Learning Objectives
1. Compare and contrast the symptoms and treatment of mononucleosis and Lyme disease. State nursing considerations for each infection.
2. Define and discuss the nursing implications of each of the following skin disorders: acne vulgaris, impetigo contagiosa, and tinea pedis.
3. Define and discuss the nursing implications of each of the following musculoskeletal disorders: lordosis, kyphosis, scoliosis, juvenile rheumatoid arthritis, Legg-Calvé-Perthes disease, dental malocclusion, and malignant bone tumors.
4. Compare and contrast the nursing implications for diabetes mellitus type 1 and diabetes mellitus type 2.
5. Define and discuss the nursing implications of retinitis pigmentosa and juvenile glaucoma.
6. Define and discuss the nursing implications of IBD.
7. Define and discuss the nursing implications of mittelschmerz and dysmenorrhea.
8. Present a therapeutic teaching session for a family with an adolescent who has concerns about sexual development.
9. Present a therapeutic teaching session for an adolescent with a known or suspected STI.
10. Define and discuss the nursing implications of narcolepsy, hypersomnia, nightmares, somnambulism, night terrors, somniloquism, and insomnia.
11. Identify and differentiate between anorexia nervosa and bulimia nervosa. State the nursing considerations for each condition.
12. Present a therapeutic teaching session to the parents of a child who is obese.
13. Define and discuss the nursing implications for enuresis and encopresis.
14. Identify the nutritional concerns for a school-age child and state the nursing considerations for each concern.
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IMPORTANT TERMINOLOGY |
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acne vulgaris |
impetigo contagiosa |
orthodontia |
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anorexia nervosa |
insomnia |
polydipsia |
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bulimia nervosa |
kyphosis |
polyphagia |
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cataplexy |
lordosis |
polyuria |
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chronic ulcerative colitis |
Lyme disease |
scoliosis |
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conjunctivitis |
malocclusion |
sleep apnea |
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dermabrasion |
mittelschmerz |
somnambulism |
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dysmenorrhea |
mononucleosis |
somniloquism |
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hypersomnia |
narcolepsy |
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Acronyms
BMI
EBV
IBD
IDDM
JRA
NIDDM
NSAIDs
REM
RP
Pediatric nursing continues with the study of common con-ions found in school-age children and adolescents. Older school-age children and adolescents often feel uncomfortable in healthcare settings in which most clients are young children. Healthcare personnel must be sensitive to these feelings and make every effort to provide a comfortable atmosphere for them.
COMMUNICABLE DISEASES
The Common Cold
The common cold is a viral infection that includes more than 200 known viruses; the rhinovirus is the most common viral source. It differs from “the flu” by the intensity of symptoms and the severity of illness. Typically, a cold starts with rhinorrhea (a runny nose) with clear mucus. As the infection is attacked by the body’s own immune system, the clear rhinorrhea can start to look white, yellow, or greenish. Other symptoms of a cold include sneezing, sore throat, coughing, malaise (body aches), mild headache, and watery eyes. The individual may be febrile, which is a helpful immune response; however, notify the healthcare provider if the fever persists or exceeds 100.4°F (38°C). Rest and symptomatic treatment for 5 to 10 days is generally sufficient therapy.
Sore Throat
A sore throat is common with many respiratory tract infections, but this symptom may be a sign of more serious problems. The typical sore throat makes swallowing painful and dry, and the throat feel “scratchy.” Many sore throats are accompanied by a low-grade fever. A healthcare provider needs to be contacted if breathing or swallowing difficulty develops, pus forms on the back of the throat, a body rash develops, or blood-tinged secretions occur. Excessive drooling may indicate a swollen esophagus or blocked trachea (which can occlude the esophagus); this may indicate an emergency. When a sore throat occurs, monitor the individual for dry mouth, poor skin turgor, lethargy, decreased intake and output, headache, and few or no tears when crying. Recurring sore throats can indicate minor problems such as allergies, dry air, and exposure to smoke or other forms of pollution. However, sore throats that happen several times per year can be more serious problems, including non- or partially treated bacterial throat infections, such as strep throat, which need medical interventions.
Conjunctivitis
Conjunctivitis, also known as “pink eye,” is a very common eye condition in all age groups. Viruses, bacteria, or multiple environmental allergens cause the conjunctiva to become inflamed and swollen, making the white part of the eye appear pink or red. Symptoms include eye irritation or itching, eye redness, and photophobia (sensitivity to light). Viral or bacterial conjunctivitis is highly contagious and typically passes from one eye to the other, as well as to other people by contact with secretions. Most viral infections clear without specific treatment in 2 weeks or less. Bacterial infections are treated with topical antibiotics. Allergic conjunctivitis occurs seasonally or year round, especially with individuals who have a history of allergies, hay fever, eczema, or sensitivity to dust mites and animal dander. Contact lenses, contact lens solutions, some cosmetics, and certain medications can also cause allergic conjunctivitis. With allergic conjunctivitis, both eyes are typically affected simultaneously. Over-the-counter antihistamine eye drops are the most common treatment.
Acute Infectious Mononucleosis
Mononucleosis is an infection of the Epstein-Barr virus (EBV). EBV is one of the herpes viruses. This illness, which typically infects the salivary glands, is transmitted by droplets in saliva, coughs, and sneezes, and by direct contact with mucous membranes (mouth-to-mouth). Symptoms are typically flu-like, with headache, low-grade fever, anorexia, cervical lymphadenopathy, and often an enlarged spleen or liver. Upper airway obstruction, severe dysphagia, and dehydration can occur during the first weeks of the acute phase. To determine mononucleosis, the physician may order a complete blood count (CBC) and a “mono spot” test. An individual can have EBV and not be infectious (Fig. 73-1).
Treatment for mononucleosis is symptomatic. Rest, fluids, and analgesics are essential in the treatment plan. If liver or spleen enlargement is present, the greatest risk of rupture is present during the first 2 to 4 weeks of the illness. Strenuous exercise and contact sports should be avoided while the organ(s) are enlarged. Acute symptoms generally improve over 3 to 4 months, but therapy may be needed for 6 months or more.
Systemic steroids may be used to reduce severe pharyngeal inflammation and edema. Fatigue and weakness may persist for several weeks. The school nurse and teachers need to make arrangements for schooling at home during the acute phase (first 2 to 4 weeks).
NCLEX Alert Mononucleosis or "mono” is a relatively common disorder The causative agent, the treatment, or the recovery period may be a consideration for a clinical scenario in an NCLEX question.
FIGURE 73-1 · Appearance of tonsils in a child with infectious mononucleosis. Note the degree of erythema, enlargement, and purulent covering.
Lyme Disease
Lyme disease is a tick-borne bacterial illness that is likely to infect anyone who spends time outdoors or near wooded areas populated with deer and certain other animals. The deer tick, which is less than half the size of the common wood tick, approximately the size of a printed period, carries the bacteria, which it then passes to a human or an animal through bites.
Signs and Symptoms. Symptoms may appear 3 to 31 days after the bite. The affected individual may develop a distinct ring-shaped rash. As it fades, there is central clearing with red edges. The rash appears mostly on the thighs, groin, trunk, armpits, and on the faces of children. The person also has flu-like symptoms. When these symptoms appear, a person can be easily diagnosed and treated with antibiotics (doxycycline, amoxicillin, erythromycin). Treatment at the time of the rash usually prevents development of later stages of the disease.
Many people with Lyme disease, however, never develop the rash. In these people, the bacteria travel through their blood, settle in their tissues, and begin to multiply. No immediate symptoms manifest themselves. Weeks after the bite, affected individuals may begin to complain of angina, chronic fatigue, headaches, facial palsy, limb numbness, heart dysrhythmia, or intellectual impairment.
Many months or even years later, chronic symptoms, such as pain caused by nerve degeneration, loss of muscle function, and even psychiatric disturbances, may develop. The most characteristic symptom is an arthritis that resembles rheumatoid arthritis.
Because of its diversity of symptoms, Lyme disease has been called a “great imitator.” Polymerase chain reaction is a laboratory test that can identify specific spirochetes. This test, along with other general blood tests, aids in the diagnosis of Lyme disease.
Lyme disease can be treated with antibiotics after later symptoms develop, but diagnosis and treatment are much more difficult. Providers sometimes treat the symptoms individually, never thinking of Lyme disease as the cause because the affected person did not develop a rash.
Prevention. People who cannot avoid potentially infested areas must take preventive measures. Common geographic areas for contracting Lyme disease include the Pacific coast, and upper Midwestern, and Northeastern coastal states (see In Practice: Educating the Client 73-1).
Nursing Alert Lyme disease can cause miscarriage, stillbirth, or fetal abnormalities in pregnant women.
SKIN DISORDERS
Acne Vulgaris
A skin eruption called acne vulgaris, or simply acne, affects 85% of the population between 12 and 25 years of age. Blackheads, whiteheads, pimples, cysts, nodules, and scarring characterize acne, which is most commonly seen on the face, back, chest, and upper arms (Fig. 73-2). Acne usually develops first during puberty and is slightly more common in boys than in girls. Research indicates that hormonal changes during puberty, accompanied by over secretion of sebum, are acne’s underlying causes. Stress seems to cause acne flare-ups. Severe acne can leave permanent facial scars.
IN PRACTICE: EDUCATING THE CLIENT 73-1
PREVENTION OF LYME DISEASE
• Wear long sleeves and long pants tucked into the socks or boots (and tape them). Wear closed shoes or sneakers (no sandals).
• Wear light-colored clothing so ticks can be seen more easily
• Check skin and clothing frequently
• Brush clothing off before going indoors.
• Insect repellants, such as DEET may be used, but use with caution on infants and children because of toxicity dangers. Permethrin can be sprayed on clothing to prevent tick attachment.
• Apply spray repellants outdoors.
• Walk on paved areas or cleaned paths rather than through brush, if possible.
• Check the entire body after leaving an infected area. Have someone else assist with the inspection.
• Wash clothes after being outdoors.
• To remove a tick, use tweezers; grasp the tick at its head, and slowly pull it straight out without crushing its body. Crushing the body may force some of the infected fluid into the wound.
• Wash the wound with soap and water and apply an antiseptic.
• Use tick and flea collars on pets that are outside in possible infected areas. Inspect them regularly Common pet ticks do not carry the offending spirochete, but pets can pick up the tick if they are in infested areas outdoors.
• Keep areas where children play free from tall grass, weeds, scrubby areas, and leaf litter.
FIGURE 73-2 · (A) Acne of the face. (B) Acne of the chest.
Treatment. Treatment includes topical and systemic medications. Key medications for acne are listed at In Practice: Important Medications 73-1. Emotional support is an important aspect of the care for these adolescents. Intense pulse light (IpL) therapies have been shown to be effective in treating some forms of acne. (IPL is not the same as a LASER light.) Serial treatments of IPL can reduce the size of skin pores and decrease the amount of skin bacteria that cause acne. IPL may be used in combination with other types of therapies, especially topical medications. A well-balanced, nutritional diet is essential for good overall health.
Dermabrasion, a surgical means of smoothing the skin, may be considered only after active acne has ceased. This procedure is used to minimize scarring.
Nursing Considerations. Accept and acknowledge that physical appearance is important to the adolescent. The emotional stress, social withdrawal, and anxiety that accompany acne can greatly affect a young person’s development. Education needs to include a review of personal hygiene, good general health, and diet. Be sure to cover instructions regarding medications and skin care regimen (see In Practice: Educating the Client 73-2 and In Practice: Nursing Care Plan 73-1).
IN PRACTICE IMPORTANT MEDICATIONS 73-1
FOR ACNE VULGARIS
Topical Agents
Salicylic acid—available in many over-the-counter topical agents
Benzoyl peroxide—available in many over-the-counter topical agents
Retinoic acid, tretinoin (Retin-A)
Tetracycline cream
Erythromycin cream
Systemic Agents
Tetracycline (e.g., Panmycin, Achromycin)
Isotretinoin (Accutane)—careful monitoring by physician needed because of serious side effects; use only when other agents not effective
Nursing Considerations—Topical Agents
• When combined with other agents, they may cause excessive drying of skin.
• Avoid application to mucous membranes, eyes, inflamed skin, or sunburned skin.
• Use with caution in fair-skinned clients, and in clients with eczema or other skin conditions.
• May cause bleaching of hair or clothing.
Nursing Considerations—Tetracycline
• Take 1 hour before or 2 hours after any food, especially milk, dairy products, or meat.
• May interact negatively with iron, lithium, and oral contraceptives.
• Do not use with renal (kidney) or hepatic (liver) dysfunction
Drink plenty of water
• Contraindicated in pregnancy and lactation; may cause permanent staining of teeth of infants
IN PRACTICE: EDUCATING THE CLIENT 73-2
ACNE CARE
• Follow skin care instructions carefully and patiently Acne takes a long time to clear up.
• Use gentle cleansing to avoid further skin damage. Avoid scrubbing the face.
• Review side effects and instructions for use of any prescribed medications (especially Accutane).
• Inspect the skin for any adverse reactions following any treatment.
• Avoid pinching or picking at pimples. This results in inflammation and possible scarring, as well as an increased risk of infection.
• Use a clean towel with each washing. Shampoo frequently
• Maintain good health practices, including regular exercise and balanced nutrition.
• Maintain careful skin care, even after acne lesions have cleared.
