NURS 1400 Unit VICommon Childhood Illnesses

Metro Community CollegeNursing Program

Nancy Pares, RN, MSN

Integumentary system

• Tinea Corporis– Fungal infection; “body ringworm”– Occurs in non terminal, non hairy areas of body– Occurs in children of any age; acquired from

animals

Tinea Corporis

• Clinical manifestations– Annular, expanding lesion– Raised erythematous border– Scaly, clear center

• Treatment– Topical: miconazole, clotrimazole(lotrimin)• Twice daily for 2-3 wks

– Oral: itraconazole, terbinafine

Infestations

• Pediculosis: Head lice– Ectoparasites: live on the surface– Most common in 3-10 years; greater in girls of

caucasian origin– Classroom is primary source of infestation

pediculosis

• Pathophysiology– Head to head contact: hats, combs, bedding– Lice crawl-do not fly or jump– Eggs(nits) attach to hair shaft with water insoluble

glue usually in the auricular or occipital areas of the head

– Nymphs emerge in 7-10 days; lifespan=30 days– Brown in color, size of sesame seed

pediculosis

• Clinical manifestations: itching• Diagnosis: identification of nits on scalp• Treatment:– Manual removal: less than 2 years of age– Permethin (Nix): > 2 years of age; kills lice and ova– Lindane (Kwell): > 2 years of age; less potent

agent

Pediculosis

• Nursing Management– Assessment: careful handwashing; done with hair

wet; examine known areas; – Nursing diagnosis• Impaired skin integrity• Low self esteem• Deficient knowledge

– Family teaching: treatment of household; notify schools and contacts

Scabies

• Ectoparasite; significant world wide• Occurs at any age, most common <2 year old• Pathophysiology– Transmitted by close person to person contact– Burrow into the stratum corneum depositing feces– Females lay eggs in 2-3 day intervals; hatch in 3-8– Adult mites are round, eyeless, life span of female

is 2 months; male dies after mating

Scabies

• Clinical manifestations– Inflammatory response, generalized pruritus

which increases at night– Sites: skin surfaces that are opposing: axillary,

cubital,

• Diagnosis: microscopic exam of scrapings• Treatment : Permethrine cream(Elimite)– One application is usually sufficient

Scabies

• Nursing management– Promotion of comfort– Prevention of secondary infections– Handwashing

• Family teaching– All members of household need treatment– All clothes and bedding in hot water– Daycare: no attendance for 24 hours after

treatment

Inflammatory disordersAcne Vulgaris

• Predominately adolescent skin disease• Chronic condition; 85% of all adolescents• Pathophysiology– Accumulation of sebum in the pilosebaceous

follicles which become very cohesive– Comedones are lesions of non inflammatory

(white heads); open lesions are black heads

Acne vulgaris

• Diagnosis: age and appearance of lesions• Treatment:– Individualized– Topical• Benzoyl peroxide, reinoids, azelaic acid, and abx

– Systemic• Anbx, oral contraceptives, accutane

Acne vulgaris

• Nursing management– Reduction of severity, supportive care,

information about diet, hygiene, rest

• Teaching– Educate about misconceptions– Avoid cosmetics

Hearing and Visual disorders

• Hearing impairment– See page 1023 table– Congenital vs acquired– Classifications• Conductive hearing loss• Sensoneural hearing loss• Mixed conductive sensoneural hearing loss• Central hearing loss

– Behavioral signs: pg 1025 table

Hearing loss

• Diagnosis– Newborn screening– BAER (Brainstem Auditory Evoked Response)• Main test for hearing loss

• Treatment:– Dependent on type of hearing impairment– Conductive: hearing aid– Sensoneural: cochlear implants– Sign language, lip reading, cued speech

Hearing loss

• Nursing management– Assessment– Nursing diagnosis• Disturbed sensory perception• Delayed growth and development• Ineffective coping

Visual impairment

• Binocularity: fixation of 2 ocular images, occurs at 6 months

• Visual acuity: clearness of image: changes with age

• Etiology– Eyeball mis proportioned– Damage to one or more parts of the eye

interfering with visual process– Brain may not process information correctly

Visual impairment

• Manifestations based on age: pg 1033 table

• Diagnosis: Snellen chart; assessed indirectly with children< 3..see page 1034

Impairment of muscular efficiency

• Strabismus– Condition where the visual lines of each eye do

not focus on the same object due to lack of muscle coordination; cross eyed appearance

– Clinical manifestations• Clumsy, difficulty picking up objects, crossed eyes

– Diagnosis• Hirshberg corneal light reflex, cover test, esotropia,

hypertropia

strabismus

• Treatment– Medical:• Occlusion dressing (eye patch), glasses, pharmacologic

– Surgical• Children < 12-18 months when medical did not work

strabismus

• Nursing management– Early identification

• Nursing diagnosis– Delayed growth and development– anxiety

Amblyopia (Lazy eye)• A reduction or loss of vision in one eye

unrelated to an organic cause• Pathophysiology– Occurs in first 6 months of life– Brain is trained to compensate– If not corrected by age 7, restoration is minimal

• Clinical manifestations;– Rare, child is unaware of any problem

• Treatment: glasses

Respiratory disorders: Acute Epiglottitis

• Life threatening bacterial infection• Also called ‘croup syndrome’• Can lead to complete airway obstruction• Clinical manifestations– Respiratory distress, fever, sore throat, dysphagia,

drooling, agitation, and lethargy,

• Diagnosis: no spontaneous cough,DO NOT look in throat by depressing tongue

Acute epiglottitis

• Nursing management– Anbx, fluids and supportive care– Have emergency equipment on had for

tracheotomy.

Bronchiolitis

• Acute, typically viral, infection of the bronchioles usually caused by RSV

• Usually young children• Causes inflammation of the bronchioles• Wheezing is classic symptom with tachypnea• Complications– Apnea, atelectasis, secondary bacterial infection

and respiratory failure

Bronchiolitis

• Nursing management/diagnosis– Ineffective airway clearance– Deficient fluid volume– Deficient knowledge of caregivers

• Planning /implementation– Family teaching– Acute setting focus on adequate ventilation and

fluid balance

Bronchiolitis

• Treatment/prevention– Ribuvirin (Virazole) is the only med for RSV

bronchiolitis– Prevention drugs• RSV immune globulin (RespiGam) • Synagis

– Administered monthly as an IM injection– First dose Usually given prior to RSV season

Asthma

• Characterized by chronic inflammation, bronchoconstriction, and bronchial hyper responsiveness

• Wheezing, coughing and dyspnea• Airways are damaged over time• Classified by severity of symptoms

Asthma

• Categories– Mild intermittent– Mild persistent– Moderate persistent– Severe persistent

Asthma

• Pharmacologic treatments– Short acting inhaled beta 2 agonists– Long acting inhaled beta 2 agonists– Leukotriene modifiers– Oral anti asthmatics– Methylxanthines– Systemic corticosteroids

asthma

• Treatments– Avoid triggers– Regular peak flow monitoring– Medical follow up– Rapid access to medical care

• Prevention– Avoid allergen exposure, warm up before

exercising, relaxation exercises

Bacterial meningitis

• Meningitis is inflammation of meninges• Causative agent is age dependent– Neonates: e coli, group b strep, H influenza, strep

pneumoniae– Infants and children: H influenza type b, strep

pneumoniae– Adolescent: Neisseria meningitis, strep

pneumoniae

Asthma

• Nursing management/diagnosis– Risk for suffocation – Ineffective airway clearance– Interrupted family processes

Bacterial meningitis

• Clinical manifestation– Infants may have subtle symptoms– Child over 2 may have GI upset and cold like

symptoms– Hyperactive reflexes– Kernigs sign: supine with hip flexed..pain on

resistance on extension of leg– Brudzinski sign; supine, flex head..hip and knees

will also flex

Bacterial meningitis

• Diagnosis– CSF via lumbar punctures; fluid will be cloudy– Urine for culture, osmolarity, sp. Gravity– Chest x ray– CT/MRI

• Treatment– Oxygen– Seizure precautions– Antibiotics/dexamethazone– isolation

Viral meningitis

• Inflammatory response of the leptomeninges• Caused by non polio enterovirus; most occur

in summer• Often associated with partially treated

bacterial infections• Clinical manifestations– Not as ill as bacterial; general malaise, gradual

onset, Kernig and Brudzinski signs may be present

Viral meningitis

• Diagnosis– CSF• Less than 500 WBC/cubic mm• Glucose increased• Protein decreased• May do second spinal tap within 6-8 hrs for

confirmation

Viral meningitis

• Treatment– Same as bacterial until viral is confirmed

• Nursing management– Same as bacterial until viral is confirmed– Comfort measures,– Administer meds as ordered

Encephalitis

• Inflammation of the brain caused by bacteria, virus, fungi or protozoa

• See page 1085 for table of causes• Pathophysiology– Invasion of pathogen to CNS

• Clinical manifestations– Intense HA, s/s of respiratory infection, n/v,

slurred speech, seizures, ataxia, personality and behavior changes

Encephalitis

• Diagnosis– H&P,– CSF• Initially normal, recheck in 2 days

– Leukocytes increase– Protein increase

– Nasopharynx swab

• Treatment:– Supportive, anbx til bacterial cause r/o

encephalitis

• Nursing management/interventions– Vital sign assessment– Neuro checks– PROM– Good skin care

GER ( gastroesophogeal reflux)

• Common disorder of infants; improvement seen in 6-12 months; boys affected more than girls, common in preterm infants

• Clinical Manifestations– Vomiting, regurgitation, excessive crying, blood in

stools

• Diagnosis– Observing feedings, upper GI, endoscopy

GER

• Treatment– Dietary modifications– Thicken formula with cereal– Positioning: seated vs prone vs head elevated prone– Pharmacologic intervention

• Previcid, reglan

• Nursing diagnosis– Risk for aspiration; imbalanced nutrition; deficient

knowledge

Parasitic infections

• See pages 442-443• Pinworms

• roundworms

Urinary Tract Infections

• Infection of one or more structures of the urinary tract– Cystitis– Urethritis– Pyelonephritis

• Pathophysiology– Same as adults

UTI

• Clinical manifestations– Infants– Preschoolers– School age and adolescents– See page 626 table

• Diagnosis– UA

UTI

• Treatment– Eradicating the infection– Preventing re infections– Correcting underlying causes– Preserving renal function– Abx, fluids

Enuresis• Involuntary voiding of urine beyond the

expected age• More common in boys• Pathophysiology– Neurologic development delay– Frequent UTI– Structural disorders– Chronic constipation– DM– Sleep arousal problems– Stress and family history

enuresis

• Clinical manifestations– Dribbling after voiding– Urgency– Ineffective stream– Infrequent and painful voiding– Incontinence with laughing

Enuresis

• Diagnosis– Family history– Neuro exam: reflexes, sphincter tone, spinal

defects– Voiding diary– UA, renal ultrasound, urine flow rate

Enuresis

• Treatment– Medications: see page 632– Bed wetting alarms– Motivational therapies: rewards for dry nights– Elimination diets: certain foods may irritate the

bladder---sugar, caffeine, dairy , carbonated bev.

Enuresis

• Nursing diagnosis– Impaired urinary elimination– Impaired skin integrity– Disturbed sleep pattern– Low self esteem– Impaired social interactions