PEDIATRIC CASE NOTES

By BSN 2-1 (Group 3)

MENINGITIS
Meningitis is the inflammation of the tissue surrounding the brain and spinal cord.
Different types of meningitis include bacterial meningitis, fungal meningitis, parasitic
meningitis, noninfectious meningitis, viral meningitis, and acute meningitis. It can
affect all ages but young children are most at risk. Inflammation from meningitis
triggers signs and symptoms such as headache, nausea, vomiting ,fever, seizure, and
stiff neck. Meningitis can detect through lumbar puncture or spinal tap, blood
cultures, and imaging or CT scan.

CAUSATIVE AGENT OF MENINGITIS

Streptococcus pneumoniae MOST FREQUENT ONES
Haemophilus influenzae BACTERIA THAT CAN CAUSE
MENINGITIS
Neisseria meningitidis

PREDISPOSING FACTORS
Diabetes
AIDS
alcohol use disorder
use of immunosuppressant drugs and
other factor that affect the immune system increases the risk for
having meningitis.

NURSING MANAGEMENT
Nursing management
Monitor and record vital signs BP,TEMP,RR and PR
Elevate head of the bed to 30° with straight neck for venous drainage from brain
Assess patient mental status and provide psychological support
Administer antibiotics as prescribed
Ensure patient has IV line for fluids and medication
Apply side rails for patient safety measure as patient may fall down while having seizure

MEDICAL MANAGEMENT
Antibiotics are given directly to vein
Fluids given directly to vein to prevent dehydration
Oxygen therapy if there are difficulties of breathing
In some cases,steroids medication to help reduce swelling around brain
 HIV PEDIATRICS
HIV is a virus that weakens the immune system making the body less able to fight
infections and cancers. Without proper treatment, it can lead to advance stage called
AIDS ( Acquired Immunodeficiency Syndrome)

DETECTION: HIV ANTIBODY TEST

TRANSMISSION: Can acquire the virus from their HIV positive mother during pregnancy,
delivery, and through breastfeeding

CAUSATIVE AGENT OF HIV

Human Immunodeficiency Virus
Destroying white blood cells called CD4 T cells
EFFECTS
Slow growth & weight gain
Severe wasting
Diarrhea
Upper Respiratory Tract Infection
Tuberculosis
Enlargement of lymph nodes
Hepatitis
Nephritis
Heart problems

NURSING MANAGEMENT
Assess for signs of opportunistic infections and other complications
Regularly monitor CD4+ T-cell counts and viral load
Administer medications as prescribed
Conduct routine growth and development assessments
Monitor for any side effects or adverse effects of the medications

MEDICAL MANAGEMENT
Antiretroviral Therapy - drugs that improve immune function
Prophylactic treatments like Cotrimoxazole to prevent life threatening infections
Routine vaccination (Hepa B, Rota Virus, etc.)
 ABO INCOMPATIBILITY
ABO incompatibility occurs when a mother’s blood type is O, and her baby’s blood
type is A, B, or AB. The mother's immune system may produce antibodies against the
A or B antigens found on the baby's red blood cells. These antibodies can cross the
placenta and attack the baby’s red blood cells, leading to their destruction
(hemolysis)
SYMPTOMS
Jaundice (yellowing of the skin and eyes), which is the most common symptom due to elevated bilirubin levels
from red blood cell breakdown. Anemia, though it is usually mild, as red blood cells are destroyed faster than
they can be replaced.
Enlarged liver or spleen, in severe cases, as these organs work harder to break down damaged red blood cells.
Dark urine, which may result from excess bilirubin.
Lethargy or low energy levels, as a result of anemia.
Poor feeding or difficulty feeding due to jaundice and lethargy.
Pale skin, due to anemia in rare cases of more severe red blood cell destruction.

RH INCOMPATIBILITY
Rh incompatibility occurs when a mother is Rh-negative and her fetus is Rh-positive.
During pregnancy or delivery, some of the fetus's Rh-positive red blood cells may
enter the mother's bloodstream. This causes the mother's immune system to produce
antibodies against the Rh antigen, seeing it as foreign. In a first pregnancy, this is
usually not a problem, as the mother’s immune system hasn’t yet produced many
antibodies. However, in subsequent pregnancies with another Rh-positive fetus, the
antibodies can cross the placenta and attack the baby's red blood cells. This can lead
to hemolytic disease of the newborn (HDN), which can cause severe anemia, jaundice,
and even heart failure in the baby.
SYMPTOMS
Jaundice (yellowing of the skin and eyes) due to the breakdown of red blood cells.
Anemia, as red blood cells are destroyed faster than they can be replaced.
Enlarged liver and spleen due to increased blood cell production.
Edema (swelling) from fluid buildup in the baby's tissues.
Breathing difficulties, especially if heart failure or severe anemia occurs.
Lethargy and reduced activity due to low oxygen levels from anemia.
Poor feeding in newborns with severe anemia.
PREDISPOSING FACTOR
It is genetically acquired

NURSING RESPONSIBILITIES
Monitor for Jaundice:.
Monitor Bilirubin Levels:
Phototherapy
Monitor for Anemia:
Provide Immunoglobulin Therapy:
Prepare for Exchange Transfusion:
Monitor Vital Signs:.
Educate Parents:.
Support Breastfeeding:

MEDICAL MANAGEMENT
Rh-negative mothers are given RhoGAM (Rh immunoglobulin) during pregnancy and after
delivery. RhoGAM prevents the mother's immune system from becoming sensitized to Rh-
positive cells.
·In severe cases, treatments like blood transfusions may be needed. Early detection and
management are crucial to preventing complications. It is applied for both ABO And Rh
incompatability
 ADHD
ADHD which means Attention-Deficit Hyperactivity Disorder is a neurodevelopmental
disorder that commonly affects young children and elderly due to lack of activity in a
specific part of the brain and other factors. It is associated with abnormally low
levels of neurotransmitters transmitting between the prefrontal cortex and the basal
ganglia. This causes dysfunctional neural networking in the above parts of the brain
such as the gray and white matter that leads to symptoms like lack of Alertness,
shortened attention span, and decreased efficiency of memory.
TYPES OD ADHD
Predominantly inattentive presentation
Predominantly hyperactive-impulsive presentation
Combined presentation
PREDOMINANTLY INATTENTIVE PRESENTATION
People with difficulty focusing, following through on tasks, and organizing
work but no impulsive and hyperactivity
PREDOMINANTLY HYPERACTIVE-IMPULSIVE PRESENTATION
People are very active and fidgety, and impulsive but may not struggle
with attention.
COMBINED PRESENTATION
Shows both hyperactivity/impulsiveness and inattentiveness. This is the
most common type of ADHD
PREDISPOSING FACTORS
Genetics
Environmental Factors such as exposure to lead at a very young age
Head Injury
Preterm birth
Alcohol and nicotine exposure during pregnancy
NURSING RESPONSIBILITIES
Patient education
Medication Management
Behavioral Interventions
Environmental Modifications
Support for social stress
Family Support
School Collaboration
Emotional support
Monitor for comorbid conditions
Promote healthy lifestyle habits
MEDICAL MANAGEMENT
Medication option ( Stimulants such as methylphenidate and Amphetamines: Enhancing the
dopamine and norepinephrine levels to improve focus. Non-Stimulants such as Atomoxetine,
Guanfacine, Clonidine: Alternative for those who cannot tolerate stimulants.
Behavioral and Psychosocial Therapies
Collaboration with other professional
 RESPIRATORY DISTRESS
SYNDROME
Respiratory distress syndrome (RDS) occurs in babies born early (premature) whose
lungs are not fully developed. The earlier the infant is born, the more likely it is for
them to have RDS and need extra oxygen and help breathing. RDS is caused by the
baby not having enough surfactant in the lungs. Surfactant is a liquid made in the
lungs at about 26 weeks of pregnancy. As the fetus grows, the lungs make more
surfactant. Surfactant coats the tiny air sacs in the lungs and to help keep them
from collapsing. The air sacs must be open to allow oxygen to enter the blood from
the lungs and carbon dioxide to be released from the blood into the lungs. While RDS is
most common in babies born early, other newborns can get it.

SIGNS AND SYMPTOMS

Fast breathing very soon after birth
Grunting “ugh” sound with each breath
Changes in color of lips, fingers, and toes
Widening (flaring) of the nostrils with each breath
Chest retractions - skin over the breatbone and ribs pulls in during breathing
TREATMENT

Oxygen - Babies with RDS need extra oxygen. It may be given several ways:
Nasal cannula: A small tube with prongs is placed in the nostrils.
Continuous Positive Airway Pressure (CPAP): This machine gently pushes air or
oxygen into the lungs to keep the air sacs open.
Ventilator (for severe RDS): This is a machine that helps the infant breathe when
they cannot breathe well enough without help. A breathing tube is put down the
infant’s windpipe. This is called intubation (in-too-BAY-shun). The infant is then
placed on the ventilator to help them breathe.
Surfactant - Surfactant can be given into the baby’s lungs to replace what they do
not have. This is given directly down the breathing tube that was placed in the
windpipe.
Intravenous (IV) catheter treatments - A very small tube called a catheter, is
placed into one or two of the blood vessels in the umbilical cord. This is how the
infant gets IV fluids, nutrition and medicines. It is also used to take blood samples.
Medicines - Sometimes antibiotics are given if an infection is suspected. Calming
medicines may be given to help ease pain during treatment.
NURSING RESPONSIBILITIES
The medical device tubing can get wrapped around a child’s neck. This can lead to choking
(strangulation) or death.
DO NOT leave the medical device tubing where infants or children can get tangled up in it.
If your child is injured by the medical device tubing, please report the event to the FDA. Your
report can provide information that helps improve patient safety. The website to make a
report
 SPINA BIFIDA
Spina bifida is a congenital defect that occurs when the spine and spinal cord do not
form properly during early fetal development. It is a type of neural tube defect
(NTD), where the neural tube (which eventually forms the brain and spinal cord) fails
to close completely.
TYPES OF SPINA BIFIDA
Spina Bifida Occulta: The mildest form, often unnoticed because there is no visible
opening on the back, just a small gap in the spine.
Meningocele: In this type, the meninges (protective coverings of the spinal cord)
protrude through an opening in the spine but the spinal cord itself is not involved.
Myelomeningocele: The most severe form, where both the meninges and the spinal
cord protrude through the opening. This can cause significant neurological impairment.

SYMPTOMS
Spina Bifida Occulta:
Often asymptomatic but may present with subtle signs such as a tuft of hair, a
dimple, or a small lump over the defect.
Meningocele and Myelomeningocele:
Weakness or paralysis in the lower limbs
Loss of bladder or bowel control
Hydrocephalus (buildup of fluid in the brain)
Orthopedic issues (e.g., scoliosis, clubfoot)
Learning difficulties (in some cases)
Chiari II malformation (displacement of brain tissue into the spinal canal)

CAUSES
Folic acid deficiency during pregnancy
Genetic factors
Environmental influences (e.g., certain medications, diabetes, or obesity in the
mother)
Maternal diabetes or hyperthermia (elevated body temperature during
pregnancy)
NURSING RESPONSIBILITIES
Pre-Operative Care:
Infection prevention: Keep the sac moist and sterile if myelomeningocele is present.
Monitor for signs of increased intracranial pressure (e.g., bulging fontanelle, irritability) if
hydrocephalus is suspected.
Positioning: Place the child in a prone position to avoid pressure on the sac.
Provide emotional support to the parents.
Post-Operative Care (if surgery is performed):
Wound care: Monitor for signs of infection and ensure proper healing.
Monitor neurological function: Assess for any changes in motor or sensory function.
Bladder and bowel management: Interventions may include intermittent catheterization and
bowel training programs.
Educate parents: Teach the importance of follow-up care and potential long-term challenges,
such as mobility aids or special education needs.
Long-Term Care:
Prevent contractures and deformities by encouraging range-of-motion exercises and providing
physical therapy.
Skin care: Prevent pressure ulcers, particularly in children with impaired mobility or sensation.
Support developmental needs: Assess for learning disabilities and provide appropriate
interventions.

MEDICAL MANAGEMENT
1. Surgical Intervention:
Closure of the defect: Early surgical closure (within 24-48 hours after birth) to prevent
infection and protect exposed neural elements in cases of myelomeningocele.
Ventriculoperitoneal shunt placement: For hydrocephalus, a shunt may be placed to drain
excess cerebrospinal fluid from the brain to the abdomen.
2. Pharmacologic Therapy:
Antibiotics: To prevent or treat infections postoperatively or in cases of meningitis.
Anticholinergics and other medications may be used for bladder management.
3. Rehabilitation:
Physical therapy: Helps improve motor function and mobility.
Occupational therapy: Aids in daily activities and adaptive techniques for the child.
Orthopedic interventions: Braces or surgery for deformities, such as scoliosis or clubfoot.

Early detection through prenatal care, including maternal folic acid supplementation, can significantly
reduce the incidence of spina bifida.
 ASTHMA IN
NEONATES
Asthma in neonates, although rare, can manifest as respiratory distress or wheezing.
In this age group, it may be challenging to diagnose since the lungs are still developing
and respiratory issues can be due to various factors. In many cases, what is thought
to be asthma in neonates could be transient wheezing or viral bronchiolitis.

CAUSES OF ASTHMA IN NEONATES

Genetic Predisposition: Family history of asthma or allergies may increase the risk of
a neonate developing respiratory conditions similar to asthma.
Environmental Factors:
1. Prenatal Exposure to Smoke: Maternal smoking or exposure to environmental tobacco
smoke increases the risk of asthma-like symptoms in neonates.
2. Air Pollutants: Exposure to air pollutants may affect lung development.
Prematurity: Preterm babies with underdeveloped lungs may be at a higher risk of
respiratory issues that resemble asthma.
Viral Infections: Respiratory syncytial virus (RSV) and other viral infections are
common triggers in early life.
Low Birth Weight: Associated with underdeveloped lungs, increasing the likelihood of
respiratory problems.
Maternal Health: Maternal conditions like infections, obesity, or poorly controlled
asthma during pregnancy can affect neonatal lung development.

TREATMENT
Oxygen Therapy: If the neonate experiences breathing difficulties, supplemental
oxygen may be provided.
Bronchodilators: In some cases, medications such as albuterol may be administered to
relieve airway constriction.
Corticosteroids: Steroids may be used to reduce inflammation in severe cases, though
they are not commonly used in neonates due to potential side effects.
Management of Underlying Causes: Treating any infections, reducing exposure to
allergens or irritants, and ensuring the neonate has a clean, smoke-free environment.
Nebulizers: Inhaled medications may be given through a nebulizer if appropriate.
Supportive Care: Includes fluid management, nutritional support, and monitoring for
complications like infections
NURSING RESPONSIBILITIES
1. Monitoring Respiratory Status:
2. Observe for signs of respiratory distress (increased respiratory rate, grunting, flaring
nostrils, retractions).
3. Monitor oxygen saturation and provide oxygen as needed.
4. Medication Administration:
5. Ensure the correct administration of bronchodilators or corticosteroids, monitoring for side
effects.
6. Educate parents on medication use if discharged with an inhaler or nebulizer.
7. Infection Control: Minimize exposure to infections by following hygiene protocols and advising
the family on preventive measures.
8. Parental Education:
9. Teach parents about asthma triggers, how to avoid them, and signs of respiratory distress.
10. Provide guidance on creating a smoke-free and pollutant-free environment.
11. Psychosocial Support: Offer emotional support to the family, especially if the neonate has
chronic respiratory problems or requires long-term treatment.
12. Collaboration with Healthcare Providers: Work with pediatricians, respiratory therapists, and
other healthcare professionals to create a care plan tailored to the neonate’s needs.
13. Documentation: Record the neonate's response to treatment, changes in respiratory status,
and any concerns or complications.
 DENGUE
Dengue- also called break-bone fever. It is viral infection that spreads from
mosquitoes bites and it is common in tropical and subtropical climates. Most people
who get dengue will not have symptoms. But for those who do, the most common
symptoms are high fever, headache, body aches, nausea, and rashes.
FOCUS
Plasma leakage
Low platelet counts
Rhythm abnormalities
FOUR TYPES OF DENGUE VIRUSES
DEN -1, 2, 3, and 4 (Serotypes) - they have different interactions with antibodies in human
blood or serum.
Severe cases = fatal
Treated with pain medicine as there is no specific treatment.

CAUSATIVE AGENT
Virus of Flavivindae family, Flavivirus genus
SIGNS AND SYMPTOMS
High Fever
Headache (severe)
Skin rashes
Mild bleeding (Gums and Nosebleed)
Abdominal Pain
Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS)
LABORATORY AND DIAGNOSTIC PROCEDURE
CBC
Dengue NSI Antigen Test
Dengue IgM and IgG Antibody Test
Liver Function test
NURSING RESPONSIBILITIES
1. Monitor the VS, Fluid intake/ output, signs of bleeding or shock, and lab results (Platelet,
hematocrit and WBC)
2. Provide oral or IV fluids as needed for hydration.
3. Use paracetamol for fever and avoid aspirin or NSAIDs.
4. Use mosquitos nets or repellent to prevent infection
5. Educate the patient about dengue. Inform them about warning signs of severe dengue
(vomiting, abdominal pain, bleeding)

MEDICAL MANAGEMENT
1. Oral fluids for mild cases and IV for moderate or severe
2. Use paracetamol for fever and blood transfusion for bleeding
3. Monitor Lob results and signs for severe dengue
4. Platelet transfusions for bleeding and fluid resuscitation for shock.
 BILIARY ATRESIA
Biliary atresia is a condition in infants where the bile ducts are absent or damaged,
obstructing bile flow from the liver to the intestine. The exact cause is unknown, but
it may involve genetic or environmental factors.

SYMPTOMS
Jaundice (Yellowing of skin and eyes
pale stools
dark urine
abdominal swelling
TREATMENT
Treatment typically involves a surgical procedure called the Kasai procedure to
restore bile flow, often followed by liver transplantation if the Kasai procedure
failed.

GASTROENTERITIS
Gastroenteritis in an inflammation in the stomach and intestines. It can cause nausea,
diarrhea, and vomiting, which may cause dehydration. It can also include body pain,
loss of appetite, fatigue, chills, and body aches in children and infants. people with
weakened immune system and people with less access to clean water, nutrition,
sanitation, and healthcare are more vulnerable to gastroenteritis.
CAUSATIVE AGENT
usually caused by a viral, bacterial, or parasitic infection. main types are: norovirus
and rotavirus
MEDICAL MANAGEMENT
Focuses on rehydration. drink plenty of fluids and get plenty of rest. do not consume
alcohol or caffeine
NURSING RESPONSIBILITIES
The nursing care plan goals for gastroenteritis include preventing dehydration by
promoting adequate fluid and electrolyte intake, managing symptoms such as nausea,
diarrhea, and preventing the spread of infections to others. Fluid therapy is a
fundamental part of treatment. drink fluids slowly in frequent, and small amounts.
 NEONATAL
SEPSIS
Neonatal sepsis is a type of neonatal infection and specifically refers to the
presence in a newborn baby of a bacterial bloodstream infection in the setting of
fever. Older textbooks may refer to neonatal sepsis as “neonatum”.
TYPES OF NEONATAL SEPSIS
EARLY-ONSET SEPSIS ( EOS)
Occurs within the first 72 hours of life. Get an infection from their birthing parent
before or during delivery.
LATE-ONSET SEPSIS (LOS)
Occurs after 72 hours, up to 28 days of life. Get an infection after delivery.
CAUSATIVE AGENT
Sepsis is usually caused by bacterial infections but may be result of other infections such
as viruses, parasites or fungi. It’s treatment requires medical care, including the use of
antimicrobials, intravenous fluid and other measures.
Staphylococcus aureus
Streptococcus pyogenes
Klebsiella spp.
Pseudomonas aeruginosa
PREDISPOSING FACTORS
Low apgar score ( <6 at 1 or 5)
Poor prenatal care
Poor maternal nutrition
Low socioeconomic status
Low birth weight
Poor environment
SIGNS AND SYMPTOMS
Poor feeding
Temperature instability ( fever or hypothermia)
Rapid breathing
Irritability
Vomiting
Jaundice
LABORATORY
BLOOD CULTURE - to identify bacteria or fungi in the bloodstream
CBC - to check for signs of infection, such as elevated white blood cells count
C-REACTIVE PROTEIN (CRP) - A marker that can indicate inflammation or infection.
NURSING RESPONSIBILITIES
Nursing care management for patients with sepsis or septic shock involves prompt assessment and
monitoring vital signs, fluid resuscitation with intravenous fluids, timely administration of
appropriate antibiotics, hemodynamic support with vasoactive medication, ensuring adequate
oxygenation and respiratory support.

MEDICAL MANAGEMENT
Resuscitation. Immediate resuscitation of a critically ill sepsis patient is not appreciably
different from non-septic patients.
Prompt and appropriate antimicrobial therapy
Blood glucose
Source control

TREATMENT
Treatment for sepsis in newborns may include:
Intravenous fluid
IV antibiotics to fight bacterial infections
Antiviral medication to fight viral infections
Heart and/or blood pressure medications
Extra oxygen and other forms of respiratory support, if needed.