avoid bubble baths and strong soaps that might symptomatic UTI cause irritation - Persistent – persistent of bacteriuria despite Wear cotton underwear instead of nylon because it's antibiotic treatment. less likely to encourage bacterial Growth Febrile UTI – accompanied by fever and other Drink plenty of fluids Avoid caffeine, which can physical signs of UTI irritate the bladder - Cystitis – inflammation of the bladder. - Urethritis – inflammation of the urethra. BURNS - Pyelonephritis – inflammation of upper urinary tract Injuries to body tissue caused by excessive heat and kidneys greater than 104*F (40*C).  Second most common unintentional injury seen in - At temperatures greater than 44 °C (111 °F), children 1 to 4 years of age proteins begin losing their three-dimensional shape Third most common cause of injury in children 5 to and start breaking down. 14 years of age - This results in cell and tissue damage. Every day, more than 300 children treated in the - Many of the direct health effects of a burn are emergency room for burn-related injuries. secondary to disruption in the normal functioning of Type of injury to skin or flesh the skin. - They include disruption of the skin's sensation, Common Causes of burns: ability to prevent water loss through evaporation, and ability to control body temperature. Thermal: cold (frostbite) or heat (burns) Face and Throat Burns – particularly hazardous Scalding (exposure to hot drinks, high temperature because there may be accompanying but unseen tap water in showers, hot cooking oil, or steam) burns in the respiratory tract that could lead to Contact with hot objects (tipped-over coffee cups, respiratory tract obstructions hot foods, cooking fluids) Hand Burns – hazardous because if the fingers and Fireworks thumb are not positioned properly during healing, Electricity: adhesions will inhibit full range of motion in the high voltage (greater than or equal to 1000 volts) future. low voltage (less than 1000 volts) Burns of the Feet – carry a high risk of secondary The most common causes of electrical burns in children infection. are: Genital Burns – hazardous because edema of the urinary meatus may prevent a child from voiding. Biting on electrical cords Sticking fingers on electrical outlets Three types of burns according to depth: Lightning Superficial or First-degree burns Chemicals: - the mildest form Ingestion - burns that cause local inflammation of the superficial Spilling onto the skin skin Common agents include: - Involves the epidermis or outer layer of the skin. Acids are those with pH less than 7 (common Clinical Manifestations: household compounds like acetic acid, hydrochloric redness, pain, and minor swelling, skin may be very acid, or sulfuric acid like toilet cleaners) tender to touch. Bases or alkali compounds with pH greater than 7 Skin is dry without blisters. (Ammonia, Sodium hypochlorite or bleach) Friction (Contact with flames or hot objects (from Healing time: 3 to 6 days; the superficial skin layer the stove, fireplace, curling iron, etc.) over the burn may peel off in 1 or 2 days Radiation (Overexposure to the sun) Exposure to ultraviolet light (from the sun, tanning Partial-thickness or Second-degree burns booths or arc welding) - more serious and involve the skin layers beneath the Ionizing radiation (from radiation therapy, X-rays or top layer radioactive fallout - Involves epidermis and part of the dermis layer of the skin Pathophysiology: Clinical Manifestations: The skin is the body's first defense against infection by microorganisms. A burn is also a break in the skin, and Blisters, severe pain, and redness the risk of infection exists both at the site of the injury The blisters sometimes break open and the area is and potentially throughout the body. Burns that extend wet looking with a bright pink to cherry red color. deeper may cause permanent injury and scarring and not allow the skin in that area to return to normal Healing time: Can take up to 3 weeks or more. function. Full-thickness or Third-degree burns There are three skin layers: - the most serious type of burn - involve all the layers of the skin and underlying 1. Epidermis, the outer layer of the skin; Only the tissue, in effect killing that area of skin epidermis has the ability to regenerate itself - the nerves and blood vessels are damage 2. Dermis, made up of collagen and elastic fibers and where nerves, blood vessels, sweat glands, and hair Clinical Manifestations: follicles reside. The surface appears dry and can look waxy white, 3. Hypodermis or subcutaneous tissue, where larger leathery, brown, ocharred. blood vessels and nerves are located. There may be little or no pain or the area may feel - This is the layer of tissue that is most important in numb at first because of nerve damage temperature regulation. Healing time: Healing time depends on the severity of the burn.  Fourth-degree burn Therapeutic Management: - involves injury to deeper tissues, such as muscle or bone Do not break any blisters - Skin grafting is necessary, muscle and bone may be Early cooling (within 30 minutes of the burn) with permanently damaged cool water 10-25*C (50.0-77.0*F) - Scarring will cover the healed site Do not use ice as it may cause more destruction to the injured skin, avoid over-cooling as it can result in hypothermia Burns can be classified by depth, mechanism of The burn may be dressed in a topical antibiotic injury, extent, and associated injuries ointment like Bacitracin or Neosporin. - Silvadene (silver sulfadiazine) topical is the The size of a burn is measured as a percentage of total preferred agent for most burns. body surface area (TBSA) affected by partial thickness - Do not apply butter, grease, powder, or any other or full thickness burns remedies to the burn, as these can make the burn deeper and increase the risk of infection. When estimating the depth of a burn, use the appearance of the burn and the sensitivity of the Seek Medical Help Immediately When: area to pain as criteria. Many burns are compound, involving first-, second- Child has a second- or third-degree burn. and third- degree burns, or there may be central The burned area is large (2-3 inches in diameter) white area insensitive to pain (third degree), For any burn that appears to cover more than 10% surrounded by an area of erythematous blisters of the body (second degree), and surrounded by an area that is The burn comes from a fire, an electrical wire or erythematous only (first degree) socket, or chemicals. Wallace Rule of Nines – quick method of The burn is on the face, scalp, hands, joint surfaces, estimating the extent of a burn. or genitals. - Easy to remember but only accurate in people over The burn looks infected (with swelling, pus, 16 years old. increasing redness, or red streaking of the skin near wound) Medical Management: Isotonic crystalloid solution is given Maintenance fluid because of the subsequent inflammatory response that causes significant capillary fluid leakage and edema Blood transfusions when hemoglobin level falls below 60-80 g/L (6-8 g/dL) due to associated risk of complications Early feeding Palmar Method – size of a person’s handprint Tetanus booster shot should be given if an individual (including the palm and fingers) is approximately has not been immunized within the last five years. 1% of their TBSA (total body surface area) Hyperbaric oxygenation may be useful in addition to traditional treatments Early intubation Resuscitation begins with assessment and stabilization of the person's airway, breathing and circulation. Care of the burn wound itself (Sulfamylon (mafenide acetate) cream which produces a burning sensation when applied Pain management by analgesics (Ibuprofen and Lund and Browder Chart – takes into account acetaminophen) the different proportions of body parts in adults Antihistamines and massage during the healing and children. process to aid with itching Calcium gluconate is an antidote for burns caused by hydrofluoric acid (fluorescent lights, fire extinguishers, etc) Surgery: Skin grafts or flaps Escharotomy - surgical release of the skin done to treat or prevent problems with distal circulation, or ventilation Fasciotomy - fascia is cut to relieve tension or pressure to treat the resulting loss of circulation to  an area of tissue or muscle (may be required for electrical burns) Alternative medicine: Honey has been used since ancient times to aid wound healing & may be beneficial in first- & second-degree burns Common complications of burns: Infection Pneumonia occurs particularly commonly in those with inhalation injuries. Cellulitis Urinary tract infections Respiratory Failure Anemia secondary to full thickness burns of greater than 10% TBSA. Compartment syndrome due to electrical burns Rhabdomyolysis due to muscle breakdown Keloids particularly in those who are young and dark skinned. Breathing problems if the burn involves the face, nose, mouth or neck causing. - Inflammation and swelling resulting to obstruction of the airway. If circumferential burns occur to arms, legs, fingers, or toes, the same constriction may not allow blood flow and put the survival of the extremity at risk. Burns to areas of the body with flexion creases, like the palm of the hand, the back of the knee, the face, and the groin may need specialized care. As the burn matures, the skin may scar and shorten, preventing full range of motion of the body area. Fluid and electrolyte problems If more than15%- 20% of the body is involved. Shock if inadequate fluid is not provided intravenously. Risk of death if burns involve greater than 50% Disturbance in body image Post-traumatic stress disorder Prognosis: The prognosis is worse in those with larger burns, those who are older, and those who are females The Baux score used to determine prognosis of major burns. The score is determined by adding the size of the burn (% TBSA) to the age of the person, to predict percent mortality after trauma. By: Balana, Jessey S. - Colic episodes may last from a few minutes to three hours or more on any given day. NUR 1210 – NCM 109 CARE OF THE - Baby may have a bowel movement or pass gas near MOTHER AND CHILD AT RISK OR the end of the colic episode Intense or inconsolable crying: WITH PROBLEM - Intense, sounds distressed and is often high-pitched - Baby's face may flush and extremely difficult to Module 3B: Pedia Concept comfort Alteration in Nutrition and Gastrointestinal, Crying that occurs for no apparent reason Metabolism, and Endocrine: Posture changes - Curled up legs, clenched fists and tensed abdominal Endocrine Glands – regulate homeostasis by muscles during colic episodes secretion of hormones which affect many organ systems. Relieving Colic: Metabolism – process of a body uses to get or make Change infant’s position frequently, with child’s face energy for food. down and with body across parent’s arm, with - Disorder happens when normal function disrupts parents’ hand under infant’s abdomen, applying from the process. gentle pressure Gently massage infant’s abdomen ❖ COLIC – infant colic, baby colic Swaddle infant tightly with a soft stretchy blanket - KABAG Provide smaller, frequent feedings - Paroxysmal abdominal pain or cramping that is Burp infant during and after feeding manifested by loud crying and drawing the legs up Place infant in an upright seat after feeding to the abdomen. Respond immediately to the crying - The term applies to any healthy, well-fed infant who Change from one cow's milk formula to another cries more than 3 hours a day, more than 3 days a Change from a cow's milk formula to a soy formula week, for more than 3 weeks. Change from a regular formula to a "predigested," Regurgitation – return of undigested food from the hypoallergenic formula stomach, usually accompanied by burping If you're breastfeeding, avoid eating certain foods - LUNGAD (such as caffeine, milk, certain vegetables) and Spitting up – dribbling of unswallowed formula from taking herbal supplements. the infant’s mouth immediately after a feeding. Change the type of nipples on your baby's bottle, Possible triggering factors: use bottles with plastic liners. Try giving him more time in a front baby carrier (the More common in young infants less than 3 months kind you wear over your chest) old. Take your baby for a ride in the car for a change in Infants of mothers who smoke during pregnancy or environment (but not when you are sleepy) after delivery. Use "white noise" (such as static on the radio or the Allergy to formula milk or problem with the cow's vacuum cleaner), classical music, or a "heartbeat milk protein or lactose in some baby formulas tape" next to the crib Try infant massage. Reflux - heartburn due to stomach acid and milk Put a warm water bottle on your baby's belly. flowing back into the windpipe. Have him or her suck on a pacifier. Soak baby in a warm bath A growing digestive system with muscles that often Try an infant swing. spasm. Increase or decrease the amount of stimulation in Air intake from feeding or crying the environment. Hormones that cause stomachaches or a fussy Watch out for over-stimulation or increased fatigue. mood. Use of homeopathic drops for colic, some parents Oversensitivity or over-stimulated by light, noise, say they have helped their colicky baby. etc. A moody baby ❖ CLEFT LIP AND PALATE A still-developing nervous system - Birth defects that occur when a baby's lip or mouth Improper feeding technique do not form properly. Over feeding the infant - They happen early during pregnancy. A baby can Too rapid feeding have a cleft lip, a cleft palate, or both. Emotional stress or tension between parent and - During the first six to eight weeks of pregnancy, the child shape of the embryo's head is formed. Clinical Manifestations: Five primitive tissue lobes grow: Abdominal bloating 1.One from the top of the head down towards the Predictable crying episodes: future upper lip; (Frontonasal Prominence) - Cries about the same time every day, usually in the late afternoon or evening 2and3: two from the cheeks, which meet the first lobe to form the upper lip; (Maxillar Prominence) 4and5: and just below, two additional lobes grow from Diagnostic and Laboratory Procedures: each side, which form the chin and lower lip; (Mandibular Prominence) Ultrasonography - As early as 14 to 16 weeks of gestation - If these tissues fail to meet, a gap appears where Determine whether the defect is isolated or one the tissues should have joined (fused). This may feature of a broader syndrome happen in any single joining site, or simultaneously in several or all of them. Therapeutic Management: - The resulting birth defect reflects the locations and Cheiloplasty severity of individual fusion failures (e.g., from a - Surgical Correction of Cleft Lip small lip or palate fissure up to a completely - Within the first 2–3 months after birth malformed face). - "Rule of 10s": the child is at least 10 weeks of age; - The upper lip is formed earlier than the palate, from weighs at least 10 pounds and has at least 10g the first three lobes named a to c above. hemoglobin). - Formation of the palate is the last step in joining the - If the cleft is bilateral and extensive, two surgeries five embryonic facial lobes, and involves the back may be required to close the cleft, one side first, and portions of the lobes b the second side a few weeks later. The most - These back portions are called palatal shelves, which common procedure to repair a cleft lip is the Millard grow towards each other until they fuse in the procedure middle. - Repair involves one of the staggered suture lines (Z - This process is very vulnerable to multiple toxic – plasty) substances, environmental pollutants, and Palatoplasty nutritional imbalance. - Surgical Correction of Cleft Palate - A cleft lip happens if the tissue that makes up the lip - Often a cleft palate is temporarily covered by a does not join completely before birth. This causes an palatal obturator (a prosthetic device made to fit the opening in the upper lip. The opening can be a small roof of the mouth covering the gap). slit or a large opening that goes through the lip into - Usually performed between 6 and 12 months. the nose. - Bone tissue can be acquired from the patient’s own - It can be on one or both sides of the lip or, rarely, in chin, rib or hip the middle of the lip. Insertion of Tympanostomy tube into the - Children with a cleft lip also can have a cleft palate. eardrum to aerate the middle ear. - The roof of the mouth is called the "palate." With a - Beneficial for the hearing ability of the child. cleft palate, the tissue that makes up the roof of the - Hearing impairment is particularly prevalent in mouth does not join correctly. children with cleft palate. The tensor muscle fibers - Babies may have both the front and back parts of that the eustachian tubes lack an anchor to function the palate open, or they may have only one part effectively. open. - In this situation when the air in the middle ear is Causes: absorbed by the mucous membrane, the negative pressure is not compensated, which results in the Genetic secretion of fluid into the middle ear space from the Maternal hypoxia (due to maternal smoking, mucous memb