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INFANTS WITH SPECIAL NEEDS: BIRTH TO 12 MONTHS L. Lehmkuhl, RN 2008

SECTION III MATERNAL & PEDIATRIC NURSING. UNIT 18 NURSING CARE OF THE CLIENT: CHILDREARING CHAPTER 56. INFANTS WITH SPECIAL NEEDS: BIRTH TO 12 MONTHS L. Lehmkuhl, RN 2008. Inflammation of the middle ear. Eustachian tubes in infants are shorter, wider and more horizontal than in adults.

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INFANTS WITH SPECIAL NEEDS: BIRTH TO 12 MONTHS L. Lehmkuhl, RN 2008

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  1. SECTION III MATERNAL & PEDIATRIC NURSING UNIT 18NURSING CARE OF THE CLIENT: CHILDREARING CHAPTER 56 INFANTS WITH SPECIAL NEEDS:BIRTH TO 12 MONTHS L. Lehmkuhl, RN 2008

  2. Inflammation of the middle ear. Eustachian tubes in infants are shorter, wider and more horizontal than in adults. Drainage from middle ear to nasopharnyx is often impaired. Secretions and air become trapped as bacteria moves up from pharnyx to the middle ear Irritability, pulling at the infected ear, diarrhea, vomiting, fever, hearing loss. Treatment includes medications or myringotomy for recurrent infections. Prevention: proper positioning when feeding (upright), smoke-free environment (to prevent respiratory congestion). OTITIS MEDIA

  3. Infant Adult

  4. Otitis media is an inflammation and/or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids. Middle Ear Infection (Otitis Media)

  5. Eustachian tube

  6. LARYNGOTRACHEOBRONCHITIS • Viral illness–swelling of the upper airway. • Symptoms include stridor, “barking” cough, hoarseness. • Treat to maintain a patent airway and improve respiratory effort. • Cool mist and medications.

  7. Edema in airways

  8. Profuse nasal drainage

  9. PNEUMONIA • Often preceded by an upper respiratory infection. • Onset is abrupt, fever, flaring nostrils, circumoral cyanosis, chest retractions, increased pulse and respirations, cough. • Oxygen, cool mist hydration, respiratory therapy, and medications.

  10. Most often found in pre-term infants. Lungs are deficient in surfactant (a slippery, protective substance, which helps the lungs inflate with air and keeps the air sacs from collapsing). When lungs collapse after each breath O2 supply reduced Symptoms include tachypnea, retractions, grunting, crackles, pallor, cyanosis, hypothermia, edema, flaccid muscle tone, GI shutdown (no voiding), jaundice, acidosis. First 96 hours are critical to recovery. Treatment: surfactant through endotracheal tube, supportive care (e.g. CPAP). RESPIRATORY DISTRESS SYNDROME

  11. Affects lungs, pancreas, liver, and reproductive organs. Autosomal-recessive trait (both parents are carriers) Meconium ileus (impacted feces in NB causing Bowel obstruction), intussusception, problems gaining and maintaining weight, pulmonary problems, salty taste on skin. Treat to manage pulmonary complications, postural drainage, high calorie diet (CF asorb only 50% of ingested foods). CYSTIC FIBROSIS

  12. Cystic Fibrosis

  13. Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen. Diseases which cause malabsorption, such as cystic fibrosis or celiac disease can also cause clubbing. Cystic Fibrosis/Clubbed Fingers

  14. Clubbing

  15. There are 6 to 12 positions a person with pulmonary disease may take to drain mucus from a certain part of the lungs. Another person may tap in certain areas to help loosen the mucus and allow it to be coughed out. Other ways to relieve the lung congestion of cystic fibrosis include percussion vests and inhaled aerosols. Postural Drainage

  16. * (often the earliest manifestation)*

  17. SUDDEN INFANT DEATH SYNDROME (SIDS) • “Crib death.” • Sudden unexpected death of apparently healthy infant. • No single cause has been identified. • Provide empathic support to the family. • Inform family that autopsy must be done.

  18. CONGENITAL CARDIOVASCULAR DISEASE • Increased pulmonary blood flow. • Decreased pulmonary blood flow. • Obstructed blood flow out of heart. • Mixed blood flow. • Symptoms vary with type of disease. • Infants with sever defects often exhibit S/S CHF (fatigue, orthopnea, failure to thrive, pale, mottled or cyanotic skin, tachy,) • Treatment includes medications (dig to increase heart contractibility), surgery.

  19. *

  20. HYPERBILIRUBINEMIA • Also known as jaundice, yellow discoloration of the skin, sclera, mucous membranes, and body fluids. • Treat to reduce the amount of unconjugated bilirubin. • Treatment is usually phototherapy with a bililight.

  21. IRON-DEFICIENCY ANEMIA • Full-term infants have iron stores that last for 5 to 6 months. • Surfaces between 9 and 24 months. • Symptoms: pallor, tachycardia, lethargy, irritability, and below-normal hemoglobin, hematocrit, and iron levels. • Treatment is iron replacement (foods, formula, supplements, IM Fe).

  22. Genetic disorder characterized by the production of abnormal hemoglobin. Symptoms not until 6 months of age: abdominal pain, fever, growth retardation, anemia. Prevent crises with hydration. During: bed rest, oxygen, analgesics, fluids. Immunizations for children with this disease include: influenza, pneumococcal, meninggococcal, and hep B. Prophalatic po pcn til 5-6 y/o SICKLE-CELL ANEMIA

  23. THRUSH • Oral fungal infection often acquired after atb treatment of another illness. • Symptoms include painless, white patches that look like curdled milk on the oral mucosa. • Topical nystatin is the most commonly used treatment.

  24. ACUTE GASTROENTERITIS • Inflammation of the stomach and intestines with diarrhea and vomiting. • The infant may become dehydrated and gravely ill. • Adequate fluids to replace fluid loss (rehydration) is the goal of treatment.

  25. COLIC • Sudden, periodic attack of abdominal pain, cramping; usually ends by 3 months. • Infant cries for several hours and draws the legs up to the abdomen. • Usually occurs at the same time of day. • Treatment includes medications and exploration of ways to comfort the infant.

  26. FAILURE TO THRIVE • Infant failing to gain weight and showing signs of delayed development. • Sustained growth failure, developmental delays, poor feeding, sleeping patterns. • Treatment: provide nutrition, promote growth and development, and assist parents to develop skills.

  27. May occur separately or together. Infants with cleft palate are at risk for aspiration, feeding difficulties, and respiratory infections. Treat to close defects Surgical lip closure @ *6-12 weeks, followed by palate closure 12-18 months. Maintain nutrition, prevent complications, and foster normal growth and development. CLEFT LIP/PALATE

  28. Failure of the esophagus to develop as a continuous passage and/or an unnatural connection between esophagus and the trachea. S/S excessive salivation, drooling, coughing, choking during fdg’s, cyanosis, hx of polyhydraminos (excessive production of amniotic fkluid) durting prenatal period Prognosis is usually good with surgery ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA

  29. Occurs when circular muscle surrounding the pylorus hypertrophies and blocks gastric emptying. The main symptom is projectile vomiting (ejection up to three feet). Other S/S: hunger, visible peristalic waves, Hyperbowelsounds, irritable, olive shape mass on RUQ Complete recovery with surgery treatment. PYLORIC STENOSIS

  30. Congenital anomaly manifested as partial or complete mechanical obstruction resulting from inadequate colon motility. Failure to have a stool* in the first 24 hours may be indicative of this defect. Surgical intervention is usually necessary. HIRSCHSPRUNG’S MEGACOLON

  31. GASTROESOPHAGEAL REFLUX • Return of abdominal contents into the esophagus. • Symptoms include hunger, irritability, FTT, vomiting, and frequent upper respiratory infections. • Often resolves with dietary modifications, medication and positioning.

  32. INTUSSUSCEPTION • Telescoping of one portion of the bowel into a distal portion (part of the intestine being pulled inward into itself) • This can block the passage of food through the intestine. If the blood supply is cut off, the segment of intestine pulled inside can die. • The infant will suddenly become pale, cry out sharply, and draw up the legs in a severe colicky spasm of pain, vomiting and “current-jelly” stool occur. • Barium enema is the main treatment.

  33. Foot has clublike appearance with entire foot inverted, apparent at birth. Treatment includes manipulation and casting of the foot and surgery. Even with aggressive therapy/surgery the club foot may recur. CONGENITAL TALIPES EQUINOVARUS (CLUB FOOT)

  34. DEVELOPMENTAL DYSPLASIA OF THE HIP • Dysplasia–refers to a variety of conditions wherein the femoral head and the acetabulum are improperly aligned. • Limited abduction, asymmetry of the gluteal and thigh fat folds, and telescoping of the thigh. • Treatment: casting, bracing and surgery.

  35. Flattened head syndrome. Occurs when the infant is put to sleep in the same position repeatedly or by neck muscle problems. Not self-correcting. Light-weight plastic helmet to redirect symmetrical growth of infant’s head. Prevention is key…teach parents to alternate sleeping positions. POSITIONAL PLAGIOCEPHALY

  36. MILIA RUBRA • Prickly heat. • Rash appears as pinhead-sized erythematous papules. • Often found in folds of skin from being overdressed in Summer heat. • Infants may be irritable because of itching. • Treatment is primarily preventative.

  37. DIAPER DERMATITIS • Diaper rash. • Erythema, edema, vesicles, papules, and scaling on the perineum, genitals, buttocks, and skin folds. • Treatment: change diapers regularly and keep the infant’s skin clean and dry.

  38. SEBORRHEIC DERMATITIS • Cradle cap. • Characterized by yellowish, scaly, or crusted patches on the scalp. • Caused by overactive sebaceous gland activity. • Crusting can usually be prevented by washing infant’s head with a washcloth and using a fine-toothed comb. Mineral oil will help loosen crusty sebum prior to washing.

  39. Eczema–chronic superficial inflammatory skin disorder characterized by intense pruritis. Treat to relieve pruritis, hydrate skin, reduce inflammation, and prevent secondary infections. Baths, compresses give temporary relief. Control allergens: Smoking outside Family pets kept outside * Removing dust ATOPIC DERMATITIS

  40. Atopic dermatitis is quite often seen on the cheeks of infants. It consists of red (erythematous), scaling plaques that are diffusely scattered over the infant's body and face. Dermatitis, Atopic in an Infant

  41. Neural tube defect wherein incomplete closure of vertebrae and neural tube results in an opening through which meninges and spinal cord may protrude. Caused by maternal folic acid deficiency during pregnancy Surgery is required to close the defect. SPINA BIFIDA

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