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Chapter 31- Care of Child with a Physical Disorder Jessica Gonzales RN, MSN.

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Presentation on theme: "Chapter 31- Care of Child with a Physical Disorder Jessica Gonzales RN, MSN."— Presentation transcript:

1 Chapter 31- Care of Child with a Physical Disorder Jessica Gonzales RN, MSN

2 Cardiovascular assessment clubbing Periorbital edema Monitor BP for hypo or hypertension Monitor apical and peripheral Pulses for rate, rhythm, and quality Auscultate for extra heart sounds Monitor respirations for rate and effort Ausculate for adventitious sounds Assess height And weight, Growth failure Can occur with Sever cardiac disease Peripheral edema Palpate inspect cyanosis Engorged Neck veins Abdominal distension Palpate for Hepatomegaly And splenogmegaly

3 Congenital Heart Disease Etiology and pathophysiology: Family history of CHD Mom comes in contact with certain substances during first few weeks of pregnancy Mom with seizure disorder and on meds Depression and lithium Uncontrolled diabetes or lupus Rubella Chromosomal abnormalities (downs syndrome, turners) infection

4 1. Inferior and superior vena cava from body into right atrium 2. Right atrium to right ventricle via tricuspid valve 3. Through pulmonary valve to pulmonary artery 4. Pulmonary artery to lungs 5. To pulmonary veins from lungs 6.Pulmonary veins to left atrium 7.Through mitral valve into left ventricle 8.Through aortic valve to aorta 9. To body T issue P aper M y A ssests R u i o I l t r C m r t U o a i S n l c P i I c D Left ventricle Left atrium tricuspid Superior vena cava Inferior vena cava pulmonic aortic mitral Right atrium Right ventricle

5 Types of defects: Pulmonary Blood flow Pulmonary Blood Flow Obstruction to systemic blood flow Mixed blood flow Cyanotic Acyonotic

6 Cyanotic Acyanotic Pulmonary Blood flow TGA Pulmonary Blood flow VSD PDA ASD Pulmonary Blood flow TOF Normal Blood Flow COA

7 R L LR Cyanotic Acyanotic 4 Ts Tetralogy of fallot Truncus Ateriosus Transportation of the great vessels Tricuspid Atresia PDA ASD VSD

8 Clinical manifestations Cyanosis pallor Cardiomegaly, additional heart sounds (pericardial rubs, murmurs,) Discrepancies between apical and radial pulses Tachypnea Dyspnea, grunting, crackles, and wheezes Digital clubbing Hepatomegaly, splenomegaly

9 Acyanotic nt+ductus+arteriosus Patent ductus arteriosus (PDA) is a condition in which a blood vessel called the ductus arteriosus fails to close normally in an infant soon after birth. (The word "patent" means open.) Increased Pulmonary Blood flow

10 Acyanotic Increased pulmonary blood flow Atrial septal defect (ASD) is a congenital heart defect in which the wall that separates the upper heart chambers (atria) does not close completely. Congenital means the defect is present at birth.

11 Ventricular septal defect (VSD)describes one or more holes in the wall that separates the right and left ventricles of the heart. Ventricular septal defect is one of the most common congenital (present from birth) heart defects. It may occur by itself or with other congenital diseases. acyanotic Increased pulmonary blood flow

12 Opening between ventricles A large ventricular septal defect (VSD): a hole in the part of the septum that separatesventricular septal defect the ventricles, the lower chambers of the heart. The hole allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood from the right ventricle. Pulmonary stenosis Pulmonary stenosis : This defect is a narrowing of the pulmonary valve and the passage through which blood flows from the right ventricle to the pulmonary artery. In pulmonary stenosis, the heart has to work harder than normal to pump blood, and not enough blood reaches the lungs. Right ventricular hypertrophy Right ventricular hypertrophy : This defect occurs if the right ventricle thickens because the heart has to pump harder than it should to move blood through the narrowed pulmonary valve. Overriding aorta An overriding aorta: the aorta is between the left and right ventricles, directly over the VSD. As a result, oxygen-poor blood from the right ventricle flows directly cyanotic Decreased Pulmonary Blood flow

13 Children with TOF may develop "tet spells (acute hypoxia) The precise mechanism of these episodes is in doubt presumably results from a transient In resistance to blood flow to the lungs with flow of desaturated blood to the body characterized by a sudden, marked, increase in cyanosis followed by syncope, and may result in hypoxic brain injury and death, prolonged crying, irritability treatment: Calm infant- hold over shoulder or in knee chest position or have child squat (increases pressure on the left side of the heart, decreaseing the R to L shunt thus decreasing the amount of deoxygenated blood entering systemic circulation) Morphine (to decrease spasm and supress resp center) Oxygen (it is a potent pulmonary vasodilator and systemic vasoconstrictor. This allows more blood flow to the lungs) Consider sedation and parlaysis with intubation if these measures fail

14 Transposition of the great vessels is a congenital heart defect in which the two major vessels that carry blood away from the heart -- the aorta and the pulmonary artery -- are switched (transposed). cyanotic Increased Pulmonary blood flow

15 Aortic coarctation is a narrowing of part of the aorta (the major artery leading out of the heart). It is a type of birth defect. Coarctation means narrowing Acyanotic Normal pulmonary blood flow

16 Hematological assessment Pallor,flushing Jaundice, Purpura, Petichiae, Scratch marks cyanosis Jaundice, sclera, retinal hemorrhage Tachycardia Auscultate for murmurs Tachypnea, orthopnea, dyspnea Impaired thought Process or lethargy Palpate decreased cap fill time Joint swelling, Bone and joint tenderness Blood in urine and abnormal Mentsraul bleeding Gingival pallor or bleeding Lymphadenopathy or tenderness Abdominal tenderness, Hepatomegaly, splenomegaly Decreased muscle mass

17 Disorders of Hematological Function Anemia: The condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen- carrying capacity of the blood is, therefore, decreasedred blood cellshemoglobin

18 Failure to produce (hem)oglobin due to lack of iron Iron containing O2 transport protein that carries O2 from the lungs to the body Iron needed to bind O2 Reduces O2 carrying capacity of the blood O2 state to the tissues: dyspnea on exertion, fatique, fainting, lightheadedness, tinnitus, headache In anemia selective vasoconstriction of blood vessels allows nonvital areas to be bypassed to allow more blood to flow into critical areas. The skin is one of the areas to be considered nonvital and the result is pallor. Tissue hypoxia= cardiac input= PVR & blood viscosity (thinner blood) = tachycardia and heart murmur

19 A genetic disorder characterized by an abnormal form of hemoglobin within the erythrocyte Ischemia in the small blood vessels and infarction in the small bones O2 = sickle shaped red blood cells break apart not acting effectively Damaged sickle RBCs clump together and stick to the walls of blood vessels, blocking blood flow causing sever pain and permanent damage to brain, heart, lungs, kidneys, liver, bones, and spleen Risk of infection due to damaged spleen from sickled cells getting trapped

20 Aplastic Anemia is a rare but potentially life threatening syndrome of bone marrow failure characterized by pancytopenia RBCs fatigue due to O2 infections Bruising and bleeding

21 Failure to produce hemoglobin due to lack of iron Iron replacement therapy Nutritional or dietary counseling Treatment of underlying cause Infection Pain Fatigue Shortness if breath broad spectrum antibiotics Pain medications, local heat application ** hydration to prevent sickling Pallor Dyspnea Petechiae bleeding Fever Infection Administer O2, semi- fowlers postion Good oral hygiene, patient safety Prophylactic antibiotics Transfusions as needed Isolation precautions per institute (reverse isolation)

22 platelets bleeding Prevent bruising Control bleeding Counsel family to not use salicylate drugs Transfusion of RBCs IV gamma globulin and anti-D antibody therapy splenectomy Idiopathic thrombocytopenic purpura (bleeding in the tissue) A bleeding disorder in which the immune system destroys platelets, which are necessary for normal blood clotting. Persons with the disease have too few platelets in the bloodbleeding disorder *antiplatelet antibody in the spleen

23 Hemophillia Hereditary (x-linked recessive transmitted by females found predominately in males) bleeding disorder characterized by deficincy in a blood clotting factor (*factor VIII{A} or IX {B}) platelets Bleeding into the tissue Bruising and petichiae Minimize bleeding Prednisone: decreases antiplatelet antibodies IVIG Anti D antibody

24 Disorders of Hematological Function Leukemia -ALL (acute lymphoblastic leukemia) uncontrolled proliferation of blast cells,which accumulate in the marrow causing crowding and depression of other cells Hodgkins disease- This is a malignant lymphoma distinguished by painless, progressive enlargement of lymphoid tissue.

25 Assessment of the Immune System Temperature for hyperthermia Inspect skin for hives, edema, lesions Conjunctival redness Palpate for spleneomegaly Assess the joints for Swelling, redness, Tenderness, decreased mobility Palpate for adenopathy Auscultate for abnormal Breath sounds Auscultate for tachycardia

26 Disorders of the Immune System Infection with HIV produces Lymphopenia resulting in immunosupression and AIDS Symptoms may not Appear for 1 to 2 yrs Nonspecific clinical manifestations Prevent opportunistic infections Administer prophylactic therapy for P. carnii (co-trimoxazole) beginning at 6 mos of age Immunizations Pulmonary hygiene Promote adequate nutrition Foster healthy growth and development

27 Disorders of the Immune System Clinical manifestations: Daily afternoon temperature spikes macular rash on trunk and extremities joint involvement- swelling, pain, redness Medical management Nonsteroidal anti- inflammatory drugs antirheumatic drugs cytotoxic drugs corticosteroids

28 Assessment of the Respiratory System Temperature for hyperthermia Inspect skin color changes, especially cyanosis Auscultate for abnormal Breath sounds Monitor respirations for rate, depth, and quality, Note any dyspnea, use of accessory muscles Percuss for dullness which indicates fluid Observe for Alertness, change In mental status Intercostsal, suprasternal, Sternal and substernal retractions Chest diameter

29 Disorders of the respiratory system Bronchopulmonary Dysplasia Premature lungs needing mechanical ventilation (high 02 and PIP) can injure the aveolar Saccules and lead to fibrosis of these structures Long term O2 therapy Cyanosis when breathing RA Manifestations of right sided failure Administer medications: bronchodilators, diuretic Planned rest periods to decrease respiratory effort and conserve energy Small frequent meals to prevent over distension of stomach Counsel parents in ways to prevent respiratory infection Teach parents CPR

30 Disorders of the respiratory system pneumonia Acute inflammation of the lung parenchyma (bronchioles, alveolar ducts, and sacs, and alveoli) Impairs gas exchange Antibiotics if bacterial Assess for respiratory distress Provide family teaching Respiratory Distress Wheezing, crackles Use of accessory muscles

31 Disorders of Respiratory Function- Bronchitis/Bronchiolitis Viral infection of the lower respiratory tract characterized by inflammation of the Bronchioles and production of mucous (usually caused by RSV) Wheezing Crackles Tachypnea Retractions Assess for respiratory Distress Contact isolation Prescribed Medications (RT) O2 if needed Fluids

32 Inflammation and edema of muscle (spasms) Wheezing Use of accessory muscles Production of thick mucosa resulting in increased airway resistance, premature closure Of airways, hyperinflation, increased work of breathing, impaired gas exchange Increased RR Cough Fatigue Anxiety dyspnea Assess respiratory status Administer prescribed meds Promote adequate O2 Fowlers position Asthma is a chronic, reversible, obstructive airway disease, triggered by various stimuli

33 Disorders of the respiratory system Respiratory distress syndrome- mainly caused by a lack of a slippery, protective substance called surfactant, which helps the lungs inflate with air and keeps the air sacs from collapsing. Common in premature babies whose lungs are not fully developed. Sudden infant death syndrome Acute pharyngitis (sore throat)- inflammation of the pharynx Tonsillitis Croup – inflamation of the larynx (voice box)** Acute epiglotitis –bacterial infection of t he epiglottis Pulmonary tuberculosis- chronic bacterial infection caused by bacillius mycobacterium tuberculosis Cystic fibrosis- an inherited disorder of the exocrine glands characterized by excessive thick mucous that obstructs the lungs and GI tract

34 Assessment of the GI System Temperature for hyperthermia Inspect skin for pallor, jaundice, carotenimia Inspect abdomen for distention, depression, umbilical herniation Auscultate to assess bowel sounds (do first) Palpate for tenderness, rigidity, masses and organomegaly Inspect the anus for rectal bleeding and nonpatency Inspect mouth For caries, periodontal Disease, lesions, And clefts Palpate hard and soft palates for defects Measure height And weight for growth failure

35 Disorders of Gastrointestinal Function Cleft lip and cleft palate are birth defects that affect the upper lip and roof of the mouth. They happen when the tissue that forms the roof of the mouth and upper lip don't join before birth. The problem can range from a small notch in the lip to a groove that runs into the roof of the mouth and nose. This can affect the way the child's face looks. It can also lead to problems with eating, talking and ear infections.birth defects Treatment usually is surgery to close the lip and palate. Doctors often do this surgery in several stages. Usually the first surgery is during the baby's first year. With treatment, most children with cleft lip or palate do well. Ensure adequate intake of food and fluids without aspiration. Special feeding devices may be used. Frequent burping is necessary. Assist parents in dealing with the diagnosis

36 Disorders of Gastrointestinal Function- constipation/dehydration The passage of hardened stools; may be associated with failure of complete evacuation of the colon with defecation Add fluid or carbohydrate to the formula, add foods with bulk, and increase fluid intake. Manually dilate the sphincter; administer mild laxatives/enemas. Obtain history of bowel patterns educate on dietary changes and normal stool patterns.

37 Disorders of Gastrointestinal Function- diarrhea/gastroenteritis May be a result of a number of disease processes that cause abnormal losses through the skin, respiratory, renal, and GI systems – vomiting/diarrhea Diarrhea- A disturbance in intestinal motility characterized by an increase in frequency, fluid content, and volume of stools Assess for clinical manifestations of dehydration. Observations should include I&O; vital signs; body weight; skin color, temperature, and turgor; capillary refill; presence or absence of the sensation of thirst; and in infants, assessment of the fontanels. I&O, promotion of rehydration, correction of electrolyte imbalances, provision of age-appropriate nutrition, prevention of the spread of the diarrhea, prevention of complications, support of the child and family

38 Disorders of Gastrointestinal Function- Gastroesophageal reflux Hypertrophic pyloric stenosis Intusseception Hirschprungs disease The backflow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower esophageal sphincter Narrowing of pyloric sphincter at the outlet of the stomach Pyloromytomy: Relieves obstruction Telescoping of one portion of the Intestine into an adjacent portion Causing an obstruction Congenital anomaly characterized by absence of nerves to a section of the intestine causing inadequate mobility Which leads to the absence of propulsive movements, causing accumulation of intestinal contents and distention of bowel

39 Disorders of Gastrointestinal Function-hernias Umbilical Femoral Inguinal Hiatal Diaphragmatic A protrusion of the bowel through an abnormal opening in the abdominal wall Most common in children Usually closes by the time the child is 3 years old Surgical repair

40 Assessment of the GU System Temperature for hyperthermia Inspect skin for peripheral cyanosis, slow cap refill time, pallor, peripheral edema Monitor RR for abnormal rate and depth of respiration Inspect the anus for rectal bleeding and nonpatency Measure height And weight for growth failure Monitor blood Pressure for hypo Or hypertension Abdominal distension Uremic encephalopathy- Lethargy, poor concentration, confusion Hypospadias, epispadias Ear abnormalities Palpate kidneys for Tenderness, and enlargemnt Bladder For distension

41 Disorders of Genitourinary Function- UTI- characterized by inflammation, usually of bacterial origin, of the urethra, bladder, ureters, or kidneys Nephrotic syndrome- characterized by proteinuria, hypoalbuminemia, hyperlipidemia, altered immunity and edema. Increased permeability to protein, protien leaks through the glomerular membrane resulting in albumin in the urine. Once albumin is lost colloidal osmatic pressure decreases permiting fluid to escape from the intravascular spaces to the intirstial spaces. The volume decrease stimulates antidiuertic hormone to reabsorb water = edema. Acute glomerulonephritis- antibodies interact with antigens that remain in the glomeruli, leading to immune complex formation and tissue injury, filtration decreases and excretion of less Na and H2O. High Blood pressure, edema, and heart failure may result. Wilms tumor- Structural defects of gu tract

42 Assessment of the EndocrineSystem Inspect skin for color changes, hirsutism, easy bruising Palpate to note dryness, coldness, changes in texture Measure height And weight for growth Failure, plot size of head Monitor blood Pressure for hypo Or hypertension Lethargy, poor concentration, confusion, irritability Assess for sexual development Monitor pulse Increase= hyperthyroid Decrease=hypothyroid Auscultate to note for murmurs Assess vision Facial abnormalities, mouth for abnormal odors and Dental delays Palpate hair & nails Assess muscle Strength and tone

43 Disorders of Endocrine Function Hypothyroidism Hyperthyroidism Diabetes mellitus A chronic condition Characterized by inadequate amount of thyroid hormone to meet metabolic needs. Congenital- T4 is not produced which is essential for growth and development especially brian development, left untreated = MR. Acquired- inadequate amount of T4 A chronic metabolic disorder that results from either a partial or complete deficiency in insulin. Type 1- characterized by beta cell destruction, leading to absolute insulin deficiency. Type II- insulin resistance, progressive deterioration of Insulin secretion 3 ps Polydipsia Polyuria Polyphagia

44 Assessment of the Musculoskeletal System Measure height And weight for growth Inspect posture and gait Observe for structural abnormalities Asymmetrical limbs Palpate boney Structures for tenderness, Masses, lesions Palpate spine to assess curvature Assess, muscle mass, tone

45 Disorders of Musculoskeletal Function A spinal deformity that usually Involves lateral curvature of the Spine, spinal rotation, and thoracic Kyphosis (hunch back) Surgery to correct A disorder caused by decreased blood supply to the femoral head; results in epiphyseal necrosis and degeneration Legg-Calvé-Perthes Disease Developmental Dysplasia of the Hip A developmental abnormality of the femoral head, the acetabulum, or both; subluxation of the hip Scoliosis

46 Disorders of Musculoskeletal Function Congenital deformity of the foot and ankle Varies in severity; may involve one foot or both feet Manipulation and application of a series of short leg casts; changed weekly to allow for further manipulation Talipes (Clubfoot) Osteomyelitis Infection within the bone In children, the metaphysis of the femur, the tibia, and the humerus are the areas most affected. It can occur at any age; the peak incidence in children is between ages 3 and 15 years, and boys are affected twice as often as girls.

47 Disorders of Musculoskeletal Function Duchennes Muscular Dystrophy A sex-linked inherited disorder characterized by gradually progressive skeletal muscle wasting and weakness No effective treatment Septic Arthritis An infection of a joint, which can occur from bacteria in the blood or as a direct extension of an existing infection Joint aspiration and surgical irrigation Broad-spectrum IV antibiotics Fractures Most common sites in children are long bones, clavicles, wrists, fingers, and skull.

48 Assessment of the Neurological System Measure head size, Palpate fontanels Tachycardia Increased ICP Hypertension Increased ICP Assess LOC, Cerebullar status- gait Balance and coordination Cranial nerve function Esp pupillary response, Taste, olfaction, and tactile sense Assess muscle tone and strength Assess reflexes

49 Disorders of Neurological Function An infection of the meninges that is usually caused by bacterial invasion and less Common by viruses. The bacteria Enter the meniges through the blood stream and spread through the csf. Children under 2- poor feeding, irritability And lethargy, high pitched cry, bulging Fontanel, fever, resistance to being held, Opisthotonos (hyperextension of the Neck) Older children- respiratory or GI problems, nuchal rigidity (stiff neck), HA, kernigs sign, bruzinski sign, petichial rash Check for neurolical signs and monitor LOC Administer prescribed meds (antibiotic, steroid for cerebral Edema, anticonvulsant) Keep room quite and decrease Environmental stimuli Meningitis

50 Disorders of Neurological Function A condition caused by an imbalance in the production and absorption of CSF In the ventricular system. When production exceeds absorption, CSF Accumulates, usually under pressure and Produces a dilation of the ventricles. Occurs with a number of anomalies Communicating hydrocephalus- an impaired Absorption of CSF in the arachnoid space Noncommunicationg hydrocephalus- obstruction to the flow of CSF through the ventricular system Increased ICP- HA, emesis, irritability, Lethargy, apathy, and confusion

51 Disorders of Neurological Function Surgical treatment- removal of obstruction and insertion of shunts to provide primary drainage of the CSF to an extracranial compartment, usually the peritoneum (ventriculperitonel shunt or VP shunt)

52 Disorders of Neurological Function Spina Bifida Defective closure of the vertebral Column that may occur anywhere But usually occurs in the lumbosacral area. Occulta- does not affect spinal cord May be dimpling of the skin, nevi, hair tuft Meningocele- sac consisting of meninges and CSF protruding outside the vertebrae. The spinal cord is not involved Myelomeningocele (most common)- Similar to meningocele but spinal Cord and nerve roots are involved Resulting in sensorimotor deficits, Urinary and bowel problems No cure. Surgery to minimize infection. Preoperatively- apply a sterile dressing To the lesion and constantly moisten it With saline. Use protective devices And handle infant with care.

53 Disorders of Neurological Function Encephalitis- An inflammation of the CNS, mainly the brain and spinal cord Cerebral palsy- group of disabilities caused by injury or insult to the brain either before or during birth Seizure disorders- disturbances in normal brain function that result in abnormal electrical discharges in the brain, which can cause LOC, uncontrolled body movements, changes in behaviors and sensation, and changes in the autonomic system. Many underlying causes: Prenatal or perinatal hypoxia Infection Congenital malformaiton Metobolic disturbances Lead poisoning Head injury Tumor Medication Toxin exposure Administer prescribed meds Prevent injury Document all seizure activity

54 Disorders of Integumentary Function Contact – inflammation of the skin Diaper- form of contact dermatitis, exposure to feces and urine Atopic (eczema)- a pruritic response Seborrheic – cradle cap resulting from contact with environmental antigens Antihistamines Clip fingernails Keep the diaper area clean and dry; change diapers as soon as possible; cleanse area with mild soap and water, pat dry. Hydration of the skin; control pruritus; decrease inflammation; and prevent secondary infections. Crusts should be soaked with warm water and compresses until loosened; shampoo and rinse.

55 Disorders of Integumentary Function Acne Vulgaris – inflammatory process of the skin commonly seem in adolescents Psoriasis- a chronic proliferative skin disorder characterized by thick, scaly patches and inflammation Herpes Simplex – a common infection, transmitted by direct contact of infected body fliuds with nonintact skin or mucous membranes Candidiasis (thrush)-white patches of candida frequently found on moist tissues, tongue, buccal cavity, vagina meticulous skin care is emphasized Nystatin suspension; administer after feedings. Inform parents that the full 7-day course of nystatin is to be completed. Teach parents to sterilize bottles, nipples, pacifiers, and teethers

56 Disorders of Integumentary Function Parasitic infections –scabies, head lice Bacterial Infections- impetigo, folliculitis, and cellulitis The assessment of systemic signs and symptoms, areas involved, and appearance of lesions are helpful in establishing the type of infection.

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