Growth and Development digestive grows rapidly during childhood

circulatory
Growth- increase in physical size of a structure or whole. musculoskeletal
-quantitative change.
2. )Neuromuscular tissue (CNS, brain, S. cord)
Two parameters of Growth - grow rapidly 1-2 years of life
- brain achieved its adult proportion by 5 years.
1. weight- most sensitive measure of growth, especially low birth
rate. 3. )Lymphatic system- lymph nodes, spleen grows rapidly- infancy
Wt doubles 6 months and childhood to provide protection -infection
3x 1yr - tonsil adult proportion by 5 years
4x 2-2 ½ yrs
4. )Repro organ- grows rapidly at puberty
2. Height- increase by 1”/mo during 1st 6 months
- average increase in ht - 1st year = 50% Rates of G&D
stoppage of ht coincide with eruption of wisdom tooth. 1. fetal and infancy – most rapid G&D
2. adolescent- rapid G&D
Development- increase skills or capability to function 3. toddler- slow G period
- qualitative 4. Toddler and preschool- alternating rapid and slow
5. school age- slower growth
How to measure development
fetal and infancy- prone to develop anemia
1. Observe child doing specific task.
2. Role description of child’s progress 3. Each child is unique
3. DDST- Denver development screening test.
MMDST (Phil) Metro Manila Developmental Screening Test. 2 primary factors affecting G&D
DDST measures mental A. Heredity - R – race
I – intelligence
4 main rated categories of DDST S – sex
1. Language communication N - nationality
2. personal social-interaction
3. fine motor adaptive- ability to use hand movement Females are born less in weight than males by 1 oz.
4. gross motor skills- large body movement Females are born less in length than males by 1 inch

maturation- same with development “readiness” B. Environment

Q – quality of nutrition
Cognitive development –ability to learn and understand from S – socio eco. status
experience to acquire and retain knowledge. To respond to a new H – health
situation and to solve problems. O – ordinal pos in family
P – parent child relationship
IQ test- test to determine cognitive development
Mental age x 100 = IQ Eldest- skillful in language and social skills
Chronological age Younger- toilet trained self

Average IQ – 90-100 4.G&D occurs in a regular direction reflecting a definitive and

Gifted child- > 130 IQ predictable patterns or trends.

Directional trends- occur in a regular direction reflecting the

Basic Divisions of Life development of neuromuscular function. These apply to
I. Prenatal stage from conception- birth physical, mental, social and emotional development and
includes.
II. Period of infancy a. cephalo-caudal “head to tail”
1. Neonatal- 1st 28 days or 1st 4 weeks of life - occurs along bodies long axis in which control over head,
2. Formal infancy- 29 day – 1 year mouth and eye movements and precedes control over upper
body torso and legs.
III.Early childhood b. proximo- distal “Centro distal”
1. Toddler – 1-3 yrs - progressing form center of body to extremities.
2. Pre school 4-6 years c. Symmetrical- at side of body develop on same direction at
same time at same rate.
IV. Middle childhood d. Mass specific “differentiation”
1. School age- 7 – 12 yrs - child learns form simple operations before complex function of
move from a broad general pattern of behavior. To a bore refined
V. Late childhood pattern.
1. Pre adolescent 11 – 13 yrs
2. Adolescent 12 - 18 – 21 B. Sequential- involves a predictable sequence of G&D to which the child
no9rmally passes.
Principles of G & D a. locomotion- creep than crawls, sit then stand.
1. G&D is a continuous process b. socio and language skills- solitary games, parallel games
-begins form conception- ends in death C. Secular- worldwide trend of maturing earlier and growing larger as
- womb to tomb principles compared to succeeding generations.
2. not all parts of the body grow at the same time or at same rate.
- asynchronism 5.Behavioral in the most compressive indicator of developmental
status.
Patterns of G&D 6. universal language of child- play
1. )renal

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 7. great deal of skill and behavior is learned by practice. Practice 3.) give an experience that will add to security- touch, eye to eye
makes perfect. contact, soft music.
9. neonatal reflexes us must be lost before one can proceed.
-plantar reflex should disappear before baby can walk b.) Autonomy vs shame and doubt 18-3 years ---
-moro reflex should disappear before baby can roll independence /self gov’t
persistent primitive infantile reflexes- case of cerebral palsy develop autonomy on toddler
1. give an opportunity of decision making like offer choices.
Theories of G&D 2. encourage to make decision rather then judge.
Developmental tasks- different form chronological age 3. set limits
-skill or growth responsibility arising at a particular time in the
individuals life. c. initiative vs guilt- 4-6 years
The successful achievement of which will ------- a foundation for the -learns how to do basic things
accomplishments of future tasks. -let explore new places and events
-activity recommended- modeling clay, finger painting will enhance
Theorists imagination and creativity and facilitate fine motor dev’t
1. Sigmund Freud 1856-1939 Austrian neurologists. Founder of
psychoanalysis d. industry vs inferiority 7-12 yrs
- offered personality development -child learns how to do things well
Psychosexual theory -give short assignments and projects

a.) Oral Phase 0-18 months e. Identity vs role confusion or diffusion 12-18 yrs
- mouths site of gratification - learns who he/she is or what kind of person he/ she will become by
-activity of infant- biting, sucking crying. adjusting to new body image and seeking emancipation form
-why do babies suck?- enjoyment and release of tension. parents
-provide oral stimulation even if baby was placed on NPO. -freedom form parents.
-pacifier.
-never discourage thumb sucking. f. Intimacy vs isolation 20-40 yrs -looking for a lifetime partner and
career focus
b.) ANAL- 18 months-3 years
-site of gratification- anus g. generatively vs stagnation 40- 60 45-65 yrs
-activity- elimination, retention or defecation of feces make take place h. ego integrity vs, despair 60-65
- principle of holding on or letting go.
-mother wins or child wins
-child wins- stubborn, hardheaded anti social. (anak pupu na, child JEAN PIAGET- Swiss psychologists
holds pupu, child wins) -develop reasoning power
-mother wins- obedient, kind, perfectionist, meticulous
OC-anal phase STAGES OF COGNITIVE DEVELOPMENT
-help child achieve bowel and bladder control even if child is A-Sensory motor 0-2 yrs
hospitalized. -“practical intelligence”- words and symbols not yet available baby
communicates through senses and reflexes.
c.) Phallic- 3-6 years (sub div.)
site of gratification -genitals
activity- may show exhibitionism Schema Age Behavior
-increase knowledge of a sexes 1.) neonate 1 month All reflexes
-accept child fondling his/her own genitalia as normal exploration reflex
-answer Childs question directly. 2.) primary 1-4 -Activity related to body
Right age to introduce sexuality – preschool circular months -repetition of behavior
ex. thumb sucking
d.) Latent- 7-12 years 3.) secondary 4-8 -activity not related to body
-period of suppression- no obvious development. circular months -discover obj and person’s
-Childs libido or energy is diverted to more concrete type of thinking reaction permanence
-helps child achieve (+) experience so ready to face conflict of -memory traces present
adolescence -anticipate familiar events.
Coordination 8-12 -exhibit goal directed behavior
e.) Genital- 12-18 years of secondary months -increase of separateness (will
-site of gratification -genitals reaction search of lost toy, knows mom)
-achieve sexual maturity Tertiary 12-18 -use trial and error to discover
-learns to establish relationships with opposite sex. circular months places and events
-give an opportunity to relate to opposite sex. reaction -“ invention of new means”
-capable of space and time
ERIC ERICKSON- psychoanalysis theory perception
- stresses important of culture and society to the development (hits fork, spoon on table or drops
of ones personality fork)
- environment Invention of 18-24 -transitional phase to the pre
- culture new means months operational thought period.
there mental
stages of psychosocial combination
a.) trust vs mistrust – 0-18 months.
-foundations of all psychosocial task
-to give and receive is the psychosocial theme
-know to develop trust baby
1. satisfy needs on time
- breastfeed
2. care must be consistent and adequate
-both parents- 1st 1 year of life

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Preoperational thought 2-7 years
Schema age Behavior
Preconcep 2-4 yrs -thinking basically complete literal
tual and static
-egocentric- unable to view others
interrupt
-concept of dying is only now
-concept of distance is only as fat as
they can see.
-concept of amenism inanimate
object is alive
-not aware of concept of
r3eversibility- in every action theories
an opposite reaction or cause and
effect
Initiative 4-7 yrs Beginning of causation
Concrete Operational thought 7-12 years
1. able to find solution to everyday problems which systematic
reasoning.
2. have concept of reversibility- cause and effect
3. have concept of longer uation – constancy despite of
transformation.
4. 4. activity recommended- collecting and classifying
5. –stamps stationeries, dolls, rubber band markers.
Formal Operational thought 12 and up.
1. Cognition achieved its final form
2. can deal with past present and future
3. have abstract and mature thoughts.
4. can find solutions to hypothetical problems with scientific
reasoning.
5. activity ------- will sort out opinions and current events.
KOHLBERG- recognized the theory of moral dev’t as considered to
closely approximate cognitive stages of dev’t
-sabay with cognitive dev;t
Stages of Moral dev’t
Infancy – premoral, prereligious, amoral stage
AGE STAGE DESCRIPTION
Pre- Level 1
conventional
2-3 yrs 1 -Punishment/ obedience oriented
(heteronymous morality) child does
right cause a parent tells him or
her to and to avoid punishment
4-7 2 -Individualism. Instrumental
purpose and exch. Carries out
action to satisfy own needs rather
than society.
-Will do something for another if
that person does something for the
child.
Conventional Level
7-10 3 -Orientation to interpersonal
relations of mutuality. Child
followers rules cause of a need to
be a “good” person in own eyes
and eyes of others.
10-12 4 -Maintenance of social order fixed
rules and authority. Child finds ff.
rules satisfying. Follows rules of
authority figures.
Post- Level III
conventional
Above 12 yrs 5 -Social contract, utilitarian level
making perspectives. Followers
standards of society.
6 Universal ethical principle
orientation. Follows internalized
standards of conduct.
E. DEV’T MILESTONES-major markers of growth and dev’t
1. Period of infancy- universal language of child-play
a.) Play- Infancy- solitary plays
-solo, mom interactive
-facilitate motor and sensory dev’t
-safety- important age appropriate
solitary play- mobile, teeter, music box, rattle
b.) fear of infancy- stranger anxiety begin 6-7 months peak 8
months diminishes 9 months
1 month- dance reflex disappears looks at mobile
2 months- holds head up when in prone,
social smile,
baby coos “doing sound”
cry with tears
-closure of frontal fontanel 2-3 months
head lag when pulled to sitting position.
3 months- holds head and chest up when prone
follows obj. past midline
grasp and tonic neck reflex fading
hand regard (looks at hand)
4 months – turns form front to back
head control complete
needs space to turn
Laugh aloud, bubbling sounds
5 months- turn both ways “roll over”
-teething rings
-handles rattle well
-moro reflex disappears ( 4-5 months)
6 months- reaches out in anticipatory of being picked up
-sits with support
-uses palmar grasp
-eruption of 1st temp teeth 6-8 months 2 lower incisors
-say vowel sounds “ah”, “oh”
-handles bottle well
7 months- transfer obj. hand to hand
-likes obj that are good size
8 months- sits without support
-peak of stranger anxiety
-planters reflex disappears 8-9 months in prep for walking
9 months - creeps or crawls
-neat finger grasp reflex
- combine 2 syllables “mama” and “papa”
- needs space for creeping
10 months – pull self to stand
-understands “no”
-responds to own name
-peak a boo, pat a cake
-can clap
11 months- cruisse
- stands with assistance
12 months- stand alone take 1st step
-walk with assistance
-drink from cup, cooperate in dressing
-says 2 words mama and dada
-pots and pans, pull tay, nursery rhymes
Toddler- parallel play- 2 toddlers playing separately
-provide with similar toys
-squeaky frog to squeeze
waddling duck to pull
trucks to push-push pull toy
building blocks, pounding peg
toys to ride on
fear- separation anxiety
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 begin 9 months physiologic anorexia- due to preoccupation with
peak 18 months environment- food jag that last for short period of
time
3 phases of separation anxiety (in order) loves rough and tumbling play
1. P- protect loves toilet training-
2. d despair failure of toilet training- unreadiness
3. d- denial
Clues of toilet readiness:
-don’t prolong goodbye 1.) can stand, squat walk alone
-say goodbye firmly to develop trust- say when ul be back 2.) can communicate toilet needs
3.) can maintain dry for 2 hours
15 months – plateau stage
walks alone Pre schoolers- associative or cooperative play
lateness in walking- mild mental retardation 1.) bahay-bahayan – play house
-puts small pellets into small bowl 2.) role playing
-holds spoon well 3.) fear-body mutilation or castration
- seats self on chair fear of dark places witches
-creeps up stairs fear of thunder and lightning
- 4 - 6 words fear of ghosts

18 months- height of possessiveness Milestones

favorite word- “mine” 4years old- furious 4 , noisy, aggressive, stormy
bowel control achieved (bowel 1st before bladder) -can button buttons
-no longer rotates spoon -copy a square
-can run and jump in place -jumps and skips
walks up and down stairs holding railing or persons hand -laces shoes
-1-20 words -vocabulary 1,500
-name, body part -knows four basic colors
-puts both feet on 1 step before advancing.
5 years old- frustrating 5
24 months- terrible two -copy a triangle
-can open doors by turning door knobs -draw a 6 part man
-unscrew lids -imaginary playmates
-can walk upstairs alone –using both feet on same step at -2,100 words
same time
-50-200 words ( 2 words sentences) Character Traits of Pre-schooler:
-daytime bladder control achieved ( daytime 1st- next nighttime 1.) curious, creative imaginative, imitative
bladder control) 2.) 2. favorite words- why and how
3.) complexes- word identification to parent of same sex and
30 months or 2 ½ years – makes simple lines or stroke for crosses attachment to parent of opposite sex
with a pencil ex. Oedipal complex- boy to mom
-can jump down from chairs Electra complex- girl to dad
-knows full name
- copy a circle Cause of incest marital discord
- holds up finger to show age
- temp teeth complete Death-sleep only

post molar- last temp teeth to appear Behavior problems Preschool

how many deciduous teeth -20
beginning of toothbrush – 2-2 ½ yrs 1. telling tall tales-over imagination
tooth brushing with little assistance 3 yrs 2. imaginary friend- to release tension and anxieties
tooth brushing alone – 6 yrs 3. sibling rivalry- jealousy to newly delivered baby.
right time to bring to dentist- when temp teeth complete 4. regression- going back to early stage
-thumb sucking (should be oral stage only)
36 months or 3 yrs- trusting 3 -baby talk
- unbutton buttons (unbutton before learn to button) -bed wetting
-draw a + -fetal position
- learns how to share 5. masturbation- sign of boredom
-knows full name and sex (gender identity) -divert attention- offer a toy
- speaks fluently
-nighttime bladder control School Age
-300-900 words Play- competitive play
-ride a tricycle Ex. Tug of war, track and field, basket ball

Characteristic Traits of toddler Fear. 1.) school phobia

negativistic- “NO!” -way to search for independence -orient to new environment
–limit questions 2.) displacement from school
–modify questions to a statement -teacher and peer of same sex
2.) rigid, ritualistic and stereotype 3. loss of privacy
ritualism- for mastering -wants bra
3.)Temper tantrums- head banging, 4.) fear of death
screaming, stamping feet, holds breath -7-9yrs death is personified
–ignore behavior -death- permanent loss of life
scaffoid abdominal-due to underdeveloped abdominal
muscles Significant Development

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 a. boys- prone to bone fracture Significant dev’t
b. mature vision 20/20 1. experiences conflict bet his needs for sexual satisfaction and
societies expectation
6 years- temp teeth begin to fall 2. change of body image and acceptance of opp/sex
perm teeth appear- 1st molar 3. nocturnal emission – wet dreams
1st temp teeth- 5 months 4. distinctive odor- due to stimulation apocrine glands
1st perm teeth- 6 yrs 5. sperm is viable by 17 yrs
-yr of constant motion 6. testes & scrotum increase until age 17
clensy mou’t 7. breast and female genitalia increase until age 18
recognize all shapes
-1st grade teacher becomes authority figure Personality Traits Adolescents
-nail biting 1. idealistic
-begin interest in God. 2. rebellious
3. reformers
7 yrs- assimilation age 4. conscious with body image
-copy a diamond 5. adventuresome
-enjoys teasing and playing alone
-quieting down period Problems:
1. vehicular accident
8 yrs- expansive age 2. smoking
-smoother mouth 3. alcoholism
-loves to collect objects 4. drug addiction
-count backwards 5. pre marital sex

9 yrs –coordination improves IMMEDIATE CARE OF NEWBORN

-tells time correctly 1st days of life
-hero worship
-stealing and lying are common 1. initiation and maintenance of respiration
-takes care of body needs completely 2. establishment of extra uterine circulation
-teacher finds this group difficult to handle 3. control of body temp
4. intake of adequate nourishment
10 yrs- age of special talent 5. establishment of waste elimination
-writes legibly 6. prevention of infection
-ready for competitive games 7. establishment of an infant parent relationship
-more considerate and cooperative 8. dev’t care that balances rest and stimulation or mental dev’t
-joins orgs.
-well mannered with adult
-critical of adults 1.) Initiation and maintenance of respiration
2nd stage of labor- initial airway
11-12 yrs – pre adolescents -initiation of a /w is a crucial adjustment
-full of energy and constantly active -most neonatal deaths with in 24 h caused by inability to initiate a/w
-secret language are common -lung function begins after birth only
-share with friends secrets
-sense of humor present How to initiate a/w
-social and cooperative a.) remove secretions bulb syringe

Character Traits School Age B. Catheter Suctioning

1. industrious- 1.) place head to side to facilitate drainage
2. modest 2,) suction mouth 1st before nose
3. can’t bear to lose- will cheat -neonates are nasal breathers
4. love collections- stamps 3.) period of time
-5-10 sec suctioning, gentle and quick
Signs of sexual maturity prolonged and deep suctioning can lead to hypoxia, laryngo
GIRLS: spasm, brady cardia due to stimulation vagal nerve
I-inc size breast and genitalia (pelarche- 1st sign sexual mat.
W- widening of hips 4.) evaluate for patency
A- appearance axillary, pubic ( adrenarch) -cover nostril and baby struggles there’s a need for additional
M- menarche- last sign sexual mat. Girls suctioning

BOYS: C. If not effective, requires effective laryngoscopy to open a/w. After

A-appearance axillary, pubic hair ( 1st sign sexual mat) deep suctioning an endotracheal tube can be inserted and
D-deepening voice oxygen can be administered by an (+) pressure bag and mask
D- development of muscles with 100% oxygen at 40-60b/m.
I--inc in testes and penis size
P- prod of viable sperm ( last sign sexual maturity) Nsg alert:
1. No smoking
Adolescent 2. Always humidify to prevent drying of mucosa
Fear 3. Over dosage of oxygen can lead to scarring of retina leading to
1. obesity blindness ( retro lentalfibrolasia or retinopathy of prematurity)
2. acne 4. When mecomium stained (greenish) never administer oxygen
3. homosexuality with pressure ( O2 pressure will push mecomium inside)
4. death
5. replacement from friends 2.) Establishing extra uterine circulation
6. significant person- opp sex. - circulation is initiated by lung expansion or pulmo ventilation and
completed by cutting of cord.

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FETO PLACENTAL CIRCULATION
-Placenta(simple diffusion) –oxygenated blood is carried by the
umbilical vein- passes liver-ductus venousus- IVC- RT atrium 70% SHUNTS-shortcuts
blood is shunted to foramen ovale- LT atrium mitral valve – LT Ductus venosus- -shunts from liver to IVF
ventricle- aorta-lower extremities. Foramen ovale- shunts bet 2 atrias
Ductus arteriosus- from pulmonary artery to aorta
-Remaining 30%- tricuspid valve- RT ventricle- pulmonary arteries-
lungs (for nutrition) (vasoconstriction of lungs pushes blood to ductus
arteriousus to aorta to supply upper extremities.

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 Decrease PO2, increase PCO2 acidosis

Will cause 1st breath /cry of baby

Decrease pulmo artery pressure

Increase PO2 Decrease blood Increase pressure to Lt

flow side of heart

Closure of Closure of Closure of foramen

ductus ductus venosus ovale
arteriosus & AVA

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What will sustain 1st breath- decreased artery pressure 3. baby is not capable of shivering
What will initiate lung circulation-lung expansion 4. babies are born wet
What will complete circulation- cutting of cord

4.) 2 way to facilitate closure of foramen ovale

a.) Tangential Footstep- slap foot of baby
-never stimulate baby to cry if secretions not fully
drained to prevent aspiration
-check characteristic of cry
normal cry- strong, vigorous and lusty cry
cri-du-chat syndrome-chromosomal obliteration
cat like cry
b.) proper position -right side lying pos.
-will increase pressure on left and foramen ovale
will close
Foramen Ovale and Ductus arteriosus will begin to close within 24h
PROCESS OF HEAT LOSS
1. evaporation-body to air (TSB)
2. conduction- body to cold solid object (cold compress)
3. convection- body to cooler surrounding air (aircon)
4. radiation- body to cold object not in contact with body
earliest sign of hypothermia- increase in RR
Effects of Hypothermia ( Cold stress)
1.) Hypoglycemia- 45-55 mg/dl normal
50- borderline
2.) met acidosis- catabolism of brown fats (best insulator of
newborns body)
will form ketones
3.) high risk for kernicterus- bilirubin in brain leading to
cerebral palsy
4.) additional fatigue to allergy stressful heart

To Prevent Hypothermia
1. dry and wrap baby
2. mechanical pressure – radiant warmer
Obliteration-complete closure pre-heated first isolette (or square acrylic sided incubator)
3. prevent an necessary exposure – cover baby
Structure Appropriate Structure Failure to close 4. cover baby with tin foil or plastic
time of remaining 5. embrace the baby- kangaroo care
obliteration
F. Ovale 1yr Fossa Ovalis Atrial Septal A. Establish Adequate Nutritional Intake
Defect
Ductus 1 month Ligamentum Patent ductus CS- breastfeeding after 4 hours
Arteriosus Arteriosum arteriosus NSD- breastfeeding asap
Ductus 2 months Ligamentum
Venosus venosum Physiology breast milk production
Umbilical 2-3 months 1.) lateral umb. As you deliver baby, decrease Estrogen, decrease Progesterone-
artery Ligament -Anterior Posterior Gland (APG) releases prolactin – acts on
2.) interior iliac acinar cells (or alveoli) – produce foremilk – stored in
artery lactiferous tubules ( or collecting tubules)
Umbilical 2-3 months -ligamentum where breast milk is produced – alveoli post-pit.gland
vein teres ( round
ligament of liver) Sucking- PPG – oxytocin – contraction of lactiferous tubules - milk
Position of infant immediately after birth: ejection reflex- let down reflex.
NSD-trendelenberg/ T position for drainage
contraindication of trendelenberg position - increase ICP Advantages of Breastfeeding
CS- supine or crib level position 1. Economical
2. Always available
Signs of increased ICP 3. Breastfed babies have higher IQ than bottle fed babies.
1.) abnormally large head 4. It facilitates rapid involution
2.) bulging and tense fontanel 5. Decrease incidence of breast cancer.
3.) increase BP and widening pulse pressure #3 & #4 6. Has antibodies- IgA
are Cushings triad of 7. Has lactobacillius bifidus- interferes with attack of
4.) Decreased RR, decreased PR pathogenic bacteria in GIT
ICP 8. Has macrophages
5.) projective vomiting- sure sign of cerebral irritation Store milk- plastic storage container
6.) high deviation – diplopia – sign of ICP older child Store milk – good for 6 months from freezer- put rm temp.
4-6 months- normal eye deviation don’t heat
>6 months- lazy eyes Disadvantages:
7.) High pitch shrill cry-late sign of ICP 1. Possibility of transfer HEP B, HIV, cytomegalo virus.
2. No iron
Temp Regulation 3. Father can’t feed & bond as well
- goal in temp regulation is to maintain it not less than Stages of Breastmilk:
97.7% F (36.5 C) 1. Colostrum- 2-4 days present
- maintenance of temp is crucial on preterm and SGA (small content: decrease fats, increase IgA, dec CHO, dec
for gestational age) - babies prone to hypothermia or cold CHON, inc minerals,
stress inc fat soluble minerals
- 2. Transitional milk- 4 – 14 days
A. factors leading to dev’t of HYPOTHERMIA content: inc lactose, inc water soluble vit., inc minerals
1. preterms are born poi kilo thermic- cold blooded 3. Mature milk- 14 & up
- babies easily adapt to temp of environment due to content: inc fats (linoleic acid) – resp for devt of brain &
immaturity of thermo regulating system of body. integrity of skin
Hypothalamus inc CHO- lactose – easily digested, baby not
2. inadequate SQ tissue constipated.

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 - resp of sour milk smelling odor of stool. Contra Indications in Breast Feeding:
Maternal Conditions:
Lactose intolerance- deficiency of enzyme LACTASE that 1. HIV CMV
digest LACTOSE Hepa BCoumadin
Decrease CHON- lactalbumin
Cows milk – inc fats- Newborn Condition - Inborn errors of metabolism
Dec CHO Erythrobastosis Fetalis – Rh incompatibility
Inc CHON – casing- has curd that’s hard to digest. Hydrops Fetalis
Inc minerals–traumatic effect on kidneys of babies. Can Phenylketonuria
trigger stone formation. Galactosemia
Inc phosphorus Tay Sachs disease

Health Teachings: 5. Establish of waste elimination

1. Proper hygiene- proper hand washing A. Diff stools
Care of breast - cotton balls with lukewarm water 1. Meconium - physiologic stool
Caked colostrum- dry milk on breast - black green, sticky, tar like, odorless (Sterile intestine)
2. Best position in breastfeeding – upright sitting -avoid tension! will pass with in 24 – 36 hrs
3. Stimulate & evaluate feeding reflexes failure to pass mecomium after 24h- GIT obstruction
a.) Rooting reflex- by touching the side of lips/cheeks then ex. Hirschsprungs disease
baby will turn to stimulus. Disappear by 6 weeks- by 6 weeks baby can imperforate anus
focus. Reflex will be gone mecomium ileus – due to Cystic Fibrosis
- Purpose rooting- to look for food.
b.) Sucking – when you touch middle of lips then baby will 2. Transitional stool -
suck - green loose & shiny, like diarrhea to the untrained eye
- Disappears by 6 months 3. Breastfed stool - golden yellow, soft, mushy with sour milk smell,
- When not stimulated sucking will stop. frequently passed
- recur every feeding
c.) Swallowing- when food touches posterior of tongue then 4. Bottlefed stool –
it will be automatically swallowed - pale yellow, formed hard with typical offensive odor,
seldom passed, 2–3 x/day
d.) Extrusion/ Protrusion reflex - with food added -brown & odorous
-when food touches anterior portion of tongue then food will
be extruded. Jaundice baby – light stool
Purpose: to prevent from poisoning Under phototherapy – bright green
Disappear by 4 months & baby can already spit out by 4 Mucus mixed with stool - milk allergy
months. Clay colored stool – obstruction to bile duct
Chalk clay stool – after barium enema
Criteria Effective Sucking Black stool – GIT bleeding (melena)
a.) Baby’s mouth is hiked up to areola Blood flecked stool - anal fissure.
b.) Mom experiences after pain. Currant jelly stool – instussusection
c.) Other nipple is also flowing with milk. Ribbon like stool – hirschsprung disease
Steatorrhea stool – fatty, bulky foul smelling odor stool
To prevent from crack nipples & initiate proper production of oxytocin. - malabasorption syndrome ( celiac
- begin 2-3 min at @ breast ( 5 – 7 min other authors) disease or cystic fibrosis)
to initiate production of oxytocin Cult blood – stool exam
- increase 1 min/ day – until reaching 10 mins @ breast or 20 mins/
feeding. III Assessment for Well–being
For proper emptying & continuous milk production / feeding APGAR SCORE – Dr. Virginia Apgar
-feed baby on last breast that you feed her with, alternately ( if not Special Considerations:
emptied - mastitis) 1st 1 min – determine general condition of baby
Next 5 min- determine baby’s capabilities to adjust extra uterinely
Problems experienced in Breastfeeding : Next 15 min – dependent on the 5 min
3RD day changes in breast post partum
a.)Engorged- feeling of fullness & tension in breast. A- appearance- color – slightly cyanotic after 1st cry baby becomes
- sometimes accompanied by fever known as MILK FEVER. pink.
P- pulse rate – apical pulse – left lower nipple
Mgt: Warm compress- for breastfeeding mom G- grimace – reflex irritability- tangential foot slap, catheter insertion
Cold compress – for bottle feeding & wear supportive bra. A – activity – degree of flexion or muscle tone
When is involution of breast- 4 weeks R – respiration

b.) Sore nipple – cracked with painful nipple Baby cry – within 30 secs
Mgt: 1.) exposure to air – remove bra & wear dress, if not, Failure to cry after 30 secs – asphyxia near the neatorum
expose to 20 Watt bulb Resp. depression – due mom given Demerol. Administer
avoid wearing plastic liner bra Naloxone
- will create moisture, cotton only
c.) Mastitis- inflammation of breast : staphylococcus aureus
Factors: APGAR Scoring Chart:
1. Improper breast emptying
2. Unhealthy sexual practices 0 1 2
-contraindicated for breast feeding HR -absent <100 >100
- manually express inflamed breast Resp effort -absent - slow, irreg, -good strong cry
feed on unaffected breast weak
- give antibiotics – can still feed on unaffected breast Muscle tone - flaccid - some flexion - well flexed
extremities

9
Reflex Ear lobe Pliable Some Thick cartilage
irritability cartilage
Catheter - no - grimace - cough, sneeze Testes and testes in lower Some Testes
response Scrotum canal intermediate pendulus
Tangential - NR - grimace - cry Scrotum – small Scrotum full
Footslap few rugae extensive
Color - blue/pale - acrocyanosis - pinkish rugae
(body- pink
extremities- Signs of Preterm Babies
blue) Born after 20 weeks, after 37 weeks
-frog leg or laxed positon
APGAR result -hypotonic muscle tone- prone resp problem
0 – 3 = severely depressed, need CPR, admission NICU -scarf sign – elbow passes midline pos.
4 – 6 = moderately depressed, needs add’l suctioning & O2 - square window wrist – 90 degree angle of wrist
7 - 10 =good/ healthy - heal to ear sign-
abundant lanugo-
CPR – cardio pulmonary resuscitation or CPR
Cardio pulmonary cerebral resuscitation (CPCR) Signs of Post term babies:
> 42 weeks
5 min no O2 – irreversible brain damage - classic sign – old man’s face
1. shake, no resp, call for help - desquamation – peeling of skin
2. flat on head - long brittle finger nails
3. head tilt chin lift maneuver except spinal cord injury over - wide & alert eyes
extension may occlude airway
Neonates in Nursery
Breathing ( ventilating the lungs) Nsg responsibility upon receiving baby- proper identification
1. check for breathlessness - foot printing, affixing mother thumb print
if breathless, give 2 breaths- ambu bag - take anthropometic measurement
> 1 yr old- mouth to mouth, pinch nose normal length- 19.5 – 21 inch or 47.5 – 53.75cm, average 50 cm
< 1 yr – mouth to nose head circumference 33- 35 cm or 13 – 14 “
force – different between baby & child Hydrocephalus - >14”
infant – puff Chest 31 – 33 cm or 12 – 13”
Abd 31 – 33 cm or 12 – 13”
Circulation
Check for pulslessness :carotid- adult Bathing
Brachial – infants - oil bath – initial
CPR – breathless/pulseless - to cleanse baby & spread vernix caseosa
Compression – inf – 1 finger breath below nipple line or 2 finger Fx of vernix caseosa
breaths or thumb 1. insulator
2. bacterio- static
CPR inf 1:5 Babies of HIV + mom – immediately give full bath to lessen
Adults 2:15 transmission of HIV
- 13 – 39% possibly of transmission of HIV
Assessment tool determines respiration of baby
Silvermann Anderson Index Full bath – safely given when cord fall

Respiration Evaluation – lowest score – best Dressing the Umbilical Cord – strict asepsis to prevent tetanus
Criteria 0 1 2
Chest synchronized Lag on See - saw 3 cleans in community
movement respiration 1. clean hand
Intercostal No Just visible Marked 2. clean cord
retraction retraction 3. clean surface
Xiphoid None Just visible Marked
retraction betadine or povidone iodine – to clean cord
Nares dilatation None Minimal Marked check AVA, then draw 3 vessel cord
Expiratory grunt None Heard on Heard on
If 2 vessel cord- suspect kidney malformation
stet only naked ear
- leave about 1” of cord
- if BT or IV infusion – leave 8” of cord best access - no nerve
Interpretation result:
- check cord every 15 min for 1st 6 hrs – bleeding .> 30 cc of blood
0 -3 – normal, no RDS
bleeding of cord – Omphalagia – suspect hemophilia
4 – 6 – moderate RDS
7 – 10 – severe RDS
Cord turns black on 3rd day & fall 7 – 10 days
Faiture to fall after 2 weeks- Umbilical granulation
Assessment of Gestational Age
Mgt: silver nitrate or catheterization
-Ballards & Dobowitz
- clean with normal saline solution not alcohol
Findings Less 36 weeks 37 - 38 39 and up
- don’t use bigkis – air
(Preterm)
- persistent moisture-urine, suspect patent uracus – fistula
Sole Anterior Occasional Covered with bet bladder and normal umbilicus
creases transverse creases 2/3 in creases dx: nitrazine paper test – yellow – urine
crease only mgt: surgery
Breast 2mm 4mm or 3.5 > 5 or 7mm
nodules mm Credes Prophylaxis – Dr. Crede
Scalp hair Fine & fuzzy Fine & fuzzy Coarse & silky -prevent opthalmia neonatorum or gonorrheal conjunctivitis

10
- how transmitted – mom with gonorrhea Acyanotic heart defects L to R
drug: erythromycin ophthalmic ointment- inner to outer 1. ventricular septal defect - opening between 2 ventricles

silver nitrate (used before) – 2 drops lower conjunctiva (not used now) S&Sx
1. systolic murmurs at lower border of sternum and no other
Vit-K – to prevent hemorrhage R/T physiologic hypoprothrombinemia significant sign
- Aquamephyton, phytomenadione or konakion 2. cardiac catheterization reveals increased o2 saturation @
- .5 – 1.5 ml IM, vastus lateral or lateral ant thigh R side of heart
- 5 ml preterm baby 3. ECG reveals hypertrophy of R side of heart

Vit K – synthesized by normal flora of intestine Nsg Care:

Vit K – meds is synthetic due intestine is sterile Cardiac catheterization: site – Rt femoral vein
1. NPO 6 hrs before procedure
Weight: Normal wt 3.000 – 3400 gms/ 3 – 3.4 kg / 6.5 - 7.5 lbs 2. protect site of catheterization. Avoid flexion of joints
proximal to site.
Arbitrary lower limit 2500 gm 3. assess for complication – infection, thrombus formation –
Low birth wt baby delivered < 2500g check pedal pulses
Small for gestational age (SGA) < 10th % rank or born small ( dorsalis pedis)
Large for gestational age > 90th % rank or macrosomia >4000 g
Appropriate for GA – within 2 standard deviation of mean Mgt.
Physiologic wt loss – 5 – 10% wt loss few days after birth 1.) long term antibiotic – to prevent subacute bacterial
endocarditis
Small GA < (less) 10 2.) open heart surgery-
Large GA > (more) 90
2.) ASD – failure of foramen ovale to close
Physical Exam and Deviations fr Normal S&SX
1. if client is new born, cover areas not being examined 1. systolic murmur @ upper border of sternum
2. if client is infant – the 1st yr of life - get VS – take RR 1st 2. result of cardiac catheterization & ECG same with VSD
- begin fr least intrusive to the most intrusive area
3. if client is a toddler and preschool, let them handle an Mgt: open heart surgery
instrument like: 3.) endocardial cushion defects - atrium ventricular (AV) - affects
- play syringe or stet, security blanket – favorite article. Let baby both tricuspid and mitral valve
hold it. Dx – confirmed by cardiac catheterization
4. Explain procedure and respect their modesty - school age and Mgt: - open heart surgery
adolescent Antibiotics to prevent subacute bacterial endocarditis

V/S: 4.) PDA - failure of ductus arteriosus to close

Temp: rectal- newborn – to rule out imperforate anus - should close within 24 h -complete close – 1
- take it once only, 1 inch insertion month
S&Sx
Imperforate anus 1. continuous machinery like murmurs
1. atretic – no anal opening 2. prominent radial pulse
2. agenetic – no anal opening 3. ECG- hypertrophy Left ventricle
3. stenos – has opening Drug:
4. membranous – has opening 1. endomethazine – prostaglandin inhibitor - facilitate closing
of PDA
Earliest sign: 2. ligation of PDA by 3-4 yo
1. no mecomium 3. thoracotomy procedure- nakadapa child
2. abd destention
3. foul odor breath 5.)Pulmunary Stenosis- narrowing of valve of pulmo artery
4. vomitous of fecal matter S &Sx: 1.) typical systolic ejection murmur
5. can aspirate – resp problem 2. S2 sound widely split
Mgt: 3. ECG- Lt ventricular hypertrophy
Surgery with temporary colostomy 6.)Aortic Stenosis – narrowing of valve of aorta
S & Sx: 1. inactive, sx sme with angina
Cardiac rate: 120 – 160 bpm newborn 2. typical murmur
Apical pulse – left lower nipple 3. rough systolic sound and thrill
Radial pulse – normally absent. If present PDA 4. ECG- Left ventricular hypertrophy
Femoral pulse – normal present. If absent- COA - coartation of aorta
cardiac catheterization-
Congenital Heart Dse Mgt Pulmo Stenosis & Aortic Stenosis
Common in girls – PDA, ASD atrial septal 1.) balloon stenostomy
Common in boys – TOGA ( transportation of great arteries) 2.) surgery
TA – tronchus arteriosus
TOF – tetralogy of fallot Duplication of Aortic Arch- doubling of arch of aorta causing
compression to trachea and esophagus
Causes: S&Sx : 1. dysphagia 2. dyspnea
1. familial 3. left ventricular hypertrophy
2. exposure to rubella – 1st month Mgt: - close heart surgery
3. failure of strucute to progress
8.) Coartation of Aorta – narrowing of arch of aorta
acyanotic L to R outstanding Sx : absent femoral pulse
cyanotic R – L BP increased on upper extremities and decreased on
lower extremities

11
 ECG – hypertrophy Lft ventricle
Mgt: close heart surgery ACQUIRED HEART DSE

CYANOTIC HEART DEFECTS R to L 1. RHD Rheumatic Heart Disease

- inflammation disease ff an infection acquired by group A Beta
1. Transportation of Great Arteries (TOGA) - aorta arising from Rt hemolytic strepto coccus
ventricle pulmo artery arising form Lt ventricle
Affected body – cardiac muscles and valves , musculoskeletal ,
Outstanding Sx: CNS, Integumentary
1. cyanosis after 1st cry (due no exygenation)
2. polycythemia – increased RBC =compensatory due to O2 Sorethroat before RHD
supply=viscous blood
=thrombus = embolus = stroke Aschoff – rounded nodules with nucleated cells and fibroblasts –
3. ECG – cardiomegaly stays and occludes mitral valve.
Cardiac cath – decreased O2 saturation
Palliative repair – rashkind procedure Jones Criteria
Complete repair – mustard repair
2.) Total Anomalous Pulmonary Major Minor
venous return – pulmo vein instead of entering Lt atrium, enters Rt 1. polyarthritis – multi joint pain 1. arthralgia – joint pain
atrium or SVC 2. chorea – sydenhamms chores or 2. low grade fever
Increased pressure on Rt so blood goes to Lft st. vetaus dance-purposeless
involuntary hand and shoulder with
Outstanding Sx: Open foramen ovale grimace
Mild to moderate cyanosis 3. carditis – tachycardia 3. all lab results
Polycythemia = thrombus = embolus = stroke erythema marginatum - macular rashes increase antibody
asplenia- absent spleen SQ nodules “ C reactive
Mgt: restructuring of heart protein
“ erythrocyte
3.) Truncus Arteriousus- aorta & pulmo artery is arising fr 1 single sedimentation rate
vessel or common trunk with VSD “ anti streptolysin
S & Sx 1. cyanosis o titer (ASO)
2. polycythemia – thrombus = embolus = stroke Criteria:Presence of 2 major, or 1 major and 2 minor + history of
sore throat will confirm the dx.
Mgt: Heart transplant
Nsg Care:
4.) Hypoplastic Left heart syndrome – non fx Left ventricle 1. CBR
1. cynosis 2. throat swab – culture and sensitivity
2. polycythemia – throm, emb, stroke 3. antibiotic mgt – to prevent recurrence
Mgt: heart transplant 4. aspirin – anti-inflammatory. Low grade fever – don’t give
aspirin.
5.) Tricuspid atresia – failure of tricuspid valve to open S/E of aspirin:
S&SX: open foramen ovale - Reyes syndrome – encephalopathy- fatty infiltration of
(R to L shunting – goes to Lt atrium) organs such as liver and brain
cynosis, polycythemia
Mgt: fontan procedure – open tricuspid valve Respiration
Newborn resp – 30-60 cpm, irregular abd or diaphramatic with short
6.) Tetralogy of Fallot period of apnea without cyanosis.
P – pulmonary stenosis < 15 secs – normal apnea –newborn
V – ventricular SD
O – overriding or dextroposition of aorta Resp Check
R – Rt ventricular hypertrophy Newborn – 40 – 90
S &Sx: 1 yr - 20 – 40
1. Rt ventricular hypertrophy 2-3yr 20 – 30
2. high degree of cyanosis 5 yrs 20 – 25
3. polycythemia 10 yrs 17 – 22
4. severe dyspnea – squatting position – relief , inhibit venous 15 & above 12- 20
return facilitate lung expansion.
5. growth retardation – due no O2 BREATH SOUNDS HEARD DURING ASCULTATION:
6. tet spell or blue spells- short episodes of hypoxia 1.) VESICULAR – soft, low pitched, heard over periphery of lungs,
7. syncope inspiration longer then expiration -Normal
8. clubbing of fingernails – due to chronic tissue hypoxia
9. mental retardation – due decreased O2 in brain 2.) BRONCHOVESICULAR- soft, medium pitched, heard over major
10. boot shaped heart – x-ray bronchi, inspiration equals exp. Normal
Mgt:
1. O2 3.) BRONCHIAL SOUNDS- loud high pitched, heard over trachea,
2. no valsalva maneuver , fiber diet laxative expiration longer than inspiration. Normal
3. morphine – hypoxia
4. propranolol – decrease heart spasms 4.) RHONCHI – snoring sound made by air moving through mucus
5. palliative repair – in bronchi. Normal
BLT blalock taussig procedure 5.) RALES-or crackles – like cellophane – made by air moving
Brock procedure – complete procedure through fluid in alveoli.
Abnormal- asthma, foreign body obstruction.

12
6.) WHEEZING- whistling on expiration made by air being pushed BP taking begins by 3 yo
through narrowed bronchi .Abnormal – asthma, foreign body COA – take BP on 4 extremities
obstruction
7.) STRIDOR- crowing or ropster life sound – air being pulled through SKIN:
a constricted larynx. Abnormal – resp obstruction Acrocyanosis
Asthma- pathognomonic sign – expiratory wheezing BIRTHMARKS:
Pet – fish. Sport – swimming 1. Mongolian spots – stale gray or bluish discoloration
Drugs – amynophylline – monitor bp, may lead to hypotension patches commonly seen across the sacrum or buttocks
due to accumulation of melanocytes. Disappear by 1 yr
Laryngo Tracheo Bronchitis LTB old
- inspiratory stridor – pathognomonic sign 2. MIlla – plugged or unopened sebaceous gland . white pin
point patches on nose, chin or cheek.
RDS respiratory dist synd or hyaline membrane dis 3. Lanugo – fine, downy hair – common preterm
Cause- lack of surfactant – for lung expansion 4. Desquamation – peeling of newborn, extreme dryness
Hypotonia, Post surgery, Common to preterm that begin sole and palm.
5. Stork bites (Talengeictasi nevi) – pink patches nape of
Fibrine hyaline neck
Sx – definite with in 1st of life  hair will grow as child grows old
Increase RR with retraction 6. Erythema Toxicum – (flea bite rash)- 1st self limiting rash
Inspiratory grunting – pathognomonic appear sporadically & unpredictably as to time & place.
7 – 10 severe RDS (silvermenn Anderson index) 7. Harlequin sign – dependent part is pink, independent part
cyanosis due to atelectasis is blue
Mgt: (side lying – bottom part is dependent pink)
1. surfactant replacement and rescue 8. Cutis Marmorato – transitory mottling of neonates skin
2. pos- head elevated when exposed to cold.
3. proper suctioning 9. Hemangiomas – vascular tumors of the skin
4. o2 with increase humidity- to prevent drying of mucosa
5. monitor V/S skin color , ABG 3 types Hemangiomas
a.) Nevus Flammeus – port wine stain – macular purple or dark red
6. CPAP- continuous + a/w pressure lesions seen on face or thigh. NEVER disappear. Can be removed
7. PEEP - + end expiratory pressure surgically
Purpose of #6-7- to maintain alveoli partially open and alveoli b.) Strawberry hemangiomas – nevus vasculosus – dilated
collapse capillaries in the entire dermal or subdermal area. Enlarges,
disappears at 10 yo.
LARYNGOTRACHEOBRONCHITIS c.) Cavernous hemangiomas – communication network of venules in
LTB – most common Creup -viral infection of larynx, trachea & SQ tissue that never disappear with age. - MOST DANGERIOUS –
bronchi intestinal hemorrhage
outstanding sx - croupy cough or barking Skin color blue – cyanosis or hypoxia
pathognomonic - stridor White – edema
- labored resp Grey – inf
- resp acidosis Yellow – jaundice , carotene
- end stage – death Vernix Caseosa – white cheese like for lubrication, insulator
Lab:
1. ABG BURN TRAUMA – injury to body tissue caused by excessive heat.
2. neck and throat culture
3. dx- neck x-ray to rule out epiglotitis INFANT 5-9 yo
Nsg Mgt: ANTERIOR POSTERIOR Ant Post
1. bronchodilators Head 9.5 9.5 6.5 6.5
2.increase o2 with humidity Neck 1 1 1 1
3. prepair tracheostomy set Upper 2 2 2 2
arm
BRONCHOLITIS- Inflammation of bronchioles – tenatious mucus Lower 1.5 1.5 1.5 1.5
Causative agaent – RSV - Resp sincytial viruses arm
Sx: flu like sx Hand 13 1.25 1.25 1.25
Increased RR Trunk 13 13
Drug: Antiviral – Ribavirin
Back 13 13
End stage – epiglotitis
Genital 1 1
EPIGLOTITIS - infl of epiglottis @ 2.5@ 2.5 @
- emer. Condition of URTI buttocks
Sx: sudden onset Thigh 2.75 2.75 4 4
Tripod position – leaning forward with tongue protrusion Leg 2.5 2.5 3 3
- never use tongue depressor foot 1.75 1.75 1.75 1.75
prepare tracheotomy set
< 5 yo – unable to cough out, put on mist tent (humidifier o2) or croupe
tie DEPTH
Nsg Care: check edges tucked on mist tent 1st degree – partial thickness – superficial epidermis -
Provide washable plastic material erythema, dryness, PAIN
No toys with friction due O2 on -sunburn, heals by regeneration from 1 – 10
No hairy toys – due moist environment medium for days
bacterial growth 2nd degree – epidermis & dermis- erythema, blisters, moist,
extremely painful
BP – 80/46 mmHg newborn  scalds
BP after 10 days- 100/50

13
3rd degree – full thickness- epidermis, dermis, adipose tissue,
fascia, muscle & bone Assessment:
 lethargy, white or black, not painful – nerve - umphalagia – earliest sign
endings destroyed - newborn receive maternal clotting factor
 ex. lava burns - newborn growing – sudden bruising on bump area- marks
earliest sign
Mgt: - continuous bleeding – hematrosis – damage or bleeding
1.) 1st aid a.) put out flames by rolling child on blanket synovial membrane
b.) immerse burned part on cold H2o
c.) remove burned clothing of with sterile material Dx test :
d.) cover burn with sterile dressing PTT. Partial thromboplastin time – reveals deficiency in clotting
2.) a/w factor
a.) suction PRN, o2 with increased humidity Long Term Goal- prevention of injury
b.) endotracheal intubation Nsg Dx- increase risk of injury
c.) tracheostomy HT: avoid contact sport, swimming only, don’t stop
3.) Preventiuon of shock & F&E imbalance immunization – just change gauge of needle
a. colloids to expand bld volume Falls – immobilized , elevate affected part, apply pressure-not more
b. isotonic saline to replace electrolytes then 10 min
c. dextrose & H2o to provide calories cold compress
4.) Tetanus toxoid booster -determine case before doing invasive procedure
5.) Relief of pain – IV analgesic MORPHINE SO4 – needed for 2nd
degree – very painful LEUKEMIA- grp of malignant disease
6.) 1st defense of body – intact skin - rapid proliferation of immature WBC
prevention of wound infection - WBC – protection from infection, soldiers of body
a.) cleaning & debriding of wound
b.) open or close method of wound care Classification :
c.) whirlpool therapy – drum with solution 1. Lympho – affects lymphatic system
7.) skin grafting – 3rd degree – thigh or buttocks (autograft), pigs/ 2. Myelo – affects bone marrow
animals – xenograft 3. acute / blastic- affects immature cells
frozen cadaver – hallow graft 4. chronic/ cystic- affects mature cells
8,) diet – increase CHON, increase calories.
MOST COMMON CANCER – (ALL) – Acute Lymphocytic Leukemia
ATOPIC DERMATITIS- infantile eczema (galis) S&Sx:
Papulo vesicular erythematus lesions with weeping & crusting 1. from invasion of bone marrow
Cause – food allergies: milk, citrus juice, eggs, tomatoes, wheat signs of infection
Sx: - extreme pruritus, linear excoriation, weeping a.) fever
crusting; scaly shiny and white – lechenification b.) poor wound healing
c.) bone weakness & causes fracture
Goal of care: decrease pruritus – avoid food allergens signs of bleeding
Diet: Prosobi or Isomil a.) petecchiae-small, round, flat, dark red spot
Hydrate skin, borow solution 1% hydrocortisone cream b.) epistaxis
Prevent infection – proper handwahsing, trim nails c.) blood in urine/ emesis
signs of anemia
IMPETIGO- skin disease. a.) pallor , body malaise , constipation
Causative agent – grp A beta Hemolytic streptococcus
- papulovesicular surrounded by localized erythema – 2. from invasion of body organ- hepato spenomegaly – abd pain ,
becomes purulent , oozes a honey colored crust CNS affectation, increase
Pediculosiscapitis –“KUTO” ICP
- Mgt: proper hygiene – wash soap and H2o, oral Dx Tests:
penicillin – bactroban ointment 1. PBS- peripheral blood smear – determine immature RBC
Can lead to acute glomerulonephritis AGN 2. CBC – determine anemia, leukocytosis, thrombocytopenia
neutropenia
ACNE- adolescent problem 3. lumbar puncture (LP) – determine CNS involvement.
- self limiting infl dis – sebaceous gland comedones – sebum Before LP, fetal pos.- avoid flexion of neck – will cause
causing white heads a/w obstruction.“C” position or shrimp position only.
- sebum- lipids causing acne bulgaris 4. bone marrow aspiration – determine blast cells,
Mgt: - proper hygiene- mild soap or sulfur soap- antibacterial retin A - common site- iliac crest
or tretinoi - post BMA s/effect – bleeding
- apply pressure. Put pt on affected side to prevent
hemorrhage
ANEMIA-pallor 5. Bone scan – determine bone involvement
Causes: 6. CT scan – determine organ involvement
1.)early cutting of cord – preterm – cut umb cord ASAP
fullterm – cut umb cord when pulsation stops Therapeutic Mgt:
2.) Bleeding disorders – blood dyscrasias TRIAD:
1. surgery
HEMOPHILIA – deficiency of clotting factor. X linked recessive – 2. irradiation
inherited 3. chemotheraphy
If mom – carrier, son – affected Focus Nsg Care: prevent infection
If father carrier- transmitted to daughter
4 LEVELS OF CHEMOTHERAPHY
Hemophilia A – deficiency of coagulation component factor 8 1. induction – goal of tx; to achieve remission
Hemophilia B –or christmas disease, deficiency of clotting factor 9 meds: IV vincristine
Hemophilia C – deficiency of clotting factor 11 L- agpariginase

14
 Oral predinisone
2. Sanctuary- treat leukemic cells that invaded testes & CNS Nsg Resp:
give: methotrixate- adm intrathecally via CNS or spine 1. cover eyes – prevent retinal damage
cytocine, Arabinoside, steroids with irradiation 2. cover genitals – prevent priapism – painful continuous
erection
3. maintenance- to continue remission 3. change position regularly – even exposed to light
give: oral methotrisate – check WBC 4. increase fld intake – due prone to dehydration
-adm of methotrisate – do weekly WBC 5. monitor I&O – weigh baby
check 6. monitor V/S – avoid use of oil or lotion due- heat at
phototherapy
4. Reinductin – treat leukemic cells after relapse occurs. Meds – same = bronze baby syndrome-transient S/E of
as induction phototherapy
weigh diaper 1gm = 1cc
- give antigout agents: allopurinol or Zyloprim- treat or prevent hyperurecemic
nephropathy. Head – largest part of baby
¼ of its length
Nsg mgt: Outstanding nsg dx: alteration in nutrition less
body requirement. Craniostenosis or craniosinustosis – premature closing of
Based on Maslow’s heirarchy fontanel
S/Effect of Chemotherapy Hydrocephalus – ant fontanel open after 18 mos
1. N/V – adm antiemetic drugs 30 mins before chemo until 1 day after Microcephaly – small growing brain due- alcohol & HIV
chemo mom
2. Ulcerations / stomatitis / abscess of oral mucosa- (alteration nutrition Anencepahly – absence of cerebral hemisphere
less body req) Craniotabes – localized softening cranial bone. Common
- oral care – alcohol free mouthwash , betadine mouthwash – 1st born child
- don’t brush – use cotton pledgets -due early lightening (2 weeks prior to EDD)
- topical xylocaine before meals Rickets of Vit B deficiency – soft cranial bone in older
diet- soft, bland diet according to child’s preference children
Caput Succedaneum – edema of scalp due prolonged
Temporary S/E of chemo: pressure at birth
Alopecia – altered body image Char:
Hirsutism – hair 1. present at birth
-give emotional support to parents 2. crosses suture lines
3. disappear after 2-3 days
ABO incompatibility –
Most common incompatibility – ( mom) O – ( fetus) A Cephalhematoma- collection of blood due to rapture of pericostal
Most severe incompatibility (Mom) O– (Fetus) B capillaries
Can affect 1st pregnancy Char :
1. present after 24 h
2. never cross suture line
Hydrops (h20) Fetalis – edematous on lethal state with pathologic 3. disappear after 4-6 weeks
jaundice 4. monitor for developing jaundice
Within 24 h
Seborrheic Dermatitis – ‘craddle cap”
Mgt: Scaling, greasy appearing salmon colored patches – seen
1. initiate breastfeeding to get colostrum on scalp behind ears and umbilicus
2. Temp suspension of breastfeeding Cause: - improper hygiene
- content breast milk pregnanedioles – that delays action of Mgt:
glucoronil transferees 1. proper hygiene
liver enzymes converts in direct bilirubin to become direct 2. put oil night before shampoo
bilirubin - baby oil
3. Needs phototherapy
4. needs exchange therapy Hydrocephalus – excessive accumulation of CSF
1. communicating – extra ventricular hydrocephalus
Hyperbilirubinemia - > 12 mg/dL of indirect bilirubin among full term 2. non-communicating- intraventricular hydrocephalus or
Normal – 0-3 mg/dL obstructive hydrocephalus
- bilirubin encephalopathy due to tumor obstruction
- Kemicterus - > 20 mg/dL among full term &
>12 mg /dl of indirect – preterm Sx – ICP – abnormally large head, bulging fontanel
=can lead to cerebral palsy- - cushings triad
- high pitched cry
Physiologic jaundice – jaundice within 48 -72 h (2-3 days) expose older child – diplopia – eye deviation, projectile vomiting
morning sunlight - fontanel bossing – prominent forehead
Pathologic Jaundice – within 24h. Jaundice during delivery. - - prominent skull vein
- sunset eyes
Breastfeeding jaundice – caused by pregnanediole Mgt: position to lessen ICP – low semi-fowlers 30
degree angle
Assessment of Jaudice : Administer- osmotic diuretic Mannitol/ Osmitrol ,
1. Blanching neonates forehead, nose or sternum Diamex- Azetam
- yellow skin & sclera Decrease CSF production
- color of stool – light stool Shunting – AV shunt or Vp shunt
- color of urine – dark urine (ventriculoperitoneal shunt)
Shave hair – in OR – to prevent growth of micro
Mgt: Phototheraphy – photo oxygenation org.

15
 EARS:
Nsg Care: 1. Properly aligned with outer cantus of eyes
1.) post VP shunt – side lying on non operated site - to low set ear – kidney malformation
prevent increase ICP ex. Renal aginesis – absence of
-monitor for good drainage - sign – sunken fontanel kidney
-bulging fontanel – blocked shunt sign in uterus : oligohydramnios
-change fontanel as child is growing sign in newborn: 2 vessel cord
SENSES failure to void within 24 h
EYES: Assessment
1. check for symmetry Mgt: kidney transplant
2. sclera – normal color – light blue then become dirty white
pupil – round- adult size
coloboma- part of iris is missing Chromosomal aberrations : -advance maternal age
sign: key hole pupil 1. non disjunction – uneven division
-whiteness & opacity of lens congenital cataract
cornea – round & adult size Trisomy 21 - down syndrome - extra chromosome
large – congenital glaucoma 47xx + 21 - related to advance paternal age
Sx:
Test for blindness common tests Mongolian slant
1. newborn – general appearance Broad flat nose
- can only see 10 – 12 “ Protruding neck
- visual acuity 20 /200 to 20/ 800 Puppy’s neck
Doll’s eyes test- test for blindness Hypotonic – prone to resp problem
- done 10th day Simean crease – single transverse line on palm.
- pupil goes opposite to direction when head is moved
Globellars test – test for blink reflex. Points near nose – baby should Trisomy 18 – “endvard syndrome”
blink Trisomy 13- patau syndrome
Turner – Monosomy of X synd.
2. Infant & children - 45x0
- appearance - affected girls
- ability to follow object past midline - signs evident during puberty
- has poorly developed 2dary sexual char.
3. 3 yrs – school age - Sterile
- general appearance
Allen cards – test for visual acuity. Show picture 20 ft away Klinefelters Syndrome- has male genitalia - 47 XXY
- poorly devt secpndary sexual characteristics
Ishiharas plates – test for color blindness - no deepening of voice
Prechool E chart - test for stereopsi of depth perception -small testes, penis -sterile
Cover testing test – cover 1 eye for 10 – 15 min. Then remove. Test for
strabismus Klinefelter – Calvin Kline – male
Turner – Tina Turner – female
4. School age – adult
- general appearance Otitis Media – inflammation of middle ear. Common children due to
- snellens test wider & shorter Eustachian tube
Causes
Retinobastoma – malignant tumor of retina 1.) bottle propping
Outstanding sign : oat’s eye reflex-whitish glow of pupil 2.) Cleft lip/ cleft palate –
- red painful eye Sx: Otitis
- blindness 1. bulging tympanic membrane, color – pearly gray
2. absence light reflex
surgery – Enucliation – removal of eyeball put artificial aye 3. observe for passage of milky, purulent foul smelling odor
discharge
NOSE: 4. observe for URTI
1. flaring alenase – case of RDS Nsg Care:
2. cyanosis at rest – choanal atresia - post nares obstructed 1. position side lying on affected aside – to facilitate drainage
with bone or membrane 2. supportive care- bedrest, increase fld intake
Sx: Med Mgt:
1. resistance during catheter insertion 1. Massive dosage antibiotic
2. emer. Surgery within 24 h Complication – bacterial meningitis
normal color nasal membrane – pinkish 2. Apply ear ointment
rhinitis – presence of creases & pale
check sense of smell – blindfold – smell School age – up and down
< 3 yo – down & back
Hair in nose – cilia > 3 yo – up & back
Adolescent no hair with ulceration of nasal mucosa suspect cocaine Small child – down & back ( no age)
user surgery (to prevent permanent hearing loss)– otitis media –
myringotmy with tympanostomy tube
Epistasis – nosebleed post surgery – position affected side for drainage
- sit upright, head slightly forward to facilitate drainage both – put ear plug
- cold compress , apply gentle pressure, epinephrine if tympanous tube falls – healed na

most developed sense of newborn – sense of touch Bells Palsy- facial nerve #7 paralysis R/T forcep delivery
1st sense to develop & last to disappear – hearing Sx.
1. Continuous drooling saliva

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 2. inability to open , eye & close either eye - colds & pharyngitis = can lead to generalized infection –
Mgt: septicemia
Refer to PT
TEF (Tracheoesophageal Fistula)-TEA- no connection bet Post Op Nsg Care :
esophagus and stomach 1. airway – positon post cheilopasty – side lying for
drainage
Outstanding Sx – Coughing post uranoplasty (tonsillectomy)- prone
Choking 2. assess for RDS sx bleeding
Continuous drooling 3. assess for bleeding – freq swallowing. 6-7 days after
Cyanosis surgery – bleeding
Mgt: 4. proper nutrition
Emergency surgery - clear liquids- ( gelatin except red or brown color due may
mask bleeding)
Epstein pearl – white glistering cyst at palate & gums related to - ( popsicle- not ice cream)
hypercalcemia full liquid
soft diet
Hypervitaminosis regular diet
Natal tooth – tooth at birth. Move with gauze 5. Maintain integrity of suture line such as:
Neonatal tooth – tooth within 28days of life Logan bar – wash ½ strength Hydrogen Peroxide & saline solution-
Bubbling effect
Moniliasis – oral candidiasis traps microorganism
- white cheese like, curd like patches that coats tongue - prevent baby form crying
- oral thrush for pain- analgesic
- Nsg Care – don’t remove, wash with cold boiled H2o
Meds – nystatin / Mysnastatin – antifungal
NECK-
Kawasaki Dse--strawberry tongue - originated in Korea 1.) check symmetry
- Dr. Kawasaki discovered it Congenital torticolis- “ wryneck”-burn injury of sternocleidomsstoid
- common in Japan muscle during
- “mucocutaneous Lymphnode Syndrome” delivery – due to excessive traction at cephalic
Sx: delivery
-persistent fever – 5 days
-strawberry tongue , Mgt: passive stretching exercise , Surgery
-desquamation of palm & sole Complication – scoliosis
- lymph adenopathy > 1.5 cm
Drug: aspirin THYROID gland – for basal metabolism
Can lead to MI Congenial cretinism – absence or non functioning thyroid glands

LIPS- symmetrical reasons for delaying dx:

Cleft lip – failure of median maxillary nasal process to fuse by 5-8 wks 1. Thyroid glands covered by sternocleidomastoid muscles
of pregnancy in newborn
- common to boys 2. baby received maternal thyroxine
- unilateral 3. baby sleeps 16 – 20 h a day
earliest sign:
Cleft Palate- Failed palate to fuse by 9 – 12 wks of pregnancy 1. change in crying
- common to girls 2. change in sucking
- unilateral or bilateral 3. sleep excessively
4. constipation
Sx: 5. edema – moon face
1. evident at birth late sign
2. milk escapes to nostril during feeding 1. mental retardation
3. frequent colic & otitis media or URTI prognosis : mental retardation preventable when Dx is early
Dx:
Mgt: 1. PPI-protein
1. Surgery 2. radioimmunoassay test
cleft lip repair – Cheiloplasty =done 1-3 months to save sucking reflex 3. radioactive iodine uptake
(lost in 6 months )
Cleft Palate- uranoplasty = done 4-6 months to save speech Mgt: synthroid – sodium Levothyrosine -synthetic thyroid given
lifetime
Pre op care - check pulse rate before giving synthroid
1. emotional support especially to mom - tachycardia – Sx of hyperthyroidism
2. proper nutrition
3. prevent colic CHEST
feed – upright seating or prone pos 1. symmetry
burp frequently 2x at middle and after feeding- 2. breast - transparent fluid coming out from newborn
lower to upper tap related to hormonal changes-
4. orient parents to type of feeding 3. chest has retroactive – RDS
rubber tipped syringe – cheiloplasty 4. sternum sunken – pectus excavation
paper cup/ soup spoon/ plastic cup – urano plasty
5. apply restraints – elbow restraints ABDOMEN (in order)
so baby can adjust post op 1. inspection I
2. Auscultation A
Condition that warrants suspension of operation 3. percussion P
4. Palpation P = Will change bowel sounds, so do last

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 - malnutrition
Normal contour of abd – slightly protruding - ciliac crisis
Sunken abd- diaphramatic hernia – protrusion of stomach content Met Alkalosis – base HCO3 excess
through a defective diaphragm due to failure of puroperitoneal - uncontrolled vomiting
canal to close. - NGT aspiration
Sx: - Gastric lavage
1. sunken abd
2. Sx of RDS PROBLEMS LEADIING TO F&E IMBALANCE
3. R to L shunting 1. vomiting – forceful expulsion of stomach content
Mgt: Sx:
Emergency surgery within 24h 1. nausea
2. dizziness
Omphalocele – protrusion of stomach contents in between junction of 3. facial flushing
abd wall and umbilicus. 4. abd cramping

Mgt- very small surgery assess: amt, freq, force

If large – suspension surgery projectile vomiting= increase ICP or pyloric stenosis
Nsg Mgt: protect sac- sterile wet dressing
Mgt:BRAT diet - banana, rice – cereal, apple sauce, toast
Gastrochisis – absence of abd wall
Nsg Mgt: sterile wet dressing 2. Diarrhea – exaggerated excretion of intestinal contents
Types:
Fx of GIT Acute diarrhea – related to gastroenteritis, salmoneliosis
1. assists in maintaining F&E & acid base balance - dietary indiscretions
2. Processes & absorbs nutrients to maintain metabolism & - antibiotic use
support G & D
3. excrete waste products from digestive process Chronic non specific diarrhea
Cause:
Recommended Daily Allowance 1. food intolerance
Calories : 120 cal / Kbw/day (kilo body wt) 2. excessive fld intake
360 – 380 cal/ day 3. CHO, CHON malabsorption

CHON_ 2.2g /Kbw/day Assess: freq, consistency, appearance of given colored stool.
Best criteria to determine diarrhea : consistency
Principles in Supplementary Feeding
Supplementary Feeding usually – 6 mos Complication = dehydration
Supplementary feeding given – 4 mos. Mild dehydration 5% wt loss
Moderate dehydration 10% wt loss
a.) solid food offered to ff sequence! Severe dehydration 15 % wt loss
1. cereals – rich in iron
2. fruits Earliest sx of dehydration
3. veg tachycardia increase temp
4. meat weight loss
b.) begin with small quantities tachypnea sunken fontanel & eyeballs scanty
c,) finger foods – offered 6 months urine
d.) soft table food – “modified family menu” given 1 yr hypotension absence of tears
e.) dilute fruit juices – 6 mos
f.) never give half cooked eggs – usually causes of Severe dehydration:
salmoneliosis Oliguria , Prolonged capillary refill time
g.) don’t give honey – infant botulism
h.) offered new food one at a time – interval of 4 – 7days or Mgt:
1 week – determines food allergens Acute – NPO ( rest the bowel )
- with fluid replacement – IV
Total Body Fluids- comprises 65 - 85% of body wt of infants & - prone to Hypokalemia – give K chloride
children before adm of K chloride – check if baby can void, if cant void –
Where fluids are greater in infants hypokalemia
Extracellular fld – prone to develop dehydration Drug: Na HCO3 – adm slowly to prevent cardiac overload

Acid Base Balance dependent on the ff:

a. chemical buffers Gastric Motility Disorder:
b. renal & resp system involvement HIRSCHPRUNGS DISEASE – congenital aganglionic megacolon
c. dilution of strong acids and bases in bld Aganglionic – absence of ganglion cells needed for peristalis
Resp Acidosis – carbonic acid excess
- hypoventilation Earliest sign
- RDS 1. failure to pass mecomium after 24h
- COPD 2. abd distension
- Laryngotracheobronchitis (LTB) 3. vomitus of fecal material
Resp Alkalosis – carbonic acid deficit early childhood – ribbon like stool
- hyperventilation foul smelling stool
- fever constipations
- encephalopathy diarrhea
Met. Acidosis – base HCO3 deficit Dx:
- diarrhea 1. Barium enema – reveals narrowed portion of bowel
- severe dehydration 2. Rectal Biopsy – reveals absence of ganglionic cells

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 3. abd x-ray – reveals dilated loops on intestine
4. rectal manometry – revels failure of intestine sphincter to Mgt:
relax 1. Pyleromyotomy
2. Fredet Ramstedt procedure
Therapeutic Mgt/Nsg care
1. NGT feeding – measure tube fr nose to ear to midline of INSTUSSUSCEPTION- invagination or telescoping of position of
xyphoid & umbilicus bowel to another
2. surgery Common site – ilio-secal junction
a.) temp colostomy Prone pt: person who eats fat
b.) anastomosis & pull through procedure Complication – peritonitis – emergency
Diet: Sx:
Increase CHON, increase calories , decrease residue – 1.) persistent paroxysmal abd pain
pasta 2.) vomiting
3.) currant jelly stool- dye bleeding & inflammation
GER- Gastroesophageal Reflux - palpate sausage shaped mass
Chalasia – presence of stomach contents to esophagus Mgt:
Will lead to esophagitis complication – aspiration pneumonia 1.) Hydrostatic reduction with barium enema
2.) Anastomosis & pull thru procedura
Esophageal cancer
Assessment : Inborn Errors of Metabolism- deficient liver enzymes
1. chronic vomiting PHENYLKETONURIA (PKU) – deficiency of liver enzymes (PHT)
2. faiture to thrive syndrome Phenylalaninehydroxylase Transferase – liver enzyme that converts
3. organic – organ affected CHON to amino acid
4. melena or hematemesis – esophageal bleeding
Dx procedure 9 amino acids:
1. barium esophogram – reveals reflux valine isolensinetryptophase
2. esophageal manometry – reveals lower esophageal lysine phenylalanine
sphincter pressure
3. intra esophageal pH content – reveals pH of distal Thyronine – decrease malanine production
esophagus. 1.) fair complexion
Meds of GERD 2.) blond hair
Anti-cholinergic 3.) blue eyes
a.) Betanicol ( urecholine) – increase esophageal tone & Thyroxine – decrease basal metabolism
peristaltic activity - accumulation of Phenyl Pyruvic acid
b.) Metachloporomide (Reglam) – decrease esophageal 4.) Atopic dermatitis
pressure by relaxing pyloric & duodenal segments 5.) musty / mousy odor urine
- increase peristalsis without stimulating secretions 6.) seizure – mental retardation
c.) H2 Histamine Receptor Antagonist – decrease gastric acidity
& pepsin secretion Test – GUTHRIE TEST – specimen – blood
- Zimetidine, Ranitidine (Zantac) – take 30 min before meals - preparation increase CHON intake
d.) antacid – neutralizes gastric acid between feedings - Maalox - test if CHON will convert to amino acid

Surgery: Nissen funduplication : specimen and urine

Chronic vomiting – mixed with pheric chloride, presence of green spots at diaper a sign
- thickened feeding with baby cereals - effective if without of PKU
vomiting DIET:
- feed slowly, burp often every 1 ounce Low phenylalanine diet- food contraindicated- meats, chicken, milk,
- positioning legumes, cheese, peanuts
< 9 months – infant sit with infant supine Give Lofenalac- milk with synthetic protein
> 9 months – prone with head of mattress slightly
elevated 30 degree angle Galactosemia – deficiency of liver enzyme
- GUPT – Galactose Urovil Phosphatetranferase
OBSTRUCTIVE DISORDERS - Converts galactose to phosphate tranferace glucose
A. PYLORIC STENOSIS – hypertrophy of muscles of Galactose – will destroy brain cells if untreated – death within 3 days
pylorus causing narrowing &
obstruction. Dx:
1.) outstanding Sx- projectile vomiting Beutler test – get blood -done after 1st feeding
- vomiting is an initial sx of upper GI obstruction presence of glucose in blood – sign of galactosemia
- vomitus of upper GI can be blood tinged not bile streaked. (with galactose free diet lifetime
blood) neutramigen – milk formula
- vomitus of lower GI is bilous ( with pupu)
- projectile vomiting – increase ICP or GI obstruction CELIAC DISEASE – gluten enteropathy
- abd distension – major sx of lower GIT obst Common gluten food:
2.) met alk Intolerance to food with brow
3.) failure to gain wt B- barley
4.) olive shaped mass – on palpation R- rye
5.)serum electrolyte – increase Na & K, decrease chloride O- oat
6.) ultrasound W- wheat
7.) x ray of upper abd with barium swallow reveal “string sign”

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 Gluten – glutamine ( normal absorption)

Gliadin ( toxic to epithelial cells of

villi of intestines, effects is
malabsorption syndrome)

Malabsorption

Fats CHON & CHO Vit D calcium Vit K Iron folic acid
peripheral edema &
malnutrition

Inadequate
blood
coagulation

Steatorrhea Osteomalasia Bleedin anemia

gg

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Early Sx: surgery – orchidopexy
1. diarrhea – failure to gain wt ff diarrheal episodes assess scrotum- warm room & hands
2. constipation
3. vomiting baby – pee within 24 h
Late Sx: -check for arch of urination
1. abd pain – protruberant abd even if with muscle wasting Epispadias- urinary meatus located dorsal or above glans penis
2. steatorrhea Hypospadias- urinary meauts loc ventral or below glans penis

Celiac Crisis- exaggerated vomiting with bowel inflammation Hypospadias with chordee- fibrous band causing penis to curb
Dx: downward
1. lab studies – stool analysis
2. serum antiglyadin – confirmatory of disease Mgt:
Surgery
gluten free diet – lifetime
all BROW – not allowed Phimosis- tight foreskin
ok – rice & corn Balanitis-infection of glands penis – due smegma

Mgt: Mgt:
1. vitamin supplements Circusicion
2. mineral supplements
3. steroids Hydroseal – fld filled scrotum

Tst of Dx:
POISONING- common in toddlers. (falls- common to infant) Transillumination with use of flashlight - glowing sign
1. determine substance taken, assess LOC
2. unless poison is corrosive, caustic (strong alkali such as lye) Varicoseal – enlarged vein of epididimis ( girls- vulvular varicosities)
or a hydrocarbon, vomiting is the most effective way to
remove poison.
- Give syrup 1 pecac to induce vomiting Renal Cause Sx Tx NSG CARE
3. 1 pecac – oral emetic Disorder
- 15 ml – adolescent, school age & pre school
NEPHROTIC infectious 1. Anasarca- gen Prednisone Focus of care:
- 10 ml to infant
SYNDROME edema Diuretic monitor edema
4. UNIVERSAL ANTIDOTE- charcoal, milk of magnesia
2. massive -weigh daily
& burned toast
protenuria Diet:
5. Never adm charcoal before 1 pecac
3. microscopic or Increase CHON
6. antidote for acetaminophen poisoning –
no hematuria Increase K- OJ,
acetylsysterine ( mucomyst)
4. serum CHON beef broth,
7. caustic poisoning ( muriatic acid ) neutralize acid by
decreased banana
giving vinegar . Don’t vomit prepare tracheostomy set
5. serum lipid Decrease Na
8. Gas- mineral oil will coat intestine
increased
6. fatigue
Lead poisoning
7. normal or
Lead = Destroy RBC functioning = Hypochornic Microcytic
decreased BP
Anemia = Destroy kidney functioning
AGN ( acute Autoimm 1. (PPP) primary 1. anti HPN 1. weigh daily
Accumulation of anemia = Encepalopathy
Glomerulo une peripheral drug 2. monitor BP &
Nephritis) Grp A periobital - neurologiuc
Sx:
beta edema hydralazine status
1. beginning sx of lethargy
3A’s; hemolytic 2. moderate or 3. Diet: decrease
2. impulsiveness, learning difficulties
AGN, streptoco protenuria apresoline K, decrease Na
3. as lead increases, severe encepalopathy with seizure
autoimmune ccus 3. gross hematuria 2. iron
and permanent mental retardation
, ( smokey
Grp A urine)
Dx:
4. serum K
1. Blood smear
increased
2. abd x ray
5. fatigue
3. long bones
6. increase BP
Mgt:
Complication :
1. remove child from source
1. hypersensive
2. if > 20 ug/dL – need chelation therapy = binds with led
encephalopathy
& excreted by kidney
2. anemia
=nephrotoxic

Amogenital BACK- check for flatness & symmetry

Female:
Pseudomenstration slight bleeding on vagina related to hormonal Open Neural Tube Defect- decreased Folic Acid intake
changes
SPINA BIFIDA OCCULTA- failure of post laminae of vertebrae to
Tearing of fourchette with blood – rape/ child abuse fuse
Rape- Report within 48 h Sx: dimpling of back , Abnormal tufts of hair
Shape pubic hair in inverted triangle ( female)
SPINA BIFIDA CYSTICA- failure of post laminae of vertebrae to fuse
Male: with a sac
Undescended testes – cyrptorchidism -common to preterm
Types:
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 1. Meningocele – protrusion of CSF & Meninges a.)
Equinos – plantar flexion – horsefoot
2. Myelomeningocele – protrusion of CSF & Meninges b.)
Calcaneous – dorsiflexion – heal lower that foot anterior
& spinal cord ( most dangerous) posterior of foot flexed towards anterior leg
3. Encephalocele ( CNS complication – hydrocephalus) c.) Varus- foot turns in
– cranial meningocele or myelomeningocele d.) Valgus- foot turns out
Most common problem Equino varus- most common
- rupture of sac
- prone pos Assessment:
- sterile wet dressing 1. Straighten legs & flexing them at midline pos
Most common complication - infection
Myelomeningocele – genitourinary complication- urinary & fecal
incontinence Mgt:
Nsg care: always check diaper 1. Corrective shoe- Dennis brown shoe, spica cast
Orthopedic complication – paralysis of lower extremities
Surgery to prevent infection Fx: of cast –
Post op – prone position - to immobilize
- bone alignment
SCOLIOSIS- lateral curvature of the spine - prevent muscle spasm
2 types: lead pencil – mark area to be amputated
1. structural – rye neck cold H20 – hasten setting process
2. postural – improper posture hot H20- slow setting process

After cast application – how to move pt:

Dx: - use open palm not fingers- fingers will cause indention
1. uneven hemline - dry cast – natural air not blower
2. bend forward- 1 hip higher - priority check : neurovascular check
1 shoulder blade more prominent C- circulation
Nsg care: M- motionS- sensation
1. conservative – avoid obesity, exercise
2. preventive – Milwaukee brace - worn 23 h a day Cast – with bleeding
3. corrective surgery – insert Harrington rod - mask with ball pen edge of blood to know if bleeding is on going
post op- how to move sign cast is dry = resonant sound, cast cold to touch
log rolling- move client as 1 unit
do petaline – making rough surface of cast smooth
EXTREMITIES:
check # of digits = 20 CRUTCHES
1. syndactyly – webbing of digits Fx: To maintain balance
2. polydactyly – extra digits - To support weakened leg
3. olidactyly – lack of digits
4. Amelia – total absence of digits Principles in crutches
5. pocoamelia- absence of distal part of extremities - wt of body on palm!
- Brachial pulsing – if wt of body in axila
ErQ duchennes – paralysis- brachial plexus injury or brachial palsy - Do palm exercise- squeeze ball
- birth injury caused by lateral & excessive traction during a Different crutch Gaits:
breech injury 1. Swing Through
Sx: 2. Swing to
1. unable to abduct arms from shoulders, rotate arm externally - no weight bearing are allowed into lower ext
or supinate forearm
2. absence or asymetrical moro reflex 3. Three point Gait
Mgt: - wt bearing is allowed in 1 ext
1. abduct arm from shoulders with elbow flex.
4. Four point gait
CONGENITAL HIP DISLOCATION – head of femur is outside 5. Two point Gait
acetabulum - wt bearing allowed in 2 lower ext
Types;
1. subluxated – most common type
2. dislocated
Sx:
1. shortening of affected leg
2. asymmetrical gluteal fold
3. limited movement – earliest sx
4. (+) ortolanis sign – abnormal clicking sound
5. when able to walk – child limps – late sx- trendelenburg sign

Goal of Mgt:
Facilitate abduction
Mgt.
1. triple diaper
2. carry baby astride
3. Frejka splint
4. Pavlik harness
5. Hip Spica Cast

TALIPES – “clubfoot”

22