Pediatric Nursing

Growth and Development Growth- increase in physical size of a structure or whole. -quantitative change. Two parameters of Growth 1. weight- most sensitive measure of growth, especially low birth rate. Wt doubles 6 months 3x 1yr 4x 2-2 ½ yrs 2. Height- increase by 1”/mo during 1st 6 months - average increase in ht - 1st year = 50% stoppage of ht coincide with eruption of wisdom tooth. Development- increase skills or capability to function - qualitative How to measure development 1. Observe child doing specific task. 2. Role description of child‟s progress 3. DDST- Denver development screening test. MMDST (Phil) Metro Manila Developmental Screening Test. DDST measures mental 4 main rated categories of DDST 1. Language communication 2. personal social-interaction 3. fine motor adaptive- ability to use hand movement 4. gross motor skills- large body movement maturation- same with development “readiness” Cognitive development –ability to learn and understand from experience to acquire and retain knowledge. To respond to a new situation and to solve problems. IQ test- test to determine cognitive development Mental age x 100 = IQ Chronological age Average IQ – 90-100 Gifted child- > 130 IQ

Basic Divisions of Life I. Prenatal stage from conception- birth II. Period of infancy 1. Neonatal- 1st 28 days or 1st 4 weeks of life 2. Formal infancy- 29 day – 1 year

III. Early childhood 1. Toddler – 1-3 yrs 2. Pre school 4-6 years IV. Middle childhood 1. School age- 7 – 12 yrs V. Late childhood 1. Pre adolescent 11 – 13 yrs 2. Adolescent 12 - 18 – 21 Principles of G & D 1. G&D is a continuous process -begins form conception- ends in death - womb to tomb principles 2. not all parts of the body grow at the same time or at same rate. - asynchronism

Patterns of G&D 1. )renal digestive grows rapidly during childhood circulatory musculoskeletal 2. )Neuromuscular tissue (CNS, brain, S. cord) - grow rapidly 1-2 years of life - brain achieved its adult proportion by 5 years. 3. )Lymphatic system- lymph nodes, spleen grows rapidly- infancy and childhood to provide protection -infection - tonsil adult proportion by 5 years 4. )Repro organ- grows rapidly at puberty Rates of G&D 1. fetal and infancy – most rapid G&D 2. adolescent- rapid G&D 3. toddler- slow G period 4. Toddler and preschool- alternating rapid and slow 5. school age- slower growth fetal and infancy- prone to develop anemia 3. Each child is unique 2 primary factors affecting G&D A. Heredity - R – race I – intelligence S – sex N - nationality Females are born less in weight than males by 1 oz. Females are born less in length than males by 1 inch

B. Environment Q – quality of nutrition S – socio eco. status H – health O – ordinal pos in family P – parent child relationship Eldest- skillful in language and social skills Younger- toilet trained self 4.G&D occurs in a regular direction reflecting a definitive and predictable patterns or trends. Directional trends- occur in a regular direction reflecting the development of neuromuscular function. These apply to physical, mental, social and emotional development and includes. a. cephalo-caudal “head to tail” - occurs along bodies long axis in which control over head, mouth and eye movements and precedes control over upper body torso and legs. b. proximo- distal “Centro distal” - progressing form center of body to extremities. c. Symmetrical- at side of body develop on same direction at same time at same rate. d. Mass specific “differentiation” - child learns form simple operations before complex function of move from a broad general pattern of behavior. To a bore refined pattern. B. Sequential- involves a predictable sequence of G&D to which the child no9rmally passes. a. locomotion- creep than crawls, sit then stand. b. socio and language skills- solitary games, parallel games C. Secular- worldwide trend of maturing earlier and growing larger as compared to succeeding generations. 5.Behavioral in the most compressive indicator of developmental status. 6. universal language of child- play 7. great deal of skill and behavior is learned by practice. Practice makes perfect. 9. neonatal reflexes us must be lost before one can proceed. -plantar reflex should disappear before baby can walk -moro reflex should disappear before baby can roll persistent primitive infantile reflexes- case of cerebral palsy

Theories of G&D Developmental tasks- different form chronological age -skill or growth responsibility arising at a particular time in the individuals life. The successful achievement of which will ------- a foundation for the accomplishments of future tasks. Theorists 1. Sigmund Freud 1856-1939 Austrian neurologists. Founder of psychoanalysis - offered personality development Psychosexual theory a.) Oral Phase 0-18 months - mouths site of gratification -activity of infant- biting, sucking crying. -why do babies suck?- enjoyment and release of tension. -provide oral stimulation even if baby was placed on NPO. -pacifier. -never discourage thumb sucking. b.) ANAL- 18 months-3 years -site of gratification- anus -activity- elimination, retention or defecation of feces make take place - principle of holding on or letting go. -mother wins or child wins -child wins- stubborn, hardheaded anti social. (anak pupu na, child holds pupu, child wins) -mother wins- obedient, kind, perfectionist, meticulous OC-anal phase -help child achieve bowel and bladder control even if child is hospitalized. c.) Phallic- 3-6 years site of gratification -genitals activity- may show exhibitionism -increase knowledge of a sexes -accept child fondling his/her own genitalia as normal exploration -answer Childs question directly. Right age to introduce sexuality – preschool d.) Latent- 7-12 years -period of suppression- no obvious development. -Childs libido or energy is diverted to more concrete type of thinking -helps child achieve (+) experience so ready to face conflict of adolescence e.) Genital- 12-18 years -site of gratification -genitals -achieve sexual maturity -learns to establish relationships with opposite sex. -give an opportunity to relate to opposite sex. ERIC ERICKSON- psychoanalysis theory - stresses important of culture and society to the development of ones personality - environment - culture stages of psychosocial a.) trust vs mistrust – 0-18 months. -foundations of all psychosocial task -to give and receive is the psychosocial theme -know to develop trust baby 1. satisfy needs on time - breastfeed 2. care must be consistent and adequate -both parents- 1st 1 year of life 3.) give an experience that will add to security- touch, eye to eye contact, soft music. b.) Autonomy vs shame and doubt 18-3 years --- independence /self gov‟t develop autonomy on toddler 1. give an opportunity of decision making like offer choices. 2. encourage to make decision rather then judge. 3. set limits c. initiative vs guilt- 4-6 years -learns how to do basic things -let explore new places and events -activity recommended- modeling clay, finger painting will enhance imagination and creativity and facilitate fine motor dev‟t

can find solutions to hypothetical problems with scientific reasoning. can deal with past present and future 3. spoon on table or drops fork) Invention of new means there mental combination 18-24 months -transitional phase to the pre operational thought period. Preoperational thought 2-7 years Schema age Behavior Preconceptual 2-4 yrs -thinking basically complete literal and static -egocentric. (sub div.learns who he/she is or what kind of person he/ she will become by adjusting to new body image and seeking emancipation form parents -freedom form parents.d. knows mom) Tertiary circular reaction 12-18 months -use trial and error to discover places and events -“ invention of new means” -capable of space and time perception (hits fork. Intimacy vs isolation 20-40 yrs -looking for a lifetime partner and career focus g. industry vs inferiority 7-12 yrs -child learns how to do things well -give short assignments and projects e.) neonate reflex 1 month All reflexes 2.cause and effect 3. -concept of amenism inanimate object is alive -not aware of concept of r3eversibility.unable to view others interrupt -concept of dying is only now -concept of distance is only as fat as they can see. . activity recommended.collecting and classifying 5. have concept of reversibility. have concept of longer uation – constancy despite of transformation. able to find solution to everyday problems which systematic reasoning. generatively vs stagnation 40. –stamps stationeries.will sort out opinions and current events. rubber band markers.) primary circular 1-4 months -Activity related to body -repetition of behavior ex. every action theories an opposite reaction or cause and effect Initiative 4-7 yrs Beginning of causation Concrete Operational thought 7-12 years 1. despair 60-65 JEAN PIAGET. thumb sucking 3.) Schema Age Behavior 1.) secondary circular reaction 4-8 months -activity not related to body -discover obj and person‟s permanence -memory traces present -anticipate familiar events. Formal Operational thought 12 and up. 2. dolls. 4. f. 1. 4.Swiss psychologists -develop reasoning power STAGES OF COGNITIVE DEVELOPMENT A-Sensory motor 0-2 yrs -“practical intelligence”. Coordination of secondary reaction 8-12 months -exhibit goal directed behavior -increase of separateness (will search of lost toy.60 45-65 yrs h. have abstract and mature thoughts.words and symbols not yet available baby communicates through senses and reflexes. 5. Cognition achieved its final form 2. ego integrity vs. Identity vs role confusion or diffusion 12-18 yrs . activity ------.

Follows internalized standards of conduct.solitary plays -solo.stranger anxiety begin 6-7 months peak 8 months diminishes 9 months 1 month. DEV‟T MILESTONES-major markers of growth and dev‟t 1. rattle b.) Play. rules satisfying.universal language of child-play a. 10-12 4 -Maintenance of social order fixed rules and authority.important age appropriate solitary play. E.holds head and chest up when prone follows obj. hand to hand -likes obj that are good size 8 months. 6 Universal ethical principle orientation. Carries out action to satisfy own needs rather than society. pat a cake . prereligious. music Followers standards of society. Conventional Level 7-10 3 -Orientation to interpersonal relations of mutuality.) fear of infancy. Post-conventional Level III Above 12 yrs 5 -Social contract. “oh” -handles bottle well 7 months.reaches out in anticipatory of being picked up -sits with support -uses palmar grasp -eruption of 1st temp teeth 6-8 months 2 lower incisors -say vowel sounds “ah”.t Stages of Moral dev‟t Infancy – premoral. Child followers rules cause of a need to be a “good” person in own eyes and eyes of others. Follows rules of authority figures.combine 2 syllables “mama” and “papa” . amoral stage AGE STAGE DESCRIPTION Pre-conventional Level 1 2-3 yrs 1 -Punishment/ obedience oriented (heteronymous morality) child does right cause a parent tells him or her to and to avoid punishment 4-7 2 -Individualism.turn both ways “roll over” -teething rings -handles rattle well -moro reflex disappears ( 4-5 months) 6 months. past midline grasp and tonic neck reflex fading hand regard (looks at hand) 4 months – turns form front to back head control complete needs space to turn Laugh aloud.needs space for creeping 10 months – pull self to stand -understands “no” -responds to own name -peak a boo.sits without support -peak of stranger anxiety -planters reflex disappears 8-9 months in prep for walking 9 months . Period of infancy. teeter.Infancy. 3 months.KOHLBERG. baby coos “doing sound” cry with tears -closure of frontal fontanel 2-3 months head lag when pulled to sitting position.recognized the theory of moral dev‟t as considered to closely approximate cognitive stages of dev‟t -sabay with cognitive dev.creeps or crawls -neat finger grasp reflex . bubbling sounds 5 months. social smile.transfer obj.holds head up when in prone. -Will do something for another if that person does something for the child. utilitarian level making perspectives. mom interactive -facilitate motor and sensory dev‟t reflex disappears looks at mobile 2 months. Child finds ff. Instrumental purpose and exch.

say when ul be back 15 months – plateau stage walks alone lateness in walking. d despair 3. pull tay. cooperate in dressing -says 2 words mama and dada -pots and pans.last temp teeth to appear how many deciduous teeth -20 beginning of toothbrush – 2-2 ½ yrs tooth brushing with little assistance 3 yrs tooth brushing alone – 6 yrs right time to bring to dentist.mild mental retardation -puts small pellets into small bowl -holds spoon well .cruisse .copy a circle .terrible two -can open doors by turning door knobs -unscrew lids -can walk upstairs alone –using both feet on same step at same time -50-200 words ( 2 words sentences) -daytime bladder control achieved ( daytime 1st.stand alone take 1st step -walk with assistance -drink from cup.when temp teeth complete 36 months or 3 yrs.stands with assistance 12 months.6 words 18 months.unbutton buttons (unbutton before learn to button) -draw a + . d.parallel play.protect 2.seats self on chair -creeps up stairs .height of possessiveness favorite word.denial -don‟t prolong goodbye -say goodbye firmly to develop trust.learns how to share -knows full name and sex (gender identity) .temp teeth complete post molar.trusting 3 . nursery rhymes Toddler. pounding peg toys to ride on fear. body part -puts both feet on 1 step before advancing. 24 months.“mine” bowel control achieved (bowel 1st before bladder) -no longer rotates spoon -can run and jump in place walks up and down stairs holding railing or persons hand -1-20 words nighttime bladder control) 30 months or 2 ½ years – makes simple lines or stroke for crosses with a pencil -can jump down from chairs -knows full name .-can clap 11 months.holds up finger to show age . P.2 toddlers playing separately -provide with similar toys -squeaky frog to squeeze waddling duck to pull trucks to push-push pull toy building blocks.4 .separation anxiety begin 9 months peak 18 months 3 phases of separation anxiety (in order) 1.

head banging. stamping feet. holds breath –ignore behavior scaffoid abdominal-due to underdeveloped abdominal muscles physiologic anorexia.going back to early stage -thumb sucking (should be oral stage only) -baby talk -bed wetting -fetal position 5. sibling rivalry.500 -knows four basic colors 5 years old.) rigid.word identification to parent of same sex and attachment to parent of opposite sex ex. regression. screaming.boy to mom Electra complex.) can communicate toilet needs 3. telling tall tales-over imagination 2.girl to dad Cause of incest marital discord Death-sleep only Behavior problems Preschool 1.offer a toy School Age Play.) bahay-bahayan – play house 2. favorite words. ritualistic and stereotype ritualism.jealousy to newly delivered baby. 4.) fear-body mutilation or castration fear of dark places witches fear of thunder and lightning fear of ghosts Milestones 4years old. squat walk alone 2.) 2.speaks fluently -nighttime bladder control -300-900 words -ride a tricycle Characteristic Traits of toddler negativistic.) role playing 3.“NO!” -way to search for independence –limit questions –modify questions to a statement 2.) can maintain dry for 2 hours Pre schoolers.associative or cooperative play 1. creative imaginative. stormy -can button buttons -copy a square -jumps and skips -laces shoes -vocabulary 1.sign of boredom -divert attention.furious 4 . masturbation.unreadiness Clues of toilet readiness: 1.frustrating 5 -copy a triangle -draw a 6 part man -imaginary playmates -2.why and how 3. aggressive..) curious. jag that last for short period of time loves rough and tumbling play loves toilet trainingfailure of toilet training.) can stand.competitive play .due to preoccupation with environment.100 words Character Traits of Pre-schooler: 1. imitative release tension and anxieties 3. imaginary friend.)Temper tantrums.) complexes.for mastering 3. Oedipal complex.

5 months 1st perm teeth. love collections.expansive age -smoother mouth -loves to collect objects -count backwards 9 yrs –coordination improves -tells time correctly -hero worship -stealing and lying are common -takes care of body needs completely -teacher finds this group difficult to handle 10 yrs. modest 3. Girls BOYS: . pubic ( adrenarch) M. track and field.Ex.age of special talent -writes legibly -ready for competitive games -more considerate and cooperative -joins orgs. boys.stamps Signs of sexual maturity GIRLS: I-inc size breast and genitalia (pelarche. mature vision 20/20 6 years. loss of privacy -wants bra 4.assimilation age -copy a diamond -enjoys teasing and playing alone -quieting down period 8 yrs.6 yrs -yr of constant motion clensy mou‟t recognize all shapes -1st grade teacher becomes authority figure -nail biting -begin interest in God.menarche. can‟t bear to lose. basket ball Fear.1st sign sexual mat. Tug of war.widening of hips A.appearance axillary.prone to bone fracture b.1st molar 1st temp teeth. 7 yrs.) school phobia -orient to new environment 2.temp teeth begin to fall perm teeth appear.last sign sexual mat.permanent loss of life Significant Development a. industrious2.will cheat 4. 1. W.) displacement from school -teacher and peer of same sex 3.) fear of death -7-9yrs death is personified -death. -well mannered with adult -critical of adults 11-12 yrs – pre adolescents -full of energy and constantly active -secret language are common -share with friends secrets -sense of humor present -social and cooperative Character Traits School Age 1.

Nsg alert: . brady cardia due to stimulation vagal nerve 4. idealistic 2.) period of time -5-10 sec suctioning. nocturnal emission – wet dreams 4.due to stimulation apocrine glands 5. requires effective laryngoscopy to open a/w. prevention of infection 7. After deep suctioning an endotracheal tube can be inserted and oxygen can be administered by an (+) pressure bag and mask with 100% oxygen at 40-60b/m. establishment of an infant parent relationship 8. pre marital sex IMMEDIATE CARE OF NEWBORN 1st days of life 1. vehicular accident 2. Significant dev‟t of viable sperm ( last sign sexual maturity) Adolescent Fear 1. smoking 3. reformers 4. sperm is viable by 17 yrs 6. establishment of waste elimination 6. testes & scrotum increase until age 17 7. breast and female genitalia increase until age 18 Personality Traits Adolescents 1.initial airway -initiation of a /w is a crucial adjustment -most neonatal deaths with in 24 h caused by inability to initiate a/w -lung function begins after birth only How to initiate a/w a.A-appearance axillary. establishment of extra uterine circulation 3. acne 3. pubic hair ( 1st sign sexual mat) D-deepening voice D. death 5. rebellious 3.) evaluate for patency -cover nostril and baby struggles there‟s a need for additional suctioning C. change of body image and acceptance of opp/sex 3.opp sex.) suction mouth 1st before nose -neonates are nasal breathers 3.development of muscles I--inc in testes and penis size P. If not effective. intake of adequate nourishment 5. dev‟t care that balances rest and stimulation or mental dev‟t 1. replacement from friends 6. initiation and maintenance of respiration 2. experiences conflict bet his needs for sexual satisfaction and societies expectation 2. significant person. adventuresome Problems: 1.) place head to side to facilitate drainage 2. conscious with body image 5.) Initiation and maintenance of respiration 2nd stage of labor. homosexuality 4. laryngo spasm.) remove secretions bulb syringe B. drug addiction 5. gentle and quick prolonged and deep suctioning can lead to hypoxia. obesity 2. distinctive odor. Catheter Suctioning 1. alcoholism 4. control of body temp 4.

Ovale 1yr Fossa Ovalis Atrial Septal Defect Ductus Arteriosus 1 month Ligamentum Arteriosum Patent ductus arteriosus Ductus Venosus 2 months Ligamentum venosum Umbilical artery 2-3 months 1.shunts bet 2 atrias Ductus arteriosus.tricuspid valve.) Tangential Footstep. Over dosage of oxygen can lead to scarring of retina leading to blindness ( retro lentalfibrolasia or retinopathy of prematurity) 4.) Establishing extra uterine circulation .decreased artery pressure What will initiate lung circulation-lung expansion What will complete circulation. SHUNTS-shortcuts Ductus venosus.passes liver-ductus venousus.-shunts from liver to IVF Foramen ovale. decreased PR ICP .aorta-lower extremities.) interior iliac artery Umbilical vein 2-3 months -ligamentum teres ( round ligament of liver) Position of infant immediately after birth: NSD-trendelenberg/ T position for drainage contraindication of trendelenberg position . vigorous and lusty cry cri-du-chat syndrome-chromosomal obliteration cat like cry b.) abnormally large head 2. -Remaining 30%.increase ICP CS.) 2 way to facilitate closure of foramen ovale a.from pulmonary artery to aorta What will sustain 1st breath.supine or crib level position Signs of increased ICP 1. No smoking 2.RT atrium 70% blood is shunted to foramen ovale. Always humidify to prevent drying of mucosa 3. FETO PLACENTAL CIRCULATION -Placenta(simple diffusion) –oxygenated blood is carried by the umbilical vein.) Decreased RR.) increase BP and widening pulse pressure #3 & #4 are Cushings triad of 4.pulmonary arteries.cutting of cord 4.slap foot of baby -never stimulate baby to cry if secretions not fully drained to prevent aspiration -check characteristic of cry normal cry.) proper position -right side lying pos. When mecomium stained (greenish) never administer oxygen with pressure ( O2 pressure will push mecomium inside) 2.) bulging and tense fontanel 3.1.circulation is initiated by lung expansion or pulmo ventilation and completed by cutting of cord.LT atrium mitral valve – LT ventricle.strong.RT ventricle.) lateral umb.IVC. -will increase pressure on left and foramen ovale will close Foramen Ovale and Ductus arteriosus will begin to close within 24h Obliteration-complete closure Structure Appropriate time of obliteration Structure remaining Failure to close F.lungs (for nutrition) (vasoconstriction of lungs pushes blood to ductus arteriousus to aorta to supply upper extremities. Ligament 2.

Breastfed babies have higher IQ than bottle fed babies. dec CHO.) Hypoglycemia. decrease Progesterone.7% F (36.bilirubin in brain leading to cerebral palsy 4. Economical 2.5 C) . Establish Adequate Nutritional Intake CS.5. preterms are born poi kilo thermic. factors leading to dev‟t of HYPOTHERMIA 1.body to cold object not in contact with body earliest sign of hypothermia.milk ejection reflex.normal eye deviation >6 months.babies easily adapt to temp of environment due to immaturity of thermo regulating system of body.) high deviation – diplopia – sign of ICP older child 4-6 months.-Anterior Posterior Gland (APG) releases prolactin – acts on acinar cells (or alveoli) – produce foremilk – stored in lactiferous tubules ( or collecting tubules) where breast milk is produced – alveoli post-pit.catabolism of brown fats (best insulator of newborns body) will form ketones 3. radiation.) High pitch shrill cry-late sign of ICP Temp Regulation .body to cold solid object (cold compress) 3.let down reflex.) met acidosis. decrease Estrogen.breastfeeding after 4 hours NSD. Possibility of transfer HEP B. 6. Has antibodies.increase in RR Effects of Hypothermia ( Cold stress) 1. embrace the baby.cold blooded .goal in temp regulation is to maintain it not less than 97.) projective vomiting.babies prone to hypothermia or cold stress A.IgA 7.2-4 days present content: decrease fats. convection-body to cooler surrounding air (aircon) 4.borderline 2. cytomegalo virus.sure sign of cerebral irritation 6. baby is not capable of shivering 4.kangaroo care A. don‟t heat Disadvantages: 1.put rm temp.maintenance of temp is crucial on preterm and SGA (small for gestational age) . Decrease incidence of breast cancer. dec CHON. prevent an necessary exposure – cover baby 4.) additional fatigue to allergy stressful heart To Prevent Hypothermia 1. It facilitates rapid involution 5. Has lactobacillius bifidus.plastic storage container Store milk – good for 6 months from freezer. inc minerals. Always available 3.gland Sucking.45-55 mg/dl normal 50. dry and wrap baby 2.interferes with attack of pathogenic bacteria in GIT 8.lazy eyes 7. 4. inc fat soluble minerals . Colostrum. evaporation-body to air (TSB) 2. cover baby with tin foil or plastic 5. HIV. No iron 3. 2. Father can‟t feed & bond as well Stages of Breastmilk: 1.PPG – oxytocin – contraction of lactiferous tubules .breastfeeding asap Physiology breast milk production As you deliver baby. Has macrophages Store milk. Hypothalamus 2. Advantages of Breastfeeding 1. babies are born wet PROCESS OF HEAT LOSS 1. mechanical pressure – radiant warmer pre-heated first isolette (or square acrylic sided incubator) 3. conduction. inadequate SQ tissue 3. increase IgA.) high risk for kernicterus.

mastitis) Problems experienced in Breastfeeding : 3RD day changes in breast post partum a. inc minerals 3.lactalbumin Cows milk – inc fatsDec CHO Inc CHON – casing. baby not constipated.4 weeks b.sometimes accompanied by fever known as MILK FEVER.proper hand washing Care of breast . Proper hygiene. if not.when food touches posterior of tongue then it will be automatically swallowed d.) Mom experiences after pain.for breastfeeding mom Cold compress – for bottle feeding & wear supportive bra.) Mastitis.) Baby‟s mouth is hiked up to areola b.14 & up content: inc fats (linoleic acid) – resp for devt of brain & integrity of skin inc CHO. Inc minerals–traumatic effect on kidneys of look for food. Stimulate & evaluate feeding reflexes a.When not stimulated sucking will stop. expose to 20 Watt bulb avoid wearing plastic liner bra .)Engorged.Disappears by 6 months .Purpose rooting. Lactose intolerance. Best position in breastfeeding – upright sitting -avoid tension! 6 weeks baby can focus.will create moisture.deficiency of enzyme LACTASE that digest LACTOSE Decrease CHON.) Swallowing.increase 1 min/ day – until reaching 10 mins @ breast or 20 mins/ feeding. c. Reflex will be gone . Purpose: to prevent from poisoning Disappear by 4 months & baby can already spit out by 4 months. To prevent from crack nipples & initiate proper production of oxytocin. HIV CMV Hepa B Coumadin Newborn Condition .cotton balls with lukewarm water Caked colostrum. .has curd that‟s hard to digest.dry milk on breast 2.lactose – easily digested.4 – 14 days content: inc lactose. Transitional milk. cotton only c. Unhealthy sexual practices -contraindicated for breast feeding . b. alternately ( if not emptied .) exposure to air – remove bra & wear dress.) Rooting reflex. Mature milk. Improper breast emptying touching the side of lips/cheeks then baby will turn to stimulus. Can trigger stone formation.begin 2-3 min at @ breast ( 5 – 7 min other authors) to initiate production of oxytocin ..give antibiotics – can still feed on unaffected breast Contra Indications in Breast Feeding: Maternal Conditions: 1. Inc phosphorus Health Teachings: 1. For proper emptying & continuous milk production / feeding -feed baby on last breast that you feed her with. . c. inc water soluble vit.) Sore nipple – cracked with painful nipple Mgt: 1.inflammation of breast : staphylococcus aureus Factors: 1.feeling of fullness & tension in breast.) Other nipple is also flowing with milk.2.manually express inflamed breast feed on unaffected breast .) Extrusion/ Protrusion reflex -when food touches anterior portion of tongue then food will be extruded.resp of sour milk smelling odor of stool. Mgt: Warm compress. Disappear by 6 weeks.) Sucking – when you touch middle of lips then baby will suck .Inborn errors of metabolism . . When is involution of breast. Criteria Effective Sucking a.

slow.tangential foot slap. mushy with sour milk smell. Meconium . Establish of waste elimination A. sneeze Tangential Footslap . odorless (Sterile intestine) will pass with in 24 – 36 hrs failure to pass mecomium after 24h. catheter insertion A – activity – degree of flexion or muscle tone R – respiration Baby cry – within 30 secs Failure to cry after 30 secs – asphyxia near the neatorum Resp.recur every feeding 4. 2–3 x/day .acrocyanosis (body. needs add‟l suctioning & O2 7 .physiologic stool .blue/pale . seldom passed. Administer Naloxone APGAR Scoring Chart: 012 HR -absent <100 >100 Resp effort -absent . like diarrhea to the untrained eye 3.milk allergy Clay colored stool – obstruction to bile duct Chalk clay stool – after barium enema Black stool – GIT bleeding (melena) Blood flecked stool .Erythrobastosis Fetalis – Rh incompatibility Hydrops Fetalis Phenylketonuria Galactosemia Tay Sachs disease response . green.golden yellow.GIT obstruction ex. irreg. bulky foul smelling odor stool .some flexion .with food added -brown & odorous Jaundice baby – light stool Under phototherapy – bright green Mucus mixed with stool .NR .green loose & shiny. P.pulse rate – apical pulse – left lower nipple G.pale yellow.10 =good/ healthy .cough.grimace . need CPR. Bottlefed stool – .anal fissure.color – slightly cyanotic after 1st cry baby becomes extremities-blue) . admission NICU 4 – 6 = moderately depressed.appearance. Diff stools 1. Hirschsprungs disease imperforate anus mecomium ileus – due to Cystic Fibrosis 2. soft.grimace – reflex irritability.determine baby‟s capabilities to adjust extra uterinely Next 15 min – dependent on the 5 min A.grimace . frequently passed .well flexed Reflex irritability Catheter . Virginia Apgar Special Considerations: 1st 1 min – determine general condition of baby Next 5 min. depression – due mom given Demerol. Transitional stool . Breastfed stool . tar like.cry Color .flaccid extremities . Currant jelly stool – instussusection Ribbon like stool – hirschsprung disease Steatorrhea stool – fatty.pinkish APGAR result 0 – 3 = severely depressed. formed hard with typical offensive odor.malabasorption syndrome ( celiac disease or cystic fibrosis) Cult blood – stool exam III Assessment for Well–being APGAR SCORE – Dr. weak -good strong cry Muscle tone .

check for breathlessness if breathless.classic sign – old man‟s face .wide & alert eyes Neonates in Nursery Nsg responsibility upon receiving baby. head tilt chin lift maneuver except spinal cord injury over extension may occlude airway Breathing ( ventilating the lungs) 1.proper identification . give 2 breaths.5 mm > 5 or 7mm Scalp hair Fine & fuzzy Fine & fuzzy Coarse & silky Ear lobe Pliable Some cartilage Thick cartilage Testes and Scrotum testes in lower canal Scrotum – small few rugae Some intermediate Testes pendulus Scrotum full extensive rugae Signs of Preterm Babies Born after 20 weeks. call for help 2.38 39 and up Sole creases Anterior transverse crease only Occasional creases 2/3 in Covered with creases Breast nodules 2mm 4mm or 3.mouth to mouth.heal to ear signabundant lanugoSigns of Post term babies: > 42 weeks .ambu bag > 1 yr Brachial – infants CPR – breathless/pulseless Compression – inf – 1 finger breath below nipple line or 2 finger breaths or thumb CPR inf 1:5 Adults 2:15 Assessment tool determines respiration of baby Silvermann Anderson Index Respiration Evaluation – lowest score – best Criteria 0 1 2 Chest movement synchronized Lag on respiration See .desquamation – peeling of skin . after 37 weeks -frog leg or laxed positon -hypotonic muscle tone. shake. no resp. no RDS 4 – 6 – moderate RDS 7 – 10 – severe RDS Assessment of Gestational Age -Ballards & Dobowitz Findings Less 36 weeks (Preterm) 37 .prone resp problem -scarf sign – elbow passes midline pos. pinch nose < 1 yr – mouth to nose force – different between baby & child infant – puff Circulation Check for pulslessness :carotid. flat on head 3.square window wrist – 90 degree angle of wrist .saw Intercostal retraction No retraction Just visible Marked Xiphoid retraction None Just visible Marked Nares dilatation None Minimal Marked Expiratory grunt None Heard on stet only Heard on naked ear Interpretation result: 0 -3 – normal. .CPR – cardio pulmonary resuscitation or CPR Cardio pulmonary cerebral resuscitation 5 min no O2 – irreversible brain damage 1.long brittle finger nails .

5 – 53.check cord every 15 min for 1st 6 hrs – bleeding . average 50 cm head circumference 33. if client is infant – the 1st yr of life . cover areas not being examined 2.leave about 1” of cord .get VS – take RR 1st . suspect patent uracus – fistula bet bladder and normal umbilicus dx: nitrazine paper test – yellow – urine mgt: surgery Credes Prophylaxis – Dr.clean with normal saline solution not alcohol ..7.inner to outer silver nitrate (used before) – 2 drops lower conjunctiva (not used now) Vit-K – to prevent hemorrhage R/T physiologic hypoprothrombinemia .13 – 39% possibly of transmission of HIV Full bath – safely given when cord fall Dressing the Umbilical Cord – strict asepsis to prevent tetanus 3 cleans in community 1.19.take anthropometic measurement normal length.Aquamephyton.35 cm or 13 – 14 “ Hydrocephalus . clean hand 2.5 .4 kg / transmitted – mom with gonorrhea drug: erythromycin ophthalmic ointment.5 lbs Arbitrary lower limit 2500 gm Low birth wt baby delivered < 2500g Small for gestational age (SGA) < 10th % rank or born small Large for gestational age > 90th % rank or macrosomia >4000 g Appropriate for GA – within 2 standard deviation of mean Physiologic wt loss – 5 – 10% wt loss few days after birth Small GA < (less) 10 Large GA > (more) 90 Physical Exam and Deviations fr Normal 1..5 – 1.suspect kidney malformation .begin fr least intrusive to the most intrusive area . insulator 2.> 30 cc of blood bleeding of cord – Omphalagia – suspect hemophilia Cord turns black on 3rd day & fall 7 – 10 days Faiture to fall after 2 weeks.5 ml IM.75cm. clean cord 3. vastus lateral or lateral ant thigh .persistent moisture-urine. if client is new born.000 – 3400 gms/ 3 – 3. then draw 3 vessel cord If 2 vessel cord.if BT or IV infusion – leave 8” of cord best access . clean surface betadine or povidone iodine – to clean cord check AVA.5 – 21 inch or 47. Crede -prevent opthalmia neonatorum or gonorrheal conjunctivitis . bacterio. phytomenadione or konakion . affixing mother thumb print .to cleanse baby & spread vernix caseosa Fx of vernix caseosa 1.Umbilical granulation Mgt: silver nitrate or catheterization .oil bath – initial .no nerve .don‟t use bigkis – air .5 ml preterm baby Vit K – synthesized by normal flora of intestine Vit K – meds is synthetic due intestine is sterile Weight: Normal wt 3.>14” Chest 31 – 33 cm or 12 – 13” Abd 31 – 33 cm or 12 – 13” Bathing .static Babies of HIV + mom – immediately give full bath to lessen transmission of HIV .foot printing.

) PDA . protect site of catheterization. no mecomium 2. let them handle an instrument like: . if client is a toddler and preschool.) long term antibiotic – to prevent subacute bacterial endocarditis 2. atretic – no anal opening 2.should close within 24 h -complete close – 1 month S&Sx 1. systolic murmurs at lower border of sternum and no other significant sign 2.coartation of aorta Congenital Heart Dse Common in girls – PDA. familial 2. Avoid flexion of joints proximal to site.affects both tricuspid and mitral valve Dx – confirmed by cardiac catheterization Mgt: .COA . continuous machinery like murmurs . failure of strucute to progress acyanotic L to R cyanotic R – L Acyanotic heart defects L to R 1. foul odor breath 4. agenetic – no anal opening 3. 1. Let baby hold it. ventricular septal defect .play syringe or stet. membranous – has opening Earliest sign: 1. vomitous of fecal matter heart surgery Antibiotics to prevent subacute bacterial endocarditis 4. can aspirate – resp problem Mgt: Surgery with temporary colostomy Cardiac rate: 120 – 160 bpm newborn Apical pulse – left lower nipple Radial pulse – normally absent.newborn – to rule out imperforate anus .atrium ventricular (AV) .) endocardial cushion defects . thrombus formation – check pedal pulses ( dorsalis pedis) Mgt. security blanket – favorite article. exposure to rubella – 1st month 3. systolic murmur @ upper border of sternum 2. NPO 6 hrs before procedure 2. Explain procedure and respect their modesty . If absent.failure of ductus arteriosus to close .3.) open heart surgery2. cardiac catheterization reveals increased o2 saturation @ R side of heart 3. 1 inch insertion Imperforate anus 1. abd destention 3. stenos – has opening 4. ASD atrial septal Common in boys – TOGA ( transportation of great arteries) TA – tronchus arteriosus TOF – tetralogy of fallot Causes: 1. assess for complication – infection. 4. ECG reveals hypertrophy of R side of heart Nsg Care: Cardiac catheterization: site – Rt femoral vein 1.take it once age and adolescent V/S: Temp: rectal.) ASD – failure of foramen ovale to close S&SX 1. If present PDA Femoral pulse – normal present. 3. result of cardiac catheterization & ECG same with VSD Mgt: open heart surgery 3.opening between 2 ventricles S&Sx 1.

) balloon stenostomy 2. dyspnea 3.hypertrophy Left ventricle Drug: 1. ligation of PDA by 3-4 yo 3.aorta & pulmo artery is arising fr 1 single vessel or common trunk with VSD S & Sx 1. sx sme with angina 2. ECG – cardiomegaly Cardiac cath – decreased O2 saturation Palliative repair – rashkind procedure Complete repair – mustard repair 2. ECG.) Tetralogy of Fallot P – pulmonary stenosis V – ventricular SD O – overriding or dextroposition of aorta .) Hypoplastic Left heart syndrome – non fx Left ventricle 1. cynosis 2. polycythemia Mgt: fontan procedure – open tricuspid valve 6.) Tricuspid atresia – failure of tricuspid valve to open S&SX: open foramen ovale (R to L shunting – goes to Lt atrium) cynosis.) Coartation of Aorta – narrowing of arch of aorta outstanding Sx : absent femoral pulse BP increased on upper extremities and decreased on lower extremities ECG – hypertrophy Lft ventricle Mgt: close heart surgery CYANOTIC HEART DEFECTS R to L 1. polycythemia – increased RBC =compensatory due to O2 supply=viscous blood =thrombus = embolus = stroke 3. polycythemia – thrombus = embolus = stroke Mgt: Heart transplant 4.) Total Anomalous Pulmonary venous return – pulmo vein instead of entering Lt atrium.doubling of arch of aorta causing compression to trachea and esophagus S&Sx : 1. rough systolic sound and thrill 4.narrowing of valve of pulmo artery S &Sx: 1.Lt ventricular hypertrophy 6.Left ventricular hypertrophy Mgt Pulmo Stenosis & Aortic Stenosis 1. prominent radial pulse 3. thoracotomy procedure.) typical systolic ejection murmur 2.aorta arising from Rt ventricle pulmo artery arising form Lt ventricle Outstanding Sx: 1. cyanosis after 1st cry (due no exygenation) 2.)Pulmunary Stenosis.2.absent spleen Mgt: restructuring of heart 3. inactive. Transportation of Great Arteries (TOGA) .close heart surgery 8. endomethazine – prostaglandin inhibitor . cyanosis 2.) Truncus Arteriousus.)Aortic Stenosis – narrowing of valve of aorta S & Sx: 1. polycythemia – throm. S2 sound widely split 3. ECG. left ventricular hypertrophy Mgt: . dysphagia 2.) surgery Duplication of Aortic Arch. typical murmur 3. enters Rt atrium or SVC Increased pressure on Rt so blood goes to Lft Outstanding Sx: Open foramen ovale Mild to moderate cyanosis Polycythemia = thrombus = embolus = stroke asplenia.nakadapa child 5.facilitate closing of PDA 2. emb. ECG. stroke Mgt: heart transplant 5.

vetaus dance-purposeless involuntary hand and shoulder with grimace 2. inhibit venous return facilitate lung expansion. all lab results increase antibody “ C reactive protein “ erythrocyte sedimentation rate “ anti streptolysin o titer (ASO) Criteria:Presence of 2 major. heard over major bronchi. or 1 major and 2 minor + history of sore throat will confirm the dx. throat swab – culture and sensitivity 3. morphine – hypoxia 4. low pitched. Low grade fever – don‟t give aspirin. chorea – sydenhamms chores or st.inflammation disease ff an infection acquired by group A Beta hemolytic strepto coccus Affected body – cardiac muscles and valves . carditis – tachycardia erythema marginatum .) BRONCHOVESICULAR. fiber diet laxative 3. low grade fever 3. clubbing of fingernails – due to chronic tissue hypoxia 9.20 BREATH SOUNDS HEARD DURING ASCULTATION: 1. 5. irregular abd or diaphramatic with short period of apnea without cyanosis. antibiotic mgt – to prevent recurrence 4. musculoskeletal .soft. Jones Criteria Major Minor 1. boot shaped heart – x-ray Mgt: 1. mental retardation – due decreased O2 in brain 10. propranolol – decrease heart spasms 5. Normal . palliative repair – BLT blalock taussig procedure Brock procedure – complete procedure ACQUIRED HEART DSE 1. growth retardation – due no O2 6. CNS. inspiration equals exp. Integumentary Sorethroat before RHD Aschoff – rounded nodules with nucleated cells and fibroblasts – stays and occludes mitral valve.macular rashes SQ nodules 3. Nsg Care: 1.fatty infiltration of organs such as liver and brain Respiration Newborn resp – 30-60 cpm. RHD Rheumatic Heart Disease . medium pitched. Rt ventricular hypertrophy 2. S/E of aspirin: . high degree of cyanosis 3.R – Rt ventricular hypertrophy S &Sx: 1. < 15 secs – normal apnea –newborn Resp Check Newborn – 40 – 90 1 yr . inspiration longer then expiration -Normal 2. arthralgia – joint pain 2. CBR 2. heard over periphery of lungs. O2 2. polyarthritis – multi joint pain 1. aspirin – anti-inflammatory. polycythemia 4. syncope 8. severe dyspnea – squatting position – relief . tet spell or blue spells.Reyes syndrome – encephalopathy.) VESICULAR – soft.20 – 40 2-3yr 20 – 30 5 yrs 20 – 25 10 yrs 17 – 22 15 & above 12.short episodes of hypoxia 7. no valsalva maneuver .

crowing or ropster life sound – air being pulled through a constricted larynx. monitor V/S skin color .) RALES-or crackles – like cellophane – made by air moving through fluid in alveoli.loud high pitched. Condition of URTI Sx: sudden onset Tripod position – leaning forward with tongue protrusion . dx. Normal 4.3. neck and throat culture 3. prepair tracheostomy set BRONCHOLITIS.+ end expiratory pressure Purpose of #6-7.pathognomonic sign – expiratory wheezing Pet – fish. Sport – swimming Drugs – amynophylline – monitor bp. Abnormal – resp obstruction Asthma. foreign body obstruction. ABG 2.inspiratory stridor – pathognomonic sign RDS respiratory dist synd or hyaline membrane dis Cause.croupy cough or barking pathognomonic . heard over trachea.) BRONCHIAL SOUNDS. may lead to hypotension Laryngo Tracheo Bronchitis LTB . trachea & bronchi outstanding sx .lack of surfactant – for lung expansion Hypotonia. put on mist tent (humidifier o2) or croupe tie Nsg Care: check edges tucked on mist tent Provide washable plastic material No toys with friction due O2 on No hairy toys – due moist environment medium for bacterial growth BP – 80/46 mmHg newborn BP after 10 days.) WHEEZING. Common to preterm Fibrine hyaline Sx – definite with in 1st of life Increase RR with retraction Inspiratory grunting – pathognomonic 7 – 10 severe RDS (silvermenn Anderson index) cyanosis due to atelectasis Mgt: 1. 6. ABG 6. Post surgery.end stage – death Lab: 1.neck x-ray to rule out epiglotitis Nsg Mgt: 1. PEEP . o2 with increase humidity.resp acidosis .head elevated 3.increase o2 with humidity 3. pos. bronchodilators 2. proper suctioning prevent drying of mucosa 5. surfactant replacement and rescue 2. foreign body obstruction 7.) STRIDOR.stridor .) RHONCHI – snoring sound made by air moving through mucus in maintain alveoli partially open and alveoli collapse LARYNGOTRACHEOBRONCHITIS LTB – most common Creup -viral infection of larynx.continuous + a/w pressure 7.asthma.100/50 BP taking begins by 3 yo COA – take BP on 4 extremities .infl of epiglottis . Normal 5.labored resp .never use tongue depressor prepare tracheotomy set < 5 yo – unable to cough out. Abnormal. expiration longer than inspiration. CPAP.whistling on expiration made by air being pushed through narrowed bronchi .Abnormal – asthma.Inflammation of bronchioles – tenatious mucus Causative agaent – RSV .Resp sincytial viruses Sx: flu like sx Increased RR Drug: Antiviral – Ribavirin End stage – epiglotitis EPIGLOTITIS .

Lanugo – fine.1st self limiting rash appear sporadically & unpredictably as to time & place. PAIN -sunburn. isotonic saline to replace electrolytes c. 9. white or black.5 3 3 foot 1.) cover burn with sterile dressing 2.75 2.) remove burned clothing of with sterile material d. not painful – nerve endings destroyed ex. c.75 1. NEVER disappear.) Preventiuon of shock & F&E imbalance a. extremely painful scalds 3rd degree – full thickness.epidermis.5 6. dermis. white pin point patches on nose. Mongolian spots – stale gray or bluish discoloration patches commonly seen across the sacrum or buttocks due to accumulation of melanocytes.) Cavernous hemangiomas – communication network of venules in SQ tissue that never disappear with age.25 Trunk 13 13 Back 13 13 Genital 1 1 @ buttocks 2. Erythema Toxicum – (flea bite rash).erythema.) a/w a.5 2. Hemangiomas – vascular tumors of the skin 3 types Hemangiomas a.75 DEPTH 1st degree – partial thickness – superficial epidermis .5 1.SKIN: Acrocyanosis BIRTHMARKS: 1. Enlarges. downy hair – common preterm 4. chin or cheek. disappears at 10 yo.5 1. dextrose & H2o to provide calories 4.) immerse burned part on cold H2o c. MIlla – plugged or unopened sebaceous gland . Stork bites (Talengeictasi nevi) – pink patches nape of neck hair will grow as child grows old 6. adipose tissue.) Tetanus toxoid booster 5. dryness.) Nevus Flammeus – port wine stain – macular purple or dark red lesions seen on face or thigh.erythema. heals by regeneration from 1 – 10 days 2nd degree – epidermis & dermis.) tracheostomy 3.) suction PRN.) 1st aid a. colloids to expand bld volume b.5@ 2.) endotracheal intubation c. blisters. lava burns Mgt: 1. Can be removed surgically b.5 1. o2 with increased humidity b.MOST DANGERIOUS – intestinal hemorrhage Skin color blue – cyanosis or hypoxia White – edema Grey – inf Yellow – jaundice .) 1st defense of body – intact skin prevention of wound infection . independent part is blue (side lying – bottom part is dependent pink) 8.5 Hand 13 1. INFANT 5-9 yo ANTERIOR POSTERIOR Ant Post Head 9.5 @ Thigh 2. insulator BURN TRAUMA – injury to body tissue caused by excessive heat. .) put out flames by rolling child on blanket b. Cutis Marmorato – transitory mottling of neonates skin when exposed to cold. moist.25 1. muscle & bone lethargy.5 Neck 1 1 1 1 Upper arm 2 2 2 2 Lower arm 1. fascia. carotene Vernix Caseosa – white cheese like for lubrication. 7.) Strawberry hemangiomas – nevus vasculosus – dilated capillaries in the entire dermal or subdermal area.5 9.75 4 4 Leg 2. 5. Disappear by 1 yr old 2.5 6. Desquamation – peeling of newborn. 3.75 1.75 1. Harlequin sign – dependent part is pink.25 1.) Relief of pain – IV analgesic MORPHINE SO4 – needed for 2nd degree – very painful 6. extreme dryness that begin sole and palm.

son – affected If father carrier. Causative agent – grp A beta Hemolytic streptococcus .transmitted to daughter Hemophilia A – deficiency of coagulation component factor 8 Hemophilia B –or christmas disease. tomatoes. oral penicillin – bactroban ointment Can lead to acute glomerulonephritis AGN ACNE. don‟t stop immunization – just change gauge of needle Falls – immobilized .umphalagia – earliest sign . Lympho – affects lymphatic system 2. from invasion of bone marrow signs of infection a.infantile eczema (galis) Papulo vesicular erythematus lesions with weeping & crusting Cause – food allergies: milk. weeping crusting. X linked recessive – inherited If mom – carrier.rapid proliferation of immature WBC .) open or close method of wound care c. soldiers of body Classification : 1.antibacterial retin A or tretinoi ANEMIA-pallor Causes: 1.WBC – protection from infection. Myelo – affects bone marrow 3. chronic/ cystic.) skin grafting – 3rd degree – thigh or buttocks (autograft). trim nails IMPETIGO.) whirlpool therapy – drum with solution 7.newborn receive maternal clotting factor .sebum. scaly shiny and white – lechenification Goal of care: decrease pruritus – avoid food allergens Diet: Prosobi or Isomil Hydrate skin.) cleaning & debriding of wound b.affects mature cells MOST COMMON CANCER – (ALL) – Acute Lymphocytic Leukemia S&Sx: 1. apply pressure-not more then 10 min cold compress -determine case before doing invasive procedure LEUKEMIA. deficiency of clotting factor 9 Hemophilia C – deficiency of clotting factor 11 Assessment: .proper hygiene.continuous bleeding – hematrosis – damage or bleeding synovial membrane Dx test : PTT.) diet – increase CHON. linear excoriation.) poor wound healing .mild soap or sulfur soap.) Bleeding disorders – blood dyscrasias HEMOPHILIA – deficiency of clotting factor. citrus juice. increase calories.marks earliest sign .grp of malignant disease . borow solution 1% hydrocortisone cream Prevent infection – proper handwahsing.)early cutting of cord – preterm – cut umb cord ASAP fullterm – cut umb cord when pulsation stops 2. elevate affected part.increase risk of injury HT: avoid contact sport.Mgt: proper hygiene – wash soap and H2o.newborn growing – sudden bruising on bump area. oozes a honey colored crust Pediculosiscapitis –“KUTO” .) fever b.prevention of injury Nsg Dx.a.affects immature cells 4.self limiting infl dis – sebaceous gland comedones – sebum causing white heads . wheat Sx: .skin disease. ATOPIC DERMATITIS. acute / blastic.lipids causing acne bulgaris Mgt: .adolescent problem . eggs. pigs/ animals – xenograft frozen cadaver – hallow graft 8. swimming only. Partial thromboplastin time – reveals deficiency in clotting factor Long Term Goal.papulovesicular surrounded by localized erythema –becomes purulent .extreme pruritus.

iliac crest .hepato spenomegaly – abd pain . initiate breastfeeding to get colostrum 2. fetal pos. . thrombocytopenia neutropenia 3. leukocytosis.) bone weakness & causes fracture signs of bleeding a. lumbar puncture (LP) – determine CNS involvement.apply pressure. CBC – determine anemia. bland diet according to child‟s preference Temporary S/E of chemo: Alopecia – altered body image Hirsutism – hair -give emotional support to parents ABO incompatibility – Most common incompatibility – ( mom) O – ( fetus) A Most severe incompatibility (Mom) O– (Fetus) B Can affect 1st pregnancy Hydrops (h20) Fetalis – edematous on lethal state with pathologic jaundice Within 24 h Mgt: 1. CNS affectation..) petecchiae-small.c. increase ICP Dx Tests: 1.oral care – alcohol free mouthwash . dark red spot b.(alteration nutrition less body req) . 4. Nsg mgt: Outstanding nsg dx: alteration in nutrition less body requirement. N/V – adm antiemetic drugs 30 mins before chemo until 1 day after chemo 2. Based on Maslow‟s heirarchy S/Effect of Chemotherapy 1. Bone scan – determine bone involvement 6.treat leukemic cells that invaded testes & CNS give: methotrixate. Reinductin – treat leukemic cells after relapse occurs. Arabinoside. PBS. Meds – same as induction .give antigout agents: allopurinol or continue remission give: oral methotrisate – check WBC -adm of methotrisate – do weekly WBC check 4. Ulcerations / stomatitis / abscess of oral mucosa. flat.content breast milk pregnanedioles – that delays action of glucoronil transferees liver enzymes converts in direct bilirubin to become direct bilirubin 3. from invasion of body organ. Sanctuary.) pallor .“C” position or shrimp position only.common site.don‟t brush – use cotton pledgets .agpariginase Oral predinisone 2. betadine mouthwash . maintenance. body malaise .adm intrathecally via CNS or spine cytocine. induction – goal of tx. bone marrow aspiration – determine blast cells. steroids with irradiation BMA s/effect – bleeding .) blood in urine/ emesis signs of anemia a. Needs phototherapy .avoid flexion of neck – will cause a/w obstruction.) epistaxis c. CT scan – determine organ involvement Therapeutic Mgt: TRIAD: 1. round.soft. surgery 2. irradiation 3. Temp suspension of breastfeeding . Put pt on affected side to prevent hemorrhage 5. constipation 2.peripheral blood smear – determine immature RBC 2.topical xylocaine before meals diet.treat or prevent hyperurecemic nephropathy. Before LP. chemotheraphy Focus Nsg Care: prevent infection 4 LEVELS OF CHEMOTHERAPHY 1. to achieve remission meds: IV vincristine L.

greasy appearing salmon colored patches – seen on scalp behind ears and umbilicus Cause: . crosses suture lines 3.> 20 mg/dL among full term & >12 mg /dl of indirect – preterm =can lead to cerebral palsyPhysiologic jaundice – jaundice within 48 -72 h (2-3 days) expose morning sunlight Pathologic Jaundice – within 24h. Common – 1st born child -due early lightening (2 weeks prior to EDD) Rickets of Vit B deficiency – soft cranial bone in older children Caput Succedaneum – edema of scalp due prolonged pressure at birth Char: 1. projectile vomiting .fontanel bossing – prominent forehead .prominent skull vein . nose or sternum .4.> 12 mg/dL of indirect bilirubin among full term Normal – 0-3 mg/dL . disappear after 2-3 days Cephalhematoma. cover eyes – prevent retinal damage 2.high pitched cry older child – diplopia – eye deviation.yellow skin & sclera . Jaundice during delivery.collection of blood due to rapture of pericostal capillaries Char : 1. needs exchange therapy Hyperbilirubinemia . disappear after 4-6 weeks 4. cover genitals – prevent priapism – painful continuous erection 3. non-communicating. increase fld intake – due prone to dehydration 5. change position regularly – even exposed to light 4.alcohol & HIV mom Anencepahly – absence of cerebral hemisphere Craniotabes – localized softening cranial bone.Kemicterus . present at birth 2. put oil night before shampoo .sunset eyes .improper hygiene Mgt: 1.color of stool – light stool . bulging fontanel .baby oil Hydrocephalus – excessive accumulation of CSF 1.cushings triad . Blanching neonates forehead.heat at phototherapy = bronze baby syndrome-transient S/E of phototherapy weigh diaper 1gm = 1cc Head – largest part of baby ¼ of its length Craniostenosis or craniosinustosis – premature closing of fontanel Hydrocephalus – ant fontanel open after 18 mos Microcephaly – small growing brain due. monitor I&O – weigh baby 6.color of urine – dark urine Mgt: Phototheraphy – photo oxygenation Nsg Resp: 1. monitor V/S – avoid use of oil or lotion due. proper hygiene 2. present after 24 h 2.bilirubin encephalopathy . monitor for developing jaundice Seborrheic Dermatitis – „craddle cap” Scaling. communicating – extra ventricular hydrocephalus 2.. Breastfeeding jaundice – caused by pregnanediole Assessment of Jaudice : 1. never cross suture line 3.intraventricular hydrocephalus or obstructive hydrocephalus due to tumor obstruction Sx – ICP – abnormally large head.

sclera – normal color – light blue then become dirty white pupil – round.done 10th day .snellens test Retinobastoma – malignant tumor of retina Outstanding sign : oat‟s eye reflex-whitish glow of pupil . cyanosis at rest – choanal atresia . head slightly forward to facilitate drainage . newborn – general appearance . Properly aligned with outer cantus of eyes .to prevent increase ICP -monitor for good drainage . epinephrine most developed sense of newborn – sense of touch 1st sense to develop & last to disappear – hearing EARS: 1. Diamex.ability to follow object past midline 3.test for blindness . check for symmetry nares obstructed with bone or membrane Sx: 1.visual acuity 20 /200 to 20/ 800 Doll‟s eyes test.test for stereopsi of depth perception Cover testing test – cover 1 eye for 10 – 15 min.) post VP shunt – side lying on non operated site . resistance during catheter insertion 2.Mgt: position to lessen ICP – low semi-fowlers 30 degree angle Administer.osmotic diuretic Mannitol/ Osmitrol .Azetam Decrease CSF production Shunting – AV shunt or Vp shunt (ventriculoperitoneal shunt) Shave hair – in OR – to prevent growth of micro org. emer. apply gentle pressure.part of iris is missing sign: key hole pupil -whiteness & opacity of lens congenital cataract cornea – round & adult size large – congenital glaucoma Test for blindness common tests size coloboma.general appearance Allen cards – test for visual acuity.sign – sunken fontanel -bulging fontanel – blocked shunt -change fontanel as child is growing SENSES EYES: Assessment 1. School age – adult . Infant & children . Points near nose – baby should blink 2.appearance . Test for strabismus 4.sit upright. 3 yrs – school age . Nsg Care: 1.cold compress .red painful eye . flaring alenase – case of RDS 2. Then remove.pupil goes opposite to direction when head is moved Globellars test – test for blink reflex. Show picture 20 ft away Ishiharas plates – test for color blindness Prechool E chart .blindness surgery – Enucliation – removal of eyeball put artificial aye NOSE: 1.can only see 10 – 12 “ . Surgery within 24 h normal color nasal membrane – pinkish rhinitis – presence of creases & pale check sense of smell – blindfold – smell Hair in nose – cilia Adolescent no hair with ulceration of nasal mucosa suspect cocaine user Epistaxis – nosebleed .general appearance .

absence light reflex 3.facial nerve #7 paralysis R/T forcep delivery Sx. inability to open . Renal aginesis – absence of kidney sign in uterus : oligohydramnios sign in newborn: 2 vessel cord failure to void within 24 h Mgt: kidney transplant Chromosomal aberrations : -advance maternal age connection bet esophagus and stomach Outstanding Sx – Coughing .extra chromosome 47xx + 21 . Apply ear ointment School age – up and down < 3 yo – down & back > 3 yo – up & back Small child – down & back ( no age) surgery (to prevent permanent hearing loss)– otitis media – myringotmy with tympanostomy tube post surgery – position affected side for drainage both – put ear plug if tympanous tube falls – healed na Bells Palsy.) Cleft lip/ cleft palate – Sx: Otitis 1.47 XXY . purulent foul smelling odor discharge 4. . Trisomy 18 – “edward syndrome” Trisomy 13. Continuous drooling saliva 2. eye & close either eye Mgt: Refer to PT TEF (Tracheoesophageal Fistula) deepening of voice -small testes.) bottle propping 2.down syndrome . Common children due to wider & shorter Eustachian tube Causes 1. observe for passage of milky. position side lying on affected aside – to facilitate drainage 2. non disjunction – uneven division Trisomy 21 . penis -sterile Klinefelter – Calvin Kline – male Turner – Tina Turner – female Otitis Media – inflammation of middle ear.has male genitalia .bedrest.has poorly developed 2dary sexual char. increase fld intake Med Mgt: 1. bulging tympanic membrane.signs evident during puberty . . Massive dosage antibiotic Complication – bacterial meningitis 2. supportive care.affected girls . observe for URTI Nsg Care: 1.patau syndrome Turner – Monosomy of X synd.poorly devt secpndary sexual characteristics .related to advance paternal age Sx: Mongolian slant Broad flat nose Protruding neck Puppy‟s neck Hypotonic – prone to resp problem Simean crease – single transverse line on palm. color – pearly gray 2.Sterile Klinefelters Syndrome.low set ear – kidney malformation ex.45x0 . 1.

apply restraints – elbow restraints so baby can adjust post op Condition that warrants suspension of operation .Choking Continuous drooling Cyanosis Mgt:: Emergency surgery Epstein pearl – white glistering cyst at palate & gums related to hypercalcemia Hypervitaminosis Natal tooth – tooth at birth. orient parents to type of feeding rubber tipped syringe – cheiloplasty paper cup/ soup spoon/ plastic cup – urano plasty 5. 6-7 days after surgery – bleeding 4. assess for RDS sx bleeding 3. Move with gauze Neonatal tooth – tooth within 28days of life Moniliasis – oral candidiasis . proper nutrition . airway – positon post cheilopasty – side lying for drainage post uranoplasty (tonsillectomy).white cheese like. proper nutrition 3.colds & pharyngitis = can lead to generalized infection – septicemia Post Op Nsg Care : 1. frequent colic & otitis media or URTI Mgt: 1.lymph adenopathy > 1.Dr.not ice cream) full liquid soft diet regular diet 5. milk escapes to nostril during feeding 3.prone 2.originated in Korea . evident at birth 2.clear liquids.uranoplasty = done 4-6 months to save speech Pre op care 1.Nsg Care – don‟t remove.unilateral Cleft Palate. wash with cold boiled H2o Meds – nystatin / Mysnastatin – antifungal Kawasaki Dse--strawberry tongue .common to girls .unilateral or bilateral Sx: 1.“mucocutaneous Lymphnode Syndrome” Sx: -persistent fever – 5 days -strawberry tongue .common to boys .5 cm Drug: aspirin Can lead to MI LIPS.( popsicle. -desquamation of palm & sole . assess for bleeding – freq swallowing. Kawasaki discovered it .( gelatin except red or brown color due may mask bleeding) . Maintain integrity of suture line such as: .common in Japan .Failed palate to fuse by 9 – 12 wks of pregnancy . emotional support especially to mom 2. prevent colic feed – upright seating or prone pos burp frequently 2x at middle and after feeding-lower to upper tap 4.oral thrush .symmetrical Cleft lip – failure of median maxillary nasal process to fuse by 5-8 wks of pregnancy . Surgery cleft lip repair – Cheiloplasty =done 1-3 months to save sucking reflex (lost in 6 months ) Cleft Palate. curd like patches that coats tongue .

inspection I 2.tachycardia – Sx of hyperthyroidism CHEST 1.Bubbling effect traps microorganism . baby sleeps 16 – 20 h a day earliest sign: 1.very small surgery If large – suspension surgery Nsg Mgt: protect sac. Surgery Complication – scoliosis THYROID gland – for basal metabolism Congenial cretinism – absence or non functioning thyroid glands reasons for delaying dx: 1. Thyroid glands covered by sternocleidomastoid muscles in newborn 2. change in crying 2.“ wryneck”-burn injury of sternocleidomsstoid muscle during delivery – due to excessive traction at cephalic delivery Mgt: passive stretching exercise . change in sucking 3.check pulse rate before giving synthroid . excrete waste products from digestive process Recommended Daily Allowance . chest has retroactive – RDS 4.analgesic NECK1. radioactive iodine uptake Mgt: synthroid – sodium Levothyrosine -synthetic thyroid given lifetime . sleep excessively 4.prevent baby form crying for pain. R to L shunting Mgt: Emergency surgery within 24h Omphalocele – protrusion of stomach contents in between junction of abd wall and umbilicus. Sx of RDS 3.sterile wet dressing Gastrochisis – absence of abd wall Nsg Mgt: sterile wet dressing Fx of GIT 1.diaphramatic hernia – protrusion of stomach content through a defective diaphragm due to failure of puroperitoneal canal to close. constipation 5. Mgt. Palpation P = Will change bowel sounds. assists in maintaining F&E & acid base balance 2. sunken abd 2.) check symmetry Congenital torticolis.Logan bar – wash ½ strength Hydrogen Peroxide & saline solution. breast . sternum sunken – pectus excavation ABDOMEN (in order) 1. Sx: 1. Processes & absorbs nutrients to maintain metabolism & support G & D 3. symmetry 2. PPI-protein 2.transparent fluid coming out from newborn related to hormonal changes3. Auscultation A 3. radioimmunoassay test 3. so do last Normal contour of abd – slightly protruding Sunken abd. baby received maternal thyroxine 3. percussion P 4. edema – moon face late sign 1. mental retardation prognosis : mental retardation preventable when Dx is early Dx: 1.

force projectile vomiting= increase ICP or pyloric stenosis Mgt: BRAT diet . renal & resp system involvement c.) solid food offered to ff sequence! 1.) don‟t give honey – infant botulism h. vomiting – forceful expulsion of stomach content Sx: 1. excessive fld intake 3.) soft table food – “modified family menu” given 1 yr e.severe dehydration . freq.) never give half cooked eggs – usually causes of salmoneliosis g. meat b.Laryngotracheobronchitis (LTB) Resp Alkalosis – carbonic acid deficit . fruits 3. dizziness 3. Diarrhea – exaggerated excretion of intestinal contents Types: Acute diarrhea – related to gastroenteritis.antibiotic use Chronic non specific diarrhea Cause: 1.fever . cereals – rich in iron 2.hyperventilation .hypoventilation . abd cramping assess: amt.) begin with small quantities c.COPD . dilution of strong acids and bases in bld Resp Acidosis – carbonic acid excess . facial flushing 4.comprises 65 . .RDS .banana. food intolerance 2.) finger foods – offered 6 months d.2g /Kbw/day Principles in Supplementary Feeding Supplementary Feeding usually – 6 mos Supplementary feeding given – 4 mos.) offered new food one at a time – interval of 4 – 7days or 1 week – determines food allergens Total Body Fluids.85% of body wt of infants & children Where fluids are greater in infants Extracellular fld – prone to develop dehydration Acid Base Balance dependent on the ff: a. a.) dilute fruit juices – 6 mos f. salmoneliosis .encephalopathy Met. consistency. veg 4.Gastric lavage PROBLEMS LEADIING TO F&E IMBALANCE 1. chemical buffers b.dietary indiscretions .diarrhea .uncontrolled vomiting . CHON malabsorption Assess: freq. rice – cereal. Acidosis – base HCO3 deficit . toast 2. appearance of given colored stool.malnutrition . nausea 2. apple sauce.Calories : 120 cal / Kbw/day (kilo body wt) 360 – 380 cal/ day CHON_ 2.ciliac crisis Met Alkalosis – base HCO3 excess .NGT aspiration . CHO.

Gastroesophageal Reflux Chalasia – presence of stomach contents to esophagus Will lead to esophagitis complication – aspiration pneumonia Esophageal cancer Assessment : 1. Meds of GERD Anti-cholinergic a. chronic vomiting 2.) Betanicol ( urecholine) – increase esophageal tone & peristaltic activity b. rectal manometry – revels failure of intestine sphincter to relax Therapeutic Mgt/Nsg care 1. abd distension 3. Ranitidine (Zantac) – take 30 min before meals d. organic – organ affected 4. Barium enema – reveals narrowed portion of bowel 2.) H2 Histamine Receptor Antagonist – decrease gastric acidity & pepsin secretion . faiture to thrive syndrome 3.) Metachloporomide (Reglam) – decrease esophageal pressure by relaxing pyloric & duodenal segments . surgery a.prone to Hypokalemia – give K chloride before adm of K chloride – check if baby can void.) anastomosis & pull through procedure Diet: Increase CHON.Zimetidine. melena or hematemesis – esophageal bleeding Dx procedure 1. vomitus of fecal material early childhood – ribbon like stool foul smelling stool constipations diarrhea Dx: 1. decrease residue – pasta GER. Rectal Biopsy – reveals absence of ganglionic cells 3.Maalox .Best criteria to determine diarrhea : consistency Complication = dehydration Mild dehydration 5% wt loss Moderate dehydration 10% wt loss Severe dehydration 15 % wt loss Earliest sx of dehydration tachycardia increase temp weight loss tachypnea sunken fontanel & eyeballs scanty urine hypotension absence of tears Severe dehydration: Oliguria . if cant void – hypokalemia Drug: Na HCO3 – adm slowly to prevent cardiac overload Gastric Motility Disorder: HIRSCHPRUNGS DISEASE – congenital aganglionic megacolon Aganglionic – absence of ganglion cells needed for peristalis Earliest sign 1.increase peristalsis without stimulating secretions c. intra esophageal pH content – reveals pH of distal esophagus. Prolonged capillary refill time Mgt: Acute – NPO ( rest the bowel ) . failure to pass mecomium after 24h 2.) temp colostomy b.) antacid – neutralizes gastric acid between feedings .with fluid replacement – IV . abd x-ray – reveals dilated loops on intestine 4. NGT feeding – measure tube fr nose to ear to midline of xyphoid & umbilicus 2. esophageal manometry – reveals lower esophageal sphincter pressure 3. increase calories . barium esophogram – reveals reflux 2.

feed slowly.preparation increase CHON intake . presence of green spots at diaper a sign of PKU DIET: Low phenylalanine diet.test if CHON will convert to amino acid specimen and urine mixed with pheric chloride.) x ray of upper abd with barium swallow reveal “string sign” Mgt: 1.meats.) fair complexion 2.Converts galactose to phosphate tranferace glucose Galactose – will destroy brain cells if untreated – death within 3 days Dx: Beutler test – get blood -done after 1st feeding .) vomiting 3. legumes. 1. Pyleromyotomy 2.vomitus of upper GI can be blood tinged not bile streaked.invagination or telescoping of position of bowel to another Common site – ilio-secal junction Prone pt: person who eats fat Complication – peritonitis – emergency Sx: 1.) Atopic dermatitis 5.)serum electrolyte – increase Na & K. decrease chloride 6. cheese.vomiting is an initial sx of upper GI obstruction . PYLORIC STENOSIS – hypertrophy of muscles of pylorus causing narrowing & obstruction. milk.milk with synthetic protein Galactosemia – deficiency of liver enzyme .) ultrasound 7.palpate sausage shaped mass Mgt: 1.thickened feeding with baby cereals .) olive shaped mass – on palpation 5.effective if without vomiting . chicken.) musty / mousy odor urine contraindicated.projectile vomiting – increase ICP or GI obstruction .) met alk 3.) persistent paroxysmal abd pain 2.) Anastomosis & pull thru procedura Inborn Errors of Metabolism.) blond hair 3.) seizure – mental retardation Test – GUTHRIE TEST – specimen – blood .GUPT – Galactose Urovil Phosphatetranferase . burp often every 1 ounce .projectile vomiting . peanuts Give Lofenalac.) failure to gain wt 4.dye bleeding & inflammation . (with blood) .) blue eyes Thyroxine – decrease basal metabolism . Fredet Ramstedt procedure INSTUSSUSCEPTION.) Hydrostatic reduction with barium enema 2.abd distension – major sx of lower GIT obst 2.deficient liver enzymes PHENYLKETONURIA (PKU) – deficiency of liver enzymes (PHT) Phenylalaninehydroxylase Transferase – liver enzyme that converts CHON to amino acid 9 amino acids: valine isolensine tryptophase lysine phenylalanine Thyronine – decrease malanine production 1.) outstanding Sx.Surgery: Nissen funduplication : Chronic vomiting – .positioning < 9 months – infant sit with infant supine > 9 months – prone with head of mattress slightly elevated 30 degree angle OBSTRUCTIVE DISORDERS A.vomitus of lower GI is bilous ( with pupu) .accumulation of Phenyl Pyruvic acid 4.) currant jelly stool.

learning difficulties 3.rye O. 1 pecac – oral emetic . steroids POISONING. caustic (strong alkali such as lye) or a hydrocarbon. beginning sx of lethargy 2. unless poison is corrosive. abd x ray 3. diarrhea – failure to gain wt ff diarrheal episodes 2. caustic poisoning ( muriatic acid ) neutralize acid by giving vinegar . steatorrhea Celiac Crisis.exaggerated vomiting with bowel inflammation Dx: 1. milk of magnesia & burned toast 5. Don‟t vomit prepare tracheostomy set 8. serum antiglyadin – confirmatory of disease gluten free diet – lifetime all BROW – not allowed ok – rice & corn Mgt: 1.common to infant) 1. as lead increases. determine substance taken. (falls.wheat Early Sx: 1. vitamin supplements 2. impulsiveness. abd pain – protruberant abd even if with muscle wasting 2. assess LOC 2.barley R.oat W.mineral oil will coat intestine Lead poisoning Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney functioning Accumulation of anemia = Encepalopathy Sx: 1. UNIVERSAL ANTIDOTE. school age & pre school .common in toddlers.presence of glucose in blood – sign of galactosemia galactose free diet lifetime neutramigen – milk formula CELIAC DISEASE – gluten enteropathy Common gluten food: Intolerance to food with brow B. Never adm charcoal before 1 pecac 6. long bones Mgt: 1. constipation 3.15 ml – adolescent. antidote for acetaminophen poisoning – acetylsysterine ( mucomyst) 7. Gas.Give syrup 1 pecac to induce vomiting 3. .10 ml to infant 4. if > 20 ug/dL – need chelation therapy = binds with led & excreted by kidney =nephrotoxic Amogenital Female: Pseudomenstration slight bleeding on vagina related to hormonal changes . severe encepalopathy with seizure and permanent mental retardation Dx: 1. remove child from source 2. vomiting is the most effective way to remove poison. Blood smear 2. lab studies – stool analysis 2. vomiting Late Sx: 1. mineral supplements 3.charcoal.

urinary & fecal incontinence Nsg care: always check diaper Orthopedic complication – paralysis of lower extremities Surgery to prevent infection Post op – prone position SCOLIOSIS. preventive – Milwaukee brace . Encephalocele ( CNS complication – hydrocephalus) – cranial meningocele or myelomeningocele Most common problem .decreased Folic Acid intake SPINA BIFIDA OCCULTA. Meningocele – protrusion of CSF & Meninges 2.tight foreskin Balanitis-infection of glands penis – due smegma Mgt: Circumsicion Hydrocele – fld filled scrotum Tst of Dx: Transillumination with use of flashlight . Abnormal tufts of hair SPINA BIFIDA CYSTICA.rupture of sac . uneven hemline 2. exercise 2.urinary meatus located dorsal or above glans penis Hypospadias.lateral curvature of the spine 2 types: 1.failure of post laminae of vertebrae to fuse with a sac Types: 1.prone pos .Tearing of fourchette with blood – rape/ child abuse Rape.Report within 48 h Shape pubic hair in inverted triangle ( female) Male: Undescended testes – cyrptorchidism -common to preterm surgery – orchidopexy assess scrotum.infection Myelomeningocele – genitourinary complication.urinary meauts loc ventral or below glans penis Hypospadias with chordee. bend forward.vulvular varicosities) BACK.sterile wet dressing Most common complication . structural – rye neck 2.check for flatness & symmetry Open Neural Tube Defect.warm room & hands baby – pee within 24 h -check for arch of urination Epispadias.failure of post laminae of vertebrae to fuse Sx: dimpling of back . Myelomeningocele – protrusion of CSF & Meninges & spinal cord ( most dangerous) 3. postural – improper posture Dx: 1.glowing sign Varicocele – enlarged vein of epididimis ( girls. conservative – avoid obesity.1 hip higher 1 shoulder blade more prominent Nsg care: 1.worn 23 h a day .fibrous band causing penis to curb downward Mgt: Surgery Phimosis.

(+) ortolanis sign – abnormal clicking sound 5.birth injury caused by lateral & excessive traction during a breech injury Sx: 1. pocoamelia.) Valgus. corrective surgery – insert Harrington rod post op. unable to abduct arms from shoulders. spica cast Fx: of cast – . syndactyly – webbing of digits 2. 1. shortening of affected leg 2. rotate arm externally or supinate forearm 2.mask with ball pen edge of blood to know if bleeding is on going sign cast is dry = resonant to move log rolling. triple diaper 2. CONGENITAL HIP DISLOCATION – head of femur is outside acetabulum Types.circulation M. Corrective shoe. olidactyly – lack of digits 4.Dennis brown shoe.trendelenburg sign Goal of Mgt: Facilitate abduction Mgt.most common Assessment: 1. Straighten legs & flexing them at midline pos Mgt: 1.use open palm not fingers. Pavlik harness 5.brachial plexus injury or brachial palsy . 1.prevent muscle spasm lead pencil – mark area to be amputated cold H20 – hasten setting process hot H20.bone alignment .3. subluxated – most common type 2. cast cold to touch do petaling– making rough surface of cast smooth CRUTCHES Fx: To maintain balance .foot turns in d. abduct arm from shoulders with elbow flex. Amelia – total absence of digits 5. Frejka splint 4.foot turns out Equino varus.) Calcaneous – dorsiflexion – heal lower that foot anterior posterior of foot flexed towards anterior leg c.) Equinos – plantar flexion – horsefoot b.move client as 1 unit EXTREMITIES: check # of digits = 20 immobilize .priority check : neurovascular check C.dry cast – natural air not blower . when able to walk – child limps – late sx. absence or asymetrical moro reflex Mgt: 1.motion S. limited movement – earliest sx 4. carry baby astride 3.fingers will cause indention .) Varus. polydactyly – extra digits 3. Hip Spica Cast TALIPES – “clubfoot” a. asymmetrical gluteal fold 3.To support weakened leg .slow setting process After cast application – how to move pt: .sensation Cast – with bleeding .absence of distal part of extremities ErQ duchennes – paralysis. dislocated Sx: 1.

anti HPN drug . serum K increased 5. Anasarca.Do palm exercise. weigh daily 2. (PPP) primary peripheral periobital edema 2. AGN. Swing to . banana Decrease Na AGN ( acute Glomerulo Nephritis) 3A‟s.Brachial pulsing – if wt of body in axila Renal Disorder Cause Sx Tx NSG CARE NEPHROTIC SYNDROME infectious 1. increase BP Complication : 1. iron 1. Swing Through 2. anemia 1.OJ.squeeze ball Different crutch Gaits: 1. fatigue 7. beef broth. Three point Gait . normal or decreased BP Prednisone Diuretic Focus of care: monitor edema -weigh daily Diet: Increase CHON Increase K. gross hematuria ( smokey urine) 4. fatigue 6.gen edema 2. serum lipid increased weight bearing are allowed into lower ext 3.hydralazine or apresoline 2. moderate protenuria 3. hypersensive encephalopathy 2.wt bearing allowed in 2 lower ext . microscopic or no hematuria 4. Grp A Autoimmune Grp A beta hemolytic streptococcus 1.wt bearing is allowed in 1 ext 4. decrease Na . monitor BP & neurologiuc status 3.Principles in crutches . serum CHON decreased 5.wt of body on palm! . Four point gait 5. Two point Gait . massive protenuria 3. autoimmune. Diet: decrease K.

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