irenes.pptxgft123345666777788887899777665

EPISPADIAS

EPISPADIAS This is where the urethral orifice opens at the upper surface of the penis.

Causes The causes of epispadias are unknown at this time. It is believed to be related to improper development of the pubic bone. In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip. In girls, the opening is usually between the clitoris and the labia.

Epispadias can be associated with bladder exstrophy, an uncommon birth defect in which the bladder is exposed, inside out, and sticks through the abdominal wall. However, epispadias can also occur alone or with defects.

Incidence Epispadias occurs in 1 in 117,000 newborn boys and 1 in 484,000 newborn girls. The condition is usually diagnosed at birth or shortly thereafter.

classification Based on the location On the glans (granular) Along the shaft (penile) Near pubic bone ( penopubic ) NOTE: The position of the meatus is important because if predict the degree to which the bladder can store urine (continence).

Symptoms In males: Abnormal opening from the joint between the pubic bones to the area above the tip of the penis Backward flow of urine into the kidney (reflux nephropathy) Short, widened penis with an abnormal curvature Urinary tract infections Widened pubic bone

In females : Abnormal clitoris and labia Abnormal opening from the bladder neck to the area above the normal urethral opening Backward flow of urine into the kidney (reflux nephropathy) Widened pubic bone Urinary incontinence Urinary tract infections

Diagnostic Investigations Blood test to check electrolyte levels Intravenous pyelogram (IVP), a special x-ray of the kidneys, bladder, and ureters Pelvic x-ray Ultrasound of the urogenital system

Pre – op care Physical examination and history taking before the procedure. Laboratory investigations are carried out such as FBCs. Vital signs checked and recorded such as temperature, pulse, respiration and blood pressure. Ensure nil per os . Aseptic technique is ensured when caring for the incisional site .

Treatment Surgical repair of epispadias is recommended in patients with more than a mild case. Leakage of urine (incontinence) after surgery is common and may require a second operation.

Post-op care A dressing is placed over the penis to protect the site. A urinary catheter is put in place so that urine will flow. Fluid intake is encourage so that the child can urinate frequently. Analgesics may be given to relieve pain. Antibiotics are prescribed for the patient.

Prognosis: Surgery generally leads to the ability to control the flow of urine and a good cosmetic outcome

Possible Complications Persistent urinary incontinence can occur in some persons with this condition even after several operations. Upper urinary tract (ureter and kidney) damage and infertility may occur. Hematoma. Scar.

HYPOSPADIA HYPOSPADIA It is a congenital anomaly in which the urethral meatus is located on the ventral surface of the penis or underside of the shaft of the penis. Chordae accompanies most types of hypospadias and results from the normal tissue being. It may occur in females, where urethra opens into vagina. Hypospadias is a birth defect found in boys in which the penile meatus is not at the tip of the penis. The meatus is the term for the opening of the penis through which urine normally exists the bladder

Hypospadias is usually classified according to the location of the opening. As the defect increases in severity, the opening to the penis will be found further back on the penis. The most severe types can have openings at the region of the scrotum and even in the perineum (the region between the anus and scrotum).

Hypospadias can be associated with another defect called chordae. Chordee is a downward curvature of the penis. Both Hypospadias and chordee must be repaired so that a child can have normal urinary and reproductive health. .

Diagram of hypospadia

Hypospadias is a birth defect of the urethra in the male that involves an abnormally placed urinary meatus (the opening, or male external urethral orifice). Instead of opening at the tip of the glans of the penis, a hypospadic urethra opens anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum. A distal hypospadias may be suspected even in an uncircumcised boy from an abnormally formed foreskin and downward tilt of the glans. The urethra meatus opens on the underside of the glans penis in about 50-75% of cases; these are categorized as first degree Hypospadias. Second degree (when the urethra opens on the shaft), and third degree (when the urethra opens on the perineum) occur in up to 20 and 30% of cases respectively. The more severe degrees are more likely to be associated with chordee , in which the phallus is incompletely separated from the perineum or is still tethered downwards by connective tissue, or with undescended testes (cryptorchidism).

INCIDENCE The incidence is reported to be 1 in 300 live male births. Less common form in which the meatus is found in the scrotum. Most severe in the perineum.

RISK FACTORS There is some family risk of hypospadias, as familial tendencies have been noted. Up to 14% of male siblings are affected . Further risk factors: increased maternal age, low birth weight, in-vitro fertilization

EMBRYOLOGY As a boy is developing in utero, the penis begins to form in the sixth week of fetal life. Two folds of tissue join each other in the middle and a hallow tube is formed in the middle of the future penis. This tube is the urethra and its opening is called the penile meatus. As the skin folds develop to form the penis, any interruption in this process leads to the meatus being located in a location further from the end of the penis. The exact etiology for this premature cessation of urethral formation is poorly understood. In addition, the etiology of the often-associated abnormal downward curvature ( chordee ) is also poorly understood.

Reasons To Treat. Hypospadias is repaired through a surgical procedure. When the repair is performed, the urethra is extended to the tips of the penis to its normal location. In addition, any bend is straightened. This is important for many reasons. When the opening is too ventral (underside), a male is unable to stand and urinate like other boys. It is harmful to a boy’s normal social development to have to sit while he urinates. Additionally, a straight phallus is essential for normal reproductive health and sexual function.

SIGNS AND SYMPTOMS Hypospadias is a male defect in which the opening of the tube that carries urine from the body (urethra) develops abnormally, usually on the underside of the penis. The opening can occur anywhere from just below the end of the penis to the scrotum. A form of Hypospadias in which the genitals are abnormally positioned can also develop in females. Associated With Defects

Mild Hypospadias most often occurs as an isolated birth defect without detectable abnormality of the remainder of the reproductive or endocrine system. However, a minority of infants, especially those with more severe degrees of Hypospadias will have additional structural anomalies of the genitourinary tract. Up to 10% of boys with Hypospadias have at least one undescended testis, and a similar number have an inguinal hernia. An enlarged prostatic utricle is common when the Hypospadias is severe (social or perineal ), and can predispose to urinary tract infections, pseudo-incontinence, or even stone formation,

TREATMENT The treatment of Hypospadias is always surgical. Initially, when the child is born and Hypospadias is identified, it is important to delay any thoughts of circumcision until seen by a urologist. This is because the foreskin can provide essential additional skin needed to reconstruct the urethra.

We often repair Hypospadias before a child is one year of age. This way, the boy is in diapers and management of dressings are made easier. However, the exact age of repair can vary according to the size of the penis and severity of the defect. We have been able to repair most of the children with a single operation, but on occasion, a second operation may be needed. The operation is performed under general anesthesia with the child completely unconscious. This “stent” will protect the new urethra and allow for adequate healing. Most patients leave the hospital the same day or the following day. However, more complex repairs for the more severe types of Hypospadias can require longer hospital stays to the need for bed rest and immobilization in the immediate post-operative setting.

The exact type of operation employed varies according to the severity of the defect. For the more distal defects that have openings closer to the normal position at the end of the penis, a new tube can be created from the surrounding skin. This creation of a tube is known as a Thiersch-Duplay repair. For more severe defects, the options range. Additional hairless skin is often needed to recreate the urethral tube when longer defects are seen. Here, the subdermal skin of the inside of the cheek or use subdermal skin from other hairless parts of the body. It is important to use hairless skin as future hair growth in the neourethra can present multiple problems.

Pre – op care Before the Procedure The child's surgeon may ask for a complete medical history and do a physical exam before the procedure. Always tell the doctor or nurse: What drugs your child is taking Include drugs, herbs, and vitamins you bought without a prescription Tell them about any allergies the child has to medicine, latex, tape, or skin cleaner Ask the child's doctor which drugs your child should still take on the day of surgery. On the day of the surgery:

Your child will usually be asked not to drink or eat anything after midnight the night before surgery. Give your child any drugs your doctor told you to give your child with a small sip of water. Your child's doctor or nurse will tell you when to arrive for the surgery. The doctor will make sure your child is healthy enough for surgery. If your child is ill, the surgery may be delayed.

Post-op care After the Procedure Right after surgery, the baby’s penis will be taped to his belly so that it does not move. Often, a bulky dressing or plastic cup is placed over the penis to protect the surgical area. A urinary catheter (a tube used to drain urine from the bladder) will be put through the dressing so urine can flow into the diaper. Your child will be encouraged to drink fluids so that he will urinate. Urinating will keep pressure from building up in the urethra.

Your child may be given medicine to relieve pain. Most of the time, the child can leave the hospital the same day as the surgery. If you live a long way from the hospital, you may want to stay in a hotel near the hospital the first night. Your healthcare provider will explain how to take care of your son at home after leaving the hospital .

Discharge Instructions for Patients After Hypospadias Repair Activity: once your son is at home, he does not have to stay in bed, but he needs to be watched closely. He may walk and play quietly. Your son may not use straddle toys, walkers, or bicycles until it is okayed by his doctor. His doctor will also tell you when he can return to dayc Dence some soreness. Your son’s doctor will prescribe medication to help relieve the pain. Give your son the pain medication on a regular schedule, as prescribed by his doctor, to keep him comfortable. Medications: In addition to pain medication, your son’s doctor may prescribe anticholinergics to help decrease bladder spasms. Bacitracin is an antibiotic ointment used to help prevent infection and soothe the penile area. You can buy bacitracin in any drug store without prescription.

Your son’s penis will look red and swollen for a while. Applying bacitracin ointment gently on the tip of his penis 4 to 6 times a day will soothe the area and help prevent infection and crusting. The bandage may fall off by itself. If it does, apply bacitracin on the entire area until it is completely healed.

Give your son a sponge bath for the first 7 days. As long as your son does not have a tube or stent, he may take a bath in the bathtub after 7 days. It is okay if the bandage falls off in the tub. Use only warm water for the first bath (NO SOAP). Use double diapers to protect and pad your son’s penis for one week. Dress your son in loose fitting clothing such as sweat pants or loose pajamas to keep him comfortable.

Care Of Stent A stent is a small, soft tube that is placed in the urethra and sometimes the bladder to hold it open during healing. A stent will be inserted in the urethra and a dressing will be placed around the penis. The stent will be sutured in place during surgery; its tip visible at all times. It is acceptable for your son to urinate around as well as through the stent. The stent will be removed during your son’s post-operative visit. Care of the bandage is the same with or without a stent. When you put bacitracin on the penis, be careful not to block the stent. Although the suture holding the stent in place will keep it attached to the penis, the pressure of the urinary stream may cause the stent to fall out (do not attempt to put it back). If this happens, do not be attempt to put it back). If this happens, do not be alarmed, just notify your doctor.

The stent will stay in place for 7 to 21 days after surgery. It will be taken out in the doctor’s office. Seek immediate attention from doctor if:  You notice bleeding from the stitches or blood in the urine (red diaper). It is okay if the urine is pink tinged for a few days.  Fever of 102Fº or higher for more than 24 hours.  Your son has continued nausea and vomiting after the first day.  The bandage seems too tight or the penis tip is gray or blue.  You notice your son is straining or unable to urinate.  You cannot see the tube or if it falls out (do not replace it).  Your son has severe pain that doesn’t get better with pain medication.

Possible c omplications A hole that leaks urine (fistula) Large blood clot (hematoma) Scarring or narrowing of the repaired urethra

THANK YOU

A PRESENTATION ON CONGENITAL CATARACT BY KOKAA BERNARD

DEFINITION A cataract is a development of opacity in the crystalline lens that prevents light rays from getting directly to the retina. Capsule Cortex Nucleus

RISK FACTORS Aging Heavy drinking Smoking Obesity Previous eye injuries Family history Too much UV light (sun) exposure Diabetes Maternal infections (rubella)

Signs and symptoms Absence of red reflex Cloudiness Nystagmus Inappropriate responses

DIAGNOSIS Eye examination History taking

Pre op care Explain and reassure Answer question appropriately Conduct vision test under different lighting conditions. Doll with patch Antibiotics, corticosteroids and mydriatics

Surgery Extracapsular extraction Phacoemulsification surgery

Post op care Fluid therapy Sedate Observe site closely Restrain arms if necessary

Complications Drooping eyelids Secondary glaucoma PCO Retinal detachment

PAEDIATERIC NURSING PRESENTATION ON IMPERFORATE ANUS BY: DASSAH GRACE INDEX NUMBER: 402013025

OBJECTIVES By the end the lesson student should be able to; Define imperforate anus. Types and causes of imperforate anus Diagnostic investigation. Treatment Prevention and complication.

IMPERFORATE ANUS Imperforate anus is a birth defect that is present from birth (congenital). The opening to the anus is missing or blocked. The anus is the opening to the rectum through which stool leave the body. The baby develops this defect or abnormality during the fifth to seventh weeks of the mother’s pregnancy.

CAUSES No one knows the exact reason some baby’s have imperforate anus. The exact cause of imperforate anus is unknown. In some cases, environmental factors or drug use during pregnancy may play a role, but no one is completely sure. INCIDENCE Imperforate anus affects one in 5,000 babies and is a little more common in males.

TYPES Typically, there are two types of imperforates anus: The “low type "means that the bowel ends below the muscles of the pelvis and there is an opening present. The “high type "means that no opening is present on the outside of the child’s body, and the bowel ends above the muscles at the bottom of the pelvis.

CLINICAL FEATURES 1 . 1.Anal opening very near vaginal opening in girls. 2. First stool is not passed within 24 to 48 hours after birth. 3 . The rectum may connect to part of the urinary tract or reproductive system through an opening called a fistula, and anal opening is not present. 4 . Stool passes through the vagina, base of penis, scrotum or urethra. 4. Swollen belly area. 5. A membrane (covering) may be present over the anal opening. 6. The rectum may not connect to the anus.

HOW IS IMPERFORATE ANUS DIAGNOSED? When a baby is born, the midwife or pediatrician performs a thorough physical examination that includes seeing if anus is opened and in proper position. A number of diagnostic tests may also be done to further evaluate a problem and determine whether other abnormalities are present. Abdominal x-ray. Abdominal ultrasound and spinal ultrasound. Echocardiogram.

TREATMENT The infants should be checked for other problems, such as abnormalities of the genitals, urinary tract and spine. Surgery to corrects with other organs, these organs will also need to be repaired. A temporary colostomy (connecting the end of the large intestine to the abdomen wall so that stool can be collected in a bag is often needed. How this surgery (Anoplasty) is performed depends on type of imperforate anus. The surgery is done under general anesthesia.

NURSING MANAGEMENT Before the procedure: Allay anxiety from the mother and family by explaining the out come surgery to them. Written consent should be taken after explaining the procedure. Meticulous care must be carry out on the child. Childs’s weight must be checked and noted. Laboratory investigations should be done.

After the produce : Put the child in the right position to prevent aspiration.(recovery position). Check vital signs especially temperature . Administer prescribed medication. Give intravenous fluids to hydrate child. Inspect the incisional site for bleeding. Advice mother to change wet diapers frequently. The mother is also instructed to performed regular anal dilatations to prevent stenosis.

PREVENTION There is no known prevention. Parents with a family history of this defect may seek genetic counseling. COMPLICATIONS Constipation Faecal incontinence Anal fistula

REFERENCE Principles of health on the net foundation (www.hon.ch).

Exomphalus - Omphalocele (Or Umbilical Hernia)

introduction During fetal development, the intestines are located outside the abdomen around the 10 th week of pregnancy. In babies with exomphalus, the abdominal wall does not develop properly and the bowels and sometimes the liver remain outside the abdominal cavity where they are contained in a loose sac around the umbilical cord.

Introduction cont’ The abdominal cavity does not develop properly and remains small in size and most of the contents are lying outside in the sac.

a child with exomphalus

definition Exomphalus means “outside the navel” A congenital deformity where there is an enlargement of the floor of the belly caused by the extrusion of a portion of bowel through the navel opening . It seldom occurs after the age of one year.

incidence The incidence of exomphalus is 1:3000 live births. It is usually identified on perinatal ultrasound

Cause/risk factors idiopathic Mothers above age 40 Genetic defects like trisomy 18

diagnosis Ultrasound scan MRI of the abdomen

Signs and symptoms Visible mass at umbilicus Covered by a membrane May have other deformities

treatment When the orifice is small (< 1 or 2 cm), 90% close within 3 years. In severe cases, surgery is performed to correct the deformity

Nursing management When the sac is intact Reassure the child’s mother use latex free products including gloves Provide nasogastric suction Nil per os Cover the sac with warm saline soaked in gauze, then wrap the sac on the abdomen Wrap with plastic to support the intestinal viscera on the abdominal wall. Keep baby warm by wrapping the baby Place a reliable IV line and serve infusions as prescribed

Monitor temperature and pH Start broad spectrum antibiotics (ampicillin and gentamicin) Obtain surgical consultation

Feeding Some babies can feed within a few days of their operation but the bowels of some babies with exomphalus can take several weeks to work normally.

PREOPERATIVE CARE Reassure the child’s family especially the child’s mother Ng tube is passed to drain bile from the child’s stomach Ensure nil per os Provide warmth to prevent hypothermia Serve prescribed IV fluids Monitor the child’s vital signs

POST OPERATIVE CARE R eassure the child’s mother Monitor the child’s vital signs Keep the baby warm Continue nil per os until intestinal motility is present Monitor incisional site for bleeding Serve prescribed antibiotics

complication If other organs like heart, lung and kidneys are affected along with the existence of exomphalus, chances of recovery are slim.

MEGACOLON ( HirschSpRUng’s disease )

HirschSpRUng’s disease or Megacolon It is a congenital condition in which an absence of certain nerve structures (parasympathetic ganglia) in a segment of the colon result in failure of peristalsis in the affected portion of the bowel. Coordinated peristalsis cannot pass beyond the aganglionic area. There is stagnation of faeces in that part.

Definition/Description cont’d Reabsorption of water from accumulated faeces occurs leading to constipation. It becomes hardened causing partial obstruction in the rectum. Continuous accumulation of faecal matter causes hypertrophy and dilation of proximal colon, leading to distension of the abdomen. There is also erosion of mucosa

INCIDENCE More common in children and infants. 1:500 – 1:3000; accounts for about 25% of all intestinal obstructions in the newborn.

CAUSES Causes is unknown May be familial Arrest of embryological development affecting the migration of parasympathetic nerves ( innervation ) of the intestine, occurring prior to the 10 th week of gestation

Signs and Symptoms Newborns: No meconium passed Vomiting- bile stained or faecal Abdominal distension Constipation Overflow type of diarrhoea Anorexia Temporary relief of symptoms with enema

Signs and Symptoms cont’d Older child: Hx may reveal constipation at birth Thin abdominal wall superficial veins are visible Constipation for days, weeks or even months. Progressive abdominal distension. Ribbon like stools, fluid like or pellets form In severe cases the respiratory and cardiovascular systems are affected. There is palpable pelvic tumour (faecal mass). Pain due to partial obstruction which increase with distension Failure to grow – malnutrition.

Diagnostic Evaluation History Rectal exam shows no faecal matter Barium enema Rectal biopsy to establish absence or reduced number of ganglia. Anorectal manometry – records reflex response of sphincter

Management In mild cases; Low residue diet / liquid diet Bowel evacuation example, enema, manual removal, rectal washout. Bowel training or adopting regular habit of removing the bowel daily.

Management cont’d Liquid paraffin to keep faeces soft but aperients are avoided. Abdominal exercises Parasympathomimetic drugs.

Surgical Treatment Resection of affected bowel. Temporary caecostomy or colostomy in seriously ill patient to relieve obstruction. Later resection and anastomosis is performed, result is satisfactory in 80% of the cases.

Indications for Colostomy Tumour of the large bowel Congenital absence of anus Severe bowel incontinence Disease of the bowel Before certain bowel operation Injury of the spinal cord leading to incontinence Traumas of the lower bowel

Nursing management Preoperative care: Daily rectal wash with about 300ml N/S, remove fluid by siphoning Give antibiotics for infections Note frequency and type of stools passed if any Maintain nutritional needs of child

Post operative care: General post operative care Infection prevention : administering prescribed antibiotics, changing dressing aseptically, hand washing, noting for early signs of infection such as redness, swelling, drainage, evisceration, etc.

ii. Care of the Colostomy Observe colostomy for Paul’s tube in position, and connected to bottle/bag or petrolatum gauze dressing on stoma. Observe for bleeding, slight bleeding is normal for the first 24 hours after surgery, but if bleeding is profuse, the surgeon and theatre team are informed. Change dressing on colostomy if wet

ii. Care of the Colostomy cont’d Removal of Paul’s tube- this is usually removed by the 3 rd to the 5 th day post-op when bowel action has resumed. Observe for bowel action, including bowel sound, passage of stool and gas which begins usually within 72 hours of surgery.

ii. Care of the Colostomy cont’d Fix pouch or colostomy bag when bowel sounds resume, usually within 2 nd – 5 th day post-operative and when the Paul’s Tube or dressing has been removed. Change bag as soon as it is about 1 / 3 to ½ full. Clean stoma and surrounding preferably with normal saline.

ii. Care of the Colostomy cont’d Observe stoma and note whether it is pinkish, pale, cyanosed, necrotic, prolapsing or retracting. Apply Vaseline or zinc oxide ointment to the surrounding skin of the stoma before fixing a bag to prevent skin excoriation.

ii. Care of the Colostomy cont’d Minimize odour:- odour may be a source of worry to the patient, to control this, patient must avoid gas-producing foods and maintain cleanliness. Deodorizing colostomy using commercially produced deodorants or aspirin tablets is helpful. 4 tablets of aspirin can be placed in the bag/pouch before fixing each time a change is made. It reduces the odour.

ii. Care of the Colostomy cont’d Regulation of colostomy:- the bowel movement is regulated so that, stool flow occurs at specific times of the day. This can be done by irrigation of functioning orifice, use of diet or use of methylcellulose preparations. For irrigation; Luke warm tap water or normal saline is used. About 500-1000 mls of fluid is used at a time. Irrigation is preferably done early in the mornings

ii. Care of the Colostomy cont’d Using diet, the patient is trained to take meals at specific times of the day and avoid irritating foods.

iii. Diet: Well balanced and nutritious diet but free of gas producing and irritant foods such as spices, acidic foods, caffeine beverages and alcohol. Gas producing foods such as beans, onions and eggs should be avoided. Spicy foods such as pepper ginger should be avoided

iii. Diet: cont’d Acidic foods such as lemon and green orange should be taken in moderation. Serve foods attractively. Remove all nauseating objects from the environment before serving foods.

Complications Prior to primary surgery: Enterocolitis Hydro- ureter or hydronephrosis Water intoxication from tap water enemas Caecal perforation Post operative: Enterocolitis Leaking of anastomosis and pelvic abscess Temporary sudden inability to evacuate colon

Complication cont’d Postoperative – colostomy Abdominal distension Respiratory distress Infection Haemorrhage shock

ESOPHAGEAL ATRESIA Definition Esophageal atresia is a congenital defect in which the upper segment of the esophagus ends in a blind pouch. Or abnormal esophagus that ends in a blind pouch and does not provide a continuous passage to the stomach

Children with esophageal atresia always have another birth defect called tracheoesophageal fistula Instead of forming tube between the mouth and the stomach, the esophagus grows into separate segments that do not connect

CAUSES The cause of esophageal atresia is like that of most birth defect, the cause is unknown. Incidence Esophageal atresia occurs in about 1 of 4,000 live birth in the united state making it the 25 th most common birth defect.

SIGNS AND SYMPTOMS Depending on the defect, various symptoms appear. Copious oral and nasal secretions may be the first sign of the defect Coughing or choking which make the baby become cyanosed. Aspiration pneumonia When fed, the baby will also immediately regurgitate what she or he has eaten.

DIAGNOSIS X-ray imaging Esophageal atresia is indicated if a catheter hits an obstruction about 10-13cm from the nostrils Signs and symptoms

NURSING MANAGEMENT Preoperative care Detection of the defect, prevention of aspiration when diagnosed, and attainment of normal function after surgery are the nursing goals. infants are placed in a head-up position with continuous suctioning Intravenous fluids are administered until surgery.

Con’t A small tube, attached to suction is passed through the mouth to the upper pouch to provide continuous drainage of saliva.

Con’t Postoperative care Gastrostomy feedings are begun, during which infants are given pacifiers to help them retain the sucking reflex and to provide comfort. When possible, infants are held quietly for a time after feedings. As soon as possible oral feedings are begun to reduce the degree of stricture of the esophagus

Con’t Parents of these infant need much support and information. They are encouraged to participate in the care and feeding of the infant so that the normal bonding process will occurs and they will gain confidence and skill.

Medical and surgical interventions Medical care focuses on prevention of aspiration. A drainage tube may be placed in the blind pouch to suction the pooled secretions. Once diagnosed, the baby will be fed intravenously until he/she has recovered sufficiently from the surgery

Con’t Esophageal atresia is considered a surgical emergency. The surgical repair may be done in a one-stage or two-stage operation The procedure is done as soon as possible; however, prematurity, the presence of other birth defects or complications of aspiration pneumonia may delay surgery.

Con’t depending on the defect. Where there is sufficient tissue, the two segments of the esophagus are sewn together in what is called an end-to end anastomosis . If there is insufficient tissue, a section of colon may be transplanted to connect the

esophageal stump to the stomach. A feeding tube may be inserted into the stomach through a gastrostomy until the repair heals. A tracheostomy also may be necessary.

Con’t A common complication of these surgeries is the formation of esophageal strictures (narrowed sections). When strictures occur, the child may need repeated dilations to prevent complete closure of the esophagus.

COMPLICATIONS Chronic lung problems Pain at the incision Aspiration pneumonia Difficulty swallowing liquid and solids A red incision

CONGENITAL ABNORMALITIES TRACHEOESOPHAGEAL FISTULA

Definition: Tracheoesophageal fistula is a defect in which embryonic structures fail to divide into a separate oesophagus and trachea, causing an opening (fistula) between the two structures.

Although oesophgeal atresia and tracheoesophageal fistula may occur separately, they often occur together with the upper portion of the oesophagus ending in a blind pouch and the portion just above the stomach connecting to the trachea. Sometimes the oesophgus is connected to the trachea so that feedings go directly into the lungs.

Incidence occurs in about 1 of 3500 live births. Many of these infants are premature or of low birth weight. About one fourth are born with other anomalies.

Causes Unknown in most cases Failure of embryonic development

CLASSES OF OESOPHAGEAL ATRESIA AND TRACHEA-OESOPHAGEAL FISTULA Type I: Proximal and distal segments of oesophagus are blind; no connection to trachea – 15 -20% of cases (E)

Type II: Proximal segment of oesophagus opens into trachea by a fistula; distal segment is blind- very rare.(B)

Type III: Proximal segment of oesophagus has blind end: distal segment of oesophagus connects into trachea by a fistula (most common – 80 – 90%) (A)

Type IV: oesophageal atresia with fistula between both proximal and distal ends of trachea and oesophagus – very rare(C)

Type V: - Both proximal and distal segments of oesophagus open into trachea by a fistula; no oesophageal atresia (H-type) - not usually diagnosed at birth.(D)

SIGNS AND SYMPTOMS Appear soon after birth Excessive drooling and secretion from nose Intermittent cyanosis- unexplained; laryngospasm due to aspiration of accumulated saliva in blind pouch Abdominal distension – inspired air from trachea passes through fistula to stomach

After feeding infant responds violently after first two feeds- coughs & chokes, fluid returns through mouth and nose, cyanosis, struggling. Inability to pass catheter through nose or mouth into stomach – tip stops at blind pouch

DIAGNOSIS Recognize infants at higher risk i.e. infants with polyhydraminous (this might be present due to inability to adequately swallow fluid and it is found in 90% of cases) and low birth weight infants Observing for specific signs and symptoms A firm catheter is passed through the oesophagus to check if passage is continuous

X-ray shows flat plate of abdomen and chest reveals presence of gas in stomach and tip of catheter in blind pouch. Bronchoscopy

TREATMENT Nurse in a supine position and prop infant’s head up at 60 degrees angle to prevent aspiration and minimize reflux Place a nasal catheter into the pouch to suction the pharynx and the upper oesophageal pouch. The catheter is passed carefully and should be changed daily Give nil per os to infant but IV fluids should be administered to correct fluid and electrolyte imbalance

Meeting nutritional requirements, intravenous fluids, antibiotics, respiratory support, During transportation of the child suctioning of secretions should be ensured with the head and chest elevated to a 45 degrees to prevent aspiration and minimise reflux

SURGERY Prompt primary repair – division of fistula followed by oesophageal anastomosis of proximal and distal segments. Note: infant should be more than 2kg and without pneumonia

Nursing management Preoperative care: Position infant with head and chest elevated 60 degrees to prevent or decrease reflux or decrease reflux of gastric juices into tracheobronchial tree. Assist in removing nasopharyngeal secretions from oesopharyngeal blind pouch and support infant’s respiration

PREOPERATIVE CARE(CONT’D): Administer antibiotics and other medications as prescribed Monitor parenteral fluids as prescribed in order to prevent dehydration and electrolyte imbalance Observe infant carefully for any change in condition and report changes immediately

PREOPERATIVE CARE(CONT’D): Be available and recognize the need for emergency care or resuscitation Administer supportive nursing care that will prevent any deterioration of infant’s condition and will assist in preparation for surgery

POSTOPERATIVE CARE Observe for signs of possible complications Maintain a patent airway to prevent oxygen starvation, apnoea , and aspiration of secretions Beware of type of chest drainage present which may be determined by surgical approach and provide appropriate care ;

retropleural – small tube in posterior transthoracic chest tube placed in pleural space and connected to suction. Assist in maintaining adequate nutrition to promote healing, growth and development of infant ; gastrostomy feeding before oesophageal healing, NG tube feeding and then oral feeding after 10 to 14 days postoperatively following anastomosis .

Postoperative care(cont’d) Appropriate care for cervical oesophagostomy (artificial opening in neck which allows for drainage of upper oesophagus ). Observe for the likely complications of oesophageal repair and report

POST OP cont Provide for the infant’s emotional and social needs by cuddling baby during and after feeding, providing visual , auditory and tactile stimulation Encourage parental participation in learning to care for and handle the infant and foster acceptance of the child by the parents and family.

Complications associated with trachea- oesophageal fistula Pneumonia secondary to salivary aspiration and gastric acid reflux

Post operative complications Leak at anastomosis site Recurrent fistulas Oesophageal strictures Abnormal function of distal oesophagus sphincter( gatrooesophageal reflux) and oesophagitis Tracheomalacia Atelectasis or pneumonitis Feeding problems with the older child Repeated RTIs

Prevention Tracheoesophageal fistulas are not birth preventable defects.

PYLORIC STENOSIS Pyloric stenosis is the narrowing of the pylorus, the opening from the stomach, into the small intestine. OR The narrowing of the outlet of the stomach to the small intestine called the pylorus. Other names: Congenital hypertrophic pyloric stenosis ; Infantile hypertrophic pyloric stenosis ; Gastric outlet obstruction.

CAUSES The cause of the muscles thickening is unknown, although genetic and environmental factors may play a role. Genes (children of parents who had pyloric stenosis are more likely to have the condition) and Acids.

INCIDENCE The incidence is 2-4 per 1000 live births and is more common in whites than Hispanics, Blacks, or Asians. 1.8 in Hispanics, 0.7 in Blacks and 0.6 in Asians. And more common in Males than Females thus 4;I. And when you take 30% of patients with pyloric stenosis , the first-born males are at high risk.

SIGNS AND SYMPTOMS Babies with this condition usually present with progressively worsening vomiting. The vomiting usually starts around 3 weeks of age, but may start any time between 1 week and 5 months of age. The vomiting may occur after every feeding or only after some feedings. The vomiting is forceful ( projectile vomiting )and the vomit itself is usually clear or has the appearance of partially digested (curdled) milk.

The infant is hungry after vomiting and wants to feed again. There is wave-like motion of the abdomen shortly after feeding and just before vimiting occurs The baby usually has small stools because of little feeds reaching theintestine . These stools are described as “pellet stools” or “ribbon-like stools.” There is belching, abdominal pains, sunken fontanel and dehydration.

DIAGNOSIS History taken and signs and symptoms. Barium meal Ultrasound

Treatment Is done by a surgical procedure called pyloromyotomy . A device called an endoscope with a tiny balloon at the end is used. The balloon is inflated to widen the pylorus.

Nursing Management Before And After Before BEFORE Reassure parents The infant must be protected from infection. The infant position must be changed frequently to prevent hypostatic pneumonia The infant must be kept warm Charting of voiding, type and number of stools The infant is weighed daily at the same time in days schedule

AFTER IV fluid for first few days may be given The infant should be kept on his/her right side or on his/her abdomen then on the upright position If symptom of shock appear the foot of the bed should be elevated and additional warmth provided Prevention of infection of the wound by; observing the redness around the wound. Instructing the mother not to give the infant bath until the incision is completely healed

COMPLICATIONS If not treated, the baby won’t get enough nutrition and fluid, and can underweight and dehydrated.

CHOANAL ATRESIA It is a congenital disorder where the back of the nasal passage ( choana ) is blocked, usually by abnormal bony or membranous tissue due to failed recanalisation of the nasal fossae during fetal development. It can be unilateral or bilateral.

CAUSES The cause is unknown but researchers say that genetic and environmental factors play a part in this condition.

INCIDENCE Approximately 1 to 7000 to 8000 live births Female babies than males

CLINICAL FEATURES Chest retracts unless the child is breathing through the mouth or crying Difficulty in breathing Inability to nurse and breath at the same time Inability to pass a catheter through each side of the nose into the throat Cyanosis in the infant after breastfeeding

DIAGNOSES Computed tomographic scanning X-ray of the sinus area Endoscopy of the nose The use of signs and symptoms

MEDICAL MANAGEMENT Intubation or tracheostomy : an airway needs to be placed so that the infant can breath Transnasal or Transpalatal surgery to remove the obstruction

NURSING MANAGEMENT BEFORE Initial insertion of an oral airway to break the seal formed by the tongue against the palate. The nurse ensures that the nostrils of the infant are kept clean

AFTER Monitor vital signs especially temperature Dress the wound aseptically to prevent infection Serve prescribed analgesics and antibiotics

PREVENTION There is no known prevention since the causes are not known

COMPLICATIONS Aspiration Respiratory arrest Renarrowing of the area after surgery

PRESENTATION ON IMPERFORATE VAGINA BY ATTA KWADWO SAMUEL

Objectives By the end of the presentation, students should be able to; Define imperforate vagina. State the risk factors and causes of the condition. The management of imperforate vagina.

IMPERFORATE VAGINA It is a congenital abnormality characterized by occlusion of the vaginal canal by a membrane. It normally occurs at the lower third of the vagina . Causes/ Risk factors Imperforate hymen. Occlusion by a membrane. Genetic and family history.

Signs and symptoms A child with imperforate vagina has no signs and symptoms until the period of menarche where menstrual flow is obstructed. Abdominal swelling Bulging membrane from the vagina resembling a cystocele . Blood builds up in the vagina causing increased pressure in the vagina. Abdominal pain Reduction of the urethral orifice Lower abdominal mass on palpitation Enlargement of the bladder

Diagnostic investigations Vaginal examination will reveal bulging vaginal membrane or an occlusion. Abdominal palpation will reveal lower abdominal mass. Inspection will show the vagina at the level of the hymen or slightly above it.

Management Management is by means of a surgical intervention to split the membrane or vagina. This is known as hymenectomy or hymenotomy. Pain following surgery is treated with mild analgesic.

Nursing Management Pre-op management Mother and child are reassured about the competency of health team and also encouraged that surgery will not interfere with the child‟s sexual relation in the future or child bearing. Pictures of the reproductive tract should be shown to the mother and child to make them aware that the condition is localised and can be managed. Client and mother should be introduced to people who have undergone similar surgery to allay fears and anxiety and also to tell them that she can live a normal life after it.

Post-op management Warm sitz bath should be encouraged following surgery. Check vital signs and record accurately. Maintain personal hygiene. Serve prescribed analgesics e.g. Paracetamol syrup. Serve prescribed antibiotics to combat any infections e.g. flagyl .

Complications Infections Dyspareunia (painful coitus) Rectal obstruction due to posterior pressure Urinary tract obstruction.

A PRESENTATION BY OWUSU ANSAH GABRIEL ON SPINA BIFIDA

SPINA BIFIDA Spina bifida is also called a neural tube defect or cleft spin It occurs when the bones of the spine (vertebrae) don't form properly around part of the baby's spinal cord. Spina bifida can be mild or severe. The mild form is the most common.

DEFINITION Is a birth defect where there is incomplete closing of the backbone and membranes around the spinal cord Idiopathic

SPINA BIFIDA

EMBRYOLOGY Spina bifida is caused by failure of the neural tube to close during the first month of embryonic development Under normal circumstances, the closure of the neural tube occurs around the 23 rd (rostral closure) and 27 th (caudal closure)day after fertilization 0.1% – 5% in 1000 live births

Embryonic development

TYPES Spina bifida occulta Meningocele Myelomeningocele Myeloschisis

SPINA BIFIDA OCCULTA Occulta is Latin for hidden Mildest form A portion of some vertebrae not completely closed Small split (no protrusion of cord) Normal skin at site of lesion Dimple skin with hair over it Mostly asymptomatic Further studies suggest that is not always harmless

MENINGOCELE The least common form Vertebrae develops normally Meninges are forced into the gap between the vertebrae 3 in 1,000 births

MYELOMENINGOCELE S evere form Spinal cord protrudes through and opening Meningeal membrane covers spinal cord Sac is filled with fluid, nerves

MYELOSCHISIS Spina bifida with myeloschisis is the most severe form of myelomeningocele Involved area is represented by a flattened plate-like mass of nervous tissue No overlying membrane The exposer of these nerves and tissues make the baby more prone to life-threatening infections such as meningitis

RISK FACTORS Genetic and Environmental factors Folic acid insufficiency Increase body temperature Obesity Medications such as anticonvulsants and valproic acid carbamazepine

Signs and symptoms Physical problems Leg weakness and paralysis Orthopedic abnormalities (i.e., club foot, hip dislocation, scoliosis) Bladder and bowel control problems U rinary tract infections poor kidney function Pressure sores and skin irritations Abnormal eye movement

Back pain Dimpling of the sacral area Difficulty in swallowing Dark spot Hairy patch

NEUROLOGICAL PROBLEMS Abnormalities of the cerebellum Displaced back portion of the brain

EXECUTIVE/ACCADEMIC FUNCTION Difficulty planning Organizing Initiating Problem solving Abstraction Memorizing Below average intelligence

DIAGNOSTIC INVESTIGATIONS Prenatal Tests AFP Ultrasound Testing of Amniotic fluid Evaluation Analysis of individual medial history Physical examination Evaluation of critical body systems Imaging Studies X-rays Ultrasound CT scan MRI Gait Analysis

MANAGEMENT No cure Regular check ups with physician Surgery (24 hours after birth) Medication Physiotherapy

IMMEDIATE CARE Place the child in prone position Cover the affected area with sterile gauze dipped in normal saline Maintain hydration Monitor for associated defects

PRE - OP Support mother psychologically Monitor senses Prepare skin

AFTER SURGERY Monitor vital signs Fluid therapy Prevent infections Barrier nursing Positioning - on the back

Complications Difficult delivery (females) Obesity Poor functional strength M eningitis Respiratory difficulties Learning and Perceptual difficulties Motor functioning seizures

Assistive Devices Braces Crutches Wheel chairs

Physical/Health Educator Considerations Try to include students in all activities. Be aware of the students abilities and limitations. Plan for their needs. Make sure activities are age appropriate. Allow opportunities for self directed learning and experimentation.

Research performed Recent studies have shown that the addition of folic acid to the diet of women of child bearing age may significantly reduce the incidence of neural tube defects. Therefore it is recommended that all women of child bearing age consume 0.4 mg of folic acid daily.

SYNDACTYLY Definition : The word syndactyly is a Greek which means “ syn ”- together and “dactyly” – fingers. It’s a condition of having some or all of the fingers or toes wholly or partly united, either naturally (as in web footed animals) or as in malformation. It’s a failure of differentiation in which the fingers fail to separate into individual appendages. This separation usually occurs during the 6 TH and 8 TH weeks of embryonic development.

CLASSIFICATION The classification is based on the severity of the clinical presentation. The mildest form is simple syndactyly, which refers to fingers joined only by soft tissue. Incomplete simple syndactyly is when the soft tissue union is only partial and does not extend to the finger tips.

Complex syndactyly refers to fingers joined by bone or cartilaginous union , usually in a side to side fashion at the distal phalanges. CLASSIFICATION

Unknown cause (idiopathic) Drugs ( those contraindicated during pregnancy) Hereditary (family history of syndactyly) CAUSES

Syndactyly is one of the of the most common congenital hand deformity of about 1 in 2000. Family history usually contribute to 10-40% of most cases INCIDENCE

Webbed fingers CLINICAL FEATURES

Physical examination An x-ray to see whether the phalanges are joined or only the skin and soft tissues are joined DIAGNOSIS

Syndactyly requires surgical intervention. Full term infants can be schedules for elective surgical procedure as early as 5 or 6 months of age. Surgery before this age can increase anesthetic risks MEDICAL MANAGEMENT

CONGENITAL ABNORMALITIES POLYDACTYL

DEFINITION This is a deformity in which the hand or the feet has one or more extra fingers in any of the three places of the hand or feet.

FORMS OR DEGREES OF SEVERITY OF POLYDACTYLY The extra fingers are usually smaller and abnormally developed than normal and can be made up of: Skin and soft tissue – simplest to remove Skin, soft tissue and bone but no joint – more challenging to remove or remodel Skin, soft tissue, bone and with joint (closer to a fully formed finger)

INCIDENCE It is seen in approximately 2:1000 births African – American children are more likely to have an extra finger while Asians are more likely to have an extra thumb.

TYPES POSTAXIAL TYPE: This occurs on the little finger CENTRAL POLYDACTYLY: occurs in any of the 3 central fingers. It typically has autosomal dominant inheritance. PREAXIAL POLYDACTYLY: affects or appears on the thumb

CAUSES when the hands and feet are developing in the womb, they start out as flat “paddles” and then eventually split into five digits in about 6 th or 7 th week of gestation. Polyductyl occurs when this separation process is excessive and an extra segment is created This may be caused by a genetic abnormality or by environmental influences

RISK FACTORS GENETIC FACTORS - Chromosomal abnormalities Environmental Factors maternal factors Prescribed drugs Alcoholism Infections

Clinical manifestation Extra digits May be fully formed or simply extra tissue with a pedicle No pain

Diagnosis Ultrasound scan prenatally Physical examination after birth The physician may also use X-rays to assess the underlying structure of the baby’s finger and determine the course of treatment

TREATMENT The goal of treatment is to give your child a hand or foot that works well and looks typical Surgical treatment is by surgical removal of the extra digits when the child is about a year old

VASCULAR CLIP If the digit is poorly formed and contains no bone, sometimes the treatment is simple as attaching a vascular clip at the base during the clinic visit. The clip stops blood flow to the digit so it will fall off.

NURSING MANAGEMENT Before the procedure: Reassure the mother and family of competent staff and that the condition is not a life threatening one and the outcome of the surgery to them. Written consent should be taken after explaining the procedure.

Meticulous care must be carry out on the child. Childs’s weight must be checked and noted. Laboratory investigations should be done.

After the produce : Put the child in the right position to prevent aspiration.(recovery position). Monitor the vital signs of the child especially temperature . Administer prescribed medication as ordered. Give intravenous fluids to hydrate child.

Inspect the inscisional site for bleeding. Use aseptic technique in caring for the wound Observe the limb or feet for any other deformities

COMPLICATIONS Infection Widened forefoot in people with central polydactyl contractures

PRESENTATION ON TALIPES EQUINOVARUS BY BOAKYE-BOATENG YAW

DEFINITION OF TALIPES The Latin word talipes was compounded from talus (ankle) + pes (foot) Talipes is a condition in which one or both feet are twisted into an abnormal position. The foot is turned in sharply and the person seems to be walking on their ankle.

Talipes is also known as club foot. It is a deformity of the foot and ankle that a baby can be born with(congenital condition) In about half of babies that are born with talipes, both feet are affected. Talipes means the ankle and foot and equinovarus refers to the position that the foot is in.

If a baby has talipes, Their foot points downwards at their ankle (doctors call this position equinus). The heel of their foot is turned inwards (doctors call this position varus ). The middle section of their foot is also twisted inwards and their foot appears quite short and wide. It stays (is fixed) in this position and cannot be moved into a normal foot position

The baby's foot is held in this position because the Achilles tendon at the back of the baby's heel is very tight and the tendons on the inside of their leg have also shortened. If nothing is done to correct the problem, as the baby develops and learns to stand, they will not be able to stand with the sole of their foot flat on the ground.

In some babies, the position that they hold their foot in may look as if they have talipes but, in fact, their foot can be moved easily into a normal position. These babies do not have true talipes.

CAUSES OF TALIPES Idiopathic but associated with genetic factors Experts say the condition is not caused by the fetus' position in the uterus. Sometimes club foot may be linked to skeletal abnormalities, such as spina bifida cystica .

INCIDENCE Talipes is a fairly common problem. It is one of the most common deformities that a baby can be born with. About 1 in 1,000 babies born in the UK have talipes. About twice as many boys as girls are born with talipes. Talipes can affect both feet.

CLINICAL FEATURES The top of the baby's foot twists downwards and inwards. The arch is more pronounced and the heel turns inward. In severe cases the foot may look as if it is upside-down. The calf muscles are generally underdeveloped .

If only one foot is affected, it is usually slightly shorter than the other (especially the heel). There is usually no discomfort or pain when the patient is not trying to walk.

DIAGNOSIS Talipes is usually diagnosed after a baby is born.(physical examination) U ltrasound scanning during pregnancy can detect talipes before a baby is born. Investigations such as X-rays are not usually needed to confirm the diagnosis.

There can be different degrees of foot deformity with talipes. Some babies have milder foot deformity than others. If a baby is diagnosed with talipes, a specialist (usually an orthopedic surgeon) will often use a grading system to grade the severity of the foot deformity. A common grading system that is used is the Pirani score . With this grading system, a grade from 0 to 6 is given. The higher the grade, the greater the degree of foot deformity.

TREATMENT The aim of treatment, which occurs during the weeks following the baby's birth, is to give the child functional feet which are free of pain. Orthopedic surgeon advice Physiotherapist advice Serial casting Dennis browne shoes Tendinectomy Observe for perfusion or toes in splints Education/emotional support to parents

The Ponseti method - a specialist manipulates the baby's foot with their hands. The aim is to correct the bend in the foot. Then a plaster cast is applied from the patient's toes to their thigh to hold the foot in position. Each session is generally done once a week. The manipulation and casting are done very gently and the patient should experience no pain.

Surgery the doctor will then (after Ponseti method treatment) decide whether a minor operation on the Achilles tendon (to release it) is needed. ( tendinectomy ) Percutaneous Transverse Achilles Lengthening (TAL). The procedure typically takes 15 minutes. A small nick is made in the skin along the crease above the heel bone. This nick will heal with a very tiny scar. The tendon is found and a small cut is made through the tendon to allow it to stretch and lengthen.

When the foot is eventually corrected the patient has to wear special boots attached to a brace to hold the foot (feet) in the best position

COMPLICATIONS Arthritis. Your child is likely to develop arthritis. Poor self-image. The unusual appearance of the foot may make your child's body image a concern during the teen years. Inability to walk normally

Problems stemming from walking adjustments. Walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the foot, and result in an awkward gait.

SHALOM

Famous people born with a club foot Claudius (Roman emperor) Tutankhamen (Egyptian pharaoh) Thaddeus Stevens (American Civil War politician) Dudley Moore (English actor, comedian, musician) Damon Wayans (American actor, comedian) Eric Richard (English actor in UK police series "The Bill ") Steven Gerard (English soccer player) Lord Byron (English romantic poet) Kristi Yamaguchi (Went on to win figure skating gold medal in 1992 Olympics)

CONGENITAL HEART DEFECTS presented by Adomako Belinda.

The heart.

Congenital heart disease is a problem with the structure of the heart . It is the most common type of birth defect. Babies born with congenital heart diseases comprise of the second largest group of babies with abnormalities

The defect can involve the walls of the heart, the valves of the heart , arteries and veins near the heart. They can disrupt the normal flow of blood through the heart. The blood flow can slow down go in the wrong place or in wrong direction or even be blocked completely.

Types of congenital heart defect. A. Defect causing increase in pulmonary blood flow include; Atrial septal defect (ASD) ; this is where there is an opening between the atria. The hole allows oxygenated blood in the left atrium to mix with deoxygenated blood in the right atrium. This can be repaired surgically by dacron patch closure.

Ventricular septal defect; this is opening between the ventricles, which allows oxygenated blood from the left ventricles to flow to the right ventricles. Small holes can close spontaneously by one year.

Endocardial cushion defect ( atrioventricular canal) ; this is a combination of defect in the atria and ventricular septal and portions of the tricuspid and mitral valves.

Patent ductus arteriosus (PDA); this is as a result of failure of fetal circulation ( ductus arteriosus ) to close at birth. Administration of indomethacin in preterm infant can close the patent ductus .

B. Obstructive heart defects. Coarctation of the aorta. This is the narrowing or constriction in the descending aorta, obstructing systemic blood flow.

Aortic stenosis; this is the narrowing of the aortic valve which result in ventricular hypertrophy . Pulmonary stenosis; this is the narrowing of the pulmonary artery, leading to right ventricular hypertrophy. Pulmonary atresia; is the fused valve that allows no blood flow to the lungs.

3 . Defect causing decrease in pulmonary blood flow . Tricuspid atresia ; this is failure of the tricuspid valve to develop. Tetralogy of fallot ; is a characteristics combination of four congenital cardiac abnormalities which cause cyanosis, growth retardation and exercise intolerance in babies and young children; The four anomalies are;

Ventricular septal defect. Right ventricular hypertrophy Pulmonary stenosis Overriding aorta/ aortic misplacement.

Congenital heart defect can further be divided into two. 1. Cyanotic heart defect. These conditions are accompanied by persistence of cyanosis (cyanosis of the lips and mucus membrane). Transportation of great vessels Tetralogy of fallot Tricuspid atresia

Total anomalous pulmonary drainage Pulmonary atresia Univentricular Truncus arteriouses

Transportation of the great vessels. A condition where the aorta arises from the right ventricles and the pulmonary artery from the left ventricles. Consequently oxygenated blood is circulated back through the lungs and deoxygenated blood back into systemic circulation.

Truncus arteriosus This is when the person has one large artery instead of two separate ones to carry blood to the lungs and body. In a normal heart, the blood follow this cycle: BODY – HEART- LUNGS-HEART-BODY. With truncus arteriosus the blood leaving the heart does not follow this path.

It has only one vessel , instead of two separate ones for the lung and the body. With only one artery , there is no specific path to the lungs for oxygen before returning to the heart to deliver oxygen to the body.

A cyanotic heart defect. They are conditions that are not accompanied by cyanosis. They include; Left heart hyoplasia ; this is underdevelopment of the component of the left side of the heart. Coartation of the aorta Patent ductus arteriosus Ventricular and atrial septal defect

Causes/ risk factors of congenital heart defect. Approximately 90% of cardiac heart defects cannot be attributed to a singular cause ; Chromosomal and genetic factors account for 8% and further 2% are reckoned to be caused by teratogens .

The critical period of exposure to teratogens in respect of embryonic development of cardiac tissue is from the 3 rd to the 6 th week. Maternal age, over 40 years. Rubella or other viral infections Alcoholism and smoking

Signs and symptoms Failure to thrive Dyspnea Cyanosis Rapid breathing Poor blood circulation Heart murmurs Tachypnea Difficulty feeding Irritability

Diagnosis Physical examination mostly achieve post natal. Ultrasound scanning while the baby is in utero. Echocardiography Electrocardiogram Chest X- ray Heart MRI Cardiac catherization .

Treatment Constructive heart surgery. Examples; Atrial septostomy B allon angioplasty Aortic valvotomy Dracon patch closure.

Nursing Management Nurse patient in an upright position. Give oxygen therapy. Feed small frequent meals. Child may need nutritional supplements.

When child experiences ‘ tet spells’ also known to be hyper cyanosis, bring child's knee up tight against his/her chest or let the child squat to increase blood flow to the heart. Limit the activity level of the child. Administer digoxin and diuretics.

Thank you.

A PRESENTATION BY KONADU ACHEAMPONG EDNA LARYNGOMALACIA

LARYNGOMALACIA DEFINITION It is an infantile condition where the larynx does not develop fully which causes the immature cartilage of the upper part of the larynx to collapse upon inhalation. It is the most common cause of noisy breathing in children. The laryngeal structure is malformed and floppy causing the tissues to fall over the airway opening and partially block it.

CAUSES There are no known causes associated with this condition

RISK FACTORS. Genetics

CLINICAL FEATURES Noisy breathing ( stridor ) High pitched sound Difficulty feeding Choking while feeding Apnea Cyanosis

DIAGNOSTIC INVESTIGATION Laryngoscopy

MEDICAL AND SURGICAL TREATMENT There is no medical treatment since it resolves by itself. Surgical intervention occurs when the baby fails to gain weight and when there is life threatening apnea.

PRE OPERATIVE MANAGEMENT. Explain procedure to parents and reassure them by showing them pictures of clients who have undergone the same procedure safely. Ensure nil per os . Check vital signs to serve as a baseline data. Administer prescribed IV fluids. Instruct mother to remove all contra indicated items on the child.

POST OPERATIVE MANAGEMENT. Assess the level of consciousness of the child. Assess the incisional site for bleeding. Check the vital signs to know any deviation from normal. Administer prescribed IV fluids and analgesics

COMPLICATIONS OF LARYNGOMALACIA. Stridor Dysphonia

PRESENTATION ON MALARIA BY OWUSU LUCY

MALARIA It is a parasitic disease caused by a female anopheles mosquito called plasmodium parasite. Malaria is the single most important disease hazard for people travelling to foreign Countries.

It is a parasitic disease caused by a female anopheles mosquito called plasmodium parasite. Malaria is the single most important disease hazard for people travelling to foreign Countries.

CAUSES It is caused by a protozoan of the genus Plasmodium. The Plasmodium is carried by the Female Anopheles mosquito. Incidence It occurs in all age groups irrespective of the blood group. It is most severe in children and pregnant women. It is most prevalent in the tropics, sub-tropics and temperate zones. Malaria is the most common causes of fever and morbidity in the tropics.

MODE OF TRANSMISSION Malaria is most often transmitted by the bite of infected female Anopheles mosquito. It can also be transmitted by transfusion of blood of infected person or by contaminated needles through injections. A congenital infection is rare. When an infected mosquito bites, it injects the Plasmodium into the bloodstream of the victim. The infective microorganism moves through the circulation to the liver, where they form cyst-like cells. When the cysts rupture, they invade erythrocytes (red blood cells) and feed on the haemoglobin (iron-containing pigment). Eventually, the erythrocytes rupture, releasing the contents into the bloodstream to infect other erythrocytes. At this point, the person becomes a reservoir for malaria and infects any mosquito that feeds on him or her.

DIAGNOSIS Confirmed by finding parasite of a blood smear under the microscope or blood for MP‟s History and signs and symptoms

MANAGEMENT Admit patients to the intensive care unit and make a blood film Baby is nurse in cot with minimal handling Tepid sponge the child to bring down the temperature and place cold compresses on The forehead and in the armpit after tepid sponging. Baby is kept warmth and not under or over heated. Check temperature, pulse, respiration and apex beat 2 hourly. Monitor intake and output chart Observe baby for convulsions, consciousness or changes in behaviour.

MEDICAL MANAGEMENT Artesunate and Amodiaquine can also be prescribed. Coartem D 2daily for 3 days can also be prescribed Syrup paracetamol 2.5mls given to cool down the temperature Vitamins should be given Anemia is corrected by blood transfusion Fluid therapy given to maintain electrolyte balance Anticonvulsants like valium to control conculsions

PREVENTION Health education to pregnant women on weeding of surrounding bushy areas, draining of stagnant water and burring of empty things to keep mosquitoes away. The should use bed nets and avoid hanging of things in the room Babies should be protected well with protective clothing that covers the whole body except the face. Bed nets should be used for babies, doors and windows should be netted and closed early in the evenings to prevent mosquitoes from entering the room. Treatment of all adults and older children suffering from malaria in the same room with the baby.

COMPLICATIONS Cerebral malaria Acute Renal Failure Massive Haemolysis Spleenomegaly Cerebral convulsion Pneumonia Neonatal death.

PRESENTATION ON CHICKENPOX BY AMPONSAA FREDERICA

FORMS OF VARICELLA Congenital varicella syndrome Congenital varicella syndrome occurs in 2% of children born to women who develop varicella during the first or second trimester of pregnancy. Infantile zoster Infantile zoster is caused by maternal varicella infection after 20 weeks’ gestation. It usually manifests within the first year of life and commonly involves the thoracic dermatomes.

PICTURES ON CHICKEN POX

DEFINITION Chickenpox (varicella) is a viral infection that causes an itchy rash with small, fluid-filled blisters. or is highly contagious disease caused by herpes virus varicella, characterized by vesicular eruptions on the skin and mucous membranes usually with mild constitutional manifestations.

CON’T Neonatal varicella If the mother develops varicella within 5 days before or 2 days after delivery, the baby is exposed to the secondary viremia of the mother. CAUSETIVE ORGANISM : Varicella zoster virus Incidence: Most frequent in childhood but it may occur at any age, including the neonatal period with peak age between 5 and 9 years old.

SIGNS AND SYMPTONS

CON’T Chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include: Fever Loss of appetite Headache Tiredness and a general feeling of being unwell (malaise)

CON’T Once the chickenpox rash appears, it goes through three phases: Raised pink or red bumps (papules), which break out over several days Small fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking Crusts and scabs, which cover the broken blisters and take several more days to heal

DIAGNOSIS Physical examination based on the telltale rash. History Taking Full blood count. Culture of lesion samples

MEDICAL MANAGEMENT A cool bath with added baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for soaking. Calamine lotion dabbed on the spots. A soft, bland diet if chickenpox sores develop in the mouth.

CON’T Antihistamines such as diphenhydramine (Benadryl, others) for itching. Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, Children's Motrin, others) for a mild fever. Administer varicella –zoster immune globulin Antiviral agent , Acyclovir

Giving varicella zoster immuno-globulin (VZIG) is given less than 96 hours after exposure, namely on: Women with pregnancy. Children with impaired immune systems. Newborns whose mothers contracted varicella within 5 days before delivery or 48 hours after birth. Premature infants 28 weeks of age or younger with a parent without a history of previous varicella

CON’T NOTE: Don't give aspirin to anyone with chickenpox because it can lead to a serious condition called Reye's syndrome. And don't treat a high fever without consulting your doctor.

PREVENTION The chickenpox (varicella) vaccine is the best way to prevent chickenpox. Experts from the Centers for Disease Control and Prevention (CDC) estimate that the vaccine provides complete protection from the virus for nearly 98 percent of people who receive both of the recommended doses. When the vaccine doesn't provide complete protection, it significantly lessens the severity of the disease.

THE CHICKEN POX VACCINE (VARIVAX )IS RECOMMENDED FOR : Young children. In the United States, children receive two doses of the varicella vaccine — the first between ages 12 and 15 months and the second between ages 4 and 6 years — as part of the routine childhood immunization schedule. The vaccine can be combined with the measles, mumps and rubella vaccine, but for some children between the ages of 12 and 23 months, the combination may increase the risk of fever and seizure from the vaccine.

UNVACCINATED OLDER CHILDREN Children ages 7 to 12 years who haven't been vaccinated should receive two catch-up doses of the varicella vaccine, given at least three months apart. Children age 13 or older who haven't been vaccinated should also receive two catch-up doses of the vaccine, given at least four weeks apart.

REFERENCE www .mayoclinic .org www.auctionexport.com . Emedicine.medscape.com.

By; Asamoah Martinson Twum A presentation on tuberculosis

Objectives By the end of the study, students will be able to; Define TB State the causative organism(s) for TB explain pathogenesis of TB Name risk factors for TB Management of TB( medical,nursing) Complications of TB Prevention of TB

TUBERCULOSIS Definition – TB is an infectious chronic inflammatory disease that affects the lungs but can affect other organs such as the brain, skin, kidney, meninges, joints of bones and lymph nodes

Results from increased resistance of the causative agent to phagocytosis or the body defense mechanism is depressed. Shows lower vascular and exudative response The inflammatory cells are mainly macrophages, plasma cells, giant cells, lymphocytes, fibroblasts. Occurs in the form of granuloma. Chronic inflammation usually occur with granulomatous infections; e.g. leprosy, tuberculosis and fungal infection

CAUSATIVE ORGANISM(s) The primary infectious agent is Mycobacterium tuberculosis. It i s an acid fast gram- positive bacilli that grows slowly and is sensitive to heat and ultraviolet light . Mycobacterium bovis and Mycobacterium avium have rarely been associated with the development of a TB infection.

RISK FACTORS for TB Hereditary Age – immunity less in infants, reduced reisitance to infections Malnutrtion Drug therapy- immunosuppressiive/corticosteroids People living in overcrowded areas

CLASSIFICATION Mainly classified into 2 Extra –pulmonary TB Pulmonary TB EXTRA -PULMONARY Extra –pulmonary- TB affects other parts of the body with exception of lungs Cardiovascular-pericarditis TB Gastro-intestinal- peritonitis TB

EXTRA-PULMONARY TB cont, Neurologic -meningitis TB Systemic – miliary TB Lymphatic- lymphadenitis Musculoskeletal- osteoarticular TB Genito-urinary TB Spinal cord- pott’s disease ( TB of sspine)

PULMONARY TB Commonest form which affects mainly the lungs May be acute or chronic In acute, it is fatal, normally seen in those with lowered resistance. There is rapid spread and it occurs with no fibrosis Chronic PTB – degenerative chessy mass formed within lungs, with fibrosis.

MODE OF TRANSMISSION TB spreads from person to person by airborne transmission. Mycobacterium tuberculosis infection is usually acquired by inhalation of the bacilli from the respiratory secretions of people with the disease. Also an infected person releases droplets of the bacilli through talking, coughing, sneezing, laughing, or singing.

PATHOGENESIS TB begins when a susceptible person inhales mycobacteria and becomes infected. The bacteria are transmitted through the airways to the alveoli, where they are deposited and begin to multiply . The initial response to the presence of Mycobacterium tuberculosis is an influx of neutrophil polymorphs from the body but these are unable to kill the mycobacteria.

PATHO, CONT. The bacilli spread through the lymphatic tissues, the regional lymph nodes via the thoracic duct to the blood stream. The body’s immune system responds by initiating an inflammatory reaction. This tissue reaction results in the accumulation of exudate in the alveoli, causing bronchopneumonia. This characteristic response of the body to mycobacteria infection is the formation of epitheloid cell granulomas . These are often called “ tubercles.”

PATHO, CONT. Granulomas , new tissue masses of live and dead bacilli, are surrounded by macrophages which engulf many of the bacilli and phagocytose or digest them. The epitheloid cell granulomas progresses and becomes necrotic forming a cheesy mass (caseous necrosis) or a lesion. The lesion may also undergo liquefactions, sloughing and cavitation.

Summary of patho. mycobacterium TB deposited on alveolar surfaces of lungs Initial response( influx of NP),due to presence of MT….. But fails Bacilli spreads through blood…formation of exudate due to bacilli in blood as result of immune response= epitheloid cell granuloma

Summary of patho. Granuloma progress to become necrotic forming a cheesy mass or a lesion Lesion undergoes liquefaction, sloughing and cavitation

SIGNS AND SYMPTOMS Initially asymptomatic Fever(recurrent), malaise, Chronic cough which lasts for more than 3 weeks Tightness in chest night sweats Haemoptysis Severe weightloss Young infants fail to thrive Diminished breath sounds and rates on auscultation pallor

INVESTIGATIONS TO DIAGNOSE PTB P/E Historyof TB immunisation and onset of disease Tuberculin skin test.it tests positive if disease is present. – inoculation of tubercle bacillus extract ( tuberculin ) into the intradermal layer of the inner aspect of the forearm. The result of the test is read after 48 – 72 hours tuberculin as positive, the patient will experience skin reaction with redness and swelling.

INVESTIGATIONS cont, Radiographic examination- reveals accumulated sputum and head enlargement Sputum smear for acid fast bacilli/ gastric aspiration from infants – AFB detection

PROGNOSIS Most children recover from the condition except in the case of TB meningitis. Death seldom occurs in treated children

MANAGEMENT OF TB Medications are the cornerstone of tuberculosis treatment. The therapy is lengthy. Normally a person diagnosed as having the disease takes a combination of antibiotics for up to a minimum period of six months to completely destroy the bacteria. However, the exact drugs and length of treatment depends on age, other health factors, the results of susceptibility test and nutritional support.

AIMS OF MANAGEMENT To increase patient’s resistance to the disease by improving nutritional status. To improve lungs condition through the use of drugs. To prevent the occurrence of any complication. The anti-tuberculosis drugs used include; Streptomycin (S) Isoniazide (INH) Pyrazinamide (Z) Ethambutol (E) Refampicin (R) Ethionamide

MEDICAL THERAPIES FOR TB TREATMENT DOT( Directly observed therapy) DOT: it is a regimen when drugs are given under supervision for a period. After some period, there is continuation test of sputum which when proved negative, will still require for a furthur maintenance dose. Phases of DOT; INITIAL/INTENSIVE PHASE; (2-3months) Isoniazid 10-15mg/kg body weight daily Rifampicin,pyrazinamide as prescribed CONTINUATION PHASE(4-5) Streptomycin and Rifampicin with same dose as for initial

Medical management according to NEW TREATMENT REGIMEN New treatment regimen classifies TB management into 3 categories Category 1 Category 2 Category 3

Category 1 For newly diagnosed TB patients, PTB with HIV,PTB with extra pulmonary TB 3 or more anti-TB drugs prescribed for the patient to reduce TB bacteria rapidly Drug combination; Isoniazide , Rifampicin There is a higher risk of drug resistance since there are more PTB bacteira during early stage of treatments.

Category 2 Used for children with relapse,treatment failure Combination of rifampicin , isoniazid , ethambutol and it is for 3months with inj.streptomycin for 2 months Continuation phase; Rifampicin Isoniazid Ethambutol

Category 3 Used for children under 12yrs Initial phase; Isoniazid , rifampicin , pyrazinamide Continuation phase; Isoniazid Rifampicin Note; It should be noted that the most important thing to consider is the weight because drugs are given according to child’s weight.

Supplementary drugs Haematinics ; drugs such as vitamin ‘B’ complex, ferrous sulphate , pyridoxine to treat or prevent complications such as peripheral neuropathy. Analgesics such as paracetamol, Ibuprofen, diclofenac are prescribed for pain. Cough suppressants for example Benylin and cofeine are also given, to aid in expectoration or suppressing cough and relieve of chest pain. Oxygen therapy is also given in case of respiratory distress to enhance breathing

SURGERY sometimes surgical treatments is necessary for resection of the segment or removal of the affected part.

NURSING MANAGEMENT Patient teaching : Teach patient mother and contact person how to take medication and to complete the course of drug therapy to prevent resistance. Also teach mother preventive measures such as avoiding overcrowding, covering of the mouth during sneezing and coughing. 2. Diet: Serve client diet rich in carbohydrates, protein, vitamins and minerals to enhance healing and boost client’s immunity.

NURSING MANAGEMENT Encourage intake of adequate fluid to liquefy bronchial secretions. Serve easily digested foods to conserve energy and prevent dyspnoea and fluid losses. Serve food in bits at frequent intervals. Ensure mouth and skin care to prevent halitosis and boost appetite. 3. Observation Observe closely during drug administration to ensure strict compliance. Monitor and record client’s vital signs 4 hourly to assess improvement in condition. Give sputum mug and observe sputum for colour, quantity and consistency. Ensure all laboratory examinations requested such as sputum specimen, FBC and X-rays are done. Monitor for desired as well as adverse effects of drugs. Weigh client daily to assess weight and determine drugs dosage.

NURSING MANAGEMENT Adequate rest and sleep Strict isolation Vigorous exercises like play with other children at the ward should be avoided to reduce malaise and possible spread through droplets as the child is sneezes, coughs to other children

PREVENTION Educate child’s mother on the need for early immunization and regular immunization should be continued. Avoidance of overcrowding Ensure adequate balanced diet Periodic medical checkup The need of the use of handkerchief when child is sneezing Teahc the child if old not to spit around the environment instead a container can be used and disinfectant after use,and sputum well disposed

Child mother is advised that TB bacilli are not spread through sharing of dishes, plates, clothes or through rape. Child’s parents should avoid overcrowded places and ensure adequate ventilation in the room he/she sleeps Restrict visitors PREVENTION OF TB

COMPLICATIONS Paralysis Fracture of spine Atelectasis Pleural effusion Intestinal obstruction Septicaemia Pneumonia Emphysema

THANK YOU

WHOOPING COUGH (PERTUSSIS)

DEFINITION It is an acute bacteria disease which affect the respiratory tract. Causative organism: bordetella pertussis . Incubation period: commonly 5-21days. It affect mostly infants and young children.

Signs and symptoms Whooping cough is a 6-8 weeks illness and characterised by 3 stages

Stage I (catarrhal stage) Coryza , sneezing, tearing, dry cough, fever, loss of appetite.

stage II (paroxysmal stage) Severe violent coughing attacks, occurring in clusters leading to vomiting and cyanosis.

stage III (convalescent phase) Coughing attacks decrease, but may return with each respiratory infection.

Diagnosis Culture of nasopharyngeal mucus.

Medical management Antibiotics e.g.: erythromycin 20-40mg / qid for 10-14 days. Administration of pertussis - immune globulin. Increase oxygen intake

Nursing management Bed rest Suctioning of nasopharyngeal secretion Administer antipyretics/ antibiotics Increase fluids and electrolyte intake Nutrition-highly nourishing meals more frequently after bouts of cough. Tube feeding if necessary.

Nurse in environment with reduced stimuli, to reduce cough. Nurse in a highly humidified environment. Sedation Isolation: 4 weeks after coughing begins and continued for 7 days after onset of therapy with erythromycin.

prevention Immunization Isolate and treat infected person.

complications Pneumonia Otitis media weight loss and dehydration subconjuntival hemorrhage Hernia

A PRESENTATION ON DIPHTHERIA BY ANLAAKUU DORCAS

DIPHTHERIA Diphtheria is an acute contagious disease caused by corynebacterium diphtheriae ( klebs – loeffler bacillus). This is a preventable disease of the tonsils, pharynx, larynx, nose and skin. In this disease, there is formation of fibrous pseudo membrane upon the mucosa of respiratory tract, occasionally on an open wound. Incubation period is 2 – 5 days Symptoms depend on the age of the child and location of the membrane.It mostly affects children below 5 years and adults above 60 years.

TYPES 1. Faucial diphtheria ( tonsillar ): Children with the faucial diphtheria may complain of pain and difficulty in swallowing, generalized malaise and fever. Whitish gray patch may develop by 24 to 48 hours and may spread to the uvula or pharynx. Cervical glands enlarge in severe cases and result in bull neck appearance.

TYPES CON’T 2. Laryngeal diphtheria: It is less common than faucial diphtheria. It frequently occurs in infants, the children may have brassy cough (barking cough), hoarseness of voice, dyspnoea , anxiety and cyanosis. 3. Nasal diphtheria: It is seen rarely. It may be unilateral or bilateral. The nose and upper lip may get excoriated (wear off).

DIAGNOSIS Throat swab for culture and sensitivity

SIGNS AND SYMPTOMS Low- grade fever , malaise, sore throat Foul-smell, mucopurulent nasal discharge Gray membrane on the tonsils and pharynx Lymphadenitis(Inflammation of lymph nodes) Purulent nasal discharge Difficulty in breathing

MEDICAL MANAGEMENT 1. Administration of anti-diphtheria serum, after the skin sensitivity test. The dose may be from 20,000 units to 100,000 units according to severity of the disease. This serum is always given after the test dose. 2. Procaine penicillin may be prescribed to control the infection. If the patient is allergic to penicillin, erythromycin or amoxicillin is used according to doctors prescription. It is usually continued for five to seven days or until three consecutive swab culture reports are negative.

Con’t of medical management 3.Analgesics for throat pain

NUSING MANAGEMENT 1. Strict bed rest is important to avoid exertion as there may be myocarditis or other toxic symptoms. 2. Observation of vital signs, especially of respiration and pulse is important to detect early changes of complication and to provide prompt treatment. 3.Respiratory obstruction should be treated with suction of the secretions and administration of oxygen. Sometimes tracheostomy may be required.

NURSING MANAGEMENT CON’T Gargles with normal saline are helpful to clean the throat, to relieve the inflammation and to make patient feel better. 4. Nutrition: Due to pain on swallowing, patients may not eat. If patients are able to swallow, they may be given liquid or soft diet. In severe cases, intravenous fluids may be necessary: Adequate fluids should be given in febrile state.

NURSING MANAGEMENT CON,T 6. Provide good ventilation 7. Antitoxin should be administered as prescribed. 8. Ensure strict isolation of the hospitalized child.

PREVENTION 1 Persons in immediate contact with the patients should get diagnosed by throat culture if possible. They should be treated with anti-diphtheria serum 2000 units after the rest dose and antibiotic such as penicillin, as prescribed by the doctor. 2. Patients with diphtheria should be isolated for three weeks as it is the period of infectivity. 3. Active immunization, diphtheria, pertussis and tetanus vaccine (D.P.T) should be given after three months of age. The booster doses of D.P.T up to five years and Diphtheria Tetanus toxoid after five years of age is recommended.

CON’T OF PREVENTION 4.Observe proper disposal of secretions from the throat , nose, and skin lesion of infected person to it from coming into contact with other people. 5.Food handlers found to be exposed should be prevented from work till investigated. 6.Health education on all aspect of the disease. 7.Notify the health authorities for control measures to be instituted.

COMPLICATIONS Myocarditis Renal failure

REFERENCE Offei . V. (2014). Principles of Community Health Nursing Practice and Disease Prevention (2 nd edition). Accra: Beap Publication.

CONVULSIONS

CONVULSIONS Convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body. Because a convulsion is often a symptom of an epileptic seizure, the term convulsion is sometimes used as a synonym for seizure. However , not all epileptic seizures lead to convulsions, and not all convulsions are caused by epileptic seizures

CAUSES Fevers Meningitis Hypoglycemia Head trauma Lack of oxygen to the brain

INCIDENCE Convulsions are mostly common in children. About 4% of children aged between six months and five years have them. Two-thirds of these children only ever have one fit. Most happen when children are younger than three years.

SIGNS AND SYMPTOMS Fever is usually high-over 38.8 c (101.8F) Seizures generally last less than 15 minutes Child’s body suddenly stiffened Child becomes unconscious Child jerks and eyes possibly rolled back in the head Child usually sleep deeply for an hour or afterwards

DIAGNOSTIC INVESTIGATIONS Physical examination Blood or urine test Chest x-ray EEG (electroencephalography) CT scan of the brain

MEDICAL MANAGEMENT Phenytoin sodium Paracetamol Phenobarbitone Carbamazepine Diazepam

NURSING MANAGEMENT

ASSESSMENT AND REDUCING FEVER Increase the child’s fluid intake to prevent dehydration Expose the skin to air by leaving the child lightly dressed in an absorbent material Avoid warm binding clothing and blankets Administer a tepid sponge bath Administer antipyretics Use tub or hypothermia blanket Use ice bags for local comfort

PREVENTING INJURY Ease the child on the ground to prevent fall Provide bed rails Do not restrain the child Do not place anything in the child’s mouth Loosen restrictive clothing Prevent the child from hitting the head to objects by removing objects from the area Turn child to side to facilitate clearing airway of secretions

OBSERVATION Observe vital signs Monitor child’s adverse reactions to medications Provide rest and sleep after seizure Time of onset and precipitation events Type of seizure or level of consciousness Length of seizure

COMPLICATIONS Mental retardation Learning disability Physical injuries Asphyxia

Poliomyelitis By Kyere Kwarteng

Definition Polio (also known as poliomyelitis) is a highly contagious disease caused by a virus that attacks the nervous system. An acute viral disease marked by inflammation of nerve cells of the brain stem and spinal cord. One in 200 polio infections will result in permanent paralysis (WHO). However, the disease has been largely eradicated thanks to the development of a polio vaccine.

Types There are three types; Sub-clinical : Approximately 95 percent of polio cases are sub-clinical, and patients may not experience any symptoms. This form of polio does not affect the central nervous system (the brain and spinal cord). Non-paralytic : This form, which does affect the central nervous system, produces only mild symptoms and does not result in paralysis.

Types cont’ Paralytic : This is the rarest and most serious form of polio, which produces full or partial paralysis in the patient. There are three types of paralytic polio: spinal polio (affects the spine), bulbar polio (affects the brainstem), and bulbospinal polio (affects the spine and brainstem).

Causes Poliovirus is often transmitted from person-to-person through fecal matter. People often get the virus from drinking water contaminated by human waste that contains the virus. In addition, the virus can be spread by contaminated food or direct contact with another infected person.

Risk Factors People with weakened immune systems, and young children are the most susceptible to the polio virus. traveling to an area that has had a recent polio outbreak having your tonsils removed

Signs & Symptoms Sub-Clinical Polio If patients do have symptoms, they usually last for 72 hours or less and may include: headache sore, red throat slight fever vomiting general discomfort

Non-Paralytic Polio The symptoms of non paralytic polio may last for a couple of days to a week or two and includes fever sore throat headache vomiting fatigue abnormal reflexes problems swallowing and/or breathing back and neck pain and stiffness, particularly neck stiffness with forward flexion of the neck arm and leg pain or stiffness muscle tenderness and spasms

Paralytic Polio People with paralytic polio experience the symptoms associated with non-paralytic polio first. Soon after, the following symptoms appear: loss of reflexes severe spasms and muscle pain loose and floppy limbs, sometimes on just one side of the body, this is due to the weakness which results from the involvement of the spine sudden paralysis (temporary or permanent) deformed limbs (especially the hips, ankles, and feet)

Diagnosis Signs and symptoms Culture of the patient’s throat secretions, stool, or cerebrospinal fluid.

Treatment There is no cure for polio. We can only treat the symptoms while the infection runs its course. The most common treatments include: Isolation Complete bed rest in early stages Analgesics to relieve headaches, muscle aches, and muscle spasms. (narcotics are not usually given) Antibiotics for infections. Physical therapy and/or corrective braces to help with walking. Monitor intake and output. Monitor vital signs (especially temperature and respiration)

Treatment cont’ A careful watch must be kept for dyspnoea , and restlessness that can herald the onset of respiratory paralysis. A ventilator should be readily available Heating pads or warm towels to ease muscle aches and spasms. In advanced cases of leg weakness, when a patient has difficulty walking he or she may need a wheelchair or other mobility device.

Prevention The best way to prevent polio is to get vaccinated. Rarely, the shots can cause mild or severe allergic reactions, including: breathing problems high fever dizziness hives swelling of throat rapid heart rate

Complication Respiratory paralysis Urinary Tract Infection Paralytic ileus Post-polio syndrome is a complication that can occur after a person has caught and recovered from poliovirus. Symptoms of the syndrome can appear up to 35 years after the polio infection.

Post-Polio Syndrome The symptoms of post-polio syndrome are: continuing muscle and joint weakness muscle pain that gets worse becoming easily exhausted or fatigued muscle wasting, also called muscle atrophy trouble breathing and/or swallowing sleep related breathing problems (sleep apnea)

DIARRHOEAL DISEASES/ DIARRHOEA Diarrhoeal diseases remain a leading cause of preventable death, especially among children under five worldwide and especially in developing countries. In the United States, it is the most commonly reported illness second to respiratory infections

PEDIATRIC NURSING PRESENTATION ON MENINGITIS BY SAH SAMUEL KWASI (402013045)

MENINGITIS IN CHILDREN

MENINGITIS Meningitis is an inflammation of the membranes surrounding the brain and spinal cord (meninges).

Incidence Peak occurrence of H. influenzae meningitis is between the ages of 6 and 12 months. Rare during the first 2 months and seldom seen after the 4 th year

TYPES OF MENINGITIS Bacteria meningitis Viral meningitis Fugal meningitis

Bacteria Meningitis Causative Organisms Neisserria meningitides Streptococcus pneumoniae /tubercle bacillus Haemophilus influenzae ( meningococcus ) . in young children E. coli (staphylococcus ) Mycobacterium tuberculosis (tubercle bacillus)

Viral Meningitis Viral meningitis is associated with virus such as mumps, paramyxovirus, herpes virus and enterovirus. Fungal Meningitis Fungal meningitis is much less common than the other two infectious forms. However, someone who has an impaired immune system such as a person with AIDS -- is more likely to become infected with this form of meningitis.

RISK FACTORS FOR MENINGITIS Skipping vaccinations. Age. Institutionalization. Compromised immune system. Being born to a mother infected

The Routes By Which The Infective Agents Of Meningitis Can Enter The Body Respiratory tract Through the ear Head trauma Neurosurgical procedures (lumbar puncture).

Signs and Symptoms Severe headache, altered consciousness, irritability Disorientation and memory impairment Bulging anterior fontanel Nuchal rigidity

Positive kernig’s sign ;- When patient is lying down with his thigh flexed on the abdomen, he can’t completely extend his leg.

Positive Brudzinski’s sign ; – when neck is flexed, flexion of the knees and hips is produced, or when passive flexion of the lower extremity of one side is made a similar movement is seen on the opposite extremity.

Photophobia Seizures Vomiting Back ache Decreased level of consciousness . A rash – a petechial rash with purpuric lesion to large areas of ecchymosis opisthotonos position Fever / chils

Diagonostic investigations Full blood count, B/F for malaria parasites as differential diagnosis A blood film (B/F) shows no malaria parasites but may contain many white blood cells particularly neutrophils. Blood culture and sensitivity, Lumbar puncture (analysis of cerebrospinal fluid;

white cell (polymorph) count above 100/mm3. CSF glucose (low : <1.5 mmol / litre ) CSF protein (high: >0.4 g/ litre )

5. Chest X- ray 6. Blood chemistry ( electrolytes, liver and kidney function.)

Treatment Pharmacological Treatment /Class of drugs to be given 1. Osmotic diuretics, mannitol 2. Analgesics, morpine , codein , aspirin 3. Antibiotics , Ceftriaxone. Chloramphenicol, Benzylpenicillin , 4. sedative/Antianxiety/ Anticovulsants , drugs, diazepam or phenytoin 5. Antipyretics, paracetamol 6. Cortecosteroids - dexamolethazole

Supportive Therapy 1. Fever in children-Sponge frequently, 2. Convulsions-Diazepam, 3. Maintain good nutrition. Patient in coma, pass NG Tube. 4. Keep the airway clear. 5. Cardiovascular monitoring

Prophylaxis Prophylactic treatment is recommended for patients 2 days prior to discharge and also for their close contacts. Ciprofloxacin; Ceftriaxone .

Nursing Management/Care Psychological care : Reassure patient and family of competent care. Explain all procedures to them. Explain the patient’s condition to him and family. Allow relatives to ask any question and provide appropriate answers tactfully.

Rest and sleep: Remove pillows if child has rigid neck. The child should be isolated and nursed in a well ventilated room which is quiet and darkened. The nurse must plan and carry out nursing activities together to prevent disturbing the child. Bed linen should be clean and neatly laid and changed when wet from diaphoresis.

Protection Child should be nursed in a bed with side rails. Protect the head with a pad to prevent injury during seizures, if patient is on the floor. Remove pillow if on a bed, insert a padded tongue blade between the teeth to reduce the possibility of the tongue being bitter. Place patient on one side with head flexed forward to prevent the tongue from fallen backwards and facilitates drainage of saliva and mucus.

Observation Monitor vital signs especially temperature, pulse and respiration at regular intervals. Record and report any abnormality noted. If high temperature, tepid sponge to lower body temperature and serve prescribed antipyretic. Monitor intake and output level by maintaining intake and output chart.

Observe level of consciousness. Maintaining a fit chart Neck for stiffness Patent airway

Diet: If patient is unconscious, pass NG tube for feeding. If patient is vomiting; administer IVF as prescribed. If patient can tolerate oral diet, then offer high calorie, high protein diet that is easily digestible with copious fluids.

Vitamin supplements; e.g. Vit B complex, ascorbic acid , vitamin A, etc may be prescribed and administered. Serve food in small quantity but at frequent intervals. Plan menu with mother Give small NG tube.

Personal hygiene: Bed bath, treatment of pressure areas and turning if comatose. Oral hygiene should be maintained. Inspect oral cavity for colour, oedema, and presence of lesions, cracks, coating, bleeding. Use oral mouth wash, warm N / S, Sodium bicarbonate to rinse mouth, assist patient if unable to perform by himself. Offer frequent oral fluids if tolerated.

Medication Administer prescribed medication such as: Antibiotics – e.g Benzylpenicillin , Chloranphenicol Analgesic – e.g. Paracetamol , Codeine Anticonvulsants – e.g. Diazepam, Phenytoin Cerebral oedema;- e.g. Manitol

Health education: Educate patient’s relative on the condition, signs and symptoms, causes and complication. Educate on infection prevention. Teach patient’s reletive to report to the hospital promptly when he has infections of the nose, upper lip, ear and sinus to prevent spread to the brain. Teach patient how to cough, sneeze, and spit to prevent infecting others with the disease. Teach the patient and relative the need for isolation, the use of medications

Complications Cerebral oedema Circulatory collapse Adrenal damage Blindness Epilepsy Hydrocephalus Diffuse brain swelling Cerebral palsy. Coma

THANK YOU. TOGETHER WE MOVE FAR

Definition: Diarrhoea is an increased frequency, with the liquidity, of the faecal discharge. Diarrhoea can be classified as; Acute diarrhoea Persistent diarrhoea Chronic diarrhoea Diarrhoea with severe malnutrition Diarrhoea that lasts less than 2 weeks is termed acute diarrhoea . Persistent diarrhoea lasts between 2 and 4 weeks. Chronic diarrhoea lasts longer than 4 weeks.

Causes Dietary: Overfeeding Indigestion Imbalance diet Deficiency of diasaecharides Infective: Bacterial: E coli, Shigella , Salmonella Viral: Enterovirus Parasites: protozoa Fungal: Candida albicans Parenteral : Due to infections outside the gastroenteral tract such as urinary tract infection, otitis media, or upper respiratory infections.

Predisposing factors Infants are more susceptible. Low socioeconomic status and unhygienic feeding habits. Contamination of the feeding. Repeated infections lower the body resistance.

Clinical Manifestation The clinical manifestations depend on the age of the children, nature of the case, resistance of the children, health of the children and a severity of the diarrhoea . If the diarrhoea is accompanied by vomiting, the fluid and electrolyte imbalances deteriorate the condition.

Clinical manifestation cont’ There may be a fever ranging from low grade to high grade Anorexia Mild or severe vomiting Stools are loose, and liquid in consistency, and may contain mucus, pus, or blood. It may be greenish or yellow in colour . There may be behaviour change such as irritability and restlessness. Children may look pale and become weak. The respiration may become rapid and deep.

Investigation History of loose motions Examination of stools Blood urea nitrogen levels Serum pH

Treatment Supportive care, Fluid and electrolyte balance should be maintained. The amount and type of fluid depends on the severity of diarrhoea . In mild diarrhoea with few loose stools, small amount (about 300ml) of oral rehydration solution may be given every hour. In a moderate diarrhoea , with several loose stools and 10% weight with dehydration, clear fluid intake should be encouraged. The amount of oral rehydration solution is increased up to 200ml/kg/day.

Treatment cont’ If children have no nausea , vomiting they should be encouraged to drink oral electrolyte solution: Sodium chloride 3.5 g Sodium bi carbonate 2.5 g Potassium chloride 1.5 g Glucose 20 g Water 1000ml

Treatment cont’ In severe dehydration with more than 10% weight loss, intravenous fluids are necessary. The fluids must be administered at 225 ml/kg/day. Fifty percent of the calculated fluids should be given by a fast drip, over a period of six hours. 25% in the next four hours and remaining amount over the rest of the day. 2. Oral rehydration solution with zinc tablet prescibed . 3. Administer prescribed ReSoMaL 4. Specific antibiotics are prescribed for E coli, shigella and salmonella. 5. Sedatives may be prescribed only to the children with severe restlessness, to control the pain and cramps. 6. Adsorbents, may not reduce the fluid loss but mask the fluid loss.

How oral rehydration solution (ORS) is prepared Items or Requirements: A bottle to measure 1 litre of water;i.e . beer or fanta bottle. A bowl of clean water boiled and cooled or portable water Teaspoon 8 level teaspoon sugar 1 level teaspoon salt A clean container with a lid to hold solution A table on which to prepare the solution Baby’s cup A napkin to dry hands Soap

How ORS is prepared Wash hands with soap and water and dry with a clean napkin Wash bottle Measure 1 litre of water; i.e. 1 ½ bottles of beer or 3 bottles of fanta Pour water into clean container to hold the solution Take 8 and 1 teaspoonful of sugar and salt respectively and pour into the water in the container Stir well to dissolve the sugar and salt thoroughly Cover and place at appropriate pl

Recipe for ReSoMaL Ingredient Amount Water 2 litres WHO- ORS 1 litre packet Sucrose 50g Electrolyte/mineral solution 40ml 2.6 g sodium chloride, 2.9 g trisodium citrate dihydrate , 1.5 g potassium chloride, 13.5 g glucose ReSoMal contains approximately 37.5 mmol Na, 40 mmol K, and 3 mmol Mg per litre .

Cont’ This is used in the preparation of starter and catch-up feeding formulas and ReSoMal . Electrolyte and mineral powders are produced by some manufacturers. If these are not available or affordable, prepare the solution (2500 ml) using the following ingredients: g mol/20ml Potassium chloride: KCL 224 24mmol Tripotassiumcitrate 81 2mmol Magnesiumchloride:MgCl2.6H2O 76 3mmol Zinc acelate : Zn acelate.2H2O 8.2 300 μ mol Copper sulfate: CuSO4. 5H2O 1.4 45 μ mol Water: make up to 2500ml

Cont’ If available, also add selenium (0.028 g of sodium selenate , NaSeO4.10H20) and iodine (0.012 g of potassium iodide, KI) per 2500ml. Dissolve the ingredients in cooled boiled water. Store the solution in sterilized bottles in the fridge to retard deterioration. Discard if it turns cloudy. Make fresh each month. Add 20 ml of the concentrated electrolyte/mineral solution to each 1000 ml of milk feed.If it is not possible to prepare this electrolyte/mineral solution and pre-mixed sachets are not available, give K, Mg and Zn separately. Make a 10% stock solution of potassium chloride (100 g in 1 litre of water) and a 1.5% solution of zinc acetate (15 g in 1 litre of water). For the oral rehydration solution ReSoMal , use 45 ml of the stock KCl solution instead of 40 ml electrolyte/mineral solution.

Management Children should be isolated to prevent the spread of infection when the diarrhoea is caused by a bacteria, virus, fungal or protozoa. The excreta should be disinfected and disposed. Contamination should be prevented. If children have no vomiting and are conscious, they should be encouraged to take oral fluids, such as buttermilk, coconut water, skimmed milk, weak tea, and apple juice. In case of severe dehydration when intravenous fluids are necessary. The rate of the fluid intake should be monitored carefully as prescribed. A care of the intravenous infusion site is important to prevent infiltration, infection, thrombosis.

Management cont’ Observation is required, for the signs of complications by monitoring vital signs, skin changes, and behaviour changes of the patient Assessment of the characteristics of diarrhoea and recording of the number, amount, and consistency of stools. Any vomiting and cramps should be noted. Care of the skin at the perineum and buttocks is important because the stools have chemicals that affect the skin, around the anal region, causing irritation, redness and excoriation. The diaper should be changed immediately after each soiling and application of a cream or zinc paste can prevent skin irritation.

Management cont’ Comforting the patient is essential. A dry, clean, and comfortable linen should be provided. The close contact and affection can be provided by holding the children when ever necessary. General hygiene care should be provided.

Management cont’d Nutritional status should be monitored. During the diarrhoea , if children are on intravenous fluids, or in severe diarrhoea where nutritional imbalance can not be met, they may develop malnutrition. Therefore, as soon as vomiting stops, oral feeding should be started which are easily digestible such as soft cooked rice, banana, curds, and buttermilk. Once loose motions are controlled, high calories and high protein diet should be given to make up the weight loss.

Parental advice The parents should be supported especially when their children cannot have any thing by mouth and when they are on intravenous fluids. The parents should be explained about the following precautions related to feeding. To follow the cleanliness while preparimg feeds and feeding the children The importance of hand washing before handling the food and after cleaning the patient. Needing for boiling of the vessels used for feeding and preventing contamination is required especially for the infant. Use of boiled and cooled water for drinking should be emphasized.

Parental advice cont’d Parents should be explained about the early signs of diarrhoea and dehydration. The parents should be explained about the use of oral rehydration fluids, in the early stage of diarrhoea .

Prevention Improving access to clean water and sanitation Promoting hygiene – education Exclusive breast-feeding Improving weaning practices Immunizing all children, especially rotavirus Using latrines Keep food and water clean Wash hands with soap (the baby’s as well) before touching food and after changing napkins. And by sanitary disposal of stools.

Complications Dehydration Acute renal failure Convulsions Malnutrition

Reference Tambulwadkar , R.S (2001). Peadiatric Nursing, 2 nd Edition. Vora Medical Publications Bombay. www.google.com

A PRESENTATION ON SCABIES BY ATI KYEREH NATHANIEL RGN1 HOLY FAMILY NMTC

DEFINITION Scabies is an extremely itchy skin disorder that can be passed from one person to another. It is caused by an infestation with a parasite - the scabies mite (like a tiny insect) called Sarcoptes scabiei . The mite lives on the skin and burrows into it. Scabies is spread to others through close skin-to-skin contact. It is easily treated with an insecticide lotion applied to the skin.

DESCRIPTION OF SCABIES MITE The mite is a parasite, meaning it lives off the host (a human) with no benefit to the host. Scabies mites are tiny. They have a cream- coloured body, bristles and spines on their back, and four pairs of legs. The female mite is bigger (about 0.4 mm x 0.3 mm) compared with the male (0.2 mm x 0.15 mm).

With the naked eye you might be able to see them as a speck. The female mites tunnel into the skin and lay eggs. About 40-50 eggs are laid in the lifetime of a mite. The eggs hatch into larvae after 3-4 days; these then grow into adults within 10-15 days. The mites live in skin and can survive away from the host human for about 24-36 hours. Most of the symptoms of scabies are due to your immune system's response to the mites, or to their saliva, their eggs or their poo ( faeces ).

In other words, the rash and the itching are mostly caused by your body's allergic-like reaction to the mites, rather than the mites themselves. The average number of mites on an infested person is 12. Common sites affected by scabies in babies and toddlers, are : head face neck hands soles of the feet

INCIDENCE Scabies is common. In the UK, about 1 in 1,000 people develop scabies each month. Scabies is more common in town (urban) areas, in women and children, in the winter, and in the North of the country. It is very common worldwide, particularly where there is poverty and overcrowding. There may be outbreaks in overcrowded places such as refugee camps . Sometimes outbreaks of scabies occur in places such as nurseries and residential homes, where people are in regular close contact.

CAUSES Scabies is caused by a parasitic mite known as the sarcoptes scabiei .

RISK FACTORS Close skin-to-skin contact with an infected person to catch scabies. Most cases of scabies are probably caught from prolonged hand-holding with an infected person. The hand is the most common site to be first affected. Close skin-to-skin contact when having sex is another common way of catching scabies.

The skin-to-skin contact needs to be for a reasonable time to catch the mite. You usually need to be in skin contact for 15-20 minutes to catch scabies. Therefore, you are unlikely to catch scabies from an infected person by casual short contact such as a handshake or a hug. The more mites there are, the faster they can spread to another person.

Bedding, sharing towels and cloths. Even you are unlikely to catch scabies from bedding and towels unless you use them immediately after being used by someone with scabies. However, just in case, it is best to treat bedding and towels by hot washing.

SIGNS AND SYPTOMS Typical manifestations of scabies in infants are different from adults. With respect to scabies, infants are more likely to develop vesicles, pustules, and crusting than older children or adults . Itching . This is the main symptom of scabies. This is often severe and tends to be in one place at first (often the hands), and then spreads to other areas. The itch is generally worse at night and after a hot bath. You can itch all over, even with only a few mites, and even in the areas where the mites are not present.

Mite tunnels (burrows) . These may be seen on the skin as fine, dark, or silvery lines about 2-10 mm long. They most commonly occur in the loose skin between the fingers (the web spaces), the inner surface of the wrists, and the hands. However, they can occur on any part of the skin. You may not notice the burrows until a rash or itch develops.

Rash . The rash usually appears soon after the itch starts. It is typically a blotchy, lumpy red rash that can appear anywhere on the body. The rash is often most obvious on the inside of the thighs, parts of the tummy (abdomen) and buttocks, armpits, and around the nipples in women. The appearance of the rash is often typical. However, some people develop unusual rashes which may be confused with other skin conditions.

Scratching . Scratching due to intense itching can cause minor skin damage. In some cases the damaged skin becomes infected by other germs (bacteria). This is a secondary skin infection. If skin becomes infected with bacteria it becomes red, inflamed, hot, and tender .

Note : the itch and rash of scabies are due to a reaction (allergy) to the mites (or their saliva, poo ( faeces ) or eggs). Scabies symptoms usually take 2-6 weeks to occur after you are first infected. The itch and rash can develop on any part of the skin, away from where the mites are actually burrowing. This means that you are infectious and can spread scabies before you even know you have scabies.

DIAGNOSIS Scabies is usually diagnosed just by looking at the rash. A doctor will often be able to recognise the typical appearance of the scabies rash. Often, a doctor will find one or more mite tunnels (burrows) on the skin to confirm the diagnosis. Sometimes the doctor will rub some ink on the skin, and then wipe it off. If there are burrows in that area of skin, the ink will move along the burrow under the skin. It will be visible as a line after the rest of the ink has been wiped away.

It is sometimes difficult to tell the difference between the rash caused by scabies and the rashes of some other skin conditions. Therefore, a scraping from the skin is sometimes sent to the laboratory to look for mites under the microscope if there is doubt about the diagnosis. If itching and a rash develop in several people who live in the same home at about the same time then scabies is a likely cause.

TREATMENT Scabies is curable. The usual scabies treatment is with 5% permethrin cream . 5% Permethrin is an insecticide that kills the mites. This is known to be the treatment that works the best. If permethrin cannot be used, an alternative is to use a lotion called malathion liquid . (For example, some people may be allergic to permethrin .) Some people who develop a secondary skin infection may also need antibiotics.

NOTE; Avoid applying strong steroid creams, especially if the diagnosis of scabies is uncertain. Crotamiton cream or lotion has soothing qualities and may help to relieve itch. Apply crotamiton 2-3 times a day (but only once a day for children under 3 years old). Hydrocortisone cream. This is a mild steroid cream that may ease any inflammation and help to ease itch.

An antihistamine medicine that makes you drowsy, such as chlorphenamine (brand name Piriton ®) . This does not ease the itch directly, but can help you to sleep if itching is a problem at night (particularly for children).

Crusted scabies ('Norwegian' scabies) This type of scabies is unusual, and most people who develop scabies do not get 'Norwegian' scabies . It is a more severe form of scabies with a hyperinfestation of lots of scabies mites. This means that there are thousands or millions of the mites, causing excessive scaling and flaking of the skin.

. Because there are so many mites, and because the skin is flaking off, scabies can be spread to others extremely easily. The rash is crusting (and looks a bit like psoriasis). It can be very extensive and can, if severe, lead to serious secondary bacterial skin infections . Crusted scabies mainly occurs in people who have a poor immune system (are immunocompromised ).

Crusted scabies is more easily transmitted through contact with towels, bedding and upholstery. In crusted scabies, the mites can survive for a few days away from their host. Even minimally exposed people, such as cleaners and laundry personnel, are at risk from crusted scabies and need insecticide treatment if they are working in an institution with an outbreak. An outbreak in an institution with many vulnerable people, such as a nursing home, can be extremely challenging

SCABIES 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 mite. NURSING MANAGEMENT Monitor for signs and symptoms of infection Limit visitors when necessary Instruct visitors to wash their hands when visiting remedy and after leaving the patient Maintain aseptic environment during the installation of equipment Inspection of skin and mucous membranes of the redness

Provide antibiotic therapy if necessary Instruct mother to apply the cream at bedtime, from neck down to toes, covering the entire body. Advise mother to report any skin irritation. Suggest the family members and other close contact of the patient be checked for possible symptoms and be treated if necessary. If patient is hospitalized, practice good handwashing technique, or use gloves while performing nursing procedure. Terminal disinfection should be carried out after discharge of patient.

COMPLICATIONS Vigorous scratching can break your skin and allow a secondary bacterial infection, such as impetigo, to occur. Impetigo is a superficial infection of the skin that's caused most often by staph (staphylococci) bacteria or occasionally by strep (streptococci) bacteria. A more severe form of scabies, called crusted scabies, may affect certain high-risk groups, including: People with chronic health conditions that weaken the immune system, such as HIV or chronic leukemia People who are very ill

THANK U

PRESENTATION ON BRONCHOPNUEMONIA BY: GYAA DORA

DEFINITION Pneumonia is an acute inflammation of the lung parenchyma “Pneumonia” is a more general term that describe an inflammatory process in the lung tissue that may predispose a patient to or place a patient at risk for micraobial invasion. Pneumonia was derived from the Greek word “ Pneumon ” which means lung.

CAUSES Pneumonia can be caused by many infectious agents such as pseudomonas aeruginosa , klebisella species, staphylococcus aureus , haemophilus influenzae , staphylococcus pneumoniae , enteric gram – negative bacilli, fungi and virus (common in children) other causes includes; inhalation of infectious particles, aspiration of oropharyngeal or gastric contents, haematogenous deposition which is uncommon, direct inoculation as a result of surgery (this is rare) chronic lung disease

INCIDENCE It is estimated that pneumonia is the most common cause of death in the United State of America (Brunner and Suddarth 1992) smeltzer C.S and Bare G.B. It occurs in all age groups but commonly the elderly and children. Incidence is very high during the harmattan season.

CLINICAL MANIFESTATIONS Chills Fever Chest pain Dyspnoea (difficulty in breathing) is present Cough Tachypnoea

CONT Vomiting and convulsion are the signs in children under two(2) years Insomnia Headache Cyanosis General malaise

CONT There may be chest congestion Increased pulse and respiratory rate Nostrils are flared on inspiration. Elevation of white blood cells Rhinorrhoea .

DIAGNOSTIC INVESTIGATIONS Chest X – ray discloses infiltration of the lung. History and clinical features manifested by child. White blood cell count is elevated. Blood culture to reveal causative organism. Sputum culture and sensitivity to isolate the causative organism. Chest auscultation and percussion to reveal dullness and decreased breath sound.

MEDICAL MANAGEMENT 1. Antibiotics : This is given to treat infections and inhibit the growth of the specific organism e.g. Streptococcus pneumonia is treated with penicillin G. Klebsiella pneumonia is treated with cephalosporin. example ceftriazone . Pneumocystic carinii pneumonia is treated with pentamidine methane sulfonate and trimethoprim – sulfamethoxazole . Other antimicrobials used include erythromycin, clindamycin and other penicillin. 2. Analgesics : It is administered to relieve pain example paracetamol and in children suppository paracetamol 125mg/250mg.

CONT 3. Cough Suppressants: They are administered to suppress cough, example, syrup bronchoped 4. Mixture of Expectorate: They are served as sedative and facilitate the removal of sputum, example, Guaifenesin 5. Haematinics : They are administered to prevent or combat anaemia , example, Ferrous Ascorbate , folic acid

6. Antipyretics: They are administered to reduce or bring temperature to normal, example, ibuprofen, naproxen 7. Intravenous therapy: They are administered to prevent dehydration and restore energy, example, Dextrose Saline. 8. Oxygen therapy: This is administered to enhance respiration and prevent cyanosis as well as nourishing body tissue.

NURSING MANAGEMENT Psychological care Provide emotional support by reassuring patient and relatives that he is in the company of competent medical and nursing staff and that measure would be implemented to aid in his recovery. This is done to allay fears and anxiety in the mother. Explain all procedures to patient and family to gain their co-operation. Patient should be encouraged to ask questions and appropriate answers provided to clear any misconceptions.

CONT Observation Patient vital signs; temperature, pulse and respiration are monitored four hourly or as ordered to assess any improvement or deterioration in the child condition. Patient is also observed for signs and symptoms of the disease condition such as dyspnoea , pyrexia and cyanosis to know whether child is responding to treatment or not. Signs of complications are also observed and appropriate measures taken. The desired and side effects of drugs administered are also observed.

CONT Personal hygiene Patient is given bed bath twice daily to remove dirt, improve circulation, refresh and help him to relax. Mouth is cared for with tooth paste and cotton wool or Normal Saline with cotton wool. This prevents oral infections being transmitted into the alimentary canal and to prevent halitosis.

CONT Nutrition Patient is given a well balanced diet containing high carbohydrate to provide energy. Since pneumonia causes labored breathing Protein and vitamins are also needed to repair worn out tissues and boost the immune system. Encourage intake of copious fluids to thin mucus secretions and flush out toxins. Food is served in bit and in frequent interval, if patient cannot tolerate food by mouth due to vomiting, a nasogastric tube is passed.

CONT Rest and sleep Patient is placed in a semi – fowler’s position to facilitate breathing. Complete bed rest is ensured to conserve energy. All procedure should be performed at once to avoid disruption of sleep. Noise on the ward is reduced to promote adequate sleep, provide diversional therapy such as toys, cars and trucks. Ensure that bed is free from creases and cramps.

CONT Medication The patient drugs are introduced to the family and are made aware of the right time, dosage and all the side effects as well as allergic reaction The right of patient in drug administration which includes the right drug, route, dosage, time and the right to refuse medication is accepted. Education on the side effect of drug administered.rational for the drug is explained to the mother

CONT Oxygen therapy Oxygen is regulated to suit patient condition. Proper fixation of oxygen mask is ensured. Oxygen is administered when dyspnoea is severe

PREVENTATION Emphasize on the importance of adequate rest to promote full recovery and prevent relapse. Review patients medications, stress on the importance of completing the treatment even if patient feels better. Educate patient to avoid irritants that stimulate secretions such as cigarette smoking and dust .

CONT Encourage patient to drink two to three liters of fluid a day to maintain adequate hydration. Educate patient and relatives on proper disposal of used tissue and wash hand properly with Soap after handling of contaminated tissue. Educate them to avoid exposure to cold weather Avoid overcrowding

COMPLICATIONS Meningitis Pneumothorax Bronchiectasis septicaemia Persisting lobar collapse Lung abscess Respiration failure Dehydration Emphysema pleural effusion Recurrent pneumonia Pulmonary edema

BRONCHIOLITIES Definition Bronchiolitis is a common illness of the respiratory tract. It's caused by an infection that affects the tiny airways, called the bronchioles that lead to the lungs. As these airways become inflamed, they swell and fill with mucus, which can make breathing difficult.

Bronchiolitis : most often affects infants and young children because their noses and small airways can become blocked more easily than those of older kids or adults typically happens during the first 2 years of life, most commonly at about 3 to 6 months of age

Incidence Approximately 1 in 3 infants will develop clinical bronchiolitis in the first year of life and 2–3% of all infants require hospitalization.

Causes Bronchiolitis is usually caused by a viral infection, most commonly respiratory Syncytial Virus (RSV) infections are responsible for more than half of all cases of bronchiolitis . Other viruses associated with bronchiolitis include rhinovirus (the common cold virus), influenza, human metapneumovirus , adenovirus, coronavirus , and parainfluenza .

Risk Factors Pre mature babies Babies with chronic heart or lung disease Babies with weakened immune system due to illness or medicines Exposure to cigaratte smoke also can increase a child's risk for bronchiolitis .

Duration Cases of bronchiolitis usually last about 12 days, but kids with severe cases can cough and have wheezing for weeks. The illness generally reaches its peak on the second or third day after coughing begins, causing breathing difficulty before slowly getting better.

Signs and Symptoms The first symptoms of bronchiolitis are usually the same as those of a common cold: stuff nose and congestion runny nose cough fever These symptoms last a day or two and are followed by worsening of the cough and wheezing (high-pitched whistling noises when exhaling).

Sometimes, more severe respiratory difficulties gradually develop. Signs to watch for include: fast, shallow breathing a rapid heartbeat retractions — when the areas below the ribs, between the ribs, and in the neck sink in as a child inhales flaring of the nostrils irritability, with difficulty sleeping and signs of fatigue (tiredness) or lethargy vomiting after coughing poor appetite or not feeding well, causing decreased peeing and fewer wet diapers

Sometimes these symptoms can lead to dehydration. Less commonly, babies (especially preemies) may have episodes where they briefly stop breathing (called apnea ) before developing other symptoms. In severe cases, symptoms may worsen quickly.

A child with severe bronchiolitis may get very tired from the work of breathing and have poor air movement in and out of the lungs due to the clogging of the small airways. The skin can turn blue (called cyanosis), which is especially noticeable in the lips and fingernails.

Diagnosis Physical examination Chest X-ray is sometimes useful to exclude pneumonia, but not indicated in routine cases. Testing for the specific viral cause can be done but has little effect on management and thus is not routinely recommended. RSV testing by direct immunoflorescence testing on nasopharyngeal aspirate had a sensitivity of 61% and specificity of 89%.

Management Treatment and management of bronchiolitis is usually focused on the symptoms instead of the infection itself (supportive therapies) since the infection will run its course and complications are typically from the symptoms themselves.

Inhaled epinephrine Nebulized and inhaled epinephrine (both racemic and levo (1)-epinephrine) has been shown to decrease hospitalization rates. Inhaled epinephrine is often a treatment usually in conjunction with a cortiocosteroid such as dexamethasone and sometimes inhaled hypertonic saline is used Antibiotics may be given in cases of bacteria infections. Oxygen may also be administered PRN.

NURSING INTERVENTIONS Maintain a patent airway Provide cool humidified oxygen. Position the child at a 30-to-40-degree angle with the neck slightly extended. Encourage fluids Isolate the child in a single room. Maintain the good hand-washing procedures.

Ensure that the nurses caring for these children do not care for other high-risk children. Wear gowns when soiling of clothing may occur during care. Wash hands before and after working on patient.

Prevention Prevention of bronchiolitis relies strongly on measures to reduce the spread of the viruses that cause respiratory infections. That is, hand washing, and avoiding exposure to those symptomatic with respiratory infections. In addition to good hygiene an improved immune system is a great tool for prevention.

One way to improve the immune system is to feed the infant with breast milk, especially during the first six months of life. Immunizations are available for premature infants who meet certain criteria (some cardiac and respiratory disorders) such as Palivizumab (a monoclonal antibody against RSV). Passive immunization therapy requires monthly injections every winter.

COMPLICATION Atelectasis Pneumonia Bronchopneumonia

TOPIC: CORYZA A PRESENTATION BY AMPAH ALBERTA PAEDIATRIC NURSING

Coryza (also known as nasopharyngitis , rhinopharyngitis ,common cold, or a cold) is a viral infectious disease of the upper respiratory system. DEFINITION: it is an inflammation of the mucous membrane of the nose ; it may be either acute or chronic.

Coryza is from the Greek word Which is made up of two compounded words “ kara ” and “ zeein ” with kara meaning head and zeein meaning to boil. So basically coryza means boiling over the head.

CAUSES Coryza is basically caused by bacteria eg: staphylococcus, viruses eg: rhinovirus and allergens eg: pollen, dust Some other conditions which may cause rhinitis are: Measles Sinusitis influenza

INCIDENCE Rhinitis is a very common conditon . Rhinitis is more common in some countries than others ; in the United state, about 10% -30% of children are affected annually. Approximately 25% of colds will last up to two weeks.

TYPES OF CORYZA This can be categoriesed into three main types. Infectious rhinitis Non allergic rhinitis Allergic rhinitis

INFECTIOUS RHINITIS This type of rhinitis is caused by viral or bacterial infection. Including common cold, which is caused by rhinovirus, coronavirus , adenovirus, streptococcus e.t.c

NON ALLERGIC RHINITIS This refers to rhinitis that is not due to an allergy and is also known as vasomotor rhinitis. This cause was thought to be as a result of vasodilatation caused by over activity of the parasympathetic nerve response. This is usually caused by hormones or medications

ALLERGIC RHINITS This type of rhinitis is as a result of allergic reaction. Some of these allergens are pollen grains, dust etc This sensitizes the immune system of the individual in the production of antibody which causes inflammatory reactions in the individual

CLINICAL FEATURES Sneezing Sore throat Nasal congestion Head ache Fever Enlarged lymph nodes Malaise Cough

DIAGNOSTIC INVETIGATIONS Physical examination Nasal smear Throat swab Signs and symptoms of rhinitis

MEDICAL MANAGEMENT Antipyretic drugs such as Syrup Paracetamol are used to relief the fever. Nasal drops are used to relief nasal congestion. Eg: Ephedrine In case of bacteria infection antibiotics such as penicillin are prescribed. For allergic Rhinitis antihistamines and corticosteroids are prescribed

NURSING MANAGEMENT Ensure adequate rest and sleep of patient by carrying out nursing activities at a time , keep baby warm, maintaining quiet environment, providing bed that is free from creases, changing of soiled linen etc. Avoid stuffy environment (closed environment or unventilated places, dusty environment etc).

Monitor and record vital signs especially temperature and give interventions when necessary and record any abnormalities if present. Nasal and pharyngeal congestion can be relieved by hot moist inhalation

Nutritional intake can be improved by giving soft well cooked none-irritating food such as milk, boiled and mashed roots food and cooked, give extra fluids. Supervise feeding. A nurse with the upper respiratory tract infection should not be allowed to work in the nursery

The patient and family should be educated on the use of separate wash cloth and towel. Older children should be taught to cover the mouth and nose whilst sneezing or coughing. Avoid overcrowding in the in the ward.

PREVENTION Educate grown up children to cover mouth when coughing or sneezing. Barrier nursing such as face mask, gowns, and disposable gloves must be used. Sleeping in a well ventilated room.

Good nutritional intake. Proper hand washing with soap. Frequent washing of clothing that are used in sneezing, coughing and wiping of the nose

COMPLICATIONS Tonsilitis Otitis media Bronchitis Pneumonia Laryngitis

SICKLE CELL BY AMEYAW COLLINS

SICKLE CELL DISEASE Definition: Sickle cell disease is associated with an inherited defect in the synthesis of hemoglobin . It is the name of a group of disorders of red blood cells in which the predominant haemoglobin in the red blood cell is haemoglobins, also known as sickle cell haemoglobin.

Incidence The disease is found predominately in Africans and Black Americans. It also occurs in people from Mediterranean and Arab countries. It affects both males and females. Causes It is a genetic condition caused by the transfer of haemoglobin S gene from parents to their offspring

Forms of sickle cell disease SS (Sickle Cell Anemia ) SC (Sickle- Hemoglobin C Disease) S beta-plus thalassemia S beta-zero thalassemia

SICKLE CELL TRAIT A trait is a common word for a condition where a person gets an abnormal gene from one parent and the normal type from the other parent. If he gets the abnormal genes from both parents he is said to have the disease. Sickle cell trait is described as a heterozygous form of the disease. Here, the individual inherits one haemoglobin C or S from one parent. Such persons seldom experience sickle cell crises and have life expectancy and their frequency of hospitalization do not differ from those with normal haemoglobin A.

SICKLE CELL ANAEMIA Sickle anaemia is a severe haemolytic anaemia that results from inheritance of the sickle haemoglobin S gene from both parents. The gene causes the haemoglobin molecule to be defective. That is, it causes the red blood cell to assume crescent of sickle shape. These red bloods impair circulation resulting in chronic ill health period cries, long term complication and premature death.

Types of Sickle Cell Disease There are two types of the disease The severe type and Asymptomatic condition.

SEVERE TYPE In the severe type there is a persistent hemolytic anemia with periodic episodes of painful crises. This appears in homozygous form (inherited from both parents). ASYMPTOMATIC TYPE This is when the defect is heterozygous (inherited from only one parent), thus having a sickle cell trait. This is much more frequent among Negroes in the United States than is the true disease. If both parents are heterozygous, one of their children will have sickle cell disease, on the average, two will have the trait, and one will be hematologically normal.

Pathologically, hemoglobin in both forms is abnormal ( hemoglobin S). Under reduced oxygen tension this hemoglobin is responsible for changing red blood cell into a sickled shape. In sickle cell disease these malformed cells clump together and obstruct capillaries, thereby causing what is known as a crisis in the disease. Capillary obstruction leads to anoxic changes which cause further sickling and thus still further obstruction in the blood vessels resulting in pain in the area .

FACTORS THAT PRECIPITATE SICKLE CELL CRISIS Exposure to extreme of temperature either cold or hot High altitude Stress Dehydration Malaria Extremes of emotion either over excitement or depression Anxiety

CLINICAL MANIFESTATIONS In children with sickle cell disease the onset may be as early as the second or third month of life, when normal fetal hemoglobin is replaced by the abnormal hemoglobin which causes sickling . Approximately half of all children affected by this condition have symptoms by one year of age.

CLINICAL MANIFESTATION CONT The first clinical manifestation the infant may have is sickle cell crisis. The child may also have an extreme pallor fever vomiting severe flank pain with hematuria

convulsions stiff neck coma or paralysis Two to three minutes after the crisis, Jaundice may appear. Between crises the manifestations are pallor anemia

LABORATORY FINDINGS AND DIAGNOSES CBC: Reticulocytosis (count may vary from 30%–50%); leukocytosis (especially in vaso -occlusive crisis), with counts over 20,000 indicate infection, decreased Hb (5–10 g/ dL ) and total RBCs, elevated platelets, and a normal to elevated MCV. Stained RBC examination: Demonstrates partially or completely sickled, crescent-shaped cells; anisocytosis ; poikilocytosis ; polychromasia ; target cells; Howell-Jolly bodies; basophilic stippling; occasional nucleated RBCs ( normoblasts ). Sickle-turbidity tube test ( Sickledex ) : Routine screening test that determines the presence of hemoglobin S ( HbS ) but does not differentiate between sickle cell anemia and trait.

DIAGNOSIS CONT Hemoglobin electrophoresis: Identifies any abnormal hemoglobin types and differentiates between sickle cell trait and sickle cell anemia. Results may be inaccurate if patient has received a blood transfusion within 3–4 mo before testing. ESR: Elevated. Erythrocyte fragility: Decreased (osmotic fragility or RBC fragility); RBC survival time decreased (accelerated breakdown). ABGs: May reflect decreased Po 2 (defects in gas exchange at the alveolar capillary level); acidosis (hypoxemia and acidic states in vaso -occlusive crisis). Serum bilirubin ( total and indirect ) : Elevated (increased RBC hemolysis).

TREATMENT Treatment during crises includes codeine and aspirin for relive of pain and maintenance of hydration. Antibiotic therapy may be necessary if a bacteria infection such as pneumonia or meningitis is present such as penicillin when they're about 2 months of age and continue taking it until they're at least 5 years old . Transfusion of erythrocytes may be required Oxygen is given if the hemoglobin level falls rapidly to as low as 4gm. Per100ml. and the child has symptoms of hypoxia

TREATMENT CONT Recently research has shown that the administration of urea dissolve in a sugar solution relieved acute sickle cell crises by dissipating the electrochemical bounds that hold the hemoglobin sickle cell in rod – shaped aggregations. Investigation is now being done to determine whether these crises can be prevented by given urea orally in a sweat soft drink daily.

TREATMENT CONT Folic acid is administered daily for increased marrow requirement. Supportive care involves pain management (aspirin or NSAIDs, morphine, and patient controlled analgesia), oral or IV hydration, physical and occupational therapy, physiotherapy, cognitive and behavioral intervention, and support groups.

NURSING CARE Assisting the physician with the treatments mentioned such as checking of vitals especially assessing the level of pain and administering prescribed analgesics Helping other members of the health team to educate the parent and the child about the disease. The clinical manifestations of the disease can be explained to the parent so that they know when to bring the child to the hospital and when it is necessary only to call the physician for information. The parents need to know that the child should consume huge quantities of liquids, especially in harmattan , and should also have well balanced meals.

They also need to know that the child should be treated immediately when infections occurs. Enhance tissue perfusion. Provide nutritional and ﬂuid needs. Other children in the family should be tested to find those who may similarity afflicted.

Complications Congestive heart failure Leg ulcers Renal failure Periodic bone pain Anaemia Splenomegaly Hepatomegaly Opoiod tolerance Osteomyelitis Priapism and infection of the penis Stroke Decreased immune reactions

PRESENTATION ON LEUKEMIA BY KALALA JOHN

DEFINITION Leukemia are malignant disorders of the blood and bone marrow that result in an accumulation of dysfunctional, immature cells that are caused by loss of regulation of cell division. OR

The term Leukemia refers to cancers of the white blood cells (also called leukocytes or WBCs). When a child has leukemia, large numbers of abnormal white blood cells are produced in the bone marrow. These abnormal white cells crowd the bone marrow and flood the bloodstream, but they cannot perform their proper role of protecting the body against disease because they are defective.

cont’ As leukemia progresses, the cancer interferes with the body’s production of other types of blood cells, including red blood cells and platelets. This results in anemia (low numbers of red cells) and bleeding problems, in addition to the increased risk of infection caused by white cell abnormalities.

CAUSES Genetics problems e.g. down syndrome, klinefelter syndrome, neurofibromatosis Environmental factors exposure to certain chemicals and toxins (benzene, alkylating agents) Exposure to ionizing radiation Familial susceptibility Human T-cell leukemia lymphoma virus (HTLV-1 and HTLV-2) in certain areas of the world including caribbean and southern Japan

INCIDENCE leukemia account for about 25% of all childhood cancers and affect about 2,200 American young people each year . In children, about 89% of leukemia are acute. ALL is most common in children between ages of 2 and 8 with peak incidence of 4

CLASSIFICATION In general, leukemia are classified into acute (rapidly developing) and chronic (slowly developing) forms Acute leukemias affect immature cells and are characterized by rapid progression of symptoms Acute childhood leukemias are also divided into ; acute lymphocytic leukemia (ALL) (when lymphocytes are the predominant malignant cell)

acute myelogenous leukemia (AML) (when monocytes or granulocytes are predominant malignant cell).

Cont’ It depends on whether specific white blood cells called lymphocytes (or myelocytes ), which are linked to immune defenses, are involved Although slow-growing chronic myelogenous leukemia (CML) may also be seen in children, it is very rare.

CLINICAL FEATURES Common symptoms Fatigue Weakness Recurrent infections Fever Lymphadenopathy Weight loss Abnormal bruising and bleeding Pallo r

Other symptoms Bone and joint pain Headache Splenomegaly Hepatomegaly Neurologic dysfunction

DIAGNOSIS A bone marrow biopsy and aspiration, in which marrow samples are removed (usually from the back of the hip) for testing A lymph node biopsy, in which lymph nodes are removed and examined under a microscope to look for abnormal cells A lumbar puncture (spinal tap), where a sample of spinal fluid is removed from the lower back and examined for evidence of abnormal cells. This will show whether the leukemia has spread to the central nervous system (brain and spinal cord).

Cont’ CBC and blood smear peripheral WBC count varies widely from 1,000 to 100,000/mm 3 and may include significant numbers of abnormal immature (blast) cells; anemia may be profound; platelet count may be abnormal and coagulopathies may exist.

MEDICAL MANAGEMENT To eradicate leukemic cells and allow restoration of normal hematopoiesis . High-dose chemotherapy given as an induction course to obtain a remission (disappearance of abnormal cells in bone marrow and blood) and then in cycles as consolidation or maintenance therapy to prevent recurrence of disease

Cont’ Common Chemotherapeutic Drugs Used in Acute Leukemia Cytarabine (ARA-C, Cytosar -U), Daunorubicin ( Cerubidine ), Doxorubicin ( Adriamycin PFS), L- asparaginase ( Elspar ), 6-Mercaptopurine (6-MP, Purinethol ), Methotrexate ( Rheumatex , Trexall ), Vincristine ( Oncovin , Vincasar )

Cont’ Leukapheresis (or exchange transfusion in infants) may be used when abnormally high numbers of white cells are present to reduce the risk of leukostasis and tumor burden before chemotherapy. Radiation, particularly of central nervous system (CNS) in ALL

Cont’ Autologous or allogeneic bone marrow or stem cell transplantation. Supportive care and symptom management

NURSING MANAGEMENT Infection Place patient in private room with hand-washing precautions strictly enforced. Avoid exposure to all sources of stagnant water ( eg , flower vases, denture cups, water pitchers, humidifiers) and plants. Encourage or assist with personal hygiene mouth care, perirectal care, daily shower or bath with mild soap. Inspect skin and mucous membranes daily for possible signs of infection

Cont’ Monitor vital signs q4h. Obtain baseline pulse oximetre reading (SaO 2 Assess respiratory function q4h while symptoms present, otherwise q8h. Encourage ambulation, deep breathing, and coughing. Assess for changes in mental status at least q8h, including restlessness, irritability, confusion, headache, or changes in level of consciousness.

Bleeding Assess for signs of bleeding at least q8h Provide soft toothbrush and mild mouthwash for mouth care. Use only an electric razor for shaving. Keep fingernails and toenails short and smooth. Lubricate skin with mild lotion

Cont’ Avoid I.M. injections, invasive procedures, rectal procedures. Use stool softeners to prevent constipation. Restrict activity based on assessment of platelet count and presence of active bleeding Administer blood product replacement as ordered. Monitor for signs and symptoms of allergic reactions, anaphylaxis, and volume overload.

Cont’ Teach patient to avoid activities likely to cause injury ( eg , contact sports) and other methods to prevent bleeding

Pain Assess at least q4h for presence, location, intensity, and characteristics of pain. Administer analgesics as ordered to control pain. Administer on regular schedule rather than as needed. Avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) in thrombocytopenic patients

Cont’ If oral analgesics in optimal doses are not effective or not tolerated, consider I.V. route Teach and use nonpharmacologic measures, such as the use of music, relaxation breathing, progressive muscle relaxation, distraction and imagery to help manage pain.

Family care Encourage verbalization of feelings regarding diagnosis, treatment plan, and anticipated course of illness. Refer as needed to social worker, psychiatric liaison nurse, psychologist. Share information regarding national and local resources.

Prevention Infection Especially monitor for pneumonia, pharyngitis , esophagitis , perianal cellulitis , urinary tract infection, and cellulitis , which are common in leukemia and which carry significant morbidity and mortality. Monitor for fever, flushed appearance, chills, tachycardia; appearance of white patches in mouth; redness, swelling, heat or pain of eyes, ears, throat, skin, joints, abdomen, rectal and perineal areas; cough, changes in sputum; skin rash

Cont’ Check results of granulocyte counts. Concentrations less than 500/mm 3 put the patient at serious risk for infection. Avoid invasive procedures and trauma to skin or mucous membrane to prevent entry of microorganisms.

Cont’ Encourage and assist patient with personal hygiene, bathing, and oral care. Obtain cultures and administer antimicrobials promptly as directed

Bleeding Watch for signs of minor bleeding, such as petechiae , ecchymosis, conjunctival hemorrhage, epistaxis , bleeding gums, bleeding at puncture sites, vaginal spotting. Be alert for signs of serious bleeding, such as headache with change in responsiveness, blurred vision, hemoptysis , hematemesis , melena , hypotension, tachycardia, dizziness

Cont’ Test all urine, stool, emesis for gross and occult blood. Monitor platelet counts daily. Administer blood components as directed. Keep patient on bed rest during bleeding episodes

Patient teaching Teach infection precautions. Teach signs and symptoms of infection and advise whom to notify. Encourage adequate nutrition to prevent emaciation from chemotherapy. Teach avoidance of constipation with increased fluid and fiber, and good perianal care Encourage regular dental visits to detect and treat dental infections and diseases

complications Leukostasis : in setting of high numbers (greater than 50,000/mm 3 ) of circulating leukemic cells (blasts), blood vessel walls are infiltrated and weakened, with high risk of rupture and bleeding, including intracranial hemorrhage

Cont’ Tumor lysis syndrome: rapid destruction of large numbers of malignant cells leads to alterations in electrolytes ( hyperuricemia , hyperkalemia, hyperphosphatemia , and hypocalcemia ). May lead to renal failure and other complications. Infection, bleeding, organ damage.

THANK YOU

PAEDI ATRIC NURSING INTEGUMENTERY SYSTEM TOPIC: ECZEMA BY; MR. NUOBASOLE FIDELIS

ECZEMA

OJECTIVES By the end of the Presentation, the student should be able to: define Eczema explain the two main causes of Eczema mention at least 4 signs and symptoms of Eczema describe the appropriate management for Eczema mention at least 2 complications of Eczema

What is this?

DEFINITION Eczema also known as (infantile eczema , atopic dermatitis, or atopic eczema), is a term for a group of medical conditions that cause the skin to become inflamed or irritated. Eczema “A general term for any superficial inflammatory process involving the epidermis mainly, marked by redness, itching, tiny papules and vesicles, weeping, oozing and crusting, and later by scaling and often pigmentation."

INFANTILE ECZEMA Infantile eczema is an inflammation of genetically hypersensitive skin. Eczema is usually a symptom rather than disorder. It indicates the infant’s oversensitive to certain substances called allergens which enter the body via the digestive tract (food) by inhalation (dust, pollen) by direct contact ( wool, strong soap, sunlight) or by injections (insect bites, vaccines). In most cases, the skin heals by the age of 5 years and eczema does not occur again. Some children have the trial if atopic dermatitis asthma and hay fever develop.

"ATOPIC" The word "atopic" refers to a collection of immune-mediated diseases, including atopic dermatitis, asthma and hay fever, to which a person can inherit a predisposition. "Dermatitis" means inflammation of the skin.

CAUSES OF ECZEMA The exact cause of eczema is unknown, but it is believed to develop due to a combination of hereditary and environmental factors. It’s thought to be linked to an overactive response by the body's immune system to an irritant. It is this response that causes the symptoms of eczema . Children are more likely to develop eczema if a parent has had it or another atopic disease. If both parents have an atopic disease, the chances increase further.

Environmental factors are also known to bring out the symptoms of eczema . Irritants: soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats or vegetables Allergens: dust mites, pets, pollens, mold, dandruff Microbes: bacteria such as Staphylococcus aureus, viruses, certain fungi Hot and cold temperatures: hot weather, high and low humidity, perspiration from exercise Foods: dairy products, eggs, nuts and seeds, soy products, wheat Stress: it is not a cause of eczema but can make symptoms worse

Hormones: women can experience worsening of eczema symptoms at times when their hormone levels are changing, for example during pregnancy and at certain points in their menstrual cycle. Organic soaps and material can irritate the skin. Wool may irritate the skin; try and wear cotton undergarments in any area where clothing is in contact with the skin. Perfumes, preservatives and alcohol in cosmetics and creams can aggravate symptoms.

INCIDENCES OF ECZEMA Eczema affects about 10% to 20% of infants and about 3% of adults and children and also affects about 9-30% of the US population. In the US, most infants who develop the condition outgrow it by their tenth birthday, while some people continue to have symptoms on and off throughout life. People living in dry climates and cities appear to be more likely to develop eczema. Eczema occurs equally in both males and females. Eczema is likely related to conditions that adversely affect the skin's barrier function (including genetic factors, nutrient deficiencies, bacterial infection, and dry, irritated skin).

SIGNS AND SYMPTOMS OF ECZEMA Symptoms commonly manifests itself in infants with dry and scaly patches appearing on the skin. These patches are often intensely itchy. The symptoms of eczema vary, depending on the age of the person with the condition. Infants : Rashes commonly appear on scalp and cheeks Rashes usually bubble up before weeping fluid Rashes can cause extreme itchiness, which may lead to difficulty in sleeping. Continuous rubbing and scratching can lead to skin infections.

Children, from 2 years old to puberty: Rashes commonly appear behind the creases of elbows or knees Also common on neck, wrists, ankles, crease between buttock and legs. Rashes can become bumpy, like goosebumps Rashes can lighten or darken in color Rashes can thicken (also known as lichenification) and then develop knots and a permanent itch.

Adults: Rashes commonly appear in creases of elbows or knees or nape of neck Rashes cover much of the body Rashes can be especially prominent on neck, face and around the eyes Rashes can cause very dry skin Rashes can be permanently itchy Rashes can cause scaly skin (more scaly than in children) Rashes can lead to skin infections.

DIAGNOSTIC INVESTIGATION There is no single test that is used in order to diagnose eczema. The doctor may need to see a patient multiple times in order to make an accurate diagnosis. Diagnosis is based mainly on the patient's symptoms

An increase in immunoglobulin E (IgE) and eosinophil levels Physical examination Family history, such as asthma, hay fever, possible exposure to irritants Patch testing: substances are placed onto the surface of the skin to test for skin allergies Skin prick testing: a needle containing a small amount of a suspected allergen pricks the skin to test for allergies that do not necessarily occur on the skin, such as pollen or food Supervised food challenges: foods are eliminated and then introduced into the diet to determine whether a food allergy is present. blood tests

NURSING MANAGEMENT Encourage mothers to breast-feed and follow a hypoallergenic diet to decrease the risk of atopic dermatitis. Eliminate trigger foods for infants and toddlers with known or suspected food allergies. Teach patient and family to avoid potential precipitants including; exposure to excessive heat and cold or extremes of humidity, use of irritating soaps, perfumes, detergents, and chemicals. Suggest referral to allergy specialist for infants and young children with moderate to severe atopic dermatitis.

Consult with dietitian to ensure a balanced diet and notify dietary department of food allergies. Teach parents and caregivers to read food labels for the elimination of offending food proteins. Be aware of environmental triggers by; maintaining a warm climate with moderate humidity. Dress child in soft, lightweight cotton clothing. Avoid wool and occlusive synthetic fabrics.

Apply a thin layer of topical corticosteroids to the affected skin two to four times per day as directed. Observe for possible adverse effects from long-term use of topical corticosteroids (cutaneous atrophy, telangiectasia, acne, and growth retardation). Observe the skin for signs of bacterial, viral, or fungal infection (discharge, oozing, or crusts). Report positive findings. Make sure that the family knows the common triggers to avoid, how to prevent dry skin, signs of flares or secondary infection, when to apply topical medications, and the need for routine follow-up appointments.

MEDICAL MANAGEMENT Topical corticosteroid creams and ointments. These are a type of anti-inflammatory medication and should relieve the main symptoms of eczema, such as skin inflammation and itchiness If ineffective, systemic corticosteroids can be prescribed. These are either injected or taken by mouth, and are only used for short periods of time Antibiotics

Antihistamines that cause drowsiness are often recommended, as these can help to reduce the risk of nighttime scratching, some examples include diphenhydramine (Benadryl) or hydroxyzine (Atarax) or promethazine (Phenergan). Topical calcineurin inhibitors (a type of drug that suppresses the activities of the immune system) decreases inflammation and helps prevent flares Barrier repair moisturizers reduce water loss and work to repair the skin.

COMPLICATIONS OF ECZEMA Conjunctivitis Dehydration Infection Malnutrition Oedema (swelling) Retarded growth

REFERENCES Burks, W. (2003). Skin manifestations of food allergy . Pediatrics Nursing Beck. L. (2003). A nonsteroidal topical agent for treatment of atopic dermatitis. Journal of Allergy & Clinical Immunology . Elidel (pimecrolimus) cream 1% Eichenfield, L.F., et al. (2003). Atopic dermatitis and asthma: Parallels in the evolution of treatment . Pediatrics Nursing Gupta, A.K. et al. (2003). The efficacy and safety of terbinafine in children. Dermatologic Clinics Cooper, E.A. et al. (2003). Efficacy and safety of itraconazole use in children. Dermatologic Clinics. Montero-Gei, F. et al. (2003). The use of fluconazole to treat superficial fungal infections in children . Dermatologic Clinics. Williams & Wilkins. (2006). Lippincott Manual of Nursing Practice . 8th Edition https://www.google.com

THA NK YOU

BYE presenting on burns

BURNS Burns is the destruction of the skin or body tissues by dry heat, moist heat or chemical . This occurs by the exposure of the body surface to temperature greater than forty five degree Celsius .

Incidence According to centre for disease control and prevention (CDCP) 2003, Burns can affect any person at any time in any place. Burns affect people of all age groups and socio-economic group. Those it mostly affect are the very young, the elderly and the very poor

TYPES OF BURNS ACCORDING TO ETIOLOGY Flame burns; this is tissue destruction by dry heat such as fire, hot metal etc .

z

SCALD BURNS Scald ;this is tissue destruction by moist heat such as hot soup, hot water ,hot tea, hot oil , etc

Scald burns

CHEMICAL BURNS this occur when corrosive chemicals come into contact with the body. chemicals such as hydrochloric acid , sulphuric acid and strong alkalis such as sodium hydroxide are examples

Picture of chemical burns

Diagnosis of burns Physical examination Full blood count

TYPES OF BURNS ACCORDING TO ETIOLOGY Radiations burns; most commonly occur from over exposure to ultraviolet light eg , sunlight or radioactive sources like nuclear explosions.

VARIOUS CLASSIFICATIONS OF BURNS

CLASSIFICATION IN DEGREE First degree ; Erythema[pink to red colour] Mild oedema or no oedema Pain Healing is within 3 to 5 days. Affects only the epidermis .

SECOND DEGREE Redness Oedema Blisters Pain Heals within 2 to 6 weeks Affects the epidemics and part of the dermis

THIRD DEGREE Red White Brown-yellow or black colour of tissue, severe oedema,eschar [hard tissue].there is usually no pain. Heals in weeks Whole skin is affected .

FOURTH DEGREE Black eschar without pain, blister or oedema.healing is in weeks to months. S kin, muscles, tendons and bones are damaged .

CLASSIFICATION ACCORDING TO MAGNITUDE minor burns Extent is 15% or less If full thickness injury exists, it must not exceed 2%. Burns do not involve the eyes,face,hands,feet or perineum.

MODERATE BURNS Burns extent is less than 25%. If full thickness, must not exceed 10% Burn area does not include face, eye,hands,or perineum .

MAJOR BURNS Burn extent is more than 25% Full thickness if present exceeds 10% The eye,face,hands and perineum could be involved There has been inhalation of heat.

CALCULATING SURFACE AREA OF BURNS This is the means by which burns is usually assessed.the criteria commonly used are the PALMER METHOD AND WALLANCE RULE OF NINE.

PALMER METHOD This method assesses smaller areas of burns. With gloved hand, the patient uses the palm to measure the burned area. Each palmer measurement amount 1% of the total body surface area.

WALLACE RULE OF NINE children Head=18% Each arm=9% Each leg=14% Front of trunk=18 % Back of trunk=18% Perineum, palm=1%

PACKLAND FORMULAR Parkland formula The Parkland Formula gives you the calculation you need to know how much fluids to give to patient. V ( fluids volume)= total body surface area of burn (%) x weight (kg) x 4

GENERAL CLINICAL MANIFESTATIONS Dyspnea due to oropharyngeal oedema Hypovolemic shock resulting from fluid shift from vessels into interstitial space. Skin lesion[wound] Dehydration due to fluid loss. Oedema Thirst Tachycardia

COMPLICATION Infection shock t etanus Keloids Contractures Scarring

EMERGENCY MANAGEMENT OF BURNS Call for help Remove source of injury, if it is flame, smother the fire and remove clothing .If chemical, brush off chemical with care not to contact self. Examine chemical and if electrical burns, switch off the power and use an insulated hand to remove client from contact. Remove tight clothing.

EMERGENCY MANAGEMENT CONT , D Position client and elevate the lower extremities. Ensure that the environment is well ventilated Reassure client Cool the burnt area to help reduce pain and limit the extent of the burn and any damage

EMERGENCY MANAGEMENT CONT,D Remove any constricting items such as watches and bracelets before swelling cuts off the circulation. Cover the burnt area with sterile or clean dressing to prevent infection. Arrange immediate transport to hospital

TREATMENT OF SPECIFIC BURNS BURNS FROM STEAM OR HOT WATER ; Flash water under clothing to start cooling and separate it from the skin. Scalded skin is often fragile, so remove clothing carefully by cutting it first some distance away from the scalded area.

Burns from steam or hot water cont’d Apply a clean dressing and bandage lightly in position. If blisters appear do not try to burst them; protect them by the dressing. Arrange transport to hospital Reassure the patient Treat for shock

Chemical burn to the eye Turn the patient head to one side with the affected eye below the good eye so that no chemical runs into the good eye. Hold the eyelid open under a gently running tap or pour water from a glass or bottle. Flash both sides of the eye; don’t splash contaminated water in to the unaffected eye

Chemical burn to the eye cont’d Cover the eye with a sterile eye pad and secure loosely. Try to find out what chemical has caused the burn. Take casualty to hospital.

SURGICAL INTERVENTION Skin grafting is done to replace healthy skin onto an area where the skin has been damaged, lost or surgically removed. A healthy skin is harvested from a donor site and transplanted to the recipient site .

SOURCE OF SKIN FOR SKIN GRAFTING Autograft. Skin taken from a cadaver (Allograft) Skin taken from an animal (Xenograft)

SPECIFIC MEDICAL TREATMENT Intravenous infusion such as dextrose saline, normal saline and ringers lactate are given as prescribed to compensate fluid and electrolyte loss. Antibiotics such as Gentamycin and Amoxicillin is given to combat infection. Sedative such as valium are also administer for rest and sleep and also to reduce pain. Analgesic such as Diclofenac and Pethidine are administered as prescribed to relief pain. Injection such as anti-tetanus serum is given as prescribed to immunize against tetanus

PAIN MANAGEMENT Administer prescribed analgesia such as paracetamol Involved patient in diversional therapy such as watching television Assist patient to assume a comfortable position Perform all procedures at once, enhance minimal touch Control noise at the ward Facilitate rest and sleep

WOUND CARE Advise patient not to touch wound Prevent pressure on wound Avoid wound contact to water Dress wound aseptically with iodine and normal saline Examine for wound infection such as high body temperature Remove stitches as ordered Wound culture is taken for laboratory analysis Tubes or drains to be inserted to drain pus, observe them for patency

Wound care con’t Check for wound bleeding and reinforce Monitor colour, amount , odour of drainage Balance diet Observe wound for swelling, bleeding, and signs of inflammation Change soiled linen Maintain personal hygiene-bathing Hand washing before and after procedure Perform catheter care if in situ

REFERENCE Smith M. J., Goodman J. A., Ramsey N. L. and Pasternack S. B.. Child and Family Concept of Nursing Practice. ISBN 0-07-048720-0 Marks G. M (1994). Broadribb’s Introductory Paediatric Nursing. 4 th Edition. J. B. Lippinchott Company, Philadelphia. Joana Owusu-Danso . Concise Notes on Paediatric Nursing

THANK YOU

FOREIGN BODIES PEDIATRIC NURSING PRESENTATION BY Richmond Annor (Student Nurse) 402013012

FOREIGN BODIES Foreign body ingestion is most common in infants and children between the ages of 6 months and 3 years . Coins , buttons, batteries and toys are the items most frequently swallowed, at these ages. Older children and adolescents with mental retardation or psychiatric illness may swallow anything.

Foreign bodies tend to become impacted at normally narrow site of GIT or at areas of pathologic narrowing . Foreign bodies, including food boluses, are more likely to become impacted in the oesophagus of children with motility disorders or other oesophageal abnormalities. .

CLASSIFICATION OF FOREIGN BODIES They are generally classified as; Sharps or dull Pointed or blunt Toxic

Impaction by toxic foreign bodies can lead to local damage from pressure necrosis and corrosive action or burns from the alkaline content of battery. Treatment is based on the type of foreign body, its location and whether the patient is symptomatic.

Management of common foreign bodies in the Ear, Nose and Throat Ear If foreign object become lodged in the ear, it may cause temporary deafness by blocking the ear canal. In some cases, the foreign body, may damage the ear drum . Young children frequently push objects in to their ears.

Some of the objects that may enter the ear are; insects, beans, buttons, pebbles, popcorn, beads, cotton wool. Children may present asymptomatically or pain or discharge caused by otitis externa.

TREATMENT OF FOREIGN BODY IN THE EAR

Prior to removal, it may be useful to consider three aspects of the situation; The nature of the foreign body: Living insects should first be killed by instilling oil into the meatus before removal. Irregular/soft graspable non-living object(dead insects, cotton wool, paper, small toy) may be removed with a crocodile forceps. Organic objects (beans etc) which absorbed water, swell & cause pain, should not be syringed. Round ,hard ,smooth, non-graspable should be removed with foreign body hook or syringing under G/A. Button batteries should not be syringed as they may leak on exposure to water. They should be removed urgently.

Location of the foreign body: Lateral lying foreign body easier access, wider diameter, elastic nature, &lesser sensitivity of the lateral canal make the removal of foreign bodies easier. Foreign body impacted medial to isthmus, when failed, removal attempts have caused trauma & swelling of the canal skin may required surgical removal. A post-auricular approach & widening of the canal by bone drilling is advised.

Patient considerations Younger uncooperative children require special handling, Time spent gaining the child’s confidence is a worthwhile investment Syringing is often useful &better tolerated & risk of trauma is low. Once the foreign body is removed, it is advisable to check the ears for the underlying pathology, as the child may have put the foreign body due to itch, pain, otorrhoea

EAR IRRIGATION The irrigation solution, usually water, should be warmed to body temperature. A ceruminolytic is instilled into the ear canal about 15 to 30 minutes before the procedure to soften the cerumen. The patient is draped with a protective plastic drape, and a basin is placed below the ear to catch the irrigating solution. The patient sits with the ear toward the nurse and the head tilted toward the opposite ear. For irrigation, the external ear is pulled downward and back for a child . A low-pressure stream of water is directed toward the top of the ear canal. Care is taken not to obstruct the canal with the syringe so that the irrigation solutions can flow back out of the canal. Ensure that only the tip of the syringe is in the ear canal and that gentle pressure is used to prevent trauma to the ear canal and eardrum

Removing foreign bodies from ears involves manual removal with alligator forceps or curette.

COMPLICATIONS Laceration of the ear canal Perforation of TM Ossicular chain dislocation Facial nerve palsy may occur secondary to leakage of alkaline matter from the button battery & necrosis of the surrounding tissue.

Foreign bodies in the ear Children frequently insert beads, buttons, berries and pebbles, etc into their noses. Sometimes, insects may also fly in to the nose. Child may present; Pain Bloody discharges from the nostril Breathing difficulties

Treatment Grasping with forceps Suction catheter Thin, lubricated, balloon-tip catheter Patient “blows nose” with opposite nostril obstructed

INFLATE

COMPLICATIONS Nasal Infection Sinusitis Rhinolith - Stone Formation over the Foreign Body Inhalation into the Tracheobroncheal Tree.

Foreign bodies in the throat Small objects such as coins, safety pins or buttons are the most commonest swallowed by young children. Often, they travel straight through the digestive tract, but there is a risk that they may enter the respiratory tract and cause choking. Button batteries, which are used in some toys, watches and hearing aids, are dangerous if swallowed because they contain corrosive chemicals They can cause severe damage, and even death if not removed. A large or sharp object may damage the digestive tract.

80% occur in children , with the majority of the foreign body ingestion being accidental Most often foreign body ingestion occurs in children between ages of six months and three years

Treatment Endoscopically Requiring sedation and, thus, referral Heimlich Maneuver can be performed.

HEIMLICH MANEUVER Ask the person if he or she is choking. (Note: Hands crossed at the neck is the universal sign of choking.) Assess ability to speak and cough. If the person cannot talk or cough, say that you can help and place your arms around his or her waist. Make a fist with one hand and place the thumb toward the victim above the umbilicus. Hold your fist with the other hand and thrust upward into the abdomen. Repeat thrusts. If the object is dislodged and the victim can cough effectively, encourage him or her to do so to eject the object.

If the object is not ejected or coughed out and the victim loses consciousness, lower the victim to the ground. Straddle the victim’s body and place the heel of one hand on top of the other. Position the hands midway between the umbilicus and the xiphoid process. Deliver thrusts and repeat. Open the mouth to assess if the object can be swept out with a hooked finger (do not sweep the mouth in children). If the airway remains obstructed, repeat the procedure.

COMPLICATIONS Lacerations or abrasions of the oropharyngeal mucosa Oesophageal necrosis Oesophageal stricture Tracheo-oesophageal fistula

Foreign bodies in the eyes It is the lodging of objects in the eye. It is very common and very painful. The danger is that, it may be embedded in the conjunctiva, damaging the cornea (the mucous membranes around the inner surface of the eye lids). Normally caused by; Dust. Insects. Eye lashes. Flying objects. Minute pieces of metal and wood

The child may present; Discomfort and pain in the affected eye Redness, congestion and watering of the eye Swelling Sudden vision problems Bleeding from the surface blood vessels

TREATMENT If the foreign object has caused corneal abrasions, antibiotic ointment may be administered to prevent infection For larger corneal abrasions eye drops containing homatropine may be given to keep the pupil dilated. Painful muscle spasms could occur if the pupil constricts before the cornea heals Acetaminophen may be prescribed to treat pain.

COMPLICATIONS Infection and scarring Corneal scratches Penetration of the eye

PREVENTION OF FOREIGN BODIES IN THE EAR, NOSE, THROAT AND EYE All children who are old enough to understand are taught not to put anything in their mouth except food. Infants and young children who cannot follow such advice must have their environment protected (any small item, diaper pins or sharp objects are placed out of the area where an infant is usually cared for, plays or sleeps). Supervise and educate the child as he matures. As the infant become more mobile, the environment is inspected carefully for hazardous objects.

CONT Any potentially dangerous items are placed out of reach of young child or discarded where they cannot be retrieved easily. Toys are carefully inspected for small or removable parts that could be accidentally ingested. If infants and small children wear ear rings, the ear rings should have screw backs to prevent them from falling off and they should be supervised to wear jewelries. Infants or young ones should not be allowed to play with marbles, coins or objects with small batteries.

REFERENCES DiMuzio J Jr , Deschler DG. (2002). Emergency department management of foreign bodies of the external ear canal in children . Otol Neurotol . ;23:473–5.

PEDIATRIC NURSING. PRESENTATION ON WORM INFESTATION BY: HON. OWUSU ASANTE JOSEPH

Worm Infestation Most of the parents every now-and-then encounter long white/pinkish worms or tiny thread like worms, in their child's stool. This is called Worm Infestation or infection by worms. It is a common cause of malnutrition in sub-Saharan countries, India, especially in rural areas where practice of defecation in open fields is prevalent.

Commonly seen worms: Round worms ( Ascaris ): Round, thin, white/pink worm and 10-20 inches long. Pinworms (Thread worms): White, small and thin like thread. Hookworms ( Ankylostomes ): Tiny dark-pink worms not visible in stools. Tape worms ( Taniea saginata / solium ): Flat worms, extremely long (2-3 meters). Liver Flukes, Giardiasis , Amebiasis etc

FOUR Common Types of Worms that Could be Infected With and the Route By Which Each of Them Enters the Body Round worms; Ascaris lumbricoides : They get into the body through the mouth. That is, during feeding on vegetables. Pinworm or threadworm: Children can get the infection through contaminated clothes, toys and towels. Children feed with their contaminated hands and the organism gets into the body through the mouth (oral)

FOUR Common Types of Worms that Could be Infected With and the Route By Which Each of Them Enters the Body cont’d Hookworm: The larvae penetrate the child’s skin, usually through the feet, get into the circulation and migrate like ascaris . Tapeworm: They enter the body through the mouth (oral) when the child eats raw or undercooked meat that is infested.

How does the Infestation Occur? It is mostly through fecal-oral route. Eggs of worms from stools of infected humans and animals defecating out in open, reaches soil where they grow and survive. When children play in soil contaminated with such excreta or stool of humans and animals they get infested. Worm eggs stick under nails of children filled with soil and mud. When they don't wash their hands before eating, eggs go inside the stomach become larva.

How does the Infestation Occur? Cont’d Hookworm eggs hatch into larva in the stools in 5-7 days and it is then ingested or then the larva enters through skin and reaches the stomach. Once there then it matures to become adult worm and liberates more eggs that are passed in the stool to infest others. This adult worm sticks to the lining of the intestines where it resides and sucks blood causing anemia and produce other symptoms.

How does the Infestation Occur? Cont’d When they multiply inside the intestines they form a ball which becomes so big that it obstructs intestines causing acute pain and the patient may land up in an emergency. Small thread worms come out of the anus in the night to lay eggs around, causing itching. Some worms called cysticercoids enter the stomach by eating contaminated pork or beef. They can become dangerous because they can go into the blood circulation and reach brain, heart, liver etc and prove to-be dangerous.

How does the Infestation Occur? Cont’d Bad hygiene, unwashed hands and using each others towels, handkerchief can also contribute in spread of infestation. They can also infect through eating unwashed raw vegetables and drinking contaminated water.

Signs & Symptoms Constipation / diarrhoea Abdominal pain Flatulence Anaemia Anorexia Itching of anus Pica

Signs & Symptoms cont’d Cough Dyspnoea Chest pains Large protruding abdomen Vomiting Convulsions

TREATMENT Administer prescribed “ dewormers ” Administer prescribed medications for symptomatic treatment.

Education to Mother on Prevention of Worm Infestation in Children Educate her to ensure the child washes his/her hands before and after meals and after defecation. Uncooked foods such as vegetables and fruits should be washed thoroughly before the child eats them. Mother should keep her nails short when cooking for the child. Child’s nails should also be kept short.

Education to Mother on Prevention of Worm Infestation in Children cont’d Mother should maintain good personal and environmental hygiene. Meat should be properly cooked before it is consumed. Child should be given prescribed “ dewormer ” at least every three months.

COMPLICATIONS Malnutrition Severe wasting Brain damage

THANK U FOR YOUUR ATTENTION MAY GOD BLESS YOU ALL……………. MEDAMOASE*****

irenes.pptxgft123345666777788887899777665

About This Presentation

Slide Content

Tags

Categories

Download

Quick Actions

Statistics

Related Slideshows

irenes.pptxgft123345666777788887899777665

About This Presentation

Slide Content

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

Slide 39

Slide 40

Slide 41

Slide 42

Slide 43

Slide 44

Slide 45

Slide 46

Slide 47

Slide 48

Slide 49

Slide 50

Slide 51

Slide 52

Slide 53

Slide 54

Slide 55

Slide 56

Slide 57

Slide 58

Slide 59

Slide 60

Slide 61

Slide 62

Slide 63

Slide 64

Slide 65

Slide 66

Slide 67

Slide 68

Slide 69

Slide 70

Slide 71

Slide 72

Slide 73

Slide 74

Slide 75

Slide 76

Slide 77