PEDIATRIC NURSING
ABNORMAL PEDIA Other Manifestations
NEUROLOGIC DISORDERS
INCREASED INTRACRANIAL PRESSURE
→ Pressure inside the brain
→ Maintained the brain function and development
→ N: 5-15 mmHg
• >15 mmHg→↑ICP but if >20 mmHg it becomes
life-threatening
→ Cushing’s triad
• ↑systolic BP, ↓RR, ↓PR, and widened pulse
pressure (the complete opposite of the shock
triad- ↓BP, ↑RR, and ↑PR)
• Pulse pressure is the difference between the
systolic and diastolic pressure (N: 30-40 mmHg)
• If only two of the triad are present, it is not
considered as Cushing’s triad but can still be a
manifestation of IICP because some of the
systems may still be able to compensate
Manifestations of IICP
→ Bulging fontanelles that is aggravated by crying
• There are two fontanelles in the pediatric
population (anterior and posterior fontanelles)
• Anterior- diamond-shaped and closes at around
12-18 months
• Posterior- triangular shaped and closes at 2-3
months
• For a child with IICP, fontanelles will not close
because the pressure inside the brain pushes it
outwards (hydrocephalus)
• Crying will all the more increase the pressure
inside the brain, this may be normally expected in
crying children but not as much as children with
hydrocephalus
→ High-pitched cry: considered one of the early signs
• This is a sign that may be d/t pain
Early signs of ↑ICP per each age group
→ Infant- high-pitched cry
→ Child- irritability and agitation
→ Adult - restlessness
→ Geriatric- confusion
→ Increase head circumference
• The tape measure should be at the bedside for
monitoring
• This will be used to measure if the head increases
or decreases in size (↑size= ↑ICP)
• Measured every shift
• From the forehead to the occipital area
• N: 33-35 cm
→ Headache- the initial sign of IICP
• First to appear
• Compression of the brain and nerve structures→
pain
• Crying may be the sign of pain in infants
→ Projectile vomiting
• D/t compression of the CTZ (chemoreceptor
trigger zone- vomiting center of the brain) in the
medulla oblongata→ may be d/t alteration in the
brain structure/ cerebral edema
→ Diplopia (double vision)
• ↑ICP= ↑IOP and this will cause the damage of the
optic nerve→ double vision, blurring of vision, or
blindness if not addressed promptly
→ Pupillary changes
• N: PERRLA (pupils are equally round and reactive
to light and accommodation)
• Anisocoria- uneven pupils, one is constricted, one
is dilated (if this presents, brain damage may be
suspected)
• Dilated pupils- shock
• Both eyes are constricted- narcotic overdose (d/t
opioid drugs that are usually given for seizure
disorders)
→ Sunset eyes
• Eyes are pushed downward because of increased
pressure in the brain
→ Anorexia and weight loss
→ Nausea
→ Seizures
• Two reasons why seizure will occur
1. Irritability of the brain will cause erratic
transmission of signals= ↑neuronal impulses
(electrical impulses from the brain is not
properly transmitted to the muscles→ erratic
muscle movements
2. Dehydration d/t vomiting, insufficient fluid
intake→↑temperature d/t insufficient fluids
that will regulate the temperature→
convulsions
Lack of oxygen in the brain may also induce seizures, ↓O2 in
the brain→ cerebral hypoxia→ brain dysfunction, and the
afferent and efferent nerve fibers→ erratic neural impulses→
seizures
Management of IICP
→ Proper positioning: semi-fowler’s position
• Promotes venous return and drainage of CSF that
will decrease ICP through the use of gravity
→ Coughing and sneezing is avoided
• This increases the ICP
• If cough cannot be suppressed, cough with an
open the mouth→ pressure will be released
towards the mouth
→ Limit fluid intake (1,200-1,500 mL or as regulated by
the physician)
• N: 2-3 L
• Increase in fluids, increase in pressure d/t
retention
Pharmacotherapy
→ Diuretics
• Mannitol (osmotic diuretic) to decrease fluids in
the cerebrum
o Can cross the BBB
o Follows the principle of osmosis (pulls fluids)
o The function is more generalized
• Furosemide (loop diuretic)
o Takes effect in the loop of Henle
o A specific range of function
• Both are potassium-wasting diuretics; monitor the
serum potassium
o WOF: hypokalemia
 • Stop administration when hypokalemia, severe
dehydration, severe fluctuations in the FE
→ Decadron (dexamethasone)
• Anti-inflammatory, prevents cerebral edema if the
brain becomes more edematous→ exacerbation
of symptoms
• Decadron will be stopped depending on the ICP,
edema, and CT scan results
→ Anticonvulsants (phenytoin)
• Prevents seizure episodes
• Low dose anticonvulsants should only be used as
they may cause respiratory depression in children
(at risk for ARDS)
→ Antacids
• Indications:
1. If increased ICP, ↑HCl production=
hyperacidity
2. Steroids are used, to prevent GI ulcerations
because steroids are GI irritants (mucosal
barriers are thin in infants)
• Aluminum hydroxide (ALa poop, constipation)
• Magnesium hydroxide (MArami poop, diarrhea)
• Maalox or Mylanta is a combination of Al and Mg
that are not usually given in IICP d/t FE imbalances
o Take note that magnesium tends to
counteract calcium, if calcium is altered
because of potassium (inversely proportional)
administering this combination drug will
further exacerbate fluctuation
• Low doses are also used because drugs are
computed according to body weight in kilograms
and age
→ Anticoagulants
• IICP, blood flow in the brain has increased
vascular resistance→ wounding of the blood
vessels→ bleeding→ clotting→ thromboembolism
• Prevents thromboembolism
• Heparin (IV or SQ); short-term
o Check PTT (partial thromboplastin time)
• Warfarin (oral); long-term
o Check PT (prothrombin time)
Remember
Opiates and sedatives are contraindicated in ↑ICP
These are both depressants, this will exacerbate the
bradypnea and bradycardia leading to respiratory and
cardiac depression
SEIZURE DISORDER
→ Alternating contraction and relaxation of the
muscles→ spasms
→ AKA epilepsy
Types
→ Grand-mal seizure (generalized seizure)
• From head to toe (+) seizures
• Has two phases
• Tonic (mild contraction)- clonic (severe
contraction)
o Period during the seizure
o Manifested with dyspnea, salivation, urination
o Position them flat or supine
o Never place in side-lying during as it may
cause bad alignment of the spine and cervical
fractures
• Postictal- exhaustion phase (after the seizure)
o Position after the seizure: side-lying, lateral,
recovery position
• Never restrain as it may cause fractures
• Never put a tongue depressor in the mouth it may
cause aspiration
• Clear the area of any object that may cause harm
• Protect the head of the patient
If >4-6 minutes it may cause irreversible brain damage
→ Petit-mal seizures/ blank or absent seizures
• Blank facial expression
• Automatisms (repeated purposeless behaviors)
• Lip-smacking
o Occurs because it is proximal to the brain
o Cranial nerves involved is the facial nerve
(responsible for the movements of the face
and lips) that leads to spasms of the lips and
face
• Small seizures that include few muscles
→ Jacksonian
• One small group of muscles will start to seize then
progress to grand-mal
• Psychomotor
• Seen in mental clouding and intoxication
o Seen in people who are near death
o Hallucinations, delusions, illusions may
present
o Cognition and mental thinking is clouded d/t
the intoxication of the brain
→ Febrile
• Most common in children
• AKA under five seizure
o Hypothalamus is not well-developed to
regulate the temperature→ ↑temperature→
seizures
o Characterized by the temperature of 38.5°C
to 39-40°C
o Never place in cold baths, as it may cause
rupture of the blood vessels and may suffer
from hypothermia
o A tepid sponge bath may be done
• People above age five may still experience febrile
seizures
o Persons who are predisposed to enormous
amounts of stress→ failure of the
hypothalamus
o Superinfections
→ Status epilepticus (seizures that can last for 30
minutes)
• The most dangerous type of seizure
• (+) Brain damage
• Considered a medical emergency
• Triggers: CN damage, underlying disease
condition, untreated and unmanaged seizures,
meningitis
• To prevent brain damage in status epilepticus
emergency drugs will be given hydantoins,
benzodiazepines
Additional notes
The type of seizure that is going to present is dependent on
the age and affectations, and comorbidities
CN affectation- petit-mal
General neurologic problems- grand-mal
Pediatric- petit-mal
Meningitis- grand-mal or status epilepticus
 Diagnostics
All of the neurotransmitters are capable of causing seizures,
especially in wide-range imbalances Lumbar puncture (confirmatory test)
But nerves have larger factors in causing seizures → Inserted at L3, L4, or L5 to get a CSF sample
→ Position: C-shape, fetal, genupectoral (knee-chest)
Neurons normalize and compensate after seizures → Normal CSF: clear
• Cloudy- infection
Thrombosis in the brain may also cause seizures especially → This is done even if with increased ICP and can be
when it is located in the corona radiata (bundle of nerve
managed by:
fibers located in the brain), thalamic parts, and spinothalamic
tracts
• Positioning
• Decreased OFI
• Diuretics
Management
→ Seizure is mostly managed by drugs but can be CSF Analysis
managed by surgery also → Cloudy
→ Elevated WBC (triggered release d/t infection)
Hydantoins: Phenytoin → Elevated protein (byproduct of bacteria)
→ WOF: gingival hyperplasia • The combination of elevated WBC and protein
• Use soft-bristled toothbrush causes the CSF to be cloudy
• Meticulous oral care → Presence of causative agent (Neisseria Meningitides)
→ Pinkish red urine (normal)
• Explain/inform the significant other Signs and Symptoms
→ Kernig’s
Benzodiazepines (Anxiolytics) • Flex the knee = pain in the back, hamstring, neck
→ Act as an antidepressant → Brudzinski
→ Relaxation of the muscles, electrical impulses causing • Flex the batok/nape = pain in the neck and back
seizure to disappear
The difference between Kernig’s and Brudzinski is where the
→ -pam, -lam (Diazepam, Midazolam, Alprazolam)
pain is triggered (knee or nape)
→ If the seizure is caused by increased ICP with the
presence of the Cushing’s triad, this is → Nuchal rigidity (stiff neck) d/t nerve irritation
contraindicated. However, if the physician prescribed → Seizures
it after measuring the parameters, this may be given in → Opisthotonos (arching of the back) – late sign
low doses only • Position the client side-lying

Iminostilbenes: Carbamazepine Management

→ For refractory seizures (pabalik-balik) → Series of antibiotics (no specific antibiotic)
→ For maintenance purposes • Depending on the physician
• Depending on the patient’s status
Valproates: Valproic Acid • Depending on the involved causative agent
→ Last resort for pediatric clients • Penicillin, Ampicillin, Erythromycin, Clindamycin
→ Hepatotoxic → Finish the duration of antibiotic therapy to prevent drug
• Pediatric clients have immature liver resistance
→ Do not give to pregnant mothers especially in the first • The same drug cannot be used if the bacteria
trimester because it can cause neural tube defects become resistant
(e.g., hydrocephalus, myelomeningocele) • 10-14 days but can extend of there is
→ Avoid valproates if planning to conceive because it exacerbation or remission
causes stasis in the blood, which can still affect the
fetus when implantation occurs
Bacterial
• It is safe to conceive after taking valproates after Meningitis
Viral Meningitis
checking blood results for remnants of valproates
in the blood, especially for long-term use Both are isolated because both are
→ If all drugs render ineffective, this is given Isolation
communicable

Surgery Antibiotics Antiviral

Treatment
→ Neurectomy: surgical resection of the nerve/cranial
nerve involved in the seizure
→ This is done when all of the drugs are ineffective After recovery, Can recover without
→ The nursing responsibility depends on the cranial there are complications
nerve involved complications
→ Damaged
E.g., Sequelae
nerve
• Facial nerve- pain in the facial area → Movement
• Acoustic nerve- hearing and balance abnormalities
• Vagus- swallowing → Rigid muscles

BACTERIAL MENINGITIS Can be acquired if there

→ Infection of the meninges is myelomeningocele
• The meninges support and nourish the brain because the spinal cord
is exposed and there is a
→ Mode of transmission: direct contact
neural tube defect (direct
inoculation of bacteria)
HEAD TRAUMA ▪ >20ml: pericardial effusion
→ Common in children ▪ >50ml: cardiac tamponade (medical
→ Concussion: jarring of the brain caused by forceful emergency- cardiac arrest)
contact in a rigid skull→ loss of consciousness→ brain
damage (na-alog) Chambers of the Heart
→ Contusion: bruising, extravasation of blood cells
(nabukulan)

Management
→ Safety
• Wear bike helmets during activities/sports that
require it
• Seatbelts
• Safe driving
• Proper use of infant car seats
o <3 years old: rear-facing (for them to have
back support when there is a sudden break or
accident)
→ Right Atrium
o >3 years old: front-facing booster seat (the
→ Right Ventricle
spine is stable and can withstand sudden
→ Left Atrium
brakes or accidents)
→ Left Ventricle
→ Assess for cerebral functioning: GCS, PERRLA (Pupil
→ The flow of blood in the heart is 1 way (normal)
Equally Round and Reactive to Light and
• If 2 way = regurgitation
Accommodation)
→ Unoxygenated blood→ superior vena cava and inferior
• The prognostic indicator for head trauma is the
vena cava→ right atrium→ tricuspid valve→ right
level of consciousness
ventricle→ pulmonary valve→ pulmonary trunk→
• Difficult recovery if coma
pulmonary artery→ lungs for oxygenation→
• Uneven pupils (anisocoria)- brain damage
oxygenated blood→ pulmonary vein→ left atrium→
→ Assess for cervical injury
mitral valve or bicuspid valve→ left ventricle→ aortic
• Do not allow the child to sleep d/t possibility to
valve→ aorta→ different parts of the body system
progress to coma
→ One-way- normal
• (+) CI- immobilize to prevent further damage and
→ Two-way- regurgitation/ valvular problems
rush to the hospital
o Do not move the client
o Apply the splint according to the position in Artery Vein
which the px is found (wag mo na galawin
yung px) Oxygenated blood Unoxygenated
o Move the patient as a unit
From the heart To the heart
• (-) CI- HOBE (head of bed elevated) to decrease
ICP by the use of gravity (to decrease ICP by the Pressurized Non-pressurized
use of principle of gravity)
• If the patient is seen on the road, immobilize first Spurting blood when injured Oozing blood when injured
then move to a safe place

CARDIOVASCULAR DISORDERS Classification

Anatomy
Layers of the Heart
→ Endocardium- innermost layer
→ Myocardium- muscle layer; responsible for the heart’s
contraction and cardiac output (amount of blood
ejected by the heart per contraction)
• If destroyed/ affected there is an insufficient beat
of the heart
• One of the strongest muscles in the body (beats at
the time you were born until death; continuous
contraction)
→ Pericardium- outermost layer
• Visceral Pericardium- inner
• Parietal Pericardium- outer
• Pericardial Space- contains the pericardial fluid;
between the visceral and parietal pericardium
• Pericardial Fluid
o Prevents friction rub, prevents the layers of
the heart to rub together, prevents
inflammatory response in the heart (reduces
friction)
o Normal pericardial fluid: <20ml
→ Acyanotic: 1 problem only
→ Cyanotic “blue babies” (Evidence of ineffective tissue
perfusion): 2 or more problems
PATENT DUCTUS ARTERIOSUS (PDA) - Acyanotic
→ The ductus arteriosus did not close after delivery
→ The lifespan varies on how the size of patency and the
urgency of treatment
Signs and Symptoms
→ Machinery-like murmur (pathognomonic sign/ hallmark
manifestation)- distinguishing characteristic
• Banggaan ng mag dugo in the ductus arteriosus
• Ductus Arteriosus should close after cutting the
umbilical cord
o The pressure should close the ductus
arteriosus
→ Signs and symptoms of heart failure especially if not
managed
→ Poor feeding
• Mode of feeding is sucking therefore they need an
enormous amount of oxygen but there is a mixing
of blood resulting in insufficient oxygenation
 • PDA has decrease in O2 → poor sucking → poor
feeding → poor weight gain
→ Fatigue
• Poor feeding d/t easy fatigability
• Easily fatigued during crying
→ Poor weight gain d/t poor feeding
• Weight is the primary indicator of health in
newborn
• Ideal birth weight
o 6 months: double birth weight
o 1-year-old: triple birth weight
→ Irritability d/t cerebral hypoxia
Management
→ Indomethacin- facilitate closure of PDA (DOC)
→ HOBE to promote lung expansion
→ Surgery (bypass) is rare. Only if not managed by
medication
SEPTAL DEFECTS - Acyanotic
→ Atrial Septal Defect (ASD)
→ Ventricular Septal Defect (VSD)
→ The only difference is the area of affectation
→ If the hole appears on upper/lower portion → Mixing of
blood can happen → d/t the abnormal hole, either
unoxygenated or oxygenated goes into the other side
→ Only one occurs, either ASD or VSD
Signs and Symptoms
→ Fatigue - d/t mixing of unoxygenated and oxygenated
blood
→ Failure to thrive (delayed milestones; Slow progress of
development) d/t poor feeding
→ Dyspnea on exertion (e.g., crying, feeding)
• There is increased demand for oxygen during
activities but if there is a mixing of blood, there is
insufficient oxygen
• Leading to exercise/activity intolerance
• If during breastfeeding: Brow sweats d/t too much
exertion of effort
→ Signs and symptoms of heart failure if left unmanaged
Management
→ Dacron patch- implantable consumables in cardiac
surgery
• Tissue: decreased rejection rate (commonly used)
o Normal microflora → less inflammatory
response → decreased rejection rate
o Obtained in other parts of the body with the
same tissue integrity (usually from the heart)
▪ A scintillation camera is inserted for
visualization with a fiber optic scope to
disintegrate/scrape the tissue to be used
o If the tissue is rejected, the surgery is
repeated until compatibility
• Plastic: increased rejection rate (a foreign body
that may cause inflammatory response)
o Only used when the tissue type is not effective
or rejection occurs
• Immunosuppressant therapy is given to prevent
rejection (the duration depends on the physician)
• If there is no rejection in the dacron patch, s/sx of
septal defect should diminish after a few weeks
• Indomethacin is not used because the abnormal
holes are larger
COARCTATION OF AORTA – Acyanotic
→ Narrowing of the aorta (descending aorta)
• Narrowing aorta → increase pressure → decrease
in output
Signs and Symptoms
→ Different vital signs in the upper extremities and lower
extremities
• The upper extremities are proximal to the heart
which has increased pressure, while the lower
extremities (higher VS) are distal to the heart
where the output is decreased (lower VS)
Upper Lower
Extremities Extremities
BP Increased Decreased
Pulse Bounding Weak/Absent
→ Rib notching- the heartbeat can be seen in the rib
cage area d/t the narrowed aorta which causes the
heart to compensate by increasing its workload
• Mas malakas na rib notching, mas narrowed ang
aorta
Management
→ Balloon angioplasty with coronary stenting
• “Repair of aorta using balloon”
• Stent: scaffold/ support; made up of mesh
(superfine screen)
• Balloon angioplasty: repair of an artery using a
balloon
• The balloon is deflated while inserting it to the
narrowed aorta together with the stent→ once in
place, the balloon is inflated to expand the stent
and dilate the aorta→ once expanded, the
balloon is deflated for withdrawal while the stent
stays in place
• The stent prevents the aorta from narrowing again
because it acts as a support
o Has low probability for rejection; made of
synthetic plastic or wire
o Only replaced if damaged or dislodged
→ The activities are regulated depending on what the
child can tolerate
→ Before surgery: stable VS, no underlying conditions
TRANSPOSITION OF THE GREAT ARTERIES (TOGA)
→ Cyanotic
→ Mechanism: the right ventricle is connected to the
aorta, the left ventricle is connected to the pulmonary
artery

→ PDA is kept open to allow the mixture of blood
• PDA keeps the patient alive
→ Unoxygenated blood is deposited into the body
→ Detected with a low APGAR score and 2D echo
Signs and Symptoms
→ Severe respiratory depression
→ Cyanosis: A sign of ineffective tissue perfusion
→ Failure to thrive
→ Easy fatigability
→ No murmur even if there is PDA d/t incomplete
pressure of the heart because of transposition of the
two major blood vessels (no compression)
Management
→ Prostaglandin E: maintains/keeps PDA open
→ Surgery: Arterial switch (the connection is corrected to
achieve the normal structure of the heart)
• Done during the first week of life (performed in a
live client)
o The child can only live with PDA for only a
week or less
• Predisposed to bleeding and shock
• Difficult and risky surgery
→ Supportive management
• Oxygen therapy
• Vitals signs monitoring
• WOF signs and symptoms of heart failure
• Notify the physician if difficulty of breathing occurs
TETRALOGY OF FALLOT (cyanotic type)
Problems (PROV)
→ Pulmonary stenosis
→ Right ventricular hypertrophy
→ Overriding aorta
→ Ventricular septal defect
Common four questions asked in the boards
1. What is the primary problem?
• Pulmonary stenosis
2. What is the compensatory mechanism?
• Right ventricular hypertrophy
• RV has increased in workload to allow passage
through the narrowed pulmonary stenosis→
overworked→ hypertrophy
• Boot shaped heart will be seen in the 2D echo
3. What allows the mixing of blood?
• Overriding aorta
• An anatomical defect
• Normally the aorta should be connected to the end
of the LV, but in this case, it is connected to the
middle that is completely adjacent to the VSD
• UnO2ed blood from the RV→ shunts to the VSD
and mixes with O2ed blood in the LV
4. What keeps the patient alive?
• Ventricular septal defect
• Somehow relieves the pressure in the right
ventricle, if VSD is closed, the heart (right vnetricle)
may have the risk of rupturing
Manifestations
→ Cyanosis (blue babies)
• Higher unO2ed blood than O2ed blood
→ Squatting
• Two reasons
1. Decreases venous return to the heart→ relax
the heart
2. Conserves oxygenated blood in the upper
body area
▪ Cutting the circulation in the lower
extremities → decreasing the return flow
of blood to the heart → giving sufficient
time for the heart to relax
▪ There will be difficult venous return from
the lower extremities d/t hip flexion
▪ The O2ed blood should be concentrated
in the upper body because the vital
organs are there– lungs, brain, and heart
❖ Conservation of O2 in the upper
extremities, sufficing blood to the vital
organs
• (+) cyanosis of the lower extremities
• Squatting is a compensatory mechanism
• Tripod position - sitting on a chair and leaning on a
table
• Squatting - knee chest position
• This is not done throughput the day; only when
there's difficulty of breathing
• In infants, position: Lying down with head slightly
elevated
o To promote lung expansion
→ Tet spells
• Group of signs and symptoms that depicts lack of
oxygenation
• Pathognomonic sign/ hallmark manifestation of
TOF
1. Irritability
2. Pallor
3. Blackouts (fainting spells)
4. Convulsions (d/t lack O2 in the brain)→
cerebral hypoxia
→ Cardiomegaly d/t overworking
→ Clubbing
• One of the main symptoms
• Spoon-shaped fingernails d/t compensation of
capillaries (enlargement)
• Represents chronic hypoxia
 • Also seen in IDA d/t lack of iron → RBC have no age. But if the child is already stabilized even without the BT
enough O2 → hypoxia shunt, intracardiac surgery may be done
→ Pansystolic murmur
If BT shunt is done first, then intracardiac surgery follows,
• Every contraction of the heart (+) murmur the shunt (subclavian artery) will not be removed
because of numerous holes in the heart (VSD)
The age of curative surgery will be dependent on when the
Diagnostics child stabilizes
→ 2D echo- boot-shaped heart will be
seen Vital signs, FE balances, and all other aspects should be
balanced first before surgery can ensue
Nursing care:
→ Allow the child to squat RHEUMATIC HEART FEVER
• It is a form of compensation of → An infectious heart disease
the child → Caused by GABHS (group-A beta-hemolytic
streptococcus)
Medical Management • Causes sore throat and AGN (acute
→ Surgery glomerulonephritis)
1. Palliative surgery (Blalock-Tausig shunt)
• Relieve signs and symptoms Criteria for RHF: Jone’s criteria
• The goal is to increase oxygenated blood than → There should be two major symptoms + history of
oxygenated blood GABHS or 1 major symptom + 2 minor symptoms +
• Anastomosis of the pulmonary artery and the history of GABHS
aorta using the subclavian artery
o The subclavian is part of the aorta, it will not
Major Symptoms Minor Symptoms
be harvested it will only be rerouted and
connected Carditis Low-grade fever
• Blood that passes through the VSD may be
allowed to pass through the aorta→ subclavian Inflammation of the walls of
artery connected to the aorta→ lungs the heart d/t the presence of
a bacteria

Polyarthritis Arthralgia without swelling

Inflammation of various joints Joint pain, if it swells, then it

becomes a major symptom

Chorea ASO titer

St. Vitus dance/ worm-like Antistreptolysin- O titer

movements – especially
seen on fingers GABHS specific only
increases when (+) infection
Involuntary, irregular, of streptococcus
unpredictable muscle
movements Only minor because still
increases in AGN and sore
throat, not only specific to
2. Curative surgery (Intracardiac surgery/ Brock’s
RHF
procedure)
• Treats the disease condition Subcutaneous nodules C-reactive protein
• Involves two surgeries:
o Balloon angioplasty (to widen the pulmonary Usually seen in bony A protein released during an
stenosis) prominences because it has inflammatory response
▪ This will also resolve the RVH d/t few SQ tissue (knees,
↓workload elbows, nodules) An inflammatory marker,
▪ VSD will no longer be needed to relieve even in ordinary
inflammation, is not specific
the pressure
to RHF. Therefore, it is
o Insertion of Dacron patch (closing of the VSD) considered a minor symptom
▪ This will also resolve the overriding aorta
(wala nang katapat na butas na VSD) Erythema marginatum Erythrocyte sedimentation
rate (ESR)
Rashes of the trunk
There is no pharmacologic treatment for TOF, the only
Also released during an
management aside from surgery is to increase the
inflammatory response
oxygenation
An inflammatory marker,
Let the child regulate activities of their own
even in ordinary
inflammation, is not specific
to RHF
For infants, surgery is not done yet for TOF because they are
not stable yet, surgery will be done at toddlerhood or school
Management
side of the heart is → Fluid located inside the
→ DOC: penicillin increased → backflow in lungs are heard
• A broad-spectrum antibiotic that can kill both the jugular vein → → Gurgling sounds
gram-negative and gram-positive bacteria bulging
• Given 5-10 days and duration should be finished,
this is to completely eradicate the streptococcus Hepatomegaly (the liver is Cough reflex
(penicillins are highly effective in streptococcus) proximal to the heart and the → Fluids in the lungs will
• Administered via IV liver is sensitive to changes trigger the cough reflex
in oxygenation)
• If (+) allergy to penicillin, erythromycin, or
→ ↑pressure in the liver→
clindamycin may be given portal HTN→
• If (+) exacerbation and remission (manifestations destruction of the liver
become more severe), treatment is continued for
about 10 years (the physician schedules when the Ascites Tachycardia
antibiotic will be taken within the 10 years), the → Fluid accumulation in → In the early stages, in
only continuous is the monitoring the abdominal area d/t an attempt to
→ Salicylates (ASA- acetylsalicylic acid) fluid retention and portal compensate for the lung
HTN failure and decrease of
• Aspirin
oxygenation
• Four As of aspirin Body weakness → But in the long term,
o Antiplatelet aggregate bradycardia will occur
o Antipyretic Anorexia d/t fatigue and will stop
o Analgesic
o Anti-inflammatory → Nausea d/t bloating→
• Given for pain and swelling ↓appetite to eat that
• Side Effect results to anorexia and
o WOF: s/sx of bleeding body weakness
→ Corticosteroids
• To relieve carditis (inflammation) Diagnostics
→ Chest x-ray- (+) cardiomegaly d/t overworking
HEART FAILURE → 2D echo- hypokinetic heart (slow contraction of the
→ A condition where the heart fails to contract to pump heart that will present in the latter stages)
blood out of the heart → Pulse oximetry- decreased O2 saturation d/t decrease
→ Insufficient ↓CO to oxygenate the different organs in tissue perfusion
→ Has two types: RSHF (right-sided) and LSHF (left- → PCWP (pulmonary capillary wedge pressure)
sided) • Measures the pressure in the left side of the heart
• RSHF- manifestations is systemic • Determines LSHF
• LSHF- manifestations are pulmonary → CVP (central venous pressure)
→ Concept of backflow: • Connected to the RA, therefore, measures
• Damaged left ventricle → blood goes back to the pressure in the right side of the heart
left atrium → lungs → lung manifestations (LSHF) • Determines RSHF
• Damaged right ventricle → right atrium → goes
back to system → systemic manifestations (RSHF) Management (FAILURE)
→ Both can have edema → F- fowler’s position
• To allow maximizing lung expansion that will
Right-Sided Heart Failure Left-Sided Heart Failure enhance circulation and oxygenation
→ A- administer high O2
Symptoms are systemic in Symptoms are pulmonary in • Using venturi mask that delivers precise and
nature nature accurate oxygen delivery
→ I- inotropic drugs
Peripheral edema/ Dyspnea on exertion • Strengthens the heart’s contraction to increase
dependent/ pitting edema (+)
the cardiac output
indentation → Difficulty of breathing
especially during activity
→ L-Lanoxin or digoxin
→ D/t fluid retention, blood
is not circulating well→ Digoxin toxicity
fluids are also not N- nausea
properly circulated→ A- anorexia
extravasation→ edema V- visual disturbances (halos) and vomiting
D- diarrhea
Weight gain d/t fluid Orthopnea A- abdominal cramps
retention
→ Difficulty of breathing If one or two appear, stop administration, and digibind
especially in a lying (digoxin immune fab) will be given as an antidote to digoxin
position→ when lying toxicity
down, lung expansion is
not maximal
→ Should be placed on a → U- urine output and intake monitoring
semi-fowler’s position • D/t fluid retention
→ R- record daily weight
Distended neck veins (JVD) Crackles or rales d/t fluid • To determine if edema worsens
→ The pressure in the right retention
• Same time, clothes, weighing scale, and patient
 • Done early in the morning • Large-brimmed hats
→ E- edminister diuretics (LOL PINILIT) • Sun visors
• To decrease retained excess fluids in the body → Polymorphous rash
• To relieve pulmonary edema • Rashes of different shapes
• This is d/t inflamed vessels that can rupture and
Management for Heart Failure: LISENSYA
extravasate in the skin
→ Lanoxin/digoxin (maximize cardiac output) → Palmar desquamation
→ Inotropic drug • Only localized in the palms
→ Set at bedside: digibind/digoxin immune fab • Shedding of skin on the palms
→ Elevate head of the bed to maximize lung expansion • The blood vessels in the hands are small,
(semi-fowler's position) inflammation will decrease circulation in the hands
→ Note I and O causing the death of cells in the hand leading to
→ Same time, clothes, weighing scale, patient (weight shedding
monitoring)
→ Yes to venturi mask (accurate oxygen delivery) Diagnostics
→ Administer high O2 → Elevated ESR
• This is always elevated when there is inflammation
(multisystemic vasculitis)
KAWASAKI DISEASE
→ Very common in children especially in the newborn
Management
→ Involves two disease conditions:
→ Immunoglobulins to enhance and activate the immune
• Mucocutaneous lymph node syndrome- response
affectation of the immune system
• Children with Kawasaki disease have weak
• Multisystemic vasculitis- inflammation of the blood immune systems
vessels specifically affecting the cardiovascular
→ Aspirin
system
• Low dose only
• To address high spiking fever, inflammation, and
Manifestations
serves as an analgesic
→ High spiking fever d/t affectation of the lymph nodes
→ Clear liquid diet
that alters the immune system (erratic)
• To allow monitoring bleeding in the stools
• A sharp increase in temperature
• Avoid dark-colored foods
• The hypothalamus is having difficulties in
• Clear liquids do not contain milk and are
regulating the temperature
determined according to opacity to light
→ Strawberry red tongue (pathognomonic sign)
o If light passes through it, it is considered a
• D/t multisystemic vasculitis
clear liquid
• The tongue is rich in blood vessels
→ CPR
• Children tend to develop coronary artery
diseases→ at risk for cardiac arrest

GASTROINTESTINAL DISORDERS
→ Cephalocaudal (mouth to anus)

CLEFT LIP AND CLEFT PALATE

→ Photophobia/ photosensitivity
→ They have the same manifestations
• The retina is composed of the minute blood
→ Both are congenital
vessels
• Dark-colored glasses are advised to be worn
CLEFT LIP CLEFT PALATE

MANIFESTATION
Tuwid magsalita

→ aka Ngongo
→ Has speech problems
→ If palate is open → tongue cannot articulate well
(walang tinatamaan yung tongue sa ibabaw na
portion ng bibig)
→ It can also manifest when cleft lip + cleft palate
happens

Deformity/Alteration in appearance
PROBLEM
 Heredity: Transferred genetically; balanced translocation of genes
CAUSE

Maternal smoking → CO2 will go up with the hemoglobin receptor sites → normally hemoglobin carries O2
PROBLEM IN (O2 are nutrients for the fetus) → if CO2 binds to the receptors, it would yield carboxyhemoglobin → O2
PREGNANCY cannot bind anymore → lesser oxygen → lesser development of the baby → deformities in the lip and/or
palate

COMMON ON Males/Lalaki (Lip) Females/Pemales (Palate)

GENDER GROUP

→ Difficulty of Feeding
→ Risk for Aspiration
PROBLEM → Risk for Infection
• URTI (Upper Respiratory Tract Infection) → risk for aspiration → food aspirated in the lung
structure → inflammatory response activated → infection sets in

Should have a lot of patience

Don’t laugh at them (it would decrease their self-esteem)

Provide with large nipples (synthetic nipples)
→ The larger the nipple the easier/stronger they can
suction
→ If small nipple, milk will spill from the mouth
→ Cross cut nipples depends on the strength of
NURSING
RESPONSIBILITIES
suction of the infant, also matters with age
Training cup (made up of rubber) or medicine
dropper
→ More precise and therefore delivers accurate
fluid flow
→ Less likely for the baby to be aspirated
→ If cup and medicine dropper both appears in
the choices, look for the age:
• 3 months or <1 yr old → use medicine
dropper
• >1 year old - cup → because it is more
sufficient to the baby’s needs

→ If not severe, pacifier can be used

• Make sure there is no fluid retention in the mouth because this might put the child at risk for aspiration

Cheiloplasty Palatoplasty
→ Rule of 10 - should be accomplished to undergo Surgical repair of the cleft palate
Cheiloplasty → Rule:
• 10 weeks • Not too early → if early → surgical site might
• 10 lbs reopen d.t growth of the baby
• 10k WBC • Not too late → speech problems had already
SURGERY
• 10g/dL Hgb occurred
• 18-24 months → before 2 years old
because the child is starting to learn to
speak; hence, if the surgery is done within
this period, speech problems will be
prevented.

→ Turn to unaffected side → Side-lying (<2 yrs old)

→ Prone position (>2 yrs old)
POST-OP
• To drain secretions and bleeding out of the
POSITIONING
mouth
→ Frequent swallowing → sign of bleeding

GASTROESOPHAGEAL REFLUX DISEASE (GERD)/CHALASIA

→ If the sphincter is incompetent, backflow of food
happens including hydrochloric acid → esophageal
lining will be damaged → chest pains → because LES
is located near the chest
→ Signs and Symptoms:
• Forceful vomiting
o Pressurized vomiting
o Sphincter has no function → backflow is
pressurized
• Heartburn (chest pain)
o d/t hydrochloric acid reflux
• Bitter taste in the mouth
o HCL acid has bitter taste
→ Problem: Incompetent LES (lower esophageal • Dysphagia (difficulty of swallowing)
sphinter/cardiac sphinter) o Occurs hand in hand with odynophagia →
• Responsible for entry of food from esophagus to because of pain, the child will have difficulty
stomach with swallowing
 • Odynophagia (painful swallowing)
o Reflux → HCL acid damages lining → painful
swallowing → d/t pain → difficulty swallowing
• Hoarseness of voice
o d/t laryngeal damage/affection
o “Hindi gagana ang chalasia kung walang
hoarse” O.O
→ Diagnostics - Barium Swallow
• Barium stays within 2 days only
o >2 days → harden → obstruction
o Primary responsible of nurse: Excrete barium
▪ Increase OFI
❖ Assess DHN based on appearance of
the patient and lab results
▪ Laxatives as ordered (with proper
assessment by the physician)
→ Management:
• Diet: low fat, high fiber
o Fats are hard to digest → stimulate vomiting
reflux/regurgitation of the infant
o Fiber enhances digestion
o Manggang hilaw → aggravates acid
▪ But does not cause GERD or hyperacidity
▪ Only a risk factor
• SFF: Small frequent feedings
o If large frequent feeding → abdominal
distention → contraction → reverse peristalsis
→ vomiting
• Avoid: GI irritants
o Especially in adolescents
▪ Spicy foods
▪ Tobacco
▪ Caffeine
▪ Alcohol (excessive)
▪ Apple and bananas → hardest to digest
• Medications:
o Antacids
o H2 Blockers “tidine”
▪ Cimetidine, Ranitidine
→ Proton Pump Inhibitors (PPI) “zole”
• Omeprazole, pantoprazole
→ HOBE: 6-8 inches during sleeping
• To prevent food regurgitation
Additional Notes:
Adult GERD
→ Adults tend to consume excessive alcohol d/t peer
pressure
→ Stress as a risk factor for GERD is more common to
occur in adults
• Stress occurs in pediatric clients d/t
malnourishment or abuse
→ Surgery:
• Nissen fundoplication
• Fredet Ramstedt/Pyloromyotomy
→ Diagnostics: Esophageal manometry
PYLORIC STENOSIS
→ Narrowing of the pyloric sphincter
• Food cannot pass → stomach distention → olive
shaped mass (distinguishing characteristic)
• Possible regurgitation
• Pyloric sphincter: responsible for gastric emptying
→ Congenital defect
→ Signs and symptoms:
• Regurgitation → possibility of laryngeal damage →
could also cause dysphagia and odynophagia
• Projectile vomiting
o Vomiting with gastric contents w/o bile
▪ Bile is seen in the intestines
❖ If bile is seen in vomitus, it indicates
an intestinal obstruction
▪ If vomiting is prolonged, bile can be seen
▪ No bile d/t narrowed sphincter
▪ Metabolic alkalosis
• No anorexia, with good appetite but with vomiting
• Weight loss
• Upper abdominal distention: Olive shaped mass
• Malnutrition and dehydration
o Malnutrition: d/t the child cannot eat well
o DHN: d/t vomiting
→ Diagnostic: Barium swallow
→ Management:
• Monitor feeding pattern
• Assess vomitus
o To check if w/ or w/o bile (greenish-yellowish)
▪ If w/ bile - intestinal obstruction
• Increase OFI
o To enhance digestion
• Prevent aspiration
o Feeding slowly
▪ If feeding is too fast → rapid distention →
contraction → vomiting
• Burp frequently
o To prevent gas formation
▪ (+) stenosis → gas cannot exit the body
→ encourage burping
o Stimulate burping by positioning or tapping
the back
• High-Fowler’s Position
o Prevent vomiting
• Diet: any food that causes digestion
o Avoid gas forming foods → causes abdominal
digestion and colic
• Surgery: Pyloromyotomy
o Cutting the muscle layer of the pyloric
sphincter
o Incision that splits the obstruction
▪ Open → food can pass through (the child
can now eat 🎶 epples and benenes 🎶)
 → Diagnostics:
• Bowel Biopsy: obtaining the actual tissue
o Findings: Flat mucosal surface with
hyperplastic villous atrophy
▪ If a tissue/villi atrophies (not
developed/dysfunctional) → doesn’t carry
out its ability to absorb gluten
(malabsorption of gluten)
o Confirmatory test
• Elevated IgA and IgG
o Congenital disease → autoimmune
complication → elevation for IgA and IgG
→ Management:
• Avoid foods with gluten, such as: (BROW)
o Barley
o Rye
o Oats
o Wheat
o (X) commercially prepared cakes and breads
CELIAC DISEASE/CELIAC SPRUE/GLUTEN SENSITIVE • Allowed foods, such as:
ENTEROPATHY o Meat
o Eggs
o Milk products (milk, cheese, cream)
o All fruits and vegetables (🎶 apples and
bananas🎶)
o Rice, Corn, Cornflakes

Additional Notes: Lactose intolerant

→ AVOID: milk, eggs and milk products

• In a birthday party, bring own cake (gluten-free)

o Children anticipates cake but these are
commercially prepared which contains gluten
:<
• Gluten-free diet FOR LIFE
• Allow the child to vomit and have diarrhea
→ Problem: Malabsorption of gluten o To excrete the gluten (compensation)
• Intake of gluten → Body cannot process gluten → o (x) antidiarrheals, antiemetics
body will compensate → gluten will be forced to o If signs and symptoms became severe,
exit the body antidiarrheals may be given
→ Irreversible/Incurable but easily manageable o Supportive fluids during vomiting episodes:
→ Congenital ▪ Check electrolytes first before giving
• Elevated IgA and IgG drinks such as gatorade / pocari sweat
→ Signs and symptoms: it occurs once the child has ▪ Some electrolytes may be retained → inc
eaten gluten-containing food/s of electrolytes → imbalance
• Acute diarrhea ▪ (❌) erceflora (✅) pedialyte
o Characteristics: Steatorrhea → fats are not ▪ ORS → for electrolyte imbalance
emulsified → lipase did not perform its
function HIRSCHSPRUNG'S DISEASE
▪ FFF (foul fatty feces)
• Anorexia
• Vomiting
o As compensatory mechanism to excrete
gluten
• Severe abdominal distention
o Body cannot process gluten → gas formation
→ abdominal distention
• Body wasting (pumapayat)
o AKA Cachexia/johnis octubris 💀
o Gluten is needed → to develop muscles
• Retarded growth
o AKA archieris alvized
o Gluten is needed for muscle building → → Megacolon / Aganglionic / Ribbon-like Stools
malabsorption of gluten → slows growth and → AKA Congenital Aganglionic Megacolon
development → Cause: Absence of ganglion → the affected part of the
• Failure to thrive intestine has no peristalsis → accumulation of feces →
o Delayed development intestinal distention → megacolon → forceful
o AKA ejnis flaminianonosis
 contraction happens d/t stretch → feces has no shape • Descending
(pellet-like stool) o Proximal to the anus
• Ganglions - cells/nerves responsible for peristalsis o Solid in nature
→ Problem: Failure to pass meconium for the first 24-48 o With odor
hours o Needs irrigation: NSS (depending on the
• Imperforated anus or hirschsprung disease electrolyte levels, other solutions may also be
→ Diagnostics: used; hypotonic, hypertonic)
• Barium enema o Continuous appliance of the bag:
o Findings: megacolon ▪ YES, because pediatric clients has no
• Rectal biopsy control in bowel
o Findings: absence of ganglionic cells ▪ For adults, not necessary, because the
o Confirmatory test patient has control and therefore can put
→ Pathognomonic Sign: Meconium/Stool - Ribbon like the bag when they feel the urge to move
stool bowels
→ Management: → Assess the Characteristics of the Stoma:
• Surgery: Swenson Pullthrough with temporary • Color:
Colostomy o Normal: pinkish
o Brick red/cyanotic
▪ Notify the physician!
▪ d/t lack of circulation → gangrene
formation → infection
• Moist:
o Normal: Moist
o If dry: the child is dehydrated (insensible water
loss)
▪ Notify the physician!
• Elevated/Protruded
o Normal: slightly protruded
o If depressed, the ostomy not healing
▪ Notify the physician!
→ Avoid foods that can obstruct the stoma:
• Gas forming foods (cabbage, sweet potato)
• Seeds
→ Foods to allow: SPYB
• Spinach
• Parsley
• Yogurt
• Broccoli
→ 🏊 The client can swim
• It is the only non-contact sport that develops the
abdominal muscles
o End to end anastomosis → aganglionic part is o Developing abdominal muscles → faster
only removed and the remaining parts are healing
reconnected (cut cut reconnect) • The bag will not leak, as long as it is properly
o With temporary colostomy to facilitate the placed and sealed
recovery of the stoma → Stool softeners
o Inflammatory response is activated when both • To prevent obstruction
sides of the aganglionic colon is cut → if both
are connected immediately while it is INTUSSUSCEPTION
inflammed → there will be gangrene formation
→ no wound healing / recovery → one side is
connected to the stoma → the other is still in
the abdominal cavity → (X) inflammation in 1-
3 months maximum of 6 months recovery →
that is the time to reconnect → normal
pooping activity
→ Colostomy care:
• Habang lumalapit sa pwet bumabaho/tumitigas
ang poop
• Ascending
o Stool is liquid in nature without odor (kasi
malayo sa pwet)
o Irrigation (NSS) is not needed because stool is
liquid → less likely for obstruction/s to happen → Telescoping of the colon → obstruction → intestinal
o Continuous appliance of the bag: distention → sausage-shaped mass
▪ YES, since the stool is liquid, there is → Could be congenital and or acquired later on
continuous flow of stool → Location affected: Descending colon
• Transverse → Signs and Symptoms:
o Stool is mushy in nature with slight odor • Colicky pain
 o Gas-formed pain Manifestations
o Kabag → Barking seal-like cough (pathognomonic sign)
• Pathognomonic/Hallmark Sign: Sausage-shaped → Inspiratory stridor (constriction of the upper airways)-
mass and Currant Jelly-like Stool (bloody mucoid passage of air through narrowed airways
stool) → Dyspnea
• Bile-stained fecal emesis → Cyanosis d/t ineffective tissue perfusion
o Vomit with stool and bile d/t intestinal → Low grade or no fever
obstruction (pressurized) • The virus causes low-grade fever
• Dance Sign: d/t obstruction → there would be → WOF: drooling/grunting
rhythmic contractions or increase peristalsis in the • If (+) drooling/grunting this may indicate
proximal area → high pitched bowel sounds respiratory distress syndrome/epiglottis/
→ Diagnostics: bronchospasms (an emergency situation) if not
• Barium Enema addressed this will lead to total closure of the
o Introduction of barium → area of obstruction airways
→ determines sausage-shaped mass
• Guaiac’s test Management
o Test for occult blood → Increase humidity in the room
▪ Hidden blood in the stool • Through the use of cool mist (mixed with the
o Considerations: humidifier) for easier respiration
▪ 24 - 48 hours before the procedure, dark- → Inhale cool night air and warm bathroom air
colored foods and vitamin c should not be • Cool night air can bring comfort to breathing
taken • Warm bathroom air will cause bronchodilation and
▪ Avoid dark colored food: will open the airways
❖ Dark colored food → Black tarry stool → Tracheostomy set should always be at the bedside
→ masks the bleeding → blue ring • Anytime the airways may close, the only
will not be identified → false (+) result management to address the child is to create a
▪ Avoid vitamin C rich food: tracheostomy
❖ Normal: Hydrogen peroxide is used in • Time is of the essence!
guaiac test → formation of blue ring
→ indicative of bleeding Medical Management
❖ Vit. C oxidizes the hydrogen peroxide → Antibiotics and antivirals
→ blue ring will not form → bleeding • Antibiotics are given for prophylaxis and
will not be identified → false (-) result complications caused by croup (susceptible for
→ Nursing Care/Management: infections)
• Auscultate bowel sounds • E.g., aspiration- pneumonia
o High pitched bowel sounds d/t increased • Antivirals: -vir
peristalsis → Bronchodilators
• Assess for abdominal distention • To dilate the bronchioles (open the airway) to
o Presence of gas formation → abdominal enhance oxygenation
distention • Side effect: tachycardia
• NGT insertion: functions are: FID Me o Never give with caffeine-containing products
o Feeding (cause dysrhythmias)
o Irrigation
o Decompression - used as management for CYSTIC FIBROSIS
intussusception
o Medications
• Increase OFI
o Minimize obstruction
o Hasten digestion
→ Surgery: Swenson pull through

RESPIRATORY DISORDERS

CROUP (LARYNGOTRACHEOBRONCHITIS)
→ Narrowing of the areas d/t viral inflammation; self-
limiting
→ Priority: airway
→ Blockage of the exocrine glands d/t mucus
obstruction
→ Organs affected:
• Lungs, pancreas, intestines, and sweat glands
• When the organs are wrapped with mucus, it loses
their functions

Manifestations
→ Dyspnea/ DOB
→ Pancreatitis (which makes cystic fibrosis deadly;
Pancreas is covered with mucus → pancreatic
leakage → pancreatitis)
→ Meconium ileus- meconium is retained in the ileum • Common allergens:
and has not moved d/t decreased peristalsis d/t o Pollen
blocking o Molds
• Ileum is covered with mucus → no peristalsis → o Dust
feces accumulate in the ileum → meconium o Weeds (seaweeds - rich in iodine e.g., iodized
remains in the ileum salt)
→ Increase salty sweat d/t clogged sweat glands ▪ Iodine is a common allergen
• Cystic fibrosis is the only condition that can cause o Pet danders - pet fur
this o Eggs - has albumin
▪ Albumin is a common allergen
Diagnostics o Seafoods
→ Sweat chloride test- ↑chloride levels in the sweat → Factors that causes exacerbation of asthma:
• Sweat naturally has sodium and it comes out with • Air pollutants
sweat, with the addition and increase of chloride in • Cold heat weather changes
the sweat→ Na+Cl→ salty sweat • Strong odors (perfume, smoke)
• White crystals in sweat: normal sodium • Extreme emotions
• Sweat glands → semi porous membranes → → Signs and Symptoms
selectively permeable → clogged → excretes, • Wheezes: expiratory
which it doesn’t normally do o During an asthmatic attack → if there’s
absence/decrease of wheezing (A DANGER
Management SIGN!) → represents complete obstruction of
→ CPT (chest physiotherapy) to address dyspnea the airway → Status Asthmaticus
• Percussion, vibration, postural drainage ▪ During emergency: Administer
• Done to loosen the retained secretions in the bronchodilators, corticosteroids,
lungs epinephrine, opening of airway
• Postural drainage uses gravity to expectorate (tracheostomy)
mucus (head is lower than the extremities) → Management:
• Done before meals, on an empty stomach to • Bronchodilators
prevent vomiting or 2 hours after meals (food is • Corticosteroids
already in the intestines) o For inflammatory responses
o Combi Drugs are now used (Bronchodilators
Medical Management + Corticosteroids)
→ Pancreatic enzymes • O2 therapy
• For digestion, because the pancreas is blocked → Avoid Allergens (best way to prevent asthma)
• Given with meals, never give it without meals as it
may cause autodigestion of the pancreas and
ulcerations
• Never double the dosage as it can also lead to
autodigestion
• Pancreatic Enzymes:
o Amylase - digests CHO
o Lipase - digests fats
o Trypsin - digests proteins (CHON)

ASTHMA

→ Most common childhood illness

→ Reversible (if no allergens, no asthma)
→ Can be inherited
→ Hika
→ Cause: Allergens - substances that causes allergic
reactions
• Presence of allergens → hyper responsiveness
(severe allergic reaction) → bronchospasms
(dangerous - might cause complete closure of
airway)
 NORMAL PEDIA
→ Growth and development theories
→ The age of the child is important to determine milestones

Erikson Freud Piaget Kohlberg

Age
(Psychosocial) (Psychosexual) (Cognitive stages of development) (Moral development)

Infant (0-18 Trust vs. mistrust Oral stage, the center Sensorimotor
months/ 0-12 So long as you give of gratification is the
months) the needs: food, mouth Learning through the sense
warmth, care trust
will be developed Breastfeeding, Toys given should be toys that would
teethers, pacifiers stimulate the senses (mobile toys,
lighting toys)
(+) risk for aspiration
because everything is
put in the mouth

Fear: stranger anxiety, those who are unfamiliar to them will stimulate fear

Play: solitary play (plays alone) since they are still in the sensorimotor stage, they learn still through the senses

Toddler (18 Autonomy vs. shame Anal stage, the center Preoperational Preconventional
months- 3 and doubt of gratification is the
years old) anus Egocentric, inability to understand the Punishment and
Offer the child point of view of others obedience
choices Most important is the
toilet training Best punishment and
obedience: timeout
Criteria for (remove all stimuli from
readiness for toilet the child)
training:
1. Can sit and squat Place the child in a non-
2. Ability to remain stimulating environment
dry for about 2 hours (face the wall)
3. Ability to verbalize
the need to defecate Rule: should be timed (1
and urinate minute per year of age)
4. Show willingness e.g., The child is 3 y.o.,
to please parents face the wall for 3
5. They want to minutes
immediately change
their soiled diapers

Fear: separation anxiety, they do not want to be separated from their guardians or parents

Play: parallel play (side-by-side play), two kids play side by side but does not play with one another, no sharing or interaction this will
cause fights because both of them are autonomous

Preschooler Initiative vs. guilt Phallic stage→ Preoperational (Highest imagination, Preconventional
(3-6 years complexes can understand symbols/
old): symbolizations) Still egocentric
1. Oedipal- the baby E.g., leaves are imagined as money
boy is close to the
mother
2. Elektra- the baby
first is close to the
father

Loves the opposite-

sex parent, but hates
the same-sex parent

Fear: body mutilation (scared of being injured or wounded)

Play: associative/ cooperative play (plays of children are related with one another) E.g., role-playing, make-believe plays

School-age Industry vs. inferiority Latent stage (same- Concrete operational Conventional (believes
(6-12 years sex orientation- in authority)
old) boys vs girls, no Understand the theory of conservation
mixing of sexes) and reversibility

Conservation- being able to conserve

means knowing that a quantity doesn't
change if it's been altered (by being
 stretched, cut, elongated, spread out,
shrunk, poured, etc.)

Reversibility- reverses a sequence of

events or restores a changed state of
affairs to the original condition. It is
exemplified by the ability to realize that
a glass of milk poured into a bottle can
be poured back into the glass and
remain unchanged

Fear: death, they know that death is irreversible and it is final

Play: competitive play (more on indoors- board games, a little on sports)

Adolescent Identity vs. role Genital stage (sexual Formal operational Post conventional
(12-18 years confusion curiosity)
old) Already hypothetical, can rationalize Already knows morals,
Body image is Unwanted, laws, and is already
important at this unexpected responsible
stage pregnancies usually
occur here Knows what is good and
what is bad

Fear: rejection, that is why body image is the focus, peer pressure usually occurs here (nakikisama)

Play: interactive/ competitive (more on outdoors- sports)