Infants with soecial needs part two

  1. Club foot
    • 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.
  2. Congenital or developmental hip dysplasia
    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.
  3. Miliaria of milia rubra.
    • 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
  4. Diaper dermatitis
    • 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.
  5. Seborrheic dermatitis
    • 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
  6. Atopic dermatitis
    • 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.
  7. Treatment for infantile eczema
    • 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
  8. Spina bifida
    • 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.
  9. Hydrocephalus
    • 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.
  10. Tx for hydrocephalus
    • 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.
  11. Febrile seizure
    • 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
  12. Meningitis
    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
  13. Cerebral palsy
    • 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.
  14. Hypospadias and episoadias
    • 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.
  15. Hydrocele
    Water tumor

    • Fluid around the testicles
    • Causes scrotal swelling
    • Usually does not require treatment
    • If persists after one year, surgery may be needed
  16. Cryptorchidism
    • 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
  17. Bladder exstrophy
    • 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
  18. Vesicoureteral reflux
    • Reflux of urine back into the bladder
    • Ss: uti
    • Fever
    • Poor feeding
    • Vomiting

    Tx: prophylactic antibiotics or surgery if structural defect
  19. Wilms tumor
    • 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 ****
  20. Down’s syndrome
    • 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.
  21. Strabismus
    • 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
  22. Pink eye
    • 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
  23. Hearing impairment
    • 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
  24. Child abuse
    • 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****
  25. Poisoning
    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.
  26. Lead poisoning
    • 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
  27. Possible airways obstruction
    • 80% of foreign bodies pass through the gi tract
    • May take 5-6 days
    • Avoid laxatives
    • Maintain normal diet

    Tx: may require surgical removal
  28. Drowning
    Treatment : immediate treatment of hypoxia, aspiration and hypothermia.
Card Set
Infants with soecial needs part two