Professional Documents
Culture Documents
Pediatric Nursing
GROWTH
• Increase in physical size of a structure or whole
• Quantitative
• 2 parameters
o Weight
Most sensitive measurement for growth
Weight gain:
2x = 5 – 6 mos.
3x = 1 year
4x = 2 – 2½ years
o Height
ESTROGEN responsible for increase in height in female
TESTOSTERONE responsible for the increase in height in male
Stoppage of height coincide with the eruption of the wisdom teeth
↑ - 1”/ mo – 1 – 6 mos
↑ - 1.5”/ mo – 7 – 12 mos
↑ - 50 % - 1st Year
HEIGHT COMPARISON
9 y/o male = female
12 y/o Male < Female
13 y/o Male > Female
DEVELOPMENT
• Increase in the skills or capacity to function
• Qualitatively
• How to measure development
o By simply observing the child doing simple task
o By noting parent’s description of the child’s progress
o Measure by DENVER DEVELOPMENTAL SCREENING TEST (DDST)
• MMDST
o Metro Manila Developmental Screening Test
o Philippine Based exam
• Main Rated Categories
o LANGUAGE ability to communicate
o PERSONAL/ SOCIAL ability to interact
o FINE MOTOR ADAPTIVE ability to use hand movements
o GROSS MOTOR SKILLS ability to use large body movements
MATURATION
• Synonymous with development
COGNITIVE DEVELOPMENT
• Ability to learn and understand from experiences, to acquire and retain knowledge, to
respond to a new situation and to solve problems
o Sequential Trend
Involves a predictable sequence of growth and development to which
the child normally passes
Locomotion
Creeps → Stands → Walks → Run
Language and Social Skills
Cry → coo
o Secular Trend
Refers to the worldwide tend of maturing earlier and growing larger as
compared to succeeding generation
• Environment
o Quality of Nutrition
o Socio Economic Status
o Health
o Ordinal Position in the family
o Parent – Child Relationship
*Universal Principle: F are born < wt. than M by 1 oz.; F are born < lt. than M by 1 in.
THEORIES OF DEVELOPMENT
Developmental Task
• 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
o Child turns to be
hardheaded, antisocial,
stubborn, unreliable,
irresponsible
• Mother Wins
o Letting go
o Child turns to be kind,
obedient, perfectionist
o Meticulous, OCs, reliable,
responsible
Phallic 4 – 6 yrs. Genital • May show • Accept the child fondling his
Phase exhibitionis own genetalia as normal area
m of exploration
• Have or • Divert attention from
increase masturbation
knowledge • Answer the child’s question
of 2 sexes directly
• Human sexuality
Latent 7 – 12 yrs. School • Period of • Help the child achieve (+)
Phase aged suppression experiences so that he’ll be
• No obvious ready to face the conflicts of
developmen adolescents
t, slower
growth
• Child’s
energy or
Libido is
diverted into
more
concrete
type of
thinking
Genital 12 – 18 yrs Genitalia • Achieve • Give opportunity to relate to
Phase sexual opposite sex
maturity and
learn to
establish
satisfactory
relationship
with the
opposite
sex
1. Sensorimotor
• 0 – 2 years old
• Also called Practical Intelligence
o words and symbols are not yet available
o communication through senses
2. Pre-operational Thought
1. Pre – conceptual Thought
o 2 – 4 years old
o Concrete, literal, static thinking
o CBQ EGOCENTRIC – unable to view anothers viewpoint
o CBQ (-) REVERSIBILITY – in every action there is opposite reaction; cause
and effect
o Concept of time is only now and concept of distance is only as far as they can
see
o CBQ ANIMISM – consider inanimate object as alive
2. Intuitive Thought
o Beginning of causation
3. Concrete Operational
o 7 – 12 years old
4. Formal Operational
o 12 years old and above
o Period when cognition achieve its final form
o Can solve hypothetical problem with SCIENTIFIC REASONING
o Can deal with past, present and future
o Capable of ABSTRACT, mature thought and formal reasoning
o Activity recommended: talk time; focus on opinions and current events
DEVELOPMENTAL MILESTONES
• Major marker of growth and development
• Determines developmental delays
TEETH QUESTIONS
6 mos. Eruption of first temporary teeth 2 LOWER CENTRAL INCISORS
30 mos. Temporary teeth complete
20 decidous teeth
POSTERIOR MOLAR --> last to appear
Time to go to Dentist
Begins to brush teeth
3 years Tooth brushing with minimal supervision
6 years Tooth brushing alone
Temporary teeth begins to fail
1st permanent teeth → 1st MOLAR
Last to appear → WISDOM TOOTH
BOWEL/ BLADDER CONTROL
Bowel Control → 18 months / 1 ½ years
Day Time Bladder Control → 2 years
Night Time Bladder Control → 3 years
MILESTONES
Infancy
• Solitary play
o Consider when choosing a play
Safety
Age appropriateness
Hygiene
• Fear: Stranger Anxiety
o Begins: 6 – 7 months
o Peaks: 8 months
o Diminishes: 9 months
Neonate
• Complete head lag
• Largely reflex visual fixation for human face
• Hands fisted with thumbs in
• Cries without tears because lacrimal glands are not fully developed
1 month
• Dance reflex disappears
2 months
• Holds head up when in prone
• Social smile, cries with tears, cooing sound
• Closure of posterior fontanel (2-3 months)
• Head lag when pulled to sitting position
• No longer clinches fist tightly
• Follows object past midline
• Recognizes parents
3 months
• Holds head and chest up when in prone
• Holds hands open at rest
• Hand regard, follows object past midline
• Grasp and tonic neck reflexes are fading
• Reaches for familiar people or object
• Anticipates feeding
4 months
• Head control complete
• Turns front to back; needs space to turn
• Laughs aloud; Babbling sound
• Babinski Reflex disappears
5 months
• Turn both ways (roll over)
• Teething rings, handles rattle well
• Moro reflex disappears (5 – 6 months)
• Enjoys looking around environment
6 months
• Reaches out in the anticipation of being picked- up
• Sits with support
• Puts feet in mouth in supine position
• Eruption of first temporary teeth ( Lower 2 central incisors)
• Vowel sounds “ah, eh”
• Uses palmar grasp; handless bottle well
• Recognizes strangers
7 months
• Transfer objects from hand to hand (6 – 7 months)
• Likes objects that are good sized for transferring
8 months
9 months
• Creeps or crawls; need space for creeping
• Neat pincer grasp reflex, probes with forefinger
• Finger feeds, combine 2 syllables “mama & dada”
10 months
• Pulls self to stand
• Understand the word no
• Respond to name
• Peek – a – boo, pat a cake, since they can clap
11 months
• Cruising, stand with assistance
• Walking while holding to his crib’s handle
• One word other than mama and dada
12 months
• Stands alone
• Walk with assistance
• Drink from cup, cooperates in dressing
• Says two words other than mama and dada
• Pots & pans, pull toys and nursery rhymes
• Imitates actions, comes when called
• Follows one – step command and gesture
• Uses mature pincer graps, throws objects
Toddlerhood
• Parallel Play – 2 toddlers playing separately
• Provide 2 similar toys for 2 toddlers
• Toys
o Squeaky frogs to squeeze
o Waddling ducks to pull
o Trucks to push
o Building blocks
o Pounding peg
• Fear: Separation Anxiety
o Begins: 9 months
o Peaks: 18 months
o 3 stages
Protest
Despair
Denial
o Prevent:
Do not prolong goodbye
Say goodbye firmly
Say when you’re back
15 Months
• Plateau stage
• CBQ WALKS ALONE – lateness in walking is a sign of mild mental retardation
• Puts small pellets into small bottle
• Creep upstairs
• 4 – 6 words
• Scribbles voluntarily with pencil, holds spoon well, seat self in a chair
18 Months
• Height of POSSESIVENESS – favorite word MINE
• Bowel control achieved
• No longer rotates a spoon
• Can run and jump in place
• Walks up and downstairs holding on to a person’s hand or railing, typically places
both feet on one step before advancing
• Names one body part
24 months
• TERRIBLE TWOS
• Turns pages one at a time, removes shoes, pants, etc
• Can open doors by turning door knobs, unscrew lids
• 50 – 200 words (2 word sentences), knows 5 body parts
• Walk upstairs alone, still using feet on the same step at same time
• Daytime Bladder Control
• CBQ best time to bring the child to dentist: 2 – 3 years or when temporary teeth is
complete
30 months
• Makes simple lines or stroke or crosses with pencil
• Can jump down from chair
• Knows full name, holds up finger to show age
• Copy a circle
• CBQ Temporary teeth complete (posterior molar: last to erupt)
• CBQ 20 deciduous teeth
• CBQ tooth brushing: 2 – 3 years
36 months
• TRUSTING THREES
• Tooth brushing with little supervision
• Unbutton buttons
• Draws a cross, learns how to share
• Knows full name and sex
• Speaks fluently, 200 – 900 words
• NIGHTIME BLADDER CONTROL achieved
• Rides tricycle
Preschoolers
• Cooperative play – playhouse
• Role playing is usual
• Fears:
o Castration/ Body Mutilation
o Dark places and witches
o Thunder and lightning
o Ghost
• Curious, creative, imaginative and imitative
4 years old
• FURIOUS FOUR
• Noisy, aggressive and stormy
• Buttons button
• Copy square
• Catches ball, jumps, skips
• Alternates feet going downstairs
• CBQ LACES SHOES
• Vocabulary of 1500, knows the basic color
• Says song or poem from memory
5 years old
• FRUSTRATING FIVES
• Jumps over low obstacles
• Spreads with a knife
• Draws 6 part man, copy triangle
• Imaginary playmates
• 2100 words
• Identification with same sex
• Attachment to opposite sex
School – Aged
• Competitive Play: Tug of war
• Fears
o School Phobia orienting child to his new environment
o Displacement from school
o Death
• Significant Person
o Teacher
o Peer of same sex
• Stoppage of height coincide with the eruption of wisdom tooth
• Prone to fracture: Common Green stick
• Mature vision
o 20/200 legal blindness
• They’ll Cheat → can’t afford to lose
6 years old
• Temporary teeth begins to fall, permanent teeth begins to appear (1st: First Molar)
• Tooth brushing alone
• A year of continuous motion, clumsy moving
• 1st grade teacher becomes authority figure
o nail biting → sign of strict teacher
• Beginning interest with God
7 years old
• Age of assimilation
• Copies a diamond
• Enjoys teasing and playing alone
• Quieting down phase
8 years old
• Expansive age
• Smoother movements
• Normal homosexual
• Loves to collexct objects
• Counts backwards
9 years old
• Coordination improves
• Tells time correctly
• Hero worship
• Stealing and lying are common
• Takes care of body needs completely
• Teachers find their group difficult to handle
10 years old
• Age of special talents
• Write legibly
• Ready for competitive games
• More considerate and cooperative
• Joins organizations
• Well mannered with adults and critical with adults
11 – 12 years old
• Pre adolescent
• Full of energy and constantly active
• Secret languages are common
• Share secrets with friends
• Sense of humor is present
• Social and coopoerative
D eepening of voice
D evelopment of muscle
I ncrease in size of penis and scrotum – 1st sign
P roduction of viable sperm – last sign
Adolescence
• Fear
o Acne
o Obesity
o Homosexuality
o Death
o Replacement from friends
• Peer of opposite sex significant other
• Experiences conflicts between his needs for sexual satisfaction and societal
expectations
• Core Concern
o Change of body image
o Acceptance of the opposite sex
• Nocturnal Emission: Wet dreams
o Hallmark of adolescence
• CBQ distinctive odor due to stimulation of apocrine gland
• Testes and scrotum increases until age 17
• Sperm is viable by age 17
• Breast of female and genitalia increases until age 18
• Signs of sexual maturity
• Characteristic traits
o Idealistic, rebellious, reformers
o Parent child conflict
o Very conscious with body image
o Peer pressure
• Problems
o Vehicular accident
o Smoking
o Alcoholism
o Drug Addiction
o Pre Marital Sex
Concept of Death
6 years old death is reversible
CBQ 7 – 9 years old personification of death, permanent loss of the corporal life
Alerts!
• Expulsion is @ 2nd stage of labor
• Most neonatal deaths w/in the first 24 hours is due to INABILITY TO INITIATE
AIRWAY
• Lung function begins only after birth
How?
• Support head and remove secretion
• Proper suctioning with a catheter
o Place baby’s head to side facilitates drainage
o Suction the mouth first before nose newborns are nose breathers
o Period of 5 – 10 seconds, should be gentle and quick
Prolonged suctioning can cause hypoxia, laryngospasm and
bradycardia due to vagal nerve stimulation
o Evaluate patency
Cover 1 nostril, if newborn struggles, additional suctioning needed
• If not effective requires effective LARYNGOSCOPY to open airway. After deep
suctioning, and ET tube can be inserted and O2 administration by (+) Pressure Bag
and mask with 100% O2 @ 40 – 60 bpm
Alerts in O2 Administration
• No Smoking O2 is combustible
• Must be humidified prevent drying of mucosa
• Cover the nose and mouth only
• Scarring Retina results Retinopathy (O2 overdose)
• Meconium Stain never administer O2 with pressure causes atelactasis
Alerts!
• Circulation id initiated by LUNG EXPANSION and PULMONARY VENTILATION
• Completed by cutting the cord
• Assess characteristics of cry
o Normal strong, vigorous, lusty cry
o Hypoglycemia/ Increased ICP high pitched, small cry
o Never stimulate crying before all secretion are remove to prevent aspiration
Alerts!
• The goal of temperature regulation is to maintain Temperature not less than 97.7 F or
36.7 C
Breastfeeding
Best time
• NSD – ASAP
• CS – after 4 hours
Advantages of Breastfeeding
• Economical
• Promotes bonding
• Contains LACTOBACILLUS BIFIDUS → interfere the attack of pathogenic bacteria
in the GIT
• Helps in early involution of uterus → oxytocin causes contraction
• Always available
• ↓ Incidence of breast cancer
• Breastfed babies have higher IQ than bottle fed ones
• Antibody → IgA
• Macrophages
Disadvantages of Breastfeeding
• No iron
• Possibility of transfer of Hepa B, HIV, CMV (13 – 39% possibility)
• Father can’t bond with the mother and baby → instead, father can sing, suddle, kiss,
put baby to sleep
Alerts!
• Freezer → good for 6 mos./ don’t reheat
• Should be stored in a sterile plastic container
• Pre – Colostrums → 6 weeks
• Colostrums → 3
Stages of Breastmilk
• COLOSTRUM
o Present 2 – 4 days
o Contents
↓ fats
↓ CHO
↑ Immunoglobulin
↑ protein
↑ fat soluble vitamin
↑ minerals
• TRANSITIONAL MILK
o Present 4 – 14 days
o Contents
↑ Lactose
↑ minerals
↑ water soluble vitamins
o Lactose Intolerance → deficiency in enzyme
COWS MILK
• ↑ fats – almost similar to mature milk
• Causes constipation
• Content
o ↑ fats
o ↓ CHO → add sugar
o ↑ CHON → casein → hard to digest
o ↑ Minerals (has traumatic effect to kidneys of babies)
o ↑ PHOSPHORUS ( causes inversely proportional effect of Calcium
• ↑ water to prevent kidney stones
Health Teachings
1. Proper Hygiene
• Hand washing, clean areola with cotton and water or NSS
• Cleanse the area with CAKE COLOSTRUM
2. Position while Breastfeeding
• Upright Sitting (best position)
3. Stimulate and Evaluate Feeding Reflexes
• Rooting Reflexes
o Stimulate by touching the side of the cheek or side of flip then the
baby will turn to the syimulus
o Purpose: to look for food
o Disappear by 6th weeks
• Sucking Reflexes
o Stimulate the middle part of the lips and the baby will suck
o Disappear by 6 months
• Swallowing Reflexes
o When the food touches the posterior part of the tongue, the baby
will automatically swallow
o Never disappears
• Extrusion Reflexes
o When food touches anterior part of tounge, it will extrude/ protrude
o Purpose: prevent poisoning
o Disappears @ 4 moths
4. Criteria for effective sucking
• Baby’s mouth is hiked well – up @ areola
• MASTITIS
o Inflammation of breast
o Causative Agent: STAPHYLOCOCCUS AUREUS
o Management
Avoid wearing lined/ wired bra
o 4 weeks – Breast Involution
GIT Obstructions
• Hirshsprung Disease
• Imperforate Anus
• Meconium Ileus (common with Cystic Fibrosis)
Different Stools
• MECONIUM/ PHYSIOLOGIC STOOL
o Blackish green
o Odorless (sterile intestine)
o Normally passed within 24 hours
o Tar like
o Sticky
• TRANSITIONAL STOOL
o Present 4 – 14 days
o Green
o Loose
o Slimy that may appear like diarrhea to the untrained eyes
• BREASTFED STOOL
o Golden yellow
o Occur almost nearly after feeding
o With sour milk smell
o Mushy
o Soft
• BOTTLEFED STOOL
o Pale yellow
o Hard → due to casein
o Formed
o Typically offensive odor
o Seldom passed 2 – 3 days
INDICATION OF STOOL CHANGES
Light Stool With jaundice
Bright Green Under phototherapy
Mucus –mixed Milk Allergy
Clay Colored Bile Duct Obstruction
Black GIT Hemorrhage
Blood – Flecked Anal Fissure
Curant Jelly Intussuception
Fatty, bulky, foul Suspect malabsorption
smelling/ Steatorrhea syndrome/ Cystic Fibrosis/
Celiac Disease
Ribbon – like Hirshsprung disease
Apgar Scoring
• Virginia Apgar
Special Consideration
• 1st 1 minute → determines general coneral condition of the baby
• Next 5 Minute → determines the capability of the baby to adjust extrauterinely (most
important)
• Next 15 minutes → optional → depndent on the 5 minutes apgar score
Components
A ppearance Color upon birth is slightly cyanotic
After first cry baby will be pink
P ulse Rate Take apical pulse at the lower left nipple
G rimace Determines reflex irritability using tangential foot slap and catheter
insertion
A ctivity To determine the degree of muscle tone
R espiration
APGAR SCORING
Score
Criteria 0 1 2
Heart Rate Absent < 100 > 100
Respiratory Effort Absent Slow RR/ Weak Good strong cry
Muscle Tone Flaccid Extremities Some reflexes Well Flexed
Reflex Irritability
Catheter No Response Grimace Cough or sneeze
Tangential FS No Response Grimace Cry
Color Blue / Pale Acrocyanosis Pink
• High score means healthy baby
Interpretation
0-3
• Severely depressed
• Needs CPR
• Admission at NICU
4-6
• Moderate depression
• Additional suctioning
7 – 10
• Good and healthy
CARDIOPULMONARY RESUSCITATION
• CPCR → cardiopulmonary and cerebral resuscitation
• 5 minutes of 02 deprivation will cause irreversible brain damage
• Priority: Airway, Breathing, Circulation
AIRWAY
• Clear the airway
• Shake the baby
• If no response, call help
• Immediately do 1 minute CPR before calling for help
• Flat on bed, put a board if the bed is soft
• Head tilt – chin lift maneuver
• No head tilt for suspect of cervical damage
• Overextension may cause occlusion
BREATHING
• Ventilating the lungs
• Check breathlessness
• If breathless → give 2 breaths
• If newborn → mouth and nose
• If child → mouth and pinch the nose
• Force → puff only
• Use one way mask to prevent contact with the secretion
CIRCULATION
• By cardiac compression
• Check if pulseless
• Use brachial pulse → children
• No breath + No pulse → CPR
• Infant → 1 finger breadth below nipple line, 2 finger
• 1 year old → heal of the palm
CPR RATIO
Adult → 2:15
Infant → 1:5
Score
Criteria 0 1 2
Chest movement Synchronized Long on inspiration See-saw
Intercoastal retraction No retraction Just visible Marked
Xiphoid Retraction No retraction Just visible Marked
Nares dilatation No dilatation Minimal Marked
Expiratory Grunt None Heard by stet only Heard by ear
PRETERM BABIES
• babies delivered after 20 weeks and before 37 weeks
• sign of preterm – less 36 weeks according to Ballatrd and Dubowitz
• plus frog legs or lax position
• Hypotonic – prone to repiratory infection
• There is a Scarf Sign → elbow passes midline
• Square window – wrist 90 deg. Angle
• Heal to ear sign
• Anterior traverse crease
• Abundant lanugo
• Prominent labia minora and clitoris
o Head Circumference
13 – 14 inches
33 – 35 cm Ave: 34 cm
o Chest Circumference
12 – 13 inches
31 – 33 cm Ave: 32 cm
o Abdominal Circumference
12 – 13 inches
31 – 33 inches Ave: 32 cm
3. Bathing the baby
o Give oil Bath
To cleanse the baby and spread the vernix caseosa
2 functions of vernix caseosa
• insulator
• bacteriostatic
o Full bath is given when cord falls off
o Babies of HIV + mothers will be given a full bath immediately after the birth to
lessen the transmission of HIV
4. Dressing the Umbilical Cord
o Strict asepsis to prevent tetanus neonatorum that is why mothers are given
tetanus toxoid while pregnant
CHN – 3 Cleans
• Hand
• Surface
• Cord
o Betadine (Povidone Iodine)
Check 3 vessels (AVA)
If only 2 vessels is seen suspect that the baby has a kidney
malformation
1 inch above the base of the cord when cutting
But if IV infusion or blood transfusion is going to be given to the
newborn, leave at least 8 inches of the umbilical cord
Umbilical cord is the best site for IV and blood transfusion because it
has no nerve and no pain
OMPHALAGIA → bleeding of the cord for more than 30 cc, suspect
hemophilia
The umbilical cord turns black by the 3rd day and falls of 7 – 10th day
UMBILICAL GRANULATION → failure of the cord to fall after 2
weeks without foul odor, bring the baby to the hospital and will be
given Silver Nitrate or will be cauterized
Clean the umbilical cord with saline or 70% alcohol
It should be dry
PATENT URACHUS → itf the cord is always moist, suspect a fistula
between the bladder and the umbilicus, do NITRAZINE PAPER TEST
(+ for urine if it turns yellow)
5. Crede’s Prophylaxis
o Purpose: to prevent opthalmia neonatorum or gonnorheal conjeunctivitis
Important Consideration
• If the client is a newborn, cover areas that is not being examined (prevent
hypothermia)
• If the client is an infant, he first vital sign to take is the RR because of fear of
stranger will change the normal respiration. Begin from at least intrusive to the
most intrusive procedure.
• If the client is a toddler and preschooler, le them handle the instruments like
stethoscope or play syringe. If the client has security blanket (like stuffed toy)
give it to them to lessen anxiety
• If the client is a school age and adolescent, explain the procedure and respect
their modesty
Components
• Temperature
o Temperature of the newborn is taken rectally
o Rectal temperature taking is done only once to rule out imperforated anus
o Insert thermometer 1 inch inside the anus
• Common in Girls
o Patent Ductus Arteriosus
o Atrio Septal Defect
• Causes
o Familial tendency
o Exposure to rubella/ German measles – 1st month
o Failure of the Heart Structure to progress
1. Pulmonary Stenosis
• Narrowing of valve of pulmonary artery
2. Aortic Stenosis
• Narrowing of valve of aorta
• Signs and symptoms
o Typical systolic ejection murmur
o Murmur
o ECG reveals right ventricular hypertrophy
o Only 50% of the blood goes to the body
o Angina like symptoms may be present when active
• Management
o Balloon stenotomy
4. Coarctation of Aorta
• Narrowing of ach of aorta
• Outstanding signs
o Absent femoral pulse
o BP is higher on the upper extremities and ↓ on the lower
extremities
o Epistaxis
o Lesser blood goes to the lower extremities
• Management
o Take BP on 4 extremities
o Close hear surgery
• Aorta is arising from the right ventricle while the pulmonary artery is
arising from the left
• Signs and symptoms
o Cyanosis after 1st cry
o Polycythemia because of increase production of RBC, a
compensatory mechanism to the ↓ oxygen supply to the body, the
blood become viscous
o Polycythemia will lead to:
Thrombuis
Embolus
Stroke (CVA)
o ECG reveals Cardiomegaly
• Management
o Palliative repair – Rash Kind repair
o Complete repair – Mustard repair
3. Truncus Arteriosus
• Situation in which pulmonary artery and aorta is arising in one common
trunk or a single vessel with ventricular septal defect
• Signs and symptoms
o Cyanosis after 1st cry
o Polycythemia because of increase production of RBC, a
compensatory mechanism to the ↓ oxygen supply to the body, the
blood become viscous
o Polycythemia will lead to:
Thrombuis
Embolus
Stroke (CVA)
• Management
o Restructuring the heart
1. Tricuspid Atresia
• Failure of the tricuspid valve to open
• Signs and symptoms
o Open foramen ovale
o Cyanosis
o Polycythemia because of increase production of RBC, a
compensatory mechanism to the ↓ oxygen supply to the body, the
blood become viscous
o Polycythemia will lead to:
Thrombuis
Embolus
Stroke (CVA)
• Management
o Fontan Proledum
2. Tetralogy of Fallot
• 4 Anomalies Present (PVOR)
o Pulmonary Stenosis
o Ventricular Septal Defect
o Overriding of Aorta
o Right Ventricular Hypertrophy
• Signs and symptoms
o High degree of Cyanosis outstanding Sign
o Polycythemia because of increase production of RBC, a
compensatory mechanism to the ↓ oxygen supply to the body, the
blood become viscous
o Polycythemia will lead to:
Thrombuis
Embolus
Stroke (CVA)
o Severe dyspnea relieved by squatting position because it will
prevent venous return and facilitate maximum lung expansion
Knee chest position in infants
o There is growth retardation
o TET Spells – blue spells or short episode of hypoxia
o Syncope – faintaing
o Mental retardation
o Clubbing in fingernails because of tissue hypoxia – late and last
sign
o X – ray reveal a boot shape heart
• Management
o Oxygen therapy
o Morphine sulfate – for hypoxic episode
o Propanolol (inderal) – decrease heart spasm
o Palliative repair – BLT or Blalock Taussig Shunt Procedure
o Complete repair – Brock Procedure
• Management
o Bed rest
o Avoid contact sports
o Throat swab for C & S
o Antibiotics – purpose is to prevent recurrence
o Aspirin Therapy or salicylates – act as an anti-inflammatory agent in RHD
o Side effect: Reye’s Syndrome encephalopathy accompanied by fatty
infiltration of the organs such as the heart and liver
RESPIRATION
• Normal Values = 30 – 60 bpm irregular
• Either abdominal or diaphragmatic breathing with short period of apnea without
cyanosis
• Normal apnea in newborn is 15 seconds or less
Age Rate
Newborn 40 – 90
1 year old 20 – 40
2 – 3 years old 20 – 30
5 years old 20 – 25
10 years old 18 – 22
15 and above 12 – 20
3. BRONCHIOLITIS
• Inflammation of the bronchioles characterized by production of tenacious
mucus
• FLU – LIKE SYMPTOMS – outstanding sign
• ↑ RR
• Causative Agent: Respiratory Syncitial Virus
• Drug: Antiviral – Ribavirin
4. EPIGLOTITIS
• Inflammation of the epiglotitis
• Sudden onset
• The child always assume the tripod position
• Less than 18 months cannot cough – must be placed on mist tent or “Croup
tie” – make sure that the edges are tucked in
o Provide washable plastic toys or materials
o Avoid toys that crate friction
o Avoid toys that are hairy or furry
Blood Pressure
• Newborn – 80 – 46 mmHg
• After 10 days – 100/ 50 mmHg
• BP taking begins by 3 years old
SKIN
• If cyanotic after the first cry suspect Transposition of the Great Arteries
h. Cutis Memorata
• Transitory motlling of the neonates skin when exposed to cold
i. Hemangiomas
• Vascular tumors of the skin
• Types:
o Nevus Flammeus/ Port Wine Stain
Macular purple or dark red lesions usually seen on
the face or thigh, disappears and be removed
surgically
o Nevus Vasculosus/ Strawberry Hemangioma
Dilated capillary in the entire dermal or subdermal
area continuing to enlarge but disappear after 10
years old
o Cavenous Hemangiomas
Consist of communicating network of venules in the
subcutaneous tissue that never disappear with age
j. Vernix Caseosa
• White cream cheese – like substance that serves as skin lubricant
Burn Trauma
• Injury to body tissues caused by excessive heat
Characteristic
1st Degree Involves only the superficial epidermis characterized by erethema,
Partial Thickness dryness and pain
Ex: Sunburn – heals by regeneration in 1 – 10 weeks
2nd Degree Involves the entire epidermis, and portion of the dermis,
Partial Thickness characterized by erythema, blistered and moist from exudates
which is extremely painful
Ex: Scalds
rd
3 Degree Involves skin layers, epidermis and dermis, may involve adipose
Full Thickness tissue, fascia, muscle and bone. It appears to be leathery, white or
black, not sensitive to pain since nerve ending had been destroyed
Ex: Lava Burn
Management:
• First Aid
o Put out the flames by rolling the child on a blanket
o Immerse the burned part on cold water
o Removed burned clothing (sterile material)
o Cover burned part with sterile dressing
• Maintainance of patent airway
o Suction PRN
o O2 administration with ↑ humidity
o Endotracheal Intubation
o Tracheostomy
• Prevention of shock and flued and electrolyte imbalances
o Colloids to expand blood volume
o Isotonic saline to replace electrolyte
o Dextrose in water to provide calories
• Booster dose of Tetanus Toxoid
• Relief pain such as IV analgesic (morphine sulfate)
• Prevention of wound infection
o Cleaning and debriding the wound
o Open or close method of wound care
o Whirl pool therapy
• Skin grafting
o 3rd degree burn
o get skin from buttocks or pig skin (xenograft) or from frozen cadaver
• Diet ↑ CHON and calories
Atopic Dermatitis
• Skin disease characterized by papulo-vesicular eruthematous lesions with weeping
and crusting
• Usually caused by food allergen
o Milk
o Eggs
o Citrus Juice
o Tomatoes
o Wheat
• Signs and symptoms
o Extremely pruritus – outstanding sign
o Linear excoriation
o Crusty
o Lichenification dry and shinny, scaly white skin
• Management
o Avoid allergens
o Prosobes/ Isomil – hypoallergenic milk
o Prevent infection by proper handwashing, cut the fingernails
o Hydrate with a burrows solution
o Topical steroid – 1% hydrocortisone cream
Impetigo
• Skin disease caused by Group A Beta Hemolytic Sreptococcuscharacterized by
papulovesicular lesions surrounded by localized erythema becoming purulent and
ooze forming honey colored crust
• Before the development, the baby should always been exposed to Pediculosis
Capitis (kuto)
• Management
o Proper handwashing
o Treated with antibiotic
• Complication: AGN
Acne
• Self limiting inflammatory disease involving sebaceous gland, common in
adolescents
• Comadones – composed o sebum that is mainly causing white heads
• Sebum – composed of lipids
• Management
o Proper handwashing wild mild soap (sulfur soap) and water, leave for 5 – 10
minutes or use tretenoin or Retin A – anti acne
Anemia/ Pallor
• Caused by
o Early cutting of the cord
o Bleeding disorders/ blood dyscarias
Hemophilia
• Sex – linked (X) Recessive disorders
• The mother is the carrier
• The son is affected
• The father transmits to daughter
• Deficiency in clotting factor
o Hemophilia A factor 8 classic hemophilia
o Hemophilia B Factor 9 Christmas disease
o Hemophilia C Factor 11
• OMPHALAGIA earliest sign
o >300 cc loss of blood during cutting of the cord
• the maternal clotting factor is present in the new born that is why there is a delayed
diagnosis of hemophilia
• in toddlers sudden bruising
• HEMARTHROSIS major sign repeated bleeding, bleeding of the synovial
membrane
• Diagnostic exam: PTT
• Nursing Diagnosis: High Risk for Injury
• Goal: Prevention of injury
• Health Teaching
o Avoid contact sports
o Determine the case before doing any invasive procedure
In immunization change the needle into a smaller one
o In case of fracture/ injury
Leukemia
• Group of malignant disease characterized by rapid proliferation of immature RBC
• Ratio is 500 RBC : 1 WBC
• The client is immunocompromised
• Classification of Leukemia
o Lympho – affects the lymphatic system
o Myelo – affects the bone marrow
o Acute/ Blastic – affects the immature cells
o Chronic/ cystic – affects the mature cells
HEMOLYTIC DISORDERS
Rh Incompatibility
• Rh = monkey foreign body
• Mother (-) – no antigen; no protein factor
• Fetus (+), Father (+) – has antigen and protein factor
• 4th baby is severely affected
• Erythroblastocis Fetalis
o hemolysis/ destruction of RBC leading to ↓ O2 carrying capacity leading to
IUGR with pathologic jaundice w/in 24 hours
• ALERT! Baby is small and yellowish
• Management
o RHOGAM
Vaccine given to Rh(-) mothers within the first 24 hours or within 72 hours
Given once
If pregnancy was aborted and the mother udergo D & C, RHOGAM must
be given w/in 24 hours, if not given within 24 hours, mother will produce
antibody
Action: destroys RBC preventing antibody formation
• Diagnostic Test Coomb’s Test
ABO Incompatibility
• Mother – Type O; Fetus – Type A most common
• Mother – Type O; Fetus – Type B most severe
• Hydrops Fetalis
o Common in abo incompatibility
o Newborn is edematous, on lethal state, accompanied by pathologic jaundice
w/in 24 hours
• Difference from Rh Incompatibility
o First pregnancy is affected
o NB is yellow and edematous
• Management
o Initiation of breastfeeding, then temporary suspension of breastfeeding after 4
days ( breastfeeding realeses prenanediole causing kernicterus)
o Pregnanediole delays actions of Glucoonyl transferase ( liver enzyme that
converts indirect bilirubin into direct bilirubin)
Indirect bilirubin
Fat soluble
Can’t be excreted by kidneys
Causes hyperbilirubenemia causing jaundice
Direct Bilirubin
Water soluble
Can be excreted by the kidneys
o Use phototherapy
o Exchange transfusion for Rh and ABO affectations that tend to casue a
continuous decrease in hemoglobin during the first 6 months because the
bone marrow fails to produce erythrocytes in reponse to the continuous
hemolysis
Hyperbilirubenemia
• More than 12mg of indirect bilirubin among full terms
• Normal Indirect Bilirubin Level: 0 – 3 mg/dl
Assessment of Jaundice
• blanching of forehead, nose and sternum
• yellow skin, sclera
• light stool
• dark urine
Management
• Phototherapy/ Photooxygenation
o Nursing Responsibilities
Cover the eyes – prevents retinal damage
Height of light from baby – 18 – 20 inches
Increase Fluid intake
Cover genetalia – prevent priapism ( painful continuous erection
Change position
Avoid lotion and oils
Monitor I&O – best way is to weigh the baby
Monitor VS
HEAD
• ¼ of its legth
• Structures
o sutures
o fontanels
anterior/ bregma – 3 x 4 – 12 – 18 mos
posterior/ lambda - 1 x 1 – 2 – 3 mos
• Noticeable structures of the Head
o Craniotabes
Localized softening of the cranial bone common to first bone chiold
due to early lightening
If present in older children; sign of rickets or Vit. D deficiency
o Seborrheic dermatitis/ Cradle Cap
SENSES
Sense of Sight
• Sclera
o Normal – light blue
o Later Color – dirty white
• Pupils
o Normal – round and adult size
o Coloboma – key hole pupils part of the iris is missing
o Congenital N Cataract – whiteness/ opacity of the lens
• Cornea
o Normal – round and adult size
o Congenital Glaucoma – larger than normal
RETINOBLASTOMA
• malignant tumor of the eye
• signs and symptoms
o cat’s eye reflex (whitish glow of pupil)
o red, painful eye usually accompanied by glaucoma
• Management
o Surgery innucleation - removal of the eyeball
o Irradiation
o Therapy
SENSE OF SMELL
• Normal nasal membrane - pinkish
• Check for sense of smell
• Check for nasal flaring
Epistaxis
• Nose bleeding
• Management
o Position, upright, sitting, head trilted, slightly forward
o Gentle pressure
o Cold compress
o Epinephrine – last resort
SENSE OF HEARING
• Normal should be aligned with the outer canthus of the eye
• Low Set Ears is a sign of
o Kidney malformation
• Renal agenesis
• Absence of kidney
o Chromosomal Abnormalities
• Due to advance maternal age - >35y/o
• Types
o Nondisjunction (uneven divison)
• Trisomy 21
• Down Syndrome
• Most common type
• Extra chromosome 21
• 47xx + 21/ 47xy + 21
• can be related to advance paternal age
• signs and symptoms
o broad nose
o protruding tongue
o low- set ears
o puppy’s neck
o hypotonia prone to URTI
o simian crease single traverse line in palm
o mental retardation – ranging from educable to
institutionalization
• Trisomy 18
• Has 3 numbers of 18 chromosomes
• Severely cognitively impaire SGA
• Low set ears, small jaw, CHD, index finger crosses over the
other fingers, rounded soles of feet
• Trisomy 13
• Patau’s syndrome
• Extra chromosome 13
• Severely cognitively impaired
• Signs and symptoms
o Microcephaly
o Micropthalmia
o Cleft-lip and palate
o Low-set ears
o VSD
o Do not survive
• Turners
• Gonadal Dysgenesia
• One functional x chromosome
• Short in stature
• Neck appear to be webbed and short
• COA and kidney problems
• Only 1 streak (nonfunctional) gonads
• Secondary sex characteristic does not develop except for
pubic hair
• Lack ovarian function – sterility
• Cognitively challenged but mostly normal intelligence
• Klinefelter’s syndrome
• Males with a XXY chromosome pattern
• @ puberty child has poorly developed secondary
characteristics and small testes that produces ineffective
sperm
• boys tend to develop Gynecomastia
o Deletion Abnormalities
• Cri – du – chat Syndrome
• Result of a short arm on chromosome 5
• Cat’s cry
• Small head, wide set eyes, downward slant to the palbepral
fissure of the eyes
• Severe cognitive impairment
• Fragile X Syndrome
• X linked pattern
• One arm of x chromosome is weakened
• Most common cause of cognitive impairment in boys
• Before puberty, boys typically have maladaptive behavior like
hyperactivity and autism
• Large head, long face with high forehead, prominent lower jaw,
large protruding ears
o Translocation abnormalities
• Balance translocation Carrier
• Unbalanced Translocation Syndrome
o Others
• Mosaicism
• A situation wherein the nondisjunction of chromosome occurs
during mitotic cell division after fertilization resulting to different
cells contains different numbers of chromosome
• Isochromosomes
• A situation wherein the chromosome instead of dividing
vertically it divides horizontally resulting to chromosomal
mismatch
Otitis Media
• Inflammation of the middle ear
• Common to children due to wider and shorter Eustachian tube
• Predisposing factors
o Bottle propping
o Cleft lip/ palate
Signs and symptoms
o During otoscopic exam, reveals bulging tympanic membrane
o Observe for passage of purulent, foul – smeeling odor discharge
Management
o Positioning – sidelying on the affected side
o Supportive care
Medical management
o Massive dosage of antibiotics
o Mucolytics
o Ear drops
< 3 y/o – down and back
>3 y/o – up and back
o Surgery
Myringectomy – slight incision of tympanic membrane to prevent
hearing loss
Side effect – bacterial meningitis
• Management
o Artificial tear
o Self limiting
TEF/ TEA
• No connection between esophagus and stomach
• There is a blind pouch
• Hydramnios – earliest sign intrauterine
• Signs and symptoms
o Coughing
o Chocking
o Cyanosis
o Continuous drooling
• Management
o Emergency surgery
Epstein Pearls
• White glistening cyst
• Usually seen on palate, gum
• Related to hypercalcemia
Natal Tooth
• Tooth at the moment of birth
• Related to hypervitaminosis
• Management
o Manual extraction if rootless
Neonatal Tooth
• Appearance of tooth within 28 days of life
Oral Thrush
• White cheese-like, curd like patches
• Usually seen in mouth and on toingue
• Causative agent C. Albicans – fungi
• Management
o Do not remove – can cause wound
o Wash with cold, bottled water
o Medical – Mycostatin/ Nystatin
Kawasaki Disease
• Discovered in Korea
• Strawberry tongue
• Common in asian countries
• Criteria for diagnosis
o Fever lasting for more than 5 days
o Bilateral conjunctivitis
o Changes in lips and oral cavity
Dry red fissure lips
Strawberry tongue
Cleft Lip
• Failure of the median maxillary nasal process to fuse
• Common to boys
• Surgery – cheiloplasty
o Done w/in 1 – 3 months
o To save sucking reflex
• Signs and symptoms
o Evident at birth
o Milk from nostrils spills
o Cold is common
o Frequent URTI and otitis media
• Post cheilo – sidelying
• Nutrition – use rubber tip syringe
Cleft Palate
• Failure of the palate to fuse
• Common to girls
• Surgery – Uranoplasty
o Done w/in 4 – 6 months
o To save speech
• Signs and symptoms
o Evident at birth
o Milk from nostrils spills
o Cold is common
o Frequent URTI and otitis media
• Post cheilo – prone
• Nutrition – use paper cup/ plastic cup/ soup spoon
General management
• Maintainance of patent airway
• Proper nutrition
o NPO 4 hours post op
o Clear liquid
Therapeutic Management
• Emotional support
• Proper Nutrition
• Cleft lip nipple (long tip, made by silicon)
• Prevent Colic
o Burp frequently
o One at the middle of the feeding
o Another at the end of the feeding
o Upright sitting position
o Pat at the back – lower to upper
o Prone position
o Right – sidelying position – facilitates gastric emptying
• Educate parents
• Apply elbow restraints so the baby can easily adjust post –op
NECK
• Check for symmetry
o Change in sucking
o Change in crying
o Excessive sleeping (16-20 hours/ day)
o Constipation
o Edema – moon faced baby
o Mental retardation – late sign
• Diagnostic Test
o Radioimmunoassay Test
o Protein bounbd iodine
• Treatment
o Synthroid / sodium levothyroxine for life
CHEST
Witch Milk
• Transparent
• Liquid coming out from newborns breast related to hormonal changes
ABDOMEN
Abdominal Assessment
• Inspection
• Ausculation
• Percussion
• Palpation
Diaphragmatic Hernia
• Protrusion of stomach contents through a defect in diaphragm due to failure of
pleuroperitoneal canal to close
• Signs and Symptoms
o Sunken abdomen
o Signs of RDS
o Right to left Shunting
• Treatment – diaphragmatic repair w/in 24 hours
Omphalocele
• Protrusion of stomach content between the the junction of abdominal wall and
umbilicus
• If small – surgery
• If large – suspend surgery
• Apply wet dressing
GASTROINTESTINAL SYSTEM
• Functions
o Assist in maintaining fluid and electrolytes and acid and base balance
o Processes and absorbs nutrients to maintain and support growth and
development
o Excrete wasted products from the digestive process
Supplementary Feeding
• Begin 4 – 6 months
• As early as 4 months
• Usually at 6 months
• Principles
o Solid food are often according to the following sequence
Cereals rich in iron
Fruits
Vegetables
Meat
o Begin with small quantities
o Finger food are offered @ 6 months
o Soft table food is offered @ 1 year
o Diluted citrus/ fruit juices @ 6 months
o Offer new food one at a time with an interval of 4 – 7 days or 1 week
o Never offer half cooked egg may lead to gastroenteritis/ salmoneliosis
o Metabolic Alkalosis
Base bicarbonate excess due to uncontrolled vomiting
NGT aspiration
Gastric lavage
Pyloric stenosis
Vomiting
• Forceful expulsion of stomach content
• Signs and symptoms
o Nausea
o Abdominal crumping
o Flushing of face
o Watery eyes
• Assessment
o Frequency
o Forces
Projectile – increase ICP/ Pyloric stenosis
Non – projectile
• Alerts
o Vomiting is an initial symptom of GI Obstruction
o Vomitus of upper GI can be blood tinged but bot bile streaked
o Vomitus of lower GI is bilous
o Projectile vomiting is ewither a sign of increased ICP or GI Obstruction
o Abdominal distention is the major symptom of lower GIT obstruction
• Management
o Banana
o Rice cereal
o Apple sauce
o Toast
Diarrhea
• Exaggerated excretion of intestinal contents
• Acute diarrhea is associated with the following
o Gastroenteritis/ salmonelliasis
o Antibiotic use – penicillin, tetracycline
o Dietary indigestion
• Chronic non specific diarrhea
o Food intolerance
o CHO/ CHON malabsorption
o Excessive fluid intake
• Assessment
o Frequemcy
o Consistency (best criteria)
o Appearance of green colored stool
• Complications
Gastroesophageal Reflux
• presence of stomach content on esophagus
• Assessment
o chronic vomiting
o failure to thrive syndrome – organic
o esophageal bleeding manifested by melena and hematemesis
• Complications
o esophagitis
o aspiration pneumonia
o esophageal cancer
• Diagnostic Procedure
o barium esophogram
o esophageal manometry – reveals lower esophageal pressure
o intraesophageal pH content – reveals pH of distal esophagus
• Medications
o anticholinergics
bathanechol/ urecholine
• ↑ esophageal tone and peristaltic activity
Methachlopromide (Reglan)
• ↓ esophageal pressure by relaxing pyloric and duodenal
segments
• ↑ peristalsis without stimulating secretions
H2 Blocker/ histamine Receptor Antagonist
• ↓ gastric acidity and pepsin secretion
Maalox/ Cimetidine (Tagamet)/ Ranitidine (Zantac)
• Neutralizes gastric acid between feedings
• Surgery: Nissen Fundoplication
• Diet
o Thickened feeding with rice cereal prevents vomiting
o Feed slowly
o Burp often every 1 oz
o Positioning
< 9 mos – infant sit/ infant supine
> 9 mos – prone with head on mattres slightly elevated on a 30° angle
Obstructive Disorders
Pyloric Stenosis
• hypertrophy of the muscle of pylorus causing narrowing and obstruction
• Assessment
o Projectile vomiting
o Failure to gain weight
o Metabolic alkalosis
o Peristaltic wave visible from left to right across epigastrum
o Palpation of olived shaped mass
• Diagnostic Procedure
o ABG
o Serum Electrolyte - ↑ Na and K, ↓ Cl
o Ultrasound
o X-ray of upper abdomen with barium swallow
• Management
o Pyloromyotomy/ Fredet – Ramstedt Operation
Intussusception
• Telescoping or invagination of one portion of the bowel into the other
• Peritonitis – danger of intussusception
• Emergency for URT – epiglotitis
• Emergency for GIT – peritonitis
• Signs and symptoms
o Acute paroxysmal abdominal pain
o Currant jelly stool caused by inflammation and bleeding
o Sausage shaped mass
• Non congenital
• Caused by fast eating and positioning
• Management
o Hydrostatic reduction with barium enema
o Surgery – Anastomosis
Phenylketonuria/ PKU
• Deficiency of the liver in Phenyalanine Hydroxylase Transferase (PHT)
• PHT is a liver enzyme that coverts protein into amino acid
• 9 Essential Amino Acids
o Tyrosine / phenylalanine
o Histidine
o Isoleucine
o Leucine
o Lysine
o Methionine/ cysteine
o Threonine
o Tryptophan
o Valine
• Tyrosine or Phenylalanine – responsible for the melanin production
• Signs and Symptoms
o Fair complexion
o Blond hair
o Blue eyes
o Infantile eczema
o Mousy/ musty odor urine
o Seizure – due to Phenyl Pyruvic Acid goes to brain
o Mental retardation
• Guthrie Test
o Specimen – Blood
o Preparation – Increase Fluid Intake
• Management
o Diet
↓ phenylalanine diet indefinitely
Chicken, meat, peanuts, milk, legumes, cheese – contraindicated
Lofenalac – special formula
Poisoning
• Common accident in toddlers – poisoning
Lead Poisoning
• Pencil, paint, crayon Lead
↓
Destruction of RBC Functioning
↓
hyupochromic Microcytic Anemia
↓
Destroys Kidney Function
↓
Accumulation of ammonia
↓
Leading to Encephalitis (Late stage)
↓
Severe mental retardation
• Assessment
o Beginning symptoms of lethargy
o Impulsiveness and learning difficulty
o As lead ↑, severe encephalopathy with seizure and permanent mental
retardation
• Diagnostic procedure
o Blood smear
o Abdominal x-ray
o Lone bone
• Management
o Chelation – binds with the lead and excreted via kidneys
ANOGENITAL
Female
• Pseudomenstruation
o Slight vaginal bleeding related to hormonal changes
• Rape/ Child Abuse
o If the client came with a laceration and bleeding at the perineum
o Report rape within 48 hours
o Preschool are proneto rape because of their innocence
o CBQ Report rape cases to barangay chairman first or bantay bata
Male
• Cryptochirdism
o Undecended testes or empty scrotum or ectopic testes
Common in preterm babies
Testes is palpable at lower quadrant
Surgery: Orchioprexy
• Preop – warm the room and hands
• Epispadias
o Urinary meatus is located at the dorsal or above the glans penis
• Hypospadias
o Urinary meatus is located at the ventral or below the glans penis
o Hypospadias is usually accompanied by Chordee ( A fibrous band causing
penis to curved downward)
o Both are manage by surgery
• Phimosis
o Tight foreskin
o This will cause infection
o Circumcision as management
• Hydrocele
o Fluid filled scrotum
o Flashlight/ transillumination test to determine
• Varicocele
o Enlarged vein opf the epididymis
RENAL DISORDERS
Normal or ↓ BP
Fatigue
Acute Autoimmun Primary pheripheral AntiHPN Monitor weight
Glomerul e perioprbital edema Hydralazine Skin Care
onephritis Group A Moderate Proteinuria Apresoline Monitor BP and
beta Goss hematuria neurologic status
hemolytic (smokey urine) Complication ↓K
streptyococ ↑ serum K Hypertensive ↑ Fe
cus Fatigue Encephalopat ↓ Na
HPN hy
BACK
• Check for flatness and symmetry of the back
Scoliosis
• Lateral curvature of the spine, common in school age because of heavy bags
• Uneven hemline
• Tell the child to bend forward, one hip higher than athe other and one shoulder is
most prominent
• Types
o Structural
o Postural
• Management
o Conserbvative
Exercise
Avoid obesity
o Preventive
EXTREMITIES
• Count the number of digits
Digits
• Syndactyl – webbing of the digits (foot – ginger –like foot)
• Polydactyl – extra digits
• Olidactyl – lacks digits
Talipes
• Club foot
• 4 types
o Equinos – plantar rotation/ horse foot (most common)
o Calcenuous – dorsiflexion/ the heel is held lower than the foot/ the anterior
portion of the foot is flexed towards the anterior leg
o Varus – foot turns in
CRUTCHES
• Wait is on the palm not the axilla
• Exercise – squeeze ball
Swing Through
• Advance both crutches
• Lift both feet/ swing forward/ land feet in front of crutches
• Advance both crutches
• Lift both feet/ swing forward/ land feet in front of crutches
Swing To
• Advance both crutches
• Lift both feet/ swing forward/ land feet next to crutches
• Advance both crutches
• Lift both feet/ swing forward/ land feet next to crutches
To Sit Down
• Grasp the crutches at the hand pieces for control
• Bend forward slightly while assuming a sitting position
• Place the affected leg forward to prevent weight bearing and flexion
To Stand Up
• Move forward to the edge of the chair with the strog leg slightly under the seat
• Place both crutches in the hand on the side of the affected extremity
• Push down on the hand piece while raising the body to a standing position
To Go Downstairs
• Walk forward as far as possible to the step
• Advance the crutches to the lower step. The weaker leg is advanced first and then
the stronger leg. In this way, the stronger extremity shares the work of raising and
lowering the patient’s body weight with the arms
To Go Upstairs
• Advance the stronger leg first up to the next step
• Then advance the crutches and the weaker extremity ( strong legs goes up first and
comes down last.)
• A memory device for the patient is “UP WITH THE GOOD, DOWN WITH THE BAD”
WALKER
• A walker provides more support than cane andf crutches
• The patient is taught to ambulate with a walker as follows
o Patient must hold the walker on the hand grips for stability
o Lift the walker, placing it in front of you while leaning your body slightly
forward
o Walk into the walker, supporting your body weight on your hands while
advancing the weaker leg, permitting partial weight bearing or non weight
bearing leg as prescribed
o Balance yourself on your feet
o Lift the walker and place it in front of you again and continue the pattern of
walking.
CANE
• Used to help patient walk with greater balance and support and to relieve the
pressure on the weight bearing joints by redistributing the weight.
• Quad Cane (four – footed cane) is hold on the hand of affected extremity.
THERAPEUTIC EXERCISE
Exercise Description Purpose Action
Passive carried out by the To retain as much Stabiolize the
therapist or the nurse joint range of motion proximal joinyt, and
without assistance as possible support the distal
from the patient To maintain part. Move the joint
circulation smoothly, slowly and
gently through its full
rang of motion
Avoid producing
pain.
Active Assistance Carried out by the To encourage normal Support the distal
patient with the muscle function part and encourage
assistance of the the patient to take
therapist or the nurse the joint actively
through its ROM.
Give no more
assistance than is
necessary to
accomplish the
action. Short periods
of activity should be
followed by adequate
rest periods.
Active Accomplished by the To increase muscle When possible,
patient without strength active exercise
assistance, activities should be performed
include turning from against gravity. The
side to side and from joint is moved
back to abdomen through full ROM
and moving up and without assistance.
down in bed (make sure that the
patient does not
substitute another
joint movement for
the one intended)
TRACTION
• Use to reduce dislocation
Principles of Traction
• The client should be in dorsal or supine position
• For every traction, there is always a counter traction
• Line of pull should be in line with deformity
• For traction to be effective it must be continuous
• Weight must be freely hanging
Types of Traction
• Straight traction – weight of the body serves as counter pull
• Skin traction – applied directly to the skin
o Bryant’s Traction
use to immobilize for < 2 years old at a 90 ° angle with buttocks off the
bed
o Buck’s extension
For > 2 years old
• Halo traction – immobilize the spine
• Skeletal traction
o Nursing responsibilities
AUTOIMMUNE SYSTEM
• Types of Immunity
o Passive Natural
Developed via exposure to a disease
o Active Natural
Transplacental transfer, IgA from breastmilk
o Passive Artificial
Vaccination
o Active Artificial
Anti Rabies Serum
NEUROMUSCULAR SYSTEM
Reflexes
Blink reflex
• Rapid eye closure when strong light is shown to protect the eyes; never disappears
Palmar Grasp Reflex
• When a solid object is placed on the palm then the baby will grasp the object
• To cling to the mother for safety
• Disappears at 3 months
Step – in/ Walk – in Place Reflex/ Dance Reflex
• Neonate placed on a vertical position with their feet touching on hard surface will
take a few quick alternating steps
• Placing reflex almost the same with the dance reflex except that is when you are
touching the anterior surface of newborns leg
Plantar Grasp Reflex
• When an object touches the sole of the newborn’s foot at the base of his toes, the
toes grasp in the same manner as the fingers do
• Disappears @ 8 – 9 months in preparation for walking
Tonic Neck Reflex/ Fencing/ Boxing reflex
• When the newborn lies on its bact, their heads usually turns to one side, the arm and
the leg on the side to which the head turns extend to the opposite arm and legs
contract
Moro Reflex/ Startle Reflex
• With a loud voice or by a jarring the base of the crib, the baby will assume a c
position
• Test for neurologic integrity
Magnet Reflex
• When there is pressure at the sole of the foot, the baby pushes back against the
pressure
Crossed extension Reflex
• While supine and the sole of the foot is stimulated by a sharp object, it causes the
foot to raise and the other foot to extend
• Test for spinal nerve integrity
Trunk Incurvation Reflex/ Galant Reflex
• While in prone position and the parabvertebral area is stimulated, it causes flexion of
the trunk and swing his pelvis towards the touch
Landau reflex
• While the infant is placed on a vertical position with the hand underneath supporting
the trunk the baby exhibit some muscle tone
• Present at 3 months
• Test for muscle tone
Parachute Reflex
• When the infant is placed on a vertical suspension with the change in equilibrium, it
causes the extension of the hands and legs
• Present at 6 – 9 months
Babinski Reflex
• When the sole of the foot is stimulated by inverted j, it causes fanning of the toes
• Disappears by 2 months but may persist till 2 years old