PEDIATRIC NURSING

I. A. GROWTH AND DEVELOPMENT Definition of Terms: Growth – increase in physical size of a structure or whole quantitative structure

2 Parameters of Growth 1. Weight - Most sensitive especially in low birth weight - Weight 2x by 6 months 3x by 1 year 4x by 2 ½ year

2. Height - Increase 1 inch/month during first 6 months ½ inch/month from 7 – 12 months

Development – increase in the skills or capacity to function qualitative change How to Measure Development? 1. by simply observing a child doing specific task 2. by noting parent’s description of the child’s progress 3. by DDST (Denver Developmental Screening Test), MMDST (Metro Manila Developmental Screening Test) 4 Main Rated Categories 1. Language – for communication 2. Personal Social 3. Fine Motor Adaptive – pre tensile ability (ability to use hand movement) 4. Gross Motor Skills – ability to use large body movement Maturation – synonymous with development (readiness) Cognitive Development – is the ability to learn and understand from experience, to acquire and retain knowledge to respond to a new situation and to solve problems I. B. BASIC DIVISION OF LIFE 1. Pre-Natal – begins at conception and ends at birth 2. Period of Infancy - Neonatal (first 28 days or first 4 weeks) - Formal Infancy (from 29th day to 1 year) 3. Early Childhood - Toddler (1 – 3 years) - Pre-School (4 – 6 years) 4. Middle Childhood – school age 7 – 12 years 5. Period of Adolescent - Pre-Adolescent/Late childhood (11 – 13 years) - Adolescent (12 – 21 years)

I. C. PRINCIPLE OF GROWTH AND DEVELOPMENT 1. Growth and Development is a continuous process that begins from conception and ends with death. Principle: womb to tomb 2. Not all parts of the body grow at the same time or at the same rate. Patterns of Growth and Development 1. Renal, digestive, circulatory, Musculo-skeletal (childhood) 2. Neurologic Tissue - Grows rapidly during 1 – 2 years of life - Brain (achieve to its adult proportion by 5 years) - Central Nervous System - SC 3. Lymphatic System - Lymph nodes, Spleen, Thymus - Grows rapidly during infancy and childhood (to provide protection against infxn) - Tonsils is achieved in 5 years 4. Reproductive Organ – grows rapidly during puberty 3. Each child is unique 2 Primary factors affecting Growth and Development A. Heredity Race Intelligence Sex Nationality B. Environment Quality of nutrition Socio-Economic status Health Ordinal position in family Parent-Child relationship 4. Growth and Development occurs in a regular direction reflecting a definite and predictable patterns or trends A. Directional Trends – occurs in a regular direction reflecting the development of neuromuscular functions: these apply to physical, mental, social and emotional developments and includes: a. Cephalo - caudal (head to tail) - It occurs along bodies’ long axis in which control over head, mouth and eye movements and precedes control over upper body torso and legs. b. Proximo – distal (centro distal) - Progressing from the center of the body to the extremeties c. Symmetrical - Each side of the body develop on the same direction at the same time at the same rate d. Mass – specific (differentiation)

- In which the child learns from simple operations before complex function or move from a broad general pattern of behavior to a more refined pattern. B. Sequential – involves a predictable sequence of growth and development to which the child normally passes. a. Locomotion b. Language and Social skills C. Secular – refers to the worldwide trend of maturing earlier and growing larger as compared to succeeding generations. 5. Behavior is a most comprehensive indicator of developmental status 6. Play is the universal language of a child 7. A great deal of skill and behavior is leaned by practice 8. There is an optimum time for initiation of experience or learning 9. Neonatal reflexes must be lost first before development can proceed  Persistent Primitive Infantile Reflex (suspect Cerebral Palsy) I. D. THEORIES OF DEVELOPMENT Development Tasks is a skill or growth responsibility arising at a particular time in the individual’s life. The successful achievement of which will provide a foundation for the accomplishments of the future tasks.

THEORISTS
1. Sigmund Freud (1856-1939) – an Austrian neurologist, Founder of psychoanalysis

PHASE OF PSYCHOSEXUAL THEORY
a. Oral Phase (0 – 18 months) - Mouth is the site of gratification - Biting, crying or sucking for enjoyment and to release tension - Provide oral stimulation even the baby is NPO, offer pacifier - Never discourage thumb sucking b. Anal Phase (18 months – 3 years) - Anus - May show toilet training - Elimination, defecation - Principle of - Holding on (child wins, hard headed, anti social and stubborn) - Letting Go - Mother wins (kind, perfectionist, obedient, obsessive – compulsive) c. Phallic Phase (4 – 6 years) - Genitals - May show exhibitionism - Accept the child fondling his own genital area as the normal area of exploration - Answer the child’s question early d. Latent Phase (7 – 12 years) - Period of suppression

Learn how to do things well . Role Confusion (12 – 20 years) . Stagnation (40 – 60 years) Ego Integrity vs.Learn how he/she is or what kind of person he/she will become by adjusting to new body image .Give and experience that will add to security (touch.Activity recommended are modeling clay. Eric Erickson .How industry is developed: .Give an opportunity to relate with opposite sex 2.Learns to do basic things . Isolation (20 – 40 years) .Encourage the child to make decisions rather than judge Initiative vs.Because there is no obvious development . soft music Autonomy vs.Care must be consistent and adequate .How initiative is developed: .How trust is developed: . finger painting . Genital Phase (12 – 18 years) . eye to eye contact. Shame and Doubt (18 months – 3 years) .To give and to receive is the psychosocial theme .Give an opportunity for decision making such as offering choices .Child’s energy or libido is diverted to more concrete type of thinking .Focus on career or looking for lifetime partners Generativity vs.How autonomy is developed . hugs and kisses.Trust is the foundation of all psychosocial task .Give an opportunity of exploring new places and events Industry vs.Learn to establish satisfactory relationship with opposite sex .Trained in psychoanalysis theory .. Mistrust (0 – 18 months) .Give an opportunity no short assignment and projects Identity vs.Develop creativity and imagination to facilitate fine motor development . Guilt (4 – 6 years) .Help child achieve positive experiences e.Autonomy is independence or self governance .Satisfy needs on time .Achieved sexual maturity .Seeking emancipation or freedom from parents Intimacy vs. Inferiority (7 – 12 years) . Despair (65 and above) .Transits the importance of culture and society to their development of ones society STAGES OF PSYCHOSOCIAL THEORY Trust vs.

They are capable .Their concept of time is only now and their concept of distance is only as far as they can see . Jean Piaget – a Swiss psychologist STAGES OF COGNITIVE DEVELOPMENT A.Capable of abstract and mature thought .4 years Intuitive 4 – 7 years C.Period when cognition has achieved its final form .Can find solutions to everyday problems with systemic reasoning .Capable of space and time perception . Preoperational Thought SCHEMA Pre-conceptual 18 – 24 months 2 – 7 years old AGE 2. Concrete Operational (7 – 12 years) .Not yet aware of the concept of reversibility .They have concept of reversibility .Exhibit goal directed behavior .Practical intelligence because words and symbols are not applicable .Activity not related to body .All reflexes .Use trial and error to discover change of places and events .Egocentric (unable to view another point of view) .3.Concept of animism (inanimate object is alive) 8 – 12 months Coordination of Secondary Tertiary Circular Reaction 12 – 18 months (1 – 1 ½ year) Invention of new means thru mental combination B. Formal Operational (12 and above) .Discover object or persons code and code memory arises .Transitional phase to operational period BEHAVIOR .Babies are communicating through sense and reflex SCHEMA Neonatal Reflex Primary Circular Reaction Secondary Reaction Circular AGE 1 month 1 – 4 months 4 – 8 months BEHAVIOR .Increase sense of separateness .Code and Code invention of new means .Activities related to bodies repetition of behavior (thumb sucking) . present and future) .Their thinking is basically concrete and static .Can find scientific reasoning (can deal with the past.Anticipate familiar events . Sensorimotor (0 – 2 years) .Activity recommended is collecting and classifying D.

Carries out action to satisfy own needs rather than society. Kohlberg (1984) – recognized the theory of moral development as considered closely to approximate cognitive stages of development STAGES OF MORAL DEVELOPMENT INFANCY Age (Year) Description Preconventional 2-3 Stage (Level I) 1 Punishment/obedience orientation (“heteronomous morality”). Will do something for another if that person do something for the child Conventional 7-10 (Level II) 3 Orientation to interpersonal relations of mutuality. Follows standards of society for the good of all people 6 Universal ethical Principle orientation. fixed rules and authority. Instrumental purpose and exchange. utilitarian law-making perspectives.. Follows rules of Authority figures as well as parents in an effort to keep the “system” working Postconventional Older than 12 (Level III) 5 Social contract. Individualism. . Childs finds following rules satisfying. Follows internalized standards of conduct.Do abstraction by talk time that will sort 4. Maintenance of social order. Child follows rules because of a need 10-2 4 to be a “good” person in own eyes and the eyes of others. Child does right because a parent tells 4-7 2 him/her to and to avoid punishment.

Needs space to turn .Laugh aloud .Age who appreciate teddy bears . Milestones E.Complete head lag .Follow object past midline .Largely reflex .Grasp and tonic neck reflex are fading .Peak at 8 months .Solitary play .Cry without tears (due to immature larcrimal duct) .Head control complete .Diminish by 9 months c.Closure of posterior fontanel by 2 – 3 months . Fear . DEVELOPMENTAL MILESTONE PERIOD OF INFANCY a.I NEONATE .Looks at mobile objects 2 months .Holds head up when in prone . Play .Visual fixation of human face 1 month . E.I.Dance reflex disappears .Attitude: proper hygiene b.Cry with tears .Stranger anxiety .Baby “coos” .Holds head and chest when in prone .Non interactive .Begin at 6 – 7 months .Social smile .Head lag when pulled to a sitting position 3 months .Turns from front to back .Hands fisted .Bubbling sounds .Hand regards (3 months) 4 months .Priority is safety .

Turn both ways .Likes objects that are good sized 8 months .Pat a cake since they can clap 11 months .Stand with assistance 12 months .Drink from a cup .Understand word “No” .Stand alone .Peak – a – boo .Respond to own name . pull toy and learn nursery rhymes .Pincer grasp reflex .Sits with support .Moro reflex disappear by 4 – 5 months 6 months .Reaches outs in anticipation of being picked up .5 months .Handle bottle well .Beginning fear of stranger .Priority: safety 10 months .Says vowel sounds “Ah. ah” 7 months .Cruises .Creeps/crawl .Uses palmar grasp by 6 months .Pull self to stand .Eruption of first temporary teeth (2 lower incisors) .Combine two syllables “Papa.Plantar reflex disappear 9 months .Says the 2 words “Mama.Walk with assistance . Papa” .Take first step .Toys: pots and pans.Teething rings .Sits with support .Needs space for creeping .Handles rattle well . Mama” .Transfer objects hand to hand .Cooperate in dressing .Peak of stranger anxiety .Roll over .

Play .Seat self on chair . pull truck. Fear .Hide of possessiveness .E.Speak 50 – 200 words 30 months .Can open doors by turning doorknobs .Creep upstairs .Unscrew lids .Can jump down from the stairs .Do not prolong goodbye. Denial c.Able to name body part .Parallel (2 toddlers playing separately) .2.Provide two similar toys (squawky squeeze toy) .Daytime bladder control .Trusting three .Walk up and down stairs holding on (typically places both feet on one step before advancing) .Walk upstairs alone by still using both feet on the same step at same time .3 Phases of separation anxiety a. TODDLER a. building block and pounding peg b.2 – 3 year old is the right time to bring to the dentist .Copy a circle . Despair c.3 year old do tooth brushing with little supervision . Protest b.Holds up fingers 36 months .Can make simple lines or stroke for crosses with a pencil . Milestones 15 months .Waddling duck to pull.Knows full name .Puts small pellets into small bottle .Walks alone (delay in walking maybe a sign of mental retardation) .Run and jump in place .No longer rotates a spoon .Separation anxiety .Scribbles voluntarily with pencil .Plateau stage .Speaks 4 – 6 words 18 months .20 deciduous teeth by age 2 ½ years . say goodbye firmly .Bowel control achieved .Speaks 7 – 20 words 24 months .Holds a spoon well .Temporary teeth complete and last temporary teeth to appear is the posterior molars .

Can maintain himself dry with interval of 2 hours d.3. PRE-SCHOOL a.Ignore the behavior .Clues for toilet training a. Play .Unsteady gait .Know the 4 basic colors .Play house .Lace shoes .Limit questions and offer options .Protruded abdomen .Under development of abdomen .speak fluently .Learns how to share .Imaginary playmates . Fear .Physiologic anorexia (give foods that last for a short period of time) E. Can communicate toilet needs c.Furious four (noisy and aggressive) .Able to button .Able to ride a tricycle .Copy a square .Cause: .Associative play.Speak 300 – 400 words .Vocabulary of 1500 words 5 years .Body mutilation or castration fear .Draw a cross . squat and walk alone b.Full name and sex .Right time for bladder control (night time control) .Role playing b.Cause: mastering .Dark places and witches . Cooperative play . Can stand.Frustrating five .2100 words ..Rigid ritualistic: stereotype .Able to unbutton .Thunder and lighting c.Draw a 6 part . Milestone 4 years .Negativistic likes to say no (it is their way to search independence) . Character Traits .Temper tantrums (stomping feet and screaming) .Copy a triangle .

Enjoys teasing and play alone .Creative .d.Competitive play .Bed wetting .Normal homosexual .Displacement from school .Imitative . Milestones 6 years .Permanent teeth begins to appear (first molar) .Masturbation is a sign of boredom and should divert their attention E.Fear of death c.4.School phobia .Why and How e.Clumsy movement .Smoother movement . Significant Development .Temporary teeth begins to fall .Imaginative .Baby talk .Fetal position .Copy a diamond . SCHOOL AGE (7 YEARS) a. Fear .Age of assimilation .Year of constant motion .Recognizes all shapes .Quieting down period 8 years .Beginning interest with God 7 years .Curious .Telling tall tales (over imagination) . Behavior Problems .Significant person is the teacher and peer of the same sex . Character Traits .To prevent phobia orient child to new environment .Loss of privacy .Prone to bone fracture (green stick fracture) .Tug – o – war b.Imaginary friends (purpose: release their anxiety and tension) . Play .Mature vision d.Sibling rivalry (jealousy to a newly delivered baby) .Expansive age .Teacher becomes authority figure that may result to nail biting .

Writes legibly .Obesity .More considerate and cooperative . Character Traits .They are modest SIGNS OF SEXUAL MATURITY Boys Girls Increase size of breast and genetalia Widening of hips Appearance of axillary and pubic hair Menarch (last sign) .telarch is the 1st sign of sexual maturity Appearance of axillary and pubic hair Deepening of voice Development of muscles Increase in size of testes and scrotum (1st sign) Production of viable sperm (last sign) E.Sperm also viable .Coordination improves . Fear .Joins organization .Testes and scrotum increase in size until age 17 .Takes care of body needs completely .Love to collect objects .Industrious .They have nocturnal emission (wet dreams) the hallmark for adolescent .Pre adolescent .Acne .Age of special talents .Stealing and lying are common .They have distinctive odor because of the stimulation of apocrine gland .Sense of humor present .Cant bear to loose they will cheat .Share with friends about their secrets .Well mannered with adults ..Tells time correctly .Hero worship .Ready for competitive sports .Love to collect objects .Secret language are common .Count backwards 9 years .Teacher find this group difficult to handle 10 years .Critical of adults 11-12 years .Breast and female genetalia increase until age 18 a. ADOLESCENT PERIOD .Full of energy and constantly active .5.Social and cooperative e.

THE 8 PRIORITIES OF THE NEWBORN IN THE FIRST DAY OF LIFE 1.Place baby’s head to side to facilitate drainage . Proper Suctioning of catheter . Initiation and Maintenance of respiration Alerts . Control of body temperature 4. Intake of adequate nourishment 5.Smoking . Initiation and Maintenance of respiration 2. Establishment of waste elimination 6. Removal of secretions by proper suctioning B. Prevention of infection 7.. Establishment of an infant-parent relationship 8.Lung function begins only after birth How A.Most neonatal deaths with in the first 24 – 48 hours is primarily the inability to initiate airway . Significant Development .Vehicular accident .Idealistic (parent-child conflict begins) .Second stage of labor initiate airway .Adventuresome e.Initiation of airway is a crucial adjustment among newborn .Core concern is change of body image and acceptance from the opposite sex d.Drug addiction .Experiences conflict between his needs for sexual satisfaction and societies expectations . Problems .Peer of opposite sex c. Establishment of extra uterine circulation 3.Replacement from friends b.Rebellious . Development care that balances rest and stimulation for mental development 1.Homosexuality .Death .Reformer . Significant Person .Alcoholism .Pre marital sex IMMEDIATE CARE OF THE NEWBORN A.Very conscious with body image . Personality Trait .Suction nose first because neonates are nasal obligates .

Proper Positioning .Right side lying STRUCTURE APPROPRIATE TIME OF Foramen Ovale OBLITERATION 24 hours complete by 1 year STRUCTURE REMAINING Fossa Ovalis FAILURE TO CLOSE Atrial Septal Defect . Tangential foot slap . The remaining 30% .No smoking sign to prevent combustion .When meconium stained never administer oxygen because pressure will force meconium to the alveolar sac and cause atelectasis 2. If not effective. requires effective laryngoscopy to open the airway. an endotracheal tube can be inserted and oxygen can be administered by a positive pressure bag and mask with 100% oxygen at 40 – 60 b/min.tricuspid valve – right ventricle – pulmonary artery – lungs (for nutrition) – vasoconstriction of the lungs pushes the blood to the Ductus arteriosus to aorta to supply the extremities. Alerts: Increase pressure on the left side of heart causes closure of foramen ovale SHUNTS 1. Ductus Arteriosus – shunt from pulmonary artery to aorta (begin to close within 24 hours) A.So baby will cry to expand lungs . The two arteries carry the unoxygenated blood back to the placenta for reoxygenation.. bradycardia (caused by vagal nerve stimulation) and laryngospasm C.Mask should cover nose and mouth . Nursing Alerts: . Ductus Venosus – shunt from umbilical vein to inferior vena cava 2.Suction for 5 – 10 seconds and should be gentle and quick because prolong deep suctioning may result to hypoxia. Establishing extrauterine circulation Alerts: circulation is initiated by pulmonary ventilation and is completed by cutting of cord THE FETO-PLACENTAL CIRCULATION Placenta (via simple diffusion) – oxygenated blood is carried by the vein – liver – Ductus venosus Inferior vena cava – right atrium – 70% shunted to Foramen ovale .Never stimulate baby to cry when not yet properly suctioned . Foramen Ovale – shunt between 2 atria (begin to close within 24 hours) 3. 2 Way to facilitate Closure-of Foramen-ovale 1.Cri – du – chat (meow cry) 2.Overdosage of oxygen may lead to scaring of retina which may lead to blindness called RETROLENTAL FIBROPLASIAS (retinopathy of prematurity) . After deep suctioning.Check characteristics of cry (strong vigorous and lusty cry) .Always humidify to prevent drying of mucosa .left atrium – mitral valve – left ventricle – aorta – lower extremities.

Ductus Arteriosus Ductus Venosus Umbilical Arteries 24 hours complete by 1 month 2 months 2 – 3 months Ligamentum Arteriosum Ligamentum Venosum Lateral Umbilical Patent Arteriosus Ductus Umbilical Vein 2 – 3 months Ligament Inferior Iliac Artery Lateral Umbilical Ligament Inferior Iliac Artery Ligamentum Teres (round ligament of liver) .

Metabolic Acidosis – due to catabolism of brown fats (best insulator of a newborn) 3. Use tin foil in absence of electricity 5. Additional fatigue to already stressful heart D. Newborns are not yet capable of shivering (increase basal metabolism) 4. Prevent unnecessary exposure – cover areas not being examined 4. Convection – body to cooler surrounding air 4. Effects of Hypothermia (Cold Stress) 1. Hypoglycemia – due to utilization of glucose (40 – 45 gm/dl is the normal blood sugar of a newborn) 2. Abnormally large head 2. must be pre heated first) 3. Inadequate subcutaneous tissue 3. Projectile vomiting (surest sign of cerebral irritation) 4. Embrace baby (called kangaroo care) 4. Dry and wrapped newborns 2.Radiant warmer . High risk for KERNICTERUS (bilirubin in brain) 4.B. Increase blood pressure but widening pulse pressure 5. Conduction – body to cold solid object 3. Radiation – body to cold object not in contact with body C. Best position immediately after birth: NSD – trendelendberg CS – supine or crib level position Signs of increase ICP 1. Factors Leading to the development of Hypothermia 1. Evaporation – body to air 2. Process of Heat Loss 1. Decrease pulse rate 7. Bulging and tense fontanel 3.Maintenance of temperature is important for preterm and SGA because it may lead to hypothermia or cold stress A. Babies are born wet B. High pitch shrill cry (late sign) 8. Decrease respiratory rate 6.7 oF – 36. Mechanical measures .Isolette (square acrylic sided incubator. Temperature Regulation Alerts: . Establish Adequate Nutritional Intake .5 oC . Diplopia (sign of ICP from 6 months – 1 year) 3.The goal in temperature regulation is to maintain it not less than 97. Prevention of Cold Stress 1. Preterm are born poikilothermic (cold blooded) they easily adapt to temperature of environment due to immaturity of thermo regulating system of body 2.

Promotes bonding . Hepatitis B . Physiology of Breast milk Production .High fats (linoleic acid responsible for integrity of skin and development of skin) .Low protein (lactalbumin) D.Alerts: Breastfeed immediately for NSD and after 4 hours for CS (Colostrum is present on the 3rd trimester) A. Mature milk – 14 days and above Contents: .High fats .Possibility of transfer of HIV.Contains macrophages (store in plastic container. Cow’s milk Contents: . Stages of Breastmilk 1.High lactose .Breast fed babies has higher IQ .It contains anti body (IgA) lactobacillus bifidus that interfere attack of pathogenic bacteria in GIT . easily digested. Colostrum – available 2 – 4 days after delivery Contents: Low fats Low carbohydrates High protein High immunoglobulin High minerals High fat-soluble vitamins 2.Decrease incidence of breast cancer .High carbohydrates (lactose.Low carbohydrates (add sugar) . Advantage of Breastfeeding .Helps in rapid involution . good for 6 months when stored in freezer) .Disadvantages of breast milk and cow’s milk .Very economical .High minerals . stimulates the anterior pituitary gland.Decrease in level of estrogen and progestin.High water soluble vitamins 3. responsible for sour milk smelling odor of stool) . that stimulates the prolactin of the acinar cells (alveoli) to produce the foremilk stored in lactiferous tubules B.Both has no iron .Father cannot feed or bond as well C.Always available . Transitional – covering 4 – 14 days Contents: .

purpose: take in food . For proper emptying and continuous milk production per feeding .food touches anterior portion of tongue and tongue automatically extruded/protruded .increase 1 minute per day each breast until you reach 10 minutes each breast or 20 minutes per feeding 6. Sucking . Proper Hygiene .cracked. Stimulate and evaluate feeding reflexes a.by touching the middle of lips then baby will suck . sneeze d. Health Teachings 1.purpose: prevent from poisoning .disappear at 6 months .easily disappear when not stimulated c.Upright sitting avoid tension to properly empty breast milk 3.soft and non tender (1 day) .disappear by 4 months because baby can already spit out 4. Rooting .Importance of hand washing . Engorgement . To prevent from crack nipples and initiate proper production of oxytocin . gag.feeling of tension and fullness of breast .food touches posterior portion of tongue automatically swallowed .feed baby on the last breast that you fed him PROBLEMS EXPERIENCED IN BREASTFEEDING a.bottle feeding cold compress and wear supportive bra b. Sore nipple . baby’s mouth is hike well up to areola b.begin 2 – 3 minutes per breast .disappear at 6 weeks because baby can already focus b. has traumatic effect on kidneys of baby . mother experiences after pain c. The criteria of effective sucking a.Removal of caked colostrum 2.touch side of lips or cheek and baby will turn to the stimulus .while feeding warm compress . Position .purpose: to look for food .never disappear cough.High minerals.exposure to air is the management or 20 watt bulb .. wet and painful nipple . Swallowing .High phosphorus that may cause inverse proportion with calcium E. Extrusion/Protrusion reflex .High protein (casein) has a curd that is hard to digest . other nipple is flowing with milk 5.

hydrops fetalis . Meconium . soft.inflammation of breast .Become green. comadin/warfarin sulfate intake Newborn Conditions .Sticky . CMV. formed.tay-sachs disease 5.take antibiotic . hirschsprung b. hard with a typical offensive odor seldom passed 2 – 3 times a day .increase 500 calories when breastfeeding .Golden yellow. Transitional .galactosemia .Odorless (because of sterile intestines) . mushy with sour milk smelling odor frequently passed occurring almost nearly every feeding 4..improper breast emptying .erythroblastosis fetalis . Different stools 1.breast feed on unaffected breast .Light yellow.Tar like .Physiologic stool .HIV.No bacteria .express your breast on affected side . Breastfed stool .avoid wearing plastic liner bra. instead wear cotton bra c. Bottle-fed stool .phenylketonuria (PKU) . Establishment of waste-elimination A.unhealthy sexual practices . loose and slimy that may appear to be a slight diarrhea to the untrained eye 3. Hepatitis B.causative factor: staphylococcus aureus .Blackish green . imperforate anus c.involution of breast is 4 weeks CONTRAINDICATIONS IN BREASTFEEDING Maternal Conditions .Failure to pass meconium suspect GIT obstruction a.Passed with in 24 – 36 hours . meconium ileu (cystic fibrosis) 2. Mastitis .

catheter insertion) Activity . after first cry baby becomes pinkish Pulse rate .Clay colored: obstruction to bile duct .5. bulky.Light stool: jaundice baby .Blood flecked: anal fissure .Reflex irritability (foot slap.Curant jelly: intususeption .Bright green: phototherapy .15 minutes is optional . Indication of Stool Changes .Color: slightly cyanotic. to determine baby’s capability to adapt/ adjust extrauterinely Components Appearance . foul smelling – suspect malabsorption a case of cystic fibrosis or celiac disease ASSESSMENT FOR WELL-BEING A.Ribbon like: hirschsprung .Degree of flexion (muscle tone) Respiration APGAR SCORING CHART Criteria Heart rate Respiratory effort Muscle tone Reflex irritability Catheter Tangential Footslap Color 0 Absent Absent Flaccid extremities No response No response Blue/Pale Score 1 Less than 100 Slow irregular weak cry Some flexion Grimace Grimace Acrocyanosis (body and extremities blue) 2 More than 100 Good strong cry Well flexed Cough or sneeze Cry Pink .Steatorrhea: fatty.Taken again after 5 minutes. APGAR SCORING Special Considerations .Taken on first 1 minute. shows the general condition of baby .Mucous mixed with stool: allergy .Black stool: GIT hemorrhage .Apical pulse (left lower nipple) Grimace .Brown and odorous B. With supplementary foods added .Chalk clay/whitish clay: barium enema .

need CPR. Check for pulselessness 7.5 mm Fine and fuzzy Fine and fuzzy Coarse and silky Pliable Some Thick Testes and scrotum Intermediate Testes pendulous. Administer 2 rescue breaths Circulation (by cardiac compression) 6.Contraindicated to spinal cord injury . Place flat on bed 3. Shake. Do CPR (when breathless and pulse less) B. in lower canal. additional suction and oxygen administration 7-10: good/healthy CARDIO PULMONARY-RESUSCITATION Airway (Clear Airway) 1.Over extension may occlude airway Breathing (Ventilating the lungs) 4. ASSESSMENT OF GESTATIONAL AGE BALLARD AND DOBOWITZ CLINICAL CRITERIA Findings Sole creases Breast nodule (dm. Check for breathlessness 5. RESPIRATION EVALUATION SILVERMAN ANDERSON INDEX CHART Criteria Chest movement Intercostal retraction Xiphoid retraction Nares dilation Expiratory grunt Interpretation of Result 0 – 3: Normal no respiratory distress syndrome 4 – 6: Moderate RDS 7 – 10: Severe RDS 0 Synchronized No retractions None None None Score 1 Lag on respiration Just visible Just visible Minimal Stethoscope 2 See saw Marked Marked Marked Naked ear C. admission to NICU 4-6: moderately depressed. no response call for help 2. scrotum full with scrotum is small extensive rugae with few rugae . Head tilt – chin lift maneuver .Interpretation of APGAR Result 0-3: severely depressed.) Scalp hair Ear Lobe Testes Scrotum Gestational Age (Weeks) Less THAN 36 37-38 39 and up Anterior transverse Occasional creases Sole covered with crease only in 2/3 creases 2 mm 4mm or 3 – 5 mm 7 mm – 7.

Failure to fall is umbilical granulation (silver nitrate) .Use saline to clean .Hemophilia is excessive bleeding . Upon receiving . Bathing Baby .Babies of HIV positive mothers are given full bath to lessen transmission of infection .PRE TERM BABIES 28 – 32 weeks Frog leg or lax position Hypotonic muscle tone Scarf sign (elbow passes the midline) Square window wrist (90o angle) Heel to ear sign Abundant lanugo Prominent labia minora and clitoris Post term Babies .Full bath is safely given when cord falls 4.Cord turns black on the third day .Proper identification (foot print with mothers thumb print) .Normal oil bath . Length = 19.Old mans face (classic sign) . Dressing the umbilical cord .5 – 53.8 inches if anticipating IV or BT . Abdominal Circumference = 31 – 33 cm average of 32 cm/12 – 13 inches 3.More than 42 weeks .Leave about 1 inch of cord . Chest Circumference = 31 – 33 cm average of 32 cm/12 – 13 inches d.AVA (2 vessel cord suspect kidney malformation) .Bacteriostatic .5 – 21 inches/47.Check for 3 vessels (2 arteries and 1 vein) .Ompalagia is bleeding of the cord .Take antropometric measurement 2. Head Circumference = 33 – 35 cm average of 34 cm/13 – 14 inches c.Cleanse and spread vernix .Insulator . Neonate in the Nursery *Special and Immediate Interventions 1.Check for the cord q 15 minutes for the first 6 hours .Falls by 7th – 10th day .Use Povidone iodine . Then take anthropometric measurements a.30 cc is bleeding to newborn .Follow strict asepsis to prevent infection/tetanus .For bleeding: .Desquamation (peeling of neonate skin characterized by extreme dryness than begin from sole and palm within 24 hours D.75 cm average of 50 cm b.

d.Types of imperforate anus a. PHYSICAL EXAMINATION AND DEVIATIONS FROM THE NORMAL A. if present suspect PDA RESPIRATION . Vital signs .Radial pulse is absent.5 mg. stethoscope.5 – 1. If the client is new born.Related to physiologic hypoprothrombinemia . let them handle an instrument play syringe. If the client is school age and adolescent explain procedure COMPONENTS: 1. cover areas that is not being examined b. causing failure to pass meconium .Action: prevent hemorrhage .Purpose: prevent opthalmia neonatorum (use erythromycine ophthalmic ointment) 6.foul smelling stool .Don’t force insertion because it may lead to pruritus . Credes Prophylaxis . konakoib (.vomitus of fecal materials .5 lbs Arbitrary Lower Limit: 2500 grams Low Birth Weight: below 2500 grams Small for Gestational Age: less 10 percentile rank Large for Gestational Age: more than 90 percentile rank Appropriate for Gestational Age: within the 2 standard deviation of the mean Physiological Weight Loss: 5 – 10 percent occurs a few days after birth E. causing failure to pass meconium b. IM) 7. Atretic – no anal opening.Give Aquamephyton. If the client is infant.no anal opening. Administration of Vitamin K . Important Considerations a. Membranous CARDIAC RATE 120-160/min .5 – 7. phytomenadione.5.Management: surgery with temporary colostomy c.Temperature is taken rectally to rule out imperforate anus and thermometer is inserted 1 inch .respiratory problems .Normal apnea of newborn is less than 15 seconds Respiration Check Newborn 1 year 40-90 20-40 2-3 years 5 years 20-30 20-25 .Irregular . Agenetic .Abnormal/diaphragmatic .Short period of apnea without cyanosis .abdominal distention . the first vital sign to take is RR (due to fear of stranger) .4 kg/6. If the client is toddler and preschool.Begin at east intrusive to the most intrusive c. Weight-taking Normal Weight: 3000 – 3400 grams/3 – 3.

Crackles (like cellophane) made by air moving through fluid in alveoli. Abnormal. heard over trachea. heard over major bronchi. medium-pitched. low tone. Abnormal. normal. inspiration equals expiration.10 years 17-22 15 and above 12-20 Breath Sounds Heard on Auscultation Sound VESICULAR BRONCHOVESICULA R BRONCHIAL RHONCHI RALES Characteristics Soft. normal. heard over periphery of lungs. seen in infants with respiratory obstruction. Loud. Snoring sound made by air moving through mucus in bronchi. Loud. normal. Abnormal. Crowing or rooster like sound made by air being pulled through a constricted larynx. expiration longer than inspiration. WHEEZING STRIDOR RESONANCE HYPERRESONANCE . lower sound than resonance. Whistling on expiration made by air being pushed through narrowed bronchi. normal. low pitched. Louder. Soft. high-pitched. a percussion sound over hyperinflated lung issue. percussion sound over normal lung tissue. seen on children with asthma or foreign-body obstruction. denotes pneumonia or pulmonary edema which is fluid in alveoli. inspiration longer than expiration.

Cause: lack of surfactant . Expiratory grunting (major sign) 3. Xiphoid retractions 5.Respiratory acidosis Laboratory Studies a. Chest and neck x-ray (to rule out epiglotitis) . Surfactant replacement and rescue LARYNGOTRACHEOBRONCHITIS . ABG b. ABG 4. CBC Diagnostic Studies a. Throat culture c.Infection of larynx. Respiratory acidosis Management 1.Formation of hyaline .Barking cough/croupy cough .Oxygen administration .Definite within 4 hours of life 1.Common in preterm infants . Flaring alae nassi 4.Place on continuous positive airway pressure . Intercoastal retractions 6.Hypoxic . Proper suctioning . trachea and bronchi Assessment .RESPIRATORY DISTRESS SYNDROME .Hyaline membrane disease .Positive end expiratory pressure (maintain alveoli partially open and prevent collapse) 3. Increase RR with retractions (early sign) 2. Keep head elevated 2. Monitor skin color. vital signs.Causing atelectasis Signs and Symptoms .

Bronchodilators b.Management a.To large cuff results to false low BP .Drug: Ribavirin (anti viral drug) .To small cuff results to false high BP SKIN . sudden onset Management . Avoid toys that cause friction and hairy and furry materials BLOOD PRESSURE .Nursing management a.80/46 mmHg after 10 days 100/50 .Prepare tracheostomy set .Causative agent: respiratory syncitial virus .End stage epiglotitis (emergency condition or URTI). Check edges if properly tucked b.BP cuff must cover 50 – 75% (2/3) of upper arm . Oxygen with increase humidity c.Tripod position (leaning forward with tongue protrusion) .Cold like/flu like symptoms .Encircle age .Never use tongue depressor . Prepare tracheostomy set when necessary Broncholitis . Washable plastic material c.Inflammation of bronchioles characterized by production of thick tenacious mucous Signs and Symptoms .Mist tent “croup tent”. croupette .Normal blood pressure taking begins by 3 years old Alerts .

Due to increase melanocytes . Mongolian Spots – slate-gray-or-bluish discoloration/patches commonly seen across he sacrum or buttocks . Color of vernix is same as amniotic fluid SKIN COLOR AND THEIR SIGNIFICANCE Blue – cyanosis/ hypoxia White – edema Gray – infection Yellowish – jaundice/ carotinemia (increase carotin) Pale – anemia ATOPIC DERMATITIS . Erythema Toxicum (flea bite rash) – first self limiting rash to appear sporadically and unpredictably as to time and place.Never disappear but is covered by hair 6.Disappear by 1 year. . preschool. Nevus Flammeus – macular purple or dark red lesions usually seen on the face or thigh . chin and cheek. Harlequin sign – dependent part is pink. 7.Generalized mottling due to the immaturity of the circulatory system BIRTHMARKS 1.Acrocyanosis (body pink extremities blue) . Desquamation – peeling of the newborn skin within 24 hours. 5 years old 2. Milia – plugged unopened sebaceous gland usually seen as white pinpoint patches on nose. Hemangiomas – vascular tumors of the skin 3 TYPES a. Stork bites (telengiectasis nevi) – pink patches at the nape of the neck . Vernix Caseosa – white cheese like substance for lubrication.Dangerous type may lead to internal hemorrhage 10. disappears by 2 – 4 weeks 3. common among post term 5. c.. Cavernous hemangiomas – Consist of communicating network of venules in the subcutaneous tissue that never disappear with age. Lanugo – fine downy hair 4.Portwine stain: never disappear but can be removed surgically b. Cutis marmorata – transitory motling of neonates skin when exposed to cold 9. independent part is blue (RBC settles down) 8.Common in asian newborn . Strawberry hemangiomas (nevus vasculosus)– dilated capillaries in the entire dermal or subdermal area continuing to enlarge but disappear after 10 years old.

Wash face with soap and water .Characterized by populo vesicular surrounded by localized errythema becoming purulent and ooze forming a honey colored crust .Cause: group A beta hemolytic streptococcus .Prevent infection .Cut short the nails IMPETIGO . lichenified – scaling Management .Give oral penicillin .Hydrate skin with burrow’s solution ..Pediculosis capitis (kuto) .Signs: Comedones (sebum causing white heads) .Proper hygiene . milk.Self limiting inflammatory disease affects sebaceous glands common in adolescence .Skin disease characterized by maculo vesicular errythematous lesion with weeping and crusting .Treat main cause .Infantile eczema . citrus juices.AGN complication ACNE .Use sulfur soap or mild soap .Cause: allergens (main).Sebum is composed of lipids Management .Sign: linear excoriation.Retin A HEMOLYTIC DISORDER . tomatoes and wheat .Prosorbbee or Isomil (milk) . eggs.Characterized by extreme pruritus .

Use of Phototherapy 4. fetus positive . ABO Incompatibility . and A .Bilirubin encephalopathy more than 20 mg/dl indirect bilirubin in fullterm . AB .More than 12 mg/dl of indirect bilirubin in fullterm Kernicterus .Erythroblastosis fetalis: hemolysis leading to decrease oxygen carrying capacity with pathologic jaundice within 24 hours . Pregnandiole – delays action of glucoronyl transferace (liver enzyme that converts indirect bilirubin to direct bilirubin) 3.Mother is type O. Exchange Transfusion of Rh or ABO affectations that tend to cause continuous decrease in hemoglobin during the first 6 months because bone marrow fails to produce erythrocytes in response to continuing hemolysis. Rh Incompatibility .Given to RH negative mother within first 72 hours to destroy fetal RBC therefore preventing antibody formation b.Common is Hydrops fetalis.Icterus neonatorum .Vaccine: Rhogam .Test: Comb’s Test .Mother negative.Less than 12 mg/dl in preterm because of immature liver Physiological Jaundice . Initiation of feeding.Mother negative. Yellow – Jaundice Hyperbilirubinemia .4th baby affected .First pregnancy can be affected Assessment .Normal: indirect bilirubin 0 – 3 mg/dl .Severe O and B . fetus is type A.Most common is O.a. temporary suspension of breast feeding to prevent kernikterus 2. edematous on lethal state with pathologic jaundice within 24 hours Management 1. no antigen (no protein factor) . B.

Cover the eyes – prevent retinal damage 2.Light stool .Yellow skin and sclera .Avoid use of lotion or oil because it may result to bronze baby syndrome HEAD Structures Sutures: 3 . Cover genitals – prevent priapism (painful continuous erection) 3.Dark urine Management Phototherapy .Photo oxidation . Monitor Vital Signs .Height of 18 – 20 inches away from baby Nursing Responsibilities 1.Pregnandiole .Clinical jaundice within 24 hours Breastfeeding Jaundice .Blanching the neonates forehead . Monitor I & O – weigh baby 1 gram:1 cc 6.Icterus gravis neonatorum .6 to 7 days Assessment . Increase fluid intake – to prevent dehydration 5.48 – 72 hours .Expose to sunlight Pathological Jaundice . Change position – for even exposure to light 4.. nose or sternum .

Absence of cerebral hemisphere Noticeable Structure of the head 1.Primary cause: improper hygiene .Cradle cap .Scaling.Present at birth .Craniostenosis/ craniosinostosis (premature closure of anterior fontanel) Posterior fontanel .Fetal alcohol and HIV positive Anencephaly .Never cross the suture line .Closes by 2 – 3 months Microcephaly . Cephalhematoma .Characteristics .Disappear after 2 – 3 days 3.Present after 24 hours . behind ears and umbilicus .Localized softening of cranial bones to 1st born child due to early lightening . Seborrheic Dermatitis .Fontanels: 12 – 18 months close Anterior fontanel . greasy appearing salmon colored patches usually seen on scalp.1 x 1 cm .Ricketts in older children 2. Craniotabes .Small/slow growing brain . Caput Succedaneum .Crosses the suture line .Characteristics .Edema of scalp due to prolonged pressure at birth .Disappear after 4 – 6 weeks 4.Collection of blood due to rupture of periostial capillaries .

Monitor for good drainage . Non communicating – intra ventricular hydrocephalus also called obstructive Signs and Symptoms . Communicating – extra ventricular hydrocephalus b.Sunset eyes Therapeutic Management .Mental retardation depend on extent of hydrocephalus SENSES .Seizure precaution .Sign of frontal bossing (prominent forehead) .Shave just before surgery . Hydrocephalus .Sign of increase ICP ..Diamox (Acetazolamide) to decrease CSF production .Surgery (AV shunt.Place client in low semi fowlers position (30o) .Collection of CSF 2 types a.Prominent scalp vein .Place in side lying position on non operated side .Osmotic diuretic . apply oil the night before shampooing (use baby oil or coconut oil) 5.Sunken fontanel is a good sign . VP shunt) .Management: proper hygiene.

To prevent permanent hearing loss MOUTH AND TONGUE .Massive dosage of antibiotic (may lead to bacterial meningitis) .First to develop and last sense to disappear . purulent and foul smelling odor discharge .Apply ear ointment a.Side lying on affected side to facilitate drainage .Sense of Hearing (Ears) .Properly aligned to outer canthus of eye OTITIS MEDIA . may also result to dental caries .Myringotomy: surgical procedure done by making a slight incision of the tympanic membrane . above 3 years up and back .Place client on the operated side .Inflammation of middle ear.Otoscopic: bulging tympanic membrane and absence of light reflex .Supportive care (TSB.Observe for URTI Management .Common with cleft lip and palate .Mucolytics to shrink mucous . common in children due to wider and shorter Eustachian tube . antipyretic) .Observe for passage of milky.Bottle propping. below 3 years down and back b.

Maintenance of airway .Cleft lip: cheiloplasty done as early as 1 – 3 months to save sucking reflex . Common URTI (otitis. Milk escape to the nostril d. Prone position/on abdomen . Ultrasound/3 dimensional UTZ c.Emotional support .Use Rubber tipped medicine dropper .Cleft palate: uranoplasty done 4 – 6 months to save speech Nursing Responsibility (Pre Op) .Proper nutrition . Feed upright position b. cholic) Therapeutic Management .CLEFT LIP . Evident at birth b.Use rubber tipped syringe Cleft Palate .Failure of the palate to fuse by 9 – 12 weeks of pregnancy . Burp twice c.Common in boys .Surgery .Prevention of cholic a. plastic cup.Use paper cup. soup spoon .Use elbow restraints (pre op) .Common in girls Signs and Symptoms a.Failure of the median maxillary nasal processes to fuse by 5 – 8 weeks of pregnancy .So baby can easily adjust post op (Post Op) .Orient parents to feeding technique Cleft Lip .Can be unilateral or bilateral CLEFT PALATE .

Check for colds or nasopharyngitis .Proper nutrition .Monitor for developing RDS .Begin with clear liquid . Half strength hydrogen peroxide and saline b.Maintain integrity of logan bar a.NPO 4 hours post op .Facilitate drainage . Prevent baby from crying c.May cause septicemia .Deficient liver enzyme .Observe for signs of hemorrhage (frequent swallowing) .Protect site of operation . Prevent cholic d. Check for wet diaper GASTROINTESTINAL SYSTEM INBORN ERRORS OF METABOLISM ..Usually happens 6 – 7 days post op .Side lying (cheiloplasty) .Prone (uranoplasty) .

Seizure .Atopic dermatitis . Guthrie test Management . Blink reflex – rapid eyelid closure when strong light is shown b. eggs.Mental retardation Diagnostic Tests a.No tyrosine.Purpose: cling to mother for safety (disappear by 6 weeks – 2 months) .PHENYLKETONURIA .Musty or mousy odor urine . melanin.Fair skin .Lofenalac = milk form for PKU NEUROMUSCULAR SYSTEM Reflexes a.Low phenylalanine indefinitely . Palmar grasp reflex – solid object is placed on palm and baby grasp object .Accumulation of phenyl pyrobic acid in the blood .Blonde hair . meat. peanut) . tyroxine – basal metabolism Signs and Symptoms .No food rich in protein (chicken.Blue eyes .Deficiency of liver PHT (Phenylalanine Hydroylase Transferase) . legumes.

and the opposite arm and leg contract.c. the baby exhibit some muscle tone (test for muscle tone and present by 6 – 9 months) k. it causes flexion of the trunk and swing his pelvis toward the touch. Magnet reflex – when there is pressure at the sole of the foot he pushes back against the pressure. Step in/Walk-in Place Reflex – neonate placed on a vertical position with their face touching a hard surface will take few quick. Parachute reaction – while on ventral suspension with the sudden change of equilibrium. The arm and the leg on the side to which the head turns extend.Placing Reflex: almost the same with step in place reflex only that you are touching anterior surface of a newborn’s leg. it causes extension of the hands and legs (present by 6 – 9 months) l. Plantar grasp reflex – when an object touches the sole of a newborn’s foot at the base of toes. Tonic-neck-reflex – when newborns lie on their backs. f. Moro reflex – test for neurological integrity (jarring crib. their heads usually turn to one side or the other. the toes grasp in the same manner as fingers do (disappear by 8 – 9 months in preparation for walking) e. h. alternating steps. it causes the foot to rise and the other foot extend (test for spinal cord integrity) i. Babinski reflex – when the sole of foot is stimulated by an inverted “J”. Crossed extension reflex – when the sole of foot is stimulated by a sharp object. Landau reflex – while prone position and the trunk is being supported. Truck Incurvation reflex – while in prone position and the paravertical area is stimulated. it causes fanning of toes (disappear by 2 months but may persist up to 2 years) . loud voice) assume a letter C position (disappear by 4 – 5 months) g. . d. j.

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