Growth- increase in physical size of a structure or whole.
-quantitative change. Two parameters of Growth 1. weight- most sensitive measure of growth, especially low birth rate. Wt doubles months !" 1yr #" $-$ % yrs $. &eight- increase by 1'(mo during 1 st months - average increase in ht - 1 st year ) *+, stoppage of ht coincide with eruption of wisdom tooth. Development- increase s-ills or capability to function - qualitative &ow to measure development 1. .bserve child doing specific tas-. $. /ole description of child0s progress !. 112T- 1enver development screening test. 3312T 45hil6 3etro 3anila 1evelopmental 2creening Test. 112T measures mental # main rated categories of 112T 1. 7anguage communication $. personal social-interaction !. fine motor adaptive- ability to use hand movement #. gross motor s-ills- large body movement maturation- same with development 8readiness' Cognitive development 9ability to learn and understand from e"perience to acquire and retain -nowledge. To respond to a new situation and to solve problems. :; test- test to determine cognitive development 3ental age " 1++ ) :; <hronological age =verage :; 9 >+-1++ Gifted child- ? 1!+ :; @asic 1ivisions of 7ife :. 5renatal stage from conception- birth ::. 5eriod of infancy 1. Aeonatal- 1 st $B days or 1 st # wee-s of life $. Cormal infancy- $> day 9 1 year :::. Darly childhood 1. Toddler 9 1-! yrs $. 5re school #- years :E. 3iddle childhood 1. 2chool age- F 9 1$ yrs 1 E.7ate childhood 1. 5re adolescent 11 9 1! yrs $. =dolescent 1$ - 1B 9 $1 5rinciples of G G 1 1. GG1 is a continuous process -begins form conception- ends in death - womb to tomb principles 2. not all parts of the body grow at the same time or at same rate. - asynchronism 5atterns of GG1 1. 6renal digestive grows rapidly during childhood circulatory musculos-eletal $. 6Aeuromuscular tissue 4<A2, brain, 2. cord6 - grow rapidly 1-$ years of life - brain achieved its adult proportion by * years. !. 67ymphatic system- lymph nodes, spleen grows rapidly- infancy and childhood to provide protection -infection - tonsil adult proportion by * years #. 6/epro organ- grows rapidly at puberty /ates of GG1 1. fetal and infancy 9 most rapid GG1 $. adolescent- rapid GG1 !. toddler- slow G period #. Toddler and preschool- alternating rapid and slow *. school age- slower growth fetal and infancy- prone to develop anemia !. Dach child is unique $ primary factors affecting GG1 =. &eredity - / 9 race : 9 intelligence 2 9 se" A - nationality Cemales are born less in weight than males by 1 oz. Cemales are born less in length than males by 1 inch @. Dnvironment ; 9 quality of nutrition 2 9 socio eco. status & 9 health . 9 ordinal pos in family 5 9 parent child relationship Dldest- s-illful in language and social s-ills Hounger- toilet trained self #.GG1 occurs in a regular direction reflecting a definitive and predictable patterns or trends. $ 1irectional trends- occur in a regular direction reflecting the development of neuromuscular function. These apply to physical, mental, social and emotional development and includes. a. cephalo-caudal 8head to tail' - occurs along bodies long a"is in which control over head, mouth and eye movements and precedes control over upper body torso and legs. b. pro"imo- distal 8<entro distal' - progressing form center of body to e"tremities. c. 2ymmetrical- at side of body develop on same direction at same time at same rate. d. 3ass specific 8differentiation' - child learns form simple operations before comple" function of move from a broad general pattern of behavior. To a bore refined pattern. @. 2equential- involves a predictable sequence of GG1 to which the child no>rmally passes. a. locomotion- creep than crawls, sit then stand. b. socio and language s-ills- solitary games, parallel games <. 2ecular- worldwide trend of maturing earlier and growing larger as compared to succeeding generations. *.@ehavioral in the most compressive indicator of developmental status. . universal language of child- play F. great deal of s-ill and behavior is learned by practice. 5ractice ma-es perfect. >. neonatal refle"es us must be lost before one can proceed. -plantar refle" should disappear before baby can wal- -moro refle" should disappear before baby can roll persistent primitive infantile refle"es- case of cerebral palsy Theories of GG1 1evelopmental tas-s- different form chronological age -s-ill or growth responsibility arising at a particular time in the individuals life. The successful achievement of which will ------- a foundation for the accomplishments of future tas-s. Theorists 1. Sigmund Freud 1B*-1>!> =ustrian neurologists. Counder of psychoanalysis - offered personality development 5sychose"ual theory a.6 Oral Phase 0-18 months - mouths site of gratification -activity of infant- biting, suc-ing crying. -why do babies suc-I- enJoyment and release of tension. -provide oral stimulation even if baby was placed on A5.. -pacifier. -never discourage thumb suc-ing. b.6 AA!- 18 months-" #ears -site of gratification- anus -activity- elimination, retention or defecation of feces ma-e ta-e place - principle of holding on or letting go. -mother wins or child wins -child wins- stubborn, hardheaded anti social. 4ana- pupu na, child holds pupu, child wins6 -mother wins- obedient, -ind, perfectionist, meticulous .<-anal phase -help child achieve bowel and bladder control even if child is hospitalized. c.6 Phalli$- "-% #ears site of gratification -genitals activity- may show e"hibitionism -increase -nowledge of a se"es -accept child fondling his(her own genitalia as normal e"ploration ! -answer <hilds question directly. /ight age to introduce se"uality 9 preschool d.6 !atent- &-12 #ears -period of suppression- no obvious development. -<hilds libido or energy is diverted to more concrete type of thin-ing -helps child achieve 4K6 e"perience so ready to face conflict of adolescence e.6 Genital- 12-18 #ears -site of gratification -genitals -achieve se"ual maturity -learns to establish relationships with opposite se". -give an opportunity to relate to opposite se". '()C '()C*SO- psychoanalysis theory - stresses important of culture and society to the development of ones personality - environment - culture stages of psychosocial a.6 trust vs mistrust + 0-18 months. -foundations of all psychosocial tas- -to give and receive is the psychosocial theme --now to develop trust baby 1. satisfy needs on time - breastfeed $. care must be consistent and adequate -both parents- 1 st 1 year of life !.6 give an e"perience that will add to security- touch, eye to eye contact, soft music. b.6 Autonom# vs shame and dou,t 18-" #ears --- independence (self gov0t develop autonomy on toddler 1. give an opportunity of decision ma-ing li-e offer choices. $. encourage to ma-e decision rather then Judge. !. set limits c. initiative vs guilt- --% #ears -learns how to do basic things -let e"plore new places and events -activity recommended- modeling clay, finger painting will enhance imagination and creativity and facilitate fine motor dev0t d. industr# vs in/eriorit# &-12 #rs -child learns how to do things well -give short assignments and proJects e. )dentit# vs role $on/usion or di//usion 12-18 #rs - learns who he(she is or what -ind of person he( she will become by adJusting to new body image and see-ing emancipation form parents -freedom form parents. f. )ntima$# vs isolation 20--0 #rs -loo-ing for a lifetime partner and career focus g. generatively vs stagnation #+- + #*-* yrs h. ego integrity vs, despair +-* # 0'A P)AG'1- 2wiss psychologists -develop reasoning power S1AG'S OF COG)1)2' D'2'!OP3'1 =-Sensor# motor 0-2 #rs -8practical intelligence'- words and symbols not yet available baby communicates through senses and refle"es. 4sub div.6 2chema =ge @ehavior 1.6 neonate refle" 1 month =ll refle"es $.6 primary circular 1-# months -=ctivity related to body -repetition of behavior e". thumb suc-ing !.6 secondary circular reaction #-B months -activity not related to body -discover obJ and person0s permanence -memory traces present -anticipate familiar events. <oordination of secondary reaction B-1$ months -e"hibit goal directed behavior -increase of separateness 4will search of lost toy, -nows mom6 Tertiary circular reaction 1$-1B months -use trial and error to discover places and events -8 invention of new means' -capable of space and time perception 4hits for-, spoon on table or drops for-6 :nvention of new means there mental combination 1B-$# months -transitional phase to the pre operational thought period. Preoperational thought 2-& #ears 2chema age @ehavior 5reconceptual $-# yrs -thin-ing basically complete literal and static -egocentric- unable to view others interrupt -concept of dying is only now -concept of distance is only as fat as they can see. -concept of amenism inanimate obJect is alive -not aware of concept of r!eversibility- in every action theories an opposite reaction or cause and effect :nitiative #-F yrs @eginning of causation Con$rete Operational thought &-12 #ears 1. able to find solution to everyday problems which systematic reasoning. $. have concept of reversibility- cause and effect !. have concept of longer uation 9 constancy despite of transformation. #. #. activity recommended- collecting and classifying *. 9stamps stationeries, dolls, rubber band mar-ers. Formal Operational thought 12 and up. 1. <ognition achieved its final form $. can deal with past present and future !. have abstract and mature thoughts. #. can find solutions to hypothetical problems with scientific reasoning. *. activity ------- will sort out opinions and current events. * *O4!5'(G- recognized the theory of moral dev0t as considered to closely appro"imate cognitive stages of dev0t -sabay with cognitive devLt Stages o/ 3oral dev6t :nfancy 9 premoral, prereligious, amoral stage =GD 2T=GD 1D2</:5T:.A 5re-conventional 7evel 1 $-! yrs 1 -5unishment( obedience oriented 4heteronymous morality6 child does right cause a parent tells him or her to and to avoid punishment #-F $ -:ndividualism. :nstrumental purpose and e"ch. <arries out action to satisfy own needs rather than society. -Will do something for another if that person does something for the child. <onventional 7evel F-1+ ! -.rientation to interpersonal relations of mutuality. <hild followers rules cause of a need to be a 8good' person in own eyes and eyes of others. 1+-1$ # -3aintenance of social order fi"ed rules and authority. <hild finds ff. rules satisfying. Collows rules of authority figures. 5ost-conventional 7evel ::: =bove 1$ yrs * -2ocial contract, utilitarian level ma-ing perspectives. Collowers standards of society. Mniversal ethical principle orientation. Collows internalized standards of conduct. D. 1DE0T 3:7D2T.AD2-maJor mar-ers of growth and dev0t 1. Period o/ in/an$#- universal language of child-pla# a.6 Pla#- )n/an$#- solitar# pla#s -solo, mom interactive -facilitate motor and sensory dev0t -safety- important age appropriate solitary play- mobile, teeter, music bo", rattle b.6 fear of infancy- stranger an"iety begin -F months pea- B months diminishes > months 1 month- dance refle" disappears loo-s at mobile 2 months- holds head up when in prone, social smile, baby coos 8doing sound' cry with tears -closure of frontal fontanel $-! months head lag when pulled to sitting position. " months- holds head and chest up when prone follows obJ. past midline grasp and tonic nec- refle" fading hand regard 4loo-s at hand6 - months 9 turns form front to bac- head control complete needs space to turn 7augh aloud, bubbling sounds 7 months- turn both ways 8roll over' -teething rings -handles rattle well -moro refle" disappears 4 #-* months6
% months- reaches out in anticipatory of being pic-ed up
-sits with support -uses palmar grasp -eruption o/ 1 st temp teeth %-8 months 2 lower in$isors -say vowel sounds 8ah', 8oh' -handles bottle well & months- transfer obJ. hand to hand -li-es obJ that are good size 8 months- sits without support -pea- of stranger an"iety -planters refle" disappears B-> months in prep for wal-ing 8 months - creeps or crawls -neat finger grasp refle" - combine $ syllables 8mama' and 8papa' - needs space for creeping 10 months 9 pull self to stand -understands 8no' -responds to own name -pea- a boo, pat a ca-e -can clap 11 months- cruisse - stands with assistance 12 months- stand alone ta-e 1 st step -wal- with assistance -drin- from cup, cooperate in dressing -says $ words mama and dada -pots and pans, pull tay, nursery rhymes 1oddler- parallel pla# - 2 toddlers pla#ing separatel# -provide with similar toys -squea-y frog to squeeze waddling duc- to pull truc-s to push-push pull toy building bloc-s, pounding peg toys to ride on fear- separation an"iety begin > months pea- 1B months ! phases of separation an"iety 4in order6 1. 5- protect $. d despair !. d- denial -don0t prolong goodbye -say goodbye firmly to develop trust- say when ul be bac- F 17 months 9 plateau stage wal-s alone lateness in wal-ing- mild mental retardation -puts small pellets into small bowl -holds spoon well - seats self on chair -creeps up stairs - # - words 18 months- height of possessiveness favorite word- 8mine' bowel control achieved 4bowel 1 st before bladder6 -no longer rotates spoon -can run and Jump in place wal-s up and down stairs holding railing or persons hand -1-$+ words -name, body part -puts both feet on 1 step before advancing. 2- months- terrible two -can open doors by turning door -nobs -unscrew lids -can wal- upstairs alone 9using both feet on same step at same time -*+-$++ words 4 $ words sentences6 -daytime bladder control achieved 4 daytime 1 st - ne"t nighttime bladder control6 "0 months or 2 9 #ears 9 ma-es simple lines or stro-e for crosses with a pencil -can Jump down from chairs --nows full name - copy a circle - holds up finger to show age - temp teeth complete post molar- last temp teeth to appear how many deciduous teeth -$+ beginning of toothbrush 9 $-$ % yrs tooth brushing with little assistance ! yrs tooth brushing alone 9 yrs right time to bring to dentist- when temp teeth complete "% months or " #rs- trusting ! - unbutton buttons 4unbutton before learn to button6 -draw a K - learns how to share --nows full name and se" 4gender identity6 - spea-s fluently -nighttime bladder control -!++->++ words -ride a tricycle <haracteristic Traits of toddler negativistic- 8A.N' -way to search for independence 9limit questions 9modify questions to a statement $.6 rigid, ritualistic and stereotype ritualism- for mastering !.6Temper tantrums- head banging, screaming, stamping feet, holds breath 9ignore behavior scaffoid abdominal-due to underdeveloped abdominal muscles B physiologic anore"ia- due to preoccupation with environment- food Jag that last for short period of time loves rough and tumbling play loves toilet training- failure of toilet training- unreadiness <lues of toilet readinessO 1.6 can stand, squat wal- alone $.6 can communicate toilet needs !.6 can maintain dry for $ hours Pre s$hoolers- associative or cooperative play 1.6 bahay-bahayan 9 play house $.6 role playing !.6 fear-body mutilation or castration fear of dar- places witches fear of thunder and lightning fear of ghosts 3ilestones -#ears old- furious # , noisy, aggressive, stormy -can button buttons -copy a square -Jumps and s-ips -laces shoes -vocabulary 1,*++ --nows four basic colors 7 #ears old- frustrating * -copy a triangle -draw a part man -imaginary playmates -$,1++ words <haracter Traits of 5re-schoolerO 1.6 curious, creative imaginative, imitative $.6 $. favorite words- why and how !.6 comple"es- word identification to parent of same se" and attachment to parent of opposite se" e". .edipal comple"- boy to mom Dlectra comple"- girl to dad <ause of incest marital discord 1eath-sleep only @ehavior problems 5reschool 1. telling tall tales-over imagination $. imaginary friend- to release tension and an"ieties !. sibling rivalry- Jealousy to newly delivered baby. #. regression- going bac- to early stage -thumb suc-ing 4should be oral stage only6 -baby tal- -bed wetting -fetal position *. masturbation- sign of boredom -divert attention- offer a toy > S$hool Age 5lay- competitive play D". Tug of war, trac- and field, bas-et ball Cear. 1.6 school phobia -orient to new environment $.6 displacement from school -teacher and peer of same se" !. loss of privacy -wants bra #.6 fear of death -F->yrs death is personified -death- permanent loss of life 2ignificant 1evelopment a. boys- prone to bone fracture b. mature vision $+($+ % #ears- temp teeth begin to fall perm teeth appear- 1 st molar 1 st temp teeth- * months 1 st perm teeth- yrs -yr of constant motion clensy mou0t recognize all shapes -1 st grade teacher becomes authority figure -nail biting -begin interest in God. & #rs- assimilation age -copy a diamond -enJoys teasing and playing alone -quieting down period 8 #rs- e:pansive age -smoother mouth -loves to collect obJects -count bac-wards 8 #rs 9coordination improves -tells time correctly -hero worship -stealing and lying are common -ta-es care of body needs completely -teacher finds this group difficult to handle 10 #rs- age o/ spe$ial talent -writes legibly -ready for competitive games -more considerate and cooperative -Joins orgs. -well mannered with adult -critical of adults 11-12 #rs + pre adoles$ents -full of energy and constantly active -secret language are common -share with friends secrets -sense of humor present 1+ -social and cooperative <haracter Traits 2chool =ge 1. industrious- $. modest !. can0t bear to lose- will cheat #. love collections- stamps Signs o/ se:ual maturit# G:/72O :-inc size breast and genitalia 4pelarche- 1 st sign se"ual mat. W- widening of hips =- appearance a"illary, pubic 4 adrenarch6 3- menarche- last sign se"ual mat. Girls @.H2O =-appearance a"illary, pubic hair 4 1 st sign se"ual mat6 1-deepening voice 1- development of muscles :--inc in testes and penis size 5- prod of viable sperm 4 last sign se"ual maturity6 =dolescent Cear 1. obesity $. acne !. homose"uality #. death *. replacement from friends . significant person- opp se". 2ignificant dev0t 1. e"periences conflict bet his needs for se"ual satisfaction and societies e"pectation $. change of body image and acceptance of opp(se" !. nocturnal emission 9 wet dreams #. distinctive odor- due to stimulation apocrine glands *. sperm is viable by 1F yrs . testes G scrotum increase until age 1F F. breast and female genitalia increase until age 1B 5ersonality Traits =dolescents 1. idealistic $. rebellious !. reformers #. conscious with body image *. adventuresome 5roblemsO 1. vehicular accident $. smo-ing !. alcoholism #. drug addiction *. pre marital se" 11 :33D1:=TD <=/D .C ADW@./A 1 st days of life 1. initiation and maintenance of respiration $. establishment of e"tra uterine circulation !. control of body temp #. inta-e of adequate nourishment *. establishment of waste elimination . prevention of infection F. establishment of an infant parent relationship B. dev0t care that balances rest and stimulation or mental dev0t 1.6 :nitiation and maintenance of respiration $ nd stage of labor- initial airway -initiation of a (w is a crucial adJustment -most neonatal deaths with in $# h caused by inability to initiate a(w -lung function begins after birth only &ow to initiate a(w a.6 remove secretions bulb syringe @. <atheter 2uctioning 1.6 place head to side to facilitate drainage $,6 suction mouth 1 st before nose -neonates are nasal breathers !.6 period of time -*-1+ sec suctioning, gentle and quic- prolonged and deep suctioning can lead to hypo"ia, laryngo spasm, brady cardia due to stimulation vagal nerve #.6 evaluate for patency -cover nostril and baby struggles there0s a need for additional suctioning <. :f not effective, requires effective laryngoscopy to open a(w. =fter deep suctioning an endotracheal tube can be inserted and o"ygen can be administered by an 4K6 pressure bag and mas- with 1++, o"ygen at #+-+b(m. Asg alertO 1. Ao smo-ing $. =lways humidify to prevent drying of mucosa !. .ver dosage of o"ygen can lead to scarring of retina leading to blindness 4 retro lentalfibrolasia or retinopathy of prematurity6 #. When mecomium stained 4greenish6 never administer o"ygen with pressure 4 .$ pressure will push mecomium inside6 $.6 Dstablishing e"tra uterine circulation - circulation is initiated by lung e"pansion or pulmo ventilation and completed by cutting of cord. F'1O P!AC'1A! C)(C;!A1)O -5lacenta4simple diffusion6 9o"ygenated blood is carried by the umbilical vein- passes liver-ductus venousus- :E<- /T atrium F+, blood is shunted to foramen ovale- 7T atrium mitral valve 9 7T ventricle- aorta-lower e"tremities. -/emaining !+,- tricuspid valve- /T ventricle- pulmonary arteries- lungs 4for nutrition6 4vasoconstriction of lungs pushes blood to ductus arteriousus to aorta to supply upper e"tremities. 1$ 2&MAT2-shortcuts 1uctus venosus- -shunts from liver to :EC Coramen ovale- shunts bet $ atrias 1uctus arteriosus- from pulmonary artery to aorta What will sustain 1 st breath- decreased artery pressure What will initiate lung circulation-lung e"pansion What will complete circulation- cutting of cord #.6 $ way to facilitate closure of foramen ovale a.6 Tangential Cootstep- slap foot of baby -never stimulate baby to cry if secretions not fully drained to prevent aspiration -chec- characteristic of cry normal cry- strong, vigorous and lusty cry cri-du-chat syndrome-chromosomal obliteration cat li-e cry b.6 proper position -right side lying pos. -will increase pressure on left and foramen ovale will close Coramen .vale and 1uctus arteriosus will begin to close within $#h 1ecrease 5.$, increase 5<.$ acidosis Will cause 1 st breath (cry of baby 1ecrease pulmo artery pressure :ncrease 5.$ 1ecrease blood flow :ncrease pressure to 7t side of heart <losure of ductus arteriosus <losure of ductus venosus G =E= <losure of foramen ovale 1! .bliteration-complete closure 2tructure =ppropriate time of obliteration 2tructure remaining Cailure to close C. .vale 1yr Cossa .valis =trial 2eptal 1efect 1uctus =rteriosus 1 month 7igamentum =rteriosum 5atent ductus arteriosus 1uctus Eenosus $ months 7igamentum venosum Mmbilical artery $-! months 1.6 lateral umb. 7igament $.6 interior iliac artery Mmbilical vein $-! months -ligamentum teres 4 round ligament of liver6 5osition of infant immediately after birthO A21-trendelenberg( T position for drainage contraindication of trendelenberg position - increase :<5 <2- supine or crib level position Signs o/ in$reased )CP 1.< abnormally large head 2.< bulging and tense fontanel ".< increase @5 and widening pulse pressure P! G P# are Cushings triad of -.< 1ecreased //, decreased 5/ )CP 7.< proJective vomiting- sure sign of cerebral irritation %.< high deviation 9 diplopia 9 sign of :<5 older child #- months- normal eye deviation ? months- lazy eyes F.6 &igh pitch shrill cry-late sign of :<5 1emp (egulation - goal in temp regulation is to maintain it not less than >F.F, C 4!.* <6 - maintenance of temp is crucial on preterm and 2G= 4small for gestational age6 - babies prone to hypothermia or cold stress - =. factors leading to dev0t of &H5.T&D/3:= 1. preterms are born poi -ilo thermic- cold blooded - babies easily adapt to temp of environment due to immaturity of thermo regulating system of body. &ypothalamus $. inadequate 2; tissue !. baby is not capable of shivering #. babies are born wet 5/.<D22 .C &D=T 7.22 1. evaporation- body to air 4T2@6 $. conduction- body to cold solid obJect 4cold compress6 !. convection- body to cooler surrounding air 4aircon6 #. radiation- body to cold obJect not in contact with body earliest sign of hypothermia- increase in // Dffects of &ypothermia 4 <old stress6 1.6 &ypoglycemia- #*-** mg(dl normal *+- borderline $.6 met acidosis- catabolism of brown fats 4best insulator of newborns body6 will form -etones !.6 high ris- for -ernicterus- bilirubin in brain leading to cerebral palsy #.6 additional fatigue to allergy stressful heart To 5revent &ypothermia 1# 1. dry and wrap baby $. mechanical pressure 9 radiant warmer i. pre-heated first isolette 4or square acrylic sided incubator6 !. prevent an necessary e"posure 9 cover baby #. cover baby with tin foil or plastic *. embrace the baby- -angaroo care A. 'sta,lish Ade=uate utritional )nta>e <2- breastfeeding after # hours A21- breastfeeding asap 5hysiology breast mil- production =s you deliver baby, decrease Dstrogen, decrease 5rogesterone- -=nterior 5osterior Gland 4=5G6 releases prolactin 9 acts on acinar cells 4or alveoli6 9 produce foremil- 9 stored in lactiferous tubules 4 or collecting tubules6 where breast mil- is produced 9 alveoli post-pit.gland 2uc-ing- 55G 9 o"ytocin 9 contraction of lactiferous tubules - mil- eJection refle"- let down refle". Advantages o/ 5reast/eeding 1. Dconomical $. =lways available !. @reastfed babies have higher :; than bottle fed babies. #. :t facilitates rapid involution *. 1ecrease incidence of breast cancer. . &as antibodies- :g= F. &as lactobacillius bifidus- interferes with attac- of pathogenic bacteria in G:T B. &as macrophages 2tore mil-- plastic storage container 2tore mil- 9 good for months from freezer- put rm temp. don0t heat Disadvantages? 1. 5ossibility of transfer &D5 @, &:E, cytomegalo virus. $. Ao iron !. Cather can0t feed G bond as well Stages o/ 5reastmil>? 1. <olostrum- $-# days present contentO decrease fats, increase :g=, dec <&., dec <&.A, inc minerals, inc fat soluble minerals $. Transitional mil-- # 9 1# days contentO inc lactose, inc water soluble vit., inc minerals !. 3ature mil-- 1# G up contentO inc fats 4linoleic acid6 9 resp for devt of brain G integrity of s-in inc <&.- lactose 9 easily digested, baby not constipated. - resp of sour mil- smelling odor of stool. 7actose intolerance- deficiency of enzyme 7=<T=2D that digest 7=<T.2D 1ecrease <&.A- lactalbumin <ows mil- 9 inc fats- 1ec <&. :nc <&.A 9 casing- has curd that0s hard to digest. :nc minerals9traumatic effect on -idneys of babies. <an trigger stone formation. :nc phosphorus 4ealth 1ea$hings? 1. 5roper hygiene- proper hand washing <are of breast - cotton balls with lu-ewarm water <a-ed colostrum- dry mil- on breast $. @est position in breastfeeding 9 upright sitting -avoid tensionN 1* !. 2timulate G evaluate feeding refle"es a.6 /ooting refle"- by touching the side of lips(chee-s then baby will turn to stimulus. 1isappear by wee-s- by wee-s baby can focus. /efle" will be gone - 5urpose rooting- to loo- for food. b.6 2uc-ing 9 when you touch middle of lips then baby will suc- - 1isappears by months - When not stimulated suc-ing will stop. c.6 2wallowing- when food touches posterior of tongue then it will be automatically swallowed d.6 D"trusion( 5rotrusion refle" -when food touches anterior portion of tongue then food will be e"truded. 5urposeO to prevent from poisoning 1isappear by # months G baby can already spit out by # months. Criteria '//e$tive Su$>ing a.6 @aby0s mouth is hi-ed up to areola b.6 3om e"periences after pain. c.6 .ther nipple is also flowing with mil-. To prevent from crac- nipples G initiate proper production of o"ytocin. - begin $-! min at Q breast 4 * 9 F min other authors6 to initiate production of o"ytocin - increase 1 min( day 9 until reaching 1+ mins Q breast or $+ mins( feeding. Cor proper emptying G continuous mil- production ( feeding -feed baby on last breast that you feed her with, alternately 4 if not emptied - mastitis6 Pro,lems e:perien$ed in 5reast/eeding ? ! /1 day changes in breast post partum a.6Dngorged- feeling of fullness G tension in breast. - sometimes accompanied by fever -nown as 3:7R CDED/. 3gt? Warm compress- for breastfeeding mom <old compress 9 for bottle feeding G wear supportive bra. When is involution of breast- # wee-s b.6 2ore nipple 9 crac-ed with painful nipple 3gtO 1.6 e"posure to air 9 remove bra G wear dress, if not, e"pose to $+ Watt bulb avoid wearing plastic liner bra - will create moisture, cotton only c.6 3astitis- inflammation of breast O staphylococcus aureus CactorsO 1. :mproper breast emptying $. Mnhealthy se"ual practices -contraindicated for breast feeding - manually e"press inflamed breast feed on unaffected breast - give antibiotics 9 can still feed on unaffected breast Contra )ndi$ations in 5reast Feeding? 3aternal <onditionsO 1. &:E <3E &epa @ <oumadin Aewborn <ondition - :nborn errors of metabolism Drythrobastosis Cetalis 9 /h incompatibility &ydrops Cetalis 5henyl-etonuria 1 Galactosemia Tay 2achs disease *. Dstablish of waste elimination =. 1iff stools 1. 3econium - physiologic stool - blac- green, stic-y, tar li-e, odorless 42terile intestine6 will pass with in $# 9 ! hrs failure to pass mecomium after $#h- G:T obstruction e". &irschsprungs disease imperforate anus mecomium ileus 9 due to <ystic Cibrosis $. Transitional stool - - green loose G shiny, li-e diarrhea to the untrained eye !. @reastfed stool - golden yellow, soft, mushy with sour mil- smell, frequently passed - recur every feeding #. @ottlefed stool 9 - pale yellow, formed hard with typical offensive odor, seldom passed, $9! "(day - with food added -brown G odorous Saundice baby 9 light stool Mnder phototherapy 9 bright green 3ucus mi"ed with stool - mil- allergy <lay colored stool 9 obstruction to bile duct <hal- clay stool 9 after barium enema @lac- stool 9 G:T bleeding 4melena6 @lood flec-ed stool - anal fissure. <urrant Jelly stool 9 instussusection /ibbon li-e stool 9 hirschsprung disease 2teatorrhea stool 9 fatty, bul-y foul smelling odor stool - malabasorption syndrome 4 celiac disease or cystic fibrosis6 <ult blood 9 stool e"am ))) Assessment /or @ell+,eing APGA( SCO(' 9 1r. Eirginia =pgar 2pecial <onsiderationsO 1 st 1 min 9 determine general condition of baby Ae"t * min- determine baby0s capabilities to adJust e"tra uterinely Ae"t 1* min 9 dependent on the * min =- appearance- color 9 slightly cyanotic after 1 st cry baby becomes pin-. 5- pulse rate 9 apical pulse 9 left lower nipple G- grimace 9 refle" irritability- tangential foot slap, catheter insertion = 9 activity 9 degree of fle"ion or muscle tone / 9 respiration @aby cry 9 within !+ secs Cailure to cry after !+ secs 9 asphy"ia near the neatorum /esp. depression 9 due mom given 1emerol. =dminister Aalo"one
APGA( S$oring Chart? 1F + 1 $ &/ -absent T1++ ?1++ /esp effort -absent - slow, irreg, wea- -good strong cry 3uscle tone - flaccid e"tremities - some fle"ion - well fle"ed /efle" irritability <atheter - no response - grimace - cough, sneeze Tangential Cootslap - A/ - grimace - cry <olor - blue(pale - acrocyanosis 4body- pin- e"tremities-blue6 - pin-ish APGA( result + 9 ! ) severely depressed, need <5/, admission A:<M # 9 ) moderately depressed, needs add0l suctioning G .$ F - 1+ )good( healthy <5/ 9 cardio pulmonary resuscitation or <5/ <ardio pulmonary cerebral resuscitation 4<5</6 * min no .$ 9 irreversible brain damage 1. sha-e, no resp, call for help $. flat on head !. head tilt chin lift maneuver e"cept spinal cord inJury over e"tension may occlude airway @reathing 4 ventilating the lungs6 1. chec- for breathlessness if breathless, give $ breaths- ambu bag ? 1 yr old- mouth to mouth, pinch nose T 1 yr 9 mouth to nose force 9 different between baby G child infant 9 puff <irculation <hec- for pulslessness Ocarotid- adult @rachial 9 infants <5/ 9 breathless(pulseless <ompression 9 inf 9 1 finger breath below nipple line or $ finger breaths or thumb <5/ inf 1O* =dults $O1* =ssessment tool determines respiration of baby Silvermann Anderson )nde: (espiration 'valuation 9 lowest score 9 best <riteria + 1 $ <hest movement synchronized 7ag on respiration 2ee - saw :ntercostal retraction Ao retraction Sust visible 3ar-ed Uiphoid retraction Aone Sust visible 3ar-ed Aares dilatation Aone 3inimal 3ar-ed D"piratory grunt Aone &eard on stet only &eard on na-ed ear :nterpretation resultO + -! 9 normal, no /12 # 9 9 moderate /12 F 9 1+ 9 severe /12 1B Assessment o/ Gestational Age -5allards A Do,owitB Cindings 7ess ! wee-s 45reterm6 !F - !B !> and up 2ole creases =nterior transverse crease only .ccasional creases $(! in <overed with creases @reast nodules $mm #mm or !.* mm ? * or Fmm 2calp hair Cine G fuzzy Cine G fuzzy <oarse G sil-y Dar lobe 5liable 2ome cartilage Thic- cartilage Testes and 2crotum testes in lower canal 2crotum 9 small few rugae 2ome intermediate Testes pendulus 2crotum full e"tensive rugae Signs o/ Preterm 5a,ies @orn after $+ wee-s, after !F wee-s -frog leg or la"ed positon -hypotonic muscle tone- prone resp problem -scarf sign 9 elbow passes midline pos. - square window wrist 9 >+ degree angle of wrist - heal to ear sign- abundant lanugo- Signs o/ Post term ,a,ies? ? #$ wee-s - classic sign 9 old man0s face - desquamation 9 peeling of s-in - long brittle finger nails - wide G alert eyes eonates in urser# Asg responsibility upon receiving baby- proper identification - foot printing, affi"ing mother thumb print - ta-e anthropometic measurement normal length- 1>.* 9 $1 inch or #F.* 9 *!.F*cm, average *+ cm head circumference !!- !* cm or 1! 9 1# 8 &ydrocephalus - ?1#' <hest !1 9 !! cm or 1$ 9 1!' =bd !1 9 !! cm or 1$ 9 1!' 5athing - oil bath 9 initial - to cleanse baby G spread verni" caseosa C" of verni" caseosa 1. insulator $. bacterio- static @abies of &:E K mom 9 immediately give full bath to lessen transmission of &:E - 1! 9 !>, possibly of transmission of &:E Cull bath 9 safely given when cord fall 1ressing the Mmbilical <ord 9 strict asepsis to prevent tetanus " $leans in $ommunit# 1. clean hand $. clean cord !. clean surface betadine or povidone iodine 9 to clean cord chec- =E=, then draw ! vessel cord 1> :f $ vessel cord- suspect -idney malformation - leave about 1' of cord - if @T or :E infusion 9 leave B' of cord best access - no nerve - chec- cord every 1* min for 1 st hrs 9 bleeding .? !+ cc of blood bleeding of cord 9 .mphalagia 9 suspect hemophilia <ord turns blac- on ! rd day G fall F 9 1+ days Caiture to fall after $ wee-s- Mmbilical granulation 3gtO silver nitrate or catheterization - clean with normal saline solution not alcohol - don0t use big-is 9 air - persistent moisture-urine, suspect patent uracus 9 fistula bet bladder and normal umbilicus d"O nitrazine paper test 9 yellow 9 urine mgtO surgery <redes 5rophyla"is 9 1r. <rede -prevent opthalmia neonatorum or gonorrheal conJunctivitis - how transmitted 9 mom with gonorrhea drugO erythromycin ophthalmic ointment- inner to outer silver nitrate 4used before6 9 $ drops lower conJunctiva 4not used now6 Eit-R 9 to prevent hemorrhage /(T physiologic hypoprothrombinemia - =quamephyton, phytomenadione or -ona-ion - .* 9 1.* ml :3, vastus lateral or lateral ant thigh - * ml preterm baby Eit R 9 synthesized by normal flora of intestine Eit R 9 meds is synthetic due intestine is sterile @eight? Aormal wt !.+++ 9 !#++ gms( ! 9 !.# -g ( .* - F.* lbs =rbitrary lower limit $*++ gm 7ow birth wt baby delivered T $*++g 2mall for gestational age 42G=6 T 1+ th , ran- or born small 7arge for gestational age ? >+ th , ran- or macrosomia ?#+++ g =ppropriate for G= 9 within $ standard deviation of mean 5hysiologic wt loss 9 * 9 1+, wt loss few days after birth 2mall G= T 4less6 1+ 7arge G= ? 4more6 >+ Ph#si$al ':am and Deviations /r ormal 1. if client is new born, cover areas not being e"amined $. if client is infant 9 the 1 st yr of life - get E2 9 ta-e // 1 st
- begin fr least intrusive to the most intrusive area !. if client is a toddler and preschool, let them handle an instrument li-eO - play syringe or stet, security blan-et 9 favorite article. 7et baby hold it. #. D"plain procedure and respect their modesty - school age and adolescent E(2O TempO rectal- newborn 9 to rule out imperforate anus - ta-e it once only, 1 inch insertion :mperforate anus 1. atretic 9 no anal opening $. agenetic 9 no anal opening !. stenos 9 has opening $+ #. membranous 9 has opening Darliest signO 1. no mecomium $. abd destention !. foul odor breath #. vomitous of fecal matter *. can aspirate 9 resp problem 3gtO 2urgery with temporary colostomy <ardiac rateO 1$+ 9 1+ bpm newborn =pical pulse 9 left lower nipple /adial pulse 9 normally absent. :f present 51= Cemoral pulse 9 normal present. :f absent- <.= - coartation of aorta Congenital 4eart Dse <ommon in girls 9 51=, =21 atrial septal <ommon in boys 9 T.G= 4 transportation of great arteries6 T= 9 tronchus arteriosus T.C 9 tetralogy of fallot <ausesO 1. familial $. e"posure to rubella 9 1 st month !. failure of strucute to progress acyanotic 7 to / cyanotic / 9 7 A$#anoti$ heart de/e$ts 7 to / 1. ventricular septal defect - opening between $ ventricles 2G2" 1. systolic murmurs at lower border of sternum and no other significant sign $. cardiac catheterization reveals increased o$ saturation Q / side of heart !. D<G reveals hypertrophy of / side of heart Asg <areO <ardiac catheterizationO site 9 /t femoral vein 1. A5. hrs before procedure $. protect site of catheterization. =void fle"ion of Joints pro"imal to site. !. assess for complication 9 infection, thrombus formation 9 chec- pedal pulses 4 dorsalis pedis6 3gt. 1.6 long term antibiotic 9 to prevent subacute bacterial endocarditis $.6 open heart surgery- $.< ASD 9 failure of foramen ovale to close 2G2U 1. systolic murmur Q upper border of sternum $. result of cardiac catheterization G D<G same with E21 3gtO open heart surgery !.6 endo$ardial $ushion de/e$ts - atrium ventricular 4=E6 - affects both tricuspid and mitral valve 1" 9 confirmed by cardiac catheterization 3gtO - open heart surgery =ntibiotics to prevent subacute bacterial endocarditis $1 #.6 51= - failure of ductus arteriosus to close - should close within $# h -complete close 9 1 month 2G2" 1. continuous machinery li-e murmurs $. prominent radial pulse !. D<G- hypertrophy 7eft ventricle 1rugO 1. endomethazine 9 prostaglandin inhibitor - facilitate closing of 51= $. ligation of 51= by !-# yo !. thoracotomy procedure- na-adapa child 7.<Pulmunar# Stenosis- narrowing of valve of pulmo artery 2 G2"O 1.6 typical systolic eJection murmur $. 2$ sound widely split !. D<G- 7t ventricular hypertrophy .6Aorti$ Stenosis 9 narrowing of valve of aorta 2 G 2"O 1. inactive, s" sme with angina $. typical murmur !. rough systolic sound and thrill #. D<G- 7eft ventricular hypertrophy cardiac catheterization- 3gt 5ulmo 2tenosis G =ortic 2tenosis 1.6 balloon stenostomy $.6 surgery 1uplication of =ortic =rch- doubling of arch of aorta causing compression to trachea and esophagus 2G2" O 1. dysphagia $. dyspnea !. left ventricular hypertrophy 3gtO - close heart surgery B.6 Coartation o/ Aorta 9 narrowing of arch of aorta outstanding 2" O absent femoral pulse @5 increased on upper e"tremities and decreased on lower e"tremities D<G 9 hypertrophy 7ft ventricle 3gtO close heart surgery CCAO1)C 4'A(1 D'F'C1S ( to ! 1. Transportation of Great =rteries 4T.G=6 - aorta arising from /t ventricle pulmo artery arising form 7t ventricle .utstanding 2"O 1. cyanosis after 1 st cry 4due no e"ygenation6 $. polycythemia 9 increased /@< )compensatory due to .$ supply)viscous blood )thrombus ) embolus ) stro-e !. D<G 9 cardiomegaly <ardiac cath 9 decreased .$ saturation 5alliative repair 9 rash-ind procedure <omplete repair 9 mustard repair $.6 1otal Anomalous Pulmonar# venous return 9 pulmo vein instead of entering 7t atrium, enters /t atrium or 2E< :ncreased pressure on /t so blood goes to 7ft .utstanding 2"O .pen foramen ovale 3ild to moderate cyanosis 5olycythemia ) thrombus ) embolus ) stro-e asplenia- absent spleen 3gtO restructuring of heart $$ !.6 1run$us Arteriousus- aorta G pulmo artery is arising fr 1 single vessel or common trun- with E21 2 G 2" 1. cyanosis $. polycythemia 9 thrombus ) embolus ) stro-e 3gtO &eart transplant #.6 4#poplasti$ !e/t heart s#ndrome 9 non f" 7eft ventricle 1. cynosis $. polycythemia 9 throm, emb, stro-e 3gtO heart transplant *.6 1ri$uspid atresia 9 failure of tricuspid valve to open 2G2UO open foramen ovale 4/ to 7 shunting 9 goes to 7t atrium6 cynosis, polycythemia 3gtO fontan procedure 9 open tricuspid valve .6 1etralog# o/ Fallot 5 9 pulmonary stenosis E 9 ventricular 21 . 9 overriding or de"troposition of aorta / 9 /t ventricular hypertrophy 2 G2"O 1. /t ventricular hypertrophy $. high degree of cyanosis !. polycythemia #. severe dyspnea 9 squatting position 9 relief , inhibit venous return facilitate lung e"pansion. *. growth retardation 9 due no .$ . tet spell or blue spells- short episodes of hypo"ia F. syncope B. clubbing of fingernails 9 due to chronic tissue hypo"ia >. mental retardation 9 due decreased .$ in brain 1+. boot shaped heart 9 "-ray 3gtO 1. .$ $. no valsalva maneuver , fiber diet la"ative !. morphine 9 hypo"ia #. propranolol 9 decrease heart spasms *. palliative repair 9 @7T blaloc- taussig procedure @roc- procedure 9 complete procedure ACD;)('D 4'A(1 DS' 1. (4D (heumati$ 4eart Disease - inflammation disease ff an infection acquired by group = @eta hemolytic strepto coccus =ffected body 9 cardiac muscles and valves , musculos-eletal , <A2, :ntegumentary 2orethroat before /&1 =schoff 9 rounded nodules with nucleated cells and fibroblasts 9 stays and occludes mitral valve. $! 0ones Criteria 3aJor 3inor 1. polyarthritis 9 multi Joint pain 1. arthralgia 9 Joint pain $. chorea 9 sydenhamms chores or st. vetaus dance-purposeless involuntary hand and shoulder with grimace $. low grade fever !. carditis 9 tachycardia erythema marginatum - macular rashes 2; nodules !. all lab results increase antibody 8 < reactive protein 8 erythrocyte sedimentation rate 8 anti streptolysin o titer 4=2.6 <riteriaO5resence of $ maJor, or 1 maJor and $ minor K history of sore throat will confirm the d". Asg <areO 1. <@/ $. throat swab 9 culture and sensitivity !. antibiotic mgt 9 to prevent recurrence #. aspirin 9 anti-inflammatory. 7ow grade fever 9 don0t give aspirin. 2(D of aspirinO - /eyes syndrome 9 encephalopathy- fatty infiltration of organs such as liver and brain /espiration Aewborn resp 9 !+-+ cpm, irregular abd or diaphramatic with short period of apnea without cyanosis. T 1* secs 9 normal apnea 9newborn /esp <hec- Aewborn 9 #+ 9 >+ 1 yr - $+ 9 #+ $-!yr $+ 9 !+ * yrs $+ 9 $* 1+ yrs 1F 9 $$ 1* G above 1$- $+ 5('A14 SO;DS 4'A(D D;()G ASC;!1A1)O? 1.6 ED2:<M7=/ 9 soft, low pitched, heard over periphery of lungs, inspiration longer then e"piration -Aormal $.6 @/.A<&.ED2:<M7=/- soft, medium pitched, heard over maJor bronchi, inspiration equals e"p. Aormal !.6 @/.A<&:=7 2.MA12- loud high pitched, heard over trachea, e"piration longer than inspiration. Aormal #.6 /&.A<&: 9 snoring sound made by air moving through mucus in bronchi. Aormal *.6 /=7D2-or crac-les 9 li-e cellophane 9 made by air moving through fluid in alveoli. =bnormal- asthma, foreign body obstruction. .6 W&DDV:AG- whistling on e"piration made by air being pushed through narrowed bronchi .=bnormal 9 asthma, foreign body obstruction F.6 2T/:1./- crowing or ropster life sound 9 air being pulled through a constricted laryn". =bnormal 9 resp obstruction $# =sthma- pathognomonic sign 9 e"piratory wheezing 5et 9 fish. 2port 9 swimming 1rugs 9 amynophylline 9 monitor bp, may lead to hypotension 7aryngo Tracheo @ronchitis 7T@ - inspiratory stridor 9 pathognomonic sign /12 respiratory dist synd or hyaline membrane dis <ause- lac- of surfactant 9 for lung e"pansion &ypotonia, 5ost surgery, <ommon to preterm Fi,rine h#aline 2" 9 definite with in 1 st of life :ncrease // with retraction :nspiratory grunting 9 pathognomonic F 9 1+ severe /12 4silvermenn =nderson inde"6 cyanosis due to atelectasis 3gtO 1. surfactant replacement and rescue $. pos- head elevated !. proper suctioning #. o$ with increase humidity- to prevent drying of mucosa *. monitor E(2 s-in color , =@G . <5=5- continuous K a(w pressure F. 5DD5 - K end e"piratory pressure 5urpose of P-F- to maintain alveoli partially open and alveoli collapse !A(CGO1(AC4'O5(OC4)1)S 7T@ 9 most common Creup -viral infection of laryn", trachea G bronchi outstanding s" - croupy cough or bar-ing pathognomonic - stridor - labored resp - resp acidosis - end stage 9 death 7abO 1. =@G $. nec- and throat culture !. d"- nec- "-ray to rule out epiglotitis Asg 3gtO 1. bronchodilators $.increase o$ with humidity !. prepair tracheostomy set 5(OC4O!)1)S- :nflammation of bronchioles 9 tenatious mucus <ausative agaent 9 /2E - /esp sincytial viruses 2"O flu li-e s" :ncreased // 1rugO =ntiviral 9 /ibavirin Dnd stage 9 epiglotitis 'P)G!O1)1)S - infl of epiglottis - emer. <ondition of M/T: 2"O sudden onset Tripod position 9 leaning forward with tongue protrusion - never use tongue depressor prepare tracheotomy set $* T * yo 9 unable to cough out, put on mist tent 4humidifier o$6 or croupe tie Asg <areO chec- edges tuc-ed on mist tent 5rovide washable plastic material Ao toys with friction due .$ on Ao hairy toys 9 due moist environment medium for bacterial growth @5 9 B+(# mm&g newborn @5 after 1+ days- 1++(*+ @5 ta-ing begins by ! yo <.= 9 ta-e @5 on # e"tremities S*)? =crocyanosis 5)(143A(*S? 1. 3ongolian spots 9 stale gray or bluish discoloration patches commonly seen across the sacrum or buttoc-s due to accumulation of melanocytes. 1isappear by 1 yr old $. 3:lla 9 plugged or unopened sebaceous gland . white pin point patches on nose, chin or chee-. !. 7anugo 9 fine, downy hair 9 common preterm #. 1esquamation 9 peeling of newborn, e"treme dryness that begin sole and palm. *. 2tor- bites 4Talengeictasi nevi6 9 pin- patches nape of nec- hair will grow as child grows old . Drythema To"icum 9 4flea bite rash6- 1 st self limiting rash appear sporadically G unpredictably as to time G place. F. &arlequin sign 9 dependent part is pin-, independent part is blue 4side lying 9 bottom part is dependent pin-6 B. <utis 3armorato 9 transitory mottling of neonates s-in when e"posed to cold. >. &emangiomas 9 vascular tumors of the s-in " t#pes 4emangiomas a.6 Aevus Clammeus 9 port wine stain 9 macular purple or dar- red lesions seen on face or thigh. ADED/ disappear. <an be removed surgically b.6 2trawberry hemangiomas 9 nevus vasculosus 9 dilated capillaries in the entire dermal or subdermal area. Dnlarges, disappears at 1+ yo. c.6 <avernous hemangiomas 9 communication networ- of venules in 2; tissue that never disappear with age. - 3.2T 1=AGD/:.M2 9 intestinal hemorrhage 2-in color blue 9 cyanosis or hypo"ia White 9 edema Grey 9 inf Hellow 9 Jaundice , carotene Eerni" <aseosa 9 white cheese li-e for lubrication, insulator @M/A T/=M3= 9 inJury to body tissue caused by e"cessive heat.
:AC=AT *-> yo =ATD/:./ 5.2TD/:./ =nt 5ost &ead >.* >.* .* .* Aec- 1 1 1 1 Mpper arm $ $ $ $ 7ower arm 1.* 1.* 1.* 1.* &and 1! 1.$* 1.$* 1.$* Trun- 1! 1! @ac- 1! 1! Genital 1 1 Q buttoc-s $.*Q $.* Q Thigh $.F* $.F* # # 7eg $.* $.* ! ! foot 1.F* 1.F* 1.F* 1.F* $ D'P14 1 st degree 9 partial thic-ness 9 superficial epidermis - erythema, dryness, 5=:A -sunburn, heals by regeneration from 1 9 1+ days $ nd degree 9 epidermis G dermis- erythema, blisters, moist, e"tremely painful scalds ! rd degree 9 full thic-ness- epidermis, dermis, adipose tissue, fascia, muscle G bone lethargy, white or blac-, not painful 9 nerve endings destroyed e". lava burns 3gtO 1.6 1 st aid a.6 put out flames by rolling child on blan-et b.6 immerse burned part on cold &$o c.6 remove burned clothing of with sterile material d.6 cover burn with sterile dressing $.6 a(w a.6 suction 5/A, o$ with increased humidity b.6 endotracheal intubation c.6 tracheostomy !.6 5reventiuon of shoc- G CGD imbalance a. colloids to e"pand bld volume b. isotonic saline to replace electrolytes c. de"trose G &$o to provide calories #.6 Tetanus to"oid booster *.6 /elief of pain 9 :E analgesic 3./5&:AD 2.# 9 needed for $ nd degree 9 very painful .6 1 st defense of body 9 intact s-in prevention of wound infection a.6 cleaning G debriding of wound b.6 open or close method of wound care c.6 whirlpool therapy 9 drum with solution F.6 s-in grafting 9 ! rd degree 9 thigh or buttoc-s 4autograft6, pigs( animals 9 "enograft frozen cadaver 9 hallow graft B,6 diet 9 increase <&.A, increase calories. A1OP)C D'(3A1)1)S- infantile eczema 4galis6 5apulo vesicular erythematus lesions with weeping G crusting <ause 9 food allergiesO mil-, citrus Juice, eggs, tomatoes, wheat 2"O - e"treme pruritus, linear e"coriation, weeping crustingL scaly shiny and white 9 lechenification Goal o/ $areO decrease pruritus 9 avoid food allergens 1ietO 5rosobi or :somil &ydrate s-in, borow solution 1, hydrocortisone cream 5revent infection 9 proper handwahsing, trim nails )3P'1)GO- s-in disease. <ausative agent 9 grp = beta &emolytic streptococcus - papulovesicular surrounded by localized erythema 9becomes purulent , oozes a honey colored crust Pedi$ulosis$apitis 98RMT.' - 3gtO proper hygiene 9 wash soap and &$o, oral penicillin 9 bactroban ointment <an lead to acute glomerulonephritis =GA AC'- adolescent problem - self limiting infl dis 9 sebaceous gland comedones 9 sebum causing white heads - sebum- lipids causing acne bulgaris 3gtO - proper hygiene- mild soap or sulfur soap- antibacterial retin = or tretinoi $F A'3)A-pallor <ausesO 1.6early cutting of cord 9 preterm 9 cut umb cord =2=5 fullterm 9 cut umb cord when pulsation stops $.6 @leeding disorders 9 blood dyscrasias 4'3OP4)!)A 9 deficiency of clotting factor. U lin-ed recessive 9 inherited :f mom 9 carrier, son 9 affected :f father carrier- transmitted to daughter
&emophilia = 9 deficiency of coagulation component factor B &emophilia @ 9or christmas disease, deficiency of clotting factor > &emophilia < 9 deficiency of clotting factor 11 =ssessmentO - umphalagia 9 earliest sign - newborn receive maternal clotting factor - newborn growing 9 sudden bruising on bump area- mar-s earliest sign - continuous bleeding 9 hematrosis 9 damage or bleeding synovial membrane 1" test O 5TT. 5artial thromboplastin time 9 reveals deficiency in clotting factor 7ong Term Goal- prevention of inJury Asg 1"- increase ris- of inJury &TO avoid contact sport, swimming only, don0t stop immunization 9 Just change gauge of needle Calls 9 immobilized , elevate affected part, apply pressure-not more then 1+ min cold compress -determine case before doing invasive procedure !';*'3)A- grp of malignant disease - rapid proliferation of immature W@< - W@< 9 protection from infection, soldiers of body <lassification O 1. !#mpho 9 affects lymphatic system $. 3#elo 9 affects bone marrow !. a$ute E ,lasti$- affects immature cells #. $hroni$E $#sti$- affects mature cells 3OS1 CO33O CAC'( 9 4=776 9 =cute 7ymphocytic 7eu-emia 2G2"O 1. from invasion of bone marrow signs of infection a.6 fever b.6 poor wound healing c.6 bone wea-ness G causes fracture signs of bleeding a.6 petecchiae-small, round, flat, dar- red spot b.6 epista"is c.6 blood in urine( emesis signs of anemia a.6 pallor , body malaise , constipation $. from invasion of body organ- hepato spenomegaly 9 abd pain , <A2 affectation, increase :<5 1" TestsO 1. 5@2- peripheral blood smear 9 determine immature /@< $. <@< 9 determine anemia, leu-ocytosis, thrombocytopenia neutropenia $B !. lumbar puncture 4756 9 determine <A2 involvement. @efore 75, fetal pos.- avoid fle"ion of nec- 9 will cause a(w obstruction.8<' position or shrimp position only. #. bone marrow aspiration 9 determine blast cells, - common site- iliac crest - post @3= s(effect 9 bleeding - apply pressure. 5ut pt on affected side to prevent hemorrhage *. @one scan 9 determine bone involvement . <T scan 9 determine organ involvement Therapeutic 3gtO 1()AD? 1. surgery $. irradiation !. chemotheraphy Cocus Asg <areO prevent infection - !'2'!S OF C4'3O14'(AP4C 1. induction 9 goal of t"L to achieve remission medsO :E vincristine 7- agpariginase .ral predinisone $. 2anctuary- treat leu-emic cells that invaded testes G <A2 giveO methotri"ate- adm intrathecally via <A2 or spine cytocine, =rabinoside, steroids with irradiation !. maintenance- to continue remission giveO oral methotrisate 9 chec- W@< -adm of methotrisate 9 do wee-ly W@< chec- #. /einductin 9 treat leu-emic cells after relapse occurs. 3eds 9 same as induction - give antigout agentsO allopurinol or Vyloprim- treat or prevent hyperurecemic nephropathy. sg mgt? .utstanding nsg d"O alteration in nutrition less body requirement. @ased on 3aslow0s heirarchy SE'//e$t o/ Chemotherap# 1. A(E 9 adm antiemetic drugs !+ mins before chemo until 1 day after chemo $. Mlcerations ( stomatitis ( abscess of oral mucosa- 4alteration nutrition less body req6 - oral care 9 alcohol free mouthwash , betadine mouthwash - don0t brush 9 use cotton pledgets - topical "ylocaine before meals diet- soft, bland diet according to child0s preference Temporary 2(D of chemoO =lopecia 9 altered body image &irsutism 9 hair -give emotional support to parents A5O in$ompati,ilit# 9 3ost common incompatibility 9 4 mom6 . 9 4 fetus6 = 3ost severe incompatibility 43om6 .9 4Cetus6 @ <an affect 1 st pregnancy $> 4#drops 4h$+6 Fetalis 9 edematous on lethal state with pathologic Jaundice Within $# h 3gtO 1. initiate breastfeeding to get colostrum $. Temp suspension of breastfeeding - content breast mil- pregnanedioles 9 that delays action of glucoronil transferees liver enzymes converts in direct bilirubin to become direct bilirubin !. Aeeds phototherapy #. needs e"change therapy &yperbilirubinemia - ? 1$ mg(d7 of indirect bilirubin among full term Aormal 9 +-! mg(d7 - bilirubin encephalopathy - Remicterus - ? $+ mg(d7 among full term G ?1$ mg (dl of indirect 9 preterm )can lead to cerebral palsy- Ph#siologi$ Faundi$e 9 Jaundice within #B -F$ h 4$-! days6 e"pose morning sunlight 5athologic Saundice 9 within $#h. Saundice during delivery. @reastfeeding Jaundice 9 caused by pregnanediole =ssessment of Saudice O 1. @lanching neonates forehead, nose or sternum - yellow s-in G sclera - color of stool 9 light stool - color of urine 9 dar- urine 3gtO 5hototheraphy 9 photo o"ygenation Asg /espO 1. cover eyes 9 prevent retinal damage $. cover genitals 9 prevent priapism 9 painful continuous erection !. change position regularly 9 even e"posed to light #. increase fld inta-e 9 due prone to dehydration *. monitor :G. 9 weigh baby . monitor E(2 9 avoid use of oil or lotion due- heat at phototherapy ) bronze baby syndrome-transient 2(D of phototherapy weigh diaper 1gm ) 1cc &ead 9 largest part of baby W of its length Craniostenosis or $raniosinustosis 9 premature closing of fontanel &ydrocephalus 9 ant fontanel open after 1B mos 3icrocephaly 9 small growing brain due- alcohol G &:E mom =nencepahly 9 absence of cerebral hemisphere <raniotabes 9 localized softening cranial bone. <ommon 9 1 st born child -due early lightening 4$ wee-s prior to D116 /ic-ets of Eit @ deficiency 9 soft cranial bone in older children <aput 2uccedaneum 9 edema of scalp due prolonged pressure at birth <harO 1. present at birth $. crosses suture lines !. disappear after $-! days !+ Cephalhematoma- collection of blood due to rapture of pericostal capillaries <har O 1. present after $# h $. never cross suture line !. disappear after #- wee-s #. monitor for developing Jaundice Se,orrhei$ Dermatitis 9 Xcraddle cap' 2caling, greasy appearing salmon colored patches 9 seen on scalp behind ears and umbilicus <auseO - improper hygiene 3gtO 1. proper hygiene $. put oil night before shampoo - baby oil 4#dro$ephalus 9 e"cessive accumulation of <2C 1. communicating 9 e"tra ventricular hydrocephalus $. non-communicating- intraventricular hydrocephalus or obstructive hydrocephalus due to tumor obstruction 2" 9 :<5 9 abnormally large head, bulging fontanel - cushings triad - high pitched cry older child 9 diplopia 9 eye deviation, proJectile vomiting - fontanel bossing 9 prominent forehead - - prominent s-ull vein - sunset eyes 3gtO position to lessen :<5 9 low semi-fowlers !+ degree angle =dminister- osmotic diuretic 3annitol( .smitrol , 1iame"- =zetam 1ecrease <2C production 2hunting 9 =E shunt or Ep shunt 4ventriculoperitoneal shunt6 2have hair 9 in ./ 9 to prevent growth of micro org. Asg <areO 1.6 post E5 shunt 9 side lying on non operated site - to prevent increase :<5 monitor for good drainage - sign 9 sun-en fontanel bulging fontanel 9 bloc-ed shunt change fontanel as child is growing S'S'S DHD2O =ssessment 1. chec- for symmetry $. sclera 9 normal color 9 light blue then become dirty white pupil 9 round- adult size coloboma- part of iris is missing signO -ey hole pupil whiteness G opacity of lens congenital cataract cornea 9 round G adult size large 9 congenital glaucoma 1est /or ,lindness common tests 1. newborn 9 general appearance - can only see 1+ 9 1$ 8 - visual acuity $+ ($++ to $+( B++ 1oll0s eyes test- test for blindness - done 1+ th day - pupil goes opposite to direction when head is moved Globellars test 9 test for blin- refle". 5oints near nose 9 baby should blin- !1 $. :nfant G children - appearance - ability to follow obJect past midline !. ! yrs 9 school age - general appearance =llen cards 9 test for visual acuity. 2how picture $+ ft away :shiharas plates 9 test for color blindness 5rechool D chart - test for stereopsi of depth perception <over testing test 9 cover 1 eye for 1+ 9 1* min. Then remove. Test for strabismus #. 2chool age 9 adult - general appearance - snellens test /etinobastoma 9 malignant tumor of retina .utstanding sign O oat0s eye refle"-whitish glow of pupil - red painful eye - blindness surgery 9 Dnucliation 9 removal of eyeball put artificial aye OS'? 1. flaring alenase 9 case of /12 $. cyanosis at rest 9 choanal atresia - post nares obstructed with bone or membrane 2"O 1. resistance during catheter insertion $. emer. 2urgery within $# h normal color nasal membrane 9 pin-ish rhinitis 9 presence of creases G pale chec- sense of smell 9 blindfold 9 smell &air in nose 9 cilia =dolescent no hair with ulceration of nasal mucosa suspect cocaine user 'pistasis 9 nosebleed - sit upright, head slightly forward to facilitate drainage - $old compress , apply gentle pressure, epinephrine most developed sense of newborn 9 sense of touch 1 st sense to develop G last to disappear 9 hearing 'A(S? 1. 5roperly aligned with outer cantus of eyes low set ear 9 -idney malformation e". /enal aginesis 9 absence of -idney sign in uterus O oligohydramnios sign in newbornO $ vessel cord failure to void within $# h 3gtO -idney transplant !$ Chromosomal a,errations O -advance maternal age 1. non disJunction 9 uneven division 1risom# 21 - down syndrome - e"tra chromosome #F"" K $1 - related to advance paternal age 2"O 3ongolian slant @road flat nose 5rotruding nec- 5uppy0s nec- &ypotonic 9 prone to resp problem 2imean crease 9 single transverse line on palm. 1risom# 18 9 8endvard syndrome' 1risom# 1"- patau syndrome 1urner 9 3onosomy of U synd. - #*"+ - affected girls - signs evident during puberty - has poorly developed $dary se"ual char. - 2terile *line/elters S#ndrome- has male genitalia - #F UUH - poorly devt secpndary se"ual characteristics - no deepening of voice -small testes, penis -sterile Rlinefelter 9 <alvin Rline 9 male Turner 9 Tina Turner 9 female Otitis 3edia 9 inflammation of middle ear. <ommon children due to wider G shorter Dustachian tube <auses 1.6 bottle propping $.6 <left lip( cleft palate 9 2"O .titis 1. bulging tympanic membrane, color 9 pearly gray $. absence light refle" !. observe for passage of mil-y, purulent foul smelling odor discharge #. observe for M/T: Asg <areO 1. position side lying on affected aside 9 to facilitate drainage $. supportive care- bedrest, increase fld inta-e 3ed 3gtO 1. 3assive dosage antibiotic <omplication 9 bacterial meningitis $. =pply ear ointment 2chool age 9 up and down T ! yo 9 down G bac- ? ! yo 9 up G bac- 2mall child 9 down G bac- 4 no age6 surgery 4to prevent permanent hearing loss69 otitis media 9 myringotmy with tympanostomy tube post surgery 9 position affected side for drainage both 9 put ear plug if tympanous tube falls 9 healed na 5ells Pals#- facial nerve PF paralysis /(T forcep delivery 2". !! 1. <ontinuous drooling saliva $. inability to open , eye G close either eye 3gtO /efer to 5T TDC 4Tracheoesophageal Cistula6-TD=- no connection bet esophagus and stomach .utstanding 2" 9 <oughing <ho-ing <ontinuous drooling <yanosis 3gtO Dmergency surgery 'pstein pearl 9 white glistering cyst at palate G gums related to hypercalcemia 4#pervitaminosis Aatal tooth 9 tooth at birth. 3ove with gauze Aeonatal tooth 9 tooth within $Bdays of life 3oniliasis 9 oral candidiasis - white cheese li-e, curd li-e patches that coats tongue - oral thrush - Asg <are 9 don0t remove, wash with cold boiled &$o 3eds 9 nystatin ( 3ysnastatin 9 antifungal *awasa>i Dse--strawberry tongue - originated in *orea - 1r. Rawasa-i discovered it - common in Sapan - 8mucocutaneous 7ymphnode 2yndrome' 2"O -persistent fever 9 * days -strawberry tongue , -desquamation of palm G sole - lymph adenopathy ? 1.* cm 1rugO aspirin <an lead to 3: !)PS- symmetrical Cle/t lip 9 failure of median ma"illary nasal process to fuse by *-B w-s of pregnancy - common to boys - unilateral Cle/t Palate- Cailed palate to fuse by > 9 1$ w-s of pregnancy - common to girls - unilateral or bilateral 2"O 1. evident at birth $. mil- escapes to nostril during feeding !. frequent colic G otitis media or M/T: 3gtO 1. 2urgery cleft lip repair 9 <heiloplasty )done 1-! months to save suc-ing refle" 4lost in months 6 <left 5alate- uranoplasty ) done #- months to save speech Pre op $are 1. emotional support especially to mom $. proper nutrition !# !. prevent colic feed 9 upright seating or prone pos burp frequently $" at middle and after feeding-lower to upper tap #. orient parents to type of feeding rubber tipped syringe 9 cheiloplasty paper cup( soup spoon( plastic cup 9 urano plasty *. apply restraints 9 elbow restraints so baby can adJust post op <ondition that warrants suspension of operation - colds G pharyngitis ) can lead to generalized infection 9 septicemia Post Op sg Care ? 1. airway 9 positon post cheilopasty 9 side lying for drainage post uranoplasty 4tonsillectomy6- prone $. assess for /12 s" bleeding !. assess for bleeding 9 freq swallowing. -F days after surgery 9 bleeding #. proper nutrition - clear liquids- 4 gelatin e"cept red or brown color due may mas- bleeding6 - 4 popsicle- not ice cream6 full liquid soft diet regular diet *. 3aintain integrity of suture line such asO 7ogan bar 9 wash % strength &ydrogen 5ero"ide G saline solution- @ubbling effect traps microorganism - prevent baby form crying for pain- analgesic 'C*- 1.6 chec- symmetry <ongenital torticolis- 8 wrynec-'-burn inJury of sternocleidomsstoid muscle during delivery 9 due to e"cessive traction at cephalic delivery 3gtO passive stretching e"ercise , 2urgery <omplication 9 scoliosis 14C(O)D gland 9 for basal metabolism <ongenial cretinism 9 absence or non functioning thyroid glands reasons for delaying d"O 1. Thyroid glands covered by sternocleidomastoid muscles in newborn $. baby received maternal thyro"ine !. baby sleeps 1 9 $+ h a day earliest signO 1. change in crying $. change in suc-ing !. sleep e"cessively #. constipation *. edema 9 moon face late sign 1. mental retardation prognosis O mental retardation preventable when 1" is early 1"O 1. 55:-protein $. radioimmunoassay test !. radioactive iodine upta-e !* 3gtO synthroid 9 sodium 7evothyrosine -synthetic thyroid given lifetime - chec- pulse rate before giving synthroid - tachycardia 9 2" of hyperthyroidism C4'S1 1. symmetry $. breast - transparent fluid coming out from newborn related to hormonal changes- !. chest has retroactive 9 /12 #. sternum sun-en 9 pectus e"cavation A5DO3' 4in order6 1. inspection : $. =uscultation = !. percussion 5 #. 5alpation 5 ) Will change bowel sounds, so do last Aormal contour of abd 9 slightly protruding 2un-en abd- diaphramatic hernia 9 protrusion of stomach content through a defective diaphragm due to failure of puroperitoneal canal to close. 2"O 1. sun-en abd $. 2" of /12 !. / to 7 shunting 3gtO Dmergency surgery within $#h .mphalocele 9 protrusion of stomach contents in between Junction of abd wall and umbilicus. 3gt- very small surgery :f large 9 suspension surgery Asg 3gtO protect sac- sterile wet dressing Gastro$hisis 9 absence of abd wall Asg 3gtO sterile wet dressing F: o/ G)1 1. assists in maintaining CGD G acid base balance $. 5rocesses G absorbs nutrients to maintain metabolism G support G G 1 !. e"crete waste products from digestive process /ecommended 1aily =llowance <alories O 1$+ cal ( Rbw(day 4-ilo body wt6 !+ 9 !B+ cal( day <&.AY $.$g (Rbw(day Prin$iples in Supplementar# Feeding 2upplementary Ceeding usually 9 mos 2upplementary feeding given 9 # mos. a.6 solid food offered to ff sequenceN 1. cereals 9 rich in iron $. fruits !. veg #. meat b.6 begin with small quantities c,6 finger foods 9 offered months d.6 soft table food 9 8modified family menu' given 1 yr ! e.6 dilute fruit Juices 9 mos f.6 never give half coo-ed eggs 9 usually causes of salmoneliosis g.6 don0t give honey 9 infant botulism h.6 offered new food one at a time 9 interval of # 9 Fdays or 1 wee- 9 determines food allergens 1otal 5od# Fluids- comprises * - B*, of body wt of infants G children Where fluids are greater in infants D"tracellular fld 9 prone to develop dehydration =cid @ase @alance dependent on the ffO a. chemical buffers b. renal G resp system involvement c. dilution of strong acids and bases in bld /esp =cidosis 9 carbonic acid e"cess - hypoventilation - /12 - <.51 - 7aryngotracheobronchitis 47T@6 /esp =l-alosis 9 carbonic acid deficit - hyperventilation - fever - encephalopathy 3et. =cidosis 9 base &<.! deficit - diarrhea - severe dehydration - malnutrition - ciliac crisis 3et =l-alosis 9 base &<.! e"cess - uncontrolled vomiting - AGT aspiration - Gastric lavage P(O5!'3S !'AD))G 1O FA' )35A!AC' 1. vomiting 9 forceful e"pulsion of stomach content 2"O 1. nausea $. dizziness !. facial flushing #. abd cramping assessO amt, freq, force proJectile vomiting) increase :<5 or pyloric stenosis 3gtO @/=T diet - banana, rice 9 cereal, apple sauce, toast 2. Diarrhea 9 e"aggerated e"cretion of intestinal contents TypesO =cute diarrhea 9 related to gastroenteritis, salmoneliosis - dietary indiscretions - antibiotic use <hronic non specific diarrhea <auseO 1. food intolerance $. e"cessive fld inta-e !F !. <&., <&.A malabsorption =ssessO freq, consistency, appearance of given colored stool. @est criteria to determine diarrhea O consistency <omplication ) dehydration 3ild dehydration *, wt loss 3oderate dehydration 1+, wt loss 2evere dehydration 1* , wt loss 'arliest s: o/ deh#dration tachycardia increase temp weight loss tachypnea sun-en fontanel G eyeballs scanty urine hypotension absence of tears Severe deh#dration? .liguria , 5rolonged capillary refill time 3gtO =cute 9 A5. 4 rest the bowel 6 - with fluid replacement 9 :E - prone to &ypo-alemia 9 give R chloride before adm of R chloride 9 chec- if baby can void, if cant void 9 hypo-alemia 1rugO Aa &<.! 9 adm slowly to prevent cardiac overload Gastric 3otility 1isorderO 4)(SC4P(;GS D)S'AS' 9 congenital aganglionic megacolon =ganglionic 9 absence of ganglion cells needed for peristalis Darliest sign 1. failure to pass mecomium after $#h $. abd distension !. vomitus of fecal material early childhood 9 ribbon li-e stool foul smelling stool constipations diarrhea 1"O 1. @arium enema 9 reveals narrowed portion of bowel $. /ectal @iopsy 9 reveals absence of ganglionic cells !. abd "-ray 9 reveals dilated loops on intestine #. rectal manometry 9 revels failure of intestine sphincter to rela" Therapeutic 3gt(Asg care 1. AGT feeding 9 measure tube fr nose to ear to midline of "yphoid G umbilicus $. surgery a.6 temp colostomy b.6 anastomosis G pull through procedure 1ietO :ncrease <&.A, increase calories , decrease residue 9 pasta G'(- Gastroesophageal (e/lu: <halasia 9 presence of stomach contents to esophagus Will lead to esophagitis complication 9 aspiration pneumonia !B 'sophageal $an$er =ssessment O 1. chronic vomiting $. faiture to thrive syndrome !. organic 9 organ affected #. melena or hematemesis 9 esophageal bleeding 1" procedure 1. barium esophogram 9 reveals reflu" $. esophageal manometry 9 reveals lower esophageal sphincter pressure !. intra esophageal p& content 9 reveals p& of distal esophagus. 3eds o/ G'(D =nti-cholinergic a.6 @etanicol 4 urecholine6 9 increase esophageal tone G peristaltic activity b.6 3etachloporomide 4/eglam6 9 decrease esophageal pressure by rela"ing pyloric G duodenal segments - increase peristalsis without stimulating secretions c.6 &$ &istamine /eceptor =ntagonist 9 decrease gastric acidity G pepsin secretion - Vimetidine, /anitidine 4Vantac6 9 ta-e !+ min before meals d.6 antacid 9 neutralizes gastric acid between feedings - 3aalo" 2urgeryO Aissen funduplication O <hronic vomiting 9 - thic-ened feeding with baby cereals - effective if without vomiting - feed slowly, burp often every 1 ounce - positioning T > months 9 infant sit with infant supine ? > months 9 prone with head of mattress slightly elevated !+ degree angle O5S1(;C1)2' D)SO(D'(S =. 5H7./:< 2TDA.2:2 9 hypertrophy of muscles of pylorus causing narrowing G obstruction. 1.6 outstanding 2"- proJectile vomiting - vomiting is an initial s" of upper G: obstruction - vomitus of upper G: can be blood tinged not bile strea-ed. 4with blood6 - vomitus of lower G: is bilous 4 with pupu6 - proJectile vomiting 9 increase :<5 or G: obstruction - abd distension 9 maJor s" of lower G:T obst $.6 met al- !.6 failure to gain wt #.6 olive shaped mass 9 on palpation *.6serum electrolyte 9 increase Aa G R, decrease chloride .6 ultrasound F.6 " ray of upper abd with barium swallow reveal 8string sign' 3gtO 1. 5yleromyotomy $. Credet /amstedt procedure )S1;SS;SC'P1)O- invagination or telescoping of position of bowel to another <ommon site 9 ilio-secal Junction 5rone ptO person who eats fat <omplication 9 peritonitis 9 emergency 2"O 1.6 persistent paro"ysmal abd pain $.6 vomiting !.6 currant Jelly stool- dye bleeding G inflammation !> - palpate sausage shaped mass 3gtO 1.6 &ydrostatic reduction with barium enema $.6 =nastomosis G pull thru procedura :nborn Drrors of 3etabolism- deficient liver enzymes P4'C!*'1O;()A 45RM6 9 deficiency of liver enzymes 45&T6 5henylalaninehydro"ylase Transferase 9 liver enzyme that converts <&.A to amino acid > amino acidsO valine isolensine tryptophase lysine phenylalanine Thyronine 9 decrease malanine production 1.6 fair comple"ion $.6 blond hair !.6 blue eyes Thyro"ine 9 decrease basal metabolism - accumulation of 5henyl 5yruvic acid #.6 =topic dermatitis *.6 musty ( mousy odor urine .6 seizure 9 mental retardation Test 9 GMT&/:D TD2T 9 specimen 9 blood - preparation increase <&.A inta-e - test if <&.A will convert to amino acid specimen and urine mi"ed with pheric chloride, presence of green spots at diaper a sign of 5RM D)'1? 7ow phenylalanine diet- food contraindicated- meats, chic-en, mil-, legumes, cheese, peanuts Give 7ofenalac- mil- with synthetic protein Gala$tosemia 9 deficiency of liver enzyme - GM5T 9 Galactose Mrovil 5hosphatetranferase - <onverts galactose to phosphate tranferace glucose Galactose 9 will destroy brain cells if untreated 9 death within ! days 1"O @eutler test 9 get blood -done after 1 st feeding presence of glucose in blood 9 sign of galactosemia galactose free diet lifetime neutramigen 9 mil- formula C'!)AC D)S'AS' 9 gluten enteropathy <ommon gluten foodO :ntolerance to food with brow @- barley /- rye .- oat W- wheat #+ Darly 2"O 1. diarrhea 9 failure to gain wt ff diarrheal episodes $. constipation !. vomiting 7ate 2"O 1. abd pain 9 protruberant abd even if with muscle wasting $. steatorrhea <eliac <risis- e"aggerated vomiting with bowel inflammation 1"O 1. lab studies 9 stool analysis $. serum antiglyadin 9 confirmatory of disease gluten free diet 9 lifetime all @/.W 9 not allowed o- 9 rice G corn 3gtO 1. vitamin supplements $. mineral supplements !. steroids PO)SO)G- common in toddlers. 4falls- common to infant6 1. determine substance ta-en, assess 7.< $. unless poison is corrosive, caustic 4strong al-ali such as lye6 or a hydrocarbon, vomiting is the most effective way to remove poison. - Give syrup 1 pecac to induce vomiting !. 1 pecac 9 oral emetic - 1* ml 9 adolescent, school age G pre school - 1+ ml to infant #. MA:ED/2=7 =AT:1.TD- charcoal, mil- of magnesia G burned toast *. Aever adm charcoal before 1 pecac Gluten 9 glutamine 4 normal absorption6 Gliadin 4 to"ic to epithelial cells of villi of intestines, effects is malabsorption syndrome6 3alabsorption Cats <&.A G <&. peripheral edema G malnutrition Eit 1 calcium Eit R :ron folic acid :nadequate blood coagulation 2teatorrhea .steomalasia @leedin gg anemia #1 . antidote for acetaminophen poisoning 9 acetylsysterine 4 mucomyst6 F. caustic poisoning 4 muriatic acid 6 neutralize acid by giving vinegar . 1on0t vomit prepare tracheostomy set B. Gas- mineral oil will coat intestine !ead poisoning 7ead ) 1estroy /@< functioning ) &ypochornic 3icrocytic =nemia ) 1estroy -idney functioning =ccumulation of anemia ) Dncepalopathy 2"O 1. beginning s" of lethargy $. impulsiveness, learning difficulties !. as lead increases, severe encepalopathy with seizure and permanent mental retardation 1"O 1. @lood smear $. abd " ray !. long bones 3gtO 1. remove child from source $. if ? $+ ug(d7 9 need chelation therapy ) binds with led G e"creted by -idney )nephroto"ic Amogenital CemaleO 5seudomenstration slight bleeding on vagina related to hormonal changes Tearing of fourchette with blood 9 rape( child abuse /ape- /eport within #B h 2hape pubic hair in inverted triangle 4 female6 3aleO Mndescended testes 9 cyrptorchidism -common to preterm surgery 9 orchidope"y assess scrotum- warm room G hands baby 9 pee within $# h -chec- for arch of urination 'pispadias- urinary meatus located dorsal or above glans penis 4ypospadias- urinary meauts loc ventral or ,elow glans penis &ypospadias with chordee- fibrous band causing penis to curb downward 3gtO 2urgery 5himosis- tight fores-in @alanitis-infection of glands penis 9 due smegma 3gtO <ircusicion 4#droseal 9 fld filled scrotum Tst of 1"O Transillumination with use of flashlight - glowing sign 2ari$oseal 9 enlarged vein of epididimis 4 girls- vulvular varicosities6 #$ (enal Disorder Cause S: 1: SG CA(' AD5&/.T:< 2HA1/.3D infectious 1. =nasarca- gen edema $. massive protenuria !. microscopic or no hematuria #. serum <&.A decreased *. serum lipid increased . fatigue F. normal or decreased @5 5rednisone 1iuretic Cocus of careO monitor edema - weigh daily 1ietO :ncrease <&.A :ncrease R- .S, beef broth, banana 1ecrease Aa =GA 4 acute Glomerulo Aephritis6 "A6sG AGH autoimmuneH Grp A =utoimmune Grp = beta hemolytic streptococcus 1. 45556 primary peripheral periobital edema $. moderate protenuria !. gross hematuria 4 smo-ey urine6 #. serum R increased *. fatigue . increase @5 <omplication O 1. hypersensive encephalopathy $. anemia 1. anti &5A drug - hydralazine or apresoline $. iron 1. weigh daily $. monitor @5 G neurologiuc status !. 1ietO decrease R, decrease Aa @=<R- chec- for flatness G symmetry Open eural 1u,e De/e$t- decreased Colic =cid inta-e 25:A= @:C:1= .<<M7T=- failure of post laminae of vertebrae to fuse 2"O dimpling of bac- , =bnormal tufts of hair 25:A= @:C:1= <H2T:<=- failure of post laminae of vertebrae to fuse with a sac 1#pes? 1. 3eningocele 9 protrusion of <2C G 3eninges $. 3yelomeningocele 9 protrusion of <2C G 3eninges G spinal cord 4 most dangerous6 !. Dncephalocele 4 <A2 complication 9 hydrocephalus6 9 cranial meningocele or myelomeningocele 3ost common problem - rupture of sac - prone pos - sterile wet dressing 3ost common complication - infection 3yelomeningocele 9 genitourinary complication- urinary G fecal incontinence Asg careO always chec- diaper .rthopedic complication 9 paralysis of lower e"tremities 2urgery to prevent infection 5ost op 9 prone position SCO!)OS)S- lateral curvature of the spine $ typesO 1. structural 9 rye nec- $. postural 9 improper posture #! 1"O 1. uneven hemline $. bend forward- 1 hip higher 1 shoulder blade more prominent Asg careO 1. conservative 9 avoid obesity, e"ercise $. preventive 9 3ilwau-ee brace - worn $! h a day !. corrective surgery 9 insert &arrington rod post op- how to move log rolling- move client as 1 unit 'I1('3)1)'S? chec- P of digits ) $+ 1. syndactyly 9 webbing of digits $. polydactyly 9 e"tra digits !. olidactyly 9 lac- of digits #. =melia 9 total absence of digits *. pocoamelia- absence of distal part of e"tremities 'rD du$hennes 9 paralysis- brachial ple"us inJury or brachial palsy - birth inJury caused by lateral G e"cessive traction during a breech inJury 2"O 1. unable to abduct arms from shoulders, rotate arm e"ternally or supinate forearm $. absence or asymetrical moro refle" 3gtO 1. abduct arm from shoulders with elbow fle". COG')1A! 4)P D)S!OCA1)O 9 head of femur is outside acetabulum 1#pesG 1. sublu"ated 9 most common type $. dislocated 2"O 1. shortening of affected leg $. asymmetrical gluteal fold !. limited movement 9 earliest s" #. 4K6 ortolanis sign 9 abnormal clic-ing sound *. when able to wal- 9 child limps 9 late s"- trendelenburg sign Goal of 3gtO Cacilitate abduction 3gt. 1. triple diaper $. carry baby astride !. CreJ-a splint #. 5avli- harness *. &ip 2pica <ast 1A!)P'S 9 8clubfoot' a.6 Dquinos 9 plantar fle"ion 9 horsefoot b.6 <alcaneous 9 dorsifle"ion 9 heal lower that foot anterior posterior of foot fle"ed towards anterior leg c.6 Earus- foot turns in d.6 Ealgus- foot turns out Dquino varus- most common =ssessmentO 1. 2traighten legs G fle"ing them at midline pos ## 3gtO 1. <orrective shoe- 1ennis brown shoe, spica cast C"O of $ast 9 - to immobilize - bone alignment - prevent muscle spasm lead pencil 9 mar- area to be amputated cold &$+ 9 hasten setting process hot &$+- slow setting process =fter cast application 9 how to move ptO - use open palm not fingers- fingers will cause indention - dry cast 9 natural air not blower - priority chec- O neurovascular chec- <- circulation 3- motion 2- sensation <ast 9 with bleeding - mas- with ball pen edge of blood to -now if bleeding is on going sign cast is dry ) resonant sound, cast cold to touch do petaline 9 ma-ing rough surface of cast smooth C(;1C4'S C"O To maintain balance - To support wea-ened leg Prin$iples in $rut$hes - wt of body on palmN - @rachial pulsing 9 if wt of body in a"ila - 1o palm e"ercise- squeeze ball Di//erent $rut$h Gaits? 1. 2wing Through $. 2wing to - no weight bearing are allowed into lower e"t !. Three point Gait - wt bearing is allowed in 1 e"t #. Cour point gait *. Two point Gait - wt bearing allowed in $ lower e"t #*