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

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

Maintain appropriate temperature y y = Temp of the NB at birth.36.2.37.4.2 o C = usually unstable and takes 6-8 hours to stabilize .

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

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

complications y 1. RESPIRATORY DISTRESS . 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.

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

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

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

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.

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

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

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

y ASSESSMENT TOOLS .V.

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

CRITERIA .

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

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

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

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

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 .

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

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 .

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

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 . PINK.TERM y SMOOTH.SUPERFICIAL CRACKING.

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

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 .

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

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

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

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)

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

MILIA .

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VERNIX CASEOSA .

NEWBORN RASH/FLEABITE RASH ( Erythema Toxicum) .

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

DESQUAMATION .

48-54 cm or 18-22 im HEAD CIRCUMFERENCE.29-31 cm or 11-12 in .33-35 cm or 13-14 in CHEST CIRCUMFERENCE.4 kg or 5.2.5.5-7.8 lbs BIRTHLENGTH.3.ANTHROPOMETRIC MEASUREMENTS y y y y y BIRTHWEIGHT.31-33 cm or 12-13 in ABDOMINAL CIRCUMFERENCE.

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

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 .

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

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

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

Diaphragmatic Hernia .

BOCHDALEK HERNIA y Right sided-MORGAGNI 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.

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 .

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

Na HCO3.correct acidosis d. O2 therapy. CPAP/ CPPB( Continues + a y Airway Pressure) aims to keep alveoli open thus prevent atelectasis y 2. Steroid ( Betamethasone )= promote surfactant maturation b. Prevent Infection thru Reverse Isolation 4. Surfactant ( Beractant ) given intratracheal c.34. INCUBATION= purposes a. Gamma/ Immunoglobulin . Provide warm environment to conserve energy = temp.MANAGEMENT y 1. Medications: a.4oC and humidity @ 55-65% b.kept at 40 % to prevent blindness ( Retrolental Fibroplasia ) and Emphysema ( Bronchopulmonary Dysplasia ) 3.

y 4. ANEMIA results from smaller mass of RBC and frequent extraction of blood y Management: BT with PRBC ( 50 ML ) y b. 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. Breastfeeding . Gavage y 3. Watch for Complications like y a. MINIMAL HANDLING y 5. HYPERBILIRUBINEMIA managed by phototherapy and exchange transfusion y c.

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

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respiratory distress . fever.limiting.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.

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. Aspiration precaution y 4.Ribavirin ( Virazole via SPAG ) a.Management y 1. Proper positioning = head elevated during acute distress y 3. Antiviral. .Medications: Bronchodilators and mucolytics b.

trachea .Croup y Inflammation of the bronchi. 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 .

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

B.Fontanels . HEAD 1.

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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. BRAIN HERNIATION y 4. DEATH . MENTAL RETARDATION y 3.

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.

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

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

COLOBOMA .

EXOTROPIA STRABISMUS .

ESOTROPIA STRABISMUS .

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

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 .

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

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

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. CARDIAC DEFECTS y 2.ESOPHAGEAL ATRESIA y 3. GUT DEFECTS . GIT DEFECTS.

CRANIOFACIAL DEFECT .

NOSE .

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

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

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

GASTROINTESTINAL DISORDERS .

CLEFT PALATE .

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

etc For dental defects-m Orthodontic exercise and surgery Speech therapy .Pre operativeespecially during and after y Proper positioning care y y y y y feeding.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.Otitis media.

suctioning.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. pointed and sharp objects ( spoon. fork. and straw ) Make sure baby does not suck the LOGAN S BAR or BOW .

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 .

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norectal defects y C.imbs y Cause: unknown but common in children with Down Syndrome .sophagus y R.rachea and y E.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.enal defects y L.ardiac like PDA ( most common ) y T.ertebral defects y A.

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tachypnea hx of hydramnios ( antepartum ) .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.

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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.

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

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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 .

SYNTHROID .not palpable y test for CRETINISM T3 T4 det y MENTAL RETARDATION y Tx.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 .

Reduction Process thru a Silastic Silo y 2.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. Surgery . Use overhead warming unit y 3. Prophylactic antibiotic y 2.

Pyloric Stenosis .

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

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

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.

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

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.± for non retention.Small but frequent meals of low residue 3.Daily enema.Administer drugs as ordered.Measure abdominal circumference daily 4. Stool softeners 6. Ex.for retention olive oil or diluted antibioti i.Position with head elevated to ease breathing 5.Psychosocial support Nursing care: Pre operative .isotonic saline solution 2.1.

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

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

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

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 .

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

HYPOSPADIAS .

CRYPTOORCHIDISM .

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

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 .

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

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 ) .

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

LEG CASTING .

SCOLIOSIS .

MILWAUKEE BRACE .

POST HARRINGTON RODS APPLICATION .

SPINA BIFIDA .

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

HYDROCEPHALUS .

iris lower than sclera d.cracked pot sound b.protuberant forehead c. MACEWEN. 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. change in VS .SIGNS and back y 1. change in LOC g. BOSSING. bulge and tense fontanel e. high pitch and shrill cry f. SUNSET. Increase ICP related to Hydrocephalus w/c include a. SAC at the SYMPTOMS y y y y y y y y y y y y Management: A.

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

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

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

SHUNTING .

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JAUNDICE .

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Sickle Cell Anemia .

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

HEMOPHILIA .

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