Infants with soecial needs part two

• Entire foot inverted.
• Can be unilateral or bilateral
• Treatment should begin ASAP

Tx: stretching exercises, splinting or casting. If no improvement within 3-6 mo, then surgery.

Care: nv check, casts are changed q 2-3 weeks to bring foot into alignment.

S/s affected leg appears shorter. Limitation of Rom on affected side; knee in affected side lower. With more skin folds. Limp in the walking infant. Ortilanis click.

• Dx: x Ray
• Tx: if under 6 mo, pavlik harness. Helps with slignmrnt and develops ball and socket connection.
• Tx : if over 6 mo: traction followed by casting. Ex: hip spica cast. Surgery may be required may be required for severe cases not corrected with traction or casting.

• Caused by blocked sweat glands
• Heat rash
• Itching may or may not be present musically in high moisture areas
• Treatment involves frequent diaper changes and removing excess clothing

• Diaper rash
• Skin irritation from prolonged contact with urine or feces
• S/s depend on severity
• Tx; expose to air, clean with warm water and dry
• Meds:A&p ointment, destin
• Prevention is easier than curing.

• Cradle cap
• Inflammation of sebaceous gland involving the scalp. Secondary infections can occur
• Characterized by crust like scales, yellowish in color and oily
• Can also occur at puberty
• Tx: will eventually disappear
• Mild shampoo or baby oil

• Aka: infantile eczema
• Superficial inflammation of the epidermis
• Associated with allergic reaction to allergens. Often associated with asthma l.
• Common appears on the face, neck, and folds of elbows and knees
• Scratching leads to coarse, rough skin.
• Redness and constant itching are most common ss
• Vesicles form that weep and develop dry crust.

• Relieve itching. Hydrate skin and prevent infection avoid skin irritants
• Antihistamines snd corticosteroid ointments in small amounts
• Avoid steroids with viral illness minimize scratching
• Keep nails short
• Oatmeal bath

• Neural tube defects
• Spina bifida occulta: closed. May have sacral dimple or tuft of hair
• Spina bifida cystica: open with cyst protruding.
• Meningocele- meninges snd CSF. Least severe of the 2
• Myleomeningocele- meninges, CSF, snd spinal cord

• Tx: surgical closure m.
• Pre op: prone positioning, keep sac moist, prevent infection, no diaper. Good skin care.

• Post op. Initially- infection control.
• Later- rehab and bladder training.
• If paralyzed- teach in and out cath.

• Accumulation of CSF within the ventricles in the brain.
• Leads to increase ICP and size
• S/s infants: increase in head size*, bulging fontenelles, setting sun eyes, shiny scalp with dilated veins; shrill/high pitched cry; irritable; vomiting; possible seizures.
• Older children: h/a snd changed in LOC.
• Increased bp, decreased hr snd resp, bulging fontenelles or ha, unequal pupils, irritability or high pitches cry.

• Watch for ss of icp
• Surgical shunts to bypass obstruction
• Must check head and abd girth.
• Increases in abd girth can signify problems with absorption.
• Increase in head girth can indicate kink in the tube.
• They are repacked as the child grows.

• Baby with VP shunt :sunken Fontanel means it’s draining too quickly and they should be laid flat.
• If bulging, it’s not draining enough so eleveate HOB 30 degrees **

After feeding , Lay on side.

• S/s sudden onset jerking and muscle stiffening
• Seizures occur in response to rapid rise in temp. Not high it goes
• Often follows infection
• Prognosis: excellent

Teach to control temp with anti pyretics and cooling methods

Viral or bacterial

• S/s high pitched cry.
• Fever
• Vomiting
• Nuchal rigidity
• Bulging fontenelles
• Poor feeding or anorexia
• Ha
• Lethargy
• Involuntary arching of the back
• Irritability

• Tx: isolation until 24 hr post imitation of antibiotics if bacterial.
• Treat symptoms of viral.
• Close monitoring of neuro status
• I&O
• Vs
• Quiet, dim room

• Brain abnormality that causes impaired movement and coordination
• S/s delayed gross motor development
• Abnormal posturing/ muscle tone
• Extreme irritability
• Feeding difficulties
• Stuff snd right extremities

• 4 types : spastic- spasm occur with purposeful movement
• Athetoid: sometimes continuous involuntary movements with no purpose
• Ataxic
• Mixed.

No cure but disabilities can be lessened with treatment

• Tx: foster independence
• Treatment is highly individualized
• Preventing contractures
• Rehab
• Community resources available.

• Hypo- uriniary meatus is on the underside of penis
• Epi- top side of penis

Circumcision is postponed at birth and in order to preserve foreskin for repair

• Treatment depends on severity and whether voiding is altered
• Treatment -surgery
• Should be done prior to port training.

Water tumor

• Fluid around the testicles
• Causes scrotal swelling
• Usually does not require treatment
• If persists after one year, surgery may be needed

• Failure of restocked to descend
• Sperm deteriorates snd can lead to infertility
• Secondary sex traits are not affected

• Treatment: hormone therapy (hCG)
• Surgery- if teste isn’t descending within a year

• Bladder lies open on outside of the body
• Involves defect on lower abd wall
• Treatment- surgery /in stages.
• Keep bladder covered with plastic wrap or with sterile not adherent dressing
• Position infant supine with diaper underneath

• Goal of care: preventing infection ; protecting the mucosa of the exposed bladder, preventing drying out of bladder; skin care important
• Closure usually performed within 48 hr

• Reflux of urine back into the bladder
• Ss: uti
• Fever
• Poor feeding
• Vomiting

Tx: prophylactic antibiotics or surgery if structural defect

• Malignant mass on kidney
• Usually visible
• No ss present in early stages

X-ray confirms it

• Treatment : surgery (ASAP) radiation and chemical
• Avoid palpating if abdomen ****

• Caused by faulty chromosomal distribution. Had 47 chromosomes.
• SS: close-set upward slanting eyes; large protruding tongues; small skull; short thick hands, underdeveloped muscles and joints, developmental delays; mental retardation.

• Eyes are mal-aligned or crosses.
• Can not focus both eyes on same object
• Permanent loss can occur in the weak eye
• SS: squinting, missing objects reached for, covering or closing eye to focus, tilting head to see, headache

Treatment: glasses, eye patch on good eye, or surgery

• Inflammation of the conjunctiva
• Can be infectious or non infectious
• Can be very contagious
• Often caused by allergies, infection, trauma or tear ducts obstruction

Teaching ; warm compresses , prevent rubbing eyes, keep home for 24 hr post initiative of antibiotics

• 2 main types:
• Congenital (at birth)
• Acquired (occurs over time)

Hearing loss can affect speech as well as social development

First sign : lack of response to sound and failure to turn toward voice

• Be cautious of kids who point when they should be talking.
• Dx with hearing test and tympanogram

• Option available: hearing aids for mild to moderate
• Cochlear implant: used with nerve involvement

• To communicate:
• Face child at eye level
• Use short phrases or sentences
• Sign language

• Types
• Emotional (abuse and neglect ), physical (abuse snd neglect), sexual (abuse and neglect)
• *** nurses are obligated to report suspect abuse. **

• Assessment
• Sketchy history
• Bruises of different colors
• Delay in seeking treatment
• Story may change
• ***documentation is important****

Accidental - caustic vs non- caustic solutions

• Tylenol: can cause liver damage
• Treated with pumping of stomach or mucomyst
• Monitor liver

• Salicylate: watch for bleeding
• Treatment: vit k, and possible dialysis if condition severe enough.

• A common cause of mental retardation
• SS: irritability, weight loss, abd pain, vomiting, possible seizures

• Dx: urine snd blood levels
• Tx: months of chelating therapy
• Does not reverse effects of lead

• 80% of foreign bodies pass through the gi tract
• May take 5-6 days
• Avoid laxatives
• Maintain normal diet

Tx: may require surgical removal

Treatment : immediate treatment of hypoxia, aspiration and hypothermia.