Johnson J., Keogh J. Pediatric Nursing Demystified: A Self-Teaching Guide
Подождите немного. Документ загружается.
Nursing Interventions
䊋 Monitor hematologic, renal, and hepatic laboratory tests for signs of tox-
icity from long-term intravenous antibiotic therapy.
䊋 Monitor for ototoxic side effects.
䊋 Support the infected area when repositioning the patient.
䊋 Avoid weightbearing on the infected area until healed.
䊋 Keep the patient on bed rest.
䊋 Assess for ischemia—pain, pallor, pulselessness, paresthesia, paralysis.
䊋 Teach the patient and parents about the disorder and treatment.
Pediatric Nursing Demystified
292
1. Why is there an increase in the white blood cell count?
a. White blood cells increase as part of the inflammation process to attack the bacte-
ria that is causing the infection.
b. The infection disrupts the bone marrow’s production of white blood cells.
c. This is in response to antibiotic treatment of the disorder.
d. The increased white blood cell count is the result of production of immature white
blood cells.
Answer:
✔ ROUTINE CHECKUP 4
JUVENILE RHEUMATOID ARTHRITIS
What Went Wrong?
Juvenile rheumatoid arthritis (JRA) is an autoimmune disease that causes
chronic inflammation of connective tissue and joints resulting in swelling,
pain, and limited motion that occurs <16 years of age. The synovial mem-
brane becomes inflamed, called synovitis, resulting in increased fluid, lym-
phocytes, and plasma in the joint, which causes the joint to swell and become
joint effused. The joint can erode and deform over time resulting in bone loss,
osteoporosis, subluxation, and ankylosis. There are two peak ages of onset—
between 1 and 3 years and between 8 and 10 years of age.
There are three types of JRA:
䊋 Oligoarticular: This affects fewer than five joints and might exhibit
inflammation of the iris without joint symptoms.
䊋 Polyarticular: This affects the small joints of the hands and weightbear-
ing joints.
䊋 Systemic: This affects the entire body resulting in high fever that sud-
denly drops to normal. A rash may appear and then suddenly disappear.
7
Signs and Symptoms
䊋 Irritability
䊋 Poor appetite
䊋 Mild growth delay
䊋 Tires easily
䊋 Changes in gait
䊋 Poor weight gain
䊋 High fever
䊋 Rash
䊋 Flex position at rest
Test Results
䊋 Increased erythrocyte sedimentation rate (ESR)
䊋 Positive rheumatoid factor (RF) in serum
䊋 Positive immunoglobulin (Ig)G and IgM present in serum
䊋 Positive antinuclear antibodies (ANA) in serum
䊋 Low hemoglobin
Treatments
䊋 Administer nonsteroidal antiinflammatory drugs (NSAIDs) such as
ibuprofen and naproxen for pain relief. It can take 3 weeks for antiin-
flammatory response to occur.
䊋 Administer slow-acting antirheumatic drugs (SAARDS) such as
methotrexate, sulfasalazine, and hydroxychloroquine to suppress the
autoimmune response.
䊋 Administer steroids if other treatments fail. Steroids reduce inflamma-
tion but have adverse side effects with long-term use.
䊋 Administer etanercept (Enbrel) if NSAIDs and SAARDS fail. Etanercept
blocks the binding of tumor necrosis factor with cell surface receptors,
thus reducing inflammation.
䊋 Physical therapy to ensure safety ambulation.
Nursing alert Monitor the patient for signs of infection because antiinflamma-
tory medication suppresses the immune system.
Nursing Interventions
䊋 Perform range-of-motion exercise on the affected joint to maintain joint
mobilization.
䊋 Encourage nonweight bearing activities to strengthen muscles.
䊋 Use splints and braces to reduce flexion and minimize pain.
䊋 Monitor renal and hepatic labs to detect adverse reaction to long use of
NSAIDs.
䊋 Apply warm compresses on joints when sleeping to prevent viscous that
results in stiffness.
CHAPTER 13 / Musculoskeletal Conditions
293
䊋 Increase foods high in iron.
䊋 Increase fluids if the patient has a fever to prevent dehydration.
䊋 Encourage self-care and normal independent activities of daily life.
䊋 No restrictions on daily activity.
䊋 Teach the parent:
• To give the patient a warm bath when awaking to reduce stiffness
• To avoid the patient remaining in a fixed flexion position
• That the patient should sleep 8 to 10 hours at a time to avoid fatigue.
Avoid naps because this inactivity results in stiffness.
• That the patient should alternate between active and quiet activities
to avoid fatigue.
EWING SARCOMA
What Went Wrong?
Ewing sarcoma is cancer of the bone that stems from primitive nerve cells
and is related to chromosomal abnormalities. Ewing sarcoma metastasizes to
bone marrow, other bones, and the lungs.
Nursing alert Ewing sarcoma is commonly misdiagnosed as a sports injury.
Signs and Symptoms
䊋 Awakening at night with pain at the site of the tumor
䊋 Weight loss
䊋 Swelling at the site
䊋 A limp, if the legs are affected
䊋 Difficulty breathing, if ribs are affected
Test Results
䊋 Radiograph: Tumor present
䊋 CT scan: Tumor present
䊋 Bone marrow biopsy
䊋 Positive serology study for Ewing sarcoma cells
Treatment
䊋 Surgical removal of the tumor without amputation
䊋 Chemotherapy to kill the Ewing sarcoma cells
Nursing Interventions
䊋 Enable the child to make choices about daily care to give the child a
sense of control.
䊋 Teach the parents and the child about the disorder and treatment.
䊋 Encourage the child to continue normal activities of daily living as pos-
sible, including interaction with the child’s friends.
Pediatric Nursing Demystified
294
LEGG-CALVÉ-PERTHES DISEASE
What Went Wrong?
Legg-Calvé-Perthes disease is a necrosis of the femoral head that occurs in
children between 2 and 12 years of age caused by a decreased blood supply
to the femoral head. This disease is self-limiting, and the child will fully
recover after the disease has run its course.
There are three stages of Legg-Calvé-Perthes disease:
䊋 Avascular: Blood supply to the head of the femur is interrupted within
1 year.
䊋 Revascularization: Creeping substitution occurs where connective and
vascular tissue enter the necrotic bone causing live noncalcified bone to
replace the necrotic tissue.
䊋 Healing: The bone ossifies over 3 years.
Signs and Symptoms
䊋 Painless limp
䊋 Pin in the knee during activity
䊋 Pain in the groin
䊋 Pain in the anterior thigh
Test Results
䊋 Radiograph: Shows decreased bone mass, ossification centers, and possibly
subchondral fracture.
Treatment
䊋 Legg-Calvé-Perthes disease is self-limiting.
䊋 Physical therapy to restore range of motion.
䊋 Administer analgesic to reduce pain.
Nursing Interventions
䊋 Perform range-of-motion activities to maintain normal motion of the joint.
䊋 Teach the patient how to use crutches.
䊋 Explain to the parents and the patient that the disease is self-limiting and
that the patient will fully recover once the disease has run its course.
TALIPES (CLUBFOOT)
What Went Wrong?
A clubfoot is a congenital deformity that occurs in utero due to adverse effects
of medication, infection, trauma, or genetic trait resulting in contracture of
soft tissue and abnormal development of a joint and muscles.
Signs and Symptoms
䊋 Usually position or forming of one or both feet
CHAPTER 13 / Musculoskeletal Conditions
295
Test Results
䊋 Radiograph: Talus is superimposed and the metatarsal is ladder-like.
Treatment
䊋 Splint the foot in the realigned position in the adduction position and
then cast the foot for 2 weeks.
䊋 Remove the cast and realign in the heel inversion position and then cast
the foot for 2 weeks.
䊋 Remove the cast and realign in the flexion of the ankle position and then
cast the foot for 2 weeks.
䊋 Apply an ongoing night brace once the cast is removed.
䊋 If casting does not permanently realign the foot, corrective surgery is
performed.
䊋 Special shoes containing adjustable bars are worn to realign the foot
as a noncasting and nonsurgical intervention.
Nursing Interventions
䊋 If the foot is in a cast:
• Elevate the affected foot on pillows.
• Assess for ischemia: Pain, pallor, pulselessness, paresthesia, paral-
ysis every 2 hours.
• Teach parents how to assess for ischemia and how to exercise the
affected foot at home.
䊋 Explain to parents the importance of wearing corrective shoes.
CONCLUSION
The musculoskeletal system provides the framework, protection, and move-
ment for the body through the interconnectivity of bones, muscles, tendons,
ligaments, and fascia. It is also the repository for calcium and phosphorus and
the site where red blood cells are produced.
Soft tissue injuries are the most common musculoskeletal system disorder
because children are exposed to activities that might result in sprains, strains,
and contusions. These activities can also lead to fractures. Fractures can also
be caused by osteogenesis imperfecta where fractures occur for no obvious
reason.
Osteogenesis imperfecta is one of a number of disorders that affect the mus-
culoskeletal system. Some disorders are congenital, such as clubfoot or hip
dysplasia, where there is abnormal development of the hip and torticollis
where the sternocleidomastoid muscle is damaged from intrauterine malposi-
tion of the fetus in or from birth trauma. Ewing sarcoma is cancer of the bone
that is related to chromosomal abnormalities.
8
Pediatric Nursing Demystified
296
Children are also susceptible to scoliosis, which is the lateral curvature of
the spine, and osteomyelitis in which the Staphylococcus aureus bacteria
infects the bone. Some children <16 years of age develop juvenile rheumatoid
arthritis, an autoimmune disease that causes chronic inflammation of connec-
tive tissue and joints resulting in swelling, pain, and limited motion.
Two other disorders that affect children are a slipped capital femoral epi-
physis and Legg-Calvé-Perthes disease. A combination of a weak epiph-
ysis and a growth spurt can cause a slipped capital femoral epiphysis where
the upper end of the femur is dislocated. Legg-Calvé-Perthes disease is
self-limiting. Disruption of the blood supply to the femoral head results in
necrosis.
CHAPTER 13 / Musculoskeletal Conditions
297
FINAL CHECKUP
1. What is a fracture where the bone is partially broken and bending called?
a. Hairline fracture
b. Comminuted fracture
c. Greenstick fracture
d. Complete fracture
2. What causes compartment syndrome?
a. Edema at the site of the fracture
b. Infection
c. Osteomyelitis
d. Nerve damage
3. What might you conclude if you notice a wide perineum and unequal gluteal
and thigh folds when assessing a newborn?
a. Osteogenesis imperfecta
b. Torticollis
c. Scoliosis
d. Hip dysplasia
4. Following an upper respiratory infection, the 3-year-old becomes irritable and
lethargic. He has an abrupt fever and swelling and warmth near his knee. What
would you suspect?
a. Otitis media
b. Ototoxic
c. Legg-Calvé-Perthes
d. Osteomyelitis
?
Pediatric Nursing Demystified
298
5. The health-care provider diagnosed a child with Legg-Calvé-Perthes disease.
The parents expressed their concern to you that their child’s leg will be ampu-
tated. How should you respond?
a. It is too soon to determine if amputation is necessary.
b. No amputation is necessary because the child will make a full recovery once the
disease runs its course.
c. The health-care provider is the best person to talk to you about amputation.
d. Not all children who have the disease require amputation.
6. The parents of a child who has been diagnosed with juvenile rheumatoid arthri-
tis calls you complaining that there is no improvement with their son’s pain after
a week of taking naproxen. How would you respond?
a. I’ll mention this to your health-care provider.
b. You should switch to ibuprofen.
c. It can take 3 weeks before you see pain relief when taking naproxen.
d. Naproxen takes 2 weeks to work in children.
7. A child of short stature for his age is taken to the Emergency Department for a
fractured arm. This is the second fracture that the child received this year. Both
the child and parents say they have no idea how the fracture occurred. You
notice that the child has a bluish sclera. What do you suspect?
a. Greenstick fracture
b. Child abuse
c. Osteogenesis imperfecta
d. Torticollis
8. An 8-year-old Little Leaguer was taken to the Emergency Department in January
complaining that he was awakened by pain above his knee. There is slight
swelling at the site. What would you suspect?
a. A sports injury
b. Talipes
c. Juvenile rheumatoid arthritis
d. Ewing sarcoma
9. A 10-year-old is brought to the Emergency Department following an automo-
bile accident. You notice a contusion on her outer left thigh. What should
you do?
a. Bring the crash cart to the bedside.
b. Encircle the area of the contusion and write the date and time outside the contu-
sion so you can assess if bleeding has stopped or is continuing.
c. Suspect child abuse.
d. Notify the health-care provider immediately.
CHAPTER 13 / Musculoskeletal Conditions
299
10. A 2-month-old is diagnosed with hip dysplasia. The parent asks you how long
will the child be in the hip spica cast. How should you respond?
a. Not longer than 4 months.
b. The child will be placed in a Pavlik harness for 3 to 5 months.
c. Following the osteotomy, the child remains in a cast for 5 months.
d. Between 2 and 4 months.
ANSWERS
Routine checkup 1
1. d. Cartilage does not contain blood vessels that are required for healing.
Routine checkup 2
1. b
Routine checkup 3
1. c
Routine checkup 4
1. a
Final checkup
1. c 2. a 3. d 4. d
5. b 6. c 7. c 8. d
9. b 10. b
This page intentionally left blank
CHAPTER
Infectious and
Communicable
Conditions
14
Learning Objectives
At the end of the chapter, the student will be able to
1 Understand the stages of infection.
2 Identify signs of diphtheria.
3 Know the interventions for pertussis.
4 Explain the treatment for pertussis.
5 Care for a patient who is diagnosed with tetanus.
6 Assess a patient who has fifth disease.
7 Teach families about the mumps.
8 Intervene with a patient who has poliomyelitis.
9 Describe the incubation period for roseola infantum.
10 Discuss the transmission of rubella.
11 Recognize when a patient diagnosed with rubeola is contagious.