Common Health Problems

• Intussusception


  Invagination of one portion of the intestine into another
• Intussusception


  • Occurs for idiopathic reasons
  • Developed by most children after administration of rotavirus vaccine
  • Children may draw up legs, cry as if in severe pain and may possible vomit at approximately every 15 to 20 minutes
  • In 12 hours blood in stool may develop
  • Abdomen becomes distended
• Necrosis of invaginated portion must be prevented
• Signs of necrosis in intussusception

  • Elevated temperature
  • Peritoneal irritation
  • Tender abdomen
  • Increased WBC
  • Rapid pulse
• Intussusception is confirmed by sonogram
• Nursing management of intussusception

  1. Assist in surgery to straighten the invaginated portion or reduction (water-soluble solution, barium enema or pneumatic insufflation)

  2. After treatment children are to be observed for 24 hours for reoccurrence

  3. Provide guidance and support to parents
• Imperforate anus


  Occurs in approximately 1 in 5,000 live births; common in boys than in girls
• Imperforate anus may occur as an additional complication of spinal cord defect
• Initiate wink reflex in imperforate anus
• Abdominal distention may be evident in imperforate anus
• 1. ray or sonogram will reveal the defect in imperforate anus
• Assess if infant has pass stool 24 hours after birth in imperforate anus
• Nursing management of imperforate anus

  1. Collect a urine specimen from infant to assist in anastomosis

  2. Assist in temporary colostomy when repair is complicated

  3. Upon repair no rectal temperature taking, enema and rectal suppository

  4. Do not place infant on the abdomen

  5. After repair infant may need rectal dilatation twice a day for few months

  6. Administer stool softener as prescribed

  7. Provide support to parents
• Spina bifida


  Occurs when the posterior laminae of the vertebrae fail to fuse commonly at the 5th lumbar or first sacral
• Causes of spina bifida

  Congenital defects and folic acid insufficiency
• Types of spina bifida


  • Spina bifida occulta
  • Spina bifida meningocele
  • Myelomeningocele
• Nursing management of spina bifida

  1. May not need immediate surgery

  2. Provide support to parents

  3. Minimize risk of infection
• Failure to thrive (FTT)

  A unique syndrome in which an infant falls below the fifth percentile for weight and high on standard growth chart
• Causes of FTT


  Non-organic and organic
• Characteristics of FTT


  • Lethargy
  • Inability to resist
  • Rocking on all (4)
  • Reluctant to reach toys
  • Starves for human contact
• Nursing management of FTT

  1. Ensure adequate nutrition

  2. Nurture the child

  3. Support and encourage parents

  4. Ensure evaluation and follow-up
• Colic


  Paroxysmal abdominal pain occurs in infants under 3 months of age
• Causes of colic


  • Overfeeding and swallowing
  • Formula-fed babies are more likely to have colic
• Nursing management of colic

  1. Allow infant to burp after feeding

  2. Determine infant's feeding pattern

  3. Place hot water bottle on infant's abdomen

  4. Car rides, music boxes

  5. Maintain upright position in feeding infant
• Cleft lip and palate

  The fusion of the maxillary and median nasal processes normally occurs between weeks 5 and 8 and the palatal process closes at weeks 9 to 12 of intrauterine life
• Cleft lip and palate occurs approximately 1 in every 700 live births
• Causes of cleft lip and palate

  • Familial tendency or most likely occurs from transmission of multiple genes
  • Cleft palate is a component of many syndromes
  • Cleft lip may be detected by sonogram
• Nursing management of cleft lip and palate

  1. Assist in cleft lip surgical repair shortly after birth and sometimes between 2 to 10 weeks

  2. Reinforce to parents that a revision of the original repair may be necessary when the child reaches 4 - 6 years of age

  3. Inform parents that repair of cleft palate is usually postponed until child is 6 – 18 months old

  4. Show parents photographs of babies with good repairs to assure them that their child's outcome can be a success

  5. Assist feeding using specialty feeding devices
• Hirschsprung's disease (Aganglionic megacolon)


  Absence of ganglionic innervation to the muscle of a section of the bowel
• Hirschsprung's disease

  • Results in chronic constipation or ribbon-like stools
  • Occur at a greater incidence in siblings of a child with the disorder
  • Caused by an abnormal gene on chromosome
  • Symptoms in newborn – 6 to 12 months
• Nursing management of Hirschsprung's disease

  1. Assist in anorectal manometry

  2. Assist in temporary colostomy followed by bowel repair at 12 to 18 months of age

  3. Before surgery, the child may be prescribed daily enemas (using PNSS) to achieve bowel movements
• Hydrocephalus

  An excessive cerebrospinal fluid (CSF) in the ventricles and subarachnoid spaces of the brain
• Types of hydrocephalus

  • Communicating hydrocephalus / extraventricular
  • Obstructive hydrocephalus / intraventricular
• Causes of excess CSF in newborn with hydrocephalus

  • Overproduction by a choroid plexus in the first or second ventricle
  • Obstruction of passage of fluid between point of origin and point of absorption
  • Interference with the absorption of the fluid from subarachnoid space
• Hydrocephalus occurs at 3 to 4 per 1,000 live births; it could be congenital or acquired
• Signs and symptoms of hydrocephalus

  • Prominent scalp veins
  • Bossing of forehead
  • Enlarged fontanelles
  • Sunset eyes
  • Shrill cry
  • Hyperactive reflexes
  • Separated suture lines
  • Increased head circumference
  • Lethargy or irritability
  • Signs of increased intracranial pressure (PTRB)
• Hydrocephalus can be demonstrated by sonogram, CT scan, MRI and Transillumination
• Nursing management of hydrocephalus

  1. Administer acetazolamide (Diamox) as ordered

  2. Assist in CSF bypass (V-P Shunt or V-A Shunt)

  3. Administer oxygen as ordered

  4. Monitor intake and output closely

  5. Obtain daily weight

  6. Encourage mother to breastfeed
• Acute otitis media


  Inflammation of the ear is the most prevalent disease among children after RTI
• Acute otitis media


  • Occurs most often in children 6-36 months of age and again at 4-6 years
  • Seen most frequently in males and children with cleft palate
  • Higher incidence in formula-fed infant rather than those who are breast-fed
  • Caused by streptococcus pneumoniae, haemophilus influenzae, group A beta hemolytic streptococci
  • If not treated, it could lead to hearing impairment
  • Generally follows a respiratory infection