- 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.
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.
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
- 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.
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
- 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.
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.
- 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.
- Nuchal rigidity
- Bulging fontenelles
- Poor feeding or anorexia
- Involuntary arching of the back
- Tx: isolation until 24 hr post imitation of antibiotics if bacterial.
- Treat symptoms of viral.
- Close monitoring of neuro status
- 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
No cure but disabilities can be lessened with treatment
- Tx: foster independence
- Treatment is highly individualized
- Preventing contractures
- Community resources available.
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.
- 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
- Poor feeding
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
- Emotional (abuse and neglect ), physical (abuse snd neglect), sexual (abuse and neglect)
- *** nurses are obligated to report suspect abuse. **
- 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
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
Treatment : immediate treatment of hypoxia, aspiration and hypothermia.