Chronic Illnesses & Children Flashcards
Chronic Illness is a condition that…
Interferes with daily functioning for 3+ mths in a year
Hospitalization for + 1mth in a year
What impact does Chronic Illness have on a child?
Developmental Aspects
Coping Mechanisms
Responses to Parental Behaviour
Types of illness or disability
What are the 3 adaption and coping STAGES?
- Shock & Denial
- Adjustment
- Reintegration and acknoledgment
What behaviours can we expect from someone in the Shock and Denial Stage?
Seeking Second Opinions Minimizing Symptoms Refusing to believe results Delaying consent to treatment Optimism despite diagnoses Suspicion Apathy/disinterest Maladaptive which negatively affects treatment/life of child
What behaviours can we expect from someone in the Adjustment Stage?
Guilt Anger Over protection Rejection & Rigidity Overcompensation Movement towards acceptance
What behaviours can we expect from someone in the Reintegration & Acknowledgment Stage?
Realism, realistic expectations
Becoming an expert
Getting on with life
What are the nursing interventions when caring for a child/family with a chronic illness
Provide support/accept families reaction i.e anger, denial..
Therapeutic communication
Education
Provided community resources
Normalization-promote independence
Self care practices: diabetes, meds, insulin admin etc.
Set Realistic future goals.
Assess families strengths and ability to adjust
Assess acceptance of child’s condition (phases)
Support families coping methods
Advocate for empowerment
Define Asthma.
List the S&S and what causes it.
Asthma is a common chronic airway disorder marked by:
- Bronchoconstriction
- Airway hyper responsiveness to various stimuli
S&S: proxysmal/persistant, DYSPENA, chest tightness WHEEZING, COUGH, and sputum.
Caused by: exposure to allergens, infections, stress, environmental changes
What is Status Asthmaticus? How is it diagnosed?
Severe bronchospasm that is not reversible by usual measures. If continues, hypoxemia worsens, more reduction in expiratory flow & effective ventilations decreases = increased acidosis.
Diagnoses: assessment of symptoms, medical history, allergy test, pulmonary function test (PFT’s spirometer, measurement FEVI, FVC=PEFR)
What triggers asthma?
Smoke( tabbacco, wood, oil) Viral respiratory symptoms Environmental Allergies Humidity & Cold Weather Pollution Exercise (SOBOE) Aerosol Sprays Medications (asprins) Emotions ( anxiety attacks)
How is Asthma therapeutically managed?
Bronchodilators
Corticosteroids/Anti-inflammatory
Relaxation techniques
Manage the triggers
Exercise
Chest physiotherapy
Patient & Parent teaching
Hyposensitization
Airway management by:
Short & long acting bronchodilators
Anticholinergic (atrovent)
GlucocorticoidsList the Controller medications used to manage asthma
Controllers:
Inhaled steroids (anti-inflammatory) - pulmicort, flovent
Long acting bronchodilators - servent (salmeterol)
Leukotriene-bronchodilators ( singulair)
Combination: long acting broncho and steroid - advair
( flovent + servent)
* works to prevent asthma episode
* Taken daily
* does not eliminate the need for reliever medications
* inhaled
* Prevents inflammation and controls symptoms
* Will not help during an acute episode
What are the Quick Relief rescue medications that are used to manage asthma? How do they work?
Fast acting bronchodilators ( short acting) - ventolin
Oral Steroids - prednisone/prednisolone
* Fast acting
* Relaxes bronchioles & relieves inflammation
* Relieves symptoms during acute episodes
* PRN
What are the goals of asthma therapy?
Control chronic and night time symptoms
Maintain the normal activity levels of a child
Prevent acute episodes
Avoid adverse effects of medications
List reasons for poor asthma control?
No $ for medications/devices
No understanding of meds / don’t take them correctly
Stopped taking controller b/c symptoms improved
Concerns re: side effects = stop taking
Poor perceiver of S&S
Severe asthmatic
What is involved in Acute Asthma Management?
assessment, history, interventions, eval, education
AIRWAY ** VS
ASSESSMENT: respiratory, cardio, other
HISTORY: what were they doing? what triggered attack?
INTERVENTIONS: O2, meds, iv access/hydration
EVALUATION/REASSESSMENT: improving, no wheezing, silent chest, Resp failure/arrest
EDUCATION: asthma symptoms and control; use of devices
Define Sickle Cell Anemia
Inherited hematologic disorder, leads to chronic hemolytic anemia & vaso-occlusive episodes
Most common among african decent
Defective hemoglobin molecule (Hb S) causes RBS’s to b/c sickle-shaped in hypoxic states leading to: hemolysis, impaired circulation, pain, inadequate oxygenation and possible tissue infarction
How is Sickle Cell Anemia diagnosed?
Newborn Screening ( not diagnostic, just recognized)
Cord Blood Testing
Genetic Testing
What is Sickle Cell Crisis?
Acute exacerbation of disorder
Patient presents with pain, swollen extremities
Dactolytic: sickle cell crisis in children ( hand/feet)
6 mths: for typical age of diagnoses b/c the hemoglobins are gone 9 hemoglobin F are replaced with A, so presents)
What triggers Sickle Cell Crisis?
Exercise past limit causing hypoxia High altitude conditions Dehydration Infection Extreme hot/cold Anaesthesia (without adequate O2/) Stress Hypothermia *Patient in sickle cell crisis presents with pain*
What complications occur with Sickle Cell Crisis?
Splenic Sequestration
(enlarged due to pooling of blood in spleen –> hypovolemic shock)
Acute Chest Crisis
(sickling occurs in chest, impacting oxygenation/ventilation)
Can be life threateningconditons
What are the S&S with Sickle Cell Crisis?
Pain
Irritability
Swollen Extremities/Joints
Pale
Fatigue
Jaundice: sickle cells are destroyed which released bilirubin)
Anemia-due to bone marrow inability to keep up
* Sickle Cells last 10-20 days, normal cells last 120 days*
What therapeutic management is involved in sickle cell disease?
Hydration Prophylactic antibiotics (penicillin) Medications- Fever Pain mangament Education Psychosocial support child/family Bone marrow/stem cell transplant Splenectomy Sports/extra circular activities** *freq. rest periods to lessen chance of sickling * Ensure dry after swimming
When caring for a child in sickle cell crisis what is the nursing management that takes place?
Pain Management Oxygen/vitals Promote Hydration Monitor I &O Administer antibiotics- post collection of cultures if febrile Monitor for complications Blood transfusion Physiotherapy consult
Describe Cystic Fibrosis. What is it characterized by?
Genetically inherited autosomal recessive disease which affects the respiratory/digestive systems and sweat glands.
Characterized by:
Excessive thick mucous production due to failure of chloride channels to function with obstruct the airways, GI tract and reproductive tract.
Lungs & Pancreas
There is a high concentration of sodium and chloride in secretions rom sweat glands and lacrimal/salvia glands
Common among white ppl
How is Cystic Fibrosis diagnosed?
- Sweat test
- Newborns diagnosed 1st 2 weeks of life b/c or screening
- Test absence/presence of enzymes in intestines
- 3 day fecal fat analysis (assesses digestion)
- CXR: lung assessment
- PFT’s ( pulmonary function tests - when older)
What are the S&S of Cystic Fibroses?
Affects both lungs and digestive system Repeated lung infections Cough with thick mucous Breathing difficulties Poor weight gain Bulky, greasy, foul smelling stool (steatorrhea) Salty tasting skin Treatment depends on state of disease/affected organs
What therapeutic management is involved with Cystic Fibroses?
Antibiotics (oral/inhaled/IV) Bronchodilators Mucolytics Pancreatic enzymes Vitamins Chest Physiotherapy O2 Diet (high calorie, protein, fat) Physical activity Immunizations Education/support lung transplantation, heart-lung transplant Liver transplantation
