At 6 years old: deciduous teeth will start to fall

Pedia off → lower central incisor will be the first to fall

off
Below 6 months or 1 year old (when the first
Growth and Development tooth erupts): First dental check up
Growth Development
Principles of Development:
● Quantitative ● Qualitative change
1. Cephalo - caudal → from head to toe
change
● Observable 2. Proximo distal → from center to side
● Measurable 3. Differentiation → simple to complex
● Increase in skill or 4. Secular → universal
● Increase in size ability 5. Sequential → has pattern/predictable

Psychological Development:
WEIGHT ● Sigmund Freud: Psychosexual/
At birth: 6 to 9 lbs psychoanalytic theory
On the first of life: wt. decreases ½ to 1 lb ● Erik Erikson: Psychosocial
Failure to thrive (FTT): progressive decrease in ● Jean Piaget: Cognitive development
weight (underweight/ malnourished infant) ● Kohlberg: Moral development
At 6 mos: the weight will double (2x)
At one year: the weight will triple (3x) FREUD’S PSYCHOSEXUAL/ PSYCHOANALYTIC
At 2 ½ y.o.: the weight will quadruple (4x) THEORY
Purpose: Satisfy libido (pleasure)
HEIGHT [OAPhaLaGe]
At 4 years old: the height will be doubled (2x)
which is the normal height of the child Age Zone Freud
At 13 y.o.: the height will triple (3x)
Infant 0 - 1 y.o. Mouth Oral stage
HEAD CIRCUMFERENCE: Toddler 1 - 3 y.o. Anus Anal stage
Is much bigger in infants (33-35 cm)
Small head circumference: microcephaly Preschool 3 - 5 y.o. Genitalia Phallic stage
Large head circumference: hydrocephalus
School-age 6 - 12 y.o Dormant Latent stage
CHEST CIRCUMFERENCE:
2 cm below the head circumference; Adolescent 13 - 19 y.o. Genitalia Genital stage
measured on the nipple line (31 - 33 cm)
Oral stage
ABDOMINAL CIRCUMFERENCE Zone: mouth
31 to 33 cm If not satisfied/deprived, it will lead to oral
fixation (smoking, gum-chewing, nail biting)
Growth chart:
Normal percentile: 5 to 95 percentile N/I:
● Breastfeeding
DENTITION: Teeth development ● Bottle feeding
Natal teeth – teeth that is present at birth; ● Pacifier
should be removed
Anal stage
Epstein pearls – are small, harmless cysts that Zone: Anus
form in a newborn’s mouth during the early ➢ Control: holding on
weeks and months of development; will ➢ Balance: letting go
disappear after a while. ➢ Toilet training
Candidiasis oral thrush – suspected of HIV If not satisfied, child will hold on too much; it
will also lead to anal fixation (orderliness,
At 6 mos: the first tooth will erupt → lower obsessiveness, rigidity)
central incisors (milk teeth)
At 3 years old: 20 milk teeth → deciduous Readiness of toilet training (18 to 24 mos):
teeth. Can brush his teeth on his own 1. Physiological readiness
- Myelinization of the spinal cord
- Child can stay dry for 2 hrs
 - Child can SSW (sit, squat, and walk) Sex education should start at 10 years old
2. Psychological readiness
- Verbal cues (Mama, pupu/wiwi)/ Female Male
nonverbal cues (removing his diaper)
● Increase in height ● Increase in weight (first
Guidelines of toilet training ● Increase in pelvic sign of puberty)
1. Introduction of potty chair - supervise the diameter ● Testicular development
child ● Thelarche (breast (caused by
2. Dress in easily removed clothing (e.g. enlargement) testosterone)
garterized shorts) ● Pubic hair ● Hairy
● Menarche (First ● Voice changes
3. Remind child every 2 hours
menstruation) – first ● Penis size increase
sign of puberty ● Height
Factors that delay toilet training
● Stress: Regression is normal and temporary
○ Hospital or new environment ERIKSON’S PSYCHOLOGICAL THEORY
○ Sibling Rivalry Continuous development
Developmental Virtue
Bowel training is learned first than bladder Tasks
training
Infant Trust vs Mistrust Hope
Daytime control is learned first than Nighttime
control Toddler Autonomy vs Will
Shame/Doubt
Enuresis
Pre-schooler Initiative vs Guilt Purpose
Intervention:
● Limit fluid at night School age Industry vs Competence
● Urinate before sleeping Inferiority
● Wake child up in the middle of the night
Adolescent Identity vs Role Fidelity
Phallic stage confusion
Zone: genitalia
Sexual identity is known Young adult Intimacy vs Love
(20-35 y.o.) Isolation
Boy: masturbation
Girls: Penis Envy Middle adult Generativity vs Care
Oedipus complex Electra Complex (35 - 55 y.o.) Stagnation

Son loves Mother, hates Daughter loves Old adult Integrity vs Wisdom
Father Father, hates Mother (55 y.o. Despair
above)
Father should show love Daughter should
to help son overcome identify with the
the oedipus complex. mother to overcome
this stage
Son still loves the mother
but identifies father
Infant: “Dependent”
■ Trust vs mistrust
■ Satisfy the infant’s gratification immediately
Latent stage:
(e.g. feed when hungry, change wet
School age: Socialization
diapers)
Homosexual stage
■ Do not discipline the infant since he/she has
- Boys play together
no superego yet.
- Girls play together
Toddler:
Genital stage:
■ Autonomy vs Shame/Doubt
Adolescent
■ Decision making
Secondary sex character
■ Characteristics:
Puberty
1. Negativism
○ Girls: 10 - 12 years
➢ persistent “no” for an answer (not a sign
○ Boys: 12 -14 years
of disrespect but a sign of autonomy)
 ➢ N/I: ■ Immature CNS
a. Do not ask a yes/no question ■ Reflex will disappear 4 to 6 months except
b. Offer choices some of the reflexes:
c. Play games and challenge child ○ Plantar grasp reflex (10-11 mos)
2. Temper Tantrums ○ Babinski reflex (when the child begins to
➢ Is a form of manipulation walk)
➢ Expression of frustration ○ Tonic neck reflex (boxing/fencing)
➢ N/I : ○ Palmar Grasp Reflex (10 - 11 mos)
a. Ignore tantrums ○ Plantar Grasp reflex
b. Praise the child when not having ○ Rooting reflex
tantrums (positive reinforcement) ○ Sucking reflex
c. Time - out → discipline technique in ○ Moro Reflex: stimulus - motion (Startle:
which you place a child in a very stimulus - loud sound)
boring place for several minutes (as
long as his age, e.g. 2 y.o. → 2 Object Permanence (8 to 10 months)
minutes) ■ Things exist even when out of view
3. Ritualism ■ Infants start to develop separation
➢ Sense of control anxiety at 8 - 10 mos → leave a personal
object. It peaks at the age of toddlers.
Pre-school and School-age: ■ 3 stages of separation anxiety:
1. Protest
Pre-school School-age 2. Despair
3. detachment
Initiative vs Guilt Industry vs Inferiority

Learning how to do Learning how to do

things things well:
● Mastery
● Perfection

Adolescent:
Identity vs Role Confusion
Identity → Who am I? What am I going to be?
● Peers are most important
● Body Image
● Parents → Enemy
2. Pre - operational stage (2 - 7 y.o.)
Characteristics: [MAE]
Young Adult (20 -35 y.o.)
● Magical thinking
Intimacy vs Isolation
○ Animism: talk to inanimate object as if
Intimacy → long - term relationship
it is alive
○ Imaginary friend: you should increase
Middle Adult (35 - 55 y.o.)
social interaction of the child
Generativity vs Stagnation
● Assimilation – inability to adjust to new
Generativity → Know how to share
situations.
Stagnation → Self absorb
● Egocentrism – close minded
Old Adult (55 y.o. above)
3. Concrete Operational (7 - 12 y.o.)
Integrity vs Despair
● Decentering (open minded)
Integrity → you are the source of wisdom
● Accommodation → adjust in new
situations
JEAN PIAGET: COGNITIVE DEVELOPMENT
● Class Inclusion → group objects with
4 Stages of Cognitive Development
similar properties; children become
1. Sensorimotor stage (0-2 y.o.)
collectors
● not thinking and no memory
● Conservation → a change in shape does
not necessarily mean a change in size
Reflexive Activity
■ Present at birth
4. Formal Operational (12 y.o. above)
■ Involuntary (controlled by the spinal cord)
● Mature Abstract Thinking

DDST: Denver Developmental Screening Test
● tool to determine if the child is improving
(6 y.o. below)
Four areas to check
1. Gross motor: control muscles of the body for
large movements
If infant has head lag for more than 6mos, it
must be reported since it might be due to
cerebral palsy or autism
1 month: side to side
2 months: lift head
3 months: lift head and chest
4 months: turn front to back
5 months: turn back to front (roll-over)
Don’t leave infant alone in bed since he/she is
at risk for falls
6 months: sit with support
7 months: sit without support
8 months: crawling (use upper body to move)
9 months: creeping (use knees and hands to
move)
10 months: stand with support
11 months: cruising (walking while holding onto
objects)
12 months: WWHOH (Walk While Holding One’s
Hand)
15 months: walk alone (if the baby can now
walk, give push and pull toy)
2. Fine motor: control small muscle to perform
a specific movement
At 5 months: grasp object voluntarily
At 7 months: transfer object from one hand to
another
At 9 months: Pincer Grasp → child can now
pick up small objects (high risk for aspiration)
3. Language
1 month: Cry
2 months: Social smile
3 months: Cooing
4 months: Babbling
5 - 6 months: Simple vowel sounds
9 months: first word (mama/dada)
10 months: two words (dada+mama)
12 months: 4 words (dada+mama+two other
words)
Vocabulary
2 y.o.: 50 words → can create 2-word
sentence (dada go, mama come)
3 y.o.: 900 words → 3 word sentence (mama
go out, yaya come here)
4 y.o.: 1500 words
5 y.o.: 2100 words
Preschool asks an average of 300 questions a
day
4. Personal - social
Play - considered as the work of children
Infant: solitary play (any play that stimulates
their senses; e.g. mobiles with alternating color
placed near their face; risk of aspiration and
choking so there should be no detachable
parts and sharp edges)
Toddler: Parallel play (Two children side by side
each other but do not play together; provide
same type of toys for the two to avoid fighting
because they are egocentric)
Preschool: Associative play (children learn to
share)
School age: Competitive play
Hydrocephalus - increased CSF
Two (2) Kinds of Hydrocephalus:
Communicating/ Non- Non Communicating/
obstructive Obstructive
CSF has good flow but There’s
no absorption in the tumor/inflammation that
(arachnoid villi) blocks the flow; easier to
subarachnoid space treat (remove the tumor/
give steroids)
CSF flow: lateral ventricle (choroid plexus)
responsible for CSF production → 3rd ventricle
→ Aqueduct of Sylvius → 4th ventricle →
subarachnoid space (part of meninges; area
responsible for CSF absorption)
S/sx:
Macewen’s Sign: crackpot sound on
percussion of the skull (because the sutures on
the skull are separated)
Sunset eyes (eyeballs rotate downward)
Increased ICP
Bulging fontanelle
Dilated scalp veins
Management:
Communicating/ Non-obstructive:
■ Shunt procedure → Divert the flow of the
CSF
○ 2 types of shunt:
➢ VP shunt (ventriculoperitoneal shunt)
- peritoneum; most common type
 ➢ VA shunt (ventriculoatrial shunt) -
right atrium
Pre - op: To reduce ICP to stabilize the child
● Mannitol (osmitrol) - reduces cerebral
edema
● Acetazolamide (Diamox) - reduces CSF
production
Post-op:
● Flat on bed (first 24 hours - lie on
unaffected side)
● Upright position (gradually; after 24 hours)
● CIC (Clean Intermittent Catheterization) -
a pedia 10 yrs of age can do it on his/her
own
KOHLBERG: MORAL DEVELOPMENT
1. Pre-conventional (2-7 y.o.)
Level 1: Punishment-obedience orientation
➢ Right: reward
➢ Wrong: punishment
Level 2: Individualism → self

Complications: 2. Conventional (7-12 y.o.):

➢ Bleeding Level 3: Good boy/nice girl orientation
➢ Infection (perception of right action depends on
➢ CSF leakage - clear fluid behind the ear; others/parents/elderlies)
(+) halo sign Level 4: Fixed rules/regulations

Discharge: 3. Post - conventional (12 y.o.):

○ No contact sports Level 5: Majority wins → respect the
○ s/sx of shunt failure (return of increased decision of others
ICP, anorexia) Level 6: Conscience → self < others
NTD: Neural Tube Defect
● CNS malformation NEUROLOGIC DISORDERS
○ Brain is not formed Normal ICP: 0-15 mmHg
○ Spinal cord is not formed Increased ICP
Risk factors: Insufficient folic acid Cushing’s triad: Hypertension, bradycardia,
bradypnea; widened pulse pressure (> 40)
Brain malformation Spinal cord malformation
Early S/sx:
Anencephaly (no Spina Bifida: ■ Infant: High pitched crying
cerebrum) → infant will a. Occulta - mildest (skin
die depression – dimpling ■ Child: Irritability & agitation
Nx diagnosis: Anticipate of the skin) ■ Adult: Restlessness
grieving b. Cystica - sac (needs ■ Geria: Confusion
to be operated)
Exancephaly (brain
formed outside the skull) S/sx:
Young children
1. Bulging fontanels: aggravated by crying
Pre-op for Cystica: Protect the sac
(should be prevented)
● Position: Prone
○ Anterior: diamond shaped; closes at 12
● Don’t turn the child from side to side
● Don’t close the diaper, leave it open - 18 months
● Moisten with NSS ○ Posterior: triangular shaped; closes at 2-
3 months
Post-op 2. High-pitched cry (early sign)
● Position: prone 3. Increased head circumference (use tape
● You can turn the child from side to side measure)
● You can close the diaper 4. Irritability and restlessness
● Check for latex allergy (allergic to tropical
fruits)
Older Children
● Non latex gloves (nitrile gloves)
● Assess extent of paralysis (for 1. Headache (initial sign)
myelomeningocele) → needle prick test 2. Projectile vomiting: compression of medulla
→ CTZ (chemoreceptor trigger zone: vomiting
Discharge center) → cerebral edema
● Enema 3. Declining school performance
4. Inability to follow simple commands Seizure Disorder/Epilepsy
5. Diplopia (double vision): Inc ICP → inc IOP Contract → relax → spasms
→ optic nerve damage → blurring of vision →
blindness GRAND MAL SEIZURE
6. Anorexia, nausea, weight loss ● Generalized; head to toe
7. Seizures ● Tonic (mild) - clonic (severe) → dyspnea,
8. Pupillary changes: PERRLA (Pupil Equally saliva, and urine.
Round and Reactive to Light and ○ Position during seizure: FOB/Supine
Accommodation) ● Post-ictal phase → exhaustion
○ Anisocoria: uneven pupils (brain ○ Position after seizure: Side lying/
damage) recovery
○ Dilated pupils (shock)
○ Constricted (narcotic damage) PETITE MAL
○ Sunset eyes: eyes driven downward ● Absent seizure
bilaterally ● Blank facial expression, automatisms
(repeated), lip smacking
Late manifestations
1. Decreased LOC (lethargy to coma) JACKSONIAN SEIZURE
2. Abnormal sensation to pain stimuli ● Tonic clonic of group of muscles that
3. Anisocoria proceeds to grandmal
4. Decerebrate – midbrain dysfunction PSYCHOMOTOR SEIZURE
5. Decorticate – cerebral cortex dysfunction ● Mental clouding intoxication
6. Papilledema
7. Cheyne-Stokes respiration
FEBRILE SEIZURE
● Due to convulsions
Management for Increased ICP
● Under 5 seizure (38.5 - 39c)
❖ Position: Semi Fowlers (↓ICP = gravity)
❖ Coughing and sneezing is avoided STATUS EPILEPTICUS
❖ Limit fluid intake 1,200 – 1,500 ml ● Emergency: Brain damage could occur
● Last for 30 minutes
Pharmacotherapy
Diuretics: K wasting (monitor K levels) Pharmacotherapy
■ Mannitol – osmotic diuretic ■ Hydantoins
○ generalized effect ➢ e.g. phenytoin, mephenytoin, ethotoin
■ Lasix – loop diuretic
➢ WOF: gingival hyperplasia (soft bristled
○ localized effect
toothbrush/ meticulous oral care), pinkish
■ Decadron (dexamethasone)
red urine (normal: inform SO)
○ anti inflammatory → cerebral edema
■ Anticonvulsants – valium, dilantin, ■ Benzodiazepines
carbamazepine
➢ e.g. diazepam, lorazepam
○ Minimize seizure episodes
■ Antacids
○ Mg: diarrhea (Mg tae)
○ Al: constipation (Ala tae) ■ Iminostilbenes
○ ↑ ICP → stressed body → ↑HCl; Decadron ➢ e.g. carbamazepine – for refractory
s/e → GI irritation → thin mucus lining seizures
■ Anticoagulants
○ Heparin: IV/Sub Q → ptt (partial ■ Valproates (last resort)
thromboplastin time) ➢ e.g. valproic acid – hepatotoxic and can
○ Warfarin: Oral → pt (prothrombin time) cause neural tube defects → never given
REMEMBER: Opiates and sedatives are in pregnancy
contraindicated in increased ICP
Surgery: Neurectomy → surgical resection of ➢ < 3 y/o: rear facing
the cranial nerve involved in the seizure ➢ > 3 y/o: forward facing booster seat
❖ Assess for cerebral functioning: GCS/
Bacterial Meningitis PERRLA (LOC is the most important
● Infection of the meninges (Meninges
prognostic indicator)
support and nourishes the brain)
❖ Assess for cervical injury
● Bacterial: Permanent effects; Viral:
➢ (+): immobilize
temporary effects
➢ (-): HOBE 30 degrees → ↓ ICP = gravity
S/sx:
CARDIOVASCULAR DISORDERS
Pathognomonic sign: Kernig’s sign & Brudzinski
Layers of the heart:
sign
● Endocardium: inner layer
■ Kernig’s sign: K(nee) Flex then Extend =
● Myocardium: muscle → contraction →
pain in the hamstring (+)
cardiac output
■ Brudzinski sign: B(atok)/ Nape flexion =
● Pericardium: outer layer
pain in neck & back (+); elicit hip and knee
○ Visceral: inner pericardium
flexion
■ Pericardial space: pericardial fluid
■ Nuchal rigidity
(prevents friction rub)
■ Seizures
○ Parietal: outer pericardium
■ Opistotonus: arching of the back
○ Position: side lying
Chambers of the heart
● Right Atrium
Diagnostics: Lumbar puncture (L3, L4, & L5)
● Right Ventricle
Position: C-shape, fetal, knee chest
(genupectoral) ● Left Atrium
CSF analysis: ● Left Ventricle
Normal: Clear CSF One way → Normal
a. Cloudy Two way → Regurgitation (↓valvular problems)
b. Elevated WBC
c. Elevated protein/ CHON (↑ byproduct of Acyanotic: absence of cyanosis (1 problem)
Cyanotic: presence of cyanosis (2 or more
bacteria)
problems)
Presence of causative agent: Neisseria
Meningitides

Management:
Patent Ductus Arteriosus (Acyanotic)
❖ Antibiotics: finish the duration to prevent
S/sx:
resistance
Pathognomonic sign: Machine-like murmur
■ Signs of Heart failure
■ Poor feeding
■ Fatigue
■ Poor weight gain
Head Trauma
■ Irritability: due to cerebral hypoxia
Two types:
1. Concussion: jarring of the brain, sudden
forceful contact in a frigid skull (loss of Management:
❖ DOC: Indomethacin → facilitates closure
consciousness)
of PDA
2. Contusion: bruising, a structural
alteration characterized by
Septal defects
extravasation of blood cells
● Atrial Septal Defect (ASD)
● Ventricular Septal Defect (VSD)
Management:
❖ Safety: bike helmet, seat belts, safe driving,
S/sx:
infant car seat
 ■ Failure to thrive (delayed milestones) 1. Primary problem: Pulmonary stenosis
■ Fatigue → poor feeding 2. Allows mixing of blood: Overriding of the
■ Dyspnea on exertion aorta → anatomical defect
■ S/sx of heart failure 3. Compensatory mechanism: Right
ventricular hypertrophy → Cause: right
Management: ventricle is overworked
❖ Surgery by suture/patch: Dacron patch 4. Keeps patient alive: VSD → relieves
➢ Tissue: ↓rejection rate (↓ risk of infection) pressure in the right ventricle
➢ Plastic: ↑ rejection rate (last resort)
S/sx:
Transposition of the great arteries ■ Cyanosis (blue babies): deoxygenated
(TOGA/TGA/TGV) (Cyanotic) blood > oxygenated (ineffective tissue
Mechanism: perfusion)
● Right Ventricle → aorta ■ Squatting: Allow child to squat
● Left Ventricle → pulmonary artery ○ ↓venous return → ↓cardiac workload
PDA: keeps patient alive; allows mixing of ○ Conserves oxygen in the upper body
blood ■ Tet spells – irritability, pallor, blackouts,
convulsions (Pathognomonic)
S/sx: ■ Cardiomegaly
■ Severe respiratory depression and ■ Clubbing: spoon shaped fingernails
cyanosis (chronic hypoxia)
■ Failure to thrive ■ Pansystolic murmur
■ Fatigue → poor feeding
■ No murmur Diagnostics: 2D-echo → boot-shaped heart
Nursing Care:
Management: ● Allow child to squat to decrease venous
❖ Prostaglandin E: maintains PDA/ keeps return to the heart
PDA open
❖ Surgery: Arterial Switch (done during the Medical Management:
first week of life) Palliative Surgery (relieve s/sx)
❖ Blalock Taussig Shunt (to ↑ oxygenated
Coarctation of Aorta blood) → anastomosis of the pulmonary
● Narrowing of aorta (descending); ↑ artery and aorta (subclavian artery)
pressure; ↓ output Best time: depends on patient’s status

UE LE Curative Surgery (resolves the problem/ cures

condition)
❖ Intracardiac/ Brock’s procedure
Blood Pressure Increase Decrease
➢ Balloon Angioplasty → P.S. & R.V.H
Pulse Bounding Weak/ absent ➢ Dacron patch → V.S.D & O.A.

S/sx: Rheumatic Heart Fever

■ Systolic murmur – anterior chest and
scapula
■ Rib notching (older child)
Management:
❖ Surgery: Balloon angioplasty with coronary
stenting → scaffolding → support (mesh)
Tetralogy of Fallot (Cyanotic)
Four (4) characteristics:
Cause: Autoimmune
Precipitating factors: Group A Beta Hemolytic
Streptococci (GABHS)
Sore throat → untreated, bacteria will migrate
to the blood vessels → heart → immune system
will send antibodies → cause inflammation of
heart (carditis)
Aerophilic - bacteria active in the presence of
oxygen
JONES CRITERIA
 2 Major + history
■ Hepatomegaly (portal ■ Cough
1 Major + 2 minor + history HPN)
○ Esophageal varices
Major symptoms: [may CarE ka pa ba sa PoSu ○ Ascites
ni St. vitus] ○ Hemorrhoid
Carditis ■ Body weakness,
anorexia, nausea
Erythema (redness) Marginatum (trunk)
Polyarthritis (migratory) Tachycardia is manifested in both HF
Subcutaneous Nodules (knees, elbow,
knuckles) Diagnostics
St. vitus dance (Sydenham’s Chorea): worm- 1. CXR: CARDIOMEGALY
like movements
2. 2D Echo: HYPOKINETIC HEART (late stages)
3. Pulse Oximetry: DEC O2 SATURATION
Minor symptoms: [FARE]
Fever (low grade) 4. Pulmonary Capillary Wedge Pressure (PCWP:
Arthralgia: without swelling (painful joints) 4 - 12 mmHg) → LSHF
Raised C-reactive protein & ESR (Erythrocyte 5. Central Venous Pressure (CVP: 8 - 12 mmHg)
Sedimentation Rate → marker of → RSHF
inflammation; 0 - 20 mm/hr)
ECG changes (prolonged PR interval)

Diagnostic test for minor symptom

Management:
ASO titer (Antistreptolysin O-Titer) - test to
check the antibodies. If results are positive ❖ Fowlers: maximize lung expansion → ↑
then the patient had previous GABHS oxygenation
infection. ❖ Administer high O2 (venturi): precise &
accurate
Management: ❖ Inotropic drugs (Dopamine): strengthen
❖ DOC: Penicillin (broad spectrum) → 5-10 heart contraction → ↑ CO
days (ave. of 7 days) ❖ Lanoxin/ digoxin
➢ If with allergy → Erythromycin/ ❖ UO and intake monitoring: same time,
Clindamycin clothes, weighing scale, patient
➢ Exacerbation and remission: treatment ❖ Record daily weight
continued up to 10 years ❖ Administer diuretics and digoxin
❖ Salicylates (ASA): pain and swelling
➢ 4s of ASA Digoxin Toxicity [NAVDA]
■ Antiplatelet Nausea
■ Antipyretic Anorexia
■ Analgesic Visual disturbances/ Vomiting
■ Anti inflammatory Diarrhea
❖ Corticosteroids (Prednisone): relieves Abdomen cramps
carditis (DOC for inflammation)
Heart failure: ↓cardiac output → ↓ tissue Give digibind/ digoxin-immune fab: antidote
perfusion for digoxin toxicity
● RSHF: Systemic
Kawasaki Disease
● LSHF: Pulmonary
● Mucocutaneous lymph node syndrome
Remember: Concept of backflow (↓ immune response)
● Multisystemic Vasculitis (cardiovascular
RSHF LSHF system)
Cause: Idiopathic
■ Peripheral/ pitting/ ■ Dyspnea on ● More common in male, children before 5
dependent edema exertion y.o.
■ Weight gain ■ Orthopnea (DOB ● Affects the connective tissues causing
■ Distended neck vein when lying down) vasculitis (inflammation of small and
(JVD) ■ Crackles/ rales
medium sized blood vessels)
 Problem:
S/sx ★ Difficulty feeding
■ Fever is high for 5 days and unresponsive to ★ Risk for aspiration
antipyretic ★ Risk for infection (URTI)
■ Photophobia (photosensitivity): dark
colored glasses, large brim hat, sun visors
■ Other symptoms: [SIR RED] Surgery
Strawberry tongue: Pathognomonic ● CL: Cheiloplasty → surgery of the lip
Inflamed joints (arthritis) ○ Rule of 10
Red eyes (conjunctivitis) ■ Child should be 10 weeks
■ Weigh 10 lbs
Rashes (Polymorphous rashes) ■ 10g/dl of hemoglobin
Enlarged lymph nodes ■ 10k WBC
Palmar Desquamation ● CP: Palatoplasty → surgery to reconstruct
palate.
○ Child should be 18 - 24 months old
(before 2 y/o)
Diagnostic Tests: ■ Not too early: re-open
1. Elevated ESR: >40 mm/hr because of ■ Not too late: speech problems
massive inflammation Cheiloplasty is done first because it is easier
2. Platelet: In subacute stage, platelet will
increase, leading to thrombocytosis Pre-op:
1. Feeding: [ESSR]
Management: Self-limiting ○ Enlarge nipple
❖ Drug of choice: Gamma Globulin → IVIG ○ Stimulate the suck reflex
(stop immune response to reduce ○ Swallow
inflammation) ○ Rest
➢ N/R: delay immunization
❖ Aspirin as ordered → Antipyretic/ Post - op: Protect the suture line
antiplatelet/ anti - inflammatory 1. Position:
❖ Abxicimab → only platelet inhibitor ○ CL: Unaffected side
designed for patients with Kawasaki ○ CP: Prone
Disease 2. Logan’s Bar (keep suture line intact)
➢ Complications: It can cause MI 3. Elbow restraint
(symptoms: severe abdominal pain), 4. Avoid something hard that enters the
and aneurysm mouth (e.g. crackers, use of spoon, fork)
❖ Clear liquid diet (opacity to light)
❖ CPR (patient is prone to coronary artery Gastroesophageal reflux disease (GERD)/
disease) chalasia
● Incompetent LES/ cardiac sphincter
GI DISORDERS
Cleft Lip Cleft Palate S/sx:
■ Forceful vomiting
Male (Lalake) Female (Pempem) ■ Heartburn (chest pain) → HCl acid reflux
● Large nipple: ● Speech problem ■ Bitter taste in mouth
easier to suction ● Cup and Medicine
dropper (rubber tip): ■ Dysphagia: difficulty of swallowing
precise fluid flow ■ Odynophagia: painful swallowing
■ Hoarseness: laryngeal affectation
Risk factors: Diagnostic:
● Genetic/ hereditary Barium swallow (2 days) → excretion of the
● Maternal smoking: CO2 bind to Hgb = barium (↑OFI & laxatives as ordered)
Carboxyhgb
● Medications (Category X) Management
○ Thalidomide ❖ Low fat, high fiber (fat is hard to digest, fiber
○ Nifedipine ↑ digestion)
○ Valproic Acid
❖ SFF
❖ AVOID: spicy foods, tobacco, caffeine, 1. Bowel biopsy (confirmatory): flat mucosal
alcohol (GI irritants) surface with HYPERPLASTIC VILLOUS
❖ H2 blockers, antacids, PPI ATROPHY
❖ HOB elevated 6-8 inches during sleeping Other Diagnostic: IgG and IgA levels
(to prevent regurgitation) increased

Management
Pyloric Stenosis ❖ Avoid: BROW
● Narrowing of pyloric sphincter → no gastric ➢ Barley
emptying → stomach becomes olive- ➢ Rye
shaped mass
➢ Oat
● food is blocked from entering the small
intestine ➢ Wheat
❖ Allow:
S/sx: ➢ Meat
■ Regurgitation ➢ Egg
■ Projectile vomiting (immediately after
➢ Milk products
feeding: blood tinged, gastric contents, no
bile ➢ All fruits & vegetables
■ No anorexia, with good appetite but with
vomiting Hirschsprung's Disease
■ Weight loss ● Aka: CONGENITAL AGANGLIONIC
■ Upper abdominal distention: (olive- MEGACOLON
shaped mass) ● Cause: absence of ganglions
■ Peristaltic waves (from left to right side) ● Problem among newborns: No passage of
■ Malnutrition and DHN
meconium for the first 24 - 48 hrs
■ Metabolic alkalosis
● Insufficient ganglion (group of nerve cells
Management: which are important for peristalsis) thus
❖ Monitor feeding pattern feces are unable to move to the rectum
❖ Assess vomitus (without bile) resulting to megacolon
❖ Increase OFI
❖ Prevent aspiration → feed slowly S/sx:
■ Abdominal distention
❖ Burp frequently
■ Vomitus → bile-stained
❖ High fowler’s position ■ (-) Meconium stool (24 - 48 hrs)
❖ Pyloromyotomy - incision that splits the ■ Ribbon-like stool
obstruction
Diagnostic
Celiac Disease (irreversible) 1. Barium Enema (Lower GI): megacolon.
● Aka: CELIAC SPRUE/ GLUTEN-SENSITIVE Barium swallow (Upper GI)
ENTEROPATHY 2. Rectal biopsy (confirmatory): absence of
● Cause: MALABSORPTION OF GLUTEN ganglion cells

S/sx: Nursing Care:

■ Acute diarrhea 1. Colostomy care
■ Steatorrhea – FFF (foul fatty feces) 2. Assess characteristics of stoma
■ Anorexia a. Color: pinkish, if bluish (notify)
■ Vomiting b. Moist: yes, if dry → dehydrated (notify)
■ Severe abdominal distention (gas c. Elevated: slightly, if concaved/
formation) depressed (notify)
■ Body wasting 3. Avoid gas forming foods that can obstruct
■ Retarded growth the stoma
■ Failure to thrive 4. Foods - SPYB
a. Spinach
Definitive Diagnostic:
 b. Parsley
c. Yogurt RESPIRATORY DISORDERS
d. Broccoli Croup
5. Can the client swim? Yes, it stimulates the ● Narrowing of airway due to viral
abdomen inflammation

Ascending → Transverse → Descending S/sx:

Ascending: Liquid without odor, continuous ■ Pathognomonic: Barking seal-like cough
appliance of bag ■ Inspiratory stridor: passage of air in a
Transverse: Mushy, slight odor narrowed airway
Descending: Solid with odor, irrigation, ■ Dyspnea
continuous appliance of bag ■ Cyanosis
Habang lumalapit sa pwet BUMABAHO/ ■ No fever/ low grade fever
TUMITIGAS ■ Drooling, grunting, nasal flaring → NEEDS
RESUSCITATION
Medical Management:
❖ Surgery: Swenson Pullthrough Procedure Management:
with temporary colostomy (end to end ❖ Increase humidity in the room (cool mist)
anastomosis)
❖ Inhale cool night air/ warm bathroom air
❖ Stool softeners as ordered (bronchodilation)
❖ Tracheostomy set on the bedside
Intussusception
● Telescoping of the colon
Medical Management:
● Sausage-shaped mass (Pathognomonic)
Cause: Idiopathic, hyperperistalsis ❖ Antiviral: “vir”
❖ Antibiotics: prophylaxis
S/sx: ❖ Bronchodilators → S/E: tachycardia
○ Severe colicky intermittent abdominal pain
(gas formed pain) Cystic Fibrosis
○ Biles stained fecal emesis ● Blockage of exocrine glands (mucus)
○ Currant-jelly stool (bloody mucoid stool) ● Organs affected: pancreas, intestines,
lungs, sweat glands
Diagnostic:
1. Barium enema: diagnostic and therapeutic S/sx:
2. Guaiac’s test/ Occult blood test ■ Pancreatitis
a. Dark colored foods: false (+) result
■ Meconium ileus
b. Vitamin C rich foods: false (-) result
Hydrogen peroxide: blue ring (+) bleeding ■ DOB/ dyspnea
3. Corrected intussusception: passing out of ■ ↑ salty sweat
normal brown stool (notify MD to cancel
surgery) Diagnostic:
1. Sweat Chloride test: ↑ chloride levels in the
Management: sweat
❖ Auscultate bowel sounds
❖ Assess abdominal distention (gas
formation)
Management:
❖ NGT insertion – function:
❖ Chest Physiotherapy: before meals/ empty
➢ Feeding
stomach/ 2 hours after meals
➢ Irrigation
➢ Percussion
➢ Decompression for abdominal
➢ Vibration
distention
➢ Postural drainage (gravity)
➢ Medication
❖ Increase OFI Medical Management:
❖ Swenson Pullthrough
❖ Pancreatic enzymes: with meals; never
double the dosage

Asthma (reversible)
● Cause: allergens → substances that cause
allergic reactions
● Hyperresponsiveness → bronchospasms

Common allergens:
➢ Pollen, molds, dust, weeds, pet danders,
eggs, seafood

Exacerbation
➢ Air pollutants, cold heat weather changes,
strong odors, exertion exercise, laughing,
GERD, sinusitis

S/sx: WhEEzes (expiratory)

During asthmatic attack: sudden absence of
wheezing → complete obstruction of airway
(Status Asthmaticus)

Management:
❖ Bronchodilator
❖ Corticosteroids
❖ O2 Therapy
❖ Avoid allergens

Tracheoesophageal Fistula/ Atresia

● Fistula: Abnormal Connection
● Atresia: Abnormal closure

3 Cs:
❖ Coughing
❖ Choking
❖ Cyanosis
There’s also drooling of saliva
Prepare NPO for surgery