Infants with special needs part 1

• Small airways
• Large tongue

Obligate nose

Higher set in the neck

Eustachian tube is shorter, straighter and wider. Increases risk of infection due to anatomical structure.

Ear canal wall: more pliable and easily bent

• Infection of the middle ear.
• Very common
• Poor drainage is primary cause due to anatomy of Eustachian tubes

Follows URI.

• Pain
• Crying/irritability
• Pulling on ears
• Turning head back and forth
• Fever
• Hearing impairment
• Red tympanic membrane in exam.

• Antibiotics
• Antipyretics
• Analgesics
• Surged (myringotomy) ear tubes
• Avoid water in ears.
• Tubes stay in for about a year.

• Inflammation of larynx, trachea, bronchi resulting in resp obstruction.
• Most common type of croup.
• Can be viral or bacterial

Fever, hoarse voice, seal barking, cough, strider, and labored resp

• Patent airways
• Monitor resp
• Croup tent
• Warm steam or cool moist air
• Cool PO fluids
• Bronchodilators
• Nebulizers
• steroids
• Oxygen

• Inflammation of the lungs where the alveoli becomes filled with exudate.
• Gas exchange is impaired due to atelectasis.
• Types: bacterial( the worst), viral (most common), aspiration (foreign substance )

• Fever
• Dry cough
• Increased resp rate
• Nasal flaring
• Resps usually shallow
• Possible retractions
• Circumoral cyanosis

• Depends on type
• Antipyretics
• Oxygen
• Increases fluid Intake
• Antibiotics

• Exocrine gland dysfunction where mucous is abnormally thick.
• Both parents have to pass the gene
• Loss of electrolytes in sweat because of abnormal
• Chloride movement
• Multi symptom disorder.

• Resp system ( chronic cough, freq infections, clubbing)
• Digestive system( constipation, fatty stools, weight loss)
• Integumentary system ( salty taste)
• Reproductive system ( infertility)

• Chloride sweat test
• Chest x Ray
• PFT
• Stool testing for fat

Respiratory- prevention of infection. Chest Pt, and postural drainage (after nebulizers), nebulizers, avoid cough supp.

Gi- pancreatic enzymes to aid in digestion of fats and proteins. Supplement with salt in hot weather. Provide adequate fluids in replace electrolytes

Skin- good diaper care and perineal care.

• Sudden death of infant less than 1 year
• Babies sleep safer on their backs
• Sleep surface matters
• At risk: preterm infants, infants of drug addicted mothers.
• Prevention : at home apnea monitor

Acyanotic- defects that increase pulmonary blood flow

Cyanosis- defects that decrease pulmonary blood flow

• Atrial septal defect
• Ventricular septal defect
• PDA

• Abnormal opening between R and L atria
• Blood that is already oxygenated is forced back into the R atrium to be recirculated

• R atrial and ventricular enlargement occurs
• Infant may be asymptomatic or may develop CHF

• Surgical closure is treatment of choice
• Non surgical closure is possible sometimes by way of heart cath

• Most common defect
• Abnormal opening between R and L ventricles
• Many close spontaneously during first year of life of small
• A murmur is usually apparent
• Frequent EKGs and observation is usually treatment

Failure of the fetal ductus arteriosus to close in the first weeks of life (w/in 15 hrs)****

Oxygenated blood passes from sorts back into the pulmonary artery to re-circulate back to lungs

• A machine like murmur***
• Child may be asymptomatic or show s/s of CHF
• Can treat premies with *indomethacin* to close ducts
• Full term babies have closed heart surgery
• Usually excellent prognosis

Narrowing near the aortic arch. Leads to increases pressure proximal to defect and decreased pressure distally.

• May not develop symptoms until late childhood.
• If detected in infancy, s/s of CHF
• Bounding pulses in arms and very weak pulses in LE
• Differences in BP of upper vs lower extremities

• Depends on severity
• Surg is closed heart
• Can have pulmonary and aortic stenosis

• Involves obstructed pulmonary blood flow and an anatomical defect between the R and the L sides of the heart.
• Allows right to left shunt bc pressure is greater in the right side of the heart
• Allows unoxygenated blood to enter the aorta

• Includes 4 defects:
• VSD
• Pulmonic stenosis
• Overriding aorta
• R vent hypertrophy

• Cyanosis that increases with age, growth failure, polycythemia, black out spells, clubbing, fatigue and squatting position.
• Tet spells very common in first 2 years.

• Goal is to increase pulmonary blood flow and provide oxygenated blood to relieve hypoxia.
• A temperate procedure is done until baby is able to endure open heart to correct all 4 defects

• Normal levels < 10
• Check at tip of nose or the palms of the hands

• 2 types:
• Physiological -somewhat normal
• Pathological- usually associated with Rh incompatibility. The kind is bad and occurs rapidly in the first 24hrs after birth.

• Common during periods of rapid growth. Presents after 6 mo.
• Commonly occurs from blood loss, increased metabolic demands, gi syndromes of malabsorption and dietary deficiency.

• Supplementation
• Teaching: give iron with vitamin C. Stools will be dark green or black. Take on an Empty stomach.
• Drink through straw. Can cause constipation. Don’t give with milk or calcium- inhibits absorption.

• A hereditary disorder
• Affects African- Americans
• Insufficient oxygen causes cells to take sickle shape.
• Very short life span with sickle cells
• Cells clump together and obstruct blood flow
• Is reversible with adequate treatment
• 2 types: sickle-cell trait or sickle cell anemia

• Onset is usually 6 mo to 1 year
• Most common type is Vado-occlusive

• Pain
• Fever
• Joint swelling
• Sob
• Low h/h
• Dehydration

• Infection
• Dehydration
• Hypoxia
• Fever
• Stress
• Exposure to cold

• Bed rest
• Oxygen
• Ov fluid
• Analgesics
• Transfusions
• Heating pads
• **prevention is key**

• Commonly follows completion of antibiotics
• Oral Candidiasis

S/s white patches or covering over tongue; anorexia. Usually passes thru the gi tract.

Tx: nystatin oral sup and or ointment

Teaching: divide dose evenly to each side of the mouth and NPO for 30 minutes after giving dose

• S/s characterizes by diarrhea and vomiting. Dehydration, sunken fontenelles, poor turtle, sunken eyes, dry mm, enteric precautions.
• Tx: clear liquid diet, iv fluids, anti diarrheals, I&O. Tx is aimed at preventing dehydration.

• Persistent abdominal pain in early days of life
• S/s fussy baby that cries for more than 3 hours/day, 3days/weeks, snd more than 3 weeks (3/3/3)
• Tx: meds.
• Antispasmotics, antihistamines, antifkatulents.

• 2 types
• Organic- medical reason
• Non-organic - neglect/ poor care

• S/s hypotonia, delayed development, wt loss, irritability
• Mother observed
• Me order for nurse to feed

• Opening in upper lip
• Can be unilateral or bilateral
• Psychological support is significant
• Tx: cheiloplasty
• Usually between 6 weeks to 3 mo
• Feeding is a challenge pre-op and post -op. Fed with syringe or medicine dropper.
• Post op: pain control, elbow restraints, semi Fowler’s, oxygen tent, avoid sucking, syringe feed

Given iv Demerol

Failure of hard palate to fuse

Predisposes to infections/dental caries and aspiration/feeding difficulties

• Tx: surgical closure around 12-18 months
• Post op: no straws or sucking; can drink from cup, avoid crying, feed from side of spoon; light activities; keep mouth clean; avoid hot liquids, should eat soft foods only.
• Ear infections common.

Esophagus ends in a blind pouch.

• S/s vomiting with first feeding
• Excessive drooling in the newborn

Dx:clinical observation and x Ray

• Tx: prevent aspiration
• Oral suction
• surgery

• An opening between something
• Oral intake enters the lungs and or air enters the stomach

S/s coughing and choking during feedings, unexplained sonar or cyanosis, vomiting abdominal distention

• Dx: clinicals observation and x Ray
• Tx: surgery
• Treatment is aimed at preventing respiratory distress, pneumonia and choking prior to surgery

• Hypertrophy of pyloric muscle
• S/s: projectile vomiting, failure to thrive or weight loss, and dehydration l. Baby appears hungry and irritable.
• Olive shaped mass in RUQ just rt of the umbilicus.
• Dx: ultrasound or ct scan
• Tx: surgery ( pyloromyotomy)

• Iv
• Thickened formula in hopes of some retention
• Burp before and during feedings
• Lie on Right side following feedings

• Monitor i&o
• Small feedings initially then progress as tolerated
• Usually by 3-4 days a regular formula feeding schedule is established
• Avoid over feeding
• Frequently burp
• Water incision for infection

• Absence of ganglionic nerve cells in the muscles of part or all of the large intestine
• Aka : megacolon
• Congenital defect
• Area of the bowel right above the instruction dilated causing the major s/s abdonminal distention
• Stools ribbon like

• S/s in newborn: failure to pass meconium, abd distention, bile stained vomit, poor suck
• S/s in child: poor weight gain, and distention, vomiting constipation alternatining either diarrhea

• Dx: rectal biopsy
• Tx: for mild disease, simply treating constipation. For moderate severe disease, survey is usually required

Nursing care: avoid rectal temps, measure abdominal girth, avoid future constipation.

Most infants with GERD can be managed with meds

SS: poor weight gain, irritability, vomiting. Fussy

• Dx: barium swallow and UGI
• Tx: depends on severity. Meds

• Position infant upright
• Avoid infant seats bc increase intrabdominal press

• Small frequent feedings, thickening formula, be alert to coughing during feedings
• Burp frequently, handle child minimally after feedings

• Telescoping of one portion of bowel into another due to hyperparastalsis.
• ***emergency situation***
• Most often seen at the ileocecal valve

• S/s: sudden onset of abdominal pain that leads to screaming and drawing knees up to abdomen.
• Vomiting bile stained , current jelly stools containing blood and mucus
• Bs hypoactive, distended abdomen.

Dx: barium enema, abdominal film

Tx: if reduction does not occur with BE, surgery may be required. Considered emergency surgery

S/s failure to odds meconium in first 24 hrs. A sense of stenosis of the anorectal canal, inability to obtain rectal temp.

• Dx: X-ray and mri
• Tx: NPO for surgical repair
• May involve temporary colostomy

• Gluten intolerance, found in barley, oats, wheat, and rye.
• Number one malabsorption problem in children
• Levels of glutamine increase leading to toxicity to the intestinal tract

S/s usually doesn’t appear until after 6 mo. Ftt anorexia m, abdominal pain, gross distention, muscle wasting, irritability and stools large- bulky and frothy

Tx: gluten free diet and vitamin

• Protrusion of abd contents through abnormal opening in inner abd wall or groin.
• Common in infants.
• Inguinal and umbilical are the most common sites ***

Umbilical: soft swelling/ protrusion around umbilicus. May be reducible.

Inguinal: painless swelling in the groin. May disappear when at rest.

Surgery is treatment option : herniorrhaphy