6/4/12

You meet Ms. Kurdapya , 19 years old, at the Out Patient Department (Pediatric Clinic) of Laoag City General Hospital when she brings in her 2-month-old son, Wakowako. She looks tired. She tells you that she is exhausted because her baby is awake all night, crying constantly. According to Ms. Kurdapya, she stopped breast-feeding and changed him to formula milk to see if that would help, but it didnt. She tells you that Wako-wakos bowel movements are normal. When you weigh Wako-wako, you find he has gained weight well. When you talk to him he demonstrates a social smile.

FAMILY ASSESSMENT Wako-wako lived with a single parent

and his family (Lolo, Lola one uncle and his one aunt). Grandmother cares for the infant while mother works as a manager in a fast-food restaurant from 8am to 5pm.
CLIENT ASSESSMENT

Well proportioned 2-month old baby. Height and weight at 50th percentile on growth chart. Bottle feeding with intake of approximately 4 oz of commercial formula every 4 hours. Experiencing 2 or 3 soft yellow bowel movements daily. The mother reports, Agib ibit toy annak ko kada rabii, mangrugi alas siyete agingana

alas dos iti parbangon (My baby has been crying every night lately from about 6PM till 2AM. His face gets red, and he pulls his legs up against his belly. I give him a bottle, he sucks for a minute like hes starving, and then stops, pulls up his legs and starts to cry. Hes good for my mother in the afternoon; cries from six to nine at night for me. Im at the end of my rope

Dr. Swapan, the pediatrician on duty, performed a physical examination and assessment on Wako-wako and made a diagnosis of COLIC.

AN INFANT WITH COLIC

What is a Colic?
Is a paroxysmal abdominal pain that generally occurs in .an infant under 3 months of age. (Karp, 2004) An inconsolable crying 3 hours per day, more than 3 days per week, for more than 3 weeks. (Morris Wessel,1954),

What is the cause?

Remains UNKNOWN and UNCLEAR Changes in the GI Flora Formula Feeding Excessive gas in the stomach Food allergies Cramping or Indigestion

FACTORS:

Assessment

Ask the mother about:

q q

Duration of the problem and frequency What happens just before the attack and describe the attack itself & the associated symptom

Documentmedical history and type of bowe q Family the number movement. Determine the babys feeding pattern

q q

If Formula Fed: Ask the type of formula and position when feeding If Breastfed : Ask the diet of the mother

Assessment

Ask the mother about:

q q

Duration of the problem and frequency What happens just before the attack and describe the attack itself & the associated symptom

Documentmedical history and type of bowe q Family the number movement. Determine the babys feeding pattern

q q

If Formula Fed: Ask the type of formula and position when feeding If Breastfed : Ask the diet of the mother

MANAGEMENT
Mothers Responsibilities
1. 2.

3.

Avoid placing a bottle of hot water or any other heating pad on their infants abdomen. Changing formula bottles to the type with disposable bags that collapse as the baby sucks. Suggest the use of an infant pacifier and sitting upright.
Click the mother about common characteristics of colic, Educate to edit Master subtitle style including its duration, timing and intensity of crying Review methods for formula preparation, bottle holding and burping as needed. Reassure parent that she is not the cause of the child discomfort. Its a coincidence since she is giving care at the time colic occurs.

Nurses Responsibilities
1. 2.

3.

6/4/12

CHIROPRACTIC TREATMENT

Chiropractic treatment is a method of complementary and alternative medicine (CAM) that focuses on realigning thespineto achievepain reliefand promote healing.

It operates under the belief that a misaligned, restricted spine leads to health issues since it interferes with the bodys health-sustaining energy flow. When energy is blocked, a person cannot thrive. 6/4/12

PEDIATRIC CHIROPRACTIC TREATMENT

Babies instantly Believe that gently relaxing after their realigning the spine treatment, or even can aid in digestion, falling asleep resulting in less spontaneously during spitting up, and just a the treatment. generally easier time Sometimes parents say digesting food. The that while they didnt Click to edit Master subtitle style theory goes that notice a decrease in aiding the digestive their babys crying system will decrease immediately, after colicky behavior and several sessions they crying. started to see improvement.
6/4/12

INFANT PROBIOTICS

Research released in 2006 looked at the intestinal flora (bacteria) of both colicky and non-colicky infants. The research found that the colicky infants tended to have less of a type of bacteria called Lactobacillus (although, it is not known whether this is the cause of colic, the result of another condition that causes colic, or simply a consequence of colic).

6/4/12

Furtherresearchreleased in early 2007 looked at a possible treatment for colic, based on the assumption that decreased Lactobacillus was causing the colic. The study compared the use of L. Reuteri Probtiocs with Simethicone (gas drops).The study showed improvement in 95% of babies treated with L. Reuteri probiotics, as compared with the improvement seen in only 7% of babies treated with gas 6/4/12 drops.

THUMB SUCKING Starts at 3 months Sucking reflex peaks at 6-8 months Thumb sucking peaks at 18 months Thumb sucking is normal The best approach: Certain infant has adequate sucking pleasure and then to ignore thumb sucking

6/4/12

USE OF PACIFIERS Who use pacifiers? -Infant who completes feeding and still restless and discontent -Infant who actively searches for something to put into the mouth -Infant who sucks on clothes and hands -Infants who are in pain
q

6/4/12

A child who is deprived of their sucking needs will likely to become a

6/4/12

Disadvantages of using a pacifier -Problem on cleanliness -Aspiration -Strangulation qManagement -Parents should check nipples of pacifiers (holes are small and rubber is sturdy) -Wean a child from a pacifier any time after 3 months of age & certainly during the time sucking reflex is fading.
q

6/4/12

6/4/12

HEAD BANGING qBeginning during the second half of the first year of life and continuing through the preschool period, associated with naptime or bedtime and lasting over 15 minutes. qManagement: q -Investigate stress factors operating the house q Advise parents to put side rails of cribs q Reassure parents that this is a normal mechanism for relief of tension among children.

6/4/12

SLEEP PROBLEM qCauses: -Colic -Breastfed babies qEffect: -Parents become extremely fatigued. qManagement -Delay bedtime by 1 hour -Shorten an afternoon sleep period -Do not respond immediately to infants at night so thet can have time to fall back to sleep on their own -Provide soft toys or music to allow infants to play quietly

CONSTIPATION qIf constipation persist beyond 5 to 6 months of age, consult the HCP. -Increase Fluid Intake (apple juice or prune juice), adding food with bulk. qIf infants has a history of constipation for more than 1 week, the infant will be examined for an anal fissure or tight anal sphincter. qChronic Constipation also may occur in children with Hirschprung s Disease and Congenital Hypothyroidism.
6/4/12

HIRSCHPRUNG DISEASE Aka Aganglionic Megacolon qCongenital absence of parasympathetic ganglion nerve cells usually in rectosigmoid area . qThis maybe manifested in the early life as constipation. qSymptoms include: - ribbon like stool
q
-

Bouts of diarrhea Distended abdomen

6/4/12

CONGENITAL HYPOTHYROIDISM Decrease functoning of the Thyroid gland qSymptoms include: - Lethargy
q
-

Protruding tongue Delayed developmental Milestone

6/4/12

6/4/12

FIVE -ITEM POST TEST

1. You review infant safety with Wakowakos mother. What are the two most common types of accidents in infant?
A. B. C. D.

Drowning and homicide Poisoning and burns Falls and auto accidents Aspiration and falls

6/4/12

Aspiration of small objects and falls from tables are the most common type of accidents in infants.

6/4/12

2.

A nurse provides instructions to the parents of an infant regarding car travel and safety seats. Which of the following is the appropriate information related to the safety of the infant?
A. Restrain in a car seat in the back seat in a semi-reclined, rear facing position. B. Restrain in a car seat in the front seat in a semi-reclined, rear facing position. C. Restrain in a car seat in the back seat in a semi-reclined, forward-facing position. D. Restrain in a car seat in the front seat in a semi-reclined, forward-facing position.

6/4/12

Infants who weigh up to 20 lb and are at least 1 year of age should be restrained in a car seat (convertible seat) or infant-only seat in a semi-reclined position, rear facing position in the back seat of the car.

6/4/12

3.

A maternity nurse is caring providing instructions to a new mother regarding the psychosocial development of the newborn infant. Using Ericksons Psychosocial Development Theory, the nurse instruct the mother to:
A. Allow the NB infant to signal a need. B. Anticipate the needs of the NB infant. C. Attend to the NB infant immediately . D. Avoid the NB infant during the first 10 minutes of crying.

6/4/12

According to Erickson, the caregiver should not try to anticipate the NB infants need at all time but must allow the NB infant to signal needs. If a NB infant is not allowed to signal a need, the NB will not learn how to control the environment. Erikson believed that a delayed or prolonged response to a NB infants signal would inhibit the development of trust and would lead to mistrust to others.

6/4/12

4. Which interventions are appropriate for

the care of an infant like Wako-wako? Select all that apply. 1. Provide swaddling. 2. Talk in a loud voice 3. Provide the infant with a bottle of juice at nap time. 4. Hang mobiles with black and white contrast designs. 5. Caress the infant while bathing or diaper changes. 6. Allow the infant to cry for at least 10minutes before responding.
A. B. C. D.

6/4/12

1,3,5,6 1,4,5 1,3,4,5 1,4,6

Holding, caressing and swaddling provide warmth and tactile stimulation for the infant. To provide auditory stimulation, the nurse should talk to the infant in a soft voice and should instruct the mother to do so also. Additional intervention include playing a music box, radio or television or having a ticking clock nearby. Hanging a bright shiny object in midline within 20-25cm of the infants face and hanging mobiles with contrasting colors such as black and white provide visual stimulation. Crying is an infants way of communicating therefore the nurse would respond to infants crying and the mother is taught to do also. An infant or any child should never be allowed to fall asleep with a bottle containing milk, juice , soda because of the risk of developing bottle-mouth carries.
6/4/12

5. A nurse educator is preparing to conduct a

6/4/12

2 , 3 4, 6 C. 2,3 ,4, 5
A.

session to the nursing staff regarding the theories of growth and development and plans to discuss Kohlbergs Theory of Moral development. Which of the following should the nurse include in the session? Select all that apply. 1. Individuals move through all six stages in a sequentila fashion 2. Moral development progresses in a relationship to cognitive development. 3. A persons ability to make moral judgments develops over a period of time. 4. The theory provides a framework for understanding how individuals determine a moral code to guide their behavior 5. In stage 1 children are expected to reason a mature members of society. 6. In stage 3 the child conforms to rules to obtain rewards or have favors returned.

B. 1, 2 , 4, 6 D. 2, 3, 5, 6

6/4/12

6/4/12

6/4/12

6/4/12

6/4/12

3. Stranger anxiety is the distress that young children experience when they are exposed to people who are unfamiliar to them. Wako-wakos mother is very concern if his baby will now be able to recognized strangers from his environment . As a knowledgeable nurse, you know for a fact that the PEAK OF STRANGER ANXIETY is when?
A. B. C.

6/4/12

D.

By 6 mos. By 2 mos. By 8 mos. None of the above

Stranger Anxiety starts by the 6th month of an infant and its peak is on the 8th month. Before this age (8 months), most infants accept unfamiliar people without much fuss. But as infants approach eight and nine months of age, they begin to show strong preferences for the people who care for them the most - usually their parents. At this time infants are beginning to realize that all people are not the same, and that the relationship they have with their primary caregivers is special.

6/4/12

4. Hirschsprung disease may be manifested early in life as constipation and its symptoms includes ribbon like stool, distended abdomen and bouts of diarrhea. If you as a nurse notice that a child diagnosed with Hirschprung Disease has fever and watery explosive diarrhea, which of the following should you do first?
A. B. C. D.

6/4/12

Notify the physician immediately Administer antidiarrheal medications Monitor child ever 30 minutes Nothing, this is characteristic of Hirschsprung disease

For the child withHirschsprung disease, fever and explosive diarrhea indicate enterocolitis, a lifethreatening situation. Therefore, thephysician should be notified immediately. Generally, because of the intestinalobstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung disease. The child is acutely ill and requires intervention, with monitoring more frequently than every 30minutes. Hirschsprung disease typically presents with chronic constipation.

6/4/12