PEDIATRIC DISORDER

Respiratory disorder

Respiratory disorders are among the most common cause of illness and hospitalization of children. Overall, respiratory dysfunctions in children tend to be more serious than in adults because the lumens of the child’s respiratory tract are smaller and therefore more likely to become obstructed.

Because respiratory disorders range from minor illnesses such as simple upper respiratory tract infection to life-threatening lower respiratory tract disease.

Assessment for a child with respiratory disorder

Physical examination Laboratory testing Interview health history

Signs and symptoms for children with respiratory dysfunction

Cough Tachypnea Retractions Restlessness Cyanosis Clubbing of fingers Adventitious sounds

Laboratory test

Blood gas analysis Nasopharyngeal culture Respiratory syncytial virus nasal washing Sputum analysis Diagnostic procedure Chest radiography Bronchography Pulmonary function studies

Therapeutic techniques used in the treatment of respiratory illness in children

Expectorant therapy Liquefying agents Humidification

Vaporizers Nebulizers

Coughing Mucus clearing devices Chest physiotherapy Pharmacologic therapy Intensive spirometry Breathing techniques Tracheostomy Endotracheal intubation Assisted ventilation Lung transplantation

Disorders of the upper respiratory tract

The upper respiratory tract warms, humidifies, and filters the air that enters the body. The structures of the upper respiratory tract constantly come into contact with a barrage of

foreign organisms, including pathogens, that can lead to airway irritation and illness. Congenital malformations of respiratory structures also cause some upper respiratory tract

disorder. Choanal Atresia is congenital obstruction of the posterior nares by an obstructing

membrane or bony growth, preventing a newborn from drawing air through the nose and down into the neuropharynx. It may be either unilateral or bilateral.

Acute Nasopharyngitis (Common Cold) is the most frequent infectious disease in children. The intubation period is typically 2-3 days. Caused by one of several viruses.

Pharyngitis is an infection and inflammation of the throat it may be bacterial or viral in origin.

Viral Pahryngitis the causative agent is usually adenovirus. The symptoms are generally mild: sore throat, fever and general malaise.

Streptococcal Pharyngitis group A beta-hemolytic streptococcus is the organism most frequently involved in bacterial pahryngitis in children. All streptococcal infections must be taken seriously because they can lead to cardiac and kidney damage from the accompanying autoimmune process.

Retropharyngeal Abscess in infants, the lymph nodes that drain the nasopahrynx are located just behind the posterior pharynx wall. These nodes may become infected following nasopharyngitis or pharyngitis.

Tonsillitis refers to infection and inflammation of palatine tonsils. Adenitis refers to infection and inflammation of the adenoid tonsils. Tonsillar tissue is lymphoid tissue that filters pathogenic organisms from the head and neck area.

Epistaxis is extremely common in children and usually occurs from trauma, such as picking at the nose, from falling, or from being hit. In homes that lack humidification, the hot environment causes children’s mucous membranes to dry, feel uncomfortable and be susceptible to cracking or bleeding. In all children it tends to occur during respiratory illnesses.

Sinusitis is infection of sinus cavities. it can occur as primary or secondary one in older children when organisms spread from the nasal cavity.

Laryngitis is inflammation of the larynx. It results in brassy, hoarse voice sounds. Congenital Laryngomalacia/ Tracheomalacia means that an infant’s laryngeal structure is

weaker then normal and collapses more than usual on inspiration. Croup (Laryngotracheobronchitis) inflammation of the larynx, trachea, and major

bronchi. It is one of the most frightening disease of early childrenhood. Epiglottitis is an inflammation of the epiglottis. (the flap of tissue the covers the opening

to the larynx to keep out food and fluid during swallowing.) Aspiration is inhalation of a foreign object into the airway. occurs most frequently in

infants and toddlers. Bronchial obstruction the right main bronchus is straighter and has a larger lumen than

the left bronchus in the children older than 2 years of age.

Disorder of the Lower Respiratory tract

The structures of the lower respiratory tract are subject to infection by the same pathogens that attack the upper respiratory tract. Inflammation and infection of the lungs or bronchi is particularly troublesome.

Influenza involves inflammation and infection of the major airways. Bronchitis or inflammation of the major bronchi and trachea, is one of the more

common illness affecting preschool and school age children. Bronchiolitis is the inflammation of the fine bronchioles and small bronchi. It is the

most common lower respiratory illness in children younger than 2years. Respiratory Syncytial Virus Bronchiolitis Is a pathogenic RNA virus that is the most

common cause of bronchiolitis in young children. Asthma, an immediate hypersensitivity (type1) response, is the most common chronic

illness in children. The condition may be intermittent, with symptom free periods, or chronic with continuous symptoms. It tends to occur in children with atopy or those who tend to be hypersensitive to allergens.

Status asthmaticus is an extreme emergency because if the attack cannot be relieved the child may die of heart failure caused by the combination of exhaustion, atelectasis, and respiratory acidosis from bronchial plugging.

Bronchiectasis is chronic dilatation and plugging of the bronchi Pneumonia infection and inflammation of the alveoli Pnemococcal pneumonia is generally abrupt and follows an upper respiratory tract

infection Chlamydial pneumonia is seen in new born up to 12 weeks of age because the

chlamydial organisms is contracted from the mother’s vagina during birth. Viral pneumonia Mycoplasm pneumonia similar yet larger than iruses Lipid pneumonia caused by the aspiration of an ouly or lipid substances Hydrocarbon pneumonia Atelectasis Pneumothorax Bronchopulmonary dysplasia Tuberculos Cystic fibrosis

Cardiovascular disorder

The cardiovascular system, the body system on which all other system depend consists of the heart.

Most cardiovascular disorders in children occur as a result of congenital anomaly; either the heart developed inadequately in utero, or the heart cannot adopt to extrauterine life for some reason.

Assessing a child with a cardiovascular disorder

Decreased height and weight Easily fatigue Cyanosis of mucous membrane or polycythemia Enlarged liver Absent femoral pulses Pain in legs Frequent nose bleeds Tachypnea or tachycardia Displaced apex heart beat Heart murmur Faint peripheral pulses Clubbing of fingers

Diagnostic test

Electrocardiogram Radiography Echocardiography Phonocardiography and magnetic resonance imaging Exercise testing Laboratory test

Treatment

Cardiac catheterization Cardiac surgery

Congenital heart disorder usual cause is failure of a heart structure to progress beyond an early stage of embryonic development.

Acyanotic heart disease Cyanotic heart disease

Disorder with increased pulmonary blood flow involve blood flow from the left side of the heart, which is under greater pressure, to the right side of the heart, which is under less pressure, through some abnormal opening or connection between the two systems or the great arteries.

Ventricular septal defect Arterial septal defect Patent ductus arteriosus Atrioventricular canal defect

Disorders with obstruction to blood flow a number of congenital anomalies cause the blood flow leaving the heart to be obstructed because a vessel or a valve is narrower then the usual.

Pulmonary stenosis Aortic stenosis Coarctation of the aorta

Disorders with mixed blood flow are cardiac anomalies that involve mixing of blood from the pulmonary and systemic circulation in the heart chambers.

Transposition of the great arteries Total anomalous pulmonary venous return Truncus arteriosus Hypoplastic left heart syndrome

Disorders with decrease pulmonary blood flow involve some type of obstruction to blood flow in the pulmonary artery.

Tricuspid atresia Tetralogy of fallot

Acquired heart disease condition where the heart is overwhelmed and unable to effectively pump blood forward.

Congestive heart failure Persistent pulmonary hypertension Rheumatic fever Kawasaki disease Endocarditis Arrhythmias Hypertension Dyslipidemia Cardiomyopathy Cardiopulmonary arrest

Immune Disorder

The immune system consists of a complex network of a cells interacting to protect the body against invasion by foreign substances.

Disorder of immune system include deficiencies of immune substances and function that affect the body’s ability to ward off infection; abnormal excessive immune response to foreign substances ; abnormal and excessive immune response to self (autoimmune disorders)

Immunodeficiency disorders when any one portion of the immune system is not functioning adequately, an immunodeficiency results.

Primary (Congenital) Immunodeficiencyo B-lymphocyte deficiencieso T-lymphocyte deficiencieso Combine T-and B-Lymphocyte deficiency

Secondary (acquired) immunodeficiencyo HIV infection and AIDS

Allergy disease occur as a result of an abnormal antigen-anti body response.

Hypersensitivityo Type I: anaphylaxiso Type II: cytotoxic responseo Type III: immune complexo Type IV: Cell- mediated hypersensitivity

Assessment of allergy in children

History Laboratory testing Skin testing Therapeutic management Environmental control Hypo sensitization Pharmacologic therapy

Urticaria and angioedema, urticaria or hives refers to flat wheals surrounded by erythema arising from the chorion layer of skin; they are intensely pruritic.

Serum sickness is a type III hypersensitive response of the body to a foreign serum antigen or drug.

Atopic disorders, individuals with atopy are prone to all allergic responses.

Allergic rhinitis Perennial allergic rhinitis Atopic dermatitis (infantile eczema) Atopic dermatitis in older child

Drug and food allergies

Drug allergies one of the hazards of giving any medication is the risk that a child may experience a reaction to it or exhibit allergic symptoms.

Food allergies manifest themselves differently from one child to another, but urticaria, angioedema, pruritis, stomach pain, colic, cramps, diarrhea, respiratory symptoms and atopic dermatitis are common symptoms.

Infectious disorder, despite the number of preventive measures available, infectious disease remain a leading cause of morbidity in children.

Stages of infectious process

Incubation period Prodromal period Convalescent period

Chain of infection

Reservoir Portal of exit Portal of entry Susceptible host

Assessing a child with common signs and symptoms of infectious disorder

Koplik’s spot Thrush Warm and dry skin from fever Presence of rashes Infectious mononucleosis pharyngitis Diphtheria Tinea corporis Plantar warf Pediculosis Prodromal symptoms of measles Mumps Herpes simplex Whooping cough Impetigo Scabies

Different types of infectious diseases

Viral infection Exanthema subitum (Roseola infantum) Rubella (German measles) Chickenpox (varicella) Herpes zoster Smallpox (variola) Erythema infectious (fifth disease) Pityriasis rosea

Enteroviruses Echovirus infection Coxsackievirus infections Poliovirus infections: poliomyelitis (infantile paralysis)

Viral infection of the integumantary system Herpes virus infection Herpes simplex (herpes labialis) Warts (verrucae)

Viruses causing CNS disease Rabies West nile virus disease

Other viral infections Mumps (ependemic parotitis) Infectious mononucleosis Hantavirus pulmonary syndrome infection

Bacterial infections Streptococcal disease Scarlet fever Impetigo Cat-scratch disease

Staphylococcal infections Furunculosis infection Cellulitis Methicilline-resistant staphylococcus aureus Scalded skin disease

Other bacterial infections Diphtheria Whooping cough Anthrax Tetanus (lockjaw) Lyme disease

Other infectious pathogens Rickettsial disease

o Rocky mountain spotted fevero Murine typhus

Chlamydial infectionso Psittacosis

Parasitic infections Helminthic infectins

o Roundworms (ascariasis)o Hookwormso Pinworms

Protozoan infectionso Giardiasis

Fungal infectionso Superficial fungal infections

Tinea cruris Tinea pedis Tinea capitis Tinea corporis

o Candidiasis

Hematologic disorder

Hematologic disorder often called blood dyscrasias, occur when components of the blood are formrd incorrectly or either increase or decrease in amount beyond normal ranges.

Therapeutic techniques for hematologic disorders

Bone marrow aspiration and biopsy Blood transfusion Hematologic stem cell transplantation

Assessing a child with hematologic disorder

Obese infant Fatigue Retinal hemorrhage Bossing of maxillary bone Pale mucous membrane Ecchymotic or bleeding gumline Increased heart rate and possible murmur Petechiae Ecchymosis Blood oozing from wound or injection point Jaundice Pallor Bronze color Pain on abdomen when palpated Hepatomegaly Spleenomegaly Delayed secondary sex characteristics Spoon nails Joint swelling Pain on extremities Weak muscle tone

Disorders of the RBC

Anemia

Disorder of WBC

leukemia

Disorder of blood coagulation

Purpuras Disseminated intravascular coagulation Hemophilias

Gastrointestinal disorder

Food poisoning and hepatitis are examples of GI illnesses

Diagnostic and therapeutic techniques

Fiberoptic Endoscopy Colonoscopy Barium enema Nasogastric or gastrostomy tube feedings IV therapy Colostomy or ileostomy

Assessment in child with altered GI function

Signs of dehydration (Dry mucous) Caries, malocclusion, inflamed gumline (Periodontal disease) Enlarged liver (Cirrhosis, Hepatitis) Visible peristalsis(Pyloric stenosis) Increased bowel sound (Diarrhea) Tender abdomen (Appendicitis) Mass at umbilicus or by inguinal ring (Hernia) Distended veins from pressure in portal circulation (Liver disease ) Hair brittle and loss of pigment (Decreased protein intake) Jaundice Lethargy and paleness Displaced heart sound Distended abdomen Weight below 10th percentile

Disorders

Acid base imbalance Fluid imbalance Common disorders of the stomach and duodenum

Gastroesophageal reflux Pyloric stenosis Peptic ulcer disease

Hepatic disorders Obstruction of bile ducts Cirrhosis Intestinal disorders Disorders of lower bowel Irritable bowel syndrome Chronic recurrent abdominal pain Disorder caused by food, vitamin, and mineral deficiencies

Kwashiorkor Marasmus Vitamin and mineral deficiency

Renal or urinary tract disorder

Normally the urinary system maintains the proper balance of fluid and electrolytes in the blood. When disease occurs such as with structural abnormalities or kidney malfunction. Children may be left with excessive amounts of fluid in the body or with an imbalance of

electrolytes essential to their body function.

Assessing a child with urinary tract dysfunction

Pale mucous membrane Hypertension Rapid respiration Pain over kidney area Reddened urethra Diaper area rash in infants Round urethra in males Constant dripping of urine A stronger than usual arc of urine in males Displaced urethral opening Poor skin turgor With white crystals on skin Edema Swelling around eyes Odd facies; beaklike nose Small chin Prominent epicanthal folds Low-set ears Gynecomastia Tenderness over bladder area Abdominal mass Slack abdominal muscles

Protuberant abdomen Bowed legs Confusion Muscle twitching

Laboratory/ diagnostic test

Urinalysis Creatinine clearance rate Radioisotope scanning Urine culture Blood studies Ultrasunography/ MRI X-ray studies CT scan Cystoscopy Renal biopsy

Therapeutic measures

Peritoneal dialysis Hemodialysis

Therapeutic management

Kidney transplantation

Structural abnormalities of the urinary tract

Patent urachus Hypospadias

Infections of the urinary system and related disorders

UTI “honeymoon” cystitis Vesicoureteral reflux Hydronephrosis

Disorder affecting normal urinary elimination

Enuresis Postural (orthostatic) proteinuria Kidney agenesis

Polycystic kidney Renal hypoplasia Prune belly syndrome Glumerulonephritis Nephritic syndrome Acute renal failure Systemic lupus erythematosus Hemolytic- uremic syndrome Chronic renal failure

Neurologic disorder

neurologic disorder encompass a wide array of problems resulting from congenital disorders, acquired dysfunctions, infection, or trauma.

Many of these disorders can cause severe illness. Others can result in life threatening complication.

Assessing child for sign and symptoms of neurologic disorder

Increased head circumference Bulging fontanelles Bulging forehead Enequal size and response of pupil Enequal eye globe movements Projectile vomiting Widening systolic and diastolic blood pressure Decreased pulse rate Headache Increased temperature Pain on neck Decreased respiratory rate Spasticity of muscle

Health history

Neurologic examination Cerebral function Cranial nerve function Cerebellar function

Motor function Sensory function Reflex testing

Diagnostic testing

Lumbar puncture Ventricular tap X-ray techniques CT scan Nuclear medicine studies Echoencephalography Electroencephalography

Neurologic disorders

Increased intracranial pressure Cerebral palsy

Types: Spastic type Dyskinetic or athetoid type Ataxic type

Mixed type

Infection Bacterial meningitis Group B streptococcal infection Encephalitis Reye’s syndrome Guillain-barre syndrome Botulism

Inflammatory disorders Carpal tunnel disorders Facial palsy (Belle’s palsy)

Paroxysmal disorder Recurrent seizures Breath holding Headache

Ataxic disorders Ataxia-telangiectasia Friedrich’s ataxia

Spinal cord injury

Vision or hearing disorder

Any interference with vision or hearing poses a threat to normal growth and development, because of what and how a child learns about the world is achieved through these sensory organs.

Eye and ear disorders may be transitory.

Assessing a child vision or hearing disorder

Hair: white forelock associated with congenital deafness Eyes: tearing Crusting of eyelids Uneven size of pupils Improperly formed pupils Squinting White pupils Cocking neck Incompletely formed pinna Unclear speech Posture: leaning forward

Disorders that interfere with vision

Refractive errors Astigmatism Nystagmus Amblyopia

Structural problems of the eye

Coloboma Hypertelorism Ptosis Strabismus

Infection or inflammation of the eye

Stye Chalazion Blepharitis marginalis Conjunctivitis Inclusion blennorrhea Acute catarrhal conjunctivitis Herpetic conjunctivitis Allergic conjunctivitis Keratitis Periorbital cellulitis Dacryostenosis Dacryocystitis

Traumatic injury to the eye

Foreign bodies Contusion injury Eyelid injuries

Inner eye condition

Congenital glaucoma Cataract

Disorder of the ear

External otitis Acute otitis media Otitis media with effusion Cholesteatoma

Musculoskeletal disorder

The skeletal system, composed of more than 200 bones connected by the joints and tendons, provides a structural casing or protective armor for the internal organs of the body.

Because their bones and muscles are still growing, children suffer from disorders of the musculoskeletal system more frequently than do adults.

Assessment of musculoskeletal system

Radiography Bone scan Electromyography Muscle or bone biopsy Arthroscopy

Therapeutic management of musculoskeletal disorder for children

Casting Crutches Traction

Disorders of bone development

Flat feet (flat panus)

Bowlegs (genu varum)

Knock knees (genu valgum)

Blounts disease (tibia vara)

Toeing-in

Limps Growing pains Osteogenesis imperfecta

Legg-calve-perthes disease

Osgood-schlatter disease

Slipped capital femoral epiphysis

Infectious disorders of the bones and joints

Osteomyelitis

Synovitis

Apophysitis

Functional (postural) scoliosis

Structural scoliosis Osteoporosis

Disorders of the joints and tendons: collagen-vascular disease

Juvenile arthritis (JA)

Disorders of the skeletal muscles

Myasthenia gravis

Dermatomyostitis

Muscular dystrophies

Injuries of the extremities

Finger injuries Bicycle-spoke injuries Fractures Athletic injuries