COMMON HEALTH PROBLEMS THAT DEVELOP DURING Surgical Management • Weight monitoring

INFANCY • Laparoscopic surgery Medical Management

• Bowel resection • Observation of feeding
INTUSSUSCEPTION • Appendectomy • Feeding techniques
Etiology Drug of Choice • Increase protein
• enlarged lymph nodes, a tumor, or a blood vessel problem • Intravenous morphine • Consider vitamin and mineral supplements especially
in the intestines. • Analgesic zinc and iron
• Infections • Acetaminophen Nursing Management
Risk factors • Cefoxitin • Maintain adequate nutrition and fluid intake
• Age. Children – especially young children – are much • Penicillins and cephalosporins • Post-feeding instruction
more likely to develop intussusception than adults are. Nursing Diagnosis • Document the intake
• Sex. Intussusception more often affects boys. • Acute pain related to bowel invagination. • Monitor elimination pattern
• Irregular intestinal formation at birth. • Deficient fluid volume related to vomiting, nausea, fever, • Providing family teaching
• Certain conditions include: cystic fibrosis, IgA vasculitis, and diaphoresis. Surgical management
Crohn’s disease, celiac disease. • Ineffective breathing pattern related to abdominal • Gastrostomy feeding tube
Signs and Symptoms: distention and rigidity. Nursing Diagnosis
• Sudden loud crying caused by belly pain. • Imbalanced Nutrition: Less than body requirements
• Stool mixed with blood and mucus FAILURE TO THRIVE related to low calorie intake of the infant
• Vomiting A lump in the belly. Etiology • Risk for impaired skin integrity related to poor nutrition
• Weakness or lack of energy. • Congenital abnormalities • Deficient fluid volume related to inadequate oral intake of
• Diarrhea • Inadequate nutrition the infant
• Dehydration Risk factors
• sweating • Not enough calories provided. SUDDEN INFANT DEATH SYNDROME
Diagnostic procedure • Eats too little Risk factors
• Ultrasound • Health problem involving the digestive system. • Sex
• Abdominal X-ray • Food intolerance • Age
• Barium enema and air contrast • Infections • Race
• Rectal examination • Metabolic disorders • Family history
• Palpation Signs and symptoms • Secondhand smoke/maternal smoking
• Radiographs • Poor sucking • Being premature
• CT scanning • Hard to feed • Sleeping position and bedtime environment
Medical management • Vomiting or diarrhea Clinical manifestations
• IVF • Sleeps too much or not enough • Cyanosis
• Prescription of pain medication • Fussiness Weak cry • Breathing difficulties
• Therapeutic enema • Loses weight or does not gain enough weight • Abnormal limb movements Diagnostic procedure
• Surgical reduction • Stiff or floppy muscles Laboratory studies
• Laparoscopy • Slow in growth and development • Radiography and computed tomography scans
Nursing Management • Does not move around much • Histology
• Administer IVF as ordered Diagnostic Procedure Medical management
• A nasogastric tube is inserted to decompress the bowel. • CBC and differential • Emergency Care
• Monitor v/s frequently • Urinalysis, urine culture • Management of apnea
• If surgery is required, provide preoperative teaching to the • Serum electrolytes Nursing diagnosis
SO • Stool tests • Dysfunctional grieving related to sudden, unpredictable
• Monitor I&O • Diet history death of the infant
• Education • Interrupted family processes related to grieving
TRISOMY 21 • Digitalis and diuretics. Such as Furosemide and Digoxin It is based on the characteristics symptoms and ruling out other
Etiology: for cardiac management. potential causes of crying and fussiness, such as ear infections or
It is also known as “Down Syndrome”. The term “trisomy” means • Vaccines. Consider Pneumococcal and Influenza reflux.
having an extra copy of a chromosome. Trisomy 21 vaccination for children with chronic cardiac and Medical Management:
occurs when a developing fetus has three copies of respiratory disease; consider prophylactic palivizumab, Medications:
chromosome 21 in every cell instead of the typical two copies. since infants with Down syndrome are at high risk for • Anti-gas agent or anti-foaming agent: Used to relieve
Risk Factors: hospitalization with a respiratory syncytial virus. symptoms of excessive gas, bloating, and discomfort in
• Women who become pregnant at an older age, Nursing Management: the gastrointestinal tract by breaking down gas bubbles,
particularly those over the age of 35. • Provide a safe and supportive environment. making them easier to pass.
• Family history of Down Syndrome. • Provide adequate nutrition. • Anti-spasmodic drugs: To help relieve muscle spasms
• Having previously given birth to a baby with Down • Frequent consultation is a must. and cramping in the intestines.
syndrome. • Assess understanding of Down Syndrome. • Antacids: To neutralize stomach acid and can provide
Signs and symptoms: • Promote safe sleep practices, such as placing the infant relief for children with acid reflux or indigestion.
• Flattened face, especially the bridge of the nose on their back to sleep. • Prokinetics: To help speed up movement of food through
• Almond-shaped eyes that slant up • Provide age-appropriate stimulation, such as visual and the digestive tract.
• Short neck auditory toys and activities, to promote development. Probiotics: This can treat colic in pediatric patients by improving
• Small ears • Assess the infant’s physical and developmental status gut health and reducing inflammation.
• A tongue that tends to stick out of the mouth regularly. • Balancing gut bacteria.
• Tiny white spots on the iris of the eye • Identify any medical or developmental concerns early. • Reducing inflammation.
• Small hands and feet 3 Nursing Diagnosis: • Improving gut motility.
• Small pink fingers that sometimes curve toward the thumb • Risk for delayed development related to genetic disorder. • Strengthening the gut barrier.
• Poor muscle tone or loose joints • Risk for impaired social interaction related to cognitive Dietary changes: This can be effective way to manage symptoms
• Shorter in heights as children and adults development. of colic in pediatric patients.
Diagnostic Test: • Risk for altered body image related to physical • Avoiding trigger foods such as dairy, soy, gluten, and
• Amniocentesis: This test involves taking a small sample characteristics. certain fruits and vegetables.
of the amniotic fluid and analyzing it for chromosomal • Increasing fiber intake such as whole grains, fruits, and
abnormalities. It is typically performed between 15-20 COLIC vegetables.
weeks of pregnancy. Etiology: • Staying hydrated by drinking plenty of water and other
• Chorionic villus sampling (CVS): This test involves • Refers to excessive and prolonged crying or fussiness in fluids.
removing a tiny piece of tissue from the placenta analysis. an otherwise healthy infant for at least three hours a day, • Limiting gas-producing foods such as beans. Onions, and
It can be performed as early as 10-12 weeks of three days a week, for at least three weeks. lentils.
pregnancy. • The exact cause of colic is unknown, but it is thought to • Referral to a specialist to help diagnose and treat
Medical Intervention: be related to gastrointestinal, neurological, or behavioral underlying conditions.
• Treatment options could include: factors. Drug of Choice:
• Physical therapy. Sign and symptoms: Simethicone drops are often used as a firstline medication for colic
• Speech therapy. • Excessive crying or fussiness. in infants.
• Participating in special education programs in schools. • Crying for no apparent reasons. Nursing Management:
• Treating underlying medical conditions. • Predictable timing with episodes often occurring in the • Assess pain and relieve or reduce pain.
• Wearing glasses for vision problems or assisted hearing evening. • Educate caregivers on the disease.
devices for hearing loss. • Facial discoloring, such as skin flushed or blushing. • Improve parenting skills.
• In addition, specific manifestations of the syndrome and • Body tension, such as pulled up or stiffened legs, stiffened • Provide rest periods to promote relief, sleep, and relaxation.
associated conditions must be addressed, as follows: arms, clenched fists, arched back, or tense abdomen. • Place infant on a position of comfort to reduce pain.
• Thyroid hormone. To prevent intellectual deterioration Diagnostic Procedures: 3 Nursing Diagnosis:
and to improve the individual’s overall function, academic • Impaired parenting related to lack of knowledge and
achievement, ad vocational abilities. confidence in parenting.
 • Deficient knowledge related to lack of exposure and • Assess for symptoms of alcohol • Physical Examination of mouth, nose and palate after
unfamiliarity with information resources. withdrawal. child’s birth
• Risk for injury related to exhaustion and frustration of • Increase the mother’s awareness of the detrimental Medical Management
caregivers. effects of alcohol. • Surgery
• Decrease environmental stimuli and plan care activities • Dental Speech Appliance
FETAL ALCOHOL SYNDROME (FAS) carefully. Nursing Management
Etiology: • Wrap or swaddle the infant snugly. • Maintain adequate nutrition.
It is a disorder that can occur in infants who are exposed to alcohol • Provide adequate nutrition to support weight gain. • Positioning
in the womb. It is a leading cause of preventable birth defects and • Encourage mother to interact with the newborn. • Tools for feeding. Lamb’s nipples
developmental disabilities. • Administer opioid replacement therapy to mother. • Promote family coping
FAS is caused by alcohol exposure during pregnancy. The alcohol • Instruct the mother to avoid breastfeeding if using street • Reduce family anxiety
can damage the developing brain and other organs of the fetus. drugs. • Provide family teaching
The severity of the symptoms depends on the amount and timing 3 Nursing diagnosis: Surgical Management
of alcohol exposure. • Risk for impaired social interaction related to behavioral • Palatoplasty (Palate Repair Surgery)
Signs and symptoms: and cognitive deficits. 3 Nursing Diagnosis
• Physical symptoms may include a small head, low birth • Ineffective coping related to stress and challenges • Risk for imbalanced nutrition, less than body
weight, and fetal abnormalities such as thin upper lip and associated with caring for a child with FAS. requirements, related to feeding problem caused by cleft
small eye openings.
• Risk for injury related to hyperactivity and impulsivity. lip or palate
• Behavioral symptoms may include hyperactivity, impulsivity,
• Risk for ineffective airway clearance related to oral
and difficulties with social skills. Cleft Lip and Palate surgery
• Cognitive symptoms may include learning disabilities, cleft lip: failure of the maxillary and median nasal processes to • Risk for infection related to surgical incision
intellectual disabilities, and memory problems. fuse normally
Diagnostic Procedures: cleft palate: an opening of the palate Imperforate Anus
It is diagnosed based on the physical examination, medical Etiology stricture of the anus, resulting in inability to pass stool.
history, and assessment of cognitive and behavioral symptoms. A • Polygenic inheritance Etiology
diagnosis may also involve laboratory tests and imaging studies
• Environmental influences - No known cause
to evaluate organ damage.
Risk Factors: Risk Factors:
Medical Management:
• Vitamin Deficiency (Folic Acid) Not clear what factors raise the risk for this condition
• Early intervention services such as occupational therapy,
• Obesity Signs and Symptoms
speech therapy, and physical therapy.
• Smoking or Tobacco use during pregnancy • No anal opening
• Medications:
• Substance Abuse • An anal opening in the wrong place such as too close to
• Stimulant medication such as methylphenidate (Ritalin) or
amphetamines to manage hyperactivity and impulsivity. • Birth disorders like DiGeorge syndrome Or Pierre Robin the vagina
syndrome • No stool in the first 24 to 48 hrs of life or not having bowel
• Antidepressant such as fluoxetine (Prozac) or sertraline
(Zoloft) to manage depression or anxiety. • Exposure to Viruses or Chemicals while fetus develops in movements
the uterus • Stool passing through the wrong place, such as the
• Antipsychotic such risperidone (Risperdal) or olanzapine urethra, vagina, scrotum, or the base of the penis
Signs and Symptoms
(Zyprexa) to manage violent behavior.
• Crooked, poorly shaped or missing teeth • Swollen abdomen
• There is NO cure or specific treatment for FAS. The physical
• Misalignment of teeth and jaw • An abnormal connection, Fistula, between your baby’s
defects and mental deficiencies typically persist for a
longtime. • Deformities of the upper jaw (maxilla) rectum and their reproductive system or urinary tract
Nursing Management: • Speech problems Diagnostic Procedures
• Unrepaired oronasal fistulae, which is a hole between • Prenatal sonogram
• Assess for fetal exposure to illicit drug substance.
• Alveolar celfts, which are defects in the bone that • X-rays
• Review ultrasound results to determine fetal growth and
supports the teeth • Renal Ultrasound
gestational age.
Diagnostic Procedures • Spinal Ultrasound
• Assess fetal heart rate regularly.
• Prenatal Ultrasound • Spinal Ultrasound
 • Echocardiogram • Meconium does not pass • Having had a recent cold, flu, sinus, or ear infection
Medical Management • Failure to thrive Signs and Symptoms
• Nothing per orem Diagnostic Procedures • Crying
• Neonatal colostomy • Laboratory studies • Irritability
• Primary neonatal pull-through without colostomy • Plain abdominal radiography • Sleeplessness
• Posterior sagittal pull-throughwith a colostomy • Unprepared single-contrast barium enema • Pulling on the ears
• Colostomy closure • Rectal biopsy • Ear pain
• Diet • Rectal manometry • Headache
• Activity Medical Management • Neck Pain
Pharmacologic management • Initial therapy • Feeling of fullness in the ear
• Antibiotic prophylaxis • Decompression • Fluid drainage from the ear
• Laxatives • Diet • Fever
Nursing Management Pharmacologic management • Vomiting
• Avoid infection Antibiotics • Diarrhea
• Protect skin integrity Nursing Management • Lack of balance
• Restore balanced fluid volume • Promote skin integrity. • Hearing loss
• Maintaining adequate hydration • Promote comfort. Diagnostic Procedures
• Maintaining stable vital signs • Maintain fluid balance. • Laboratory tests
Surgical Management • Provide oral and nasal care. • Tympanocentesis or Tympanometry test
• Temporary Colostomy • Provide family teaching. • Reflectomy Test
• Perineal anoplasty Surgical Management • Hearing Test
3 Nursing Diagnosis • Leveling Colostomy Medical Management
• Imbalanced nutrition, less than body requirements, • Single-stage Pull-through Procedure Antibiotic therapy
related to bowel obstruction and inability for oral intake 3 Nursing Diagnosis Pharmacologic management
• Impaired tissue integrity at rectum related to surgical • Constipation related to reduced bowel function Antimicrobial agents
incision • Imbalanced nutrition, less than body requirements, Nursing Management
• Risk for impaired parenting related to difficulty in bonding related to reduced bowel function • Positioning. Have the child sit up, raise head on pillows,
with infant ill from birth • Risk for compromised family coping related to chronic or lie on unaffected ear.
illness in child • Heat application. Apply heating pad or a warm hot water
Hirschsprung’s Disease (Aganglionic Megacolon) bottle.
absence of ganglionic innervation to the muscle of a section of the Otitis Media • Diet. Encourage breastfeeding of infants as breastfeeding
bowel Inflammation of the middle ear affords natural immunity to infectious agents; position
Etiology Etiology bole-fed infants upright when feeding.
=Arrest of aboral neuroblast migration • Common in Infants and Children • Hygiene. Teach family members to cover mouths and
Risk Factors: • Lower socioeconomic group noses when sneezing or coughing and to wash hands
• Genetics factors • Viral infections frequently.
• Down syndrome • Organisms invade the middle ear • Monitoring hearing loss. Assess hearing ability frequently.
• Males Risk Factors: Surgical Management
Signs and Symptoms • Being between 6 and 36 months • Myringotomy and TT placement
• Sigmoid Colon • Using pacifier • Adenoidectomy
• Absence of movement • Bottle fed 3 Nursing Diagnosis
• Ribbon shaped stool (older kids) • Drinking while laying down • Pain related to inflammation and erythema secondary to
• Constipation/ Congenital • Exposed to cigarette smoke ear infection
• Abdominal obstruction/ Abnormal feeding • Exposed to higher levels of air pollution • Risk for injury related to hearing loss, decreased visual
• Syndrome Downs (Down Syndrome) • Being in cold climate acuity.
 • Impaired verbal communication related to effects of Signs and symptoms: These burns cause redness, pain, • Respiratory failure. Pulmonary complications are
hearing loss and minor swelling. The skin is dry without blisters. secondary to inhalational injuries.
• Second Degree (Partial Thickness) Burns NURSING DIAGNOSIS
HEALTH COMMON PROBLEMS IN TODDLERS: Signs and symptoms: The burned area is red and • Pain related to tissue and nerve injury.
blistered and can swell and be painful. The blisters • Hypothermia related to loss of skin microcirculation and
WHAT ARE TODDLERS? (1-3 YEARS OLD) sometimes break open and the area is wet looking with a open wounds.
A baby is considered a toddler around 1 year (12 months) bright pink to cherry red color. • ▪ Fluid volume deficit r/t increased capillary permeability
of age and is typically considered one until around 3-years-old. DIAGNOSTIC TESTS and evaporative losses from burn wound.
During the second year, toddlers are moving around more, • Physical Examination ABC
and are aware of themselves and their surroundings. Their desire • Basic laboratory studies should be obtained in patients POISONING
to explore new objects and people also is increasing. During this with severe burns or concomitant trauma, including a Poisoning is injury or death due to swallowing, inhaling, touching
stage, toddlers will show greater independence; begin to show complete blood count, type and crossmatch, chemistries, or injecting various drugs, chemicals, venoms or gases. Many
defiant behavior; recognize themselves in pictures or a mirror; and coagulation profiles, arterial blood gas measurement, and substances — such as drugs and carbon monoxide — are
imitate the behavior of others, especially adults and older children. a pregnancy test, when appropriate. poisonous only in higher concentrations or dosages.
Toddlers will experience huge thinking, learning, social, and MEDICAL MANAGEMENT ETIOLOGY/RISK FACTORS
emotional changes that will help them to explore their new world • Wound cleaning • Aged at 1-3 years old
and make sense of it. During this stage, toddlers should be able • debridement • Family Stress
to follow two. • Dressing changes and skin grafting ▪ Escharotomies • Number of family Members
NURSING MANAGEMENT • Socio economic Status
BURN • Focus on the major priorities of any trauma patient. • Residential circumstances
A burn occurs when heat, chemicals, sunlight, electricity or • Assess circumstances surrounding the injury. • less proximal maternal supervision during risk taking
radiation damages skin tissue. Most burns happen accidentally.
• Monitor vital signs frequently. activities (poisoninginjury)
There are different degrees of burns. Your healthcare provider
• Start cardiac monitoring if indicated. • Medicinal substances stored in more accessible locations
determines the seriousness (degree) of a burn based on the depth
of the burn and the amount of affected skin. Burns can be painful. • Obtain History in bathrooms.
Left untreated, a burn can lead to infection. • Monitor fluid intake (IV fluids). DIAGNOSTIC PROCEDURES
SURGICAL MANAGEMENT ❑ Toxicology Test- Any group of laboratory analyses that are
TYPES OF BURN • Escharotomies used determinethe presence of poisons and other potentially toxic
• First-degree burns are mild (like most sunburns). The • Tangential excision. The principle is to remove all the agents in blood and urine.
top layer of skin (epidermis) turns red and is painful but necrotic tissue and to preserve viable dermis in the wound SIGNS AND SYMPTOMS
doesn’t typically blister. bed. • Nausea
• Second-degree burns affect skin’s top and lower layers • Fascial excision is an alternative that is quicker and easier • Vomiting
(dermis). You may experience pain, redness, swelling and to perform and, above all, the degree of blood loss is low. • Drowsiness
blistering. • Amputation is applicable in unsalvageable limbs, in very • Falling over ❑ Abdominal pain ❑ Fitting.
• Third-degree burns affect all three skin layers: deep burns and electrocutions. It eliminates the function MEDICAL MANAGEMENT
epidermis, dermis and fat. The burn also destroys hair as well as the burn; • Gastrointestinal Decontamination
follicles and sweat glands. DRUG OF CHOICE • Orogastric Lavage
ETIOLOGY/RISK FACTORS • Topical antimicrobials: Include mafenide acetate, silver • Activated Charcoal
• Ignoring of the parents towards their toddler. sulfadiazine, silver nitrate solution, and silver-impregnate
• Whole-Bowel Irrigation ❑ Antidotes
• Playing with matches, cigarette lighters, fires in fireplaces, dressings.
SURGICAL MANAGEMENT
COMPLICATIONS
barbecue pits, and trash fires.
• Ischemia. As edema increases, pressure on small blood
 Gastrostomy
• Due to fire play and risk-taking behavior, Sunlight,  COMPLICATIONS
Radiation from x-rays, Electric current, steam, and hot vessels and nerves in the distal extremities causes an
obstruction of blood flow.  Nausea
liquids.
SIGNS AND SYMPTOMS • Tissue hypoxia. Tissue hypoxia is the result of carbon  Vomiting
monoxide inhalation. • Seizure
• First-Degree (Superficial) Burns
NURSING MANAGEMENT SURGICAL MANAGEMENT • Ataxic cerebral palsy – when a person has balance and
• Assess stool characteristics. • Orthopedic Surgery- treating injuries and diseases of co-ordination problems, resulting in shaky or clumsy
• Assess for vomiting. the musculoskeletal system. Children with severe movements and sometimes tremors.
contractures or deformities might need surgery on bones • Mixed cerebral palsy – when a person has symptoms of
• Assess for presence of illness. . more than one type of cerebral palsy.
• Physical Examination • Casting/Plastic Surgery ETIOLOGY/RISK FACTORS
DRUG OF CHOICE • Trauma-focused cognitive behavioral therapy (CBT) • Age is a risk factor for Cerebral Palsy in men and women
❑ Acetaminophen, Aspirin, and narcotics called opioids. COMPLICATIONS younger than 18 and older than 35.
NURSING DIAGNOSIS • Low self-esteem • Smoking, alcohol,
• Ineffective breathing pattern related to shortness of • Educational difficulties • obesity, and infections.
breath. • Trouble forming and maintain relationships • Birth complications
• Delayed growth and development related to effects of DRUG CHOICES • Blood Type Incompatibility and Jaundice
lead on the brain. • Barbiturates • Multiple Births
• Disorganized infant behavior related to irritability and • Codeine • Fetal Growth Restriction
lethargy. • Benzodiazepines DIAGNOSTIC PROCEDURE
• Morphine • Brain Imaging Tests such as x-ray, CT scan
CHILD ABUSE • Fentanyl • Magnetic Resonance Imaging (MRI)
Etiology • Oxycodone • Electroencephalogram (EEG) ▪ Genetic Testing
• Behavior NURSING MANAGEMENT SIGNS AND SYMPTOMS
• Family Problem • Assess for signs and symptoms of malnutrition. • Delays in reaching development
• Socioeconomic status or Poverty • Monitor intake and output and food intake, Weigh client milestones.
• Poorer parenting practices daily. • Seeming too stiff or too floppy (hypotonia).
• Poor stress- coping skills • Proving emotional support to the child. • Weak arms or legs.
• Unsupportive family System • Improving Parenting skills • Feeding, drooling and swallowing
DIAGNOSTIC PROCEDURES • Building parenting Confidence difficulties
• Diagnostic imaging • Promoting safety of the child abuse
• Constipation
• Laboratory Tests NURSING DIAGNOSIS
• Problems with speaking and
• CT Scan • Imbalanced nutrition related to Parental neglect on
communication
• Stressful life circumference nutritional status.
• Impaired parenting related to situational crisis. • Seizures or fits (epilepsy)
SIGNS AND SYMPTOMS
• Infants excessive crying or developmental delay • Risk for trauma related to sexual assault of a child. • Difficulty falling asleep and/or staying asleep.
• Fear, anxiety, clinging • Gastro-oesophageal reflux disease
• Phobias CEREBRAL PALSY (GORD)
Cerebral palsy is a disorder of movement, muscle tone or posture MEDICAL MANAGEMENT
• Nightmares, sleeping problems.
• Bed wetting
that is caused by damage that occurs to the immature, developing • Braces or Splints
• Eating issues
brain, most often before birth. • Physical therapy
4 TYPES OF CEREBRAL PALSY
• Depression, passivity SURGICAL MANAGEMENT
• Spastic cerebral palsy – the muscles are stiff and tight
• increased verbal abuse.
(especially when trying to move them quickly), making it • Orthopedic surgery. Children with severe contractures
MEDICAL MANAGEMENT or deformities might need surgery on bones.
difficult to move
• Stabilization • Cutting nerve fibers (selective dorsal rhizotomy). In
• Dyskinetic cerebral palsy – the muscles switch between
• Assessing Airway, Breathing and stiffness and floppiness, causing random, uncontrolled some severe cases, when other treatments haven’t helped,
• Circulation body movements. surgeons might cut the nerves serving specific spastic
• Physical Examination. muscles in a procedure called selective dorsal rhizotomy.
• X-ray
COMPLICATIONS • Overdistention of the bladder supported on a stool and knees apart. Some children
• Spasticity • Vesicoureteral Reflux benefit from “double voiding” (void, wait a few minutes,
• Contractures • Tight-fitting clothes and void again).
• Poor toilet and hygiene habits • Avoid constipation.
• Communication difficulties • Encourage adequate fluid intake.
• Delaying urination for long period of time
• Osteopenia Signs and symptoms • Instruct SO to have patient take antibiotics as prescribed
• Fractures ▪ Vomiting GENERAL: Surgical management:
• constipation • Poor appetite • Ureteral Reimplantation {If UTI is caused by
DRUG OF CHOICES • Vomiting Vesicoureteral Reflux (VUR)}
• Botulinum toxin with or without casting. • Diarrhea Drug of choice:
• Phenol intramuscular neurolysis. • Irritability • penicillins, sulfonamide (including trimethoprim-
• Antiparkinsonian, anticonvulsant, antidopaminergic, and • Overall feeling of illness sulfamethoxazole)
antidepressant agents. Bladder infection: • cephalosporins
NURSING MANAGEMENT • Blood in the urine • nitrofurantoin)
• Interview and observe the child and the family to • Cloudy urine • Amoxicillin
determine the child’s needs, the level of development, • Foul-smelling urine 3 Nursing diagnosis:
and the stage of family acceptance and to set realistic • Pain, stinging or burning w/ urination • Acute pain related to urinary tract infection
long-range goals. • Pain in the lower back • Hyperthermia related to urinary tract infection
• Patient history and maternal history often reveals the • Frequent urination • Impaired urinary elimination related to urinary tract
possible cause of cerebral palsy. • Feeling the need to urinate w/ minimal urine output infection
• Neurologic examination may reveal hyperactive deep If infection traveled to the kidney:
tendon reflexes and increased stretch reflexes, rapid • Chills w/ shaking ASTHMA
alternating muscle contraction and relaxation, and What is asthma in children? Asthma is a long-term (chronic) lung
• High fever
weakness. disease that causes your child's airways to become sensitive to
• Warm skin
NURSING DIAGNOSIS certain things (triggers). Several things happen to the airways
• Nausea and vomiting
• Risk for injury related to spasms, uncontrolled when a child is exposed to triggers: The lining of the airways
• Side or back pain swells. The muscles around the airways tighten. the lungs and
movements, and seizures.
• Severe fatigue
• Impaired physical mobility related to spasms and airways become easily inflamed when exposed to certain triggers.
• Severe abdominal pain Such triggers include inhaling pollen or catching a cold or other
muscle weakness.
Diagnostic procedures: respiratory infection.
• Impaired verbal communication related to
• Urinalysis Etiology:
difficulty in articulation.
• Urine culture • Exposure to various irritants and substances that trigger
COMMON HEALTH PROBLEMS AMONG PRESCHOOLERS: • Kidney ultrasound allergies (allergens) can trigger signs and symptoms of
• Voiding cystourethrogram asthma. Asthma triggers are different from person to
URINARY TRACT INFECTIONS (UTI) • Nuclear medicine renal scan (DMSA) person and can include: Airborne allergens, such as
Urinary tract infections (UTIs) are common in kids. They happen Medical management: pollen, dust mites, mold spores, pet dander or
when bacteria (germs) get into the bladder or kidneys. A baby with • Prescription of antibiotics particles of cockroach waste.
a UTI may have a fever, throw up, or be fussy. Older kids may • IV fluids Risk factors:
have a fever, have pain when peeing, need to pee a lot, or have Nursing management: • Allergies.
lower belly pain. Kids with UTIs need to see a doctor. • Advise patient/ SO to practice perineal hygiene; wipe from • Family history of asthma and/or allergies.
Etiology: front to back. • Frequent respiratory infections as a young child.
• Escherichia coli. • Avoid tight clothing • Low birth weight.
Risk factors: • Avoid “holding” urine; encourage child to void frequently. • Exposure to tobacco smoke before and/or after birth.
• Girls as they have shorter urethra • Take time to empty bladder completely. This may be • Being assigned male at birth (AMAB).
• urinary stasis. helped by relaxed toilet posture for girls, with feet
 • Being Black, African American, Puerto Rican, Indigenous, Systemic corticosteroids such as Oral prednisone and • Fluticasone (Flovent Diskus)
Native American or Alaska Native. Largely due to dexamethasone) • Budesonide (Pulmicort Flexhaler)
socioeconomic factors, such as lower-quality housing and • Long-term control medicines (Corticosteroids such as • Mometasone (Asmanex HFA)
unequal access to health care. salmeterol and formoterol, Leukotriene modifiers, Long- • Ciclesonide (Alvesco)
• Living in an inner city or near high amounts of air pollution. acting beta2-agonists (LABAs)) • Beclomethasone (Qvar Redihaler)
Signs and symptoms Nursing management: 3 Nursing diagnosis:
- Not all children have the same asthma symptoms. And Initial management of a child who presents to the emergency • Ineffective breathing pattern related to inability to mobilize
symptoms can vary from episode to episode in the same child. department with an acute asthma exacerbation includes and spontaneously expel secretions
Childhood asthma symptoms may include: bronchodilators and steroids. • Ineffective airway clearance related to increased
• Frequent coughing spells. Coughing fits may occur while • Nebulization: 2.5 - 5 mg of nebulized albuterol should be pulmonary secretions
your child is playing or laughing. They may also occur at given as initial management and can be re-dosed every • Impaired gas exchange related to obstruction of airways
night or right after your child wakes up. Coughing may be 20 minutes. If the child is 5 years or older, 5 mg is the by secretions
their only symptom. recommended dose. If a child is experiencing significant
• Less energy during play. respiratory distress and is declining between doses, it WILMS TUMOR
• Rapid breathing or shortness of breath (dyspnea). may be re-dosed more frequently, or continuous • Wilms tumor (also called Wilms' tumor or
• Complaining of chest tightness or their chest “hurting.” nebulization of albuterol may be required. nephroblastoma) is a type of childhood cancer that starts
• A whistling sound (wheezing) when your child breathes in • Ipratropium: Dosing of 250 to 500 mcg of ipratropium in the kidneys. It is the most common type of kidney
or out. should be co-administered with albuterol for three doses cancer in children. About 9 of 10 kidney cancers in
• Retractions. When the area between your child’s ribs and in moderate to severe exacerbations. children are Wilms tumors. Cancer starts when cells in the
neck area sinks in when they try to exhale. Retractions • Corticosteroids: Oral and IV steroids have been body begin to grow out of control.
are a sign your child is working hard to breathe. demonstrated to have equivalent potency in treating acute • A disease in which malignant (cancer) cells are found in
• Feelings of weakness or tiredness. asthma exacerbations. Patients should be given the kidney, and may spread to the lungs, liver, or nearby
• Irritability. prednisolone PO or methylprednisolone IV 1 to 2 lymph nodes. Wilms tumor usually occurs in children
• Trouble feeding (sucking or eating). mg/kg/day or dexamethasone 0.6 mg/kg PO or IV younger than 5 years old.
depending on their level of respiratory distress and ability STAGING:
--- When your child has an asthma attack (asthma exacerbation), to swallow. Dexamethasone has been shown non-inferior Stage 1- Tumor confined to kidney and completely excised
their symptoms may get much worse. The attacks may come on to a short course of prednisone or prednisolone for an Stage 2- Tumor extends beyond kidney but completely excised
slowly or quickly. Sometimes, they can be life-threatening (status acute exacerbation. Stage 3- Tumor infiltrates renal fat residual tumor after surgery
asthmaticus). If your child has any of the following warning signs • Supplemental oxygen can be applied to maintain lymphnode involvement of hilum, para-aortic or beyond
of a severe attack, you should get medical help right away: oxygen saturation above 90 to 92%, and heliox can be Stage 4- Metastasis in lung or liver rarely in bone and brain
• Severe coughing. considered to aid in delivering oxygen to lower airways. If Stage 5- Bilateral renal involvement
patients have been treated with all of the above and still
• Rapid worsening of shortness of breath or wheezing.
are experiencing respiratory distress, non-invasive
• Serious breathing problems. Etiology: Unknown
positive pressure ventilation should be started as it may Risk factors:
• Increase in respiratory rate at rest. alleviate muscle fatigue and assist in maximizing
• Turning pale or bluish in their face, lips and/or fingernails. • Having a family history of Wilms tumor.
inspiration. • Aniridia
• Trouble speaking, inability to speak in sentences or not Surgical management:
being able to speak at all. • Hemihypertrophy.
• First generation (glomectomy, gangliectomy, vagotomy,
Diagnostic procedures: • WAGR syndrome. Denys-Drash syndrome and
pulmonary roots denervation),
• Lung (pulmonary) function tests • Second generation (implantation of neurostimulators of
Beckwith-Wiedemann syndrome.
• Allergy skin testing and blood tests Signs and symptoms:
sinocarotid, diaphragmal nerves, vagus, sympathic
• Chest X-ray • painless swelling or mass within the abdomen
trunks),
Medical management: • Hematuria
• Third generation (implants of programmed microchips)
• Quick-relief medicines (Short-acting beta2-agonists • Anemia (pallor, anorexia, and lethargy.)
Drug of choice:
(SABAs) like albuterol and terbutaline, Short-acting • Hypertension
• Albuterol
anticholinergics such as ipratropium bromide (Atrovent), • weight loss and fever
• Levalbuterol
 • If metastasis has occurred (dyspnea, cough, shortness of minutes prior or after meals; instruct to refrain from eating • Exposure to chemotherapy and certain other chemicals
breath, and pain in the chest) or drinking for 30 minutes after completion of oral hygiene; • Immune system suppression
Diagnostic procedures: and offer moist, soft, bland foods. • Age
• Abdominal ultrasound • Prevent anxiety. Have the parents to stay with the child • Gender
• CT or encourage open visitation, provide a telephone number Signs and symptoms
• MRI to call for information; explain all procedures and care • Pale skin
• Complete blood count in simple, direct, honest terms and repeat as often as • Feeling tired, weak, or cold
• Biochemical studies necessary; reinforce physician information if needed and • Dizziness
• urinalysis. provide specific information as needed; and provide • Headaches
consistent nurse assignment with the same personnel;
Medical management: • Shortness of breath, trouble breathing
encourage parents to participate in care.
Treatment consists of surgical removal as soon as possible, after • Frequent or long-term infections
• Prevent injury. Avoid any palpation of abdominal mass;
the growth is discovered, combined with radiation and • Fever
chemotherapy. post sign on bed stating not to palpate preoperatively;
assess incision site for redness, swelling, drainage, • Easy bruising or bleeding, such as nosebleeds or
• Focal anaplastic stage I-III Wilms tumors and diffuse bleeding gums
anaplastic stage I Wilms tumors. Nephrectomy intactness, and healing and change dressing when soiled
or wet; assess oral and perineal area; and encourage • Bone or joint pain
followed by vincristine, actinomycin-D, and doxorubicin in • Belly (abdominal) swelling
addition to local radiotherapy. parents to appropriately dress child based on weather
conditions and to refrain from participating on rough • Poor appetite
• Focal anaplastic stage IV Wilms tumors and diffuse • Weight loss
anaplastic stage II-III tumors. Patients undergo the activities or sports.
Surgical management: • Swollen lymph glands (nodes)
same treatment, with the addition of cyclophosphamide,
etoposide, and carboplatin. • Nephron-sparing surgery (NSS) Diagnostic procedures:
• Transperitoneal radical nephrectomy • Complete Blood Count (CBC)
• Stage IV diffuse anaplastic Wilms tumors. More
Drug of choice: • Bone marrow aspiration or biopsy
aggressive treatment is delivered; nephrectomy is
followed by initial irinotecan and vincristine • Antineoplastics (dactinomycin, vincristine, doxorubicin, • Lab tests of blood and bone marrow samples
administration, which in turn is followed by actinomycin- cyclophosphamide, etoposide, and carboplatin) • X-ray
D, doxorubicin, cyclophosphamide, carboplatin, 3 Nursing diagnosis: • Ultrasound (sonography)
etoposide, and radiotherapy. • Ineffective protection related to antineoplastic agents, • Lymph node biopsy
Nursing management: radiation therapy, or leukopenia. • Lumbar puncture
• Assess for bleeding. Assess for bleeding from any site • Impaired oral mucous membrane related to Medical management:
and febrile episodes; Monitor WBC, platelet count, chemotherapy. • Chemotherapy
hematocrit, absolute neutrophil count. • Anxiety related to change in health status and threat of • Blood transfusion
• Assess the oral cavity. Assess oral cavity for death. • Antibiotics
pain ulcers, lesions, gingivitis, mucositis or stomatitis and • Radiation therapy
effect on the ability to ingest food and fluids. • Targeted therapy
• Assess for anxiety. Assess source and level of LEUKEMIA • Immunotherapy
anxiety and need for information and support that will Leukemia is cancer that starts in young (immature) blood cells. It's • Supportive care
relieve it. the most common kind of cancer in children. The leukemia cells • Follow-up care
• Prevent transfer of microorganism. Perform hand grow in bone marrow and then go out into the blood. The bone Nursing management:
marrow is the soft, spongy center of certain bones. Healthy blood
washing prior • Conduct a comprehensive pain assessment.
cells are made in the bone marrow.
giving care, utilize mask and gown when needed, provide • Assess and monitor vital signs and any non-verbal
a private room, monitor for any signs and symptoms of Etiology:
cues.
• Unknown
infection. • Monitor and assess laboratory values.
• Prevent oral trauma. Instruct the use of a soft-sponge Risk factors:
• Explain to the parents or S/O the disease course,
toothbrush or sponge toothette or gauze when rinsing the • Genetic syndromes
treatment, and adverse effects.
mouth; instruct to avoid foods which are hot, spicy, or high • Inherited immune system problems
in ascorbic acid (vitamin C); provide oral hygiene 30 • Radiation exposure
 • Teach the family how to recognize symptoms of infection • Black burrow filled with mite feces 1–2 in. long, usually DIABETES MELLITUS
such as chills, cough, and sore throat. between fingers and toes, on palms, Inability of pancreas to produce enough insulin to control the
• Educate the family how to recognize abnormal bleeding Risk Factors amount of glucose, or sugar, in your blood. Deficiency of insulin.
through bruising and how to stop it with direct pressure • Presence of many children in the household Assessment Findings
and ice application. • Poor housing • Hyperglycemia
• Promote good nutrition. • Skin-to-skin contact with someone who has itch mite • Glycosuria
• Monitor adverse effects and complications. • Poor hygiene • Polydipsia
• Administer prescribed medications. Surgical Management • Polyuria
• Promote psychological support. - None • - Polyphagia - Weight loss.
• Encourage planned exercise activities. Medical Management • Nonspecific malaise.
• Promote infection control measures. - Topical permethrin 5% cream is the drug of choice with • Diabetic ketoacidosis (DKA)
Surgical management: two doses of oral ivermectin (offlabel use) 1 week apart, also Risk Factors
• Bone Marrow Transplant being an effective drug. Family history of diabetes - Diseases of the pancreas
Drugs of choice: - Lindane lotion should not be used in children younger - Infection or illness
• Vincristine than 2 years because of the risk of neurotoxicity and seizures. Surgical management:
• Anthracycline drugs (daunorubicin, doxorubicin, Nursing Diagnosis • Pancreas transplantation / Simultaneous pancreas-
idarubicin, metoxantrone) • Risk for infection related to tissue damage. kidney (SPK) transplantation
• Cytarabine (cytosine arabinoside or ara-C) • Impaired skin integrity related to edema. Medical Management
• L-asparaginase, PEG-L-asparaginase (pegaspargase) • Acute pain related to injury to biological agents. - Insulin administration/ Insulin therapy o Insulin therapy is an
• Etoposide Nursing Management essential part of the treatment of diabetes in children; the dosage
• 6-mercaptopurine (6-MP) • Caution that adolescent groin infestations might be of insulin is adjusted according to blood glucose levels so that the
spread by physical intimacy. levels are maintained near normal; many children are prescribed
• 6-thioguanine (6-TG)
• Methotrexate • When permethrin is used, care should be taken to avoid with an insulin regimen given at two times during the day: one
contact with the eyes. before breakfast and the second before the evening meal.
• Cyclophosphamide
• Household members and contacts of the infected child ✓ Insulin Pumps
• Corticosteroid drugs
3 Nursing diagnosis:
need to be treated at the same time. ✓ Inhalation Insulin
• Stress importance of proper hygiene. Nursing Diagnosis
• Activity intolerance related to imbalance between oxygen
supply and demand • Teach the patient, family, and caregivers, the purpose - Imbalanced nutrition: less than body requirements related
and proper technique for maintaining isolation. to insufficient caloric intake to meet growth and development
• Acute pain related to physical injury agents
• If infection occurs, teach the patient to take antibiotics as needs and the inability of the body to use nutrients.
• Risk for infection related to alterations in mature WBCs
prescribed. - Risk for impaired skin integrity related to slow healing
COMMON HEALTH PROBLEMS IN SCHOOL-AGED • Instruct patient to take the full course of antibiotics even if process and decreased circulation.
symptoms improve or disappear. - Risk for infection related to elevated glucose levels.
CHILDREN
SCABIES • Monitor status of skin around wound. Nursing Management
• Monitor patient’s skin care practices, noting the type of • Provide teaching regarding nutritional program that
- A contagious parasitic infestation caused by tiny mites
soap or other cleansing agents used, temperature of provides adequate nutrition for normal growth while it
that burrow into the skin.
water, and frequency of skin cleansing. maintains the blood glucose at near normal levels; the
- Caused by an infestation of the skin by the human itch
mite Sarcoptes scabiei var. hominis where mites burrows into the • Tell patient to avoid rubbing and scratching, provide food plan should be well balanced with foods that take into
gloves or clip the nails if necessary. consideration the child’s food preferences, cultural
upper layer of the skin where it lives and lays its eggs.
• Instruct patient, significant others, and family in the proper customs, and lifestyle.
Assessment Findings
• Teach the patient and the parent regarding and
• Intense itching, especially at night care of the wound including hand washing, wound
cleansing, dressing changes, and application of topical carbohydrate counting.
• A pimple-like rash
medications. • Teach children to design a consistent daily exercise
• Scales or blisters
• Sores caused by scratching • Acknowledge reports of pain immediately and provide rest program.
periods to promote relief, sleep, and relaxation.
 • Teach the caregiver and child to inspect the skin daily and • Low socioeconomic status (poverty, poor hygiene, RHEUMATOID ARTHRITIS
promptly treat even small breaks in the skin. medical deprivation_ - simply juvenile arthritis (JA) or juvenile rheumatoid
• teach the child and caregiver to be alert for signs of • Age: 6-15 years arthritis (JRA), primarily involves the joints of the body, although it
urinary tract infection. • Crowding can increase the risk of spreading a group A also affects blood vessels and other connective tissues
• Monitor blood glucose level at least twice a day, before strep andthus increases the risk of developing rheumatic - Etiology is unknown
breakfast and before the evening meal fever - Three groups have developed sets of criteria to classify
• Offer encouragement and support, helping the child to Surgical Management children with arthritis:
express fears and acknowledging that the fingerstick does • Balloon valvotomy / commissurotomy ✓ American College of Rheumatology
hurt and it is acceptable to dislike it. • Valve repair (ACR)
• Provide child and family teaching in the management of • Valve replacement ✓ European League Against Rheumatism (EULAR)
hypoglycemia and hyperglycemia. Medical Management ✓ International League of Associations for
• Teach parents to notify their primary healthcare provider • If rheumatic fever diagnosis is entertained, penicillin Rheumatology (ILAR)
if their child appears to be ill (particularly if the child is therapy is immediately begun once throat cultures and Assessment Findings ACR
nauseated or vomiting) for careful observation and a blood work have been obtained. - Accepted terminology for JIA includes children younger
change in insulin dosage if necessary. • Therapeutic doses of intramuscular (IM) or oral penicillin than 16 years of age who have chronic arthritis (swelling or
• If a child with diabetes is scheduled for surgery, careful are prescribed for a full 10-day course. effusion, or presence of two or more of the following signs:
regulation on the day of surgery and in the immediate • Oral nonsteroidal antiinflammatory agents may be limitation of range of motion, tenderness or pain on motion, and
postoperative period is essential, especially if oral fluids prescribed to reduce inflammation and joint pain. increased heat) in one or more joints (lasting more than 6 weeks)
will be restricted. • The use of steroids is controversial and thought to be and in whom no other specific cause of arthritis can be identified.
utilized only in children with severe carditis and valve - Onset type is defined by type of disease in the first 6
RHEUMATIC FEVER damage. months. The organization recognizes the following three
- Rheumatic fever is an autoimmune disease that occurs as • Phenobarbital and diazepam (Valium) are both effective subtypes:
a reaction to a group A βhemolytic streptococcal infection, in reducing the purposeless movements of chorea. ✓ Polyarticular
specifically, a pharyngitis. Nursing Diagnosis ✓ Pauciarticular
- Inflammation from the immune response leads to - Risk for nonadherence to drug therapy related to knowledge ✓ Systemic
inflammatory lesions being found in the heart, blood vessels, deficit about importance of longterm therapy.
brain, and joints. Nursing Management ILAR
Assessment Findings • Preventive maintenance doses of penicillin are started - Systemic-onset JIA: characterized by spiking fevers,
- To have a diagnosis of rheumatic fever, children must once initial treatment is completed. These doses are typically occurring once or twice each day, at about the same time
have two major manifestations or one major and two given either as a monthly IM injection of penicillin G of day, with temperature returning to normal or below normal
minor manifestations documented. Of these, the heart benzathine or twicedaily oral tablets of penicillin V - Oligoarticular JIA: oligoarthritis (pauciarticular disease):
involvement is the most serious. potassium. less than five inflamed joints. Large, weight-bearing joints, such
• ✓ Major symptoms: Carditis; Erythema; Subcutaneous; • Although the IM injection is more painful and necessitates as the knees and ankles, are typically affected.
Polyarthritis; Chorea a trip to the provider’s office, it is considered more - Polyarticular JIA: polyarthritis: five or more inflamed joints,
• ✓ Minor: Fever, Arthralgia; History of previous rheumatic effective due to the potential lack of compliance with often involving weight-bearing joints. Rheumatoid nodules may be
fever; prolonged PR interval; Elevated sedimentation rate; C- twice-daily oral medications. seen in patients with RFpositive disease and symmetrical
reactive protein, leukocytosis • Preventive therapy continues until the child is at least 21 involvement of small joints in the hands.
- Important laboratory findings include the presence of an years of age as patients who have had acute rheumatic - Psoriatic arthritis: usually mild. Onset of arthritis precedes
elevated antistreptolysin-O (ASO) titer which is evidence fever are highly susceptible to recurrent rheumatic fever. that of psoriasis in approximately half of children.
that the child had a recent streptococcal infection. • If the child incurred valve damage, preventive therapy will - Enthesitis-related arthritis: frequently presents as evening
- The child will have a fever >38.5°C, and inflammatory continue until at least 40 years of age. and postexercise pain. Attention should be given to buttock pain
markers such as ESR and CRP will also be elevated. • Provide comfort and reduce pain. and back pain that improves with activity (inflammatory back pain).
- Echocardiogram is imperative to evaluate the extent of • Provide diversional activities and sensory stimulation These children cannot lie in bed all morning but have to get up
cardiac involvement. • Promote energy conservation due to back pain.
Risk Factors • Prevent injury - Enthesitis-related arthritis: frequently presents as evening
- Family history of rheumatic fever and postexercise pain. Attention should be given to buttock pain
and back pain that improves with activity (inflammatory back pain). Surgical Management
These children cannot lie in bed all morning but have to get up Nursing Diagnosis - No surgical procedures needed.
due to back pain. - Deficient knowledge related to care necessary to manage Nursing Diagnosis
EULAR disease symptoms. - Impaired Skin Integrity related to itchy scalp secondary to
The EULAR proposed the term juvenile chronic arthritis (JCA) for Nursing Management pediculosis capitis (head lice), as evidenced by visible head lice
the heterogeneous group of disorders that manifest as JA. The • Help parents and children to understand the necessity for or nits, itchiness of scalp, and erythema or redness
diagnosis requires that the arthritis begins before age 16 years them to take an active role in therapy by planning exercise of the scalp
and lasts for at least 3 months. The EULAR criteria for JCA and medication programs around school or other
recognize the following subtypes based on characteristics at activities. Nursing Management
onset: • Children with JA commonly experience irritability and • Institute skin isolation precautions
• Pauciarticular (one to four joints) fatigue, which may interfere with plans. Assist them with • ✓ Head covering
• Polyarticular (five or more joints) devising a schedule that allows for a balance of rest • ✓ Gloves
• Presence of RF (two positive tests at least 3 months periods with exercise to maximize the possibility of • Use specific shampoo/comb (fine tooth)
apart) success. • Avoid sharing linens/pillows
• Systemic onset with characteristic features • Evaluate how well children are managing their symptoms • Don’t use hairdryers.
• Positivity for RF in addition to how they view themselves (hopefully feeling • Use of OTC or prescribed medications
• Juvenile ankylosing spondylitis well after a long period of pain and illness). The few • Explain or reinforce explanation of the condition and its
• Juvenile psoriatic arthritis children who develop joint contractures may require soft- mode of transmission 7. Allay child’s feelings of shame
Risk Factors tissue surgery, such as contracture release, tendon and embarrassment
• Genetic makeup reconstruction, and synovectomy, or orthopedic surgery, • Caution family against cutting child’s hair or shaving head
• Environmental factors such as infections such as equalization of leg length or orthoplasty, at a later as treatment
• Inheritance date. Surgery of these types are usually delayed until • Provide health teachings on treatment and prevention
Surgical Management growth is complete, so further growth will not influence the • ✓ Check on other family members
outcome. • ✓
• Synovectomy Washing of bed linens
• Children need a great deal of support to perform
• Osteotomy and arthrodesis • ✓ No sharing of combs and hats
exercises and take daily medication as prescribed
• Total hip and knee replacements
• Promote Daily Activities and Exercise
Medical Management IMPETIGO
• Application of Heat
• NSAIDs such as ibuprofen (Motrin) or naproxen • Superficial bacterial infection of the outer layers of the
(Naprosyn) are the analgesics of choice for children with skin caused by Staphylococcus aureus/ Beta H.
PEDICULOSIS
JA. streptococcus
- Parasitic infection caused by head-and-body louse, Pediculus
• Slow-acting antirheumatic drugs (SAARDs), also called • ✓ Incubation period – 2 to 5 days;
humanus
disease-modifying antirheumatic drugs (DMARDs), can
✓ Spread by close physical contact • ✓ Period of communicability – outbreak of lesion
be used if NSAIDs are ineffective. until healed
• Methotrexate, a cytotoxic drug, is the second drug usually ✓ Occurs in school age, particularly with long hair
Assessment Findings • ✓ Mode of transmission – direct contact
prescribed. Assessment Findings
• Steroids, such as prednisone, are only added to the drug • White eggs firmly attached to base of hair shafts
• Pruritus of scalp • Well demarcated lesions
therapy if the disease is extremely severe or is an
• Sores on the head • Macules, vesicles, papule that rupture - moist erosion
incapacitating systemic disease that has not responded
• Irritability • Once most area dries; honey colored crust
to other antiinflammatory agents.
• Pruritus
• Therapies continue to include the administration of Risk Factors
• Sharing of clothing or hair ribbons Risk Factors
medications called tumor necrosis factor (TNF) inhibitors,
• Using infested combs, brushes or towels • Diabetes
such as etanercept (Enbrel) or infliximab (Remicade).
• Overcrowding
• The newest targets for arthritis treatment are the kinase Medical Management
inhibitors, such as tofacitinib. - Medicated shampoos or cream rinses • Malnutrition
containing pyrethrins and permethrin • Immunosuppression
• Impaired skin integrity
 • Poor hygiene ✓ Exposure • Erythromycin ethyl succinate (E.E.S, EryPed, Ery-Tab)
• Weather/environment THERAPEUTIC MANAGEMENT • Clindamycin (Cleocin)
Medical Management ✓ Acetaminophen or Ibuprofen • Rifampin (Rifadin)
- Topical antibiotic – Bactroban ✓ Saline Nose Drops or Nasal Spray • Dexamethasone (Baycadron)
• - Systemic antibiotic – NURSING MANAGEMENT • Cephalosporin
penicillin or erythromycin ✓ Elevate the head of the bed or crib mattress to help with • Cefuroxime (Ceftin, Zinacef)
Surgical Management drainage of secretions. • Ceftriaxone (Rocephin)
- Biopsy ✓ Suctioning and vaporization may also provide relief.
• Cefditoren (Spectracef)
Nursing Diagnosis ✓ Removing nasal mucus via a bulb syringe before feedings
• Cefixime (Suprax)
• Risk for infection related to contagious skin infection also allows infants to breathe more freely and be able to
suck more efficiently. • Cefpodoxime (Vantin)
Nursing Management
✓ Maintaining adequate fluid intake is important to prevent • Cephalexin (Keflex)
• Assess patient’s skin on his whole body
• Implement skin isolation techniques dehydration • Cefadroxil
• Soften skin and crust with burrow’s solution; then ✓ Promote rest DIAGNOSIS
removes crust slowly DIAGNOSIS ✓ Rapid Antigen Detection Test
• Cover lesion to prevent spread of infection Most common colds are diagnosed based on symptoms. ✓ Throat Swab
• Remove crust gently But cold symptoms may seem like other bacterial infections, SURGICAL
• Administer antibiotics as ordered allergies, and health problems. ✓ Tonsillectomy- is removal of the palatine tonsils
• Health teachings ✓ Adenoidectomy- is removal of the pharyngeal tonsils
RISK FACTORS
• ✓ Proper wound care PHARYNGITIS
Pharyngitis The inflammation of the mucous membranes of the ✓ History of ill contact
• ✓ Hand hygiene ✓ Over crowding
oropharynx, with an incubation period of 2 to 5 days.
ETIOLOGY ✓ Frequent sinus infections
ALTERATIONS IN OXYGENATION ✓ Smoking
❖ Viral Pharyngitis ✓ Attending day care
ACUTE NASOPHARYNGITIS (COMMON COLD) The causative agent of pharyngitis is usually a virus. ✓ Immunocompromised
Is the swelling of nasal passages and the back of the throat. The The symptoms are generally mild: a sore throat, fever, ✓ Cold season
incubation period for the common cold is typically 2 to 3 days, and rhinorrhea, cough, and general malaise. ✓ Allergic rhinitis
most occur in the fall and winter, when respiratory viruses ❖ Streptococcal Pharyngitis ✓ Gastroesophageal reflux disease
circulate. Group A β-hemolytic streptococcus is the organism
ETIOLOGY most frequently involved in bacterial pharyngitis in EPISTAXIS
• Rhinovirus, Respiratory Syncytial Virus (RSV), children, particularly those between the ages of 5 and is bleeding from tissues inside the nose (nasal mucus
Adenovirus, Parainfluenza Viruses, and Influenza 15 years. Fever, Pain when swallowing, Sore throat, membranes) caused by a broken blood vessel
Viruses. Red and swollen tonsils. White patches or streaks of ETIOLOGY
SIGNS AND SYMPTOMS pus on the tonsils, Petechiae, Swollen lymph nodes ✓ Dry air
● Nasal Congestion in the front of the neck ✓ Nasal Polyps, Sinusitis, Allergic Rhinitis
● Watery Rhinitis ❖ Retropharyngeal Abscess ✓ Strenuous Exercise
● Low-grade Fever Although uncommon, an abscess can form in these lymph nodes ✓ Hemolytic Disorder
● Difficulty Breathing and may constitute a medical emergency as it may impact the DIAGNOSIS
● Pharyngitis (Sore Throat) airway. Breathing difficulty, Difficulty swallowing, Drooling, High ✓ Complete blood count
● Cough fever, Stridor, Muscles between the ribs pull in when breathing ✓ CT scan or Xray of the sinuses and nasal area
RISK FACTORS (intercostal retractions), Severe throat pain, Difficulty turning the RISK FACTORS
These factors can increase your chances of getting a cold: head. A child may be more at risk for nosebleed if he or she:
✓ Age DRUG OF CHOICE • Lives in a dry climate
✓ Weakened immune system • Penicillin • Picks his or her nose
✓ Time of year. • Amoxicillin (Moxatag) • Has allergies
✓ Smoking • Azithromycin (Zithromax, Zmax) • Has a cold
THERAPEUTIC MANAGEMENT SURGICAL MANAGEMENT SIGNS & SYMPTOMS
✓ Direct pressure with the patient tilted forward decreases ✓ Tonsillectomy ✓ Postnasal drip (mucus dripping down your throat).
ingestion or aspiration of blood. DIAGNOSIS ✓ Facial pressure
✓ Topical medications, aimed at vasoconstriction ❖ Throat Swab ✓ Pressure or pain in your teeth.
(oxymetazoline, phenylephrine) or antifibrinolytics ❖ Complete Blood Count (CBC) ✓ Ear pressure or pain.
(tranexamic acid, epsilon-aminocaproic acid), NURSING MANAGEMENT ✓ Fever.
✓ Nasal packing (sponge or balloon), which is more likely ✓ Abdomen or side lying position to facilitate drainage of ✓ Halitosis
to reach posterior sources than direct pressure. secretion ✓ Cough.
NURSING MANAGEMENT ✓ Promote Tepid Sponge Bath to reduce temperature ✓ Headache
✓ Monitor for patient vital signs assists in the control of ✓ encourage soft or liquid diet ✓ Fatigue
bleeding. ✓ Promote gargling warm salt water
✓ Provides tissues and emesis basin to allow the patient to ✓ Administer analgesics and antipyretics as ordered DIAGNOSTIC
expectorate any excess blood. ✓ Nasal Endoscopy
✓ Administer humidified oxygen by facemask to a patient SINUSITIS ✓ Nasal swabs
with posterior packing. Is infection and inflammation of the sinus cavities. It rarely occurs ✓ Imaging
✓ Assuring the patient in a calm, efficient manner that in children younger than 6 years of age because the frontal ✓ Allergy testing
bleeding can be controlled can help reduce anxiety. sinuses do not develop fully until that age. ✓ Biopsy
What is Sinus? DRUG OF CHOICE
TONSILITIS Sinuses are structures inside your face that are normally ✓ Decongestants.
is an inflammation of the tonsils, which are in the back of the throat filled with air, they are four paired cavities (spaces) in your head. ✓ Nasal saline rinses.
on both sides. Narrow passages connect them. Sinuses make mucus that drains ✓ Topical antihistamine sprays or oral pills.
SIGNS AND SYMPTOMS out of the passages in your nose. This drainage helps keep your ✓ Antibiotics such as:
✓ Swollen tonsils nose clean and free of bacteria, allergens and other germs • Augmentin
✓ Sore throat (pathogens). • Amoxicillin.
✓ Pain when swallowing ETIOLOGY • Levofloxacin.
✓ Swollen or tender lymph nodes in the neck Sinusitis is usually caused by a pathogen it may be a Virus, • Cefixime.
✓ Redness in the throat Bacteria, Fungi and Allergens. Specific triggers for sinusitis • Clindamycin.
✓ Blisters or pustules on the tonsils include: NURSING MANAGEMENT
✓ Congestion or runny nose ✓ The common cold. ➢ Observation of vital signs
✓ Ear pain ✓ The flu (influenza). ➢ Assess client's level of pain
✓ Fever ✓ Streptococcus pneumonia bacteria. ➢ Explain the causes and effects of pain on the client and
✓ Fatigue or lethargy ✓ Haemophilus influenza bacteria. family.
ETIOLOGY ✓ Moraxella catarrhalis bacteria. ➢ Teach relaxation techniques and distractions.
Viruses, bacteria, allergens or irritants such as air pollution or ✓ Nasal and Seasonal Allergies ➢ Assess client's level of anxiety
cigarette smoke ➢ Get rid of excessive stimulation such as:
DIAGNOSIS Types of Sinusitis • Place the room quieter client
✓ Throat swabs ◼ By Time: • Limit contact with others / other clients are likely to
✓ Complete Blood Count • Acute sinusitis – less than four weeks. experience anxiety
DRUG OF CHOICE • Subacute sinusitis – symptoms last four to 12 weeks. MEDICAL MANAGEMENT
✓ Antibiotics for Strep throat (Penicillin) • Chronic sinusitis – symptoms last at least 12 weeks. ➢ Manage Infection
✓ Acetaminophen
• Recurrent acute sinusitis – symptoms come back four ➢ Prescribe Antibiotics
MEDICAL MANAGEMENT ➢ Immunotherapy
or more times in one year
✓ Staying hydrated
◼ By Pathogen: SURGICAL MANAGEMENT
✓ Gargling with salt water
• Bacterial • Endoscopic Sinus Surgery
✓ Using throat lozenges
✓ Use of acetaminophen to assist with pain relief • Viral 1. EPIGLOTTITIS
• Fungi It is the inflammation and swelling of your epiglottis.
What is Epiglottis? ✓ Endotracheal intubation. ✓ Monitor respiratory rate, depth, and effort. Note any
- It is a thin flap of cartilage near the base of the tongue. ✓ Tracheostomy signs of aspiration such as dyspnea, cough, cyanosis
It keeps food and liquids from going down the trachea (windpipe) SURGICAL MANAGEMENT wheezing, or fever.
upon swallowing. ✓ Epiglottis surgery ✓ Review results of swallowing studies.
ETIOLOGY 2. ASPIRATION ✓ Auscultate bowel sounds to assess for
✓ Haemophilus influenzae type B Is the inhalation of a foreign object into the airway, occurs gastrointestinal motility.
✓ Pneumococci, Streptococci, or Staphylococci which most frequently in infants and toddlers. It can also be an infection ✓ Assess pulmonary status for clinical evidence of
is called as Acute Bacterial Epiglottitis. of the lungs caused by inhaling saliva, food, liquid, vomit and even aspiration.
✓ Echovirus and RSV small foreign objects ✓ Auscultate breath sounds and note for crackles and
Other possible epiglottitis causes include: ETIOLOGY rhonchi.
•Fungal infections, particularly in people with a weak Aspiration pneumonia is caused by inhaling foreign ✓ Prescribe medications.
immune system. materials into your lungs. These materials can be: SURGICAL MANAGEMENT
•Injury to the throat, either through a physical blow or by •Bacteria from saliva and secretions from your mouth and ✓ Tracheotomy
drinking a very hot liquid nose.
•Smoking. •Stomach contents such as digestive juices or vomit. ASTHMA
•Side effects of Chemotheraphy. •Food or beverages. It is a lung disease that causes your airways to swell and narrow,
•Small foreign objects. making it very hard to breathe, it is a chronic inflammatory disorder
SIGNS AND SYMPTOMS SIGNS & SYMPTOMS of the respiratory track and is the most common chronic illness in
✓ Dysphagia Aspiration pneumonia symptoms include: children.
✓ Dysphonia ✓ Dyspnea ETIOLOGY
✓ Drooling ✓ Wheezing • Many factors may affect how a child’s lungs develop or
✓ Distress ✓ Productive cough how their body fights germs. These include:
It also includes: ✓ Chest pain • Genetics: Biological family history, such as a parent who
✓ Fever ✓ Bad breath has asthma
✓ Tripod Position DIAGNOSTIC PROCEDURE • Allergens: Things in the environment that affect your
Generally, the first thing to do is to take medical history and child, such as dust or tobacco smoke.
DIAGNOSTIC PROCEDURE perform assessment then proceeds to further test such as • Viral Infections at a young age: Respiratory infections
✓ Laryngoscopy ◆ Chest X-Rays. that affect breathing, such as the common cold.
✓ Lateral neck radiography. ◆ Blood tests. SIGNS & SYMPTOMS
✓ Blood and epiglottis cultures. ◆ Sputum tests. • Frequent Coughing.
DRUG OF CHOICE ◆ Swallowing tests. • Less energy during play.
✓ Antibiotics DRUG OF CHOICE • Dyspnea
✓ Corticosteroids. ✓ Antibiotics • Agitation of Chest
NURSING MANAGEMENT NURSING MANAGEMENT • Wheezing expiratory grunt.
✓ Assessment: ✓ Assess breathing and Oxygenation • Retractions.
✓ Respiratory assessment. ✓ Assess any respiratory distress • Malaise.
✓ Cardiovascular assessment. ✓ Provide oxygen saturation if less than 92%
• Irritability.
✓ Gastrointestinal assessment. ✓ Assess coughing ability and productivity
DIAGNOSTIC PROCEDURE
✓ Anxiety control.. ✓ Listen for adventitious breath sounds
• Lung pulmonary function test.
✓ Learning facilitation. ✓ Assess hydration status
✓ Medications. ✓ Administer medications prescribed • Allergy skin testing and blood tests
✓ Hydration. ✓ Keep Patient comfortable and encourage coughing • Chest X-Ray
MEDICAL MANAGEMENT ✓ Be aware of aspiration if the patient is intubated, or NGT. DRUG OF CHOICE
✓ Manage respiratory arrest. MEDICAL MANAGEMENT Types of quick-relief medicines include:
✓ Moist air administration. • Short-acting beta2-agonists (SABAs).
✓ Pulse oximetry. • Short-acting anticholinergics.
 • Systemic corticosteroids. breathing; auscultate the lung fields for the presence of NURSING MANAGEMENT
wheezes, crackles, rhonchi, or decreased breath sounds. ✓ Take a careful history to help establish etiologic
Types of long-term control medicines include: MEDICAL MANAGEMENT diagnosis. History of recent respiratory illness including
• Corticosteroids. ✓ The flu may be treated with acetaminophen, cough mode of onset.
• Leukotriene modifiers. medicine, and antiviral medicine. ✓ Observe for anxious, flushed appearance, shallow
• Long-acting beta2-agonists (LABAs) ✓ Oseltamivir (Tamiflu). respiration, splinting of affected side, confusion,
NURSING MANAGEMENT ✓ To prevent the infection, children over 6 months of age disorientation.
✓ Assess history. should receive either the inactivated vaccine (given by ✓ Auscultate fro crackles overlying affected region, and for
✓ Assess respiratory status. injection) or the activated vaccine (given by a nasal bronchial breath sounds when consolidation is present
✓ Assess medications. spray). MEDICAL MANAGEMENT
✓ Pharmacologic therapy. ✓ Vaccines, inactivated. ✓ Antimicrobial Therapy
✓ Fluid therapy. ✓ Oxygen Therapy
MEDICAL MANAGEMENT PNEUMONIA SURGICAL MANAGEMENT
Immediate intervention may be necessary, because continuing Pneumonia is an infection and inflammation of alveoli. It often has ✓ Video Assisted Thorascopic Surgery (VATS)
and progressive Dyspnea leads to increased anxiety, aggravating a bacterial or viral origin and is categorized as hospital- or
the situation. community-acquired. Pneumonia occurs most often in late winter TUBERCULOSIS
➢ Daily peak flow monitoring. and early spring. Tuberculosis, caused by the bacterium Mycobacterium
➢ Function TYPES OF PNEUMONIA tuberculosis, is a highly contagious pulmonary disease that
SURGICAL MANAGEMENT ❖ Pneumococcal Pneumonia is caused by bacteria called affects children worldwide
✓ Bronchial Thermoplasty Streptococcus pneumoniae. ETIOLOGY
• Tuberculosis, caused by the bacterium Mycobacterium
❖ Chlamydial Pneumonia is a type of bacteria that causes tuberculosis, is a highly contagious pulmonary disease
INFLUENZA respiratory tract infections, such as pneumonia.
- Influenza involves inflammation and infection of the major that affects children worldwide.
airways. ❖ Viral Pneumonia causes inflammation in the lungs, SIGNS&SYMPTOMS
ETIOLOGY leading to abnormal exchange of oxygen and carbon In initial stages of infection, primary inflammation occurs and a
It is caused by infection of respiratory tract with orthomyxovirus dioxide in the alveoli caused by the virus. slight cough develops. As the disease progresses, anorexia,
influenza viruses. ❖ Mycoplasmal pneumonia is caused by the bacteria weight loss, night sweats, and a lowgrade fever may be present
SIGNS & SYMPTOMS Mycoplasma pneumoniae. .
It is marked by a cough and fever but may be accompanied by SIGNS & SYMPTOMS DIAGNOSTIC PROCEDURE
fatigue, body aches, a sore throat, runny or stuffy nose and ✓ Cough, which my produce greenish, yellowish or even ✓ Tuberculin Test
gastrointestinal symptoms such as vomiting or diarrhea. bloody mucus. ✓ Mantoux Test, also known as a Purified Protein Derivative
DIAGNOSTIC PROCEDURE ✓ Fever, sweating and shaking chills. (PPD) Test
• Rapid Influenza Diagnostic Tests (RIDTs), ✓ Shortness of breathing ✓ Chest Radiograph.
• Viral Culture ✓ Rapid, shallow breathing ✓ Sputum Analysis
• Polymerase Chain Reaction Testing ✓ Sharp or Stabbing chestpain THERAPEUTIC MANAGEMENT
• Serologic Testing ✓ Loss of apetite, low energy, and fatigue. ✓ Antituberculosis drugs include isoniazid, rifampin,
DIAGNOSTIC PROCEDURE pyrazinamide, and
• Chest Radiography
❖ Chest X-ray ✓ Diet high in protein and calcium. Children should have
THERAPEUTIC MANAGEMENT
❖ Gram Strain and Culture and Sensitivity periodic chest radiographs to ensure the disease does
• Antiviral Drugs can help treat flu illness. These drugs
❖ Blood Culture. not reactivate.
include Oseltamivir, Zanamivir, Peramivir or
❖ Immunologic tests ✓ Up-to-date vaccination is encouraged.
Baloxavir
THERAPEUTIC MANAGEMENT NURSING MANAGEMENT
NURSING MANAGEMENT
Pharmacologic management may include IV fluid ✓ Obtain history of exposure to TB.
Assessment of the patient with influenza include:
therapy, antibiotics, and antipyretics. ✓ Assess for symptoms of active disease.
• History. Assess the patient’s travel history, if any. ✓ Auscultate lungs for crackles.
• Physical examination. Assess respiratory status for rate, ✓ During drug therapy, assess for liver dysfunction.
depth, ease, use of accessory muscles, and work of
MEDICAL MANAGEMENT ✓ Removal Of Nasal Polyps or The Placement of a Feeding Medical Management
• Including Isoniazid (INH), Rifampin (Rifadin), Tube Medications won't repair a ventricular septal defect, but they may
Pyrazinamide (PZA), and Ethambutol (EMB). ✓ Lung Transplant and Bowel Surgery be given to treat symptoms or complications. The specific
• Sputum smears may be obtained every 2weeks until they medications used depend on the symptoms and their cause.
are negative; sputum cultures do not become negative for ALTERATIONS IN CARDIOVASCULAR FUNCTIONS Water pills (diuretics) are used to decrease the amount of fluid in
3 to 5 months. the body and reduce the strain on the heart. Oxygen may be given.
SURGICAL MANAGEMENT Septal Defects Surgical Management
• A Lobectomy is a type of surgery, mostly used for lung • Ventricular Septal Defect Surgery may be done if the VSD is medium or large or if it's
cancer, in which one lobe of a lung is removed. A ventricular septal defect (VSD) is a hole in the heart. It's a causing severe symptoms. Babies who need surgery to repair the
CYSTIC FIBROSIS common heart problem present at birth (congenital heart defect). hole often have the procedure in their first year.
Cystic fibrosis (CF) is an inherited disease of the secretory The hole occurs in the wall that separates the heart's lower Surgeries and procedures to repair a ventricular septal defect
glands. The disease is characterized by a thick mucus chambers (ventricles). With this defect, an opening is present in include:
secretions, particularly in the pancreas and the lungs, as well the septum between the two ventricles. Because pressure in the • Open-heart surgery. This is the preferred procedure for
as electrolyte abnormalities in sweat gland secretions. left ventricle is greater than that in the right ventricle, blood shunts repairing most ventricular septal defects. A surgeon uses
ETIOLOGY from left to right across the septum (an acyanotic disorder). This a patch or stitches to close the hole between the lower
Cystic fibrosis (CF) is a disease that is passed down through impairs the effort of the heart because blood that should go into heart chambers. This type of VSD surgery requires a
families. It is caused by a defective gene that makes the body the aorta and out to the body is shunted back into the pulmonary heart-lung machine and an incision in the chest.
produce abnormally thick and sticky fluid, called mucus. This circulation, resulting in right ventricular hypertrophy and increased • Catheter procedure. Some ventricular septal defects can
mucus builds up in the breathing passages of the lungs and in the pressure in the pulmonary artery. be repaired using thin, flexible tubes (catheters) without
pancreas. Signs and Symptoms the need for open-heart surgery. The health care provider
SIGNS&SYMPTOMS Symptoms of a ventricular septal defect (VSD) depend on the size inserts a catheter into a blood vessel, usually in the groin,
✓ Salty-tasting skin. of the hole and if there are any other heart problems. A small VSD and guides it to the
✓ Daily cough, at times with mucus. may never cause symptoms. • heart. A small device is inserted through the catheter to
✓ Lung infections. • Anorexia (Poor eating) close the hole.
✓ Shortness of breath. • Slow or no physical growth (Failure to thrive) • After ventricular septal defect surgery, regular checkups
✓ Poor growth or slow weight gain even with a good • Tachypnea are needed for life, ideally by a heart doctor (cardiologist).
appetite. • Fatigue Checkups often include imaging tests to determine how
✓ Frequent greasy, bulky, foul-smelling stools or trouble • Loud or harsh pansystolic murmur (Whooshing sound well surgery is working.
having a bowel movement. when listening to the heart with a stethoscope) Nursing Management
DIAGNOSTIC PROCEDURE Risk Factors • Asses the patient for coughing.
✓ Sweat Testing Risk factors for ventricular septal defect include: • Auscultate chest of the patient.
✓ Duodenal secretions • Premature Birth • Give chest physiotherapy.
✓ Pulmonary Testing • Family history of congenital heart defects • Give nebulization with Levolin as dose of ¼ resp.
NURSING MANAGEMENT • Atrial septal defect • Auscultate after nebulization.
• Interview the caregivers. • Coarctation of the aorta • Advice the mother of the patient to prevent drinking
• Assess caregiver‘s knowledge. • Double outlet syndrome alcohol and using of antiseizure medicines in pregnancy.
• Assess vital signs. • Patent ductus arteriosus • Administer prophylactic antibiotics.
• Assess skin condition. • Tetralogy of Fallot • Inspect fluid balance.
MEDICAL MANAGEMENT Diagnostic Procedures • Position the patient in a semi-fowler position.
✓ Pancreatic enzymes • Echocardiogram
✓ Vitamins • Electrocardiogram Atrial Septal Defect
✓ Bronchodilators • Chest X-ray An ASD is an abnormal communication between the two atria,
✓ Mucolytics • Pulse Oximetry allowing blood to shift from the left to the right atrium (an acyanotic
✓ Antibiotics • Cardiac Catheterization defect). It is more common in girls than boys (Fulton & Freed,
SURGICAL MANAGEMENT • Cardiac magnetic resonance imaging (MRI) scan 2008). Blood flow is from left to right (oxygenated to
• Computerized Tomography (CT) Scan deoxygenated) because of the stronger contraction of the left side
of the heart. This causes an increase in the volume in the right • Cardiac magnetic resonance imaging The ductus arteriosus is an accessory fetal structure that connects
side of the heart and generally results in ventricular hypertrophy • (MRI) scan the pulmonary artery to the aorta. If it fails to close at birth (closure
and increased pulmonary artery blood flow, the same as with a • Computerized Tomography (CT) Scan begins with the first breath and is usually complete between 7 to
VSD. Medical Management 14 days of age, although full closure may not occur until 3 months
There are four different types of Atrial Septal Defects: Medications won't repair an atrial septal defect, but they can help of age), blood will shunt from the aorta (oxygenated blood) to the
• Secundum. This is the most common type of ASD. It reduce signs and symptoms. Medications for atrial septal defect pulmonary artery (deoxygenated blood) because of the increased
occurs in the middle of the wall between the upper heart might include drugs to control the heartbeat (beta blockers) or to pressure in the aorta. The shunted blood returns to the left atrium
chambers (atrial septum). reduce the risk of blood clots (anticoagulants). of the heart, passes to the left ventricle, out to the aorta, and
• Primum. This type of ASD affects the lower part of the Surgical Management shunts back to the pulmonary artery. This causes increased
atrial septum and might occur with other congenital heart Many cardiologists recommend surgery to repair a medium to pressure in the pulmonary circulation from the extra shunted
defects. large atrial septal defect that's diagnosed during childhood or blood; this leads to right ventricle hypertrophy and ineffective heart
• Sinus venosus. This rare type of ASD usually occurs in adulthood to prevent future complications. For adults and children, action.
the upper part of the wall separating the heart chambers. atrial septal defect repair surgery involves closing the hole in the Signs and Symptoms
It's also associated with other heart structure changes heart. This can be done two ways: Patent ductus arteriosus symptoms (PDA) depend on the size of
present at birth. • Catheter-based repair. A thin, flexible tube (catheter) is the opening and the person's age. A small PDA might not cause
• Coronary sinus. In this rare type of ASD, part of the wall inserted into a blood vessel, usually in the groin, and symptoms. A
between the coronary sinus — which is part of the vein guided to the heart using imaging techniques. A mesh large PDA can cause symptoms of heart failure soon after birth. A
system of the heart — and the left upper heart chamber patch or plug is passed through the catheter and used to large PDA found during infancy or childhood might cause:
(left atrium) is missing. close the hole. Heart tissue grows around the seal, • Anorexia which could lead to poor growth.
Signs and Symptoms permanently closing the hole. • Sweating with crying or eating
Many babies born with atrial septal defects have no signs or • The catheter-based repair procedure is used only for the • Tachypnea
symptoms. Signs or symptoms can begin in adulthood. Atrial secundum type of atrial septal defects. Some large • Fatigue
septal defect signs and symptoms can include: secundum atrial septal defects, however, might require • Tachycardia
• Dyspnea open-heart surgery. Risk factors
• Fatigue • Open-heart surgery. This type of atrial septal defect repair Risk factors for patent ductus arteriosus (PDA) include:
• Swelling of legs, feet, or abdomen surgery involves an incision through the chest wall to • Premature birth
• Arrythmias access the heart directly. The surgeons use patches to
• Palpitations close the hole. This open-heart repair surgery is the only • Family history and other genetic conditions
• Harsh systolic murmur way to fix primum, sinus venosus and coronary sinus • Rubella
Risk Factors atrial defects. • Being born at a high altitude
Atrial septal defect (ASD) occurs as the baby's heart is developing • Sometimes, atrial septal defect repair can be done using • Female
during pregnancy. Certain health conditions or drug use during small incisions (minimally invasive surgery) and with a • Diagnostic Procedures
pregnancy may increase a baby's risk of atrial septal defect or robot (robot-assisted heart surgery). • Echocardiogram
other congenital heart defect. These things include: Nursing Management • Electrocardiogram
• Rubella • Asses the patient for coughing. • Chest X-ray
• Diabetes • Auscultate chest of the patient. • Cardiac Catheterization
• Lupus • Give chest physiotherapy. Medical Management
• Alcohol or Tobacco use • Give nebulization with Levolin as dose of ¼ resp. Medicines called nonsteroidal anti-inflammatory drugs (NSAIDs)
• Illegal use of drugs • Auscultate after nebulization. may be given to premature babies to treat a PDA. These
• Use of certain medications, including some anti-seizure • Advice the mother of the patient to prevent drinking medicines block certain body chemicals that keep a PDA open.
medications and drugs to treat alcohol and using of antiseizure medicines in pregnancy. However, these medicines won't close a PDA in full-term babies,
• mood disorders • Administer prophylactic antibiotics. children or adults.
Diagnostic Procedure • Inspect fluid balance. Surgical Management
• Echocardiogram • Position the patient in a semi-fowler position. Advanced treatments to close a patent ductus arteriosus include:
• Electrocardiogram Using a thin tube called a catheter and a plug or coil to close the
• Chest X-ray Patent Ductus Arteriosus opening. This treatment is called a catheter procedure. It allows a
repair to be done without open-heart surgery. During a catheter • Branch peripheral pulmonic stenosis – The right or left • People who have had pulmonary valve replacement need
procedure, the health care provider inserts a thin tube into a blood pulmonary artery is narrowed, or both may be narrowed. to take antibiotics before certain dental procedures or
vessel in the groin and guides it to the heart. A plug or coil passes Signs and Symptoms surgeries to prevent endocarditis.
through the catheter. The plug or coil closes the ductus arteriosus. Some children with pulmonary stenosis do not have symptoms. Nursing Management
The treatment doesn't usually require an overnight hospital stay. The more severe the stenosis, the more likely the child is to have • Prehospital Care If the patient has a large left-to-right
Premature babies are too small for catheter treatments. If the PDA symptoms. The most common symptoms may include: shunt, such as patent ductus arteriosus or ventricular
isn't causing problems, a catheter treatment to close the opening • Shortness of breath septal defect, and is in respiratory distress, diuresis is
may be done when the baby is older. Open-heart surgery to close • Tachycardia effective in reducing the cyanosis secondary to pulmonary
the PDA. This treatment is called surgical closure. Heart surgery • Angina edema.
may be needed if medicine doesn't work or the PDA is large or • Swelling • Oxygen should be administered to any cyanotic patient in
causing complications. A surgeon makes a small cut between the • Cyanosis respiratory distress. Use of oxygen may reduce
ribs to reach the child's heart. The opening is closed using stitches • Fatigue pulmonary artery pressure in patients with a reactive
or clips. It usually takes a few weeks for a child to fully recover • Syncope pulmonary vasculature, thus increasing pulmonary blood
from this surgery. Risk factors flow.
Nursing Management May increase the risk of pulmonary valve stenosis include:
• Watch carefully for signs of PDA in premature infants. • Carcinoid syndrome Coarctation of Aorta
• Frequently assess vital signs, ECG, electrolyte levels, and • Noonan syndrome Coarctation of the aorta, a narrowing of the lumen of the aorta due
intake and output. • Rheumatic fever to a constricting band, accounts for about 6% of instances of
• If the infant receives indomethacin for ductus closure, • Radiation congenital heart disease. It occurs more frequently in boys than in
watch for possible adverse effects, such as diarrhea, • Rubella girls and is the leading cause of congestive heart failure in the first
jaundice, bleeding, and renal dysfunction. Diagnostic Procedures few months of life. There are two locations in which this commonly
• Before surgery, carefully explain all treatments and tests • Echocardiogram occurs. In the first, termed “preductal,” the constriction occurs
to parents, including the child, and tell them about • Electrocardiogram between the subclavian artery and the ductus arteriosus. In the
expected IV lines, monitoring equipment, and • Cardiac Catheterization second, postductal, the constriction is distal to the ductus
postoperative procedures. • Other imaging tests arteriosus. Because it is difficult for blood to pass through the
• Immediately after surgery, the child may have a central Medical Management narrowed lumen of the aorta, blood pressure increases proximal
venous pressure catheter and an arterial line in place, so No medications are useful in isolated pulmonic valvular stenosis. to the coarctation and decreases distal to it. This results in
careful assessment of vital signs, intake and output, and Surgical Management increased blood pressure in the heart and upper portions of the
arterial and venous pressures are needed, as well as pain Pulmonary valve stenosis treatment may include: body as pressure in the subclavian artery increases.
relief. • Balloon valvuloplasty. The provider in- Signs and Symptoms
Pulmonary Stenosis • serts a flexible tube with a balloon on the tip into an artery, If the narrowing is mild, coarctation of the aorta symptoms may go
Pulmonary stenosis is narrowing of the pulmonary valve or the usually in the groin. X-rays help guide the tube, called a unnoticed until the child is older or even an adult. In those cases,
pulmonary artery just distal to the valve. It accounts for about 10% catheter, to the narrowed valve in the heart. The balloon symptoms can include:
of congenital heart anomalies (Fulton & Freed, 2008). Inability of inflates, making the valve opening larger. The balloon is • Tachypnea
the right ventricle to evacuate blood by way of the pulmonary deflated. The catheter and balloon are removed. • High blood pressure
artery because of the obstruction leads to right ventricular • Valvuloplasty may improve blood flow through the heart • Heart murmur
hypertrophy. and reduce pulmonary valve stenosis symptoms. But the • Epistaxis
There are four different types of pulmonary stenosis: valve may narrow again. Some people need valve repair • Cephalgia
• Valvar pulmonary stenosis – The valve leaflets are or replacement in the future. • Syncope
thickened and/or narrowed. • Pulmonary valve replacement. If balloon valvuloplasty • Fatigue
• Supravalvar pulmonary stenosis – The pulmonary artery isn't an option, open-heart surgery or a catheter • Pallor
just above the pulmonary valve is narrowed. procedure may be done to replace the pulmonary valve. • Hyperhidrosis
• Subvalvar (infundibular) pulmonary stenosis – The If there are other heart problems, the surgeon may repair Risk Factors
muscle under the valve area is thickened, narrowing the those during the same surgery. Coarctation of the aorta often occurs along with other congenital
outflow tract from the right ventricle. heart defects. Heart conditions associated with coarctation
include:
 • Bicuspid aortic valve • Subclavian flap aortoplasty. A part of the blood vessel that dextroposition (overriding) of the aorta, and hypertrophy of the
• Ventricular septal defect delivers blood to the left arm (left subclavian artery) might right ventricle. Because of the pulmonary stenosis, pressure
• Subaortic stenosis be used to expand the narrowed area of the aorta. builds up in the right side of the heart. Blood then shunts from this
• Patent ductus arteriosus • Bypass graft repair. This surgery uses a tube called a area of increased pressure into the left ventricle and the overriding
• Congenital mitral valve stenosis graft to reroute blood around the narrowed area of the aorta. The extra effort involved to force blood through the
Diagnostic Procedures aorta. stenosed pulmonary artery causes the fourth deformity,
• Echocardiogram • Patch aortoplasty. The surgeon cuts across the narrowed hypertrophy of the right ventricle. A number of children with this
• Electrocardiogram area of the aorta and then attaches a patch of synthetic disorder show a deletion abnormality of chromosome, or the
• Chest X-ray material to widen the blood vessel. Patch aortoplasty is disorder can result from a documented chromosome disorder.
• Cardiac Catheterization useful if the coarctation involves a long part of the aorta. Signs and Symptoms
• Cardiac magnetic resonance imaging Nursing Management Tetralogy of Fallot symptoms vary, depending on the amount of
• (MRI) scan • Nurses maintained an hourly B.P chart. BP was blood flow that's blocked. Signs and symptoms may include:
• Computerized Tomography (CT) Scan stabilized. • Cyanosis
• CT Angiogram • Nurses skilled in IV infusion and blood sampling • Dyspnea and tachypnea, especially during feeding or
Medical Management techniques (Phlebotomy) obtained the samples for blood exercise
Medication may be prescribed to control blood pressure before investigations like CBC, LFT & RFT with a sterile • Poor weight gain
and, sometimes, after repair surgery. Although repairing aortic technique to prevent thrombophlebitis. • Fatigue
coarctation improves blood pressure, many people still need to • Tagged the patient case note With NO CHEST PHYSIO • Irritability
take blood pressure drugs after a successful surgery or mark. • Prolonged crying
procedure. Babies with severe coarctation of the aorta often are • Diet was provided with salt - 5g/day, Fluid administer of 2 • Heart murmur
given a medication that keeps the ductus arteriosus open. This - 4 liter of water/day. • Fainting
allows blood to flow around the narrowed area of the aorta until • Doctors explained the patient condition to the attenders. • An abnormal, rounded shape of the nail bed in the fingers
surgery is done. Nurses obtained consent for the clinical procedures after and toes (clubbing)
Surgical Management proper counseling. Risk Factors
There are several procedures and surgeries to repair aortic • Keen observation & splinting for immobilization of femoral While the exact cause of tetralogy of Fallot is unknown, some
coarctation. Together, you and your health care team can discuss site was done to prevent complications. things might increase the risk of a baby being born with this
which type is most likely to be successful. Options include: • • Nurses used AIDET technique condition. Risk factors for tetralogy of Fallot include:
• Balloon angioplasty and stenting. This may be the first • (Acknowledge, Introduce, Duration, Explanation and • Rubella
treatment for aortic coarctation. Sometimes it's done if Thank you) while communicating with patient and • Drinking alcohol during pregnancy
narrowing occurs again after coarctation surgery. attenders to gain their confidence and improve the • Poor nutrition during pregnancy
• During balloon angioplasty, the doctor inserts a thin, satisfaction level. • A mother older than age 40
flexible tube (catheter) into an artery in the groin. It's • Nurses monitored Femoral site for any active bleeding. • A parent who has tetralogy of Fallot
moved through the blood vessels to the heart using X- • Maintained pulse chart with Doppler to prevent stasis and • The presence of Down syndrome or
rays as a guide. An uninflated balloon is placed into the embolism formation. Vital parameters were keenly • DiGeorge syndrome in the baby
catheter and moved into the area of the narrowed aorta. monitored during procedure and post operatively. Diagnostic Procedures
The balloon is inflated. The inflated balloon widens the • Nurses cared for ADL activities, developed rapport with • Echocardiogram
aorta, so blood flows more easily. Angioplasty is often attender and patient which aids in early prognosis. • Electrocardiogram
combined with the placement of a small wire mesh tube • Diversional therapy was provided with News papers, • Chest X-ray
called a stent. The stent helps keep the artery open, Television, Active listening to patient voice by Nurses. • Cardiac Catheterization
decreasing the chance of narrowing again. • Oxygen level measurement (pulse oximetry)
• Resection with end-to-end anastomosis. This method Tetralogy of Fallot Medical Management
involves removing the narrowed area of the aorta Tetralogy of Fallot is a birth defect that affects normal blood flow The majority of patients with tetralogy of Fallot (TOF) require no
(resection) and then connecting the two healthy parts of through the heart. It happens when a baby’s heart does not form medical therapy prior to undergoing surgical repair. In rare
the aorta (anastomosis). correctly as the baby grows and develops in the mother’s womb instances, medications may be needed to treat ductal patency in
during pregnancy. It is called a tetralogy because four anomalies severely cyanotic neonates and signs of congestive heart failure
are present: pulmonary stenosis, VSD (usually large),
in patients with a minimal degree of right ventricular outflow tract Aortic Stenosis • Cardiac Catheterization
obstruction. Aortic valve stenosis or aortic stenosis is a type of heart valve • Cardiac magnetic resonance imaging
Surgical Management disease (valvular heart disease). The valve between the lower left • (MRI) scan
• Open-heart surgery to close the PDA. This treatment is called heart chamber and the body's main artery (aorta) is narrowed and Medical Management
surgical closure. Heart surgery may be needed if medicine doesn't doesn't open fully. This reduces or blocks blood flow from the No pill can cure or even improve your aortic stenosis. But there
work or the PDA is large or causing complications. A surgeon heart to the aorta and to the rest of the body. are some medications that may help you control your symptoms
makes a small cut between the ribs to reach the child's heart. The -Stenosis, or stricture, of the aortic valve prevents blood from and lower the chance of having certain complications.
opening is closed using stitches or clips. It usually takes a few passing freely from the left ventricle of the heart into the aorta. Among the medicines your doctor might prescribe are:
weeks for a child to fully recover from this surgery. Because the heart cannot force blood through the strictured valve, • ACE inhibitors, which can open blood vessels more fully
Nursing Management increased pressure and hypertrophy of the left ventricle occur. If • Medicines that tame heart rhythm problems
• Assess cardiac status. Reduced cardiac output and the left ventricular pressure becomes acute, pressure in the left • Beta-blockers, which slow your heart rate •
stroke volume are indicators of weak pulses. Capillary atrium also increases, resulting in back-pressure in pulmonary Diuretics (“water pills”), which lessen the amount
refill may be sluggish. Presence of abnormal heart sounds veins and possibly pulmonary edema. Aortic stenosis accounts for of fluid in your body and ease stress on your heart
such as S3 and S4. S3 indicates left ventricular failure and about 7% of congenital cardiac abnormalities. Surgical Management
denotes diminished left ventricular ejection. The left Signs and Symptoms Surgery options for aortic valve stenosis include:
ventricle’s lower compliance in S4 compromises diastolic Aortic valve stenosis ranges from mild to severe. Symptoms • Balloon valvuloplasty. This procedure can treat aortic
filling. generally occur when narrowing of the valve is severe. Some valve stenosis in infants and children. In adults, the aortic
• Monitor blood pressure and heart rate. As a result of the people with aortic valve stenosis may not have symptoms for valve tends to narrow again after the procedure. In this
lower cardiac output, most cardiac patients experience many years. procedure, a long, thin tube (catheter) with a balloon on
compensatory tachycardia and abnormally low blood Symptoms of aortic valve stenosis may include: the tip is inserted into an artery in the arm or groin. It's
pressure. • Heart murmur guided to the aortic valve. Once in place, the balloon is
• Note for other cardiovascular symptoms. Note complaints • Angina inflated, which widens the valve opening. The balloon is
of fatigue, decreased activity tolerance, skin color, • Feeling faint or dizzy or fainting with activity then deflated, and the catheter and balloon are removed.
temperature, and moisture. These are indicators of • Dyspnea • Aortic valve replacement. Aortic valve replacement is
decreased cardiac output and oxygen desaturation. • Fatigue, especially during times of increased activity often needed to treat aortic valve stenosis. In aortic valve
• Monitor for Tet spells. Tet spells describe newborns with • Palpitations replacement, the surgeon removes the damaged valve
deep blue skin, lips, and nails after crying, feeding, • Anorexia (mainly in children with aortic valve stenosis) and replaces it with a mechanical valve or a valve made
defecating, or becoming restless. A rapid decline in blood • Failure to thrive (mainly in children with aortic valve from cow, pig or human heart tissue (biological tissue
oxygen levels brings on Tet spells. stenosis) valve). Sometimes, the aortic valve is replaced with the
• Review RBC and hemoglobin levels. As the body works Risk Factors person's own lung (pulmonary) valve. The pulmonary
to remedy the tissues’ shortage of oxygen, complete Risk factors of aortic valve stenosis include: valve is replaced with a biological lung tissue valve from
blood count may reveal increased red blood cell count • Older age a deceased donor This more complicated surgery is
and hemoglobin. • Certain heart conditions present at birth (congenital heart called the Ross procedure.
• Obtain ECG. Low perfusion, acidosis, or hypoxia caused defects), such as a bicuspid aortic valve • Transcatheter aortic valve replacement (TAVR). TAVR is
by low cardiac output can all lead to cardiac dysrhythmias. • Chronic kidney disease an alternative to openheart aortic valve replacement
• Cardiovascular blood flow can also be impaired by • Having heart disease risk factors, such as diabetes, high surgery. This minimally invasive procedure replaces a
tachycardia, bradycardia, and ectopic beats. cholesterol and high blood pressure narrowed aortic valve with a valve made of cow or pig
• Verify with echocardiography. The degree of pulmonary • History of infections that can affect the heart, such as tissue. It may be an option if you're at intermediate or high
stenosis, the ventricular septal defect, a hole between the rheumatic fever and infective endocarditis risk of complications from surgical aortic valve
left and right ventricles, and other unexpected anomalies • History of radiation therapy to the chest replacement. Ask your health care provider about your
will be visible using echocardiography. • Diagnostic Procedures options.
• Assist in cardiac catheterization. Cardiac catheterization • Echocardiogram • Aortic valve repair. To repair an aortic valve, surgeons
may further measure the blood pressure and oxygen in • Electrocardiogram separate valve flaps (cusps) that have fused. However,
the pulmonary artery and aorta and can open narrowed • Chest X-ray valve repair is rarely used to treat aortic valve stenosis.
arteries. • Exercise tests or stress tests Generally aortic valve stenosis requires aortic valve
• Cardiac Computerized Tomography (CT) Scan replacement.
Nursing Management • Ventricles have switched places. This type of TGA, in the CONGESTIVE HEART FAILURE (CHF)
• Assist the patient in bathing, if necessary. absence of other heart defects, may not require repair Is a long-term condition where the heart is too weak to pump
• Provide a bedside commode because using a commode early in life. efficiently. And because it can't pump efficiently, it can't provide
puts less stress on the heart than using a bedpan. • Circulation of deoxygenated blood is partially oxygenated the proper cardiac output that your body needs to maintain its
• Offer diversional activities that are physically before returning to the body. And circulation of metabolic needs.
undemanding. oxygenated blood is partially deoxygenated before RELATED TERMS:
• Alternate periods of rest to prevent extreme fatigue and returning to the lungs. • Preload: the volume of blood in the ventricles at the point
dyspnea. ASSESSMENT Symptoms just before contraction; it is an indicator of circulating
• To reduce anxiety, allow the patient to express his • Cyanosis (bluish skin, lips and nails from • Rapid heart blood volume.
concerns about the effects of activity restrictions on his rate not getting enough oxygen-rich blood) • Slow weight • Contractility: ability to modulate the rate and force of fiber
resposibilities and routine. gain shortening
• Keep the patient’s legs elevated while he sits in a chair to • • Fast or labored breathing • Weak pulse • Afterload: amount of resistance met by the ventricles
improve venous return in the heart. • • Low appetite • Tachypneic upon ejection
• Place the patient in an upright position to relieve dyspnea. • Poor feeding • Compliance: the ability of the ventricles to stretch and fill
• Administer oxygen as needed to prevent tissue hypoxia. • Tests that can confirm a TGA diagnosis include: ASSESSMENT
• Keep the patient in a low sodium diet. Consult with a • • Chest X-ray • Pulse oximetry Symptoms (CHF is more difficult to detect in infants because it
dietitian to ensure that the patient receives foods that he • Electrocardiogram (ECG) may be more subtle)
likes while adhering to the diet restrictions. MEDICAL MANAGEMENT • Breathlessness • Dyspnea
• Allow the patient to express his fears and concerns about Treatments that can help a baby’s heart and lungs before surgery • Rapid respirations • Weigh Loss (caloric
the disorder, it’s impact on his life, and any impending include: expenditure is
surgery. • Intravenous (IV) medication to help the heart and lungs • Diaphoretic greater than the caloric intake)
• Monitor the patient’s vital signs, weight, and intake and work better • Right-sided failure (Increased venous pressure)
output for signs of fluid overload. • Prostaglandin E1, a medication that helps blood flow • Hepatomegaly • Periorbital edema (Edema is
• Evaluate patient’s activity tolerance and degree of fatigue. through the heart uncommon
• Monitor the patient for chest pain that may indicate • Supplemental oxygen or a ventilator (a machine that • Jugular venous distention in children)
cardiac ischemia. helps do the work of breathing) • Left-sided failure (Increased pulmonary pressures)
• Regularly assess the patient’s cardiopulmonary function. SURGICAL Management • Can ultimately lead to right-sided failure, as excessive
• Observe the patient for complications and adverse • Jatene procedure - Includes dissecting both the pressure in the pulmonary system
reactions to drug therapy. pulmonary artery and aorta above their respective valves and • prevents blood from leaving the right ventricle.
switching the vessels to the appropriate location. The final • Rales
component of the surgical repair is removing the coronary arteries • Tachypnea
TRANPOSITION OF THE GREAT ARTERIES (TGA) from the base of the original aorta and surgically placing them in • Clinical Findings • Shortness of breath
TGA occurs when the two main blood vessels coming out of the an appropriate spot on the new aortic root, now coming off of the • Hepatomegaly
heart — the aorta and the pulmonary artery — are transposed, or left ventricle. • • Cardiac gallop • Enlarged heart (Chest
switched in position. The aorta is positioned in front of the • Cardiopulmonary bypass - Reimplantation of the coronary radiograph, with or without pulmonary edema
pulmonary artery instead of behind it. arteries, however this may produces other potential THERAPEUTIC MANAGEMENT
2 Types of Tranposition of the Great Arteries: complications; Ischemia. Poor myocardial function, decreased Management of heart failure is twofold:
Dextro transposition of the great arteries (D-TGA) cardiac output & impair ventricular function, and long segment • symptomatically manage the patient and
• Aorta have switched places. This type of TGA almost narrowing of the pulmonary artery. • treat the underlying cause of the heart failure
always needs to be repaired in the first year of life. NURSING MANAGEMENT Goals:
• Circulation of deoxygenated blood is returned to the body Nursing care before surgery includes ensuring their oxygen • The goal is to decrease any fluid overload, enhance
and is never oxygenated. And circulation of oxygenated saturation remains normal for this defect, which is 75% to 85%; myocardial contractility, and decrease afterload in order
blood is returned to the lungs and is never deoxygenated. monitoring for signs of increased pulmonary blood flow; and to ensure adequate perfusion and decrease the work of
• Levo transposition of the great arteries (L-TGA) supporting the family as they wait for their newborn to undergo the heart.
heart surgery. • Be certain that outcomes established for the care of a
child with congestive heart disease are realistic in light of
 the child’s overall condition and are individualized for and acids in the blood. They help to tell how well your • Sedatives: to help your baby rest and stay calm. When
each child. Not all children may be able to attain “normal” baby uses oxygen or if they have an infection. the baby is calm, the machines that give him oxygen can
vital signs, but they should be comfortable and be able to • Pulse oximeter: This checks oxygen saturation levels. work better and he may need to use less.
participate in their regular daily activities, regardless of the MEDICAL MANAGEMENT • Surfactant: to help the lungs work better. Surfactant
actual heart rate or respiratory rate. The goal of treatment is to increase oxygen levels in the blood, allows the lungs to use oxygen and get rid of carbon
• Interventions focus on helping support heart function and open the blood vessels in the lungs, and maintain a normal blood dioxide. It is given to the baby through a breathing tube.
helping parents deal with this crisis until the child is pressure. This is done with oxygen, medicines, and fluids. Your SURGICAL MANAGEMENT
stabilized and the underlying condition can be treated, if baby may get oxygen by: Some people with pulmonary hypertension may need surgery.
possible. • Nasal cannula: A small tube with prongs is placed in the The 3 types of surgery currently used are:
nostrils and hooked up to oxygen. • Pulmonary endarterectomy – an operation to remove old
PERSISTENT PULMONARY HYPERTENSION ETIOLOGY • Continuous Positive Air Pressure (CPAP): This machine blood clots from the pulmonary arteries in the lungs in
Persistent pulmonary hypertension, also called persistent fetal gently pushes air or oxygen into the lungs. people with chronic thromboembolic pulmonary
circulation, occurs due to an abnormal transition from fetal to • Ventilator: This machine will breathe for your baby until hypertension
extrauterine circulation. It can also result from poor lung the baby can breathe on their own. The physician will put • Balloon pulmonary angioplasty – a new procedure where
vascularization in conditions such as congenital diaphragmatic a breathing tube down their windpipe. This is called a tiny balloon is guided into the arteries and inflated for a
hernia. intubation (in-too-BAY-shun). The breathing tube is then few seconds to push the blockage aside and restore blood
RISK FACTORS hooked up to the ventilator. The ventilator is programmed flow to the lung; it may be considered if pulmonary
• Breathed in their own bowel movements before birth to give your baby even and regular breaths. endarterectomy is not suitable, and has been shown to
(meconium aspiration) • High frequency oscillation ventilation: This is a special lower blood pressure in the lung arteries, improve
• Lack of oxygen before or during birth type of ventilator. It can deliver rapid, short bursts of air breathing, and increase the ability to exercise
• Infection in their lungs or blood through a breathing tube. • Atrial septostomy – a small hole is made in the wall
• Abnormal development of the heart or lungs • The types of medicines given are: between the left and right atria of the heart using a cardiac
• Been born to a mother with diabetes mellitus • Blood pressure medicine: to keep the blood pressure at catheter, a thin, flexible tube inserted into the heart’s
• Been born large for gestational age (LGA). the right level chambers or blood vessels; it reduces the pressure in the
SIGNS AND SYMPTOMS • Antibiotics: to treat or prevent infection right side of the heart, so the heart can pump more
At birth, or within the first hours after birth, the baby will have: • Sedatives: to help your baby rest and stay calm. When efficiently and the blood flow to the lungs can be improved
• Fast breathing and a fast heart rate the baby is calm, the machines that give him oxygen can • Transplant – in severe cases, a lung transplant or a heart-
• Grunting or moaning when breathing Retractions – the work better and he may need to use less. lung transplant may be needed; this type of surgery is
skin between and under the ribs pulls in during fast and • Surfactant: to help the lungs work better. Surfactant rarely used because effective medicine is available
hard breathing Cyanosis • allows the lungs to use oxygen and get rid of carbon NURSING DIAGNOSIS
• • dioxide. It is given to the baby through a breathing tube. If • Decreased cardiac output related to arrhythmias
• Low amount of oxygen carried in the blood (oxygen other treatments don’t work, very severe PPHN may be secondary to pulmonary hypertension, as evidenced by
saturation) even after getting oxygen treated with: palpitations, heart rate of above 120 bpm (tachycardia)
• Lower oxygen saturation in the baby’s • Nitric oxide – This is a gas that helps expand the blood • Acute Pain related to increased strain in cardiac muscles
• legs than in the right wrist vessels in the lungs. secondary to pulmonary hypertension, as evidenced by
• Low blood pressure • Extracorporeal membrane oxygenation (ECMO) – Your pain score of 10 out of 10, heart rate of above 120 bpm,
DIAGNOSTIC LABORATORIES baby’s blood is pumped through a machine that acts as a respiratory rate of higher than 60 cpm, and restlessness
The following tests may be done to diagnose PPHN: lung. It puts oxygen right into the blood. It also takes out • Ineffective Breathing Pattern related to pulmonary
• Echocardiogram (echo): This painless test uses sound carbon dioxide before pumping the blood back into the hypertension secondary to chronic obstructive pulmonary
waves to take a picture of the heart and blood vessels. It baby. If your baby needs ECMO, their health care disorder (COPD) as evidenced by nasal flaring, pursed lip
will show how the blood flows through the body. provider will explain it to you. breathing, and use of accessory muscles.
• X-rays: A camera takes a picture of the lungs and can also DRUGS OF CHOICE NURSING INTERVENTIONS
see if the heart is too large. • Blood pressure medicine: to keep the blood pressure at • Assess the patient’s vital signs and characteristics of
• Blood tests: These tests will show changes in the number the right level heartbeat at least every 4 hours.
of blood cells and the level of other things like salt, sugar, • Antibiotics: to treat or prevent infection • Assess heart sounds via auscultation.
 • Observe for signs of decreasing peripheral tissue • Environmental factors. A greater risk of rheumatic fever is antibodies are particularly useful in patients who present
perfusion such as slow capillary refill, facial pallor, associated with overcrowding, poor sanitation and other with chorea as the only diagnostic criterion.
cyanosis, and cool, clammy skin. conditions that can cause strep bacteria to easily spread • Acute-phase reactants. C-reactive protein and
• Administer prescribed medications for pulmonary among many people. erythrocyte sedimentation rate are elevated in individuals
hypertension. SIGNS AND SYMPTOMS with rheumatic fever due to the inflammatory nature of the
• Assess the patient’s vital signs and characteristics of pain Rheumatic fever signs and symptoms can include: disease; both tests have high sensitivity but low specificity
at least 30 minutes after administration of medication. • Carditis for rheumatic fever.
• Administer supplemental oxygen, as prescribed. • Polyarthritis • Heart reactive antibodies. Tropomyosin is elevated in
• Discontinue if SpO2 level is within the target range, or as • Chorea persons with acute rheumatic fever.
ordered by the physician. • Subcutaneous nodules • Rapid detection test for D8/17. This immunofluorescence
• Erythema marginatum technique for identifying the B-cell marker D8/17 is
RHEUMATIC FEVER ETIOLOGY • Fever positive in 90% of patients with rheumatic fever and may
Rheumatic fever is an autoimmune disease that occurs as a • Painful and tender joints — most often in the knees, be useful for identifying patients who are at risk of
reaction to a group A β-hemolytic streptococcal infection, ankles, elbows and wrists developing rheumatic fever.
specifically, a pharyngitis. Inflammation from the immune • Pain in one joint that migrates to another joint • Chest radiography. Cardiomegaly, pulmonary
response leads to inflammatory lesions being found in the heart, • Red, hot or swollen joints congestion, and other findings consistent with heart
blood vessels, brain, and joints. • Chest pain failure may be observed on chest radiograph in
• GABHS infection. Rheumatic fever only develops in • Fatigue individuals with rheumatic fever.
children and adolescents following group A beta- • Flat or slightly raised, painless rash with a ragged edge • Echocardiography. In individuals with acute RHD,
hemolytic streptococcal (GABHS) pharyngitis, and only • Heart murmur echocardiography identified and quantitated valve
infections of the pharynx initiate or reactivate rheumatic • Jerky, uncontrollable body movements (Sydenham insufficiency and ventricular dysfunction.
fever. chorea) — most often in the hands, feet and face MEDICAL MANAGEMENT
• Molecular mimicry. So-called molecular mimicry between • Outbursts of unusual behavior, such as crying or • Anti-inflammatory. Treatment of the acute inflammatory
streptococcal and human proteins is felt to involve both inappropriate laughing, that accompanies Sydenham manifestations of acute rheumatic fever consists of
the B and T cells of peripheral blood, with infiltration of the chorea salicylates and steroids; aspirin in anti-inflammatory
heart by T cells; some believe that an increased • Small, painless bumps beneath the skin doses effectively reduces all manifestations of the
production of inflammatory cytokines is the final • Polyarthralgia disease except chorea, and the response typically is
mechanism of the autoimmune reaction that causes • Prolonged PR interval dramatic.
damage to cardiac tissue in RHD. • Increased ESR • Corticosteroids. If moderate to severe carditis is present
• Streptococcal antigens. Streptococcal antigens, which DIAGNOSTIC LABORATORY as indicated by cardiomegaly, third-degree heart block, or
are structurally similar to those in the heart, include • Throat culture. Throat cultures for GABHS infections CHF, add PO prednisone to salicylate therapy.
hyaluronate in the bacterial capsule, cell wall usually are negative by the time symptoms of rheumatic • Anticonvulsant medications. For severe involuntary
polysaccharides (similar to glycoproteins in heart valves), fever or rheumatic heart disease (RHD) appear; make movements caused by Sydenham chorea, your doctor
and membrane antigens that share epitopes with the attempts to isolate the organism prior to the initiation of might prescribe an anticonvulsant, such as valproic acid
sarcolemma and smooth muscle. antibiotic therapy to help confirm a diagnosis of (Depakene) or carbamazepine (Carbatrol, Tegretol,
• Decrease in regulatory T-cells. Decreased levels of streptococcal pharyngitis and to allow typing of the others).
regulatory T-cells have also been associated with organism if it is isolated successfully. • Antibiotics. Your child’s doctor will prescribe penicillin or
rheumatic heart disease and with increased severity. • Rapid antigen detection test. This test allows rapid another antibiotic to eliminate remaining strep bacteria.
RISK FACTOR detection of group A streptococci (GAS) antigen, allowing • Surgical care. When heart failure persists or worsens after
• Things that may increase the risk of rheumatic fever the diagnosis of streptococcal pharyngitis to be made and aggressive medical therapy for acute RHD, surgery to
include: antibiotic therapy to be initiated while the patient is still in decrease valve insufficiency may be lifesaving;
• Genes. Some people have one or more genes that might the physician’s office. approximately 40% of patients with acute rheumatic fever
make them more likely to develop rheumatic fever. • Antistreptococcal antibodies. Clinical features of subsequently develop mitral stenosis as adults.
• Specific type of strep bacteria. Certain strains of strep rheumatic fever begin when antistreptococcal antibody • Diet. Advise nutritious diet without restrictions except in
bacteria are more likely to contribute to rheumatic fever levels are at their peak; thus, these tests are useful for patients with CHF, who should follow a fluid-restricted and
than are other strains. confirming previous GAS infection; antistreptococcal sodium-restricted diet; potassium supplementation may
 be necessary because of the mineralocorticoid effect of • Examine affected joints, degree of joint pain, and level of child to thrombus formation and a high risk of myocardial
corticosteroid and the diuretics if used. joint movement. infarction.
• Activity. Initially, place patients on bed rest, followed by a • Elevate involved extremities above heart level. ETIOLOGY
period of indoor activity before they are permitted to return • Maintain bed rest during the acute stage of the disease. • It has an unknown etiology.
to school; do not allow full activity until the APRs have • Advise positional changes every 2 hours while • There is also a strong suggestion of an
returned to normal; patients with chorea may require a maintaining body alignment. • Does seem to be a genetic predisposition infectious
wheelchair and should be on homebound instruction until • Apply bed cradle under outside covers over painful joints. precursor. to the syndrome.
the abnormal movements resolve • Encourage the use of nonpharmacologic interventions RISK FACTORS
DRUGS OF CHOICE such as imagery, relaxation, distraction, cutaneous • Age: Mostly affects children younger than 5.
• Antibiotics. The roles for antibiotics are to (1) initially treat stimulation, and heat application. • Sex: Boys are slightly more likely than girls to develop the
GABHS pharyngitis, (2) prevent recurrent streptococcal • Provide toys, and games for quiet, sedentary play. disease.
pharyngitis, rheumatic fever (RF), and rheumatic heart • Stress the importance of limited activity or the amount of • Ethnicity: More common in people of Asian or Pacific
disease (RHD), and (3) provide prophylaxis against joint movement allowed. Island descent.
bacterial endocarditis. • Teach parents and children about the need for analgesia SIGNS AND SYMPTOMS
• Anti-inflammatory agents. Manifestations of acute and that it will help him/her to feel better. Kawasaki disease has no imaging or laboratory test that can
rheumatic fever (including carditis) typically respond • Educate parents in proper body positioning and handling diagnose it. However, there are clinical criteria to help with the
rapidly to therapy with anti-inflammatory agents; aspirin, of affected parts. diagnosis of kawasaki disease. • Prolonged fever (>100.4°F
in antiinflammatory doses, is DOC; prednisone is added • Administer salicylates and anti-inflammatory medications [39°C]) of 5 or more days
when evidence of worsening carditis and heart failure is as prescribed, and advise the child that the medication will • Four or more of the following symptoms:
noted. decrease the pain; administer a sustained action • Changes in hands and feet (erythema, edema, peeling)
• Therapy for congestive heart failure. Heart failure in RHD analgesic before bedtime or 1 hour before anticipated • Polymorphous exanthema (diffuse maculopapular rash of
probably is related in part to the severe insufficiency of the movement. the trunk and extremities)
mitral and aortic valves and in part to pancarditis; therapy • Teach the children and family members good proper hand • Bilateral conjunctivitis without exudates
traditionally has consisted of an inotropic agent (digitalis) hygiene. • Changes in lips and mouth (erythema, strawberry tongue,
in combination with diuretics • Ensure that the child’s room and equipment are clean and dry, cracked lips)
• (furosemide, spironolactone) and afterload reduction disinfected to prevent the spread of infection. • Cervical lymphadenopathy (>1.5 cm diameter, usually
(captopril) • Encourage the children to follow a diet rich in fruits, unilateral)
SURGICAL MANAGEMENT vegetables, whole grains, and lean proteins.
• If the heart valves are damaged as a result of rheumatic fever, • Notify the physician immediately of any upper respiratory 3 Phases of Kawasaki Disease:
eventually you or your child may need heart valve repair or heart infections, elevated temperature, joint pain, or non- Acute Phase (Week 1 and 2)
valve replacement compliance to antibiotic therapy. Children are very irritable and uncomfortable from the fever and
NURSING DIAGNOSIS • Encourage and teach the child active range-of-motion inflammatory process that causes joint pain.
• Acute pain related to inflammation exercises. Subacute Phase (Week 3 and 4)
• Risk for infection related to Chronic recurrence of disease • Instruct the child to resume activity gradually once The fever, rash, and lymph node swelling go away, but other
• Activity Intolerance related to Joint pain and swelling asymptomatic at rest and indicators of acute inflammation symptoms may remain. Some symptoms associated are
NURSING INTERVENTIONS have resolved irritability, poor appetite, some eye redness, and peeling skin in
• Assess the child’s pain perception using an appropriate • Encourage the child to increase fluid intake as indicated the hands and feet.
scale every 2 to 3 hours. and allow a dietary intake of low sodium and low sugar Convalescent Phase (Week 6 and 8)
• Assess the child’s mobility and physical activity level. diet. All symptoms are gone, but a blood test show there is still
• Monitor pulse rate, and blood pressure; observe for abnormal inflammation in the body. Ends when lab values returns
dyspnea, use of accessory muscles, and skin color before KAWASAKI DISEASE to normal Changes in laboratory data may help support diagnosis
and after activity. Kawasaki disease (mucocutaneous lymph node syndrome) is or rule out other diseases The changes mandate a thorough
• Assess changes in behavior, such as high-pitched crying, defined as an acute febrile syndrome associated with generalized investigation into possible causes for the child’s symptoms (e.g.,
irritability, restlessness, refusal to move, facial grimace, vasculitis affecting all blood vessels throughout the body, viral infection, scarlet fever, juvenile rheumatoid arthritis, etc.) If
and aggressive or dependent behavior. including the coronary arteries.The vasculitis can lead to the no definitive cause is determined and the child’s symptoms fit the
formation of coronary artery aneurysms which will predispose the criteria listed above, the child is given the
 diagnosis of Kawasaki disease. NURSING MANAGEMENT INFECTIOUS ENDOCARDITIS
• Thrombocytosis • Promoting comfort and rest of the child, and preventing Infective endocarditis is inflammation and infection of the
• Leukocytosis dehydration Skin: endocardium or valves of the heart. Bacteria travel through your
• Mild anemia • Provide tepid sponge bath for fever. bloodstream and attach to damaged tissue in your endocardium,
• Elevated liver enzymes • Remove wet and wrinkled bed linens. forming colonies (vegetations). These colonies release toxins and
• Elevated erythrocyte sedimentation rate • Instruct intake of adequate fluid intake. enzymes that destroy healthy cells and prevent healing.
(ESR) and C-reactive protein (CRP) • Instruct intake of protein-rich foods such as eggs, beans, It is noted in children with and without heart disease. The
DIAGNOSTIC LABORATORY and chicken. incidence of infective endocarditis in children is rare but may be
• Electrocardiogram (ECG or EKG): Electrodes are Eyes: increasing due to the increased survival of children with congenital
attached to the skin to measure the electrical impulses of • Darken room; Provide cool cloth to cover eyes or instruct heart disease.
the heartbeat. Kawasaki disease can cause heart rhythm to let child wear sunglasses. ETIOLOGY
problems. • Instruct child to avoid rubbing eyes. The infection is generally caused by Streptococcus viridans and
• Echocardiogram (cardiac ultrasound): Uses ultrasound • Provide artificial tear drops as required by physician. Lips Staphylococcus aureus, although fungal organisms have also
images to show how well the heart is working and can and Mouth: been noted.
help identify problems with the coronary arteries. • Provide soft food, nonirritating foods such as gelatin. RISK FACTORS
• Blood tests: CBC, ESR, CRP, GGT • Provide mouth care every 1-4 hours with special mouth Risk factors include the presence of a prosthetic heart valve,
MEDICAL MANAGEMENT swabs; soft tooth brush only when healing occurred. structural or congenital heart disease, intravenous drug use, and
Treatment for Kawasaki disease is focused on addressing the • Apply petroleum to dry and cracked lips. a recent history of invasive procedures.
immediate symptoms and preventing any long-term • Dehydration: • Congenital heart defects • Damaged heart valves
consequences. • Monitor urinary output. • Long-term catheter use • Artificial heart valves
• Children are treated with 2 g/kg of intravenous immune • Monitor intravenous infusion hourly. • Poor dental health • Implanted heart device
globulin (IVIG). This dose may be repeated if the fever • Asses skin turgor to aid in assessment of hydration status. SIGNS AND SYMPTOMS
does not break. • Instruct patient to maintain adequate intake of water. 2 Presentation of Infective Endocarditis:
• High-dose aspirin at 80 to 100 mg/kg divided four times a • Carrying out continual cardiac monitoring and Acute Presentation
day is also continued for 48 to 72 hours after the fever assessment for complications • Systemic response to infection
breaks. The aspirin is then continued at a low dose of 3 to • Take vital signs every 2 hours. • Children have high-spiking fevers
5 mg/kg/day once a day for 6 to 8 weeks with no evidence • Ensure proper functioning of cardiac monitor, observe for • Severely ill and toxic in appearance.
of coronary artery abnormalities. If abnormalities occur, and report signs of arrhythmias, myocarditis and • Symptoms of congestive heart failure (CHF) may be
aspirin may be continued indefinitely. congestive heart failure. present.
DRUG OF CHOICE • Monitor child for signs of aspirin toxicity when high-dose • Murmurs are frequently noted due to destruction of the
• Gamma globulin: Infusion of an immune protein (gamma aspirin is prescribed cardiac valve tissue.
globulin) through a vein (intravenously) can lower the risk • Provide for emotional support and diversional activities Subacute Presentation
of coronary artery problems. This helps to reduce appropriate for age • Persistent low-grade fever • Fatigue
inflammation in the vessels. • Explain procedure to the child. • Malaise • Rigors
• Aspirin: High doses of aspirin might help treat • Provide soft toys and quiet play. • Weight loss, • Diaphoresis
inflammation. Aspirin can also decrease pain, joint • Provide play therapy. • Arthralgias
inflammation and fever. The aspirin dose will likely be • Allow the child to have periods of uninterrupted rest. Diagnostic Testing
lowered once the fever has been gone for 48 hours. • Provide emotional support for the parents who are • Positive blood cultures are necessary for a diagnosis of
NURSING DIAGNOSIS distressed and concerned about their child’ infective endocarditis.
• Hyperthermia related to inflammatory disease process as • Involve the parents in comforting the child and care of • Echocardiogram is extremely helpful in allowing for
evidenced by fever as high as 39°C that last for more than child. visualization of the vegetations as well as the damage to
5 days • Provide health education. the heart itself such as valve destruction and perforation,
• Impaired skin integrity related to peripheral erythema as • Encourage parents to verbalize their concerns, fears, and rupture of chordae, and development of valvar leaks.
evidenced by erythematous generalized rash questions. • Other laboratory studies will reveal
• Impaired oral mucous membrane related to dehydration proteinuria or hematuria, a
as evidenced by dry mouth
 normochromic, leukocytosis, and an increased • Administer the prescribed antibiotic and anti-pyretic
elevated erythrocyte sedimentation rate (ESR). medications.
MEDICAL MANAGEMENT • Provide tepid sponge bath.
Treatment is aimed at the underlying bacterial infection but an • Elevate the head of the bed.
extended course of antibiotics is necessary as the organisms are • Assess the patient’s breathing pattern, respiratory rate,
imbedded in a fibrin platelet matrix in high concentrations. auxiliary muscle use, indications of air hunger, lung
• Once sensitivity is determined, treatment is typically for 4 excursion, cyanosis, and any notable changes in the
to 6 weeks of IV therapy. This will necessitate the patient’s vital signs.
insertion of a PICC in children so they may go home and • Auscultate the patient’s lung fields to check the presence
receive home nursing services to administer their of crackles with the use of a stethoscope.
antibiotic therapy. • Determine and monitor the patient’s oxygen saturation,
• Lesions will heal, but children may be left with long-term WBC count, and ABG levels as indicated and report any
sequelae such as renal dysfunction from thrombi or leaky deviation from the normal values.
cardiac valves from primary damage. • Assess the patient skin color, and observe the color of the
• All children diagnosed with endocarditis must receive mucous membranes, and nail beds to see if there is
prophylactic antibiotics prior to some invasive procedures peripheral cyanosis.
including dental work. • Instruct patient to have proper rest periods and to get a
DRUG OF CHOICE night of adequate sleep.
• Antibiotics: Antibiotics are usually given through the vein • Administer supplemental oxygen, as prescribed.
(intravenous or IV) for several weeks. Discontinue if SpO2 level is above the target range, or as
SURGICAL MANAGEMENT ordered by the physician.
• Infective endocarditis surgery: If the heart valves are • Have airway emergency equipment at the ready at all
damaged or developed severe heart infection, the child times.
may need surgery to clear away bacteria, and have heart • Educate the parents to understand the symptoms and
valve repair or heart valve replacement. Repair or indications of endocarditis.
replacement procedure depends on the type and severity • Assess characteristics of heart beat at least every 4
of heart valve damage. hours. Assess heart sounds via auscultation. Observe for
NURSING DIAGNOSIS signs of decreasing peripheral tissue perfusion such as
• Hyperthermia secondary to infective process of slow capillary refill, facial pallor, cyanosis, and cool,
endocarditis as evidenced by temperature of 38.7 clammy skin.
degrees Celsius, rapid breathing, profuse sweating, and • Educate patient and parents on stress management,
chills deep breathing exercises, and relaxation techniques.
• Decreased cardiac output secondary to valvular
dysfunction from infective process as evidenced by
fatigue and inability to do ADLs as normal
• Impaired gas exchange related to alveolar inflammation
due to increased ventricular pressure secondary to
endocarditis, as evidenced by productive cough, crackles
heard on auscultation, shortness of breath, pallor noted
on the conjunctiva, nailbeds, and buccal mucosa and
fatigue.
NURSING MANAGEMENT
• Monitor patient’s vital signs.
• Remove excessive clothing, blankets and linens. Adjust
the room temperature.