ESSENTIAL NEWBORN CARE and Pediatric care

Mrs. Aurisita M. Delos Reyes, RN, MAN

FOUR PRIORITIES
y 1. AIRWAY y 2. TEMPERATURE MAINTENANCE y 3. TIMELY CUTTING OF THE CORD y 4. UNINTERRUPTED BREASTFEEDING

1. Establish and maintain patency of the airway
y Do a quick assessment on breathing y Stimulate to cry by rubbing the skin particular

attention on back and chest y Suctioning ( optional ) y = duration- 5-10 sec or < 5 secs in preterm y = mouth before nose

Prone. prevents increase ICP 3. Side lying Purposes 1.Positioning y y y y y y y y A. ) C.increase pressure L side of the heart which favor the closure of Ductus Arteriosus and Foramen Ovale 4.( maybe a cause in SIDS ) . Promotes gastric emptying thereby prevent reflux of gastric contents and aspiration B. promotes drainage of secretions 2. Supine (recommended for infants above 3 mos. R side lying.

Maintain appropriate temperature y y = Temp of the NB at birth.37.36.4.2.2 o C = usually unstable and takes 6-8 hours to stabilize .

y 3. convection. Shivering mechanism of the NB is underdeveloped. . The thermoregulating center is immature y 2.Factors affecting temperature of the NB y 1. Inadequate adipose tissues (Brown fat) y 4. radiation. Neonates are prone to heat loss thru evaporation. and conduction.

Delay Bath until 6 hours . EXPOSE TO DROPLIGHT ( if necessary) 4. SKIN TO SKIN CONTACT Transfers the following HEAT LOVE Normal Bacterial Flora 2. DRY and WRAP THE NEWBORN 3.NURSING MANAGEMENT: y y y y y y y y 1.

HYPOGLYCEMIA results from utilization of glucose in the form of glycogen y Normal blood sugary 35 60 mg% 2.breakdown of fatsaccumulation of fatty acids 3. METABOLIC ACIDOSIS. RESPIRATORY DISTRESS .complications y 1.

III. y y y y Promote adequate circulation Factors that influence circulatory changes after birth Lung expansion Cutting of the umbilical cord .

a. LUNG EXPANSION y Increase pressure in the LEFT side Heart y Closure of fetal structures (Foramen ovale and Ductus Arteriosus) .

Nursing care: y 1. administer INDOMETHACIN as ordered . stimulate to cry y =except if Preterm ( Conserve energy) y 2. proper position y 3.

Cutting of the umbilical cord y Decrease pressure in the RIGHT side of the Heart y Closure of the DUCTUS VENOSUS and UMBILICAL BLOOD VESSSELS .b.

a special mutual relationship between mother and infant.4. Ideally started on the FIRST PERIOD OF REACTIVITY. . Bonding y .

CUDDLING. BREASTFEEDING = immediately after birth 2. ROOMING.METHODS: y y y y y y 1. EYE TO EYE CONTACT = Crede s Prophylaxis maybe delayed for 2 hours 3. HUGGING. and EMBRACING .IN 4.

BONDING y 2.STIMULATES GASTROCOLIC REFLEX FACILITATING EARLY and MORE FREQUENT DEFECATION THUS PREVENT JAUNDICE .STIMULATES PRODUCTION OF PROLACTIN AND OXYTOCIN y 4.PURPOSES OF BREASTFEEDING y 1. FACILITATES RELEASE OF COLOSTRUM AND BREAST MILK y 3.

V. y ASSESSMENT TOOLS .

respectively y y y Purposes: 1.y Apgar Screening Test authored by Dr. To evaluate ability of the NB to adjust extrauterinely and the prognosis . Virginia Apgar y Done twice at 1 and 5 min. To determine the degree of acidosis and the need for CPR 2.

CRITERIA .

ABSENT y GRIMACE.BLUE y PR.LIMP y RESPIRATION.ABSENT .CRITERIA: y0 y APPEARANCE.NO RESPONSE y MUSCLE TONE.

y ONE y ACROCYANOTIC y < 100 y GRIMACE y SOME FLEXION y WEAK CRY .

SNEEZE. COUGH y ALL FLEXED y STRONG CRY .y TWO y COMPLETELY PINK y >100 y STRONG CRY.

INTERPRETATION y 0-3= y POOR.SEVERELY DEPRESSED. MODERATELY DEPRESSED y NEEDS SUCTIONING & FURTHER OBSERVATION y 7-10 y GOOD. HEALTHY .GUARDED. CPR y 4-6 y FAIR.SERIOUS.

SILVERMANN AND ANDERSON y PURPOSE: y TO DETERMINE THE DEGREE OF RESPIRATORY DISTRESS y HIGH RISK BABIES y AS NECESSARY .

y CRITERIA: y NASAL FLARING y UPPER AND LOWER CHEST y XIPHOID RETRACTIONS y EXPIRATORY GRUNT .

serious with severe respiratory distress .y INTERPRETATION: y 0-3 y Good or healthy. no respiratory distress y 4-6 y Fair. Guarded with mild respiratory distress y 7-10 y Poor.

Dubowitz/Ballard Exam for Gestational Age Done on the first 24 hours and twice y Used by MD y Two criteria: y Neuromuscular y Physical Maturity Neuromuscular .

.

.

.

PROMINENT SOLE CREASES. TRANSPARENT.TESTES. VISIBLE BLOOD VESSELS EAR CARTILAGE ABSENT/ PLIABLE BREAST NODULE 1-2 mm GENITALS MALE.LESS SWOLLEN.PHYSICAL MATURITY y y y y y y y y y y y y y y PREMATURE SKIN GELATINOUS. FEW RUGAE FEMALE.CLITORIS AND MINORA.ANETRIOR TRANSVERSE LANUGO ABUNDANT .UNDESCENDED SCROTUM.

TERM y SMOOTH. PINK. LESS VISIBLE VEINS y FORMED AND FIRM WITH INSTANT RECOIL y 3-5 mm y PARTIALLY DESCENDED y MORE SWOLLEN AND RUGAE y PARTIALLY COVERED BY MAJORA y 2/3 OF THE SOLE WITH CREASES y LESS LANUGO .SUPERFICIAL CRACKING.

DESQUAMATES. NO VISIBLE BV y THICK CARTILAGE AND STIFF y 6 TO 10 mm y FULLY DESCENDED.DEEP CRACKING.POST TERM y PARCHMENT. EXTENSIVE RUGAE y MAJORA COMPLETELY COVERS MINORA and CLITORIS y ENTIRE SOLE with CREASES y NO LANUGO . PENDULOUS y MARKED SWOLLEN.

MATURITY RATING SCALE y y y y y y y y y y y y y y TOTAL SCORE -10 -5 0 5 10 15 20 25 30 35 40 45 50 AOG (weeks) 20 weeks Below 35= PRETERM 22 24 35-45 = TERM 26 28 ABOVE 45= POSTERM 30 32 34 36 38 40 42 44 .

Newborn Screening test RA 9288-NBS Act 2004 y Purposes: y Prevent MR y Prevent Physical defects y Prevent Death .

Diseases included in the NBS y 1.inborn error of metabolism y 4. Glucose 6 phosphatase Dehydrogenase deficiency y 5. Congenital Adrenal hyperplasia .inborn error of CHO metabolism y 3. Cretinism. Galactosemia. Phenylketonuria.inborn error of CHON metabolism y 2.

48-72 hours y Blood heelprick ( 4 drops blotted on paper y Results 2 to 3 weeks y Php 600 .y Done bet.

preferably in the presence of the parents = include: Double banding Finger and footprints Birthmarks.HEMANGIOMA .VI. y y y y IDENTIFICATION.

STRAWBERRY MARKS .

STRAWBERRY MARKS-(Nevus vasculosus)
y Elevated areas formed by immature capillaries and

endothelial tissues y PORTWINE STAINS-(Nevus Flammeus )
y a macular purple or dark red lesion or patches y Can be seen face, buttocks, thigh and genitals

TELANGIECTASIS NEVI
y =flat , red areas of capillary dilatation commonly seen

at the glabella, upper eyelid, and upper lip

PORTWINE STAINS(Nevus Flammeus)

.

COMMON MARKS (not to be use in ID) y MONGOLIAN SPOTS .

MILIA .

.

VERNIX CASEOSA .

NEWBORN RASH/FLEABITE RASH ( Erythema Toxicum) .

nape. and buttocks =Disappears 3rd week =Self limiting .ERYTHEMA TOXICUM =Pink papules with superimposed vesicles =Seen in the face . back.

DESQUAMATION .

5-7.3.33-35 cm or 13-14 in CHEST CIRCUMFERENCE.8 lbs BIRTHLENGTH.ANTHROPOMETRIC MEASUREMENTS y y y y y BIRTHWEIGHT.4 kg or 5.31-33 cm or 12-13 in ABDOMINAL CIRCUMFERENCE.2.5.48-54 cm or 18-22 im HEAD CIRCUMFERENCE.29-31 cm or 11-12 in .

irregular. with normal physiologic apnea of <15 sec. 30- 60 breaths/ min y = rapid. per min y = shallow but quiet y = abdominal and diaphragmatic . VITAL SIGNS y RR.IX.80 breaths/min at birth. stabilize bet.

180 beats per min y = stabilizes between 120-160 bpm y = rapid and irregular y = usually increased when crying and low if asleep y = sites= Apical pulse y Brachial y Femoral.if weak or absent suggest COA y Pedal .y PR.

TEMPERATURE y BLOOD PRESSUREy = 80/46 mmHg at birth y = at 10 days maybe 100/50 mmHg y = higher in the LE and lower in the UE y = maybe by Doppler or Flush methods .

X. PHYSICAL ASSESSMENT y Infant and young children y CHEST first before head y Beginning School period= CEPHALOCAUDAL .

retractions 2.DIAPHRAGMATIC HERNIA b.A. BREATH SOUNDS a.bronchospasm ( Bronchiolitis and Asthma ) c.inexpansion of the lungs as in RDS = assymetrical. CHEST y ASSESS : 1. stridor= laryngospasm ( Croup and Epiglotittis) . absence. wheezes.

Witch milk. rales or crackles=pulmonary congestion 2.c.colorless or transparent fluid caused by maternal hormones .

Diaphragmatic Hernia .

y a birth defect resulting to crowding of the abdominal organs in the chest cavity thus leading to collapse of the lungs y = Two types y Left sided.BOCHDALEK HERNIA y Right sided-MORGAGNI HERNIA .

with one side being larger than the other y abdomen that appears caved in (concave) y A baby born with a Morgagni hernia may or may not show any symptom .Signs and Symptoms y difficulty breathing y fast breathing y fast heart rate y cyanosis (blue color of the skin) y abnormal chest development.

Treatment may include: y neonatal intensive care y Mechanical ventilator y Extra corporeal membrane oxygenator y surgery .

RESPIRATORY DISTRESS SYNDROME =also known as HYALINE MEMBRANE DISEASE cause: unknown Basic defect: lack or deficiency of surfactant Predisposing factors: 1. Born CS 4. Prematurity 2. LBW/ SGA 3. LGA .

MANAGEMENT y 1.4oC and humidity @ 55-65% b.correct acidosis d. Provide warm environment to conserve energy = temp. Gamma/ Immunoglobulin .kept at 40 % to prevent blindness ( Retrolental Fibroplasia ) and Emphysema ( Bronchopulmonary Dysplasia ) 3. O2 therapy. INCUBATION= purposes a. Medications: a. Prevent Infection thru Reverse Isolation 4. Steroid ( Betamethasone )= promote surfactant maturation b. CPAP/ CPPB( Continues + a y Airway Pressure) aims to keep alveoli open thus prevent atelectasis y 2. Surfactant ( Beractant ) given intratracheal c.34. Na HCO3.

y 4. Gavage y 3. Breastfeeding . HYPERBILIRUBINEMIA managed by phototherapy and exchange transfusion y c. MALNUTRITION related to too much utilization of Oxygen resulting to poor growth and development y Management: y 1. TOUCH THERAPY y 6. TPN y 2. ANEMIA results from smaller mass of RBC and frequent extraction of blood y Management: BT with PRBC ( 50 ML ) y b. MINIMAL HANDLING y 5. Watch for Complications like y a.

AGE y 2. RESPONSE TO TREATMENT .Factors affecting prognosis y 1. AVAILABILITY OF TREATMENT y 3.

.

BRONCHIOLITIS y Self. Acute phase 1st 48 to 72 hrs y A viral infection y Inflammation of the bronchioles causing obstruction of the entrance and egress of air leading to overdistention of alveoli y Common to infants below 18 mos y Signs and symptoms y Wheezes. fever.limiting. respiratory distress .

Proper positioning = head elevated during acute distress y 3.Ribavirin ( Virazole via SPAG ) a. Aspiration precaution y 4. Mist or Croup tent ( O2 8 to 10 l/min) y = decrease Airway resistance y = keep child dry at all times y = monitor VS y 2. Antiviral.Medications: Bronchodilators and mucolytics b. .Management y 1.

and larynx y Maybe caused by bacteria or virus y Common to infants and young children y Most severe type Epiglotittis y Never inspect throat = precipitate complete airway obstruction y Have tracheostomy set always available at bedside . trachea .Croup y Inflammation of the bronchi.

Inspiratory stridor y 2. Tripod position y 3. Respiratory distress y 4. cherry red epiglottis y Management y Same as Bronchiolitis y Medication include anti bacterial .Signs and Symptoms y 1.

B. HEAD 1.Fontanels .

.

PAIRED y = ANTEROLATERAL ( SPHENOID ) y = POSTEROLATERAL ( MASTOID ) y 2.FONTANELS y TYPES: y 1. SINGLE y = ANTERIOR ( BREGMA ) y = POSTERIOR ( LAMBDA ) .

CHARACTERISTICS: y ANTERIOR FONTANELS y = diamond shape y = 3-4 cm long and 2-3 cm width y = if > 5cm maybe a sign of HYDROCEPHALUS and CRETINISM y = it closes 12 to 18 months .

Posterior fontanel y Characteristics y Triangle in shape y Located between lambdoidal and sagittal sutures y Measures 2 cm long and 1 cm wide y Closes between 2 to 3 mos .

INCREASE ICP y 2.craniosynostosis or craniostenosis y Premature closure of the fontanels and sutures y Complications y 1. MENTAL RETARDATION y 3. DEATH . BRAIN HERNIATION y 4.

CAPUT SUCCEDANEUM .

Caput Succedaneum y Swelling of the scalp y Caused by prolong second stage of labor y It crosses the suture line thereby affect both sides y Disappears in 2 to 3 days .

CEPHALHEMATOMA .

cephalhematoma
y Caused by increase pressure of birth y leading to rupture of capillaries y Does not cross the suture line thereby affects one side y Disappears in 3 to 4 weeks y A birth injury and may aggravate jaundice

craniotabes
y Localized softening of the cranial bones y Cause= early lightening ( descent of the presenting

part in the pelvic brim ) y Common to firstborn babies y Disappears 6 weeks

MOLDING

Face y Assess for BELL S PALSY y A birth injury caused by FORCEPS .B.

.

management y Feed baby with droppers and syringe and connect to artificial nipple y RATIONALE: TO PREVENT PREMATURE DISAPPEARANCE OF THE SUCKING REFLEX .

DOLL S EYE y 2. GLABELLAR TAP TEST y = best done first ten days . reactive to light and accomodation y = if keyhole COLOBOMA y = lacrimal duct= immature ( tearless ) y TEST x BLINDNESS y 1.EYES y =maybe slate blue or gray y =pupils equal. round.

COLOBOMA .

EXOTROPIA STRABISMUS .

ESOTROPIA STRABISMUS .

Laser therapy . Occlussion therapy y 2 Surgery. Corrective Glasses y 4.MANAGEMENT y Immediate treatment for non physiologic strabismus y 1.SQUINT Operation y 3.

y Assessment of the Ears y Note: y Infant and below three years y PULL PINNA DOWN and BACK y Above three y PULL PINNA UP and BACK .

EARS (PINNA ) ASSESSMENT .

abnormal y Chromosomal defects.y Note: if set lower.Down syndrome y = Patau syndrome y = Edward disease y Kidney defects y Craniofacial defects .

.

DOWN SYNDROME/TRISOMY 21 AGE y Basic defect= presence of three ( 3) chromosome 21 ( trisomy ) y Total no. Karyotyping y LIFE SPAN= VARIABLE y Cause = unknown y Predisposing factor=ADVANCE PARENTAL . 47 y Dx tests y 1. Alpha feto protein = low y 2. Chorionic villi sampling y 3.

CHARACTERISTICS y Microcephaly y Low set ears y Saddle nose y Small mouth with large tongue ( macroglossia ) y Short neck y Short and stubby digits with single transverse line ( SIMIAN CREASE ) y Hypotonic musculature y Protuberant abdomen y Small penis with undescended testes ( Cryptoorchidism ) y MENTAL RETARDATION .

COMMON PROBLEMS y 1. GUT DEFECTS .ESOPHAGEAL ATRESIA y 3. CARDIAC DEFECTS y 2. GIT DEFECTS.

CRANIOFACIAL DEFECT .

NOSE .

. bone or membrane Commonly blocking the choana or posterior nares CHOANAL ATRESIA y 2.nose Assess nasal flaring/ respiratory distress Causes 1. OBSTRUCTION a. LACK OF SURFACTANT y y y y y y . secretions B.

caused be extra load of Calcium y 2. EPSTEIN PEARLS y White glistening epithelial cysts at the palate and gums. TOOTH y Needs extraction to prevent ASPIRATION y Caused by too much intake of vitamins y 3. ORAL CANDIDIASIS .mouth y assess y 1. excessive drooling of saliva ESOPHAGEAL ATRESIA y 4. CLEFT LIP AND PALATE y 5.

intussusception y 3. pyloric stenosis y 2.obstructive y 1. infection y 2.non obstructive y 1.chalasia or GERD y PROJECTILE. hirchsprungs disease .vomiting y Non-projectile.

GASTROINTESTINAL DISORDERS .

CLEFT PALATE .

upper respiratory and ear y speech defect ( cleft palate ) y dental defect ( nasal twang ) y altered normal body image y respiratory distress .Folic acid deficiency Steroid Exposure to TORCH y Common problems: y feeding difficulty y infections.

Pre operativeespecially during and after y Proper positioning care y y y y y feeding.Otitis media. etc For dental defects-m Orthodontic exercise and surgery Speech therapy .Upright position Burp or bubble the NB more often Feed baby with the use of cross cut large holed nipple or Breck feeder technique Observe for signs of complications.

Post operative care y y y y y y y Proper positioning= PRONE x Cleft palate and SUPINE or SIDE LYING x Cleft lip Apply elbow restraint and release every 2 hours Give feeding with rubber tipped medicine dropper after Cleft lip and paper cups and soup spoon after cleft palate Cleanse the wound with hydrogen peroxide Give post operative meds which include analgesic and antibiotic Avoid sucking. blowing. and straw ) Make sure baby does not suck the LOGAN S BAR or BOW . fork. pointed and sharp objects ( spoon. suctioning.

surgery y Rule of 10 y 10 weeks old y 10 grams hemoglobin y 10 lbs weight Palatoplasty y Before speech development y Between 8 to 18 months y Watch for Respiratory Distress and Hemorrhage .

CHEILOPLASTY AND PALATOPLASTY .

.

.

enal defects y L.ESOPHAGEAL ATRESIA y failure of the esophagus to form a continuous passage between the mouth and the stomach y = a congenital defect y = often associated with other defects y = assessment include VACTERL y V.ertebral defects y A.norectal defects y C.ardiac like PDA ( most common ) y T.sophagus y R.rachea and y E.imbs y Cause: unknown but common in children with Down Syndrome .

.

Signs and Symptoms y y y y y y y excessive drooling of saliva choke after initial feeding resistance on NGT insertion respiratory distress abdominal distention cyanosis. tachypnea hx of hydramnios ( antepartum ) .

.

depends on the type of defect Creation of gastrostomy and cervical esophagostomy y Division of Fistula and Esophageal Anastmosis y Closure of the gastrostomy y .Diagnostic tests: X-rays y Treatment: Surgery.

Nursing care: y y y y Proper positioning.primary source of nutrition .elevate head at 20-30 degrees angle Regular suctioning Administer Oxygen if cyanotic Administer TPN.

arm. minerals and vitamins . and groin veins y = the solution contains sugar.Total Parenteral Nutrition or IV hyperalimentation y = introduction of hypertonic solution into the SVC thru a central line inserted in the neck.protein. fats .

.

ORAL MONILIASIS /CANDIDIASIS .

MONILIASIS/ CANDIDIASIS y Acquired by the baby during passage y Cause: Candida Albicans y Management: y Antifungal ( Nystatin ) spread with gloved finger .

not palpable y test for CRETINISM T3 T4 det y MENTAL RETARDATION y Tx.SYNTHROID .neck y Short y THYROID GLAND.

CONGENITAL TORTICOLLIS .

surgical release of contracted muscle .y = also known as wry neck y = contraction of the sternocleidomastoid muscle y = maybe treated by: y EXERCISE y APPLICATION OF WARM PACKS OR COMPRESS y TENOTOMY.

DIAPHRAGMATIC HERNIA y LIVER= 2-3 cm BELOW RIGHT COSTAL MARGIN y KIDNEYS= 1-2 cm above umbilicus y SPLEEN= left quadrant .ABDOMEN y DOME and CYLINDRICAL y SCAPHOID.

OMPHALOCELE .

GASTROSCHISIS .

OMPHALOCELE organs thru the umbilicus y Protrusion of the abdominal y Usually contained in a sac y Prone to infection y Management: y Cover the defect with sterile saline dressing and preferably change every two hours .

Prophylactic antibiotic y 2. Use overhead warming unit y 3.GASTROSCHISIS thru a defect or a hole y Protrusion of abdominal organs in the abdominal wall y Very prone to Infection y Management: y 1. Reduction Process thru a Silastic Silo y 2. Surgery .

Pyloric Stenosis .

palpable olive shaped mass y4. visible peristalsis y3. irritable and restless . projectile vomiting ( maybe bloody ) y2.Narrowing of the pylorus due to thickening of the pyloric muscle ySigns and Symptoms y1.

Monitor for Complications such as: y a.NURSING CARE y 1. Give thickened formula y = Rice Cereal and Milk thru gavage y 2. Dehydration . Prevent and correct dehydration y = IV fluids y 3. Measure I and O y 4. Metabolic alkalosis and acidosis y b.

Surgical mgt y FREDET RAMSTED PROCEDURE y ( PYLOROMYOTOMY ) y = separation of the hypertrophied muscle of the pylorus without mucosal incision y LAPAROSCOPY .

INTUSSUSCEPTION .

bloody and mucoid stool .y = invagination or the telescoping of the small bowel into the large bowel y = may occur as early as 3 weeks old manifested by y abdominal pain y projectile vomiting with bile or fecaloid y sausage shaped mass y passage of CURRANT jelly.

revels a Coiled Spring or Staircase sign y TX: BARIUM ENEMA y SURGERY: BOWEL RESECTION with END to END ANASTOMOSIS y BOWEL MILKING .DX: LGIS or Barium Enema.

HIRSCHPRUNGS DISEASE .

Hirchsprungs/ Aganglionic Megacolon y Absence of ganglion nerve cells resulting to the absence of peristalsis in the affected segment y Accumulation of intestinal materials leading to y MEGACOLON .

Signs and symptoms: y y y y y non passage of meconium vomiting and abdominal distention chronic constipation passage of ribbon-like or pellet stool anorexia. shortness of breath .

Diagnostic tests: y y y Barium Enema Rectal exam Anorectal biopsy.most reliable .

Treatment:Surgery y Colostomy y Swenson and Soave y Closure of Colostomy .

Oral hygiene 7.Measure abdominal circumference daily 4.1.Daily enema. Ex.Administer drugs as ordered.Psychosocial support Nursing care: Pre operative .for retention olive oil or diluted antibioti i. Stool softeners 6.Position with head elevated to ease breathing 5.Small but frequent meals of low residue 3.± for non retention.isotonic saline solution 2.

passed 4X per day y TRANSITIONAL. odorless. sticky. slimy.yellow-green. Breast fed baby stool y B.ANOGENITAL y THREE TYPES OF STOOLS y MECONIUM. Bottle fed baby stool .green black . 6X or more y MILK y a.

BREAST FED BABY STOOL y Characterisitics: y Golden yellow y Mushy and soft y Sweet odor y Passed every after breastfeeding .

BOTTLE FED BABY STOOL y Characteristics: y Pale yellow y Hard and formed y Offensive. foul odor y Passed once/ day .

IMPERFORATE ANUS .

Signs and Symptoms y absence of anal opening y misplaced anal opening y anal opening very near the vaginal opening in the female y no passage of first stool within 24 to 48 hours after birth y stool passed by way of vagina. base of penis or scrotum. or urethra y abdominal distention .

Treatment: Surgery y Stage I: Colostomy ( newborn) y Stage II: Pull thru y Stage III: Closure of colostomy .

Voiding y =expected to void 6 to 8x on 1st 24 hours y = failure may suggest dehydration or absence of urinary meatus y =After 24 hrs= 12 to 20X/ day y = failure means renal agenesis .

Epispadias.urinary meatus located at ventral surface or under penis y management: MEATOPLASTY . LOCATION OF THE URINARY MEATUS.urinary meatus above or dorsal surface of the penis y B. maybe y A. Hypospadias.GENITOURINARY DEFECTS y ASSESS: y 1.

HYPOSPADIAS .

CRYPTOORCHIDISM .

UNDESCENDED TESTES COMPLICATIONS: y 1. Sterility y Management: y 1. ORCHIOPEXYor ORCHIDOPEXY . Hormonal tx. Inguinal Hernia y 2. Testicular cancer y 3.HCG & TESTOSTERONE y 2.

HYDROCELE

ACCUMULATION OF INTRAABDOMINAL FLUID IN THE SCROTUM
y TYPES: y 1. NON- COMMUNICATING y 2. COMMUNICATING needs elective

repair to prevent HERNIA y NOTE: Trans illumination may reveal fluid or loop of intestines

EXTREMITIES
y Assess for symmetrical movements y If absent suggests: weakness or paralysis y Note the following abnormalities y 1. Amelia- absence of entire limb y 2. Phocomelia- absence of arms or legs y 3. Hemimelia- absence of hands or feet

PHOCOMELIA .

ERBS PALSY

SIGNS AND SYMPTOMS
OF MORO RERLEX IN THE AFFECTED SIDE y 2. INCOMPLETE TONIC NECK REFLEX y 3 DECREASE SENSORY AND MOTOR FUNCTION
y 1. ABSENCE

TREATMENT y Abduction with external rotation of the affected arm and immobilize with FIGURE EIGHT or AIRPLANE SPLINT .

ORTOLANI TEST .

HIP DISLOCATION/DYSPLASIA .

PAVLIK HARNESS .

HIP SPICA CAST .

BRYANT S TRACTION .

.

EXERCISE y 2.Management: y 1. Application of LEG cast y check the following: y = Color y = Pulse y = Temperature y = Capillary refill .

EQUINOVARUS .

EQUINOVARUS y Characterized by: y = plantar flexion ( toes pointing down ) y = inversion ( toes pointing inward ) y OTHER TYPES: y = eversion ( toes pointing outward ) y = calcaneus ( toes pointing upward ) .

Application of cast y 3. Dennis Browne application . Arthrodesis y 4. Exercise y 2.Management: y 1.

LEG CASTING .

SCOLIOSIS .

MILWAUKEE BRACE .

POST HARRINGTON RODS APPLICATION .

SPINA BIFIDA .

.

Meninges. maybe y A. no protrusion of Spinal contents tho manifested by tuft of hair.Incomplete closure of the vertebrae y Types: y 1. OCCULTA. Cystica. dimple and small mass y 2. Myelomeningocele. Meningocele. Rachischisis. and Spinal cord y C.HIDDEN.protrusion of CSF. Nerve roots.protrusion of SC and Meninges .with protrusion of the spinal contents.protrusion of meninges and CSF y B.

HYDROCEPHALUS .

high pitch and shrill cry f. SAC at the SYMPTOMS y y y y y y y y y y y y Management: A. change in VS .cracked pot sound b.SIGNS and back y 1. bulge and tense fontanel e. Protect the sac from rupture thru = prone with hips abducted and head slightly elevated = apply sterile donut ring = cover with sterile saline dressing and change every two hours 2.protuberant forehead c. SUNSET.iris lower than sclera d. MACEWEN. change in LOC g. Increase ICP related to Hydrocephalus w/c include a. BOSSING.

proper position y 2. Use or apply protective devices 7.y 1. avoid straining y 3. If possible avoid LP due to Brain herniation 6. Mannitol. give drugs as ordered like: y A. Steroid. Avoid constipation .Dexamethasone y C. regulate flow rate of the IV accurately avoid management over infusion y 4.osmotic diuretic y B. Acetazolamide ( Diamox ) decreases production of CSF temporarily 5. Passive ROM 8. Intermittent straight catheterization to empty the bladder 9.

Ventriculo atrial Note: observe for signs of shunt malfunction . Ventriculoperitoneal b. Excision of the sac 2. Shunting.surgery 1.divert CSF to decrease and prevent increase ICP a.

.

location of the defect. Availability of treatment .pr g sis y Depends on: y 1.the lower the defect the better chance y 2.

SHUNTING .

.

JAUNDICE .

.

Sickle Cell Anemia .

.

.

.

y Complications y Pain Lethargy Lifelong anemia (low red blood count) Organ failure Stroke .

HEMOPHILIA .

.

.y When a female with hemophilia has children. she will pass the gene to each of her sons.

Sign up to vote on this title
UsefulNot useful