Question

Pediatric diseases : Please describe the following diseases in Infants through adolescents and nursing internvention for the following. Thanks

Cleft lip and cleft palate Esophageal Atresia and Tracheoesophageal Fistula Hirschsprung Disease Intussusception Inguinal Hernia Ingestion of Poisons Nephrotic Syndrome Cryptorchidism Hypospadias/Epispadias Scabies Pediculosis Capitis Metabolic/Endocrine Obesity

Answer 1

1.Cleft lip is a congenital defect . It is an opening in the upper lip between the mouth and nose .

Cleft palate is also a congenital defect ,in which there is a spilt in the roof of the mouth .

Nursing interventions :-

- Assess the vital signs of the patient .

- Assess the respiratory rate and depth and effort before and after surgery because cleft can cause aspiration and it will lead to respiratory distress and pulmonary infections .

- Assess the skin colour and capillary refill of the infant because chances of aspiration and decreased oxygenation is more with cleft lip and palate .

- Assess infants sucking ability , provide special nipples and feeding bottles with one way valve to prevent aspiration

- Suctioning mouth and nose when ever needed . ( First mouth then nose to avoid aspiration) .

- Monitor infants calorie intake and weight to determine nutrition is adequate or not and to initiate an another method as soon as possible if the first one is not appropriate.

- Prepare patient and family for surgery . Provide parents psychological and emotional support .

- Provide referral information for dental ,speech ,and audiology consultation.

2. Esophageal atresia is a congenital defect . In this condition the esophagus ends in a blind ended pouch .

Tracheoesophageal fistula is also a congenital defect . It is an abnormal connection (fistula) between the esophagus and the trachea.

Nursing interventions :-

- Assess for symptoms immediately after birth .

- Assess the patency of esophagus before feeding

- Evaluate difficulty in feeding , respiratory distress , three C's- choking ,cyanosis , coughing .

- Assess lung sounds

- Use semi -fowlers position to prevent reflux of gastric contents into trachea and to decrease respiratory effort.

- Monitor respiratory status closely

- Prevent aspiration

- Maintain fluid and electrolyte balance

3. Hirschsprung disease is also known as congenital megacolon . It is a disease condition in which nerve cells are missing at the end of large intestine mainly in colon and causes difficulty in passing stools .

Nursing interventions (Preoperative ):-

- Assist in emptying the bowel by giving repeated enemas and colonic irrigations.

- If abdominal distention is not relieved by enemas, discomfort is significant, and rectal tube insertion fails to give relief, consult doctor for a nasogastric (NG) tube.

- Offer pacifier for infant to suck if on parenteral fluids.

- Maintain position of comfort with head elevated. Offer soothing stimulation

- Offer small frequent feedings. Low residue diet will aid in keeping the stool soft.

- Administer parenteral nutrition if feeding causes additional discomfort because of distention and nausea.

Postoperative :-

- Change wound dressing using sterile technique.

- Prevent wound contamination from diaper.

- Prevent perianal and anal excoriation by thorough cleaning and use of ointments after the infant soils

- Strict Hand washing

- Report any wound redness, swelling or drainage, evisceration, or dehiscence immediately.

- Suction oral secretions frequently to prevent infection

- In older child, encourage frequent coughing and deep breathing to maintain respiratory status.

- Change position of infant frequently to increase circulation and allow for aeration of all lung areas.

- Maintain patency of NG tube immediately postoperatively.

- Maintain NPO status until bowel sounds return and the bowel is ready for feedings as determined by the physician.

- Provide frequent oral hygiene

- Administer fluids to maintain hydration and replace lost electrolytes. Begin oral feedings as ordered.

- Support the parents when teaching them to care for their child’s colostomy. Reassure parents that colostomy will not cause delay in the child’s normal development.

- Involve the entire family in teaching colostomy care to enhance acceptance of body change of the child.

4. Intussusception is a form of bowel obstruction in which one segment of intestine invaginates into another.

Nursing interventions :-

- Assess the vital signs

- Monitor I.V. fluids and intake and output

- Be alert for respiratory distress due to abdominal distention.

- Monitor urine output, pain, distention, and general behavior preoperatively and postoperatively.

- Observe infant’s behavior - may be irritable and very sensitive to handling or lethargic or unresponsive. Handle the infant gently.

- Administer analgesic as prescribed.

- Maintain NPO status as ordered.

- Insert nasogastric tube if ordered to decompress stomach.

- Continually reasses condition because increased pain and bloody stools may indicate perforation.

- Encourage follow up