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Pedia Note1

Pedia Note1

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Published by FreeNursingNotes
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Published by: FreeNursingNotes on Nov 26, 2009
Copyright:Attribution Non-commercial

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12/15/2012

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Pedia NotesPhysiologic wt loss – 5 – 10% wt loss few days after birthSmall GA < (less) 10Large GA > (more) 90
Physical Exam and Deviations fr Normal
1. if client is new born, cover areas not being examined2.if client is infant – the 1
st
yr of life - get VS
 – take RR 1
st
 - begin fr least intrusive to the most intrusive area3. if client is a toddler and preschool, let them handle an instrument like:- play syringe or stet, security blanket – favorite article. Let baby hold it.4. Explain procedure and respect their modesty - school age and adolescentV/S:Temp: rectal- newborn – to rule out imperforate anus
take it once only, 1 inch insertionImperforate anus1.atretic – no anal opening2.agenetic – no anal opening3.stenos – has opening4.membranous – has openingEarliest sign:1. no mecomium2. abd destention3. foul odor breath4. vomitous of fecal matter 5. can aspirate – resp problemMgt:
 
Surgery with temporary colostomyCardiac rate: 120 – 160 bpm newbornApical pulse – left lower nippleRadial pulse – normally absent. If present PDAFemoral pulse – normal present. If absent- COA - coartation of aorta
Congenital Heart Dse
Common in girls – PDA, ASD atrial septalCommon in boys – TOGA ( transportation of great arteries)TA – tronchus arteriosusTOF – tetralogy of fallotCauses:1.familial
2.
exposure to rubella – 1
st
month3.failure of strucute to progressacyanotic L to R cyanotic R – L
Acyanotic heart defects
L to R 1.ventricular septal defect - opening between 2 ventriclesS&Sx 1. systolic murmurs at lower border of sternum and no other significant sign2.cardiac catheterization reveals increased o2 saturation @ R side of heart3.ECG reveals hypertrophy of R side of heart Nsg Care:Cardiac catheterization: site – Rt femoral vein1.NPO 6 hrs before procedure2.protect site of catheterization. Avoid flexion of joints proximal to site.3.assess for complication – infection, thrombus formation – check pedal pulses( dorsalis pedis)Mgt.
 
1.long term antibiotic – to prevent subacute bacterial endocarditis2.open heart surgery-2
.) ASD
– failure of foramen ovale to closeS&SX1.systolic murmur @ upper border of sternum2.result of cardiac catheterization & ECG same with VSDMgt: open heart surgery3.)
endocardial cushion defects
- atrium ventricular (AV) - affects both tricuspid and mitral valveDx – confirmed by cardiac catheterizationMgt: - open heart surgeryAntibiotics to prevent subacute bacterial endocarditis4.) PDA - failure of ductus arteriosus to close- should close within 24 h -complete close – 1 monthS&Sx1.continuous machinery likemurmurs2.prominent radial pulse3.ECG- hypertrophy Left ventricleDrug:1.endomethazine – prostaglandin inhibitor - facilitate closing of PDA2.ligation of PDA by 3-4 yo3.thoracotomy procedure- nakadapa child
5.)Pulmunary Stenosis-
narrowing of valve of pulmo arteryS &Sx: 1.) typical systolic ejection murmur 2. S2 sound widely split3. ECG- Lt ventricular hypertrophy6.)
Aortic Stenosis
– narrowing of valve of aortaS & Sx: 1. inactive, sx sme with angina

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