Week 15 Discussion: Maternal – Child Nursing
What are the symptoms of epiglottitis and how is it treated? Symptoms Unlike croup, epiglottis has an abrupt onset w/rapid progression of symptoms. Often parents report that the child was put to bed well and awakened w/a severe sore throat and difficulty swallowing. The child demonstrates a high fever and appears to be in a toxic condition and very ill. The accompanying sore throat can progress to acute respiratory distress in a few hours. The child appears anxious and frightened and may be irritable or lethargic. One of the classic signs of epiglottis is that the child insists on sitting upright, often in a tripod position (leaning forward supported on the arms), with the chin thrust out and the mouth open. Respiratory symptoms include nasal flaring, suprasternal, substernal, and intercostal retractions; pale skin color to cyanosis (depending on the degree of airway obstruction); and tachycardia. The epiglottis appears edematous and cherry red (most reliable diagnostic sign of epiglottitis). Cardinal Signs and Symptoms of Epiglottitis
Drooling Dysphagia (difficulty swallowing) Dysphonia (difficulty talking) Distressed Inspiratory Efforts
Do not examine or obtain material for culture from a child’s throat if epiglottitis is suspected because any stimulation w/a tongue depressor or culture swab could trigger complete airway obstruction. TX Achieve a patent airway as quickly as possible. The child w/epiglottitis has an edematous epiglottis, which can completely obstruct the airway at any time. Radiographs are best obtained at the bedside, where the child can be constantly monitored and emergency equipment is readily available. The danger of airway obstruction is so great that usually all invasive procedures, such as venipuncture, are postponed until the child is intubated. Once the airway is secured, the child is transferred to the intensive care unit. Oxygenation status is closely monitored w/arterial blood gas values or pulse oximetry, and humidified oxygen is administered. Mechanical ventilation is sometimes instituted. Throat and blood specimens are obtained for culture after the child is intubated. Antipyretics are given for fever. Antibiotics are administered IV until the child is extubated. Usually the child improves dramatically after 48 hours of antibiotic therapy and can be extubated at this time. The usual course of treatment is 7 to 10 days. Discharge occurs in about 3 to 7 days, and the child is sent home on a regimen of oral antibiotics. Do not leave a child w/epiglottitis unattended. Jennifer Cook
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Week 15 Discussion: Maternal – Child Nursing
Why are children more prone for respiratory illnesses than adults? Children have more immature immune systems, smaller upper and lower airways, and underdeveloped supporting cartilage. Although most respiratory infections are self-limiting, in infants and young children respiratory distress can occur quickly as mucus and edema obstruct their small airways. List the signs of respiratory distress in an infant. Tachypnea (most common sign of respiratory distress), Retractions (result when the soft tissue around the bones of the chest is drawn in w/the effort of pulling air into the lungs), Flaring of the Nares, Cyanosis, Grunting, Seesaw or Paradoxical Respirations (chest falls when the abdomen rises and the chest rises when the abdomen falls), Asymmetry (decreased movement on one side) may indicate the collapse of a lung – pneumothorax.
Jennifer Cook
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Week 15 Discussion: Maternal – Child Nursing
What are the assessment findings in a child with congenital hip dysplasia? When Developmental Dysplasia of the Hip (DDH) is present at birth, it is called Congenital. The symptoms of DDH vary according to age. In neonates, it is characterized by instability of the hip; the femoral head can be displaced partially (subluxated) or fully (dislocated) from the acetabulum by the examiner. The hip may also rest in a dislocated position and be reduced on examination. This can be detected by performing the Ortolani and Barlow tests or by observing significant changes in the morphology of the hip on sonograms. Infants beyond the newborn period exhibit asymmetry of the gluteal skinfolds when lying w/legs extended against the examining table (or when infant is held upright w/legs dangling). The affected hip has a limited ROM, and asymmetric abduction is present when the child is placed supine w/knees and hips flexed. The femur on the affected side appears to be shorter than the other side. The symptoms range from lax ligaments to contractures and stiffness in the affected hip joint or joints. Any abnormalities in an older child’s gait need to be carefully evaluated as possible signs of the condition. Walking children may exhibit limping, toe-walking, or a waddling gait. Bilateral dysplasia is always more difficult to identify than unilateral dysplasia because no normal hip can be used for comparison. What is vesicoureteral reflux and what type health problems does it cause. What Is It? Defect at Vesicoureteral Junction
Valve-like mechanism at junction of ureter and bladder fails to prevent reflux Does not close under pressure when urine fills the bladder or contracts during voiding Congenital abnormality (mostly) Graded I through V o Grade I (Reflux into ureter only, no dilation) o Grade II (Reflux into ureter, pelvis, and calyces) o Grade III (Mild dilation of ureter and renal pelvis o Grade IV (Moderate dilation of ureter, pelvis, and calyces o Grade V (Gross dilation of ureter, pelvis, and calyces)
Health Problems It Causes Results in UTI
Pyelonephritis results in renal damage and scarring – caused by urine being carried up to the kidney. o Severe VUR; Grade V – includes gross dilation and reflux involving the kidney. Reflux into lower ureter creates urine residual (Medium for bacterial growth)
Jennifer Cook
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Week 15 Discussion: Maternal – Child Nursing
What is cryptorchidism? Undescended or hidden testes. It occurs when one or both testes fail to descend through the inguinal canal into the scrotal sac. It is a common urologic problem. The cause is unknown. What is a neural tube defect? Define each type. What Is It? (NTD) A congenital defect in the closure of the bony encasement of the spinal cord or of the skull. Types
Spina Bifida – most common type. It occurs when the neural tube does not close completely. There are several common types including: o Spina bifida occulta is the mildest form, and most experts do not consider it to be a true neural tube defect. There is a small gap in the spine but no opening or sac on the back. The nerves and spinal cord are not damaged, and the defect usually does not cause any disability. Consequently, spina bifida occulta sometimes is called “hidden” spina bifida.2 o Closed neural tube defect is a malformation of the fat, bone, or membranes. In some persons, it causes few or no symptoms, but other people might experience partial paralysis or other symptoms. In some cases, the only outward sign might be a dimple or tuft of hair on the spine.3 o Meningocele includes a sac of fluid that protrudes through an opening in the back, but the spinal cord is not involved. Some people will have no symptoms, and some people will have more severe problems.2 o Myelomeningocele is the most severe and also the most common form of spina bifida. In this condition, the bones of the spinal column do not form completely, which causes some of the spinal cord and tissues covering the spinal cord to bulge out of the opening. A person with this condition usually has partial or complete paralysis in the parts of the body below the spinal column abnormality. Bowel and urinary dysfunction are common. Children with myelomeningocele may develop hydrocephalus (excess fluid on the brain). Hydrocephalus can lead to intellectual and learning disabilities. Some infants born with myelomeningocele have severe intellectual disabilities. Anencephaly – nonclosure of the spinal cord. It is more severe by less common. This condition occurs when the neural tube fails to close at the top. The fetus has little or no brain matter and also may be lacking part of its skull. Infants born with this condition are usually unconscious as well as deaf and blind and unable to feel pain. They may have reflex actions, such as breathing and responding to touch. All infants with anencephaly are stillborn or die soon after birth.
Jennifer Cook
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Week 15 Discussion: Maternal – Child Nursing
Encephalocele - another rare type of neural tube defect occurs when the tube fails to close near the brain and there is an opening in the skull. The brain and membranes that cover it can protrude through the skull, forming a sac-like bulge. The infant may have other problems as well, such as hydrocephalus, paralysis of the arms and legs, developmental delays, intellectual disabilities, seizures, vision problems, a small head, facial and skull abnormalities, and uncoordinated movements (ataxia). Despite the various disabilities and developmental effects, some children with this condition have normal intelligence. Iniencephaly - another rare but severe type of neural tube defect, is diagnosed when the infant’s head is bent severely backward. The spine is exceptionally distorted. Often, the infant lacks a neck, with the skin of the face connected to the chest and the scalp connected to the back. Other abnormalities may exist as well, such as a cleft lip and palate, cardiovascular irregularities, anencephaly, and malformed intestines. Infants born with this condition usually do not live longer than a few hours.
References In addition to our PowerPoint presentations for this class, I also used the following: McKinney, E. (2013). Maternal-child nursing (Fourth ed.). St. Louis, Missouri: Elsevier/Saunders. Neural Tube Defects (NTDs): Condition Information. (n.d.). Retrieved from https://www.nichd.nih.gov/health/topics/ntds/conditioninfo/Pages/default.aspx
Jennifer Cook
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