COURSE OUTLINE: ■ The more it grows, the more

1. Neurologic Disorders increased the ICP

a. Increased Intracranial Pressure ● Headache: Initial Sign [Pinakaunang symptom]
b. Seizure Disorder / Epilepsy ● Projectile Vomiting = Forceful vomiting
c. Bacterial Meningitis ○ Due to the compression in the medulla →
d. Head Trauma CTZ [Chemoreceptor trigger zone /
2. Cardiovascular Disorders
vomiting center of the body] is trigger
a. Layers of the Heart
b. Chambers of the Heart ○ Structural changes in the brain →
c. Acyanotic Cerebral edema
i. Patent Ductus Arteriosus ● Diplopia → Double vision
ii. Atrial & Ventricular Septal ○ Increased ICP = Increased IOP → Optic
Defect Nerve Damage → Papilledema [Blurring
iii. Coarctation of Aorta of vision] → Blindness
d. Cyanotic
○ If extensive damage → Might be
i. Tetralogy of Fallot
ii. Transposition of the Great permanent
Vessels ● Pupillary Changes [DANGER SIGNS]
e. Rheumatic Heart Fever ○ Anisocoria = Uneven Pupils → Brain
f. Heart Failure Damage
g. Kawasaki Disease ○ Dilated Pupils = Representation of shock
3. Gastrointestinal Disorders ○ Constricted [Pinpoint] Pupil = Narcotic
a. Cleft Lip & Cleft Palate
Overdose
b. GERD
c. Pyloric Stenosis ● Sunset Eyes → parang paglubog ng araw
d. Celiac Disease ● Anorexia, Nausea, Weight Loss
e. Hirschsprung Disease ● Seizured
f. Intussusception ○ Increased neuronal impulses → Nerve
4. Respiratory Disorders irritation → Erratic transmission of
a. Croup
electrical impulses → Seizures
b. Cystic Fibrosis
c. Asthma ○ Vomiting → Decreased fluid levels →
5. Growth & Development Theories Dehydration → Increased Temperature →
hyperpyrexia → Convulsions → Seizures
REFERENCE
○ Hypothalamus is altered → Alteration in
Toprank – Archie Alvis thermoregulation → hyperpyrexia → send
abnormal electrical signals to brain that
causes seizures
NEUROLOGIC DISORDERS
INCREASED INTRACRANIAL PRESSURE MANAGEMENT
● Increased ICP = Normal → 5-15mmHg ● Position: Semi-fowler's → To decrease ICP by
● Cushing Triads → Hypertension, Bradycardia,
gravity
Bradypnea
● Widened Pulse pressure ● Coughing & sneezing avoided d/t increased ICP
○ 120/80 = 40 ○ If the child is capable of instruction →
○ Normal is 30-40 instruct them to open mouth when
○ 180/100 = 80 coughing → to decrease ICP so the
pressure from abdomen will go to the
SIGNS & SYMPTOMS mouth, not to the head
● Bulging Fontanels : Aggravated by crying ● Limit fluid intake → 1,200 - 1,500 mL (LIMIT
○ Anterior: Diamond, Closes at 12-18 ONLY, not avoid in a child bc she will be
months dehydrated easily)
○ Posterior: Triangular, closes 2-3 Months ○ Where Na goes water follows
● High pitched Cry [Universal language of Infant →
Crying] PHARMACOTHERAPY
○ Early signs of increased ICP ● Diuretics
■ Infant = High pitched cry ○ Loop – Lasix/Furosemide
■ Child = Irritability & agitation ■ Effect is in the Loop of Henle
■ Adult = Restlessness ONLY – as a localized function
■ Geria = Confusion ■ Mild edema!
● Increased head circumference due to bulging of ○ Osmotic – Mannitol
fontanels and separating suture lines ■ Osmosis → From head to toe
○ Tape Measure → Measure the head magaatract ng water =
circumference every shift Generalized effect
■ For severe edema

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING
○ Both of these diuretics are potassium
wasting [releases potassium]
○ Minotor K levels!
○ Monitor I & O Strictly to prevent
dehydration
● Decadron [Dexamethasone]
○ Anti-inflammatory = Cerebral Edema
○ Cerebral edema → Decreased LOC →
Decrease prognosis
○ May be used as a prophylaxis
● Anticonvulsants
○ Prevents seizure episodes
○ Given low doses → Pediatric patient
○ Diazepam, Dilantin, Carbamazepine
[Seizure episodes]
○ Carbamazepine → Can be used after
seizures [Maintenance to prevent
recurrent episodes]
● Antacids
○ Decadron → Causes gastric irritation
○ Prevention of gastric irritation
○ Magnesium Base: SE – Diarrhea
■ Mg Tae
○ Aluminum Base: SE – Constipation
■ Al-ang TAE
● Anticoagulants
○ Prevents coagulation → prevents
clumping of blood
○ Clumping of blood → Embolism
○ Increased ICP → Increase Blood pressure
going inside the blood vessels →
Damages the blood vessels → Bleeding
→ Clotting → Thromboembolism
■ Brain: Stroke
■ Heart: Infarction
■ Lung: Pulmonary Embolism
○ Heparin → Given via IV or SubQ
■ Checks PTT [Partial
thromboplastin time]
■ NV:60-70 sec
○ Warfarin → Given Orally
■ Checks PT [Prothrombin time]
■ NV: 11-13sec
REMEMBER
● Opiates and sedatives are contraindicated in
Increased ICP
○ Bcos they are depressants!
○ CUSHING’S TRIAD (Hyper brady brady)
→ Will cause respiratory & cardiac
depression
SEIZURE DISORDER/EPILEPSY
● Contraction – relax → Spasms
GRAND MAL SEIZURES
● Generalized seizure → Head to Toe
1. TONIC CLONIC
○ Mild [Tonic] to Severe [Clonic]
○ Period during the seizure
○ Experiences: Dyspnea, Salivation, &
Urination
○ How will you position the child =
Supine/Flat on bed
■ HOWEVER - if in the choices
walang flat - Then answer
SIDELYING
■ IF BOTH NASA CHOICES - FLAT
ang sagot
■ *Kapag kasi DURING seizure
tapos nag side lying si pt, then at
risk siya for cervical trauma
■ If DURING seizure, less likely sila
na-aaspirate bcos nagcoconstrict
ang airway and sa mouth naiipon
ang secretions
2. POST ICTAL
○ Exhaustion
○ Period after seizure
○ Position: Side-lying/recovery
PETITE MAL / ABSENT SEIZURE
● Blank facial expression, automatism, lip smacking
JACKSONIAN SEIZURE
● Tonic clonic of a group of muscle → Progress into
grand mal seizure
● Example: First is shoulder part then Whole body
PSYCHOMOTOR SEIZURE
● Mental coding and intoxication → Hallucinations
● Common sa adult kesa sa pedia
FEBRILE SEIZURE
● Most common in pediatrics, 5 years old
● Hypothalamus is not yet well developed to
regulate temperature
● Temperature → 39º-40ºC → Convulsions
[Hyperpyrexia]
○ 38.5ºC → Borderline
STATUS EPILEPTICUS
● MOST DANGEROUS; EMERGENCY!
● Brain damage → Seizure that lasts for 30 minutes
● Paulit ulit for 30 mins
● Causes: Decrease O2 in the brain, cerebral
hypoxia → Severe brian damage
● Decreased O2 in the brain for 4-6 minutes →
Causes irreversible brain damage
● No post-ictal phase
PHARMACOTHERAPY
1. Hydantoins : Phenytoin
a. SE: Gingival Hyperplasia [Use soft
bristled toothbrush and meticulous soft
oral care]
b. Can cause pinkish red urine: Inform the
SO
2. Benzodiazepines
a. Depressant effect → Relaxes the body →
Prevents episodes
b. “Pam/Lam” drugs [Diazepam, Lorazepam]
3. Iminostilbenes
a. Carbamazepine → Refractory seizures
b. Main effect at neurotransmitters → Relax
the body
c. Opiates → Relaxes muscles → May
cause respiratory failure
4. Valproates : Valproic Acid
a. Last resort
b. Hepatotoxic → Easily destroyed because
pediatric patient’s liver is not fully
developed
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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

c. Not given in pregnancy → Causes neural ● Structural alteration characterized by

tube defects extravasation of blood cells → Severe bleeding
(kaya nagbukol)
MANAGEMENT [SURGERY] ● Both have NO open wound – if magkakaopen
● Neurectomy wound, might be Abrasion
○ Surgical resection of the cranial nerve
involved in the seizure MANAGEMENT
○ It will depend on what the cranial nerve is ● BEST: is to Prevent!
affected ● Priority: SAFETY!
○ Bike helmets
BACTERIAL MENINGITIS ○ Seat belts
● Permanent effects – Invasive ○ Safe driving
● Viral Meningitis: Self limiting [No permanent ○ Proper usage of infant car seat
effects] ● Infant car seat in Ph
● Infection of the meninges ○ <3yrs old: Rear facing
● Meninges = Supports and nourishes the brain ○ >3yrs old: Front facing booster seat
● Assess cerebral functioning
DIAGNOSTIC PROCEDURE ○ GCS
● Lumbar Puncture: CSF Analysis ○ PERRLA → Pupil Equally Round and
○ L3, L4, L5 Reactive to Light and Accommodation
○ Position: C-Shaped / Fetal Position / ○ Primary prognostic indicator – LOC!
Knee-chest [genupectoral] – Exposed ■ Habang nag dedec ang LOC ng
lumbar area infant, lalo bababa ang prognosis
● CSF Analysis ● Assess for cervical injury → Stimulate child, don’t
○ Normal Color: Clear allow to sleep
■ Cloudy w/ bacterial meningitis = ○ (+) Immobilize – If applying Splint, apply it
Infection = Elevated WBC and in the position in which it is found (wag mo
protein contents = Due to the na galawin)
byproduct of the bacteria [waste ■ Move px as a unit!
product] ○ (-) HOBE (Head of Bed Elevated) – 30
■ The higher protein in the CSF = deg (Dec ICP = Gravity)
Higher bacterial level
■ Neisseria Meningitides → Main
Causative Agent CARDIOVASCULAR DISORDERS
LAYERS OF THE HEART
SIGNS & SYMPTOMS ENDOCARDIUm
● 2 distinguishing/Hallmark signs: ● Innermost
○ Kernigs : K → Knee → Flex → Pain
MYOCARDIUM
hamstring, back and neck [+]
● Muscle layer → responsible for
■ Hamstring → Muscle at the back
contraction/pumping mechanism → Cardiac
portion of the thigh
Output (Amount of blood ejected from the heart
○ Brudzinski: B → Batok/Nape → Flex →
per contraction)
Pain neck and back
● Play important role in heart contraction
● Nuchal Rigidity = Stiff Neck
○ Damage to this will affect contraction →
● Seizures → cause errac transmission of nerve
damage in O2 circulation
impulses
● Opistotonus = Arching of the back [Late sign]
PERICARDIUM
○ How to position? → SIDELYING
● Outermost layer
● 2 layers:
MANAGEMENT
○ Visceral – Inner pericardium
● Series of antibiotic → Multidrug therapy
■ In between the two layers:
● Always finish the duration of antibiotic therapy
Pericardial Space
○ To prevent drug resistance
● Has pericardial fluid
(prevent friction rub)
HEAD TRAUMA
CONCUSSION ○ If friction happens
● Jarring of the brain - an inflammation
● Sudden forceful contact happens
● Rigid skull ○ Parietal – Outer
● Transient loss of consciousness → brain damage
● Shaken baby syndrome
● Both have NO open wound – if magkakaopen
wound, might be Abrasion

CONTUSION
● Bruising

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

CHAMBERS OF THE HEART SEPTAL DEFECTS: ACYANOTIC

Flow of blood in heart → 1 way only ATRIAL & VENTRICULAR SEPTAL DEFECT
○ Cannot be 2 way → indicate
REGURGITATION

SIGNS & SYMPTOMS

● Fatigue – d/t mixing of oxy and unoxy blood
● Dyspnea on exertion – if doing activity lalo
nahihirapan huminga (ex. Feeding, bathing)
2 CLASSIFICATION ○ Exercise/activity intolerance
ACYANOTIC ● Brow sweaters during feeding – Nageexert siya ng
● No cyanosis! – Absence so much effort
● Usually have 1 problem only ● Failure to thrive: Delayed milestones
● s/sx of heart failure:
CYANOTIC
● Presence of cyanosis (Blue babies) – evidence of MANAGEMENT
ineffective tissue perfusion ● Dacron patch – Installed via coronary bypass
● Has 2 or more problems surgery
○ Surgery – when Px is stable already
ACYANOTIC: PATENT DUCTUS ARTERIOSUS (PDA) ○ Hindi pinapalitan ang dacron patch as
● Yung dapat nagsara na ductus arteriosus, hindi infant ages
nagsara
○ Normal: should close at birth when you 2 TYPES OF DACRON PATCH
● Tissue – Normal microflora inside body than it
cut the cord
is LESS LIKELY to stimulate an inflammatory
● Has 1 problem! – this is the Acyanotic type! response
○ Decrease rejection rate
○ More favorable of use
○ Take cardiac tissue
● Plastic – Foreign body inside body
(Synthetically made) most likely to initiate
inflammatory response
○ Increase rejection rate

*After a few days-weeks, nagrerecover na ang patient

and s/sx start to diminish

ACYANOTIC: COARCTATION OF AORTA

● Narrowing of aorta (Descending) → Lead to
Increased pressure! → Decreased output
● Acyanotic type

SIGNS & SYMPTOMS SIGNS & SYMPTOMS

● Machinery like murmur: Patho/hallmark! UPPER EXTREMITIES
○ Nagbabanggan ang dugo sa ductus ● Heart proximal to UE → Then all are INCREASED
arteriosus LOWER EXTREMITIES
● Heart Failure ● Heart distal to UE → Then all are DECREASED
● Poor feeding UE LE
● Easy fatigability
● Poor weight gain – Primary indicator of health for BP Inc Dec
newborns!
Pulse Bounding Weak / Absent
○ Normal: 6 months – Double birth weight
○ 12 months – Triple birth weight ● Rib notching – Visualize the beating of their heart
● Irritability – d/t cerebral hypoxia d/t narrowing of aorta, then heart is pressured too
much, and as a compensatory they try to contract
MANAGEMENT more – Rib notching
● DOC: Indomethacin – Drug that facilitate
CLOSURE of PDA MANAGEMENT
● Surgery: Balloon Angioplasty with Coronary
Stenting
○ Stent – Form of Scaffolding or support
made up of mesh
○ Plasty (repair), Ang (

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

○ Balloon – Deflated during insertion ○ Irritability

○ Usually the mesh and stent are there up ○ Pallor
until the infant grows old ○ Blackouts
■ Only taken off if there are ○ Convulsions
complications ● Cardiomegaly: Enlargement of the heart
■ Mesh is usually not rejected bcos ● Clubbing of fingernails [spoon shaped]
its in the blood vessel ○ Chronic hypoxia
● Pan systolic murmur → Murmur in every
contraction

DIAGNOSTICS
● 2D Echo
○ Boot shaped heart due to the enlargement
of the ventricle

NURSING CARE
CYANOTIC: TETRALOGY OF FALLOT
● Cyanotic problem
MEDICAL MANAGEMENT
4 PROBLEMS SURGERY
● Pulmonary Stenosis
● Right Ventricular Hypertrophy
● Overriding Aorta (Anatomical Defect, COngenital)
● VSD (Ventricular Septal Defect)
QUESTIONS
1. Primary problem?
a. Pulmonary Stenosis! – Narrowing in the
pulmonary valve area, the blood from
RV cannot go to lungs → RV
hypertrophy
2. Compensatory mechanism?
a. RV hypertrophy
b. XRAY – See boot shaped heart
3. Mixing of blood?
a. Overriding of Aorta (Anatomical defect)
i. Aorta normally should be in the
end of ventricle, but it is placed
now in the middle (Katapat ng
VSD) → kaya the unoxy blood
from RV goes to Septum → SIGNS & SYMPTOMS
Mixes with oxy blood
4. Keeps the patient alive?
a. Ventricular Septal Defect – somehow
relieves the pressure in RV (If sarado
kasi puede na pumutok ang RV)
SIGNS & SYMPTOMS
● Cyanosis MANAGEMENT
● Squatting / Knee Chest Position
○ To decrease venous return [promotes
relaxation of the heart]
○ Conserve the oxygenated blood in the
vital organ
● Tet Spells [Pathognomonic Sign]
● Allow the child to Squat (Compensation)
● For infant: Position lying down with HOB elevate
→ Allow maximum lung expansion
● Palliative: Only relive s/sx
○ Blalock Taussig Shunt → Anastomosis of
the pulmonary artery and aorta (using
Subclavian artery)
■ Rerouting of blood: Instead of
blood directed to aorta, it may go
back to the pulmonary artery
hence relieving symptoms
■ Done only to stabilize child before
curative surgery
● Curative: Cures the condition
○ Intracardiac surgery / Brocks procedure
■ Involves 2 procedures
● Balloon angioplasty –
Solves Pulmonary
stenosis and Right
ventricular hypertrophy
● Dacron Patch – Solves
VSD and Overriding of
aorta
○ Puede direct na curative surgery agad if
the cardiopulmonary doctor gives
clearance
TRANSPOSITION OF THE GREAT ARTERIES [TOGA]
● Cyanotic → Blue baby
● Mechanism: Right ventricle is connected to the
aorta | Left ventricle is connected to pulmonary
artery
● PDA keeps the patient alive
● Severe respiratory depression
● Cyanosis
● Failure to thrive
● Fatigue
● No murmurs → Baliktad yung arteries, walang
pressure sa puso
● Prostaglandin E
○ Keeps the PDA open
● Surgery: Arterial Switch
○ Must be done during the first week of life

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

RHEUMATIC HEART FEVER over time this will lessen until it stops
● Type of infectious heart disease (Death)
● Caused: GABHS (Group A Beta Hemolytic
Streptococcus)
○ Causes sore throat and AGN [Acute
glomerulonephritis]

JONES CRITERIA
● 2 major sx + Hx OR 1 major s/x + Hx

MAJOR MINOR

1. Carditis: 1. Low grade fever

Inflammation of the 2. Arthralgia (painful
heart d/t infection join w/o swelling)
2. Polyarthritis: 3. ASO titer
Inflammation of (Antistreptolysin O
various joints titer) – GABHS
3. Chorea: St. Vitus Specific RIGHT SIDED HF
Dance – Worm like 4. C-reactive Protein & ● Systemic Manifestation
movements ESR: Inflammatory ● Peripheral, Dependent, Pitting Edema
4. Subcutaneous markers
● Weight gain
Nodules – Bony
Prominences [Knees, ● Distended neck veins [JVD]
Knuckles. Elbows] ● Hepatomegaly: Portal Hypertension
5. Erythema ○ Can lead to esophageal varices,
Marginatum [Trunki] hemorrhoids and ascites
● Anorexia, Nausea
MANAGEMENT
● DOC: Penicillin → Broad Spectrum [Positive and
negative]
○ 5-10 days: Average of 7 days
○ If with allergy with penicillin, Clindamycin
& Erythromycin
● Exacerbation: Lumalala | Remission: Bumabalik
○ Continuous check up for 10 years
● Salicylates: Pain & Swelling
○ ASA – Aspirin
○ 4 A’S of ASA
■ Antiplatelet = WOF Bleeding
■ Antipyretic
■ Analgesic
■ Anti Inflammatory DIAGNOSTICS
● Corticosteroid ● Chest X-ray → Cardiomegaly
○ To relieve carditis – Major symptom of RF ● 2D Echo – Hypokiinetic heart (Decreased
○ Anti-inflammatory movement in heart)
● Pulse Oximetry = Decreased O2 Saturation
HEART FAILURE ● Pulmonary Capillary Wedge Pressure [PCWP]
● Failure of the heart to contract → Lead to ○ Measures the pressure of the left side of
insufficient CO → O2 become insufficient the heart
● HF is the end stage of all heart disorders ○ NV: 4-12 mmHg
● Concept of backflow: ● Central Venous Pressure → Right Sided
○ LSHF – backflow from the LA / LV into the ○ NV: 8-12 mmHg
pulmonary system
○ RSHF – backflow from RA / RV into the MANAGEMENT [FAILURE]
system ● F – Fowler’s position = To maximize lung
expansion → Enhances Oxygenation
LEFT SIDED HF ● A – Administer High O2 by the use of venturi
● Lung/Pulmonary manifestation mask [Delivers precise & accurate O2 amount] →
● Dyspnea on exertion D/insufficient tissue perfusion
● Orthopnea – difficulty of breathing during ○ Non-Rebreather causes lung collapse
positional changes especially when LYING DOWN because High O2 = High Flow
○ Optimal position: Orthopnic position, ● I – Inotropic Drugs = Strengthen heart’s
Sitting on chair, leaning in table contractions] → Maximizes cardiac output /
● Crackles/rales – Fluid filled lung Decreases cardiac Output
● Cough ● L – Lanoxin & Digoxin [Type of Inotropic drugs]
● Tachycardia – first sign of HF ○ Toxicity [NAVDA]
○ The 1st time this will appear is the ○ Nausea
compensation of heart to increase CO, ○ Anorexia

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

○ Visual Disturbances & Vomiting NURSING CARE

○ Diarrhea 1. Give Aspirin as ordered [4A’s]
○ Abdominal Cramps 2. Immunoglobulins = To enhance immune response
○ Digibind & Digoxin Immune Fab 3. Clear Liquid diet [If the light passes through the
[Antidote] fluid, clear]
● U – Urine Output and Intake Monitoring a. Orange juice, Brewed Coffee
● R – Record daily weight b. Breast Milk is an exemption because it is
○ Same Time naturally formed = Puede pa rin mag
○ Same Clothes breastfeed
○ Same Weighing Scale c. Not allowed to eat irritating foods =
○ Same Patient Irritates GI
● E – Edminister Diuretics 4. CPR = At risk for coronary artery diseases [CAD]
a. Heart can shut down anytime

GASTROINTESTINAL DISORDERS
CLEFT LIP & CLEFT PALATE
CLEFT LIP CLEFT PALATE

KAWASAKI DISEASE Male Females

● Originated from Japan
● Involves 2 conditions
○ Mucocutaneous Lymph Node Syndrome
■ Lymph node is a part of the
immune system leading to
decreased immune response
○ Multisystemic Vasculitis (Inflammation of
cardiovascular system)
● Rare condition! – But always in Board Exam
hekhek
SIGNS & SYMPTOMS
● High spiking fever (Hyperpyrexia)
● Strawberry red tongue (Pathog sign) – Because
tongue is full of blood vessels, so when there is
hyperpyrexia, the vessels become inflamed
● Photophobia – Mabilis masilaw
○ Advice to wear dark colored glasses /
large brim hats
○ D/t hyperemia of conjunctiva (vasculitis)
● Polymorphous rash → Different shapes of rashes
● PALMAR desquamation
○ Hand only, not skin desquamation (hole
body)
○ d/t inflamed blood vessels, hindi
nakapunta sa hands (menute kasi ang bv
sa hands)
L-lalake P-Females
Speech problem – If open
palate, the tongue cannot
articulate well
● Hereditary
● Maternal Smoking – if not hereditary, the
problem is during maternal pregnancy, usually
– SMOKING _ initiates Carboxyhemglobin
*No good because O2 for baby = well being
PROBLEMS
● Difficulty of feeding
● Risk for aspiration
● Risk for Infection (URTI) – The lodged food in
the palate/lip can cause aspiration – causing
inflammatory response – infection
● Puede sabay cleft lip & palate
No speech problem Speech problem – If open
palate, the tongue cannot
articulate well
NURSING CARE
CLEFT LIP CLEFT PALATE
Large nipples – Stronger Cup, medicine dropper
suction (Made of rubber) – deliver
precise amounts of fluid
(Promote accurate fluid
flow), decrease risk for
aspiration

*If months ang age –

Choose Medicine
Dropper?
*if above 1yo – Go for cup
(Higher consumption of
milk)

Cheiloplasty – Surgical Palatoplasty – Surgical

repair of cleft lip repair of cleft palate

RULE OF 10 RULE
- Should be 10 wks - Not too early
old - Too early
DIAGNOSTICS - 10 lbs - may
● Elevated ESR [Erythrocyte Sedimentation Rate] = - 10k WBC reopen
Inflammatory marker - 10 g/dL hgb - Not too late
- May
Position post op: Position develop
on unaffected side speech

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

FOOD TO AVOID
problem
● Spicy food
18-24 months – Viable for ● Tobacco
surgery ● Caffeine containing products
● Alcohol
Position post op: Side ● GI Irritants / vices
Lying / Prone ○ ALWAYS REMEMBER: Pediatrics has 5
- Look for frequent
stages (including adolescents) – 0-18 yo
swallowing (sign
of bleeding) ● HOBE 6-8 inches during sleep (prevent food
- If need pumili, regurgitation)
side lying for
<1yo, prone for PHARMACOLOGIC
>1yo ● Antacids
● H2 blockers (-Tidine)
GASTROESOPHAGEAL REFLUX DISEASE (GERD) / ● PPI (Proton Pump Inhibitors) (-Prazole)
CHALASIA
● You have incompetent LES (lower esophageal PYLORIC STENOSIS
sphincter) / cardiac sphincter ● Narrowing of pyloric sphincter – decrease gastric
○ LES responsible of entry of food from emptying – abdominal distention – formation of
esophagus to stomach (Regulation) – olive shaped mass
incompetent LES leads to backflow of
food – Vomiting
○ Backflow contains HCL acid and damages
LES – chest pain
● *hindi gagana ang chalasia ng walang GERD

SIGNS & SYMPTOMS

SIGNS & SYMPTOMS
● Forceful vomiting / Projectile vomiting
● Heartburn (chest pain) → HCL acid reflux
● Bitter taste in the mouth – HCL is naturally bitter
● Dysphagia → difficulty swallowing
● Odynophagia → painful swallowing
○ Reflux of HCL acid causes damage in
LES – causing pain (Odynophagia),
because masakit kadalunok nahihirapan
lumunok (Dysphagia)
● Hoarseness
DIAGNOSTICS
● Barium swallow – Can only stay in the body for 2
days
○ Responsibility: Excretion of the barium
(Inc OFI & laxatives as ordered)
○ We are not going to use laxatives IF there
are signs of electrolyte imbalance
/dehydration
■ Always check if there's “as
ordered” means it has been
assessed
● Regurgitation
● Vomiting (projectile) – With gastric contents,
without bile
● No anorexia, with good appetite but with vomiting
● Weight loss
● Upper abdominal distention: Olive Shaped Mass
● Malnutrition and Dehydration
● Metabolic Alkalosis
MANAGEMENT
● Monitor feeding pattern
● Assess the vomitus (w/o bile) – If w/ bile then that
means it's in the intestine
● Increase OFI
○ If child cannot tolerate – Then IV to
prevent aspiration
● Prevent spiration: Feeding slowly
● Burp frequently – To prevent gas formation
● High fowler
● Surgery: Pyloromyotomy / Fredet Ramstedt –
“Otomy” Cutting the muscle layer of pyloric
sphincter
○ Incision that splits the obstruction

MANAGEMENT
● Low fat, high fiber
○ Fat is hard to digest
○ Fiber enhances digestion
● SFF (small frequent feeding)

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

CELIAC DISEASE / CELIAC SPRUE / GLUTEN
SENSITIVE ENTEROPATHY
● Cause: Malabsorption of gluten
○ Our body tends to compensate: If body
cannot absorb gluten, the body will try to
excrete them – Acute diarrhea
● Hereditary
● In a birthday party: Bring your own cake! (Gluten
free)
● GLUTEN FREE DIET 4 LIFE!
HIRSCHSPRUNG DISEASE
● HD AKA Congenital Aganglionic Megacolon
● Megacolon
● Cause: absence of ganglions! (Aganglionic) –
cells of the nerves responsible for peristalsis
○ Affected part has no peristalsis – then
abdominal distention happens leading to
megacolon
● Problem: failure to pass meconium for the first
24-48 hrs
○ Either imperforate anus or HD only!
● RLS (Ribbon Like Stools) / Pellet like
○ Since there's no more peristalsis, the
stool becomes the shape of the colon –
pellet like/ ribbon like stools

SIGNS & SYMPTOMS

● Acute diarrhea – Compensatory mechanism
● Steatorrhea: FFF (Foul fatty feces)
● Anorexia
● Vomiting
● Severe abdominal distention – Bcos body cannot
process gluten, it will tend to form gas, leading to
abdominal distention
● Body wasting (Cachexia)– Pumapayat
● Retarded growth
● Failure to thrive (Delayed development)

DIAGNOSTICS
● Confirmatory: Bowel biopsy – Flat mucosa DIAGNOSTICS
surface with hypertrophic villous atrophy ● Barium enema: Megacolon
○ Kaya hindi maabsorb (loss of function) ● Confirmatory: Rectal biopsy: Absence of
dahil nag atrophy ang vili ganglion cells
● Meconium/stool (Pathog/hallmark) – Ribbon
● Elevated IgA & IgG – bcos this is hereditary, may like/pellet like stool
have high results
○ Irreversible, incurable, but easily SURGICAL MANAGEMENT
manageable ● Surgery: Swenson Pull Through (end to end
Anastomosis) with temporary colostomy
MANAGEMENT ○ Cut one side, cut onside, reconnect the
AVOID BROW two sides
● B – Barley ○ Colostomy – To facilitate recovery of
● R – Rye stoma
● O – Oats ■ Because when both sides are
● W – Wheats inflamed need muna ng
● Avoid commercially prepared bread, oatmeal, and colostomy to let it heal, once wala
cereal ng inflammation, then puede na
Also Avoid pagdugtungin
● If child is showing symptoms after ingestion – Do ○ Recovery: 1-3 months, max 6 months
not give anti diarrhea/anti vomiting meds to let it
excrete the irritant MANAGEMENT
○ NR: Support with liquid! ● Colostomy care
● gatorade/pocari seat – use in caution because not ○ Remember: Habang lumalapit sa pwet
all electrolytes are excreted o the problem may be BUMABAHO/TUMITIGAS
an excess
● Do not give erceflora – this is an antibiotic
ALLOWED FOOD: Everything not BROW base
● Meat
● Eggs
● Mild products (Milk, Cheese, Cream)
● All fruits & vegetables (Rice, corn, corn flakes)
ALWAYS REMEMBER

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

INTUSSUSCEPTION
● Telescoping of the colon
● Increased peristaltic movement in the proximal
area where an obstruction occurs, in an attempt to
excrete the blocked stool.
○ Increase peristaltic movement = causes
high pitched bowel sound above the
obstruction
○ Dancing bowel?
● Most common location: In Descending colon

Ascending ● Liquid
● w/o odor
● NO Irrigation (PNSS - not
commonly asked in pedia)
● Continue appliance of bag

Transverse ● Mushy
● Slight odor
● Physician call f need mag irrigate
or not (very uncommon din na site
of HD) SIGNS & SYMPTOMS
● Colicky pain (gas formed pain)
Descending ● Solid in nature ● Sausage shaped mass (Pathog/Hallmark)
● w/ odor ● Bile stained fecal emesis → susuka ka ng tae na
● Yes to Irrigation – solid stool may bile EW d/t intestinal obstruction
● Continue appliance of bag
● Currant jelly like stool (bloody mucoid stool)
*if infant, continues appliance of bag,
because di nila alam kelan sila natatae (Hallmark)
unlike adults
DIAGNOSTICS
● Assess the characteristics of the stoma
● Barium enema
○ Color: Pinkish
● Guiac’s test / Test for occult blood (hidden blood)
■ If it becomes brick red or cyanotic
○ No dark colored food: False (+) result
– Always remember to NOTIFY
■ Mask feeding d/t black tarry stool
PHYSICIAN d/t lack of circulation
○ Vit C rich food: False (-) result
of ostomy – lead to gangrene &
■ Product pampatak sa stool is
infection
hydrogen peroxide (agua
○ Moist: Yes
oxinada) – it will form blue ring
■ Dry: dehydrated child
dapat to visualize bleeding
● NOTIFY PHYSICIAN
■ But vit C oxidizes your hydrogen
■ In our ostomy: Insensible water
○ Do not take 24-48 hrs before procedure
loss – fluid loss w/o noticing
○ Elevated / Protruded: Yes (Slightly)
MANAGEMENT
■ If depressed – ostomy not healing ● Auscultate bowel sounds (high pitch) d/t increased
● NOTIFY PHYSICIAN peristalsis
AVOID FOOD ● Assess for abdominal distention
● Avoid food that can OBSTRUCT stoma ○ D/t gas formation
● Seeds ● NGT Insertion
● Increase OFI (Hasten digestion, minimize
ALLOWED FOOD obstruction
● Spinach ● Surgery: Swenson Pull Through
● Parsley
● Yogurt FUNCTIONS OF NGT
● Broccoli ● F– Feeding
● I – Irrigation
● Can a client swim with an ostomy? – Yes! ● D – Decompression / Lavage (We use this for
○ This is the ONLY NON CONTACT sport intussusception)
that develops your abdominal muscle – ● M – Medication
faster healing
○ Recommended sports for ostomy client

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

RESPIRATORY DISORDERS ○ Ileum is covered by mucus because

there’s no peristalsis → Puro stool yung
CROUP
ileus
● Narrowing of airway due to viral inflammation
● Blocked sweat glands → increase salty sweat
● Self limiting → Make sure that the virus kills itself
before the patient
DIAGNOSTICS
● Sweat chloride test: Increased chloride levels in
sweat
○ Sodium + Chloride = Table salt
○ Altered sweat glands → Nakalabas ang
chloride sa sweat

MANAGEMENT
● Chest Physiotherapy
1. Percussion
2. Vibration
3. Postural Drainage – Head of bed is
lowered = Expelling the mucus via gravity
○ Done before meals = Empty stomach
○ 2 hours after meals is allowed

SIGNS & SYMPTOMS MEDICAL MANAGEMENT

● Barking seal like cough [Pathognomonic mark / ● Administer pancreatic enzymes to aid in digestion
Hallmark] ○ Given with meals
● Inspiratory stridor ○ If given without meals = Autodigestion of
○ Stridor = Passage of air in a narrowed the pancreas
airway ○ NEVER double the dosage =
○ st I dor = Inspiratory Autodigestion
○ wh EE zes = Expiration ○ Autodigestion = The pancreas digests
● Dyspnea itself
● Cyanosis – Ineffective tissue perfusion ○ Pancreatic Enzymes
● No fever / Low grade fever ■ Amylase: For carbohydrates
○ If virally caused = Low grade ■ Lipase – Lipids / Fats
○ If bacterial caused = High grade ■ Trypsin – Protein
● Drooling / Grunting : EMERGENCY → Respiratory
distress syndrome / Epiglotitis / Bronchospasm ASTHMA
○ Resuscitation is needed ● Most common childhood illness
● Reversible – bcos it is caused by allergens = NO
NURSING MANAGEMENT ALLERGEN NO ASTHMA
● Increase humidity in the room by using cool mist ● Hyperresponsiveness → Lead to bronchospasm
○ Hinahalo sa humidifier makes asthma dangerous) because it can
● Inhale cool night air / warm bathroom air completely close the airway (Death!)
[bronchodilation] ● Chronic asthma → meaning the allergen is still
● Tracheostomy at the bedside – For emergency there!
purposes ● Asthma can be hereditary

COMMON ALLERGENS
MEDICAL MANAGEMENT ● Pollens
● Antibiotics & Antivirals [-vir] ● Molds
○ Antibiotics = Prophylaxis because ● Dust
immune system is down, susceptible in ● Weeds (Seaweed) – rich in iodine (common
infection allergen)
● Bronchodilators ● Pet danders
○ SE: Tachycardia ● Eggs [albumin]
○ Don’t give caffeine ● Seafoods

CYSTIC FIBROSIS EXACERBATIONS

● Blockage of the exocrine glands ● Air pollutants
○ Blocked by mucus ● cold/heat weather changes
● Organs: Pancreas, lungs, intestines, sweat glands ● Strong odors
○ Will lose their function
SIGNS & SYMPTOMS
SIGNS & SYMPTOMS ● Wheezes → During expiratory
● Pancreatitis ○ During an asthmatic attack: absence or
● Dyspnea decrease of wheezing → DANGER SIGN!
● Meconium Ileus ■ Represents COMPLETE
OBSTRUCTION of airway!

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

■ STATUS ASTHMATICUS! → ○ They don’t understand the feelings of

tracheostomy, drugs: others
bronchodilator + Epi
KOHLBERG: PRE-CONVENTIONAL
MANAGEMENT ● Punishment & Obedience
● Bronchodilators ● Best punishment: Time Out [Face the wall] –
● Corticosteroids Remove all stimuli
○ Hindi na magiging issue which drug to ○ Audible Alarm = To know when the
use, because many asthma drugs are punishment is over
now in COMBINATION ■ 1min/age
● O2 therapy
● Avoid allergens PLAY
● Parallel (Side by side play)
○ Toddlers play beside each other but their
GROWTH & DEVELOPMENT plays are not related
THEORIES ○ No sharing of toys
INFANT [0-12 MONTHS]
ERIK-ERIKSON: TRUST VS. MISTRUST FEAR
● Needs, food, warmth, care) ● Separation Anxiety – Mga bata sa mall na gusto
maging autonomous kaya bibitay sa naay, pero
FREUD: ORAL STAGE [MOUTH] mawawala na agad
● Feeding, pacifiers, teethers
○ They will put in mouth whatever they get a PRE-SCHOOLER [3-6 YEARS OLD]
hold of → Risk for aspiration! ● Age with HIGHEST IMAGINATION

PIAGET: SENSORIMOTOR [LEARNING THROUGH ERIK-ERIKSON: INITIATIVE VS. GUILT

SENSES] ● Gve opportunities to participate
● Sensorimotor (Learning through senses) ● If undergoing medical procedure: Therapeutic use
○ Srattles, mobiles/tumutunog sa taas ng of play (Ex. give toy syringe)
crib
■ Tumutunog, may sounds, umiilaw, FREUD: PHALLIC STAGE [COMPLEXES]
tumutunog ● Oedipal → Baby boy gusto si mother (mama’s
boy, hate same sex parent)
KOHLBERG ● Elektra → Baby girl gusto si father (daddy’s girl,
● No specific theory hate same sex parent)

PLAY PIAGET: PRE-OPERATIONAL [SYMBOLS]

● Solitary therapy – Play alone ● D/t high imagination, they can now imagine
symbols
FEAR ● Ex. Dahon as money, spoon as airplane
● Stranger anxiety
KOHLBERG: PRE-CONVENTIONAL
● Egocentric
TODDLER [1-3 YRS OLD]
ERIK-ERIKSON: AUTONOMY VS. SHAME & DOUBT
● Always offer then choices PLAY
● Associative/Cooperative
● Ex. hot dog sila mahilig. What you will do is ask
○ Sabay na maglalaro (ex. Make believe,
with choices → what do you want? Eggs or
role playing)
chicken?
FEAR
● He will exercise his autonomy but you will be in
● Body mutilation and castration, view death as
control of the choices
involving physical harm
● Allow them to participate as much as possible
○ Aklaa nila nasaktan ka lang pero
mabubuhay ka pa (death as temporary)
FREUD: ANAL AGE
● Criteria for readiness for toilet training:
SCHOOL/SCHOOL AGE [6-12 YRS OLD]
○ Sit and squat
ERIK-ERIKSON: INDUSTRY VS. INFERIORITY
○ Remain dry for 2 hrs
● Stage wherein the child enters into a greater
○ Ability to verbalize the need to defecate &
society besides his/her family for the first time
urinate
○ Willingness to please parents
FREUD: LATENT [SAME SEX ORIENTATION
○ Soiled diapers – They want to change
● Girl vs. boys | Boys vs. girls
immediately
○ No mixing of sexes
○ *kahit may nakita ka palang na ilan dsa
○ “Boys are yucky”
criteria, puede na simulan
PIAGET: CONCRETE OPERATIONAL
PIAGET: PRE-OPERATIONAL [CONSERVATION/REVERSIBILITY]
● Egocentric ● Conservation: Akala nila mas maraming laman
○ Inability to see the POV of others yung manipis na matangkad na baso kesa sa
maliit na malapad

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 TOPRANK INTENSIVE PHASE – PEDIATRIC NURSING

● Reversibility: Alam mo na pag nilagay mo tubig

sa freezer magiging yelo, and if tatanggalin mo
magiging tubig ulit

KOHLBERG: CONVENTIONAL
● They want o be good in the eyes of others bcos
they believe in AUTHORITY
PLAY
● Competitive (indoor)
○ Board games, scrabble, quiz bee
FEAR
● Death (Death is FINAL)

ADOLESCENCE [12-18 YRS OLD]

ADOLESCENCE [12-18 YO]
● Erikson: Identity vs. Role Confusion [Peers &
Body Image]
● Fraud: Genital (Sexual curiosity)
● Piaget’s: Formal operational [Hypothetical]
● Kohlberg: Postconventional [Morally inclined, Law,
Responsible]
● Play: Competitive / Interruptive [Outdoor] – Sports
● Fear: Peer rejection
ERIK-ERIKSON: IDENTITY VS. ROLE CONFUSION
● Peers & Body Image

FREUD: GENITAL
● Sexual Curiosity

PIAGET: FORMAL OPERATIONAL

● Hypothetical Thinking

KOHLBERG: POSTCONVENTIONAL
● Morally inclined, Law, Responisble

PLAY
● Competitive / Interruptive [Outdoor] – Sports

FEAR
● Peer Rejection

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