Nursing management of children with intestinal worms

the presentation outlines the nursing management of children with dfferent types of intestinal worms

1. Worms in children

2. Objectives State common worms that affects children Explain the sources of infection Explain the life cycle of the worms State the clinical presentation Discuss the management of worms(nursing and medical) Discuss the prevention measures

3. introduction Children are usually affected with worms because they usually play in the soil. It is determined by the local habits of disposal of human excreta. If poor more infections,

4. Common helminths Worm Source of infection Mode of entry into human host Ascaris Fecal contamination of soil and vegetables Eggs swallowed trichuris Eggs swallowed enterobuis Person to person. hands to anus to mouth Eggs swallowed Trichinella Meat esp. pork Encapsulated larvae swallowed Hookworms Damp ground, skin contact Filariform larvae penetrate the skin Strongyloides Damp ground, skin contact Filariform larvae penetrate the skin filaria Blood sucking insects Filariform larvae deposited through insect bites

5. Ascaris lumbricoides (round worm) The largest round worm infesting human beings. Females can be 400mm in length. It is white pink in colour and tapers at both ends with the posterior end of the male being curved.

6. Life cycle The ova is laid especially in moist clay soil and matures within 15 days. Children playing in contaminated soil or eating vegetables contaminated may be infected. The larvae hatches rapidly in the deoudenum , penetrates the bowel wall and enter the lymphatic circulation. When the reach the lung they burrow into the alveoli and make their way up to the pharynx, are then swallowed and finally come to mature in the gut.

7. Pathophysiology of manifestations Respiratory tract infections like bronchospasms , pneumonia as a result of migration of the larvae through the lungs. Intestinal symptoms as a result of large no. of worms in the lumen of the gut, causing worm boluses leading to colic , intestinal obstruction due to worms migrating to the orifices of the appendix, bile and pancreatic duct. Reduced appetite due to worm interference of digestion and absorption in the gut.

8. Investigations Stool microscopy Abdominal x-rays Nursing management Adequate sanitation Medical management Mebendazole 100mg bd for 3 days Albendazole 200mg stat dose if 2 – 5 yrs and > 5yrs 400mg

9. Whip worms The worm has a whip like anterior portions . Common in in warm moist areas Life cycle Eggs mature in 3 weeks in soil After ingestion larvae hatch in the terminal ileum and caecum and full maturation occurs in 3 months. There is involvement of the ascending colon, sigmoid and rectum.

10. Clinical manifestations Usually asymptomatic depends on coexisting bacteria and parasites Chronic diarrhea with mucoid stools Anemia Rectal prolapse Marasmus /failure to thrive Acute appendicitis

11. Investigations Inspection will reveal fresh coloured whip like structures that attach to the mucous membrane. Treatment Mebendazole 100mg bd for 4 days Albendazole 400mg od for 3 days

12. Hookworms These are small worms that live attached to the deudenal mucosa from which they suck the blood. Common in school going children.

13. Lifecycle Eggs hatch within 24 hours when deposited in soil The infective filariform larvae penetrate the human skin through soles of bale feet and are conveyed to the lungs and heart where they migrate to the respiratory passages . Then maturation occurs in upper smal l intestines The worm attach themselves to the mucosa and cause loss of minute amounts of blood. It takes 7 – 10 weeks for the eggs to be deposited in the stool.

14. Clinical manifestations Irritating papulovesicular dermatitis esp. feet Bronchospasms and pneumonia Epigastric pain Peptic ulceration due to attachment of the worms to upper mucosa. Pica Bloody diarrhea

15. Treatment Mebendazole 100mg bd for 3 days Albendazole 400mg stat if > 2 yrs Prevention Wearing of shoes Improve sanitation

16. Tape worms These are segmented flat worms that consists of head which is attached to the gut. Eggs are ingested by the susceptible intermediate hosts. Treatment Praziquatel 40mg/kg stat or mebendazole 100mg bd for 6 days.