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• Asthma


  Chronic inflammatory disorder of the respiratory tract and the most common chronic illness in children
• Asthma pathophysiology

  Allergen invasion > Mast cells release histamine and leukotrienes > Inflammation/Bronchoconstriction/Increased mucus production > Obstruction in the airway
• Pneumonia


  Infection and inflammation of the lung parenchyma associated with alveolar edema and congestion that impaired gas exchange. Spread to droplets or by contact.
• Tetralogy of Fallot


  A syndrome of four defects: ventricular septal defect (VSD), pulmonary artery stenosis, overriding aorta that straddles the VSD, and right ventricular hypertrophy. The right ventricular hypertrophy is not an isolated problem but occurs secondary to the pulmonary stenosis.
• Sickle Cell Anemia


  An autosomal recessive inherited disorder carried on the beta chain of hemoglobin; the amino acid valine takes the place of the normally appearing glutamic acid. The erythrocytes appear elongated and crescent-shaped (sickled) when they are submitted to low oxygen tension (less than 60% to 70%), low blood pH (acidosis), or increased blood viscosity. When RBCs sickle, they cannot move freely through the vessels.
• Aorta


  The main artery that carries blood from the heart to the rest of the body
• Drug Therapy

  The use of medications to treat or manage a medical condition
• Sample Drug Study
• Propranolol


  A beta blocker medication
• Propranolol


  • Route: Oral/IV
  • Indication: To prevent tet spells; increase venous circulation
  • Action: Competes with sympathomimetic neurotransmitters for binding to receptors, which inhibits sympathetic stimulation of the heart
  • Dosage: 0.6 mg/kg (Oral)
• Sickle Cell Anemia


  An autosomal recessive inherited disorder carried on the beta chain of hemoglobin; the amino acid valine takes the place of the normally appearing glutamic acid
• Sickle Cell Anemia Pathophysiology

  1. SCA > Blood deoxygenation > Polymerization > Damaged RBC > Vascular occlusion > Pain / Tissue Infarctions / Swelling

  2. SCA > Stasis / Further sickling > Blood flow halts / Tissue distal to the blockage becomes ischemic > Acute pain / Cell destruction
• Sickle Cell Anemia Symptoms

  • Tachycardia, cardiomegaly, chronic fatigue, unexplained dyspnea, hepatomegaly, joint swelling, aching bones, or chest pain
  • Severe pain in the abdomen, thorax, muscle, or bones
  • Jaundice, dark urine, and low-grade fever due to blood vessel obstruction by rigid, tangled, sickle cells leading to tissue anoxia and possibly necrosis
• Sickle Cell Anemia Complications

  • Retinopathy, nephropathy,and cerebral vessel occlusion due to organ infarction; hypovolemic shock and death due to massive entrapment of cells; necrosis; infection; and gangrene
• Sickle Cell Anemia Diagnostic Tests

  • Positive family history and typical clinical features confirm diagnosis
  • Hb electrophoresis shows Hb S
  • Electrophoresis of umbilical cord blood provides screening for all neonates at risk
  • Stained blood smear shows sickle cells
  • Blood studies reveal low RBC counts, elevated WBC and platelet counts, decreased erythrocyte sedimentation rate, increased serum iron levels, decreased RBC survival, and reticulocytosis (Hb levels may be low or normal)
  • Lateral chest X-ray shows "Lincoln log" deformity
  • Neonatal screening for Hb abnormalities
• Sickle Cell Anemia Nursing Diagnoses

  • Ineffective Tissue Perfusion r/t vaso-occlusive crisis
  • Chronic Pain
  • Risk for Decreased Cardiac Output
• Sickle Cell Anemia Independent Nursing Interventions

  • Apply warm compresses to painful areas. Encourage bed rest, and place the patient in a sitting position
  • During remissions advise the patient to avoid tight clothing that restricts circulation and conditions that provoke hypoxia, such as strenuous exercise, vasoconstricting medications, cold temperatures (including drinking large amounts of ice water and swimming), unpressurized aircraft, and high altitude
  • Emphasize the need for prompt treatment of infection
  • Tell parents to encourage the child to drink more fluids, especially in the summer
  • Provide emotional support to the family and refer them to resource groups as indicated
• Sickle Cell Anemia Collaborative Nursing Interventions

  • During a crisis, administer analgesic-antipyretics as ordered
  • Administer oxygen, as ordered
• Sickle Cell Anemia Treatment

  • Packed RBC transfusion to correct hypovolemia (if Hb levels decrease)
  • Sedation and analgesics, such as morphine, for pain
  • Oxygen administration to correct hypoxia
  • Large amounts of oral or IV fluids to correct hypovolemia and prevent dehydration and vessel occlusion
  • Prophylactic penicillin before age 4 months to prevent infection
  • Hydroxyurea to reduce painful episodes by increasing production of fetal Hb
  • Iron and folic acid supplements to prevent anemia
• Morphine Sulfate


  An opioid analgesic medication
• Morphine Sulfate


  • Route: Oral solution
  • Indication: For management of chronic, moderate to severe pain
  • Action: Binds with opioid receptors within CNS, inhibiting ascending pain pathways
  • Dosage: 0.08-0.1 mg/kg
• Hirschsprung's Disease


  An absence of ganglion innervation to the muscle of a section of the bowel–in most instances, the lower portion of the sigmoid colon just above the anus
• Hirschsprung's Disease Pathophysiology


  Parasympathetic NS fails to produce intramural ganglion cells in the enteric nerve plexuses > Section of the colon becomes immotile > Functional intestinal obstruction in the affected area > Section becomes distended with feces
• Hirschsprung's Disease Symptoms


  • Mild to severe chronic constipation
  • Diarrhea (liquid can only pass through the aganglionic section)
  • Thin, undernourished appearance
  • Distended abdomen
  • History of not having a bowel movement more than once a week of ribbonlike or watery stools
• Hirschsprung's Disease Complications


  • Enterocolitis, tissue destruction (due to the severe edema of the colon, obstructing blood and lymphatic flow)
  • Gram-negative sepsis (bacteria infiltration in the bowel wall from the lumen)
• Hirschsprung's Disease Diagnostic Tests

  • Rectal biopsy that demonstrates the aganglionic bowel; a more definitive diagnosis
  • Anorectal manometry - tests the strength of the internal rectal sphincter by inserting a balloon catheter into the rectum and measuring the pressure
  • Rectal Exam - in true constipation, the examining finger will touch hard, caked stool. In HD, the rectum is empty because fecal material cannot pass through the rectum
  • Barium enema (X-ray) or UTZ - outline the narrow, nerveless portion and large proximal distended portion of the bowel
• Hirschsprung's Disease Treatment

  • Resection and removal of the aganglionic segment with anastomosis of the intestine (pull-through operation)
  • Constant attention to bowel hygiene
• Gentamicin


  An aminoglycoside antibiotic medication
• Gentamicin


  • Route: IV
  • Indication: For treatment of enterocolitis
  • Action: Passes through the gram-negative membrane in an oxygen-dependent active transport
  • Dosage: 2.5 mg/kg
• Hirschsprung's Disease Nursing Diagnoses

  • Imbalanced Nutritions; less than body requirements r/t reduced bowel function
  • Constipation r/t decreased bowel motility
  • Risk for Impaired Skin Integrity r/t irritation from the colostomy
• Child ingests a low-residue diet; weight follows a percentile curve on a growth chart
• Hirschsprung's Disease Independent Nursing Interventions

  • Maintain fluid balance. Monitor I/O. Report unusual drainage
  • Promote comfort. Observe signs of pain, such as crying, pulse, and respiration rate increases, restlessness, guarding of the abdomen, or drawing up the legs
  • Advise parents on the importance of adhering to the prescribed diet (full fluids > soft diet > minimal-residue diet > normal diet)
  • Provide family teaching. Show the family caregiver how to care for the colostomy at home; discuss topics such as devices and their use, daily irrigation, and skin care
• Hirschsprung's Disease Collaborative Nursing Interventions

  • Administer total parenteral nutrition, as ordered
• Acute Gastroenteritis


  Inflammation of the lining of the stomach and small and large intestines
• Acute Gastroenteritis Pathophysiology

  1. Damage to the villous brush border of the intestine > Malabsorption of intestinal contents > Osmotic diarrhea

  2. Release of toxins > Binds to specific enterocyte receptors > Release of Cl- into intestinal lumen > Secretory diarrhea
• Acute Gastroenteritis Symptoms


  • Diarrhea (loose, watery stools)
  • Dehydration
  • Vomiting
  • Dysuria
  • Abdominal pain
  • Infection (fever, chills, myalgias, rash, rhinorrhea, sore throat, cough)
  • Poor skin turgor
  • Dry lips and oral mucosa
• Acute Gastroenteritis Diagnostic Tests

  • Stool exam - stool specimens are collected for culture and sensitivity testing to determine the causative infectious organism
• Acute Gastroenteritis Treatment


  • Oral rehydration solution (ORS) - for mild-to-moderate gastroenteritis
  • NG Feeding - for patients who do not tolerate ORS
  • IV rehydration - for severe dehydration
  • Diet - normal diet ASAP through small, frequent meals
• Metronidazole


  A nitroimidazole antibiotic medication
• Metronidazole


  • Route: IV/Oral
  • Indication: Used to treat gastrointestinal infections; in H. pylori infections; taken with Amoxicillin
  • Action: Diffuses into the organism, inhibits protein synthesis by interacting with DNA, and causes a loss of helical DNA structure and strand breakage
  • Dosage: 15-20 mg/kg