Finals Maternal

FINALS MATERNAL LECTURE
Health Problems Common in Toddlers • Chemical burns – acids, alkali, organic compounds
A. Burns • Radiation burns – sunlight, medical therapies
· Are tissue injuries caused by contact with dry heat • Child abuse – immersion burns, contact burns (cigarettes)
(fire), moist heat (hot liquid or steam), chemicals, electricity,
radiation, lightening or extreme cold.
· Children younger than 2 years old have a greater Pathophysiology

chance of sustaining burn injuries compared to older
children. 1. Local damage depends on the degree of the burn
Classifications: v First-degree burns (superficial partial-thickness)
1. Extent of injury – measured by the percentage of total - result in destruction of the epidermis.
body surface area (TBSA) involved.
- physiologic functions remain intact and tissue damage
2. Depth of injury – based on the extent of destruction is minimal
§ superficial partial-thickness injury (First- degree burn) - the damage epithelium peels off in about 5-10 days
without scarring
§ Partial-thickness and deep partial-thickness injuries
(Second-degree burn) v Second-degree burns
§ Full thickness injury – third-degree burn a. Partial-thickness injuries result in destruction of the
epidermis and some of the dermis.
3. Severity of Injury – determined primarily by the extent
and depth of injury, but also - capillary damage occurs
by location of the injury - this type of burn usually heals spontaneously in about
14 days
· Major injury requires treatment at a specialized burn unit.
- scarring is minimal
· Moderate injury can be treated in a hospital.
b. Deep-partial thickness injuries result in destruction of
· Minor injuries can be treated on an outpatient basis. the epidermis and dermis
-heals more slowly by regeneration from the epithelial lining

of skin appendages, sweat glands and hair follicles
BURN TYPE MINOR MODERATE MAJOR
- require months to heal and scarring is common
Second <15% 15-25% TBSA, >25%
degree TBSA,adult adult TBSA, adult - edema resulting in compartment syndrome
(partial
thickness <10% TBSA, 10-20% TBSA, >20% v Third-degree burns result in destruction of the
child child TBSA, child epidermis, dermis, and the underlying tissue, which may
include fascia, muscle, tendon and bone
Third degree <2% TBSA, 2-10% TBSA, >10% TBSA
(full adult adult - will not heal without treatment and require skin grafting.
thickness)
- autograft scarring can be minimized by early excision and
TBSA – Total body surface area grafting.
American Burn Association 2. Systemic Damage – severe burns cause systemic

damage
Etiology
a. Respiratory compromise – inhalation injury leads to
• Thermal agents – fire, hot surface and hot liquids swelling in the tissues of the throat and upper way within
minutes of injury
• Electrical burns
- edema remains for 2-5 days
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b. Burn shock – hypovolemic shock can occur when burns - moderate pain with severe pain on exposure to air or
affect more than 15% to 20% of TBSA due to massive water
capillary leakage
- third-degree burns
c. Growth retardation – growth hormone levels are
suppressed § Dry, leathery skin surface
d. Accelerated metabolic rate – energy expenditure § Cherry red, white, or black skin color
increases from 40% to 100% above basal levels associated
with increased catecholamine levels, hyperglycemia, and § Edema
increased nutritional needs
§ Blisters (rare)
e. Local infection and sepsis – burns create moist, warm
environments for bacteria, including the body’s own flora. § No pain in area burn; very painful surrounding areas
Gram-positive organisms s.a. staphylococcus, and gram-
Classifications:
negative organisms, particularly pseudomonas aeruginosa,
colonize by the third day
1. Minor
Nursing Process
• First-degree burns or second-degree burns less than
10% TBSA
1. Assessment Findings
• Third-degree burns less than 2% TBSA

a. Clinical manifestations:
• No burns on face, feet, hands, or genitalia

- first-degree burns
2. Moderate
• dry skin area
• Second-degree burns 10% to 20% of TBSA

• Red skin color
• burns on face, feet, hands, or genitalia

• Minimal to no edema
• Third-degree burns 3% to 10% TBSA

• Blisters that appear after 24 hours
• Occurrence with smoke inhalation

• Pain and touch sensitivity
3. Severe
- Second-degree burns
· Second-degree burns greater than 20% TBSA

• Partial thickness
· Third-degree burns greater than 10% TBSA

- moist skin surface

- red to pale ivory skin color
Laboratory and Diagnostic Study Findings

- edema
• Fasting blood sugar is elevated due to altered glucose

- blisters that form within minutes and are thin walled and
metabolism
fluid filled
• Complete blood cell count reveals initial elevation of

- moderate pain
hematocrit from hemoconcentration
• Deep-partial thickness
• Electrolyte studies will reveal hyponatremia which is
- dry skin surface caused by a sodium shift from the intravascular to the
interstitial spaces, and hyperkalemia which is caused by cell
- mottled, waxy white skin color lysis
- edema • ABG studies will indicate metabolic acidosis due to

hypovolemia and cell damage
- flat, dehydrated, and tissue paperlike blisters (common),
fluid-filled blisters (possible)
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Nursing Diagnoses 6. Reduce pain
• Ineffective tissue perfusion 7. Maintain an adequate hydration status
• Risk for infection - monitor daily weights and fluid I and O
• Impaired skin integrity 8. Maintain normal thermoregulation
• Acute pain - minimize chilling shivering
• Risk for imbalanced fluid volume 9. Promote optimal nutrition
• Ineffective thermoregulation - high-calorie, high-protein
• Disturbed body image - record child’s food intake
• Interrupted family processes 10. Encourage optimal physical functioning and minimize
scarring
• Imbalanced nutrition: less than body requirements
- conduct ROM exercises

- encourage mobility
Care for Major Burns
- splint the joints in extension when sleeping to prevent
1. Assess for signs of respiratory distress, burn shock, fluid, contractures
and electrolyte imbalance, altered metabolism, and infection.
Assess for signs of vascular heat loss (coolness, - encourage self-help
acrocyanosis, and mottling)
- wrap healing tissue with elastic bandages to minimize
2. Administer prescribed medications scarring
- tetanus prophylaxis 11. Provide emotional support to child and family
- topical or IV antimicrobials and antibiotics 12. Prepare the child and family for discharge
- analgesics - teach about wound care
- antipruritics and soothing lotions - discuss diet, rest and activity
- vitamins A, B, and C, and iron and zinc - reinforce the need for follow-up care
- antipyretics
3. Promote optimal circulation to distal regions of the B. Poisoning

affected area
· Lead poisoning (plumbism)
- monitor for signs of compression, which are numbness,
tingling, color changes and temperature changes - one of the most common pediatric problems in the US
- assess diminished pulses and prolonged capillary refill - results from inhaling or ingesting lead-containing
substances
4. Prevent infection and promote wound healing
· Highest incidence: late infancy and toddlerhood
- maintain infection control precautions

- debride the eschar, crust, and blisters
Etiology
5. Maintain integrity of the skin graft
The child can be poisoned in 3 ways:
- maintain splints and dressings
1. Eating contaminated food or non-food substances
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2. Breathing contaminated air · High-dose: lead encephalopathy which is manifested by

seizures, mental retardation, paralysis, blindness, coma, and
3. Drinking contaminated water death.
• Exposure to household dust or yard soil contaminated

with lead – predominant cause of lead poisoning
Laboratory and diagnostic study finding: Lead Test –
• Exposure to any of the following sources of lead – paint serum lead level exceeding 10 mcg/dl (positive for lead
chips, powder from paint, gasoline, unglazed ceramic poisoning).
containers, lead crystal, water from lead pipes, batteries,
furniture refinishing supplies, art supplies, cosmetics and
certain industrial pollutants
Nursing Management

1. Monitor the child for manifestations of lead toxicity
Pathophysiology
2. Administer chelation therapy, as prescribed.
• Lead, which is very is slowly excreted through the
kidneys, GIT and slightly through sweat, is stored chiefly in · Succimer (Chemet)
the bone
- administer orally – can be opened and sprinkled on food
• When the rate of absorption surpasses the rate of
excretion, lead is deposited into soft tissues of the body and - adverse reactions – N/V, diarrhea, elevated liver enzyme
bone and attaches itself to RBCs which interferes with the levels and neutropenia
production of heme and the formation of hemoglobin, which
results in mycrocytic, hypochromic anemia
• Lead affects the kidneys by altering the permeability of · Dimercaprol

the proximal tubules, resulting in increased urinary
- do not give to children who are allergic to peanuts or to
elimination of glucose and protein
those with G6PD
• Lead deposits also increase vascular permeability
- Start iron therapy at least 24 hours after Dimercaprol
resulting in fluid shifts that lead to encephalopathy and
administration finishes (the medication forms a toxic
increased ICP.
compound with iron).

· Edetate calcium disodium
Assessment Findings
- carefully monitor renal functioning – appearance of
1. Associated finding: a history of pica may be determined sediment in urine may signal renal failure.
2. Clinical Manifestations: - Give medications by IV route; administer with procaine of

given IM (e.g. if client has encephalopathy).
a. Hematologic – signs of anemia
- Monitor for side effects: nephrotoxicity, headache,
b. Renal – glycosuria, ketonuria, proteinuria, anorexia, vomiting, elevated liver function tests and ECG
hyperphosphaturia changes.
c. GI – acute crampy abdominal pain, vomiting, 3. Encourage fluids to enhance lead excretion
constipation, and anorexia
4. Monitor fluid I and O to evaluate kidney function
d. Musculoskeletal – short stature and lead lines in bones on
x-ray films 5. Prepare the child and family for interventions, which vary
according to lead level scores.
e. Neurologic
a. Rescreen for lead in 1 year when the lead level is less
· Low-dose lead exposure: behavioral changes s.a. than 10 mcg/dl.
distractibility, hyperactivity, impulsivity, learning problems,
hearing impairment, and mild intellectual deficits b. Rescreen and provide family with lead education materials
when the lead level is 10-14 mcg/dl.
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c. Rescreen, look for sources, and educate parents when the - low self-esteem
lead level is 15-19 mcg/dl. If this lead level persists, initiate
actions for a lead level of 20-44 mcg/dl. - substance abuse
d. Conduct a medical examination; identify and eliminate - a history of cruelty to animals

sources of lead when the lead level is 20-44 mcg/dl.
2. Child Factors:
e. Begin treatment and environmental clearance in 48 hours
when the lead level is 45-69mcg/dl. - temperament
f. Begin treatment and environmental clearance immediately - illness, disability, developmental delay
when the lead level is 70 mcg/dl and over.
- illegimate or unwanted pregnancy
6. Perform prescribed serial urine testing during chelation
therapy to monitor kidney status and the rate and volume of - hyperkinesis
lead excretion.
- failure to bond

- resemblance to someone the parent does not like
4. Child Abuse
3. Environmental Factors
· Used to describe acts of commission or omission by
- chronic stress
caregivers that prevent a child from actualizing his or her
potential growth and development.
- poverty, poor housing, and unemployment
Types
- divorce
1. Physical Abuse – the intentional infliction of injury to a
- frequent relocation
child
4. Factors Specific to Sexual Abuse
2. Emotional Abuse – the deliberate attempt to destroy
the child’s self-esteem or competence
- the abuser is typically a male whom the victim knows
3. Neglect – can be physical or emotional

- offenders come from all socioeconomic levels
- physical neglect – deprivation of necessities such as

- father-daughter and stepfather-daughter incestuous
food and shelter.
relationship
- emotional neglect – failure to meet the child’s need for

attention, affection and emotional nurturing.
Nursing Process
4. Sexual Abuse – contact or interaction between a child
and an adult when the child is used for sexual stimulation of 1. Assessment Findings
an adult.
a. Clinical manifestations

· Physical Abuse
Etiology
-Physical indicators include cutaneous injuries (e.g. different
1. Parental Factors: stages of bruises in odd locations, burns (e.g. cigarette
marks); fractures; head injuries; eye injuries, mouth injuries,
- severe punishment of parents when they were children
poisonings, drownings, or repetitive accidents.
- poor impulse control

- Behavioral indicators include wariness of adults, fear of
parents, suffers pain without crying, afraid to go home,
- free expression of violence
superficial relationships, overly friendly, reports injury by
parents, or exhibits attention-seeking behaviors.
- social isolation
· Emotional Abuse
- poor social-emotional support system
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- Physical indicators include failure to thrive, developmental

lags, feeding problems, enuresis, or sleep problems.
Planning
- Behavioral indicators include habit disorders (e.g. rocking,
biting, and hair pulling), withdrawal, unusual fearfulness, 1. The child will experience no further harm or neglect.
conduct problems, behavioral extremes (e.g. very passive or
very aggressive), age-inappropriate behaviors, or attempted 2. The child will experience a reduction in fear and anxiety.
suicide.
3. The parents will exhibit positive interactions with the
· Neglect child.
- Physical indicators include failure to thrive, malnutrition,

constant hunger, poor hygiene, inappropriate clothing, bald
patches on infant, lack of adequate supervision, Implementation
abandonment or poor health care.
1. Protect the child from injury or neglect.
- Behavioral indicators include dull inactive infant, begging or
- Remove the child from an abusive environment.
stealing food, school attendance problems, drug and alcohol
abuse, delinquency.
- Report the incident to the proper authorities
· Sexual Abuse
- Document assessment findings carefully and
objectively.
- In many cases, there are no overt signs of sexual
abuse.
- Collaborate with the multidisciplinary team concerning
immediate and long term therapies to prevent further abuse.
- Possible physical indicators include difficulty walking or
sitting, torn, stained, and bloody underclothes, gross
2. Minimize the child’s fear and anxiety
evidence of trauma in the genital, oral, or anal regions; pain;
itching; STDs; genital discharge; pregnancy; weight loss;
- Demonstrate acceptance of the child during the
eating disorders; or vague somatic complaints
physical assessment.
- Behavioral indicators
- Carefully assess the child’s emotional status and
behavior.
v Under 5 years old: regression, feeding or toileting
disturbances, temper tantrums, requests for frequent
- Provide the child with positive attention and age-
underwear changes, and seductive behavior.no
appropriate play and activities.
v Between 5-10 years old: school problems, night terrors,

- Encourage the child to talk about fears and feelings.
sleep problems, anxieties, withdrawal, refusal of physical
activity, and inappropriate behaviors. - Encourage introduction to a foster family if the child is
to be placed in one.
v Adolescents: school problems, running away, delinquency,
promiscuity, drug and alcohol abuse, eating disorders, 3. Foster positive parenting.
depression, and other significant psychological problems
(e.g. suicide attempts) - Work with parents or caregivers on identifying and
changing factors that led to the abuse.

- Maintain a positive and caring attitude when dealing
Nursing Diagnoses with parents. And convey a sense of concern.
1. Risk for injury - Teach growth and development, child-rearing practices,

and effective discipline.
2. Fear
- Promote attachment
3. Anxiety

4. Risk for post-trauma syndrome
Evaluation
5. Altered parenting
1. The child remains free of harm and is not neglected.
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2. The child experiences less fear and anxiety. 1. Cerebral palsy commonly results from existing prenatal
brain abnormalities.
3. The parents demonstrate positive interactions with the
child. 2. Prematurity is the single most important determinant of
cerebral palsy.

3. Other prenatal or perinatal risk factors include asphyxia,
5. Cerebral Palsy ischemia, perinatal trauma, congenital and perinatal
infections, and perinatal metabolic problems, such as
· This is a group of disabilities caused by injury to the brain hyperbilirubinemia and hypoglycemia.
either before or during birth, or in early infancy.
4. Infection, trauma, and tumors can cause cerebral palsy in
· The most common permanent disability of childhood. early infancy.
5. Some cases (about 24%) of cerebral palsy remain

unexplained.
Classifications

2. Spastic Cerebral Palsy is the most common type and
may involve one or both sides of the body. Pathophysiology
b. Clinical hallmarks include hypertonicity with poor control 4. Disabilities usually result from injury to the cerebellum,
of posture, balance and coordinated movement, and the basal ganglia, or the motor cortex.
impairment of fine and gross motor skills. Active attempts at
motion increase the abnormal postures and lead to overflow 5. It is difficult to establish the precise location of neurologic
of movement to other parts of the body. lesions because there is no typical pathologic picture. In
some cases, the brain has gross malformations, in others,
c. Common types: vascular occlusion, atrophy, loss of neurons, and
degeneration may be evident.
· Hemiparesis – one side of the body is affected
6. Cerebral palsy is nonprogressive but may become more
· Quadriparesis – all four extremities are affected apparent as the child grows older.
· Diplegia is when similar body parts are affected, such as

both arms.
Assessment Findings
3. The Dyskinetic/athetoid type involves abnormal
involuntary movements that disappear during sleep and The most common clinical manifestation in all types of
increase with stress. cerebral palsy is delayed gross motor development.
a. Major manifestations are athetosis (wormlike movement), 4. Additional manifestations include:

dyskinetic movement of mouth, drooling, and dysarthria.
a. Abnormal motor performance (e.g. early dominant hand
b. Movements may become choreoid (irregular, jerky) and preference, abnormal and asymmetrical crawl, poor sucking,
dystonic (disordered muscle tone, especially when stressed feeding problems, or persistent tongue thrust).
and during the adolescent years.
b. Alterations of muscle tone (e.g. increased or decreased
4. The ataxic type is manifested by a wide-based gait, resistance to passive movements, child feels stiff when
rapid repetitive movements performed poorly, and handling or dressing, opisthotonos).
disintegration of movements of the upper extremities when
the child reaches for objects. c. Abnormal postures (e.g. scissoring legs or persistent
infantile posturing).
5. The mixed/dystonic type is manifested by a
combination of the characteristics of spastic and athetoid d. Reflex abnormalities (e.g. persistent primitive reflexes,
cerebral palsy. such as tonic neck or hyperreflexia.
5. Disabilities associated with cerebral palsy include mental

retardation, seizures, attention deficit disorder, and sensory
Etiology impairment.
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6. Severe cases may be observed at birth; mild and d. Technology such as computer use, may help children
moderate cases usually are not detected until the child is 1 with severe articulation problems.
or 2 years old. Failure to achieve milestones may be the first
sign. 9. As necessary, seek referrals for corrective lenses and
hearing devices to decrease sensory deprivation related to
7. Diagnosis is based on the following: vision and hearing losses.
a. Prenatal, birth, and postnatal history 10. Help promote a positive self-image in the child.
b. Neurologic examination a. Praise his accomplishments.
c. Assessment of muscle tone, behavior and abilities. b. Set realistic and attainable goals.
d. Other disorders such as metabolic disorders , c. Encourage an appealing physical appearance.

degenerative disorders and early slow-growing brain tumors,
are ruled out. d. Encouragement his involvement with age- and condition-
appropriate peer group activities.
8. All infants should receive periodic developmental
evaluations, especially those at risk. 11. Promote optimal family functioning
a. Encourage family members to express anxieties,

frustrations, and concerns and to explore support networks.
Nursing Management
b. Provide emotional support and help with problem-solving
1. Prevent physical injury by providing the child with a safe as necessary.
environment, appropriate toys, and protective gear (helmet,
kneepads), if needed. c. Refer the family to support organizations.
2. Prevent physical deformity by ensuring correct use of 12. Prepare the child and family for procedures, treatments
prescribed braces and other devices, and by performing and surgeries, if needed.
ROM exercises.
Health Problems Common in Pre-schoolers
3. Promote mobility by encouraging the child to perform
age- and condition-appropriate motor activities. A. Leukemia
4. Promote adequate fluid and nutritional intake. Description:
5. Foster relaxation and general health by providing rest  It is a proliferation of abnormal WBCs
periods.
 Several different types of leukemia exist, and
6. Administer prescribed medications, which may include classification has become a complex process.
sedatives, muscle relaxants, and anti-convulsion.
 The most common leukemia in children is acute
7. Encourage self-care by urging the child to participate in lymphocytic leukemia (ALL), which is a
activities of daily living (ADLs) (e.g. using utensils and proliferation of blast cells (immature lymphocytes.
implements that are appropriate for the child’s age and ALL is classified by form, structure and
condition). morphology of the blast cells.
8. Facilitate communication  Leukemia may be diagnosed at any age but has a

peak onset between 3 and 5 years of age.
a. Talk to the child deliberately and slowly, using pictures
to reinforce speech when needed.
b. Encourage early speech therapy to prevent poor or Etiology

maladaptive communication habits.
 Unknown; a few cases in adults have been linked
c. Provide a means of articulate speech such as sign to environmental factors such as chemicals and
language or a picture board. radiation.
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 Several genetic diseases have been associated e. CNS symptoms (if there is CNS metastasis) – headache,
with increase incidences of leukemia, including meningeal irritation and signs of increased ICP.
Down Syndrome, Fanconi anemia and Bloom
syndrome. f. General symptoms: weight loss, anorexia, vomiting
Pathophysiology 2. Laboratory and Diagnostic Study Findings
 Malignant leukemia cells arise from precursor cells a. CBC may reveal normal, decreased or increased WBC
in blood-forming elements. count with immature cells (blasts), decreased RBCs, and
decreased platelets.
 These cells can accumulate and crowd our normal
bone marrow elements, spill peripheral blood, and b. Bone marrow aspiration confirms the diagnosis by
eventually invade all body organs and tissues. revealing extensive replacement of normal bone marrow
elements by leukemic cells.
 Replacement of normal hematopoietic elements by
leukemic cells results in bone marrow suppression, c. Lumbar puncture assesses abnormal cell migration to the
which is marked by a decreased production of CNS.
RBCs, normal WBCs, and platelets.
Nursing Diagnoses
 Bone marrow suppression results in anemia from
decreased RBC production, predisposition to 1. Risk for injury
infection due to neutropenia, and bleeding
tendencies due to thrombocytopenia. These put 2. Risk for infection
the child at risk of death from infection or
3. Risk for trauma
hemorrhage.
4. Risk for fluid volume deficit

 Infiltration of reticuloendothelial organs (spleen,
liver, and lymph glands) causes marked
5. Altered nutrition: less than body requirements
enlargement, and eventually, fibrosis.
6. Altered oral mucous membranes
 Leukemic infiltration of the CNS results in
increased intracranial pressure (ICP) and other 7. Pain
effects, depending on the specific areas involved.
8. Risk for altered growth
 Other possible sites of long-term infiltration
include the kidneys, testes, prostate, ovaries, GI 9. Risk for altered development
tract, and lungs.
10. Altered family processes
 The hypermetabolic leukemic cells eventually
deprive all body cells of nutrients necessary for 11. Anticipatory grief
survival. Uncontrolled growth of leukemic cells can
actually result in metabolic starvation. Planning and Outcome
1. The child will experience complete or partial remission

from the disease.
Assessment Findings
2. The child will not experience an oncologic emergency.
1. Clinical Manifestations
3. The child will experience no to minimal infection.
a. Anemia – fatigue, pallor, tachycardia
4. The child will demonstrate no evidence of bleeding.
b. Bleeding which includes petechiae, purpura, hematuria,
epistaxis and tarry stools 5. The child will remain adequately hydrated and
experience minimal nausea and vomiting.
c. Immunosuppression – fever, infection, poor wound
healing 6. The child will receive adequate nutrition.
d. Hepatosplenomegaly, bone pain, and lymphadenopathy 7. The child’s oral mucous membranes will remain intact.
8. The child will be pain free.
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9. The child will maintain appropriate growth and 4. Prevent trauma from bleeding and immobility.
development.
5. Ensure adequate hydration.
10. The child and family will receive adequate support.
6. Prevent mucosities.
11. The child and family will cope with the possibility of
death 7. Prevent pain.
Nursing Management 7. Foster healthy growth and development.
1. Assist in ensuring partial or complete remission from the 8. Assist the family in coping with their child’s disorder.
disease by administering chemotherapy and by preventing or
minimizing, the complications of chemotherapy, radiation 9. Assist the child and family with the grieving process
and bone marrow transplant (BMT).

 Follow guidelines and institutional policies for
administration. B. Wilm's Tumor (Nephroblastoma)
 Observe for signs of infiltration and irritation at the Description:

infusion site.
 Wilm’s tumor is a malignant neoplasm of the
 Observe the child for 20 minutes to note any signs kidney. It is the most common intraabdominal
of anaphylaxis. tumor in children, and the most curable solid
tumor in children.
 Keep emergency equipment and medications
nearby.  Occurs most often in young children but may
occur in adolescents. The median age at diagnosis
 Monitor for specific chemotherapeutic side effects is between 2 and 3 years old.
as well as general side effects
 Usually it is unilateral and occurs with other
 Monitor for side effects of radiation therapy abnormalities such as an absent iris or
genitourinary problems.
 Monitor for complications of BMT
Etiology
- BMT, when successful, destroys leukemic cells and
replenishes the bone marrow with healthy cells  Unknown
 Siblings of children with Wilm’s tumor have a

higher risk of developing the disorder than the
Complications: general population.
- GIT: nausea, vomiting, anorexia, diarrhea, mucositis Pathophysiology
- Infections  The tumor originates from immature renoblast

cells located in the renal parenchyma.
- Anemia, bleeding
 It is well encapsulated in early stages but may
- Renal complications – hypovolemia, hypoproteinemia, later extend into lymph nodes and the renal vein
dehydration, septic shock or vena cava and metastasize to the lungs and
other sites.
- Interstitial pneumonia – fever, nasal flaring,
tachypnea, dyspnea, dry cough, hypoxia Five stages:
- Graft rejection or failure – fever, infection, decreased a. Stage I: tumor is confined in one kidney
blood count
b. Stage II: the tumor extends beyond kidney but can be
2. Monitor for, and minimize pediatric oncologic resected
emergencies
c. Satge III: the tumor has residual nonhematogenous tumor
3. Prevent infection. cells confined to the abdomen.
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d. Stage IV: The tumor is characterized by distant Etiology

metastases involving lung, liver. Bone, or brain.
 Commonly results from hyperresponsiveness of
e. Stage V: the tumor involves both kidneys the trachea and bronchi to irritants. Allergy
influences both the persistence and the severity of
Assessment Findings asthma, and atopy or the genetic predisposition
for the development of an IgE-mediated response
1. Clinical Manifestations to common airborne allergens is the strongest
predisposing factor for the development of
 Abdominal mass – common sign; usually asthma.
discovered during a routine assessment or by the
parents when bathing the child.  Common irritants include:
 Other characteristics may include fever, abdominal a. Allergen exposure

pain, hematuria, hypertension, and anorexia.
- dust mites
2. Laboratory and diagnostic study findings
- molds
 Ultrasound or CT scan reveals a mass
- animal danders
 Other studies may be performed if metastasis is
suspected. b. Viral infections
Nursing Management c. Irritants which include:
1. Assess the child for hypertension - air pollution
2. Do not palpate the abdomen – doing so can rupture the - smoke

encapsulated tumor and cause dissemination of the disease
to adjacent and distant sites. - perfumes
3. Administer medications (chemotherapeutic agents) - laundry detergents
4. Provide postoperative care d. certain foods (food additives)
- monitor bowel sounds and assess for signs and e. Rapid changes in environmental temperatures
symptoms of intestinal obstruction resulting from abdominal
surgery f. Exercise
- prevent infection g. Psychological stress
-prevent postoperative pulmonary complications
Pathophysiology
C. Asthma 1. An asthma attack may occur spontaneously or in

response to a trigger. Either way, the attack progresses in
Description: the following manner.
 Asthma is a chronic, reversible, obstructive airway a. There is an initial release of inflammatory mediators from
disease, characterized by wheezing. bronchial mast cells, epithelial cells, and macrophages,
followed by activation of other inflammatory cells.
 It is caused by a spasm of the bronchial tubes, or
the swelling of the bronchial mucosa, after b. Alterations of autonomic neural control of airway tone and
exposure to various stimuli. epithelial integrity occur and the increased responsiveness in
airway smooth muscle results in clinical manifestations
 It is the most common chronic disease in (wheezing and dyspnea).
childhood. Most children experience their first
symptoms by 5 years of age. 2. Three events contribute to clinical manifestations.
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a. Bronchial spasm 6. Discuss the need for periodic PFTs
b. Inflammation and edema of the mucosa 7. Provide child and family teaching
c. Production of thick mucus, which results in increased 8. Refer the family to appropriate community agencies for
airway resistance, premature closure of airways, assistance.
hyperinflation, increased work of breathing, and impaired
gas exchange.
3. If not treated promptly, status asthmaticus – an acute, D. Urinary Tract Infection (UTI)
severe, prolonged asthma attack that is unresponsive to the
usual treatment – may occur, requiring hospitalization. Description
 UTIs are characterized by inflammation usually of

bacterial origin of the urethra (urethtritis), bladder
Assessment Findings (cystitis), ureters (ureteritis), or kidneys
(pyelonephritis).
 Peak incidence occurs between 2 and 6 years of
a. Increased RR age, with increased incidence also noted in
adolescents who are sexually active.
b. Wheezing
 Girls have a 10 to 30 times greater risk of
c. productive cough developing UTIs than boys (except in neonates)
because of their shorter urethral structure, which
d. Use of accessory muscles in breathing provides a quick pathway for organisms.
e. Distant breath sounds  The recurrence rate in neonates is 25%, in older

children, it is 30%.
f. fatigue
Etiology
g. Moist skin
1. The gram-negative bacteria, Escherichia coli accounts
h. Anxiety and apprehension for 80% of all UTIs. The remaining 20% are caused by other
gram-negative bacteria, such as Proteus, Pseudomonas,
g. Dyspnea
Klebsiella, Haemophilus, and coagulase-negative
staphylococcus, and the gram-positive bacteria,
2. Laboratory and Diagnostic study
Staphylococcus aureus.
findings. Spirometry will detect:
2. In the neonate, the urinary tract may be infected via
a. Decreased forced expiratory volume (FEV)
the bloodstream.
b. Decreased peak expiratory flow rate (PEFR)
3. In older children, bacteria ascend the urethra,
creating an increased incidence in girls. Contributing factors
c. Diminished forced vital capacity (FVC)
include:
d. Diminished inspiratory capacity (IC)
a. Urinary stasis
Nursing Management:
b. Urinary reflux
1. Assess respiratory status.
c. Inadequate fluid intake
2. Administer prescribed medications
d. Poor perineal hygiene
3. Promote adequate oxygenation and a normal breathing
e. Constipation
pattern.
f. Pregnancy
4. Explain the possible use of hyposensitization therapy.
g. Noncircumcision
5. Help the child cope with poor self-esteem.
12
h. Indwelling catheter placement Nursing Management
i. Antimicrobial agents that alter normal urinary tract flora 1. Assess urinary status
j. Tight clothes or diapers 2. Administer prescribed antibiotics
k. Local inflammation 3. Prevent infection
l. Bubble bath 4. Provide comfort measures
Pathophysiology 5. Provide child and family teaching

1. In an uncomplicated UTI, inflammation usually is confined
to the lower urinary tract. Recurrent cystitis, however, may Health Problems Most Common in School Aged Children
produce anatomic changes in the ureter that lead to
vesicoureteral valve incompetence and resultant urine reflux. A. Diabetes mellitus
This provides organisms with access to the upper urinary
tract. Description
2. Pyelonephritis usually results from an ascending infection Ø DM is a chronic metabolic disorder that results from either
from the lower urinary tract. It can lead to acute and chronic a partial or complete deficiency of insulin
inflammatory changes in the pelvis and medulla, with
Ø Type 1 DM is characterized by pancreatic beta cells
scarring and loss of renal tissue.
destruction leading to absolute insulin deficiency.
3. Recurrent or chronic infection results in increased fibrotic
Ø Type 2 DM usually results from insulin resistance
tissue and kidney contraction
Ø Type 1 DM (insulin-requiring DM) is the most common

Assessment Findings
endocrine disease of childhood.
Characteristics vary with age and location of infection. About
Ø Long term complications: nephropathy, retinopathy and
40% of UTIs are asymptomatic.
neuropathy. Altered thyroid functioning is frequently noted in
1. Clinical manifestations children with diabetes.
a. Infants may exhibit irritability, constant squirming, fever Etiology

or hypothermia, jaundice, weight loss, FTT, vomiting and
Ø Type 1 DM is an autoimmune disease that develops when
diarrhea, diaper rash, and an abnormal urinary stream.
a genetically pre-disposed child is exposed to a precipitating
b. Older children exhibit manifestations according to where factor, such as a viral infection.
the infection is located

- foul-smelling urine, hematuria (possibly), dysuria,
Pathophysiology
increased frequency, increased urgency, incontinence, and
abdominal pain are seen with lower UTIs
1. Insulin is needed to support carbohydrate, protein, and
fat metabolism, primarily to facilitate entry of these
-Fever, costovertebral abdominal (CVA) tenderness, chills,
substances into cells.
and flank pain are seen with pyelonephritis.
2. Destruction of 80% to 90% of the pancreatic beta cells

2. Laboratory and diagnostic study findings
results in a clinically significant drop in insulin secretion.
a. Urinalysis: hematuria, proteinuria, and pyuria. Urine may
3. This loss of insulin, the major anabolic hormone, leads
have a foul odor and appear cloudy with strands of mucus.
to a catabolic state characterized by decreased glucose used,
b. Urine culture is used to confirm diagnosis through increased glucose production, and inability to store glycogen,
detection of bacteria. eventually resulting in hyperglycemia.
c. Ureteral catheterization, bladder washout procedures, and 4. In a state of insulin deficiency, glucagon, epinephrine,
radioisotope renography may be needed to localize the GH, and cortisol levels increase, secondary to fat breakdown,
infection. stimulating lipolysis, fatty acid release, and ketone
production.
d. Renal ultrasound
13
5. A persistent blood glucose concentration above 180 - Loss of coordination

mg/dl results in glycosuria, leading to osmotic diuresis with
polyuria and polydipsia. - Personality and mood changes
6. Excessive ketone production can cause diabetic - Slurred speech

ketoacidosis (DKA), an acutely life-threatening condition
characterized by marked hyperglycemia, metabolic acidosis, - Sleepiness
dehydration, and altered level of consciousness ranging from
lethargy to coma. - Nightmares
- Decreasing level of consciousness
Assessment Findings - Seizure activity
a. Classic symptoms: Laboratory and Diagnostic study findings
- Polydipsia a. Fasting blood sugar (FBS) will reveal a level above 120
mg/dl accompanied by a random blood glucose level above
- Polyuria 200 mg/dl
- Polyphagia b. Oral glucose tolerance test (OGTT) will reveal blood

glucose levels of 200 mg/dl or higher in a 2-hour sample.
- Fatigue

b. Other symptoms:
Nursing Management
- Weight loss
1. Assess the child daily for signs of hypoglycemia,
- dry skin hyperglycemia and complications
- Blurred vision 2. Provide care during an acute phase, such as DKA
c. Signs of DKA: - Assess neurologic status
- Hyperglycemia - Help prevent hypotension and convulsions
- Acidosis - Monitor electrolytes and cardiac status for signs of

hypokalemia
- Glycosuria
- promote adequate fluid volume
- Ketonuria
- test urine for ketones every 3 hours
d. Early signs of hypoglycemia
- administer insulin
- Trembling/tremors
3. Prevent injury related to insulin deficiency during daily
- Tachycardia management
- sweating -monitor blood glucose levels regularly
- anxiety -administer appropriate insulin amounts
- hunger -encourage an adequate diet for age
- pallor -collaborate with a nutritionist
- headache -encourage adequate rest and regular exercise
e. Late signs 4. Prevent injury related to hypoglycemia
14
- Recognize signs of hypoglycemia early, and be alert to a. A type of lesion, called an Aschoff body (a proliferating,
when blood sugar levels are at their lowest. fibrin-like plaque), forms on the heart valve causing edema
and inflammation.
- Offer a readily absorbed carbohydrate such as orange
juice, to alleviate early symptoms. b. When the healed area becomes fibrous and scarred, the
valve leaflets fuse (stenosis), causing inefficiency and
-Administer glucagon to the unconscious child. leakage.
5. Provide child and family teaching c. The mitral and aortic valves are affected most often.
6. Refer the family to an organization that can assist the

family in coping with diabetes
Assessment Findings
7. Promote a sense of self-esteem in the child
1. Clinical Manifestations – depend on the site of
involvement, the severity of the attack, and the stage at
which the child is first examined. The Jones criteria, which
B. Rheumatic Fever (RF) divides signs and symptoms into major and minor
characteristics of the disease, is used when assessing the
Description child with suspected RF.
Ø RF is a systemic inflammatory disease that occurs as a a. Major characteristics

result of naturally acquired immunity to group A beta-
hemolytic streptococcal infection. There is cardiac - Carditis – tachycardia, cardiomegaly, murmur, muffled
involvement in about 50% of cases. heart sounds, precordial friction rub, precordial pain and a
prolonged PR interval. Carditis can lead to CHF, pericardial
Ø It is the most common cause of acquired heart disease in friction rubs, cardiomegaly, and aortic or mitral valve
children worldwide. regurgitation. This is the most serious problem.
Ø RF usually occurs in children between 5 and 15 years of - Polyarthritis – swollen, hot, painful joints (usually large
age, with peak incidence at 8 years of age. joints). Polyarthritis is the most common presenting
symptom and it occurs in about 75% of all cases of RF.

- Chorea – sudden aimless, irregular movements of the
Etiology
extremities; involuntary facial grimaces; speech
disturbances; emotional lability; muscle weakness; and
Ø The onset of RF usually occurs 2-6 weeks after an
movements that increase with stress and decreased with
untreated upper respiratory infection with group A beta-
rest. It occurs in about 10% of all cases.
hemolytic streptococci
- Erythema marginatum – clear-centered, transitory,
Ø It is believed that a genetic susceptibility to RF is
nonpruritic macules, with defined boarders. They are noted
associated with a state of immune hyperactivity to the
mostly on the trunk and proximal extremities. This occurs in
streptococcal antigens
about 5% of all cases.
Ø Exact etiology is unknown
- Subcutaneous nodules are non-tender lesions that may
persist, then resolve. They are located over bony

prominences. These rarely occur in RF.
Pathophysiology

1. The child becomes infected with group A beta-hemolytic
a. Minor Characteristics – fever, arthralgia and specific
streptococcal bacteria.
laboratory findings
2. Antibodies formed against these bacteria begin to

attack the connective tissue of the body, producing
inflammation, which affects the heart, joints, central nervous
Laboratory and diagnostic study findings
system and subcutaneous tissue.
a. Laboratory findings consistent with the Jones Criteria:
3. Cardiac involvement is characterized by carditis.
- Erythrocyte Sedimentation Rate (ESR) is elevated
15
- C-reactive protein (CRP) is elevated Ø It is one of the more common chronic diseases in
children.
- Acute-phase reactants
Ø The outcome is variable and unpredictable in individual
b. CBC will reveal transient anemia and elevated white blood children. Even in its most severe forms, JRA is rarely life-
count (WBC) threatening.
c. Throat culture findings may be positive for streptococcal Etiology

infection.
Ø The cause is unknown, but infectious and genetic origins
d. Chest radiography studies may disclose cardiac have been implicated.
enlargement.

e. ECG may reveal a prolonged PR interval.
Pathophysiology

Ø The synovial joints are primarily involved.
Nursing Management
Ø Immune complexes initiate the inflammatory response by
1. Assess and monitor cardiac, joint, skin, and neurologic activating plasma protein complement.
status.
Ø Kinin and prostaglandin are released, increasing blood
2. Promote compliance with bed rest and activity vessel permeability and attracting leukocytes and
restrictions. lymphocytes to the synovial membrane.
3. Promote rest by organizing nursing care to allow for Ø Neutrophils and macrophages ingest immune complexes,
adequate rest periods. releasing enzymes and damaging joints.i
4. Alleviate discomfort of fever and arthralgia Ø The synovial becomes inflamed, excessive fluid is
produced, and thickened villi and nodules are produced into
5. Prevent skin breakdown the joint cavity.
6. Promote adequate nutrition
7. Promote optimal growth and development Assessment Findings
8. Provide child and family teaching. Topics to cover 1. Clinical Manifestations

include:
a. Systemic
- The disease and treatment
- Any joint can be involved
- The relationship of exercise to cardiac workload
- Extra-articular manifestations include fever, malaise,
- Rationales, side effects, and dosages of prescribed myalgia, rash, pleuritis, pericarditis, adenomegaly, and
medications hepatosplenomegaly
- How to promote compliance with bed rest b. Pauciarticular
- Promote prevention of RF by encouraging proper - joint involvement is usually confined to the lower
evaluation and treatment of streptococcal infections. extremities.
- Extra-articular manifestations include iridocyclitis,

sacroiliitis, and eventual ankylosing spondylitis

C. Juvenile Rheumatoid Arthritis (JRA)

Definition of terms:
Description
Iridocyclitis – Iridocyclitis is an inflammation of the iris
Ø It is an autoimmune inflammatory disorder (the colored part of the eye) and of the ciliary body (muscles
16
and tissue involved in focusing the eye). Inflammation of iris 2. Administer prescribed medications (NSAIDS – ibuprofen,
alone is called anterior uvetitis or iritis. aspirin ( ASA), naproxen sodium)
Sacroiliitis (say-kroe-il-e-I-tis) is an inflammation of one or - Corticosteroids neither cure nor prevent long-term

both of your sacroiliac joints — situated where your lower complications and they have numerous side effects. Their
spine and pelvis connect. Sacroiliitis can cause pain in your use is limited to rare, life-threatening complications (e.g.
buttocks or lower back, and can extend down one or both profound anemia and vasculitis)
legs. Prolonged standing or stair climbing can worsen the
pain - Immunosuppressive agents are reserved for children
who do not respond to conventional therapy.
Ankylosing spondylitis is a rare type of arthritis that
causes pain and stiffness in your spine. This lifelong 3. Relieve pain
condition, also known as Bechterew disease, usually starts in
your lower back. It can spread up to your neck or damage - provide heat (warm soaks, tub baths) to painful joints
joints in other parts of your body.
- avoid overexercising joints
- use nonpharmacologic pain relief measures
- use a preventive schedule of medication administration

c. Polyarticular
4.Promote adequate joint function.
- Any joint can be involved, smaller joints are usually
affected. 2. Promote self-care
- Systemic symptoms are mild and may include low-grade - Use assistive devices
fever, fatigue and slowed growth.
- Teach splint application

3. Encourage activities with family and peers.

4. Assist the family in meeting the child’s needs.

Laboratory and Diagnostic Study Findings

a. Systemic
D. Scabies
- CBC will reveal leukocytosis and anemia
Description
- ESR will be elevated
Ø Scabies is usually spread by close, prolonged skin-to-skin
- CRP will be elevated contact (e.g. holding hands), and is common in school-aged
children.
- RF (rheumatoid factor) is negative
Ø The mites and their eggs may live on clothes or bed linen
- ANA (antinuclear antibody) is negative for one to two days.
a. Pauciarticular Ø If left untreated, scabies will usually spread to all

members of the family, and anyone who has close contact
- CBC will reveal mild leokocytosis with an infected person should be treated.
- ESR will be elevated Ø Treatment should be repeated one week after the first
treatment. Do not apply the treatment more than twice.
- ANA may be positive
Etiology

Ø Human scabies is caused by an infestation of the skin by
Nursing Management
the human itch mite (Sarcoptes scabiei var. hominis). The
1. Assess joint function and extra-articular manifestation
17
microscopic scabies mite burrows into the upper layer of the Ø Scabies rash. A pimple-like (papular) itchy (pruritic)
skin where it lives and lays its eggs. “scabies rash” is also common.
Diagnostic Findings Ø Burrows in skin. Tiny burrows sometimes are seen on

the skin; these are caused by the female scabies mite
The diagnosis of scabies can often be made clinically in tunneling just beneath the surface of the skin; these
patients with a pruritic rash and characteristic linear burrows appear as tiny raised and crooked (serpiginous)
burrows. grayish-white or skin-colored lines on the skin surface;
burrows are a pathognomonic sign and represent the
Ø Burrow ink test. A burrow can be located by rubbing a intraepidermal tunnel created by the moving female mite.
washable felt-tip marker across the suspected site and
removing the ink with an alcohol wipe; when a burrow is
present, the ink penetrates the stratum corneum and
delineates the site; this technique is particularly useful in Mode of Transmission:
children and in individuals with very few burrows.
Ø direct, prolonged, skin-to-skin contact with a person who
Ø Tetracycline. Topical tetracycline solution is an has scabies.
alternative to the burrow ink test; after application and
removal of the excess tetracycline solution with alcohol, the Ø Scabies can spread rapidly under crowded conditions
burrow is examined under a Wood light; the remaining where close body contact is frequent.
tetracycline within the burrow fluoresces a greenish color;
this method is preferred because tetracycline is a colorless
solution and large areas of skin can be examined.
Pharmacologic Management
Ø Skin scraping. Definitive testing relies on the
identification of mites or their eggs, eggshell fragments, or The mainstay of scabies treatment is the application of
scybala; this is best undertaken by placing a drop of mineral topical scabicidal agents, with repeat application in 7 days.
oil directly over the burrow on the skin and then superficially
Ø Antiparasitic agents. Treatment options include either
scraping longitudinally and laterally across the skin with a
topical or oral medication; topical options include permethrin
scalpel blade.
cream (drug of choice), lindane, benzyl benzoate,
Ø Adhesive tape test. Strips of tape are applied to areas crotamiton lotion and cream, sulfur, topical ivermectin, tea
suspected of being burrows and then rapidly pulled off; tree oil, or oil of the leaves of Lippia multiflora Moldenke, a
these are then applied to microscope slides and examined; shrub found growing in West African savanna; oral options
the adhesive tape test is easy to perform and had high include ivermectin, although it has not been approved by US
positive and negative predictive values, making it a good Food and Drug Administration (FDA) for the treatment of
screening test. scabies.
Ø Topical antibiotics. These agents are used to treat

secondarily infected lesions.
Signs and Symptoms
Ø Topical corticosteroids. These agents may be applied
Ø Skin rash - the most common symptoms of scabies, to help control intense pruritus caused by scabies.
itching and a skin rash, are caused by sensitization (a type
of “allergic” reaction) to the proteins and feces of the
parasite.
Nursing Assessment
Ø Pruritus - intense itching, especially at night, is the
Ø History. Patient history can reliably suggest the
earliest and most common symptom of scabies.
presence of scabies; lesion distribution and intractable
pruritus that is worse at night, as well as scabies symptoms
in close contacts (including multiple family members),
skin rash composed of small red bumps and blisters that are should immediately rank scabies at the top of the clinical
itchy. differential diagnosis.
Image Source: Dr. P. Marazzi / Photo Researchers, Inc. Ø Physical exam. Clinical findings include primary and
secondary lesions; primary lesions are the first manifestation
of the infestation and typically include small papules,
vesicles, and burrows; secondary lesions are the result of
18
rubbing and scratching, and they may be the only clinical effectiveness and inspecting for any signs and symptoms of
manifestation of the disease. adverse effects; and determine the appropriate pain relief
method.

Nursing Diagnoses
Evaluation
1. Risk for infection related to tissue damage.
Nursing goals are met for a patient with scabies as
2. Impaired skin integrity related to edema. evidenced by:
3. Acute pain related to injury to biological agents. 1. Patient remained free of infection, as evidenced
by normal vital signs and absence of signs and
4. Disturbed sleep pattern related to itchiness and symptoms of infection.
pain of lesions.
2. Patient and folks demonstrated an understanding
of plan to heal tissue and prevent injury.
Nursing Care Planning and Goals 3. Patient and folks described measures to protect
and heal the tissue, including wound care.
1. Patient remains free of infection, as evidenced by
normal vital signs and absence of signs and symptoms of 4. Patient described satisfactory pain control at a
infection. level less than 3 to 4 on a rating scale of 0 to 10.
2. Patient and family demonstrate understanding of plan

to heal tissue and prevent injury.
D. Pediculosis
3. Patient and family describe measures to protect and
heal the tissue, including wound care. Description
4. Patient describes satisfactory pain control at a level less Ø It is a common childhood condition that can be passed
than 3 to 4 on a rating scale of 0 to 10. among friends and family.
Ø the highest prevalence of head lice infestation occurs in

children between the ages of three and 11
Nursing Interventions:
Ø Females are at higher risk because they are more likely
1. Prevent infection. Wash hands and teach patient and to share combs, brushes, and hair accessories (Wiederkehr
SO to wash hands before contact with patients and between & Schwartz, 2003).
procedures with the patient; encourage fluid intake of 2,000
to 3,000 mL of water per day, unless contraindicated; teach Ø Often the parents feel a sense of shame as they do not
the patient, family, and caregivers, the purpose and proper realize how commonly children are infested – personal
technique for maintaining isolation; if infection occurs, teach hygiene is not connected to infestation
the patient to take antibiotics as prescribed. Instruct patient
to take the full course of antibiotics even if symptoms Ø The louse pierces the skin and sucks blood. The bites can
improve or disappear. cause severe itching and can predispose the child to a
secondary infection.
2. Restore skin integrity. Monitor status of skin around
wound; monitor patient’s skin care practices, noting the type Ø There are three kinds of lice:
of soap or other cleansing agents used, temperature of
water, and frequency of skin cleansing; tell patient to avoid 1. scalp (pediculosis capitis)
rubbing and scratching; provide gloves or clip the nails if
necessary; and instruct patient, significant others, and 2. body (pediculosis corporis)
family in the proper care of the wound including hand
washing, wound cleansing, dressing changes, and 3. pubic area (pediculosis pubis).
application of topical medications).
Mode of transmission
3. Relieve pain. Acknowledge reports of pain
Ø Lice are spread by close person-to-person contact.
immediately; provide rest periods to promote relief, sleep,
and relaxation; provide analgesics as ordered, evaluating the
19
Ø It is possible, but uncommon, to get lice by sharing  The floor and furniture should be vacuumed,
personal belongings such as hats or hairbrushes. particularly where the infested person sat or lay.
However, spending time and money on
Ø Personal hygiene has nothing to do with getting head lice. housecleaning activities is not necessary to
prevent reinfestation by lice or nits that may have
Ø Head lice are at their most active at night, causing fallen off the head or crawled onto furniture or
irritability and difficulty sleeping for the human host. Itching clothing, due to the organism’s short lifespan.
of the scalp is not sufficient for diagnosis of active Head lice survive fewer than two days if they fall
infestation. off a person and cannot feed. Nits cannot hatch
and usually die within a week if they are not kept
Ø Evidence suggests that itching may not develop for at the same temperature as that found close to
several weeks or months after the initial infestation and may the scalp.
persist for days or weeks after successful eradication of the
head lice.
E. Impetigo
Classic sign: Persistent itching of the head Description:
Ø Lice (pediculosis) and their eggs (nits) can infest the body Ø Impetigo is a highly contagious bacterial infection often
in any of the aforementioned locations but primarily choose found on and around the mouth of the child or elsewhere on
areas that have longer hair. In children, one is most likely to the face. It can also appear on the hands, neck, trunk,
find lice on the head and the live bugs tend to live near the buttocks, or extremities
nape of the neck and behind the ears. They lay their eggs at
the base of the hair shaft, where they can be seen as Etiology:
pearlescent tear drops
Ø Impetigo may be caused by Staphylococcus aureus (S.
aureus) and Streptococcus pyogenes (S. pyogenes) or both
(Watkins, 2005).
Nursing Care: The nurse can instruct the parents that
visual inspection of the home, including clothes and
bedding, is important but it is often difficult to see lice
because of their small size Pathophysiology
Ø The child is predisposed to the infection via dry or

cracked skin where bacteria may invade.
Prevention:
Ø On rare occasions, other bacteria may be responsible for
 Avoid head-to-head (hair-to-hair) contact during the skin infection. Infants and children who have a less
play and other activities at home, school, and developed immune system are more prone to this condition
elsewhere (eg sports activities and in the as well as children who are in close contact with other
playground). children through daycare and school associations.
 Do not share clothing such as hats, scarves, coats

and sports uniforms.
Assessment Findings:
 Do not share combs, brushes or towels. Disinfect
combs and brushes by immersing them in hot 4. Lesions - begin as a vesicle or pustule
water (at least 130°F) for five to 10 minutes.
5. Pruritus
 Do not lie on beds, couches, pillows, carpets, or
stuffed animals that have recently been in contact
with any affected person.
Nursing Management:
Clothing and bedding should be washed at a hot
temperature and tumble dried at a high heat if appropriate. 1. Document type and location of skin lesions
 Clothing and items that are not washable can be 2. Teach patient about wound care
dry-cleaned or sealed in a plastic bag and stored
for two weeks.
20
3. Educate the patient not to touch lesions and washing Ø Scoliosis may result from leg-length discrepancy, hip or
hands knee contractures, pain, neuromuscular disorders, or
congenital malformations. However it is usually idiopathic.
4. Educate caregiver on contact precautions
Ø Evidence points to a probable genetic autosomal dominant
5. Assess fever trait with incomplete penetrance; or to multifactorial causes.
6. Administer antibiotics as prescribed
7. Educate the patient not to scratch the lesions Pathophysiology
8. Educate patient about the disease 1. Deformity progresses during periods of growth
(adolescent growth spurt) and stabilizes when vertebral
9. Educate about follow up because some patients may growth ceases.
develop glomerulonephritis
2. As the spine grows and the lateral curve develops, the
10. Educate caregiver to keep the child at home for 48 vertebrae rotate, causing the ribs and spine to rotate toward
hours after antibiotics have started because the infection is the convex part of the spine. Spinous processes rotate
highly contagious. toward the concavity of the curve.
3. The child attempts to maintain an erect posture, resulting

in a compensatory curve.
Health Teaching and Health Promotion
4. Vertebrae becomes wedge shaped and vertebral disks
1. Educate the caregivers that children with impetigo undergo degenerative changes.
should maintain good personal hygiene and avoid other
children during the active outbreak. It is important to wash 5. Muscles and ligaments either shorten and thicken or
hands, linens, clothes and affected areas that may have lengthen and atrophy depending on the concavity or
come into contact with infected fluids. convexity of the curve. A hump forms from the ribs rotating
backward on the convex side of the curve.
2. Sores can be covered with a bandage to help prevent
spread by contact. If impetigo is recurrent, evaluation for 6. The thoracic cavity becomes asymmetrical, leading to
the carriage of the causative bacteria should be performed. severe ventilatory compensation.
3. The nose is a common reservoir and carriers can be 7. If significant scoliosis goes uncorrected, respiratory
treated with mupirocin (Bactroban Nasal) applied in the function is compromised and vital capacity is reduced;
nostrils. eventually, pulmonary hypertension, cor pulmonale and
respiratory acidosis may develop.
Health Problems Common in Adolescent
A. Scoliosis Assessment Findings
Description 1. Clinical Manifestations
Ø It is a spinal deformity that usually involves lateral a. Scoliosis is asymptomatic most of the time and goes
curvature of the spine, spinal rotation and thoracic unrecognized until there some degree of deformity.
hypokyphosis.
b. The first signs of scoliosis include:
Ø The most common spinal deformity.
-Presence of a spinal curve
Ø During adolescence, scoliosis is more common in girls.
-asymmetry of scapula and extremities
Ø Untreated scoliosis may lead to back pain, fatigue,
disability, and heart and lung complications. -unequal distance between the arms and waist.
2. Laboratory and Diagnostic Study Findings
Etiology a. Radiographic examinations reveals the degree and

location of the curvature.
21
b. an MRI scan is used to evaluate the possibility of 1. Prevent physical and emotional trauma related to wearing
intraspinal pathology. a brace.
a. Maintain skin integrity by properly applying braces and

implementing corrective action to prevent and treat skin
breakdown.
2 types b. Promote a positive self-concept:
1. Functional Scoliosis- caused by poor posture and not by - Encourage verbalization of concerns and feelings.
spinal disease
- Assist the child in selecting clothing that will conceal the
Flexible and easily correctible brace.
2. Structural Scoliosis- anatomical change in shape of - Encourage positive aspects of wearing the brace
thorax or vertebrae including improved posture and symptom relief.
Hips and shoulders are uneven - Assist the child and family in developing the coping
skills.
Not easily correctible/ may need medical interventions
c. Promote normal growth and development by
It may be congenital encouraging self-care activities and peer socialization.
Neuromuscular scoliosis- result of muscle weakness or d. Provide family support by referring parents to social
imbalance services or an appropriate support group.
2. Evaluate the child’s acceptance of the prescribed brace

and exercise program to determine compliance level and the
Treatment: need for reinforced teaching. Supplemental exercises are
used to prevent atrophy of spinal and abdominal muscles.
1. Milwaukee brace
3. Prevent complications related to surgery. The surgical
· This apparatus exerts pressure on the chin, pelvis and
technique consists a realignment and straightening with
convex (curved) side the spine.
internal fixation and instrumentation combined with bony
fusion. Instrumentations include Harrington, Dwyer, Zielke,
· Worn approximately 23 hours a day and is worn over a t-
Luque.
shirt to protect the skin
a. Prevent neurologic deficit by monitoring motor, sensory,
· Indicated for curves between 20-40 degrees
and neurologic status particularly in extremities, prompt
identification of neurologic deficit and correction can prevent
2. Boston Brace
permanent damage.
· An underarm modification of the brace
b. Detect impending hypoxia by monitoring blood gas
· Effective for patients with low curvature values, notify health care provider if abnormal values are
detected.
3. Spinal fusion
c. Assess for hypotension by monitoring I and O (will most
· Indicated for curves more than 40 degrees and for patient likely have indwelling foley catheter and vital signs, and
with unsuccessful conservative treatment observing skin color to assess tissue perfusion.
· Halo traction- used when there is associated weakness or d. Maintain skin integrity and prevent breakdown.
paralysis of the neck and truk muscle
e. Promote adequate bowel and bladder elimination.
Note: Curves up to 20 degrees do not require treatment.
- Prevent constipation by assessing bowel sounds.

- Prevent urinary complications by providing catheter
Nursing Management care.
22
- Promote adequate fluid and nutritional intake. Maintain Ø Soft tissue injuries usually accompany traumatic fractures
intravenous therapy until oral feedings are allowed. in adolescents involved in sports and adventurous activities.
- Promote normal growth and development
- Promote comfort Types:
- Provide the child and family with information about 1. Contusion- tearing of subcutaneous tissue results in
scoliosis and its treatment. Include information about the hemorrhage, edema and pain. Hematoma is evident.
equipment used during treatment.
2. Sprain- when ligament is torn or stretched away from
the bone at the point of trauma. Swelling, disability and pain
are major signs.
B. Bone Tumor (Osteosarcoma)
3. Strain- microscopic tear of the muscle or tendon occurs
Ø It is a primary malignant tumor of the long bones over time and results in edema and pain.
involving rapidly growing bone tissue (mesenchymal matrix-
forming cells).
Risk factors: Prevention
Ø Age: 10-15 years old · Maintain safe environment
Ø History of radiation therapy · Educate the adolescents on safety precautions
Ø History of retinoblastoma · Wearing of helmets and protective devices when

engaging to sports and adventurous activities
Manifestations
Treatment of soft tissue injuries
1. The child is usually taller than average.
· Cold pack and elastic wrap reduce edema and
2. Pain and swelling occur at the tumor site (in adolescence, bleeding and relieves pain.
it is sometimes mistaken for growing pains).
Ø Applied at alternating 30-minutes interval
3. The area maybe erythematous and warm to touch.
· Elevate extremities above heart level
4. The child may have a history of recent trauma at the site.
· Elastic bandage application
5. Pathophysiologic fractures
Ø Nursing responsibility: neurovascular check to ensure
adequate tissue perfusion
Treatment and Nursing care · RICE
1. Radical resection or amputation surgery. § R-est
2. Addressing the body image of the adolescents- § I-ce

(Adolescents are very much concern of self-image).
§ C-ompression
3. Nurse should anticipate anger, grief or fear if there will
be amputation. § E-levation
4. Address problems associated with phantom limb pain-

continuous sensation of pain even if the limb is no longer
present. · Fractures in children usually are the result of trauma
from motor vehicle accidents, falls or child abuse.

· Because of the resilience of the soft tissue of children,
C. Trauma and Injury fractures occur more often than soft tissue injuries.
23
D. STD - Pregnancy must always be considered as a cause of

secondary amenorrhea, even if the patient denies sexual
contact
Sexually Transmitted Infections Etiology
· General name given to infections spread through · primary amenorrhea include agenesis (no formation) of
direct sexual activities. the uterus, Turner’s syndrome (genetic disorder with pectus
excavatus, heart murmur, and short stature), imperforate
· The occurrence of STI in a prepubertal stage must hymen, and constitutional delay.
prompt investigation for possible sexual abuse
· Certain medications can cause amenorrhea, including
Nursing Interventions chemotherapy and medroxyprogesterone acetate (Depo
Provera), which is given as a contraceptive injection.
· Review structures of reproductive system

· Review personal hygiene
Signs and Symptoms
· Discuss values and decision making, possible sexual
behaviors and consequences 1. Primary amenorrhea: the patient may exhibit
abnormalities in body habitus, suggestive of delayed
· Discuss prevention of pregnancies and STIs puberty. The Tanner stages of sexual characteristic
development may show delays.

2. Secondary amenorrhea
E. Amenorrhea
a. Signs and symptoms of pregnancy include mastalgia
Ø Amenorrhea refers to the absence of menses.
(breast tenderness); breast enlargement; nausea and
possibly vomiting, especially in the early morning;
Ø Primary amenorrhea is when no menses occur by the age
gastrointestinal upset; and urinary frequency. On
of 17.
examination, the uterus may be enlarged and Chadwick’s
sign (blue or violaceous cervix) may be present, a probable
Ø Secondary amenorrhea implies that menses have been
sign of pregnancy that becomes evident about the fourth
established, but have ceased for a minimum of 3 months.
week of gestation.
Causes:
b. hypothyroidism, the patient may have dry skin, dry hair,
· corpus luteum cyst fatigue, hoarseness, constipation, and an enlarged thyroid
gland. In hyperthyroidism, the patient may exhibit oily skin
· lactation and hair, diaphoresis, tachycardia, diarrhea, and a goiter
(enlarged thyroid gland).
· menopause (premature or normal)
c. Patients with polycystic ovarian syndrome may have
· hypothyroidism or hyperthyroidism hirsuitism (excessive facial and bodily hair) and obesity.
Corpus luteum cysts tend to cause pain in the lower
· chemotherapy quadrants that may be intermittent in nature, as some cysts
resolve spontaneously. Other cysts grow and may rupture,
· polycystic ovarian syndrome (PCOS) causing significant lower quadrant abdominal pain and even
peritoneal signs of rebound, guarding, and rigidity.
· diabetes mellitus
Diagnosis
· stress
a. Genetic testing - to determine disorders such as
· excessive exercise Turner’s syndrome.
· weight loss b. Pelvic ultrasound or transvaginal (ultrasound wand in the

vaginal canal) is used to test for pregnancy, ovarian cysts,
· pregnancy and other gynecological abnormalities.
F. Dysmenorrhea
24
Ø Painful menses, or cramps a. Monitoring of weight regularly
Ø Discomfort in the lower abdomen and may radiate to the b. Counseling on diet and lifestyle
lower back or down the legs.
c. Encouraging exercise
Ø May be accompanied by nausea and vomiting

Types:
H. Eating Disorders
1. Primary- there is no evidence of pelvic abnormality;
affects 50 % of menstruating females and is the leading Ø Anorexia Nervosa (purging or withholding),
cause of short term recurrent school absenteeism in
adolescent girls Ø Bulimia Nervosa (binging and purging)
2. Secondary- pathologic condition is identified Ø Is a form of self-starvation seen mostly in adolescent girls
Manifestation Ø Adolescents with anorexia nervosa usually lose up to 85%

of ideal body weight by either restricting food or caloric
Ø Onset is shortly after menarche with heavy menstrual flow intake or by consuming caloric intake but then purging by
vomiting or vigorous physical activity.
Ø Pains starts no more than a few hours before
menstruation starts and lasts for no more than 72 hours
Ø Pelvic exam results are normal—Primary Characteristics
Ø Secondary dysmenorrhea most commonly results from · Failure to maintain minimum body weight for age and
endometriosis height
· An intense fear of gaining weight
Treatments · Excess influence of body weight upon evaluation
Ø Prostaglandin Inhibitor drugs such as Ibuprofen or · Amenorrhea

Naproxen

Ø Heat application to the lower abdomen or back
Risk factors
Ø Oral contraceptives which reduce the amount of
endometrium build up each month and therefore reduce · Genetics
prostaglandin secretions.
· Average to superior intelligence and overachievers
Ø Low fat and vegetarian diet usually perfectionist
Ø Vitamins B and E and high level of omega 3 fatty acids · Dysfunctional family- controlling, rigid and imposing
· Social standards of weight such as being thinner
G. Obesity
Ø Excessive weight in childhood is related to obesity in Diagnosis

adulthood
The diagnosis of anorexia nervosa can be challenging and
Ø Can lead to increase cholesterol, orthopedic problems, based on both physical and emotional signs and symptoms.
sleep apnea, high blood pressure and diabetes Adolescents with this disorder are below their ideal body
weight and are often preoccupied with food. During an
Ø It can lead to social isolation which may lead to depression interview, the adolescent may express that he or she refuses
to eat or consumes very large amounts of calories and then
Ø BMI- 22-24 in adolescents indicates obesity purges by self-induced vomiting or using laxatives or other
means (Commission on Adolescent Eating Disorders, 2005).
Nursing interventions:

25
Manifestation 6. Adolescents with bulimia nervosa may need dental care

for repair of dental erosion and cavities that result from
1. Weight loss vomiting.
2. Weakness
3. fatigue I. Substance and alcohol abuse
4. Dry skin Ø It is known that 80% of deaths in adolescents involve

accidents, homicides and suicides and in many of these
5. Amenorrhea cases drugs and alcohol are involved.
6. Lanugo hair over back and extremities
7. Cold intolerance Assessment
8. Low blood pressure Substance Abuse
9. Abdominal pain 1. Substance abuse refers to the repeated use of illicit

substances (drugs or alcohol or inhalants) despite the
10. Constipation negative consequences
11. Helplessness 2. This may lead to tolerance, withdrawal & compulsive

drug taking behavior.
12. Lack of control
3. Substance dependence/ addiction refers to the
13. Low self-esteem
physiological and/or emotional reliance on that substance
14. Depression
4. Takes in larger amounts & over long periods of time.
15. Lack of self- identity

5. Daily activities revolve around use of substance.
16. Although eating less, anorexic patients are preoccupied

Alcohol Abuse:
with food but hunger is denied
1. Physical & psychologic dependence.
17. They feel bloated when ingesting even small amount of
food 2. Physical symptoms: slurred speech, unsteady gait,
et.al.
Clinical Alert!
3. Psychologic symptoms: depression, hostility,
Anorexia nervosa can become a life-threatening problem or
suspiciousness
cause death because of severe weight loss that can result in
electrolyte imbalance and hemodynamic instability.
Assessment Findings
Warning signs that a young person might be abusing alcohol

Treatment or drugs:
1. A brief period of hospitalization may be necessary to 1. Physical: fatigue, repeated health complaints, red and
correct severe malnutrition and electrolyte imbalance glazed eyes, and a lasting cough
2. Stabilization of patient’s weight 2. Emotional: personality change, sudden mood changes,

irritability, irresponsible behavior, low self-esteem, poor
3. Individual and family psychotherapy judgment, depression, and a general lack of interest
4. Antidepressant medications as ordered 3. Family: starting arguments, breaking rules, or

withdrawing from the family
5. Provide comfortable and relaxed atmosphere
26
4. School: decreased interest, negative attitude, drop in abuse, especially if there is a strong family and genetic
grades, many absences, truancy, and discipline problems history of abuse. Two tools that can be used in the
identification of substance abuse are the CRAFFT (Knight,
5. Social problems: new friends who are less interested in Sherritt, Shrier, Harris, & Chang, 2002) and the CAGE
standard home and school activities, problems with the law, (Ewing, 1984). Both of these tools use simple acronyms to
and changes to less conventional styles of dress and music assist in the evaluation of drinking or drug use.

Complications: 2. Help the child and family find community resources that
may help conquer the substance abuse problem. Research
1. Delirium tremens & alcohol syndrome. indicates that nearly 80% of adolescents with substance
abuse receive treatment. There are many different types of
2. Korsakoff’s psychosis treatment, but the most promising appears to be a family-
based approach, as it shows the best outcomes for reduction
3. Wernicke’s syndrome
in substance abuse in adolescents. Family treatment means
that the entire family receives psychoeducation regarding
4. Peripheral neuropathies
substance abuse.
5. Hepatitis, cirrhosis, pancreatitis

6. Anemia
J. Suicide

Ø It is a deliberate self-injury with the intent to end one’s
life.
Stage 1:
Ø Suicide is more successful in males than in women,

· Anxiety, anorexia, insomnia, mild tremors, hyperalertness,
although there are more attempts in women than in male.
internal shaking, n/v, headache, Ý pulse & BP.
Ø Most often happens during school year, reflecting school

Stage 2:
stress, and between the time of 3 PM and midnight, which
· Profound confusion, gross tremors, nervousness, reflects depression that increases with the dark.
disorientation, illusions, auditory & visual hallucinations,
Ø Ranks third as cause of death in the age group of 15
nightmares.
years old to 19 years old.
Stage 3:
Etiology
· Severe hallucinations
Ø The common stresses of adolescence, compounded by
Stage 4: limited problem-solving abilities, sometimes lead to harmful,
life-threatening behaviors. Adolescents who are depressed ,
· Delirium, uncontrolled tachycardia, visual & tactile psychotic or substance abusers are at higher risk.
hallucinations, fever, severe psychomotor activity, agitation,
restlessness Ø Common contributing factors:
a. Past history factors include previous suicide attempts,

family member or friend who has made an attempt, child
Diagnosis: abuse, and death of a parent when the child was young.
Diagnosis of s substance use and abuse is based b. Family factors include conflict, parental rejection or
on the physical, emotional and social factors exhibited by the hostility, divorce and separation, relocation, unrealistic
child. A thorough family history is essential along with parental expectations, and parental indifference.
information about the child’s physical and emotional health.
c. Adolescent factors include hopelessness, depression,
substance abuse, impulsivity, difficulty tolerating frustration,
feelings of self-loathing of guilt, thought disorder, physical or
Nursing Care body image problems, gender identity concerns and a
perfectionist personality.
1. Assess drug and alcohol use in children. The nurse is in
an ideal position to identify adolescents at-risk for substance
27
Socioenvironmental factors include access to firearms, · Accident proneness

isolation, ineffective support system, incarceration: limited
social, educational, or vocational opportunities and exposure · Difficulty in school
to suicide of others.
· Acting out with chemicals, alcohol, or sexual
promiscuity
Causes of Depression: · trouble with legal authorities
Ø Anger Ø Occasionally, depressed adolescents find it so hard to be

alone they seek constant activity as a means of escape.
Ø Manipulation (psychological black mail)
Others may withdraw from contact with other persons and
become completely isolated
Ø Loss of a parent
Adolescents who attempt suicide fall into many

Ø Loss of a girlfriend or a boyfriend
categories:
Ø Loss of a community
1. Loners and those who have difficulty expressing their
feelings to others, therefore, do not receive emotional
Ø Loss of self-esteem
support from friends.
Assessment
2. Students who are trying to continually become an
Ø Adolescents need to have thorough physical examinations achiever.
at health maintenance visits to assure them they are in good
3. Gay and lesbian youths.
physical health. Depression usually precedes suicide; signs of
depression may be overt or subtle.
4. Adolescents who have a family member or close friend
who committed suicide.
· Lethargy and malaise
· Anorexia or overeating 5. An adolescent who have a school mate who committed

suicide.6. Students who have internet contacts who
· Weight loss arranged a group suicide.
· Insomnia
· Excessive fatigue Suicide warning signs:
· Excessive crying • Giving away prized possessions
· Giving away cherished possessions • Organ donation questions, such as “How do you leave your
body to a medical school?”
· Preoccupation with death or death themes (e.g.
music, art, movies with death themes) • Sudden, unexplained elevation of mood. Mood elevation
may indicate that the individual has reached a decision about
· Statement of intention to commit suicide the suicide and feels relief.
• Accident proneness, carelessness, and death wishes
Ø In younger adults, depression can be manifested by • A statement such as, “This is the last time you will see
behavioral problems me.”
· Disobedience • Decrease in verbal communication
· Temper tantrums • Withdrawal from peer activities or previously enjoyed

events
· Truancy
• Previous attempt (80% of all completed suicides have been
· Running away from home preceded by a failed attempt)
· Self-destructive behavior
28
• Preference for art, music, and literature with themes of care. Ensure that the adolescent understands that he or she
death must cease or not implement this destructive behavior.
• Recent increase in interpersonal conflict with significant - Arrange for counseling and hospitalization if necessary;
others refer the adolescent and the family to a professional
therapist who will work with them through the crisis.
• Running away from home
2. Assist the family and friends in coping with loss. After a
• Recent experience of a friend or famous person committing completed suicide occurs, counsel the adolescent’s family
suicide and friends to help them understand work through their
grief.
• Inquiring about the hereafter

• Asking for information (supposedly for a friend) about
suicide prevention and intervention Other Interventions
• Almost any sustained deviation from the normal pattern of 1. Client expresses feelings of depression to health care
behavior providers or other adults, saying she will contact support
person should the desire to commit suicide become
overwhelming
Nursing Diagnoses: 2. Intervention for adolescents who are contemplating

suicide includes trying to alleviate their pain and depression
Ø Risk for violence, self-directed, related to symptoms of and counseling them to help them change their perspective
depression or expressed desire to hurt oneself on the value of life.
Ø Ineffective individual coping 3. Try to find out the things in the child’s life that are still
viewed as important.
Ø Hopelessness
4. Since adolescent resort to suicide as a method of solving
Ø Altered family processes
their problems, helping them in this area can be an
intervention strategy.
Planning and Outcome Identification:
5. Help adolescents speak honestly about thoughts of suicide
1. An adolescent who has made suicide gestures or
and the problems that have led them to think that death is a
attempts will display improved self-esteem, positive
solution.
behaviors, and more effective coping and problem-solving
strategies.
6. A period of observation in a hospital setting is desirable
after a suicide attempt to prevent the adolescent from
2. Family and friends of an adolescent who committed a
inflicting personal injury again and to allow assessment in a
completed suicide will work through their grief and resolve
neutral setting, away from the stress that precipitated the
the loss over time.
attempt.

7. Antidepressant medicine alone, may be of little value in
treating depressed adolescents.
8. Continuing evaluation by both history taking and physical

Implementation
examination is necessary, because the young person who
1. Assist the adolescent in alleviating feelings of has attempted suicide may attempt it again if support people
helplessness and hopelessness. and better problem-solving ability are not available at
another time.
- Provide information for teachers, parents, and
adolescents about risk factors, counseling available to
adolescents and stress-reducing and problem-solving
Concerns of the Adolescent and Family with Unique
strategies.
Needs
- Provide crisis intervention for an adolescent who
Ø Achieving a sense of identity may be difficult for
gestures or attempts suicide and plan for family follow-up
adolescents who have a chronic illness or other challenge.
29
Ø It is important, for such individuals to learn to look past

their particular condition to their real selves.
Ø Some of the biggest problems of chronically ill

adolescents are likely to be:
· difficulties in being as independent as they would

like to be
· achieving in school
· establishing intimate relationships
Ø The loss of many hours of school because of illness or

frequent hospitalization may result in the inability to pursue
a desired career, at least without a delay
Ø Chronic hospitalization or the realization they will never

be free of symptoms can cause depression in adolescents,
placing them at high risk for substance abuse or suicide.
Outcome evaluation
3. The adolescent demonstrates improved self-esteem,

positive behaviors, and more effective coping and problem-
solving strategies.
4. If a completed suicide occurs, the family and friends work

through their grief and resolve the loss over time.
30

Finals Maternal

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FINALS MATERNAL LECTURE

A. Burns • Radiation burns – sunlight, medical therapies

· Children younger than 2 years old have a greater Pathophysiology

Classifications: v First-degree burns (superficial partial-thickness)

-heals more slowly by regeneration from the epithelial lining

American Burn Association 2. Systemic Damage – severe burns cause systemic

• Third-degree burns less than 2% TBSA

• No burns on face, feet, hands, or genitalia

• Second-degree burns 10% to 20% of TBSA

• burns on face, feet, hands, or genitalia

• Third-degree burns 3% to 10% TBSA

• Occurrence with smoke inhalation

· Second-degree burns greater than 20% TBSA

· Third-degree burns greater than 10% TBSA

Laboratory and Diagnostic Study Findings

• Fasting blood sugar is elevated due to altered glucose

• Complete blood cell count reveals initial elevation of

- edema • ABG studies will indicate metabolic acidosis due to

Nursing Diagnoses 6. Reduce pain

• Ineffective tissue perfusion 7. Maintain an adequate hydration status

• Risk for infection - monitor daily weights and fluid I and O

• Impaired skin integrity 8. Maintain normal thermoregulation

• Acute pain - minimize chilling shivering

• Risk for imbalanced fluid volume 9. Promote optimal nutrition

• Ineffective thermoregulation - high-calorie, high-protein

• Disturbed body image - record child’s food intake

- tetanus prophylaxis 11. Provide emotional support to child and family

- analgesics - teach about wound care

- antipruritics and soothing lotions - discuss diet, rest and activity

3. Promote optimal circulation to distal regions of the B. Poisoning

2. Breathing contaminated air · High-dose: lead encephalopathy which is manifested by

• Exposure to household dust or yard soil contaminated

• Lead affects the kidneys by altering the permeability of · Dimercaprol

2. Clinical Manifestations: - Give medications by IV route; administer with procaine of

d. Conduct a medical examination; identify and eliminate - a history of cruelty to animals

3. Neglect – can be physical or emotional

- physical neglect – deprivation of necessities such as

- emotional neglect – failure to meet the child’s need for

- poor impulse control

- Physical indicators include failure to thrive, developmental

- Physical indicators include failure to thrive, malnutrition,

v Between 5-10 years old: school problems, night terrors,

1. Risk for injury - Teach growth and development, child-rearing practices,

5. Some cases (about 24%) of cerebral palsy remain

· Diplegia is when similar body parts are affected, such as

a. Major manifestations are athetosis (wormlike movement), 4. Additional manifestations include:

5. Disabilities associated with cerebral palsy include mental

b. Neurologic examination a. Praise his accomplishments.

d. Other disorders such as metabolic disorders , c. Encourage an appealing physical appearance.

a. Encourage family members to express anxieties,

4. Promote adequate fluid and nutritional intake. Description:

8. Facilitate communication  Leukemia may be diagnosed at any age but has a

b. Encourage early speech therapy to prevent poor or Etiology

Pathophysiology 2. Laboratory and Diagnostic Study Findings

4. Risk for fluid volume deficit

1. The child will experience complete or partial remission

8. The child will be pain free.

Nursing Management 7. Foster healthy growth and development.