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COMPREHENSIVE LECTURE ON PEDIATRIC NURSING


PART 1. GROWTH AND DEVELOPMENT
GROWTH- n physca sze of a structure or whoe (Ouanttatve)
2 PARAMETERS
WEIGHT- most senstve
Brth weght: 2X by 6 mos
3x by 1 yr
4X by 2-2 yrs
LENGTH/HEIGHT
1 nch/mo. In 1
st
6 mos
nch/mo. At 7-12 mos
Ave. n ht. durng 1
st
yr s 50%
Approx. of adut ht. at 2 yrs
DEVELOPMENT- n the sks or capacty to functon (Ouatatve)
How to Measue De!e"o#$e%t
by smpy observng a chd dong specc task
by notng parents descrpton of the chds progress
by DDST
DDST & Ma'% Rate( Cate)o'es
Language
Persona-Soca
Fne Motor Adaptve
Gross Motor Sks
MATURATION- synonymous wth deveopment , aso known as READINESS
COGNITIVE DEVELOPMENT- s the abty to earn (to change behavor) and understand from experence,
to acqure and retan knowedge, to respond to a new stuaton and to sove probems.
Bass of Menta Retardaton
IO= menta age X 100
chronoogca age
*-2* profound MR (nfant)
2*-+, severe (0-2 yo)
+,-,* moderate (2-7 yo) tranabe
,*--* md (7-12 yo) educabe
-*-.* borderne
.*-11* norma (average IO)
1+* gfted
/ASIC DIVISIONS O0 LI0E
1
st
Sta)e- Prenata (from concepton to brth)
2
%(
Sta)e- Infancy
Neonata: 1
st
28 days of fe
Forma Infancy: 29
th
day to 1 yr
+
(
Sta)e- Eary Chdhood
Todder: 1-3 yrs
Preschoo: 4-6 yrs
&
t1
Sta)e- Mdde Chdhood
Schoo age: 7-12 yrs
,
t1
Sta)e- Late Chdhood
Preadoescent: 11-13 yrs
Adoescent: 12-18 yrs (or 21)
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PRINCIPLES O0 GROWTH AND DEVELOPMENT
1. Growth and deveopment s a contnuous process (from womb to tomb)
2. Not a parts of the body grow at the same tme or at the same rate (Prncpe of Asynchronsm)
PATTERNS O0 GROWTH AND DEVELOPMENT
Re%a"2 GIT2 Mus3u"os4e"eta"2 CVS- fary, smoothy durng chdhood
CNS- rapdy at 1-2 yrs
I$$u%e S5ste$- rapdy durng nfancy and chdhood
tonss: of adut proporton by 5 yrs
Re#o(u3t'!e S5ste$- rapdy durng puberty
RATES O0 GROWTH AND DEVELOPMENT
0eta" a%( I%6a%35- most rapd
To(("e- sow
Pes31oo"- aternatng rapd and sow
S31oo" a)e- sower
A(o"es3e%t- rapd
1. Ea31 31'"( 's u%'7ue
2 P'$a5 0a3tos
Hee('t5 8No%-$o('9a:"e; o <Natue=
Race
Integence
Sex
Natonaty
E%!'o%$e%t 8Mo('9a:"e; o <Nutue=
>uaty of Nutrton
Socoeconomc status
Heath
Ordna poston n the famy
Parent-chd reatonshp
4. Growth and Deveopment occurs n a reguar drecton reectng a dente and predctabe patterns or
trends
DIRECTIONAL TRENDS- occurs n a reguar drecton reectng the deveopment of neuromuscuar functons:
these appy to physca, menta, soca and emotona deveopments
Ce#1a"o ? 3au(a"@ " head to ta". It occurs aong bodys ong axs n whch contro over head, mouth and
eye movements and preceeds contro over upper body torso and egs.
PoA'$o?('sta"@ from center of the body to extremtes
e.g. baby uses whoe arm n crawng then hand pncers
S5$$et'3a"@ each sde of the body deveop on the same drecton at same tme and rate
Mass-S#e3'93 8D'Bee%t'at'o%;@ the chd earns from smpe operatons before compex functons or
move from a broad genera pattern of behavor to a more rened pattern. E.g. Cryng nfant suggests wet
daper, hunger, thrst or pan unt can use words for mk etc.
SE>UENTIAL TRENDS- nvoves a predctabe sequence of growth and deveopment to whch the chd
normay passes
a. ocomoton
b. anguage and soca sks
SECULAR TRENDS-refers to the wordwde trend of maturng earer and growng arger as compared to
succeedng generatons
5. /EHAVIOR s the most comprehensve ndcator of deveopmenta status.
6. PLAC s the unversa anguage of the chd.
7. A great dea of sk and behavor s earned by PRACTICE.
8. There s an optmum tme for ntaton of experence or earnng.
9. Neonata reexes must be ost rst before deveopment can proceed.
e.g. Spttng/extruson reex must be overcome before nfant can be fed wth sod foods
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RE0LEDES- dherent nvountary reactons to specc forms of stmuaton
Importance:
For neonates survva
e.g. feedng reexes: rootng, suckng, swaowng
protectve reexes: bnk, gag, cough, Moro
Reects how we CNS s functonng
Forms the bass for ater, more sophstcated behavor
A. /"'%4- rapd eyed cosure when strong ght s shown, To protect the eyes, Dsappears at death
/. Pa"$a Gas#- when a sod ob|ect s paced n the pam, the baby w grasp the ob|ect
To cng to the mother for safety
Begnnng abty to hod then reease ob|ects
Dsappears at 6 wks to 3-4mos
C. Ste#-'%/Wa"4-'% P"a3e? neonate paced on a vertca poston wth ther feet touchng a hard surface w
take few quck, aternatng steps, Present at brth, Dsappears at 1 mo
* P"a3'%)- amost the same wth step n pace reex ony that you are touchng the anteror
surface of a newborns eg
Norma: ex hp and knee, pace stmuated foot on top of the tabe
Abnorma: no response; consder parayss f born breech
Dsappears at 6 wks
D. P"a%ta )as#- when an ob|ect touches the soe of a newborns foot at the base of the toes, the toes grasp
n the same manner as the ngers do
Dsappears at 8-9 mos n preparaton for wakng
E. To%'3-%e34/ /oAe/ 0e%3'%)- when newborn e on ther backs, the head turn to one sde. The arm and the
eg on the sde to whch the head turns extend, and the opposte arm and eg contract.
Dsappears wthn 3-4 mos
0. Moo/ Stat"e- test for neuroogca ntegrty
upon exposure to oud voce or |arrng the crb, the baby w assume "etter C" poston: throws
arms forward and draws egs up
Abnorma- assymetrca response
To protect the baby from attacker
Present at 36 wks AOG
Dsappears at 4-5 mos when baby can ro over
G. Ma)%et- when there s pressure at the soe of the foot, the baby pushes back aganst the pressure
H. Cosse( eAte%s'o%- test for spna nerve ntegrty; when soe of foot s stmuated by sharp ob|ect, that
foot exes and the other foot extends
I. Tu%4 '%3u!at'o%/ Ga"a%t- whe n prone, when the paravertca area s stmuated, the trunk exes and
the pevs swngs towards the touch
E. La%(au- test for musce tone; whe n prone, wth the examners hands supportng the babys trunk, the
baby exhbts some musce tone
Abnorma: coapse of the baby n mp, concave poston
Present at 3 mos
F. Paa31ute ea3t'o%- whe on ventra suspenson, sudden change n equbrum causes extenson of arms
and egs
Abnorma: coapse of the baby n mp, concave poston
Present at 6-9 mos.
L. /a:'%s4'- soe of foot stmuated by bunt ob|ect n nverted | causes fannng/ dorsexon of a toes
Abnorma: fannng of great toe ony
Present due to mmature CNS; myenzaton s not yet compete
Dsappears at 2 mos to 2 yrs
THEORIES O0 DEVELOPMENT
DEVELOPMENTAL TASF- a sk or growth responsbty arsng at a partcuar tme n the ndvduas fe.
The successfu achevement of whch w provde a foundaton for the accompshments of the future tasks.
PSCCHOSEDUAL THEORC
or Psychoanaytc Theory
S')$u%( 0eu( 81G,H-1.+.; - an Austran neuroogsts, founder of psychoanayss
Lbdo (sexua energy) goes to one part of the body to another where t s responsbe for survva
5 PHASES
1. ORAL- 8*-1G $os; I%6a%t
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mouth- ste of gratcaton
Actvty: btng, suckng, cryng (for en|oyment and reease of tenson)
Never dscourage thumb suckng
Oher pacer when NPO
ID- source of a drves; present at brth; strvng for gratcaton of needs
EGO- for reaty testng and probem sovng, deveops at 4-5 mos. When nfant begns to see sef separate
from mother (deveopment of sense of sef)
2. ANAL-81G $os- + 5s; To(("e
anus- ste of gratcaton where emnaton takes pace
Prncpes n Toet Tranng:
"Hodng on"- chd wns, becomes stubborn or antsoca
"Lettng go"- mother wns, chd becomes obedent, knd, perfectonst, obsessve-compusve
+. PHALLIC-8+-H 5s; Pes31oo"
gentaa- ste of gratcaton
knowedge on 2 sexes , exhbtonsm s norma
Accept chd fondng hs/her gentaa as norma area of exporaton
Answer chds questons drecty
SUPEREGO s a necessary part of socazaton deveops at 3-6 yrs; ncudes nternazaton of vaues, deas
and mora standards of parents and socety; deveopment of CONSCIENCE
&. LATENT-8H-12 5s; S31oo" A)e
Perod of suppresson, no obvous deveopment
Hep chd acheve postve experences so that he/she w become ready to face the concts of
adoescence
5. GENITAL- 8125s; A(o"es3e%t
Focused on sexuaty
Deveopng sexua maturty; earnng how to estabsh a satsfactory reatonshp wth opposte sex
Gve opportunty to reate wth opposte sex
PSCCHOSOCIAL THEORC
E'4 E'4so%- traned n psychoanayss theory
Focuses on psychosoca tasks that are accompshed throughout the fe cyce
Stresses the mportance of cuture and socety to the deveopment of ones personaty
Unsuccessfu resouton of psychosoca crss eaves the ndvdua emotonay handcapped
G STAGES
1. Tust !s M'stust 8*-1G $os; I0ee('%)
Foundaton of a psychosoca tasks
Psychosoca Theme: "To gve s to receve"
Deveoped by:
Satsfyng needs at a tmes: feed upon demand (because stomach capacty s ow and baby
easy gets hungry
Parenta carng must be consstent and adequate
Gvng an experence that w add to securty (e.g. touch, hugs and ksses, eye-to-eye contact,
soft musc)
2. Auto%o$5 !s S1a$e a%( Dou:t 81G $os- + 5s; To(("e ITo'"et Ta'%'%)
If everythng s panned or done for the chd, autonomy s not deveoped
Deveoped by:
Gvng opportunty for decson-makng, oherng choces, rather than |udge
Settng mts s the parents mora obgaton
+. I%'t'at'!e !s Gu'"t 8+-H 5s; Pes31oo" IDo'%) :as'3 t1'%)s
Gut: anger turned nward
See pay as work and take t serousy, f faed the chd cry so much
Deveoped by:
Gvng opportunty to expore new paces and events
Provde actvtes that can enhance magnaton, creatvty and ne motor sks e.g. modeng
cay, nger pantng
If chd fas n a pay, dont say "Its |ust a game", nstead encourage chd to accept defeat and to
do hs/her best next tme
&. I%(ust5 !s I%6e'o't5 8H-12 5s; S31oo" a)e IS31oo"
Learns how to do thngs we
Deveoped by:
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Gvng opportunty on short assgnments and pro|ects
,. I(e%t't5 !s Ro"e Co%6us'o% 812-2* 5s; A(o"es3e%t IPees
Learns who he/she s, what knd of person w he/she become by ad|ustng to new body mage
Emancpaton from parents: beraton/freedom
H. I%t'$a35 !s Iso"at'o% 82*-2, 5s; Cou%) A(u"t ILo!e
Lookng for fetme partners, career-focused
-. Ge%eat'!'t5 !s Sta)%at'o% 82,-&, u# to H*-H, 5s; M'(("e A(u"t IPae%t'%)
G. E)o I%te)'t5 !s Des#a' 8H, 5s; Late A(u"t IReJe3t'o%
COGNITIVE THEORC
Eea% P'a)et- Swss Psychoogst
Denes cogntve acts as ways n whch the mnd organzes & adapts to ts envronment
SCHEMA- ndvduas framework of thought
STAGES OF COGNITIVE DEVELOPMENT
A. Se%so'$oto 8*-2 5s;@ "Practca Integence", words and symbos not yet avaabe
SCHEMA AGE BEHAVIOR
Neonata Reex/ Stmuus
Response
1 mo A reexes
Prmary Crcuar Reacton 1-4 mos Actvtes r/t body, dscover persons, no ob|ect
permanence, repetton of behavor
Secondary Crcuar Reacton 4-8 mos Actvtes not r/t body, ob|ect permanence, memory
traces present, antcpate famar events
Coordnaton of Secondary
Crcuar Reacton
8-12 mos Exhbt goa-drected actvtes, sense of permanence
Tertary Crcuar Reacton 12-18 mos Use tra and error n dscoverng paces and events,
space and tme percepton
Inventon of new means thru
menta combnaton
18-24 mos Invent new means by actve expermentaton,
Transtona phase to Preoperatona thought perod
/. Peo#eat'o%a" T1ou)1t 82-- 5s;
SCHEMA AGE BEHAVIOR
Pre-conceptua 2-4 yrs Thnkng bascay compete, tera and statc
Concept of tme: NOW
Concept of dstance: what can be seen
ANIMISM- nanmate ob|ect has fe
SYMBOLIC PLAY
Irreversbty of thnkng
Intutve 4-7 yrs Begnnng of causaton
Egocentrc n pay, thought and behavor
Undmensona casscaton (texture, coor, ength
one at a tme)
C. Co%3ete O#eat'o%a" T1ou)1t 8--12 5s;
/EHAVIOR
Fnd souton to everyday probems wth systematc reasonng
Concept of REVERSIBILITY
Concept of CONSERVATION
Cooperatve Interacton- reates own pont of vew wth others
Actvty: Coectng
Mutdmensona casscaton
D. 0o$a" O#eat'o%a" T1ou)1t 812 5s;
/EHAVIOR
Cognton acheved ts na form
Sove hypothetca probems wth scentc reasonng
ABSTRACT THINKING and mature thought
Concept of tme: past, present and future
Actvty: Tak tme- sort out opnons and current events
THEORC O0 MORAL DEVELOPMENT
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Lawrence Kohberg (1984) - recognzed the theory of mora deveopment as consdered to cosey
approxmate cogntve stages of deveopment
Not a persons may reach a stages; may be xated n one stage
STAGES OF MORAL DEVELOPMENT
AGE (YEAR) STAGE DESCRIPTION
0-2 Infant Premora/Amora or Pre-
regous
Not concerned wth what s rght or wrong
2-3 Todder Pre-conventona (Leve I)
1
Punshment/ obedence orentaton (heteronomous
moraty). Chd does rght because parents te
hm/her to and to avod punshment
4-7
Pre-schooer
Pre-conventona (Leve I)
2
Indvduasm. Instrumenta purpose and exchange.
Carres out acton to satsfy own needs and rather
than socety. W do somethng for another f that
person do somethng for the chd ("Do for me and I do
for you")
7-10
Schoo age
Conventona (Leve II)
3
Orentaton to nterpersona reatons of mutuaty.
Chd foows rues because of a need to be a "good"
person n own eyes and the eyes of others ("Good
boy, Nce gr soca concept")
10-12 Schoo age Conventona (Leve II)
4
Mantenance of soca order, xed rues and authorty.
Chd nds foowng rues satsfyng. Foows rues of
authorty gures as we as parents n an ehort to keep
the "system" workng ("Law and Order Orentaton")
12 Adoes-cent Post Conventona (Leve III)
5
Soca contract, uttaran aw- makng perspectves.
Foows standards of socety for the GOOD OF ALL
peope
12
Adoescent
6 Unversa ethca prncpe orentaton. Foows
INTERNALIZED STANDARDS of conduct
DEVELOPMENTAL MILESTONES
IN0ANCC
PLAY: Sotary, non-nteractve (begns at 4 mos)
BEST TOYS: mobes, teethers, musc box, rattes
FEAR: Stranger anxety
Begns at 6-7 mos
Peaks at 8 mos
Fades at 9 mos
NEONATE
Largey reexes
Compete head ag
Hands sted
Cres wthout tears
Vsua xaton for human face
1 MONTH
Dance reex dsappears
Looks at mobes
Prefers checker boards wth anges and not paste coors wth contours
Hang at east 8 n. (20 cm) from head
2 MONTHS
Hods head up when n prone
(+) Head ag when pued to sttng poston
(+) Soca sme
Cres wth tears
Cosure of posteror fontane (2-3 mos)
+ MONTHS
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Hods head and chest up when n prone
Foows ob|ect past mdne
Pamar grasp and tonc neck reexes are fadng
(+) Hand regard
Coos, Bubbes
& MONTHS
Turns from stomach to back, needs space to turn
Compete head contro when pued to sttng poston
Sotary pay begns
Laughs aoud
Recognzes mother
, MONTHS
Assumes crawng stance
Paces ob|ects n mouth (gve teethng rngs)
Handes ratte we
Moro reex dsappears (4-5 mo)
Reaches out to be hed
Cres when toy s removed
H MONTHS
Ros from back to stomach
Sts wth support
Starts to move from crawng stance
Handes botte we
Says vowe sounds "ah"
Erupton of 1
st
temporary teeth then every mo. Thereafter (1
st
2 ower centra ncsors)
Exhbts stranger anxety
- MONTHS
Rocks from crawng stance
Transfers ob|ect from hand to hand
Lkes ob|ect that s good n sze
Btes aggressvey
Ressts unwanted food/ob|ect
Cres when mother eaves
G MONTHS
Sts wthout support
Uses pncer grasp
Peak of stranger anxety
Responds to often used words
Pantar grasp (8-9 mos) and Babnsk reexes dsappear
. MONTHS
Creeps and craws extensvey
(+) Neat pncer grasp
Combnes 2 syabes (Mama, Dada, Yaya)
1* MONTHS
Pus sef to stand, hodng on to furnture
Understands the word "no" and smpe commands; aware of approva and dsapprova
Responds to own name
Pays peak-a-boo, pat-a-cake
11 MONTHS
Stands wth assstance
Recognzes ob|ects by name
Has a favorte toy
Expores envronment
Has 3-word vocabuary
12 MONTHS
Stands aone
Takes 1
st
step
Waks wth assstance
Pus toy
Drnks from a cup
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Cooperates n dressng
Lkes nursery rhymes
CONCERNS@ IN0ANTS
COLIC
Paroxysma abdomna pan, common among < 3 mos.
S/Sx: Loud cryng, ushed face, sts cenched, tensed abdomen
Causes:
Overfeedng
Swaowng of too much ar
Mk formua very hgh n CHO
Tensed mother durng breast feedng
Management:
Burp baby n the mdde and after breast feedng or every 1 oz. of mk formua
Keep baby n uprght poston on mothers chest or shouder or n R sde yng poston on
mothers arm/ap
CONSTIPATION/DIARRHEA
Causes:
Inaccurate mxng of formua
Addng too much sugar
Not dutng mk propery
Usng condensed mk
Introducton of sod foods wth too much fruts/sweets
WEANING- (u'%) H $o%t1s
Crtera
Chd s abe to approxmate ps to the cup
Chd begns to experence suckng ntensty
Choose a good day/mood for best cooperaton
Dont rush t
Dont set tme tabe
Provde reassurance that gvng up breast/botte doesnt mean end of physca contact wth
mother
NIGHT /OTTLE SCNDROME
Bedtme botte s hardest to gve up
Danger of propped botte
Tooth decay
Aspraton, may ead to pneumona
TODDLER
PLAC@ Parae (2 todders payng separatey); provde 2 smar toys
/EST TOCS@ waddng duck, pu-push trucks, trcyce, budng bocks, pourdng peg, erector set
0EAR@ Separaton anxety
Begns at 9 mos
Peaks at 18 mos
PHASES@ Separaton anxety
1. Potest@ cryng, screamng, searchng for a parent, re|ects stranger
2. Des#a'@ wthdrawn, depressed, unnterested
+. De%'a"/Deta31$e%t@ uncommon, occurs ony after engthy separaton
Copes by formng shaow reatonshp wth others, beng sef-centered & attachng prmary mportance
to matera ob|ects
Detaches from parents to escape the emotona pan of desrng parents presence
A form of resgnaton, not of contentment
1, MONTHS 8P"ateau Sta)e)
Waks aone
Creeps upstars
Cannot throw ba wthout fang
Stacks 2 bocks
Puts sma peets nto narrow necked botte
Hods spoon we, rotates spoon, uses cup we
Scrbbes vountary wth penc
Uses 4-6 words
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1G MONTHS
Waks we, runs cumsy and fas, |umps n pace, seats sef on a char
Waks up and downstars hodng on to a persons hand or rang
Throws ba overhead wthout fang
Buds 3-4 bocks
No onger rotates spoon
Heght of possessveness "MINE"
Temper tantrums more evdent
Uses 7-20 words
Names one body part
BOWEL CONTROL acheved
2& MONTHS 8Te':"e TwoKs;
Waks up and downstars aone wth 2 feet on one step before advancng
Runs fary we wth wde stance
Pcks up ob|ects wthout fang
Kcks ba forward
Opens doorknobs, unscrews ds
Buds 6-7 bocks
Uses 50-200 words (2-word sentences)
Pus peope to show them somethng
DAYTIME BLADDER CONTROL acheved
+* MONTHS
|umps down from a char
Stands on one foot momentary
Makes smpe nes, strokes or crosses wth penc, can copy a crce
Wth good hand-nger coordnaton
Knows fu name, hods up ngers to show age
Temporary teeth compete (20 decduous teeth, ast to appear: posteror moars)
+H MONTHS
Rdes a trcyce
Waks up and downstars usng aternate footng
Broad |umps
Buttons and unbuttons shrt
Draws a cross
Buds a tower of 9-10 bocks, buds a brdge wth 3 bocks
Knows fu name and sex
Speaks uenty (300-900 word vocabuary)
Learns how to share
NIGHTTIME BLADDER CONTROL acheved
CHARACTER TRAITS@ TOODLER
Scaphod abdomen- underdeveoped musces
Negatvstc: "No!"- a way to search for autonomy/ ndependence
Lmt questons, oher optons
TEMPER TANTRUMS
Reaso%s@
Inadequate vocabuary to express feengs n a socay-acceptabe manner
Response to unreastc requests of parents
Response to dmcuty n makng choces/decsons
Ignore the behavor
Rgd, stereotype
RITUALISTIC/DAWDLING- wastng a ot of tme accompshng a task
Reasons:
Asked to do somethng that s too dmcut for them
Short attenton span to reman nterested n the task
Gve ampe amount of tme for mastery
TOOTH /RUSHING
2-2 yrs: start of tooth brushng
3 yrs: tooth brushng wth tte assstance
6 yrs: tooth brushng aone
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Rght tme to brng the chd to the dentst: when temporary teeth are compete (at 30 mos)
TOILET TRAININGI
+ C"ues@
Can stand, squat and wak aone
Can communcate toet needs
Can mantan dryness for an nterva of 2 hrs
PRESCHOOL
Idea about death: a form of seep, reversbe
Begnnng deveopment of conscence thru punshment and reward
PLAY: Assocatve/ Cooperatve
BEST TOYS: pay house, modeng cay, nger pants, dos, cars, doctors set
FEARS: Body Mutaton/ Castraton fear, dark paces, wtches, ghosts, thunder and ghtnng
& CEARS 80u'ous 0ouKs;
Catches ba reaby, throws ba overhead, |umps/skps on 1 foot
Laces shoes but cant te a bow
Copes a square
Draws 3 body parts to stck gure
Uses scssors to cut pctures
Knows 4 basc coor
Uses 1,500 words but frequenty does not know meanng
Cannot keep secrets
Ouarresome, sesh, mpatent, boasts, wth mood swngs
, CEARS 80ustat'%) 0'!eKs;
Skps/hops on aternate feet
Throws and catches ba
|umps rope
Can wak backwards wth hee to toe
Can te shoe aces wth bow
Copes trange
Draws 7-9 parts of a man
Prnts few etters, numbers and words such as 1
st
name
Has magnary paymate
Uses 2,100 words, asks meanng of words
Can keep secrets
CHARACTER TRAITS@ PRESCHOOL
Curous ("WHY?"), creatve, magnatve, mtatve
Parents must ve by exampe not to cause confuson to the chd
IDENTIFICATION to parent of same sex, attachment to parent wth opposte sex
Oedpa Compex: tte boy oves mommy, mtates daddy
Eektra Compex: tte gr oves daddy, mtates mommy
Preschooers need parenta gure for the formaton of dentcaton
/EHAVIOR PRO/LEMS
Teng ta taes: brought by over magnaton
Imagnary paymate: way to reease tenson and anxety
Magca Thnkng: transductve reasonng (fat means pregnant)
Sbng rvary: esp. among 4 yrs, |eaousy to a newy devered baby
Preschooer regresses: bed wettng, thumb suckng, baby tak
Masturbaton: sgn of boredom; dvert attenton by oherng a toy
SCHOOL AGE
PLAC@ Compettve
0EAR@ Schoo Phoba
Causes:
Separaton anxety
Overprotectve parent and overdependent chd
Strct teacher
New actvtes n schoo
Resove underyng cause
Pedia
Spend tme wth the chd, orent chd to the new envronment
Make chd secure
OTHER 0EARS@ Dspacement from schoo, oss of prvacy, death
I(ea a:out (eat1@ (7-9 yrs) permanent oss of corpora fe
SIGNI0ICANT OTHERS@ teacher and peers of same sex
SIGNI0ICANT DEVELOPMENT
prone to greenstck fractures
have a mature vson
H CEARS
Boys and grs are of same heght
Year of constant moton/ Cumsy movements
Can rde a bcyce
Temporary teeth begns to fa, permanent teeth begns to appear (1
st
moars)
Denes words by ther use
Recognzes a shapes
Begns to nteract wth God
Teacher: authorty gure
Na btng common
- CEARS 8Ease Cea;
Age of assmaton (abty to ncorporate new deas, ob|ects and experences nto ones framework of
thought)
Outtng down perod
Can te tme
Copes a damond
En|oys teasng and payng aone
Dherences n sex seen n pay
Strves for perfecton
G CEARS 8/est 6'e%( Sta)e;
Expansve age
Smoother/gracefu movements
Understands past, present and future
Can count backwards
Loves to coect ob|ects
Wth same sex best frend
Whsperng and gggng common
. CEARS 8Ga%) A)e;
Coordnaton mproves
Takes care of body needs competey, assumes responsbty for own heath
Tes tme correcty
Hero worshp common
Has secret code
Beongs to a boys or a grs group of frends
Teacher nds ths group dmcut to hande
Cheatng, yng and steang are common
1* CEARS 8Co""e3t'%) A)e;
Age of Speca Taents
Ready for compettve games
Wrtes egby
|ons organzatons
We-mannered wth aduts but crtca of them (part of dentty formaton)
Lkes to perfect thngs
11-12 CEARS 8Pea(o"es3e%t;
Fu of energy and constanty actve
Share secrets wth frends, Secret anguage are common
Socabe and cooperatve
GROWTH SPURT
Pedia
Grs: 10-12 yrs
Boys: 12-14 yrs
CHARACTER TRAITS@ SCHOOL AGE
Industrous
Loves to coect ob|ects
Sees sef n the eyes of the teacher and cassmates
Compares abtes and achevements wth peers
PEER GROUPS tea31es@
To see onesef thru the eyes of others
How to be a eader and a foower
When to be assertve and to yed
Group oyaty
Conformty to group standards
How to be a good sport
How to accept and carry out responsbtes
Cooperaton
Independence from aduts
/EHAVIOR PRO/LEMS
Cant bear to ose they w cheat, e and stea
Reasons for cheatng
Imtatng aduts
Depends on practcaty of the stuaton
Reasons for yng
Confuson n chds cogntve abtes and egocentrsm
Inabty to separate make beeve/fantasy from reaty
Faure to come up wth expectatons
Reasons for steang
Confuson over perceved ownershp
Impuse of peer pressure
"Gettng back" on embarrassng parents
CONCERNS@ SCHOOL AGE
Sa6et5
Motor vehcuar accdents
Drownng
Open ame burns
Nut't'o%
Fondness for |unk foods
Skppng meas/ eatng n schoo
Obesty
Teach nutrent vaue of food
Contro of sae of |unk foods
Packed snacks/unch
Preventon of obesty
Weght reducton program
Cose weght montorng
SeA E(u3at'o% o%@
Menstruaton and reproductve organ functon
Secondary sex characterstcs deveopment
Mora and soca mpcaton of sexua maturty
SIGNS O0 SEDUAL MATURITC
GIRLS BOYS
Increase n sze of breasts (Thearche-1
st
sgn) and
gentaa (unt 18 yrs)
Appearance of axary and pubc har (Adrenarche)
Wdenng of hps Deepenng of voce
Appearance of axary and pubc har Deveopment of musces
Menarche-ast sgn Increase n sze of testes and pens- 1
st
sgn (unt 17
Pedia
yrs)
Producton of vabe sperm- ast sgn (nocturna
emsson by 17 yrs)
ADOLESCENT
Age of transton from chdhood to aduthood
0EARS@ obesty, acne, death, homosexuaty, repacement from frends
SIGNI0ICANT OTHERS@ peers of opposte sex
SIGNI0ICANT DEVELOPMENT@
Conct between own needs of sexua satsfacton and soceta expectatons
Core concern: change of mage and acceptance of opposte sex
Dstnct odor: due to stmuaton of Apocrne gands
PERSONALITC TRAITS
Ideastc, rebeous, reformers, conscous wth body mage
CONCERNS
Motor vehcuar accdents
Masturbaton: causes conct wth moraty
Peer Pressure: smokng, acohosm, drug addcton, premarta sex
Body mage: eatng dsorders ahectng nutrtona state
Anorexa nervosa
Buma (Bnge-eatng)
PART 2. IMMEDIATE CARE 0OR THE NEW/ORN
G PRIORITIES O0 THE NEW/ORN IN THE 0IRST DACS O0 LI0E
1. Intaton and mantenance of respraton
2. Estabshment of extrauterne crcuaton
3. Contro of body temperature
4. Intake of adequate nourshment
5. Estabshment of waste emnaton
6. Preventon of nfecton
7. Estabshment of nfant-parent reatonshp
8. Deveopmenta care that baances rest and stmuaton for menta deveopment
INITIATION AND MAINTENANCE O0 RESPIRATION
Nursng Aerts:
Lung functon begns ony after brth
Intaton of arway s cruca ad|ustment among newborns
Most neonata deaths wthn 24-48h s caused by nabty to ntate arway
How: Remove secretons
Proper suctonng wth a catheter
Pace babys head to the sde
Sucton mouth rst before nose to prevent aspraton (NB are nasa obgate)
Sucton for 5-10 sec
Sucton genty and quck
Proonged deep suctonng may ead to:
HYPOXIA
LARYNGOSPASM
BRADYCARDIA
Evauate for arway patency: Cover one nostr at a tme
If not suctonng s not ehectve, ehectve aryngoscopy s requred to open the arway. After deep
suctonng, an endotrachea tube can be nserted and oxygen can be admnstered by a postve pressure
bag and mask wth 100% oxygen at 40-60b/mn.
Aerts (wth O2 use):
No smokng
Must be humded (not to dry mucosa)
Cover mouth and nose not the EYEScornea dryness
Avod O2 overdosage, t can cause:
Retna scarrng: Retroenta 13phthamc13s or Retnopathy of Prematurty (ROP)
Bronchopumonary Dyspasa (BPD)- obstructve pum. Dsorder
If meconum staned, never gve O2 wth pressure bag ateectass
ESTA/LISHMENT O0 EDTRAUTERINE CIRCULATION
Pedia
FETO-PLACENTAL CIRCULATION
Pacenta Umbca ven (O2 bood) ver Ductus venosus IVC RA
( pressure, 70% bood) Foramen Ovae LA mtra vave LV AortaLE
Remanng 30% bood trcuspd vave RV PA ungs (non-functonng, for nourshment) ung
vasoconstrcton Ductus arterosus Aorta UE
LE & UE (unO2 bood) pacenta (for oxygenaton va smpe dhuson)
SYSTEMIC CIRCULATION
Intated by ung expanson/ pumonary ventaton
Competed by cuttng of the cord
PCO2, Po2
(ntates 1
st
breath of the NB)

PA pressure
(sustans breathng)
Po2 pacenta bood ow LA & LV
pressure
(DA cosure) (cosure of DV & AVA) (FO cosure)
2 Ways to factate cosure of Foramen Ovae
6. Tangenta Footsap
Never stmuate baby to cry uness secretons are fuy draned
Characterstc of cry:
Strong, vgorous, usty- Norma
Cat-ke "Meow"- Crduchat Syndrome
Hgh-ptched, shr- Hypogycema/ ICP
7. Proper Postonng: R sde-yng to L sde pressure of the heart
Structure Approp. Tme of Obteraton Structure Remanng
Foramen Ovae (begns to cose wthn 24h) 1yr Fossa Ovas (otherwse: ASD)
Ductus Arterosus (begns to cose wthn 24h) 1 mo Lgamentum arterosum
(otherwse: PDA)
Ductus Venosus 2 mos Lgamentum venosum
Umbca arteres 2-3 mos Latera umbca gament
Interor ac artery
Umbca ven 2-3 mos Lgamentum teres hepats
Best poston mmedatey after brth
NSD: Trendeenburg
CS: supne/crb eve
Sgns of ICP
(nta) abN arge head (>35 cm)
Buged/tensed fontane (Crack spot- Macewen Sgn)
Pro|ecte vomtng- surest sgn of cerebra rrtaton
HTN wth wdened puse pressure, HR, RR (Cushngs trad)
Dpopa (for oder chdren)
Hgh-ptched, shr cry (ate sgn)
TEMPERATURE REGULATION
Goa: to mantan T not <36.5 C or 97.7 F
Factors eadng to Hypotherma
Pedia
Prematurty: pokothermc (cod booded)- easy adapt to T of envt due to mmature
thermoreguatng system (Hypothaamus)
Thn skn and SO fats
Inabty to shver
Born wet
Process of Heat Loss
1. Evaporaton- from body to ar
2. Conducton- from body to cod, sod ob|ect
3. Convecton- from body to cooer, surroundng ar
4. Radaton- from body to a cod, sod ob|ect not n contact wth the body
Ehects of Hypotherma (Cod Stress)
Earest sgn: HR
1. Hypogycema- due to gucose utzaton gucose to the bran CP (rreversbe bran damage)
2. Metaboc acdoss- due to catabosm of brown fat or brown adpose tssue (best nsuator of NB, found
at neck, kdneys and adrenas) formaton of actc acd and ketone bodes
3. Kerncterus- due to bud-up of brubn n the bran
4. Addtona fatgue to aready stressed heart
Preventon of Cod Stress
1. Dry and wrap NB wth a banket (prevent evaporaton)
2. Keep NB away from cod ob|ects and outsde was (prevent radaton)
3. Shed NB from drafts (prevent convecton)
4. Perform a treatments on a warm, padded surface (prevent conducton)
5. Mechanca measures
- radant warmer
- soette/ncubator
*shoud be prewarmed rst before pacng the NB
6. Prevent unnecessary body exposure
7. Cover body areas not beng examned
8. Embrace/ Skn-to-skn contact (KMC)
ESTA/LISHMENT O0 ADE>UATE NUTRITIONAL INTAFE
Physoogy of Breast mk Producton
Estrogen, Progesterone Anteror Ptutary Gand Proactn Acts on acnar ces (aveo) Produces
Foremk Stored n actferous (coectng) tubues
Baby suckng on breasts Posteror Ptutary Gand Oxytocn Contracton of actferous tubues Mk E|ecton
(Let down) Reex
Advantages of Breast feedng
Very economca
Aways avaabe at rght T
Heps n rapd nvouton due to Oxytocn producton
Breast- 4 wks
Uterus- 6 wks
breast CA ncdence
Baby has more IO than bottefed
Contans Antbodes: IgA
Wth Lactobacus bdus (protects GIT from pathogens)
Wth ysozyme (destroys bactera ce membrane)
Wth macrophage
Store n stere pastc contaner for macrophage not to stck to the bottom
If stored n freezer: good for 6 mos; dont reheat (even n mcrowave oven for mk formua): w
destroy contents
Newborns are abe to dgest smpe CHO
unabe to dgest fats due to ack of pase
CHON can be broken down partay (to serve as Ag & provoke an aergc reacton)
NB has sma stomach capacty (90 m) wth rapd ntestna perstass (bowe emptyng tme: 2.5-3 hrs)
Intaton of Breast feedng
NSD: asap
CS: after 4 hrs
Breastfeedng can begn ASAP after brth
Botte-fed NB may be ohered a few m of stere water or D5water 1-4 hrs after brth before feedng wth
formua
Dsadvantages of Breast feedng
No ron: prone to deveop anema f fuy breastfed
Possbty of CMV, HIV and Hepa B vrus transfer
Pedia
Father cannot bond as we
STAGES O0 /REAST MILF
Stage CHO CHON Fat Others
Coostrum
Present 2-4 days
Ig
Mneras
Vt ADEK
Transtona Present 4-14
days
- - Mneras
Water soube Vt
Mature
Present 14 days
-
/REAST MILF VS. COWKS MILF
Mk CHO CHON Fat Others
Mature Breast
mk
Lactose easy
dgested,
(-) constpaton, sour
mk sme of stoo

Lactabumn
Lnoec acd for
bran devt and
skn ntegrty
-
Cows mk
Casen wth curd:
hard to dgest, (+)
constpaton
Phosphorus
Mneras:
traumatc to
kdneys: force
uds
HEALTH TEACHING O0 /REAST 0EEDING
Proper hygene
Hand washng
Ceanse caked 16phthamc on nppes wth cotton soaked n ukewarm water from nner to outer
moton
Proper postonng
Uprght, sttng
Mother shoud be reaxed, avod tenson not to nterrupt ow of mk, otherwse baby w deveop
coc
Stmuate and evauate feedng reexes
ROOTING: touch sde of ps, mouth w open
purpose- to ook for food
f not stmuated: dsappears n 6 wks
N: dsappears after 3-4 mos. To 1 yr
SUCKING: touch mdde of ps
f not stmuated: dsappears n 6 mos; oher pacer f on proonged NPO
SWALLOWING: when food touches posteror porton of tongue
EXTRUSION/ PROTRUSION: when food touches anteror porton of tongue
purpose- to prevent posonng
dsappears at 4 mos (baby can spt up)
Crtera of ehectve suckng
Babys mouth s we hked-up to areoa, suckng s quet and has no sound produced
Mother experences after pan
Other nppe s owng wth mk
To prevent cracked nppes and ntate proper producton of oxytocn
Begn by 2-3 mn. per breast
by 1 mn. per day unt 10mn. per breast or 20 mn. per feedng
For proper emptyng and contnuous mk producton per feedng
Feed baby on ast breast you fed
PRO/LEMS EDPERIENCED IN /REAST 0EEDING
Engorgement
Feeng of tenson/funess
Management:
warm compress f breast feedng
cod compress or supportve bra f botte feedng
Sore Nppe
Cracked, wet panfu nppe
Management:
Exposure of ahected breast to ar or to 20-watt bub 12-18 n. away from breast
Avod usng pastc ner bra
Mastts
Breast nammaton due to Staphyococcus aureus
Pedia
Causes:
Improper breast emptyng
Unheathy sexua practces
Improper hygene
Management:
Manuay express nfected breast but dont feed ths mk to the baby
Take antbotcs as ordered and contnue breast feedng
CONTRAINDICATIONS IN /REAST 0EEDING
Materna Condtons
Human Immunodecency Vrus (HIV)
Cytomegaovrus (CMV)
Hepatts B vrus (HBV)
takng Warfarn (Coumadn)
Newborn Condton
ABO/Rh ncompatbty: Erythrobastoss fetas, Hydrops fetas,
Inborn errors of metabosm: PKU, Gaactosema, Tay Sachs dsease
ESTA/LISHMENT O0 WASTE ELIMINATION
Dherent Stoos
Meconum (Physoogc Stoo)
Backsh, greensh, stcky, tar-ke, odoress (due to stere ntestnes)
Contents: amnotc ud, sheddng of ntestna mucosa and secretons/mucus, vernx,
hormones
N: passed wthn 24-36 hrs, otherwse wth GI obstructon:
Hrschsprungs dsease
Imperforate anus
Meconum eus (Cystc bross)
Transtona Stoo
On 2
nd
to 10
th
day n response to feedng pattern
Greensh, oose, smy, ke darrhea to untraned eye (esp. prm mothers)
Breastfed Stoo
Goden yeow, soft, mushy wth sour mk sme ( actc acd)
Frequenty passed: 3-4X/day
Botte-fed Stoo
Pae yeow, formed, hard wth typca ohensve odor
Sedom passed: 2-3X/day
Wth suppementary foods added
Brown, odorous
INDICATION O0 STOOL CHANGES
|aundce: ght stoo
Undergong phototherapy: brght green
Mk aergy: wth mucus
Be duct obstructon: cay
s/p Barum enema: chak-cay
Upper GI beedng: back (meena)
Lower GI beedng (Ana ssure): bood ecked (hematocheza)
Intussuscepton: currant |ey
Hrschsprungs dsease: rbbon-ke
Maabsorpton syndrome (Ceac dsease, Cystc bross): steatorrhea- fatty buky, fou smeng
PART +. ASSESSMENT 0OR WELL-/EING
APGAR SCORE
Speca Consderatons
1
st
1 mn: genera condton of the baby
1
st
5 mn: capabty to ad|ust to extrauterne fe (MOST IMPORTANT)
1
st
15 mn: (optona)
A-ppearance: Coor
P-use Rate: HR (most mpt)
G-rmace: Reex rrtabty
A-ctvty: Musce tone
R-espratory ehort
NB s expected to cry after devery wthn 30 sec, otherwse consder Asphyxa Neonatorum due to ehect
of Demero or Morphne (gve Naoxone/ Narcan 0.1 mg/kg)
APGAR SCORING CHART
CRITERIA 0 1 2
Pedia
Heart Rate (-) <100 >100
Respratory Ehort (-) Sow, rreguar weak cry Good, strong cry
Musce tone Faccd Some exon We-exed
Reex rrtabty
A. Catheter
NR Grmace Cough/ Sneeze
B. Tangenta Footsap NR Grmace Cry
Coor Bue/ Pae Acrocyanoss Pnk a over
Interpretaton of Score
0-3: severey depressed, needs CPR, NICU admsson
4-7: moderatey depressed, needs addtona suctonng and O2
8-10: good heath
PEDIATRIC CPR/ACLS
Mosty rooted from respratory faure hypoxa f >5 mn rreversbe bran damage bran death
A-'wa5 8O#e% a%( C"ea A'wa5;
Shake NR ca for hep
Head-tt-chn-ft (Snmng poston) or |aw thrust f wth head/neck (cervca) n|ury s suspected
/-eat1'%) 8Ve%t'"at'%) t1e "u%)s;
Check for breathessness (Look, sten, fee)
Gve 2 rescue breaths
Mouth-to-mouth
One-way mask wth postve pressure ventaton
Infant: cover mouth and nose
>1 yr: cover mouth and pnch nose
If no chest rse, reposton the head or consder foregn arway obstructon
Remove t usng:
Hemch maneuver (Abdomna thrust) for chd
Back bows and chest thrust for nfant
Gve O2 va face mask at hghest 02 possbe (10-15 LPM)
If st nehectve, ntubate the pt
Endotrachea tube (ET)
Emergency tracheostomy (f wth upper arway obstructon)
C-'3u"at'o% 8Ca('a3 Co$#ess'o%;
Check for puseessness
Infant: bracha/femora
>1yr: carotd
Compresson area: ower haf of sternum; 1 nger breadth beow the eve of nppe ne; 2 nger
breadths above xphod process
Avod compressng the xphod process: may n|ure ver, stomach and speen
Cardac Compresson Neonate < 1mo Infant
1mo- 1yr
1-8 yrs
Puse check Bracha/
femora
Bracha/ femora Carotd
Technque Chest encrcement- thumbs paced
sde by sde
2-3 ngers Hee of 1 hand
Depth (nch) - - 1 1- 1
Rate/mn. >120 >100 100
Compresson Ventaton
rato
3:1 X 40 cyces 5:1 X 20 cyces 5:1 X 20 cyces
C-rcuaton
Obtan IV access:
NB: umbca ven
Perphera (3 attempts wthn 90 sec)
<6 yrs: ntraosseous (anteror tba)
Centra ne (femora, subcavan, |uguar vens)
Gve meds
Atropne: 0.02 mg/kg IV, IO, ET
Epnephrne (q 3-5 mns)
1
st
dose: 0.01 mg/kg IV, IO
0.1 mg/kg ET
2
nd
dose: 0.1 mg/kg IV, IO, ET
Meds that can be gven per ET
L-docane (1 mg/kg) for PVCs
E-pnephrne
A-tropne for bradycarda
Pedia
N-aoxone (0.01mg/kg)
Shoud be ushed wth 3-5 cc pan NSS then foowed by severa postve pressure breaths
Gve 20cc/kg crystaod souton (pan NSS or pan LR) as rapd IV bous for 2-3 tmes unt
hypotenson s corrected
If faed or n case of trauma wth massve bood oss: gve 10cc/kg cood souton (Prbc), or
20cc/kg whoe bood IV bous, may gve O negatve bood mmedatey, dont wat for
crossmatchng resut.
RESPIRATION EVALUATION@ SILVERMAN ANDERSON INDEX
CRITERIA 0 1 2
Chest movement (upper
chest)
Synchronzed Lag on nspraton See-saw
Intercosta retractons (ower
chest)
(-) |ust vsbe Marked
Xphod retracton (-) |ust vsbe Marked
Nares dataton (-) Mnma Marked
Expratory Grunt (-) Heard by stethoscope
ony
Heard by naked ear
Interpretaton of Score
0-3: norma, (-) RDS
4-6: moderate RDS
7-10: severe RDS
ASSESSMENT O0 GESTATIONAL AGE@ /ALLARDS AND DO/UWITL
FINDINGS < 36 WKS 37-38 WKS >39 WKS
Soe creases Anteror transverse
crease ony
Occasona creases n
2/3
Creases a over
Breast nodue (dm) 2 mm 4 mm 7 mm
Scap har Fne and fuzzy Fne and fuzzy Coarse and sky
Earobe Pabe (-) cartage Some cartage Sth, thck cartage
Testes and scrotum Testes n ower cana,
scrotum sma, few
rugae
Intermedate Testes penduous,
scrotum fu, extensve
rugae
PRETERM /A/IES
20-37 wks AOG
Abundant anugo
Hypotona (prone to respratory probems)
Frog eg or ax poston
Irreguar RR wth perods of apnea
Hypothermc
Poor suck and swaow reexes
Thn extremtes and skn
Mae: Testes undescended
Femae: Laba narrow
Cassc Sgns:
Scarf sgn: ebow passes mdne of the body
Hee to ear sgn
Square wndow wrst: 90 ange
POSTTERM /A/IES
>42 wks AOG
Cassc Sgn: Od mans face
Wde and aert eyes
Long brtte ngernas
Pedia
Skn desquamaton
Profuse scap har
Long, thn body
Meconum stanng (on nas and umbca cord)
Hypogycemc
PART &. NEONATE IN THE NURSERC
SPECIAL AND IMMEDIATE INTERVENTIONS
Upon recevng
Proper dentcaton (foot prnt)
Take anthropometrc measurements
Measurements Cm. Ave. (Cm.) In.
Length 47.5-53.75 50 19-21.5
Head Crcumference 33-35 34 13-14
Chest Crcumference 31-33 32 12-13
Abdomna Crcumference 31-33 32 12-13
Bathng the baby
Inta: O bath
To ceanse and spread Vernx Caseosa (nsuator and bacterostatc)
Fu bath once the cord fas oh and for baby of HIV (+) mother to transmsson to the NB
Dressng the umbca cord
Sma, thn cord= poor feta growth
N: Check for 3 vesses: AVA
Foow strct asepss (to prevent Tetanus Neonatorum)
Use trpe dye, 70% acoho or pan NSS
Shoud be done wth each daper change or at east 2-3X/day
Fod daper beow cord
Leave 1 n. of the cord
If IV nfuson/BT s antcpated, eave about 8 n. of the cord: for umbca ven cannuaton (best
access to NB; no nerve endngs)
Check the cord q 15 mns for the 1
st
6 hrs
Omphaaga: beedng of the cord, suspect hemopha
>30 cc: consdered beedng to a NB (because not yet capabe of producng
RBC)
Patent urachus: persstent mostenng (stua between badder and umbcus)
Ntrazne paper test: turned yeow: (+) urne
Umbca cord
Turns back: 3
rd
day
Fas oh: 7
th
-10
th
day, otherwse wth Umbca Granuaton (wthout fou sme, not necessary wth
nfecton)
Mgt: Sver Ntrate and Cauterzaton
Credes Prophyaxs
Purpose: to prevent Opthama Neonatorum (Gonnorhea Con|unctvts) from mother wth
untreated gonorrhea and Chlamydia trachomatis f devered va NSD
May be deayed unt an hour or so after brth to factate eye contact & parent-nfant bondng
Uses:
Erythromycn (0.5%) or Tetracycne (1%) 20phthamc ontment (from nner to outer
canthus) or drops
Sver Ntrate 1% 2 gtts at ower con|unctva sac then washed wth pan NSS after 1 mn.
to prevent stanng (obsoete use because cannot protect aganst Chamyda nfecton &
can cause chemca con|unctvts)
Admnstraton of Vtamn K (Phytomenadone: Aquamephyton, Konakion, Cycomin)
To prevent hemorrhage r/t physoogc hypoprothrombnema (because Vt K s not syntheszed
unt ntestna bactera are present)
Preterm: 0.5 mg IM; Term: 1.5 mg IM
Va Vastus ateras or atera anteror thgh (Rectus femors)
Weght takng
N: 3- 3.4 kg or 6.5- 7.5 b
Arbtrary Lower Lmt: 2.5 kg
Low Brth Weght: <2.5 kg or 5.5 b
Sma for Gestatona Age: 10
th
percente rank on the ntrauterne growth curve
Large for gestatona Age: > 90
th
percente rank, macrosoma > 4 kg
Approprate for Gestatona Age: wthn the 2 standard devaton of the mean
Pedia
Physoogc Weght Loss: 5-15% of brth weght durng the 1
st
wk of fe r/t vodng and mted
ntake
PART ,-A. PHCSICAL EDAMINATION AND DEVIATION 0ROM THE NORMAL
IMPORTANT CONSIDERATIONS DURING PHCSICAL EDAMINATION
NB- cover areas not beng examned
Infant- take RR rst, move from east to most ntrusve area
Todder and Preschoo- et them hande the nstrument, aow to keep securty banket/favorte toy
Schoo age and Adoescent- expan the procedure
VITAL SIGNS
TEMPERATURE
N: 36.5-37.5 C
Take recta temp. once to r/o mperforate anus
Insert about 1 nch of the thermometer, f pushed deepy pertonts
IMPERFORATE ANUS
Congenta dsorder, ncompete deveopment or absence of anus n ts poston n the perneum
More common n M than F
4 types
1. Atresa (ana or recta)
2. Ageness (anorecta)*no ana openng, most dangerous type
3. Stenos
4. Membranous* has ana openng
Sgns and Symptoms
- Faure to pass meconum durng 24-36 hrs (1st sgn)
- Abdomna dstenton
- Vomtus of feca matera aspraton pneumona
- (-) anorecta cana
- (+) ana membrane
- Externa stua to perneum & GU system
Management
- Temporary coostomy (coostomy care)
- Ana surgca ncson
Poston post-op: sdeyng or prone
Perform ana daton as prescrbed (use water soube ubrcant, nsert dator no more
than 1-2cm deep)
Compcaton
- Contnence for a fetme due to sacra anomaes and mproper surgery
HEART/CARDIAC RATE
Norma vaues
AGE AWAKE SLEEPING AVE.
NB- 3mos 85-205 80-160 140
3 mos-2 yr 100-190 75-160 130
2 yr-10 yr 60-140 60-90 80
> 10 yr 60-100 50-90 75
NB 120-160 bpm, rreguar
Rada puse: N: non-papabe, f papated suspect Patent Ductus Arterosus (PDA)
Femora puse: N: papabe, f not suspect Coarctaton of the Aorta (COA)
CONGESTIVE HEART 0AILURE
Inabty of the heart to pump sumcenty to meet the metaboc needs of the body
Due to Congenta Heart Dseases
Eary Sgns & Symptoms
HR at rest & sght exerton
RR, dstress
Profuse scap sweatng (nfants)
Fatgue & rrtabty
Sudden wt gan
CONGENITAL HEART DISEASE
Common n Grs
PDA, ASD
Common n Boys
TGA, TA, TOF, VSD
Causes
Pedia
Fama
Exposure to Rubea (German Meases): dangerous durng the 1st mo. (feta heart s deveopng at
4-8 wks AOG)
Faure of the heart structure to progress
Genera Sgns & Symptoms
CRY
Weak, mumed, oud, breathess
ACTIVITY LEVEL
Restess, ethargc
Unresponsve to pan
POSTURING
Hypotona
Opsthotonus
HR: persstent or , (+) murmurs
RR: , retractons wth aar arng, gaspng, dyspnea wth daphoress when supne, gruntng wth
exerton such as cryng or feedng
FEEDING BEHAVIOR
Poor suck due to ack of energy and dyspnea
Dmcut, uncoordnated suck, swaow and breathng
Sow, wth pauses to rest
Poor weght gan
2 MAEOR TCPES
ACCANOTIC HD
L to R shunt
50% enters the aorta, 50% reenters RV
CCANOTIC HD
R to L shunt
wth venous admxture enterng the systemc crcuaton
CARDIAC CATHETERILATION
Fuoroscopy-guded nserton of radopaque catheter nserted thru perphera bood vesse (femora or
antecubta ven) va percutaneous puncture, combned wth angography (n|ecton of contrast
matera/dye) thru the catheter nto the crcuaton
Provdes nformaton about:
Oxygen saturaton (saO2) of chambers and great vesses
Pressure changes
Cardac Output (CO) and Stroke Voume (SV)
Anatomc abnormates
Nus'%) I%te!e%t'o%s@ Pe-o#
- Measure accurate heght/ength and weght: essenta to correct cath seecton
- Ask for hx of aergy to seafoods/odne/dye
- WOF S/Sx of nfecton at ste to be used: severe daper rash defers femora approach
- Check for presence and quaty of both peda puses and mark them
- Get basene VS esp. saO2
- Gve anagesc/sedatve as ordered (Demero/Mdazoam/ Ketamne/Propofo)
- NPO 6 hrs pre-op, wth IVF to prevent hypogycema and dehydraton as ordered
Nus'%) I%te!e%t'o%s@ I%ta-o#
- WOF arrythma durng catheter nserton
- WOF feeng of warmth, N/V, restessness and headache, urtcara, ushng durng n|ecton of dye
- Montor VS: bradycarda, hypoTN may ndcate hemorrhage or cardac perforaton
Nus'%) I%te!e%t'o%s@ Post-o#
- WOF hemorrhage
Mantan occusve, water proof dressng at ste
Check dressng for beedng
Check ste for hematoma
Ensure adequate ud ntake to prevent dehydraton (due to bood oss, NPO status and
duretc acton of the dye) and hypogycema
- WOF thrombus formaton
Check equaty and presence of dsta puses
Check for T and coor of ahected extremty
If (+) venospasm: warm compress on contraatera extremty
Keep ahected extremty straght to factate heang
Venous: 4-6 hrs
Artera: 6-8 hrs
Gve pan meds as ordered
Pedia
Pumonary Bood Fow
- Ventrcuar Septa Defect (VSD)
- Atra Septa Defect (ASD)
- Endocarda Cushon Defect (AV cana)
- Patent Ductus Arterosus (PDA)
VENTRICULAR SEPTAL DE0ECT
Most common CHD
Abnorma openng between 2 ventrces (sze: pnpont to (-) septum)
Sgns and Symptoms
Systoc murmur at ower sterna border and no other sgncant Sx, may have S/Sx of CHF
dependng on sze of defect
ECG/CXR: RA, RV hypertrophy
Cardac cath: saO2 at RA, RV
Management
Paatve: Pumonary Artery (PA) Bandng- to pumonary bood ow
Correctve: Open Heart Surgery wth cardopumonary (CP) bypass: VSD patch cosure (usng
Dacron patch)
ATRIAL SEPTAL DE0ECT
Patent Foramen Ovae
Abnorma openng between 2 atra
Sgns and Symptoms
Systoc murmur at upper sterna border and no other sgncant Sx; may have S/Sx of CHF before
schoo age
ECG/CXR: RA, RV hypertrophy
Cardac cath: saO2 at RA, RV
Management
Paatve: PA Bandng- to pumonary bood ow
Correctve: Open Heart Surgery wth cardopumonary (CP) bypass: ASD patch cosure (usng
Dacron patch)
ENDOCARDIAL CUSHION DE0ECTS
Or Atroventrcuar (AV) cana
- Assocated wth Downs Syndrome
- A chambers communcate
- Wth ow ASD and hgh VSD
Sgns and Symptoms
- Moderate to severe CHF
- Md cyanoss when cryng
- (+) murmur
- Cardac cath conrms the dx
Management
- Paatve: PA Bandng- to pumonary bood ow
- Correctve: Open Heart Surgery wth cardopumonary (CP) bypass
Patch cosure
AV vaves reconstructon
Mtra vave repacement (wth severe defect)
Cx post-op: CHF, mtra regurgtaton, arrythma, pumonary HTN
PATENT DUCTUS ARTERIOSUS
Faure of DA to cose
Sgns and Symptoms
- Contnuous machnery-ke murmur
- Promnent, boundng rada puse
- ECG/CXR: RV hypertrophy due to pum. vascuar resstance and congeston
- LV hypertrophy due to addtona bood to PA that goes back to LA and LV
Management
- Indomethacn (Indocn): Prostagandn nhbtor that factates PDA cosure n preterms and NB
- Paatve: PA Bandng
Pedia
- Correctve: PDA gaton: va L thoracotomy
- Latest: Vsua Asssted Thoracoscopc Surgery (VATS): uses thoracoscope and nstruments paced
on 3 sma ncsons on L chest (faster recovery)
Obstructve Defects
- Pumonary Stenoss (PS)
- Aortc Stenoss (AS)
- Dupcaton of aortc arch
- Coarctaton of the Aorta (COA)
PULMONARC STENOSIS
Narrowng of pumonc vave
Extreme form: Pumonary Atresa: no bood ow to the ungs, wth hypopastc RV
PDA compensates by shuntng bood from aorta to PA
Wth ASD due to RA and RV pressure
Sgns and Symptoms
Cyanoss (due to pum. bood ow)
Typca murmur
Spt S3 sound (n a CHF)
ECG: RV hypertrophy
Management
Baoon angopasty (to date narrow vave)
Transventrcuar (cosed) vavotomy or Brock Procedure (nfant)
Pumonary vavotomy wth CP bypass (chd)
AORTIC STENOSIS
Narrowng of aortc vave
Ony 50% of bood enters aorta
Sgns and Symptoms
Feedng/exercse ntoerance
Exercse ntoerance, Actve chd may experence angna-ke Sx: chest pan, dzzness, headache
Fant puses, HR, BP,
Typca murmur, rough systoc sound and thr
ECG/CXR: LV hypertrophy due to LV resstance and LA pressure pumonary HTN and edema
Management
Baoon Angopasty: done n cath ab
Cx: Coronary artery nsumcencyMI sudden death
(1. Paatve) Aortc vavotomy then (2. Compete) vave repacement
Cx: bactera endocardts, ventrcuar dysfuncton HF
DUPLICATION O0 AORTIC ARCH
Causes pressure (compresson) to trachea and esophagus
Sgns and Symptoms
- Dysphaga
- Dyspnea
- ECG/CXR: LV hypertrophy
Management
- Cosed heart surgery
COARCTATION O0 THE AORTA
Narrowng of aortc arch pressure proxma to the defect, pressure dsta to the defect
Sgns and Symptoms
BP on upper extremtes, BP on ower extremtes (montor 4-extremty BP)
Epstaxs, dzzness, headache, fantng
Weak or (-) femora puse, cod LE
Management
Percutaneous baoon angopasty
Cose Heart Surgery va thoracotomy ncson
COA resecton and end-to-end anastomoss of aorta
Enargement of COA usng a graft of prosthetc matera or a porton of L subcavan
artery
Cx: restenoss , ruptured aorta, aortc aneurysm or stroke
Mxed Defects
Transposton of Great Arteres (TGA)
Tota Anomaous Pumonary Venous Return (TAPVR)
Truncus Arterosus (TA)
Hypopastc Left Heart Syndrome (HLHS)
TRANSPOSITION O0 GREAT ARTERIES
Aorta s arsng from the RV and PA s arsng from LV
No communcaton between systemc and pumonary crcuatons, no oxygenaton happens
Pedia
Sgns and Symptoms (n a cyanotc HD)
Cyanoss after 1st cry
Cardomegay and Poycythema (n response to hypoxema) thromboembosm CVA
CHF
Acceptabe saO2>75%
Management
Prostagandn E1 to bood mxng temporary
Paatve: Rashknd procedure or Baoon Atra Septostomy (BAS) durng cardac cath. to bood
mxng and to mantan CO over ong perod
Compete: Intraatra bame repar to drect venous bood to mtra vave and pumonary bood to
trcuspd vave usng prosthess (Mustard procedure) or own atra septum (Sennng procedure)
Compete: Artera Swtch Procedure wth re-mpantaton of coronary arteres (done durng 1st
wks of fe)
Cx: coronary nsumcency, arrhythma, ventrcuar dysfuncton, HF
TOTAL ANOMALOUS PULMONARC VENOUS RETURN
Pumonary vens enter RA or SVC nstead of LA
Wth ASD (due to pressure n RA and RV)
Sgns and Symptoms
- RV hypertrophy, hypopastc LV
- Md to moderate cyanoss
- CHF (aspeena)
Management
- Compete: Open heart wth CP bypass, ncudes
ASD patch cosure
Anastomoss of pumonary vens to LA
TAPVR Lgaton
Cx: reobstructon, beedng, dysrythma- heart bock, PA HTN, HF
TRUNCUS ARTERIOSUS
PA and aorta arse from 1 snge vesse of a common trunk wth VSD
Sgns and Symptoms
CHF
Cyanoss and hypoxema, murmur
Poor growth
Actvty ntoerance
Compcatons: bran abscess, bactera endocardts
Management
Moded Raste procedure: VSD patch cosure + excson of PA from aorta and attachng them to
RV va homograft
Cx: HF, beedng, PA HTN, arrythma, resdua VSD
HCPOPLASTIC LE0T HEART SCNDROME
Underdeveoped, non-functonng LV, wth aortc atresa
Wth ASD and PDA to suppy aorta wth bood
Sgns and Symptoms
Cyanoss unt PDA coses progressve deteroraton and CO CV coapse
Management
Inotropes IV, Prostagandn E1 IV to keep PDA open
Norwood Procedure: PA anastomoss to create new aorta and creaton of arge VSD
Bdrectona Genn shunt: pumonary to systemc artery anastomoss to bood ow to the ungs
Moded Fontan Procedure
Connects RA and PA
An openng n the RA bame s done to pressure
Separates oxygenated from unoxygenated bood but doesnt restore N anatomy or
hemodynamcs
Heart transpant: best opton
Probems:
Shortage of NB organ donor
Rsk of re|ecton
Chronc mmunosupresson and nfecton
Pumonary Bood Fow
Trcuspd Atresa
Tetraogy of Faot (TOF)
TRICUSPID ATRESIA
Faure of trcuspd vave to open
Wth ASD and VSD, sometmes wth PDA
Sgns and Symptoms
Cyanoss, HR, RR, dyspnea at brth
Pedia
Chronc hypoxema wth cubbng (oder chd)
Compcatons:
Bactera endocardts
Bran abscess
CVA
Management
Prostagandn E1 IV at 0.1mg/kg/mn to keep PDA open
Paatve: Baoon Atra Septostomy (f wth pum. bood ow)
PA bandng (f wth pum. bood ow)
Bdrectona Genn shunt
Moded Fontan Procedure
TETRALOGC O0 0ALLOT
4 Anomaes Present
- P-umonc stenoss
- V-SD (arge)
- O-verrdng of aorta
- R-V hypertrophy
Sgns and Symptoms
- acute cyanoss at brth that progresses over 1 yr as PS worsens
- murmur
- Poycythemathromboembosm CVA
- Severe dyspnea reeved by squattng (oder chd) or knee-chest poston (nfant): venous
return, ung expanson
- Growth retardaton
- Cubbng of ngers and nas
- Tet/Bue spes: acute epsodes of cyanoss and hypoxa
- Anoxc spes: when O2 demand> suppy, usuay durng cryng and after feedng
- Syncope
- MR
- CXR: boot-shaped heart
Compcatons:
- Sezures, Bran abscess
- CVA, or sudden death after anoxc spe
Management
- O2 and Morphne for hypoxc epsodes
- Propranoo (Indera) to heart spasm
- Paatve: Baock Taussg Shunt (BTS)
pum. bood ow and saO2 to the PA from L or R subcavan artery
- Compete: Open heart (medan sternotomy) wth CP bypass, ncudes
Resecton of nfundbuar stenoss (Brock Procedure)
VSD patch cosure
Percarda patch to enarge RV outow tract
MANAGEMENT@ CH0/CHD
Montor
- VS, dysrythmas
- I/O: wegh daper
- Weght OD (ud retenton)
- Faca/perphera edema
- abN breath sounds
Mantan
- Sem-Fowers, Knee-chest, squattng poston
- Neutra therma envronment
- Bed rest, unnterrupted seep
- Adequate nutrtona ntake (sma, frequent feedng; feed per demand)
- Fud restrcton as ordered
Admnster as ordered
- Coo, humded O2
- Sedatves
- ACE nhbtors: Captopr (Capoten), Enaapr (Vasotec)
- Dgtas (Lanoxn exr): 50 mcg/m wth HR deferra
- Duretcs (Furosemde) wth BP deferra
WOF K+ eves (K+ drug ehect, K+ potentates Dgtas toxcty: bradycarda and
vomtng)
- K+ suppements
DIGITALIS PRECAUTIONS
Dgtas (Lanoxn exr): 50 mcg/m
N bood eve= 0.8- 2 mcg/L
(+) notropc ( contractty)
Pedia
(-) chronotropc ( HR): S/E
(-) dromotropc ( AV conducton)
Drug overdose: f nfant receves more than 50 mcg/dose
HR deferra: <90 nfant; <110 young chd; <70 oder chd
Admnster 1 hr a.c. or 2 hrs p.c.
Dont mx wth mk, foods or drnk
If <4hrs has eapsed, admnster the mssed dose; otherwse gve t on the next dose
If chd vomts, dont gve a 2nd dose
Dont doube the dose for mssed doses
Gve water or brush teeth after the meds
Keep meds n ocked cabnet
Ca poson contro center mmedatey f accdenta overdose occurs
HOME CARE A0TER CARDIAC SURGERC
AVOID
- Payng outsde for severa wks
- Actvtes that can cause fas (bke rdng) for 2-4 wks
- Crowds for 2 wks
- Saty det; ntroducng new food
- Puttng cream, oton, powder on the ncson unt competey heaed
- Physca educaton for 2 months
- Immunzatons, nvasve procedures & denta vsts for 2 months
Advse parents
- Dscpne chd normay
- Importance of denta vst q6 mos. after age 3, nformng dentst of cardac probem
- Ca MD when coughng, RR, cyanoss, A/N/V, darrhea, pan, fever, sweng, redness or dranage
occurs at ste of ncson
AC>UIRED HEART DISEASE
RHEUMATIC 0EVER- nammatory autommune dsease foowng an nfecton caused by Group A
hemoytc Streptococcus (wthn 2-6 wks)
RHEUMATIC HEART DISEASE- f wth cardac vave damage
Sef-mted
Ahected body parts:
|onts
Skn
Bran
Serous surfaces
Bood vesses
Heart (musces and vaves)
RHD@ MAEOR SIGNS AND SCMPTOMS
1. POLCARTHRITIS
- Mutpe |ont pan (for 1-2 days)
- Reversbe and mgratory ahectng arge |onts: knees, hps, ebows, shouders, wrsts, ankes
- Wth acute T durng 1st 2 wks persstng for 4 wks n untreated pt
2. CARDITIS
- Inta S/: HR out of proporton to T, even at rest/seep
- Invoves a heart ayers
- (+) murmurs
- CHF: cardomegay, percarda frcton rub (chest pan), percarda ehuson, mtra vave stenoss
+. ERCTHEMA MARGINATUM
- Dstnct erythema macue wth cear center and wavy demarcated border
- Transtory,red skn esons, non-prurtc rash, found n the trunk and proxma extremtes
&. S> NODULES
- Rare, sma (0.5-1 cm), non-tender swengs that perssts ndentey after dsease onset and
graduay resove wthout resutng damage
- Found over |onts
,. SCDENHAM CHOREA/ ST. VITUS DANCE
- Invountary, purposeess movts of extremtes accompaned wth faca grmacng, speech
dsturbance, emotona abty and musce weakness
- Exaggerated wth anxety and reeved wth seep
H. ASCHO00 /ODIES
- Inammatory, hemorrhagc, buous esons causng sweng, fragmentaton and ateratons n
connectve tssues
- Found n heart (mtra vave), bood vesses, bran, serous surfaces of |onts and peura
RHD@ MINOR SIGNS AND SCMPTOMS
Pedia
Arthraga (|ont pan)
Low-grade fever that spkes n ate pm
Dagnostc tests
- Antbody
- C-reactve proten
- ESR
- ASO tter ( 7 days after nfecton, max. eves n 4-6 wks)
Streptoysn- Streptococcus extraceuar product that yses RBC
O- oxygen abe
ASO- concentraton of Ab formed n bood aganst the product
N= 0-120 Todd unts
abN= 333 Todd unts (+) RHD
RHD@ EONES CRITERIA
Dagnoss of RHD
- 2 MA|OR OR
- 1 MA|OR + 2 MINOR + HX OF STREP/SORE THROAT
RHD@ MANAGEMENT
Bed rest (not strct)
Avod contact sports
Asprn: ant-nammatory, anagesc
- Not gven to pt wth vra nfecton; at rsk of Reyes Syndrome (encephaopathy wth fatty
ntrates on ver and bran)
C/S by throat swab
Prophyactc antbotcs to prevent recurrence
- Pen G IM monthy or Erythromycn (f aergc to Pen G)
- Pen V po or Sufadazne po
- Duraton s uncertan, usuay ong-term because pt s at rsk of bactera endocardts
Gven 1 hr pror to denta, surgca procedure
RESPIRATORC RATE
Norma Vaues
AGE RATE/MINUTE
NEWBORN 40-60
1 YR 20-40
2-3 YRS 20-30
5 YRS 20-25
10 YRS 17-22
15 YRS AND ABOVE 12-20
/REATH SOUNDS
SOUNDS CHARACTERISTICS
Vescuar Soft, ow-ptched, heard over ung perphery, I>E, N
Broncho-vescuar Soft, medum-ptched, heard over ma|or bronch, I=E, N
Broncha Loud hgh-ptched, heard over trachea, I<E, N
Rhonch Snorng sound made by ar movng through mucus n bronch, N
Raes Crackes (ke ceophane) made by ar movng through ud n aveo, abN:
denotes pneumona, whch s ud n aveo
Expratory Wheezng Whstng on expraton made by ar beng pushed through narrowed bronch2
abN: seen n chdren wth asthma or foregn-body obstructon
Inspratory Strdor Crowng or roosterke sound made by ar beng pued through a constrcted
arynx, abN, seen n nfants wth respratory obstructon
Resonance Loud, ow tone, percusson sound over norma ung tssue
Hyper-resonance Louder, ower sound than resonance, a percusson sound over hypernated ung
tssue
RESPIRATORC DISTRESS SCNDROME
Or Hyane Membrane Dsease
Due to ack of surfactant (deveoped at 7 mos AOG, N Lecthn: Sphngomyen rato= 2:1; ndcates feta
ung maturty)
There s brn around aveo ateectass, hypoxa and acdoss
Dagnoss s dente durng 4 hrs of fe
Sgns and Symptoms (see Sverman Anderson Index)
- RR
- Nasa arng
- Expratory gruntng (ma|or S/)
- Retractons (earest S/)
Pedia
Supracavcuar
Suprasterna
Intercosta
Substerna
Subcosta
Xphod
Management
Eevate head, wth neck sghty extended (Open arway)
Proper suctonng (Cear arway)
O2 admnstraton wth humdty (owest O2 concentraton possbe)
Pace on CPAP/ PEEP to mantan aveo partay open (to prevent coapse)
Montor VS, skn coor and ABG
Chest physotherapy
Percusson: use padded sma pastc cup or sma O2 mask
Vbraton: use padded eectrc toothbrush
Admnster surfactant repacement therapy va ntratrachea route
Inst thru catheter nserted nto ET
Avod suctonng for at east 2 hours after
WOF HR and desaturaton
LARCNGOTRACHEO/RONCHITIS
Most common form of croup
Due to vra or bactera nfecton
Gradua onset, may be preceded by URTI
Sgns and Symptoms
Fever
Irrtabty and restessness
Anorexa, N/V
Inspratory strdor
Suprasterna retractons
Sea bark and brassy cough
Hoarseness
Crackes, wheezes
Intermttent and permanent cyanoss (Late Sgn)
Laboratory studes
ABG: respratory acdoss
Throat cuture
Dagnostc Studes
Chest and neck X-ray to r/o epgotts
Management
Mantan patent arway
Pace chd n coo, humded mst O2 tent as ordered
WOF paor or cyanoss
Eevate head of bed; provde bed rest
Encourage ud ntake (va IV f on NPO)
Prepare ntubaton set at bedsde
Admnster meds as ordered
Antpyretc
Antbotc
Nebuzaton
Racemc epnephrne
Bronchodator
Cortcosterod
*Avod cough syrups & cod meds (thcken and dry secretons)
/RONCHIOLITIS/ RSV
Producton of thck, tenacous mucus, due to Respratory Syncyta Vrus (RSV)- va drect contact
Sgns and Symptoms
Cod/u-ke Sx
Poor feedng, ethargy, rrtabty
RR- Sgn of deveopng RDS
Nasa arng and retractons
Expratory wheeze and grunt
Dmnshed breath sounds
Management
Mantan patent arway
Poston: 30-40 degree ange wth neck sghty extended to open arway and pressure on
daphragm
Provde coo, humded O2 as ordered
WOF dehydraton: encourage uds (va IV f on NPO)
Isoate the chd n snge room or wth another chd wth RSV
Strct handwashng
Pedia
Admnster meds as ordered:
Ant-vra: Rbavrn (Vrazoe) va aeroso by hood, tent, mask or ventator tubngs
RSV IgIV (RespGam) or pavzumab (Synags)
EPIGLOTTITIS
Emergency of a URTI
Cx of bronchots
Bactera form of croup (S. pneumonae or H. nuenzae type B)
Sudden/acute onset, usuay n wnter
Common among 2-5 years of age
Sgns and Symptoms
Hgh fever
Sore, red, named throat
(-) cough
Droong
Dysphaga
Mumed voce
Inspratory strdor
Agtaton
Cassc Sgn
Trpod Poston: eanng forward wth tongue protruson
Management
Avod tongue depressor, ora thermometer, aryngoscopy, throat swab
Prepare trache set not ET set
Pace pt nsde coo Mst tent or Croupette wth hgh humdcaton (to reduce arway sweng)
Gve pastc, washabe toys
No toys causng frcton O2 supports combuston
Tuck edges propery
Mantan on NPO
Dont restran the chd or force to e down
Admnster antpyretcs and antbotcs as ordered
Ensure up-to-date Hb con|ugate vaccnaton
PNEUMONIA
Inammaton of the aveo
Causatve agents
- Vrus
- Mycopasma
- Bactera
- Aspraton of foregn substance
Sgns and Symptoms
- Acute onset, fever
- Infant: rrtabty, ethargy, poor feedng, abrupt fever wth sezures, RR dstress (ar hunger,
tachypnea, cyanoss)
- Oder chd: HA, chs, abdomna & chest pans
- Hackng, nonproductve cough puruent sputum
- breath sounds or scattered crackes, wheezes
Management
- Bed rest, e on ahected sde (spntng)
- Antmcroba therapy
- Antpyretc as ordered
- Coo, humded O2 (cannua, hood, mst tent) as ordered
- Lbera uds
- Chest physotherapy and suctonng
- Isoaton precautons for Staph or Pneumococca pneumona
- Thoracentess
ASTHMA
Chronc, nammatory dsease of the arways
Common causes
- Foods, poens, dust mtes, cockroaches, smoke, anma dander, T changes, respratory nfecton,
actvty, stress
Status asthmatcus
- A medca emergency, RR faure and death can ensue
- RR dstress despte vgorous treatment
Sgns and Symptoms
- Expratory wheezng, breathessness, tachypnea, dyspnea, chest tghtness, esp. at nght and eary
am
- Hackng, nonproductve cough frothy, cear geatnous sputum
- Cyanoss, daphoress, retractons
- Chest hyperresonance on chest percusson
Pedia
- (-) breath sounds wth tachypnea: ventatory faure and asphyxa
Management
- Emnate aergens
- Avod extremes of T and exposure to vra respratory nfecton
- Recognze eary Sx of an asthma attack
- Adequate rest, seep, we-baanced det, ud ntake, exercse
- Annua u vaccne
- Chest physotherapy
- Use of nebuzer, meter-dose nhaer, ceanng of devces (to prevent ora canddass)
- Admnster meds as ordered
Bronchodators
2 agonst (Sabutamo, Abutero)
Racemc epnephrne
Cortcosterods
Antaergc meds
NSAIDs
/LOOD PRESSURE
Norma vaues
< 1yr: 87-105/ 53-66
Estmaton of Systoc BP (ower mt):
70 mmHg + (2 X age n yrs)
A fa n 10 mmHg: consder shock
AGE SYSTOLIC DIASTOLIC
Brth (12 hrs, < 1kg) 39-59 16-36
Brth (12 hrs, 3kg) 50-70 25-45
Neonate (96 hrs) 60-90 20-60
Infant (6 mos) 87-105 53-66
Todder (2 yrs) 95-105 53-66
Schoo age (7 yrs) 97-112 57-71
Adoescent (15 yrs) 112-128 66-80
Cuh shoud cover 2/3 of arm
- Large cuh: fase ow BP
- Sma cuh: fase hgh BP
SFIN
Acrocyanoss- body pnk, extremtes bue
Generazed mottng due to mmaturty of the crcuatory system
MONGOLIAN SPOTS
sate-gray or bush dscooraton/patches commony seen across the sacrum or buttocks
Due to meanocytes accumuaton
Common among Asans
Dsappears by 1 yr or to schoo age perod
MILIA
Pugged/unopened sebaceous gands
Whte pnpont patches on nose, chn, cheek
Dsappears by 2-4 wks
LANUGO
Fne downy har coverng the shouders, back, upper arm
Common n preterms
Dsappears n 2 wks
DES>UAMATION
peeng of the NB skn wthn 24 hrs
Common n post terms
Extreme dryness begnnng at soes and pams
STORF /ITES
Or Teangectas nev
Pnk patches at the nape of the neck
Dsappears when chd grows
ERCTHEMA TODICUM
Or Fea-bte rash
1st sef-mtng rash
Appears sporadcay and unpredctaby as to tme and pace
HARLE>UIN SIGN
dependent part s pnk, ndependent part s bue, because of the tendency of RBC to go down
CUTIS MARMORATA
Transtory mottng of the skn when exposed to cod
HEMANGIOMAS
vascuar tumors of the skn
3 Types
Pedia
1. Nevus Flammeus (Portwine Stain) -macuar purpe or dark red esons usuay seen on the face or
thgh
Never dsappear, can be removed surgcay
2. Nevus vasculosus (Strawberry hemangiomas)- dated capares n the entre derma or subderma
area contnung to enarge but dsappear after 10 years od
3. Cavernous hemangiomas- consst of communcatng network of venues n the subcutaneous tssue
that never dsappear wth age
Most dangerous type, may ead to nterna hemorrhage or aneurysm
VERNID CASEOSA
Whte, cheese-ke substance for ubrcaton
Insuator and bacterostatc
If yeow: hyperbrubnema
SFIN COLORKS SIGNI0ICANCE
Bue: cyanoss (hypoxa)
Whte: edema
Pae: anema
Yeow: carotenema or |aundce
Gray: nfecton, sepss
/URN TRAUMA
n|ury to body tssue cause by excessve heat
HIGH RISF /URN VICTIM@ CHILD
Hgher proporton of body ud to smaer musce & fat mass, thnner skn Hgher mortaty r/t
- Fud & heat oss
- Dehydraton
- Metaboc acdoss
- Cardovascuar coapse
- Proten & caore decency
- Infecton
MODI0IED RULE O0 NINES ASSESSMENT O0 EDTENT 8IN0ANTS;
PARTS ANTERIOR POSTERIOR
Head 9.5 9.5
Neck 1 1
Upper Arm 2 2
Lower Arm 1.5 1.5
Hand 1.25 1.25
Trunk 13 -
Back 13 -
Genta 1 -
Each Buttock 2.5 -
Thgh 2.75 2.75
Leg 2.5 2.5
Foot 1.75 1.75
,-. CEARS
PARTS ANTERIOR POSTERIOR
Head 6.5 6.5
Neck 1 1
Upper Arm 2 2
Lower Arm 1.5 1.5
Hand 1.25 1.25
Trunk 13 -
Back 13 -
Genta 1 -
Each Buttock 2.5 -
Thgh 4 4
Leg 3 3
Foot 1.75 1.75
ASSESSMENT O0 DEPTH
1ST De)ee 8Su#e93'a" T1'34%ess;
- nvoves ony the superca epderms characterzed by erythema, dryness and pan
- Exampe: Sunburn
- Heas by regeneraton by 1-10 days
2ND De)ee 8Pat'a" T1'34%ess;
Pedia
- nvoves the entre epderms, and porton of derms characterzed by erythema, bstered and
most from exudates whch s extremey panfu
- Exampe: Scads
- Heas by regeneraton by 4-6 wks
+RD De)ee 80u"" T1'34%ess;
- nvoves both skn ayers, epderms and derms/may nvove adpose tssue, fasca, musce and
bone
- appears eathery, whte or back and not senstve to pan snce nerve endngs had been
destroyed
- Exampe: Lava, ame burns
Ma%a)e$e%t
1. 0'st a'(
- Put out ames by rong the chd on a banket
- Immerse the burned part on a cod water
- Remove burned cothng
- Cover burns wth stere dressng
2. Ma'%te%a%3e o6 a #ate%t a'wa5
- Sucton secretons prn
- O2 admnstraton wth humdty
- Tracheostomy or ET ntubaton
+. Pe!e%t'o% o6 S1o342 0"u'( a%( E"e3to"5te I$:a"a%3e
- Isotonc sane or LR to repace eectroytes
- Coods to expand bood voume
- Dextrose n water to provde caores
0LUID RESUSCITATION@ PARFLAND 0ORMULA
Pan LR 4m X body wt (kg) X TBSA burned
- of tota: 1st 8hrs post burn
- V of tota: 2nd & 3rd 8hrs post burn
Goa: U.O.= 1m/kg/hr
&. /ooste (ose o6 teta%us toAo'(
,. Re"'e6 o6 #a'% su31 as IV a%a")es'3 8Mo#1'%e SO&;
H. Pe!e%t'o% o6 wou%( '%6e3t'o%
- Wound ceanng and debrdng
- Open and cose method of wound care
- Whrpoo treatment
-. S4'% )a6t'%)@ 0o$ :utto34s o Ae%o)a6t2 6oMe% 3a(a!e
G. D'et@ caore, proten
ATOPIC DERMATITIS
Or Infante eczema (2-6mos. of age)
Papuovescuar erythematous esons wth weepng or crustng
Due to food aergens
- Mk, eggs, ctrus |uces, tomatoes, wheat
S')%s a%( S5$#to$s
- Extreme prurtus
- Lnear excoraton (due to scratchng)
- Lchencaton (scay, shny whte skn)
Ma%a)e$e%t
- Avod food aergens
- Gve Isom or Prosob (hypoaergenc mk)
- Hydrate skn wth Burows souton
- Topca sterod (1% hydrocortsone cream)
- Topca anthstamne
Skn care: avod skn rrtants (soap, detergent, fabrc softener, daper wpes, powder)
Appy coo, wet compress to soothe skn
Proper hygene: hand washng, na cuttng
Mnmze scratchng: pace goves/mttens over hands
Avod heat, wooen cothes/bankets, rough fabrcs, furry stuhed anmas
IMPETIGO
Hghy nfectous, caused by Group A -hemoytc Streptococcus, possby Staph aureus
Predsposng factor: heavy nfestaton of Pedcuoss capts then pck nose
Papuovescuar esons (face, around mouth, hands, neck, extremtes) surrounded by ocazed erythema
becomng puruent and ooze, formng a honey-coored crust
Cx: AGN
Ma%a)e$e%t
Contact soaton (Communcabe for 48hrs wthout treatment)
Skn care
- Aow esons to dry by ar exposure
Pedia
- Day bathng wth antbactera soap (pHsoHex)
- Warm compress 2-3X/day to remove crusts
- Use of skn emoents to prevent crackng
Proper hygene
- Strct handwashng
- Use separate towes, nens, dshes (washed separatey wth detergent n hot water)
Ora antbotcs (Pencn)
Antbotc ontment (Muprocn)
PEDICULOSIS CAPITIS 8HEAD LICE;
Infestaton of har and scap wth ce
Stes ahected: occpta area, behnd ears, nape, eyebrows & ashes
Transmtted by drect and ndrect contact (sharng brushes, hats, towes & beddng)
A contacts shoud be treated
S')%s N S5$#to$s
- Intense prurtus
- (+) adut ce (gray specks crawng fast)
- (+) sver/gray specks rmy attached to har shaft
Ma%a)e$e%t
- Pedcucde shampoo & repeat after 7days
- Permethrn (Nx) rnse
Appy to washed, towe-dred har, eave for 10 mns, rnse
Remove nts wth ne-toothed comb
- Change beddng & cothng OD, wash n hot water wth detergent, hot dryer for 20mns
- Sea non-essenta beddng, cothng, unwashabe toys n pastc bag for 2wks
- Dscard harbrushes/combs or soak n hot water
- No sharng of beddng, cothng, headwear, harbrush/comb
- Vacuum furnture & carpets frequenty
SCA/IES
Infestaton of Sarcoptes scabe (tch mte)
F mte burrows nto epderms, ay eggs & des after 4-5 wks
The eggs hatch n 3-5 days, arvae mature & compete fe cyce
Contagous durng course of nfestaton va drect contact
S')%s N S5$#to$s
- Intense prurtus esp. at nght
- (+) burrows (ne graysh red nes) on skn
Ma%a)e$e%t
Topca scabcdes:
- Lndane cream (Kwe, Scabene) shoud not be used for <2 y/o: rsk of neurotoxcty and sezures;
Crotamton (Eurax)
Warm soap-and-water bath
Dry and coo skn
Appy scabcde oton; eave for 8-14 hrs before rnsng
- Permethrn 5% (Emte): cream s massaged thoroughy and genty from head to soes; avod
contact wth eyes
Treat a househod members & cose contacts
Strct handwashng
Change a cothng & beddng OD, wash n detergent wth hot water, hot dryer & ron before reuse
Sea nonwashabe toys & other tems n pastc bag for 4 days
ACNE VULGARIS
Sef-mtng, nammatory skn dsease nvovng sebaceous gands
Common among adoescents
S')%@ Comedones: composed of sebum (pds) causng whteheads
Ma%a)e$e%t
Proper hygene
Use md sufur (antbactera) soap
Ant-acne cream (Tretnon, Retn-A)
HEMOLCTIC DISORDERS@ ANEMIA
Causes
- Eary cuttng of cord
Term- shoud be cut unt pusaton stops (60-100 cc)
Preterm- cut at once to prevent |aundce
- Beedng dsorders (Bood dyscrasa)
IRON DE0ICIENCC ANEMIA
ron stores needed for Hgb producton
Caused by bood oss, metaboc demands, GI maabsorpton, ron n det
S/Sx: paor, weakness & fatgue, rrtabty
Pedia
ron det (dark, green eafy veges, breads, cereas, egg yok, kdney beans, ver, meat, rasns)
Admnster ron suppements as ordered
In between meas
Wth Vt. C/ctrus |uce: absorpton
Mk/antacds: absorpton
Lqud ron: Taken wth straw or medcne dropper at the back of mouth
S/E: fou aftertaste, meena, constpaton
HEMOPHILIA
X-nked recessve
3 Types
- Hemopha A: decent cottng Factor VIII (cassc)
- Hemopha B: decent cottng Factor IX (Chrstmas dsease)
- Hemopha C: decent cottng Factor XI
S')%s a%( S5$#to$s
Sudden brusng when chd grows (earest sgn)
- Deayed dagnoss at brth because NB receved materna cottng factors
- Ma|or sgn: Hemarthross- beedng/damage to synova membrane
abN beedng n response to trauma or surgery
N: beedng tme, PT, pateet count; abN: PTT
Ma%a)e$e%t
Montor beedng: hematura, IC beed (neuro status)
Beedng precautons:
- Avod contact sports (swmmng s preferred) or f antcpated, wear protectve devces (hemets,
knee & ebow pads)
- Ask pt f hemophac before dong any nvasve procedures
- Use smaer gauge neede
Immobze and eevate beedng extremty, appy gente pressure (15 mns) and cod compress
Admnster factor VIII concentrate or desmopressn (DDAVP) as ordered
LEUFEMIA
Group of magnant dsease
Rapd mmature WBC, competes nutrton wth mature WBC and producton of RBC and pateets
N= 500 RBC: 1 WBC
CLASSI0ICATION O0 LEUFEMIA
Lympho- ahects ymphocytes
Myeo- ahects myeobasts
Acute/Bastc- ahects mmature ces
Chronc/Cystc- ahects mature ces
Most common n chdren: Acute Lymphocytc Leukema (ALL), peak onset 2-6 y/o, M>F
Acute Myeogenous Leukema (AML): peak onset 15-39 y/o
S')%s a%( S5$#to$s
From nvason of BM
Infecton: T, poor wound heang, sore throat, bone weakens fracture, bone & |ont pans,
ymphadenopathy
Beedng: hemorrhage, petechae, epstaxs, hematoma, hematura, hematemess,
hepatospenomegay
Anema: paor, fatgue, anorexa, constpaton
From nvason of CNS
ICP: LOC, severe HA, vomtng, papedema, sezures
CN VII or spna nerve nvovement
From nvason of kdneys, testes, prostate, ovares, GI and ungs
D'a)%ost'3 Tests
PBS- (+) mmature WBC
CBC- mmature WBC, RBC, pateets
Done weeky durng mantenance phase of chemotherapy
Lumbar Puncture- CNS ahectaton
Shrmp/feta/C-poston, avod neck exon may occude arway of nfants and chdren
T'a( Ma%a)e$e%t
Surgery (most preferred)
(Crana) Irradaton
Chemotherapy
/M ta%s#"a%t
& LEVELS O0 CHEMOTHERAPC
1. 0o I%(u3t'o%
- To acheve compete remsson (dsappearance of eukemc ces)
- Meds: Ora Prednsone
Vncrstne and L-asparagnase IV
2. 0o Sa%3tua5
- To treat eukemc ces that nvaded testes and CNS
- Meds: Intratheca Methotrexate
+. 0o Ma'%te%a%3e
Pedia
- To contnue remsson
- Meds: Ora Methotrexate, 6-Mercaptopurne and Cytarabne
&. 0o Re'%(u3t'o%
- To treat eukemc ces after reapse occurs
*Ant-gout agents: Aopurno (Zyoprm) to treat/prevent hyperurcemc nephropathy (force uds)
NURSING MANAGEMENT
Assess for common sde ehects: anorexa, nausea and vomtng (gve antemetcs 30mns pror to chemo
and contnue unt 1 day post chemo), WOF dehydraton
Assure pt that aopeca and hrsutsm are temporary sde ehects, har w regrow n 3-6 mos. Wth new
coor & texture
Assess for stomatts (ora ucers)
- Ora care: acoho-free mouthwash, pNSS wth or wthout NaHCO3
- Use soft-brsted toothbrush, cotton pegets
- Appy Xyocane (topca anesthetc) on mouth before meas
- Det: soft and band accordng to chds preference, sma frequent feedngs
Protect pt from nfecton
- Strct hand washng
- Reverse soaton
Protect pt from addtona fatgue
- Bed rest
- Actvtes baanced wth rest
Protect pt from beedng
- Mnmze parentera n|ectons
- Appy pressure on venpuncture stes
- Use eectrc razor n shavng
Encourage verbazaton of feengs & concerns
Introduce the famy to other fames of chdren wth CA
Consut soca servces & chapans as necessary
NEPHRO/LASTOMA 8W'"$Ks Tu$o;
Tumor of the kdney (un- or batera) wth metastass to other organs
Peak ncdence: 3 y/o
Treatment: Parta to tota nephrectomy & chemotherapy wth or wthour radaton
S')%s N S5$#to$s
Mass wthn abdomen (rm, nontender, conned to 1 sde & deep wthn the ank)
Abdomna pan
Urnary retenton, hematura
Anema (r/t tumor hemorrhage), paor, anorexa, ethargy
HTN (r/t renn producton by tumor)
Weght oss, T
Lung nvovement: dyspnea, chest pan
Ma%a)e$e%t
Montor VS, esp. BP
Pace a sgn "DO NOT PALPATE ABDOMEN" at bedsde
Measure abdomna grth
WOF abdomna dstenton, bowe sounds because of rsk of GI obstructon post op
RH INCOMPATI/ILITC
Or Isommunzaton
Rh (Rhesus factor)- 85% of popuaton: foregn body: Antgen: proten factor
Happens f:
- Mother Rh (-)
- Father/Fetus Rh (+)
4th chd s severey ahected r/t degree of senstzaton to Rh (+) RBC
Fetus: Erythrobastoss fetas
- IUGR due to hemoyss
- Pathoogc |aundce wthn 24hrs
- Hemoytc anema ( O2-carryng capacty):
Cardac decompensaton
Hydrothorax
Hepatospenomegay
Edema, asctes
D'a)%ost'3 Tests
I%('e3t Coo$:Ks test
- Materna serum mxed wth Rh(+) RBC
- In mother wth Rh (-): cumpng (+) resut
D'e3t Coo$:Ks test
- Neonata cord bood washed and mxed wth Coombs serum
- Fetus wth Rh (-): cumpng (+) resut
Pe!e%t'!e !a33'%e@ R1o )a$ IM
Pedia
- Gven to Rh(-) mother, NEVER TO BABY, at 28 wks AOG and wthn 72 hrs post devery, BT,
amnocentess, choronc v sampng, D & C, aborton
- Purpose: to destroy feta Rh (+) RBC and prevent senstzaton
- S/E: fever, pan at n|ecton ste
- CI: aergy to human Ig
A/O INCOMPATI/ILITC
Happens when:
- Mother bood type O
- Fetus: A, B, AB
O-A most common
O-B most severe
1st chd can be severey ahected
Upon uterne contracton: start of hemoyss
Fetus: Hydrops fetas
- Edematous, etha state wth pathoogc |aundce
Ma%a)e$e%t
- No breastfeedng
Has Pregnanedoe: deays acton of gucorony transferase (ver enzyme that converts
ndrect to drect brubn) otherwse, compcaton: Kerncterus (rreversbe bran death)
Use of Phototherapy
Exchange Transfuson for Rh or ABO ahectatons cause contnuous n Hgb durng the rst 6 months
because the BM fas to produce erythrocytes n response to contnung hemoyss
EAUNDICE
Hyperbrubnema
- N= 0-3 mg/d ndrect brubn
- >12 mg/d (fu terms)
Kerncterus (Brubn Encephaopathy)
- >20 mg/d (fu terms)
- >12 mg/d (preterms, because ver s mmature)
- May ead to cerebra pasy
Physoogc |aundce (Icterus Neonatorum)
- Onset: 2nd to 7th day of fe, for 48-72 hrs
- Management: exposure to eary AM sunght
Pathoogc |aundce
- Onset: wthn 24 hrs, for > 1-2 wks
Breastfeedng |aundce
- Due to pregnanedoe
Assess$e%t
- Banchng the forehead, nose or sternum
- Norma ndng: cyanoss
- Lght stoo, dark urne, yeow scerae
Ma%a)e$e%t@ Phototherapy or Photooxdaton 18-20 n. far from NB
Use of ntense orescent ghts to serum brubn eves
In|ury from treatment e.g. eye damage, dehydraton or sensory deprvaton can occur
Cover the eyes (to prevent retna damage, cornea dryness)
Cover gentas (to prevent PRIAPISM: panfu contnuous pene erecton)
Change poston q2h (for even exposure)
ud ntake (to prevent dehydraton)
Pedia
Montor I&O
- Best: wegh the baby
- Wegh the daper: 1g= 1cc
Montor VS
Avod oton or o to skn (to prevent burns)
Expect brght green urne & stoo (oose)
Transent S/E: bronze baby syndrome
AbN bood gucose
- 30mg/d n 1st 72hrs or
- 45mg/d after 1st 3 days of fe
N bood gucose:
- 40-60mg/d: 1 day-od
- 50-90mg/d: 1 day-od
S/Sx: RR, twtchng, tremors, cyanoss, unstabe T, ethargy, poor musce tone
Mgt: eary feedngs (po or IV as ordered)
HEAD
V (25%) the entre body ength
Structures
Sutures: sagtta, corona, ambdoda
Fontanes: 6, 2 are papabe (Anteror and Posteror)
A%te'o 0o%ta%e" 8/e)$a;
Damond-shaped
N=3X4 cm, coses at 12-18 mos
> 5 cm: hydrocephaus
Premature cosure: Cranostenoss or Cranosynostoss
Sma, sow growng bran: Mcrocephay
(-) cerebra hemsphere: Avencephay
Poste'o 0o%ta%e" 8La$:(a;
Tranguar shape
N=1X1 cm
Coses at 2-3 mos
STRUCTURES O0 THE HEAD
CRANIOTA/ES
Locazed softenng of the crana bones among NB
Common to 1st born due to eary ghtenng
In oder chd: a sgn of Rcketts (Vt D decency)- nght sweats at head part
CAPUT SUCCEDANEUM
Edema of the scap due to proonged pressure at brth
Present at brth
Crosses suture nes
Dsappears after 2-3 days (water absorbed easy)
CEPHALHEMATOMA
Coecton of bood due to ruptured perostea capares r/t trauma
Present after 24hrs
Doesn't cross suture nes
Dsappears after 4-6 wks (WOF |aundce)
SE/ORRHEIC DERMATITIS
Or Crade Cap
Scang, greasy-appearng, samon coored patches usuay seen on the scap, behnd ears and umbcus
Due to mproper hygene
Mgt: appy coconut/baby o the nght before shampoong the next day
HCDROCEPHALUS
CSF producton > absorpton
Causes
Maformatons
Tumors
Hemorrhage
Infecton
Trauma
2 types
Communcatng (Extraventrcuar) r/t mpared CSF absorpton
Pedia
Non-communcatng (Intraventrcuar)- r/t CSF ow obstructon
Ea"5 S')%s a%( S5$#to$s
LOC
AbN arge head >35 cm (N by 1-2 yrs, HC=CC; measure HC unt 2 yrs)
Buged/tensed fontane
Cracked-pot sound on percusson: Macewens sgn
Dated scap vens
Pro|ecte vomtng: surest sgn of cerebra rrtaton
Fronta Bossng: promnent forehead
Sunset eyes
Headache, dzzness, vertgo
Dpopa
Change n pupary response and equaty
Late S')%s a%( S5$#to$s
Hgh-ptched, shr cry
Sezures
Cushngs trad: BP wth wdened puse pressure, HR, RR
Decortcate and decerebrate posturng
Fxed and dated pups
Ma%a)e$e%t
Pos't'o%@ ow sem-fower's (head at 30-45 degree ange and at mdne)
Mannto- osmotc duretc
Acetazoamde- to decrease CSF producton
Dazepam/Phenobarbta- antconvusants
Su)e5
VP 8Ve%t'3u"o#e'to%ea"; s1u%t
CSF drans nto pertonea cavty from atera ventrce
AV 8At'o!e%t'3u"a; s1u%t
CSF drans nto R atrum from the atera ventrce
Used for oder chdren and wth pathoogca condtons of the abdomen
Post-o# Ma%a)e$e%t
Sdeyng poston on non-operatve sde to prevent pressure on the shunt vave
Keep chd at as prescrbed to avod rapd reducton of CSF
If ICP occurs, eevate head of bed 15-30 degrees to enhance gravty ow to the shunt
Sgn of good dranage: sunken fontane
If bocked/obstructed: bugng fontane
Shunt s changed as the chd grows
WOF and prevent nfecton
MENINGITIS
CNS nfecton caused by bactera or vruses
May be acqured as a compcaton of neurosurgery, trauma, nfecton of the snus, ears or systemc
nfectons
Dagnoss: CSF anayss va Lumbar Puncture (LP): nserton of spna neede thru the L3-L4 nterspace
under strct asepss
Contrandcaton: ICP bran hernaton
Preparaton: nformed consent, pt on empty badder
Coect and abe specmens n sequence
Force uds post procedure as ordered
Postons:
Durng LP: C-poston, feta or shrmp: knees exed up to abdomen, head bent, chn to
chest
After LP: at on bed for 4-12 hrs as prescrbed
CSF shows pressure, coudy, CHON, gucose
S')%s a%( S5$#to$s@
Fever, chs
Vomtng, darrhea
Anorexa Hgh-ptched cry
Bugng fontanes
LOC
Musce |ont pan
Petecha or purpurc rashes (menngococca nfecton)
Kerngs sgn: pan and spasm of hamstrng when thgh and knee are exed
Brudznks sgn: head exon knee and hp exon
Ma%a)e$e%t
Pedia
Isoaton for at east 24hrs after antbotcs are ntated
Admnster antbotc as ordered
Montor neuro VS, I/O, nutrtona status
Determne chds cose contacts for prophyactc treatment
SENSES
Se%se o6 S')1t 8E5es;
Scera
N: bush-gray, whte
AbN: subcon|unctva hemorrhage (t/c Shaken Baby Syndrome)
Pups
N: PERLA, round
AbN: Cooboma- absence of part of rs
AbN: Congenta cataract: Rubea exposure whe n utero
Cornea
N: brght, shny, cornea reex to touch, (+)bnk reex, round and adut-szed
Retna
abN: Retnobastoma (tumor)
Mgt: Enuceaton
Test for Bndness for Infant and Chdren
Do's test:
N: when head s turned, eye movement ags behnd
AbN: f beyond 10 days
Gabears or Myerson's Test:
Tap over forehead, brdge of nose or maxa
N: bnks for 1st 4-5 taps
Test for Bndness for Schoo age and Adoescents
Tonometry
Sneen's Chart
N: eyes cross because of weak EOMs
N: eyeds edematous r/t pressure durng brth & ehects of eye meds
Se%se o6 S$e"" 8Nose;
Norma ndngs (Neonate/Infant)
At mdne, appears arge for the face
Apparent ack of brdge, at, broad
Some mucus but (-) dscharge
Obgatory nose breathers
Sneezes
Abnorma ndngs (Neonate/Infant)
Maformed
(+) aar arng (RDS)
Copous dscharge
Wth or wthout cyanoss, return to pnk when cryng (Congenta syphs or Chromosoma
dsorders)
Se%se o6 Hea'%) 8Eas;
1st sense to deveop and ast sense to dsappear
N: rm cartage wth reco
N: agned wth outer canthus of eyes
Abnorma ndng: LOW-SET EARS
Kdney maformaton
Rena Ageness: unatera and batera (dangerous
Mgt: Kdney transpant
Chromosoma aberraton
DEVELOPMENTAL DE0ECTS
Mutfactora: dsease requrng both genetc predsposton and envronmenta condton
Ex: Arthrts, DM, HD
Snge gene defect
Domnant nhertance
Poydactyy
Huntngton's dsease (NS degeneraton)
Chronc/Smpe gaucoma
Recessve nhertance
PKU
Thaassema
Scke-ce anema (Medterranean |ews)
X-nked
Pedia
Coor bndness
Hemopha
CHROMOSOMAL A/ERRATION
Nonds|uncton: uneven dvson resutng 45 and 47 chromosomes (abN structure and number of
chromosomes)
Trsomy 21 (Down's Syndrome/ Mongosm): most common type
Extra chromosome 21
Karyotype: 47 XX+ 21 or 47 XY+21
Predsposng factor: materna age >35, paterna age >45
DOWNKS SCNDROME
Sgns and Symptoms
Low set ears
Mongoan eyes: santed eyes
Broad, at nose
Protrudng tongue
Puppy neck
Smean crease: snge transverse ne on pam
Hypotona: at rsk for URTI
MR: from educabe to needng nsttutonazaton
EDWARDKS SCNDROME
Or Trsomy 18
Karyotype: 47 XX+18 or 47XY+18
Sgns and Symptoms
Rockers Bottomfoot: Soe of foot rounded
Msshapen ngers and toes
PATAUKS SCNDROME
Or Trsomy 13
Karyotype: 47 XX+13 or 47XY+13
Sgns and Symptoms
Mcropthama
Eye ageness
TURNERKS SCNDROME
Or Monosomy of X chromosome
Karyotype: 45 XO wth vagna
Sgns and Symptoms (seen ony durng puberty)
Poory deveoped femae secondary sex characterstcs
Stere: Mgt: HRT (Estrogen)
FLINE0ELTERKS SCNDROME
Or Trsomy of X chromosome
Karyotype: 47 XXY wth pens
Sgns and Symptoms (seen ony durng puberty)
Poory deveoped mae secondary sex characterstcs
Voce not deep, gynecomasta
Stere: Mgt: admnstraton of androgen
Deeton Abnormates: part of chromosome breaks durng ce dvson resutng 45 chromosomes
Cr-du-chat Syndrome: 46 XX5g (5th chromosome n defect)
Frage X Syndrome
Transocaton Abnormates: norma count of chromosome but structura arrangement s dherent
Baanced Transocaton Carrer
Unbaanced Transocaton Syndrome
Mosacsm: a stuaton wheren the nonds|uncton of chromosomes occurs durng the mtoss after
fertzaton resutng to dherent ces contans dherent numbers of chromosome
Some ces are N, some abN
Better prognoss, has no severe menta defect
Assocated wth teratogens
Isochromosomes: a stuaton wheren the chromosome nstead of dvdng vertcay t dvdes horzontay
resutng to chromosoma msmatch
Pedia
Sense of Hearng (Ears)
Abnorma ndng: (+) yeowsh, fou-smeng dscharge
OTITIS MEDIA@ nfecton of mdde ear
Predsposng Factors
Shorter, wde, straght and narrow Eustachan tube n chdren
Botte proppng
Ceft p and/or paate
S')%s a%( S5$#to$s@
Mky, puruent fou-smeng dscharge
Pan on pung pnna
S/Sx of URTI: cough, cods, fever
Otoscopc exam: red, opaque, bugng tympanc membrane, (-) ght reex
Ma%a)e$e%t@
ud ntake, feed chd n uprght poston, avod chewng gums to pan
Appy oca heat
Sde-yng poston on ahected sde to dran dscharges
Cean dscharges wth stere cotton swabs
Admnster meds as ordered:
Antpyretc for fever
Antbotcs for 10-14 days: Amoxcn, Ampcn (Cx: Bactera menngts)
Ear drops
Hearng oss screenng s mportant
Surgery: Myrngotomy wth Tympanostomy tube nserton
To equaze pressure and to keep the ear aerated
Mantaned unt the tubes fa oh or after 6 mos. to prevent permanent hearng oss
Pt shoud keep ear dry, wear earpugs durgn bathng, shampoong and swmmng; avod
dvng and submergng under water
MOUTH AND TONGUE
Mouth: symmetrca, opens eveny when cryng
Tongue: appears arge, symmetrca
Soft and hard paates ntact
Uvua n mdne
TONSILLITIS N ADENOIDITIS
Inammaton or nfecton of tonss and adenods
Sgns & Symptoms
Recurrent sore throat (cough, fever)
Enarged, brght red tonss wth whte exudate
Dmcuty swaowng
Mouth breathng; unpeasant mouth odor
Enarged adenods: nasa speech, dmcuty hearng, snorng or obstructve seep apnea
PRE-OP MANAGEMENT
Assess for sgns of
Actve nfecton
Beedng (check cottng studes) because the throat s vascuar
Loose teeth to prevent aspraton
Prone or sde-yng poston
Dont sucton uness there s arway obstructon
WOF hemorrhage (frequent swaowng)
Avod coughng or cearng of throat
Gve cear, coo nonctrus, noncarbonated drnks, avod red quds (masks beedng) and mk
(covers throat)
Avod usng straw, fork or sharp ob|ects
Pan meds as ordered
/ELLKS PALSC
Faca Nerve Parayss (CN VII In|ury) due to forceps devery
Sef-mtng
Sgns and Symptoms
Contnuous droong
Inabty to open one eye and cose the other eye
Appy artca tears
Pedia
TRACHEOESOPHAGEAL 0ISTULA/ATRESIA
(-) connecton of esophagus to stomach, may have connecton to trachea
Aspraton pneumona, severe RR dstress and death may ensue wthout surgca nterventon
A surgca emergency (pacement of cervca esophagostomy and gastrostomy tube)
S')%s a%( S5$#to$s 8&CKs;
Coughng
Chokng
Cyanoss
Contnuous droong
POST OP MANAGEMENT@ TE0
Pe!e%t as#'at'o%
Uprght or prone poston
Sucton ora & nasopharyngea secretons
Keep doube umen cath n upper esophagea pouch attached to ow-pressure sucton; rrgate wth pNSS to
prevent coggng
Keep G-tube open to dran (for 5-7d)
Support nutrtona status
Progressve sma, frequent G-tube feedng wth stere water to breastmk/formua
If wth cervca esophagostomy, oher pacer
Pe!e%t s4'% :ea4(ow%
Assess cervca esophagostomy ste for redness, exudate
Remove dranage frequenty
Appy protectve ontment, barrer dressng or coecton devce
EPSTEIN PEARLS
N among NB
1-2, sma, round, gstenng whte cysts seen at the paate or gums r/t hypercacema whe n utero
NATAL TOOTH
Rootess, tooth at the moment of brth r/t hypervtamnoss whe n utero
Shoud be extracted to prevent aspraton
NEONATAL TOOTH
Tooth appearance wthn 28 days of fe
Anodonta: (-) tooth up to 5 yrs
ORAL THRUSH/ MONILIASIS
Caused by fung Candida albicans
Whte cheese/curd-ke patches at mouth and tongue
Obtaned va NVD to mother wth vagna thrush
Management
Never remove t! May cause beedng septcema
Wash mouth wth coo boed water
Appy Nystatn ora cream as ordered
FAWASAFI DISEASE
Or Mucocutaneous Lymph Node Syndrome
Acute systemc vascuts of unknown cause
Sef-mted
Common among Asans (dsease orgnated n Korea)
Compcatons: daton of coronary arteres MI (S/Sx n chdren: abdomna pan, vomtng, restessness,
paor, shock) and aneurysm, damage to heart musce
D'a)%ost'3 C'te'a 8A3ute Sta)e;
Fever > 5 days
Batera Con|unctvts
Red throat
Sweng of cervca ymph node to > 1.5 cm n dameter
Swoen hands & feet
Poymorphous rash (prmary on trunk)
Su:a3ute Sta)e
Changes of ps and ora cavty
dry, red ssure ps
STRAWBERRY TONGUE
Changes of perphera extremtes
Desquamaton of the skn from tps of ngers and toes
|ont pan
Cardac manfestatons
Thrombocytoss
Co%!a"es3e%t Sta)e
Pedia
Chd appears norma but sgns of nammaton may be present
Three Phases
Acute: a S/Sx appears, + restessness for 2 months (hamark of KD) and arthrts
Subacute: resouton of a S/Sx, at greatest rsk of coronary artery aneurysms (bood vesses
stretch 4 wks post onset) and coronary thromboss (due to thrombocytoss and
hypercoaguabty)
Convaescent: bood vaues return to N (6-8 wks post onset) e.g. ESR, thrombocytoss
Ma%a)e$e%t
Montor
T frequenty
Heart sounds & rhythm
Extremtes for edema, redness & desquamaton
Eyes & mucous membranes for nammaton
Detary & ud ntake
Weght OD
Passve ROM exercses to factate |ont movement
Gve soft foods/quds (not too hot or too cod)
Admnster as ordered
Hgh dose IV Immunogobun durng the 1st 10 days: 2g/kg as 10-12 hr drp (to ncdence of
coronary artery esons & aneurysms)
S/E: aergc rxn, extravasaton, producton of antbodes (deay MMR vaccne 11 mos. and
chckenpox vaccne 5 mos after IVIG)
Asprn
Hgh dose: 80-100mg/kg/day (n dvded dose q6h) antpyretc and antnammatory (S/E
toxcty: tnntus, HA, dzzness, confuson)
Low dose: 3-5mg/kg/day antpateet (S/E easy brusng avod contact sports)
Warfarn (Coumadn) for chdren wth gant aneurysm (>8 mm)
CLE0T LIP N CLE0T PALATE
Congenta anomay
Faure of the soft tssue or bony structure to fuse durng embryonc deveopment
Causatve factors
Genetc, Heredtary, Envronmenta, Radaton, Rubea vrus, Teratogens
CLE0T LIP
Faure of the medan maxary nasa processes to fuse by 5-8 wks of pregnancy
Can be unatera or batera
Common n boys
Surgery: Cheopasty
done as eary as 1-3 mos not to remove suckng reex
CLE0T PALATE
Faure of the paate to fuse
Common n grs
Su)e5@ Uraropasty
done as eary as 4-6 or 12-18 mos to aow norma paata growth & not to mpar speech
Ma%a)e$e%t
Emotona support
Nutrtona support (prevent aspraton)
Use feedng devces
Post cheopasty: rubber tpped Asepto syrnge wth arge hoe
Post uraropasty: paper cup, soup spoon, pastc cup
Nutrtona support (prevent aspraton)
ESSR method of feedng
E-narge (crosscut) the nppe
S-tmuate suckng
S-waow
R-est
Feed n uprght poston
Drect thckened formua to the sde & back of mouth
Sma, frequent feedng
Prevent coc: Burp q 1oz of feedng
Encourage breast feedng f approprate
Keep sucton equpment & bub syrnge at bedsde
Soft ebow or |acket restrants pre-op (so baby can ad|ust post-op); remove q2h to assess skn
Resched OR f wth URTI
Post-op postonng
Cheopasty: sde yng
Uraropasty: prone
Mantan ntegrty of Logan bow (p protector)
Pedia
Prevent baby from cryng
Ceanse t wth haf-strength H2O2 or pNSS
s/p Uraropasty: ora packng for 2-3days, no tooth brushng, no hard foods (toasts, cookes)
AVOID
Sharp ob|ects n mouth (ora sucton, tongue depressor, thermometer, straw, spoon, fork,
pacer)
NECF
N: Short and thck, amost non-exstent
Trachea n mdne
Thyrod gand not papabe
Appears soft, chubby, creased wth skn fods
Good ROM and abty to ex & extend
CONGENITAL TORTICOLIS
Or Wry neck
In|ured sternocedomastod musce
Brth n|ury r/t excessve tracton durng cephac devery
Mgt: passve neck stretchng exercses day
CONGENITAL CRETINISM
Or Thyrod Dysgeness
Absence or non functonng thyrod gands
Deayed dagnoss n NB because
Thyrod gand s covered by sternocedomastod
Baby receved materna thyroxne
Baby N seeps 16-20 hrs/day
Sgns and Symptoms
Changes n suckng (poor)
Changes n cryng (weak)
Seeps excessvey
Constpaton
Edema (moon-face)
MR (ate sgn)
Dagnostc Test
Proten bound I2
Rado mmunoassay test
RAIU (RadoActve Iodne Reuptake) test
Treatment
Thyroxne (Synthrod) for fetme
S/E tachycarda (hyperthyrodsm) NI! Check HR pror to gvng of meds
CHEST
N: smaer than the head
Crcuar: AP dameter = 1:1
Temporary breast engorgement wth Wtchs mk (thn, watery ud) r/t ehect of materna hormones
Breathng: daphragmatc and abdomna
Cavces ntact
A/DOMEN@ DIAPHRAGMATIC HERNIA
Most urgent of neonata emergences
Congenta maformaton of daphragm: Dspacement of the abdomna organs nto the thoracc cavty
(usuay on L)
Sgns and Symptoms
Bowe sounds heard at chest
Shft of heart to sde opposte the herna
Large, asymmetrc chest contour
Duness upon percusson on ahected sde
breath sounds
CXR: presence of ntestnes n thorax and medastna shft
GASTROINTESTINAL SCSTEM
Functons:
Asssts n mantanng ud and eectroyte and acd/base baance
Processes and absorbs nutrents to mantan metabosm and support growth and deveopment
Excrete waste products from the dgestve processes
Pedia
SUPPLEMENTAL 0EEDING
Prncpes
Sod food are ohered accordng to the foowng sequence: cereas (gven as eary as 4 mos: start
of ron catabosm, usuay gven at 6 mos: ron catabosm s compete)fruts veges meat
nger foods tabe foods
Begn wth sma amount
Fnger foods are ohered by 6 mos
Dute ctrus |uces ohered by 6 mos
Oher new food one at a tme, wth nterva of 4-7 days (to determne food aergy)
Soft tabe food (moded famy menu) ohered by 12 mos (baby n hgh char)
Avod gvng haf-cooked egg Samoneoss
Avod gvng honey Infant Botusm
0LUID AND ELECTROLCTE/ ACID-/ASE /ALANCE
Dependent on the foowng:
chemca buhers
rena and respratory system nvovement
duton of strong acds and bases n bood
ACID-/ASE IM/ALANCE
Res#'ato5 a3'(os's
Hypoventaton condtons
Apnea
Cystc bross (CO2/ar trappng)
Res#'ato5 a"4a"os's
Hyperventaton condtons
Tachypnea: asthma, RDS
Meta:o"'3 a3'(os's
Chronc darrhea
Severe hypotherma: NB and nfants
Meta:o"'3 a"4a"os's
Chronc vomtng
Proonged suctonng of GI contents
GI post-op (bowe obstructon)
NGT NPO to sucton to decompress stomach
VOMITING
Forcefu e|ecton of gastrc contents thru the mouth
Usuay sef-mtng, no specc tx uness Cx occurs
S')%s a%( S5$#to$s a%( Causes
Vom+T+ darrhea= GI nfecton
Vom+constpaton= GI obstructon
S')%s a%( S5$#to$s a%( Causes
Vom+ocazed abdomna pan= appendcts, pancreatts, peptc ucer
Vom+LOC+HA= CNS or metaboc dsorders
Pro|ecte vom=pyorc stenoss, ICP
Others: toxc ngeston, food ntoerance/aergy, psychogenc dsorders
Assess$e%t o6 3o"o a%( 3o%s'ste%35
Green/bous= bowe obstructon
Curded, mucus or fatty foods severa hrs post ngeston= poor gastrc emptyng or hgh ntestna
obstructon
Ma%a)e$e%t@ treat underyng cause
B-anana not gven to pt wth
R-ce darrhea; energy
A-ppesauce eectroytes and CHON
T-oast CHO (osmoaty)
Nus'%) Ma%a)e$e%t
Uprght postonng durng feedng to prevent aspraton
Ora care post vomtng
Lbera uds wth CHO to spare body proten and prevent ketoss
DIARRHEA
n stoo frequency (>3-5x/day) wth water content
2 Types
Acute darrhea
CNSD (Chronc Non-Specc Darrhea)
Assocated wth
Gastroenterts: bactera, vrus, fung
Pedia
Detary causes: overfeedng, excess sugar n formua, ntro of new foods
Meds: axatves and antbotcs
Amox, Amp, Pen
Posonng: Arsenc, Lead, Mercury, Organophosphate
CNSD
Or Irrtabe Coon of Chdhood or Todders Darrhea
Assocated wth
Food (Lactose) ntoerance
Excessve softdrnks/ frut |uces: sorbto and fructose
fat det: restrcted dary and mk products
*osmotcay actve, CHO, e+
Assocated wth contamnated water
2 wks duraton, no S/Sx of manutrton, enterc nfecton and dehydraton
rate of gastrc emptyng and ntestna transt tme
ASSESSMENT
u.o., weght, (-) tears, (-) sava, dry mucous membranes, poor skn turgor, sunken fontane, pae coo dry
skn
Severe DHN: BP, HR, RR, >2sec CRT (mpendng shock)
COMPLICATIONS
1. Dehydraton
Md: 5-6%, thrst, sghty dry bucca mucosa
Moderate: 7-9%, (-) skn turgor, sunken eyes and fontane
Severe:>9%, S/ of moderate DHN + one of the foowng
Rapd, thready puse
RR
Lethargy to coma
Severe metaboc acdoss
2. Eectroyte Imbaance
Metaboc acdoss (H+)
Respratory akaoss
3. Manutrton
Due to detary ntake, maabsorpton syndrome and cataboc response to nfecton
MANAGEMENT
Ora Rehydraton Souton (ORS): Pedayte, Hydrte, Infayte, WHO), rce-based ORS as substtute
Tx of choce for md to mod DHN
Physoogc bass: gucose-medated souton Na+ absorpton
Most ehectve, ess panfu, ess costy than IV
Repace stoo osses wth -1 cup ORS
IV (pan LR or D5NSS)
For severe DHN wth shock: 20-30 cc/kg bous
Ant-darrhea meds (Lomot, Imodum) not recommended: worsen darrheatoxcty and ADR due to
motty, eus may occur
NURSING CARE
Assess hydraton status, wegh OD, I/O, urne specc gravty
Contnue breastfeedng and usua det
Skn care on perana area (Znc oxde cream)
No recta T!: stmuate bowe and stoo passage
Hand washng, proper dsposa of dapers
HIRSCHSPRUNGKS DISEASE
Or Congenta Megacoon or Agangonoss
(-) of gangon ces n rectum & upward coon (for perstass) mechanca obstructon
Cx: Enterocots (fever, GI beedng, exposve watery darrhea)
Assess$e%t '% New:o%
Faure to pass meconum wthn 24 hrs
Abdomna dstenton
Fou-odor of breath/vomtus of be/feca matera
Assess$e%t '% C1'"(e%
Poor weght gan & deayed growth
Rbbon-ke & Fou-smeng stoo
Vomtng
Constpaton aternatng wth darrhea
D'a)%ost'3 Tests
Barum Enema - reveas the narrowed porton of the bowe
Recta Bopsy - (-) gangon ces
Abdomna x-ray - reveas dated oops on ntestne
Recta manometry - reveas faure of ntestna sphncter to reax
Pedia
Ma%a)e$e%t
Det, stoo softeners, day recta rrgaton wth pNSS
2-stage Surgery
1. Temporary coostomy
Det: CHON, caores, resdue (can cause obstructon)
2. Trans-ana anastomoss and pu-through & cosure of coostomy
Pe-o# Ma%a)e$e%t
Mantan NPO status
Mo%'to
Bowe functons
Hydraton & eectroyte status
Weght, I/O
Abdomna grth
RR dstress
Avod takng recta temp!
Admnster as ordered
IV uds
Antbotcs
Bowe prep
Post-o# Ma%a)e$e%t
Ma'%ta'%
NPO status unt bowe sounds return (48-72hrs)
IV uds unt progressve ora ntake s toerated
Assess
Stoma (shoud be pnk & most) for beedng, skn breakdown, provde coostomy care
Surgca ste for redness, sweng & dranage
Ana area for stoo, redness, dranage
Admnster Anagescs, Antpyretcs, Antbotcs as ordered
GASTROESOPHAGEAL RE0LUD DISEASE 8GERD;
Or Chaasa
Presence of stomach contents n esophagus due to reaxed/ncompetent LES
Vs. Pyross (Heartburn): HC contents go back to stomach
Assessment
Passve regurgtaton
Hematemess
Meena
Irrtabty
Faure to thrve/poor wt gan
Anema from bood oss
D'a)%ost'3 Tests
Barum Esophagogram - reveas reux
Esophagea Manometry- reveas ower esophagea sphncter pressure
Intraesophagea pH content - reveas hgh pH of dsta esophagus
Co$#"'3at'o%s
Esophagts
Esophagea strctures
Aspraton pneumona
Ma%a)e$e%t
Montor
Amount & characterstcs of emess
Reatonshp of vomtng to tmes of feedng & chds actvty
Pace sucton equpment at bedsde
I/O
S/Sx of dehydraton
Mantan rehydraton (IV, po)
Support nutrton (For nfants: same as n ceft p/paate)
For todders: feed sods 1st then quds
Avod fatty foods, chocoate, tomato products, carbonated drnks, frut |uces, ctrus products &
spcy foods
Avod vgorous pay after feedng
Avod feedng |ust before bedtme
Pan meds for reux pan (Acetamnophen)
Chonergc Meds
Bethaneco - to esophagea tone and perstatc actvty
Metochopramde (Regnan/Pas)- to esophagea pressure by reaxng pyorc and duodena
segments, perstass wthout stmuatng secretons
H2 bocker- to gastrc acdty and pepsn secreton
Pedia
Antacds (Maaox)- to neutraze gastrc acd between feedngs
Su)e5@ Nssen Fundopcaton
Creaton of vave mechansm by wrappng the greater curvature of stomach
To create pressure and prevent backow to esophagus (to restore competence of LES)
PCLORIC STENOSIS
Hypertrophy of crcuar musces of pyorus narrowng & obstructon
Sgns and Symptoms
Pro|ecte vomtng after feedng
Vomtus: gastrc contents, wth mucus or bood, no be
Hunger, rrtabty
Ove-shaped mass at RUO
Perstatc waves vsbe from eft to rght across epgastrum durng or after feedng
Metaboc akaoss, eectroyte mbaance
Dehydraton, manutrton
D'a)%ost'3 Tests
ABG: metaboc akaoss
Serum eectroyte: Na and K, chorde
Utrasound: conrms dagnoss
X-ray of upper abdomen wth barum swaow (reveas tnged sgn)
Ma%a)e$e%t
Pyoromyotomy (ncson through the musce of pyorus, done under aparoscopy)
INTUSUSSCEPTION
Teescopng or nvagnaton of one part of the bowe to another porton
Most common ste: eocecca |uncton nammaton necross PERITONITIS (ER of GIT; persstent
abdomna pan) perforaton & shock
Assess$e%t
Currant-|ey stoos (due to nammaton and beedng)
Papabe sausage-shaped mass at RUO
Abdomna dstenton & pan
Be-staned feca vomtus
Lower GI seres (Barum enema): starcase or coed sprng sgn
Ma%a)e$e%t
Hydrostatc reducton wth Barum enema
WOF passage of barum & norma brown stoo
Anastomoss and pu-through
A/DOMINAL DE0ECTS@ OMPHALOCELE
Herna of umbca cord, wth ntact pertonea sac
Rupture of sac evsceraton of abdomna contents
Cover sac wth stere gauze soaked wth pNSS then wth pastc wrap to prevent dryng
Mantan on NPO, IV uds/TPN, prevent hypotherma & nfecton
GASTROSCHISIS
Herna of ntestne atera to the umbca rng, no membrane covers the exposed bowe
Cover exposed bowe wth LOOSE stere gauze soaked wth pNSS then wth pastc wrap to prevent dryng,
pressure & necross
Emergency surgca repar needed
Mantan on NPO, IV uds/TPN, prevent hypotherma & nfecton
IN/ORN ERRORS O0 META/OLISM@
PHENCLFETONURIA
Inborn error of CHON metabosm
Autosoma recessve dsorder
Decent n ver enzyme Phenyaanne Hydroxyase Transferase (PHT) needed for the converson of
phenyaanne to thyrosne (needed for meann producton)
S')%s a%( S5$#to$s
Far skn
Bonde har
Bue eyes
Infante eczema/atopc dermatts
Musty odor urne
CNS ahectaton: Hyperactvty, sezure, MR
*a due to accumuaton of pheny pyruvc acd (from unconverted phenyaanne)
D'a)%ost'3 Tests
Bood phenyaanne >8mg/dL (N: <2mg/dL 2-5days after brth)
Guthre Bactera-nhbton Test
Pedia
Specmen: urne
Preparaton: CHON ntake, 3-4 days post breast feedng (to aow phenyaanne bud-up)
Phenstx Test
Specmen: urne + Ferrc Chorde
(+) greensh spots at daper
Ma%a)e$e%t@ avod neuroogc damage
Phenyaanne det ndentey
No meat, egumes (peanuts), dary products & aspartame
Take Lofenaac mk formua (synthetc AA)
GALACTOSEMIA
Inborn error of CHO metabosm
Decent Gaactose-1 Phosphate Urdne Transferase needed for converson of gaactose to gucose
Damages ver, speen, bran and eyes (cataract)
Assess$e%t
NB appears to be N at brth but after mk ngeston ( actose) vomt ose weght manourshed
Death durng 1st mo of fe occurs f nfant s untreated
Ma%a)e$e%t
Emnate a mk and actose-contanng foods (even breast mk)
Use actose-free formua (Soy proten formua)
Gene repacement therapy (very expensve)
NEW/ORN SCREENING TEST
-shoud be performed before any bood transfuson and after sumcent proten ntake
-NB shoud be on formua or breast mk for 24 hrs before screenng
APPENDICITIS
Inammaton of appendx
Perforaton may occur n a matter of hours pertonts & sepss
Treatment: appendectomy before perforaton occurs
S')%s a%( S5$t#o$s
Pan: perumbca area descends to RLO, most ntense at McBurneys pont
Rebound tenderness & abdomna rgdty
WBC, ow grade fever
A/N/V, darrhea
Sde-yng poston wth abdomna guardng (egs exed)
Sudden reef of pan then becomes ntense
fever, HR, RR
Progressve abdomna dstenton
Paor, chs
Restessness, rrtabty
Pe-o# Ma%a)e$e%t
Mantan NPO
Promote comfort
R sdeyng or sem-Fowers poston
Abdomna ce packs q 20-30mns houry
Montor
Changes n pan eve
Bowe sounds
Avod
Heat appcaton
Recta exam, thermometer, enema, axatves
Admnster as ordered
IV uds
Antbotcs
Post-o# Ma%a)e$e%t
Mantan NPO, mantan NGT sucton
R sdeyng or sem-Fowers poston to keep Penrose dran patent
Montor for
T, redness, sweng pan at ste (nfecton)
Presence of bowe sounds (to start feedng)
Admnster as ordered
Antbotcs
Anagescs
POISONING
Common among todders
Prncpes
Determne the substance taken
Pedia
Uness the poson was corrosve, caustc (strong aka such as LYE) or a hydrocarbon, vomtng s
the most ehectve way to remove the poson from the body
Prncpes
Syrup of Ipecac- ora emetc to cause vomtng after drug over dose or posonng
15 m to adoescent, schoo age and pre-schoo
10 m to nfant
Can gve up to 2nd dose f dont vomt after 1st dose
Unversa antdote - charcoa, mk of magnesa, and burned toast
Never admnster the charcoa before pecac
Antdote for Acetamnophen posonng: Acetysystene (Mucomyst) to prevent ver damage
For caustc posonng:
Gve vnegar (ow % acdty) to neutraze strong acds (HC)
Gve mnera o to coat ntestnes durng gasone ngeston
Prepare tracheostomy set (n case of arway strcture)
Sources: pant, varnsh, battery, crayons, penc, smoke-bechng vehces
Va ngeston or nhaaton
1st nterferes RBC functonng hypochromc, mcrocytc anema destroyng bones, teeth, kdneys
accumuaton of NH4 encephaopathy (ahects CNS)
Assessment
begnnng symptoms of ethargy
mpusveness and earnng dmcuty
as ead ncreases, severe encephaopathy wth sezures and permanent MR
Dagnostc Tests
Bood Smear: >20mcg/dL: acute posonng
Erythrocyte protoporphyrn test (ndcates anema) N: <35mcg/100m bood
Abdomna X-ray
Long Bones
Cheaton therapy: removes ead from bood/organ/tssues
Meds:
Cacum dsodum edetate (EDTA) po: for > 20 mcg/d ead n bood
Dmercapro (BAL n o): not gven f wth aergy to peanuts
Succmer (Chemet)
A meds S/E: nephrotoxcty
Force uds
WOF BUN, Creatnne eves
ACETAMAINOPHEN POISONING
Toxc dose: >150mg/kg
S')%s N S5$#to$s
1st 2-4hrs: maase, N/V, sweatng, paor, weakness
Latent perod 24-36hrs: chd mproves
Hepatc nvovement: up to 7days & may be permanent; RUO pan, |aundce, confuson, stupor,
ver enzymes, brubn, Pro tme
Ma%a)e$e%t@ N-Acetycystene (Antdote)
Dute n |uce/soda to remove ohensve odor
ASPIRIN POISONING
Toxc dose: Acute ngeston: 300-500mg/kg
Chronc ngeston:>100mg/kg/day X2days or more
Sgns & Symptoms
N/V, thrst, hypogycema, Na+, K+, daphoress, ogura, beedng, dehydraton, fever
Hyperpnea, confuson, tnntus, sezure, coma, respratory & crcuatory faure
Management
Syrup of Ipecac, gastrc avage wth actvated charcoa
Admnster as ordered: IVF, NaHCO3, eectroytes, voume expander, gucose, Vt. K
Prepare for dayss f unresponsve to the therapy
ANOGENITAL AREA
Both sexes: fou-smeng urne (Urethroana stua)
0e$a"e
N n NB:
Laba edematous, ctors enarged
Pseudomenstruaton
Hymen tag may be vsbe
1st vodng wthn 24 hrs
N n adoescents: nverted trange shape of pubc har
Preschoo: thnnng of fourchet (rape/chd abuse)
Pedia
Bruses: dentca (e.g. cgarette butts), of dherent stages
Report wthn 48 hrs
Keep chd n safe envronment
No erasure n nurses notes (used as evdence)
Ma"e
N: Prepuce (foreskn) covers gans pens, wth mky coverng (shoud not be dsrupted)
Scrotum edematous
1st vodng wthn 24 hrs
Sperm ces need <2C from body T for spermatogeness
Testces descend mmedatey after brth or wthn 24hrs; otherwse- Cryptorchdsm (common
among preterms; N descend by 28-32 wks AOG up to 12 mos.)
Durng assessment: warm hands and room
Meds: HCG: testosterone producton
Surgery: Orchopexy wth Torek procedure at 1-2 yrs of age
Hydrocee- abdomna ud n scrotum
(+) Transumnaton test
Varcocee- enarged ven of epddyms
N Vodng wthn 24hrs, otherwse rena ageness
Epspadas- dorsa urnary meatus or above gans pens
Hypospadas- ventra urnary meatus or beow gans pens
Not crcumcsed (foreskn used n surgca repar)
Surgery at 16-18 mos. age before toet tranng
Post-op: Force uds, keep urnary stent patent, WOF (-) u.o. (possbe knk), no tub
bathng unt stent s removed
Chordee- pens curve downward due to brous band
N retracton of prepuce at 6 wks
Phmoss- very tght, unretractabe prepuce (foreskn) accumuaton of smegma nfecton of
gans pens (Baants)
N n adoescents: damond-shape pubc har
RENAL DISORDER@
NEPHROTIC SCNDROME
Cause Assessment Fndngs Treatment Nursng Care
Infectous Hypoabumnema, anasarca,
massve protenura,
mcroscopc or (-) hematura,
serum CHON, serum pd, N or
BP
Cortcosterod
(Prednsone)
Immuno-suppresant
Duretcs
Pasma expander
(sat-poor human
abumn)
Montor VS, I/O, urne SG,
abumn, edema
Wegh OD (same tme, cothng,
scae)
Assess for DHN
Det: CHON, Na+
WOF nfecton
AGN
Cause Assessment Fndngs Treatment Nursng Care
Non-
nfectous
Auto-mmune
Group A Beta
Strep throat
2-3 wks
before Sx
Hx: mpetgo
Prmary edema,
Perphera edema,
Perorbta edema n am,
u.o., mod. Protenura, gross
hematura (smoky urne, Cx:
anema), fatgue, serum K+,
BUN Crea, ASO tter, BP
Anthyper-tensves
Hydraazne
(Apresone)
Duretc
Antbotcs
Fe nfuson
Montor BP, neuro status, wt,
I/O, sezures
Det: Na+, K+, CHON n
severe azotema, Fe
WOF Cx: Hypertensve
Encephaopathy, RF, pum.
edema, HF
/ACF
N: on prone appears at, curves start to form when chd has earned how to st or stand
Spne straght
SPINA /I0IDA
CNS defect as a resut of neura tube defect durng embryonc deveopment
Assocated dects:
Sensory motor dsturbance
Hp dsocaton
Cubfoot
Hydrocephaus
SPINA OCCULTA
Congenta maformaton of the spne
Posteror porton of the vertebrae fas to cose
No hernaton of mennges thru the defect
Neuro dects usuay absent
SPINA /I0IDA CCSTICA
Wth hernaton of mennges thru the defect
Pedia
3 Types
Menngocee: hernaton of mennges, contans CSF but not CNS tssue
Myeomenngocee- wth CSF and CNS tssue (cord, nerve root); neuro dects present
Pe%ata" D'a)%ost'3 Tests
Apha fetoproten: materna bood and amnotc ud determnaton
Utrasound
Amnography
Co$$o% Co$#"'3at'o%s
Hydrocephaus
Permanent mparment of neuromuscuar functon beow eve of defect
parayss, accd or spastc musces
Poor sphncter contro (assess for character and number of vodng and stoos)
CSF nfecton
Ma%a)e$e%t
Evauate the sac; measure the eson
WOF hydrocephaus, ICP; measure HC, check fontanes for funess
Prone or sdeyng wth roed towe to prevent pressure/n|ury to the defect
Cover sac wth stere, most (norma sane), non-adherent dressng; change dressng q2-4hrs and when
soed
Skn care: dressngs, ontments as ordered
Prevent nfecton of the sac
Admnster meds as ordered:
Antbotcs: to prevent nfecton
Antchonergcs: to mprove urnary contnence
Antspasmodcs: to contro badder spasms
Laxatves: to mprove bowe contnence
Treatment: Surgca repar durng nfancy
SCOLIOSIS
Latera curvature of the spne
Most common durng the growth spurt, eary adoescent stage
F>M
Assess$e%t
vsbe curve fas to straghten when the chd bends forward and hangs arms down toward feet (Adams
poston)
Asymmetrca shouder heght, scapua and ank shape
rb promnence and rb humps
Screenng begns at 8 yrs
Ma%a)e$e%t
Mwaukee Brace- worn between 16-23 hrs/day
Not curatve, but preventve: Sows/Hats progresson of the curvature when chd reaches skeeta
maturty
Inspect the skn for sgns of redness or breakdown
Keep the skn cean and dry, avod otons and powders
Advse the chd to wear soft, nonrrtatng cothng under the brace
Suppementa exercses: to prevent atrophy of spna and abdomna musces
Support n copng: Adoescents may modfy festye, may fee stgmatzed from peers by beng "dherent"
Surgery: Interna Fxaton and Instrumentaton combned wth Spna arthrodess (fuson)
Logro when turnng, to mantan agnment post-op
Assess extremtes for neurovascuar status
Promote coughng & DBE, ncentve sprometry
Gve pan meds as ordered
WOF vomtng, abdomna dstenton: Superor Mesenterc Artery syndrome r/t mechanca
changes n poston of abdomna contents durng surgery
Prepare chd n usng moded pastc |acket durng actvty
EDTREMITIES
N n state of exon
Fu ROM, symmetrca movements
Pams and soes wth numerous creases
Arms and egs appear short
Hands are pump, cenched nto sts
10 ngers, 10 toes, a separate
Legs bowed
Sght tremors common but can be a sgn of hypogycema or drug wthdrawa
Dgts
Syndactyy - webbng of dgts
Poydactyy - extra dgt
Odactyy - ack of dgt
*Amea - tota absence of extremtes
*Pocomea - absence of dsta part of extremtes (both * due to ehect of Thadomde)
Pedia
/RACHIAL PALSC 8ER/ DUCHENEKS PARALCSIS;
Bracha pexus n|ury due to excessve atera tracton durng breech devery
Sgns and Symptoms
(-) or asymmetrc Moro reex
I%a:'"'t5 to@
Abduct arm from shouder,
Rotate arm externay
Supnate forearm
Ma%a)e$e%t
Abduct arm from shouder wth ebow exed
CONGENITAL HIP DCSPLASIA
condton n whch the head of the femur s mpropery seated n the acetabuum, or hp socket, of the
pevs
2 Types
Subuxated (haf dsocaton, more common)
Dsocated (tota dsocaton)
Assess$e%t
Shortenng of the ahected eg
Asymmetrca gutea fod
Lmted ROM
(+) Barow or Ortoans sgn
T1e wa"4'%) 31'"(
The chd mps; mnma to pronounced varaton n gat wth urchng toward the ahected sde; (+)
Trendeenburg sgn (ate sgn)
Ma%a)e$e%t
Goa"@ factate hp abducton & externa rotaton
Doube or Trpe the daper
Carry the baby n strde
Fre|ka (abducton) Spnt
Pavk harness (neonata perod)
Hp Spca Cast
Tracton or surgery
TALIPES
Or Cub Foot; congenta maformaton of LE, un- or batera; defect s rgd & cannot be manpuated nto a
neutra poston
Types
Equnos - Pantar exon or Horsefoot
Cacaneous or Dorsexon - the hee s hed ower than the foot/the anteror porton of
foot s exed towards the anteror eg
Varus - foot turns n
Vagus - foot turns out
Ma%a)e$e%t
Treatment begns as soon after brth
Sera manpuaton & castng weeky for 3-6 months, otherwse surgery
Cast care
0RACTURE
Break n the contnuty of the bone due to trauma, twstng or bone decaccaton
In chdren: r/t mobty, mmature motor & cogntve sks
In nfants: rare, r/o chd abuse
S')%s a%( S5$#to$s
Pan or tenderness on ahected area
Loss of functon
Obvous deformty
Ecchymoss
Edema
Musce spasm
Ma%a)e$e%t
Assess extent of n|ury, mmobze ahected extremty
In compound fracture, spnt extremty, cover wound wth stere dressng
Reducton: restorng bone to proper agnment
Cosed: manua agnment foowed by mmobzaton
Open: surgca nserton of nterna xator (rods, wres, pns)
Use of cast & tracton
CAST
0u%3t'o%@
Pedia
For mmobzaton
Mantans bone agnment
Prevents musce spasm
Mate'a"s
Gypsum (CaSO4 crystas)
Stocknette: prevents rrtaton
Lead penc: to mark area
Basn of water
Warm: sows settng process
Cod: hastens settng process
Nus'%) Cae
P'o't5@ Neurovascuar Check
C-rcuaton
M-oton
S-ensaton
WO0 S/SA I$#a'e( C'3u"at'o% 8M)t@ :'!a"!'%);
B-ueness/ Codness
L-ack of dsta perphera puse
E-dema not corrected by eevaton
P-an on casted extremty
T-ngng sensaton (refer asap!)
Use open pam to prevent ndentaton
Support cast wth soft pow
May use bower: ow, coo settng to dry
Mark area wth beedng wth a pen
Dont put anythng nsde the cast
CRUTCHES
Purpose
For support
To mantan baance
Use the pams: pror to use- do pam exercses usng squeeze ba (to strengthen hand grp)
The dstance between the axa and the arm pece on the crutches shoud be at east 3 ngerwdths beow
the axa
The ebows shoud be sghty exed, 30 degrees
When ambuatng wth the cent, stand on the ahected sde
Crutch stance: trpod (trange) poston (6-10 nches n front and to the sde)
Never to rest the axa on the axary bars
Look up and outward when ambuatng
Stop ambuaton f numbness or tngng n the hands or arms occurs
CRUTCH GAITS
Swng through and Swng to: f weght-bearng s not aowed n 2 LE
3-pont gat: f weght-bearng s aowed n 1 LE
2-pont and 4-pont gat: f weght-bearng s aowed n 2 LE
TRACTION
mechansm by whch a steady pu s paced on a part or parts of the body
Used to reduce dsocaton and mmobze fractures
PRINCIPLES O0 TRACTION
The cent shoud be n dorsa or supne poston
For every tracton there s aways a counter tracton.
Lne of pu shoud be n ne wth deformty
For tracton to be ehectve t must contnuous
2 TCPES O0 TRACTION
S4'% ta3t'o%
Appcaton of wde band of moeskn, adhesve, or commercay avaabe devces drecty to the skn and
attachng weghts to them
1. /u34Ks eAte%s'o%
Exerts straght pu on the ahected extremty; to mmobze the eg n patent wth a fractured hp
Has a horzonta weght
Turn towards unahected sde
Check for pressure sore at the hee of the foot*
2. Russe"" ta3t'o%
Knee s suspended n a sng attached to a rope and puey on a Bakan frame, creatng upward (doube)pu
from the knee
Weghts are attached to the foot of the bed
Used to treat fracture of the femur
Aows patent to move about n bed more freey and permts bendng of the knee |ont
Assess back of the knee for pressure sores
Pedia
+. /5a%tKs ta3t'o%
Both egs rased 90 ange to bed
Used for chdren under 3 years and 30 bs to treat fractures of the femur and hp dsocaton
Buttocks must be sghty oh mattress
Knees sghty exed
+. Pe"!'3 ta3t'o%
Pevc grde wth extenson straps attached to ropes and weghts
used for ow back to reduce musce spasm and mantan agnment
S4e"eta" Ta3t'o%
Tracton apped drecty to the bones usng pns, wres, or tongs (Crutched) that are surgcay nserted,
used for fractures femur, tba, humerus, cervca spne
1. /a"a%3e( Sus#e%s'o% Ta3t'o%
Produced by a counterforce other than the patents weght
Extremty oats or baances n the tracton apparatus
Patent may change poston wthout dsturbng the ne of tracton
Used for dspaced or overrdng fx of femur
Reeves musce spasms
Reagns fx fragments
Promotes caus formaton
COMMUNICA/LE DISEASES
MEASLES 8RU/EOLA;
A)e%t@ Paa$5Ao!'us
I%3u:at'o% #e'o(@ 10-20 days
Communcabe perod: 4days before to 5days after rash appears
Source: respratory tract secretons, bood, urne
MOT: arborne, drect contact wth dropets
S')%s a%( S5$#to$s
Fever, maase, cough
Stmsons eye (con|unctvts), puhy eyeds, mucopuruent d/c, photophoba
Stomatts
Macuopapuar rash begns at behnd ears spreads down to feet, dres & pees oh
Kopk spots: sma, red spots wth bush whte center at ora mucosa X3days
Ma%a)e$e%t
Respratory soaton, Bed rest
Coo mst vaporzer for cough
Eye care, Dm ghts for photophoba
Ear care, WOF otts meda
Ora care, Nystatn (antfunga) swsh & swaow
Skn care, Caamne oton (Caadry)
TSB, Antpyretcs for fever
Vt A 200,000 IU (<6y/o) to mantan heathy eyes, skn, prevent pneumona & darrhea
GERMAN MEASLES 8RU/ELLA;
A)e%t@ To)a!'us
I%3u:at'o% #e'o(@ 14-21 days
Communcabe perod: 7days before to 5days after rash appears
Source: respratory tract secretons, bood, stoo, urne
MOT: arborne, drect contact wth dropets, transpacenta
S')%s a%( S5$#to$s
Low grade fever, maase
Pnksh red macuopapuar rash begns at face spreads to entre body
Forschemers spots: petecha spots at soft paate
Ma%a)e$e%t
Respratory soaton away from pregnant wthn 1st trm. (teratogenc & abortve)
Bed rest
Supportve treatment
Vaccne (SO) Contrandcatons
Aergy to neomycn & reated antbotcs
Pregnancy (N tter: 1:8-10)
Immunodecency
IVIg & BT (vaccne postponed for 3 mos)
MUMPS
Pedia
A)e%t@ Paa$5Ao!'us
I%3u:at'o% #e'o(@ 14-21 days
Communcabe perod: mmedatey before & after sweng begns
Source: sava, urne
MOT: drect contact wth dropets
S')%s a%( S5$#to$s
Fever, HA, maase
Anorexa
Earache esp. when chewng
Parotd gand sweng
Orchts
Ma%a)e$e%t
Respratory soaton, bedrest
Avod food that requre chewng
Hot or cod compress at neck
To reeve orchts, appy warmth & oca support wth tght-ttng underpants
CHICFENPOD 8VARICELLA;
A)e%t@ Va'3e""a-Moste !'us
I%3u:at'o% #e'o(@ 13-17 days
Communcabe perod: 1-2days before & up to 6days after crustng begns
Source: respratory tract secretons, skn esons
MOT: drect contact wth dropets
S')%s a%( S5$#to$s
Low grade fever, maase
Macuopustuar rash becomng crusts, begns on trunk and scap and spreads to extremtes
Ma%a)e$e%t
Contact and Arborne soaton
At home, soate chd unt vesces have dred
Supportve care
PERTUSSIS 8WHOOPING COUGH;
A)e%t@ /o(ete""a #etuss's
I%3u:at'o% #e'o(@ 5-21 days (usuay 10 days)
Communcabe perod: durng catarrha stage
Source: respratory tract secretons
MOT: drect contact wth dropets
S')%s a%( S5$#to$s
Respratory nfecton foowed by severty of cough
Ma%a)e$e%t
Respratory soaton
Avod dust, smoke & sudden change n T
Encourage ud ntake
Admnster as ordered
O2 tent wth hgh humdty
Antbotcs
Pertusss Ig
DIPHTHERIA
Agent: Corynebacterum dphtherae
Incubaton perod: 2-5 days
Communcabe perod: after 3 (-) cutures, usuay 2-4 weeks
Source: nasopharyngea secretons
MOT: drect contact
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Low grade fever, maase, sore throat
Fou-smeng, mucopuruent nasa d/c
Gray membrane on tonss & pharynx
Lymphadents (neck edema)
Ma%a)e$e%t
Contact soaton
Bed rest
Admnster as ordered
Antbotcs
Anttoxn after skn test to r/o senstvty to horse serum
TETANUS 8LOCFEAW/TRISMUS;
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A)e%t@ C"ost'('u$ teta%' 8a%aeo:'32 %o%-$ot'"e2 s#oe 6o$'%);
Vegetatve, actve form reeases
Tetanoysn- RBC hemoyss
Tetanospasmn- tonc type of sezures
Source: so, gut of herbvorous anmas
MOT: drect contact
Newborn: va umbca cord
Chdren: va denta cares
Adut: va wound
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Lock|aw
Rsus sardoncus (Sardonc sme/grn)
Opsthotonos
Intermttent muscuar spasms wth stmuaton
Boardke abdomen
Extenson of extremtes
Daphoress
Low-grade fever
Ma%a)e$e%t
Prevent spasm stmuaton (note duraton & freq.)
Exteroceptve: nose (ear pugs)
Proproceptve: touch (no IM, TSB, no restrants, mnma handng)
Interoceptve: phegm expectoraton
Lght (dark room, eye shed)
Sucton secretons, padded tongue depressor
A($'%'ste as o(ee(
O2, IV uds whe on NPO
ATS/TAT: to neutraze toxn after (-) skn test
Tetanus Ig- IM no need for skn test
Pen G, Metronzadoe
Dazepam
POLIOMCELITIS
A)e%t@ e%teo!'uses
I%3u:at'o% #e'o(@ 7-14 days
Communcabe perod: shorty after nfecton, 1 week n throat, 4-6 weeks n the feces
Source: oropharyngea secretons & feces
MOT: drect contact, feca-ora route
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Fever, maase, A/N, HA, sore throat
Abdomna pan
Soreness, sthness of trunk, neck & mbs
Faccd parayss
Ma%a)e$e%t
Enterc precautons, bed rest
Supportve treatment
WOF respratory parayss
Physca therapy
IMMUNE SCSTEM@ TCPES O0 IMMUNITC
TYPES OF IMMUNITY NATURAL ARTIFICIAL
ACTIVE
(onger to come, onger to go)
Exposed and contract dsease
and body produce own memory
ces
Receved vaccnes and body
produce own memory ces
Receved materna Ab from
pacenta or breast mk
Receved ant-serum wth Ab
preformed from another host
GENERAL CONTRAINDICATIONS@ IMMUNILATION
Moderate to severe ness wth or wthout fever
Anaphyactc reacton to vaccne or substance n vaccne
Lve vrus vaccnes not gven to mmunocompromsed
HepB: IM, vastus ateras (NB), detod (chdren)
CI: aergy to bakers yeast
DTaP IM CI: encephaopathy wthn 7 days of vaccnaton
Hb: IM protecton aganst bactera menngts & pneumona, epgottts, septc arthrts, sepss
IPV CI: aergy to neomycn or streptomycn
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