CA2- MIDTERMS Lowest score is 0

PEDIA Highest score is 10

New born PROTOCOLS eg:
After 30 secs – keeping the baby warm Acrocyanosis –(1) body is pink extremeties are blue. (peripheral
- Skin to skin – prevent hypothermia, hypoglycemia cyanosis), Blue all over (0), Pinkish (2), HR less than 100 (1), More
- Within 30 timely cord clamping than 100(2), None (0), Strong cry (2),Sneezes (2),Facial grimace or
- Wait for the pulsation to disappear weak (1),No reaction (0),Muscle tone
- Timely cord clamping to prevent anemia VASTUS LATERALIS
st
1 90 mins – skin to skin promote bonding - is the most develop muscle at birth;
- Promote breastfeeding TWO ARE Related with one another: Grimice and respiration
- Adjust in the environment. INTERPRETATION:
- Assess how well the baby is adjusting 0-3: severely depressed (needs immediate resuscitation)
APGAR SCORING 4-6: moderately depressed, guarded (freq suctioning,
- Dr. Virginia Apgar thermoregulation, ref. to doc)
- First assessment that will be done 7-10: good condition
- 1 min after delivery then 5 mins after delivery – if both is ACROCYANOSIS- most common signs for score fo 9
lower than 7. *Poorly controlled DM mother: baby will be born hypoglycemic at
- 3rd Apgar score – if first and second Apgar score are below birth.
seven *it can affect APGAR (activity)/ level of consciousness will also be
A-pperance: skin color affected (Respiration)
P-ulse: HR - low APGAR SCORE, anticipate resuscitation equipment.
G-rimice: reflex, irritability Most important index of APGAR score (PULSE) – cause if the heart
A-ctivity: Muscle tone shut downs everything shuts down.
R-espiration: repiratory effort or rate GROWTH AND DEVELOPMENT
0 1 2 GROWTH (quantitative)
Appearance – Ht- non modifiable, ft, m, cm
Cyanosis Acrocyanosis Pinkish
Color Size- weight (kg/ lbs)
Pulse – HR (-) <100 100> Circumferential Diameter-(cm or inches)
Grimace – Head circumference
Weak cry, facial Strong cry, - 33-35
reflex and No reflex
grimace sneezes - place tape measure along the brow
irritability
Activity – Chest
Flaccid Some flexion All are flexed - 31-33
muscle tone
Respiration – - above umbilicus, 1 finger below umbilicus
Resp effort and No cry Weak cry Strong cry - nipple line
rate
Abdominal General to specific
- 31-33 - (common name, proper name)
RULES IN CIRCUMFERENTIAL DIAMETER EG:
- Head is bigger than the chest circumference for baby with less Child is able to write (printed before cursive) SIMPLE TO COMPLEX
than 1 y/o PALMAR TO GRIP (GROSS TO FINE)
- Head and chest equal (HC=CC) **SETS LIMIT IN GROWTH AND DEVELOPMENT: HEREDITY
- Chest bigger than head (CC> HC) > 2 y/o eg: Down syndrome/ society/ nutrition/ environment
- weight can be modified: most indicator of health. LIFT HEAD before the torso (CEPHALOCAUDAL)
- Monitor till 2 years old to prevent hydrocephalus Bird then eagle (GENERAL TO SPECIFIC)
DEVELOPMENT (qualitative increase in capacity to function) Untie to tie shoes (SIMPLE TO COMPLEX)
Parameteres: 5 STAGES OF DEVELOPMENT
Speech and Language ERICK ERIKSON P. SOCIAL
- “mama and dada” 9 to 10 months I: TRUST VS MT
- ma, da, gu, (6 to 7months) T: Autonomy vs Shame and doubt
Body language PS: Initiative vs Guilt
-gestures SA:Industry vs Inferiority
Motor Development A: Identity vs role confusion
- palmar grasp (simple to complex) SIGMUND FREUD
Sensory development I: ORAL
- sightm hearing (cognitive development) T: ANAL
Self-esteem PR: PHALLIC (Gender orientation)
-developmental milestone SA: LATENCY
-different stages of development A: GENITAL
DEVELOPMENTAL THEORIES *Related Phallic and genital, masturbation starts early as Preschool
PSYCHOSOCIAL - ERICK ERIKSON JEAN PIAGET/ COGNITIVE
PSYCHOSEXUAL - SIGMUD FREUD I: SENSORIMOTOR (SENSORY IS USE MORE OFTEN)
MORAL - LAWRENCE KOHLBERG T: SENSORIMOTOR (BOTH INCREASE) / WHAT QUESTION toddler
COGNATIVE DEV. - JEAN PIAGET object orientation
Different patterns of Growth development PS: PRE CONCEPTUAL or PRE OPERATIONAL / WHY (wants to find
Cephalocaudal meaning of everything)
- (head to toe) SA: CONCRETE OPERATIONAL/HOW (procedural stage)
Proximodistal A: FORMAL OPERATION/ POST OPERATIONAL/ WHAT IF (situational)
- (near to far)
Gross to fine I: AMORAL (doesn’t know what is right and what is wrong) PRIMARY
Simple to complex CARE GIVER best next choice MOTHER
- (easy to difficult) T: PRECONVENTIONAL STAGE I /Parents
PS: PRE CONVENTIONAL STAGE 2/ Family and a little bit of neighbors
S: CONVENTIONAL/ SOCIETY(Social norms), Peers (classmates)
A: POST CONVENTIONAL/ Peer groups(selected view)
*Who is most significant
INFANT 0-1 year (most rapid) GOATS
G- rows very fast
- Birth weight doubled by 6 months, tripled by 1 year,
quadruple by 2 y/o
- BWT: eg: 6.5lbs what is the expected weight in kg by 1 year
old 6.5 at birth x 3/ /19.5 =
O-ral stage
- By means of crying,
- Need to gratify the needs of the baby
- Unmet oral needs will do thumb sucking or nail biting
- Age of 9 nail biting: DO NOT SCOLD/ DO NOT FOCUS ON THE
NAIL BITING/ GIVE ATTENTION TO YOUR CHILD INSTEAD.
A- moral (no moral development)
T- rust vs Mistrust
- establish if needs are met / convey by crying: hunger, pain
- if needs are not met will develop in mistrust
- Misturst is evident when Stranger Anxiety starts at 6 months,
peak 9 moths, disappear in 12 months
- Object permanence: retain object/ image in his/ her mind
(REMEMBER).
S-olitary play and sensory motor, stranger anxiety
- Plays alone by himself
- Ensure safety
- Not too small, not too big, chocking hazard, no detachable
parts
- Colorful Rattle (produce sounds) Age: 5 months Grasping
reflex will be gone.
* toy given earliest 2 months: MUSICAL MOBILE
*Important criteria observe during play: SAFE PLAY
best toy for all ages: BALL (UNIVERSAL TOY)
******SAFTY SAFTY SAFTY!!!!
TODDLER 1-3 y/o PRAISE (best reward is praise)
P- arallel, parent(most significant person), push & pull (motor
development).
- Parents are omnipotent (PERFECT, they do not commit
mistakes).
- Copying everything what parents do
- Parents play important role
- Parallel play (SIDE BY SIDE) but not together.
- Jelousy can develop.
- What provided to one child needs to provide to the other child
also to avoid argument of the toddlers
R- ituals, regrassion, sibling rivalry (s/o because of the attention of
the parents)
- Rivalry disappear during school age. (learning how to share).
- Toddler doesn’t want to share, encourage toddler to share.
(BEST REWARD IS TO PRAISE).
- Enforces positive behavior.
- Ego centric
- Selfish
- Selfcentered
- Manupulative
- Toodlers always say no
- Sometimes the no of a toddler means yes
- RITUALS: routinary behavior; if mother sees the toddler to
introduce healthy rituals (toothbrushing, hand washing)
A-utonomy vs shame and doubt, anal stage
- Do not carry
- Wants to be on the floor to explore
- Allow toddler explore the environment to build autonomy
with limitation (Safety) of the environment.
- Allow to make simple decisions (choose, offer choices to the
toddler)
- If toddler develop trust during infancy the toddler will develop
autonomy easily.
I-nvolve the parents in the care of the toddler
S-eperation anxiety (that can lead to regression), Sensory motor.
E-nvironment (increases the curiosity of the toddler, he wants to
explore environment), elimination, exploration.
- Elimination (INDEPENDENCE); Control is established
- Holding on and letting go
- Stage of Controlling sense of autonomy.
- TT: temper tantrum
- TT: toilet training
- Maturation of anal spichnter ready for bowel training: WALKS
WELL.
- TOILET TRAINING: 1 ½ to 2 yrs old (18 months)
- BOWEL TRAINING: STARTS 1 ½ - 2 GAIN 2 ½ - 3
- THEN BLADDER – STARTS 2 ½ - 3 GAIN 3 -4
- READINESS OF THE CHILD and Not the mother
• Maintains dry diaper for many hours
• Points to the diaper when its full
• Interested in pleasing the parents
- Potty chair put a little amount of water: no distraction, no
food, no toys, no tv. Stimulate with the baby (Support from
the toilet).
- Until the toddler is conditioned
- No fluid before going to bed, urinate before going to bed.
- Teach toddler how to go the toilet by themselves.
- Involved siblings in toilet training
**TODDLER WANTS TO BE INDEPENDENT
*Best reward is praise
*Temper tantrum- to get what they want (adding pressure) IGNORE
except the toddler is hurting his or her self. (SAFTY FIRST)
eg: When the child hit head, carry toddler put on lap do not talk, just
embrace the child.
• When making promise to a child make sure to fulfill the
promise.
• ATTENTION SEEKING ATTENTION: REGRESSION notify parent
right away. (Sudden change of training)
PRESCHOOL 3-6 y/o (MAGIC)/ magical thinking (Fantasy)
M- utilation (castration)
- Phallic development: GENDER ORIENTATION (finally learn
gender)
- Curiosity: exploring the genitalias
- Knock in the child’s room: give singnal to the child: ask if
something wrong with the genitalia
- Masterbation happens in preschool (exploring)
- ODIPAL COMPLEX – Son to mother attachment
- ELECTRA COMPLEX- daughter to father attachment
*normal during early preschool, reverse attachment: BONDING
MOMENT
*son/father: bball, fishing, going to arcade, hiking
*daughter/mother: shopping, nail spa,
A-ssociative type of play
- Make believe play
- What ever mother or the father is doing.
- Associative/ cooperative
- TOYS: Building set, cooking set, medical set etc.
G-uilt
- if you always get mad at the toddler
- or not allow toddler to do things
I-nitiative, Imaginative, imitator
- Allow to try and experience
- When child satisfied their curiosity they will give excuses, let
the child go.
- invite the child to try.
- Sense of initiative is very important for the next stage.
- Imitator: period of role modeling
- Imaginative: living in the world of fantasy
- Day dreaming: Imaginary friend, SATISFIES THE EMOTIONAL
NEEDS OF THE PRESCHOOL.
- Death is only temporary: SLEEPING
C-uriosity
- Wants to try
- Experience causes they are curious
• To make to like to play; everything is play for them
*Significant other: family members (learns sense of sharing)
SCHOOL AGE 6-12 (DIMPLE)/ please the teacher 4- 45 degrees (prone position)
“good boy” “good girl”
D-eath 6- sit with support
- permanent 8- sit without support
I-ndustry vs inferiority 9- crawling/ creeping
- Compete, excel in school 10- standing with support
- Parents is support teacher 11- cruising(shorter distance to longer distance)
M-odesty 12- walking with support
- obedient 15- walking without support
P-eers 18- running/ jumping (short distances)
L-Loss of self control 2y/o- Same level/ climb stairs
- one problem 3y/0- alternates/climb stairs
E-xplination of the procedure **4-6 months common answer 6 Months
- HOW - sits with support- maturation of the cardiac sphincter
*most significant person: PEERS Teachers and classmates (AGE - teething- Lower central incisors (6months), 7 month upper central
BRACKET- SAME SEX) incisors, 9 months Upper lateral, 12 months lower laterals
*cooperatative/ competetive 2 ½ to 3 years old first dental check up (20 teeth complete)
*group play 6-7 years old tooth fall off
*LATENCY Permanent teeth 32
ADOLESCENCE 12-18 (most rapid) (PAIRS) *teething should not develop fever or diarrhea
*special relationship -disappearance extrusion reflex (spitting), infant is ready for solid
P-eer group food.
A-cceptance of bodily changes **Iron fortified cereal (1st)
I-dentiy • Vegetable and fruits (2nd)
Role confusion/ diffusion • Meat/ shredded
- Confused about his role in the family • Chicken Liver (softer than pork)
- He can not be what he wants to be(diffusion) • Hard boiled egg less than 1 yr old (egg yolk) egg white contain
S-eperation form peer group (fear of rejection) albumin that can cause allergic reactions more than 1 yr old.
*sexuality orientation. Causes of accidents
DEVELOPMENTAL MILESTONE Infant
*ability to lift head in prone position - Aspiration of foreign bodies
* roll over more than 4 months (Prone to supine) - Fall
0- 0 degree - Drowning (especially able to walk)
1-15 degree - Burns (scalding burn)
2- 30 degrees
3- 45 degrees (can not roll over) Toddler
 - Aspiration of foreign bodies 3. Cyanosis
- Fall *suction the baby, passageway will be cleared, color the baby will
- Drowning improve.
- Burns(scalding); not allow running in kitchen area; or tell them *BEST POSITION: Semi fowlers;
not to play in the kitchen especially someone is cooking. *Suctioning PRN
- Motor accident *Put on hold feeding (NPO)
PRESCHOOL *Refer baby to physician.
- Fall *ultra sound & xray of the neck.
- Drowning *Endotracheal tube-LONGER
- Motor accident *Feeding: TPN(High in glucose) Slow feeding to prevent
- Burns hyperglycemia, remove slow to prevent hypoglycemia
SCHOOL AGE *offer pacifier: to avoid forgetting to suck.
- Fracture (rapid long bone development) CLEFT LIP OR CLEFT PALATE
- Motor accident - Congenital anomalies that occur as a result of failure of soft
- Drowning tissue or bony structure to fuse during embryonic
ADOLECENTS developmental factors.
- Motor, vehicular accidents - Most common facial defect
- Heredity
PATHOLOGIC DISORDERS - Teratogenic Drugs: anticoagulant for pregnant woman:
RESPIRATORY HEPARIN (do not cross placenta)- safe
Tracheoesophageal Fistula (TEF) - COMADIN-Crosses placenta: not safe
- Abnormal communication of trachea and esophagus PROBLEMS
- Aspiration (problem) - Unilateral
- Aspiration Pneumonia (suctioning is very important) - Bilateral: wide
GERM LAYER - Sucking difficulty
Ectoderm - Difficulty of swallowing
- skin, nervous system, - Escape of milk formula through nose.
Mesoderm - Abdomen distention.
- heart, kidneys *feeding bottle: BIG NIPPLES to cover the canal
Endoderm CL CP BOTH
- respiratory & digestive system. One track. Common: Boys Girls Boys
- Esophageal Atricia- incomplete development of esophagus. Initial reaction of the parents: SHOCK AND DENIAL
3 C’s *ACCEPTANCE maybe hard for the parents:
1. Coughing TAKING IN- herself
- clear airway TAKING HOLD-interest with the baby
2.Choking LETTING GO- assume mother role
**PROLONG TAKING IN when baby has cleft lip or cleft palate - Dyspnea
How to increase acceptance: Focus on good aspect of the baby and - barrel chest
not the defect, do not show any discomfort in handling the baby, - goblet cells producing tenacious secretion (THICK AND
offer pictures before and after surgery (same case) STICKY).
Bilateral Cleft lip & palate: Problem feeding - Proliferate microorganismàpneumonia
- Position baby semi fowlers, or head must be elevated. - Check medical history: recurrent hospitalization due to
- Use feeding apparatus (LIP)- rubber tipped syringe, if not in bronchopneumonia (indicative of cystic fibrosis)
choices possible answer: Breck feeder. - Problem: oxygenation: CLUBBING OF FINGERS.
- PALATE: Large nipple - Activity intolerance
*some milk will stay in the oral cavity, give water after or use cloth - Liquefy(maintain good hydration status),
with water and clean mouth. mobilized(Coughing,turning,deep breathing, postural
Microorganismàinfectionàotitis media drainage, tapping) expectorate the secretion
SURGICAL REPAIR - Antibiotic therapy
CHEILOPLASTY: 3-6 months: LIP surgery - Pursed lip breathing (for lung expansion)
PALATOPLASTY: After Palate development before speech - USE: Expectorant, mucolytic, bronchodilator
development: speech defect of the child (Ave:12-18 months max:24 Postural drainange
months) - before meal to avoid vomiting
Integrity of sutures - secretion will move smaller to bigger airway.
CL CP - Upper lobe: sitting position/upright
Position Supine Prone - Lower: trendelenberg or kneechest position
Sign of Bleeding: frequent swallowing. - R.Middle lobe: side lying with pillow underneath
Place pillow in the back to prevent rolling over - L.Middle portion: right lying position with pillow underneath
HEALING PROCESS - Preformed tapping and fully hydrated: ask to cough to loosen
- Speech therapy secretion
- ENT DIGESTIVE SYSTEM (PRIORITY)
- Psychologist (subjected to bullying) - Meconium ileus in the newborn is the earliest sign.
- Orthodontist - Intestinal obstruction (distal intestinal obstructive syndrome)
CYSTIC FIBROSIS caused by thick intestinal secretions can occur, signs include
- Is a progressive and incurable disorder and respiratory failure pain, abdominal distention, nausea and vomiting.
is a common cause of death. Pancreatic duct: filled with tenacious secretion
- Affecting chromosome #7- responsible in the exocrine system PANCREATIC FIBROSIS
which produces mucus - Artificial Pancreatic Enzyme: Cotazyin & pancrease taken for
- Long arm of the chromosome #7 is defected life to less steatorrhea.
3 affected body system - Vit. ADEK
Respiratory system(PRIORITY) - Risk for Diabetes mellitus TYPE 1
- Wheezing and coughing Pancreatic Enzymes
 - Trypsin
- Amalyse
- Lipase
*malabsorption of fats/ undigested fat will go to the stool:
- STEATORRHEA: bulky stool, foul smelling.
- Deficiency of the fat soluble Vit ADEK, which can result in easy
bruising, bleeding and anemia.
- Malnutrition and failure to thrive is a concern.
Aspiration of the duodenal content:
- amount of lipase, trypsin, amalayse (absence of pancreatic
enzymesàultrasound of pancreas); pancreatic fibrosisà
insulinà Diabetes
REPRODUCTIVE SYSTEM
- Can delay puberty in girls
- Infertility (plugged with secretion) due to highly viscious
cervical secretions, which act as a plug and block sperm entry.
- Males are usually sterile (but not impotent), caused by the
blockage of the vas deferens by abnormal secretions or by
failure of normal development of duct structures.
Anovulation- unable to ovulate
- Prone to ectopic pregnancy (ASSISTED PREGNANCY:IN VITRO
FERTILIZATION if fallopian tube has a problem)
- IN VITRO: Harvested sperm,will be fertilize in the dish then egg
cell will be implanted.
- Male: low sperm count instead of having a normal amount of
sperm.
INTERUMENTARY
- Abnormally concentrations of sodium and chloride in sweat
are noted.
- Infant taste salty when kissed
Sweat test: 40-60meq
- Skin baby dried, electrode will be attach, ions
PYLORIC STENOSIS
- Hypertrophy of pyloric spintchter causes narrowing of the
pyloric canal between the stomach and the duodenum.
- Causes are unknown
- Even the milk is having a hard time passing thru.
- At birth asymptomatic
- Signs & symptoms will appear after feeding the baby: milk
accumulating in the stomach, Stomach will distend;
ABDOMINAL DISTENTION
- Metabolic alkalosis
CARDIAC SPHINCTER: MATURE in 6 Months
- Prevent reflux and regurgitation
- Projectile vomiting: classical sign
- (NON BILE STAIN)- defect is above the common bile duct.
- Is not yet mature during birth.
- If defect is below the common bile duct: possible bile stained
vomitus.
*with hold feeding and look for other sign & symptom
*palpate abdomen: olive shape mass right upper quadrant
*several days after: prone to dehydration and possible constipation
*visible peristaltic wave: some milk will force to flow LEFT UPPER
QUADRANT TO THE RIGHT UPPER QUADRANT
*own decision making: NPO 10-14 days
-offer pacificer/ allow mother to hold baby
*position baby: ELEVATE THE HEAD
NOTIFY DOCTOR, utz, xray.
*Decompress the stomach before surgery: LAVAGE
PYLORIPLASTY: removed thick area
*Healing process: Stricture will develop (SCAR FORMATION)
PYLOROMYOTOMY
- An incision through the muscle fibers of the pylorus, may be
performed by laparoscopy.
CONGENITAL HEART DISEASE(CHD)
- #1 cause rubella infection during the first trimester of
pregnancy: virus crosses placenta
- period of organogenesis (First trimester)
- #1 complication of CHD is congestive heart failure (CHF)
 - #1 cause in young children is CHD
- *MOST PREVALENT DEFECT in CHD is VENTRICULAR SEPTAL
DEFECT
- Muscle of the Left ventricle is thicker than the Right ventricle
- Can affect the size of the baby IUGR (intrauterine growth
restriction)
- SGA baby: 10%
2 TYPES
1. ACYANOTIC- not cyanotic at birth
1. Obstructive lesion (not shunting of the blood, narrowing or
constriction).
- Pulmonic valve stenosis (PVS)-narrowing of the pulmonic valve
- Aortic valve stenosis (AVS)- narrowing of the aortic valve
- Coarctation of aorta(COA)-narrowing of descending aorta
PULMONIC VALVE STENOSIS
- R. Artirum, L. Ventricle
- None shunting of the blood, no abnormal opening on the
septum
- Blood from RV can not flow easily due to pulmonary stenosis,
compensatory of the RV to accommodate the pulling of the
blood THE RIGHT VENTRILCLE WILL DISTEND followed with
hyperthropy purposed is to push blood in the narrowed
Pulmonic valve.
- The blood from RV will go back to RAà since RA un able to
accommodate all the bloodà inferior vena cava
- CAUSING 3rd DISTENDED NECK VEIN, 2nd
Hepatospleenomegaly and 1st PEDAL EDEMA.
- Right sided heart failure
MANAGEMENT
- Correct: VALVE REPLACEMENT (ARTIFICIAL VALVE)
AORTIC VALVE STENOSIS (AVS)
- PULMONARY EDEMA
- Left sided heart failure
MANAGEMENT: VALVE REPLACEMENT
COARCTATION OF THE AORTA (COA)
- Decending aorta
- Hypertension on Upper extremities (MOST COMMON SIGN)
- COOLER & PALLOR in lower extremities
- WEAK PULSE: Lower
- Localized narrowing near the insertion of the ductus
arteriosus.
- Blood pressure is higher in the upper extremities than in the
lower extremities: bounding pulse in the arms, weak, or
absent femoral pulses and cool lower extremities may be
present
- Signs of heart failure may occur in infants.
- Decreased cardiac output may be present.
- Children may experience headache, dizziness, fainting and
epistaxis resulting from hypertension
- Management of the defect may be done via balloon
angioplasty in children, restenosis can occur.
- Mechanical ventilation and medications to improve cardiac
output are often necessary before surgery.
- Resection of the coarcted portion with end to end
anastomosis of the aorta or enlargement of the constricted
section, using a graft, may be required.
- Cardiopulmonary bypass is not required and thoracotomy
incision is used instead.
POST OP: CONSTIPATION SHOULD BE AVOIDED
- straining gives pressure to the aorta
2. Left to right shunt (INCREASE PULMONARY BLOOD FLOW)
AORTIC SEPTAL DEFECT (ASD)
- The septum that divides the RA to LA is not fully developed
- 25% will cross and 75% will go down (oxygenated blood)
- compensatory: Will pump faster RA going down to the RV.
MANAGEMENT: Open heart surgery (DACRON PATCH AND TEFLON
PATCH)
VENTRICULAR SEPTAL DEFECT (VSD)
- blood shunted towards the R. ventricle
- An abdominal opening between the right and left ventricles.
- Defect not corrected early, the RV will gradually goes
Hyperthropy.
 - If the R. Hyperthropy it will be reverse causing now to have a
CYANOSIS.
- Dr. will entertain REVERSAL OF SHUNT due to hyperthropy.
MANAGEMENT: Open heart surgery (DACRON PATCH AND TEFLON
PATCH)
ATRIOVENTRICULOCANAL DEFECT or ATRIOVENTRICULOSEPTAL
DEFECT (AVCD or AVSD)
- Reversal of Shunt is FASTER
- RA is receiving blood from superior and inferior vena cava à
added blood from LA 25% crosses to RA, 75% goes down and
another 25% crosses LV to RV
- More blood added in the Right side of the heart
- RV will hyperthropy FASTER Causing Reversal of the shunt.
- REPAIR first is VENTRICULAR SEPTAL DEFECT to avoid over
hyperthropy of the RV then after several months with under
go repair of Atrial septal defect.
PATENT DUCTUS ARTERIOSUS (PDA)
- Ductus arteriosus: between aorta and coronary artery
- Ductus arteriosus closes between 24 hr to 48 hrs after
delivery.
- Foramen ovale closes 12 hrs after delivery.
- patent ductus arteriosus
- (L to R shunt) AORTA is superiorly located compared to the
pulmonary artery y gravity some of the blood from aorta goes
back to the pulmonary artery.
- Machinery-life murmur is present
- Asymptomatic or may show signs of heart failure
- Widen pulse pressure and bounding pulse are present
INDOMETHACIN (DRUG)
- Will stimulate closure of ductus arteriosus
- Prostaglandin inhibitor, may be administered to close a patent
ductus in premature infants and some newborns.
- Defects may be closed during cardiac catheterization or the
defect may require surgical management.
2. CYANOTIC- cyanotic at birth
- right to left shunt (DECREASE PULMONARY BLOOD FLOW)
- R: Unoxygenated
- L: oxygenated
- MOST COMMON CYANOTIC DEFECT IS TETRALOGY OF
FALLOT
TETRALOGY OF FALLOT (TOF)
Includes 4 defects: PROVE
- If pulmonary vascular resistance is higher than systemic
resistance is higher than systemic resistance, the shunt is from
right to left; if systemic resistance is higher than pulmonary
resistance, the shunt is from left to right.
Pulmonic Valve stenosis (REPAIR FIRST)
- lungs, brain, and extremities
Right ventricular hyperthropy
– due to pulmonic valve stenosis
Overriding of Aorta (2nd to REPAIR)
– override in the middle
Ventricular Septal Defect (LAST TO REPAIR)
MANAGEMENT: 2D ECHO & ULTRASOUND (appearance: BOOT
SHAPPED HEART)
TRANSPOSITION OF GREAT VESSEL (TOGV)
- Brain is receiving majoraty of deoxygenated blood (VERY
DANGEROUS)
- Maintain the foramen ovale, maintain the ductus arteriosus.
*GIVE PROTOGLANDIN DRUGS to prevent closure of the ductus
arteriosus.
*survival rate: VERY LOW
VERY CYANOTIC AT BIRTH
PULMONARY ARTERY AND AORTA
TRICUSPID ATRISIA (TA)
- tricuspid valve is missing (did not developed)
- at birth the foramen ovale would not closeà RA receive two
sources of blood from superior inferior vena cava.
- Compensatory of RA will pump stronger that’s why blood is
shunted toward LA mixed blood going down to LV mixed blood
 then goes to the Aorta and some will go to VSD to the RV
going to the Pulmonary artery to the lungs. (BLOOD
CIRCULATION)
- 2 life saving defect: patten foramen ovale and VSD
- will not close unless placed an ARTIFICIAL TRICUSPID VALVE à
then closure
- If foramen ovale at birth closes the baby will die (no
circulation of the blood).
- Higher Chance of Survival
Diagnostic Exam: 2DECHO
Laboratory exam: CBC, ABG, oxygenation level always being
ASSESSED, Pulse Oxymetry (ALWAYS)
**No. PROBLEM OF TOF: HYPOXEMIA à requires heart to pump
faster (TACHYCARDIA), decreses o2 supply in brain signals medulla
oblongata to increase the rate of breathing (TACHYPNEA), CLUBBING
OF FINGERS.
- Rapid breathing: infant can not coordinate rapid breathing and
swallowing (PRONE TO ASPIRATION)
- Feeding difficulty
- Bone marrow produced immature RBC (POLYCETEMIA)
- Increase viscosity of blood (blood clot problem)
- Give anticoagulant
- Possible pneumonia
GIVE UNTHICKEN FORMULA- easily to suck
FORMULA- LONALAC (low in sodium)
Monitor growth of the baby, support growth and dev. Of the child.
*Child can moderate his own activity AND NOT LIMIT IT!
TET SPELL: Knee chest position/ squatting
DRUG: DIOGXIN(digitalis therapy) do not give if HR of child is infant
below 100, below 90, preschool below 80, school age below 70, Adult
below 60
CHECK VITAL SIGN: HR