NURS 2513 Rasmussen College Maternal Child Nursing Discussion

NURS 2513 Rasmussen College Maternal Child Nursing Discussion

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Module 09 Discussion – Pediatric Safety

Discussion

address the current issues in pediatric healthcare-related to safety. Growth and development is important factor that should be considered along with safety in many areas of pediatric health alterations. Many times the health alterations experienced by children can be prevented if safety education is provided.

Competency

Prioritize nursing interventions when caring for pediatric clients with health disorders.

Instructions

This discussion will focus on the importance of teaching a chosen safety concern in the pediatric population. You will present your response in the discussion addressing the following questions: (discussion should be 300 words).

Initial Post:

  1. Determine the age and developmental stage and how that impacts the child related to the safety concern.
  2. Describe why you believe the safety education you chose will benefit the pediatric population. Who do you believe is the target age range for this specific educational teaching?

Urinary, Endocrine, and Metabolic Disorder

GenitourinaryThe functions of the kidney are to remove waste products, filter blood, maintain fluid and electrolyte balance (sodium, potassium, calcium, and phosphorus), maintain acid-base balance, and releasing hormones.Fluid balance is maintained by the intake, and the output of fluid in 24-hour period is approximately the same. A fluid deficit occurs when fluids are lost by diaphoresis, vomiting, diarrhea, and hemorrhage. Fluid overload occurs from conditions that create impaired fluid excretion, kidney disease, congestive heart failure, and/or the administration of excessive amounts of intravenous fluids.Children at higher risk for fluid and electrolyte imbalance because they have a proportionately more significant amount of body water, require more fluid intake and excrete more fluid. When caring for a child with fluid and/or electrolyte imbalance, it is crucial to monitor for signs of a fluid deficit, fluid excess, and electrolyte imbalance. Emergent intervention is sometimes required with IV replacement of fluids and electrolytes.
Different Types of DehydrationIsotonic dehydration is when the electrolyte and water deficits are in balanced proportions. Serum sodium remains in normal limits (130–150 mEq/L). This type of dehydration is the most common type of dehydration. The nurse should monitor for a hypovolemic shock as the most significant concern.Hypotonic dehydration is when electrolyte deficit exceeds the water deficit. Serum sodium concentration is < 130 mEq/L. Physical signs are more severe, with smaller fluid losses.Hypertonic dehydration is the most dangerous type; water loss in excess of electrolyte loss. Sodium serum concentration is > 150 mEq/L. The nurse should monitor for seizures as they are likely to occur.Some common disorders of the genitourinary tract include; urinary tract infections, vesicoureteral reflux, hematuria, acute and chronic glomerulonephritis, hemolytic uremic syndrome, and henoch-schönlein purpura, and nephrotic syndrome.
UTIUrinary tract infections (UTI) are caused by bacterium, virus, or fungus. They most often start distally and ascend at the urethral area, causing urethritis or cystitis. If the origin of the UTI is in the upper tract, ureteritis and pyelitis or pyelonephritis may result.Unique developmental-related signs and symptoms accompany UTIs.In the neonate, they should be assessed by the nurse for failure to thrive, jaundice, hypothermia, vomiting or diarrhea, cyanosis, abdominal distention, lethargy, and/or sepsis.In infants, they tend to show signs and symptoms of poor feeding, fever (primarily when related to pyelonephritis), vomiting or diarrhea, malodor of their urine, dribbling urine, abdominal pain/colic irritability, malaise, and/or poor weight gain.In the toddler and preschooler, the nurse may expect the signs and symptoms of a UTI to include abdominal pain, vomiting or diarrhea, flank pain, fever (especially when related to pyelonephritis), malodor, altered voiding pattern, diaper rash, enuresis, and/or malaise.In school-age children and adolescents, the signs or symptoms include enuresis, malodor, the Classic dysuria with frequency, urgency, and discomfort, fever/chills (especially when related to pyelonephritis), abdominal pain, flank pain, malaise, vomiting, or diarrhea.Depending on the age and ability to collect a urine sample, the diagnosis is based on urine culture and sensitivities. When the child is more intensely ill, catheterization or suprapubic aspiration (SPA) can be ordered to provide a sterile sample of urine for the culture to determine the underlying cause of the UTI, which will determine the treatment plan.In caring for a child with a UTI, it is essential for the nurse to assess for vital signs, growth, and development, pain, tenderness, mass in the flank area, or fecal impaction. Documentation should include assessment of urine odors and record intake and output, the administration of medications if an IV is ordered, and evaluation of site along with monitoring of intake and output. Parenteral and oral antibiotics are used to treat UTIs in children. Parenteral antibiotics are recommended for children with toxic symptoms, dehydration, vomiting, or noncompliance. IV antibiotics are usually given for 14 days to toxic children or those with pyelonephritis. Oral antibiotics can be used for uncomplicated cases.Primary Nocturnal Enuresis- never been dry at night for extended period. The child is unable to sense a full bladder and does not awaken to void. There is a delayed maturing of the central nervous system.
Vesicoureteral Reflux (VUR)Urine flows typically downward from kidneys in vesicoureteral reflux (VUR), urine backflows from the bladder to ureters, and sometimes back to kidneys (this occurs at the vesicoureteral junction). VUR is a common cause of UTIs in children. The signs and symptoms are recurrent UTI with flank pain, abdominal pain, and enuresis may coexist fever, nausea/vomiting, and UTI symptoms.Collaborative care includes a treatment plan that varies based on the grade of actual reflux. In more severe cases, surgical intervention may be required. When a child undergoes surgical interventions the care for nonsurgical VUR includes vigilance in preventing and treating UTIs, avoiding renal scarring and damage, monitoring for growth failure, and hypertension. Nursing should consist of a plan of care for educating family members about signs and symptoms of UTI, emphasize importance of medication in this chronic disorder, and the importance of early identification of UTIs. The child with VUR is at risk of pyelonephritis because pyelonephritis causes renal scarring and damage.
Inflammation of the GlomeruliInterference with the glomeruli filtering waste products from the blood gives rise to acute and chronic clinical manifestations. The nurse should monitor the pediatric client for signs and symptoms such as gross hematuria (either tea-colored or red urine), edema (which may be seen in the periorbital region), hypertension and headache, and in severe disease causes ascites, due to fluid shifting. The nurse needs to consider a collaborative care approach to the pediatric client with inflammation of the glomeruli. The nurse will assess pharynx and upper respiratory tract for signs of acute infection, obtain a streptococcal culture and send swab to laboratory. Monitor for hypertension, urinary output, and renal status. Initiate dietary restrictions of sodium, potassium, and fluid intake. Treat infectious sources (e.g. streptococcus) with appropriate antibiotics. Fluid imbalances require monitoring of fluid intake and output, as well as possible treatment with diuretic medications and antihypertensive drugs. Severe glomerulonephritis may require peritoneal dialysis or hemodialysis. Corticosteroids may be useful in managing the acute process.
Hemolytic-Uremic SyndromeHemolytic-Uremic syndrome is the most common cause of acute renal failure (ARF) in children. It is most commonly associated with children ingesting beef contaminated with Escherichia coli, although other organisms have been implicated. The classic symptoms are thrombocytopenia, anemia, and acute renal failure. It mostly occurs in kids six months to 5 years. A child with HUS must be in intensive care and requires dialysis. The nurse will monitor for altered levels of consciousness, signs of increased intracranial pressure, signs of congestive heart failure, bleeding, and hypertension. Strict monitoring of fluid balance is essential in the plan of care. Measure fluid intake and output every 1–4 hours, depending on the child’s condition. Take daily weights; assess electrolyte balances and arterial blood gas measurements. Measure BUN and creatinine to determine if renal status is worsening. Assess for peripheral and periorbital edema. The nurse should implement infection control measures. Possible administration of blood products to treat severe anemia.Teach families to properly cook all ground beef products to an internal temperature of 160 °F. Beef should be ordered well-done. It should no longer be pink or red. Educate clients and families about epidemic outbreaks related to produce. Apple cider, spinach, and produce should be carefully selected and/or washed (this may still not eliminate the risk of infection).
Nephrotic SyndromeNephrotic Syndrome is a disorder of the renal system in which excessive protein is excreted into the urine. The signs and symptoms of nephrotic syndrome include; edema, especially periorbital and dependent (feet, ankles), decreased urine production, possible ascites with respiratory compromise due to enlarged abdomen, hypertension, anorexia, diarrhea, and vomiting. Growth failure and muscle wasting may occur if prolonged illness. A group of syndromes leads to glomerular injury. The glomerular membranes ordinarily impermeable abundant proteins become permeable to proteins, mainly albumin. The exact cause is unknown but probably metabolic, biochemical, or immune-mediated. The peak onset is 2-7 years of age- but unknown origin. Be aware of disease manifestations and the need for possible kidney biopsy. Treat with diuretics and albumin replacement if indicated early on.
Bladder ExstrophyBladder exstrophy is a congenital disability in which the abdominal and anterior bladder walls do not fuse during fetal development. The anterior surface of the bladder is open to the abdominal wall. The tissue that usually covers the bladder does not form correctly and is separated, and the bladder is fully exposed. On delivery, visualization of the open bladder on abdominal wall is the primary determinant of the condition. Bladder extrophy is the extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause of this congenital structural defect is unknown. The nurse should expect closure of abdominal defect within first few days of life. The treatment plan may include staged surgical management for bladder and genitalia reconstruction. Monitor urinary output and monitor for signs of urinary tract or wound infection. Maintain bladder mucosa integrity. Prevent bladder tissue from drying (cover with physician-ordered dressing to protect mucosa and prevent disease until surgery). Parents will need emotional support.
Congenital/Genetic ConditionsCongenital conditions, possibly genetic, are characterized by abnormal positioning of the urethral meatus.In hypospadias, the meatus is inferior to its usual position. The opening of the urethra is below the tip on the bottom side of the penis. The foreskin is incomplete and curvature during erection.In epispadias, the meatus is superior to its usual position or described as the urethral orifice located on the dorsal surface of the penis (above the typical opening); surgical correction with possible penile urethral lengthening may be necessary.
Testicular TorsionThis condition is considered an emergency. Surgical intervention must occur within a 4 to 8-hour timeframe from the onset of symptoms, or the client risks the need for orchiectomy (testes resection). The signs and symptoms differ by age. In the neonates, their scrotum appears dusky, or a solid mass can be palpated. Scrotal edema prevents transillumination (inspection of testis by passing light through the scrotum). Minimal or no pain from testicular motion. In older males, there is severe and persistent pain, which may begin gradually.
CryptorchidismCryptorchidism is when one or both testes fail to descend through the inguinal canal into the scrotal sac. Surgery is indicated if not descended by age one.
Endocrine SystemThe endocrine system is composed of multiple organs that secrete hormones that regulate various bodily functions. The hormones act as “messengers.” The endocrine system controls growth and development as well as energy use and energy stores in children. This system also controls levels of sugar, salt, and fluids in the bloodstream. The endocrine system regulates a child’s response to stress or physical trauma and plays a vital role in sexual development. Although all endocrine glands have a role in homeostasis, the job of the hypothalamus is to communicate the messages of the central autonomic nervous system to the organs/glands of the endocrine system, thus maintaining homeostasis throughout the body.
Diabetes InsipidusDiabetes insipidus is a result of the hypofunction of the posterior pituitary gland. It is classified in 2 ways; by either a deficient production of ADH or lack of response to ADH. Diabetes insipidus leads to dilute urine and extreme thirst.Nursing care for the pediatric client with diabetes insipidus should provide and encourage a diet low in solutes. Nursing should monitor for subtle signs of impending dehydration or fluid imbalance to prevent complications, and monitor urine output and fluid intake through daily weights using standard conditions. Document accurately!Nursing interventions include the care of a child during a water deprivation test. Comfort the irritable child and use distraction methods. Accurately administer medications such as Desmopressin (DDAVP) and hydrochlorothiazide (Microzide) in combination with chlorpropamide. Emphasize the importance of closely monitoring fluid and electrolyte balance, and encourage family involvement for successful home management. Begin a log of proper intake, output, and daily weight while the child is still hospitalized for family to continue at home. Teach parents to replace fluids in very young child or infant because these clients cannot accurately express thirst or obtain a drink independently.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)SIAHD is characterized by excessive secretion of antidiuretic hormone (ADH). ADH causes the kidneys typically to conserve water. Cushing’s syndrome causes water retention, and electrolyte imbalance specifically decreased serum sodium. The result is water intoxication, and this would appear with expected signs and symptoms such as nausea and vomiting, seizures, headache, muscle cramps, weakness, personality changes, such as irritability, combativeness, confusion, drowsiness, hallucinations, stupor, and coma.When electrolyte levels decrease, especially sodium, the client will likely experience increased blood pressure, weight gain with no externally visible edema, and reduced urine output despite high specific gravity.These children experience fluid and electrolyte imbalance as electrolyte (especially sodium) levels decrease. The child becomes lethargic and confused, and they commonly have complaints of a headache.The nursing care includes recording fluid intake and output accurately, fluid restriction, and making the child’s family members aware of fluid restrictions and the need for careful monitoring and recording of intake and output. The nurse may give certain medications with meals to prevent unnecessary fluid intake. Irrigate all oral tubes with normal saline rather than water. Monitor child’s nutritional status (diet high in sodium and protein).Continually assess level of consciousness. Monitor for headache (if child can verbalize) and seizure activity can indicate severe electrolyte imbalance. Set up and implement seizure precautions at bedside. Evaluate child for fluid retention, observing for independent edema areas. Assess the child’s lungs to detect overhydration. Monitor skin turgor carefully. Communicate findings to subsequent health-care providers and nurses who will assume care for the child. Educate parents about importance of fluid balance. Teach them to take and record daily weight most crucial indicator of fluid balance. Educate to avoid excessive fluid intake, including “hidden” fluids in foods. Teach family members to measure urine output accurately. Provide necessary information, SIADH causes, signs, and symptoms.
Cushing’s SyndromeCushing’s Syndrome is a result of extended exposure to increased levels of cortisone. In young children, they are often caused by an adrenal tumor or prolonged steroid therapy. The pediatric client may exhibit signs and symptoms such as weight gain, pendulous abdomen, fatigue, muscle wasting, weakness, thin extremities, round “moon” face, facial flushing, fatty pad between shoulders (buffalo hump), pink or purple stretch marks (striae) on abdominal skin, thighs, breasts, and arms, thin and fragile skin with little subcutaneous tissue, resulting in easy bruising and slow healing, depression, anxiety, irritability, euphoria, frank psychoses, irregular or absent menstrual periods in females, erectile dysfunction in males.Nursing care will vary depending on the cause because that will determine the medical management. Steroid therapies may need a reduction to the lowest possible level required for underlying conditions. If surgery is not possible, radiation therapy is used. If surgical intervention is necessary (to remove tumors), focus on preoperative assessments, fluid hydration, postoperative assessments, and pain control. The nurse should expect to critically evaluate medication regimens and use a cortisol replacement if needed. Teach the child and family about the disease, causes, and subsequent treatments. Teach parents how to give medication (including in emergencies). Inform parents that “Cushing-like” appearance will decrease as the child recovers. Teach parents to watch for signs of adrenal insufficiency. Encourage wearing medical alert identification.
Type 1 DiabetesType 1 diabetes is an autoimmune disease that arises when a child with a particular genetic makeup is exposed to any precipitating event, such as infection (particularly a virus) or other environmental factors (such as diet). This is the most common form of diabetes in persons < 40 years. Diabetes type 1 has classic and common symptoms such as polyuria, polydipsia, weight loss, muscle wasting, polyphagia, nocturia, tachycardia, blurred vision, fatigue, and vaginal moniliasis.The following symptoms may be present as ketoacid accumulates: abdominal pain, nausea, vomiting, fruity-smelling breath, weakness, mental confusion, coma, slow, labored breathing, flushed cheeks, and face.The nursing plan of care should be individualized based on the needs of the child and family. The plan should focus on monitoring, stabilization, and education. The goals of medical management are optimal glycemic control, normal growth and development, minimizing complications, and attainment of emotional adjustment to diabetes.
Type 2 DiabetesWorldwide, the prevalence of type 2 diabetes in children and growing adolescents has climbed over the last 30 years. It is essential to note this aligns with the obesity epidemic affecting our children. The minority groups are affected to a greater extent. The screening for type 2 diabetes in children should occur at the age of 10, according to The American Diabetes Association, if they are overweight or obese and have two other risk factors in addition to their weight classification. If diagnosed, nutritional and exercise educations should be a family-centered approach as the goal should be to decrease their weight. Diet and training should be consistent with life-long practices that are considered both healthy eating and exercise practices. Metformin is the first-line treatment. Then, if hyperglycemia or A1C are indicated, insulin therapy may be ordered. Victoza is the newest non-insulin drug approved for the pediatric population with type 2 diabetes (Xu & Verre, 2018).
Diabetic Ketoacidosis (DKA)Diabetic ketoacidosis (DKA) is a complex combination of hyperglycemia, ketosis, and acidosis resulting from severely deficient insulin in either type 1 or type 2 diabetes. In the pediatric client, there is abnormal metabolism of carbohydrates, protein, and fat leads to very high glucose levels, which result in DKA. DKA is the leading cause of death in children with type 1 diabetes.Toddlers do not exhibit the classic manifestations of DKA, and children may not be able to verbalize symptoms of DKA. Listen to the parents or caregivers!!! They know their children best. Signs like fatigue, malaise, nausea/vomiting, abdominal pain, polydipsia, polyuria, polyphagia, weight loss, fever, altered mental status (the child may be alert or in a coma), tachycardia, tachypnea, hyperventilation (Kussmaul respirations), normal or low blood pressure, increased capillary refill time, poor perfusion, lethargy, weakness, and acetone (fruity) odor of breath (which indicates metabolic acidosis).Diagnosis in children is confirmed by blood glucose > 250 mg/dL, ketonuria, or ketonemia with serum bicarbonate level < 18 mEq/L, and blood pH < 7.34 (level indicates degree of acidosis).The nursing care is based on four essential physiologic principles: 1) Restore fluid volume 2) Return child to the glucose-utilization state by inhibiting lipolysis 3) Replace the child’s body electrolytes, 4) Correct acidosis. During the restoration of acid-base balance, assess child frequently, rapidly, and accurately, expect to quickly change intravenous solutions and adjust plan before one therapy is completed, and observe and document child’s response to each intervention. Know the sound of Kussmaul breathing. Keep parents informed and as calm as possible.Teaching for the client and family should be directed at preventing DKA. Teach the family to check and recheck blood glucose levels or urine ketone levels if the child is sick (vomiting) or if the blood glucose level is > 240 mg/dL. Help parents feel comfortable with the child’s management plan before discharge. Help the family plan meals and insulin administration to give child most normal blood glucose level on average (HbA1c). Inform parents about the importance of maintaining normal blood glucose levels to avoid long-term complications.Although all endocrine glands have a role in homeostasis, the job of the hypothalamus is to communicate the messages of the central autonomic nervous system to the organs/glands of the endocrine system, thus maintaining homeostasis throughout the body.
Source(s)Arslanian, S., Bacha, F., Grey, M., Marcus, M. D., White, N. H., & Zeitler, P. (2018). Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes Care41(12), 2648–2668. Retrieved from https://care.diabetesjournals.org/content/41/12/26… Xu, & Verre, M. C. (2018). Type 2 diabetes mellitus in children. American Family Physician98(9), 590-594. Retrieved from https://search.ebscohost.com/login.aspx?direct=tru…
  1. Determine the age and developmental stage and how that impacts the child related to the safety concern.
  2. Describe why you believe the safety education you chose will benefit the pediatric population. Who do you believe is the target age range for this specific educational teaching?
  3. Describe at least three nursing diagnoses related to the incident you are providing teaching to prevent. Support your choices with rationales citing 1-2 scholarly sources.

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