ESPERILA, MYKA L.

| BSN 2-7 | CMCRP REVIEWER EAC-C

ESPERILA, MYKA L. | BSN 2-7 | CMCRP REVIEWER EAC-C

THE HEART C. THIRD HEART SOUND

✓ produced from the rapid filling of
the ventricles in early diastole
and is best heard with the bell of
the stethoscope.
✓ can be a normal sound in
children and is likened to the
rhythm of “Ken-tuc-ky” with the
last syllable being the S3 sound.
✓ cardiac diseases are associated
with this sound as well, especially
those associated with myocardial
dysfunction or volume overload
conditions.

D. FOURTH HEART SOUND

✓ produced by atrial contraction in
late diastole and is always
pathologic.
✓ heard best with the bell of the
stethoscope and produces a
gallop rhythm likened to “Ten-ne-
see” with the first syllable being
the S4 sound.
✓ noted in conditions associated
with decreased ventricular
compliance.

II. HEART MURMURS

✓ defined as turbulent flow through an
abnormal valve, vessel, or chamber.

A. You need to assess and document:

• Its position in the cardiac cycle

I. HEART SOUNDS
(systole, diastole, continuous)
• Quality (harsh, soft, blowing)
• Pitch (high- or low-sounding noise)
A. FIRST HEART SOUND (SYSTOLE) • Intensity (loudness)
✓ first heart sound (S1) is produced • Location (where it is heard best or the
by the mitral and tricuspid valve point of maximum intensity)
closing. • Radiation (do you hear it elsewhere
✓ Blood fills the ventricles, and as beside the maximum intensity area)
ventricular pressure exceeds • Presence of a thrill (a palpable purring
atrial pressure due to the volume sensation)
within, the mitral and tricuspid • The response of the murmur to
valves are forced close. exercise or change of position.
✓ aortic and pulmonic valves are
forced open and the ventricles
contract, ejecting blood out the
aorta and pulmonary artery.
✓ This action is termed systole (the
heart contracts).

B. SECOND HEART SOUND (DIASTOLE)

✓ produced by closure of the aortic
and pulmonic (semilunar) valves.
✓ After the ventricles contract and
empty, the aortic and pulmonic
valves close during ventricular
relaxation.
✓ Relaxation of the heart is termed
diastole.
 III. DIAGNOSTIC/LABORATORY
TESTS
Holter/Event Monitor
▪ allows for evaluation of average
rate, rhythm, and frequency of
A. CHEST X-RAY
ectopic beats.
• provide an understanding of the ▪ Holter monitor is worn for 24
heart’s size and orientation, hours and gives a complete
pulmonary blood flow, and any account of every heart beat the
associated lung disorders. child experiences.

B. LABORATORY TESTING Transthoracic Echocardiogram

• Potassium – is lost with most ▪ noninvasive ultrasound of the
diuretics. heart that gives detailed
• Calcium – is necessary for information about heart structure
myocardial contractility and to and function.
prevent dysrhythmias. ▪ evaluate velocity of blood flow
• Sodium – is an indicator of fluid through the heart, estimate
status. pressures in the heart chambers
• hemoglobin and hematocrit- and lungs, and provide three-
determine the need for blood dimensional images of structures.
transfusions.
• C-reactive protein (CRP) – is an Computed Tomography/ Magnetic
indicator of an active infectious Resonance Imaging
process. ▪ provide very detailed images of
• Erythrocyte sedimentation rate the heart and chest structures and
(ESR) – is an indicator of are typically used as an adjunct
inflammation such as occurs with to echocardiography.
rheumatic fever, Kawasaki ▪ Cardiac magnetic resonance
syndrome, or myocarditis. imaging (MRI) can provide
• B-Type natriuretic peptide information regarding cardiac
(BNP) – is a substance secreted anatomy and function, blood flow
from the ventricles in response to measurement, tissue
changes in pressure that occur characterization, myocardial
when heart failure develops and perfusion, and viability.
worsens.
• Arterial blood gas testing –
provides information regarding Exercise Stress Testing
the child’s arterial acid– base ▪ used to evaluate a child’s clinical
balance (pH and base status), condition during periods of
carbon dioxide, oxygen, and increased myocardial demand,
bicarbonate levels. such as with exercise.

C. SPECIFIED LABORATORY TESTS TO Cardiac Catheterization

DETERMINE CARDIAC DISORDERS ▪ Catheters are inserted through a
large vein and artery and floated
Echocardiogram into the heart.
• written record of the ▪ A cardiac catheterization allows
electrical activity generated for direct measurements of
by the heart. pressure as well as visualization
of the heart and all blood vessels
Echocardiogram provides information
with the aid of a contrast
about:
medium.
• heart rate
• Rhythm
• state of the myocardium
• presence or absence of hypertrophy
(thickening of the heart walls)
• ischemia or necrosis due to inadequate
cardiac circulation
• abnormalities of conduction
• effect of various drugs and electrolyte
imbalances on the heart.
IV. Defects that Increase Pulmonary V. Acquired Heart Disease
Blood Flow
A. KAWASAKI DISEASE

A. PATENT DUCTUS AETERIOSUS

B. VENTRICULAR SEPTAL DEFECT

B. RHEUMATIC FEVER
 VI. CARDIOMYOPATHY

VIII. RENAL
LABORATORY/DIAGNOSTOC
TESTS
A. DILATED CARDIOMYPATHY
A. Urinalysis
Dilated Cardiomyopathy is the most common
✓ one of the most revealing tests of
cardiomyopathy noted in children.
kidney function but also one of the
simplest.
✓ Techniques for obtaining urine
samples: clean-catch,
catheterization, 24-hour collections,
and suprapubic aspiration.

B. Urine Culture
✓ presence of bacteria in urine, is
diagnosed by urine culture.
C. Radioisotope Scanning
B. HYPERTHROPIC CARDIOMYOPATHY ✓ administration of radioisotopes (a
technetium scan) is another way
NOTE: HYPERTHROPY- means, thickening of to assess glomeruli filtration
muscle fibers. ability.
D. Blood studies
✓ blood urea nitrogen (BUN) test
measures the level of urea in
blood or how well the kidneys can
clear urea from the bloodstream.
✓ level of urea
E. CONTINUE KO TO LATER MEHEHEHE

C. RESTRICTIVE CARDIOMYOPATHY IX. Therapeutic Measures for the

Management of Renal Disease

A. PERITONEAL DIALYSIS
Dialysis is the separation and removal of
solutes from body fluid by diffusion through a
semipermeable membrane.
Peritoneal dialysis uses the membrane of the
peritoneal cavity to do this.
D. Arrhythmogenic Right Ventricular
Cardiomyopathy

B. HEMODIALYSIS
VII. Alterations in Fluid and
Electrolyte and Acid-Base Balance

A. URINE OUTPUT
 X. Structural Abnormalities of the
Urinary Tract

A. EPISPADIAS
Epispadias is a rare congenital (present at
birth) anomaly involving the development of the
urethra (the tube that empties urine from the D. CHRONIC GLOMERULONEPHRITIS
bladder). The urethra does not develop into a
full tube and the urine exits the body from an
abnormal location.
B. HYPOSPADIAS

E. NEPHROTIC SYNDROME

C. Acute Post-streptococcal
Glomerulonephritis
 G. Hemolytic Uremic Syndrome

F. ACUTE RENAL FAILURE

H. SYSTEMIC LUPUS ERYTHEMATOSUS

XI. HEPATIC DISORDERS

A. HEPATITIS A
• Causative agent: a picornavirus, hepatitis A
virus (HAV)
• Incubation period: 25 days on average
• Period of communicability: highest during
2 weeks preceding onset of symptoms
• Mode of transmission: in children, ingestion
of fecally contaminated water or shellfish; day
care center spread from contaminated
changing tables
• Immunity: Natural immunity: one episode
induces immunity for the specific type of virus.
• Active artificial immunity: HAV vaccine
(recommended for all children 12 to 23 months
of age, workers in day care centers, and certain
international travelers) NOTE:
• Passive artificial immunity: immune • With generalized jaundice, there is little
globulin excretion of bilirubin into the stool, so the
stools become
white or gray.
B. HEPATITIS B
• This icteric (jaundiced) phase lasts for a few
• Causative agent: a hepadnavirus; hepatitis
days to 2 weeks.
B virus (HBV)
• The majority of those infected with hepatitis
• Incubation period: 120 days on average
C will be asymptomatic, but those who become
• Period of communicability: later part of acutely ill will have similar symptoms to
incubation period and during the acute stage someone with hepatitis B.

• Mode of transmission: transfusion of • All healthcare providers should receive

contaminated blood and plasma or semen; prophylaxis against hepatitis with the hepatitis
inoculation by a contaminated syringe or B vaccine.
needle through IV drug use; may be spread to
• Newborns should also receive routine
fetus if mother has infection in third trimester
immunization against HBV.
of pregnancy
• All women should be screened during
• Immunity: Natural immunity: one episode
pregnancy for hepatitis B surface antigen
induces immunity for the specific type of virus
(HBsAg).
• Active artificial immunity: HBV vaccine
• Infants born to mothers who are hepatitis B
(recommended for routine immunization
positive should receive both hepatitis B
beginning at birth and also to all healthcare
immune globulin (HBIG) and active
providers)
immunization at birth to prevent them from
• Passive artificial immunity: specific contracting the disease
hepatitis B immune serum globulin
• Hepatitis A vaccine is available for healthcare
providers and included in routine
immunization programs for infants beginning
C. HAPTITIS C,D,E at 1 year of age
• no vaccine for hepatitis C is yet available

D. HEPATITIS
 E. CHRONIC HEPATITIS TYPES OF DIARRHEAS
• Hepatitis is considered chronic when it MILD DIARRHEA
persists for longer than 6 months.
• Children usually are anorectic,
• This is most often the result of a hepatitis B,
irritable, and appear unwell; a fever of
D, or C infection
38.4° to 39.0°C may be present.
• With chronic hepatitis, fatty infiltration and
bile duct damage can occur. • The episodes of diarrhea consist of 2 to
10 loose, watery bowel movements per
• The disease may progress to cirrhosis and day.
eventually liver failure.
• Therapy is supportive to compensate for • mucous membrane of the mouth
decreased liver function. appears dry, and the skin feels warm,
although skin turgor will not yet be
decreased.
XII. COMMON GASTROINTESTINAL
SYMPTOMS OF ILLNES IN • mucous membrane of the mouth
CHILDREN appears dry and the skin feels warm,
although skin turgor will not yet be
• Vomiting and diarrhea in children commonly decreased.
occur as symptoms of a GI tract disease as well
as symptoms of disease in other body systems
• A danger of this is that either can lead to a
disturbance in hydration, electrolyte, or acid–
base balance.

A. VOMITING
• Most children with vomiting are suffering SEVERE DIARRHEA
from a mild gastroenteritis (infection) due to a
viral or bacterial organism, but other causes of • Severe diarrhea may result in
vomiting should be considered, such as dehydration and the need for
obstruction, increased intracranial pressure, hospitalization
and metabolic disease.
• treatment for vomiting related to • Infants with severe diarrhea appear
gastroenteritis is to give small amounts of fluid obviously ill. Rectal temperature is often
frequently as soon as tolerated to prevent as high as 39.5° to
dehydration and electrolyte imbalance. 40.0°C.

• Oral rehydration solutions (ORS) such as • Both pulse and respirations are weak
Pedialyte should be used for infants and and rapid, and the skin is pale and cool.
younger children as well as older children with
dehydration. • Infants may be apprehensive, listless,
• Children with intractable vomiting or severe and lethargic.
dehydration will require IV fluids.
• Obvious signs of dehydration such as
a depressed fontanelle, sunken eyes,
and poor skin turgor are
B. DIARRHEA
usually, present.
• Diarrhea that is acute is usually associated
with infection; chronic diarrhea is more likely
related to a malabsorptive or inflammatory XIII. DEHYDRATION
cause.
When diarrhea occurs, or when a child
DIFFERENT MICROBES THAT CAUSE becomes diaphoretic because of fever, the fluid
DIARRHEA: output can be markedly increased, quickly
leading to dehydration (excessive loss of fluid).
VIRUS: rotaviruses and adenoviruses.
A. ISOTONIC DEHYDRATION
BACTERIA: Campylobacter jejuni,
Salmonella, Clostridium difficile, and - occurs when a child’s body loses
Escherichia coli. more water than it absorbs (as with
diarrhea) or absorbs less fluid than it
PROTOZOA: Giardia lamblia
 excretes (as with nausea and • Mode of transmission: ingestion of
vomiting). contaminated food, especially chicken
- main result of isotonic dehydration is and raw eggs
a decrease in the volume of blood
serum.
B. LISTERIOSIS
B. HYPOTONIC DEHYDRATION
• Causative agent: Listeria
• there is a disproportionately high loss monocytogenes
of electrolytes in proportion to fluid
loss. • Incubation period: variable, ranging
from 1 day to more than 3 weeks
• plasma concentration of sodium and
chloride are low. • Mode of transmission: ingestion of
unpasteurized milk or cheeses or
• could result from excessive loss of vegetables grown in contaminated soil.
electrolytes by vomiting, from an The infection is particularly important to
increased loss of salt from diuresis, or avoid during pregnancy because
from diseases such as adrenocortical infections during pregnancy can lead to
insufficiency or diabetic acidosis. miscarriage or stillbirth, prematurity, or
infection of the
newborn.
C. HYPERTONIC DEHYDRATION

• When water is lost in a greater C. SHIGELLOSIS (DYSENTERY)

proportion than electrolytes,
hypertonic dehydration occurs • Causative agent: organisms of the
genus Shigella
• might occur in a child with nausea
(thus preventing fluid intake) and fever • Incubation period: 1 to 7 days
(which increases fluid loss
through perspiration); • Period of communicability:
• profuse diarrhea, where there is a approximately 1 to 4 weeks
greater loss of fluid than salt.
• Mode of transmission: contaminated
food, water, or milk products

D. STAPHYLOCOCCAL FOOD POISONING

• Causative agent: staphylococcal

enterotoxin produced by some strains of
Staphylococcus aureus.

• Incubation period: 1 to 7 hours

• Period of communicability: Carriers

XIV. BACTERIAL INFECTIOUS may contaminate food as long as they
DISEASES THAT CAUSE harbor the organism.
DIARRHEA AND VOMITING
• Mode of transmission: ingestion of
contaminated food such as poultry,
A. SALMONELLOSIS creamed foods (e.g., potato
salad), and inadequate cooking.
• Causative agent: one of the
Salmonella bacteria
E. PROTOZOAN OR VIRAL DIARRHEA
• Incubation period: 6 to 72 hours for
intraluminal type; 7 to 14 days for • Most protozoan or viral diarrhea results in
extraluminal type loose, watery stools.
• The chief therapy for these is ORS. Children
• Period of communicability: if who are cultured with G. lamblia may be
organisms are being excreted (may be as prescribed metronidazole.
long as 3 months)
 XV. ELECTROLYTE IMBALANCES • Active artificial immunity: attenuated live
virus vaccine (e.g., MMR vaccine).
• Retaining fluid is of greater importance in the
body chemistry of infants than that of adults • Passive artificial immunity: Immune serum
because globulin is considered for pregnant women
exposed to the virus.
fluid constitutes a greater fraction of the
infant’s total weight. • In younger children, the rash is the first
manifestation of the disease with no prodrome.
• In infants, it accounts for as much as 75% to
80% of total weight; in children, it averages • rash is characterized by a discrete pink-red
approximately 65% to 70%. maculopapular rash that begins on the face
and then spreads downward to the trunk and
• Fluid is distributed in three body
extremities.
compartments:
In older children and adolescents, the disease
– (a) intracellular (within cells), 35% to 40% of
has a :
body weight;
• 1- to 5- day prodromal period
– (b) interstitial (surrounding cells), 20% of
body weight; and • during which children have a low-grade fever,
headache, malaise, anorexia, mild
–KH, (c) intravascular (blood plasma), 5% of
conjunctivitis, upper respiratory symptoms,
body weight.
and lymphadenopathy such as those in the
suboccipital, postauricular, and cervical
• Together, the interstitial and the chains.
intravascular fluid are often referred to as
Note:
extracellular fluid (ECF), totaling 25% of body
weight. • If a woman contracts rubella while pregnant,
it can cause extensive congenital malformation
• In infants, the ECF portion is much greater,
in the fetus.
totaling up to 45% of total body weight.
• In young children, this amount is 30%; in
adolescents, it is 25%. C. MEASLES (RUBEOLA)
• Causative agent: measles virus
XVI. VIRAL EXANTHEMS • Mode of transmission: direct contact with
droplets or airborne spread.
• Viruses cause childhood exanthems (skin
rashes). • Active artificial immunity: attenuated live
measles vaccine (e.g., MMR).
A. ROSEOLA INFANTUM (EXANTHEM
SUBITEM) • Passive artificial immunity: immune serum
globulin.
• Measles is an acute febrile viral illness
associated with cough, coryza (clear nasal
discharge), and conjunctivitis (the “three Cs”).
with a confluent maculopapular,
erythematous rash, which starts behind
the ear and spreads to the feet.
A hallmark symptoms of Rubeola: Koplik
spots, or small white spots with a bluish white
center on an erythematous background, are
seen in the oral mucosa opposite the buccal
mucosa before symptoms appear; a hallmark
symptom.

D. CHICKENPOX (VARICELLA)

B. RUBELLA (GERMAN MEASLES) • Causative agent: varicella-zoster virus

(VZV).
• Causative agent: rubella virus • Mode of transmission: highly
• Mode of transmission: direct and indirect contagious; spread by direct or indirect
contact with droplet. contact of saliva or open vesicles.
Note: because VZV is latent, it causes herpes • Causative agent: smallpox virus
zoster (shingles) when it is reactivated later. • Mode of transmission: airborne
transmission
• Passive artificial immunity: children who are
• patients with smallpox develop a febrile
immunosuppressed, such as those with
prodrome not seen in varicella
leukemia or HIV/AIDS, or those who are being
• pustular lesions are firm and deeply
treated with corticosteroids are offered
embedded in the skin dermal layer.
varicella-zoster immune globulin (VZIG) within
72 hours of exposure to help prevent or modify
disease symptoms.
• lesions of varicella present as a macule,
papule, and vesicle all appearing at the same
time, starting on the trunk and progressing
outward to the arms, face, legs, and mucosal
surfaces including the genitalia.
Note: all four stages of lesions (macule, papule,
vesicle, and crust) may be present at the same REMEMBER THIS!
time. • severe prodrome phase for this disease with a
• Topical oatmeal-based creams along with an high fever from 38.9° to 40.0°C and symptoms
antihistamine such as diphenhydramine that include headache, abdominal pain,
(Benadryl) can reduce the pruritus, and an malaise, and severe fatigue.
antipyretic such as acetaminophen (Tylenol)
can reduce the fever
XVII. LEUKEMIAS & LYMPHOMAS
Note: When having chickenpox, remind the
parents to avoid aspirin and instead use
acetaminophen or ibuprofen to control fever.
A. THE LEUKEMIAS

1. Acute Lymphocytic
(Lymphoblastic) Leukemia.

Because of the rapid proliferation of so

many immature lymphocytes, the
production of red blood cells (RBCs)
and platelets declines.
With ALL, because the bone marrow
E. HERPES ZOSTER overproduces lymphocytes and
therefore is unable to continue normal
• Herpes zoster is a reactivation of the production of other blood components,
VZV. the first symptoms of ALL in children
usually are those associated with
• herpes viral family has viral latency, decreased RBC production (anemia)
which means that once you develop such as pallor, low-grade fever, and
varicella, the virus lies latent in the lethargy.
posterior dorsal root ganglia.
CHEMOTHERAPY PROGRAM (3 PHASES)
• first manifestations are paresthesia ✓ Induction Phase: first, achieving
and pain with subsequent groups of a complete remission or absence
vesicular lesions. of leukemia cells.
✓ Sanctuary or Consolidation
• Treatment for herpes zoster includes Phase: second, preventing
analgesia for pain and measures to leukemia cells from invading or
reduce pruritus. growing in the CNS
✓ Maintenance Phase: third,
administering delayed intensive
therapy; and fourth, maintaining
the original remission.
Complications: Central Nervous System
Involvement
✓ If CNS involvement occurs, it can cause
F. SMALLPOX (VARIOLA) significant complications. Blindness,
hydrocephalus, and recurrent seizures
 are possible, although the meninges
and the sixth and seventh cranial The first indicators of disease are
nerves are the structures most often enlarged lymph nodes of the neck or
affected. abdomen.

Complications: Renal Involvement

XVIII. BONE AND BRAIN TUMORS
✓ Kidney involvement, resulting from
invasion of leukemia cells or obstruction
of renal tubules with uric acid crystals, A. BRAIN TUMORS
is another serious complication. The
kidneys enlarge, and their function will Brain tumors are the second most common
be impaired. form of cancer and the most common solid
tumor in children.
Complications: Testicular Involvement
✓ Males are at risk for testicular invasion
with leukemic cells. In children, brain tumors tend to occur at the
midline in the brainstem or cerebellum and be
2. Acute Myeloid Leukemia (AML) located beneath the tentorial membrane.

Acute myeloid leukemia (AML) involves

the over proliferation of granulocytes TYPES OF BRAIN TUMORS
(neutrophils, basophils, and
most common brain tumors are cerebellar
eosinophils).
astrocytomas, medulloblastomas, and
With AML, granulocytes grow so rapidly
brainstem gliomas.
that they are forced out into the
bloodstream while still in the blast stage; Astrocytomas - are slow-growing, cystic
these immature cells are not able to tumors that arise from the glial or
carry out normal immune functions and support tissue surrounding neural cells.
put the child at risk for infection.
Medulloblastomas - are fast-growing
tumors found most commonly in the
B. THE LYMPHOMAS cerebellum.

Lymphomas are malignancies of the lymph or Brainstem gliomas - often cause

reticuloendothelial system. paralysis of the 5th, 6th, 7th, 9th, and
1. Hodgkin’s Lymphoma 10th cranial nerves.

Symptoms of Hodgkin disease usually Children with any form of brain tumor develop
begin with the enlargement of only one symptoms of increased intracranial pressure:
painless, enlarged, rubbery lymph node. headache, vision changes, vomiting, an
The child may report accompanying enlarging head circumference, or papilledema.
symptoms of anorexia, malaise, night
sweats, and loss of weight. WHAT ARE LATE SIGNS OF BRAIN TUMOR?
Lethargy, projectile vomiting, and coma
are late signs.
2. Non-Hodgkin’s Lymphoma
As tumor growth continues, symptoms of
malignant disorders of the lymphocytes ataxia, personality change (e.g., emotional
(either B or T cells) and occur in several lability, irritability), and seizures may occur.
forms.
Unlike Hodgkin disease, spread from the
original site is through the bloodstream Therapy for brain tumors includes a
rather than directly by lymph flow, combination of surgery, radiation, and
making the course of the disease chemotherapy, depending on the location and
unpredictable. extent of the tumor.
If mediastinal lymph glands are swollen,
WHAT ARE COMMONLY DRUGS USED IN
the child may notice a cough or chest
BRAIN TUMORE?
“tightness.”
Typical drugs used are carboplatin or a
3. Burkitt Lymphoma combination of thioguanine,
procarbazine, lomustine, and
Burkitt lymphoma (a non-Hodgkin vincristine.
lymphoma involving B-lymphocyte cells)
is a rarer form of lymphoma.
The beginning movements of the seizure can ✓ a primary site outside the skeletal
help localize the point of maximum brain system where it is referred to as a
pressure. primitive neuroectodermal tumor
(PNET).
Preoperative Care
✓ pain becomes constant and so
✓ Before brain surgery, a child will usually severe the child cannot sleep at
receive a stool softener to prevent night. X-rays will reveal an
straining with bowel movements. unusual “onion-skin” reaction
✓ Dexamethasone (Decadron) may be (overlapping fine lines disclosed
prescribed to reduce cranial edema. on the Xray film) surrounding the
✓ An anticonvulsant will be prescribed if invading tumor cells.
the child is experiencing seizures.
Postoperative Care
✓ position the child as prescribed by the
Neuroblastoma
surgical team, as the best position for
✓ tumors that arise from the cells of
the child depends on the location of the
the sympathetic nervous system.
tumor and the extent of surgery.
✓ most common abdominal tumor
✓ child is positioned on the side opposite
in childhood.
the surgical incision.
✓ growing tumor is most often
✓ Keep the bed flat or only slightly
discovered on abdominal
elevated- this helps to reduce
palpation.
intracranial pressure from
✓ Pressure on the adrenal glands
accumulation of fluid in the surgical
from the tumor may cause
area.
excessive sweating, flushed face,
and hypertension.
✓ Compression on the spinal nerves
B. BONE TUMORS or invasion into the intervertebral
Tumors derived from connective tissue, such as foramina may cause loss of motor
bone and cartilage, muscle, blood vessels, or function in lower extremities.
lymphoid tissue, are termed sarcomas. ✓ swallowing may be difficult, and
neck and facial edema may occur
The two most frequently occurring types are from compression on the vena
osteogenic sarcoma and Ewing sarcoma. cava.
✓ tumor is localized (stage I or II)
✓ tumor is stage III (lymph nodes
TYPES OF BONE TUMORS are involved) or stage IV
(metastasis has occurred).
Osteogenic Sarcoma
✓ malignant tumor of long bone
involving rapidly growing bone
Rhabdomyosarcoma
tissue (mesenchymal-matrix
✓ tumor of striated muscle.
forming cells).
✓ It arises from the embryonic
✓ occurs more commonly in boys
mesenchyme tissue that forms
than in girls and in children who
muscle, connective, and vascular
have had radiation.
tissue.
✓ most common sites of occurrence
✓ Common sites of occurrence
are the distal femur, the proximal
include the eye orbit, paranasal
tibia, and the proximal humerus.
sinuses, uterus, prostate,
In osteogenic sarcoma, what is prescribed to bladder, retroperitoneum, arms,
shrink the tumor before surgery? and legs.
➢ Chemotherapy – common
chemotherapy drug regimen used for
treatment includes methotrexate,
cisplatin, doxorubicin, and ifosfamide.
2nd type is:
Ewing Sarcoma
✓ it occurs most frequently in the
bone marrow of the diaphyseal
area (midshaft) of long bones and
spreads longitudinally through
the bone.
 XIX. PARASITIC INFECTIONS

✓ primary treatment is surgical removal of

the tumor.

Nephroblastoma (Wilm’s Tumor)

o malignant tumor that rises from
the metanephric mesoderm cells
of the upper pole of the kidney.
o The tumor will be removed by
nephrectomy (excision of the
affected kidney).
TYPES OF PARASITIC INFECTIONS
o may occur in association with
congenital anomalies such as 1. HELMINTHIC INFECTIONS
aniridia (lack of color in the iris), o Helminths are pathogenic or
cryptorchidism, hypospadias, parasitic worms.
pseudo hermaphroditism, cystic o Includes:
kidneys, hemangioma, and - roundworms (nematodes)
talipes disorders. - flukes (trematodes)
o Complications such as nephritis, - or tapeworms (cestodes)
small bowel obstruction, and o Most helminths begin life when
hepatic damage caused by fibrotic the eggs or larvae are eliminated
scarring from radiation or scar in the feces or urine of humans.
tissue from surgery can occur.
2. ASCARIASIS (ROUND WORMS)
Retinoblastoma o Ascaris lumbricoides are
o malignant tumor of the retina of generally asymptomatic
the eye. infections but when there is an
o these tumors develop because of extensive parasite load,
an inherited autosomal dominant malnutrition and gastrointestinal
pattern that causes an alteration symptoms result.
of chromosome 13. o roundworm parasite lives in the
o Tumors are located on the retina. intestinal tract.
o On examination, the child’s pupil o Larvae, which hatch from the
appears white (the red reflex is ingested eggs, penetrate the
absent) or is described as a intestinal wall, and enter the
typical “cat’s eye.” circulation.
o If the tumor is very small at the o several treatment options:
time of diagnosis, it may be • a single dose of albendazole with
treated with cryosurgery (freezing food • nitazoxanide twice a day for
the tumor to destroy local cells). 3 days,
• a single dose of ivermectin (off-
label use and not to be used in
children less than 15 kg).

3. HOOKWORMS
o asymptomatic and are more
common in children living in
tropical climates with poor
sanitation.
o Abdominal pain which is colicky
in nature, nausea, and diarrhea
with marked eosinophilia can be
 a presenting sign 4 to 6 weeks central clearing and raised papular
after exposure. borders.
o If a great number of hookworms
are present, severe anemia may 5. C A N D I D I A S I S - Candida
result. albicans is a yeast that reproduces
o Treatment is with albendazole, by budding and, in well infants,
mebendazole, and pyrantel causes oral and skin monilial or
pamoate are effective. candida infections.
TYPES OF CANDIDIASIS:
4. PINWORMS (ENTEROBIASIS)
o Pinworms are small, white, •Oral candidiasis - or thrush, is
threadlike worms that live in the characterized by white plaques on an
cecum. erythematous base on the buccal
o The mature female pinworm then membrane and the surface of the
migrates out of the anus to tongue.
deposit eggs on the skin in the C. albicans can also cause a severe,
anal and perianal region. bright red, sharply circumscribed rash,
o movement of the worms causes most commonly in the diaper area.
the anal area to itch.
o Treatment is with a single dose of REMEMBER:
mebendazole or pyrantel pamoate Skin infections are treated with
(antihelminthic). antifungal drugs like nystatin,
clotrimazole, naftifine, ketoconazole,
econazole, ciclopirox, or miconazole.
XX. FUNGAL INFECTIONS
Fungi are larger than bacteria; some are
unicellular (yeasts), but generally, they are XXI. WHITE BLOOD CELLS DURING
multicellular (molds). INFECTIONS

• Subcutaneous mycoses- invade the skin,

subcutaneous tissue, and bone. • Neutrophils are the first line of defense and
• Superficial mycoses- invade only the hair, will activate another WBC, a monocyte, to
skin, or nails. become a macrophage

TYPES OF FUNGAL INFECTIONS • Macrophages have two roles—to clean cellular

debris and kill the infecting organism
SUPERFICIAL FUNGAL INFECTIONS
• The neutrophils, macrophages, complements,
1. Tinea cruris (jock itch) - a brownish and cytokines (such as leukotrienes,
to erythematous, well-demarcated interferons, and tumor necrosis factor alpha)
patch on the groin, inner thighs, and provide a host defense to help ward off
scrotum. infection.

2. Tinea pedis (athlete’s foot) -

produces pruritic, pinpoint vesicles
with fissuring between the toes and
on the plantar surface of the foot.

3. Tinea capitis - a dermatophytic

fungal infection of the scalp.
Can present one of four ways:
• a patchy alopecia with short 2 to 4 mm
broken-off hair shafts
• a well demarcated scaling erythematous
patch in circular area
• a yellow crusting, perifollicular erythema of
scalp which has heavy hair loss
• a kerion or boggy circular area of hair loss
which is the result of an inflammatory response
to the fungus. XXII. Hirschsprung disease (aganglionic
megacolon)
4. Tinea corporis - ring-like infection of
the epidermal layer of the skin absence of ganglionic innervation(cells)
characterized by slightly scaly to the muscle of a section of the bowel.
 most common cause of abdominal
surgery in children.
occurs most frequently in school-age
children and adolescents.

absence of nerve cells means there are

no peristaltic waves in this section to
move fecal material through the segment
of intestine.
results in chronic constipation or
ribbonlike stools (stools passing through appendix, a blind-ended pouch attached
such a small, narrow segment look like to the cecum, may become inflamed
ribbons). because of an upper respiratory or other
children appear thin and body infection, but the cause of
undernourished. appendicitis is generally obscure.
aganglionic colon disease, the rectum is most instances, fecal material
empty because fecal material cannot apparently enters the appendix,
pass into the rectum through the hardens, and obstructs the appendiceal
obstructed portion. lumen.
pain is a late symptom.

XXIII. Intussusception Diagnosis is made on a cluster of symptoms:

Intussusception (in-tuh-suh-SEP-shun) is a – anorexia, – pain or tenderness in the right

serious condition in which part of the intestine lower quadrant, – nausea or vomiting, –
slides into an adjacent part of the intestine. elevation of temperature, and – leukocytosis.
This telescoping action often blocks food or The point of sharpest pain is often one
fluid from passing through. Intussusception third of the way between the anterior
also cuts off the blood supply to the part of the superior iliac crest and the umbilicus
intestine that's affected. (McBurney’s point).
Therapy for appendicitis is surgical
removal of the appendix by laparoscopy
before it ruptures.

XXV. VOLVULUS WITH MALROTATION

volvulus is a twisting of the intestine.

twist leads to obstruction of the passage
of feces and to compromise of the blood
supply to the loop of intestine involved.
Volvulus occurs due to intestinal
frequently occurs in the second half of malrotation and may be associated with
the first year of life with 90% of cases other congenital anomalies.
occurring by 2 years of age.
The point of the invagination is generally
at the juncture of the distal ileum and
proximal colon.
The stool is described as having a “red
currant jelly” appearance due to the
blood and mucus it contains.

XXIV. APPENDICITIS
 A volvulus can be differentiated from
pyloric stenosis because vomiting with
pyloric stenosis occurs immediately after
feeding, whereas pain and vomiting from
a volvulus is unrelated to feeding.
Surgery is an emergency and should be
performed before necrosis of the
intestine occurs from a lack of blood
supply to the involved loop of bowel.

------------------------------------------------------END

OWNER: ESPERILA, MYKA L.

BSN 2-7
BACHELOR OF SCIENCE IN NURSING
EAC-C