APGAR Appearance - assess color Pulse - assess heart rate Grimace - assess reflex irritability Activity - assess muscle tone Respiration - assess respirations Virginia Apgar - formulated APGAR scoring APGAR scoring - do twice 1st scoring - 1 min after birth 2nd scoring - 5mins after birth 3rd scoring - if 1st and 2nd scoring is below 7 score, 10mins after birth Purpose: Evaluate adaptation of the newborn baby to extrauterine life Extrauterine - outside the uterus What is the lowest score per item? — 0, zero Average score —1Highest ae Total lowest score aan) Total highest score —10 Appearance Acrocyanosis: 1 body pink, extremities blue Cyanotic: 0, all blue Pink all over: 2 Pulse <100: 1 100>: 2 Grimace Sneezes: 2 Strong cry: 2 Weak cry: 1 Baby didn't cry but grimace: 1 No reaction at all: 0 Activity All extremities well flex: 2 Some flexion: 1 All extremities extended: 0, flacidRespiration Good strong cry: 2 Weak cry: 1 No cry/resp: 0 Most important parameter: PULSE Possible result of APGAR scoring: 0-3 - severely depress * perform resuscitation— artificial resp or CPR 4-6 - moderately depress * constant monitoring + frequent suctioning * condition is guarded 7-0) * best possible condition Assessment instrument required: * stethoscope What is the number one cause of having 9-10? — acrocynosis Situation: 90 HRSome flexion Pink all over Good strong cry Sneezes Tot: 8/10 Growth and development Growth -> quantitative Size - wt - kg-g- lbs Ht.- length - ft, meter, inch, cm Circumferential diameters - inch/cm Most important indicator of health: WEIGHT Height: does not fluctuates Wt: fluctuates Circ. Diameter Head circ - 33-35cm Chest circ - 31-33cm Abdominal circ - 3-33 (1 finger breath above the umbilicus) HC>CC/AC - Tyrs old HC=CC/AC - 1 to 2 yrs old CC/AC > HC - 2yrs old above Until what age do we monitor the circumference?— 2yrs old 6 month old baby undergoing a well baby check-up which of the following will the nurse least likely to assess? oWeight eTemperature oHeart rate oHead circumference Development -> qualitative increase in the capacity to function What are the different body parameters? - Speech and language (verbal) - Body language (nonverbal) - Motor development ~ child will learn to go up first ~ removing ~ untie shoelace ~ unbuttoning the blouse - Sensory development (cognitive development) = visual « olfactory = auditory - last sense when a person is dying = tactile - most developed sense at birth « gustatory- Self esteem Theories affecting growth and development Psychosocial (erik erikson) Psychosexual (sigmund freud) Cognitive (jean piaget) Moral (lawrence kolberg) Age-significant person-fear-toys Infant (0-1) primacy care giver - stranger anxiety - solitary(plays alone) - rattles (4-5) Toddler (1-3) parents - sepanx - parallel - push and pull Preschool (3-6) family/neighbors - mutilation - associative/cooperative - activity set (cooking set, dress up dolls, med set) Schoolage (6-12) peers/teacher (GMRC) death/ failure in school - competitive - ball Adolescence (12-18) peer group - rejection, loss of privacy - competitive - ball Theories affecting social Age-psychosocial-psychosexual-cognitive Infant - trust and mistrust - oral - sensory Toddler - autonomy vs shame and doubt - anal - Sensory Preschool - intiative vs guilt - phallic - preconceptual/ preoperationalSchoolage - industry vs inferiority - latency - operational/concrete operational adolescence- identity vs role confusion/diffusion - genital - post operational/formal operational Moral development Infant - amoral (absence of moral) Toddler - preconventional stage 1 Preschool - preconventional stage 2 Schoolage- conventional Adolescence- post conventional PATTERNS Cephalocaudal - head to toe + head + torso before the hips Proximodistal ‘arms Gross to refine * palmar Simple to complex General to specific FACTORS AFFECTING G AND D Socioeconomic status NutritionEducation Environment Heredity (trisomy 21) INFANT G AND D Grows very fast Oral Amoral Trust vs mistrust Trust: needs are met Crying - hunger - pain - discomfort - affection Mistrust: needs not met Stranger anxiety: starts at 6months - peak on 9months- fade at 12months Object permanence - infant at 6months can already remember the face of the primary care giver Sensory motor; solitary; stranger anxiety Musical mobile - 2months old 18-20hrs of sleep: for cognitive development What should be the characteristics of the toy of the infant?~ not to big ~ not too small ~ no detachable parts What is the most important criteria of a toy of a child in any age? oAge appropriate oSize eSafe oNon-toxic Age appropriate toy? e ball (universal toy) o stuffed toy ° doll ° clay dough DEVELOMENTAL MILESTONES OF INFANT ~ specific task that the child must perform ona specific age 0-0° 11159 2 - 30° 3 - 45° 4-45° 6 - sits with support8 - sits without support 9 - crawling/ creeping 10 - stand with support 11 - cruising 12 - walks with support 15 - walks without support 18 - running/jumping 2 yrs old - same level (ability to climb) 3 yrs old - alternates (alternates feet to climb) 0 - cannot lift head from head 1-4 ability of infant to lift his head from the bed 6 MONTHS ©QG- sits witH suPPORT (MATURATION) @@O.- teething (2 Lower central incisor) 20 DECIDUOS TEETH - 2 AND A HALF TO 3 YRS OLD DECIDUOS TEETH FALL OF BY ITSELF - 6 TO 7 YEARS OLD 6-7 ERRUPTION OF PERMANENT TEETH (32 TEETH) @@@GGB- disapperance of extrusion reflex (REGARDED AS FEEDING REFLEX AND PROTECTIVE REFLEX) @006 - infant is ready for solid foods 7MONTHS - UPPER CENTRAL INCISOR QMONTHS - SIDE OF UPPER CENTRAL INCISOR 1OMONTHS - SIDE OF LOWER CENTRAL INCISORTEETHING IS NORMALLY ACCOMPANIED WITH FEVER AND DIARRHEA? -NO First food to provide to infant 1. lron-fortified cereals - to prevent iron defficiency (anemia) 2. Fruits + banana/apple in moderation (to prevent) constipation * papaya (mashed) * orange (squeeze) * mango in moderation + pear (mashed) [can brush the infant's teeth 3. Vegetables (boiled/mashed) * carrots * squashed * potato + chayote * vege before fruits 4. Meats + chicken (breast part shredded and chopped) chicken liver+ pork (shredded and chopped) + fish (mashed) + egg (yolk less than Tyr old) ~ white contains albumin can cause allergic reactions ~ hard boiled + Beef - 1 and a half yrs old and above Grows very fast = birth weight 6mos (doubles) 1yrs old (triples) 2 yrs old (quadro) TODDLER ~ negativistic (nonverbal temper tantrums) Intervention for tantrums: ignore, except when toddler is hurting himself ~ theme of toddler is holding:on and letting go Intervention: encourage the toddler to share ~ gender orientation P-arents, Parallel, Push and pull R-ituals, routines, regression A-nal, autonomy vs shame and doubt I-nvolve the parents in the care of the toddler S-ensory motor, separation anxiety, sibling rivalry,selfish E-nvironment, explore, eliminations, egocentric Autonomy Allow toddler to explore Allow toddler to chose Selfish ~ Significant persons only are the parents Parralel play ~ separate side by side ~ push and pull promotes motor development No. 1 physiological sign of readiness that the toddler is ready for toilet training? ~ walks well (maturation of the anak spincter) ~ age 1 and a half, between 15 to 18 months Toilet Training types: = bowel training - gained 2 and a half to 3 yrs old « bladder control - achieved 3:to 5 years old, average of 4 Effective Training: © potty chair Ono distraction Form of distraction: no tv, no food, no toys, noplaymates Sibling rivalry ~ scold equally ~ spend time equally 4 psychological adaptation to separation anxiety 1. Protest - 2. Despair 3. Denial 4. Recovery Cognitive Development |- none T - what - objection orientation PS - why SA - how - procedural A - what if PRESCHOOL Mutilation Associative Guilt Intiative, imitator, imaginative Curious/Castration Death is temporary/sleeping Boastful - tall tales, exagerated talesPhallic stage - gender orientation *im_a boy because i have a bird * im a girl because i have a flower + Masturbation start at Preschool Oediphal/oedipus complex - son to mother attachment Electra complex - daughter to father attachment Intervention: allow bonding moments SCHOOLAGE D-eath I-ndustry vs inferiority M-odesty P-eers L-oss of self-control (competitive) E-xplanation of procedures © social norms = accdng to erik erikson schoolage develops industry vs inferiority ~ to establish industry, there must be initiative, sense of competence ADOLESCENCE ~ sexuality orientationP- eer group, privacy A- cceptance of bodily changes |- dentity R-ple confusion/diffusion, rejection, relationships S-eparation from peer group Puberty - age of 9-17 Menarch - age of 12 Female secondary sex development A-ccelerated linear growth ~ increase in height B-roadening of hips T-herlarche (enlargement of breast) A-drenarche (pubic hair:mons pubis inverted triangle) M-enarche O-vulation I-ncrease cagunal secretions Earlist sign of the sexual dev in female? TAMO: thelarche, adrenarche,; menarche, ovulation Growth spurt: ~ rapid long bone development (femur) Girls - 9 to 11 yrs old Boys - 12 to 14 yrs oldEarlist sign of sexual dev in male? I-ncrease in weight B-roadening of shoulders G-rowth of testes * scrotal growth V-oice changes (deepening of voice) A-drenarche (pubic hair: base of penis, facial, axillary) Penile growth Increase in height - 12 to 14 yrs old Spermatogenesis Commom causes among the accidents Infants ~ aspiration of foreign bodies x toys ~ fall + bed ~ burns: scalding burn "lapnos" % while bathing ~ suffocation x plastics ~ drowning x do not let the door of the bathroom open xx do not leave a basin of waterToddler ~ aspiration of foreign bodies x toys ~ fall x bed x stairs x table % chair ~ burns: scalding burn "lapnos" x while bathing ~ suffocation x plastics ~ drowning % do not let the door of the bathroom open x do not leave a basin of water ~ poisining/overdose yx when parents treats drug as candy x childproof containers = push and twist bottles ~ motor accident x what's far is close, what's close is far Preschool ~ fall x tree x fence~ burns ~ drowning ~ poisoning ~ motor accident Schoolage ~ fracture ~ motor accident ~ drowning Adolescence ~ motor/vehicular accident x don't drink if going to drive, don't drive if you're already drunk ~ fracture ~ drowning PROBLEMS OF THE ADOLESCENCE e acne bulgaris ) sebaceous gland e body odor ) apocrine gland PATHOLOGIC PEDIA Cleft Lip and Cleft palate ~ facial malformation Cleft Palate - unilateral and bilateral or combination of the two- Most prone to respi infection Unilateral bilateral GL CP BOTH Boys girls boys Accumulated & 1 &|| ay milk can cause respiratory FEO infection —o* . & wt Drying is the most common cause of infection Shock and Denial ~ parent jnfsnt bonding problem 3 psychological Taking-in - herself, 1 to 2 days primi; 1 day multipara Taking-hold - show interest to baby Letting-go - commit to responsibilities Procedure done with cleft lipCheiloplasty - 3 to 4 months Rule of 10: 10 weeks old 10g hgb 10lbs Feeding device - Rubbertip syringe/dropper/ medicine dropper (unaffected side) Procedure for Cleft palate Palatoplasty - done before speech development, after palatal dev. Age - 18 to 24 months Feeding device - wide bowl spoon (lick the milk) ) Large nipple - feeding bottle Procedure for both Uranoplasty - cleft lip will be fix first Feeding problems: ) aspiration ~ upright position * frequent burping © coli, accumulation of gas Postsurgery! Cheiloplasty Palatoplasty Maintain integrity of the suture line Supine position prone positionMinimize crying (Attend to the need of the baby) (Offer the most significant person to be present) Logan Bar Prevents Overstretching of the lips Restraint (Elbow restraint/splint) Otitis Media - Ear infection associate with cleft palate yx suction - ear suction xx antibiotics - 2 weeks to 1 month - otic drug = Less than 2 years old - back and down = More than 2 - back and up Respiratory TRACHEOESOPHAGEAL FISTULA 7+ | | ty3 primary germ layers of the developing embryo Endoderm - GI and RT Mesoderm - renal system, cardiac Ectoderm - NS, Skin, Hair Abdominal Distention - TEF € esophageal atresia - failure of esophagus to z (\ -> fluids will go to lungs, result to aspiration or pneumonia CARINA 4 Cough center#3 C's of TEF Cough ) NPO Choking )) elevate the head/fowler'’ Cyanosis ) notify MD Cystic Fibrosis (exocrine system) ~ mucoviscidosis (other name) uco - mucus Visci - viscous Dosis - acidosis ~ hereditary ~ chromosomal defect (affects chromosome number 7) ~ lifespan - depends in. the pneumonia (Until 25 years of age) Chromosome no. 7 in cystic fibrosis Fig seperate aaa acca eee aEMVVICL VES es Goblet cells producing tenacious secretions Lead to BRONCHITIS -> BRONCHOPNEUMONIA Ws, 02 -> CO2 Emphysema - loss of lung re-coil Close-tube thoracostomy - drain air Plural space Three systems badly affected by CF 1. Respi system 2. Digestive system3. Repro system Low PH - high pco2 - can be normal. H30 PROBLEM IN Gl J Se Common bile duct 4 Pancreatic Enzymes =» Trypsin » Amylase « Lipase Streatorhea- presence of indigestive fat in stool (foul smelling) = pancreas become fibrotic ADEK - fat soluble vitamins Avitaminosis- lack vitaminsREPRODUCTIVE SYSTEM 3x Infertility ~ absence of pregnancy after 1year or regular and unprotected sexual intercouse 2 types: Primary infertility - no history of previous pregnany Secondary infertility - with history of previous pregnancy Regular intercourse - 3 to 4 times a week No.-1 cause of infertility to male - low sperm count Drug: clomidine ASSISTED PREGNANCY GIFT - gamete intrafallopian tube tranfer ~ harvest sperm in male, harvest egg from the woman put inside fallopian tube ZIFT - zygote intrafallopian tube ~ harvest the egg, harvest the sperm, fertilize in laboratory put in fallopian tube once fertilized Al - Artificial Insemination ~ sperm of male placed in cervical canal of woman or in the uterine cavity 2 types: « Al-by source 1. TDI - therapeutic donor insemination2. THI - therapeutic husband insemination = Al by placement 1. Directly into cervical canal 2. Directly into uterine cavity IVF - In vitro fertilization ~ test tube baby ~ harvest sperm and egg, fertlized in lab, until fingerlike projection structure, implant directly in endometrium GIFT, ZIFT Al - require tubal patency, open, fallopian tubes patent, no obstruction Most commonly used nursing diagnosis in CF « ineffective airway clearance 1. Liquify, mobilize, expectorate secretions Liquify ) increase hydration Mobilize ) deep breathing and coughing exercises CTDB - coughing turning deep breathing exercise ) postural drainage ~ 2to 3 hours before meals to prevent vomiting Basic concept: Smallest terminal bronchioles Small bronchioles Large bronchusFowler's Position - when draining upper lobe of the lungs Trendelenburg position - when draining lower lobes Left lateral position w pillow + tapping - when draining lower lobes Ride side lying position w pillow - drain middle lobes Prome position- anterior lobes Drugs: > bronchidilator > mucolytic > antibiotic ) suctioning Artificia Pancreatic Enzyme > Cotazyne > Pancrease Pyloric Stenosis ~ hypertrophy of pyrolic spincter ) Pyloric Spincter (4 oiCardiac spincter matures - 6months sit ith support > Projecting Vomiting in PS >non bile stain > left abdominal distention > spincter , palpate olive shaped mass (right) Gastric Lavage to decrompress stomach before surgery > via nose using ngt tube (french 8 newborn baby) > 20ml syringe "Pyloroplasty" TPN - total Parental Nutrition > high in glucose > slow to prevent hyperglycemia > stop slow to prevent hypoycemia Anganglionic Mega Colon ~ "hirschpruns disease" ~ idiopathic ~ absence of ganglion cells GC- (stimulates peristalsis) No peristalsis - AMC Descending colon 4 \\ opP dt.) Sigmoid rectum Sigmoid colon «4 "No ganglion cells" Bile stain non projectile vomiting Meconium Ileus - negative meconium Absence if meconium within 24 hours > ribbon-like stool (moderate) Wavy-flat stool Obstipation - absence of defecation How to diagnose 1. Physical examination 2. Rectal biopsy - confirms absence of ganglion cells 3. Multiple saline enema 4. Colostomy - temporary procedure to decompress 5. PSOAVE Procedure - pull through Multiple saline enema solution (isotonic) > plain nss prevent electrolyte imbalance> minimum of 3 FETAL CIRCULATION ~ Z Fetal Cirwh a —— F Femportry steven nT bal ' ek ext Sr faces a 2, Uda oot ort PRE DAY A nto vein“? By rar nae ” hw Vanesns ~ “none ; we fr Heri oss Arty, wih, a we € foreman Oe oi tt ONES Upper - receives blood Lower - distributes bloodPulmonary vein - carries oxy blood Pulmonary artery - carries deoxy blood Fetal circulation ‘ ct k = eve (tw aq How will fetal circu turn into - dettachment of placenta Foramen ivale closes within 4 hours after birth Patent foramen ovale - rare close foramen ovale after 4 hrs after birth Murmur become pathologic - after 2 days ) order of 2 D-echoWhy foramen ovale closes first earlier than the ductus arteriousus? ~ because the FO is located outside Which among the fetal blood vessels contains the highest oxygen concentration? e umbilical vein o umbilical artery © ductus arteriosus © ductus venousus Rheumatic Fever Infection affecting the ff: Heart - carditis CNS - chorea st. Vitus dance Joint - polyarthritus Skin - erythrma marginatum SC - nodules jone' criteria If child presenting 2 out of 5, confirms rheumatic fever q 6 pr \ ol 1 major + minor =RF GABHS - the one causing rheumatic fever -> rheumatic heart disease -> mitral valve stenosisMinor Jone's criteria 1. Fever 2. Hx of strep infection 3. Arthralgia - presence of joint paint 4. Elevated lab findings/results ) Lab exams use for RF 1. Antistreptolysin "O" titer ASOT Normal value: 150 to 250 todds unit 250> - <500 dormant RF 500> - <5000 active RF 5000> rheumatic heart disease particularly mitral valve stenosis, permanent heart damage —) 2. C reactive protein (produce by the liver) ~ produce due to inflammation and tissue damage Drug of choice for stretococcal infection: PENICILLIN in combination with erythromycin 3. Erythrocyte sedimentation rateeee Let the blood stand on the test tube rack Ta a ee Prevent frequent sore throat = dental carries - staphylococcus aureus strep. = dental filling = tooth extraction Throay culture - identify specifically the microorganism