Alawiya, Jamal Tango P.

NCM 102 TUV

1.) Identify the (a)predisposing factors, (b)precipitating factors, (c)etiology, (d)clinical manifestation and nursing management of the following health problems of pediatric patients:

Otitis Media
Predisposing Factors
y y

y y

Age under 5 Any condition that causes a weakening of the immune system such as: o Diabetes o Organ transplant o Chemotherapy: the administration of medicines that kill cancer cells. o AIDS Poorly developed cartilage lining, which makes Eustachian tubes more likely to open prematurely Enlarged lymphoid tissue, which obstruct Eustachian tube openings

Precipitating Factors
y y y y y y y y

Allergic rhinitis Chronic sinusitis Enlarged tonsils and adenoids Exposure to high altitude Exposure to smoke Pacifier use after six months of age Food allergies Ruptured eardrum or other ear injury

Etiology
y

Bacterial Pathogen: Streptococcus pnuemoniae, haemophilis influenza and streptococcus aureus.

Clinical Manifestation Acute Otitis Media

Upper Respiratory Infection Otalgia (earache) Fever Purulent discharge may or may not be present. Infant or very young child

y y y y y y

Crying Fussy, restless, irritable Tendency to rub, hold or pull affected ear Rolls head side to side Difficulty comforting child Loss of appetite Older Child

y y y y

Crying and or verbalizes feelings of discomfort Irritability Lethargy Loss of appetite Chronic Otitis Media

y y y

Hearing loss Difficulty communicating Feeling of fullness, tinnitus, vertigo may be present

Nursing Management
y y y y y

Prevent child in exposing in secondhand smoke. Dont use pacifier to the infant age 6 months above. Prevent skin breakdown by keeping external ear clean and dry. Always hold the infant in an upright, seated position during bottle feeding. Breastfeeding for at least 6 months can make a child less prone to ear infections.

Laryngotracheobronchitis

Predisposing Factors
y y y y

Age: 6 months to 4 years Abnormality of the upper airway Family history of croup Prematurity

Precipitating Factors
y y y

Upper respiratory infections Prematurity Asthma, specifically for spasmodic croup

Etiology
y

Viral infection; 75% of all cases are the result of infection with parainfluenza virus, most commonly type I. Other causes include respiratory syncytial virus (RSV), metapneumovirus, influenzaA and B, adenovirus, and mycoplasma.

Clinical Manifestation
y y y y y y y y y y

Mild cold with low grade fever and a runny nose Fatigue Loss of appetite Acute LTB: gradual onset from upper respiratory infection, processing to signs of distress Have low-grade fever Restlessness and irritability Inspiratory stridor Harsh or brassy cough Hoarseness Wheezing, rales, rhonchi and localized areas of diminished breath sounds

Nursing Management
y y y y y y

Assess for airway obstruction by evaluating respiratory status: color, respiratory effort, evidence of fatigue, and vital signs. Reduce the childs anxiety by maintain a quit environment, promoting rest and relaxation, and minimizing intrusive procedures. Encourage parent and child interaction and diversion. Provide parental support to reduce anxiety. Provide Health teaching to the mother such as define symptoms to watch for. Assess for airway obstruction by evaluating respiratory status.

Keep emergency equipment near the bedside.

Pertussis (Whooping Cough)

Precipitating Factors

y y y y y y

Exposure to person with pertussis, through direct contact, air and objects. Otitis Media Hernia Pneumonia Prolapsed Rectum Ulcerative tongue

Etiology y Whooping cough is caused by bacteria called Bordetella pertussis (also called B. pertussis). Several types of Bordetella bacteria have been identified. Some types cause illness in humans (e.g., B. pertussis, B. parapertussis) and others affect animals (e.g., B. bronchiseptica causes kennel cough in dogs and respiratory infections and pneumonia in cats and pigs).

Clinical Manifestation First Stage (Catarhal Stage) y y y y Runny nose Sneezing Low-grade fever Mild, occasional cough

Second Stage (Paroxysmal Stage) y y There are bursts (paroxysms) of coughing, or numerous rapid coughs, apparently due to difficulty expelling thick mucus from the airways in the lungs. At the end of the bursts of rapid coughs, a long inspiratory effort (breathing in) is usually accompanied by a characteristic high-pitched "whoop" sound

y y y y y y y

During an attack, the individual may become cyanotic (turn blue) from lack of oxygen. Children and young infants appear especially ill and distressed. Vomiting (referred to by doctors as post-tussive vomiting) and exhaustion commonly follows the episodes of coughing. The person usually appears normal between episodes. Paroxysmal attacks occur more frequently at night, with an average of 15-24 attacks per 24 hours. The paroxysmal stage usually lasts from one to six weeks but may persist for up to 10 weeks. Infants under 6 months of age may not have the strength to have a whoop, but they do have paroxysms of coughing. Third Stage

The cough becomes less paroxysmal and usually disappears over two to three weeks.

Nursing Management y y y y y y y y Encourage parents to increase fluid intake of the infant to help expectoration of secretion. Provide restful environment and reduce factors that promote paroxysm (dust, smoking) Increase humidity Observe for signs of air way obstruction Small amount of sedatives may be necessary to quiet the child Protect the child from secondary infection Isolation Bed Rest

Pneumonia
Predisposing Factors

y y

Age is a non-modifiable factor in which the clients immunity against possible diseases is not that developed in comparison to adults. Sex is a non-modifiable factor in which the occurrence of the said disease in prevalent in males more it is in females.

Precipitating Factors y Poor Diet is a modifiable factor in which this is crucial in the strengthening of the immune system of the client. Without the sufficient intake of vitamins and minerals that are present in the diet, the defense mechanism of the body is weakened; making it susceptible to infection and invasion of possible microorganisms that are present in the environment. This can be attributed to the possibility that these microorganisms are dwelling in the environment itself. Place of residence is underdeveloped is another modifiable factor since crowdedness of the people living in a particular geographical area would facilitate direct contact mode of transmission of possible microorganisms or through droplet infection, as well. This will make the client susceptible for acquiring a disease from someone proximal to him; therefore, a disease may or may not develop depending on the distance of the client from an infected person and the virulence of the disease.

Etiology y y y Bacterial pneumonia: Streptococcus pneumonia Viral pneumonia: Rhinoviruses, coronavirusis Fungal pneumonia: Histoplasma, capsulatum

Clinical Manifestation y y y y y Fever Shaking chills Productive cough Sputum production Pleuritic chest pain due to the friction between the pleural layer

Nursing Management y y y y y y y Monitor v/s Auscultate both lung to determine adventitious lung sound Turn the patient towards affected side Maintain patient airway Provide adequate rest Provide comfort measures Obtain sputum specimens as needed

Gastroesophagela Refulx
Predisposing Factors

GER is the most common esophageal problem in infancy. Some reflux occurs normally in infants, children, and adults. GER is deemed pathologic when it is severe, persists into late infancy, or is associated with complications. Approximately 1 of 3oo to 1000 children has a significant problem with GER.

Precipitating Factors y Eating Pattern. People who eat a heavy meal and then lie on their back or bend over from the waist are at risk for an attack of heartburn. Anyone who snacks at bedtime is also at high risk for heartburn Obesity. A number of studies suggest that obesity contributes to GERD, and it may increase the risk for erosive esophagitis (severe inflammation in the esophagus) in GERD patients. Having a large amount of fat in the abdomen may be the most important risk factor for the development of acid reflux and associated complications such as Barrett's esophagus and cancer of the esophagus, studies indicate. Researchers have also reported that increased BMI is associated with more severe GERD symptoms. Losing weight appears to help reduce GERD symptoms. However, gastric banding surgery to combat obesity may actually increase the risk for, or worsen symptoms of GERD.

Etiology y The cause is unknown, but GER may result from delayed maturation of lower esophageal neuromuscular function or impaired local hormonal, control mechanisms.

Clinical Management y y y y y y y Forceful vomiting, possibly with hematemesis Weight loss Aspiration and recurrent respiratory infections Cyanotic and apneic episodes that may be life-threatening Esophagitis and bleeding from repeated irritation of the esophageal lining with gastric acid. Melelna Heartburn, abdominal pain, and bitter taste in the mouth.

Nursing Management Improve nutritional status through feeding techniques such as formula thickened with cereal, enlarging nipple holes, and burping infant frequently.

y y y y

Ensure adequate hydration by assessing for signs and symptoms of dehydration, monitoring I & O, and administering intravenous ( IV ) fluids as prescribed. Assess the amount, frequency, and characteristics of emesis. Assess the relationship between feeding and vomiting and the infants activity level. Help prevent reflux and respiratory complications by positioning the infant upright, as prescribed, through feedings, and afterwards, in infant seat. Assist in diagnostic procedures as well as surgical procedures prescribed.

Acute Appendicitis
Predisposing Factors y Weak Factor <6 months of breastfeeding

Precipitating Factors y y y low dietary fiber personal hygiene smoking

Etiology y Acute appendicitis is due to obstruction of the blind ending appendix, resulting in a closed loop. In children, obstruction usually results from lymphoid hyperplasia of the submucosal follicles. The cause of this hyperplasia is controversial, but dehydration and viral infection have been proposed. Another common cause of obstruction of the appendix is a fecalith. Rare causes include foreign bodies, parasitic infections (eg, nematodes), and inflammatory strictures.

Clinical Manifestation y Sudden onset of chills with rising fever, stabbing chest pain, paroxysmal or choking cough, sputum is rusty or prune juice in color, pain on the abdomen, herpes may appear on the lips, body malaise, respiratory grunting with marked tachypnea and flaring of the nares, labored respiration, pulse is rapid and bounding, diaphoresis, convulsion and vomiting in children.

Nursing Management

y y y y y y y y

y y

Monitor frequently for signs and symptoms of worsening condition, indicating perforation, abscess, or peritonitis (increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia). Notify health care provider immediately if pain suddenly ceases, this indicates perforation, which is a medical emergency. Assist patient to position of comfort such as semi-fowlers with knees are flexed. Restrict activity that may aggravate pain, such as coughing and ambulation. Apply ice bag to abdomen for comfort. Avoid indiscriminate palpation of the abdomen to avoid increasing the patients discomfort. Promptly prepare patient for surgery once diagnosis is established. Explain signs and symptoms of postoperative complications to report-elevated temperature, nausea and vomiting, or abdominal distention; these may indicate infection. Instruct patient on turning, coughing, or deep breathing, use of incentive spirometer, and ambulation. Discuss purpose and continued importance of these maneuvers during recovery period. Teach incisional care and avoidance of heavy lifting or driving until advised by the surgeon. Advice avoidance of enemas or harsh laxatives; increased fluids and stool softeners may be used for postoperative constipation.

Cleft Lip and Palate

Family history. Parents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft. Sex. Males are twice as likely to have a cleft lip with or without cleft palate. Cleft palate without cleft lip is more common in females.

Precipitating Factors
y y

Environmental factors. Exposure in early pregnancy to cigarette smoke, alcohol or illicit drugs may put a baby at higher risk of developing a cleft. Maternal obesity. Obesity in the mother is associated with a slightly increased risk of cleft lip and palate

Etiology y Causes include genetic, environmental, and teratogenic factors.

Children may have associated dental malformations, speech problems, and frequent otitis media, the latter resulting from improper functioning of the Eustachian tubes.

Clinical Manifestation y y CL and CP are readily apparent at birth. Careful physical assessment should be performed to rule out other midline birth defects. CL and CP appear as incomplete or complete defects and maybe unilateral or bilateral.

Nursing Management y y y y y y y y Support the infants and parents emotional and social adjustment Assess for problems with feeding, breathing parental bonding, and speech. Ensure adequate nutrition and prevent aspiration. Support the infants and parents emotional and social adjustment. Provide mouth care to prevent infections. Assess airway patency and vital signs. Note for edema. Show proper feeding techniques and positions. Attempt to keep child from putting tongue up to palate sutures.

Dehydration
Predisposing Factors
y

Age: Younger than 2 years old 65 and older Dehydration may result from the anumber of diseases that cause insensible losses through the skin and respiratory tract, through increased renal secretion, and through the GI tract.
o o

Precipitating Factors
y y y y

Neurological conditions, such Stroke or Cerebral Palsy Memory problems or Dementia Chronic medical conditions Athletic competition

Etiology y Dehydration is most often caused by a viral infection that causes fever, diarrhea, vomiting, and a decreased ability to drink or eat. Common viral infections causing

vomiting and diarrhea include rotavirus,Norwalk virus, and adenovirus. Sometimes sores in a child's mouth(caused by a virus) make it painful to eat or drink, which helps to cause or worsen dehydration.More serious bacterial infections may make a child less likely to eat and may cause vomiting and diarrhea. Common bacterial infections include Salmonella, Escherichia coli, Campylobacter, and Clostridium difficile.Parasitic infections such as Giardia lamblia cause the condition known asgiardiasis , which can lead to diarrhea and fluid loss. Increased sweating from a very hot environment can cause dehydration. Excessive urination caused by unrecognized or poorly treated diabetesmellitus (not taking insulin) or diabetesinsipidus are other causes.Conditions such as cystic fibrosis or celiac sprue do not allow food to be absorbed and can cause dehydration. Clinical Manifestation Minimal Dehydration y y y y y y y y Normal thirst or may refuse some liquids A moist mouth and tongue Normal to slightly decreased urine output Less than 3% weight loss Normal heart rate, pulses, breathing, and warm extremities Capillary refill less than 2 sec. Instant recoil on skin turgor test Eyes not sunken Mild Dehydration y y y y y y y Increased thirst A dry mouth and tongue Decrease urine output 3 to 9% weight loss Normal heart rate, pulses, breathing, and cool extremities Capillary refill less than 2 sec. Slightly sunken eyes Severe Dehydration y y y y y y Poor drinking or may be unable to drink A parched mouth and tongue Minimal or no urine output Greater than 9% weight loss Increased HR, weak pulse, deep breathing, and cool, mottled extremities Capillary refill that is very prolonged/minimal

y y

Recoil on skin turgor in more than 2 seconds Deeply sunken eyes

Nursing Management y y y y y y y Monitor v/s Encourage parents to increase fluid intake and electrolytes intake to promote hydration. Maintain IV lines and fluids. Obtain an accurate initial weight and monitor weight changes indicating fluid gains and losses. Offer oral fluids in small quantities. Monitor IV replacement therapy and check the IV site frequently. Teach parent about positioning, moving and caring for a child with an IV line.

Kawasaki Disease
Predisposing Factors y y y Age. Children under 5 years old are most at risk of Kawasaki disease. Sex. Boys are slightly more likely than girls are to develop Kawasaki disease. Ethnicity. Children of Asian descent, such as Japanese or Korean, have higher rates of Kawasaki disease.

Precipitating Factors y y y Myocarditis Heart valve problems Abnormal heart rhythm

Etiology
y

No one knows what causes Kawasaki disease, but scientists don't believe the disease is contagious from person to person. A number of theories link the disease to bacteria, viruses or other environmental factors, but none has been proved. Certain genes may increase your child's susceptibility to Kawasaki disease.

Clinical Manifestation

y y y y y y y y y y

Extremely bloodshot or red eyes (without pus or drainage) Bright red, chapped, or cracked lips Red mucous membranes in the mouth Strawberry tongue, white coating on the tongue, or prominent red bumps on the back of the tongue Red palms of the hands and the soles of the feet Swollen hands and feet Skin rashes on the middle of the body, NOT blister-like Peeling skin in the genital area, hands, and feet (especially around the nails, palms, and soles) Swollen lymph nodes (frequently only one lymph node is swollen), particularly in the neck area Joint pain and swelling, frequently on both sides of the body

Nursing Management y y y y y y y y Monitor pain level and childs response to analgesics. Institute continual cardiac monitoring and assessment for complications; report arrhythmias. Take vital signs as directed by condition; report abnormalities. Assess for signs of myocarditis (tachycardia, gallop rhythm, chest pain). Closely monitor intake and output, and administer oral and I.V fluids as ordered. Monitor hydration status by checking skin turgor, weight, urinary output, specific gravity, and presence of tears. Observe mouth and skin frequently for signs of infection Keep the family informed about progress and reinforce stages and prognosis.

Cardiac Dysrhythmia
Predisposing Factors y y Cardiac dysrhythmia occur less frequently in children than in adults. Congenital

Precipitating Factors y y Acquired, as seen in postoperative patients following surgery in the area of the A-V valves and ventricular system. Tachydysrhythmias: caused by fever, anxiety, pain, anemia, dehydration, or any other factor requiring increased cardiac output.

Etiology

Bradydysrhythmias

This can be either congenital or acquired as seen in postoperative patients following surgery in the area of the A-V valves and ventricular system y Sinus Bradycardia

In children is caused the influence of the autonomic nervous system, as with the hypervagal tone, or in response to hypoxia and hypotension. y Tachydysrhythmias

This is caused by fever, anxiety, pain, anemia, dehydration, or any other factor requiring increased cardiac output. Clinical Manifestation y y y y y y y Dizziness Fainting Chest discomfort Difficulty of breathing Palpitations Fatigue Pounding in your heart

Nursing Management y y y y y Provide adequate oxygen and reduce heart workload. Evaluate the monitored patients ECG regularly for arrhythmia. Monitor for predisposing factors, such as fluid and electrolyte imbalance, and signs of drug toxicity, especially with digoxin. Teach the patient how to take his pulse and recognize an irregular rhythm and instruct him to report alterations from his baseline to the doctor. Emphasize the importance of keeping laboratory and physicians appointments.

Hemophilia
Predisposing Factors
y y y

Family members with hemophilia Family history of bleeding disorders Sex: male

Precipitating Factors
y

Excessive bleeding from the umbilical cord or after circumcision

Etiology
y y

y y

Hemophilia is caused by a faulty gene inherited from one or both parent. It is called an inherited sex-linked recessive gene. The gene is located on the X chromosome. Females carry two copies of the X chromosome. If the faulty gene is only on one X, the normal gene on the second X will take over. As a result, they will not get the disease. Instead they are carriers of the gene. The risk for their male offspring to inherit the gene is 1 in 2 or 50%. The chance that their female offspring will inherit the gene is also 50%. These offspring will be carriers like their mothers. It is possible for a female to have hemophilia. For this to happen she must inherit the faulty gene from both her mother and her father. Males carry only one X chromosome. If they get the faulty gene the disease will develop.

Clinical Manifestation
y y y y y y

Frequent bruising. Frequent nose bleeds or bleeding gums. Pain and swelling in joints or muscles. Prolonged bleeding or oozing of blood from injuries, surgical incisions (cuts), or a pulled tooth site. Stools (bowel movements) that are dark or black. Urine that is pinkish or reddish in color.

Nursing Management
y

y y y y

Assess for acute or chronic bleeding: skin, joints, and muscles are assessment priorities. Check vision, hearing and neurologic development. Also check for hematuria and bleeding from the mouth, lips, gums, and rectum. Prevention is a primary goal. Prevent or minimize bleeding Provide Support Provide the child and family teaching

Anemia
Predisposing Factors y Biologic Factors

y y y

y y

Prominent in age groups experiencing rapid growth: toddlers, adolescents, pregnant and lactating women. In children, it occurs often between the ages 6 months and 3 years; adolescents and premature infants are also at risk. Pregnancy. If you're pregnant, you're at an increased risk of iron deficiency anemia because your iron stores have to serve your increased blood volume as well as be a source of hemoglobin for your growing fetus. Family history. If your family has a history of an inherited anemia, such as sickle cell anemia, you also may be at increased risk of the condition. Other factors. A history of certain infections, blood diseases and autoimmune disorders, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia.

Precipitating Factors
y y

Infants young than 12 months who drink cows milk rather than breast milk or iron fortified formula. Young children who drink a lot of cows milk rather than eating foods that supply the body with more iron.

Etiology
y y y y y

An iron-poor diet Body not being able to absorb iron very well, even though youre eating enough iron. Long-term, slow blood loss usually through menstrual periods or bleeding in the digestive tract. Rapid growth, when more iron is needed. It is caused by inadequate intake of iron-rich foods or inadequate absorption of iron.

Clinical Manifestation
y y y y y y y y y y y y

Blue-tinged or very pale whites of eyes Blood in the stools Brittle nails Decreased appetite Fatigue Headache Irritability Pale skin color Shortness of breath Sore tongue Unusual food cravings Weakness

Nursing Management

y y y y y

Asses for fatigue, activity intolerance, and other signs of impaired tissue oxygenation Asses for fatigue, activity intolerance, and other sings of impaired tissue oxygenation Promote an adequate intake of iron-rich foods (iron fortified formula and cereals, liver, egg yolk, and organ meats Explain the potential adverse effects of iron which includes nausea and vomiting, diarrhea or constipation or black stools and tooth discoloration. Instruct care givers to keep iron supplements out of reach of children since it is toxic when overdosed.

Hydrocephalus
Predisposing Factors
y y

y y y

Neural tube defects Mother has infection during pregnancy, such as: o Cytomegalovirus o Toxoplasmosis o Lymphocytic choriomeningitis virus o Chickenpox o Mumps Brain infections Malformations of the brain Brain injuries

Precipitating Factors
y

Conditions of hydrocephalus can be also affected by the environment. Other conditions of non-communicating hydrocephalus can increase by the infection from the environment.

Etiology
y y y y y

Cysts in the brain Malformation of the brain Brain injuries Blood vessels abnormalities in the brain Bleeding into the brain

Clinical Manifestation
y y y y

Rapid increase of head circumference Vomiting Sleepiness Irritability

y y y y y y

Downward deviation of the eyes also called as sunsetting Seizures Headache Papilledema Poor coordination Diplopia

Nursing Management
y y y y y y y y y y y y

Teach the family about the management required for the disorder Provide preoperative care Provide postoperative nursing care Encourage the child to participate in age-appropriate activities as tolerated. Asses for acute or chronic bleeding: skin, joints, and muscle are assessment priorities. Observe for swelling and tenderness in the joints, and prevent contractures. Monitor for signs of hypovolemia. Avoid analgesics that promote bleeding such as aspirin. Administer medication as prescribed. Assist the child and parents to recognize signs of major bleeding. Demonstrate passive range-of-motion exercises. Provide diet information because weight increases can impose further stress on joints.