NURS 1400 Unit VI

Common Childhood Illnesses

Metro Community College

Nursing 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 disorders

Acne 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