NURSING CARE OF A CHILD WITH • Electrocardiogram

CONGENITAL HEART DEFECTS • Stress test

• Coronary Angiogram

I. FETAL CIRCULATION RIGHT MANAGEMENT:

AFTER BIRTH 1. Medications
➢ Beta blockers - are used to control heart
rhythm, treat angina, and reduce high blood
pressure.
➢ Diuretics - decreased the amount of fluid
flowing through the veins and arteries.
➢ Heart rhythm medication (Propafenone)
➢ Aspirin
➢ Blood thinner (Warfarin-Coumadin)

2. Surgery
Valve repair and replacement
MITRAL VALVE PROLAPSED may be performed using open- heart surgery or
minimally invasive surgery. Minimally invasive
SYMPTOMS: surgery involves smaller incisions and may have
• A racing or irregular heartbeat (arrhythmia) less blood loss and a quicker recovery time.
• Dizziness or lightheadedness TETRALOGY OF FALLOT
• Difficulty breathing or shortness of breath,
often during physical activity or when lying ➢ Also known as steno-fallot tetralogy
flat. ➢ A congenital heart condition presenting a
• Fatigue combination of four defects in the structure of
the heart.
RISK FACTORS: ➢ The most common symptoms is bluish color of
the skin in the new-born.
1. Marfan syndrome - genetic disorder that
affects connective tissues (tissue that
supports skeleton and internal organs). It
commonly affects eyes, heart, blood vessels
and skeleton.

2. Ehlers-Danlos syndrome - group of

hereditary disorders that affect the
connective tissues of the body. Connective
tissues provide strength and flexibility to the
skin, bones, blood vessels, and other
organs.

3. Ebstein anomaly - a complex, congenital

heart defect characterized by a malformation Tetralogy of Fallot (TOF) is a congenital heart
of the tricuspid valve and right side of the defect which is classically understood to involve four
heart. anatomical abnormalities (although only three of
them are always present). In this condition there is a
4. Muscular dystrophy - group of inherited pulmonary outflow tract obstruction, a ventricular
conditions affecting the muscles, gradually septal defect, right ventricular hypertrophy and
leading to disability. an overriding aorta.

5. Graves' disease - Immune system disorder MAJOR DEFECTS:

resulting in the overproduction of thyroid
hormone. This causes swelling of thyroid 1. Pulmonary Stenosis – defect that occurs
gland, puffy eyes and rapid heartbeat. due to abnormal development of the fetal
heart during the first eight weeks of
6. Scoliosis - a condition characterized by pregnancy.
sideways curvature of the spine or back ➢ Problems with the pulmonary valve
bone, often noted during growth spurt just make it harder for the leaflets to
before a child attains puberty. open and permit blood to flow
forward from the right ventricle to the
DIAGNOSTIC TEST: lungs.
• Chest X-ray
 ➢ Classified according to how much SIGNS & SYMPTOMS:
obstruction to blood flow is present. • A loud murmur or cyanosis
- A child with mild pulmonary stenosis may • Rapid breathing
have few or no symptoms, or perhaps • Sudden drop Arterial blood gasses
none until later in adulthood. • “tetralogyspell” blue lips and skin
- A moderate or severe degree of • irritable
obstruction can become worse with time.
2. Right Ventricular Hypertrophy - a TREATMENT:
pathologic increase in muscle mass of the • A prostaglandin infusion
right ventricle in response to pressure • Surgery (Two types);
overload. - Corrective repair of tetralogy of Fallot
involves closure of the ventricular septal
Symptoms are due to pulmonary hypertension: defect with a synthetic Dacron patch so
that the blood can flow normally from the
• exertional chest pain left ventricle to the aorta.
• peripheral edema - The narrowing of the pulmonary valve and
• exertional syncope right ventricular outflow tract is then
• right upper quadrant pain (due to passive augmented (enlarged) by a combination of
hepatic congestion). cutting away (resecting) obstructive
muscle tissue in the right ventricle and by
enlarging the outflow pathway with a
patch.

COARCTATION OF THE AORTA

• Is a birth defect in which a part of the aorta

is narrower than usual.
• if the narrowing is severe enough and if it is
not diagnosed, the baby may have serious
problems and may need surgery or other
procedures soon after birth.
• also called aortic narrowing
• a congenital condition whereby the aorta is
Management Of Right Ventricular Hypertrophy
narrow, usually in the area where the ductus
arteriosus inserts.
• Diuretics
• coarctation means "pressing or drawing
• Oxygen
together; narrowing."
• Anticoagulants
• most common in the aortic arch.
• Prognosis depends on the etiology and
• other heart defects may also occur when
severity of pulmonary hypertension.
coarctation is present, occurring on the left
side of the heart.
3. Overriding Aorta - a congenital heart
• ventricle has to work harder.
defect where the aorta is positioned directly
over a ventricular septal defect, instead of • Since the aorta is narrowed, the left ventricle
over the left ventricle. must generate a much higher pressure than
normal in order to force enough blood
• The aorta receives some blood form the
through the aorta to deliver blood to the
right ventricle, which reduces the amount of
lower part of the body.
oxygen in the blood.
• If the narrowing is severe enough, the left
• The aortic root can be displaced toward the
ventricle may not be strong enough to push
front (anteriorly) or directly above the septal
blood through the coarctation, thus resulting
defect.
in a lack of blood to the lower half of the
• Abnormally located to the right of the root of
body.
the pulmonary artery.
• About 5-95% override of the valve being RISK FACTORS:
connected to the right ventricle o It is more often seen in males increased
chance of having the condition if another
4. Ventricular Septal Defect - A hole in the family member has it.
wall that separates the heart's lower o Turner Syndrome - a condition that affects
chambers. It occurs when the wall between only females, results when one of the X
the ventricles (lower chambers) does not chromosomes (sex chromosomes) is
develop fully before the baby is born. missing or partially missing.
 o Other cardiac defects (families with a history (PDA) - allows a portion of oxygenated blood from
of left-sided heart obstructive lesions.) the left heart to flow back to the lungs by flowing
from the aorta, which has a higher pressure, to the
SIGNS & SYMPTOMS: pulmonary artery.
Most common symptoms of coarctation of the o Symptoms are uncommon at birth and
aorta: shortly thereafter, later in the first year of life
• Grouchiness there is an onset of an increased breathing
• Pale skin and failure to gain weight.
• Sweating o An uncorrected PDA leads to pulmonary
• Heavy or fast breathing hypertension followed by right-sided heart
• Enlarged liver (hepatomegaly) failure.
• Poor feeding or eating o Common in newborns with persistent
• Poor weight gain respiratory problems such as hypoxia
• Weak pulses in the feet, or no pulses in the o It has a high occurrence in premature
feet newborns.
• Blood pressure in the arms that is much o Premature newborns are more likely to be
higher than the blood pressure in the legs. hypoxic and
• Chest pain o have PDA due to underdevelopment of the
• Pain in lower legs with walking (claudication) heart and
o lungs.
DIAGNOSTIC TEST: o PDA is not surgically closed since it is the
• CHEST X-RAY only way.
• Electrocardiogram (ECG) o that oxygenated blood can mix with
• Echocardiogram deoxygenated.
• Cardiac catheterization o blood
o Prostaglandins are used to keep the PDA
• CT scan
open, and
• MRI
o NSAIDs are not administered until surgical
correction of the two defects is completed.
MANAGEMENT
1. Cardiac catheterization - puts a catheter
through a blood vessel to the narrowed part
of the aorta. A balloon at the tip of the
catheter is inflated to stretch the area open.
The provider may put a small metal mesh
tube (stent) in the narrowed area to keep the
aorta open.
2. Surgery

PATENT DUCTUS ARTERIOSUS

(PDA) is a persistent opening between the two

major blood vessels leading from the heart. The
opening (ductus arteriosus) is a normal part of a
baby's circulatory system in the womb that usually
closes shortly after birth. If it remains open, it's
called a patent ductus arteriosus.
CAUSES:

o Congenital heart defects arise from

problems early in the heart's development
but there's often no clear cause.
o Genetic factors might play a role.

DIAGNOSIS:

➢ PDA is usually diagnosed using

noninvasive techniques.
➢ Phonocardiograms from normal and
abnormal heart sounds
➢ Echocardiography (in which sound waves
are used to capture the motion of the heart)
 ➢ Doppler studies are the primary methods of NURSING CARE OF A CHILD WITH
detecting PDA. ACQUIRED HEART DISEASE
➢ Electrocardiography (ECG), in which
electrodes are used to record the electrical
activity of the heart. Acquired Heart Diseases – is a condition affecting
➢ ECG patterns can be used to detect PDA. the heart and its associated blood vessels that
➢ A chest X-ray reveals overall heart size. A develop during a person’s lifetime includes:
small PDA most often accompanies a 1. Myocarditis
normal-sized heart and normal blood flow 2. Acute Rheumatic Fever
to the lungs. A large PDA generally 3. Kawasaki Disease
accompanies an enlarged cardiac 4. Infective Endocarditis
silhouette and increased blood flow to the
lungs. I. MYOCARDITIS

RISK FACTORS: • It is an inflammation of the heart muscle

• Premature birth. (myocardium).
• Family history and other genetic conditions. • It affects the heart muscle and the heart's
• Rubella infection during pregnancy. electrical system.
• Being born at a high altitude. • It reduces the heart's ability to pump and
• Being female - PDA is twice as common in causing rapid or abnormal heart rhythms
girls. (arrhythmias).

DIAGNOSTIC TEST:
• Echocardiogram
• Chest X Ray
• Electrocardiogram
• Cardiac Catheterization

MANAGEMENT:
• Watchful waiting - (also watch and wait or
WAW) an approach to a medical problem in
which time is allowed to pass before medical
intervention or therapy is used. During this
time, repeated testing may be performed.
• Medications
• Surgical closure
• Catheter procedures

CAUSES:
• Viruses - COVID-19; hepatitis B and C;
parvovirus; herpes simplex virus
• Gastrointestinal infections – echovirus,
mononucleosis (Epstein-Barr
• virus), German measles (Rubella)
• Bacteria - staphylococcus, streptococcus,
bacterium that causes diphtheria and the
tick-borne bacterium responsible for Lyme
disease.
• Parasites - Trypanosoma cruzi and
toxoplasma, Chagas disease which is more
prevalent in South America than in the
United States, but it can occur in travelers
and in immigrants from parts of the world.
• Fungi - yeast infections such as candida;
molds such as aspergillus, histoplasma
often found in bird droppings.
 MANAGEMENT:
• Avoid competitive sports for at least three to
six months
• Rest

MEDICATIONS:
• Angiotensin- converting enzyme (ACE)
inhibitors. enalapril (Vasotec), captopril
(Capoten), lisinopril (Zestril, Prinivil) and
ramipril (Altace) -relax the blood vessels in
the heart and help blood flow more easily
• Angiotensin II receptor blockers (ARBs).
losartan (Cozaar) and valsartan (Diovan
• Beta blockers - Metoprolol (Lopressor,
Toprol-XL), bisoprolol and carvedilol
(Coreg),work in multiple ways to treat heart
failure and help control arrhythmias.
• Diuretics - Furosemide (Lasix), relieve
SYMPTOMS: sodium and fluid retention.
• Fever • Corticosteroids -viral myocarditis, such as
giant cell and eosinophilic myocarditis
• Fainting
• Breathing difficulties COMPLICATIONS:
• Rapid breathing • Heart failure
• Heart attack or stroke
• Rapid or abnormal heart rhythms
• Rapid or abnormal heart rhythms • Sudden
(arrhythmias) cardiac death

DIAGNOSTIC TEST: PREVENTION:

Early diagnosis is key to preventing long-term heart • Avoid people who have a viral or flu-like
damage. After a physical examination, the doctor illness until they've recovered
might order more tests to confirm myocarditis and • Follow good hygiene - regular hand-washing
determine its severity. These include:
• Minimize exposure to ticks - wear long-
• Electrocardiogram (ECG) - shows the sleeved shirts and long pants to cover skin.
heart's electrical patterns and can detect Apply tick or insect repellents that contain
abnormal rhythms. DEET.
• Chest X-ray - shows the size and shape of • Get vaccinated with recommended vaccines
the heart and determines fluid in or around
the heart that might indicate heart failure. II. ACUTE RHEUMATIC FEVER
• MRI - shows the heart's size, shape and • an inflammatory disease that can develop as
structure and signs of inflammation of the a complication of inadequately treated strep
heart muscle. throat or scarlet fever.
• Echocardiogram - sound waves create • a systemic illness that may occur following
moving images of the beating of heart, group A beta-hemolytic streptococcal
detects enlargement of the heart, poor (GABHS) pharyngitis in children
pumping function, valve problems, a clot • Strep throat and scarlet fever are caused by
within the heart or fluid around the heart. an infection with streptococcus bacteria
• Blood test - measures white and red blood PATHOPHYSIOLOGY:
cell counts, levels of certain enzymes that • Develops in children and adolescents
indicate damage to the heart muscle, also following pharyngitis with GABHS (ie,
detects antibodies against viruses and other Streptococcus pyogenes).
organisms that indicate a myocarditis-
• Organisms attach to the epithelial cells of
related infection.
the upper respiratory tract and produce a
• Cardiac Catheterization and battery of enzymes, which damage and
endomyocardial biopsy - A small tube invade human tissues.
(catheter) is inserted into a vein in the leg or
• Incubation period is 2-4 days - the invading
neck and threaded into the heart, doctors
organisms elicit an acute inflammatory
use a special instrument to remove a tiny
response
sample of heart muscle tissue (biopsy) for
• 3-5 days of sore throat, fever, malaise,
analysis in the lab to check for inflammation
headache, and elevated leukocyte count.
or infection.
• Direct contact with oral or respiratory
secretions transmits the organism
 • Crowding enhances transmission dance) — most often in the hands, feet, and
• Patients remain infected for weeks after face.
symptomatic resolution of pharyngitis and • Subcutaneous nodules - small, painless
may serve as a reservoir for infecting others bumps (nodules) beneath the skin
• Severe scarring of the valves develops • Erythema marginatum - flat or slightly
during a period of months to years after an raised, painless rash with a ragged edge.
episode of acute rheumatic fever • warmth and fever
• Recurrent episodes may cause progressive
damage to the valves. SIGNS AND SYMPTOMS: Minor Diagnostic
• The mitral valve is affected most commonly Criteria
and severely 65-70% of patients • Fever – 38 oC – 38.5 oC
• The aortic valve is affected second most • Polyarthralgia - painful and tender joints —
commonly 25%. most often in the knees, ankles, elbows, and
wrists
CAUSES: • Prolonged PR interval.
o GABHS infection (group A beta-hemolytic • Increased ESR - erythrocyte sedimentation
streptococcal (GABHS) pharyngitis, and rate during acute illness ≥60 mm/h and/or C-
only infections of the pharynx initiate or reactive protein ≥3.0 mg/dl.
reactivate rheumatic fever - only develops in
children and adolescents
o Molecular mimicry - mimicry between
streptococcal and human proteins is felt
involving both the B and T cells of peripheral
blood, with infiltration of the heart by T cells;
an increased production of inflammatory
cytokines is the final mechanism of the
autoimmune reaction that causes damage
to cardiac tissue
o Streptococcal antigens- are structurally
similar to those in the heart, include
hyaluronate in the bacterial capsule, cell
wall and polysaccharides (similar to
glycoproteins in heart valves
o Decrease in regulatory T-cells - increased
severity of the disease

o The modified Jones criteria provide

guidelines for making the diagnosis of
rheumatic fever;
o The modified Jones criteria for recurrent
rheumatic fever require the presence of 2
major, or 1 major and 2 minor, or 3 minor
criteria for the diagnosis of rheumatic fever.

SIGNS AND SYMPTOMS: Major Diagnostic

Criteria
• Carditis - inflammation of the heart.
• Polyarthritis/monoarthritis - inflammation
of a joint by swelling, pain,
• POLYARTHRALGIA= pain in several joints
• Chorea - jerky, uncontrollable body
movements (Sydenham chorea, or St. Vitus’
DIAGNOSTIC TEST: o Risk for injury related to chorea.
Diagnosis is based on medical history, physical o Risk for noncompliance with prophylactic
exam and certain test results; drug therapy related to financial or emotional
• Throat culture - negative by the time burden of lifelong therapy.
symptoms of rheumatic fever appear; isolate o Deficient knowledge of caregiver related to
the organism prior to the initiation of the condition, need for long-term therapy,
antibiotic therapy to help confirm a diagnosis and risk factors.
of streptococcal pharyngitis and to allow
typing of the organism NURSING INTERVENTIONS:
• Rapid antigen detection test - 1. Provide comfort and reduce pain –
Antistreptococcal antibodies positioning, warm baths, gentle ROM
• Acute-phase reactants= C-reactive protein exercises, use of pain indicator scales
and erythrocyte sedimentation rate are 2. Provide diversional activities and
elevated sensory stimulation - activities that allow
• Antistreptococcal antibodies - levels are bed rest but prevent restlessness and
at their peak; particularly useful in patients boredom, such as a good book; quiet games
who present with chorea as the only can provide some entertainment, and plan
diagnostic criterion. all activities with the child’s developmental
• Heart reactive antibodies - tropomyosin is stage in mind.
elevated 3. Promote energy conservation - rest
• Rapid detection test for D8/17 - positive in periods between activities to help pace the
90% of patients child’s energies and provide for maximum
• Chest radiography - Cardiomegaly, comfort;
pulmonary congestion, and other findings 4. Prevent injury – keep side rails up and
are observed padding them; do not leave a child with
chorea unattended in a wheelchair, and use
• Echocardiography - quantitated valve
all appropriate safety measures.
insufficiency and ventricular dysfunction
EVALUATION:
MANAGEMENT:
Goals are met as evidenced by:
• Anti-inflammatory – salicylates and
• Reducing pain.
steroids: aspirin
• Providing diversional activities and sensory
• Corticosteroids – prednisone to salicylate
stimulation.
therapy
• Conserving energy.
• Anticonvulsant medications – valproic
acid (Depakene), carbamazepine (Carbatrol, • Preventing injury.
Tegretol)
• Antibiotics – penicillin III. KAWASAKI DISEASE
• Surgical care (Mucocutaneous lymph node syndrome)
• Diet - nutritious diet without restrictions
except in patients with CHF, who should • Kawasaki disease causes swelling
follow a fluid-restricted and sodium- (inflammation) in the walls of medium-sized
restricted diet; potassium supplements. arteries throughout the body.
• Activity - initially, place patients on bed rest, • Primarily affects children
followed by a period of indoor activity before • inflammation tends to affect the coronary
they are permitted to return to school; do not arteries, which supply blood to the heart
allow full activity until returned to normal; muscle.
patients with chorea may require a
wheelchair and should be on homebound CAUSES:
instruction until the abnormal movements • No one knows what causes Kawasaki
resolve. disease, but scientists don't believe the
disease is contagious from person to
NURSING ASSESSMENT: person.
• History Taking • A number of theories link the disease to
• Physical Exam bacteria, viruses or other environmental
factors, but none has been proven
NURSING DIAGNOSES
o Acute pain related to joint pain when
extremities are touched or moved.
o Deficient diversional activity related to
prescribed bed rest.
o Activity intolerance related to carditis or
arthralgia.
RISK FACTORS Causes
• Age. Children under 5 years old are most at • Improper Dental Care
risk of Kawasaki disease. • Catheters
• Sex. Boys are are more prone than girls to • Illegal Iv Drug Use
develop Kawasaki disease.
• Ethnicity. Children of Asian or Pacific Island Risk Factors
descent, such as Japanese or Korean, have o Older Age
higher rates of Kawasaki disease. o Artificial Heart Valves
o Damaged Heart Valves
o Congenital Heart Defects
o Implanted Heart Device
o A History Of Endocarditis
o A History Of Illegal Drug Use
o Poor Dental Health
o Long Term Catherter Use

SYMPTOMS
➢ Aching joints and muscles
➢ Chest pain upon breathing
➢ Fatigue
➢ Flu-like symptoms, such as fever and chills
➢ Night sweats
➢ Shortness of breath
➢ Swelling in the feet, legs or abdomen
DIAGNOSTIC TEST: ➢ A new or changed heart murmur, which is
the heart sound made by blood rushing
• Blood tests
through the heart
• B-type natriuretic peptide (BNP) test – ➢ Unexplained weight loss
released when the heart is under stress may ➢ Blood in your urine,
be helpful in diagnosing Kawasaki disease ➢ Tenderness in the spleen, which is an
• Urinalysis infection fighting organ located just below
• Electrocardiogram. the left rib cage
• Echocardiogram. ➢ Red spots on the soles of the feet or the
palms of the hands (Janeway lesions)
MANAGEMENT: ➢ Red, tender spots under the skin of the
1. The goals of initial treatment are to lower fingers or toes (Osler's nodes)
fever and inflammation and prevent heart ➢ Tiny purple or red spots, called petechiae
damage (puh-TEE-kee-ee), on the skin, in the
2. Gamma globulin. Infusion of an immune whites of the eyes or inside the mouth
protein (gamma globulin) through a vein
(intravenously) can lower the risk of DIAGNOSTIC TEST:
coronary artery problems. • Blood Culture Test
3. Aspirin. High doses of aspirin may help treat • Complete Blood Count
inflammation. Aspirin can also decrease pain • Echocardiogram
and joint inflammation, as well as reduce the
• Electrocardiogram
fever -should be given aspirin only under the
• Chest X-Ray
supervision of a doctor
• Computerized Tomography Scan

IV. INFECTIVE ENDOCARDITIS MANAGEMENT:

MEDICATIONS
• Endocarditis is a life-threatening • High doses of IV antibiotics are used to treat
inflammation of the inner lining of the heart’s endocarditis caused by bacteria
chambers and valves (endocardium). • If endocarditis is caused by a fungal
• Caused by an infection infection, the doctor will prescribe antifungal
• Bacteria, fungi or other germs from another medication.
part of the body, SURGERY
• such mouth, spread through the • Heart valve surgery may be needed to treat
bloodstream and attach to damaged areas persistent endocarditis infections or to
in the heart. replace a damaged valve
• If not treated quickly, it can damage or
destroy the heart valves
NURSING CARE OF CHILDREN SYMPTOMS:
• Dry skin
IMMUNOLOGIC DISORDERS
• Itching, which may be severe, especially
at night
• Red to brownish-gray patches, especially
on the hands, feet, ankles, wrists, neck,
upper chest, eyelids, inside the bend of
the elbows and knees, and in infants, the
face and scalp
• Small, raised bumps, which may leak fluid
and crust over when scratched
• Thickened, cracked, scaly skin
• Raw, sensitive, swollen skin from
scratching

RISK FACTORS:
• The primary risk factor for atopic
dermatitis is having a personal or family
history of eczema, allergies, hay fever or
1. PERENNIAL ALLERGIC RHINITIS asthma.

- Allergic rhinitis becomes perennial (year- DIAGNOSIS:

round) when the allergen is one that is • No lab test is needed to identify atopic
capable of affecting the child year- round, dermatitis (eczema)
such as house dust mites or pet hair. • Suspect a certain food caused your child's
rash, tell the doctor and ask about
identifying potential food allergies.

MEDICATIONS:
• Creams that control itching and help repair
the skin.
• Drugs to fight infection
• Oral drugs that control inflammation
• Therapies (wet dressings, light therapy,
counselling, relaxation, behavior
2. ATOPIC DERMATITIS (INFANTILE modification)
ECZEMA)
TREATMENT for eczema in babies (infantile
- Atopic Dermatitis is primarily a disease of eczema) includes:
infants, beginning as early as the second • Identifying and avoiding skin irritants
month of life and possibly lasting until the • Avoiding extreme temperatures
child is 2 to 3 years old. • Lubricating your baby's skin with bath oils,
creams or ointments

3. CRADLE CAP
- It is a greasy, yellowish, scaly rash that
appears in patches on young babies’
scalps. Also known as crusta lacteal,
honeycomb disease, milk crust, pityriasis
capitis and infantile seborrheic dermatitis,
seborrheic dermatitis of the scalp of the
newborn.
- Caused by overactive sebaceous glands
and/or fungal infection.
COMMON LOCATIONS: - The sebaceous glands are found in the
• Common sites for lesions include the skin and produce an oil like substance
scalp and forehead, the cheeks, neck, (known as sebum).
behind the ears, and the extensor
surfaces of the extremities The palms of
the hands and the soles of the feet are
uninvolved.
 3. DIAPER RASH
• Is characterized by a skin in the diaper area
appearing reddish and sore. More common
CAUSES: in babies below 15 months of age.
1. There is a theory that the overactive • Diaper rash may be very mild – a few prickly
sebaceous glands produce too much red spots in a small area.
sebum. • Quite extensive with tender red bumps that
2. Another theory is based on the baby spread to your baby’s tummy and thighs.
suffering a fungal infection. • Little puffy and warm when you touch it.

SIGNS & SYMPTOM: CAUSES:

• A symptom is something the patient feels Diaper rash can be caused by anything from a new
or reports. food to your baby’s own urine. Here are the most
• A sign is something that other people, likely culprits:
including the doctor detects.
• Patches, scales, crusty on scalp that are • Wetness
yellow and greasy. • Chafing or chemical sensitivity
• Dandruff-like flakes of skin on the scalp • New Foods
• The affected area may go red • Infection
• Babies on antibiotics (or whose
TREATMENT: breastfeeding mothers are on antibiotics)
In mild cases: • Thrush is a type of oral yeast infection.
- A gentle wash of the baby’s head using a Some babies with thrush dev.
mild baby shampoo
- A delicate brush of the scalp with a soft WHAT’S THE BEST WAY TO TREAT DIAPER
brush (this will loosen the scales) RASH?

If it is not helping it is important to consult a • Keep your baby clean and dry by changing
doctor/pediatrician: his diaper frequently.
• Rinse his diaper area well at each diaper
- The use of a stronger shampoo e.g. adult change. Pat your baby’s skin dry – don’t rub.
dandruff shampoo. • Using a barrier ointment – one that forms a
- Applying some oils or lotions to the
protective layer on the skin – after every
affected area to soften the scaly patches. diaper change can help protect your baby’s
- If the cradle cap has inflamed or the area irritated skin from stool and urine.
has become infected the doctor may
• Put your baby’s diaper on loosely or use a
prescribe:
diaper that’s a little big on him to allow for
better air circulation.
• A course of antibiotics
• A mild steroid-based HOW TO PREVENT?
cream e.g.
hydrocortisone. • Skip the talcum powder
• An anti-fungal • Introduce one new food at a time.
shampoo/soap e.g.
• Don’t secure the diaper so tightly that there’s
ketoconazole.
no room for air to circulate.
• Don’t wash cloth diapers with detergents
that contain fragrances, and skip the
fragrances, and skip the fabric softener –
both can irritate your baby’s skin.
 • Breastfeed your body for as long as you TREATMENT:
can. • Avoid scratching your irritated skin.
Scratching can make the irritation worse or
4. CONTACT DERMATITIS even cause a skin infection that requires
antibiotics.
Contact dermatitis is a type of eczema triggered by • Clean your skin with mild soap and
contact with a particular substance. lukewarm water to remove any irritants.
• Stop using any products you think might be
causing the problem.
• Apply bland petroleum jelly like Vaseline to
soothe the area.
• Try using anti-itch treatments such as
calamine lotion or hydrocortisone cream
(Cortisone-10).
• If needed, take an antihistamine drug such
as diphenhydramine to cut down on itching
and to reduce your allergic response.

5. ACNE

CAUSES: Acne is a chronic inflammatory skin condition that

There are three types of contact dermatitis: causes spots and pimples, especially on the face,
• Allergic contact dermatitis- occurs when the shoulders, back, neck, chest, and upper arms.
skin develops an allergic reaction after being
exposed to a foreign substance.
• Irritant contact dermatitis - the most common
type of contact dermatitis. It happens when
the skin comes in contact with a toxic
material.
• Photocontact dermatitis – less common,
occur when the active ingredients in a skin
product are exposed to the sun and result in
irritation.

SIGN & SYMPTOMS : ALLERGIC CONTACT

DERMATITIS
• dry, scaly, flaky skin
• hives
• oozing blisters
• skin redness
• skin that appears darkened or leathery • skin
that burns
• Extreme itching
• sun sensitivity TYPES:
• swelling, especially in the eyes, face, or Whiteheads: These remain under the skin and are
groin areas small
Blackheads: Clearly visible, they are black and
SIGN & SYMPTOMS : IRRITANT CONTACT appear on the
DERMATITIS Papules: Small, usually pink bumps, these are
Irritant contact dermatitis may cause slightly visible on the surface of the skin
different symptoms, such as: Pustules: Clearly visible on the surface of the skin.
• blistering They are red at their base and have pus at the top
• cracking skin due to extreme dryness Nodules: Clearly visible on the surface of the skin.
They are large, solid, painful pimples that are
• swelling
embedded deep in the skin
• skin that feels stiff or tight
Cysts: Clearly visible on the surface of the skin.
• ulcerations They are painful and filled with pus. Cysts can
• open sores that form crusts cause scars.
CAUSES NURSING CARE OF CHILDREN WITH
• Human skin has pores that connect to oil INFECTIOUS DISORDERS
glands under the skin. Follicles connect the
glands to the pores. Follicles are small sacs
that produce and secrete liquid. I. CELLULITIS
• The glands produce an oily liquid called
sebum. Sebum carries dead skin cells It is a common infection of the skin and the soft
through the follicles to the surface of the tissues underneath.
skin. A small hair grows through the follicle
out of the skin.
• Pimples grow when these follicles get
blocked, and oil builds up under the skin.
• Skin cells, sebum, and hair can clump
together into a plug. This plug gets infected
with bacteria, and swelling results. A pimple
starts to develop when the plug begins to
break down.
• Propionibacterium acnes (P. acnes) is the
name of the bacteria that live on the skin
and contributes to the infection of pimples.
RISK FACTORS:
Other causes include: • Trauma to the skin
• some medications that contain androgen • Diabetes
and lithium • Circulatory problems,
• greasy cosmetics • Liver disease like chronic hepatitis or
• hormonal changes cirrhosis
• emotional stress • Skin disorders such as eczema, psoriasis, or
• menstruation infectious diseases that cause sores, like
chickenpox
TREATMENT: MILD
MILD ACNE: CAUSES:
Mild acne can be treated with over-the-counter • Injuries that tear the skin
(OTC) medications, such as gels, soaps, pads, • Infections after surgery
creams, and lotions, that are applied to the skin. • Long-term skin conditions such as eczema
or psoriasis
OTC acne remedies may contain the following • Foreign objects in the skin
active ingredients: • Bone infections underneath the skin. (An
Resorcinol: helps break down blackheads and example is a long- standing, open wound
whiteheads that is deep enough to expose the bone to
Benzoyl peroxide: kills bacteria, accelerates the bacteria.)
replacement of skin, and slows the production of
sebum Common symptoms include:
Salicylic acid: assists the breakdown of blackheads o Redness
and whiteheads and helps reduce inflammation and o Red streaks
swelling o Swelling
Sulfur: exactly how this works is unknown o Warmth
Retin-A: helps unblock pores through cell turnover o Pain or tenderness
Azelaic acid: strengthens cells that line the follicles, o Leaking of yellow, clear fluid
stops sebum eruptions, and reduces bacterial or pus
growth. There is cream for acne, but other forms are
used for rosacea. SIGNS AND SYMPTOMS:
• High fever or chills
TREATMENT : MODERATE TO SEVERE • Nausea and vomiting
• Corticosteroid injection • Enlarging or hardening of the reddened area
• Oral antibiotics • Increased pain
• Oral contraceptives • Numbness when you touch the area
• Topical antimicrobials • Other medical problems that may be
• Isotretinoin affected by even a minor infection
HOW TO DIAGNOSE? TREATMENT
• Medical history • Antifungal medicines like nystatin,
• Physical examination clotrimazole, and fluconazole.
• A blood test if they think the infection has • Rinsing the mouth with chlorhexidine (CHX)
spread to your blood mouthwash may help prevent infections in
• An X-ray if there’s a foreign object in your people with weakened immune systems.
skin or the bone underneath is possibly
infected III. GENITAL YEAST INFECTION
• A culture, to remove fluid from the area and
send it to the lab. A yeast infection typically happens when the
balance in the vagina changes.
TREATMENT: MILD CASES
• Rest the area.
• Elevate the area to ease swelling and
discomfort.
• Use over-the-counter pain relievers like
acetaminophen or ibuprofen to ease the
pain, as well as keep your fever down.
• take antibiotics by mouth for a week to 14
days

TREATMENT: SEVERE CASES

• May use IV or intramuscular antibiotics if:
• The infection is severe.
• You have other medical problems.
• You’re very young or very old.
• The cellulitis covers large areas, is on your
hands, or is close to body parts like your SIGNS & SYMPTOMS:
eyes. • Extreme itchiness in the vagina
• The infection worsens even after taking • Redness and swelling of the vagina and
antibiotics for 2 to 3 days. vulva (the outer part of the female genitals)
• Pain and burning when voiding
• Discomfort during sex
II. THRUSH (Oropharyngeal
• A thick, white “cottage cheese” discharge
Candidiasis) from the vagina
When the candida yeast spreads in the mouth and
throat, it can cause an infection called thrush. It’s IV. TINEA INFECTIONS
most common in newborns, the elderly and people
with weakened immune systems. Are superficial fungal infections caused by three
species of fungi collectively known as
dermatophytes.

TYPES OF TINEA:
• Tinea corporis (general skin), refers
to anywhere on the body except the
scalp, beard, feet, or hands.
SIGNS & SYMPTOMS: commonly known as ringworm
• White or yellow patches on the tongue, lips, • Tinea cruris (groin), known as “jock
gums, roof of mouth, and inner cheeks itch.” It is characterized by red
• Redness or soreness in the mouth and scaling plaques on the medial thighs
throat and inguinal folds
• Cracking at the corners of the mouth • Tinea pedis (feet)
• Pain when swallowing,
• if it spreads to the throat
HOW TO DIAGNOSED: NURSING CARE OF A CHILDREN WITH
• History and clinical appearance + GASTROINTESTINAL DISORDERS
microscopy of potassium hydroxide prep
• Culture or histologic examination DIAGNOSTIC & THERAPEUTIC TECHNIQUES
FOR GI DISORDERS
TREATMENT:
1. Fiberoptic endoscopy
• Skin moisture 2. Colonoscopy
• Choosing an appropriate antifungal agent 3. Barium Enema
• Allylamine medication (Naftifine; Naftin) and 4. MRI
terbinafine (Lamisil) 5. XRAY
• Inherent anti-inflammatory properties or the 6. ULTRASOUND
use of a combination antifungal/steroid
agent. COMMON NURSING DIAGNOSIS:

V. SCABIES 1. Deficient fluid volume related to loss of fluid

through vomiting/diarrhea
Scabies is an itchy skin condition caused by a tiny 2. Risk for impaired skin integrity related to
burrowing mite called Sarcoptes Scabiei. presence of diarrheal tool on skin.

UPPER GI ALTERATIONS

I. HYPERTROPHIC PYLORIC
STENOSIS

is a narrowing of the pylorus, the opening from the

stomach into the small intestine. End result is the
stomach becomes dilated.
SYMPTOMS:
• Itching, often severe and usually worse at
night
• Thin, irregular burrow tracks made up of tiny
blisters or bumps on your skin

PREVENTION:
• To prevent re-infestation and to prevent the
mites from spreading to other people, take
these steps:
• Clean all clothes and linen. Use hot, soapy
water to wash all clothing, towels and
bedding used within three days before
beginning treatment. Dry with high heat.
Dry-clean items you can't wash at home.
• Starve the mites. Consider placing items you PHYSICAL EXAM FINDINGS IN PYLORIC
can't wash in a sealed plastic bag and STENOSIS:
leaving it in an out-of-the-way place, such as • Signs of dehydration, such as sunken
in your garage, for a couple of weeks. Mites fontanels, dry skin & mouth, less tearing
die after a few days without food. when crying, and dry diapers
• Swollen belly
• Olive-shaped mass, when feeling the upper
belly, which is the abnormal pylorus
• Projectile vomiting
• Vomiting may occur after every feeding or
only after some feedings, usually starts
around 3 weeks of age, but may start any
time between 1 week and 5 months of age.
Mother's Description of baby With Pyloric Pre-op nursing care pyloric stenosis:
stenosis: • To prep for surgery you must have balanced
• Vomit is sour and consists of undigested fluid and electrolytes, and stomach has to be
food. Mucus no bile, because it has not empty
gone beyond the stomach. • Promote skin integrity, reposition infant,
• Baby wants to keep eating but they can't change diaper, may need to add ointment to
because food keeps coming back. skin and include the family in the care for the
• Eventually baby is irritable, loses' weight infant including preparation for surgery.
quickly, and is dehydrated. • Educate them about what pyloric stenosis is
• Constipation and decreased urine output and what will be done in the procedure
occur.
Post-op nursing care of pyloric stenosis:
TREATMENT: Keep airway clean, maintain comfort, improve
• Pyloromyotomy - If putting the infant to nutritional status, preserve skin integrity, and reduce
sleep for surgery is not safe, a device called family anxiety;
an endoscope with a tiny balloon at the end • Place infant on side to prevent aspiration
is used. To comfort may need to hold, cuddle the baby; give
feedings slowly with frequent burping; support the
family and provide infant’s needs;
• Child may vomit some feedings after
surgery, but is normal and should resolve
before child is discharged home.

II. CLEFT LIP AND PALATE

NURSING DIAGNOSIS:
• Imbalanced nutrition: less than body
requirements related to inability to retain
food.
• Deficient fluid volume: related to frequent
vomiting
• Impaired oral mucous membrane: related
to NPO status.
• Risk for impaired skin integrity: related to
fluid and nutritional deficit. • The shelves move from a vertical position to
• Compromised family coping: related to a horizontal position; their free edges meet
seriousness or illness and impending and fuse in the midline.
surgery. • Later, bone forms within this tissue to form
the hard palate.
NURSING CARE OF PYLORIC STENOSIS: • Normally the palate is intact by the 10th
week of fetal life.
• Assess the baby, observe weight, skin • Exactly what happens to prevent this closure
turgor, skin condition, anterior fontanel, is not known for sure, leading to a cleft lip
irritability, lethargy, urine, mucous and cleft palate.
membranes, history of vomiting (when it is
started, character of vomiting before CAUSES:
surgery, etc.) 1. Hereditary: The mother or the father can
• Improve nutrition/hydration pass on genes that cause clefting, either
• Maintain skin integrity, and relieve anxiety alone or as part of a genetic syndrome that
includes a cleft lip or cleft palate as one of
its signs.
2. Environmental: In some cases, babies
inherit a gene that makes them more likely
to develop a cleft, and then an
environmental trigger actually causes the
cleft to occur.
CLINICAL MANIFESTATION: NURSING INTERVENTIONS:
• Cleft – a split in the lip and roof of the mouth 1. Maintain adequate nutrition
(palate) that can affect one or both sides of • Breastfeeding may be successful
the face; a split in the lip that can extend because the breast tissue may
from the lip through the upper gum and mold to close the gap;
palate into the bottom of the nose; a split in • If the newborn cannot be
the roof of the mouth that doesn’t affect the breastfeed, the mother’s breast milk
appearance of the face. may be expressed and used
• Difficulty with feedings – the newborn instead of formula;
easily becomes choked on liquids. • A soft nipple with a cross-cut made
• Difficulty swallowing – the newborn has a to promote easy flow of milk may
hard time in swallowing, with potential for work well.
liquids or foods to come out the nose.
• Nasal speaking voice - due to the split in 2. Positioning
the palate, the newborn has a nasal • If the cleft lip is unilateral, the. Nipple
speaking voice. should be aimed. At the unaffected
side; the infant should be kept in an
ASSESSMENT AND DIAGNOSTIC FINDINGS upright position during feeding.
• Inspection- Diagnosis of cleft palate is
made at birth with the close inspection of the 3. Tools for feeding
newborn’s palate • Lamb’s Nipples – extra-long nipples
• Observation - Cleft lip can be diagnosed and special cleft palate nipples
through observation of the physical molded to fit into the open palate
appearance of the newborn. area to close the gap may be used.
• Interview - In interviewing the family and
collecting data
• Physical exam - Physical examination of the
infant includes temperature, apical pulse,
and respirations

NURSING DIAGNOSIS:
• Compromised family coping related to
visible physical defect
• Anxiety of family caregivers related to child’s
condition and surgical outcome • Eyedropper or an Asepto syringe
• Deficient knowledge of family caregivers – one of the simplest and most
related to care of child before surgery and effective methods with a short piece
the surgical procedure. of rubber tubing on the tip which is
• Risk for aspiration related to a reduced level called as Breck Feeder.
of consciousness after surgery.
• Ineffective breathing pattern related to
anatomical changes.
• Risk for deficient fluid volume related to
NPO status after surgery.
• Acute pain related to surgical procedure.
• Risk of injury to the operative site related to
newborn’s desire to suck thumb or fingers
and anatomical changes.

GOAL OF CARE:
1. Prevention of Aspiration
2. Maintain Nutrition

MEDICAL MANAGEMENT:
• Surgery it is called as Palatoplasty
• Your baby will be given a general anesthetic
(where they're unconscious) and the cleft lip
will be repaired and closed with stitches.
The operation usually takes 1 to 2 hours.
NURSING INTERVENTIONS:
IV. TRACHEOESOPHAGEAL
IV.
1. Promote family coping - Encourage the FISTULA
family to verbalize their feelings regarding Is an abnormal connection in one or more places
the defect and their disappointment; serve between the esophagus (the tube that leads from
as a model for the family caregiver’s the throat to the stomach) and the trachea (the tube
attitudes toward the child. that leads from the throat to the windpipe and lungs)
2. Reduce family anxiety – Give the family
information about the cleft repairs; FIVE TYPES OF TRACHEOESOPHAGEAL
encourage them to ask question and FISTULA:
reassure them that any question is valid.
3. Provide family teaching - Explain the
usual routine of preoperative, intraoperative
and post operative care; written information
is helpful, but be certain the parents
understand the information.
4. Teach the parents the ESSR - enlarge the
nipple, stimulate the suck reflex, sucking,
swallow, rest to allow the child to finish
swallowing what has been placed in the CAUSES:
mouth. • Genetics
• O’Rahilly theory (1984)
Children with clefts will have a care plan tailored • Kluth’s theory (1987)
to meet their individual needs. A typical care • Orford’s theory. (2001)
plan timetable for cleft lip and palate is: • Spilde et al theory (2003)
• Birth to 6 weeks – feeding
assistance, support for parents, STATISTICS AND INCIDENCES:
hearing tests and paediatric Incidence of tracheoesophageal artesia are as
assessment follows:
• 3 to 6 months – surgery to repair a
cleft lip • The incidence of esophageal artesia is 1
• 6 to 12 months – surgery to repair a case in 3500 – 4500 births.
cleft palate • Internationally, the highest incidence of this
• 18 months – speech assessment disorder is reported in Finland, where it is 1
• 3 years – speech assessment case in 2500 births.
• 5 years – speech assessment
• 8 to 12 years – bone graft to repair a CLINICAL MANIFESTATIONS:
cleft in the gum area • Excessive oral secretions
• 12 to 15 years – orthodontic • Choking upon feeding
treatment and monitoring jaw growth • Oral obstruction

III. ESOPHAGREAL ARTESIA ASSESSMENT AND DIAGNOSTIC FINDINGS:

Esophageal atresia is a birth defect in which part of • Laboratory studies
a baby's esophagus (the tube that connects the • Ultrasonography
mouth to the stomach) does not develop properly • Echocardiography
• Chest radiography

NURSING DIAGNOSIS:
1. Impaired gaseous exchange related to
abnormal opening between esophagus and
trachea as evidenced by cyanosis.
2. Impaired swallowing related to mechanical
obstruction
3. Risk for injury related to surgical
procedure.
4. Anxiety related to difficulty swallowing,
discomfort due to surgery.
5. Altered family processes related to
children with physical defects
6. Risk for aspiration related to difficulty in
swallowing.
MEDICAL MANAGEMENT: NURSING DIAGNOSIS:
• Tube placement. • Acute pain related to bowel invagination
• Gastrostomy • Deficient fluid volume related to vomiting,
• TEF ligation nausea, fever, and diaphoresis.
• Esophageal Atresia Anastomosis • Ineffective breathing pattern related to
• Repair of esophageal atresia(thoracoscopic abdominal distention and rigidity.
approach) • Anxiety related to change in health status.

NURSING MANAGEMENT: ASSESSMENT TREATMENT:

• HISTORY • NGT
• Physical exam • IV LINE
• AIR OR CONTRAST ENEMA
NURSING INTERVENTIONS:
• Ensure safe swallowing NURSING INTERVENTIONS:
• Prevent aspiration • INTRAVENOUS FLUID
• Reduce anxiety • DECOMPRESSION
• MONITOR I & O
• EDUCATION
LOWER GI ALTERATIONS
II. HIRSCHSPRUNG DISEASE OR
I. INTUSSUSCEPTION CONGENITAL AGANGLIONIC
The sliding of one part of the intestine into another MEGACOLON
(telescoping). Part of the intestine being pulled is characterized by persistent constipation resulting
inward into itself. from partial or complete intestinal obstruction of
mechanical origin.

CAUSE:
CAUSE: • The nerves are missing from a part of the
• The cause is not known bowel.
• Areas without these nerves cannot push
SIGNS & SYMPTOMS: material through.
1. Colicky abdominal pain • This causes a blockage intestinal contents
2. Vomiting of gastric contents build up behind the blockage.
3. Bile-stained fecal emesis
• The bowel and abdomen swell as a result.
4. Currant jelly-like stools containing blood and
mucus
HIRSCHSPRUNG’S DISEASE SYMPTOMS THAT
5. Hypoactive or hyperactive bowel sounds
MAY BE PRESENT IN NEWBORNS AND
6. Tender distended abdomen, possibly with a
INFANTS INCLUDE:
palpable sausage-shaped mass in the upper
right quadrant
• Difficulty with bowel movements
EXAMS AND TESTS FOR INTUSSUSCEPTION: • Failure to pass meconium shortly after birth
• Abdominal Examination • Failure to pass a first stool within 24-48
hours after birth
• Abdominal X-ray
• Infrequent but explosive stools
• Air Or Contrast Enema
• Jaundice
• Poor feeding
• Poor weight gain
• Vomiting
• Watery diarrhea (in the newborn)
HIRSHSPRUNG’S DISEASE SYMPTOMS IN III. IMPERFORATE ANUS
OLDER CHILDREN Anorectal malformations include a wide
spectrum of defects in the development of the
• Constipation that gradually get worse lowest portion of the intestinal and urogenital
• Fecal Impaction tracts.
• Malnutrition
• Slow Growth
• Swollen Belly
• Foul smelling ribbon – like stools

HD EXAMS &TESTS
• Physical exam
• Rectal exam
• Abdominal X- ray
• Anal manometry
• Barium enema STATISTICS & INCIDENCE
• Rectal biopsy • Anorectal malformations occur in
approximately 1 newborn per 5000 live
NURSING DIAGNOSIS: births.
1. Constipation related to decreased bowel • Malformation – related morbidity relates
motility. to associated malformations of rectal
2. Imbalanced nutrition: less than body motility, anorectal innervation, and
requirements related to anorexia sphincteric musculature; the most
3. Fear (in the older child) related to impending common morbidity in this category is
surgery. constipation; most children have mild
4. Risk for impaired skin integrity related to malformations that commonly result in
irritation from the colostomy. constipation for reasons that remain
5. Acute pain related to the surgical procedure. unclear.
6. Deficient fluid volume related to
postoperative condition CLINICAL MANIFESTATIONS:
7. Impaired oral and nasal mucous membranes • Absence of stool
related to NPO status and irritation from NG • Passing of stool in other openings
Tube. • Swollen belly
8. Deficient knowledge of caregivers related to • Absence of anal opening
understanding of postoperative care of the
colostomy. ASSESSMENT AND DIAGNOSTIC FINDINGS:
• Laboratory studies
TREATMENT: • Sacral radiography
• Serial rectal irrigation helps relieve pressure • Abdominal ultrasonography
in (decompress) the bowel • Spinal ultrasonography or MRI • MRI
• CT scanning
NURSING MANAGEMENT:
• Promote skin integrity NURSING DIAGNOSES:
• Promote comfort 1. Fluid volume deficit related to excessive
• Maintain fluid balance loss through vomiting.
• Provide oral and nasal care 2. Impaired skin integrity related to the
• Provide family teaching colostomy
3. Risk for infection related to surgical
POSSIBLE COMPLICATIONS: procedures
1. Enterocolitis – inflammation and infection
of the intestines may occur before surgery. MEDICAL MANAGEMENT:
Symptoms are severe, including • Nothing per orem (NPO)
swelling of the abdomen, foul • Neonatal colostomy
smelling watery diarrhea, lethargy • Primary neonatal pull-through without
and poor feeding. colostomy Posterior sagittal pull-through
2. Perforation or rupture of the intestine with a colostomy Colostomy closure
3. Short bowel syndrome – a condition that • Diet
can lead to malnourishment and dehydration • Activity
PHARMACOLOGIC MANAGEMENT: CAUSES:
• Antibiotic prophylaxis – urinary The factors that contribute to infant reflux are
prophylaxis is used to mitigate the risk of common in babies and often can’t be avoided.
urinary infection and urosepsis in children These factors include:
with risk factors for urinary infection such as • Lying flat most of the time
urinary fistula, vesicoureteral reflex, or • Consuming an almost completely liquid diet
continent diversion. • Being born prematurely
• Laxatives – common laxatives include • GERD
senna products, milk of magnesia, and • Pyloric Stenosis
propylene glycol solutions (e.g., MiraLax, • Food intolerance
GlycoLax) • Eosinophilic esophagitis
• Sandifer Syndrome
NURSING MANAGEMENT: ASSESSMENT
• History MANAGEMENT:
• Physical exam • Upright position
• Botulinum toxin
NURSING MANAGEMENT • Laparoscopic/ myotomy
• Avoid infection
• Protect skin integrity NURSING DIAGNOSIS:
• Restore balanced fluid volume • Risk for imbalanced nutrition, less than body
requirements, related to regurgitation of food
IV. GASTROESOPHAGEAL REFLUX with esophageal reflux

In infants occurs from a neuromuscular disturbance NURSING MANAGEMENT:

in which the gastroesophageal(cardiac) sphincter • NGT Insertion
and the lower portion of the esophagus spasm and • Teach parents the importance of monitoring
allow easy regurgitation of gastric contents into the intake, output (urination), and weight
esophagus. • Reinforce the need to keep the infant
upright, such as in an infant seat, after a
feeding.

V. NECROTIZING ENTERCOLITIS

The bowel develops necrotic patches, interfering

with digestion with possibly leading to a paralytic
ileus

ASSESSMENT:
• Isn’t gaining weight
• Consistently up forcefully, causing stomach
contents to shoot out of his or her mouth SIGNS & SYMPTOMS:
(projectile vomiting)
• Distended abdomen
• Spits up green or yellow fluid
• Undigested milk
• Spits up blood or a material that looks like
• Positive for occult blood
coffee grounds
• Periods of apnea
• Refuses food
• Signs of blood loss
• Has blood in his or her stool
• Has difficulty in breathing or chronic cough MANAGEMENT:
• Begins spitting up at age 6 moths or older • IV or total parenteral nutrition
• Is unusually irritable after eating • Antibiotic
• Laparotomy
• Temporary colostomy
 VI. CELIAC DISEASE THERAPEUTIC INTERVENTIONS:
• Dietary modifications includes a lifelong
Gluten is a substance in wheat and other grains, gluten-free diet, avoiding all foods containing
may be found in a variety of foods including, breads, wheat, rye, barley, and possibly, oats.
cakes, cereals, pasta, commercial dairy products • In some cases, fats maybe reduced.
and alcoholic beverages. • Lactose and sucrose may be eliminated
from diet for 6 to 8 weeks, based on reduced
disaccharidase activity.

Description:
• Also called as Gluten – Sensitive
Enteropathy
• Is a disease of the small intestine marked by
atrophy of the villi and microvilli caused by
an immune-mediated inflammatory response
to gluten, a protein found in common grains
such as wheat, rye, oats, and barley.

ASSESSMENT:
Ages 9 to 18 months
• Slackening of weight followed by weight loss
• Abnormal stools
• Pale, soft, bulky
• Offensive odor
• Greasy (steatorrhea) • Abdominal distention
• Anorexia, discoloration of teeth
• Muscle wasting: most obvious in buttocks
and proximal parts of extremities NURSING INTERVENTION:
• Hypotonia, seizures • Monitor dietary intake, fluid intake and
• Mood changes: irritability, temper tantrums, output, weight, serum electrolytes, and
shyness Mild clubbing of fingers hydration status.
• Vomiting: usually occurs in the evening • Make sure that the diet is free from
• Aphthous ulcers (canker sore, dermatitis) causative agent, but inclusive of essential
nutrients, such as protein, fats, vitamins, and
DIAGNOSTIC EVALUATION: minerals.
1. Small bowel biopsy, which demonstrates • Maintain NPO status during initial treatment
characteristic abnormal mucosa. of celiac crisis or during diagnostic testing.
2. Hemoglobin, folic acid, and Vitamin K levels • Provide parenteral nutrition as prescribed.
may be reduced.
• Provide meticulous skin care after loose
3. Prothrombin time may be prolonged.
stool and apply lubricant to prevent skin
4. Total protein and albumin may be decreased.
breakdown.
5. 72 hour stool collection for fecal fat is
• Encourage small frequent meals, but do. Not
increased.
force eating if the child has anorexia.
6. Sweat test and pancreatic function studies may
• Use meticulous hand washing technique
be done to rule out cystic fibrosis in child.
and other procedures to prevent
transmission of infection.
 • Assess for fever, cough, irritability or other CAUSES:
signs of infection. • No genetic mutations are known to cause an
• Teach the parents to develop awareness of abdominal wall defect.
the child’s condition and behavior; recognize • Multiple genetic and environmental factors
changes and care for child accordingly. likely influence the development of this
• Explain that the toddler may cling to infantile disorder.
habits for security. Allow this behavior, it may
disappear as physical condition improves. REPAIR:
• Stress that the disorder is lifelong; however, • PRIMARY REPAIR - This is a surgery where
changes in the mucosal lining of the the bowel is placed back inside of the baby’s
intestine and in general clinical conditions belly and the abdominal opening is closed.
are reversible when dietary gluten is When possible, this surgery is done the day
avoided. your baby is born.
• STAGED REPAIR - several surgeries may
ABDOMINAL WALL DEFECT be needed to slowly place the bowel /
An abdominal wall defect is an opening in the organs back into the belly. This is called a
abdomen through which various abdominal organs “staged repair.” This takes place over
can protrude. several days and can last up to two weeks.

GASTROSCHISIS SURGERIES:
• Is a birth defect that occurs when a baby's • Bowel resection – a surgery on the bowel
intestines extend outside of the body needed when part of the bowel is extremely
through a hole next to the belly button. damaged
• Omphalocele is an opening in the center of • Colostomy – an opening to allow to allow
the abdominal wall where the umbilical cord stool to pass out of the body and into a bag
meets the abdomen • Short bowel syndrome – when a large
portion of the intestine does not work
normally
• Intestinal transplantation – when a new
intestine is needed (rare)

MANAGEMENT:
• IV & NUTRITION
• Medications for comfort
• Antibiotics to prevent infection
• Careful attention to control body
temperature
OMPHALOCELE
• Gastroschisis is a defect in the abdominal VII. BILIARY ATRESIA
wall, usually to the right of the umbilical Is characterized by obliteration or discontinuity of
cord, through which the large and small the extrahepatic biliary system, resulting in
intestines protrude (although other organs obstruction to bile flow.
may sometimes bulge out).

GASTROSCHISIS There are two types of biliary atresia:

• Abdominal wall defects are uncommon. • Perinatal biliary atresia - This is the most
• Omphalocele affects an estimated 2 to 2.5 in common type. It appears after birth, most
10,000 newborns. often when a baby is about 2 to 4 weeks old.
• Approximately 2 to 6 in 10,000 newborns • Fetal biliary atresia - This is less common.
are affected by gastroschisis, although It appears while a baby is still developing in
researchers have observed that this the mother’s womb.
malformation is becoming more common.
CAUSES:
Researchers are looking at possible causes, such
as:
• Viral or bacterial infections
• Immune system problems
• A permanent change in a gene’s structure,
called a genetic mutation
• Exposure to toxins

SIGNS AND SYMPTOMS:

• Yellowish skin and eyes (jaundice) • Dark
urine
• Light-colored stools
• Swollen belly (abdomen) IX. CONGENITAL
• Weight loss DIAPHRAGMATIC HERNIA
BLOOD TESTS:
• Liver enzymes
• Bilirubin
• Albumin and total protein
• Clotting studies
• Viral studies
• Blood culture

IMAGING TEST
• Abdominal Ultrasound
• Hida Or Hepatobiliary Scan CAUSES
• During gestation, the umbilical cord passes
2 TYPES OF SURGERY through a small opening in the baby's
1. Kasai procedure abdominal muscles. The opening normally
• This surgery connects the bile drainage from closes just after birth. If the muscles don't
the liver directly to the intestinal tract. It goes join together completely in the midline of the
around (bypasses) the blocked bile ducts. abdominal wall, an umbilical hernia may
appear at birth or later in life.
2. Liver transplant • The cause of CDH is unknown. Typically
A liver transplant removes the damaged liver and CDH is an isolated finding although it can
replaces it with a new liver from a donor. The new occur along with heart disease or a genetic
liver can be one of the following: abnormality which can lead to additional
• A whole liver, received from a donor who complications.
has died
• Part of a liver, received from a donor who SIGNS & SYMPTOMS:
has died • CDH is typically discovered during a routine
• Part of a liver, received from a relative or prenatal ultrasound. The sonographer may
other person whose tissue type matches the notice stomach, intestine, or liver in your
child's tissue type baby’s chest where the lungs should be. The
baby’s heart may also be pushed to one
side by the extra organs in the chest.
VIII. HERNIA
• It is the protrusion of an organ or part of an MANAGEMENT:
organ through the wall of the cavity that • Surgical repair of CDH after delivery
normally contains it. depends on your individual baby’s progress
• It is classified by location in the days following birth.

PATHOPHYSIOLOGY OF UMBILICAL HERNIA:

• Pregnancy and obesity contribute to the
development of umbilical hernia in adults.
• May be congenital and evident during
infancy, or acquired as the tissue closing the
umbilical ring weakens, allowing protrusion
of abdominal contents.
• More common in women.
 X. VOLVULUS
• It is a twisting of the intestine
• It occurs when a loop of intestine twists
around itself and the mesentery that
supplies it, causing a bowel obstruction.

MANAGEMENT
• Surgery is used to relieve the volvulus and
reattach the bowel so it no longer is so.
• This must be done promptly before necrosis
of the intestine occurs from a lack of blood
supply to the involved loop of bowel.

MECKEL’S DIVERTICULUM
• A small pouch of this duct remains, located
off the ileum, approximately 18 inches from
the ileum – colon junction.