1. weight

2. length

3. head circumference

4. chest circumference .

5. abdominal circumference .

evaporation . temperature .conduction .radiation .1.convection .

2. pulse rate .

3. respiration .

4. blood pressure .

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Ductus Arteriosus 3. Umbilical Arteries 5.STRUCTURE 1. Foramen Ovale 2. Ductus Venosus 4. Umbilical Vein APPROXIMATE TIME OF OBLITERATION 1 year 1 month 2 months 2 to 3 months 2 to 3 months STRUCTURE REMAINING Fossa Ovalis Ligamentum Arteriosum Ligamentum Venosum Lateral Umbilical Ligament Interior Iliac Artery Ligamentum Teres .

first breath initiated by lowered PO2 and increased PCO2 with a pressure of 40 to 70 cm H2O .

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odorless 2nd to 3rd day: transitional stool = green.within 24 hours: meconium = sticky. tarlike. sweet-smelling formula-fed = bright yellow. blackish-green. resemble diarrhea 4th day onwards: breast-fed = light yellow. loose. noticeable odor .

small amount of protein is normally present . thus urine is usually light in color. and odorless .008 to 1.01 .300 ml .daily urine output: first 1 to 2 days .kidneys do not concentrate urine well.specific gravity is 1.30 to 60 ml by first week ..

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moro reflex .

grasp response .

walking reflex .

tonic-neck reflex .

babinski reflex .

babinski reflex .

sucking reflex .

swimming reflex .

swimming reflex .

rooting reflex .

rooting reflex .

swallowing reflex .

extrusion reflex .

foot placing reflex .

magnet reflex .

trunk incurvation reflex .

trunk incurvation reflex .

landau reflex .

crossed extension reflex .

deep tendon reflexes C:\Documents and Settings\Dindin\My Docu .

smell .hearing .taste ..vision .touch .

first period of reactivity .1.

2. resting period of reactivity .

3. second period of reactivity .

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cyanosis . color .1.

hyperbilirubinemia . color .1.

1. color .hyperbilirubinemia .

color .1.pallor .

color .1.harlequin sign .

2.hemangiomas . birthmarks .

birthmarks .mongolian spots .2.

3. vernix caseosa .

4. erythema toxicum .

forceps mark .5.

skin turgor .6.

lanugo .7.

desquamation .8.

milia .9.

1. molding .

2. caput succedaneum .

cephalhematoma .3.

4. fontanelles .

5. sutures

6. craniotabes

- newborns cry tearlessly - irises are color gray or blue - in a supine position, lifting the head will open a newborn·s eyes - subconjunctival hemorrhage - edema until the 3rd day - cornea is round and proportionate in size to that of an adult

- pinna bends easily - normoset ears - visualizing the tympanic membrane is difficult and generally not attempted - test the hearing by ringing a bell about 6 inches from each ear

- may appear large for the face - milia is present - test for choanal atresia

- open evenly when the baby cries - tongue appears large and prominent palate should be intact, with presence of epstein·s pearls - all newborns have some mucus in their mouth - unusual to have teeth, but sometimes 1 or 2 are present

chubby.congenital torticolis . and with skin folds .short.head should rotate freely ..not strong enough to support total weight of the head .meningitis .

chest should be symmetric .breasts may be engorged ..presence of witch·s milk .breath sounds may reveal presence of ronchi .

slightly protuberant .bowel sounds must be heard within an hour after birth ..meticulous cord care .palpate for internal organs .

1.scrotum is edematous and rugated .both testes must be present . male genitalia .examine penis and prepuce .cremasteric reflex .

vulva is swollen .has mucus vaginal secretions . female genitalia .2.

3.imperforate anus . anus .

3. anus .intestinal obstruction .

inspect skin to be certain there is no pinpoint openings ..a newborn normally assumes the position in the uterus .spine appears flat .

arms and legs appear short . and can be flexed and abducted to such an extent that they touch or nearly touch the surface of the bed .test the UE muscle tone by unflexing the arms for about 5 seconds ..legs are bowed and short.hands are clenched into fists .

APGAR SCORING .ASSESSMENT FOR WELL-BEING ‡ 1.

ASSESSMENT FOR WELL-BEING ‡ 2. MATURITY TESTING TOOL .

MATURITY TESTING TOOL physical scale .ASSESSMENT FOR WELL-BEING ‡ 2.

ASSESSMENT FOR WELL-BEING ‡ 2. MATURITY TESTING TOOL neuromuscular scale .

MATURITY TESTING TOOL SCORING SYSTEM .ASSESSMENT FOR WELL-BEING ‡ 2.

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G6PD deficiency galactosemia phenylketonuria congenital hypothyroidism congenital adrenal hyperplasia .

4. quality of nutrition 2.1. ordinal position in the family 2. health . environmental influences 2.FACTORS AFFECTING GROWTH AND DEVELOPMENT 1.3.2.5. genetic influences 2. parent-child relationship 2. socioeconomic level 2.

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1. SIGMUND FREUD 2. LAWRENCE KOHLBERG . ERIC ERIKSON 3. JEAN PIAGET 4.

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infant in the oral phase .‡ 1.

toddler in the anal phase .‡ 2.

pre-schooler in the phallic phase .‡ 3.

‡ 4. school-age child in the latent phase .

adolescent in the genital phase .‡ 5.

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‡ 1. infant·s trust versus mistrust .

‡ 2. toddler·s autonomy versus shame or doubt .

pre-schooler·s initiative versus guilt .‡ 3.

‡ 4. school-age·s industry versus inferiority .

adolescent·s identity versus role confusion .‡ 5.

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infant·s sensorimotor stage .‡ 1.

toddler and pre-schooler·s preoperational thought .‡ 2.

school-age·s concrete operational thought .‡ 3.

adolescent·s formal operational thought .‡ 4.

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‡ 1. toddler and pre-schooler·s preconventional stage .

‡ 2. school-age·s conventional stage .

adolescent·s post-conventional stage .‡ 3.

a pre-school 4. an adolescent . a toddler 3.‡ ‡ ‡ ‡ ‡ 1. an infant 2. a school-age child 5.

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2x in 6 months .4x in 2 years ‡ height doubles in 1 year ‡ possible natal and neonatal teeth .‡ average changes in weight .3x in 1 year .

1. gross motor 2. fine motor .

ability to accomplish large body movements . prone .1.1. standing position .1.3. gross motor development .1.2.1.4. ventral suspension .‡ 1. sitting position .

pincer grasp .2.ability to coordinate hand movements .2.1.2.2. grasp reflex .4. open hands .5.2.‡ 2. blocks.3. fine motor development . feeding . both hands .6.2. accepting objects handed to them .2.7.2. transfer from one hand to another .

one to two words .‡ language .vowel sounds .cooing sounds .laughs .cries .

object permanence .‡ vision .binocular vision .

‡ hearing .

‡ smile .

‡ separation anxiety .

secondary circular reaction ‡ 3. primary circular reaction ‡ 2.‡ 1. coordination of secondary schema .

‡ 1. teething .

thumb-sucking .‡ 2.

‡ 3. use of pacifiers .

‡ 4. head-banging .

‡ 5. sleep problems

‡ 6. constipation

‡ 7. loose stools

‡ 8. colic

‡ 9. spitting up

‡ 10. diaper dermatitis

miliaria .‡ 11.

‡ 12. baby-bottle syndrome .

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‡ lordotic gait .

holds up fingers to show age .vocabulary .names body parts .words and sentences .knows full name .‡ language .

‡ parallel play behavior .

discipline 5. temper tantrums . ritualistic behavior 3.‡ ‡ ‡ ‡ ‡ ‡ 1. separation anxiety 6. negativism 4. toilet training 2.

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ectomorph .mesomorph .‡ future body type becomes apparent .endomorph .

imitation games .how and why questions .imaginary friends .group playing .‡ language .self-centered ‡ play .

‡ electra complex ‡ oedipus complex .

‡ intuitional thought ‡ not aware of the property of conservation and reversibility .

‡ can determine right from wrong ‡ has an elemental concept of god .

‡ 1. poisoning. choosing a pre-school or day-care center 7. difficulty sharing. falls.dark. imaginary friends. regression. preparing the child for school 8. preparing for a new sibling 5. sex education 6. separation or abandonment ‡ 3. colds. diarrhea ‡ 2. sibling rivalry ‡ ‡ ‡ ‡ ‡ 4. behavior problems .automobile accidents. broken fluency . common fears . ear infections. flu.telling tall tales. mutilation. common health problems .

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sex education . preparation for adolescence . latchkey children ‡ 4. language development ‡ 2.stealing .recreational drug use .beginning school and school phobia ‡ 3. fears and anxieties .menstruation .‡ 1.

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3. dress and hygiene .2.2.1. exercise .4. sleep .2.‡ 1. safety ‡ 2. care of teeth .2. daily activities .2.

common health problems .4. suicide ‡ 6.‡ 1. acne ‡ 3. runaways . fatigue .2. poor posture . menstrual irregularities .2. sexuality and sexual activity ‡ 4. healthy family functioning ‡ 2.3.2.2.2.1. substance abuse ‡ 5.

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congenital malformations .‡ ‡ ‡ ‡ ‡ ‡ ‡ 1. altered gestational age or birth weight 7. maternal age 2. unhealthy maternal lifestyle 5. pregnancy complications 4. concurrent maternal disease conditions 3. labor problems 6.

establishing parent-infant bonding ‡ 8. preventing infection ‡ 7.‡ ‡ ‡ ‡ ‡ 1. initiating and maintaining respirations 2. establishing adequate nutritional intake ‡ 6. temperature regulation 5. fluid and electrolyte balance 4. providing developmental care . establishing extrauterine circulation 3.

Most infants are born with some degree of respiratory acidosis. .. but the spontaneous onset of respirations rapidly corrects this.The ultimate prognosis of the high risk infant depends greatly on how the first moments of life are managed. .

establishing an airway .FOUR ORGANIZED STEPS IN RESUSCITATION ‡ 1.

FOUR ORGANIZED STEPS IN RESUSCITATION ‡ 1. establishing an airway .

FOUR ORGANIZED STEPS IN RESUSCITATION ‡ 1. establishing an airway .

expanding the lungs administer oxygen at a rate of 40 to 60 compressions per minute .FOUR ORGANIZED STEPS IN RESUSCITATION ‡ 2.

maintaining effective ventilation IMPORTANT PRINCIPLES: .keep the infant warm .position head elevated 15 degrees .FOUR ORGANIZED STEPS IN RESUSCITATION ‡ 3.undress chest and look for retractions .continued respirations must be maintained .

maintaining effective ventilation .FOUR ORGANIZED STEPS IN RESUSCITATION ‡ 3.

maintaining effective ventilation .FOUR ORGANIZED STEPS IN RESUSCITATION ‡ 3.

cardiac function must be maintained through: CLOSED CHEST MASSAGE hold the infant with fingers supporting the back and pressing the thumbs against the sternum or depressing the sternum with 2 fingers approximately 1 or 2 cm at a rate of 120 times per minute .

cardiac function must be maintained through: CLOSED CHEST MASSAGE .

‡ PULSE OXIMETER .

‡ PHYSIOLOGIC MONITOR .

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HEAT LAMP.‡ 1. DROP LIGHT .

‡ 2. RADIANT WARMER .

ISOLETTE .‡ 3. INCUBATOR.

KANGAROO CARE .‡ 4.

‡ 1. enteral feeding ~ short term (orogastric tube) .

‡ 1. enteral feeding ~ long term (gastrostomy tube. jejunostomy tube) .

parenteral nutrition ~ central line.‡ 2. peripheral line .

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‡ birth weight is below the 10th percentile on an intrauterine growth curve for that age .

placental anomaly 3. lack of adequate nutrition of the mother during pregnancy 2. chromosomal abnormalities . intrauterine infection 4.COMMON CAUSES OF SGA NEONATES 1.

sunken abdomen .decreased anthropometric measurements . prenatal assessment .increased red blood cells . laboratory findings .ASSESSMENT FINDINGS IN SGA NEONATES ‡ 1.poor skin turgor .high hematocrit .nonstress test ‡ 2.fundic height .dull and lusterless hair .widely separated skull sutures . appearance .decreased serum glucose .sonogram .dry and yellow cord ‡ 3.

‡ birth weight is above the 90th percentile on an intrauterine growth chart for that gestational age .

COMMON CAUSES OF LGA NEONATES ‡ 1. poorly controlled diabetic mothers ‡ 2. multiparous women ‡ 3. congenital anomalies .

cephalhematoma. appearance ‡ immature reflexes and low scores on gestational examinations ‡ extensive bruising or birth injury ‡ prominent caput succedaneum. or molding 2. cardiovascular dysfunction ‡ tachycardia ‡ cyanosis ‡ polycythemia ‡ hyperbilirubinemia 3.ASSESSMENT OF LGA NEONATES 1. hypoglycemia .

born after 20 weeks and before the end of 37 weeks gestation .very low birth weight (1000 to 1500 g) .extremely low birth weight (500 to 1000 g) .low birth weight (1500 to 2500 g) ..less than 2500 g .

environmental exposure to harmful substance . placental problems. eclampsia 2. poor nutrition. OTHERS: socioeconomic status. smoking. FETAL FACTORS: multiple pregnancy.CAUSES 1. MATERNAL FACTORS: age. infection 3.

apnea.‡ ‡ ‡ ‡ ‡ POTENTIAL COMPLICATIONS OF A PRE-TERM NEONATE 1. persistent patent ductus arteriosus 4. or necrotizing enterocolitis . retinopathy of prematurity. anemia of prematurity 2. respiratory distress syndrome. kernicterus 3. periventricular or intraventricular hemorrhage 5.

because a placenta appears to be timed to last effectively for 40 weeks .an infant who stays in utero past 42 weeks is at special risk.

vernix and lanugo completely disappeared .dry.yellow to green color from meconium staining 2. skin . old-looking 3. parchmentlike appearance . signs of birth injury or poor tolerance of birth process .ASSESSMENT: 1. cracked. hard nails extending beyond fingertips 4. depleted subcutaneous fat.

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‡ also called erythroblastosis fetalis ‡ characterized by RBC destruction in the newborn. with resultant anemia and hyperbilirubinemia ‡ possibly caused by Rh or ABO incompatibility between the mother and the fetus (antigen and antibody reaction) .

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during pregnancy . presence of Rh (+) RBCs from her fetus conceived with Rh (-) man b. at the time of delivery subsequent pregnancies may be affected . transfusion of Rh (+) blood ‡ this stimulates mother s immune response system to produce anti-Rh (+) antibodies that attack fetal RBCs and cause hemolysis ‡ if sensitization occurs: a.‡ sensitization of Rh (-) woman by: a.the fetus is affected in utero b.

‡ COOMB S TEST . INDIRECT performed through mother s circulation during pregnancy at first visit and again about 28 weeks gestation B.tests for presence of anti-Rh (+) antibodies A. DIRECT done on cord blood at delivery to assess fetal RBCs ‡ rhogam must be injected into unsensitized mother s system within 72 hours of delivery of Rh (+) infant .

‡ reaction less severe than with Rh incompatibility ‡ firstborn may be affected because type O mother may have anti-A and anti-B antibodies even before pregnancy ‡ fetal RBCs with A. thus fewer anti-A. or AB antigens evoke less severe reaction on part of mother. or anti-AB antibodies are produced . B. anti-B.

edema and ascites .ASSESSMENT FINDINGS: 1. enlarged placenta 5. anemia 3. erythropoesis 4. jaundice and pallor within the first 24 to 36 hours after birth 2.

initiation of early feeding 2. temporary suspension of breastfeeding 3. exchange transfusion .‡ ‡ ‡ ‡ THERAPEUTIC MANAGEMENT OF HEMOLYTIC DISEASE 1. phototherapy 4.

‡ an ischemic attack to the intestine resulting in thrombosis and infarction of affected bowel. and inflammation . mucosal ulcerations. pseudomembrane formation.

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- substance may be alcohol, heroin, morphine, or any other addictive substance - mother usually seeks prenatal care only when labor begins and has frequently taken a dose of addictive substance before seeking help - withdrawal symptoms in the neonate may be noticed within 24 hours

‡ FETAL ALCOHOL SYNDROME

PEDIATRIC
PRIORITIES IN LIFE

‡ ‡ ‡ ‡ ‡ ‡

1. airway and breathing 2. circulation 3. fluid and electrolyte balance 4. thermoregulation 5. nutrition 6. perception and coordination

record oxygen settings 4. assess respiratory rate.‡ ‡ ‡ ‡ IMPORTANT CONSIDERATIONS 1. character. note quantity. maintain patency of airway . and color of secretions 3. note pattern and depth of breathing 2.

hyperpnea 6. cheyne-stoke respirations 7. tachypnea 3. kussmaul respiration .RESPIRATORY PATTERNS ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ 1. biots respiration 8. eupnea 2. bradypnea 4. apnea 5.

‡ EVALUATING RESPIRATORY DISTRESS GRADE 0 DESCRIPTION no retractions. expiratory grunt heard with stethoscope 1 retractions. expiratory grunt heard with stethoscope 2 expiratory grunt heard with the naked ear . nasal flaring. no nasal flaring.

short neck ‡ 3. small nares ‡ 6. high glottis ‡ 7. immature laryngeal reflex ‡ 5. narrow cricoid ring .AIRWAY DIFFERENCE OF CHILDREN FROM ADULTS ‡ 1. slanted vocal cords ‡ 8. large tongue ‡ 4. large occiput ‡ 2.

positioning ‡ 2. adjunct airway devices .IMPORTANT INTERVENTIONS ‡ 1. suctioning ‡ 3. chest physiotherapy ‡ 4.

small tidal volumes are delivered at high rates 6. HFJV. which improves oxygenation at lower levels of PEEP . HFO) .prevents breath stacking 4.I is prolonged and E is shortened to promote alveolar recruitment. positive end-expiratory pressure (PEEP) .delivers a preset tidal volume at a preset rate. ignoring the patient s own ventilatory drive . synchronized intermittent mandatory ventilation (SIMV) .for those with CNS dysfunction.y y y y y y MECHANICAL VENTILATION 1. inverse ratio ventilation (IRV) .delivers a preset tidal volume when the patient initiates inspiration 3.improve ventilatory function of the lungs. patient can breathe spontaneously between ventilator breaths from an oxygen reservoir attached to the machine .effective for atelectatic alveoli and alveoli filled with fluid 5. in addition. controlled mechanical ventilation (CMV) .delivers a preset tidal volume at a preset rate. drug-induced paralysis or sedation. assist-control ventilation (ACV) .counteracts small airway collapse and keeps alveoli open . severe chest trauma 2. high-frequency ventilation and oscillation (HFPPV. thereby increasing PaO2 .

anxiety . increased intracranial pressure 6. barotrauma 2.‡ ‡ ‡ ‡ ‡ ‡ ‡ COMPLICATIONS RELATED TO MECHANICAL VENTILATION 1. gastrointestinal complications 4. tension pneumothorax 3. fluid imbalance 7. hypotension with decreased cardiac output 5.

and state of perfusion 2. peripheral pulses. blood pressure 4. ECG monitoring 3. assess apical heart rate.‡ ‡ ‡ ‡ IMPORTANTS CONSIDERATIONS 1. invasive pressures .

DOBUTAMINE (2-15 mg/kg/min) . renal blood flow. DOPAMINE (2-5 mg/kg/min) .MEDICATIONS ‡ 1.increase heart rate and contraction ‡ 3.increase heart rate. blood pressure. blood flow to heart and brain .increase heart rate.1 cc/kg) . and contraction ‡ 2. EPINEPHRINE (0.

weigh patient daily 2. Cl. record all intakes 4. assess symptoms of hypovolemia or hypervolemia 3.‡ ‡ ‡ ‡ ‡ IMPORTANTS CONSIDERATIONS 1. and Ca at least once everyday if on IV fluid . record all outputs 5. measure Na. K.

decrease intake and ongoing normal losses y2.DEFICITS IN BODY FLUID AND ELECTROLYTE y1. increased losses without intake .

ASSESSMENT 1. mucus membrane 5. urine 9. fontanel 4. blood gases MILD DEHYDRATION thirsty normal normal moist normal normal normal normal normal MODERATE DEHYDRATION restless poor sunken dry rapid deep normal reduced mild acidosis SEVERE DEHYDRATION semi-comatose very poor very sunken cyanotic rapid deep and rapid low oliguria severe acidosis . turgor 3. pulse 6. blood pressure 8. respiration 7. appearance 2.

hypertonic dehydration Na = > 150 . isotonic dehydration Na = 130 to 150 ‡ 2.TYPES OF DEHYDRATION ‡ 1. hypotonic dehydration Na = < 130 ‡ 3.

D10W for children y 2. ringers .similar to plasma and as a blood volume expander y 5.Na.provide calories . lactated ringers . K.maintain blood volume and treat shock and hypovolemia y 6. and Ca volume depletion y 4. saline .REPLACEMENTS y 1. dextran . dextrose .hypotonic to provide hydration and hypertonic for severe Na deficits y 3. lipids . Cl.

convection ‡ 2. evaporation ‡ 4. radiation ‡ 3.HEAT LOSS ‡ 1. conduction .

note quantity and characteristics of gastric residuals . compute caloric requirement for age and weight 2. measure AG every 8 hours especially if patient is less than 1 month of age 3.‡ ‡ ‡ ‡ IMPORTANT CONSIDERATIONS 1. check stool specimen for blood 4.

FLUID REQUIREMENTS y PRETERM 80-100 ml/kg/day y TERM 100-150 ml/kg/day y CHILDREN 70-110 ml/kg/day CALORIC REQUIREMENTS y MILK 20-24 kcal/oz y IV FLUID g/100 cc .

severe diarrhea 2. disorders preventing enteral nutrition within 5 days . other conditions 4. cystic fibrosis. GI abnormalities 3.TOTAL PARENTERAL NUTRITION 1. cancer.

measure HC 3. record frequency and type of seizure activity . ICP monitors 4. note LOC. tone and responsiveness to stimuli 2.‡ ‡ ‡ ‡ IMPORTANT CONSIDERATIONS 1.

‡ PEDIATRIC GLASGOW COMA SCALE EYE 4 spontaneous 3 . babbles 4 irritable.to words 2 to pain 1 none VERBAL 5 coos.none . cries 3 cries 2 moans 1 none MOTOR 6 moves spontaneously 5 withdraws touch 4 withdraws pain 3 flexion to pain 2 extension to pain 1 .

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‡ 1. MYELOMENINGOCELE . MENINGOCELE.

‡ 2. ENCEPHALOCELE .

ANENCEPHALY .‡ 3.

MICROCEPHALY .‡ 4.

‡ 5. SPINA BIFIDA OCCULTA .

DERMAL SINUS .‡ 6.

CALCANEOVARUS . EQUINOVARUS.‡ 1.

CALCANEOVALGUS .‡ 2. EQUINOVALGUS.

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Hospitalization is rarely required.Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. moderate. or severe symptoms. which interferes with normal breathing and produces the classical symptoms of a "barking" cough. . and hoarseness. It may produce mild. It is often treated with a single dose of oral steroids. occasionally epinephrine is used in more severe cases. stridor. The infection leads to swelling inside the throat. which often worsen at night.

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MOST COMMON SYMPTOMS salty tasting skin constant coughing or wheezing frequent & prolonged pneumonia excessive appetite inability to gain weight bulky stools The sweat test is a painless test that measures the amount of salt in the individual's sweat. A high salt concentration is indicative of Cystic Fibrosis. .

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Exercise . Supplements 5. Lung Transplantation 6. Oxygen Therapy 4.MANAGEMENT OF CYSTIC FIBROSIS 1. Medications Antibiotics Bronchodilators Pancreatic Enzyme Supplements Mucolytics Human DNase 2. Chest Physical Therapy Percussion PEP (positive expiratory pressure) Mask Therapy 3.

‡ 1. VENTRICULAR SEPTAL DEFECT .

‡ 2. ATRIAL SEPTAL DEFECT .

‡ 3. PATENT DUCTUS ARTERIOSUS .

PULMONARY STENOSIS .‡ 4.

AORTIC STENOSIS .‡ 5.

‡ 6. COARCTATION OF THE AORTA .

TRANSPOSITION OF THE GREAT ARTERIES .‡ 7.

‡ 8. TRUNCUS ARTERIOSUS .

‡ 9. TRICUSPID ATRESIA .

TETRALOGY OF FALLOT .‡ 10.

and congestive cardiac failure (CCF). therefore leading to the heart and body's failure. It is generally defined as inability of the heart to supply sufficient blood flow to meet the body's needs.Heart failure. . also called congestive heart failure (CHF). is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body.

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Believed to be caused by antibody crossreactivity that can involve the heart. (such as strep throat or scarlet fever). The illness is so named because of its similarity in presentation to rheumatism . and brain.Rheumatic fever is an inflammatory disease that occurs following a Group A streptococcal infection. skin. Acute rheumatic fever commonly appears in children between the ages of 5 and 15. joints. the illness typically develops two to three weeks after a streptococcal infection. with only 20% of first-time attacks occurring in adults.

carditis .‡ 1.

polyarthritis .‡ 2.

subcutaneus nodules .‡ 3.

‡ 4. chorea .

erythema marginatum .‡ 5.

Infection Patients with positive cultures for Streptococcus Pyogenes should be treated with penicillin as long as allergy is not present. Unlike normal heart failure. . rheumatic heart failure responds well to corticosteroids. 2. Heart Failure Some patients develop significant carditis which manifests as congestive heart failure. This treatment will not alter course of acute disease. 3. The most appropriate treatment stated in the Oxford Handbook of Clinical Medicine for rheumatic fever is benzylpenicillin. This requires the usual treatment for heart failure: diuretics and digoxin. Salicylates are useful for pain.1. Inflammation Patients with significant symptoms may require corticosteroids.

It affects many organ systems. is an autoimmune disease that manifests as a systemic necrotizing medium-sized vessel vasculitis and is largely seen in children under 5 years of age. and lymph nodes. mucous membranes. lymph node syndrome and Mucocutaneous Lymph Node Syndrome. mainly those including the blood vessels. its most serious effect is on the heart where it can cause severe coronary artery aneurysms in untreated children.Kawasaki Disease (KD). . skin. also known as Kawasaki Syndrome. however.

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In rare cases. . It is imperative that treatment be started as soon as the diagnosis is made to prevent damage to the coronary arteries. an additional dose may have to be considered. When in an academic medical center. IVIG by itself is most useful within the first seven days of onset of fever. If the fever does not respond. Intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease and is administered in high doses with marked improvement usually noted within 24 hours.Children with Kawasaki disease should be hospitalized and cared for by a physician who has experience with this disease. care is often shared between pediatric cardiology and pediatric infectious disease specialists (although no specific infectious agent has been identified yet). a third dose may be given to the child. in terms of preventing coronary artery aneurysm.

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causative agent: rubella virus incubation period: 14 to 21 days communicability: 7 days before to 5 days after rash appears mode of transmission: direct and indirect contact with droplets .

causative agent: measles virus incubation period: 10 to 12 days communicability: 5th day of incubation to first few days of rash mode of transmission: direct and indirect contact with droplets .

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causative agent: varicella-zoster virus incubation period: 10 to 21 days communicability: 1 day before to 6 days after rash appears. all vesicles have crusted mode of transmission: direct and indirect contact with saliva or vesicles .

causative agent: mumps virus incubation period: 14 to 21 days communicability: shortly before and after onset of symptoms mode of transmission: direct or indirect contact .

causative agent: group A betahemolytic streptococcus incubation period: 2 to 5 days communicability: acute phase of respiratory illness mode of transmission: direct contact and large droplets .

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causative agent: group A betahemolytic streptococcus. probably streptococcus incubation period: 2 to 5 days communicability: from outbreak of lesions until it disappears mode of transmission: direct contact with lesions .

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The sickling occurs because of a mutation in the Hemoglobin gene. . with studies reporting an average life expectancy of 42 in males and 48 in females.An autosomal recessive genetic blood disorder characterized by red blood cells that assume an abnormal. rigid. Sickling decreases the cells' flexibility and results in a risk of various complications. Life expectancy is shortened. sickle shape.

and other organs and body cavities) enlarged liver and spleen possible kidney infarction sudden pain throughout the body .SIGNS AND SYMPTOMS fever yellow sclera shortness of breath dizziness. headaches coldness in the hands and feet paler than normal skin or mucous membranes (the tissue that lines your nose. mouth.

supplemental oxygen 4.MANAGEMENT GOAL: avoid crises relieve symptoms prevent complications 1. bone marrow transplant . blood transfusions 3. medications antibiotics pain relievers 2.

which is necessary to maintain the blood clot. In severe haemophiliacs even a minor injury can result in blood loss lasting days or weeks. Haemophilia lowers blood plasma clotting factor levels of the coagulation factors needed for a normal clotting process. . Thus when a blood vessel is injured. A haemophiliac does not bleed more intensely than a normal person. which is used to stop bleeding when a blood vessel is broken. In areas such as the brain or inside joints.A group of hereditary genetic disorders that impair the body's ability to control blood clotting or coagulation. but can bleed for a much longer time. this can be fatal or permanently debilitating. but the missing coagulation factors prevent fibrin formation. a temporary scab does form. or even never healing completely.

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Haemophilia C is not completely recessive: heterozygous individuals also show increased bleeding. Haemophilia B is a recessive X-linked genetic disorder involving a lack of functional clotting Factor IX. It comprises approximately 20% of haemophilia cases.Haemophilia A is a recessive X-linked genetic disorder involving a lack of functional clotting Factor VIII and represents 80% of haemophilia cases. Haemophilia C is an autosomal genetic disorder (not Xlinked) involving a lack of functional clotting Factor XI. .

the muscles in the pylorus have become enlarged to the point where food is prevented from emptying out of the stomach. When an infant has pyloric stenosis. . the lower part of the stomach through which food and other stomach contents pass to enter the small intestine.Pyloric stenosis is a narrowing of the pylorus.

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3. dehydration also can occur causing the baby to cry without having tears.SIGNS AND SYMTPOMS: 1. and having less wet or dirty nappies such as going hours or a couple days without having anything 4. belching. . and colic are other possible signs as the baby is not able to eat properly. because it is more forceful than the usual spittiness (gastroesophageal reflux) 2. some infants present with poor feeding and weight loss. constant hunger. but others demonstrate normal weight gain. non-bile stained ("non-bilious") and "projectile vomiting".

This is a relatively straightforward surgery that can possibly be done through: 1. single incision (usually 3±4 cm long) 2.TREATMENT: The definitive treatment of pyloric stenosis is with surgical pyloromyotomy known as Ramstedt's procedure (dividing the muscle of the pylorus to open up the gastric outlet). laparoscopically (through several tiny incisions .

a protein in wheat. People who have celiac disease cannot tolerate gluten. and barley. Is both a disease of malabsorption (meaning nutrients are not absorbed properly) and an abnormal immune reaction to gluten.Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. . rye.

foul-smelling.SIGNS AND SYMPTOMS: abdominal bloating and pain chronic diarrhea vomiting constipation pale. or fatty stool weight loss .

The only treatment for celiac disease is a gluten-free diet. . people with celiac disease must avoid gluten for the rest of their lives. To stay well.

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or congenital aganglionic megacolon. The length of bowel that is affected varies but seldom stretches for more than about 30 cm. caused by bowel obstruction resulting from an aganglionic section of bowel (the normal enteric nerves are absent) that starts at the anus and progresses upwards.Hirschsprung's disease. involves an enlargement of the colon. .

CLINICAL FEATURES: 1) delayed passage of meconium 2) abdominal distension 3) constipation .

This allows bowel contents to be discharged into a bag. 2. There used to be two steps used to achieve this goal. age. Later.Treatment consists of surgical removal (resection) of the abnormal section of the colon. a pull-through procedure is performed. followed by re-anastomosis. . 1. When a colostomy is performed. and condition is right. when the child¶s weight. The first stage used to be a colostomy. the large intestine is cut and an opening is made through the abdomen.

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73m2 body surface area) from the blood into the urine. causing them to leak large amounts of protein (proteinuria at least 3. because some of the protein albumin has gone from the blood to the urine) but not large enough to allow cells through (hence no hematuria). .Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged. Kidneys affected by nephrotic syndrome have small pores in the podocytes. large enough to permit proteinuria (and subsequently hypoalbuminemia.5 grams per day per 1.

hyperlipidemia 4. hypoalbumineia 3.5g/day) 2. generalized edema .characterized by: 1. proteinuria (>3.

Independent of their blood pressure lowering effect. Fluid restrict to 1 L. Prophylactic anticoagulation may be appropriate in some circumstances. Blood pressure control. frequent relapses treated by cyclophosphamide. Treat hyperlipidemia to prevent further atherosclerosis.MANAGEMENT Monitoring urine output. Immunosuppression for the glomerulonephritides (corticosteroids. Standard regime for first episode is prednisolone. they have been shown to decrease protein loss. . cyclosporin). Diuretics (IV furosemide). Albumin infusions are generally not used because their effect lasts only transiently. Achieving better blood glucose level control if the patient is diabetic. ACE inhibitors are the drug of choice.

No potassium or phosphorus restriction necessary. Monitor fluid intake. 5. ham. season salt). adobo. ketchup. bologna. canned vegetables containing salt. egg yolks. Fluid management in nephrotic syndrome is tenuous. . especially during an acute flare. and salami. On food labels. canned soups. fatty cuts of red meat. fish. Eat low-fat desserts. canola oil. Avoid saturated fats such as butter. Increase unsaturated fat intake. fast foods. Increase intake of fruits and vegetables. prepared foods. Sodium should be less than or equal to calories per serving. avocadoes. and salad dressings. including olive oil.DIETARY RECOMMENDATIONS 1. fried foods. 2. 4. Eat a moderate amount of high protein animal food: 3 to 5 oz per meal (preferably lean cuts of meat. seasoning blends (garlic salt. and poultry) 3. Reduce sodium intake to 1000 to 2000 mg daily. and poultry skin. compare milligrams of sodium to calories per serving. Foods high in sodium include salt used in cooking and at the table. luncheon meats including turkey. peanut butter. soy sauce. cheese. which includes all fluids and foods that are liquid at room temperature. fish and nuts.

Congenital hypothyroidism (CH) is a condition of thyroid hormone deficiency present at birth. If untreated for several months after birth. Because the treatment is simple. . effective. nearly all of the developed world practices newborn screening to detect and treat congenital hypothyroidism in the first weeks of life. severe congenital hypothyroidism can lead to growth failure and permanent mental retardation. Treatment consists of a daily dose of thyroid hormone (thyroxine) by mouth. and inexpensive.

excessive sleeping reduced interest in nursing poor muscle tone low or hoarse cry infrequent bowel movements exaggerated jaundice low body temperature larger anterior fontanel persistence of a posterior fontanel umbilical hernia large tongue (macroglossia) .

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Phenylketonuria (PKU) is an autosomal recessive metabolic genetic disorder characterized by a deficiency in the hepatic enzyme phenylalanine hydroxylase (PAH). This enzyme is necessary to metabolize the amino acid phenylalanine to the amino acid tyrosine. When PAH is deficient, phenylalanine accumulates and is converted into phenylpyruvate (also known as phenylketone), which is detected in the urine. If the condition is left untreated, it can cause problems with brain development, leading to progressive mental retardation, brain damage, and seizures.

MANAGEMENT:
All PKU patients must adhere to a special diet low in phenylalanine for at least the first 16 years of their lives. This requires severely restricting or eliminating foods high in phenylalanine, such as meat, chicken, fish, eggs, nuts, cheese, legumes, cow milk and other dairy products. Starchy foods such as potatoes, bread, pasta, and corn must be monitored. Infants may still be breastfed to provide all of the benefits of breastmilk, but the quantity must also be monitored and supplementation for missing nutrients will be required. Many diet foods and diet soft drinks that contain the sweetener aspartame must also be avoided, as aspartame consists of two amino acids: phenylalanine and aspartic acid. The oral administration of tetrahydrobiopterin or BH4 (a co-factor for the oxidation of phenylalanine), can reduce blood levels of this amino acid in certain patients.

Galactosemia is a rare genetic metabolic disorder that affects an individual's ability to metabolize the sugar galactose properly. It is not related to and should not be confused with lactose intolerance. It follows an autosomal recessive mode of inheritance that confers a deficiency in an enzyme responsible for adequate galactose degradation. Lactose in food (such as dairy products) is broken down by the enzyme lactase into glucose and galactose. In individuals with galactosemia, the enzymes needed for further metabolism of galactose are severely diminished or missing entirely, leading to toxic levels of galactose in the blood. Without treatment, mortality in infants with galactosemia is about 75%.

The only treatment for classic galactosemia is eliminating lactose and galactose from the diet.

Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive, noncontagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement. 1. Cerebral refers to the cerebrum, which is the affected area of the brain (although the disorder most likely involves connections between the cortex and other parts of the brain such as the cerebellum). 2. Palsy refers to disorder of movement.

and sometimes even cognition 3. communication ability. limits in movement and posture cause activity limitation 2. disturbances of sensation. during childbirth or after birth up to about age three. depth perception and other sight-based perceptual problems. 1. some develop epilepsy .Cerebral palsy is caused by damage to the motor control centers of the developing brain and can occur during pregnancy.

SPASTIC TYPE .‡ 1.

‡ 2. ATHETOID TYPE .

ATAXIC TYPE .‡ 3.

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guillain barre syndrome is characterized by ascending weakness .

ventilatory insufficiency 5. autonomic dysfunction .‡ ‡ ‡ ‡ ‡ ‡ ASSESSMENT FINDINGS 1. clumsiness 3. dysphagia 4. mild sensory changes 2. absence of deep tendon reflexes 6.

refer for rehabilitation . monitor vital signs and observe autonomic dysfunction 4. prevent complications of immobility 6. promote optimum nutrition 8. maintain adequate ventilation 2. promote comfort 7. administer corticosteroids or antiarrhythmics as ordered 5.‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ INTERVENTIONS 1. provide psychological support 9. check muscle groups and cranial nerve function 3.

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Muscular dystrophy (abbreviated MD) refers to a group of hereditary muscle diseases that weaken the muscles that move the human body. Muscular dystrophies are characterized by progressive skeletal muscle weakness. and the death of muscle cells and tissue. . defects in muscle proteins.

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