Pediate

TAKE IT EASY
 Pediatric Nursing
7/27/ v3 Abnormalities 6 .

Diplopia
:
double vision due to ICP ,

Approach Cephalocandal ↑ IC + ↑ 1OP

:

NEUROLOGIC DISORDERS 7
.
Pupillary changes
·
Increased IP Normal : PERRLA pupil equally round Preactive to

pressure located in the cranium light and acomodation

:

ILP anisocora-uneven pupils : brain

damage
:
Normal
5-15mmHg
·

Life-threatening : To ·
dilated-pt is
undergoing shock

Cushing's Triad-Hyperbradybrady ·
constricted -

pt is undergoing narcotic overdose

x Hypertension Bradynea . Sunset

8
eyes
x Bradycardia 9 . Anorexia

Widenedpulse pressure 10
. Nausea

difference between
diastolic 11. Weight loss
systolic &
Normal pulse pressure : 30-40 12
. Seizures

SAS
C↑ neuronal impulses erraticMission seizure
1 . Bulging fontanel :
aggravated by crying L Vomit A fluid- PNF temp
convulsions
(size)

f
Anterior . ; closes at 12-18 months MANAGEMENT

Posterior f . Ai closes at 2-3 months ·

Position : SEMI FOWLER'S -
↓IP : the use of gravity

Early signs of 2 .
High pitched cry Where sodium
goes .
·
Coughing & sneezing is avoided

↑ ICP/ age grp

↳ early signs of ICP water follows. · Limit fluid intake 1 , 200-1 , 500m//day
Infant - Increased
.
3 head circumference ↑ fluid = ↑ I .
Pharmacotherapy
Mannitol Cosmotic)-pullingere-generalized
Child ↳ the bigger ,
the IP ↑ Diuretics : Lasix Hoop) -
localized

initability bedside to G both potassium wasting

tape are
-

on measure
-

, .

agitation measure head circumference

monitor for hypokalemia
Cerebral
Adult ↑ Decadron
every shift
Dexamethasone to prevent
↑ stress :
edema

-
restlessness 4 Headache ↑ hydrochloric
=
Anticonvulsants : minimize seizure ourence
.
avid Clow dose

Geria & initial sign of F ILP L can cause Antacids

: neutralize acidity in the stomach
adv diarrhea
ulceration Magnesium :

confusion 5 .

Projectile vomiting Aluminum : adv constipation

: forceful vomiting due to the PTT :
partial Anticoagulation :
prevents dumping of blood
thromboplastin time
Heparin : I so
. i check PTT

compression of medulla PT prothrombin time

:

Warfarin : oral ; Check PT

CTZ :
Chemoreceptor trigger zone ; REMEMBER : Opiates and
sedatives are
- -

center contraindicated in A ICP ;

vomiting
will lead to
resp cardial depression
 I
do this !
you can

you're halfway there

,

registered nurse

SEIZURE DISORDER

EPILEPSY last resort -

↓ Valproates : Valproic avid

: erratic transmission of electric impulses ·

Lepatotoxicity
: neural tube
that will lead to spasms NTD
in NTD
never
given
·

defect pregnancy , can cause

# ES Surgery
Grand Mal-generalized X Neurectomy surgical
:
resection of the cranial

·
tonic (mild)-clonic (severe nerve involve in the seizure

during dyspnea
:
, salivation ,
urination HEAD TRAUMA
management
FOB / supine protect the head Concussion :
jarring of the brain forceful contact
position :
·
post intal : after in a rigid skull; transient loss of consciousness
management
side lying/recovery bruising/Contussion : structural alteration characterized by
position
J
:

Petite Mal-absent scizure bukol extravasation of blood

blank facial expression automatism lip smacking

,
,
MANAGEMENT
:
car seat
Jacksonian Safety : bike helmets seat belts. safe
,
driving ,
proper
>3 ylo front facing
tonic-conic of a
grp of muscle- grand
mal Le y /o rear
facing usage of infant car seat

to support spine
common in adult -
Psychomotor Assess for cerebral functioning : GCS ,
PERRLA

mental clouding/intoxication REMEMBER most important prognostic indicator LOC -

due to under
Febrile ↑ LOL F chance=
Assess for cervical injury
developed
hypothalamus under 5 ; 38 5 + 39-* 4/0 %
.
of recovery (+> immobilize

Status Epilepticus
() HOBE 30 °
to ↓ ICP (gravity
would last 30 mins i can lead to BACTERIAL MENINGITIS

brain damage ; EMERGENCY :

always
-
= permanent effects

MANAGEMENT : infection of meninges

main
management Pharmacotherapy ↳supports nourishes the brain

T not all
drugs = Hydantoins : Phenytoin ,
watch out for DIAGNOSTICS : Lumbar Puncture : CSF analysis
can control seizure; GINGIVAL HYPERPLASIA ; Use soft ↳ L3 L4 L5
.
. ; POSITION :
C-shape , fetal,

surgery next option bristled toothbrush ,

meticulous oral care
. genupectoral aka knee chest

WOF pinkish red urine , inform the so

Normal : Clear CSF infection
F WBL
CHON : by Products analysis Meningitis : OUDY CSF
Benzodiazepines : minimize seizure episodes CSF CHON
of
↑ shorten acteria
↓ Imino stilbenes
:
carbamazepine for causative agent
: Neisseria meningitides

retractory seizures , to prevent

Seizure rocurence
 6 mos-birth wt
must be double
12mos-bw must
Poor weight gain
SOS
·

be tripled
in the
pain
Kernig's flex the Knee= hamstring.
back , neck
=
(+ ·
Irritability due to cerebral hypoxia
pathognomonic Hex the pain in the
signs Brudzinki's :
atok
=
neck back
= (t) MANAGEMENT

Nuchal rigidity : stiff neck DOC : Indomethacin : facilitates closure of PDA

Seizures : altered neuronal impulses Acyanotic - SEPTAL DEFECT

taas and
Opisthotonus arching of the
: back Atrial Septal Detect can
pass from
butas

Cside-lying position
baba any JR to left who even

butay Ventricular Septal Defect passing the lungs

MANAGEMENT S& S
DOL :

Antibiotics - depends on the physicians

·
Fatigue , that can lead to poor feeding
DURATION of
NISH drug to prevent
·
Dyspnea on exertion - activity intolerance .

DRUG RESISTANCE
· Failure to thrive
I delayed milestones
CARDIOVASCULAR DISORDERS
long term - 5S of heart failure (tissue perfusion)
the heart
Layers of
endocardium : innermost
MANAGEMENT

:
myocardium : muscle , responsible for contraction and Dacron Patch by pass surgery

I
more favorable
output : ↑ rejection rate
cardian
to use--tissue
foreign body ↑ rejection rate
pericardium : outer most
plastic :

pericardial fluid insideabody

-

L visceral : inner
pericardial
-

prevents friction rub in between

pericardial span-A fluid Ayanoti-COARTATION Of AORTA

parietal : outer
:
narrowing of aorta (Common : descending) ;
aorta
Chambers of the heart

pressure , output
↑
Normal : One
way How O

2 way-regurgitation SAS
Lower
vascular Upper
problems Extremities

# /P ES BP increased decreased
One
↑ rib notching Pulse bounding weak/absent
Acyanotic absence of Cyanosis ; problem
,

F narrowing of
Cyanotic presence of cyanosis ; twoormorwe aorta Rib notching-older child
Acyanotic-PATENT DULTUS ARTERIOUS (PDA)
↳ one problem
only : ductus arteriosus remained open
S &S

like : hallmark
·
Machinery murmur

· JOS of heart failure

· Poor feeding due to fatigue (bloodismixedita b

 MANAGEMENT Surgery
x Palliative : relieves SeS GOAL : Oxy > unoxy
Surgery Coronary Steating ;
:
Stent-scaffold to , Balloon Angioplasty
, ,

support blood vessels.

↳ made of mesh repair the aorta by the using of balloon stabilize pt
Shunt : anastomosis of pulmo
Blalock Tausig
Canotic-TETRALOGY
·

Of FALLOT

↑ unoxy artery and aorta by the use of subdavian

Four problems :
,

blood artery
Curative : cures the condition
LAM Si
·
Pulmonary Stenosis : narrowing of the pulmonary area
<

Echo-Boot
L
shape Ventricular Intracardiac surgery also brocks procedure
R Hypertrophy
·
.
neart
PS
·
Overriding of Aorta : anatomical defect
* Balloon angioplasty 1+
RV/

· Ventricular Septal Defect * Dacron Patch <VSD A

Questions :

What is the
primary problem
? Pulmonary Stenosis
4
2 .
What is the compensatory mechanism? RVA

What allows mixing of blood ? Overriding of #

.
3 Aorta
-o
somehow relieves the -
4. What keeps the pt alive ? VID :
pressure from ventricle
R -
-

JAS

Cyanosis (blue babies) ineffective

·
tissue

> oxygenated
o
unoxygenated
:
perfusion

-
blood

·
squatting
decrease Venous return - deccardian cardian
blood the vital organs
conserve oxygenated in

Pathognomonic
sign-Tet spells :
grp of SPS that represents Oxygenation

> Blackout s
>
Irritability

Pallor < Convulsions

·
Cardiomegaly

Clubbing
: spoon-shaped fingernails ; represents
danger
sign L Chronic
~ hypoxia

·
Pansystolic murmur

MANAGEMENT

Allow the child to squat : compensatory mechanism

,

way of the
child of regulating their own
activity
 Cyanotic TRANSPOSITION of the GREAT ARTERIES
Minor Symptoms (vague /general SPS)
· low grade fever
Mechanism :

· arthralgia : painful joint J swelling

RV is connected to aorta -

any strep = ↑ ASO

connected to Titer
· ASO titer (anti streptolysin O fiter)
LV is pulmonary artery infection

PDA : keeps the pt alive by

·
inflammatory markers
allowing mixing
↳ C-reactive CHON , ESR
Cerythrocyte
of blood

sedimentation rate)
SDS
MANAGEMENT
Severe respiratory depression
Phamacotherapy
Cyanosis
> DOC : Penicillin (5-10 days) ; finish duration to
Failure to thrive
prevent drug resistance
Easy fatique
Allergy Erythromycin/Clindamycin
If :
No murmur

↓ Exacerbation & Remission : treatment is continued

MANAGEMENT

up to 10 years
E PDA
Prostaglandin
:
keep open

x Salicylates CASA) :
pain and swelling
delay= ↓ prognosis Surgery first
: Arterial switch done during the

heart
As of Aspirin
week of life
I a
beating
of aspirin
·
Analgesie ·
Antiplatelet-monitor bleeding
[
use
INFECTIOUS HEART DISEASES Analgesic
in RHF : Anti ·
Anti-inflammatory
· Antipyretic
RHEMATIC HEART FEVER intla
Corticostenoids :
relieves carditis
also causes sure cause
:
Grp A Betahemolytic Streptococcus anti-inflammatory >
HEART FAILURE
throat acute
,
glome -
Jones Criteria to confirm RHF
: insufficient cardiac output
+ Hx
rulonephritis > 2
major
2 minor + Right Sided Heart Failure : systemic manifestation
I major + X

pulmonary manifestation
:
Lett Sided Heart Failure
Major Symptoms
·
Carditis : inflammation of the heart
REMEMBER concept of backflow
·
Polyarthritis : inflammation of various joints

· Chorea : St. Vitus Dance ; worm like movements

· SQ nodules (bony prominence : Knuckles Knee elbows

.
,

redness(rashes .
Erythema marginatur (trunk)
 SAS IInotropic Drugs
:
strengthen heart contraction ;

LSHF : pulmonary goal :

↑ cardiac output
RSHF : systemic
Inotropic
A
LAR have fluid retention ·
edema (dependent .
odyspnea on exertion
Antidote Digibind/Lanoxin/Digoxin
:
: check for digoxin toxicity
Digoxin immune Fab
pitting peripheral)
,
·Orthoped : difficulty before administering
Digoxin Toxicity Nausea Visual disturbances/Diarrhea
·
weight gain breathing when lying NAVVDA Anorexia Abd
Womiting cramps
distended neck veins down Urine and intake
output monitoring
·

time weighing scale

(JVD) · crackles/rales :
Record daily wt : SAME clothes patient
·
hepatomegaly veragement retention of fluid in Edminister diuretics
↑
pressure
C portal HPN : the lungs KANSAKI DISEASE
portal vein

Exesophageal varices ·
Cough Mucocutaneous Lymph Node Syndrome
Ux ascites : altered immune response

↳ hemorrhoids Multisystemic Vasculitis

Both
RSHF
·
body weakness and Tachycardia : targets or system
LSHF Cy early sign of
· anorexia
heart failure
S &S

· nausea High spiking fever

Diagnostics
:
!!
Hallmark Strawberry red tongue

Chest X-Ray : Cardiomegaly Photosensitivity/photophobia - hyperemia of conjunctiva

Echo : Hypokinetic heart (late stages) Polymorphous rash : rashes in diff shapes

< Pulse oximetry : O2 sat ( tissue perfusion Palmar desquamation

Normal 2 sat :
95-100
DIAGNOSTICS : Elevated ESR

Pulmonary capillary wedge pressure (PCWP)

:
< MANAGEMENT

measures the pressure at LS of the heart

LSHF
Immunoglobulins as ordered : enhance/stimulate
-

Normal PCWP : 4-12mmHg immune response

> Central venous pressure

(CUP) : RSHF Aspirin as ordered : 3/4 functions used
clear liqui d
Normal Cup 8-12 mmHg liquid diet : to bleeding in the stool
:
monitor
↳ opacity in the light Clear

CPR : to diseases
FAILURE -
MANAGEMENT prone coronary artery

Fowler's : to maximize lung expansion

to enhance oxygenation F gas exchange

Administer high O2 : use of venturi mask

to deliver precise and accurate flow

 GI DISORDER SPS

Cleft Lip Cleft Palate Forceful vomiting

speech problem Heartburn : chest pain due to HU aid reflux that

Males Females will lead to damage linings

carboxyhigh -

Heredity Bitter taste in the mouth : needs oral care after

G fetus 02 -

Maternal regurgitation /vomiting

smoking Dysphagia difficulty of swallowing

:

C biggest risk
partner
I Odynophagia painful swallowing
:

factor Hoarseness due to laryngeal affectation

PROBLEMS Diagnostic : Barium swallow 2 days : obstruction

difficulty of feeding =
promote excretion ; OFI & laxative as ordered

< risk for aspiration MANAGEMENT

Fat- hard to Fiber - promote
- risk for infection (URTI) digest > peristalsis
Low fat ,
high tiber diet

NURSING RESPONSIBILITIES Small frequent feedings

easier to suction -
nipples (criss-cross) Cup/medicine dropper :
Large gastric irritants Avoid spicy foods caffeine alcohol tobano
, , ,

deliver precisel Meds :

accurate flow ; rubber antacids : neutralize avids

tipped to avoid trauma H2 blockers : "tidine" blocks HCL secretion

,

SURGERY DOC-PPI : "prazole" blocks ,

H(L Secretion + Protectiveele
monitor frequent Cheiloplasty
:
rule of Palatoplasty/Palatorhapy HOBE 6-8 inches during sleep to prevent regurgitation

swallowing
= sign 10 = 10 wks 10lbs rule: not too early PYLORIC STENOSIS
, ,
·

reopen
speech
of bleeding i 10KNBL 10g/dl
, not too late
#problem
: narrowing of pyloric sphincter
,

↳> 18-24 months gastric emptying

pyloric
notify physician high sphincter
E bile : intestinal
Position : unaffected side Position : prone to prevent Obstruction : vomiting 5 bile

aspiration S&S

GERD Gastroesophageal
: Reflux Disease Vomitus : blood tinged , stomach content s bile

aa CHALASIA No anorexia ,
a good appetite
-

incompetent lower esophageal sphincter / Weight loss

Olive shape
cardian sphincter Upper abdominal distention : mass

Visible peristaltic movement from L to R

Malnutrition & Dehydration

nagtatae: acidosis Prone to metabolic alkalosis MANAGEMENT

MANAGEMENT 0 atsWheat
Avoid Barley Rye. ,

all fruits & vegetables

Monitor feeding patterns Allow : meat
, eggs milk , products ,

Assess the vomitus (s bile) REMEMBER bring own cake in a party

↑ OFI Gluten-free diet : FOR UFE
-

Congenital gang-
Prevent aspiration : feed slowly HISCHSPRUNGS DISEASE
Lionic mega colon

Burp frequently manifestation : megacolon

cells
ganglion :
absence of
:
High-Fowler's to prevent regurgitation responsible for>
peristalsis
cause : aganglionic- ganglion

Surgery hallmark : ribbou like stool/pellet like stool

:
·
Pyloromyotomy incision that splits

the obstruction

CELIAC DISEASE CEUAL SPRUE

GLUTEN SENSITIVE ENTEROPATHY

inperforated anus-
: extreme sensitivity to gluten HD -
main problem: failure to pass meconium for the

: malabsorption of gluten ; irreversible but first 24-48 hours

manageable ; congenital DIAGNOSTICS : Barium enema megacolon

of ganglioni
e

JAS * Rectal biopsy : confirmatory : absence

Acute diarrhea MANAGEMENT

compensatory
mechanism [ Steatorrhea (FFF foul fatty fees)
:

Surgery

↳ Anorexia

Vomlting
Swenson pullthrough

c temporary colostomy (ave

:
end to end anastomosis

1.2 months, max le mos)

Severe abd distention due to gas formation

Colostomy care

Body Wasting :
Cachexia # Haban lumalapit sa pret BUMABAHO/UMITIGAS
Retarded growth ·
Ascending Liquid :
, s odor , no need to
irrigate ,

: delayed milestones of
Failure to thrive continuous appliance the bag

DIAGNOSTICS : Bowel biopsy confirmatory

·
Transverse : mushy , I slight odor

↳ flat mucosal surface hyperplastic

L
·
Descending : solid I odor needs
,
,
irrigation ,
villous atrophy
+ 19PIgA levels needs continuous appliance of the bag (pedial

Assess the characteristics of the stoma

· color :
pinkish ; bluish- lack of circulation,

notify physician
 notify Moist : yes ; dry-DN GERD/Chalasia
physician [ Elevated :
slightly elevated depressed/concave LES
,
incompetent
Avoidfoods that can obstruct stoma (gas forming) SOS

swimming develops
Foods to allow : forceful vomiting/regurgitation

abdominal muscle Spinach heartburn (chest pain) -lining damage

Parsley bitter taste in the mouth (oral carel

# ogurt dysphagia
Broccoli odinphagia painful swallowing
:

Stool softeners :
prevent obstruction of stoma hoarseness : laryngeal affectation

INTUSSUSCEPTION DIAGNOSTICS :

: telescoping of ; reverse
the colon peristalsis Barium swallow : barium (2 days : obstruction

HAMMARK!: sausage shape mass ↑ OFI 8 laxatives as ordered

SAS MANAGEMENT

Colicky pain :
gas formed pain (Kabag) ↓ fat * Fiber
,

Intestinal distention SFF

caffeine alcohol smoking

Jausage shape mass : pathognomonic AVOID : Spicy foods , , ,

Bile stained fecal emesis MEDS :

Hallmark Currant jelly like stool (bloody mucoid) Antacids : neutralize

acidity

; Guaiac's test "tidine" All

DIAGNOSTIC : Barium enema H2 blockers : blocks/inhibits production

GT : using hydrogen aka occult blood test : no dark colored PPI : "Prazole" inhibits HCI production + protective coating

peroxide foods -
false (t) ,
no vitamin C Position : HOBE 6-8 inches
during sleeping (prevent
Cabluering
+
food-false L regurgitation)
=
rich
bleeding
MANAGEMENT

Auscultate bowel sounds

Assess for abdl distention (gas formation

-

-
NOT insertion :

Ifeeding
Il rrigation

Decompression ~

Medication

↑ OFI

Surgery
Swenson pullthrough