Vous êtes sur la page 1sur 59




Cerebral Palsy

Child Abuse


Injury to body tissue caused by excessive heat (greater than 40 Celsius)

Commonly affects toddlers 2nd greatest caused of unintentional injury in children

Classifications of Burn

Minor Burns

1st or 2nd degree burn < 10% of body surface or 3rd degree burn < 2% of body surface, no area of the face, feet, hands, or genitalia burned

Moderate Burns

2nd degree burn between 10% to 20% or on the face, hands and feet or genitalia, or 3rd degree burn <10%of body surface or if smoke inhalation had occurred

Severe Burns
body surface or 3rd

2nd degree burned > 20% of degree burn > 10% of body surface

Characteristics of Burns
Severity Depth of tissue involved



First Degree (Partial Thickness)

Erythematous, dry, painful to touch and blanches on pressure

Blistered, erythematous to white, moist from exudate, extremely painful Leathery, black or white; non sensitive to pain (nerve endings destroyed),

Sunburn Sclads

Second Degree (Partial Thickness)

Entire Epidermis Portion of dermis


Third Degree Entire skin, (Full including nerves Thickness) and blood vessels in skin, adipose tissue, fascia, muscle and bone


First Degree Burn

Second Degree Burn

Third Degree Burn

Determination of Extent of Burns in Children

Emergency Management
Minor Burns/First Degree Burns/Partial Thickness Burns
immediately apply ice to cool the skin and prevent further burning - application of an alagesic-antibiotic ointment and a gauze bandage to prevent infection - Should have follow up visit in 2 days to have the area inspected for secondary infection and have dressing changed - Heals in about 1 week

Moderate Burns/Second Degree Burns

do not rupture the blisters

- debridement - covered with a topical antibiotic (silver sulfadiazine) and a bulky dressing to prevent damage to the denuded skin

Severe Burns
Fluid therapy
Systemic antibiotic therapy Pain management Physical therapy

Therapy for Burns

Topical Therapy Escharotomy Debridement Grafting

Nursing Diagnoses and Related Interventions

Pain related to trauma to body cells Deficient fluid volume related to fluid shifts from sever thermal burn Risk for ineffective tissue perfusion related to cardiovascular adjustment after thermal injury Risk for ineffective breathing pattern respiratory edema from thermal injury Risk for impaired urinary elimination related to thermal trauma

Social Isolation related to infection control precautions necessary to control spread of microorganisms Interrupted family process related to the effects of severe burns in family member Disturbed body image related to changes in physical appearance with thermal injury Risk for injury related to effects of burn, denuded skin surfaces, and lowered resistance to infection with thermal Injury Risk imbalanced nutrition less than body requirements, related to thermal trauma


Most common in children between the ages of 2 and 3 years old Common agents include soaps, cosmetics, detergents or cleaners, plants, drugs ( vitamins, iron compound, aspirin, acetaminophen, antidepressants

Acetaminophen Poisoning

A drug most frequently involved in childhood poisoning today It can caused liver destruction Anorexia, nausea and vomiting, increase SGPT(ALT) and SGOT (AST), liver tenderness


Activate charcoal or acetylcysteine (specific antidote). Administer with carbonated beverage to help the child swallow it In smaller children administer via NG tube Continue to observe for jaundice and tenderness over the liver, assess AST and ALT levels

Caustic Poisoning

Ingestion of a strong alkali such as lye, which is often contained in a toilet bowl cleaners or hair care products May cause burn or tissue necrosis in the mouth, esophagus, and stomach Parents should not let the child vomit because it could may cause further burning as they are vomited


After ingestion, has immediate pain in the mouth and throat and drools saliva because of oral edema and an inability to swallow Mouth turns white immediately and turns brown later as edema and ulceration occurs May immediately vomit blood, mucus, and necrotic tissue Tachycardia, tachypnea, pallor and hypotension

Therapeutic Management

Intubation may be necessary Monitor vital signs closely Assess for the degree of pain involved Chest radiograph Esophagoscopy Barium Swallow

Hydrocarbon Ingestion

Contained in products such as kerosene and furniture polish Since volatile, fumes rise from them and their major effect is respiratory irritation

Iron Poisoning

Frequently swallowed by small children because it is an ingredient in vitamin preparation It is corrosive to the gastric mucosa Nausea and vomiting, diarrhea and abdominal pain, by 6 hours, hemorrhagic necrosis of the lining of the GI Tract occurs by 12 hours, melena, hematemesis, lethargy and coma, cyanosis and vasomotor collapse Coagulation defects may occur and hepatic injury Shock due to peripheral vascular resistance and decrease cardiac output Long term effects: gastric scarring from fibrotic tissue formation

Therapeutic Management

Stomach lavage Cathartic Administer chelating agents IV or IM Deferoxamine (cause urine to turn orange as iron is excreted Exchange transfusion Upper GI radiographic series and liver studies may be ordered 1 week after the ingestion Test stool passed for the next 3 days for occult blood

Lead Poisoning (Plumbism)

Lead in the body interfere with red blood cell function by blocking the incorporation of iron into the protoporphyrin compound that makes up the heme portion of hemoglobin in red blood cells Leads to hypochromic, microcytic anemia Lead encephalitis (inflammation of brain cells due to toxic lead content) most serious effect


Elevated blood lead levels Anorexia and abdominal pain Lethargy, impulsiveness and learning difficulties, seizures and permanent neurologic damage lead lines (areas of increase density) near the epiphyseal line of long bones. Thickness of the line shows the length of the time lead ingestion has been occurring Damage to the kidney nephrons caused proteinuria, ketonuria and glycosuria Increase protein levels in the CSF

Therapeutic Management

Removal of the child from the environment containing lead or vice versa Chelation therapym(dimercaprol, edetate calcium disodium, Penicillamine (Cuprimine) given 3-6 months Measure intake and output Assess serum creatinine and protein in the urine.

Insecticide Poisoning

Accidental ingestion or through skin or respiratory tract contact when children play in an area that has recently been sprayed Has an organophosphate base that causes acetylcholine to accumulate at neuromuscular junction which leads to muscle paralysis

> Nausea and vomiting > diarrhea, excessive salivation > weakness of paralysis muscles, > confusion, depressed reflexes > possible seizures

Therapeutic Management

Activated charcoal if insecticide was swallow If clothing is contaminated, wash the childs skin and hair. Wear gloves while bathing the child IV atropine and cholinesterase reactivator, pralidoxime (Protopam Chloride) effective antidotes to reverse symptoms

Plant Poisoning

Ingestion of growing plants Example of poisonous plants > poinsettia, morning glory, lily of the valley, rhubarb etc

Poisoning by Drugs or Abuse

Drug overdose or a bad trip caused by an unusual reaction or the effect of an unfortunate combination of drugs Typical drugs are codeine and antidepressants Extremely disoriented hallucinations

Therapeutic Management

Oxygen administration Electrolyte replacement IV fluid administration Important areas to address: > reduction of fear and anxiety > increase coping mechanism > knowledge of the effects of drug use > availability of referral sources for a drug problem

Cerebral Palsy

Is a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction Unknown cause but associated with: > Intrauterine anoxia (faulty plAcental implantation, placenta previa, abruptio placentae, nutritional deficiencies, drugs and maternal infections) > Head injury (child abuse, and shaken baby syndrome) or severe dehydration in newborn > infections (meningitis or encephalitis) > kernicterus

Types of Cerebral Palsy

Pyramidal or Spastic type (40% of affected children Extra pyramidal type a. Ataxic (10%) b. Dyskinetic or athedoid (30%) c. Mixed (10%)

Speech and ocular difficulties, seizures, cognitive challenges or hyperactivity

Assessment of Cerebral Palsy

Physical Findings that suggest Cerebral Palsy
Finding Delayed Motor Development

Do not meet motor development milestones such as sitting, walking, saying sentences, changing objects from hand to hand when they should Smaller than normal age They hold feet plantar flexed (toes down). In prone position the infant tends to raise his head higher than normal because of arching of the back Ankle clonus (persistent movement of the ankle after you had repeatedly flexed it) occurs Persistent or last long past the point when they should fade. Abnormal use of muscle groups. They move by scooting on their back. They placed their toes down first.

Abnormal head circumference

Abnormal postures

Abnormal reflexes Abnormal muscle performance and tone

Strabismus, refractive disorders, visual perception problems, visual field defects and speech disorders such as abnormal rhythm and articulation They may show an attention deficit disorder or autism Deafness Cognitive challenge and recurrent seizure Skull radiograph : skull asymmetry

Nursing diagnosis

Deficient knowledge related to understanding of complex disease condition Risk for disuse syndrome related to spasticity of muscle group Risk for self care deficit related to impaired mobility Risk for delayed growth and development related to activity restriction secondary to CP Risk for imbalance nutrition; less than body requirements related to difficulty sucking in infancy or difficulty feeding self in an older child Impaired verbal communiation related to neurologic impairment

Long Tem Care

Help parents with CP to help their children to reach their fullest potentials within the limits of their disorder Listen to parents during health care visits and encourage them to discuss the difficulties of their daily living

Child Abuse

is the physical or psychological/emotional mistreatment of children any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child

Most child abuse occurs in a child's home, with a smaller amount occurring in the organizations, schools or communities the child interacts with.
According to the (American) National Committee to Prevent Child Abuse, in 1997 neglect represented 54% of confirmed cases of child abuse, physical abuse 22%, sexual abuse 8%, emotional maltreatment 4%, and other forms of maltreatment 12%

Theories of Child Abuse

A parent has the potential to abuse a child (special parent A child is seen as different in some way by the parent (special child) An event or circumstances brings about the abuse (special circumstances stress)

Four Major Categories of Child Abuse:

Physical Neglect Physical Abuse Psychological/Emotional abuse Sexual abuse


is a passive form of abuse in which the perpetrator is responsible to provide care for a victim who is unable to care for oneself, but fails to provide adequate care to meet the victim's needs, thereby resulting in the victim's demise may include failing to provide sufficient supervision, nourishment, medical care or other needs for which the victim is helpless to provide for him/her/itself

Physical abuse

is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or bodily harm

Psychological abuse

also referred to as emotional abuse, is a form of abuse characterized by a person subjecting or exposing another to behavior that is psychologically harmful.

Sexual abuse

referred to as molestation, is the forcing of undesired sexual behavior by one person upon another, when that force falls short of being a sexual assault. The offender is referred to as a sexual abuser or molester. The term also covers any behavior by any adult towards a child to stimulate either child sexually.

Assessing a Child for Child Abuse

Head trauma Missing patches of hair Cigarette burns Burn on dorsal surface of hand Nail biting and other mennerisms of stress Bruising (hidden or excessive) Scalded feet and legs from being lowered into hot water Multiple fractures in different stages of healing


Prevention most important intervention Appropriate reporting Parents supportive education Supplying consistent, caring adult presence for the abused child or furnishing a relationship that the child has never enjoyed Trauma-focused cognitive behavioral therapy Offending parents are included in treatment, to improve parenting skills/practices Child-parent psychotherapy Group Therapy, Play Therapy, and Art Therapy

Thank You!!!