Bullets in pediatric nursing
an increase in physical size. Human growth is orderly and predictable, but not even
an increase in the complexity of function and skill
Growth and development proceeds in:
Proximodistal Cephalocaudal General to specific
Fast growth periods:
Infancy and Adolescence
Slow growth periods:
Toddler through school-age
BIOGRAPHICAL CHARACTERISITCS WEIGHT •
Physiologic weight loss: losing 5 – 15 % of actual BW Birth weight doubles by 5-6 months. Triples by 12 months.
Length Average birth length: 50 cm, increase by 50% in 1 yr, double by 4 yrs of age
IMPORTANT DEVELOPMENTAL MILESTONES 2 MONTHS:
Posterior fontanelle closes (2-3 mos)
Head is steady
Rolls back to side
.HEAD CIRCUMFERENCE (Occipito-frontal Circumference) Average HC: 34-35 cm HC > CC at birth HC = CC @ 1 yr CC > HC @ 2 yrs CHEST CIRCUMFERENCE Normally about 1 inch (2cm) less than HC.
Brings object to mouth
Birth weight usually doubled
Completely rolls over
Smiles at mirror image
10 MONTHS Cruises Object permanence
11 MONTHS Stroll while holding on to a person or an object
12 MONTHS Stand w/o help and walks 8 teeth by end of 1st year
Rice-based cereal vegetables and fruits pureed meat 6-7 months .can drink from cup with some spilling BULLETS PEDIA DISORDERS HYDROCEPHALUS
Enlargement of the head characterized by an increased in the amount of CSF within the ventricle of the brain.has strong extrusion reflex.able to start supplemental feeding.developmentally ready to chew solid foods. 8-9 months . By 4-6 months .
By By By
Understands simple commands
FEEDING MILESTONES At 1 month . Manifestations: (BIDDS)
B-ulging fontanel I-rritability Downward rotation of the eyes D-ecreased level of consciousness S-separation of sutures Shunting
Labs: Serial Trans-illumination. Lumbar Puncture Treatment: Nursing Care: Check neuro status Post-op care
DO NOT flex neck on the side where the shunt is placed
.can hold a spoon 12 months .
Shunt.eformities S-ensory losses
Labs: Physical Exam Treatment:
Antibiotics . Surgery. Immobilization
Nursing Care: Preventing trauma to the sac
. Observe for signs of infection Observe for signs of ICP
Parental teaching SPINA BIFIDA
Failure of posterior vertebral arches to fuse during embryonic
development Manifestations: OCCULTA: (LACE)
L-ateness in walking H-ydrocephalus
A-lteration of motor function
C-hronic back pain
N-eurogenic bladder and bowel
meningitis. great vessels. or both that are present from birth
Cover with sterile dressing soaked with normal
Prone or side-lying position
Protective barrier drape
Signs of hydrocephalus. joint
Adjust objects according to position
Emotional support for parents/family
CONGENITAL HEART DISEASE CHDs are structural defects of the heart.
M-urmur C-ongestive heart failure R-espiratory infection I-rritability B-ounding pulse
Labs: ECG Treatment:
Provide parents education about treatment option. PDAs are
treated either surgically or non surgically VENTRICULAR SEPTAL DEFECT
An opening that communicates between the L and R ventricle.
2nd only to prematurity as a cause of death in the first year of life PATENT DUCTUS ARTERIOSUS
Failure of the a blood vessel to close after birth.
M-urmur E-xcessive Sweating R-espiratory infection C-ongestive Heart Failure
Labs: Doppler U/S and ECG
treated either surgically or non surgically. Manifestations: (MEET-C)
M-urmur E-pisodes of hypercyanosis
. COARCTATION OF THE AORTA
A defect that involves a localized narrowing of the aorta Manifestations: (BLEED)
B-ounding pulse L-eg cramps E-pistaxis E-elevated UE blood pressure D-decreased LE blood pressure Balloon angioplasty
Labs: Electro and Echocardiography Treatment:
Provide parents education about treatment option.
TETRALOGY OF FALLOT
A disorder consisting of 4 abnormalities in the structure of the
Provide parents education about treatment option.
Monitor the status of the child during tet spells Provide parents education about treatment options. E-xertional dyspnea T-ransient cerebral ischemia C-lubbing
Labs: Electro and Echocardiography Treatment:
Blolock-Taussig shunt. O2. Phenobarbital
or Haldol. morphine sulfate. digoxin and diuretics Nursing Care:
. NaHCo3. Corticosteroids. Provide pre-op and post-operative care
RHEUMATIC HEART DISEASE / RF
A pancarditis that follows after exposure of a child to
an infection caused by Group A Beta-hemolytic organisms
Repeated bouts with permanent scarring of the valves RHD
Manifestations: JONES CRITERIA (2 MAJ OR 1 MAJ & 2 MIN + STREP INFECTION) MAJOR: (SPEC) MINOR: (FACE)
S-ubcutaneous Nodules F-ever P-olyarthritis A-rthralgia E-rythema Marginatum C-reative protien positive C-arditis E-levated ESR
Aspirin for 4 weeks. penicillin.
mmunosupression L-arge organs E-asy bruisability
Labs: Bone Marrow aspiration Treatment: Nursing Care:
Chemotherapy and Bone marrow transplantation
Assess for signs of infection Be alert if the neutrophil count drops below 1.
Malignant disorders of blood forming cells characterized by UNCONTROLLED proliferation of WHITE BLOOD CELLS in the bone marrow. vomiting.000 cells/mm3 Maintain skin integrity
. Obtain baseline pulse
Avoid situation that increase cardiac demand nausea.replacing marrow elements.
Types: ALL and AML Manifestations: (BRAILE)
B-leeding R-RBC decreased /Anemia A-activity intolerant / Fatigue I. arrhythmias Maintain accurate input and output LEUKEMIA
Administer digoxin and WOF s/s of toxicity like anorexia.
Provide pain relief Provide Adequate hydration. antibiotics.g. IV fluids and
Monitor normal return of bowel sounds after the procedure Administer clear fluids and advance the diet gradually
. electrolytes Manage bleeding with transfusions and ice packs Provide Oral care and mucosal care (no rectal thermometer) Provide information as to therapy.chemo and bone marrow transplantation
Invagination of a section of the intestine into the distal bowel
C-olicky abdominal pain Bile-stained fecal emesis C-urrant jelly stools
Labs: Barium Enema Treatment:
Monitor for signs of perforation and shock Prepare for hydrostatic reduction e.
Results in mechanical obstruction from inadequate motility in an intestinal segment. Manifestations: (DRIVE)
D-elayed growth R-efusal to suck I-nability to pass meconium V-omiting E-Enlargement of abdomen
Labs: Barium Enema Treatment: Nursing Care:
Surgery – Double Barrel Colostomy
Daily rectal irrigations with normal saline to promote adequate elimination and prevent obstruction Provide pre-operative and post-operative care NEPHROTIC SYNDROME
A set of clinical manifestation arising from protein wasting secondary to diffuse glomerular damage
A massive proteinuria.
A congenital anomaly that occurs as a result of an absence of ganglion cells in the rectum and upward in the colon. hypoalbunemia. hyperlipidemia and
edema Manifestations: (DHAWP)
D-ark frothy urine H-ematuria A-anemia
Antibiotics Nursing Care:
Monitor vital signs and I and O Monitor urine specific gravity and albumin Maintain bed rest during periods of edema Administer the prescribed medications Instruct the parents about the side effects of corticosteroid therapy GLOMERULONEPHRITIS
A variety of disorders caused by an immunological reaction Results in proliferative and inflammatory changes within the glomerular structure
Loss of kidney function may develop Manifestations: (PHEWSS)
P-roteinuria H-ematuria (Gross) E-dema W-eakness Scanty Urine
. Plasma expanders. W-eight gain P-roteinuria
Labs: Urinalysis Treatment: Corticostroids. Diuretics. Immunosupressants.
cardiac failure NEPHROBLASTOMA / WILM’S TUMOR
A tumor of the kidney. daily weight Administer diuretics. Diuretics. and Anti-HPN Nursing Care:
Rest Diet: high calorie. It could be unilateral or bilateral. antihypertensive. low protein Monitor VS. S-mokey / Cola-colored urine
Labs: Kidney Function Test Treatment: Antibiotics. antibiotics as prescribed Monitor for signs of renal failure. I and O. Peak incidence is 3 years old
A-bdominal pain L-ethargy P-allor H-ypertension and Hematuria A – Abdominal mass
Labs: Biopsy Treatment:
chemotherapy with radiation or without radiation Nursing Care:
Monitor V/S especially BP Avoid palpating abdomen Measure abdominal girth Monitor for signs of hemorrhage Monitor intake and output JUVENILE RHEUMATOID ARTHRITIS
An autoimmune inflammatory disease affecting the joints.Nephrectomy .
Occurs most in girls before 16 years old. Manifestations: SYSTEMIC: Fever Salmon pink rash
Affects 5 or more joints PAUCI-ARTICULAR: Mild joint pain and swelling iridocyclitis Affect no more than 4 joints
cytotoxic drugs and corticosteroids Nursing Care: Monitor the child for aspirin toxicity Assit with ROM exercises and encourage perfroamce of ADLs Instruct on the use of hot or cold packs. splinting and positing during painful episodes Instruct on the importance of eye care and reporting visual disturbances Refer to the physical therapist
A chronic disorder of impaired glucose. Nsaids. Type 1 DM Insulin dependent Diabetes Mellitus 2. protein and fat metabolism due to lack of insulin CLASSIFICATION OF DM 1. Type 2 DM
Morning stiffness Low-grade fever
Affect 5 or more weight-bearing joints Labs: X-ray Treatment: Aspirin.
UPPER ARMS. Classic 3 P’s 2. altered gait Decreased LOC
. Gestational DM Diabetes Mellitus diagnosed during pregnancy 4. Body weakness 4. restlessness Hunger. Visual changes 5. Recurrent skin and mucus membrane infections LABS:
FBS equal to or greater than 126 mg/dL (7.Non-insulin dependent Diabetes Mellitus 3. DM associated with other conditions or syndromes ASSESSMENT FINDINGS 1. Slow wound healing 6.ABDOMEN. Fatigue 3. dizziness. THIGHS and HIPS Insulin reaction – Hypoglycemia
Headache. visual disturbances Slurred speech.0 mmol/L) OGTT value 1 and 2 hours post-prandial equal to or greater than 200 mg/dL RBS of equal to or greater than 200 mg/dL PLUS the 3 P’s Glycosylated Hemoglobin Urine test
Four main areas for insulin injection are.
Pallor. cold. GOAL: To save newborn lives thereby reducing newborn mortality
rate by at 50% from preventable causes 3 BASIC COMPONENTS OF ESSENTIAL NEWBORN CARE PROTOCOL: Time-bound care / procedures
Non-time bound care / procedures
Unnecessary care / procedures
4 SUB-COMPENENTS OF TIME-BOUND CARE: Immediate and thorough drying
Early skin-to-skin contact with the mother
Properly-timed cord clamping and cutting
. clammy skin
A call to action by the DOH to implement the Essential
Newborn Care protocol.
Non-separation of the mother and newborn for early
breastfeeding 4 SUB-COMPENENT OF NON-TIME BOUND CARE Immunization
Weighing and washing
4 SUB-COMPONENTS OF UNNECESSARY CARE:
Footprinting Routine suctioning Adminsitration of prelactals Routine observation and assessment