PEDIATRIC NURSING

SUBMITTED BY: MARICEL A. GALLATO

BSN 2-3
 A. NURSING CARE OF THE HIGH RISK
NEWBORN TO MATURITY
• 1. problems related to maturity
a. Prematurity
- Anemia ( baby doesnt have enough healthy red blood cells
to carry oxygen to the rest of the body.
- Apnea of Prematurity or AOP ( pause in breathing for 15 to
20s or more. it may happen togethir w/ a slow heart rate called
bradycardia.
- Bronchopulmonary dysplasia or BPD ( lund disease)
- Respiratory Distress Syndrome or RDS.
 - Infections or Neonatal sepsis (premature babies can
get infections easily than other babies because their
immune system are not fully developed.
- Intraventricular hemorrhage or IVH (bleeding in the
fluid-filled spaces or also called ventricles)
- JaundNewborn ice ( baby's skin and the whote parts
of his eye look yellow)
- Necrotizing enterocolitis or NEC ( it happens when
the tissue of intestine is injured or begins to die.)
- Patent ductus arteriosus (heart conditin that happens
when a blood vessel called the ductus arteriosus doesnt
close properly.
 -Retinopathy of prematurity or ROP ( eye disease that
happens when a baby's retina's dont fully develop in the
weeks after birth.
b. Postmaturity
- Less amniotic fluid ( this may stop the baby from gaining
weight or may even cause weight loss.)
- Poor oxygen supply ( babies who dont get enough
oxygen may have problems during labor and delivery.)
- Meconium aspiration ( babies who stay in the womb
longer are more likely to breathe in fluid containg meconium)
- Hypoglycemia or low blood sugar (thiss happens when
the baby has already used up his stores of glucose.
• 2. Problems related to gestational weight
a. small for gestational age (SGA)
-lower oxygen levels than normal.
-low apgar scores.
-breathing problems
-low blood sugar
-difficulty keeping a normal body temperature.
-too many RBC.
b. large for gestational age (LGA)
-show immature reflex
-has bruises
-cepalhematoma and caput saccedaneum.
-ineffective breathing pattern.
• 3. Acute conditions of the neonates:
a. Respiratory Distress Syndrome
-hyaline membrane disease
-due to low level of surfactant
*therapeutic management:
surfactant replacement,
oxygen administration,
extracorporeal membrane oxygenation(ECMO),
liquid ventilation and
nitric acid.
 b. Meconium Aspiration Syndrome
- if hypoxia occurs, a vagal refles is stimulated resulting in
relaxation of the rectal sphincter. this releases meconium into the
amniotic fluid from pressure in the buttocks.
- meconium can cause severe distress syndrome.
- positive to barrel chest.
*therapeutic management:
Amnioinfusion (dilute the amount of meconium in amniotic fluid)
Tracheal suction ( oxygen administration and assisted ventilation.
Antibiotic theraphy
Surfactant administration (Prevent RDS)
Chest Physiotherapy w/ clapping and vibration
 c. Sepsis
-blood infection that occurs in an infant younger than 90
days old.
- caused by bacteria.
*therapeutic management:
Anti-infectious agent (must be given as early as possible)
Supportive care of dysfunctional organs such as;
Mechanical Ventilation
Fluids
Vasopressors or Inotropes (or both) and
Blood Transfusion
 d. Hyperbilirubinemia
-jaundice
*therapeutic management
Phototherapy further subdivided to conventional,
intensive and exchange transfussion, and pharmacological
treatment subdivided to phenobarbitone, intravenous
immunoglobulins(IVIG), metalloporphyrins and follow up
remedies.
• e. Sudden Death Syndrome (SDS)
– sudden death in infancy (SIDS)
– causes is unknown.
*therapeutic management
Prevention ( put newborns to sleep on their back with pacifier.)
(infants should sleep with a fan)
Nursing Family care: (refer to trained counselor) (give autopsy
ASAP)
 B. COMMON HEALTH PROBLEMS THAT
DEVELOP DURNG INFANCY
• a. Intussusception
- “Telescoping SyndRome”
- invagination of the intestine to the other intestine.
• b. Failure to thrive
-reactive attachement disorder
- they starved for human contact
-two categories:
1. syndromes because of organic causes.
2. syndromes because of inorganic causes.
• c. Sudden infant death syndrome (SIDS)
- sudden death in infancy (2 to 4 moths)
- unknown causes

• d. Colic
-proxysmal abdominal pain
-occurs in infants under 3 months.
-cause is unknown but they consider it due to milk
allergy, and mother's diet for breastfed babies.
 • e. Trisomy 21
- Down syndrome
-[(47xy21) or (47xx21)]
-altered immune function.
-IQ of 50 to 70nto even 20 (normal: 120)
-atrioventricular defects: common cause of death

• f. Cleft palate
-congenital defect that has genetic and environmental
propositions.
-during intrauterine life the primary palate doesnt fully fused.
-deficiency of folic acid.
-common in girls “haberman feedeer”
• g. Imperforated anus
-absence of rectal opening.
-common in boys.
-”wink reflex”
-under temporary colostomy,final repair in 6-12months
-rectal dilation (once or twice a day) for few months after surgery.
• h. Hirchsprung's disease
-”aganglionic megacolon”
-absence of ganglionic innervation to the muscle of a
section of the bowel.
-lower portion of sigmoid colon just above the anus.
results in lack of motility
-vommiting since there is abdominal destruction.
*types: 1. swenson
2. duhamet
3. soave
• i. Spina bifida
-caused by polygenic inheritance and bad nutrition during
pregnancy.
-low in folic acid.
1. Spina Bifida cystica - incomplete closure of the vertebrae and
neural tube. Saclike protrusion containing meninges cerebospinal
fluid (CSF), nerve root, spinal cord.
I. Meningocele - the meninges covering the spinal cor and the
meningeshermate through an unformed vertebrae.
II. Myelomeningocoel - spinal cord and meninger protrude
through an unformed vertebrae.
2. Spina Bifida occulta - hemangiona or lipoma in lower sacral
area. small tuf hair. dimple.
• j. Hydrocephalus
-imbalanced between the production and absorption of CSF.
-cause is unknown but it may be from maternal infection.

• k. Otitis media
-It happens when viruses or bacteria get into the middle ear, the
space between the eardrum.
-the middle ear fills with pus (infected fluid). the pus pushes on
the eardrum, w/c can be very painful.
-it goes away within 2 to 3 days on their own without specific
treatment.
• l. Meningitis
-An inflamation of the meninges. the meninges are the three
membranes that cover the brain and spinal cord. meningitis can
occur when fluid surrounding the meninges becomes infected.
1.Viral Meningitis - most common type. viruses in the enterovirus
category ause 85% of cases. these are more common during the
summer and fall.
2.Bacterial Meningitis - contagious and caused by infection from
certain bacteria. it's fatat if left untreated.
3. Fungal Meningitis - rare type. it's caused by fungus tat infects
your body and then spreads from your bloodstream to your brain
and spinal cord. low immune system are most likely to have this
specially people with cancer or HIV.
 4. Parasitic Meningitis - less common type. caused by parasites
that are found in dirt, feces, and on some animals and food, like
snails, raw fish, poultry or produce.
5. Non-infectious Meningitis - it is not infection. caused by other
medical conditions or treatments such as; lupus, head injury,
brain surgery, cancer or certain medications.

• m. Febrile seizure
-they're convulsions a child can have during a very high fever
that's usually over 102.2 to 104 degree F (39 to 40 degree C) or
higher. this happen rapidly. the rapid change in temperature is
more of a factor than how high the fever gets for triggering a
seizure.
 1. Complex Febrile Seizure - last for more than 15minutes.
multiple seizures may happen over a 30-minute period. they may
happen more than once during a 24 hour time frame as well. last
longer.
2. Simplex Febrile Seizures - are more common. most last less
than 2 minutes but can last as longn as 15minutes. only happen
once in 24-hour period.
• n. Autism/ ADHD
-Children with ADHD often have difficulty paying attention to the
same thing for too long. and they may get distracted easily.
-Autistic children may have a limited scope of interest. they may
seem to obsess over tings that they enjoy and have difficulty
focusing on things that they have no interest. They may be able
to recall facts and details easily.
 C. HEALTH PROBLEMS COMMON IN
TODDLERS
• a. Burns
-Severely burned childrens are at increased risk for fluid and heat
loss, dehydration and metabolic acidosis compared w/ adults.
-A delay in growth may occur after burned.

• b. Poisoning
-Any substance that impairs health or destroys life when
ingested, inhaled or otherwise absorbed by the body.
• c. Child abuse
-Non accidental physical injury or the nonaccidental act of care
by a patient or responsible for a child.
-Abuse coprises neglect and physical, sexual and emotional
maltreatment.

• d. Cerebral Palsy
-Disorder characterized by impaired movement and
postureresulting from an abnormality in the extrapyramidal or
pyramidal motor system.
1. Spastic Cerebral Palsy - represents an upper motor neuron
type of muscle weakness.
2. Athetoid, Ataxic and Mixed - less common type.
 D. HEALTH PROBLEMS COOMON IN
PRESCHOOLER
• a. Leukemia
-May bleed more than expected after a minor injury or nosebleed.
-have small red spots on the skin or petechiae w/c occur due to tiny
blood vessels that have bled.
-May also bruise easily.

• b. Wilm's Tumor (nephroblastoma)

-A rare kidney cancer that starts when cells in the body begin to
grow out of control.
1. Unilateral - one kidney affected
2. Bilateral - two kidney affected
• c. Asthma
-A cough that doesnt go away.
-Coughing spells that happen often, especially during play or
excercise at night, in cold air, or while laughing or crying.

• d. Urinary Tract Infection (UTI)

-Pain and urgency with urination blood in the urine,
abdomila/pelvic pain, fever, flank pain and vomiting.
-When the bacteria leet into the bladder or kidneys.
 E. HEALTH PROBLEMS MOST COMMON IN
SCHOOL AGED CHILDREN
• a. Diabetis Mellitus
-Blood sugars (Glucose) are abnormally high because the body
does not produce enough insulin or fail to respond normally to the
insulin produced.
-Based on the results of Urine and blood test.
• b. Rheumatic Fever
-Inflamation of the joints, heart, skin and nervous system
resulting from a complicationof untreated streptoccocal
infection of the throat.
-Children may have combination of joint pain, fever, chest
pain or plpitations, verry uncontrollable movement, rash
and small bumps under the skin.
-Antibiotics(Penicillin) / or other antibiotic to eliminat
remaining strep bacteria.
• c. Rheumatic Athritis
-Juvenille rheumatoid athritis (JRA) often reffered as Juvenille
idiopathic athritis(JIA) that cause joint inflammation and stiffness
for more that 6 weeks in child aged 16 or younger.
-Autoimmune disorder w/c means that the body mistakenly
identifies some of its own cells and tissues are foreign.
-It results inflammation-- marked by redness, heat , pain and
swelling.
• d. Scabies
-Common parasitic infestation of cerebral proportion.
-It is highly contagious skin disease found in most rural
communities.
-The parasite doesnt survive 2 to 3 days away from human skin.
-Lukewarm bath/ shower for prevention. put cream to all clid's
body creases.

• e. Pediculosis
-Infestation w/ head lice.
-Pediculus humanus capitis (Ectoparasites)
- Scratching can occur w/ any lice infestation.
• f. Impetigo
-Skin infection caused by staphylococcus/ streptococcus bacteria.
also known as school sores more common during warmer months.
-However cuts and abrasion or eczema may allow the bacteria to
cause infection in deeper skin tissues.
-Contagious and can spread from one person to another.
1.Non-bullous (Crusted) - most common. it begins as tiny blisters that
eventually bursh and leave small wet patches of red skin that may
weep fluid. Gradually, a yellowish-brown or tan crust covers the area.
2.Bullous (Large blisters) - causes larger fluid containing blisters that
look clear then cloudy. stay longer in the skin without bursting.
3.Ecthyma (Ulcers) - looks like “punched out” ulcers with yellow crust
and red edges.
 F. HEALTH PROBLEMS COMMON IN
ADDOLESCENT
• a. Scoliosis
-not known and is called as idiopathic or adolescent idiopathic
scoliosis (AIS)
-A sideways curvature of the spine that occurs not often during
the growth spurt just before puberty.

• b. Bone Tumors
-Bone that breaks for no reason. pain is most common symptom.
-due to genetics, radiation treatment and and injuries to the bone.
• c. Accidents (trauma/injury)
-Leading cause of mortality among adolesent invoving motor
development

• d. STD
-disease that are passed from one person to another through
sexual contact.
-Chlamydia
-Human Papillomavirus
-Syphlis
-Human Immunodefficiency Virus
-Gonorrhea
• e. Amenorrhea
-Primary amenorrhea- when the first bleeding at puberty doesnt
occur by age 15
-Secondary amenorrhea- when normal menstrual bleeding stops
occuring for 3 months or more.

• f. Dysmenorrhea
-Primary dysmenorrhea
-Secondary dysmenorrhea
• g. Obesity
-body mass index equato greater than the 95th percentile for age and
gender.
-some causes are genetics but most adolescent obesity result from a lack of
physcal activity and consuming more calories than needed for activity level.

• h. Anorexia Nervosa
-an eating disorder that is difficult t treat and relapse is common.
-extreme fears of gaining weight and altered perceptions of the body.

i. Suicide
-due to psychological disorder, especially depresion, bipolar disorder and
alcohol and drug use.
-feeling of distress , irritability or agitation