FAR EASTERN UNIVERSITY

Institute of Nursing

Care of the Mother and Child at Risk or with Problems

PEDIA

Module: HEALTH PROBLEMS COMMON IN PRE -SCHOOL AGE

Introduction:

The many functions of the immune system—comprised of a number of organs and tissues, including, but
not limited to, the skin, bone marrow, spleen, and lymph system—are integral to the health and well-being of the
child. Infants and young children are at particular risk of infection because of the immaturity of their immune
systems. They are unable to mount either a rapid or an effective response to invading organisms placing them at
high risk for serious illnesses. In fact, children are unable to exhibit adult-level responses until they have reached
school age.

The preschool period, oft en referred to as the age of the magical thinker, is defined as the time between 3
and 5 years of age. Preschool children truly believe that their thoughts have power. When serious illnesses or
accidents occur, even if they are not involved, they oft en feel guilty for having wished harm on others. In
addition, the vast majority of preschool children are verbally and physically capable of giving parents the
impression that their child is knowledgeable about dangers and, therefore, no longer in need of constant
supervision. Unfortunately, that is oft en not the case. Indeed, poisonings and accidental injuries are quite
prevalent in this age group because the children continue to be inquisitive beings, oft en becoming entangled in
precarious situations.

Learning Outcomes

At the end of this module, the student will be able to

1. Describe the pathology for several illnesses of Common Health Problems in Pre school age.
2. Describe the assessment signs and symptoms seen in children with this health problems
3. Relate the assessment findings regarding difficulties specifically to the most common pre school age
illnesses
4. Discuss the treatment recommended for this disease
5. Provide safe and appropriate nursing interventions addressing health care needs of the at-risk/high
risk/sick clients during childbearing and childrearing
6. Demonstrate safe, appropriate and holistic care utilizing the nursing process.
7. Recognize cardinal signs and symptoms of the respiratory system that suggest life-threatening
emergencies.
8. Answers and submits activities provided using multi-disciplinary approach.

Topic Outline:

HEALTH PROBLEMS COMMON IN PRE -SCHOOL AGE

 Asthma
 Urinary Tract Infection (UTI)
 Leukemia
 Wilm’s Tumor

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Summary of Content

ASTHMA

1. What Went Wrong?

o Asthma is a chronic inflammatory
disorder of the airways.
o It is characterized by chronic
inflammation, bronchoconstriction, and
bronchial hyperresponsiveness.
o Asthma is the most common chronic
respiratory illness in the childhood population.

2. Signs and Symptoms

o Expiratory wheezing Chronic cough Dyspnea (shortness of breath or difficulty in breathing)
o Nonproductive cough Tachypnea Chest pain
o Irritability Restlessness Use of accessory muscles
o Orthopnea (an increase in difficulty breathing when students are lying down)

3. Test Results
o Physical assessment findings and client history
o Peak expiratory flow (PEF) rates
o Pulmonary function test (PFT)
o Peak expiratory flow rate

4. Treatment
o Prevent and minimize physical and psychologic morbidity.
o Prevent and reduce exposure to airborne allergens and irritants.
o Pharmacologic therapy to prevent and control asthma symptoms:

 Reverse airflow obstruction

 Long-term control medications
 Quick-relief medications
 Corticosteroids
 Cromolyn sodium
 Metered-dose inhaler (MDI)
 Chlorofluorocarbons (CFCs)
 Corticosteroids
 β-adrenergic agents
 Salmeterol (Serevent)
 Methylxanthines • Anticholinergics
 Leukotriene modifiers
o Exercise

5. Nursing Interventions
 Assess how asthma impacts everyday life.
 Assess child and family’s satisfaction with the effectiveness of the treatment program.
 Assist the child and family to avoid allergens.
 Teach child and family to modify the environment to relieve asthmatic episodes, (i.e., avoid excessive
heat, cold, and other extremes of the weather or wind).
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  Educate parents on reading food labels.
 Avoid foods known to provoke symptoms, foods such as monosodium glutamate (MSG), sulfites,
bisulfites, and metabisulfites.
 Avoid aspirin with children who are sensitive and subject to aspirin induced asthma.
 Monitor for and alert caregivers to signs of status asthmaticus, a life threatening complication.

TEST YOURSELF (ACTIVITY#001)

1. What is the most important aspect in the treatment of asthma?

2. What are the two categories of medications used in the treatment of asthma?
3. What are the routes of administration for many of the medications used to treat asthma?
Answer:

1. ________________________________________________________________________________
___________________________________________________________________________________

2. ________________________________________________________________________________
________________________________________________________________________________

3. ________________________________________________________________________________
________________________________________________________________________________

Note: Copy and paste activity then submit thru email aalfonso@feu.edu.ph. Do not forget to include your name and
section .

URINARY TRACT INFECTION (UTI)

1. What Went Wrong?

o Urinary tract infection occurs when a microorganism, typically a gram-negative bacteria such as E.
coli, enters the urinary tract.
o The microorganism is present in the genital area and enters through the urethral opening or during
sexual contact.
o A nosocomial urinary tract infection can also develop in patients who have a urinary catheter in place
or who have undergone procedures such as a cystoscopy where an instrument is placed in the urinary
tract.
o Nursing alert Urinary tract infections must be treated immediately to prevent pyelonephritis.

2. Signs and Symptoms

o Dysuria due to irritation of mucosal lining
o Feeling of fullness in suprapubic area
o Low back pain
o
3. Test Results
o Urinalysis:
o Presence of WBC, RBC, and nitrites.
o Urine culture and sensitivity: Identifies
microorganism and the antibiotic that kills the
microorganism.

4. Treatment
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 o Administer antibiotics:
 Nitrofurantoin
 Ciprofloxacin
 Levofloxacin
 Ofloxacin
 Trimethoprim-sulfamethoxazole
 Ampicillin
 Amoxicillin
o Encourage fluids, to make urine less concentrated.
o Administer phenazopyridine for symptoms of dysuria.
o Repeat urine testing after antibiotics are completed.

5. Nursing Intervention
o Monitor intake and output.
o Monitor vital signs for changes, signs of fever.
o Encourage fluid intake. Encourage cranberry juice to acidify urine.
o Teach patient that phenazopyridine will cause orange-colored urine

CASE STUDY (ACTIVITY#002)

Judalene Sta Maria (JS), age 6 arrived at the Emergency Department of FEU Hospital. with her mother at
5 PM. Her mother reported that she had become lethargic in recent days. Her mother became concerned
when she felt warm to the touch and hadn’t urinated as much as she normally would. The mother reports
that Judy had a strep throat 4 weeks ago, but she recovered and she was fine up to a few days ago.

Assessment data: Temperature 101.3°F +1 pitting edema bilaterally arms and legs. Slight edema around the
eyes. Urine analysis showed hematuria, proteinuria, and specific gravity is 1.034 g/mL. Blood serum shows
elevated creatinine and BUN. Urine culture and sensitivity is positive for streptococcal bacteria.

Given the data:

1. Interpret the case provided

2. List down your Nursing intervention base on the case.
3. Provide evaluation of your care

Note: Copy and paste activity then submit thru email aalfonso@feu.edu.ph. Do not forget to include your name and
section .

LEUKEMIA
1. What Went Wrong?
o Leukemia, the most common cancer in childhood, is a group of cancer diseases of blood-forming
tissues such as the bone marrow and lymphatic system.
o The problem in leukemia is the production of an excessive number of immature (still in the stem, or
“blast,” stage) white blood cells (WBCs).
o Crowding from these excessive immature cells compromises the production of other cells in the bone
marrow.
o The leukemias are categorized by subtype into two major classifications:
o acute lymphoid leukemia (ALL)/blast stem leukemia, the most common type in children,
and acute myelogenous leukemia (AML), most frequent in adults and the most common
form of leukemia overall.

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 o The primary difference is the type of leukocyte (WBC) involved. In ALL, the immature WBCs
are lymphocytes, and in AML the WBCs involved are cells from the myeloid line, primarily
granulocytes or monocytes.

2. Signs and Symptoms

o Common assessment findings:
 Diagnosis suspected by history and physical data.
 History: Describe onset as acute to vague (insidious) with few symptoms.
 Cold that does not resolve completely.
 Pallor, fatigue, listlessness, irritability, fever, and anorexia may be noted.
 May mimic symptoms of rheumatoid arthritis symptoms or mononucleosis.
 Regular physical can reveal lab values indicating disease.

The result of this crowding depends on the cells that are compromised, as shown in Table 8-1.

3. Test Results
o Peripheral blood smear
used for initial
diagnosis—immature
leukocytes noted (See
Table 8-2).

o Bone marrow aspiration or biopsy used for definitive diagnosis— hypercellular with blast cells
dominating.
o Lumbar puncture done after diagnosis to determine CNS involvement (rarely noted). Chest CT
scan and bone scans to detect metastasis to lung.

4. Treatments
o Chemotherapy is performed with or without cranial irradiation in four phases:
 Induction: Complete remission of leukemic cells (<5% blast cells)
 Steroids and vincristine, L-asparaginase, and possibly doxorubicin 4- to 6-week session

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  Intensification or consolidation therapy: Decrease tumor burden L-asparaginase, high-dose
methotrexate, leucovorin rescue,vincristine, doxorubicin, steroids, cytarabine, and
mercaptopurine
 6 months of treatment: Combinations dependent on cell type
 CNS prophylactic therapy: Decrease CNS invasion
 Intrathecal chemotherapy: Methotrexate, cytarabine, and hydrocortisone
 Possible cranial irradiation
 Maintenance: Maintain remission with irradiation as cell type indicates:
 Combined drug regimen: Varied drugs (discontinue if toxic side effects [myelosuppression
with low neutrophil count <1000/mm3])
 Reinduction with relapse: Use of prednisone and vincristine and
other chemotherapy
 Bone marrow transplantation (BMT) used to treat children with ALL
and AML:
 Reserved for second remission with ALL
 May be used with first AML remission to improve prognosis
• Radiotherapy to destroy tumor
5. Nursing Interventions
 Reinforce physician’s explanation of diagnosis and treatment plan.
 Explain procedure at child’s level of understanding including what will be seen, felt, heard, and
smelled; use drawings when appropriate.
 Maintain contact after discharge and between remissions to encourage follow-up care and respond to
questions or provide emotional support.
 Provide antiemetic and appetite stimulant to increase nutritional intake.
 Offer foods after antiemetic takes effect to reduce nausea and maximize caloric intake.
 Allow to eat any food that is tolerated; avoid forcing food during nausea episode.
 Rinse mouth to remove unpleasant taste sensation.

Nursing alert!!

While children are receiving chemotherapy, parents should not give them aspirin due to increased risk of bleeding
and possible development of Reye syndrome.

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 Test Taking skills (ACTIVITY#003)
Answer the following questions
1. To remain aware of client needs and advocate for the client nurses must do which of the following?
A. Monitor lab results
B. Note side effects from medications
C. Explore historical data
D. All of the above

2. What is the most frequent type of cancer in children other than immature blood cell overgrowth?
A. Lymphomas
B. Leukemia
C. Rhabdomyosarcoma
D. Gliomas

3. The oncogenic virus theory states which of the following?

A. There is a familial predisposition for cell mutation
B. Previous cancer produces high risk for cancer
C. Cancer development is caused by exposure to carcinogenic organisms
D. All of the above

4. An assessment of a child with cancer includes but is not limited to which of the following?
A. Determining religious philosophy
B. Assessing political views
C. Reviewing diagnostic test findings
D. None of the above

5. Bone marrow aspiration is also known as which of the following?

A. Biopsy
B. Metastasis
C. . Cachexia
D. Ewing sarcoma

6. What is Osteogenic sarcoma?

A. Malignant long-bone tumor
B. Malignant tumor of the spine
C. Malignant tumor in the bone marrow
D. Benign tumor of the knee

7. When caring for children with cancer and their families, what should the nurse do?
A. Explain procedures in terms only the parent will understand to protect the child.
B. Do not contact families and allow them their privacy after discharge.
C. Reinforce physician’s explanations of diagnosis and treatment plans.
D. None of the above. ?

8. When explaining treatment protocol to parents, what should the nurse stress?
A. Child should be included as age and maturity permits.
B. Parents should be told to continue with regular immunizations.
C. Parents should push the child to eat favorite foods when feeling nauseated.
D. b and c only.

9. The care needs of families of children with cancer include the following:
A. Stabilization of child’s weight during chemotherapy
B. Referral for family counseling
C. A maintenance of activity within the child’s tolerance
D. All of the above

10. Soft, bland diets, and saltwater rinses are used to relieve the pain of which of the following?
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B. Malignant tumors
WILMS TUMOR (Nephroblastoma)

1. What Went Wrong?

o Wilms tumor, also referred to as nephroblastoma, is cancer of the kidney that begins in the womb
that is linked to abnormal chromosomal and congenital renal abnormalities.
o The Wilms tumor is encapsulated but may begin to metastasize to the renal vein, vena cava, lymph
nodes, lungs, and other organs when the child is 4 years of age.
o Prognosis is good if the tumor is removed before it metastasizes.
o The five stages of the Wilms tumor are
 Stage I: The tumor is contained in one kidney.
 Stage II: The tumor metastasized beyond the kidney; however, the tumor can be completely
removed.
 Stage III: The tumor metastasized to lymph nodes and the abdomen.
 Stage IV: The tumor metastasized to the bone, liver, lung, and brain.
 Stage V: The tumor metastasized to both kidneys.

2. Signs and Symptoms

o Nontender abdominal mass confined to one side
o Enlarged abdomen
o Blood in urine
o Hypertension
o Vomiting
o Constipation
o Anemia

3. Test Results
o Ultrasound: Identifies the size of the mass and if the mass is solid
o CT scan: Identifies the location of the mass
o Magnetic resonance imaging (MRI): Identifies the location of the mass
o Chest radiograph: Identifies the location of the mass
o Urograph: Assesses kidney function

4. Treatment
o Biopsy to determine the type of tumor
o Surgical removal of the tumor and the kidney if necessary
o Chemotherapy (dactinomycin [Cosmegen], vincristine) to reduce the size of the tumor
o Radiation to reduce the size of the tumor

5. Nursing Intervention
o Handle the child carefully during transportation and repositioning to avoid rupturing the tumor
capsule.
o Explain the disorder and treatment to the family.

Nursing alert !!

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Don’t palpate the site of the tumor. Palpation can rupture the tumor capsule resulting in the tumor metastasizing
quickly.

CASE STUDY (ACTIVITY#004)

Mother brings 5-year, 3-month-old female to be assessed by the primary health-care practitioner

Subjective Data
• Child is seen playing with dolls in the waiting room while pretending to give the baby a bottle and wrapping
the baby in a blanket
• Mother states,• “Everything seems fi ne, but I noticed that my daughter’s urine is pink. I first saw it
yesterday evening.”
• “She has had a couple of colds this year, but nothing out of the ordinary. What do you think is going on?”

Objective Data
Nursing Assessment
• Since birth, the child’s well-child checks have been within normal limits, including weight, height, and
head circumferences all at the 50th percentile
• Child is up to date on all immunizations
• Mass palpated in left upper quadrant—child exhibits minimal guarding
• Ultrasound results
• Presumed Wilms’ tumor noted in left kidney

Vital Signs
Temperature: 98.8°F ( Convert to ˚C) _________
Heart rate: 100 bpm
Respiratory rate: 26 rpm
Blood pressure: 106/66 mm Hg

Lab Results
Complete blood count
Red blood cell count: 3.6 million/mm3
Hemoglobin: 11 g/dL
Hematocrit: 33%
White blood cell count: 10,000/mm3
Platelet count: 225,000/mm3
Urine: within normal limits except
Red blood cells: 10 (normal less thanor equal to 2)

Health-Care Provider’s Orders

• Admit to pediatric unit
• Prepare for surgery in a.m.
• NPO after midnight •
Modified bed rest
• Absolutely no one is to palpate the abdomen.

Note: Copy and paste activity then submit thru email aalfonso@feu.edu.ph. Do not forget to include your name and
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 CASE STUDY QUESTIONS

A. What subjective assessments indicate that this client is experiencing a health alteration?
1. ____________________________________________________________________________

2._____________________________________________________________________________

B. What objective assessments indicate that this client is experiencing a health alteration?
1. _________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
5. ____________________________________________________________________________
6. ____________________________________________________________________________
7. ____________________________________________________________________________

C. After analyzing the data that has been collected, what primary nursing diagnosis should the nurse assign to
this client?
1. ____________________________________________________________________________

D. What interventions should the nurse plan and/or implement to meet this child’s and her family’s need
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
5. ____________________________________________________________________________

E. What client outcomes should the nurse evaluate regarding the effectiveness of the nursing interventions?
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
5. ____________________________________________________________________________

F. What physiological characteristics should the child exhibit before being discharged home (from the
hospital)?

1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________
5. ____________________________________________________________________________

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Note:– AALFONSO2020
PEDIA Copy and paste activity then submit thru email aalfonso@feu.edu.ph. Do not forget to include your name and
section .
Learning Resources:

 Textbook: Hockenberry, M.; Wilson, D; Rodgers, C. Wong’s Nursing Care of Infants and Children (2019)
2nd Philippine Edition: Elsevier Saunders

Video Links:

1. Asthma - ..\..\Videos\Free YouTube Downloader\How does asthma work - Christopher E. Gaw.mp4

2. UTI - ..\..\Videos\Free YouTube Downloader\Urinary Tract Infection by Elizabeth Pingree for

OPENPediatrics.mp4

3. LEUKEMIA ..\..\Videos\Free YouTube Downloader\Chronic leukemia - causes, symptoms, diagnosis,

treatment, pathology.mp4

4. WILMS TUMOR ..\..\Videos\Free YouTube Downloader\WAGR syndrome (Wilms tumor-aniridia

syndrome) mnemonic!.mp4

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