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CONDITIONS AND
DISORDERS
Newborn
RESPIRATORY
DISTRESS
RESPIRATORY DISTRESS
SYNDROME (RDS)
SEQUELA OF RDS
• HYPERBILIRUBINEMIA
• RENTROLENTAL FIBROPLASIA
- retinal changes, visual impairment & eventually
blindness, resulting in too high O2 levels during
treatment
• BRONCHOPULMONARY DYSPLASIA (BPD)
- damage to alveolar epithelium of the lungs related to
high O2 concentrations and positive ventilation.
- may be difficult to wean infant from ventilator, but
most recover & have normal x-rays at 6 months to 2
years.
A. Pulmonary condition common in
preterms and characterized by hyaline
membrane formed in the alveoli ca using
atelectatis. HYALINE MEMBRANE
DISEASE
B. Etiologic Factors:
1. Prematurity
2. Hypoxia
3. Acidosis
C. Major Pathologic Finding:
Inadequate surfactant
D. Major signs:
1. Nasal flaring
2. Tachypnea (RR 70/min)
3. See-saw breathing
4. Chest RETRACTIONS
5. Expiratory GRUNTING
E. NURSING CARE:
1. Resuscitate as indicated
2. Suction PRN less than 5 sec/suction time
3. Administer O2 under CPAP (care in O2 to
prevent = RETROLENTAL FIBROPLASIA)
4. Keep warm maintain tempereture
5. Turn gently every q2h to promote lung
expansion
6. Prevent infection
7. Monitor: color, breath sounds, VS with
emphasis on Respiration using SILVERMAN-
ANDERSON INDEX:
a. 5 Signs to evaluate:
i. Upper chest movement: 2pts for SEE-saw
ii. Lower chest retractions: 2 pts for ”MARKED”
iii. Xiphoid process retractions: 2 pts for ”MARKED”
iv. Flaring: 2 pts for ”MARKED”
v. Expiratory grunting: 2 pts for severe expiratory
grunting even on bare ears
b. SILVERMAN score of 10: severe distress
c. SILVERMAN score of 0: normal respirations
Newborn
HYPOGLYCEMIA
A. Low blood sugar in the newborn
1. Fullterm: <30mg% in the first 72
hours;<45mg% after 72 hours
2. Preterm: <20mg%
3. Normal value in NB: 40-50mg% or 40-
60mg% in 1st day and 50-90mg% after day
1
B. Etiologic Factors:
1. Prematurity and Postmaturity
2. SGA
3. Congenital Defects
4. DM mother
5. Stresses during birth
C. S/Sx
1. Jitteriness
2. Tachypnea, apnea, irregular RR, cyanosis
3. Lethargy, change behavior, absent MORO
Reflex, twitching, tremors
D. Nursing Care:
1. Early Feeding
2. Give oral glucose as indicated
3. Keep warm
4. Evaluate apneic episodes
HYPERBILIRUBINEMIA
A. Increase serum bilirubin in the blood
more than 12-13mg% [NV: 2-6 mg%]
B. Etiologic factors:
1. Prematurity
2. Polycythemia
3. Infection
4. Blood incompatibilities
C. S/Sx
1. Pathologic jaundice – present in the first 24
hrs
2. Lethargy, pallor
3. Enlarge liver
Management
a. Phototherapy
Guidelines:
-done for bilirubin level > 7mg/dl
a. unclothed the baby
b. baby’s for
-continued eye5-7
shielded
days
c. ten 20-watt daylight or blue
b. Exchange Transfusion
fluorescent at 45 cm from
skin surface OR 16- 18 INCHES
-fullterm bilirubin : 20 mg/dl
d. monitor side effects:
-pre 1. dehydration
term bilirubin : 10-15 mg/dl
2.”bronze-baby syndrome”
E. Nursing care:
1. Early detection
2. Early and frequent feeding
3. Monitor color, urine, stools, serum bilirubin
4. Regular turning
5. Promote bonding
Digestive Disorders
CHALASIA
A. Abnormal relaxation of the cardiac sphincter of
stomach resulting to NON-PROJECTILE, NON-
BILE, SELF-LIMITING vomiting
B. Etiology: unknown
C. S/SX
1. Vomiting in 1st 3 months of life
2. Regurgitation after feeding
3. Increase hunger
4. Weight loss
5. Dehydration
D. Nursing care:
1. Prevent vomiting
2. Provide psychological support to parents
Cleft Lip/Palate
1:1000 births
Cleft lip Cleft Palate
Malformation bet.
Maxillary and median nasal Malformation of
process on 5 to 8 wks IUL palatal process on 9
Common in boys to 12 weeks IUL
Genetic tendency
Common in girls
Deficient intake of Folic
Acid
Cleft Lip/Palate
Treatment
Chelloplasty- closure of cleft lip
Steatorrhea
Chronic diarrhea
Failure to thrive
Gastroschisis
Omphalocoele
2.5/10,000
high rate of mortality
covered with a sac
Management: Surgical Repair
Nursing Care:
a. Cover sac with sterile gauze & wrap it
with plastic
b. Vital signs monitoring (temperature)
c. Handle infant carefully
Gastroschisis
1/10,000 live births
excellent survival
no membrane covering
Management: Surgical Repair
Nursing Care:
a. Cover the exposed bowel loosely with
saline soaked pads (no plastic wrap)
b. Vital signs monitoring
c. Handle infant carefully
Appendicitis
Inflammation of the vermiform appendix
1:500 Population
Peak Age : 10-25 years
Males > Females
Cause:
OBSTRUCTION + Infection
*50-80% due to fecalith
gallstones
tumors
ball of worms
Assessment
a. Abdominal Pain
b. Nausea & Vomiting
c. Inability to pass gas
d. Fever
e. Right Lower Quadrant Tenderness
f. Increased WBC
g. (+) Psoas & Obturator Sign
PERITONITIS Perforated Appendix!
Increased Fever & Chills
Tachycardia & Tachypnea
Pallor, Restlessness & Irritability
Sudden relief of pain after perforation
APPENDECTOMY
Surgical removal of appendix
POSSIBLE COMPLICATIONS
a. Excessive bleeding.
b. Surgical-wound infection.
c. Inadvertent injury to the
ureter.
d. Intra-abdominal abscess.
AVERAGE HOSPITAL STAY
Nursing Care
a. No laxatives, enemas or medicines for pain.
b. ACTIVITY : Bed Rest
c. DIET : NPO
d. Position on the right side or low to semi-
fowler’s position to promote comfort
e. Avoid application of heat in the abdomen
Post-Operative Care :
a. Monitor vital signs & return of bowel sounds
b. Maintain on NPO till bowel function returned
c. Change dressings as prescribed
d. Medications as prescribed
e. WOF: Signs of Infection
Situation: Bobby, a 13-year-old boy, is
being seen in the emergency room
for possible appendicitis.
December 2003
TRACHEOESOPHAGEAL FISTULA
Abdominal distention
Disorders
Urinary Tract Infection (UTI)
most common GUT problem
common : schooler girls
Escherichia Coli
Nursing Care
a. administer medications
b. increase oral fluid intake
c. acidify urine
d. proper hygiene
e. avoid tub baths or bubble baths
NURSING CARE
• Administer antibiotics as ordered.
- prevention of kidney infection/glomerulonephritis.
- obtain cultures before starting antibiotics
• Provide warm baths and allow child to void in water to
alleviate painful voiding.
• Force fluids.
•Provide client teaching and discharge planning
Undescended Testis
aka “Cryptorchidism”
common : unilateral
premature infants
75% descend spontaneously in 1 year
Treatment : Orchipexy
MEDICAL MANAGEMENT
• Whether or not to treat is still controversial.
- If the testes remains in the abdomen, damage to
the testes (sterility) is possible because of
increased body temperature.
• If not descended by age 8-9 mos, chorionic
gonadotropin can be given.
• Orchipexy
- surgical procedure to retrieve and secure testes
placement
- preformed between ages 1-3 years
NURSING CARE
• Advise parents of absence of testes and provide
information about treatment options.
• Support parents if surgery is to performed.
Post-op
• Avoid disturbing the tension mechanism.
- will be in place for about 1 week.
• Avoid contamination of incision.
Wilms’ Tumor
“Nephroblastoma” “Renal
Embryoma” “Birch-Hirschfeld
Tumor”
Incidence :
a. Highest : 3-4 years of
life
b. Uniform : 5-15 years
Etiology:
a. Hereditary
b. Sporadic
Wilms’ Tumor
Assessment: Initial : Asymptomatic
a. Abdominal Pain
b. Fever
c. Hematuria (25%)
d. Hypertension
e. Dysuria, Polyuria, Vomiting, Malaise
Diagnosis:
a. IVP : Enlarged kidney & distorted pelvis
b. Aortography : Arterial supply of tumor
c. Ultrasound, CT Scan
Treatment: Surgery, Chemotherapy, Radiation
- surgery within 24-48 hours of admission
to remove the tumor affected kidney,
and the adjacent adrenal glands
- postoperative radiation therapy
- chemotherapy (dactinomycin, vincristine,
adriamycin, cyclophosphamide)
- BP monitoring
- DO NOT PALPATE THE ABDOMEN!
Wilms’ Tumor
Nursing Care: DO NOT PALPATE Abdomen!
a.Handle and bathe carefully to prevent trauma
b. Monitor blood pressure
c. Begin teaching family about chemotherapy and
radiation therapy
Postoperative
a. Monitor blood pressure carefully
b. Monitor intake and output to assess kidney
function
c. Encourage child to turn, cough, and deep breathe
d. Teach parents to identify untoward reactions from
chemotherapy and radiation therapy
Nephrotic Syndrome
caused by a lot of factors
problem : increase glomerular
basement membrane permeability
Assessment
a. protenuria (>2 gm/day)
b. hypoprotenemia (<2.5 g/dl)
c. hyperlipidemia (>200 mg/dl)
d. edema
e. anorexia, vomiting
Plasma CHON enter the renal tubule
Excreted in urine
PROTEINURIA
Oncotic pressure
Plasma volume
HYPOVOLEMIA