Care of Mother, Child at Risk or 04 L E C

08
with Problems (Acute & Chronic)
NCM 209 – Florence Puno
ORIENTATION AND INTRODUCTION
22 O1
OUTLINE
I Orientation
GRADING SYSTEM
A REFERENCES
II INTRODUCTION QUIZZES –Set A and Set B
III PROBLEMS RELATED TO MATURITY Missed quiz – inform CI
IV PRETERM NEWBORN
 Start at the time the CI said so, as well as end
V BALLAD SCORING
at the allotted time.
VI COMMON OR SPECIAL PROBLEM OF
 Late passers - deduction of points
PRETERM NEONATES
 Very particular with the time – time
A RDS management to answer the questions.
B HYPERBILIRUBINEMIA
C INFECTION CONNECTIVITY PROBLEMS – Within 3 hours in and out
D COLD STRESS sa zoom, send letter to the CI
E ANEMIA
VII POST TERM NEWBORN CONNECTIVITY PROBLEMS – no attendance within 3
VIII COMPLICATION OF POST MATURITY hours, send to the nursing coordinator.
A SGA  Attached ID, signature of parents and proof.
B IUGR
ATTENDANCE - may be done on quipper.
Concerns: inform the CI; just message the CI
responsible
ORIENTATION

 COURSE CODE and TITLE INTRODUCTION

 NCM 209: CARE OF MOTHER, CHILD AT RISK
OR WITH PROBLEMS (ACUTE AND CHRONIC)
 COURSE DESCRIPTION:
 This course deals with concepts,
principles, theories and techniques in the
nursing care of at risk/high risk/sick clients
during the child-bearing and the
childbearing years toward health
promotion, disease prevention,
restoration and maintenance, and
rehabilitation. The learners are expected
to provide safe, appropriate, and holistic
care to clients utilizing the nursing process
Care of mother, child at risk or with or problems
(acute and chronic)
PROBLEMS RELATED TO MATURITY
 If there is complication, we need to have our
quick decision making with regards to our nursing
actions, what we can do, and what will be our
nursing care. There might be complications that
threaten the newborn babies that is why nursing
management is needed.

 REFERENCES:

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 Included in high risk- the complications that
threatened human being
 Focus- the mother, child, high-risk pregnancy,
and fetus. (In prenatal stage we could already
determine the problem inside.)
 The government has a program with regards
to the mother and child.
Objective of the concept
 Described the high-risk newborn related to
maturity and gestational age
 Utilize assessment parameters to determine
the health needs of the high-risk
Assessment for:
o Newborn
o Infant
o Toddler
 Distinguish appropriate nursing action with
different diagnostic exam for each high-risk
newborn
 Formulate comprehensive plan management
for each high-risk newborn. (NCP is universal)
PRETERM NEWBORN
- Description- a neonate born before 37 weeks
of gestation
- Primary concern relates to immaturity of all
body systems
- According to the experiences of the nurse and
doctors:
 6 and 8 months- still at high-risk
 7 months- more strong
 9 months- organs are not fully developed
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Determine the weight
 The important marker of health is the birth
weight

*Prematurity- the cause is unknown
Maternal factors:
 Age of mother (if it is too young or too old)
 Mother is into smoking
 Poor nutrition
 Placental problem
 Preeclampsia (toxemia is common)

*If high-risk then complete bed rest
Fetal factors:
 Multiple pregnancy
 Poor social economic status
 Environmental exposure to harmful
substances

Placenta abruptio- placenta peels away from the
inner wall of the uterus before delivery so the baby
deprived of the oxygen and nutrients that will lead to
bleeding.
Placenta previa- placenta is partially or totally cover
the cervix so there were sever vaginal bleeding
especially during pregnancy or delivery.
ASSESSMENT
 Check the aspiration (preterm is irregular)
 Check body temperature
o Usually below normal (Point kilo
turmeric- take on the temperature of
the environment)
o Skin is thin with visible blood vessels,
minimal subcutaneous fat pads
 Check reflexes
o Suck poorly or swallowing reflexes
 Vowel sounds are diminished
 Assess extremities:
o Minimal creasing on the soles and
palms
o Extension of extremities does not
maintain flexion
o Abandons of lanugo
o Labia are narrow on girls
o Testes are undescended on boys
o Less muscle tone
BALLAD SCORING
Ballard scoring - technique of gestational age
assessment
2
Scarf Sign - this looks at how far the baby’s elbow can
move across the chest. (kung may resistant ba si baby
or wala)
Square window - trying to access the flexibility of the
wrist of the baby.
Placenta abruptio - the placenta is away from the
inner wall of the uterus, so there is no more oxygen or
nutrients going to the fetus.
Placenta previa - can also lead to severe bleeding
(kumbaga ang placenta covers the cervix)
 Assessment (of preterm)
 Respirations are irregular with periods of
apnea
 Body temperature is below normal
 Skin is thin, with visible blood vessels and
minimal subcutaneous fat pads, may appear
jaundiced
Poikilothermic - easily take on the temperature of the
environment
 Poor sucking and swallowing reflexes
 Bowel sounds are diminished
 Extremities are thin, with minimal creasing on
soles and palms.
 Extension of extremities and does not
maintain flexion
 Abundance of lanugo hair
 Labia are narrow in girls
 Testes are undescended in boys
COMMON OR SPECIAL PROBLEM OF PRETERM
NEONATES
RESPIRATORY DISTRESS SYNDROME
 Hyaline membrane disease
 Due to lung immaturity
 Deficient in surfactant
 (The alveoli collapse, nada damage ang
airway kaya mahirapan makahinga si baby)\
HYPERBILIRUBINEMIA
 High level of bilirubin in the blood, neonates
become jaundice.
 Due to immaturity of the liver
 There is buildup of too much bilirubin in the
blood kaya nagye yellow si baby.
 Can travel through the brain (which is rare
pero once meron nagkakaroon ng seizure)
Kernicterus stains brain cells with bilirubin, causing
irreversible brain damage.
INFECTION
 Not able to receive IgG globulins
(During the last 3months of pregnancy, antibodies
from the mother are passed to the baby to the
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placenta, the amount and type of antibodies depends
on the mother's immunity and kung si mother hindi
naka receive ng mga vaccine and walang prenatal
check up then it will affect the fetus.)
COLD STRESS
 Less subcutaneous tissue, poikilothermic
ANEMIA
 Less iron stores
MANAGEMENT (PRETERM)
 Improving respiratory function
 Oxygen therapy
 Mechanical ventilator
 Maintaining body temperature
Isolette - maintains ideal temperature,
humidity and oxygen concentration isolates infant
from infection
(Unang yakap - skin to skin contact)
Kangaroo Care
 Preventing infection
 Handwashing
 Promoting nutrition
 Gavage feeding
 Milk feeding
 Promoting sensory stimulation
 Gentle touch, speaking gently and softly,
music box or low tuned radio
Nursing Interventions
1. Monitor vitals signs every 2 to 4 hours
2. Administer oxygen and humidification as
prescribed.
3. Monitor intake and output
4. Monitor daily weight
5. Maintain newborn in a warming device
6. Reposition every 1 to 2 hours, and handle
newborn carefully
7. Avoid exposure to infections
8. Provide newborn with appropriate
stimulation, such as touch
9. Suctioning of secretions as needed (as much
as possible do not suction, as needed lang lalo
na pag lead to respiratory problems)
10. Monitor for signs of infection
11. Provide skin care
12. Provide complete explanations for parents
POST-TERM NEWBORN
 Neonate born after 42 weeks of gestation
 About 12% of all infants are post-term
 Causes of delayed birth is unknown
 First pregnancies between the ages 15 to 19
years and woman older than 35 years
3
  Multiparity grunting sound while breathing, check skin color)
 Fetal anomalies such as anencephaly
Assessment
 Depleted subcutaneous fat: old lookind “old
man facies”
 Parchment-like skin (dry, wrinkled and
cracked) without lanugo
 Fingernails long and extended over ends of
fingers
 Abundant scalp hair
 Long and thin body
 Sign of meconium staining nails and umbilical
cord (yellow to green)

COMPLICATIONS
Complications OF POST MATURITY
of Post Maturity
 The placenta begins to age toward the end of
pregnancy, and may not function as efficiently
as before.
 The failing placental function will place infants
at risk for intrauterine hypoxia during labor
and delivery. (Intrauterine hypoxia occurs
when the fetus is deprived of adequate supply
of oxygen, maybe because of umbilical cord
collapse or placental infarction or maternal
factors)
Meconium Aspiration Syndrome (Occurs when there
is a breathing problem on the newborn)
Hypoglycemia
 From nutritional deprivation and poor storage
of glycogen at birth
Polycythemia
 Increase circulating rbc (hemoglobin is
responsible, it will cause blood viscosity)
MANAGEMENT
 Ultrasound is done to evaluate fetal
movement, amount of amniotic fluids and the
placenta signs of aging
 To reduce the chance of meconium aspiration,
upon delivery of newborn’s head and just
before the baby takes his first breath
 Suctioning of the mouth and nose is done
Nursing Management
1. Closely monitor the newborn
cardiopulmonary status
2. Administer supplemental oxygen therapy as
needed
3. Frequent monitoring of blood sugar; assess
for sign of hypoglycemia
4. Provide thermoregulated environment
 Use of isolette or radiant heat warmer
5. Monitor for signs of meconium aspiration
syndrome (signs of meconium aspiration syndrome-
rapid breathing, note chest part kung may retraction,
PROBLEMS RELATED TO GESTATIONAL WEIGHT
- pag deliver ng baby, we are going to weigh the baby
Small for Gestational
SMALL FORAgeGESTATIONAL AGE
o the fetus or the newborn is smaller than
normal
o SGA babies are those whose birth weight lies
below the 10th percentile for that gestational
age
o SGA babies may be:
Premature (born before 37 weeks of
gestation)
Full term (37 – 41 weeks)
Post term (after 42 weeks of pregnancy)
o what is important is the gestational age of the
baby that starts on the first day of the
mother’s last menstrual period
INTRAUTERINE
Intrauterine GROWTH (IUGR)
Growth Restriction RESTRICTION
o most common underlying condition leading to
SGA newborn
o this condition appears physically,
neurologically mature but smaller in size
o babies have birth weight below the 10%, so
they are smaller than normal babies of the
same gestational age
o the baby is weak and cannot tolerate large
feeding
o the baby is not receiving necessary nutrients
and oxygen
o Placental anomaly is the most common cause
of IUGR
Some factors that may contribute to SG are the
following:
Maternal factors:
 high blood pressure
 chronic kidney disease

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  advanced diabetes MATERNAL DIABETES
 heart or respiratory disease
- most widely known contributing factor
 malnutrition, anemia
- increase insulin acts as a fetal growth
 infection
hormone
 substance use (alcohol, drugs)
 cigarette smoking MACROSOMIA
Factors related to the fetus: - an unusually large newborn
- with birth weight of more than 4500 grams
 multiple gestation (twins)
 infection
ASSESSMENT FOR LARGE GESTATIONAL AGE
 chromosomal abnormality
 large, obese
Assessment
ASSESSMENTfor SGA
FOR SMALL GESTATIONAL AGE  lethargic and limp
 may feed poorly
 Respiratory distress – hypoxic episodes
 Loose and dry skin, little fat, little muscle mass Signs and symptoms of birth trauma
 Wasted appearance
 Small liver  bruising
 Head is larger compared to body  broken clavicle
 Wide skull sutures  evidence of molding
 Poor skin turgor  cephalhematoma
 Sunken abdomen  caput succedaneum

Problems of LGA babies

Babies with SGA may have problems at birth such as: o hypoglycemia (low blood sugar)
o respiratory distress
 Respiratory distress (asphyxia) o hyperbilirubinemia
 Meconium aspiration o potential complications related to the
 Hypoglycemia increase in body size
 Difficulty maintaining normal body o leading cause of breech position and shoulder
temperature dystocia
 Polycythemia (too many red blood cells) o fractured skull, clavicles, cervical or brachial
plexus injury and erb’s palsy

Interventions INTERVENTIONS
o Observe for signs of respiratory distress
o Maintain body temperature
o Monitor for infection and initiate measure to
prevent sepsis
o Monitor blood glucose levels and for signs of
hypoglycemia
o Initiate early feedings and monitor for signs of
aspiration
o Provide stimulation such as touch and
cuddling
LARGE FORAge
Large for Gestational GESTATIONAL AGE
o neonate who is plotted at or above the 90th
percentile on the intrauterine growth curve
o 2eigh more than 4,000 grams
o the cause is unknown but sometimes genetic
factors and maternal conditions
Generally, there is no treatment other than lifting the
child gently to prevent discomfort. Occasionally, the
arm on the affect ted side may be immobilized.
MANAGEMENT:
Routine newborn care with special emphasis on the
following:
o Monitor vital signs frequently, especially
respiratory status
o Monitor blood glucose levels and for signs of
hypoglycemia
o Initiate early feedings
o Note any signs of birth trauma or injury
o Monitor for infection and initiate measures to
prevent sepsis
o Provide stimulation such as touch and
cuddling
Common acute conditions of newborn:

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 RESPIRATORY DISTRESS SYNDROME (RDS)
 Serious lung disorder caused by immaturity and
inability to produce surfactant resulting in hypoxia
and acidosis
 Surfactant – a biochemical compound that
reduces surface tension inside the air sac
 Decrease in surfactant results to lung
collapse, thus greatly reducing infant’s vital
supply of oxygen
 Damaged lung cells combines with other
substance present in the lungs to form
fibrous substance called hyaline membrane
(Hyaline membrane disease – this
membrane lines the alveoli and blocks gas
exchange in the alveoli)
Explanation:
 There is decrease pulmonary surfactant, so
definitely there will be increased surface tension
wherein the lungs will not expand well.
 Lack of the expansion of alveoli, this make it
impossible for the baby to breathe in after
delivery, baby cannot breathe because of
insufficient surfactant.
 Lead to decrease alveolar ventilation, then there
will be inadequate o2 and co2 exchange.
 Hypoxia – baby works harder and harder to
breathe trying to reinflate the collapsed airways;
baby’s lung function decreases so less oxygen is
taken in and more co2 buildup in the blood that
will lead to increase acid in the blood and lead to
acidosis. This will affect the body organ, so if there
is no treatment, this will lead to exhaustion of the
baby to breathe.
 Atelectasis – collapse of the lung tissue
ASSESSMENT:
ASSESSMENT
Expiratory grunting – major symptoms (indicator of
RDS)
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- Is the body’s way of trying to keep air in the
lungs so they will stay open
- Tachypnea
- Nasal flaring
- Retractions
- Seesaw- like respirations (chest wall retracts
and the abdomen protrudes)
- Decrease breath sounds
- Apnea
- Pallor and cyanosis
- Hypothermia
Seesaw-like respirations: as the patients, tries to
breathe the diaphragm descends causing the
abdomen to lift and the chest to sink
MANAGEMENT:
Management: Oxygen Therapy
 When there is difficulty of breathing; consider
how may liters to administer because if there is
too much then it can lead to: fibroplasia
 Hood, nasal prong, mask, endotracheal tube
(CPAP) Continuous Positive Airway Pressure, or
PEEP (Positive-End-Expiratory Pressure) may be
used – different ways to deliver oxygen
 CPAP – usually used (gray): CPAP machine blows
air at a prescribed pressure and a very effective
way to treat sleep apnea; this is ordered by the
doctor.
 PEEP – used in NICU: maintaining the patient’s
airway pressure
MANAGEMENT:
Management: Surfactant Replacement therapy
 Attached to the newborn
 ECMO – extracorporeal membrane oxygenation;
bypass heart and lungs; will allow the lungs to rest
–it will pump and oxygenate the patient’s blood
6
 outside the body so it will allow the lungs and
heart to rest and you are connected to a machine
the blood through the tubing to an artificial lung;
so there is oxygen and takes out carbon dioxide;
blood is warm to body temperature and pump
back into your body.
 Muscle relaxants – Pancuronium (Pavulon)
 Reduces musclurar resistance
 Prevents pneumothorax
 Prepare Atropine – used to prevent the side
effect of Neostigmine; and Neostigmine
Methylsufate – given for the reversal of the
neuromuscular blocking agent
 Drugs in combination to prevent some
side effects
 Liquid Ventilation
 Uses perfluorocarbons – substances used in
industry to assess leaks
 Nitric Acid
 Causes pulmonary vasodilation – increases
blood flow to the alveoli
NURSING INTERVENTION
1. Monitor color, respiratory rate, and degree of
effort in breathing
2. Support respiration as prescribed
3. Monitor arterial blood gases and oxygen
saturation levels (arterial blood gases from
umbilical artery)
- Pulse oximeter to check o2 sat.
4. Suction every 2 hours or more often as
necessary; suction mouth and nose – only if
they are nose breathers.
5. Prepare to administer surfactant replacement
therapy (instilled into the endotracheal tube)
6. Administer respiratory therapy (percussion
and vibration
7. Provide nutrition
8. Support bonding
9. Encourage as much parental participation in
newborn’s care as condition follows

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 Care of Mother, Child at Risk or 04 L E C
12
with Problems (Acute & Chronic)
NCM 209 – Ms. Florence Puno
21 O2
OUTLINE HIGH RISK NEWBORN
I HIGH RISK NEWBORN
This birth weight is an important marker in regards to
II PRETERM NEWBORN
health. If may small 8 oz na bottle, ganun lang daw
III PLACENTAL ABRUPTIO
kaliit ang preterm.
IV PLACENTA PREVIA
COMMON OR SPECIAL PROBLEMS OF
Cause: unknown
NEONATES
Maternal factors: age, smoking, poor nutrition,
VI POSTERM NEWBORN
placental problem, preeclampsia/eclampsia
VII MECONIUM ASPIRATION SYNDROME
Fetal factors: multiple pregnancy, infection
VIII PROBLEMS RELATED TO GESTATIONAL
Other factors: poor socioeconomic status,
AGE
environmental exposure to harmful substance
IX LARGE GESTATIONAL AGE
X RESPIRATORY DISTRESS SYNDROME
If you are in the community and if tinanong mo si
XI HYPERBILIRUBENEMIA
mother then she said di siya nagapunta dun kay
XII SEPSIS
instead ipambili niya nalang ng bigas, we can tell her
XIII SIDS
na we have a program given by the government, sana
XIV KERNICTERUS
mag avail. Encourage the mother to seek for care dun.
XVI FAILURE TO THRIVE
XVII HYDROCEPHALUS
PLACENTAL ABRUPTIO
The placenta peels away from the inner wall before
RECAP: delivery. Sometimes partial, sometimes completely
Now the baby is depreived of nutrients, o2. And there
HIGH RISK NEWBORN would be bleeding.

Who among you are preterm?

They have sometimes complications that will threaten
our newborn so definitely with our technology now,
there are early treatments or advances in our
managements. Even in our doctors, there are doctors
who can handle high risk conditions. Na-aassess agad
because of technology even if nasa loob pa ang baby.
Advanced technology would tell us how to manage
these high risk pregnancies for both the mother and
the fetus para magkaroon lang man ng positive
outcome.
PRETERM NEWBORN
Description:
A neonate born before 37 weeks of gestation
Primary concern relates to immaturity of all body
systems
Ito usually ang nakikita natin sa NICU. For survival
talaga si 37 weeks. Note the weight. It is one of the
indicators. Meron tayong gestational age to consider.
PLACENTA PREVIA
This condition occurs when the placenta covers the
cervix. Common in early pregnancy. We call this as as
toxemia of pregnancy, now we term them as
complication in pregnancy.
Placenta accreta - Severe blood loss after delivery
Kaya minsan naga prepare ng blood incase
magkaroon ng bleeding after delivery.
ASSESSMENT
 Respirations are irregular with periods of
apnea
 Body temperature is below normal
 Skin is thin, with visible blood vessels and
minimal subcutaneous fat pads, may appear
jaundiced
May irregularities talaga sa respirations since not yet
mature ang organs ng preterm. Not the range and
also observe further the rise and fall of the chest.

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Poikilothermic-easily take on the temperature of the
environment
Remember, the immaturity of the lungs might lack
surfactant so dapat there is enough surfactant so
walang problem and walang flaring.
 poor sucking and swallowing reflex
 Bowel sounds are diminished
 Extremities are thin, with minimal creasing on
soles and palms.
 Extension of extremities and does not
maintain flexion
 Abundance of lanugo hair
 Labia are narrow in girls
 Testes are undescended in boys
 Extension of extremities and does not
maintain flexion
May some babies nan aka straight lang ang
extremities.
 Square window wrist
Assess the flexibility of the wrist. Try to note if there is
resistance also at the same time or if they could
extend or stretch. If ma straighten niya ba or may
resistant. Note also the degree angle.
 Scarf sign
Check the elbow. It is how the elbow can be moved
across the chest. Ang hint jan if malampas bas a chin.
Common or special problem
Common or special problem
of preterm neonates
of preterm neonates
1. Respiratory Distress Syndrome
 Hyaline membrane disease
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 due to lung immaturity; deficient in surfactant
So, the condition can cause the need to have extra o2
(baby). We need to help them breathe normaly.
When there is not enough surfactant, our aveoli will
collapse with each breath. Macollapse an gating
lungs.
2. Hyperbilirubinemia
 high level of bilirubin in the blood, neonate
become jaundice
 due to immaturity of the liver
Kernicterus - staining of brain cells with bilirubin,
causing irreversible brain damage
A rare kind of damage but preventable siya. It can
happen with newborns with jaundice.
Management: Phototherapy
Sometimes the pt would have brain problems. High
bilirubin would lead to brain damage.
Once the bilirubin falls, we can turn off the
phototherapy and we must observe and refer.
3. Infection
 not able to receive IgG globulins
Alam naman natin diba kumukha si baby ng immunity
sa mother niya during the last 3 mos of the pregnancy.
But then here, kulang p kaya may infection.
4. Cold stress
 less subcutaneous tissue, poikilothermic
This is the major risk. Nakahubad pa naman an gating
newborn. We must avoid this kay naga adjust pa siya
sa environment niya.
5. Anemia
 less iron stores
Decreased hematocrit, decreased hemoglobin.
Decreased erythropoietin.
Management
1.Improving respiratory function
 Oxygen therapy
 Mechanical ventilator
2.Maintaining body temperature
9
Isolette - maintains ideal temperature, humidity and
oxygen concentration isolates infant from infection
Kangaroo Care
Method of holding the newborn. Skin-to-skin contact
of baby and the mother.
3. Preventing infection
 Handwashing
To avoid infection
4. Promoting nutrition
 Gavage feeding
A way of providing milk directly to the baby’s stomach.
May tube na ginaplace sa nose ng baby and it carries
the breastmilk formula.
 Milk feeding
5. Promoting Sensory stimulation
Gentle touch, speaking gently and softly, music box or
low tuned radio
Nursing Interventions
1. Monitor vital signs every 2 to 4 hours
2. Administer oxygen and humidification as
prescribed.
3. Monitor intake and output
Instructions should really be clear.
4. Monitor daily weight.
So alam natin if enough ba ang nutrients. Or may
weight problems.
5. Maintain newborn in a warming device.
6. Reposition every 1 to 2 hours, and handle newborn
carefully.
7. Avoid exposure to infections.
Do the handwashing and mag gloves since very risk sa
infections and newborn.
8. Provide newborn with appropriate stimulation,
such as touch
9. Suctioning of secretions as needed
If di talaga maka breathe si newborn, then we could
suction.
10. Monitor for signs of infection
Skin color, temperature of the skin.
11. Provide skin care
12. Provide complete explanations for parents
Lalo na sa first time mothers. Ang anxiety level nila is
mataas.
POST-TERM NEWBORN
Description: Neonate born after 42 weeks of gestation
 About 12% of all infants are post-term
Causes of delayed birth is unknown
 First pregnancies between the ages 15 to
19years
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 Woman older than 35 years
 Multiparity
 Fetal anomalies such as anencephaly
It’s either without the parts of the brain or parts of the
skull. Maybe the brain did not develop properly.
Portion of the baby’s brain is missing. Maybe the brain
tissue does not form properly. Maybe walang enough
skin to cover it.
Genetic and environmental factors can contribute to
anencephaly.
Assessment
 Depleted subcutaneuos fat: old looking "old
man facies"
 Parchment-like skin (dry, wrinkled and
cracked) without lanugo
 Fingernails long and extended over ends of
fingers
 Abundant scalp hair
 Long and thin body
 Sign of meconium staining
 nails and umbilical cord (vellow to green)
COMPLICATIONS OF POST MATURITY
 The placenta begins to aged toward the end
of pregnancy, and may not function as
efficiently as before.
 The failing placental function will place infant
at risk for intrauterine hypoxia during labor
and delivery.
The fetus is derived of oxygen and nuteients
that’s why my hypoxia.
MECONIUM ASPIRATION SYNDROME
May breathing problem. The baby may pass
meconium into the amniotic fluid during labor or
delivery.
 HYPOGLYCEMIA
 FROM NUTRITIONAL DEPRIVATION AND
POOR STORAGE OF GLYCOGEN AT BIRTH
May low blood sugar because the baby has too little
glucoses na nastore.
 POLYCYTHEMIA
 increase circulating RBC
may problem sa hematocrit and hemoglobin.
Management
 Ultrasound is done to evaluate fetal development,
amount of amniotic fluids and the placenta signs
of aging to reduce the chance of meconium
aspiration, upon delivery of newborn's head and
10
 just before the baby takes his first breath The fetus or infant is smaller or less-developed
suctioning of the mouth and nose is done than normal. We consider the sex, gender or
gestational age of the baby.
Nursing management
1. Closely monitor the newborn cardiopulmonary Gestational age – age of the fetus. Starts from
status Check VS. the mother’s last menstrual period.
2. Administer supplemental oxygen therapy as needed
3. Frequent monitoring of blood sugar; assess for sign SGA babies may be:
of hypoglycemia premature (born before 37 weeks of
4. Provide thermoregulated environment pregnancy),
 use of isolette or radiant heat warmer full term (37 to 41 weeks), or
to prevent cold stress. post term (after 42 weeks of pregnancy)
5. Monitor for signs of meconium aspiration syndrome
2. Intrauterine growth restriction (IUGR)
Differences Preterm Full Term  is the most common underlying
Posture “Relaxed More flexed condition leading to SGA newborn
attitude” limbs attitude Occurs usually when the fetus does not
more extended receive the proper nutrients or O2 that is
Ear Ear cartilages Well formed needed for the proper development of
are poorly cartilages organs and tissues.
developed, may
fold easily Early sign begins any time at pregnancy.
Sole Only fine Well and deeply But if may early onset, madetermine natin
wrinkles creased. through mga ultrasound and etc.
Female Clitoris is Clitoris is not as
Genitalia prominent; prominent; Birth weight is very important in the
labia majora labia assessment.
poorly majora fully
developed developed Some factors that may contribute to SGA are
Male Genitalia Scrotum is Scrotum is fully the following:
under developed,
developed and pendulous, Maternal factors:
not rugated  high blood pressure
pendulous, with  chronic kidney disease
minimal rugae lagi naga UTI, then need na ng IV meds.
Scarf sign Elbow is easily With resisting  advanced diabetes
brought across attempt when  heart or respiratory disease
the chest elbow  malnutrition, anemia
with little or no is brought to  Infection
resistance the midline of  substance use (alcohol, drugs)
the  cigarette smoking
chest
Grasp reflex Weak Strong, allowing Factors related to the fetus:
the infant to be  multiple gestation (twins)
lifted up from  infection
the mattress  chromosomal abnormality
note those chromosomal abnormalities in
regards sa SGA, when it is abnormal bcs it can
lead to health conditions sa body.

PROBLEMS
 RELATED
Placental TO GESTATIONAL
anomaly is the mostWEIGHT
1. Small for gestational age common cause of IUGR
 (SGA) babies are those whose birth
weight lies below the 10th percentile Assessment
for that gestational age  Respiratory distress - hypoxic
episodes

BSN-2B TRANSCRIBED BY: GROUP # 11

 Hypoxic episodes. You have to know  Cephalhematoma
the rangeof RR. Other unusualities. Swelling of the head. There is a collection of bloody
Sounds. Adventitious sounds. fluid.
 Loose and dry skin ,little fat, little  Caput succedaneum
muscle mass Temporary swelling of the baby’s head.
 Wasted Appearance
 Small liver Problems of LGA babies
 Head is larger compared to body  Hypoglycemia (low blood sugar) of baby after
Syempre need to palpate. delivery
 Wide skull sutures  Respiratory distress
 poor skin turgor  Hyperbilirubinemia
o sunken abdomen
Potential complications related to increase in body
Babies with SGA may have problems at birth such as: size
 Respiratory distress (asphyxia) Leading cause of breech position and shoulder
 Meconium aspiration dystocia
 Hypoglycemia Fractured skull, clavicles, cervical or brachial plexus
 Difficulty maintaining normal body injury and erb's palsy
temperature Erb’s Palsy - Weakness or paralysis around the
 Polycythemia – too many red blood cells shoulder. May difficulty during delivery.

Interventions Generally, there is no treatment other than lifting

 Observe for signs of respiratory distress the child gently to prevent discomfort. Occasionally
 Maintain body temperature the arm on the affected side may be immobilized.
 Monitor for infection and initiate measures to
prevent sepsis
 Monitor blood glucose levels and for signs of
hypoglycemia
 Initiate early feedings and monitor for signs of
aspiration.
 Provide stimulation, such as touch and
cuddling

LARGE FOR GESTATIONAL AGE

Management
Description: Neonate who is plotted at Routine newborn care with special emphasis on the
or above the 90th percentile on following:
the intrauterine growth curve  Monitor vital signs frequently, especially
Weigh more than 4,000 grams respiratory status.
Cause - unknown  Monitor blood glucose levels and for signs of
genetic factors hypoglycemia
maternal conditions  Initiate early feedings
Maternal diabetes - is the most widely known  Note any signs of birth trauma or injury
contributing factor  Monitor for infection and initiate measures to
Increase insulin acts as a fetal growth hormone prevent sepsis
Macrosomia - an unusually large newborn  Provide stimulation, such as touch and
with birth weight of more than 4500grams cuddling.

Assessment
 large, obese
RESPIRATORY DISTRESS SYNDROME (RDS)
 Lethargic and limp
 May feed poorly Description: Serious lung disorder caused by
immaturity and inability to produce surfactant,
Sign and symptoms of birth trauma resulting in hypoxia and acidosis
 Bruising
 Broken clavicle Surfactant - a biochemical compound
 Evidence of molding that reduces surface tension inside the air sac

BSN-2B TRANSCRIBED BY: GROUP # 12

Decrease in surfactant results to lung collapse, thus
greatly reducing infant's vital supply of oxygen

Damaged lung cells combines with other substance

present in the lungs to form fibrous substance called
hyaline membrane (Hyaline membrane disease)

this membrane lines the alveoli and blocks gas

exchange in the alveoli
which means the pt has difficult getting air bcs there is
a blockage so mag compensate ang lungs sa blockage
na ‘yan so mag exert ng effort and mapagod.
PATHOPHYSIOLOGY
Management
a) Oxygen therapy
 hood, nasal prong, mask, endotracheal tube,
CPAP (Continuous Positive Airway Pressure),
or PEEP (Positive End -Expiratory Pressure)
may be used

CPAP machine blows air at a prescribed pressure

If the pt lacks surfactant, there would be surface

tension then lack expansion of alveoli, the tiny alveoli
collapse with each breath, it will further affect the
breathing ability of the baby. The more the baby will
breathe harder trying to reinflate that collapsed
airway, the baby’s lung function decreases, so there is
decreased oxygen (hypoxia). It will also lead to
increase acid in the blood (acidosis).
 Surfactant replacement therapy
Here, exhausted na ang lungs, so there would be  Extracorporeal membrane oxygenation
effusion of the alveoli and terminal bronchioles. And (ECMO)
hyaline-like membrane formation. And then the This will allow lungs to rest. They will pump and
collapsed of the lung tissue and that is the atelectasis. oxygenate the blood outside the body allowing the
heart and lungs to rest.
Assessment
 Expiratory grunting -major symptoms is the b) Muscle relaxants - Pancuronium (Pavulon)
body's way of trying to keep air in the lungs so • Reduces muscular resistance
they will stay open • Prevents pneumothorax
 Tachypnea • Prepare Atropine or Neostigmine Methylsulfate
 Nasal flaring
 Retractions c) Liquid Ventilation
 Seesaw - like respirations (chest wall retracts and • Uses perfluorocarbons - substances used in industry
the abdomen protrudes) to assess leaks
A type of paradoxical respiration
 Decreased breath sounds d) Nitric Acid
 Apnea • Causes pulmonary vasodilation - increases blood
 Pallor and cyanosis flow to the alveoli
 Hypothermia
Nursing Interventions
Seesaw - like respirations 1. Monitor color, respiratory rate, and degree of effort
in breathing.

BSN-2B TRANSCRIBED BY: GROUP # 13

2. Support respirations as prescribed  average increase of 2mg/dI; not exceeding
3. Monitor arterial blood gases and oxygen saturation 12mg/dI
levels (arterial blood gases from umbilical artery). So
that oxygen administered to the newborn is at the  Pathological Jaundice of Neonates
lowest possible Any of the following features characterizes
concentration necessary to maintain adequate arterial pathological jaundice:
oxygenation.  Clinical jaundice appearing in the first 24
4. Suction every 2 hours or more often as necessary. hours.
5. Prepare to administer surfactant replacement  Increases in the level of total bilirubin by more
therapy (instilled into the endotracheal tube) than 12 mg/dl
6.Administer respiratory therapy (percussion and
vibration Therapy is aimed at preventing Kernicterus, which
7. Provide nutrition results in permanent neurological damage resulting
8. Support bonding from the deposition of bilirubin in the brain cells.
9. Encourage as much parental participation in
newborn's care as condition allows. Causes
 Immaturity of the liver
RETINOPATHY OF PREMATURITY  Rh or ABO incompatibility
 vascular disorder involving gradual  Infections
replacement of retina by fibrous tissue and  Birth trauma
blood vessels  Maternal diabetes
 primarily caused by prematurity and use of  Medications
supplemental oxygen (longer than 30 days)
 Oxygen administration should never be more Assessment
than 40% unless hypoxia is documented  Jaundice
Kaya bantay sa pagbigay ng O2 kay baka  Dark concentrated urine
masobrahan. Paano makuha sa newborn?
That would put the baby at risk for becoming blind. Sometimes we use the condom catheter para sa bata
so para makacollect tayo and observe the urine.
Any premature newborn who required oxygen  Enlarged liver
support should be scheduled for an eye examination Usually jaundice happens when the liver does not
before discharge to assess for retinal damage. work well. So we must also check the liver. If it is
enlarged. Baka may mga infections. Remember the
Bronchopulmonary Dysplasia - over expanded lungs liver is part of the body that is most responsible where
prolonged use of 02 we can get rid of this high level of bilirubin. So once
So the breathing disorder occurs. Lalo na become may problem, the newborn can have high levels of
irritated na ang lungs. They do not develop normally. bilirubin.
 Poor muscle tone
Management:  Lethargy
a) Suction every 2 hours or more often as necessary.  Poor sucking reflex
b) Prepare to administer surfactant replacement
therapy (instilled into the endotracheal tube) Management
c) Administer respiratory therapy (percussion and 1. Phototherapy
vibration) - is use of intense florescent lights
d) Provide nutrition to reduce serum bilirubin levels
e) Support bonding - the use of blue lights overhead or in blanket -
f) Encourage as much parental participation in device wrapped around infant
newborn's care as condition allows.

HYPERBILIRUBINEMIA
Description: is an abnormally high level of Bilirubin in
the blood; results to jaundiced

TYPES:
 physiologic jaundice
 occurs on the second day to seventh day

BSN-2B TRANSCRIBED BY: GROUP # 14

 - is use of intense flourescent lights to reduce
serum bilirubin levels in the newborn
- Injury from treatment, such as: eye damage,
dehydration, or sensory deprivation
Wallaby blanket
 is simply a blanket which, when wrapped
around the infant's torso, delivers effective
therapy to jaundiced babies
 no need to cover the baby’s eyes as all light
treatment is delivered through the blanket
Possible complication of phototherapy
 eye damage
 dehydration
 sensory deprivation
2. Exchange blood transfusion via umbilical catheter
 for very severe cases
 infants blood - remove = 5 / 10ml at a time
one of the treatments to correct anemia.
Nursing Intervention
1. Expose as much of the newborn's skin as
possible.
BSN-2B TRANSCRIBED BY: GROUP #
2. Cover the genital area, and monitor the
genital area for skin irritation or breakdown.
3. Cover the newborn's eyes with eye shields or
patches; make sure that eyelids are closed
when shields or patches are applied.
1. Note: hindi naman ganun ka galaw si
newborn but if infant malaki-laki na
so bantayan baka ma move ang cover
4. Remove the shields or patches at least once
per shift (during a feeding time) to inspect the
eyes for infection or irritation and to allow
eye contact and bonding with parents.
5. Monitor skin temperature closely.
1. Note: due to cold stress and changes
of the skin color
6. Increase fluids to compensate for water loss.
7. Expect loose green stools and green urine.
8. Monitor the newborn's skin color (Jaundice,
pinkish (normal), pallor) with the fluorescent
light turned off, every 4 to 8 hours.
Note: do not hesitate to ask mother if ever gi
off ang light while on phototherapy, and tell
the mother ang tamang pag time ng
phototherapy and make sure to be confident
with your answers if may questions si mother;
tell the mother what was the ordered time;
REMEMBER TO EXPLAIN THE PROCEDURE
BEFORE STARTING THE PROCEDURE EVEN IF
NA EXPLAIN NA NI DOCTOR, MAG
ADDITIONAL KNOWLEDGE TAYO SA ATING
NURSING CARE KUNG MAG EXPLAIN NA
 Monitor the skin for bronze baby syndrome, a
grayish-brown discoloration of the skin.
Not only the skin, but also:
o Urine
o Serum
 Reposition newborn every 2 hours.
 Provide stimulation.
Bronze baby syndrome
Note: maybe there is an intense discoloration of the
skin; especially for the premature bab
After Treatment
 continue monitoring for signs of
hyperbilirubinemia, because rebound
elevations are normal after therapy is
discontinued.
 Turn off phototherapy lights before drawing
blood specimen for serum bilirubin levels
15
 and avoid allowing blood specimen to
remain uncovered under fluorescent lights
(to prevent the breakdown of bilirubin in the
blood specimen).
Jaundice
 yellowing is associated with the accumulation
of bilirubin in the skin.
Most often caused by:
o Liver disorder
o Gallbladder disorder
 a symptom where skin and eyes becomes
yellow
NURSING INTERVENTIONS
1. MONITOR FOR THE PRESENCE OF JAUNDICE;
ASSESS SKIN AND SCLERA FOR JAUNDICE.
 Examine the newborn's skin color in
natural light.
 Press finger over a bony prominence
or tip of the newborn's nose to press
out capillary blood from the tissues.
 jaundice starts at the head first,
spreads to the chest, abdomen, and
then the arms and legs, followed by
the hands and feet
2. Keep newborn well hydrated to maintain
blood volume.
3. Facilitate early, frequent feeding to hasten
passage of meconium and encourage
excretion of bilirubin.
4. Report to the physician any signs of jaundice
in the first 24 hours of life and any abnormal
S&S
5. Prepare for phototherapy, and monitor the
newborn closely during the treatment.
1. Note: if not available it could be a
problem because hindi lahat kompleto
ang facilities
Meconium aspiration syndrome (MAS)
BSN-2B TRANSCRIBED BY: GROUP #
 occurs when infants take meconium into their
lungs during or before delivery
 can lead to Respiratory distress in
newborn because they might aspirate
the meconium (present during/after
birth) to the lungs
Note: even though fetuses does not eat their
intestine consist sterile substance that is
meconium; Meconium is the first discharge
oof the newborn: Meconium is a Green
substance
 Occurs in term or post-term infants
 During fetal distress there is increases
intestinal peristalsis, relaxing the anal
sphincter and releasing meconium into the
amniotic fluid.
 Aspiration can occur in utero or with the first
breath.
 Meconium can block the airway partially or
completely and can irritate the newborn'
airway, causing respiratory distress
Note: anything that blocks the airway causes
respiratory distress
ASSESSMENT
Respiratory Distress is present at birth:
 Tachypnea,
 Cyanosis,
 Retractions,
 Nasal flaring,
 Grunting, (very common)
 Crackles, and rhonchi may be present (very
common)
 Infant’s nails, skin, and umbilical cord may be
stained a yellow-green (meconium) color
CAUSES AND RISK FACTORS
 Common to post mature
 Maternal history of diabetes
 Hypertension
 Difficult delivery
 Poor intrauterine growth
MANAGEMENT
 Suctioning must be done immediately after
the head is delivered before the first breath is
taken (for secretions than blocks airway)
Note: o2 can be administered for life support
kasi mahirap maghinga
 Vocal cords should be viewed to see if the
airway is clear before stimulation and crying
 Extracorporeal membrane oxygenation
(ECMO)
16
  Cardiopulmonary bypass to support
gas exchange, allows the lungs to rest
 pump blood; pump outside of the
body to the heart to remove the
carbon dioxide and asses oxygen
blood back to the tissue; oxygenated
pag balik
NURSING INTERVENTION
Focuses on:
1. Observing neonates respiratory status closely
2. Ensuring adequate oxygenation (as ordered)
3. Administration of antibiotic therapy (prevent
infection)
4. Maintain thermoregulation
SEPSIS
 Description: Generalized infection resulting
from the presence of bacteria in the blood
Note: neonatal, usually may B categorized in
the early onset; e.g. first few day na paglabas
(0-3 days) or late onset (after 4 days), the
newborn will be assessed with the presence
of bacteria.
If preterm it is very risky, mahirap mag adjust
ang immunity level if may infection; onset are
the very rapid sepsis for premature babies
BSN-2B TRANSCRIBED BY: GROUP #
 Major common cause is group B beta-
hemolytic streptococci (can breakdown RBCs)
- it can affect newborn and adults
SEPTISIMIA (SEPSIS)
CONTRIBUTING FACTORS
 Prolonged rupture of membranes
 Prolonged or difficult labor
 Maternal infection
 Cross contamination
 Aspiration (can be meconium aspiration)
ASSESSMENT
- often does not have specific sign of Illness
 Poor feeding
 Irritability
 Lethargy
 Pallor
 Tachypnea
 Tachycardia
 Abdominal distention
 Temperature instability - difficulty keeping
temperature within normal range
Note: due to infection; wala ng immunity
DIAGNOSING
 Blood, urine, and cerebrospinal fluid cultures
 Routine CBC, urinalysis, fecalysis
 Radiographic test
MANAGEMENT
 Intensive antibiotic therapy
 IV fluids (can be cloudy)
 Respiratory therapy
NURSING INTERVENTION
Routine newborn care with special emphasis on the
following
1. Monitor vital signs, assess for periods of
apnea or irregular respirations.
2. Administer oxygen as prescribed
3. Provide isolation as necessary.
 Monitor and limit visitor (the patient
might get additional infection; especially
for premature babies because they have
immature organs)
4. Handwashing before and after handling
neonate
17

SUDDEN INFANT DEATH SYNDROME (SIDS)
 Sudden death of any young child that is
unexpected by history and which thorough
postmortem examination fails to demonstrate
adequate cause of death
 Usually occurs during sleep
 Diagnosis is made after autopsy
 High incidence in preterm infants, infants with
abnormalities in respiration
 Unknown cause
FACTORS
 May be related to a brainstem abnormality
in the neurological regulation of cardio-
respiratory control
 Sleep on their stomach or malpositioning
 Obstruction of airway
 Overheating while sleeping or too soft ang
surface nya or a toy can cause
 Mother or father smoking (secondhand
smoke)
 any maternal factor
 Baby is born late or no prenatal check up or
premature
 Have a sibling who died also of SIDS
NURSING ROLE
1. Care is directed at supporting parents/family
2. Provide a room for the family to be alone
(allow them to grieve)
3. Reinforce that death was not their fault
4. Provide appropriate support referrals
5. Explain how parents can receive autopsy
results
PREVENTION
Infants should be placed in the supine position
for sleep.
 Soft moldable mattresses and bedding, such
as pillows or quilts, should not be used for
bedding. yung maka hinga siya ng maayos;
may proper ventilation and positioning and
allow proper circulation
 Stuffed animals should be removed from the
crib while the infant is sleeping. might cause
suffocation and might cove baby’s face
 Discourage bed sharing (sleeping with an
adult).
 Home apnea monitor to infant with near miss
SIDS when you notice na walay rice and fall sa
abdomen or chest area during the baby is
asleep
BSN-2B TRANSCRIBED BY: GROUP #
KERNICTERUS
 If untreated, hyperbilirubinemia can result to
kernicterus or the deposition of bilirubin in
the brain.
 Usually occurs if the bilirubin levels are
25mg/di or higher in term infants
 Toxicity starts at 8-12 mg/dl in sick or low
birth weights
COMMON PROBLEM DURING INFANCY
FAILURE TO THRIVE
Common in South Africa and to some areas in our
community.
 a condition in which a child fails to gain
weight and is persistently less than the fifth
percentile on standard growth chart
Malnutrition is being experienced; weight
problem
 Persistent deviation from established growth
curve. sign of delayed weight development
 delay in physical growth and weight gain
might lead to cognitive impairment or even
death
Weight is the most sensitive indicator of our
nutritional status; one of the problem of WHO
and DOH; then comes up feeding programsa
and assessments of nutritionist of the health
center
4 PRINCIPAL FACTORS FOR HUMAN GROWTH
1. Food
2. Rest and activity
3. Adequate secretions of hormones
4. Satisfactory relationship with caregiver
Classified as:
Organic (OFTT) - due to pathologic condition such as
problem in absorption and hormonal dysfunction
 there might be other chronic disease that the
child is experiencing that could interfere with
the nutrients intake or it could not be
absorbed or problem with the metabolism or
excretion
Nonorganic (NFTT) - due to psychosocial factor
 disrupted maternal child relationship
Idiopathic(IFTT) - Unexplained by the usual organic
and environmental etiologies but usually classified as
Nonorganic (NFTT)
18
  A thorough history is the best guide to
establishing the etiology of the failure to
thrive
 Poverty is the greatest single risk factor
worldwide and in the United States
 Nutritional deficiency is the fundamental
cause
ASSESSMENT FINDINGS
 Poor muscle tone, loss of subcutaneous fats,
skin breakdown
 Rumination - common characteristic,
voluntary regurgitation
 Lethargic- unresponsive
 Positive delay in growth and development
 Signs of disturbed maternal - child interaction
 Diminished or nonexistent crying
 radar gaze - wide-eyed gaze and continual
scan of environment
Characteristics of the individual providing care
 Difficulty perceiving and assessing the infant's
needs
 Frustrated and angered at the infant's
dissatisfied response
 Frequently under stress and in crisis, with
emotional, social and financial problems
 All children with failure to thrive need additional
calories for catch-up growth
TREATMENT (depends on the cause)
 Medical disorder - specific treatment is given
 Parent-child relationship - Family counseling
Psychosocial intervention
 Nutritious, high-calorie feedings
scheduled meals; feeding program every
week; offer solid before liquids pag kaya na;
Increase protein after 6 months if makakain
na
NURSING DIAGNOSIS
- Makita mo sa itsura ng bata; Makita mon a
imbalance nutrition
- Makita na less than body requirements; kulang ang
feeding
- Baka hindi naga feed si mother
- test skin integrity; baka mafeel mon a ang bone
-urinary elimination impapirment; constipation
NURSING INTERVENTIPN
1. Provide consistent caregiver.
BSN-2B TRANSCRIBED BY: GROUP #
2. Provide sufficient nutrients.
3. Make feeding a priority intervention.
4. Keep an accurate record of intake.
5. Weigh daily.
Introduce positive feeding environment
 Establish a structured routine
 Hold the young child for feeding
 Maintain eye-to-eye contact (colorful AND
creative plating)
 Maintain a calm, even temperament
 Provide a quiet, nonstimulating environment
 Talk to child giving appropriate directions and
praise for eating
 Increase stimulation appropriate to the child's
present developmental level.
 Provide the parent an opportunity to talk.
 When necessary, relieve the parent of
childrearing responsibilities until able and
ready emotionally to support the child.
 Demonstrate proper infant care by example,
not lecturing.
 Supply the parent with emotional support
with fostering dependency.
 Promote the parent's self-respect and
confidence by praising achievements with
child.
HYDROCEPHALUS
 An imbalance of cerebrospinal fluid (CSF)
absorption or production
 caused by: malformations, tumors,
hemorrhage, infections, or trauma; Results in
head enlargement and increased ICP
TYPES
COMMUNICATING
 occurs as a result of impaired absorption
within the subarachnoid space.
NONCOMMUNICATING
 blockage in the ventricular system that
prevents CSF from entering the subarachnoid
space
19
ASSESSMENT FINDINGS - treatment depends to cause

 Increased head circumference SURGICAL INTERVENTION

 Thin, widely separated bones of the head that
produce a cracked pot sound (Macewen's 1. GOAL: Prevent further SF accumulation by
sign) on percussion bypassing the blockage and draining the fluid
 Anterior fontanel tense, bulging, and from the ventricles to a location where it may
nonpulsating be reabsorbed
 Dilated scalp veins 2. Ventriculoperitoneal shunt
 Sunsetting eyes  the SF drains into the peritoneal
cavity
3. Atrioventricular shunt
 CSF drains into the right atrium of the
heart
Shunt - divert or by pass

MEDICATION

 Acetazolamide (diamox)
 promote the excretions of excess
fluids

PREOPERATIVE INTERVENTIONS

1. Give small frequent feedings as tolerated

until a preoperative PO status is prescribed.
2. Reposition head frequently and use an egg
crate mattress under the head to prevent
pressure sores.
3. Prepare the child and family for diagnostic
procedures and surgery

Instruct the parents on how to recognize shunt

infection or malfunction:
 Behavior changes, such as irritability and
lethargy
 In an infant
 Headache on awakening
 irritability, lethargy, and feeding poorly
 Nausea and vomiting
 In a toddler
 Ataxia- lack of coordination of muscle
 headache and a lack of appetite
movement
 Nystagmus- involuntary movement of the
 In older children,
eyes  an alteration in the child's level of
 Late signs: High, shrill cry and seizures. consciousness.

DIAGNOSTIC TEST

 CT scan
 MRI
 Skull X-ray
 Transillumination
 holding a bright light such as a
flashlight or specialized light (Chun
gun) against the skull in a darkened
room
 a skull filled with fluids rather than
solid brain substance

MANAGEMENT

BSN-2B TRANSCRIBED BY: GROUP # 20

 Care of Mother, Child at Risk or 04 L E C
12
with Problems (Acute & Chronic)
NCM 209 – Ms. Florence Puno
22 O3
SPINA BIFIDA

OUTLINE
I Spina Bifida
Types:
II Meningitis
III Seizure 1. Spina bifida occulta
IV Otitis Media
V Cleft lip and palate ● posterior vertebral arches fail to close in the
lumbosacral area.
● Spinal cord and meninges remains in the
normal anatomic position defect may not be
visible dimble or a tuff of hair on the spine
Bony defect that occurs without soft tissues
Spina Bifida
involvement.
Description- A central nervous system defect results
● Asymptomatic may have slight neuromuscular
from failure of the neural tube to close during
deficits.
embryonic development generally in the lumbosacral
● No treatment if asymptomatic aimed at
region.
specific symptoms
2. Spina bifida cystica
So the defect is around that neural tube (Neural tube ● Protrusion of the spinal cord and/or its
defect) meninges with varying degrees of nervous
SPINA BIFIDA tissue involvement
It is a treatable spinal cord malformation that occurs
in varying degrees, depending on the severity.
● Meningocele
○ part of spinal protrudes through
Causes opening in the spinal canal.
○ Sac is covered with thin skin no nerve
Actual cause is unknown; multiple factors roots involved
● Genetic- if a sibling has had neural tube ○ No motor or sensory loss
defect ○ good prognosis after surgery- just
There is a higher than normal risk of having a watch out for signs of infection.
baby if there is a spina bifida already Bony defects that form a certain sac around
that area.
● Environmental factors
● Medications, viral infection and radiation ● Myelomeningocele (meningomyelocele)
Medications if may na take si mother during ○ With spinal nerves roots in the sac
pregnancy ○ Have sensory or motor deficit
○ Below site of the lesion
Taking folic acid decrease incidence of neural tube ○ 80% have multiple handicaps
defect There is a protrusion of the spinal cord in the
meninges with nerve roots na nandyan around
Folic acid is a water-soluble vitamin that is essential that wall of the cyst.
for cell-growth and production. If you have low folic-
acid intake, that will indicate also the occurrence of
spina bifida

BSN-2B TRANSCRIBED BY: GROUP # 21


For the option of surgery, we will just remove
the sac then there is a closing of that skin,
then monitor the response of the patient with
regards to the surgery, and how the child
adapts to the changes.
Possibly there would be cognitive symptoms
and paralysis. Sometimes it would be
completely paralyzed, and with the cognitive
level naman because it occurs in the neural
tube so the effect will lead on how the brain
would develop.
Assessment:
Depends on the spinal cord involvement
1. Visible spinal defect- makita mo nayan from
head to toe
2. Motor/sensory involvement
a. Flaccid paralysis of the legs
b. Altered bladder and bowel function
c. Hip and joint deformities
d. Hydrocephalus
Hindi naman lahat mag occur so need talaga
frequent monitoring
Sometimes the patient will also experience
lack of strength. In the force routine
newborn, there will be examinations to be
conducted for us to know the impairment in
the neurologic aspect.
Prenatal
● Ultrasound
● Amniocentesis
Postnatal
● Xray of spine
● Ct scan
BSN-2B TRANSCRIBED BY: GROUP #
● Myelogram- uses a special dye and an
x-ray (fluoroscopy) to provide a very
detailed picture of the spinal cord and
spinal column.
● Encephalogram
● Urinalysis, BUN, Creatinine clearance
Management
 Surgery
o Closure of sac within 48 hours
o Shunt
o Orthopedic
 Drug Therapy
o Antibiotic
o Anticholinergic
Nursing management
1. Prevent trauma to the sac
a. Cover with sterile, moist (normal
saline, non-adherent dressing
b. Change the dressing every 2 to 4
hours as prescribed, keep area free
from contamination
c. Place in a prone position to minimize
tension on the sac
d. Head is turned to one side for feeding
e. Administer meds
2. Prevent Complication
a. Use aseptic technique to prevent
infection
b. Assess the sac for redness, clear or
purulent drainage, abrasions,
irritation, and signs of infection
c. Clean intermittent catheterization
d. Perform neurological assessment
e. Assess for physical impairments such
as hip and joint deformities
3. Provide adequate nutrition
4. Provide sensory stimulation
5. Provide emotional support to parents and
family
6. Provide discharge teachings
a. Wound care
b. ROM, PT
c. Signs of complications
d. Medication regimen
e. Positioning – feeding, diaper change
Meningitis MENINGITIS
- Inflammations of meninges of the brain and
spinal cord
- Cause by bacteria, viruses, other
microorganism
22
 - As a primary disease or as a result of
complications of neurosurgery, trauma,
infection of the sinus or ears, or systemic
infections.
H Influenzae Menignitis – The most common form;
between 6 to 12 months
Bacterial Meningitis
- Haemophilus influenza type B, Streptococcus
pneumoniae, or Neisseria meningitidis
- Viral Meningitis is associated with viruses
such as mumps, herpesvirus, and enterovirus
Assessment
Fever, chills, headache, high-pitched cry, irritability,
vomiting, poor feeding or anorexia, bulging anterior
fontanel in the infant
Signs of Meningeal Irritations
 Nuchal rigidity – stiff neck
 Positive Kernig sign – severe stiffness
of the hamstring muscle causes an
inability to tighten the leg when the
hip is flexed to 90 degrees.
 Opisthotonos
o Arching of the back
o Head and heels bent
backward
o And body arched forward
 Brudzinski sign – Flexion at the hip in
response to forward flexion of the
neck
Bulging of the fontanel – because of the soft spot on
the top of the head or increased intracranial pressure
or fluid in the brain
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Diagnosis
 Lumbar Tap - CSF Testing obtained by lumbar
puncture

Management
Interventions:
 Provide isolation and maintain it for at
least 24 hours after antibiotics are
initiated
 Administer antibiotics and
antipyretics as prescribed
 Perform neurological assessment and
monitor for seizures and
complications
 Assess for changes in level of
consciousness and irritability
 Monitor intake and output
 Assess nutritional status
 Determine close contacts of the child
with meningitis because the contacts
will need prophylactic treatment.
 Meningococcal vaccine is
recommended to protect against
meningitis
If a patient has meningitis, it is necessary to isolate
them.
Even if the sign of illness (fever) is minor, it should
never be taken for granted because it can become
severe in a matter of minutes or seconds.
Mastering drugs such as paracetamol, analgesics,
antipyretics, antibiotics, IV fluids, and pain relievers
since these are most commonly administered;
knowing their mode of transmission, indications, side-
effects, and responsibilities.
Always remember when sponge baths can be given,
when one can increase fluid intake, to check for good
ventilation, and give comfort to the patient since
these are somewhat part of the bed-side care.
23
A study in 2021 was conducted by The University of
Copenhagen, where a new treatment for bacterial
meningitis, specifically of the pneumococcal
pathogen, was created where if a patient undergoes
through antibacterial therapy, then it may be possible
to reprogram or dissolve the neutrophil which is an
immune cell that fights of pneumococcal pathogens.
The study then seeks to try and dissolve these
neutrophil nets because they block CFS in some parts
of the brain which would then cause edema. Once
there is an increase in WBC (neutrophils) then there is
a tendency that an infection is present.
A seizure is how the body responds to a problem, for
example if there is an increase in body temperature,
then there is definitely a change in a cellular level
which would lead to the abnormal activity of the
nerve endings.
SEIZURE
Recurrent sudden changes in consciousness, behavior,
sensation and or muscular activities beyond voluntary
control caused by excess neuronal discharge.
There may be biochemical imbalances that can result
in seizures, or multiple seizures (repetition of
electrical discharges, particularly in the nerve)
Normally the neuron sends out messages in electrical
impulses periodically and the firing individual neuron
is regulated by an inhibitory feedback loop
mechanism.
If there are changes in motor-control, alterations with
sensation in translation to muscular activities, this can
affect autonomic function. Febrile seizure is the most
common in this, where it is most common with
children (6 months - 5 years), where in sometimes this
is associated with high fever with no intracranial
infections associated
With seizure many more neurons than normal fire in a
synchronous fashion in a particular area of the brain;
the energy generated overcomes the inhibitory
feedback mechanism
Febrile seizures is common in children between 6mon
- 3yrs old
Febrile seizure are seizure that happened between
children with that age and I told you kanina na there is
high fever, there are no particular infection
Febrile seizure
Common in 5% of population under 5 years old,
familial
BSN-2B TRANSCRIBED BY: GROUP #
Non progressive does not generally result in brain
damage
Seizure occur only when fever is rising
- That is why we do not let the fever increase as
much as possible
Commonly associated with high fever – 38.9 to 41.1
Celsius
- Sponge bath kaagad tayu
Some appear to have a low seizure threshold and
convulse when a fever of 37.8 to 39.8
Different classification of Febrile Seizure
1. Partial seizure
A. Simple- localized motor activity shaking of
arm or leg limited to one side of the body
B. Complex – psychomotor seizure memory
loss and staring non purposeful
movement
Seizure is classify as with respect the abnormal
neuronal activity
Simple is affected the one side of the brain
And there is complex which alter the one side
consciousness
Aura – sensation that signals an attack
After – sleep or confuse; unaware of the
seizure
2. Generalized
A. Tonic – clonic, prodromal, AURA, tonic,
post ictal
- This begins in the both side of the brain but
can start at one side but mag spread lang siya
- The aura is the warning sign
B. Absence - rarely 20 seconds stares
straight, does not fall
Status epilepticus - A seizure that lasts longer than 5
minutes, or having more than 1 seizure within a 5
minutes period, without returning to a normal level of
consciousness between episodes is called status
epilepticus.
Absence – abrupt lapses of consciousness lasting a
few seconds
Atonic – abrupt, unexpected loss of muscle tone
Myoclonic – rapid short contractions of one or all
extremities
So this are the term to utilize on checking on your
patients level of consciousness during the seizures
24
Contributing factors: seizure disorder -restless and repeatedly shakes the head,
frequently pulls or tugs at affected ear.
1. Intracranial infection
2. Space occupying lesion 2. irritability, cough, nasal congestion, fever.
3. CNS defect
3. Hearing impairment.
Assessment findings
4. Purulent discharges.
1. Restlessness / irritability
2. Body stiffens and loss of consciousness
3. Clonic movements – quick, jerking Diagnosis
movements of arm, legs, and facial muscle
 Examination of ear with otoscope.
Reveal bright red bulging eardrum.
Treatment Diagnostic test
 Culture and sensitivity of ear discharge.
1. Drug Blood studies
a. Diazepam - To rule out lead
b. Phenobarbital poisoning Possible complication
c. Dilantin - Hypoglycemia
- Infection  Permanent hearing loss mastoiditis.
- Electrolytes imbalance
Management
EEG – this is to detect abnormal wave
1. Antibiotics, analgesics
2. Surgery Tumor hematoma 2. Myringotomy incision into the tympanic
membrane to relieve pressure and drain the
INTERVENTION
fluid with / without tube.
 Reduce fever with antipyretics
 Give prescribed medication
 Generalized seizure precautions Postoperative interventions
 Do not restrain; pad crib rails; do not use tongue
blade  Wear earplugs while bathing, shampooing,
and swimming.
 Observe and record the time of seizure,
 Diving and submerging underwater are not
duration, and body parts involved.
allowed.
 Suction and administrator oxygen after the
 Child should not blow his or her nose for 7 to
seizure as required.
10 days after surgery.
 Observe the degree of consciousness and
behavior after seizure
 Provide rest after the seizure
Interventions
 Encourage fluid intake.
OTITIS MEDIA  Teach the parents to feed infants in upright
position, to prevent reflux.
- Inflammation of the ear particularly in the  Instruct the child to avoid chewing as much as
middle part possible during the acute period because
Why does the middle part of the ear get chewing increases pain.
infection? it is a bacterial or a viral infection of  Provide local heat and have the child lie with
the middle ear. the affected ear down.
 Instruct the parents in the appropriate
- Common in infants and preschoolers. procedure to clean drainage from the ear with
- Eustachian is shorter, wider, and straighter. sterile cotton swabs.
- Thereby, allowing nasopharyngeal ear more
easily. Instruct the parents
 Administration of analgesics or
antipyretics.
Assessment findings  Administration of the prescribed
1. Behavior that would indicate pain. antibiotics, emphasizing that the 10-to-

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 14-day period is necessary to eradicate 3. Ear infection
infective organisms. 4. Speech defect, dental malformation
 Screening for hearing loss may be 5. Body image
necessary.
Management (Rule of Ten)
Administering ear medications
1. Surgical correction
 Younger than age 3, pull the lobe down and
back. Cheiloplasty – correction of cleft done – 2 months old
 Older than 3 years, pull the pinna up and Palatoplasty – cleft palate surgery done – before
back. speech development allow for palatal changes that
take place with in 12-18 months
CLEFT LIP AND PALETE
Can’t Management
 Non union of the tissue and bone of the upper
lip and hard / soft palate during embryonic 2. Team approach therapy
development.
 Failure of the maxillary and premaxillary Dentist and orthodontist, Audiologist, Speech
process to fuse during fetal development. therapist, Pediatrician.

Etiology – primarily genetic environmental factors

Viral infection exposure to radiation Folic acid Nursing Intervention – Pre op cleft lip
deficiency teratogenic factors  Feed in upright position in small frequent
Assessment findings: feedings
 Burp frequently
1. Facial abnormality  Use large-holed nipples
2. Difficulty sucking and swallowing  Use rubber-tipped syringe – if unable to suck
3. Milk escapes through nose  Gavage feeding as ordered
 Finish feeding with water
 Provide emotional support for parents and
family

Nursing Intervention – Post op cleft lip

 Maintain patent airway
 Assess color; monitor for frequent swallowing
 Do not place in prone position
 Avoid straining suture lines
 Use elbow restraints
 Resume feedings as ordered

Assessment
Nursing Intervention – Pre op cleft palate
Cleft lip
 Prepare parents to care for child after surgery
 Can range from a slight notch to a complete
 Instruct concerning feeding methods and
separation from the floor of the nose.
positioning
Cleft palate
Nursing Intervention post operative – cleft palate
 Nasal distortion
 Suction mucus and saliva gently and do not
 Midline or bilateral cleft
touch the sutures
 Variable extension from the uvula and soft
 Incision care
and hard palate.
 Clean suture with sterile cotton swab with
Associated problems half strength hydrogen peroxide followed by
saline.
1. Feeding problems  Apply antibiotic ointment
2. URTI  Do not displace Logan bar

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 Do not place in prone position, Place in side
lying position
 Keep spoons, pacifier, straws, away from
child’s mouth for 7 to 10 days post op
 Elbow restrains
 Special feeder – syringe with rubber tubing
into side of mouth, Breck feeder

BSN-2B TRANSCRIBED BY: GROUP # 27

 Care of Mother, Child at Risk or 04 L E C
19
with Problems (Acute & Chronic)
NCM 209 – Puno,
22 O1
TOPIC TITLE HERE

OUTLINE
I. BURNS CLASSIFICATION ACCORDING TO DEPTH
II. CEREBRAL PALSY
III. POISONING 1. PARTIAL THICKNESS
IV. CHILD ABUSE a. Superficial partial thickness
V. IRON DEFICIENCY ANAEMIA  Epidermis
VI.  painful erythema, No vesicles

BURNS

 Is an injury to body tissue caused by excessive

heat

 It is the most severe form of trauma to the

integumentary system.

 Once you have burns it really disrupts the skin

which leads to the increase of fluid loss and
b. Deep Partial Thickness
sometimes lead to infection.
 Epidermis / dermis
 We have also scarring which can lead to impaired  very painful
skin integrity and the immunity is also  fluid filled vesicles
compromised that’s why most of the patient are  Red, shiny, wet
placed in a private room to be isolate because - To prevent blister apply cold packs
they are high risk for infection.

 Changes in the functioning the appearance the

body image it depends also how severe is the
burn.

BASIC TYPES
a. Thermal - Caused by flames, flash, scalding
(hot liquid), contact to hot metal, grease
b. Chemical - Inhalation or ingestions of acids,
alkalines, or vesicant
c. Smoke inhalation - Fire, gases, superheated
air-smoke causes respiratory tissue damage
d. Electrical burn - Damage of nerves and vessels 2. FULL THICKNESS
due to electric current  All skin layers and nerve endings, may involve the
- We need also to determine how the muscles, tendons, and bones
patient responds on percentage
 Little or no pain
based on the area of burning total
body surface area.  Eschar-the tough, leathery scab that form over
 Local response - do not exceed with twenty moderate or severe burn area
percent
 Wound is dry, white leathery, or hard
 Systemic response - exceeds Twenty percent

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First degree burn - affect only the outer layer of skin,
the epidermis. The burn site is red, painful, dry, and
with no blisters. Mild sunburn is an example. Long-
term tissue damage is rare and often consists of an
increase or decrease in the skin color.
Second degree burn - affects both the epidermis and
the second layer of skin (dermis). It may cause
swelling and red, white or splotchy skin. Blisters may
develop, and pain can be severe. Deep second-degree
burns can cause scarring.
Third degree burn - are deep, severe burns that
completely damage the skin. Causes can include
exposure to flames, explosions, or strong chemicals.
People with third degree burns need immediate
medical attention from a special burn unit. This can
help prevent serious complications such as infection
or shock.
- After burns there is increased vasoconstriction in
response to the substance that was released by the
injured cells active hormones are released that will
increase the capillary permeability.
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Phases/Stages of Burns
1. EMERGENT PHASE - this is the onset of the burn
injury and last until the completion of that fluid
resuscitation or a period about first 24 hours since the
emergent.
- Our Priority is to maintain airway
- We’re going to treat the client for burn shock prevent
burn shock to happen.
A. Remove the person from the source of burn
- Before you remove you should check area first if it is
safe
 Thermal - smother burn beginning with the
head
 Smoke inhalation - ensure patent airway
 Chemicals - remove clothing
 Electrical - maintain airway, identify entry
and exit route
B. Wrap in dry, clean sheet
C. Assess how and when burn occurred
D. Provide IV route if possible
E. Transport immediately
2. SHOCK PHASE
- Fluid shift from plasma to interstitial causing
hypovolemia
- Low level of fluids
Assessment findings: Sign of dehydration, BP,
tachycardia, urine output, thirst
 Hypovolemia this is the immediate consequence
once there is a fluid loss because of the decreased
perfusion or oxygen delivery.
 Cardiac output might be decreased before any
significant change with regards to the fluid
volume which is very evident.
 Sometimes the patient would also experience
rapid edema after burn injury.
 Your circulation should also be assessed to keep it
tachycardia because of the blood volume also
decreases you usually during the burn shock.
Diagnostic test - hyponatremia, hypoproteinemia,
hyperkalemia
29
  Hyperkalemia - this immediately happen Major
after burn injury would result because of o partial thickness
massive cell destruction o greater than 25% of body surface
 Hypothermia - loss of skin results to inability o Full thickness greater than or equal to 10%
to regulate the body temperature.
o You check the temperature also of
your patient because of that loss of
skin portion.

3. DIURETIC PHASE / FLUID REMOBILIZATION

- Interstitial fluids returns to the vascular space

Assessment findings: Elevated BP, increase urine

output

4. CONVALESCENT - Wound healing

Assessment Focus:

1. EXTENT OF INJURY
 Rule of nines - This method divides the body's
surface area into percentages. The front and
back of the head and neck equal 9% of the
body's surface area. The front and back of
each arm and hand equal 9% of the body's
surface area.

 Lund and Browder - is commonly used to

assess the burned body surface area. Different
percentages are used in paediatrics because
the surface area of the head and neck relative
to the surface area of the limbs is typically
larger in children than adults

2. SEVERITY OF BURN CLASSIFICATION

Minor
o partial thickness (1st/2nd degree) less than 10-
15% of body surface
o full thickness (3rd degree) less than 2% of body
surface
o No burn on area of face, feet, hands or
genitalia

Moderate
o partial thickness (2nd degree) between 15-25%
of body surface
o full thickness less than 10%
o Smoke inhalation

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  CATHETERIZATION
- Parameters such as vital signs (heart
rate), urine output, adequacy of
capillary filling, and sensorium status
determine adequacy of fluid
resuscitation.

2. Wound care
o open or closed burn therapy, hydrotherapy

3. Drug therapy
o Topical antibiotic - Silver sulfadiazine
o Systemic antibiotics
o Tetanus Toxoid / HTIG - to prevent further
BASIC BURN TREATMENT infection
o Analgesic - morphine sulfate
A. Minor burns:
o Antibiotic 4. Physical therapy
o analgesic o to prevent disability caused by scarring,
o ointment contracture
o Gauze bandage
5. Surgery
B. Moderate burns: o Escharotomy (an incision made into
o Do not rupture blisters - it will start an constricting eschar to restore peripheral bld.
infection and much more painful Circulation)
o analgesia/antipyretic ointment o Debridement
o Warm water and mild soap
o Burn dressing - bulky dressing - depends on the o Skin grafting
doctors order

C. SEVERE BURN

1. Supportive therapy: fluid management

- Our very goal here is to decrease the
fluid losses
- We have to prevent infection
- We have to control pain and to have
supportive measure

 Crystalloid solutions: lactated Ringer

 COLLOID SOLUTIONS SUCH FFP

- FFP(Fresh Frozen Plasma) is a blood
product it is a form of liquid portion of
full blood we're going to treat uh this is
used to treat condition in which if
there are low blood clotting factor
lower levels of your blood protein
solutions

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 NURSING INTERVENTIONS
FORMULA
1. Provide relief or control of pain

2. Monitor alterations in fluid and electrolytes

- check the results of your electrolytes imbalances
some other diagnostic tests.

3 Promote maximum nutritional status

- promote maximum or nutritional status for fast
healing.

4 Prevent wound infection

5 Prevent Gl complications

6. Provide health teachings

PARKLAND FORMULA
o Parkland formula this is used to calculate fluid
resuscitation for critical burn patient.
o very useful specifically for patients who sustain
large deep partial thickness, full
o Thickness burn.
o These are the formula that we're going to use
when we have our fluid resuscitation to our
patient.

• LR - Lactated Ringer
BSA - Body Surface Area

4cc X wt in kg X total BSA% (deliver ½ over first 8hrs,

then other ½ over the next 16hrs)

• FFP fresh frozen plasma

- determine the coagulation factor

0.5cc x wt in kg x total BSA% (deliver over the next

four hours following fluids)

• MAINTENANCE (D5W)
1cc X wt in kg X total BSA%

BSN-2B TRANSCRIBED BY: GROUP # 32

 CEREBRAL PALSY
Types of Cerebral Palsy
Description:

- Neuromuscular disorder characterized by

impaired movement and posture resulting
from an abnormality in the extrapyramidal or
pyramidal motor system (pathway connecting
to the structure of your brain)

Neurological condition that damages the motor

system, responsible for movement

- CP is a chronic nonprogressive motor

dysfunction caused by damage to the motor
control centers of the developing brain and
can occur during:  SPASTIC
o Pregnancy - about 75% o tense, contracted muscles (most
o Childbirth – 5% common type of CP
o After birth – 15% up to about age  ATHETOID
three o Constant, uncontrolled motion of
limbs, head, and eyes
Etiology
a. Prenatal – genetic, mother with rubella, Involuntary movement, slow
accidents, PIH  RIGIDITY
b. Perinatal - drugs at delivery, precipitate o Tight muscles that resist effort to
delivery, breech deliveries make them move
c. Postnatal – kernicterus, head trauma (falls
out of crib, car accidents) Resistant to flexion and extension

The most common cause of CP is premature birth of  TREMOR

low birth weight o Uncontrollable shaking, interfering
with coordination
Also watch out baka may lacking supply of oxygen
going to the brain Repeated rhythmic involuntary contraction

early separation of placenta – maybe kulang pa ang  ATAXIC

nutrients na nakuha ng fetus o Poor sense of balance, often causing
falls and stumbles

Ataxic or ataxia is disturbances in the equillibrium

There’s compression in the cord or bleeding

Avoid infection because these infections may cause CP

Eat nutritious food – avoid nutritional deficiency

(affects brain, growth and development of child)

Kernicterus – causes brain damage

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 Characteristic according to Body’s Topographic
Response

Age Normal Cerebral palsy

development
By 3 months Lies straight on Still legs, cannot
Arm and Leg on one side (Hemiplegic) stomach, holds lift head, cannot
head up well, push up (on
- Arm bent, hand spastic or floppy, often of pushes up arms, arms)
little use lies on back, Pushes back
- She walks on tiptoe or outside of foot on brings two head to one
affected side. hands together side, one arm
- This side(unaffected) completely or almost and leg bent,
normal the other arm
and leg straight,
Both legs only (Paraplegic) or with slight involvement cannot bring
elsewhere (Diplegic) hands together
By 6 months Sits leaning on Cannot lift
- Upper body usually normal or with very minor
hands, takes head, round
signs weight on feet back, stiff arms
- Child may develop contractures of ankles and when held in and fisted
feet standing hands.
Both arms and both legs (Quadriplegic) Head falls back
when he is
- When he walks, his harms, head and even his pulled to sitting.
mouth may twist strangely. Tiptoe standing,
- Children with all 4 limbs affected often have arms pull back,
such severe brain damage that they never are stiff legs which
able to walk. are crossed like
scissors.
- The knees pressed together
By 9 months Sits alone, Round back,
- Legs and feet turned inward
reaches out, poor use of
supports self hands for play,
when placed stiff legs,
standing pointed toes.
Does not take
weight on legs,
poor head lifting

BSN-2B TRANSCRIBED BY: GROUP # 34

 muscles. This reduces muscle spasm or improve
muscle tone.
Clinical manifestation
1. Alteration in muscle tone: abnormal posturing
and movement, continued primitive reflex
response
2. Delay in gross motor skills like sitting crawling,
walking
3. Fine motor coordination may be affected
(self-feeding and dressing)
4. Other deficits: poor vision, Strabismus or
nystagmus, hearing loss, cognitive
By 12 months Pulls to stand Difficulty pulling impairments, speech/language delay, seizure,
holding to stand, still growth problems (FTT-failure to thrive)
something, legs, pointed
Diagnosis: Based on clinical findings
crawls well toes.
Cannot crawl, Treatment: There is no cure for CP
uses only one
side of the body - Intervention enable the infant and child to
or drags self by achieve the best movement, locomotion and
only using… communication skills as possible and
By 18 months Stands and One arm stiff encourage self-sufficiency
walks alone, and bent, tiptoe
moves into and walking on one Patient care management
out of sitting, side, poor - Promotion of optimal rehabilitation in the
sits straight, standing areas of locomotion, communication, and the
uses both hands balance. activities of daily living
Uses mostly one
- Correction of associated disabilities
hand to play,
one leg may be Medical Management
stiff, sits with
weight to one Drug Therapy
side
- Antianxiety
- Skeletal muscle relaxants
Common problems are: - Local nerve block (administration of
anesthesia that causes numbness)
- Visual defects (strabismus, nystagmus,
refractory errors) Speech/ audiotherapy
- Strabismus – eyes do not properly alaign
Physical/ Occupational Therapy
while looking on one object
- Nystagmus – eyes make repetitive Surgical interventions are reserved for the child who
uncontrollable movement does not respond to more conservative measures or
- Refractory – shape of eye does not bend light for the child whose spasticity causes progressive
correctly (eg. Myopia- near sightedness, deformity (orthopaedic surgery – help correct
hyperopia- farsightedness) deformities)
- Hearing loss
- Speech or language delay Nursing Interventions
- Seizures The goal of management is early recognition and
- Mental retardation interventions to maximize the child’s abilities
Dorsal root rhizotomy - a procedure where surgeons A multidisciplinary team approach
locate and sever overactivated nerves that control leg
- Assess the child’s developmental level and
intelligence

BSN-2B TRANSCRIBED BY: GROUP # 35

 - Encourage early intervention and
participation in school programs
- Prepare for using mobilizing devices (assist in
movement)
- Encourage communication and interaction
with the child on his or her developmental
level rather than chronological age level.
- Provide a safe environment
- Assist in ADL
- Provide safe appropriate toys for the child’s
age and developmental level
- Position the child upright after meals
- Administer medications as prescribed to
decrease spasticity.
- therapy
possible clinical diagnoses:
- Risk for injuries (seizure)
- Impaired physical mobility
- Deficit knowledge
INGESTION OF POISONS
POISONING
• POISON – Any substance that is harmful to the body
o Ingestion of toxic substance
Common agent in childhood – Soaps, cosmetics,
detergents or cleaners and plants
(There are some toxic plants, but sometimes it’s
difficult for us to identify which one is toxic or not. If
you are able to identify, keep it away from children)
Modes of exposure:
o Ingestion
o Inhalation
o Spray
(Common in toddlers, this is their way to find out
about the environment, exploration. With adolescents,
baka suicide. Sa sobrang depressed, they tend to
isolate, then the next step could be suicidal
tendencies. It is already common to adolescents,
remove anything that they can use, especially in a
major depressive state.)
SIGNS AND SYMPTOMS
1. GI disturbances: vomiting, abdominal pain,
anorexia, distinctive odor – kung pwede mo
ma-locate sa area or somebody brought that
patient, yun ang nakita niya doon na may na
spill or something for proper identification so
BSN-2B TRANSCRIBED BY: GROUP #
that we can manage the poisoning, mas
better. But if it will take time to look for that
item or object, then do not. We have to rush.
If di expert sa induce vomiting, then do not
induce vomiting. Tendency talaga is ilabas
niya. If di sanay, then rush the patient to the
nearest hospital for proper management. (GI
disturbances: Naka-NPO si patient, we do not
introduce anything by mouth. We have to
assess first the area
2. Respiratory/circulatory disturbances:
collapse, shock, unexplained cyanosis
(Note if the patient collapsed, note for signs of
shock, discoloration, circulation) Check
everything from head to toes
3. CNS manifestation
o Confusion
o Disorientation
o Sudden loss of consciousness
o Convulsion
DIAGNOSIS: Check the blood, urine, toxicology
screening, check electrolytes, AVG testing, electrolyte
testing, check the vomitus, and the presence of
poison
TREATMENT AND INTERVENTIONS
GENERAL MEDICAL TREATMENT
o Elimination of poisons
o Antidote administration
o General supportive measures
GENERAL INTERVENTIONS
1. Stabilize child’s condition
- Patent airway
2. Prevent absorption (Do not instill or painom
anything to prevent absorption. Magmatter
din yan anong nainom nya, acid ba, alkaline
ba.)
a. Determine type of substance ingested
b. Induced emesis – Except caustic material
ingestion, comatose, active seizure or
lacking gag reflex
- Syrup of ipecac (Meron kasi itong
combination, preparation, si ipecac. If you
do not know anything, then do not. What
is this ipecac? It is used for emergency
treatment of certain kinds of poisoning. It
is used to cause vomiting.)
c. Gastric lavage (Para makuha yung
napasok. Gastric irrigation: there is gastric
36
 irritation. The process of cleaning out the
contents of the stomach)
d. Activated charcoal (Common pa ito dati
as one of the emergency treatments for
certain kinds of poisoning. It also prevents
poison from being absorbed, para di fully
ma absorb yung poison sa stomach.
e. Cathartic (Laxatives, increase motility of
the intestine, increase the bulk of feces,
mailabas through feces.)
3. Provide treatment and prevention
information to parents
4. Incorporate anticipatory guidance related to
the developmental stage of the child
5. Discuss general first aid measures with
parents (in case poisoning will happen again
or about poisoning.)
METHODS OF PREVENTION
1. Child proofing the environment
2. Educating parents and child (You always have
to check the surroundings, check if meron
bang something poisonous diyan na pwede
magalaw ng ating toddler, educate parents if
there is lack of knowledge regarding
poisoning)
3. Anticipatory guidance
4. Understanding and applying the principles of
G/D
SPECIFIC POISONING
1. Salicylate poisoning = aspirin, oils of
wintergreen
o Toxicity begins at doses of 150-200mg/kg.
o S/S: CNS depression, vomiting, respiratory
failure
(With regards to this aspirin, the peak effect is 2-
4hours if tablet. Effect would last 8 hours more or less.
Ingestion may be accidental or therapeutic
overdosing. When administering medication, we
always have to check baka hindi natin alam if nag
overdose na tayo. Di intended na ipoison si patient but
it led to this one. Lalo na sa bata, because you are
going to do computation here, mas matagal
makabigay ng gamot sa pedia kay magcompute pa
how many milligrams, consider weight and age. It
would lead to hyperventilation, and loss of
consciousness.)
BSN-2B TRANSCRIBED BY: GROUP #
2. Acetaminophen poisoning = commonly used
analgesic
o RISK – liver damage
o Antidote – mucomyst (N-Acetylcysteine)
o S/S – vomiting, liver tenderness,
abdominal pain
(Acetaminophen cannot be used together with
activated charcoal: do not use activated if the doctor
will order acetaminophen.)
3. Lead poisoning PLUMBISM
o Toddlers/preschoolers
o Lead interferes with red blood cell function
Lead value of 15ug/dl – health hazard
Symptoms appear when lead level is 70ug/dl
THE MOST SERIOUS EFFECT IS LEAD ENCEPHALITIS
Air, soil, water, houses, ceramic cookware, solder
used in metal cans and pipes
(It is very hard for children less than 7 years old. Lead
will really interfere with normal cell functioning.
Watch out for CNS function.)
S/S: Abdominal complaints- colicky pain,
constipation, and vomiting
(Colicky pain: Occurs when there is obstruction in your
internal body. In your hollow internal organs like
intestine, gallbladder, kidney, and ureters. We have
different types of pain, describe the pain further. Is it
throbbing pain? Radiating pain? Colicky pain? If
nandoon sa intestine/s, sometimes colick.)
o Pallor
o Irritability
o Loss of coordination
o Encephalopathy
o + lead in the blood
o (Encephalopathy: There is a disease that
affects your brain)
NURSING ACTION
1. Administer chelating agents
Dimercaprol (BAL in oil)
o Not given if allergic to peanuts (prepared in
peanut oil solution)
Edetate calcium disodium (calcium EDTA)
2. Provide nutritional counseling
3. Aid in eliminating environmental conditions
that led to lead ingestion
(Chelating *KEE-lay-ting* agents: Chemical
compounds in the form of complexes in regards to
metal ions bound to the drug na pwede ma-excrete
37
safely. Metal ion ito pareho *referring to dimercaprol
and edetate calcium disodium*)
INGESTION OF POISONS: LEAD
o When lead enters the body, it affects the
erythrocytes, bones and teeth, organs and
tissues, including the brain and nervous
system; the most serious consequences are
the effects on the central nervous system.
o Chelation therapy: removes lead from the
circulating blood and from some organs and
tissues. (Chemical compounds in the form of
complexes by binding those metal ions.)
o EDTA – injected into the blood stream, to
remove heavy metal and minerals from the
body.
BLOOD LEAD LEVEL TEST
Used for screening and diagnosis
BSN-2B TRANSCRIBED BY: GROUP #
(Paint chips: Kana ganing mangapaksit sa wall?
Crayons are for coloring, pero sa kanila asan na
mapunta? Pottery contains lead also.)
4. Caustic poisoning: Ingestion of strong alkali
May cause burns and tissue necrosis in the
mouth, esophagus, and stomach
May result in significant injury to the entire
GI.
Pharyngeal edema may cause airway
obstruction: intubation might be necessary.
(Strong alkali would really result to significant
injury to your GI. Most significantly, sa upper
tract. Pagpasok palang, pag-ingest pa lang,
oropharyngeal, around your larynx,
esophagus, then the mouth.
Pharyngeal edema: abnormal accumulation of
fluid leading to the swelling around the
pharynx.) CHILD ABUSE
- involves emotional or physical abuse or
neglect, as well as sexual exploitation or
molestation by caretakers or other
individuals
- Problem – related to parents limited
ability to cope or relate to the child
- Also victims of abuse
o Parents who were experienced child
abuse handed down to the child
- Physical, Mental, Verbal
EMOTIONAL ABUSE
- Speech disorders
- Habit disorders such as sucking, biting
and rocking
- Psychoneurotic reactions
o Neurosis – class of functional mental
disorder that involves distress pero
walang delusion, walang hallucination
o The behavior is not outside socially
acceptable norms also known as
Psychoneurosis or Neurotic Disorder
o Example: there’s anxiety when the child
is trying hard and still struggle with
specific skills over time
- Learning disorders
- Suicide attempts
SEXUAL ABUSE
- Torn, stained, or bloody underclothing
- Pain, swelling, or itching of the genitals
- Bruises, bleeding, or lacerations in the
genital or anal area
38
 - Difficulty walking or sitting
- Unwillingness to change clothes or
unwillingness to participate in gym INTERVENTIONS
activities b.
- Poor peer relations o Support the child during a thorough physical
assessment
PHYSICAL ABUSE
o Assess injuries
- Unexplained bruises, burns, or fractures o Report case of suspected abuse; nurses are
- Bald spots on the scalps legally required to report all cases of
- Apprehensive child suspected abuse to the appropriate
- Extreme aggressiveness or withdrawal local/state agency
- Fear of parents o Place the child in an environment that is safe,
- Lack of crying (older infant, toddler, or thereby preventing a further injury
young preschool child) when o Document information related to the
approached by a stranger suspected abuse in an objective manner
o Assess parents’ strengths and weaknesses,
PHYSICAL NEGLECT
normal coping mechanisms, and presence or
- Inadequate weight gain absence of support systems
- Poor hygiene o Assist the family in identifying stressors,
- Consistent hunger support systems, and resources
- Inconsistent school attendance o Refer the family to appropriate support
- Constant fatigue groups
- Reports of lack of child supervision o If shaken baby syndrome is suspected,
- Delinquency monitor the infant’s level of consciousness

IRON DEFICIENCY ANEMIA

GOAL OF CARE
• IRON sotres are depleted, resulting in a decreased
1. Client will be safe supply of iron for the manufacture of hemoglobin in
a. See to it that the environment is not RBC.
safe. You really need to provide
safety; assess further. CAUSES:
2. Child will participate with nurse for emotional - Blood loss
support - Increased metabolic demands
3. Parents will participate in therapy - Syndromes of GI malabsorption
- Dietary inadequacy

NURSING INTERVENTION More common in:

- -Child bearing women
1. Attend to the needs of the child - -Poor iron intake
2. Report suspected child abuse case to - -Infants and children in rapid growth
appropriate agency - -Pregnant/ Lactating mothers
3. Provide role models for parents
4. Encourage parents to be involved in child’s ASSESSMENT
care
5. Encourage parents to express their feelings
- Compensatory tachycardia
6. Provide family education
- Pallor
7. Initiate referrals for long term follow-up
- Weakness, fatigue, irritability
a. If di na deal ang traumatic event na
- Lab results
nangyari sa child, it will lead to certain
disorder if di na manage earlier and
we call that as PTSD – Post Traumatic
Stress Disorder
ETIOLOGY

BSN-2B TRANSCRIBED BY: GROUP # 39

 TWOFOLD

 Decreased production of RBCs 1. Correction of the underlying problem

- IDA responsible or iron deficiency
- Aplastic anemia 2. Replacement of depleted iron stores
 INCREASE DESTRUCTION OF RBCs
- sickle cell anemia MANAGEMENT:
- Thalassemia
- Food choices: meats, dark green & leafy
 Blood loss
vegetables, egg yolks, liver, kidney beans,
- IDA
iron-enriched formula & cereal
- Administer iron supplements as prescribed
MOST COMMON CAUSE OF IDA - Teach parents to administer iron
supplements:
o Inadequate intake of dietary iron in the first o Between meals
few years of life and adolescence. o Give with Vitamin C
o Blood school age o Do not give with antacids or milk
o In third world country - hookworms o Oral care
o Side effects
DIAGNOSIS Monitor signs and symptoms of bleeding
Adequate rest periods
Based on history, clinical presentation, and laboratory Explaination of all diagnostic test
data.

SIGN AND SYMPTOM OF ANEMIA ACCORDING TO CYSTIC FIBROSIS

SEVERITY
- This is a chronic multisystem disorder
1. MILD ANEMIA characterized by exocrine gland dysfunction.
- The Mucus produced by the exocrine glands is
- generally asymptomatic
abnormally thick,tenacious, and copious,
- may experience symptoms of moderate
causing obstruction of the small passageways
anemia during exertion.
of the affected organs, particularly in the
2. MODERATE ANEMIA respiratory,gastrointestinal, and reproductive
systems.
 Effects of compensatory mechanism - Cystic Fibrosis is a fatal genetic disorder and
- Shortness of breath respiratory failure is the most common cause
- Rapid, pounding heart beat of death.
- Dizziness, fainting, lethargy, irritability - There is also marked electrolytes change in the
3. SEVERE ANEMIA secretion of sweat glands.

 Effects of compensatory mechanism
- Cardiac murmurs
- Congestive heart failure
EFFECTS OF TISSUE HYPOXIA
- Pale skin, mucus membranes, lips, nail beds &
conjunctiva
- Impaired healing and loss of skin elasticity
- Thinning and early greying of the hair
- Abdominal pain, , n/v, anorexia
- Low grade fever
The most common symptoms are pancreatic enzyme
deficiency.
- Caused by duct blockage
- Progressive chronic lung disease
- associated with infection, and sweat gland
dysfunction resulting in increased sodium and
chloride sweat concentrations.

TREATMENT

BSN-2B TRANSCRIBED BY: GROUP # 40

ORGANS AFFECTED:

Airways, Liver, Pancreas. Small intestine, reproductive

tract, skin

BSN-2B TRANSCRIBED BY: GROUP # 41

 Care of Mother, Child at Risk or
with Problems (Acute & Chronic)
NCM 209 – Ms. Florence Puno
OUTLINE COMMON HEALTH PROBLEMS DURING INFANCY
I. ESOPHAGEAL ATRESIA
II. HYPERTROPHIC PYLORIC STENOSIS
III. HIRSCHSPRUNG'S DISEASE
IV. INTUSSUSCEPTION
V. IMPERFORATED ANUS
VI. DISPLACED URETHRAL OPENINGS
VII. DOWN SYNDROME
VIII. AUTISM
IX. ATTENTION DEFICIT HYPERACTIVITY
DISORDER
 Where do our food enters? Esophagus. Here is
may problem sa connection. Malalaman ito earlier
pag mag submit si mother sa prenatal check-up
because this is one of the congenital concerns.
 Normally, the esophagus and the trachea is
normally separated. TEF occurs with related
condition, marelate sya sa esophageal Atresia
(EA). Kaya naka-slash yan sya. TEF means trachea
esophageal fistula.
 EA is the esophagus does not connect to the
stomach. TEF, esophagus and traches do not
connect correctly. If happens, the food will be
ESOPHAGEAL ATRESIA
aspirated. Ma-inhale natin into our lungs.
 Feeding into the stomach directly could lead to
reflux (aspiration sa food or acid).
 It could also be one or more fistula may be
present between the malformed esophagus.
 EA – they cannot effectively swallow the amniotic
fluid.
 Both resulting to abnormal development before
birth, meron na dun problem with the tube that
carries food from the mouth to the stomach.
 Early development of esophagus and trachea
begins in a single tube that normally divides (4-8
weeks after conception). If this separation does
not occur separately this will lead to EA. No cause
known but there are contributing factors to
consider.
BSN-2B TRANSCRIBED BY: GROUP #
04 L E C

18 a fistula
O5
The esophagus terminates before it reaches the
stomach, ending in a blind pouch, and/or
22
is present that forms an unnatural connection
with the trachea.
 Present lang ang EA when the upper portion of
the esophagus fails to connect to the lower
esophagus and the stomach.
 Mostly talaga mag appear sila together EA and
TEF.
 Atresia- absence of the normal opening
 Fistula – abnormal passage between two internal
organs.
o Type I/ A- lower segments of the esophagus
are blind. Only your esophageal atresia is
present.
Type II/B- upper end of esophagus opens into
the trachea: blind lower segment. Rare type
of EA, the bottom part of the esophagus is
closed. The top section attaches to the
trachea.
o Type III/C- upper end blind; lower and
connects into trachea. Most common.
o Type D is esophageal atresia with both a
proximal and distal TEF, it is rare at 3%.
o Type E esophageal atresia is just an isolated
tracheoesophageal fistula without associated
esophageal atresia. Esophagus is intact here
and connects normally to the stomach.
o With regards with our EA and TEF, this results
from defective lateral separation between
the esophagus and trachea that form
secondary to the defect.
 Clinical Manifestation:
1. Excessive amount of secretions constant
drooling large secretion from the nose
2. Intermittent/unexplained cyanosis
3. Coughs and chokes
4. Fluids returns through nose and mouth
5. Regurgitation & vomiting
6. Abdominal distention
42
 7. Inability to pass a small catheter through 8.
The mouth or nose into the stomach.
 Diagnostic Evaluation:
1. X-ray of abdomen and Chest X-ray
2. X-ray with radiopaque catheter
3. Insertion of a catheter
 Management:
o Includes maintenance of:
 a patent airway
 prevention of aspiration pneumonia
 gastric or blind pouch decompression.
 supportive therapy
 surgical repair
1. Drug Therapy
 Antibiotics for respiratory infection
2. Surgery
 Primary repair - esophageal anastomosis
 Gastrostomy- feeding
 Esophagostomy- drain secretions
 Gastrotomy Tube Placement
 if there EA/TEF, gastronomy may be
an option.
 Sometimes, laparotomy.
 When the baby is ventilated with
high pressure, gastronomy offer a
route to decrease the resistance.
 Pre-operative Interventions:
1. The infant may be placed in an incubator or
radiant warmer with high humidity
(intubation and mechanical ventilation may
be necessary if respiratory distress occurs).
2. Upright position.
3. Maintain an NPO status. - kaysa naman mag
vomit
4. Regular suctioning- if there is difficulty
breathing
5. Maintain IV fluids or hyperalimentation as
prescribed.
6. Observe closely for:
 vital signs; respiratory behavior
 amount of secretions
 abdominal distention (baka may
maraming fluids)
 skin color (cyanosis)
 Post-operative Interventions
1. Monitor respiratory status.
BSN-2B TRANSCRIBED BY: GROUP #
2. Maintain patent airway; continued use of
incubator
3. Suction as needed, change position
frequently; avoid hyperextension of neck
4. Maintain IV fluids, antibiotics, and parenteral
nutrition as prescribed.
5. Maintain adequate nutrition-gastrostomy
6. Monitor strict intake and output.
7. Monitor daily weight.
8. Inspect the surgical site for signs and
symptoms of infection.
9. Monitor for anastomotic leaks as evidenced
by purulent drainage from the chest tube,
increased temperature, and increased white
blood cell count.
10. Observe for signs of stricture at the
anastomosis site (e.g. poor/refusal to feed,
dysphagia, drooling, regurgitated undigested
food).
The prognosis of EA is treated successfully. However,
after the surgery, some infants cannot eat a week
after surgery so they are more on fluids. Kanina may
reflux kasi one complication of EA is Gerd. There is scar
tissue that can cause long term issues that with
regards to EA. Iwasan natin na mag lead to Gerd.
so with babies with EA it needs to have a continuous
treatment including those medications kung wala pa
nag proceed with surgery, so mag didiscuss na naman
yan. You have to make sure na may healthy breathing,
healthy eating ang patient. So the problem in EA is
the connectivity of the esophagus and trachea. How
will the baby adjust with this condition, kailan maka
kain, and always consider na surgical signs kasi prone
with infection.
 Orogastric Tube
HYPERTROPHIC PYLORIC STENOSIS
 One of the most common GI disorders in early
infancy
 Common GI obstruction
 Congenital hypertrophy of the circular muscles of
the pylorus in the stomach; the muscle becomes
progressively thickened and elongated with
narrowing of the pyloric canal.
43
 The PYLORIC STENOSIS HYPERTROPHY is a circular
muscle fiber of the pylorus, there is narrowing
along the lumen.
 There is a narrowing of the lumen and the pylorus
thickens and there is this consistency resembling
the cartilage already.
 There is an obstruction when there is a narrowing
of the distal canal of the stomach on the end part
and becomes dilated.
 The stenosis usually develops in the first few
weeks of life, causing projectile vomiting,
dehydration, metabolic alkalosis, and failure to
thrive.
There’s obstruction so ang tendency, pataas sha
insted of pababa
 Assessment
1. Vomiting that progresses from mild
regurgitation to forceful and projectile
vomiting
 projectile vomiting- is when the baby
brings up the stomach content in a
forceful way
2. Vomitus contains gastric contents such as milk
or formula, may contain mucus, may be blood
tinged, and does not usually contain bile.
 Do not just note vomitus. You have to
describe that vomitus and those
stomach content na nalabas.
3. Exhibits hunger and irritability.
4. Peristaltic waves are visible from left to right
across the epigastrium during or immediately
following a feeding.
BSN-2B TRANSCRIBED BY: GROUP #
 When you say elongated pylorus with
narrow lumen, we term that string sign.
5. Olive-shaped mass is in the epigastrium just
right of the umbilicus.
6. On barium enema, string sign can be seen
 Barium Enema- abnormal retention of
the barium in the stomach and there is
increased peristalsis
7. Dehydration and malnutrition can occur.
8. Electrolyte imbalances can occur.
 Sometimes, yellowish skin color or
jaundice may occur
Also, watch out for that mass if it is
palpable. If it is palpable, it is firm non-
tender, medjo magalaw pero matigas.
 Assess through ultrasound, lab tests,
electrolytes, pH level, BUN, creatinine to
note if there is pyloric stenosis. Also,
radiography and xray
 Management
o Fredet-Ramstedt Pyloromyotomy
 splits the hypertrophic pyloric muscle
down to the submucusa ,allowing
pylorus to expand so that food may pass
o Some also will give IV with atropine.
 Nursing Interventions
1. Monitor vital signs.
2. Monitor strict intake and output.
3. Obtain daily weights.
4. Monitor for signs of dehydration and
electrolyte imbalances.
5. Feed by gavage
 Thickened feedings
 Slowly upright
 Burp frequently
6. Prepare the child and parents for surgery if
prescribed.
 Pyloromyotomy
 Pre op
- Monitor hydration status
- Correct F/E imbalances
- NPO (if di na NPO, they can
have small frequent feeding)
- Monitor character of stools
44
 -
NGT (pag magpa ngt check the
peristaltic movement, check
ang tube)
 Post operative
- Monitor intake and output Start
SFF (para di mabigla si patient)
- Feed slowly, upright (para di ma
choke)
- Monitor for abdominal
distention (minsan bakai di na The disease may be a familial congenital defect or
side effect ng antibiotic kasi may be associated with other anomalies such as Down
sometimes, mahina ang syndrome and genitourinary abnormalities.
metabolism ) 4 methods,
inspect, palpate, auscultate, The affected colon becomes dilated because it is filled
percuss with feces and gas.
- Monitor for signs of infection
- Instruct parents on wound care
and feeding
 NSG Dx
o Imbalance nutrition less than body
requirement
o Deficit fluid volume
o Impaired oral mucous membrane
o Family coping

HIRSCHSPRUNG'S DISEASE (AGANGLIONIC

MEGACOLON)
 Absence of ganglion cells in a portion of the large
intestine
 Is a parasympathetic nerve cells that regulates
peristalsis in the intestine
 The absence of the ganglion cells would result to
absence peristalsis and affected colon becomes
dilated and filled with feces and gas (Hindi nalabas
ang feces kasi walang peristalsis which lose their
ability to move stool to the intestine.)
 The disease may be a familial congenital defect or
may be associated with other anomalies.
 such as Down syndrome and genitourinary
abnormalities.
AGANGLIONIC- A means absence of ganglion cells in
the portion of the large intestine. It is a Birth defect, a
developmental disorder characterized by the absence
of ganglion cells in the colon that could result in
functional obstruction in the area
o nerve cell leads to Delayed meconium passage
so pag di ka makatae ng ilang araw what will
happen? Edi na constipated ka later
o ito pa naman ang problem.ng ating mga
infant, ng mga baby, constipated sila,
karamihan sa kanila but it doesn't mean na
lahat sila may Hirschsprung's disease
o Kailangan natin ma-assess kung gano katagal
ang kaniyang constipation
o Sometimes concerning our infant, newborn,
and even out toddlers, they experience
constipation
o So if there is constipation it will sometimes
lead to Intermittent progressive abdominal
distention
 so andoon lang kain ka tapos di na ilabas
 watch your superficial veins due to thin
abdominal wall which leads to
respiratory distress
o paglumabas na accumulated na so large fecal
masses, the infant mahirapan siya maglabas
so iyak ng iyak
 Di natin alam na there could be
sometimes na dahil naliit ang butas ng

BSN-2B TRANSCRIBED BY: GROUP # 45

 anus or anal area so ang tendency baka
magbleed or bleeding
 with this one may absence of ganglions
that would really push or magmove sa
feces
 so when certain nerve cells in the wall of
the colon do not form in the right way
when the fetus is goin in congenital
 If person does not have Hirschsprung's
disease, large muscles move gas and
stool to that colon
 The nerve cells is the one helping to
move those stools
 Foul odor of breath and stools, syempre
pag hindi na nailabas
o gas and stool get back up and this can cause
partial or pagnandoon si stool sa loob total
bowel obstruction. They have problem passing
that gas and stools. almost all children will
Hirschsprung's option nila is surgery kaya lang
hindi kaagad nila masurgery kasi nga iyong
child very young so hintayin pa nila lumaki
whether the child is really experiencing this
kind of problem already.
o can be one of birth defect because of the
absence of your nerve cells
o There may be a varying signs and symptoms
from one person to another but hischsprung's
can occur as a isolated problem or part of a
disorder that affects multiple organ system
 Assessment Findings
o Newborn
 Failure to pass meconium stool
 Refusal to suck
 syempre kasi feeling niya busog
siya pero actually hindi
 Abdominal distention
 Bile-stained vomitus
meconium is the dark sticky substance present in the
intestine at birth, first bowel movememt after birth.
Problem with Hirschsprung is failure to pass first stool
(observe for the 1st 24 hrs to 48 hrs paghindi baka
hirschsprung)
o Children
 Failure to gain weight and delayed
growth
 Abdominal distention
 Vomiting
 Constipation alternating with diarrhea
 Ribbon-like and foul-smelling stools
BSN-2B TRANSCRIBED BY: GROUP #
abdominal distension there might be varying signs and
symptoms from one person to another but the
response can occur as an isolated problem or as part
of that disorder that affects multiple organ systems
respiratory.
what do you assess? failure to pass, meconium stool,
refusal to suck maybe because of this one abdominal
distension, vomitus
 Diagnostic Studies
o Rectal
 to determine what is inside
 small instrument minsan nga iniinsert
lang doon sa rectum para makakuha
tayo ngsample tissue to check if there is
a presence of nerve cells
o biopsy.
 a sample can be collected using the
suction device to examine under the
microscope to determine whether the
nerve cells are missing
 Management
o Surgery
 remove the disease section of the
intestine
 ano iyong nangyari sa intestine ng child,
ano iyonh involved
 mininal invasive technique
 Temporary colostomy
 A portion of the large intestine is
brought through the abdominal
wall to carry stool out of the body
 Colostomy bag doon ang labasan ng
stool
 monitor every shift ang colostomy
bag kung ano iyong content
 Bowel repair
 Dissection and removal of the
affected section with anastomosis
of intestine
 Abdominal-perineal pull through
 Nursing Management
1. Administer enema as ordered with Isotonic
solution only
2. Do not treat loose stools - child is constipated
3. Administer TPN (Total Parenteral Nutrition)
4. Instruct parents on colostomy care, correct
diet
o follow proper diet
o di mag sige pakain
o ang mga bata drink little water
46
 opagumiyak ng grabe nahirapan siya
magpass ng stool
 Management
o Isotonic enema
 solution that has the same salt
concentration with the cells in the blood
 Salt Solution: 0.9 NaCl (Sodium chloride)
 Physiologic salt solution
 check osmotic pressure ng isotonic
solutions
 di pwede maraming tubig dapat tama
tama lang
 we cannot drink beyond 8 glasses, has
limitation kay usually pagmaginom ka ng
tubig mafull imong abdomen kaya
becareful with this iso solution
o Drug Therapy
 Antibiotic
 stool softners
 common ang stool softener sa mga
bata kaya di ito nawawala
 lalo na pagka 3rd day wala pa
nakalibang si Infant
 you noticed that even at home
some children take stool softener
(2-3 days)
 should be as ordered
o Diet Therapy
 Low residue diet
 Prescribed in Inflammatory bowel
diseases
 may mga infection
INTUSSUSCEPTION
 one part of intestine slides inside another
 patient experiences painful disorder
 most common abdominal emergency that affects
young infant usually 2 yrs old
 could be mixed of blood mucus sa stool niya
parang jelly type
 This telescopic action often blocks food or fluid
from passing through that area
 naka cut off ang blood supply dahil may blockage,
affecting intestine and may lead to tear in the
bowel and if may tear sa bowel may infection or
perforated na ang area then maglead to death of
bowel tissue dahil nga wala ng blood supply
 Invagination or telescoping of a portion of the
small intestine into a more distal segment of the
intestine
 3 times more likely in boys than girls and the
common cause of intestinal obstruction in
childhood.
BSN-2B TRANSCRIBED BY: GROUP #
 Cause is unknown
o Notice ito ating colon
o pag may madetect sa Ultrasound o may
makita
o Though polyps are benign kahit na benign
you still need to let it remove kasi baka
magdevelop into malignant
o the obstruction could cause swelling leads
to intestinal injury
o most cases could be because of a virus
which leads to swelling on the lining of the
intestine
 Factors
1. Hyperperistalsis and unusual mobility of
cecum and ileum (part of large intestine)
2. Lesion such as polyp and tumor
 It is considered a surgical abdominal
emergency in children
 Mechanical Bowel Obstruction Occurs:
 intestinal walls press against each
other causing inflammation, edema
and decreased blood flow
 May progress to necrosis, perforation
and peritonitis.
 if not treated it may progress
 Gangrene of the bowel
 Clinical Presentation.
1. Sudden onset of abdominal pain (in a
healthy baby)
 bigla magreklamo ng pain
2. Infant cries out sharply and draws knees up
to abdomen
 knee-chest position
3. Vomiting occurs and increases overtime (Bile
stained vomitus)
4. Currant jelly stool
 because of the mucus and the blood
5. Signs of shock
6. (+) for Occult blood in stools
7. Sausage-shaped mass in RLQ
note: main symptom is severe abdominal pain,
crampimg, painful episodes (10-15 minutes or minsan
matagal pa) magwala tas magbalik
47
 8. 6. blood in the feces that is not visibly
apparent unlike other blood in stool (hidden
blood in the stool)
 Diagnosis
o Often based on history and physical
examination alone
o Barlum enema
 Is definitive (in 75% of cases)
 It is therapeutic and curative in most
cases with less than 24-hour duration
 Certain xray exam that tells us any
abnormalities in the large intestine or
colon.
 Enema - that is there is injection of
that liquid into your rectum
o Digital rectal exam
 reveals mucous, blood
 May makapa ba tayo diyan. May Makita
ba tayo na mucous or blood sa digital
rectal exam
 Kaya if masakit ang tiyan, baka hindi lang
siya gutom baka ito na yung problem
 It is assessment in the lower rectum.
Check if may mga blockage or may mga
problem diyan or prostate problem. Could
be benign or it could be a prostate cancer
 Immediate Treatment.
o IV fluids
o NPO status
o Diagnostic barium enema
 Surgery
o manual reduction of invagination
o resection with anastomosis
o possible colostomy (gangrenous)
o we need to determine the segments of the
intestines. we need to imaginate into the
adjoining intestinal lumen kasi baka doon
nag cause ng blockage. Pag hindi nakaya ng
IV fluids, NPO ipa surgery nalang talaga
because of that obstruction.
 Bowel Resection and colostomy
BSN-2B TRANSCRIBED BY: GROUP #
o is a surgery that removes any part of the
bowel so that includes your small intestine,
your large intestine, or the rectum. it's used
to treat diseases and then it's also used with
anyone who's blockage of the large intestine
or blockage little around that colon.
 Nursing Management
1. Provide routine pre- and post-operative care
for (monitor VS, assessment, intake and
output) abdominal surgery (care for
abdomen. Kayo mag assess on that area)
2. Monitor fluid and electrolyte status- monitor
fluid and electrolyte
3. Maintain nutrition and hydration
4. Resume feedings 24 hours post operative-
kapag may bowel movement you can ask the
patient “naka utot naka maam?”, “naka ihi
naka maam?” or kapag hindi pa makagalaw
no need to give resume eating food. Soft diet
lang.
IMPERFORATED ANUS
 Congenital malformation in which there is no anal
opening or there is stricture of the anus
 Etiology is unknown
 An arrest in embryonic development on 7th to 8th
week of intrauterine life
 Pag imperforated meaning may blockage diyan.
 A membrane remains and blocks the union
between the rectum and the anus
 Rectum and the anus and in pouch do not connect
with the colon. By rectum and among opening to
other.
 there is a stenosis of the anus kaya ditto close
 Blind rectal pouch with normal anus
 Clinical Presentation
1. No stool passage with in 24 hours after birth
48
 2. Meconium stool from other orifice DISPLACED URETHRAL OPENINGS
3. Only a dimple indicates the site of the anus
 Normally orifice is place at the tip of glans penis
4. Inability to insert thermometer
(male) and clitoris (female) pero here na displaced
 Diagnosis - Digital rectal exam
siya
o Ultrasound
 HYPOSPADIAS
o Abdominal X-rays
o Males: urethra opens on the lower surface of
o Wangesteen-rice method - is a method to
the penis Females: urethra opens into the
determine the relationship of our perennial
vagina
skin
 EPISPADIAS
 Management NPO, NGT
o Only in males
o Manual dilatation
o Urethra opens on the dorsal surface of the
o Surgery
penis
 Anoplasty – construction of the anus to
o Congenital absence of the upper wall of the
correct the anal stenosis which is
urethra
narrowing of the canal that cause a
o If may ganitong condition gina delay muna
painful bowel movement. Mag anoplasty
ang circumcision (first skin is used to cover
sila to open and drain the stool
the meatus
 Temporary colostomy
o Present at birth. A rare congenital
o Antibiotics
abnormality that involves the opening of the
urethra
o Dito yung urethra, the tube that urine exits.
o The urethra opens in the top of the penis
rather than the tip this is a tip that's on the
top opening
 Procreation may be interfered with in severe
 Management: cases
1. If suspected, do not take rectal temperature-  Increased risk of urinary tract infection
Baka mabutas sa kaka insert mo  MANAGEMENT:
2. Pre-operative care 1. Circumcision is delayed until surgical repair
 Monitor for the presence of stool in the 2. Surgical repair
urine and vagina (indicates a fistula) and  Meatotomy (is done because meatus is
report immediately. too narrow )
 Administer IV fluids as prescribed
 Prepare the child and parents for the
surgical procedures, including the
potential for colostomy. Mag colostomy
muna sila before surgery
3. Post-operative Care
 Expose perineum to air
 Check bowel sounds
 NGT for gastric decompression- if you're
going to apply this one you're going first
to remove the contents of the stomach to
the use of the NGT. Clear muna natin ang
tiyan
 Change position frequently
 Oral feeding started gradually as soon as
peristalsis function returned
 Instruct DOWN SYNDROME
the parents to use only a water-
soluble lubricant and to insert the dilator  Chromosomal disorder caused by the presence of
no more than 1 to 2cm all or part of an extra 21st chromosome.
 Pag naka NPO, IV fluid si baby

BSN-2B TRANSCRIBED BY: GROUP # 49

 It can affect person’s cognitive ability, physical
growth, moderate developmental issues.
Presence of higher risk of some health condition.
 like what all cells in the body contain the genes
that are grouped along chromosomes. So dito
there are normally 46 chromosomal cells so 23
inhabited from the mother 23 from the father.
 It is named after John Langdon Down, the British
doctor who described the syndrome in 1866.
 The disorder was identified as a chromosome 21
trisomy  flattened nose and face upwards slanting
 it may really be associated with the physical eyes
condition, the physical growth is delayed there  intellectual and developmental problems
might be a mild to moderate intellectual disability, may be mild, moderate, or severe
sometimes we could see also facial features  some of them are healthy some are not.
 the average IQ of this young adult usually with they have significant health problems, and
down syndromes is 50% equivalent to the mental they have some serious health condition
ability of eight years old or nine years old  soft skin
 cognitive developmental profile should really be
assessed, suggestive to mild to moderate
intellectual disability however cognitive
development and intellectual ability are
sometimes highly variable.
 Might have an error in cell division due to
chromosomal defect (extra chromosome)
 have physical, mild to moderate (can be severe)
cognitive impairment, IQ = 50-69% (or 8-9 yo),
moderate developmental issues
 23F + 23M = 46
 Assessment Findings:
1. Small head, flat facial profile
2. Low-set ears
3. Simian creases
4. 40% congenital heart defects
5. With moderate retardation

they are different in certain degree or not at all certain

physical characteristics. some of them have this low Brushfield spots = kerotoconus or thin cone shape
muscle tone (hypotonia) cornea dt inc pressure (refractive error)

6. Wide space between 1-2nd toes 8. defective motor skills

 Management:
they don't develop motor skills in the same way the
1. Prevent respiratory infections
typical developing child does. You can know motor
 Clearing the nose
functional motor skills
 Cool mist vaporizer
7. Lax muscle tone- low muscle tone of  Chest physiotherapy
hypotonia  Handwashing and avoiding exposure to
infection.
2. When feeding infants and young children, use
a small, straight-handled spoon to push food
to the side and back of the mouth. (Short but
fat tongue)
3. Encourage fluids and foods rich in fiber.

BSN-2B TRANSCRIBED BY: GROUP # 50

 4. Constipation results from decreased muscle
tone, which affects gastric motility.
5. Provide good skin care because the skin is dry
and prone to infection.
6. Family education
 Counseling
 developmental progress
7. better language skills and ability to
communicate
AUTISM
 Severe mental disorder beginning in infancy or
toddlerhood
 Pervasive developmental disorder
 Disorder apparent to the parents before the child
is 3 years old
 Characterized by:
o Severe deficit in language.
o perceptual and motor development
o Defective reality testing
o Inability to function in social setting
 The cause is unknown, and the prognosis may be
poor.
 Possible causes:
o cause is unknown and prognosis may be poor
1. Unsatisfactory mother-child relationship
 Most common
 Can still be corrected if the parent is
aware and if they are willing to help the
child
 Busy parents, less interaction with child
2. CNS abnormalities
 Pathologic problem
 Diagnosis is established based on symptoms and
the use of specialized autism assessment tools.
 tests need for ASD or Asperger’s syndrome
 social, communication, behavioral challenges
 learning and problem solving skills can range to
gifted to severely challenged
 may be genetically traced, race, socioeconomics
 more common in males
 complicated lifelong neurobiological development
disorder
 usually appear in first 2 years
 Characterized by
o Severe deficit in language, perceptual and
motor development
o Defective reality testing
o Inability to function in social setting
o Cannot establish eye-to-eye contact
 Categories
1. Inability to relate with others
2. Inability to communicate
BSN-2B TRANSCRIBED BY: GROUP #
3. Obvious limited activities/interest
 Clinical presentation
1. Infant not responsive to cuddling
2. No eye contact or facial responsiveness
3. Impaired/no verbal communication
4. Echolalia
 Mimic verbalization or parroting all your
words to the extent that is already
exasperating.
 E.g. mimicking peppa pigtypical behavior
of autism
5. Inability to tolerate change
6. Fascination with movement
 Attention is easily caught by movements
7. Labile moods
 Prolonged temper tantrums
 Assessment
1. Bizzare responses to the environment
 Intense reaction to minor changes
 Attachment to objects
 Intensely preoccupied to moving object
2. Self-absorbed and unable to relate to others.
 Solitary play
 Preoccupied with their interest
3. Repetitive hand movement, rocking, and
rhythmic body movement
 Fidgety or masyadong magalaw na parang
‘di mapakali
4. Hitting, head banging, and biting
 These manifestations are rather severe
5. Music often holds a special interest for them
6. No delusions, hallucinations, or incoherence
 Autism is a mental problem but not
associated to these.
7. Excellent long-term memory
 Depending on the interested subject.
 E.g they are interested to planets, they
can memorize all the planets. They are
smart this way.
8. May play happily alone for hours but have
temper tantrums if interrupted.
 Nursing intervention
1. Provide parents /family with support and
information about the disorder
2. Assist child with ADL
3. Promote reality testing
 Promote effective communication
 Talk at their own level of understanding
4. Encourage the child to develop relationship
with another person
5. Maintain regular schedule of activities
 Involve primary caregiver
6. Provide constant routine for child
51
 7. Protect from self injury
8. Provide safe environment
9. Provide seizure precaution
 If cause of autism is CNS problem
Additional Notes:
 Physical findings: same manifestation
because of chromosomal disorder
ATTENTION DEFICIT HYPERACTIVITY DISORDER
 Developmental disorder characterized by
inappropriate degrees of inattention, overactivity,
and impulsivity
o usually appears together, but may appear
solo
o inattention = short attention span
o impulsivity = interrupting others, cannot wait
o constant motion, difficulty remain in the seat
o cannot be prevented or cures, but can be
manages sx by mgmt., referral
 One of the most common reasons for referral of
children to mental health services
 Childhood problems include:
o Lowered intellectual development
o Some minor physical abnormalities
o Sleeping disturbances
o Behavioral or emotional disorders
o Difficulty in social relationships.
 Diagnosis
o Established on:
 parent and teachers reports
 psychological assessments (Only arise if
parents report and if there is teacher
referral)
o Diagnosable by 36 months
 During toddlerhood - start of
socialization
o 3 major characteristics revealed before 7
years of age
 Assessment
1. Fidgets with hands or feet or squirms in the
seat
 restless
 Because of the impulsivity
2. Easily distracted with external or internal
stimuli
3. Difficulty with following through on
instructions
4. Poor attention span
5. Shifting from one uncompleted activity to
another
6. Talking excessively
7. Interrupting or intruding on others
BSN-2B TRANSCRIBED BY: GROUP #
8. Engaging in physically dangerous activities
without considering the possible
consequences
 Because of impulsivity
 Prone to accidents
 Therapeutic Management
o Environment
 construction of stable environment
 strict instruction, strict activities
 treatment should be fair (dili
bunalan) since the child cannot
understand why they have the
disorder
 guide the child to help control their
impulsivity
 lengthen, improve attention span
 decrease distractions
 stimulate health control hyperactive
impulsive behavior
 special instruction free from distractions
 fair but firm and set consistent limits
o Medications
 controls excessive activity
 lengthening the attention span
 decreasing the distractibility
 Interventions
1. Provide environmental and physical safety
measures.
2. Encourage support groups for parents.
3. Administer prescribed medication; some
commonly prescribed medications that
include:
 methylphenidate hydrochloride (Ritalin).
 pemoline (Cylert), and
 dextroamphetamine sulfate (Dexedrine).
4. Inform the child and parents that positive
effects of the medication may be seen within
1 to 2 weeks
REFERENCES
“PROF’S PPT ON QUIPPER AND LECTURE”
52
Care of Mother, Child at Risk or
with Problems (Acute & Chronic)
NCM 209 – Ms. Florence Puno
OUTLINE COMMON HEALTH PROBLEMSisDURING
X. ESOPHAGEAL ATRESIA
XI. HYPERTROPHIC PYLORIC STENOSIS
XII. HIRSCHSPRUNG'S DISEASE
XIII. INTUSSUSCEPTION
XIV. IMPERFORATED ANUS
XV. DISPLACED URETHRAL OPENINGS
XVI. DOWN SYNDROME
XVII. AUTISM
XVIII. ATTENTION DEFICIT HYPERACTIVITY
DISORDER
ESOPHAGEAL ATRESIA
 Where do our food enters? Esophagus. Here is
may problem sa connection. Malalaman ito earlier
pag mag submit si mother sa prenatal check-up
because this is one of the congenital concerns.
 Normally, the esophagus and the trachea is
normally separated. TEF occurs with related
condition, marelate sya sa esophageal Atresia
(EA). Kaya naka-slash yan sya. TEF means trachea
esophageal fistula.
 EA is the esophagus does not connect to the
stomach. TEF, esophagus and traches do not
connect correctly. If happens, the food will be
aspirated. Ma-inhale natin into our lungs.
 Feeding into the stomach directly could lead to
reflux (aspiration sa food or acid).
 It could also be one or more fistula may be
present between the malformed esophagus.
 EA – they cannot effectively swallow the amniotic
fluid.
 Both resulting to abnormal development before
birth, meron na dun problem with the tube that
carries food from the mouth to the stomach.
 Early development of esophagus and trachea
begins in a single tube that normally divides (4-8
weeks after conception). If this separation does
not occur separately this will lead to EA. No cause
known but there are contributing factors to
consider.
 The esophagus terminates before it reaches the
stomach, ending in a blind pouch, and/or a fistula
BSN-2B TRANSCRIBED BY: GROUP #
04 L E C
18
22 O5
present INFANCY
that forms an unnatural connection
with the trachea.
 Present lang ang EA when the upper portion of
the esophagus fails to connect to the lower
esophagus and the stomach.
 Mostly talaga mag appear sila together EA and
TEF.
 Atresia- absence of the normal opening
 Fistula – abnormal passage between two internal
organs.
o Type I/ A- lower segments of the esophagus
are blind. Only your esophageal atresia is
present.
Type II/B- upper end of esophagus opens into
the trachea: blind lower segment. Rare type
of EA, the bottom part of the esophagus is
closed. The top section attaches to the
trachea.
o Type III/C- upper end blind; lower and
connects into trachea. Most common.
o Type D is esophageal atresia with both a
proximal and distal TEF, it is rare at 3%.
o Type E esophageal atresia is just an isolated
tracheoesophageal fistula without associated
esophageal atresia. Esophagus is intact here
and connects normally to the stomach.
o With regards with our EA and TEF, this results
from defective lateral separation between
the esophagus and trachea that form
secondary to the defect.
 Clinical Manifestation:
8. Excessive amount of secretions constant
drooling large secretion from the nose
9. Intermittent/unexplained cyanosis
10. Coughs and chokes
11. Fluids returns through nose and mouth
12. Regurgitation & vomiting
13. Abdominal distention
14. Inability to pass a small catheter through 8.
The mouth or nose into the stomach.
 Diagnostic Evaluation:
53
 4. X-ray of abdomen and Chest X-ray
5. X-ray with radiopaque catheter
6. Insertion of a catheter
 Management:
o Includes maintenance of:
 a patent airway
 prevention of aspiration pneumonia
 gastric or blind pouch decompression.
 supportive therapy
 surgical repair
3. Drug Therapy
 Antibiotics for respiratory infection
4. Surgery
 Primary repair - esophageal anastomosis
 Gastrostomy- feeding
 Esophagostomy- drain secretions
 Gastrotomy Tube Placement
 if there EA/TEF, gastronomy may be
an option.
 Sometimes, laparotomy.
 When the baby is ventilated with
high pressure, gastronomy offer a
route to decrease the resistance.
 Pre-operative Interventions:
7. The infant may be placed in an incubator or
radiant warmer with high humidity
(intubation and mechanical ventilation may
be necessary if respiratory distress occurs).
8. Upright position.
9. Maintain an NPO status. - kaysa naman mag
vomit
10. Regular suctioning- if there is difficulty
breathing
11. Maintain IV fluids or hyperalimentation as
prescribed.
12. Observe closely for:
 vital signs; respiratory behavior
 amount of secretions
 abdominal distention (baka may
maraming fluids)
 skin color (cyanosis)
 Post-operative Interventions
11. Monitor respiratory status.
12. Maintain patent airway; continued use of
incubator
BSN-2B TRANSCRIBED BY: GROUP #
13. Suction as needed, change position
frequently; avoid hyperextension of neck
14. Maintain IV fluids, antibiotics, and parenteral
nutrition as prescribed.
15. Maintain adequate nutrition-gastrostomy
16. Monitor strict intake and output.
17. Monitor daily weight.
18. Inspect the surgical site for signs and
symptoms of infection.
19. Monitor for anastomotic leaks as evidenced
by purulent drainage from the chest tube,
increased temperature, and increased white
blood cell count.
20. Observe for signs of stricture at the
anastomosis site (e.g. poor/refusal to feed,
dysphagia, drooling, regurgitated undigested
food).
The prognosis of EA is treated successfully. However,
after the surgery, some infants cannot eat a week
after surgery so they are more on fluids. Kanina may
reflux kasi one complication of EA is Gerd. There is scar
tissue that can cause long term issues that with
regards to EA. Iwasan natin na mag lead to Gerd.
so with babies with EA it needs to have a continuous
treatment including those medications kung wala pa
nag proceed with surgery, so mag didiscuss na naman
yan. You have to make sure na may healthy breathing,
healthy eating ang patient. So the problem in EA is
the connectivity of the esophagus and trachea. How
will the baby adjust with this condition, kailan maka
kain, and always consider na surgical signs kasi prone
with infection.
 Orogastric Tube
HYPERTROPHIC PYLORIC STENOSIS
 One of the most common GI disorders in early
infancy
 Common GI obstruction
 Congenital hypertrophy of the circular muscles of
the pylorus in the stomach; the muscle becomes
progressively thickened and elongated with
narrowing of the pyloric canal.
 The PYLORIC STENOSIS HYPERTROPHY is a circular
muscle fiber of the pylorus, there is narrowing
along the lumen.
54
 There is a narrowing of the lumen and the pylorus
thickens and there is this consistency resembling
the cartilage already.
 There is an obstruction when there is a narrowing
of the distal canal of the stomach on the end part
and becomes dilated.
 The stenosis usually develops in the first few
weeks of life, causing projectile vomiting,
dehydration, metabolic alkalosis, and failure to
thrive.
There’s obstruction so ang tendency, pataas sha
insted of pababa
 Assessment
9. Vomiting that progresses from mild
regurgitation to forceful and projectile
vomiting
 projectile vomiting- is when the baby
brings up the stomach content in a
forceful way
10. Vomitus contains gastric contents such as milk
or formula, may contain mucus, may be blood
tinged, and does not usually contain bile.
 Do not just note vomitus. You have to
describe that vomitus and those
stomach content na nalabas.
11. Exhibits hunger and irritability.
12. Peristaltic waves are visible from left to right
across the epigastrium during or immediately
following a feeding.
 When you say elongated pylorus with
narrow lumen, we term that string sign.
13. Olive-shaped mass is in the epigastrium just
right of the umbilicus.
BSN-2B TRANSCRIBED BY: GROUP #
14. On barium enema, string sign can be seen
 Barium Enema- abnormal retention of
the barium in the stomach and there is
increased peristalsis
15. Dehydration and malnutrition can occur.
16. Electrolyte imbalances can occur.
 Sometimes, yellowish skin color or
jaundice may occur
 Also, watch out for that mass if it is
palpable. If it is palpable, it is firm non-
tender, medjo magalaw pero matigas.
 Assess through ultrasound, lab tests,
electrolytes, pH level, BUN, creatinine to
note if there is pyloric stenosis. Also,
radiography and xray
 Management
o Fredet-Ramstedt Pyloromyotomy
 splits the hypertrophic pyloric muscle
down to the submucusa ,allowing
pylorus to expand so that food may pass
o Some also will give IV with atropine.
 Nursing Interventions
7. Monitor vital signs.
8. Monitor strict intake and output.
9. Obtain daily weights.
10. Monitor for signs of dehydration and
electrolyte imbalances.
11. Feed by gavage
 Thickened feedings
 Slowly upright
 Burp frequently
12. Prepare the child and parents for surgery if
prescribed.
 Pyloromyotomy
 Pre op
- Monitor hydration status
- Correct F/E imbalances
- NPO (if di na NPO, they can
have small frequent feeding)
- Monitor character of stools
- NGT (pag magpa ngt check the
peristaltic movement, check
ang tube)
 Post operative
55
 - Monitor intake and output Start The disease may be a familial congenital defect or
SFF (para di mabigla si patient) may be associated with other anomalies such as Down
- Feed slowly, upright (para di ma syndrome and genitourinary abnormalities.
choke)
The affected colon becomes dilated because it is filled
- Monitor for abdominal
with feces and gas.
distention (minsan bakai di na
side effect ng antibiotic kasi
sometimes, mahina ang
metabolism ) 4 methods,
inspect, palpate, auscultate,
percuss
- Monitor for signs of infection
- Instruct parents on wound care
and feeding
 NSG Dx
o Imbalance nutrition less than body
requirement
o Deficit fluid volume
o Impaired oral mucous membrane
o Family coping
o nerve cell leads to Delayed meconium passage
HIRSCHSPRUNG'S DISEASE (AGANGLIONIC so pag di ka makatae ng ilang araw what will
MEGACOLON) happen? Edi na constipated ka later
o ito pa naman ang problem.ng ating mga
 Absence of ganglion cells in a portion of the large
infant, ng mga baby, constipated sila,
intestine
karamihan sa kanila but it doesn't mean na
 Is a parasympathetic nerve cells that regulates
lahat sila may Hirschsprung's disease
peristalsis in the intestine
o Kailangan natin ma-assess kung gano katagal
 The absence of the ganglion cells would result to
ang kaniyang constipation
absence peristalsis and affected colon becomes
o Sometimes concerning our infant, newborn,
dilated and filled with feces and gas (Hindi nalabas
and even out toddlers, they experience
ang feces kasi walang peristalsis which lose their
constipation
ability to move stool to the intestine.)
o So if there is constipation it will sometimes
 The disease may be a familial congenital defect or
lead to Intermittent progressive abdominal
may be associated with other anomalies.
distention
 such as Down syndrome and genitourinary
 so andoon lang kain ka tapos di na ilabas
abnormalities.
 watch your superficial veins due to thin
AGANGLIONIC- A means absence of ganglion cells in abdominal wall which leads to
the portion of the large intestine. It is a Birth defect, a respiratory distress
developmental disorder characterized by the absence o paglumabas na accumulated na so large fecal
of ganglion cells in the colon that could result in masses, the infant mahirapan siya maglabas
functional obstruction in the area so iyak ng iyak
 Di natin alam na there could be
sometimes na dahil naliit ang butas ng
anus or anal area so ang tendency baka
magbleed or bleeding
 with this one may absence of ganglions
that would really push or magmove sa
feces
 so when certain nerve cells in the wall of
the colon do not form in the right way
when the fetus is goin in congenital

BSN-2B TRANSCRIBED BY: GROUP # 56

  If person does not have Hirschsprung's
disease, large muscles move gas and
stool to that colon
 The nerve cells is the one helping to
move those stools
 Foul odor of breath and stools, syempre
pag hindi na nailabas
o gas and stool get back up and this can cause
partial or pagnandoon si stool sa loob total
bowel obstruction. They have problem passing
that gas and stools. almost all children will
Hirschsprung's option nila is surgery kaya lang
hindi kaagad nila masurgery kasi nga iyong
child very young so hintayin pa nila lumaki
whether the child is really experiencing this
kind of problem already.
o can be one of birth defect because of the
absence of your nerve cells
o There may be a varying signs and symptoms
from one person to another but hischsprung's
can occur as a isolated problem or part of a
disorder that affects multiple organ system
 Assessment Findings
o Newborn
 Failure to pass meconium stool
 Refusal to suck
 syempre kasi feeling niya busog
siya pero actually hindi
 Abdominal distention
 Bile-stained vomitus
meconium is the dark sticky substance present in the
intestine at birth, first bowel movememt after birth.
Problem with Hirschsprung is failure to pass first stool
(observe for the 1st 24 hrs to 48 hrs paghindi baka
hirschsprung)
o Children
 Failure to gain weight and delayed
growth
 Abdominal distention
 Vomiting
 Constipation alternating with diarrhea
 Ribbon-like and foul-smelling stools
abdominal distension there might be varying signs and
symptoms from one person to another but the
response can occur as an isolated problem or as part
of that disorder that affects multiple organ systems
respiratory.
BSN-2B TRANSCRIBED BY: GROUP #
what do you assess? failure to pass, meconium stool,
refusal to suck maybe because of this one abdominal
distension, vomitus
 Diagnostic Studies
o Rectal
 to determine what is inside
 small instrument minsan nga iniinsert
lang doon sa rectum para makakuha
tayo ngsample tissue to check if there is
a presence of nerve cells
o biopsy.
 a sample can be collected using the
suction device to examine under the
microscope to determine whether the
nerve cells are missing
 Management
o Surgery
 remove the disease section of the
intestine
 ano iyong nangyari sa intestine ng child,
ano iyonh involved
 mininal invasive technique
 Temporary colostomy
 A portion of the large intestine is
brought through the abdominal
wall to carry stool out of the body
 Colostomy bag doon ang labasan ng
stool
 monitor every shift ang colostomy
bag kung ano iyong content
 Bowel repair
 Dissection and removal of the
affected section with anastomosis
of intestine
 Abdominal-perineal pull through
 Nursing Management
5. Administer enema as ordered with Isotonic
solution only
6. Do not treat loose stools - child is constipated
7. Administer TPN (Total Parenteral Nutrition)
8. Instruct parents on colostomy care, correct
diet
o follow proper diet
o di mag sige pakain
o ang mga bata drink little water
o pagumiyak ng grabe nahirapan siya
magpass ng stool
 Management
o Isotonic enema
 solution that has the same salt
concentration with the cells in the blood
 Salt Solution: 0.9 NaCl (Sodium chloride)
57
  Physiologic salt solution
 check osmotic pressure ng isotonic
solutions
 di pwede maraming tubig dapat tama
tama lang
 we cannot drink beyond 8 glasses, has
limitation kay usually pagmaginom ka ng
tubig mafull imong abdomen kaya
becareful with this iso solution
o Drug Therapy
 Antibiotic
 stool softners
 common ang stool softener sa mga
bata kaya di ito nawawala
 lalo na pagka 3rd day wala pa
nakalibang si Infant
 you noticed that even at home
some children take stool softener
(2-3 days)
 should be as ordered
o Diet Therapy
 Low residue diet
 Prescribed in Inflammatory bowel
diseases
 may mga infection
INTUSSUSCEPTION
 one part of intestine slides inside another
 patient experiences painful disorder
 most common abdominal emergency that affects
young infant usually 2 yrs old
 could be mixed of blood mucus sa stool niya
parang jelly type
 This telescopic action often blocks food or fluid
from passing through that area
 naka cut off ang blood supply dahil may blockage,
affecting intestine and may lead to tear in the
bowel and if may tear sa bowel may infection or
perforated na ang area then maglead to death of
bowel tissue dahil nga wala ng blood supply
 Invagination or telescoping of a portion of the
small intestine into a more distal segment of the
intestine
 3 times more likely in boys than girls and the
common cause of intestinal obstruction in
childhood.
 Cause is unknown
BSN-2B TRANSCRIBED BY: GROUP #
o Notice ito ating colon
o pag may madetect sa Ultrasound o may
makita
o Though polyps are benign kahit na benign
you still need to let it remove kasi baka
magdevelop into malignant
o the obstruction could cause swelling leads
to intestinal injury
o most cases could be because of a virus
which leads to swelling on the lining of the
intestine
 Factors
3. Hyperperistalsis and unusual mobility of
cecum and ileum (part of large intestine)
4. Lesion such as polyp and tumor
 It is considered a surgical abdominal
emergency in children
 Mechanical Bowel Obstruction Occurs:
 intestinal walls press against each
other causing inflammation, edema
and decreased blood flow
 May progress to necrosis, perforation
and peritonitis.
 if not treated it may progress
 Gangrene of the bowel
 Clinical Presentation.
9. Sudden onset of abdominal pain (in a
healthy baby)
 bigla magreklamo ng pain
10. Infant cries out sharply and draws knees up
to abdomen
 knee-chest position
11. Vomiting occurs and increases overtime (Bile
stained vomitus)
12. Currant jelly stool
 because of the mucus and the blood
13. Signs of shock
14. (+) for Occult blood in stools
15. Sausage-shaped mass in RLQ
note: main symptom is severe abdominal pain,
crampimg, painful episodes (10-15 minutes or minsan
matagal pa) magwala tas magbalik
16. 6. blood in the feces that is not visibly
apparent unlike other blood in stool (hidden
blood in the stool)
 Diagnosis
o Often based on history and physical
examination alone
o Barlum enema
 Is definitive (in 75% of cases)
58
  It is therapeutic and curative in most
cases with less than 24-hour duration
 Certain xray exam that tells us any
abnormalities in the large intestine or
colon.
 Enema - that is there is injection of
that liquid into your rectum
o Digital rectal exam
 reveals mucous, blood
 May makapa ba tayo diyan. May Makita
ba tayo na mucous or blood sa digital
rectal exam
 Kaya if masakit ang tiyan, baka hindi lang
siya gutom baka ito na yung problem
 It is assessment in the lower rectum.
Check if may mga blockage or may mga
problem diyan or prostate problem. Could
be benign or it could be a prostate cancer
 Immediate Treatment.
o IV fluids
o NPO status
o Diagnostic barium enema
 Surgery
o manual reduction of invagination
o resection with anastomosis
o possible colostomy (gangrenous)
o we need to determine the segments of the
intestines. we need to imaginate into the
adjoining intestinal lumen kasi baka doon
nag cause ng blockage. Pag hindi nakaya ng
IV fluids, NPO ipa surgery nalang talaga
because of that obstruction.
 Bowel Resection and colostomy
o is a surgery that removes any part of the
bowel so that includes your small intestine,
your large intestine, or the rectum. it's used
BSN-2B TRANSCRIBED BY: GROUP #
to treat diseases and then it's also used with
anyone who's blockage of the large intestine
or blockage little around that colon.
 Nursing Management
5. Provide routine pre- and post-operative care
for (monitor VS, assessment, intake and
output) abdominal surgery (care for
abdomen. Kayo mag assess on that area)
6. Monitor fluid and electrolyte status- monitor
fluid and electrolyte
7. Maintain nutrition and hydration
8. Resume feedings 24 hours post operative-
kapag may bowel movement you can ask the
patient “naka utot naka maam?”, “naka ihi
naka maam?” or kapag hindi pa makagalaw
no need to give resume eating food. Soft diet
lang.
IMPERFORATED ANUS
 Congenital malformation in which there is no anal
opening or there is stricture of the anus
 Etiology is unknown
 An arrest in embryonic development on 7th to 8th
week of intrauterine life
 Pag imperforated meaning may blockage diyan.
 A membrane remains and blocks the union
between the rectum and the anus
 Rectum and the anus and in pouch do not connect
with the colon. By rectum and among opening to
other.
 there is a stenosis of the anus kaya ditto close
 Blind rectal pouch with normal anus
 Clinical Presentation
5. No stool passage with in 24 hours after birth
6. Meconium stool from other orifice
7. Only a dimple indicates the site of the anus
8. Inability to insert thermometer
 Diagnosis - Digital rectal exam
o Ultrasound
o Abdominal X-rays
o Wangesteen-rice method - is a method to
determine the relationship of our perennial
skin
 Management NPO, NGT
o Manual dilatation
o Surgery
59
  Anoplasty – construction of the anus to
correct the anal stenosis which is
narrowing of the canal that cause a
painful bowel movement. Mag anoplasty
sila to open and drain the stool
 Temporary colostomy
o Antibiotics
 Management:
4. If suspected, do not take rectal temperature-
Baka mabutas sa kaka insert mo
5. Pre-operative care
 Monitor for the presence of stool in the
urine and vagina (indicates a fistula) and
report immediately.
 Administer IV fluids as prescribed
 Prepare the child and parents for the
surgical procedures, including the
potential for colostomy. Mag colostomy
muna sila before surgery
6. Post-operative Care
 Expose perineum to air
 Check bowel sounds
 NGT for gastric decompression- if you're
going to apply this one you're going first
to remove the contents of the stomach to
the use of the NGT. Clear muna natin ang
tiyan
 Change position frequently
 Oral feeding started gradually as soon as
peristalsis function returned
 Instruct the parents to use only a water-
solubleDOWN
lubricant and to insert the dilator
SYNDROME
no more than 1 to 2cm
 Pag naka NPO, IV fluid si baby
 Normally orifice is place at the tip of glans penis
(male) and clitoris (female) pero here na displaced
siya
 HYPOSPADIAS
o Males: urethra opens on the lower surface of
the penis Females: urethra opens into the
vagina
 EPISPADIAS
o Only in males
BSN-2B TRANSCRIBED BY: GROUP #
o Urethra opens on the dorsal surface of the
penis
o Congenital absence of the upper wall of the
urethra
o If may ganitong condition gina delay muna
ang circumcision (first skin is used to cover
the meatus
o Present at birth. A rare congenital
abnormality that involves the opening of the
urethra
o Dito yung urethra, the tube that urine exits.
o The urethra opens in the top of the penis
rather than the tip this is a tip that's on the
top opening
 Procreation may be interfered with in severe
cases
 Increased risk of urinary tract infection
 MANAGEMENT:
3. Circumcision is delayed until surgical repair
4. Surgical repair
 Meatotomy (is done because meatus is
too narrow )
 Chromosomal disorder caused by the presence of
all or part of an extra 21st chromosome.
 It can affect person’s
DISPLACED cognitiveOPENINGS
URETHRAL ability, physical
growth, moderate developmental issues.
Presence of higher risk of some health condition.
 like what all cells in the body contain the genes
that are grouped along chromosomes. So dito
there are normally 46 chromosomal cells so 23
inhabited from the mother 23 from the father.
 It is named after John Langdon Down, the British
doctor who described the syndrome in 1866.
 The disorder was identified as a chromosome 21
trisomy
60
 it may really be associated with the physical
condition, the physical growth is delayed there
might be a mild to moderate intellectual disability,
sometimes we could see also facial features
 the average IQ of this young adult usually with
down syndromes is 50% equivalent to the mental
ability of eight years old or nine years old
 cognitive developmental profile should really be
assessed, suggestive to mild to moderate
intellectual disability however cognitive
development and intellectual ability are
sometimes highly variable.
 Might have an error in cell division due to
chromosomal defect (extra chromosome)
 have physical, mild to moderate (can be severe)
cognitive impairment, IQ = 50-69% (or 8-9 yo),
moderate developmental issues
 23F + 23M = 46
 Assessment Findings:
9. Small head, flat facial profile Brushfield spots = kerotoconus or thin cone shape
10. Low-set ears cornea dt inc pressure (refractive error)
11. Simian creases 16. defective motor skills
12. 40% congenital heart defects  Management:
13. With moderate retardation 8. Prevent respiratory infections
they are different in certain degree or not at all certain  Clearing the nose
physical characteristics. some of them have this low  Cool mist vaporizer
muscle tone (hypotonia)  Chest physiotherapy
 Handwashing and avoiding exposure to
14. Wide space between 1-2nd toes infection.
9. When feeding infants and young children, use
they don't develop motor skills in the same way the
a small, straight-handled spoon to push food
typical developing child does. You can know motor
to the side and back of the mouth. (Short but
functional motor skills
fat tongue)
15. Lax muscle tone- low muscle tone of 10. Encourage fluids and foods rich in fiber.
hypotonia 11. Constipation results from decreased muscle
tone, which affects gastric motility.
12. Provide good skin care because the skin is dry
and prone to infection.
13. Family education
 Counseling
 developmental progress
14. better language skills and ability to
communicate

 flattened nose and face upwards slanting
eyes
 intellectual and developmental problems
may be mild, moderate, or severe
 some of them are healthy some are not.
they have significant health problems, and
they have some serious health condition
 soft skin
AUTISM
 Severe mental disorder beginning in infancy or
toddlerhood
 Pervasive developmental disorder
 Disorder apparent to the parents before the child
is 3 years old
 Characterized by:
o Severe deficit in language.
o perceptual and motor development

BSN-2B TRANSCRIBED BY: GROUP # 61

 o Defective reality testing
o Inability to function in social setting
 The cause is unknown, and the prognosis may be
poor.
 Possible causes:
o cause is unknown and prognosis may be poor
3. Unsatisfactory mother-child relationship
 Most common
 Can still be corrected if the parent is
aware and if they are willing to help the
child
 Busy parents, less interaction with child
4. CNS abnormalities
 Pathologic problem
 Diagnosis is established based on symptoms and
the use of specialized autism assessment tools.
 tests need for ASD or Asperger’s syndrome
 social, communication, behavioral challenges
 learning and problem solving skills can range to
gifted to severely challenged
 may be genetically traced, race, socioeconomics
 more common in males
 complicated lifelong neurobiological development
disorder
 usually appear in first 2 years
 Characterized by
o Severe deficit in language, perceptual and
motor development
o Defective reality testing
o Inability to function in social setting
o Cannot establish eye-to-eye contact
 Categories
4. Inability to relate with others
5. Inability to communicate
6. Obvious limited activities/interest
 Clinical presentation
8. Infant not responsive to cuddling
9. No eye contact or facial responsiveness
10. Impaired/no verbal communication
11. Echolalia
 Mimic verbalization or parroting all your
words to the extent that is already
exasperating.
 E.g. mimicking peppa pigtypical behavior
of autism
12. Inability to tolerate change
13. Fascination with movement
 Attention is easily caught by movements
14. Labile moods
 Prolonged temper tantrums
 Assessment
9. Bizzare responses to the environment
 Intense reaction to minor changes
BSN-2B TRANSCRIBED BY: GROUP #
 Attachment to objects
 Intensely preoccupied to moving object
10. Self-absorbed and unable to relate to others.
 Solitary play
 Preoccupied with their interest
11. Repetitive hand movement, rocking, and
rhythmic body movement
 Fidgety or masyadong magalaw na parang
‘di mapakali
12. Hitting, head banging, and biting
 These manifestations are rather severe
13. Music often holds a special interest for them
14. No delusions, hallucinations, or incoherence
 Autism is a mental problem but not
associated to these.
15. Excellent long-term memory
 Depending on the interested subject.
 E.g they are interested to planets, they
can memorize all the planets. They are
smart this way.
16. May play happily alone for hours but have
temper tantrums if interrupted.
 Nursing intervention
10. Provide parents /family with support and
information about the disorder
11. Assist child with ADL
12. Promote reality testing
 Promote effective communication
 Talk at their own level of understanding
13. Encourage the child to develop relationship
with another person
14. Maintain regular schedule of activities
 Involve primary caregiver
15. Provide constant routine for child
16. Protect from self injury
17. Provide safe environment
18. Provide seizure precaution
 If cause of autism is CNS problem
Additional Notes:
 Physical findings: same manifestation
because of chromosomal disorder
ATTENTION DEFICIT HYPERACTIVITY DISORDER
 Developmental disorder characterized by
inappropriate degrees of inattention, overactivity,
and impulsivity
o usually appears together, but may appear
solo
o inattention = short attention span
o impulsivity = interrupting others, cannot wait
o constant motion, difficulty remain in the seat
62
 o cannot be prevented or cures, but can be  stimulate health control hyperactive
manages sx by mgmt., referral impulsive behavior
 One of the most common reasons for referral of  special instruction free from distractions
children to mental health services  fair but firm and set consistent limits
 Childhood problems include: o Medications
o Lowered intellectual development  controls excessive activity
o Some minor physical abnormalities  lengthening the attention span
o Sleeping disturbances  decreasing the distractibility
o Behavioral or emotional disorders  Interventions
o Difficulty in social relationships. 5. Provide environmental and physical safety
 Diagnosis measures.
o Established on: 6. Encourage support groups for parents.
 parent and teachers reports 7. Administer prescribed medication; some
 psychological assessments (Only arise if commonly prescribed medications that
parents report and if there is teacher include:
referral)  methylphenidate hydrochloride (Ritalin).
o Diagnosable by 36 months  pemoline (Cylert), and
 During toddlerhood - start of  dextroamphetamine sulfate (Dexedrine).
socialization 8. Inform the child and parents that positive
o 3 major characteristics revealed before 7 effects of the medication may be seen within
years of age 1 to 2 weeks
 Assessment
9. Fidgets with hands or feet or squirms in the
seat
 restless
 Because of the impulsivity
10. Easily distracted with external or internal
stimuli
11. Difficulty with following through on
instructions
12. Poor attention span
13. Shifting from one uncompleted activity to
another
14. Talking excessively
15. Interrupting or intruding on others
16. Engaging in physically dangerous activities
without considering the possible
consequences
 Because of impulsivity
 Prone to accidents
 Therapeutic Management
o Environment
 construction of stable environment
 strict instruction, strict activities
 treatment should be fair (dili
bunalan) since the child cannot
understand why they have the
disorder
 guide the child to help control their
impulsivity
 lengthen, improve attention span
 decrease distractions

BSN-2B TRANSCRIBED BY: GROUP # 63

 Care of Mother, Child at Risk or 04 LEC
25
with Problems (Acute & Chronic)
NCM 209 – Florence Puno
22 O6
CYSTIC FIBROSIS (INFANT) – KAWAZAKI DISEASE (PREE-SCHOOL)

OUTLINE  need to manage this one since there

are many organs involved. Pulmonary
I CYSTIC FIBRORIS involvement, mostly bigger
II CELIAC DISEASE percentage with these kind of
III COMMON HEALTH PROBLEM IN paintings. Sometimes the prognosis is
PRESCHOOL AGE
end stage lung disease which is the
IV BRONCHIAL ASTHMA
cause of death.
V WILM’S TUMOR
VI UTI  Somehow the problem now is not
VII GLOMERULONEPHRITIS only the pancreas but then the lung
VIII AZOTEMIA disease because that is the end stage
IX NEPHROTIC SYNDORME that gets involved with cystic fibrosis
X LUKEMIA
FOUR SYMPTOMS SAME WITH CELIAC DISEASE:
XI TONSILLITIS AND ADENOIDITIS
XII KAWASAKI DISEASE  Malnutrition
 Very hereditary ang cystic fibrosis, both the
lungs and digestive are affected
 protuberant abdomen – the abdomen sticks out
farther than the usual. There is excess
CYSTIS FIBROSIS subcutaneous fats and there is also loss of muscle
tone-assess and auscultate the abdomen to hear
 This is a chronic multisystem disorder
some muscle tone. Try to know why it is
(autosomal recessive trait disorder)
protruding maybe there is a build-up of some
characterized by exocrine gland dysfunction.
substances.
 The mucus produced by the exocrine glands is
 Steatorrhea
abnormally thick, tenacious, and copious,
 fat-soluble vitamin deficiency
causing obstruction of the small passageways
of the affected organs, particularly in the
RESPIRATORY SYMPTOMS:
respiratory, gastrointestinal, and reproductive
systems.
 Wheezing and dry nonproductive cough
 CF is a fatal genetic disorder and respiratory
 Dyspnea
failure is the most common cause of death.
 Cyanosis
 There is also a marked electrolytes change in
the secretion of sweat glands  Clubbing of the fingers and toes

MOST COMMON SYMPTOMS:

 pancreatic enzyme deficiency – caused by

duct blockage; associated with some
diseases/complications such as chronic
lung disease
 progressive chronic lung disease-
associated with infection, and sweat
gland dysfunction resulting in increased
sodium and chloride sweat concentration
 need to test this one

 It can indicate some disorder with clubbing

BSN-2B TRANSCRIBED BY: GROUP # 64

  There is a possibility of low oxygen level seen
in capilliary refill
 Could be in patient cyanotic heart disease:
indication of low oxygen
 Barrel chest – anterior chest wall is bigger; usually
seen in lung conditions
 Repeated episodes of bronchitis and pneumonia
 Common in children, but some are
diagnoses especially in community they
are not diagnosed.
GASTROINTESTINAL SYSTEM:
 Meconium ileus in the neonate – thicker than
normal meconium; it will create blockage in
intestine this would lead to cystic fibrosis
 Intestinal obstruction ( pain, abdominal
distention, nausea, and vomiting)
 Steatorrhea (frothy, foul-smelling stools) –
observe when using diaper; there might be
presence of excess fats in the feces; it cannot be
flushed since it is bulky, it is oily in appearance
 easy bruising and anemia
 Malnutrition and failure to thrive
 Generalized edema ( due to hypoalbuminemia)
 Rectal prolapse (due large, bulky stools and lack of
the supportive fat pads around the rectum) –
there is loss of normal attachement inside the
body; sometimes they scope out through the anus
and turn to side.
INTEGUMENTARY SYSTEM:
 Abnormally high concentrations of sodium and
chloride in sweat – does not allow chloride to be
reabsorbed to the sweat cells; the more sodium
stays in the draft , the more fluoride remains in
the sweat
 Parents reporting that the infant tastes “salty”
when kissed – the concentration of fluoride in the
sweat are elevated with cystic
 Dehydration and electrolyte imbalances,
especially during hyperthermic conditions – high
temperature
REPRODUCTIVE SYSTEM:
 Delay puberty in girls – cause blockage
 Infertility (highly viscous cervical secretions) –
cause blockage
 Sterility (caused by the blockage of the vas
deferens by abnormal secretions or by failure of
normal development of duct structures.
BSN-2B TRANSCRIBED BY: GROUP #
 Mostly men in CF, their tube (the one that
carries the sperm to the penis is the vas
deferens), if it will not fully develop that will
lead to bilateral abcess on the vas deferens.
DIAGNOSTIC TESTS:
 Quantitative sweat chloride test (most reliable
test) - the most reliable diagnostic test; measure
the concentration of chloride being excreted in
sweat, also used as a screening test for CF
 If there is defective chloride channel, the
concentration of chloride in cells are elevated
 Pilocarpine – a cholinergic drug that stimulate
production of sweat
 the sweat is collected, and the sweat
electrolytes are measured
 Normal - if sweat chloride concentration is 20
meq/L or lower than 40mEq/L.
 Chloride concentrations of 50 to 60 mEq/L are
highly suggestive of cystic fibrosis and require
a repeat test
 A chloride concentration higher than 60
mEq/L is a positive test result.
 Notes: chloride is the standard test for cystic
fibrosis
 Chest x-ray film - reveals atelectasis
 Atelectasis - (collapse of the lungs and loss of
volume) and obstructive emphysema;
difficulty of breath leading to respiratory
failure. Sometimes patients are
asymptomatic – complain with chest pain
 Emphysema – long term progressive disease,
chronic, primarily causes shortness of breath
due to too much air in the lungs or the over
inflation of air sacs and alveoli commonly in
adults. Lung tissues are involved there is
problem with the exchange of o2 and CO2. So
if there is emphysema there will be impaired
exchange of oxygen and carbon dioxide.
 Pulmonary function tests - provide evidence of
abnormal small airway function.
 Stool, fat, enzyme analysis: A 72-hour stool
sample is collected to check the fat and/or
enzyme (trypsin – enzyme that digest our protein)
content (food intake is recorded during the
collection).
 Duodenal analysis – nasogastric tube is inserted to
aspirate duodenal secretions
Therapeutic management
 Respiratory system- Goals of treatment
include preventing and treating pulmonary
65
 infection by improving aeration, removing
secretions, and administering antimicrobial
medications.
 Chest physiotherapy – common; deep
breathing exercises and chest tapping to
loosen thr secretion in the lungs and
mobilize to not cause obstruction and to
drain
 Aerosol Therapy
 Bronchodilator
 Antimicrobial
 Mucolytic
 Use of a Flutter Mucus Clearance Device
(a small, hand-held plastic pipe with a
stainless steel ball on the inside)
 Use of a ThAIRapy vest device that
provides high-frequency chest wall
oscillation to help loosen secretions
 Gastrointestinal system
 The goal of treatment for pancreatic
insufficiency is to replace pancreatic
enzymes; pancreas is not able to produce
enough enzyme – there can be bloating,
steatorhea
 The amount of pancreatic enzymes
administered is adjusted to achieve
normal growth and a decrease in the
number of stools to two or three daily.
 Enteric-coated pancreatic enzymes should
not be crushed or chewed.
 Pancreatic enzymes should not be given if
the child is NPO.
 Encourage a well-balanced, high-protein,
high-calorie diet; multivitamins and
vitamins A, D, E, and K are also
administered.
 Assess weight and monitor for failure to
thrive.
 Monitor for constipation and intestinal
obstruction.
 Ensure adequate salt intake and fluids
that provide an adequate supply of
electrolytes during extremely hot weather
and if the child has a fever.; cannot be too
much or lack salt because it is still needed
by the body.
 Home care
BSN-2B TRANSCRIBED BY: GROUP #
1. Instruct the child and family about the
prescribed treatment measures and their
importance.
2. Instruct the parents and caregivers to be
sure immunizations are up to date.
3. Inform the parents and caregivers that
the child should be vaccinated yearly for
influenza; pneumococcus vaccine may
also be prescribed.
CELIAC DISEASE
Incidence and etiology:
 Genetic disorder that occurs in all races but
most common in Caucasians
 This disease is caused by permanent
intolerance of gluten
 Gluten – a protein component of wheat,
rice, oats or barley
 Gluten-intolerance
 Incidence varies in different regions and more
common in Europe
CELIAC DISEASE
 Gluten-Induced Enteropathy/Gluten-sensitive
enteropathy (GI tract disease - there is
interference in the absorption of the nutrients
 Malabsorption Syndrome
 Is a sensitivity or immunologic response to
protein, particularly the gluten factor of protein
found in grains of wheat, barley, rye, and oats
 results in the accumulation of the amino acid -
glutamine, which is toxic to intestinal mucosal
cells.
 Intestinal villi (absorbs the product of digestion,
so if it is injured, they could properly absorbed
nutrients) atrophy (shortening of size) occurs,
which affects absorption of ingested nutrients.
Celiac disease
66
  is a inherited condition that prevents the  Intensive therapy to replace fluids and
small intestine from absorbing nutrients, electrolytes is required
causing malnutrition.
INTERVENTIONS
What happens
 gluten, a protein found in some grains,  Maintain a gluten-free diet, substituting corn,
stimulates immune system antibodies. rice, and millet as grain sources.
Symptoms  Instruct parents and child about lifelong
 Diarrhea, malnutrition, weight loss, skin rash; elimination of gluten sources such as wheat,
some people have no symptoms rye, oats, and barley.
Microvilli  Administer mineral and vitamin supplements,
 Absorb nutrients in food including iron, folic acid, and fat-soluble
Normal intestine villi supplements A, D, E, and K
 Tiny projections on inside wall of intestine  Teach the child and parents about a gluten-
Endothelial cells free diet and about reading food labels
 Cover surface of villi carefully for hidden sources of gluten
 Instruct the parents in measures to prevent
Antibodies attack, damage lining of small intestine. celiac crisis.
 Basics of a Gluten-Free Diet
Celiac disease endothelial cells, villi, microvilli  FOODS ALLOWED
damaged by body’s reaction to gluten  Meat such as beef, pork, and poultry and
fish, eggs, milk and dairy products,
Diagnosis: vegetables, fruits, rice, corn, gluten-free
 Small Bowel Biopsy – tells if there is atrophy in wheat flour, puffed rice, cornflakes,
the villi cornmeal, and precooked gluten-free
 Serologic Test – detect antigliadin (one of the cereals
types of the gluten)  FOODS PROHIBITED
 Laboratory Test  Commercially prepared ice cream, malted
milk, prepared puddings, grains, including
Treatment anything made from wheat, rye, oats, or
 Lifelong adherence to GLUTENE FREE diet barley, such as breads, rolls, cookies,
o Education about diet cakes, crackers, cereal, spaghetti,
o Nutritional supplement may be use macaroni noodles& beer
(iron, folate, calcium, fat soluble
Basic of a Gluten-Free Diet
vitamins)
 Foods allowed
Assessment
 Meat such as beef, pork, and poultry and
 Acute or insidious diarrhea
fish, eggs, milk and dairy products,
 Steatorrhea
vegetables, fruits, rice, corn, gluten-free
 Anorexia
wheat flour, puffed rice, cornflakes,
 Abdominal pain and distention
cornmeal, and precooked gluten-free
 Muscle wasting, particularly in the
cereals
buttocks and extremities
 Foods prohibited
 Vomiting
 Commercially prepared ice cream, malted
 Anemia
milk, prepared puddings, grains, including
 Irritability
anything made from wheat, rye, oats, or
CELIAC CRISIS barley, such as breads, rolls, cookies,
cakes, crackers, cereal, spaghetti,
 Precipitated by infection, fasting, ingestion of macaroni noodles and beer
gluten
 Extreme and acute profuse watery diarrhea and
vomiting occurs
 Can lead to electrolyte imbalance, rapid
dehydration, severe acidosis

BSN-2B TRANSCRIBED BY: GROUP # 67

PROGNOSIS  Expiratory wheeze
 Cough
 Dietary avoidance of gluten results in  Thick tenacious
improvement of symptoms in 70% of patients  Barrel chest – if chronic
within 2 weeks Severe attack
 Serologic antibody titers decrease on a gluten-  Shortness of breath
free diet  Use of accessory muscles
 After 3-6 months antibody levels may  Retractions
become detectable  Nasal flaring
 Complete histological resolution of small  Irritability (earliest sign hypoxia)
bowel inflammation may take up to 2  Diaphoresis
years

COMMON HEALTH PROBLEMS IN Diagnosis

PRESCHOOL AGE
Learning Objectives
At the end of the lecture, the students will be able to:
 Describe the health problems presented by a
preschooler;
 Organize manner of assessing preschool
 With specific healthy conditions;
 Discriminate the different signs and
symptoms of each specific
conditions/illnesses common in preschool;
 Distinguish appropriate nursing actions with
corresponding diagnostic tests that could
confirm the specific condition of preschool;
 Outline safety measures in all aspects of
preschool’s care
 Formulate a comprehensive plan of
management for a given condition of a
preschool
BRONCHIAL ASTHMA (common)
 Assessment findings
 ABG – respiratory acidosis
 Peak flow meter – an object way to measure
airway obstruction
 The most reliable early sign of an asthma attack is
a drop in the child peak expiratory flow rate
Picometer
 measure the air movement out of the lungs
 prevent asthma attack
Spirometer
 lung function test to measure how patients
capacity for breathing or how well they
breathe
 assess lung function or how much air they
inhale/exhale
 measures the amount and rate of air a person
breathes in order to diagnose illness or
determine progress in treatment

 It is an obstructive disease of the lower Medical Management

respiratory tract (the airways is associated
with hyper responsive that leads to episodes 1. Drug Therapy
of wheezing, breathlessness, chest tightness) A. Bronchodilators
 Often cause by an allergic reaction to an i. Beta-2-agonist bronchodilator
environmental allergen ii. xanthine derivative
 relax the muscle that tightens the
 Allergic reaction results in histamine release- -
airway
airways responses
 clear mucus na nandun sa lungs
Allergic reaction results to 3 main airway responses
B. Antiasthma
a) Edema of mucous membrane i. Corticosteroids
b) Spasm of the smooth muscle ii. Mast cell stabilizer
c) Accumulation of secretions (due to the iii. leukotriene inhibitors
swelling) C. Antibiotics
Risk Factor
1. Family history of allergies and asthma 2. Hyposensitization
2. Client history of eczema
 this would aim the allergic patient tolerance
 ano ba ang respond ni patient dun sa allergin
Clinical manifestations

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 3. Exercise a. stage V: bilateral renal involvement

 aimed to increase expiratory function Management

 using an incentive spirometer daily
 post a visible sign “NO ABDOMINAL
Nursing Interventions PALPATION”
1. Surgery - nephrectomy
1. Place client in high fowler’s position 2. Radiation therapy
2. Administer oxygen as ordered 3. Chemotherapy
3. Administer medications as ordered
4. Provide good hydration Nursing Intervention
5. Provide chest physiotherapy
6. Promote energy conservation Pre operative
7. Monitor respiratory function
8. Provide family health teachings 1. Do not palpate the abdomen
9. Proper ventilation 2. Handle the child carefully
3. Monitor BP, intake and output
Wilm’s Tumor / Nephroblastoma
WILM’S TUMOR/NEPHROBLASTOMA 4. Provide routine preoperative care

The kidneys are responsible for removing wastes from Post operative
the body, regulating electrolyte balance and blood
pressure, and stimulating red blood cell production. 1. assess the respiratory, circulatory, fluid and
electrolytes status
 A large malignant tumor that develops in the 2. monitor patency and adequacy of urinary
renal parenchyma output
 arises from bits of embryonic tissue that 3. Observe for any postoperative complications
remains after birth 4. Provide care for child receiving radiation and
 Rare kidney cancer and highly treatable, chemotherapy
usually develops on one kidney
 It accounts for 20% of solid tumors in Urinary Tract Infection
URINARY TRACT INFECTION (UTI)
childhood
 Tumor is rarely discovered until it is large  It is a bacterial invasion of the kidneys or
enough to be palpated bladder
 slightly less frequent in boys than girls  E. Coli accounts for about 80% of acute
episodes
Assessment
Predisposing factors
 Palpable mass
 Hematuria 1. poor hygiene
 Hypertension 2. irritation from bubble
 Anemia
Assessment findings
 Low grade fever
1. low grade fever
Diagnostic Test
2. abdominal pain - lower region
 Sonogram 3. burning pain upon urination
 CT scan 4. hematuria
 IVP = intravenous pyelogram - common, 5. Foul-smelling
imaging of renal pelvis 6. urinary frequency
7. Enuresis - common sign for pre-schooler
Staging of Nephroblastoma
Diagnostic Test
1. stage I : limited to kidney
2. stage II : tumor extends beyond kidney but 1. Urinalysis - presence of pus cells
completely encapsulated
Treatment
3. stage III : tumor confined to abdomen
4. stage IV: tumor has metastasized to lung,
 antibiotic
liver, bone or brain
 analgesic and antipasmodic

BSN-2B TRANSCRIBED BY: GROUP # 69

  increase fluid intake - helps you flush those  Cloudy, smoky, brown-colored urine (hematuria)
bacterias out  mL per hour must be collected
 note the color as well
Nursing Intervention  Pallor, irritability, lethargy
 In the older child, headaches, abdominal, or flank
1. Administer antibiotics as ordered pan, dysuria
2. Provide warm baths and allow water  Proteinuria that produces a persistent and
3. Force fluids excessive foam in the urine
4. Encourage measures to acidify urine
5. Provide health teaching
 avoidance of tub bath Azotemia AZOTEMIA
 avoidance of bubble bath
 For girls wipe perineum from front to back - A form of blood poisoning that accumulates in the
 void at least every 2 to 3 hours, try to empty blood
bladder - Increased blood urea nitrogen and creatinine levels
- Increased antistreptolysin O titer (used to diagnose
(hygiene is very important in UTI) disorders caused by streptococcal infections)
- Measures the antibodies
Glomerulonephritis
GLOMERULONEPHRITIS
refers to a group of kidney disorders characterized by
an inflammatory injury in the glomerulus, most of
which are caused by an immunological reaction.

 Affect more males

 structures in your kidney that is made up of

blood vessels
 Blood vessels - help filter blood, remove
excess fluid
 If glomeruli is damaged, your kidney will stop
working properly
Assessment/Diagnostic findings
Causes
 Urinalysis (specific gravity of urine)
1. immunological diseases
 Streptozyme tests
2. Autoimmune diseases
 Blood and tissue cultures
3. Antecedent group A beta-hemolytic
 Initial blood tests
streptococcal infection of the pharynx or skin
4. History of pharyngitis or tonsillitis 2 to 3
Treatment
weeks before symptoms
 Antibiotics
Note the common infections that cause acute GN (ex:  Loop diuretics (to increase plasma volume, to
streptococci) decreaset edema)
 Vasodilators (reduce vascular resistance and
Types improve that cardiac output)
 Calcium channel blockers (the movement of
 Acute: occurs 2 to 3 weeks after a calcium iron will inhibit)
streptococcal infection
 Chronic: can occur after the acute phase or Interventions
slowly over time
 Monitor vital signs, weight, intake and output,
Assessment and the characteristics of urine
 Limit activity; provide safety measures
 Periorbital and facial edema that is more  Provide high-quality nutrient foods
prominent in the morning  Restrictions depends on the stage and severity
 Anorexia, hypertension of the disease, especially the extent of the
 Decrease urinary output edema

BSN-2B TRANSCRIBED BY: GROUP # 70

  In uncomplicated cases: Regular diet is
permitted but sodium is restricted to a “no
added salt to foods” diet.
 Moderate sodium restriction: Hypertension or
edema
 Foods high in potassium are restricted during
periods of oliguria
 Protein is restricted if the child has severe
azotemia resulting from prolonged oliguria
 Monitor for complications
 Administer diuretics, antihypertensives,
antibiotics as prescribed.
 Instruct the parents to report signs of bloody
urine, headache, or edema.
 Instruct the parents that the child needs to
obtain appropriate adequate treatment for
infections, specifically infections.
NEPHROTIC SYNDROME
 Nephrotic syndrome is a kidney disorder
characterized by massive proteinuria,
hypoalbuminemia (hypoproteinemia), and
edema.
 Autoimmune process
 The primary objective of therapeutic
management is to reduce the excretion of
urinary protein and maintain protein-free urine
(to check the presence of albumin in the urine)
WHY IS THERE A NEPHROTIC SYNDROME?
 The plasma enters the renal tubes and
excretes in the urine. The protein will cause
altered pressure and the patieng will
experience swelling.
Assessment
 Periorbital and facial edema is most prominent
in the morning
 Leg, ankle, labial, and scrotal edema occurs
 Urine output decreases; urine is dark and froth
(might be infectious if too dark)
 Ascites (fluid in the abdominal cavity)
 Blood pressure is normal or slightly decreased.
 Massive proteinuria is seen.
 Decrease serum protein
BSN-2B TRANSCRIBED BY: GROUP #
Interventions
 Monitor vital signs, intake and output, and daily
weights.
 Monitor urine for specific gravity and albumin.
 Monitor for edema.
 Nutrition: A regular diet without added salt is
prescribed if the child is in remission; sodium is
restricted during periods of massive edema.
 Corticosteroid therapy is prescribed as soon as
the diagnosis has been determined; monitor the
child closely for signs and infection.
 Immunosuppressant therapy (reduce the relapse
rate and induce long-term remission)
 Diuretics may be prescribed to reduce edema.
 Plasma expanders such as salt-poor human
albumin may be prescribed for the severely
edematous child.
 Instruct the parents regarding the signs of
infection and the need to avoid contact with
other children who may be infectious
LUKEMIA
 refers to cancers of the white blood cells
 Proliferation of abnormal white blood cells
that do not mature beyond the blast phase
 In the bone marrow, blast cell crowd out
healthy white blood cells, red blood cells, and
platelets, leading to bone marrow depression.
 White blood cells fight infection
 Blast cells also infiltrates other organs most
commonly the liver, spleen, kidneys, and
lymph tissue
 Lukemia can be seen in the bone marrow as
well as in the blood.
71
  If there are no white blood cells, it will not
help you fight infection
 In general, lukemias are classified into acute
(rapidly developing, especially if there is no
chemotherapy yet) and chronic (slowly
developing) forms.
 In children, about 98% of lukemia are acute
Types of Leukemia
 Aims to eliminate completely any
remaining leukemic cells; or maintaining
remission
 Intensifies the assault against leukemic
cells using chemotherapy
 Given for 2-3 years
Two additional phases are instituted for children
who experience relapse

1. Acute Lymphocytic Leukemia 1. Reinduction

 Primarily strikes children and young adults  Administration of the drugs previously
(80-85% of childhood leukemia used plus additional drugs
 the malignant cell involved is the
lymphoblast) 2. Bone marrow transplant
2. Acute Myeloid Lekemia
 Also known as—Acute nonlymphocytic  Usually recommended after the second
lukemia remission in children
 Cells involved is the granulocytes
Nursing intervention
Types of Leukemia
 Preventing infection
 Chronic Lymphocytic Leukemia (CLL)  Reducing pain
 Chronic Myelogenous Leukemia (CML)  Promoting energy conservation and relieving
anxiety
Assessment Findings  Promoting normal growth and development
 Promoting a positive body image
1. Anemia (weakness, pallor, dyspnea)  Promoting family coping
2. Bleeding (petechiae, bruise)
3. Infection (fever, chills, malaise) TONSILLITISTONSILLITIS
AND ADENOIDITIS
AND ADENOIDITIS
4. Enlarged lymph nodes
5. Enlarged spleen and liver (splenomegaly and Nursing intervention
hepatomegaly)
6. Abdominal pain  Preventing infection
7. Bone and Joint pain  Reducing pain
 Promoting energy conservation and relieving
Diagnosis anxiety
 Promoting normal growth and development
Blood studies b  Promoting a positive body image
One marrow aspiration  Promoting family coping
Lumbar tap
Xray of bone TONSILLITIS AND ADENOIDITIS

Management  Tonsillitis refers to inflammation and infection

of the tonsils
Goal of care: complete cure
 the most common bacteria causing
Chemotherapy tonsillitis is Streptococcus pyogenes (the
bacterium that causes strep throat)
Treatment phase:
 Adenoiditis refers to inflammation and
1. Induction—achieving complete remission or infection of the adenoids
absence of leukemic cells
2. Consolidation/Sanctuary
 Preventing leukemic cells from invading or
growing in the CNS
3. Maintenance

BSN-2B TRANSCRIBED BY: GROUP # 72

  Do not give the child any straws, forks, or
sharp objects that can be put into the mouth
 Administer acetaminophen (Tylenol) for sore
throat as prescribed
 Instruct the parents to notify the physician if
bleeding, persistent earache, or fever occurs.
 Instruct the parents to keep the child away
from crowds until healing has occurred

KAWASAKI DISEASE

 Kawasaki disease is known as mucocutaneous

lymph node syndrome and is an acute
systemic inflammatory illness
 The cause is unknown but may be associated
Assessment
with an infection from an organism or toxin
 Persistent or recurrent sore throat  Cardiac involvement is the most serious
 Enlarged, bright red tonsils that may be complication; aneurysms (abnormal swelling
covered with white exudate in the wall of blood vessels) can develop.
 Difficulty in swallowing  Etiology is unknown
 Mouth breathing and an unpleasant mouth
Assessment
odor
 Fever
Acute stage
 Cough
 Enlarged adenoids may cause nasal quality of  Fever
speech, mouth breathing, hearing difficulty,  Conjunctival hyperemia
snoring, and/or obstructive sleep apnea  Red throat
 Swollen hands, rash, and enlargement of the
Pre-operative interventions
cervical lymph nodes
 Assess for signs of active infection
Subacute stage
 Assess bleeding and clotting studies because
the throat is vascular  Cracking lips and fissures
 Prepare the child for a sore throat  Desquamation of the skin on the tips of the
postoperatively, and inform the child that he fingers and toes
or she will need to drink liquids.  Joint pain
 Assess for any loose teeth to decrease the risk  Cardiac manifestations
of aspiration during surgery  Thrombocytosis
Interventions postoperatively Convalescent stage
 Position the child prone or side-lying to  Child appears normal but signs of
facilitate drainage inflammation may be present
 Have suction equipment available but do not
suction unless there is an airway obstruction
 Monitor for signs of hemorrhage (frequent
swallowing may indicate hemorrhage); if
hemorrhage occurs, turn the child to the side
and notify the physician.
 Discourage coughing or clearing the throat
 Provide clear, cool, noncitrus, and
noncarbonated fluids
 Avoid milk products initially because they will
coat the throat
 Avoid red liquids, which simulate the
appearance of blood if the child vomits

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 Medication

 IVIG
 aspirin
 steroids

Parent education

 Follow-up care is essential to recovery

 The signs and symptoms of Kawasaki disease
include the following:
1. Irritability may last up for up
to 2 months after the onset of
symptoms
2. Peeling of the hands and feet
may occur
3. Pain in the joints may persist
for several weeks
4. Stiffness in the morning, after
naps, and in cold
temperatures may occur.
 Record the temperature until child has been
afebrile for several days
 Notify the physician if the temperature is 101F
or higher
 Salicylates such acetylsalicylic acid (aspirin)
may be given
 Signs of aspirin toxicity include tinnitus,
headache, vertigo, bruising; do not administer
aspirin or aspirin-containing products if the
child has been exposed to chickenpox or the
flu.
 S/sx of bleeding: epistaxis, hemoptysis,
hematemesis, hematuria, melena, and bruises
on body
 S/sx of cardiac complications chest pain or
tightness (older children), cool and pale
Diagnosis extremities, abdominal pain, nausea and
vomiting, irritability, restlessness, and
fever x ⅗ days + ⅘ diagnostic criteria uncontrollable crying.
 Children should avoid contact sports, if age
1. erythema
appropriate, if taking aspirin or
2. rash on trunk
anticoagulants.
3. swelling of hands or feet
 Avoid administration of MMR or varicella
4. red eyes
vaccine to the child for 11 months post-
5. swollen lymph nodes
intravenous immune globulin therapy, if
appropriate.
Interventions
VIDEO LINK: https://youtu.be/jIzARfWbqv8
 Monitor temperature frequently
 Assess heart sounds, rate, and rhythm
 Assess extremities for edema, redness, and
desquamation
 Examine eyes for conjunctivitis
 Monitor mucous membranes for
inflammation
 Monitor strict intake and output

BSN-2B TRANSCRIBED BY: GROUP # 74

Care of Mother, Child at Risk or 02 L E C
26
with Problems (Acute & Chronic)
NCM 209 – MRS. PUNO
21 O8
COMMON HEALTH PROBLEMS IN ADOLESCENT
→ Lordosis - inward curve of the spine
OUTLINE
I SCOLIOSIS → Kyphosis - outward curve
II BONE TUMOR
 ASSESSMENT FINDINGS

o Uneven shoulders (could be left or

SCOLIOSIS right)
o Uneven hips
─ a lateral curvature of the spine
o Asymmetry of rib cage
─ five times more common in girls and has peak
o Unequal length of bra strap (for
incidence at 8 to 15yrs
females)
─ Majority (75%) - idiopathic (unknown cause)
o Bump or rib hump on one side of the
has a familial pattern (30% of children with
spine
scoliosis); wala siyang genetic factor but
shows familial pattern
─ associated with other neuromuscular
disorders (because of lateral curvature
nagkakaroon ng impairment with
neuromuscular functions)

 Etiology: unknown
 Theories postulated:
o Malfunctioning of the vestibular
balancing system
o Genetic patterns
o Muscular weakness
o Collagen metabolism
 Cause is unknown called idiopathic scoliosis

 FORMS:
 DIAGNOSIS
o Structural / Progressive form
 “S” curve of the spine
1. Forward bend test / Adam’s bend test
 usually idiopathic
 does not disappear with
position changes
 needs more aggressive
treatment
o Functional/ Postural/Non structural
 “C” curve of the spine
 caused by poor posture,
muscle spasm due to trauma,
or unequal length of legs
 disappears when child lies
down can be treated with
posture exercise. The earlier
that is detected, more better
the management, the better
prognosis. Kasi di pa matigas
ang mga buto.

BSN-2B TRANSCRIBED BY: GROUP # 75

  a test used most often in
schools and doctor's offices to
screen for scoliosis

2. Scoliometer – a commercial device used

to document the extent of spinal curve
1. Ask the child to slowly bend
forward until the shoulders are
level with the hips
2. Adjust the bending position
height so the deformity of the
spine is most pronounced
3. Gently lay the scoliometer across
the deformity at right angles to
the body, with the marking
centered over the curve
 Milwaukee brace
4. General meter: refer to a
─ 23 hours/day for 3 years para ma-
physician with a scoliometer
correct talaga yung curvature.
reading of seven degrees or
─ Very hassle
greater
 If 7 degrees or greater, refer to a
 Boston brace
physician for further evaluation.
─ A scoliosis brace is usually worn under
The greater the degree of
clothing and is one method used to
curvature, the greater the
try to improve the exaggerated
severity
curvature of the spine as seen in
scoliosis
3. Radiograph (X-ray)
 Traction
 assess the angle of the curve ─ Halo-pelvic traction (sa ulo ilagay)
and determine extent of ─ Halo-femoral traction
deformity ─ Electric rotating bed - stimulates
 Cobb angle standard method positioning of the patient
for assessing the curvature
quantitatively
 MANAGEMENT
- Depends on the maturity of the skeleton
and on the degree of curvature

o Spinal curve of less 20 degree

 no therapy, pede pa siya ma-
correct
 observation until 18years of
age
o Spinal curve greater than 20 degree
 conservative, nonsurgical
approach
 Braces - init, magkaka rashes,  Harrington rod (Steel rod)
kapoyon siya
 Traction
 Plaster jacket cast
o Spinal curve of more than 40 degrees
surgery (very risky)
 Spinal fusion with insertion of
Harrington rod

BSN-2B TRANSCRIBED BY: GROUP # 76

 b. Use of incentive spirometry -
promotes lung expansion and
prevents pneumonia
c. Log roll - turn the patient as a
unit/whole para ma maintain;
do not raise the bed

2. Stress correct body mechanics

3. Promoting mobility, positive body

image and compliance with therapy

4. Preventing injury
 Some rescuers kahit walang
cervical fracture, gina stabilize
parin yung head kasi it would
case permanent disability
o Electrical stimulation 5. Preventing skin irritation
 Use as an alternative for
braces
 Electrodes are applied to the
skin or surgically implanted BONE TUMORS
 Electrical stimulation is
usually employed at night, - Ibat iba ang name sa tumor depende sa lugar
during sleeping hours 1. Sarcoma - tumors arising from connective
 To stimulate muscle to tissue, such bones and cartilage, muscle,
contract to straighten the blood vessels or lymphoid tissue
spine common neoplasm in adolescent
 Stretching exercises of the  Arise during adolescent
spine for non-structural because of rapid bone growth
changes ─ Common in adolescence. Happens at the end
 NURSING INTERVENTION of the long bone; found around the knee,
thigh bone, tibia, fibula, humerus
1. Provide care for child with brace ─ Tumor that occurs in the growth metaphysis
1. Teach the child to wear it constantly, ─ Trauma brings malignancy
except when bathing ─ Cause: unknown
2. wear over a t-shirt to protect the skin ─ Children with hereditary form of
3. report if there is rubbing (mag sweat retinoblastoma (eye tumor) have an increased
tas mangatol) risk
4. encourage exercise as prescribed ─ Osteosarcoma
5. Provide cast or traction care
a. Frequent cleansing on the pin
sites
b. Provide diversional activities
(nababagot sila kasi naka stay
put lagi)
c. Monitor for signs of
complications
6. Provide preoperative and post-
operative nursing care
a. Deep breathing exercise (kasi
naka lie lang lagi and it will
generate mucus sa lungs like
pneumonia)

BSN-2B TRANSCRIBED BY: GROUP # 77

TWO MOST FREQUENTLY OCCURING TYPES OF BONE
CANCER:

1. Osteogenic Sarcoma

 A malignant tumor of long bone involving

rapidly growing bone tissue
(mesenchymal matrix forming cells)
 Characterized by formation of osteoid
(immature bones)
o Bones are not strong
 Common sites of occurrence
o distal femur – 50% 2. Ct scan
o Proximal tibia – 20% 3. Bone scan
o Proximal humerus – 10 to 15%
 High incidence in children expose MANAGEMENT
to radiation and with
retinoblastoma 1. Surgery (orthopedic ward)
 Lungs – common site of - May be done to save the leg/arm
metastasis a. Limb salvage procedures (kung kaya pa
 Cancer cells (metastasis) ma-save) kaya need early detection
b. Bone or skin grafts
2. Ewing's sarcoma c. Amputation (if dili na masave) - BKA, AKA
d. Reconstructions - e.g. lagay ng steels,
ASSESSMENT kneecaps Resections of metastases
(tanggalin ang area kung saan na
1. Pain metastasize ang tumor)
2. Swelling, redness
3. Tender mass, warm to touch 2. Radiation therapy
4. Limitation of movement Chemotherapy - any group of drugs used in
5. Pathologic fracture - has a certain cause combination to treat a certain condition; dili
(medical cause). Due to sarcoma,naga develop tanan chemotherapy kay cancer imong itreat
ug fracture.
 Shrinking of the tumor
DIAGNOSIS
 Done in certain cycles
1. Bone Biopsy - pag may tumor, gina check ang
growth ng tissues. If mag reveal ng malignacy 3. Rehabilitation (giputol na ang limbs)
or benign. If malignancy > cancer If asa ang i. physical and occupational therapy
area na naay sarcoma, dyan insertan ng ii. psychosocial adapting (include family
syringe members)
iii. prosthesis fitting and training - Eg.
Artificial legs

BSN-2B TRANSCRIBED BY: GROUP # 78

NURSING MANAGEMENT
Provide routine preoperative care (NPO, IVF,
VS) Eg. Amputation
 need pa mag counseling before putulin
and counsel din after. Refer sa mga
guidance counselors, nurses, doctors.
b. Offer support or encouragement and accept
client’s response of anger and grief
 "out of all people ngano ako man jud?"
c. Discuss to patient and family (pre-op)
1. rehabilitation program and use of
prosthesis
2. crutch walking (kay need pa mag heal
sng siter b4 mag prosthetic)
3. phantom limb sensation as normal
recurrence (most especially if a body
part is amputated. Feeling nila andun
parin ang leg tas mafeel nila ang pain)
- common struggle in patients with
amputation
4. Prevent hip and knee contractures
prone position several times a day
(unless otherwise ordered)
5. Provide stump care (post surgical site
and mga gitahi na part tas gipang
stump > prone for infection)
d. Ewing’s Sarcoma
 Dr Ewing described the tumor
 Malignant (cancerous) tumor arising
most often in the bone marrow of the
diaphysis area (midshaft) of long bones
o Develop in flat bones
 The diaphyses of the femur are the
most common sites, followed by the
tibia and the humerus
BSN-2B TRANSCRIBED BY: GROUP #
 Lungs is the most frequent site of
metastasis (eg. Respiratory
complication tas namatay)
CLINICAL FINDINGS
a. Pain and swelling on affected part
b. Palpable mass (very typical due to presence
of tumor)
c. Tender (if i-palpate tas sakit) and warm to
touch (due to swelling)
d. 15- 35% of clients have metastasis (nag
invade sa other parts of body) at time of diagnosis
 If may erwing's > poor prognosis kasi
usually meron ng metastasis
MANAGEMENT
o High doses of radiation therapy (aggressive
ang treatment kasi poor ang prognosis,
meron ng metastasis sa other organs)
o Chemotherapy - shrink the tumor
o Surgery
DIAGNOSIS
o X-ray
o Bone scan
o Biopsy
o Bone marrow aspiration (kasi naga start sa
bone marror)
NURSING INTERVENTION
o Caution adolescent to continue to be careful
and avoid activities that may cause added
stress to affected limb such as football and
weight lifting
o (kasi sa femur usually ang ma-affect > fragile
ang bones > pathologic fracture) so iwasan
mag play ng bodily contact activities
79
 Care of Mother, Child at Risk or 05 L E C
17
with Problems (Acute & Chronic)
NCM 209 – Ms. Florence Puno
22 O9
High Risk Adolescent

OUTLINE
FORM
I High Risk Adolescent
II Menstrual Dysfunction or Disorder 1. Structural/Progressive form “S” curve of the
III Scoliosis spine
IV Bone Cancer
Does not disappear with position changes needs
more aggressive treatment
High Risk Adolescent

Common health problem in adolescent

Scoliosis
A lateral curvature of the spine
2. Functional/ Postural/Non Structural “C” curve
Five times more common in girls and has peak of the spine
incidence at 8 to 15yrs Causes by poor posture, muscle spasm due to trauma,
Majority (75%) – idiopathic or unequal length of legs
Has a familial pattern
(30% of children with scoliosis)
Associated with other neuromuscular disorders

Etiology: Unknown
- Theories postulated:
- Malfunctioning of the vestibular balancing
system Disappears when child lies down can be treated with
 Genetic Patterns posture exercise
 Muscular weakness
 Collagen Metabolism
Causes is unknown called idiopathic scoliosis Assessment findings
1. Uneven shoulders
CONDITION TO CAUSE SPINAL DEFORMITY 2. Uneven hips
- CONGENITAL SPINAL COLUMN 3. Asymmetry of rib cage
ABNORMALITIES 4. Unequal length of bra strap
- MEUROMUSCULAR DISORDER (CP, SPINA 5. Bump or rib hump on one side of the spin
BIFIDA), MUSCULAR DYSTROPHY)
- RADIATION THERAPY

BSN-2B TRANSCRIBED BY: GROUP # 80

 Spinal curve of less 20 degree no therapy observation
until 18 years of age

Spinal curve greater than 20 degree conservative,

nonsurgical approach
Braces
Traction
Plaster jacket cast
Spinal curve of more than 40 degree surgery
Spinal fusion with insertion of Harrington rod

Diagnosis
Forward bend test/ Adam’s bend test
A test used most often in schools & doctor’s offices to
screen for scoliosis

Scoliometer – a commercial device used to document

the extent of spinal curve
Cobb angle – standard method for assessing the
curvature quantitatively
Radiograph (x-ray) - assess the angle of the curve and
determine extent of deformity

Using a scoliometer
1. Ask the child to slowly bend forward until the
shoulders are level with the hips
2. Adjust the bending position health so the
deformity of the spine is most pronounce
3. Gently lay the scolimeter across the deformity
at right angles to the body, with thee marking
centered ever the curve
Steel rods help support the fusion of the vertebrae
GENERAL RULE:
Bone graft are place to grow into the bone and fuse
Refer to a physician with a scoliometer reading of
the vertebrae
seven degreed or greater

Management depends on the maturity of the skeleton

and on the degree of curvature

BSN-2B TRANSCRIBED BY: GROUP # 81


Electrical stimulation
BSN-2B TRANSCRIBED BY: GROUP #
Use as an alternative for braces
Electrodes are applied to the skin or surgically
implanted
Electrical stimulation is usually employed at night,
during sleeping hours
To stimulate muscle to contract to straighten the spin
Stretching exercises of the spine for nonstructural
changes
Nursing intervention
Provide care for child with brace
Teach the child to wear it constantly, except when
bathing
Wear over a t-shirt to protect the skin
Report if there is rubbing
Encourage exercise as prescribed
Provide cast or traction care
Frequent cleansing on the pin sites
Provide diversional activities
Monitor sign of complications
Provide preoperative and post-operative nursing care
Deep breathing exercise
Use of incentive spirometry log roll; do not raise the
head of the bed
Stress correct body mechanics
Promoting mobility, positive body image and
compliance with therapy
Preventing injury and preventing skin irritation
Bone tumors
Sarcoma – tumors arising from connective tissue, such
bones and cartilage, muscle, blood vessels or
lymphoid tissue
= common neoplasm in adolescent
=Arise during adolescent because of rapid bone
growth
82
Two most frequently occurring types of bone cancer High incidence in children expos to radiation and with
- Osteogenic Sarcoma retinoblastoma
- Ewing’s Sarcoma Lungs – common site metastasis

 Osteogenic SARCOM/ osteosarcoma Assessment

 Tumor that occurs in the growth metaphysis Pain
 Trauma brings the malignancy Swelling, redness

 Most common in children Tender mass, warm to touch

 Cause Unknown Limitation of movement

 Children with hereditary form of Pathological fracture

retinoblastoma (eye tumor) have an increased

risk Diagnosis
Bon Biopsy
Ct scan
Bone scan

Management
Surgery
- Limb salvage procedures
- Bone or skin grafts amputation
- Reconstructions
- Resections od metastases
- Radiation therapy
- Chemotherapy

Rehabilitation
- Physical and occupational therapy
Osteogenic Sarcoma
- Psychosocial adapting
A malignant tumor of long bone involving rapidly
- Prosthesis fitting and training
growing bone tissue (mesenchymal matrix forming
cells)
Nursing management
= characterized by formation of osteoid (immature
1. Provide routine preoperative care
bones)
2. Offer support or encouragement and accepts
Common sites of occurrence
clients response of anger and grief
Distal femur – 50%
3. Discuss to patient and family rehabilitation
Proximal tibia – 20%
program and use of prosthesis crutch walking
Proximal humerus – 10 to 15%
phantom link sensation as normal recurrence

BSN-2B TRANSCRIBED BY: GROUP # 83

 4. Prevent hip and knee contractures prone
position several times a day (unless otherwise
ordered)
5. Provide stump care
Nursing Intervention
Caution adolescent that may cause added stress
to affected limb such as football and weight lifting

Ewing‘s Sarcoma
Malignant tumor arising most often in the bone
Menstrual Dysfunction or Disorder
marrow of the diaphyseal area (midshaft) of lone
bones

High Risk Problem of Adolescence

The diaphyseal of the femur are the most common
sites, followed by the tibia and the hemerus
Lung is the most frequent site of metastasis
MENSTRUAL DYSFUNCTION OR DISORDER
Sexually Transmitted Disorders – are those disease
spread through sexual contact

A. Gonorrhea
Causative agent Neisseria
Gonorrhea

Signs & symptoms: often asymptomatic in

females purulent yellow-green vaginal
discharge may cause ophthalmia neonatorum
and sepsis to newborn.
Clinical findings
1. Pain and swelling on affected part Treatment:

2. Palpable mass
3. Tender and warm to touch
4. 15-35% of clients have metastasis @ time of
diagnosis
Management
1. High doses of radiation therapy
2. Chemotherapy
3. Surgery
- Penicillin
Diagnosis
- Erythromycin
X-ray
- Ceftriaxone
Bone scan
- Doxycycline
Biopsy
Bone marrow Aspiration All sexual contacts must be treated

BSN-2B TRANSCRIBED BY: GROUP # 84

 Sign & Symptoms:
Thin, irritating, frothy gray- green discharge
B. Chlamydia
strong odor, itching to genitalia
Chlamydia trachomatis
Most common STD
Treatment: metronidazole douche with weak
vinegar solution to reduce pruritus.
Signs & symptoms: watery, gray-white vaginal
discharge vulvar itching
May causes ophthalmia neonatorum, sterility
in female or male, tubal pregnancy
Drug: doxycycline or tetracycline,
azithromycin.

E. Candidiasis
C. Syphilis
Candida Albicans – fungus
Treponema pallium (spirochete)
Caused by a yeast transmitted from GI tract to
Crosses placenta after 16 weeks of pregnancy
vagina
Sign & Symptoms – thick, white cheese-like
Manifestation
vaginal discharges vulvar reddening and
Primary
pruritus.
Cardinal sign – CHANCRE – a hard red painless
lesion at the point of infection site disappear
Treatment: topical application or
without treatment in 4-6 weeks
suppositories of antifungal drug such as:
clotrimazole, nystatin, miconazole, Diflucan,
Secondary – rash, malaise, alopecia
gentian violet
Tertiary – effect any organ system –
cardiovascular, neurovascular system
Bathing with diluted sodium bicarbonate
solution to reduce pruritus.
Treatment: penicillin or erythromycin

D. Trichomoniasis
Trichomonas vaginalis – a single-cell
protozoan

BSN-2B TRANSCRIBED BY: GROUP # 85

 Anorexia nervosa - Anemia
A disorder Characterized by to maintain a - Depression. social withdrawal and poor
body weight because Of a disturbance in of individual coping
the Size or appearance of the body.

an eating disorder characterized by extremely Management

low body weight, body image distortion andan
obsessive fear of gaining weight. Nutritional therapy
Total parenteral nutrition
May be manifested as severe weight Enteral tube feeding
restriction controlled by:
- Limiting food intake Behavior modification
- Excessive exercise
- Binge eating / purging Medication - antidepressant

Counselling
Clinical findings and diagnosis
 Individual therapy
 Group therapy
 Family therapy

The American Psychiatric Association Criteria for Bulimia Nervosa

Diagnosis Bulimia — refers to recurrent and episodes

body mass index — less than 85% of expected weight binge eating and purging

 Extreme weight loss accompanied by an awareness that eating pattern is

 intense fear of getting fat or gaining weight abnormal but not being able to stop

even though underweight

 severely distorted body image Bulimic person is of normal of weight or slightly

 refusal to acknowledge seriousness of weight overnight or underweight may abuse purgative.

loss laxatives and diuretic to aid in weight control

 amenorrhea
Etiology: Unknown

Manifestation
- Almost Skeleton-like appearance
Clinical manifestation and Diagnosis
- Sexually immature
- Dry skin, brittle nails
Dental caries and erosion
- Presence of lanugo
- Constipation, hypothermia, bradycardia,
Throat irritation
low blood pressure

BSN-2B TRANSCRIBED BY: GROUP # 86

 Obesity
Electrolytes imbalance- hypokalemia An excessive of fat increases body weight by 20% or
more
Behavior problem
 Drug abuse Obesity is now among the most widespread medical
 Alcoholism problems affecting children and adolescents living in
 Stealing the United States and other developed countries.
 Impulsive activities
American Psychiatric Association the criteria Obesity increases the child's risk of serious
for bulimia are: health problems such as heart disease,
DM type 2 and stroke
Recurrent episodes of binge eating
It also can create emotional and social problems
A feeling of lack of control over behavior
during binges often feels isolated from the peer group embarrassed
to participate in sports
Self-induced purging use of laxatives, diuretics,
enemas Adolescents may have difficulty achieving a sense of
identity if they are always excluded from group and if
Average of at least two binge-eating episodes they don't like their image in a mirror
a week during 3 months period

Obsessiveness regarding body weight and shape BMI - most accurate method of assessment indicates
relationship between height and weight

Management
Pharmacology — antidepressant
Psychotherapy

Nursing intervention
- Monitor vital signs
- Monitor intake and output
- Record food intake Causes
- Encourage client to express feelings Many different factors contribute to this imbalance
- Help client to set realistic goal for self between calorie intake & consumption
- Help client identify interest and positive
aspect of self Genetic factors
Obesity tends to run in families

BSN-2B TRANSCRIBED BY: GROUP # 87

Dietary habits Cause/Reasons: a means of relieving the tension and
Fast food, processed snacked foods, and sugary pressure of their lives
drinks.
Use food as means of satisfying emotional needs in Adolescent
late — night eating  a desire to feel Confident and mature due to
peer pressure
Physical inactivity  A form of rebellion
The popularity of television. computers, and games
results into an increasingly sedentary lifestyle Children at greatest risk
1. have family in which alcohol or drug abuse is
Management present
Lifestyle modification, 2. Suffer from abuse, neglect
Physical activity, 3. Have behavior problems — and excessively
Nutrition, rebellious
4. Slow learners
Ways to manage obesity in children and adolescent 5. Have problems with depression and low-self
include: esteem
1. Start a program
2. Change eating habits (eat slowly, develop a Stages of substance abuse
routine) Stage O: Pre-abuse or Curiosity Stage
3. Plan meals and make better selections describes the adolescent with an increased potential
4. Increase physical activity and have a more for substance abuse need for peer acceptance; anger
active lifestyle and boredom
5. Know what your child eats school
6. Do not use food as a reward Stage l: Experimental Stage (Learning the Euphoria)
7. Limit Snacks Adolescents have already made a decision to "try
8. Attend a group (e.g. Overeaters Anonymous) drugs" and begun learning the drug induced mood
swing or euphoria.
Substance Abuse
is the misuse of an addictive that changes the user’s drug use is confined to social situations
mental state there are few behavioral changes other than "lying:

Refers to the use of chemical to improve a mental
state or induce euphoria
Commonly abuse substance — alcohol, tobacco and
illicit drugs
Stage 2, Early Regular Use (Seeking the Euphoria)
The adolescent now actively seeks the drug-induced
mood swing
use drugs to seeks relief from everyday stress

BSN-2B TRANSCRIBED BY: GROUP # 88

Changes in dress, decline in personal hygiene, Prevention is the most effective and least expensive
deterioration in school performance, loss of previous treatment for substance abuse
interest in extracurricular activities adolescent
exhibits more mood swings, engage in regular lying. Medication -nicotine patches and methadone
Rehabilitation -counseling, social support. family
support
Stage 3 Late Regular Use (Preoccupation the
Euphoria) Suicide
Is a deliberate self- injury with the intent to end life.
Dependent on substance abuse
successful suicide occurs more frequently in male
Dependence - compulsive need to use a substance than females
satisfying effect
- deterioration of behavior such as fighting, lying, third cause of cause of death
stealing, prostitution often depressed, suicidal between 1 5 — 19 years of age
ideation, self-destructive and risk-taking behavior.
Suicide as viable solution to life problems
Stage 4 End Stage or "Burn Out"
Adolescent needs drug just to feel normal and to Risk Factors
avoid the profound and nearly constant dysphoria. Previous suicide attempts
Close family member who has committed suicide.
Depression guilt, shame and other remorse may be
overwhelming and suicidal ideation becomes more past psychiatric hospitalization
common
Recent losses: death of a relative, o family divorce or
Paranoia, angry outbursts and aggression are a
common. breakup with a girlfriend
Social isolation
Common Assessment findings
I. Failure to complete assignments in school Drug or alcohol abuse
2. Demonstration of poor reasoning ability Exposure to violence in the home or the social
3. Decreased school attendance environment
4. Frequent mood swings
5. Deteriorating physical appearance
6. Recent change in peer group Warning Signs for Suicide
7. Expressed negative perceptions of parents Suicidal talk
Preoccupation With death and dying
Treatment

BSN-2B TRANSCRIBED BY: GROUP # 89

Signs of depression
Behavioral Changes
Giving away special possessions
arrangements to take care of unfinished business
Difficulty with appetite and sleep
Taking excessive risks
Increased drug use
Loss of interest in usual activities
Tips for parents
Know the warning signs!
Do not be afraid to talk to Child.
The message is. "Suicide option help is available".
Suicide-proof your home.
Make the knives. pills and firearms inaccessible.
Utilize school and community resources.
School psychologist, crisis intervention
Take immediate action. If your child indicates
contemplating suicide
Do not leave Child alone
Seek professional
Listen to your child's friends.
Be open. Ask questions.
Scoliosis
and making
Several things to look for when screening a scoliosis
include:
 Head appears off centered between the hips
 One shoulder appears higher than the other
 One shoulder blade is more prominent than
the other
 Trunk and ribcage appear shifted to one side
 Waist appears asymmetrical
 One hip appears lower than the other
 Clothing hangs unevenly
Adam’s Forward Bend Test
- As your spinal curve develops and the spine twists,
asymmetry of the ribcage or waist is created
Scoliometer
- Is used to measure the amount of rotation
- Trunk rotation is determined with a forward bent at
the waist and is a reflection of the severity of scoliosis
- A rotation of greater than five to seven degrees
suggests scoliosis may be present
Bone Cancer
 Everything in our bodies begins with. Our cells
divide to create new ones, our cells continue
to divide until they are too old and tired to
duplicate, when a cell is too old to duplicate it
dies, though cancer cells are different.
 A cancer cell makes new copies of itself but
doesn't know when to stop. Before a cell can
divide it goes through a series of checks to see
BSN-2B TRANSCRIBED BY: GROUP # 90
 if it is healthy. If there is a problem with the
cell it is disposed of.
 A cancer cell cheats. The cancer cell grows
and changes, if the cancer changes a little it's
called a benign tumor. Benign tumors can be
destroyed easily or removed with the help of
doctors.
 If the cancer cell changes too much it can
damage the area around it, this is called a
malignant tumor. Some cancer cells move to
other parts of the body where they grow into
other tumors, this spreading of cancer cells is
called metatarsus.If the malignant tumor is
big enough they can be shrunk by medical
treatments, removed or zapped by doctors.
 The outcome of cancer treatment depends on
many factors such as type of cancer, its
location, and speed of diagnosis. With the
help of medical research and development,
cancer treatments are seeking to better
manage symptoms and prolong life

BSN-2B TRANSCRIBED BY: GROUP # 91