1. Compare and contrast the symptoms, treatment, and immunizations for the following preventable communicable diseases: diphtheria, tetanus, pertussis, rubeola, mumps, rubella, varicella, and poliomyelitis. State one nursing consideration for each disease.

-With diphtheria the symptoms include sore throat, fever and generalized aching, malaise, and weakened child’s cardiac muscle. Treatments include antibiotic prophylactics. Immunizations include DTap, DT and Td vaccine. The child will require close observation.

Tetanus symptoms include convulsive contractions of all voluntary muscles. Immune globulin, given IM injection, is the immediate treatment of unimmunized individuals exposed to material likely to contain the tetanus bacteria. Immunization include tetanus toxoid and tetanus antitoxin in the event of deep cut or puncture wound. Residual weakness may occur for a prolonged period of time.

Pertussis or whooping cough is highly contagious and symptoms include bronchitis, slight temperature elevation, worsening cough, paroxysms of coughing, characterized by a “whooping” sound, and may vomit or become dyspneic (labored breathing) due to coughing so hard. Treatments include antibiotics. It is prevented with diphtheria, tetanus, acellular pertussis (DTP, DTaP) immunization. These children need close supervision because respiratory difficulties and nutritional problems are likely to occur.

Rubeola is common “measles,” “red measles,” and its symptoms include slight temperature elevation, a runny nose, watery eyes, bluish-white pinpoint spots with a red rim, called Koplik’s spots, in the mouth, small dark-red areas on the face and spread downward throughout the body, frequent sneezinh, sore eyes, and the discharge becomes purulent; light hurts the eyes (photophobia). The skin also begins to flake off in tiny powder-like flakes (desquamation) for 5 to 10 days. The child itches all over; therefore, soothing, antipruritic nursing measures are important to manage itching. Treatments include use of antibiotics to treat symptoms. Immunizations include two injections of the live, attenuated measles, mumps, and rubella (MMR) vaccine. It is transmitted through direct contact with an affected individual and through airborne droplets.

Mumps is also known as epidemic parotitis, and its symptoms include swelling of the parotid gland on one side or both, a low-grade fever, headache, general malaise before the swelling appears, painful swollen gland, and uncomfortable opening the mouth and eating. Treatments include antiviral medications. Immunization is a mumps vaccine. The disease is considered communicable until the swelling disappears.

Rubella or “German measles” symptoms are similar to rubeola but less severe. ; spots do not appear on the oral mucous membrane. Sometimes the facial rash is the first noticeable sign of infection. Swelling of the lymph nodes in the occipital region is another symptom often seen. The rash spreads quickly and disappears just as rapidly. Immunizations is done with the MMR vaccine. There is no treatment for rubella. Rubella can cause serious fetal malformations if a pregnant woman contracts the disease.

Varicella or chickenpox symptoms beings with fever. Then rash appears on the face and trunk and then develops into blisters surrounded by a red ring. The eruptions proceed from papules (red, elevated skin areas), to vesicles (blister-like elevations filled with serous fluid), to pustules (filled with lymph or pus), and finally to flat crusts that fall off in 1 to 3 weeks. Treatments include antihistamines (Benadryl, Periactin), acyclovir (Zovirax) and antipruritic to treat fever and itching. Chickepox vaccine is used as a preventative immunization method. Varicella is caused by the same virus that causes herpes zoster (shingles).

Poliomyelitis injures the CNS and can cause temporary or permanent paralysis and weakness. Treatments include bed rest, antibiotics for secondary symptoms, and analgesics for pain. Immuniztion include inactivated parenteral vaccine. The live polio can be transmitted through fecal matter; therefore good personal hygiene is essential.

2.         Compare and contrast the symptoms of streptococcal infections and roseola. Identify at least one nursing consideration for each: scarlet fever, “strep throat,” and rheumatic fever.

-Group A beta-hemolytic streptococcal infections (GABHS) are fairly common among children older than 2 years. The infectious bacterias are normally found in the respiratory, alimentary, and female genital tracts, and thus symptoms include irritation of respiratory, alimentary and female genital tract systems. GABHS is spread by direct contact and large droplets

Roseola is a benign disease of infancy. A very high fever lasting a few days is followed by a rash appearing first on the trunk and then spreading to the neck, face, and extremities when the child’s temperature falls. Theorists believe a virus causes roseola, which is not as communicable as many other diseases. The affected child may experience febrile seizures, but other complications are rare.

Scarlet fever is also known as scarlatina. The child has to be kept on bed rest until symptoms resolve, and administer antibiotics. Prognosis is favorable when scarlet fever is treated promptly.

Strep throat children must finish their prescribed antibiotic to ensure complete eradication of the bacteria, even if symptoms improve before the medication regimen is completed. A second course of antibiotics may also be necessary.

A rheumatic fever child has high possibility of susceptible to recurrences, which place them at a greater risk for heart damage. Continuing medical care with antibiotic prophylaxis for dental work and invasive procedures is essential.

3.         Compare and contrast the treatment and control of common parasitic infections in children, including scabies, lice, pinworms, giardiasis, roundworms, and hookworms. Identify at least two family teaching concerns for each.

Scabies: It is a mite that is easily transmitted among children. The entire family needs to be treated when infestation occurs.  A nonjudgmental and supportive attitude is essential when providing family teaching since they are embarrassed that their children got infected. Teach family household-control measures.

Lice: Wet combing can be done every two to three days over few weeks period, with small sections of hair, working out from the scalp. Check all household members and treat only if lice or nits are seen. If a child is younger than 2 years, comb to remove lice and nits but do not use over-the-counter anti-lice agents. A prescription product is available from your doctor.

Pinworms treatment consists of the administration of anthelmintics (anti-worm medications). Children need to be taught good hygiene habits and often put their dirty fingers into their mouths. Family member may need to take anthelmintics as well.

Giardiasis’ drug of choice for treatment is Metronidazole. The ingestion of contaminated water is a common protozoan infection so water needs to be tested where contamination is likely. Immune resistance is also an important factor so good nutrition may help.

Roundworms are transmitted in feces used as fertilizer, so fertilizer may need to be tested carefully. Anthelmintic agents kill specific types of worms. Examples include mebendazole and albendazole, which kill roundworms and tapeworms. Child needs to be seen by a physician after initial sign of diarrhea and intestinal obstruction. Living conditions needs to be kept clean.

Hookworms destroy red blood cells (RBCs), thereby causing anemia. Blood and ova may be found in the stool. Bathroom needs to be kept clean. Iron supplements may need to be taken.

4.         Discuss at least two nursing considerations for each of the following common injuries: fractures, lacerations, cuts and puncture wounds, foreign objects, and animal bites.

-Fracturs: some are due to abuse. When a child is in a cast or traction, check his or her circulation by observing skin color, sensitivity, temperature, motion, and pulse distal to the injury.

Lacerations, cuts and puncture wounds: apply antiseptics and dressings, and send children for x-ray examinations if necessary to determine the presence of fractures. A viable preventive measure is for family caregivers to keep such objects out of children’s reach.

Foreign objects: Young children need close observation from family caregivers to avoid injuries resulting. Hazardous foreign objects need to be put away in areas not reachable by children.

Animal bites: Children should be warned never to go near a dog that is eating (even their own family dog) or to pet any unfamiliar dog. A cat scratch often becomes infected more easily than a dog-related injury.

5.         Identify at least two methods of prevention and treatment for each of the following: burns, poisoning, suffocation, and drowning.

Burns: pressure garments are frequently used to prevent contractures and scarring.  The primary concerns are shock, alleviating pain, and restoring fluid and electrolyte balance.

Poisoning: label poisonous chemicals with warning labels and store them in locked cabinets. Never treat medicines and vitamins as though they are candy. Do not purchase medicines resembling candy, animals, people, or cartoon characters.

Suffocation: Children should not use pillows until they are able to turn themselves over freely. Mattresses should never be covered with any type of plastic bag.

Drowning: Constantly supervise children. Never allow children to swim alone. Keep small buckets of any fluid away from young children.

7.         Identify at least two potential clues to each: neglect, physical abuse, and sexual abuse. Discuss the nurse’s role and responsibility related to these conditions.

With neglect: nurse can notice inadequate medical or dental care, hygiene, clothing, supply or quality of food, sleep in child. It could also be excessive demands placed upon the child (expected to do all the housework or accept total care of younger siblings)

Physical abuse is possible when injuries at various stages of healing because they all could not have happened at the same time and attempts to hide scars with clothing.

Sexual abuse is a possibility if the child has changed his or behavioral suddenly or developed bdominal pain, gastric distress, or headaches.

Nurses role in these potentially abusive situations include reporting it. Reporting abuse is mandatory. Nurses should believe the child, observe the reactions, and document them. Also teach the child what is appropriate and what is not, and also call local child protection agency.

8.         Describe the physical and/or psychological causes of FTT. State at least three nursing considerations related to FTT.

-Failure to thrive causes include early separation of mother from infant, which leads to inappropriate bonding, depression or mental illness of a prominent caregiver early in the child’s life, serious illness of the infant, which leads to an inability to form strong familial bonding Family caregivers who isolate themselves or who have marital problems

Nursing considerations include:

1. Family caregivers should be with their infants to provide care and to spend as much time as possible.
2. Tender loving care and stimulation are essential. Hold such children and rock and cuddle them.
3. Educate caregivers to look for positive signs (smiles, responsiveness).

9.         Define and discuss at least one nursing implication of each of the following skin disorders: nevi, rash, and eczema.

Nevi: abnormal skin mark that can be either hereditary or acquired as a result of teratogens. Nevi is normally harmless but it does require close observation because they can develop into malignant melanomas.

Rash: a minor skin irritations with redness. Babies skin are very delicate and easily irritated. If no cause can be determined, treat the rash symptomatically. Exposure to air generally relieves the rash and symptoms such as itching.

Eczema: a seveve dermatitis, which is characterized by remissions and exacerbations accompanied by vesicle formation, oozing, crusting, excoriations, and itching. Scratching can lead to severe excoriation, even infections, scarring, or a dangerous complication called eczema herpeticum.

10.       Define and discuss at least one nursing implications of each of the following musculoskeletal disorders: dysplasia, talipes, and torticollis.

Dysplasia: it’s a hip dislocation cause by hips improper location in the ball and socket joints; displacement of the head of the femur, or improper development of acetabulum. If not treated, the dislocation can cause deformity in later life – shorter leg and limited abduction on the affected side. Later, the person limps and has lordosis and a protruding abdomen.

Talipes: it is also known as clubfoot. In this condition, a foot is twisted or bent out of shape as a result of hereditary factors or an abnormal fetal position. It may be flexible (due to intrauterine positioning) or rigid and fixed.

Torticollis: also known as “wryneck,” is damage to the nerves or muscles. It may be congenital or acquired. Treatment includes passive or active exercises, surgical correction, or casting.

11.       Define and discuss at least one nursing implication of each of the following neurologic disorders: Reye’s syndrome, meningitis, spina bifida, hydrocephalus, microcephaly, febrile seizures, and breath-holding spells.

Reye’s syndrome: Treatment is supportive and medications include osmotic diuretics, sedatives, and barbiturates. Monitor and record the child’s respiratory rate frequently.

Meningitis: Decreased environmental stimulation and neurologic checks are essential. Elevate the head of the bed to lessen the increased intracranial pressure that is due to edema. Monitor intake and output.

Spina bifida: The condition may be asymptomatic or may cause severe paralysis, depending on how large the opening is and whether the meninges or spinal cord herniate through the opening. Amniocentesis or ultrasound can detect this disorder in a fetus.

Hydrocephalus:  Turn the child frequently from side to side to prevent aspiration and pressure sores. Especially prevent pressure areas on the enlarged, fragile head and the ears.

Microcephaly: There is no known cure for this condition; treatment is symptomatic.

Febrile seizures: Reassure the parents of the benign nature of the seizure and of the fact that most children do not develop a seizure disorder. Teach early management of fever and seizures at home.

Breath holding spells: It mimics seizure activity. If the child does not begin to breathe spontaneously and quickly recover, child may need to be seen immediately by a physician.

12.       Define and discuss at least one nursing consideration for each of the following metabolic and nutritional disorders: marasmus, biliary atresia, celiac disease, and PKU.

Marasmus: is a separate condition often caused by a general systemic disease, an absorption problem, neglect, or abuse but often associated with kwashiorkor, rickets and scurvy. Hydration and nutrition needs to be restored, maintenance of body temperature, and general tender loving care.

Biliary atresia: it’s a defect in the bile ducts that prevents bile from escaping from the liver. Lack of bile causes defective digestion and elimination leading to obstruction and may need surgery at the end.

Celiac disease: It’s a chronic intestinal disorder that involves small bowel inflammation and nutrient malabsorption. Treatment of celiac disease includes strict adherence to a gluten-free diet. The person is not allowed any cereal grains, such as wheat, barley, rye, and oats, and is not allowed any malt.

PKU: It’s a hereditary metabolic disorder that causes severe mental retardation that begins during the first months of life. . The only treatment is a diet very low in phenylalanine, an essential amino acid necessary for growth and repair of body cells.

13.       Define and discuss at least one nursing consideration for each of the following eye disorders: strabismus, amblyopia, and cataracts in children.

Strabismus: it is commonly known as “squint” or “crossed eyes,” is an inability to appropriately move the eyes. Eye exercises and miotic drugs are prescribed to contract the pupils of the eyes. Treatment begins early to prevent further damage and to improve the child’s appearance.

Amblyopia: It is also known as lazy eye. It is a subnormal vision in one eye, which may fail to develop due to lack of visual stimulation because the child always uses the good eye for vision. Blindness may develop in the “lazy eye.” Treatment consists of patching the good eye to force the child to use the underdeveloped eye.

Cataracts: It may be present at birth or can occur due to eye trauma or disease. The pupil appears to be white. Surgical removal with insertion of internal contacts is necessary for this condition.

14.       Define and discuss at least one nursing consideration for each of the following ear disorders: otitis media, epistaxis, tonsillitis, cleft lip and cleft palate, and baby bottle syndrome.

Otitis media: It is an acute infection of the middle ear, is the most common bacterial infection of early childhood, most often caused by nasopharyngeal reflux or eustachian tube dysfunction. Breast-fed babies have a lower incidence of otitis media.

Epistaxis: or nosebleed is common in children and usually originates in the anterior portion of the nares. If a child with a nosebleed also has a head injury, do not stop the bleeding without specific physician’s orders. This is because holding blood inside the nasal cavity can increase intracranial pressure.

Tonsillitis: it is an inflammation of the tonsils. It makes swallowing difficult, and the child’s WBC count and temperature may be elevated. Because the tonsils are so close to the eustachian tubes, tonsillitis can easily spread to the middle ear and cause otitis media. Infants and toddlers are most often affected because their eustachian tubes are shorter and straighter than those of adults.

Cleft lip and left palate: these two deformities occur together at birth and are result from failure of the upper lip and palate to close completely during the second and third gestational months. Nurse has to be sensitive to the family’s feelings and careful not to reveal any personal negative feelings about the infant’s appearance.

Baby bottle syndrome: it’s a deformity that occurs after child has teeth but continues bottle feeding or uses a bottle as a pacifier. Never prop a bottle and don’t let the baby sleep with the bottle. Wean the infant to a cup by 1 year of age.

15.       Differentiate and state at least one nursing consideration for each of the following cardiovascular disorders: ASD/VSD, PDA, TGV, TOF, COA, stenosis, and tricuspid atresia.

ASD: Atrial septal defect is an abnormal opening between the right and left atria. Most of these defects occur in the area of the foramen ovale.

VSD: ventricular septal defect is the most frequent congenital anomaly of the circulatory system.  An abnormal opening is found between the left and right ventricles. If the opening is small and no pulmonary hypertension exists, the child may be asymptomatic and the septum may grow to cover the opening.  Observe for pulmonary hypertension.

PDA:  Patent ductus arteriosus is a condition in which the ductus arteriosus, a blood vessel between the aorta and the pulmonary artery, remains open after birth.  Lung pressure increases, as does the volume of oxygenated blood, and may cause pulmonary hypertension. Therefore, a closed heart procedure might be done even if the child has been asymptomatic.

TGV: transposition of the great vessels is when the aorta and the pulmonary artery are reversed, so that each connects to the wrong side of the heart. If no shunts or septal defects exist, the child dies early because of lack of sufficient oxygenation to the body cells, because only unoxygenated blood circulates systemically. Immediate intervention includes maintaining patency of the ductus arteriosus to increase pulmonary blood flow, and removal of the atrial septum to facilitate mixing of oxygenated blood into unoxygenated blood.

TOF: Tetralogy of fallot is a combination of ulmonary stenosis, VSD, Overriding aorta, and Right ventricular hypertrophy. The infant with a severe defect in any of these areas is cyanotic, so oxygen needs to be monitored.

COA: coarctation (constriction) of the aorta is the condition in which the aorta narrows, obstructing blood flow. In children, conservative medical treatment may be attempted because surgery is difficult.

Stenosis: Pumonary stenosis is the narrowing of the right ventricular outflow tract, including the valve leading to decrease of blood flow into the lungs. In aortic stenosis, an aortic valve malfunctions that causes the heart to work harder to pump blood to the body. The treatment is similar to that for pulmonary stenosis. The aorta itself may also be stenosed.

Tricuspid atresia: absence of an opening between the right atrium and the right ventricle, allowing no blood to flow from the right atrium to the right ventricle, which greatly decreases pulmonary blood flow. Medications may include digoxin, diuretics, and antibiotics. Some children regularly receive oxygen. The child should be in the best possible physical and mental condition before surgery.

16.       Differentiate and state at least one nursing consideration for each of the following blood and lymph disorders: Kawasaki disease, iron deficiency anemia, sickle cell anemia, ITP, and hemophilia.

Kawasaki disease: It is also known as mucocutaneous lymph node syndrome. It’s a febrile, multisystem disorder resulting in inflammation of the blood vessels. The platelets in the blood tend to be caught in the vessels. It occurs in children younger than 5 years of age. If untreated, as many as 25% of children with Kawasaki disease develop severe cardiac problems. Its cause is unknown. Nursing care is supportive and should include frequent oral care, skin care, and cardiac monitoring.

Iron deficiency anemia: it’s most common type of anemia in childhood. Infants should be kept on breast milk (highly absorbable iron) or an iron-fortified commercial formula until 1 year of age to prevent this condition. Maternal iron stores are exhausted in a term infant by 4 to 6 months of age. Iron preparations are best absorbed if taken on an empty stomach.

Sickle cell anemia: This type of anemia includes any of the diseases having the presence of hemoglobin S and sickle cells. Eventually the child develops chronic anemia and splenomegaly, followed by episodes of lethargy,weakness, and fever are sporadic or daily.

ITP: Idiopathic thrombocytopenic purpura is the most common acquired bleeding disorder of childhood.  Its symptoms include easy bruising, petechiae on the mucous membranes, frequent epistaxis, and bleeding into the bladder or GI tract. Symptoms appear suddenly, and the child may look as though he or she has been beaten.

The disease is seldom fatal in children. Monitor for hemorrhage, avoidance of injury, and bed rest. Do not give the child intramuscular (IM) injections because of the danger of hematoma formation.

Hemophilia: It is a sex-linked, hereditary bleeding disorder in which a deficiency exists in one or more of the factors necessary for blood clotting. Gently touch or move the child. Use measures to try to stop hemorrhage. Take tympanic temperatures to reduce the risk of hemorrhage

17.       Define and differentiate between ALL and AML. State at least two nursing considerations for each type of leukemia.

ALL: Acute lymphoid leukemia is sometimes called lymphocytic, lymphatic, lymphoblastic, stem cell, or blast cell leukemia. ALL is the most common kind of cancer (80%) in children under 15 years of age. ALL is rare in adults over age 50. Patient’s immune system is affected and need to be protected against infections. Children will need further education.

AML: Acute myeloid leukemia is also called granulocytic, myelocytic, monocytic, myelogenous, monoblastic, or monomyeloblastic leukemia. AML is the most prevalent form of leukemia in adults (80%) and usually presents in young people—from teenagers to people in their 20s. Bone marrow transplants may be a treatment of choice for some clients. Clients should be prevented from relapse which could lead to recurrence leukemia.

18.       Differentiate and state at least two nursing considerations for each of the following respiratory disorders: URIs, pneumonia, croup, epiglottitis, asthma, bronchiolitis, and cystic fibrosis.

URI: upper respiratory infection symptoms include a fever; varying degrees of dyspnea with thick, tenacious sputum and mucus; and edema of the throat. During hospitalization the child will be kept in his or her private room, and only adults may visit. At home, caregivers should try to keep ill children separate from well children and encourage the use of separate glasses and utensils. Frequent handwashing is a must.

Pneumonia: it is an inflammation of the lungs, usually with consolidation and drainage. It may initially be an infectious disease or a disease that is secondary to another disease, or it may result from aspiration. The child must take the medication for the prescribed number of days. Droplet precaution should be taken.

Croup: also known as laryngotracheobronchitis (LTB), is a viral infection of the upper airways, usually follows several days of URI. It results in a harsh, “barky” cough, inspiratory stridor (shrill sound on inhalation), hoarseness, and other signs of respiratory distress. A semi-Fowler’s position may ease respiratory efforts. Oral fluids are encouraged.

Epiglottitis:  an acute, rapidly progressive, life-threatening inflammation of the epiglottis usually caused by a bacteria. Severe respiratory distress, sore throat, high fever, absence of cough, and drooling of saliva are the cardinal symptoms. If epiglottitis is suspected, do not attempt to examine the throat or anything that might upset the child because this might cause respiratory obstruction. Endotracheal intubation for 1 to 3 days may be necessary to ensure a patent airway.

Asthma: is a chronic inflammatory disorder of the airways due to edematous airways and excessive mucus production, which cause airway obstruction. Encourage children with asthma to be active and to take part in managing their own condition. Eliminate any possible allergens in the home.

Bronchiolitis: it is a viral respiratory infection resulting in inflammation of the bronchioles. It is seen most often in children younger than 2 years and tends to be a seasonal illness, occurring in winter and early spring.

Cystic Fibrosis: it’s a multisystem chronic and incurable condition, and is a major dysfunction of the exocrine glands. Many children with cystic fibrosis eventually die of cardiopulmonary complications; but with active treatment, children often live past adolescence. Chest percussion that is performed correctly helps to loosen and move secretions out of the lungs. A nurse, physical therapist, or respiratory therapist can teach family caregivers to perform this routine as an essential part of home care. Caregivers should avoid overprotecting the child.

19.       Define and state at least one nursing consideration for each of the following gastrointestinal disorders: pyloric stenosis, Meckel’s diverticulum, intussusception, and megacolon.

Pyloric stenosis: In this condition, the child’s pyloric sphincter thickens, narrowing the canal through which food passes from the stomach to the intestine. The child needs to be carefully monitored since Vomiting is the most common symptom of pyloric stenosis.

Meckel’s diverticulum: a congenital disorder in which a small portion of the child’s ileum ends in a blind pouch just before its junction with the colon. Symptoms include the passage of bloody or tarry stools. The child experiences no pain unless the diverticulum is inflamed. When the symptoms start to appear, child needs to be prepared for surgery.

Intussusception: it’s the telescoping of one bowel part into another. It is usually caused by hyperactive peristalsis in one bowel part and hypoactivity in another. Cardinal symptoms include abdominal pain and passage of a clear mucus with bloody stool. Passage of a normal stool indicates reduction of the intussusception and should be reported to the physician immediately.

Megacolon: It is also known as Hirschsprung’s disease or aganglionic megacolon. In this disorder, the child’s colon lacks parasympathetic nerve supply. Due to a lack of peristalsis, the abdomen becomes abnormally enlarged with stool and flatus. Watch for abdominal distention, temperature spikes, and irritability after surgery for megacolon. They are signs of possible anastomotic leaks (leakage where the two ends of the bowel are sewn together.

20.       Identify the types of hernias commonly seen in children. State one pre- and one post-operative nursing consideration for hernias.

There are four types of hernias:

Diaphragmatic hernia: it occurs rarely. A portion of the intestine protrudes through the diaphragm. It is usually diagnosed at birth and repaired through immediate surgery.

Umbilical hernia: a portion of the intestine protrudes through a weak umbilical ring, producing a bulge beneath the person’s navel. Because this condition usually disappears by the time the child is 3 to 4 years old, surgery is usually unnecessary.

Indirect inguinal hernia: intestine protrudes through the round ligament into the inguinal area and may descend into the scrotal sac. Surgery is required if strangulation develops.

Direct inguinal hernia: a protrusion through the weakest part of the abdominal wall. Because the peritoneum overlying the protruding abdominal contents is transparent, the contents can be visualized, and all or part of the abdominal contents may be seen.

In pre-op, educate the family and the child about the surgery process. During post-op, monitor’s the child’s vital signs for stabilization.

21.       Discuss at least two nursing considerations for possible electrolyte disturbances and dehydration related to diarrhea in children.

Even though temperature elevation may point to infection, it may also indicate dehydration and the need to force fluids if it is occurring with diarrhea. Monitor the stool for color, consistency and amount to calculate and note the fluid loss.

22.       Discuss the physical and psychological factors related to encopresis and lactose intolerance.

Ecopresis: the child with this condition and the caregivers may need counseling. Oil-retention enemas and mineral oil are usually prescribed. Increased dietary fiber and fluids is recommended.

Lactose intolerance:  The baby is switched to a lactose-free formula. Teach family caregivers to observe for hidden sources of lactose that the child must avoid. Yogurt will provide good amount of calcium they lack by not consuming milk products.

23.       Define and state at least one nursing consideration for each of the following urinary system disorders: enuresis, HUS, urinary obstruction, UTI, pyelonephritis, glomerulonephritis, nephrotic syndrome, Wilms’ tumor, hypospadias, and epispadias.

Enuresis: it’s the involuntary passage of urine, usually at nighttime, in a child over 5 years of age. More commonly, this condition is known as “bed wetting.” Enuresis is more common in boys than in girls. A complete urologic work-up is necessary to discover any physical cause. Family stress or school problems are associated with enuresis. Family caregivers should not shame or criticize the child for bed wetting.

HUS: Hemolytic uremic syndrome is a rare, acute condition occurring in children with three illnesses: renal failure, hemolytic anemia, and thrombocytopenia. HUS is the leading cause of acute kidney failure in children. Nutritional support and management of hypertension are two main nursing interventions.

UTI: Urinary Tract Infection is most commonly caused by perianal microorganisms (E. coli in 80% of cases) and is accompanied by frequency, urgency, and dysuria. Fluid intake and output needs to be monitored.

Pyelonephritis: is a dangerous infection of the upper urinary tract and kidneys. Assess child for dysuria (painful voiding), urinary frequency and urgency, fever, chills, lower-back pain, and headache.

Glomerulonephritis: it is also called acute poststreptococcal glomerulonephritis, results from an immunologic reaction to infection (most often streptococcal) elsewhere in the body. Damage to the glomeruli may cause urinary output to decrease or cease. Encourage a low-sodium, high-calorie diet with adequate protein.

Nephrotic syndrome: it involves changes in the basement membrane of the glomeruli cause the kidneys to excrete massive amounts of protein. Main symptoms are edema, proteinuria, and hematuria. Do not restrict fluids. Offering frequent small may help the child’s nutritional intake during periods of flare ups.

Wilms’ tumor:it is a lso called nephroblastoma, is a malignant adenosarcoma of the kidney. It is one of the most common neoplasms of childhood and usually affects only one kidney. When treating a child with Wilms’ tumor, never unnecessarily palpate the abdomen preoperatively. The tumor could rupture and disseminate.

Hypospadias:  the male child’s urinary meatus is located on the bottom of the penis. Parents need to know that minor hypospadias is common and usually requires no correction.

Epispadias: the meatus is located on top of the penis. Prepare the caregivers intellectually and emotionally for surgery, which is scheduled between 6 and 18 months of age, before the child develops a strong body image.

24.       Define and state at least one nursing consideration for each of the following reproductive disorders: ambiguous genitalia, cryptorchidism, and hydrocele.

Ambiguous genitalia: newborn who exhibits genitalia that seem to have both male and female characteristics. Encourage the family to give the child an appropriate, gender-specific name and to identify the child as male or female.

Cryptorchidism: it is is an undescended testicle and is common at birth but usually corrects itself spontaneously. During post-op process, teach caregivers what to look for if the child goes home soon after surgery.

Hydrocele: it is an accumulation of serous fluid within the scrotal sac, causing the scrotum to become large and painful. Applying ice or cold therapy might help reduce the swelling.