HIGH RISK NEWBORN

Monday, 24 January 2022 4:45 pm

PROBLEMS RELATED TO MATURITY

PRETERM NEWBORN
• Description: A neonate born before 37 weeks of gestation
• Primary concern relates to immaturity of all body systems
• Cause: unknown
• Maternal factors: age, smoking, poor nutrition, Placental problem , Preeclampsia/ eclampsia
• Fetal factors: multiple pregnancy, infection
• Other factors: poor socioeconomic status, environmental exposure to harmful substance
• Placenta Abruptio vs placenta previa

Assessment
○ Respirations are irregular with periods of apnea
○ Body temperature is below normal
○ Skin is thin, with visible blood vessels and minimal subcutaneous fat pads, may appear jaundiced
(Poikilothermic- easily take on the temperature of the environment)
○ Poor sucking and swallowing reflexes
○ Bowel sounds are diminished
○ extremities are the, with minimal creasing on soles and palms
○ extension of extremities and does not maintain flexion
○ abundance of lanugo hair
○ labia are narrow in girls
○ testes are undescended in boys
○ sqaure window wrist

Common or special problem of preterm neonates

1. Respiratory Distress Syndrome
 Hyaline membrane disease
□ due to lung immaturity; deficient in surfactant
2. Hyperbilirubinemia
 high level of bilirubin in the blood,
 neonate become jaundice due to immaturity of the liver
 Kernicterus staining of brain cells with bilirubin, causing irreversible brain damage
 treatment: phototherapy
3. Infection - not able to receive IgG globulins
4. Cold stress- less subcutaneous tissue, poikilothermic
5. Anemia – less iron stores

Management
1. Improving respiratory function- Oxygen therapy, Mechanical ventilator
2. Maintaining body temperature- Isolette – maintains ideal temperature, humidity and oxygen concentration
isolates infant from infection, Kangaroo Care
3. Preventing infection- Handwashing
4. Promoting nutrition- Gavage feeding, Milk feeding
5. Promoting Sensory stimulation- Gentle touch, speaking gently and softly, music box or low tuned radio

Nursing Interventions
1. Monitor vital signs every 2 to 4 hours
 Administer oxygen and humidification as prescribed.
Monitor intake and output
Monitor daily weight.
Maintain newborn in a warming device.
Reposition every 1 to 2 hours, and handle newborn carefully
Avoid exposure to infections.
Provide newborn with appropriate stimulation, such as touch
Suctioning of secretions as needed
Monitor for signs of infection
Provide skin care
Provide complete explanations for parents

POST-TERM NEWBORN
• Description:
DIFFERENCES PRETERM FULL TERM
○ Neonate born after 42 weeks of gestation
Posture ○ About 12% “Relaxed attitude”
of all infants limbs more extended
are post-term More flexed attitude
Ear ○ Causes of delayedare
Ear cartilages birth is unknown
poorly developed, may fold easily Well formed cartilages
•
Sole Maternal factors: Only fine wrinkles Well and deeply creased
○ First pregnancies between the ages 15 to 19years
Female genitalia Clitoris is prominent; labia majora poorly developed Clitoris is not as prominent; labia majora fully developed
○ Woman older than 35 years
○ Multiparity
• Fetal factors:
○ Fetal anomalies such as anencephaly

Assessment
○ Depleted subcutaneous fat: old looking “old man facies”
○ Parchment-like skin (dry, wrinkled and cracked) without lanugo
○ Fingernails long and extended over ends of fingers
○ Abundant scalp hair
○ Long and thin body
○ Sign of meconium staining
○ Nails and umbilical cord (yellow to green)

COMPLICATIONS OF POST MATURITY

1. The placenta begins to aged toward the end of pregnancy, and may not function as efficiently as before.
2. The failing placental function will place infant at risk for intrauterine hypoxia during labor and delivery.
3. MECONIUM ASPIRATION SYNDROME
4. HYPOGLYCEMIA - FROM NUTRITIONAL DEPRIVATION AND POOR STORAGE OF GLYCOGEN AT BIRTH
5. POLYCYTHEMIA- increase RBC

Management
1. Ultrasound is done to evaluate fetal development, amount of amniotic fluids and the placenta signs of aging
2. To reduce the chance of meconium aspiration, upon delivery of newborn’s head and just before the baby takes
his first breath suctioning of the mouth and nose is done

Nursing management
1. Closely monitor the newborn cardiopulmonary status
2. Administer supplemental oxygen therapy as needed
3. Frequent monitoring of blood sugar; assess for sign of hypoglycemia
4. Provide thermoregulated environment– use of isolette or radiant heat warmer
5. Monitor for signs of meconium aspiration syndrome
 Male genitalia Scrotum is under developed and not pendulous, with Scrotum is fully developed, pendulous, rugated
minimal rugae
Scarf sign Elbow is easily brought across the chest with little or With resisting attempt when elbow is brought to the
no resistance midline of the chest
Grasp reflex Weak Strong, allowing the infant to be lifted up from
the mattress

PROBLEMS RELATED TO GESTATIONAL WEIGHT

SMALL FOR GESTATIONAL AGE
• (SGA) babies are those whose birth weight lies below the 10th percentile for that gestational age
• SGA babies may be:
○ premature (born before 37 weeks of pregnancy),
○ full term (37 to 41 Weeks), or
○ post term (after 42 weeks of pregnancy)
• Intrauterine growth restriction (IUGR) - is the most common underlying condition leading to SGA newborn
• Some factors that may contribute to SGA are the following:
○ Maternal factors:
 high blood pressure
 chronic kidney disease
 advanced diabetes
 heart or respiratory disease
 malnutrition, anemia
 infection
 substance use (alcohol, drugs)
 cigarette smoking
 Placental anomaly is the most common cause of IUGR
○ Factors related to the fetus
 multiple gestation (twins)
 infection
 chromosomal abnormality

Assessment
○ Respiratory distress - hypoxic episodes
○ Loose and dry skin ,little fat, little muscle mass
○ Wasted Appearance
○ Small liver
○ Head is larger compared to body
○ Wide skull sutures
○ Poor skin turgor
○ Sunken abdomen

Babies with SGA may have problems at birth such as:

○ Respiratory distress (asphyxia)
○ Meconium aspiration
○ Hypoglycemia
○ Difficulty maintaining normal body temperature
○ Polycythemia too many red blood cells

Nursing Interventions
○ Observe for signs of respiratory distress
○ Maintain body temperature
○ Monitor for infection and initiate measures to prevent sepsis
○ Monitor blood glucose levels and for signs of hypoglycemia
○ Initiate early feedings and monitor for signs of aspiration.
○ Provide stimulation, such as touch and cuddling

LARGE FOR GESTATIONAL AGE

Description: Neonate who is plotted at or above the 90th percentile on the intrauterine growth curve
 • Weigh more than 4,000 grams
• Cause – unknown (genetic factors and maternal conditions)
• Maternal diabetes – is the most widely known contributing factor
• Increase insulin acts as a fetal growth hormone
• Macrosomia – an unusually large newborn with birth weight of more than 4500grams

Assessment
• large, obese
• Lethargic and limp
• May feed poorly
• Sign and symptoms of birth trauma
 Bruising
 Broken clavicle
 Evidence of molding
 Cephalhematoma
 Caput succedaneum

Problems of LGA babies

1. Hypoglycemia (low blood sugar) of baby after delivery
2. Respiratory distress
3. Hyperbilirubinemia
4. Potential complications related to increase in body size:
a. Leading cause of breech position and shoulder dystocia
b. Fractured skull, clavicles, cervical or brachial plexus injury and erb’s palsy

Management
Routine newborn care with special emphasis on the following:
1. Monitor vital signs frequently, especially respiratory status.
2. Monitor blood glucose levels and for signs of hypoglycemia
3. Initiate early feedings
4. Note any signs of birth trauma or injury
5. Monitor for infection and initiate measures to prevent sepsis
6. Provide stimulation, such as touch and cuddling.

COMMON ACUTE CONDITIONS OF NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)
Description: Serious lung disorder caused by immaturity and inability to produce surfactant, resulting in hypoxia and acidosis
Surfactant – a biochemical compound that reduces surface tension inside the air sac
decrease in surfactant results to lung collapse, thus greatly reducing infant’s vital supply of oxygen
Damaged lung cells combines with other substance present in the lungs to form fibrous substance called hyaline membrane (Hyaline membr
this membrane lines the alveoli and blocks gas exchange in the alveoli

Assessment
1. Expiratory grunting –major- is the body's way of trying to keep air in the lungs so they will stay open
 2. Tachypnea
3. Nasal flaring
4. Retractions
5. Seesaw – like respirations (chest wall retracts and the abdomen protrudes)
6. Decreased breath sounds
7. Apnea
8. Pallor and cyanosis
9. Hypothermia

Management
○ Oxygen therapy- hood, nasal prong, mask, endotracheal tube , CPAP (Continuous
 Positive Airway Pressure) or PEEP (Positive End –Expiratory Pressure) may be used
○ Muscle relaxants – Pancuronium (Pavulon)
 Reduces muscular resistance
 Prevents pneumothorax
 Prepare Atropine or Neostigmine Methylsulfate
○ Liquid Ventilation- Uses perfluorocarbons – substances used in industry to assess leaks
○ Nitric Acid- Causes pulmonary vasodilation – increases blood flow to the alveoli

Nursing Interventions
1. Monitor color, respiratory rate, and degree of effort in breathing.
2. Support respirations as prescribed
3. Monitor arterial blood gases and oxygen saturation levels
(arterial blood gases from umbilical artery).so that oxygen administered to the newborn is at the lowest
possible concentration necessary to maintain adequate arterial oxygenation.

RETINOPATHY OF PREMATURITY
• Vascular disorder involving gradual replacement of retina by fibrous tissue and blood vessels
• Primarily caused by prematurity and use of supplemental oxygen (longer than 30 days)
• Oxygen administration should never be more than 40% unless hypoxia is documented
• Any premature newborn who required oxygen support should be scheduled for an eye examination before
discharge to assess for retinal damage.
• Bronchopulmonary Dysplasia- over expanded lungs prolonged use of O2

Management:
○ Suction every 2 hours or more often as necessary.
○ Prepare to administer surfactant replacement therapy (instilled into the endotracheal tube)
○ Administer respiratory therapy (percussion and vibration)
○ Provide nutrition
○ Support bonding
○ Encourage as much parental participation in newborn's care as condition allows.

HYPERBILIRUBINEMIA
Description: is an abnormally high level of Bilirubin in the blood; results to jaundiced
In physiologic jaundiced:
occurs on the second day to seventh day
average increase of 2mg/dl; not exceeding 12mg/dl
Pathological Jaundice of Neonates
Any of the following features characterizes pathological jaundice:
Clinical jaundice appearing in the first 24 hours.
Increases in the level of total bilirubin by more than 12 mg/dl
Therapy is aimed at preventing Kernicterus, which results in permanent neurological damage resulting from the deposition of bilirubin in the
Causes:
Immaturity of the liver
Rh or ABO incompatibility
Infections
Birth trauma
Maternal diabetes
 ○ Medications

Assessment
○ Jaundice
○ Dark concentrated urine
○ Enlarged liver
○ Poor muscle tone
○ Lethargy
○ Poor sucking reflex

Management
1. Phototherapy
• is use of intense florescent lights to reduce serum bilirubin levels
• The use of blue lights overhead or in blanket –device wrapped around infant
• is use of intense florescent lights to reduce serum bilirubin levels in the newborn
• Injury from treatment, such as: eye damage, dehydration, or sensory deprivation
• Possible complication of phototherapy: eye damage, dehydration, sensory deprivation
• Wallaby blanket-a blanket which, when wrapped around the infant’s torso, delivers effective therapy to
jaundiced babies
• no need to cover the baby’s eyes as all light treatment is delivered through the blanket
2. Exchange blood transfusion via umbilical catheter-for very severe cases
• infants blood – remove = 5 / 10ml at a time

Nursing Interventions
1. Expose as much of the newborn's skin as possible.
2. Cover the genital area, and monitor the genital area for skin irritation or breakdown.
3. Cover the newborn's eyes with eye shields or patches; make sure that eyelids are closed when shields or patches
are applied.
4. Remove the shields or patches at least once per shift (during a feeding time) to inspect the eyes for infection
or irritation and to allow eye contact and bonding with parents.
5. Monitor skin temperature closely.
6. Increase fluids to compensate for water loss.
7. Expect loose green stools and green urine.
8. Monitor the newborn's skin color with the fluorescent light turned off, every 4 to 8 hours.
9. Monitor the skin for bronze baby syndrome- a grayish-brown discoloration of the skin.
10.Reposition newborn every 2 hours.
11. Provide stimulation.
12. After treatment, continue monitoring for signs of hyperbilirubinemia, because rebound elevations are normal
after therapy is discontinued.
13. Turn off phototherapy lights before drawing blood specimen for serum bilirubin levels and avoid allowing
blood specimen to remain uncovered under fluorescent lights (to prevent the breakdown of bilirubin in the
blood specimen).
14.Monitor for the presence of jaundice; assess skin and sclera for jaundice.
15. Examine the newborn's skin color in natural light.
16.Press finger over a bony prominence or tip of the newborn's nose to press out capillary blood from the tissues.
17. Jaundice starts at the head first, spreads to the chest, abdomen, and then the arms and legs, followed by the
hands and feet
18.Keep newborn well hydrated to maintain blood volume.
19.Facilitate early, frequent feeding to hasten passage of meconium and encourage excretion of bilirubin.
20. Report to the physician any signs of jaundice in the first 24 hours of life and any abnormal S&S
21. Prepare for phototherapy, and monitor the newborn closely during the treatment.

MECONIUM ASPIRATION SYNDROME (MAS)

occurs when infants take meconium into their lungs during or before delivery
Occurs in term or post-term infants
During fetal distress there is increases intestinal peristalsis, relaxing the anal sphincter and releasing meconium into the amniotic fluid.
Aspiration can occur in utero or with the first breath.
Meconium can block the airway partially or completely and can irritate the newborn’ airway, causing respiratory distress
 Assessment:
Respiratory distress is present at birth:
tachypnea,
cyanosis,
retractions,
nasal flaring,
grunting,
crackles, and rhonchi may be present.
infant's nails, skin, and umbilical cord may be stained a yellow-green color.

CAUSES and RISK FACTORS:

Common to post mature
Maternal history of diabetes
Hypertension
Difficult delivery
Poor intrauterine growth

Management
Suctioning must be done immediately after the head is delivered before the first breath is taken;
Vocal cords should be viewed to see if the airway is clear before stimulation and crying
Extracorporeal membrane oxygenation (ECMO)- Cardiopulmonary bypass to support gas exchange allows the lungs to rest - help newborn

Nursing interventions
Observing neonates respiratory status closely
Ensuring adequate oxygenation
Administration of antibiotic therapy
Maintain thermoregulation

SEPSIS
Description: Generalized infection resulting from the presence of bacteria in the blood
Major common cause is group B beta- hemolytic streptococci
Contributing factors:
Prolonged rupture of membranes
Prolonged or difficult labor
Maternal infection
Cross contamination
Aspiration

Assessment findings – often does not have specific sign of illness

Poor feeding
Irritability
Lethargy
Pallor
Tachypnea
Tachycardia
Abdominal distention
Temperature instability – difficulty keeping temperature within normal range

Diagnosis:
Blood, urine, and cerebrospinal fluid cultures
Routine CBC, urinalysis, fecalysis
Radiographic test

Management
Intensive antibiotic therapy
IV fluids
Respiratory therapy
 Nursing interventions- Routine newborn care with special emphasis on the following:
Monitor vital signs, assess for periods of apnea or irregular respirations..
Administer oxygen as prescribed
Provide isolation as necessary- Monitor and limit visitors
Handwashing before after handling neonate

SUDDEN INFANT
CONGENITAL DEATH SYNDROME
HEART DEFECT
ACYANOTIC TYPE of any young child that is unexpected by history and which thorough postmortem examination fails
• Sudden death
ATRIAL toSEPTAL
demonstrate adequate cause of death
DEFECT
• Usually
Abnormal openingoccurs
in theduring
septumsleep
between left and right atria
Usually• Diagnosis is made
detected after after
neonatal autopsy
period
S/S: • High incidence in preterm infants, infants with abnormalities in respiration
- decrease activity tolerance
• Unknown cause : may be related to a brainstem abnormality in the neurological regulation of cardio-respiratory control
- dyspnea
• Nursing Role:
 + murmur – upper
a. Care left sternal
is directed at border Mgt: Surgery
supporting – 2 and 4 yrs of age
parents/family
VENTRICULAR SEPTAL
b. Provide a roomDEFECT
for the family to be alone
Opening inc.the septum between
Reinforce ventricles,
that death was notcausing
theira fault
left to right shunt
Small VSD – asymptomatic
d. Provide appropriate support referrals
Large – hypertrophy and/or failure of right ventricle
e. Explain how parents can receive autopsy results
S/S:
• Prevention:
increase respiratory effort
a. Infants infection
Frequent respiratory should be placed in the supine position for sleep.
 + murmur – heard best @ mattresses
b. Soft moldable and bedding,
lower left sternal border such as pillows or quilts, should not be used for bedding.
Congestionc.- Stuffed
pulmonary animals should be removed from the crib while the infant is sleeping.
Mgt : Surgery
d. Discourage bed sharing (sleeping with an adult).
PATENT DUCTUS ARTERIOSUS
e. Home apnea monitor to infant with near miss SIDS
Connects pulmonary trunk to aorta
S/S:
 + murmur – machinery type @ middle to upper left sternal border
poor feeding
tiring easily
Mgt: Indomethacin
Surgery – ligation
COARCTATION OF AORTA
Narrowing of the aorta
Significant decrease in blood flow to abdomen and legs
Blood shunted to head and arms
S/S:
BP /pulse - higher in arms than legs
 High pulse pressure in carotid and radial pulses
Warm upper body
Mgt: surgery – angioplasty – repaired of narrowed vessel
E. VALVULAR DEFECTS
right side
tricuspid
pulmonic valve
left side
mitral
aortic valve
S/S:
palpitations
Pain
Edema
Weakness, dizziness
Mgt: Surgery – valvotomy, valvuloplasty, valve replacement

CYANOTIC TYPE
A. TRANSPOSITION OF GREAT VESSELS
○ Aorta arises from right ventricle, pulmonary artery arises from left ventricle oxygenated blood therefore
circulates through left side of heart to lungs and back to left side
○ unoxygenated blood enters the right atrium from body ,goes back to right ventricle and back to circulation
without being oxygenated
○ S/S:
 Blueness of the skin
 Shortness of breath
 Poor feeding
 Clubbing of the fingers or toes
 peripheral hypoxemia
 severe progressive pulmonary hypertension.
○ Complications:
 Arrythmias
 Heart failure
○ Mgt: Balloon Atrial Septostomy (Rashkind Procedure)
B.TETRALOGY OF FALLOT
○ This condition is characterized by the following four defects:
 an abnormal opening, or ventricular septal defect, that allows blood to pass from the right ventricle to
the left ventricle without going through the lungs
 a narrowing (stenosis) at or just beneath the pulmonary valve that partially blocks the flow of blood
from the right side of the heart to the lungs
 the right ventricle is more muscular than normal
 the aorta lies directly over the ventricular septal defect
○ Tetralogy of Fallot results in cyanosis (bluish color of the skin and mucous membranes due to lack of oxygen).
○ Cyanosis develops within the first few years of life.
○ First presentation may include poor feeding, fussiness, tachypnea, and agitation.
○ Cyanosis occurs and demands surgical repair.
○ Dyspnea on exertion is common.
○ Hypoxic "tet" spells are potentially lethal, unpredictable episodes that occur even in noncyanotic patients with
TOF. These spells can be aborted with relatively simple procedures.
○ Birth weight is low.
○ Growth is retarded.
○ Development and puberty may be delayed.
○ Right ventricular predominance on palpation
○ May have a bulging left hemithorax
○ Systolic thrill at the lower left sternal border
○ Single S2 - Pulmonic valve closure not heard
○ Systolic ejection murmur
○ Cyanosis and clubbing - Variable
○ Squatting position
Scoliosis - Common
Retinal engorgement
Hemoptysis
Mgt: Tet Spells
Knee-chest position: This provides a calming effect, reduces systemic venous return.
Oxygen therapy
Morphine sulfate - decrease systemic venous return.
Surgery: Blalock Taussig Shunt
High Risk Infant
Monday, 31 January 2022 12:54 pm

COMMON HEALTH PROBLEM DURING INFANCY

FAILURE TO THRIVE
• A condition in which a child fails to gain weight and is persistently less than the fifth percentile on standard
growth chart
• Persistent deviation from established growth curve.
• Delay in physical growth and weight gain might lead to cognitive impairment or even death
• 4 principal factors for human growth:
1. Food
2. Rest and activity
3. Adequate secretions of hormones
4. Satisfactory relationship with care giver
• Classified as:
1. Organic (OFTT) - due to pathologic condition such as problem in absorption and hormonal dysfunction
2. Nonorganic (NFTT) – due to psychosocial factor disrupted maternal child relationship
3. Idiopathic(IFTT) - Unexplained by the usual organic and environmental etiologies but usually classified as NFTT
• A thorough history is the best guide to establishing the etiology of the failure to thrive:
○ Poverty is the greatest single risk factor worldwide and in the United States
○ Nutritional deficiency is the fundamental cause
• Assessment findings
○ Poor muscle tone, loss of subcutaneous fats, skin breakdown
○ Rumination – common
○ characteristic; voluntary regurgitation
○ Lethargic- unresponsive
○ Positive delay in growth and development
○ Signs of disturbed maternal – child interaction
○ Diminished or nonexistent crying
○ Radar gaze - wide-eyed gaze and continual scan of environment
• Characteristics of the individual providing care:
1. Difficulty perceiving and assessing the infant’s needs
2. Frustrated and angered at the infant’s dissatisfied response
3. Frequently under stress and in crisis, with emotional, social and financial problems
• All children with failure to thrive need additional calories for catch-up growth :
○ Treatment depends on the cause
○ Medical disorder - specific treatment is given Parent-child relationship - Family counseling
○ Nutritious, high-calorie feedings
• Nursing Interventions
○ Provide consistent caregiver.
○ Provide sufficient nutrients.
 Make feeding a priority intervention.
 Keep an accurate record of intake.
 Weigh daily.
○ Introduce positive feeding environment
 Establish a structured routine
 Hold the young child for feeding
 Maintain eye-to-eye contact
 Maintain a calm, even temperament
 Provide a quiet, non stimulating environment
 Talk to child giving appropriate directions and praise for eating
 Increase stimulation appropriate to the child’s present developmental level.
 Provide the parent an opportunity to talk.
 When necessary, relieve the parent of childrearing responsibilities until able and ready
emotionally to support the child.
 Demonstrate proper infant care by example, not lecturing.
Supply the parent with emotional support with fostering dependency.
Promote the parent’s self-respect and confidence by praising achievements with child.

HYDROCEPHALUS
• An imbalance of cerebrospinal fluid (CSF) absorption or production caused by: malformations, tumors,
hemorrhage, infections, or trauma
• Results in head enlargement and increased ICP
• Types:
○ COMMUNICATING- occurs as a result of impaired absorption within the subarachnoid space.
○ NONCOMMUNICATING- blockage in the ventricular system that prevents CSF from entering the
subarachnoid space
• Assessment:
1. Increased head circumference
2. Thin, widely separated bones of the head that produce a cracked pot sound (Macewen's sign) on percussion
3. Anterior fontanel tense, bulging, and non pulsating
4. Dilated scalp veins
5. Sunsetting eyes
6. Behavior changes, such as irritability and lethargy
7. Headache on awakening
8. Nausea and vomiting
9. Ataxia- lack of coordination of muscle movement
10.Nystagmus- involuntary movement of the eyes
11. Late signs: High, shrill cry and seizures.
• Diagnostic Test: CT scan, MRI, Skull X-ray
○ Transillumination- holding a bright light such as a flashlight or specialized light (Chun gun) against the skull in
a darkened room; a skull filled with fluids rather than solid brain substance
• Management - treatment depends to cause
○ Surgical interventions
 GOAL: Prevent further CSF accumulation by bypassing the blockage and draining the
fluid from the ventricles to a location where it may be reabsorbed.
a. Ventriculoperitoneal shunt - the CSF drains into the peritoneal cavity
b. Atrioventricular shunt - CSF drains into the right atrium of the heart
c. Acetazolamide (Diamox)- promote the excretions of excess fluids
 Preoperative interventions
a. Give small frequent feedings as tolerated until a preoperative NPO status is prescribed.
b. Reposition head frequently and use an egg crate mattress under the head to prevent pressure sores.
c. Prepare the child and family for diagnostic procedures and surgery
 Postoperative interventions
a. Monitor vital signs and neurological signs.
b. Position the child on the unoperated side
c. Observe for signs of increased ICP
d. elevate head 15-30 degrees
e. Monitor for signs of infection
f. Measure head circumference.
g. Provide comfort measures; expected level of functioning
h. Administer medications as prescribed, diuretics, antibiotics, or anticonvulsants.
i. Instructions on parents re: wound care, shunt revision
j. Availability of support groups; community agencies
k. Instruct the parents on how to recognize shunt infection or malfunction
 In an infant- irritability, lethargy, and feeding poorly
 In a toddler- headache and a lack of appetite
 In older children- an alteration in the child's level of consciousness.

SPINA BIFIDA
A central nervous system defect results from failure of the neural tube to close during embryonic development generally in the lumbosacra
• Causes:
○ Actual cause is unknown; multiple factors
○ Genetic – if a sibling has had neural tube defect
○ Environmental factors
○ Medications , viral infection and radiation
• Types:
1. Spina bifida occulta- Posterior vertebral arches fail to close in the lumbosacral area.
 Spinal cord and meninges remains in the normal anatomic position
 Defect may not be visible dimple or a tuff of hair on the spine
 Asymptomatic may have slight neuromuscular deficits
 No treatment if asymptomatic aimed at specific symptoms
2. Spina bifida cystica- Protrusion of the spinal cord and/or its meninges with varying degrees of nervous
tissue involvement.
a. Meningocele
• part of spinal protrudes through opening in the spinal canal
• sac is covered with thin skin no nerve roots involved
• no motor or sensory loss Good prognosis after surgery
b. Myelomeningocele (meningomyelocele)
• with spinal nerves roots in the sac
• have sensory or motor deficit
• below site of the lesion
• 80% have multiple handicaps
• Assessment- Depends on the spinal cord involvement
1. Visible spinal defect
2. Motor/sensory involvement
a. Flaccid paralysis of the legs
b. Altered bladder and bowel function
c. Hip and joint deformities
d. Hydrocephalus
• Diagnostics:
○ Prenatal- ultrasound, amniocentesis
○ Postnatal
 x-ray of spine
 CT scan
 myelogram-uses a special dye and an X-ray (fluoroscopy) to provide a very detailed picture of the
spinal cord and spinal column
 encephalogram
 urinalysis, BUN, Creatinine clearance
• Management:
1. Surgery- closure of sac within 48 hours, shunt, orthopedic
2. Drug therapy- Antibiotic, Anticholinergic
• Nursing Management:
1. Prevent trauma to the sac
a. cover with a sterile, moist (normal saline), non adherent dressing
b. change the dressing every 2 to 4 hours as prescribed, keep area free from contamination
c. place in a prone position to minimize tension on the sac
d. head is turned to one side for feeding
e. Administer meds
2. Prevent Complication
a. Use aseptic technique to prevent infection.
b. Assess the sac for redness, clear or purulent drainage, abrasions, irritation, and signs of infection.
c. Clean intermittent catheterization
d. Perform neurological assessment
e. Assess for physical impairments such as hip and joint deformities
3. Provide adequate nutrition
4. Provide sensory stimulation
5. Provide emotional support to parents and family
6. Provide discharge teachings
 wound care
ROM, PT
signs of complications
medication regimen
positioning – feeding ,diaper change

MENINGITIS
• inflammations of meninges of the brain and spinal cord
• Cause by bacteria, viruses, other microorganism
• as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or
systemic infections.
• H Influenzae Meningitis – the most common form; between 6 to 12 months
○ Bacterial meningitis - Hemophilus influenza type B, Streptococcus pneumoniae, or Neisseria meningitidis
○ Viral meningitis is associated with viruses such as mumps, herpesvirus, and enterovirus.
• Assessment
○ Fever, chills, headache,
○ high-pitched cry, irritability
○ Vomiting, Poor feeding or anorexia
○ bulging anterior fontanel in the infant
○ Signs of meningeal irritations
 nuchal rigidity – stiff neck
 Positive Kernig sign- Severe stiffness of the hamstring muscle causes an inability to straighten
the leg when the hip is flexed to 90 degrees.
 Opisthotonos
a. arching of the back
b. head and heels bent backward
c. and body arched forward
 Brudzinski sign - Flexion at the hip in response to forward flexion of the neck
• Interventions
1. Provide isolation and maintain it for at least 24 hours after antibiotics are initiated.
2. Administer antibiotics and antipyretics as prescribed.
3. Perform neurological assessment and monitor for seizures and complications
4. Assess for changes in level of consciousness and irritability.
5. Monitor intake and output.
6. Assess nutritional status.
7. Determine close contacts of the child with meningitis because the contacts will need prophylactic treatment.
8. Meningococcal vaccine is recommended to protect against meningitis.
a. Monitor for signs of infection
b. Measure head circumference.
c. Provide comfort measures; expected level of functioning
d. Administer medications as prescribed, diuretics, antibiotics, or anticonvulsants.
e. Instructions on parents re: wound care, shunt revision
f. Availability of support groups; community agencies
g. Instruct the parents on how to recognize shunt infection or malfunction
□ In an infant- irritability, lethargy, and feeding poorly
□ In a toddler- headache and a lack of appetite
□ In older children- an alteration in the child's level of consciousness.

SEIZURES
• Recurrent sudden changes in consciousness, behavior, sensations and or muscular activities beyond voluntary
control cause by excess neuronal discharge
• Normally the neuron sends out messages in electrical impulses periodically and the firing individual neuron is
regulated by an inhibitory feedback loop mechanism
• With seizures many more neurons than normal fire in a synchronous fashion in a particular area of the brain;
the energy generated overcomes the inhibitory feedback mechanism

FEBRILE SEIZURES
 • Description
○ Common in children between 6mos – 3yrs old
○ Common in 5% of population under 5 years old, familial
○ Nonprogressive, does not generally result in brain damage
○ Commonly associated with high fever – 38.9 to 41.1 Celsius
○ Some appear to have a low seizure threshold and convulse when a fever of 37.8 to 39.8
• Classification:
1. Partial seizure
a. Simple – localized motor activity
□ shaking of arm or leg
□ limited to one side of the body
b. Complex – psychomotor seizure
□ memory loss and staring
□ non purposeful movements
 AURA – sensation that signals an attack
 After – sleep or confuse; unaware of the seizure
2. Generalized
a. Tonic – clonic
□ prodromal
□ AURA
□ tonic
□ post ictal
b. Absence - rarely 20 seconds
□ stares straight, does not fall
 Status Epilepticus
• Contributing factors: seizure disorder
1. Intracranial infection
2. Space occupying lesion
3. CNS defects
• Assessment findings
1. Restlessness/irritability
2. Body stiffens and loss of consciousness
3. Clonic movements – quick, jerking movements of arms, legs, and facial muscle
4. Pupils dilate and roll up
• Diagnostic Test:
○ Blood studies
 to rule out lead poisoning,
 hypoglycemia
 infection
 Electrolytes imbalance
 EEG – to detect abnormal wave
• Treatment:
1. Drug Therapy
a. Diazepam
b. Phenobarbital
c. Dilantin
2. Surgery – for tumor and hematoma
• Interventions
1. Reduce fever with antipyretics.
2. Give prescribed medication
3. Generalized seizure precautions
4. Do not restrain; pad crib rails; do not use tongue blade
5. Observe and record the time of seizure, duration, and body parts involved.
6. Suction and administer oxygen after the seizure as required.
7. Observe the degree of consciousness and behavior after seizure
8. Provide rest after the seizure.

OTITIS MEDIA
 • Description
○ Bacterial or viral infection of the middle ear
○ Common in infants and preschoolers
○ Eustachian is shorter, wider, and straighter thereby, allowing nasopharyngeal secretion to enter middle ear
more easily
• Assessment Findings
1. Behavior that would indicate pain
• restless and repeatedly shakes the head
• frequently pulls or tugs at affected ear
2. Irritability, cough, nasal congestion, fever
3. Hearing impairment
4. Purulent discharges
• Diagnosis
1. Examination of ear with otoscope – reveals bright red bulging eardrum
2. Culture and sensitivity of ear discharges
• Possible Complication
○ permanent hearing loss
○ mastoiditis
• Management
1. Antibiotics, analgesics
2. Myringotomy incision into the tympanic membrane to relieve pressure and drain the fluid with /without tube
• Postoperative Interventions
3. Wear earplugs while bathing, shampooing, and swimming,
4. Diving and submerging under water are not allowed.
5. Child should not blow his or her nose for 7 to 10 days after surgery.
• Interventions
1. Encourage fluid intake.
2. Teach the parents to feed infants in upright position, to prevent reflux.
3. Instruct the child to avoid chewing as much as possible during the acute period because chewing increases
pain.
4. Provide local heat and have the child lie with the affected ear down.
5. Instruct the parents in the appropriate procedure to clean drainage from the ear with sterile cotton swabs.
6. Instruct the parents in:
• Administration of analgesics or antipyretics
• Administration of the prescribed antibiotics, emphasizing that the 10- to 14-day period is
necessary to eradicate infective organisms.
• Screening for hearing loss may be necessary
• Administering ear medications.
□ Younger than age 3, pull the lobe down and back.

CLEFT LIP AND CLEFT PALATE

Description
Nonunion of the tissue and bone of the upper lip and hard/soft palate during embryonic development
Failure of the maxillary and premaxillary processes to fuse during fetal development
Etiology – primarily genetic
environmental factors
viral infection
exposure to radiation
Folic acid deficiency
teratogenic factors
Assessment Findings
Facial abnormality
Difficulty sucking and swallowing
Milk escapes through nose
Assessment
Cleft lip
 can range from a slight notch to a complete separation from the floor of the nose.
Cleft palate
  nasal distortion
 midline or bilateral cleft
 variable extension from the uvula and soft and hard palate.
• Associated Problems
1. Feeding problems
2. URTI
3. Ear infection
4. Speech defect, dental malformation
5. Body image
• Management
1. Surgical correction (Rule of Ten)
 Cheiloplasty – Correction of cleft lip
 Palatoplasty – Cleft palate surgery
□ Done before speech development
□ Allow for palatal changes
 Logan bar/steri strips- to take the tension off the sutures
2. Team Approach Therapy – Dentist and orthodontist
 Audiologist
 Speech Therapist
 Pediatrician
• Nursing Intervention (Pre-op Cleft Lip)
1. Feed in upright position’ in small frequent feedings
2. Burp frequently
3. Use large-holed nipples
4. Use rubber-tipped syringe – if unable to suck
5. Gavage feeding as ordered
6. Finish feeding with water
7. Provide emotional support for parents and family
• Nursing Intervention (Post-op Cleft Lip)
1. Maintain patent airway
2. Assess color; monitor for frequent swallowing
3. Do not place in prone position
4. avoid straining suture lines
5. Use elbow restraints
6. Resume feedings as ordered (Haberman feeder)
7. Provide pain control as ordered
• Nursing Intervention (Pre-op Cleft Palate)
1. Prepare parents to care for child after surgery
2. Instruct concerning feeding methods and positioning
• Nursing Intervention (Post-op Cleft Palate)
1. Suction mucus and saliva gently and do not touch the sutures
2. Incision care
3. Clean suture with sterile cotton swab with half strength hydrogen peroxide followed by saline
4. Apply antibiotic ointment
5. Do not displace Logan bar
6. Do not place in prone position, Place in side lying position
7. Keep spoons, pacifier, straws, away from child’s mouth for 7 to 10 days post op
8. Elbow strain
9. Special feeder – syringe with rubber tubing into side of mouth, Breck feeder

ESOPHAGEAL ATRESIA/TEF
Description
The esophagus terminates before it reaches the stomach, ending in a blind pouch, and/or a fistula is present that forms an unnatural connect
Type I/A - lower segments of the esophagus are blind;
Type II/ B – upper end of esophagus opens into the trachea; blind lower segment
Type III/ C – upper end blind; lower end connects into trachea
Clinical Manifestation
 1. Excessive amount of secretions constant drooling large secretion from the nose
2. Intermittent/unexplained cyanosis
3. Coughs and chokes
4. Fluids returns through nose and mouth
5. Regurgitation & vomiting
6. Abdominal distention
7. Inability to pass a small catheter through
8. The mouth or nose into the stomach.
• Diagnostic Evaluation
1. X-ray of abdomen and Chest X-ray
2. X-ray with radiopaque catheter
3. Insertion of a catheter
• Management
○ Includes maintenance of :
 a patent airway
 prevention of aspiration pneumonia
 gastric or blind pouch decompression
 supportive therapy
 surgical repair
○ Drug Therapy
 Antibiotics – for respiratory infection
○ Surgery
 Primary repair – esophageal anastomosis
 Gastrostomy - feeding
 Esophagostomy- drain
secretions Pre-operative
Interventions
1) The infant may be placed in an incubator or radiant warmer with high humidity (intubation and
mechanical ventilation may be necessary if respiratory distress occurs).
2) Upright position
3) Maintain an NPO status.
4) Regular suctioning
5) Maintain IV fluids or hyperalimentation as prescribed.
6) Observe closely for:
- vital signs; respiratory behavior
- amount of secretions
- abdominal distention
- skin color
Post-operative Interventions
1) Monitor respiratory status.
2) Maintain patent airway; continued use of incubator
3) Suction as needed, change position frequently; avoid hyperextension of neck
4) Maintain IV fluids, antibiotics, and parenteral nutrition as prescribed.
5) Maintain adequate nutrition – gastrostomy
6) Monitor strict intake and output.
7) Monitor daily weight.
8) Inspect the surgical site for signs and symptoms of infection.
9) Monitor for anastomotic leaks as evidenced by purulent drainage from the chest tube, increased
temperature, and increased white blood cell count.
10)Observe for signs of stricture at the anastomosis site (e.g., poor/refusal to feed, dysphagia,
drooling, regurgitated undigested food).

HYPERTROPHIC PYLORIC STENOSIS

Description
Congenital hypertrophy of the circular muscles of the pylorus in the stomach; the muscle becomes progressively thickened and elongated w
The stenosis usually develops in the first few weeks of life, causing projectile vomiting, dehydration, metabolic alkalosis, and failure to thr
Assessment
 1. Vomiting that progresses from mild regurgitation to forceful and projectile vomiting
2. Vomitus contains gastric contents such as milk or formula, may contain mucus, may be bloodùtinged, and does
not usually contain bile.
3. Exhibits hunger and irritability.
4. Peristaltic waves are visible from left to right across the epigastrium during or immediately following a
feeding.
5. Olive-shaped mass is in the epigastrium just right of the umbilicus.
6. On barium enema, string sign can be seen
7. Dehydration and malnutrition can occur.
8. Electrolyte imbalances can occur.
• Management
○ Fredet-Ramstedt Pyloromyotomy
 plits the hypertrophic pyloric muscle down to the submucous, allowing pylorus to expand so that food
may pass
• Nursing Interventions
1. Monitor vital signs.
2. Monitor strict intake and output.
3. Obtain daily weights.
4. Monitor for signs of dehydration and electrolyte imbalances.
5. Feed by gavage
 Thickened feeding
 Slowly upright
 Burp frequently
6. Prepare the child and parents for surgery if prescribed.
 Pyloromyotomy
□ Pre op
▪ Monitor hydration status
▪ Correct F/E imbalances
▪ NPO
▪ Monitor character of stool
▪ NGT
□ Post operative
▪ Monitor intake and output
▪ Start SFF
▪ Feed slowly, upright
▪ Monitor for abdominal distention
▪ Monitor for signs of infection

HIRSCHSPRUNG’S DISEASE (AGANGLIONIC MEGACOLON)

Description
Absence of ganglion cells in a portion of the large intestine
Is a parasympathetic nerve cells that regulates peristalsis in the intestine
The absence of the ganglion cells would result to absence peristalsis and affected colon becomes dilated and filled with feces and gas
The disease may be a familial congenital defect or may be associated with other anomalies, such as Down syndrome and genitourinary abn

Assessment Findings
Newborn
 Failure to pass meconium stool
Refusal to suck
Abdominal distention
Bile-stained vomitus
Children
Failure to gain weight and delayed growth
Abdominal distention
Vomiting
Constipation alternating with diarrhea
Ribbon-like and foul-smelling stools
Diagnostic Studies – Rectal biopsy
Management
Surgery
Temporary colostomy
A portion of the large intestine is brought through the abdominal wall to carry stool out of the body
Bowel repair
Dissection and removal of the affected section with anastomosis of intestine
Abdominal – perineal pull through
Nursing Management
Administer enema as ordered with Isotonic solution only
Do not treat loose stools – child is constipated
Administer TPN
Instruct parents on colostomy care, correct diet

INTUSSUSCEPTION
Description
Invagination or telescoping of a portion of the small intestine into a more distal segment of the intestine
3 times more likely in boys than girls and the common cause of intestinal obstruction in childhood
Cause is unknown
Factors
Hyperperistalsis and unusual mobility of cecum and ileum
Lesion such as polyp and tumor
It is considered a surgical abdominal emergency in children
Mechanical Bowel Obstruction Occurs intestinal walls press against each other causing inflammation, edema and decreased blood flow.
May progress to necrosis, perforation and peritonitis.
Gangrene of the bowel
Clinical Presentation
Sudden onset of abdominal pain (in a healthy baby)
Infant cries out sharply and draws knees up to abdomen
Vomiting occurs and increases overtime (Bile stained vomitus)
Currant jelly stool
Signs of shock
(+) for Occult blood in stools
Sausage-shaped mass in RLQ
Diagnosis
Often based on history and physical examination alone
Barium enema
Is definitive (in 75% of cases)
It is therapeutic and curative in most cases with less than 24-hour duration
Digital rectal exam
reveals mucous, blood
Immediate Treatment
IV fluids
NPO status
Diagnostic barium enema
Surgery
 manual reduction of invagination
 resection with anastomosis
possible colostomy (gangrenous)
Nursing Management
Provide routine pre- and post-operative care for abdominal surgery
Monitor fluid and electrolyte status
Maintain nutrition and hydration
Resume feedings 24 hours post operative

IMPERFORATE ANUS
• Description
○ Congenital malformation in which there is no anal opening or there is stricture of the anus
○ Etiology is unknown
○ An arrest in embryonic development on 7th to 8th week of intrauterine lif
○ A membrane remains and blocks the union between the rectum and the anus
○ Blind rectal pouch with normal anus
• Clinical Presentation
1. No stool passage with in 24 hours after birth
2. Meconium stool from other orifice
3. Only a dimple indicates the site of the anus
4. Inability to insert thermometer
• Diagnosis
○ Digital rectal exam
○ Ultrasound
○ Abdominal X-rays
• Management
1. If suspected, do not take rectal temperature
2. Pre-operative care
 Monitor for the presence of stool in the urine and vagina (indicates a fistula) and report
immediately.
 Administer IV fluids as prescribed
 Prepare the child and parents for the surgical procedures, including the potential for colostomy.
3. post-operative Care
 Expose perineum to air
 Check bowel sounds
 NGT for gastric decompression
 Change position frequently
 Oral feeding started gradually as soon as peristalsis function returned

DISPLACED URETHRAL OPENINGS

• HYPOSPADIAS
○ Males: urethra opens on the lower surface of the penis
○ Females: urethra opens into the vagina
• EPISPADIAS
○ Only in males
○ Urethra opens on the dorsal surface of the penis
○ Congenital absence of the upper wall of the urethra
• Procreation may be interfered with in severe cases
• Increased risk of urinary tract infection
• MANAGEMENT
1. Circumcision is delayed until surgical repair
2. Surgical repair
 Meatotomy

DOWN SYNDROME
Description
Chromosomal disorder caused by the presence of all or part of an extra 21st chromosome.
 It is named after John Langdon Down, the British doctor who described the syndrome in 1866.
The disorder was identified as a chromosome 21 trisomy
Assessment Findings
Small head, flat facial profile
Low-set ears
Simian creases
40% congenital heart defects
With moderate retardation
Wide space between 1st – 2nd toes
Lax muscle tone
Management
Prevent respiratory infections
Clearing the nose
Cool mist vaporizer
Chest physiotherapy
Handwashing and avoiding exposure to infection.
When feeding infants and young children, use a small, straight-handled spoon to push food to the side and back of the mouth.
Encourage fluids and foods rich in fiber.
Constipation results from decreased muscle tone, which affects gastric motility.
Provide good skin care because the skin is dry and prone to infection.
Family education – counseling
developmental progress

AUTISM
Description
Severe mental disorder beginning in infancy or toddlerhood
Pervasive developmental disorder
Disorder apparent to the parents before the child is 3 years old
Characterized by
Severe deficit in language,
perceptual and motor development
Defective reality testing
Inability to function in social setting
The cause is unknown and the prognosis may be poor.
Possible causes
Unsatisfactory mother-child relationship
CNS abnormalities
Diagnosis is established based on symptoms and the use of specialized autism assessment tools
Categories
Inability to relate with others
Inability to communicate
Obvious limited activities/interest
Clinical presentation
Infant not responsive to cuddling
No eye contact or facial responsiveness
Impaired/no verbal communication
Echolalia
Inability to tolerate change
Fascination with movement
Labile moods
Assessment
Bizzare responses to the environment
Intense reaction to minor changes
Attachment to objects
Intensely preoccupied to moving object
Self-absorbed and unable to relate to others.
Repetitive hand movement, rocking, and rhythmic body movement
Hitting, head banging, and biting
Music often holds a special interest for them
No delusions, hallucinations, or incoherence
Excellent long-term memory
May play happily alone for hours but have temper tantrums if interrupted.
Nursing intervention
Provide parents /family with support and information about the disorder
Assist child with ADL
Promote reality testing
Encourage the child to develop relationship with another person
Maintain regular schedule of activities
Provide constant routine for child
Protect from self injury
Provide safe environment
Provide seizure precaution

ATTENTION DEFICIT HYPERACTIVITY DISORDER

• Description
○ Developmental disorder characterized by inappropriate degrees of inattention, overactivity, and impulsivity
○ One of the most common reasons for referral of children to mental health services
○ Childhood problems include lowered intellectual development, some minor physical abnormalities,
sleeping disturbances, behavioral or emotional disorders, and difficulty in social relationships.
• Diagnosis
○ Established on:
 parent and teachers reports
 psychological assessments
○ Diagnosable by 36 months
○ 3 major characteristics revealed before 7 years of age
• Assessment
1. Fidgets with hands or feet or squirms in the seat
2. Easily distracted with external or internal stimuli
3. Difficulty with following through on instructions
4. Poor attention span
5. Shifting from one uncompleted activity to another
6. Talking excessively
7. Interrupting or intruding on others
8. Engaging in physically dangerous activities without considering the possible consequences
• Therapeutic Management
○ Environment
 construction of stable environment
 special instruction free from distractions
 fair but firm and set consistent limits
○ Medications
 controls excessive activity
 lengthening the attention span
 decreasing the distractibility
• Interventions
1. Provide environmental and physical safety measures.
2. Encourage support groups for parents.
3. Administer prescribed medication; some commonly prescribed medications that include:
 methylphenidate hydrochloride (Ritalin),
 pemoline (Cylert), and
 dextroamphetamine sulfate (Dexedrine).
4. Inform the child and parents that positive effects of the medication may be seen within 1 to 2 weeks
High Risk toddler

BURNS
It is the most severe form of trauma to the integumentary system
injury to body tissue caused by excessive heat
Types:
Thermal - Caused by flames, flash, scalding (hot liquid), contact to hot metal, grease
Chemical - Inhalation or ingestions of acids, alkaline, or vesicant
Smoke inhalation - Fire, gases, superheated air – smoke causes respiratory tissue damage
Electrical burn - Damage of nerves and vessels due to electric current
Classification according to depth:
Partial thickness
Superficial partial thickness
Epidermis
painful erythema
no vesicles
Deep partial thickness – Epidermis/dermis
Very painful
Fluid filled vesicles
Red, shiny, wet
Full thickness - All skin layers and nerve endings; may involve the muscles, tendons, and bones
little or no pain
wound is dry, white leathery
 Eschar - the tough, leathery scab that form over moderate or severe burn area

Phases/Stages of Burns
Emergent Phase
Remove the person from the source of burn Thermal – smother burn beginning with the head Smoke inhalation – ensure patent airway Chemicals – remove clothing
Electrical – maintain airway, identify entry and exit route
Wrap in dry, clean sheet
Assess how and when burn occurred
Provide IV route if possible
Transport immediately
Shock Phase - Fluid shift from plasma to interstitial causing hypovolemia
Assessment Findings - Sign of dehydration, BP, tachycardia, urine output, thirst
Diagnostic Test- hyponatremia, hypoproteinemia, hyperkalemia
Diuretic Phase/Fluid remobilization - Intertesial fluids returns to the vascular space
Assessment Findings – elevated BP, increase urine output
Convalescent Phase – wound healing

Assessment Focus
Extent of injury
Rule of 9
Lund and Browder
Severity of Burn classification:
Minor
partial thickness (1st /2nd degree); less than 10 -15% of body surface
full thickness (3rd degree); less than 2% of body surface
No burn on area of face, feet, hands, or genitalia
Moderate
partial thickness (2nd degree) between15-25% of body surface
full thickness less than 10%
smoke inhalation
Major
partial thickness greater than 25% of body surface
full thickness greater than or equal to 10%

Basic Burn Treatment

Minor burns
Antibiotic
Analgesic ointment
Gauze bandage
Moderate burns
do not rupture blisters
analgesia/antipyretic ointment
warm water and mild soap
burn dressing – bulky dressing
Severe burns
Supportive Therapy; Fluid Management
Crystalloid solutions: Lactated Ringer
Colloid solutions such FFP
Catheterization
Wound Care – open or closed burn therapy, hydrotherapy
Drug Therapy
Topical antibiotic (Silver Sulfadiazine)
Systemic antibiotics
Tetanus toxoid/HTIG
Analgesic – morphine sulfate
Physical Therapy – to prevent disability caused by scarring, contracture
Surgery – Escharotomy (incision made into constricting eschar to restore peripheral bld. circulation)
Debridement
Skin grafting
Parameters such as vital sign (heart rate), urine output, adequacy of capillary filling, and sensorium status determine adequacy of fluid resuscitation

Comparing Open and Closed Burn Therapy

Other Considerations in the Treatment of Burn:

Hand injuries - each individual finger should be dressed and movement encouraged
Facial burns - open technique with ointment use only
Topical antimicrobials - silver sulfadiazine and sulfamylon - used only for major burns and shouldvnot be used in outpatients
Any burn that does not heal in a month should be referred to a burn surgeon

Parkland Formula - for fluid resuscitation

LR
4cc x Wt in kg x total BSA%
(deliver ½ over first 8hrs; then other ½ over the next 16hrs)
FFP
0.5cc x Wt in kg x total BSA%
(deliver over the next four hours following fluids)
MAINTENANCE (D5W)
1cc x Wt in kg x total BSA%

Nursing Interventions
Provide relief or control of pain
Monitor alterations in fluid and electrolytes
Promote maximum nutritional status
Prevent wound infection
Prevent GI complications
Provide health teachings

CEREBRAL PALSY
Neuromuscular disorder characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system
CP is caused by damage to the motor control centers of the developing brain and can occur during:
Pregnancy -about 75 percent
Childbirth – 5 percent
CEREBRAL PALSY
Neuromuscular disorder characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system
CP is caused by damage to the motor control centers of the developing brain and can occur during:
Pregnancy -about 75 percent
Childbirth – 5 percent
After birth -15 percent up to about age three
Etiology
Prenatal – genetic, mother with rubella, accidents, PIH
Perinatal – drugs at delivery, precipitate delivery, breech deliveries
Postnatal – kernicterus, head trauma (falls out of crib, car accidents)

Types of Cerebral Palsy

Spastic – tense, contracted muscles (most common type of CP)
Athetoid – constant, uncontrolled motion of limbs, head and eyes
Ataxic – poor sense of balance, often causing falls and stumbles
Rigidity – tight muscles that resist effort to make them move
Tremor – uncontrollable shaking, interfering with coordination

Common Problems
visual defects (strabismus, nystagmus, refractory errors),
hearing loss
speech or language delay
seizures
mental retardation

Patient Care Management

Promotion of optimal rehabilitation in the areas of locomotion, communication, and the activities of daily living.
Correction of associated disabilities

Medical Management
Drug therapy
antianxiety
skeletal muscle relaxants
local nerve block
Speech/ audio therapy
Physical/occupational therapy
Surgical interventions are reserved for the child who does not respond to more conservative measures or for the child whose spasticity causes progressive deformity.

Nursing Interventions
The goal of management is early recognition and interventions to maximize the child's abilities
A multidisciplinary team approach
Assess the child's developmental level and intelligence.
Encourage early intervention and participation in school programs.
Prepare for using mobilizing devices.
Encourage communication and interaction with the child on his or her developmental level rather than chronological age level.
Provide a safe environment
Assist in ADL
Provide safe appropriate toys for the child's age and developmental level.
Position the child upright after meals.
Administer medications as prescribed to decrease spasticity.
Therapy

INGESTION OF POISONS
• Poison
○ any substance that is harmful to the body
○ Ingestion of toxic substance
• Common agent in childhood – soaps, cosmetics, detergents or cleaner and plants

Modes of
exposure
- ingestion
- inhalation
- spray

Signs and Symptoms

1. GI disturbances - Vomiting, abdominal pain, anorexia, distinctive odor
2. Respiratory/circulatory disturbances - collapse , shock, unexplained cyanosis
3. CNS manifestation
○ confusion
○ disorientation
○ sudden loss of conc
○ convulsion

General Medical Treatment

1. Elimination of poisons
2. Antidote administration
3. General supportive measures

General Interventions
1. Stabilize child’s condition - patent airway
2. Prevent absorption
a. Determine the type of substance ingested
b. Induce emesis – except caustic material ingestion, comatose, active seizure or lacking gag
reflex
c. Syrup of ipecac
d. Gastric lavage
e. Cathartic
3. Provide treatment and prevention information to parents
4. Incorporate anticipatory guidance related to the developmental stage of the child
5. Discuss general first aid measures with parents

Methods of Prevention
1. Child proofing the environment
2. Educating parents and child
3. Anticipatory guidance
4. Understanding and applying the principles of G/D

Specific Poisoning
1. Salicylate poisoning = aspirin, oils of wintergreen,
○ Toxicity begins at doses of 150 - 200 mg/kg.
○ S/S – CNS depression
 vomiting
 respiratory failure
2. Acetaminophen poisoning = commonly used analgesics
○ risk – liver damage
○ Antidote – mucomyst(N-Acetylcysteine)
○ S/S – vomiting,liver tenderness, abdominal pain
3. Lead Poisoning (Plumbism) – common in toddlers and preschoolers
○ Lead interferes with RBC function
○ Lead value of 15ug/dl – health hazard
○ Symptoms appear when lead level is – 70ug/dl
○ Most serious effect: Lead encephalitis
○ Air, soil, water, houses, ceramic cookware, solder used in metal cans and pipes
○ S/S:
 Abdominal complaints
 colicky pain
 constipation
 vomiting
 Pallor
 Irritability
 Loss of coordination
 Encephalopathy
 + lead in the blood

Nursing Action
1. Administer chelating agents
○ dimercaprol (BAL in Oil) - not given if allergy w/ peanuts(prepared in peanut oil solution
○ edetate calcium disodium (calcium EDTA)
2. Provide nutritional counseling
 INGESTION OF POISON
LEAD
When lead enters the body, it affects the erythrocytes, bones and teeth, and organs and tissues, including the brain and nervous system; the most serious consequences are the effects on the central nervous system.
Common route is hand to mouth from contaminated objects or from eating loose paint chips, crayons, or pottery that contains lead.

Chelation Therapy
removes lead from the circulating blood and from some organs and tissues.

Blood lead level test: Used for screening and diagnosis

IRON
CHILDDEFICIENCY ANEMIA
ABUSE
• Iron stores are depleted, resulting in a decreased supply of iron for the manufacture of
• Child abuse involves emotional or physical abuse or neglect, as well as sexual
hemoglobin
exploitation in
or RBC
molestations by caretakers or other individuals.
• Causes: blood loss, increased metabolic demands, syndromes of GI malabsorption, dietary
• Problem – related to parents’ limited ability to cope or relate to the child
inadequacy
• Also victims of abuse
• More common in:
○ Emotional Abuse
○ Child bearing women
 Speech disorders
○ Poor iron intake
 Habit disorders such as sucking, biting, and rocking
○ Infants and children in rapid growth
 Psychoneurotic reactions
○ Pregnant/lactating mothers
 Learning disorders
Assessment  Suicide attempts
○ Sexual Abuse
1. Compensatory tachycardia
CAUSTIC Torn, stained, or bloody underclothing
POISONING

2. Pallor
Ingestion of strong
 alkali
Pain, swelling, or itching of the genitals
3. Weakness, fatigue, irritability
May cause burns  and tissue necrosis
Bruises, in theor
bleeding, mouth, esophagus,
lacerations stomach
in the genital or anal area
4. Lab results
Pharyngeal edema may cause airway obstruction – intubation might be necessary
 Difficulty walking or sitting
 Unwillingness to change clothes or unwillingness to participate in gym activities
Management
 Poor peer relations
1. Food choices: meats, dark green & leafy vegetables, egg yolks, liver, kidney beans, iron-
○ Physical Abuse
enriched formula & cereal
 Unexplained bruises, burns, or fractures
2. Administer iron supplements as prescribed
 bald spots on the scalp
3. Teach parents to administer iron supplements:
 Apprehensive child
a. Between meals
 Extreme aggressiveness or withdrawal
b. Give with Vit C
 Fear of parents
c. Do not give with antacids or milk
 Lack of crying (older infant, toddler, or young preschool child) when
d. Oral care
approached by a stranger
e. Side effects
○ Physical Neglect
4. Monitor signs and symptoms of bleeding
 Inadequate weight gain
5. Adequate rest periods
 Poor hygiene
 Consistent hunger
CYSTIC FIBROSIS  Inconsistent school attendance
 Constant
This is a chronic multisystem fatigue
disorder (autosomal recessive trait disorder) characterized by exocrine gland dysfunction.
The mucus producedby the exocrine
Reports of glands
lack ofis child
abnormally thick, tenacious, and copious, causing obstruction of the small passageways of the affected organs, particularly in the respiratory, gastrointestinal, and reproductive systems.
supervision
CF is a fatal genetic disorder and respiratory failure is the most common cause of death.
Delinquency
There
Goalis also
of aCare
marked electrolytes change in the secretion of sweat glands
The most common symptoms are pancreatic enzyme deficiency caused by duct blockage, progressive chronic lung disease associated with infection, and sweat gland dysfunction resulting in increased sodium and chloride sweat concentrations.
1. Client will be safe
2. Child will participate with nurse for emotional support
3. Parents will participate in therapy

Nursing Intervention
1. Attend to the needs of the child
2. Report suspected child abuse case to appropriate agency
3. Provide role models for parents
4. Encourage parents to be involved in child’s care
5. Encourage parents to express their feelings
6. Provide family education
7. Initiate referrals for long term follow-up

Interventions
1. Support the child during a thorough physical assessment.
2. Assess injuries.
3. Report case of suspected abuse; nurses are legally required to report all cases of suspected abuse
to the appropriate local/state agency.
4. Place the child in an environment that is safe, thereby preventing further injury.
5. Document information related to the suspected abuse in an objective manner.
6. Assess parents' strengths and weaknesses, normal coping mechanisms, and presence or
absence of support systems.
7. Assist the family in identifying stressors, support systems, and resources.
8. Refer the family to appropriate support groups.
9. If shaken baby syndrome is suspected, monitor the infant's level of consciousness.
 4 Symptoms Same With Celiac Disease
malnutrition
protuberant abdomen
steatorrhea
fat-soluble vitamin deficiency

Symptoms
Respiratory
Wheezing and dry nonproductive cough
Dyspnea
Cyanosis
Clubbing of the fingers and toes
Barrel chest
Repeated episodes of bronchitis and pneumonia
Gastrointestinal
Meconium ileus in the neonate
Intestinal obstruction (pain, abdominal distention, nausea, and vomiting)
Steatorrhea (frothy, foul-smelling stools)
easy bruising and anemia
Malnutrition and failure to thrive
Generalized edema (due to hypoalbuminemia)
Rectal prolapse (due large, bulky stools and lack of the supportive fat pads around the rectum)
Integumentary
Abnormally high concentrations of sodium and chloride in sweat
Parents reporting that the infant tastes “salty” when kissed
Dehydration and electrolyte imbalances, especially during hyperthermic conditions
Reproductive
Delay puberty in girls.
Infertility (highly viscous cervical secretions)
Sterility (caused by the blockage of the vas deferens by abnormal secretions or by failure of normal development of duct structures.

Diagnostic Tests
Quantitative sweat chloride test – the most reliable diagnostic test
Pilocarpine
a cholinergic drug that stimulate production of sweat
the sweat is collected, and the sweat electrolytes are measured
Normal - if sweat chloride concentration is 20 meq/L or lower than 40mEq/L.
Chloride concentrations of 50 to 60 mEq/L are highly suggestive of cystic fibrosis and require a repeat test
A chloride concentration higher than 60 mEq/L is a positive test result.
Chest x-ray film reveals atelectasis and obstructive emphysema.
Pulmonary function tests provide evidence of abnormal small airway function.
Stool, fat, enzyme analysis: A 72-hour stool sample is collected to check the fat and/or enzyme (trypsin) content (food intake is recorded during the collection).
Duodenal analysis – nasogastric tube is inserted to aspirate duodenal secretions

Therapeutic Management
Respiratory System
Goals of treatment include preventing and treating pulmonary infection by improving aeration, removing secretions, and administering antimicrobial medications.
Chest physiotherapy
Aerosol Therapy
Bronchodilator
Antimicrobial
Mucolytic
Use of a Flutter Mucus Clearance Device (a small, hand-held plastic pipe with a stainless steel ball on the inside)
Use of a Therapy vest device that provides high-frequency chest wall oscillation to help loosen secretions
Gastrointestinal System
The goal of treatment for pancreatic insufficiency is to replace pancreatic enzymes
The amount of pancreatic enzymes administered is adjusted to achieve normal growth and a decrease in the number of stools to two or three daily.
Enteric-coated pancreatic enzymes should not be crushed or chewed.
Pancreatic enzymes should not be given if the child is NPO.
CELIAC DISEASE (Gluten-Induced Enteropathy)
EncourageSyndrome
a well-balanced, high-protein, high-calorie diet; multivitamins and vitamins A, D, E and K are also administered.
Malabsorption
Assess weight and monitorresponse
for failure to thrive.particularly the gluten factor of protein found in grains of wheat, barley, rye, and oats
Is a sensitivity or immunologic to protein,
Monitor for constipation and intestinal obstruction.
Results in the accumulation of the amino acid - glutamine, which is toxic to intestinal mucosal cells.
Ensure
villiadequate
atrophy salt intake and affects
fluids that provideofaningested
adequatenutrients.
supply of electrolytes during extremely hot weather and if the child has a fever.
Intestinal occurs, which absorption

Home care
Assessment
AcuteInstruct the child and family about the prescribed treatment measures and their importance.
or insidious diarrhea
Instruct the parents and caregivers to be sure immunizations are up to date.
Steatorrhea
Inform the parents and caregivers that the child should be vaccinated yearly for influenza; pneumococcus vaccine may also be prescribed.
Anorexia
Abdominal pain and distention
Muscle wasting, particularly in the buttocks and extremities
Vomiting
Anemia
Irritability

Celiac Crisis
Precipitated by infection, fasting, ingestion of gluten
Extreme and acute profuse watery diarrhea and vomiting occurs
Can lead to electrolyte imbalance, rapid dehydration, severe acidosis
Intensive therapy to replace fluids and electrolytes is required

Interventions
Maintain a gluten-free diet, substituting corn, rice, and millet as grain sources.
Instruct parents and child about lifelong elimination of gluten sources such as wheat, rye, oats, and barley.
Administer mineral and vitamin supplements, including iron, folic acid, and fat-soluble supplements A, D, E, and K
Teach the child and parents about a gluten-free diet and about reading food labels carefully for hidden sources of gluten
Instruct the parents in measures to prevent celiac crisis.
Basics of a Gluten-Free Diet
FOODS ALLOWED
Meat such as beef, pork, and poultry and fish, eggs, milk and dairy products, vegetables, fruits, rice, corn, gluten-free wheat flour, puffed rice, cornflakes, cornmeal, and precooked gluten-free cereals
FOODS PROHIBITED
Commercially prepared ice cream, malted milk, prepared puddings, grains, including anything made from wheat, rye, oats, or barley, such as breads, rolls, cookies, cakes, crackers, cereal, spaghetti, macaroni noodles& beer

Prognosis
Dietary avoidance of gluten results in improvement of symptoms in 70% of patients within 2 weeks
Serologic antibody titers decrease on a gluten-free diet
After 3-6 months antibody levels may become undetectable
Complete histological resolution of small bowel inflammation may take up to 2 years
High risk Adolescents
Wednesday, 9 February 2022 3:23 pm

SCOLIOSIS
• a lateral curvature of the spine
• five times more common in girls and has peak incidence at 8 to 15yrs
• Majority (75%) - idiopathic has a familial pattern (30% of children with scoliosis)
• associated with other neuromuscular disorders
• Forms :
○ Structural / Progressive form
 “S” curve of the spine
 usually idiopathic
 does not disappear with position changes needs more aggressive treatment
○ Functional/ Postural/Non structural
 “C” curve of the spine
 cause by poor posture, muscle spasm due to trauma, or unequal length of legs
 disappears when child lies down can be treated with posture exercise

Assessment findings
• Uneven shoulders
• Uneven hips
• Asymmetry of rib cage
• Unequal length of bra strap
• Bump or rib hump on one side of the spine

Diagnosis
• Forward bend test/ Adam’s bend test
○ a test used most often in schools and doctor's offices to screen for scoliosis
○ Scoliometer – a commercial device used to document the extent of spinal curve
• Radiograph (X-ray)- assess the angle of the curve and determine extent of deformity

Management - Depends on the maturity of the skeleton and on the degree of curvature
• Spinal curve of less 20 degree
○ no therapy
○ observation until 18years of age
• Spinal curve greater than 20 degree
○ conservative, nonsurgical approach
○ braces
○ traction
○ Plaster jacket cast
• Spinal curve of more than 40 degree surgery
○ Spinal fusion with insertion of Harrington rod
• Electrical stimulation
○ Use as an alternative for braces
○ Electrodes are applied to the skin or surgically implanted
○ Electrical stimulation is usually employed at night, during sleeping hours
 ○ To stimulate muscle to contract to straighten the spine
• Stretching exercises of the spine for non structural changes

Nursing intervention
1. Provide care for child with brace
○ Teach the child to wear it constantly, except when bathing
○ wear over a t-shirt to protect the skin
○ report if there is rubbing
○ encourage exercise as prescribed
2. Provide cast or traction care
○ frequent cleansing on the pin sites
○ Provide diversional activities
○ Monitor for signs of complications
3. Provide preoperative and post operative nursing care
○ Deep breathing exercise
○ Use of incentive spirometry
○ Log roll; do not raise the head of the bed
4. Stress correct body mechanics
○ Promoting mobility, positive body image and compliance with therapy
○ Preventing injury and
○ Preventing skin irritation

BONE TUMORS
• Sarcoma – tumors arising from connective tissue, such bones and cartilage, muscle,
blood vessels or lymphoid tissue
• common neoplasm in adolescent
• Arise during adolescent because of rapid bone growth
• Two most frequently occuring types of bone cancer:
• Osteogenic Sarcoma
○ A malignant tumor tumor of long bone involving rapidly growing bone
tissue ( mesenchymal matrix forming cells)
○ characterized by formation of osteoid (immature bones)
○ Common sites of occurrence
 distal femur – 50%
 Proximal tibia – 20%
 Proximal humerus – 10 to 15%
○ High incidence in children expose to radiation and with retinoblastoma
○ Lungs – common site of metastasis
○ Assessment . pain
 Swelling, redness
 Tender mass, warm to touch
 Limitation of movement
 Pathologic fracture
○ Diagnosis
 Bone Biopsy
 Ct scan
 Bone scan
 ○ Management
 Surgery
 Limb salvage procedures
 Bone or skin grafts
 Amputation
 Reconstructions
 Resections of metastases
 Radiation therapy
 Chemotherapy
 Rehabilitation
□ physical and occupational therapy
□ psychosocial adapting
□ prosthesis fitting and training
○ Nursing management
 Provide routine preoperative care
 Offer support or encouragement and accept client’s response of anger and grief
 Discuss to patient and family
 rehabilitation program and use of prosthesis
 crutch walking
 phantom limb sensation as normal recurrence
 Prevent hip and knee contractures prone position several times a day
(unless otherwise ordered)
 Provide stump care
□ Ewing’s Sarcoma
 Malignant tumor arising most often in the bone marrow
of the diaphysis area (midshaft) of long bones
 The diaphysis of the femur are the most common sites,
followed by the tibia and the humerus
 Lungs is the most frequent site of metastasis
 Clinical Findings
◊ Pain and swelling on affected part
◊ Palpable mass
◊ Tender and warm to touch
◊ 15- 35% of clients have metastasis at time of diagnosis
 Management
– High doses of radiation therapy a
– Chemotherapy
– Surgery
 Diagnosis
 X-ray
 Bone scan
 Biopsy
 Bone marrow aspiration
 Nursing intervention
 Caution adolescent to continue to
be careful and avoid activities that may
cause added stress to affected limb such as
football and weight lifting
SEXUALLY TRANSMITTED DISORDERS
• are those disease spread through sexual contact
A. Gonorrhea
○ Causative agent Neisseria Gonorrhea
○ Signs & symptoms: often asymptomatic in females purulent yellow-green vaginal
discharge
○ May cause ophthalmia neonatorum and sepsis to newborn
○ Treatment:
 Penicillin
 Erythromycin
 Ceftriaxone
 Doxycycline
B.Chlamydia
○ Chlamydia trachomatis
○ Most common STD
○ Signs & symptoms:
 watery, gray-white vaginal discharge
 vulvar itching
○ May causes ophthalmia neonatorum, sterility in female or male, tubal pregnancy
○ Drug: doxycycline or tetracycline, azithromycin,
C.Syphilis
○ Treponema pallidum (spirochete)
○ Crosses placenta after 16 week of pregnancy
○ Manifestation
 Primary cardinal sign – CHANCRE - a hard red painless lesion @ the
point of infection site disappear without treatment in 4-6 weeks
 Secondary - rash, malaise, alopecia
 Tertiary - effect any organ system – cardiovascular, neurovascular system
○ Treatment : penicillin or erythromycin
D. Trichomoniasis
○ Trichomonas vaginalis - a single-cell protozoan
○ Sign & symptoms: thin, irritating, frothy gray- green discharge, strong odor,
itching to genitalia
○ Treatment:
 Metronidazole
□ douche with weak vinegar solution to reduce pruritus
E.Candidiasis
○ Candida Albicans - fungus
○ Caused by a yeast transmitted from GI tract to vagina
○ Sign & symptoms – thick , white cheese-like vaginal discharges, vulvar reddening
and pruritus
○ Treatment:
 topical application or suppositories of antifungal drug such as:
□ clotrimazole , nystatin, miconazole, diflucan, gentian violet
□ Bathing with diluted sodium bicarbonate solution to reduce pruritus
 ANOREXIA NERVOSA
• A disorder characterized by refusal to maintain a minimally normal body weight
because of a disturbance in perception of the size or appearance of the body
• an eating disorder characterized by extremely low body weight, body image
distortion and an obsessive fear of gaining weight.
• May be manifested as severe weight restriction controlled by:
○ limiting food intake
○ excessive exercise
○ binge eating/purging
• Clinical findings and diagnosis(The American Psychiatric Association Criteria
for Diagnosis)
○ body mass index – less than 85% of expected weight
○ intense fear of getting fat or gaining weight even though underweight
○ severely distorted body image
○ refusal to acknowledge seriousness of weight loss
○ amenorrhea
• Manifestation
○ Almost skeleton-like appearance
○ Sexually immature
○ Dry skin, brittle nails
○ Presence of lanugo
○ Constipation, hypothermia, bradycardia, low blood pressure
○ Anemia
○ Depression, social withdrawal and poor individual coping
• Management
○ Nutritional therapy
 Total parenteral nutrition
 Enteral tube feeding
○ Behavior modification
○ Medication - antidepressant
○ Counselling
○ Individual therapy
 Group therapy
 Family therapy

BULIMIA NERVOSA
Bulimia – refers to recurrent and episodes binge eating and purging
accompanied by an awareness that eating pattern is abnormal but not being able to stop
Bulimic person is of normal of weight or slightly overweight or underweight
may abuse purgative, laxatives and diuretic to aid in weight control
Clinical manifestation and Diagnosis
Dental caries and erosion
Throat irritation
Electrolytes imbalance- hypokalemia
Behavior problem
 drug abuse
alcoholism
stealing
impulsive activities
American Psychiatric Association the criteria for bulimia are:
Recurrent episodes of binge eating
A feeling of lack of control over behavior during binges
Self-induced purging; use of laxatives, diuretics, enemas
Average of at least two binge-eating episodes a week during 3 months period
Obsessiveness regarding body weight and shape
Management
Pharmacology – antidepressant
Psychotherapy
Nursing intervention
Monitor vital signs
Monitor intake and output
Record food intake
Monitor weight
Encourage client to express feelings
Help client to set realistic goal for self
Help client identify interest and positive aspect of self

OBESITY
• An excessive accumulation of fat that increases body weight by 20% or more
• Obesity is now among the most widespread medical problems affecting children
and adolescents living in the United States and other developed countries.
• Obesity increases the child's risk of serious health problems such as heart disease,
DM type 2 and stroke
• Causes
○ Many different factors contribute to this imbalance between calorie intake
and consumption
○ Genetic factors- Obesity tends to run in families
○ Dietary habits
○ fast food, processed snack foods, and sugary drinks
○ use food as means of satisfying emotional needs
○ Indulging in late – night eating
• Physical inactivity- The popularity of television, computers, and video games results
into an increasingly sedentary lifestyle
• Management
○ Lifestyle modification,
○ Physical activity,
○ Nutrition education
• Ways to manage obesity in children and adolescents include:
1.Start a weight-management program
2. Change eating habits (eat slowly, develop a routine)
3. Plan meals and make better food selections
4. Increase physical activity and have a more active lifestyle
5. Know what your child eats at school
6. Do not use food as a reward
Limit snacks
Attend a support group (e.g., Overeaters Anonymous)

SUBSTANCE ABUSE
• is the misuse of an addictive substance that changes the user’s mental state
• refers to the use of chemicals to improve a mental state or induce euphoria
• Commonly abuse substance – alcohol, tobacco and illicit drugs
• Cause/Reasons: a means of relieving the tension and pressure of their lives
• Adolescent : a desire to feel more confident and mature due to peer pressure as a form
of rebellion
• Children at greatest risk
1.have family in which alcohol or drug abuse is present
2. suffer from abuse, neglect
3. have behavior problems – aggressiveness and excessively rebelious
4. slow learners
5. have problems with depression and low-self esteem
• Stages of substance abuse

• Common Assessment findings

1.Failure to complete assignments in school
2. Demonstration of poor reasoning ability
3. Decreased school attendance
4. Frequent mood swings
5. Deteriorating physical appearance
6. Recent change in peer group
 7. Expressed negative perceptions of parents
Treatment
Prevention is the most effective and least expensive treatment for substance abuse
Medication, -nicotine patches and methadone
Rehabilitation, counseling, social support, family support
SUICIDE
• Is a deliberate self- injury with the intent to end one’s life.
• successful suicide occurs more frequently in male than females
• third cause of cause of death between 15 – 19 years of age
• Suicide as viable solution to life problems
• Risk Factors
1. Previous suicide attempts
2. Close family member who has committed suicide.
3. Past psychiatric hospitalization
4. Recent losses: death of a relative, a family divorce or a breakup with a girlfriend
5. Social isolation
6. Drug or alcohol abuse
7. Exposure to violence in the home or the social environment
• Warning Signs for Suicide
1. Suicidal talk
2. Preoccupation with death and dying
3. Signs of depression
4. Behavioral changes
5. Giving away special possessions and making arrangements to take care of
unfinished business
6. Difficulty with appetite and sleep
7. Taking excessive risks
8. Increased drug use
9. Loss of interest in usual activities
• Tips for Parents
1. Know the warning signs!
2. Do not be afraid to talk to your child- The message is, “Suicide is not an option, help
is available."
3. Suicide-proof your home- Make the knives, pills and firearms inaccessible.
4. Utilize school and community resources- school psychologist, crisis
intervention personnel
5. Take immediate action. If your child indicates contemplating suicide
6. Do not leave your child alone
7. Seek professional
8. Listen to your child’s friends. They may give hints.
9. Be open. Ask questions.
• Three steps teens can take
1. Take your friend's actions seriously
2. Encourage your friend to seek professional help, accompany if necessary
3. Talk to an adult you trust. Don't be alone in helping your friend.