Cultural Practice of Filipinos
RA# 9288
The Risk Neonates
Pre-eclampasia- (+) edema, proteinuria and
hypertension (TRIAGE SYMPTOMS)
-usually happens during third trimester
Eclampsia= seizure
Hypertension ---- Detachment of placenta =
Abruption placenta
“a baby is considered premature if it goes out
the womb on the 7 month or so”
The premature infant is defined as baby born
before 37 completed weeks of pregnancy
Number 1 problem of premature babies
>respiratory distress the may cause the lungs to
collapse
problems (atelectasis, grunting, problonged
apnea (more than 20 seconds), cyanosis and
asphyxia.
-it is normal for the babies to stop breathing!!
-apnea is normal only if its only less than 20
seconds
- >20 report to the physician!
- if + grunting sounds = report to the physician
(biot’s respiration)
-Bronchovesicular sounds= normal breath
sounds
MANAGEMENT
-MD inserts ET to give artificial surfactant
(SURVANTA)
-NI= inflate the lungs using a pressurized oxygen
(CPAP) or thru ambubag
Other problems
>regulation of body temperature
-due to immature hypothalamus, less amount
of subcutaneous tissues
-Ni put the baby in the incubator to maintain
neutral temperature setting.
-kangaroo care is done
>Nutritional difficulties (aspiration, gastric
distention and hypoglycemia)
-oral feeding is not done
-Oro gastric feeding is preferred to maintain the
patency of the nose
-breast milk is preferred. (ensure the date and
time when it was obtained). Put it inside the
freezer as it may last for a year.
-don’t put the breast milk in the microwave
para hindi mawala yung igA. Water bathe lang
-Small frequent feeding is done
>Hematologic Difficulties (immature liver
function)
Too much bilirubin damages the brain
(kernicterus)
Mx phototherapy
Ni = cover the eyes and the genitals
“How to you promote expulsion of bilirubin??”
-PROMOTE FEEDING
Most common cause of death to neonates???
LOW RESISTANCE TO INFECTION (sepsis)
Mx
- strict compliance with nursery aseptic protocol
-antibiotic as ordered
The Post Mature Infant – born more than 42
weeks in gestation.
-41 weeks is still okay.
PROBLEMS (long but thin, dry cracking skin, no
vernix and lanugo, long hair and nails, alert
look, possible IUFD.
Associated Problems
1. Oxygenation (hypoxia due to placental
insuffieciency)
2. Hypoglycemia due to decrease glycogen
(rhabdomyolysis leading to acidosis)
3. Fetal distress
4. Seizure disorders due to hypoxia
5. Meconium aspiration- infection and
respiratory distress
Premature- most common
Post-mature- more preventable
“Oxytocin—Abnormal Fetal Monitoring—CS”
BABY OF A DIABETIC MOTHER (>80-120mg/dl)
-due to HPL (insulin antagonist)
-Polyuria, polyphagia, polydipsia, weight loss
and glycosuria
EFFECT ON BABY
1. Intrauterine hyperinsulinism
2. More glucose absorption macrosomia (large
fetus)
3. Preterm delivery because the uterus cannot
accommodate the large baby.
4. Afterbirth hypoglycemia because of
hyperinsulinism
“average birth weight of Filipinos. 5 ½ to 7 ½
pounds. Or 2500 to 3,500 grams”
ABNORMAL IS 8 POUNDS OR 5000 GRAMS
Mx
-monitor s/s of hypoglycemia such as
restlessness and tremors
-CBG (sa foot sa baby. Heel or toe) sa matanda
sa fingertips
-40 to 60mg/dl = normal level of blood sugar in
neonate.
- if neonate is unable to take sugar by mouth,
use d50W as ordered.
RA# 9288- newborn screening act of 2004
>CAH- congenital adrenal hyperplasia-
decreased cortisol, severe salt loss leading to
dehydration. If not treated, death in 9 to 13
days.
Mx- give NaCL tablets
>Galactosemia- inability to metabolize
galactose in milk leading to vomiting, diarrhea,
liver damage, cataract, growth failure and brain
damage.
BAWAL LAHAT NG MILK SAKANILA EVEN IF
GALING SA NANAY!!!
-soy formla—isomil, nursoy and prosobee
>PKU (PHENYKETONURIA)
-common in Caucasians
-inability to utilize an essential amino acid
causing mental retardation
Mx
-special formula- lofenalac/ phenalac
>G6PD- glucose 6 phosphate dehydrogenase
-breakdown of RBC causing anemia
Mx- avoid triggers like beans, naphthalene and
sulfas
>Congenital hypothyroidism (cretinism)-
deficiency in thyroids hormones causing
physical developmental and mental delay
-ito lang yung nappredict among all na
nabanggit na sakit
Mx PATHO OF COA
-thyroid supplement for life -Mataas ang bp nila sa arms kesa sa legs
-normally mas mataas ang legs
------------------------------------------------------- -nagkakaron ng backflow from aorta to ventricle
T.O.R.C.H
Toxoplasmosis- usually comes from cats Dx for CHF
Others 1. Chest x-ray (pulmonary edema and
Rubella (german measles)- usually causes cardiomegaly)
congenital heart defects in babies -cardiomegaly is normal except to babies.
Cytomegalo virus -cardiomegaly is usually seen in elderly and
Herpes athletes
2. EKG- done to see if the babies heart are tired
Acyanotic- left to right shunt- AORTA does not
already
get unoxygentated blood 3. Echocardiography and MRI
Cyanotic- right to left shunt. The aorta will 4. Cardiac catheterization- MOST DEFINITIVE
distribute unoxygentaed blood throughout the WAY TO DIAGNOSED CHF.
body . “spontaneous closure of the septal defect is
PROBLEMS ASSOCIATED WITH ACYANOTIC possible if the damage is minimal”
BLOOD Sx
1. VSD 1. Open heart surgery- if the defect is inside the
2.ASD heart
3. PDA
-ASD, VSD
4. COA 2. Close heart surgery- if the defect is outside
PROBLEMS ASSOCIATED WITH CYANOTIC the heart (less risky)
BLOOD -PDA, COA

1. transposition of the great vessels Acyanotic condition

2. Tetralogy of fallot Nx for CHF
PATHO of ASD/VSD
left to right shunt—increased heart Objective 1 (Prevent CHF)
compensation as the child grows up— 1. Improve cardiac output
cardiomegaly- increased RR decreased heart -cardiac glycoside such as digoxin
contractility- decreased CO= CHF 2. Prevent sodium retention and promote
elimination of excess fluids
PATHO of PDA -loop diuretics
-nagkaron ng connection yung pulmonary artery -weigh the diaper. For every 1 gram=
at aorta- right ventricle gets congested- same 1ml
same -ACE inhibitors- captopril
 3. Low sodium intake
-low sodium formula- lonalac
-clarification on solids allowed
Objective 2 (Decrease oxygen demand)
1. Clustering nursing care
-quiet play activity
-decrease stress and anxiety level
2. Small frequent feeding
Objective 3 (prevent respiratory infections
1. Vitamin C
2. Promote immunization
Cyanotic conditions
>Transposition of the great vessels
“the more he cries, the bluer he gets”
Sx (palliative) EMERGENCY BALLOON
SEPTOSTOMY then (corrective) OPEN HEART
SURGERY
>Tetralogy of fallot
-S/s becomes more evident when the baby
becomes more active
-baby turns blue when crying or when
performing valsava maneuver
REMEMBER D.R.O.P. and INCREASED PRESSURE
IN THE RIGHT VENTRICLE
Displaced aorta (overriding the septum or nasa
gitna ang aorta)
Right ventricular hypertrophy (INCREASED
PRESSURE)
Opening in the septum (VSD)
Pulmonary Artery Stenosis
PATHO
normal blood flow- stenosed pulmonary artery-
right ventricular hypertrophy- vsd causes the
unoxygenated blood from the right ventricle to
shunt unoxygentaed blood to the left ventricle
S/s
1. Exertional dyspnea with cyanosis (central)
2. Activity induced “TET” spells relived by
squatting
“tet spells= bluish discoloration of extremities
and mouth
3. Clubbing of fingers due to peripheral hypoxia
4. Polycythemia due to chronic hypoxia
5. Stunted physical growth and delayed
development
6. Booth-shaped heart
Nx
1. Tell the patient to squat
2. Monitor for hemoglobin and hematocrit
count to detect polycythemia
Normal hemoglobin: 12 to 14
<7 = BT
Normal hematocrit
35 to 45%
3. assist in phlebotomy as needed to be
done (mas malapot kasi ang dugo dahil
sa polycythemia)
4. Increased fluids and maintain IVF line
as necessary
5. Positioning during attacks- squat to
decrease venous return to the heart
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Problems associated with the GIT
“kung may existing cleft lip and cleft palate, ano
ang inuuna irepair???”
ANSWER: CLEFT LIP MUNA para ma suck ng
baby ng milk (10weeks). Palate naman kapag
nagsisimula na magsalita yung bata (before 10
months old)
>Cleft lip/palate -suction PRN
-pre-op feeding: dropper with aspiration -NPO
precaution (semi-fowler’s). place the dropper at
the corner of the lips so that the water will drip Promote nutrition
on the side of cheeks towards the throat -gaastrostomy feeding

Sx CHEILOPLASTY/ Z-PLASTY (for cleft lip) >Pyloric Stenosis

Ni= never prone para hindi mapunit ang tahi -hypertrophy of the muscles of the pyloric
-prevent tension on the suture lines by; sphincter
- anticipating needs to lessen crying use of ARM Symptoms: Abdominal distention after feeding,
RESTRAINTS as ORDERED projectile vomiting, dehydration, metabolic
-clean suture lines after feeding alkalosis, hypokalemia, weight loss, PALPABLE
OLIVE-SHAPED mass in RUQ.
SX for CLEFT PALATE- uranoplasty/palatoplasty
Ni Dx: x-ray with Barium
-position of choice: PRONE to promote natural Sx: (Pyloromyotomy with pyloroplasty)
drainage of secretions
“paano mo malalaman kung may bleeding sa
loob ng mouth”?? >Intussusception- hyperactive portion of the
ANSWER: if the patient is SWALLOWING a lot small intestines telescopes into the lumen of
-bawal pasipsipin yung bata ng straw because it another
creates negative pressure that causes bleeding.
S/s
>TRACHEOESPHAGEAL FISTULA (atresia of the
1. Blood with mucus in the stool- currant jelly
esophagus) TEF
stool
Problems: Aspiration and Nutrition
“kapag green ang suka- galling sa small intestine
Symptoms: -kapag brown- large instetine
-Mom with polyhydramnios -kapag yellow- sa stomach
-baby is drooling a lot
2. Vomiting of bile-stained vomitus
REMEMBER THE 3 Cs of TEF 3. Sausage-shaped mass
1. Coughing
>Hirschsprung’s disease (congental anganglionic
2. Choking
megacolon)
3. Cyanosis
- The disease occurs as the result of an absence
of ganglion cells in the rectum and other areas
“BAWAL MAG BREASTFEED ANG BATANG MAY
of the affected intestine
TEF”
-Mechanical obstruction results because of
Dx= x-ray inadequate motility in an intestinal segment
Sx= SURGERY ASAP -napupuno ang descending colon
-pinupurga dapat ang baby before 5 months
Pre-op care
-Prevent aspiration
Sx fluid only
a. Failure to pass meconium stool Meningomyelocele-
b. Refusal to suck
c. Abdominal distention a. Protrusion of the meninges, CSF, nerve roots,
d. Bile-stained vomitus and a portion of the spinal cord occur.
e. constipated b. The sac (defect) is covered by a thin
membrane prone to leakage or rupture.
other signs of HD
a. Failure to gain weight and delayed growth c. Neurological deficits are evident
b. Abdominal distention
c. Vomiting Sx closure preferred within 24 to 48 hours after
d. Constipation alternating with diarrhea birth to prevent local infection and trauma to
e. Ribbon-like and foul-smelling stools the exposed tissues

OBJECTIVES OF NURSING CARE

Dx: Rectal biopsy = Most definitive way to
(meningocele/myelomeningcele)
diagnose HD
- protect the sac against pressure, injury and
-Barium enema: to determine the extent
infection
-Protect the sac; as prescribed, cover with a
Management of pre-op
sterile, moist (normal saline), non-adherent
-promote elimination
dressing to maintain the moisture of the sac
and contents
Corrective Surgery: ERPT
-Endorectal pull through
>Hydrocephalus
>Imperforated Anus
- An imbalance of CSF absorption or production
caused by malformations, tumors, hemorrhage,
Sx
infections, or trauma
-Absence of meconium
-Results in head enlargement and increased ICP
-unable to insert rectal thermometer
Nursing Care:
Mx 1. Assessment of signs of increased ICP
Step 1: colostomy in the nursery (palliative) -shrill cry, projectile vomitus, change in the level
Step2: before 1 y/0 (10mos, Corrective surgery of consciousness
which is ANOPLASTY and PULL-THROUGH
PROCEDURE) 2. Measures to prevent ICP
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Medical Mx- mannitol and dexamethasone
Neural Tube Defect
-cause: DEFECIENT FOLIC ACID Sx: Insertion of ventriculoperitoneal shunt
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Respiratory Problems in Pedia
Spina bifida
Meningocele- consist of sac-filled with spinal
Pharyngitis and tonsillitis
Cause: GABHS
In taking antibiotics, doctors say that in 24
hours you’re no longer infectious to other
people. But just to be sure, 24 to 48 hours is
considered to be safe.
Odynophagia- pain when swallowing
Tonsillectomy is a planned required surgery.
Pre-op check (tonsillectomy) in pedia: Check for
loose teeth and bleeding status (bleeding
disorder)
Post-op care
-put patient on prone or lateral position to
promote natural drainage of secretion
-infection is possible after 24 hours
-prevent bleeding by applying ice collars
DIET OF CHOICE: cold, clear, non-irritating fluids
(BAWAL ANG ICE CREAM!!!) (SOFT-DIET)
>SPASMODIC GROUP/ LTB
(laryngotracheobronchitis)
Causative agent: VIRUS
S/s: hoarseness (brassy spasmodic “seal-like
cough) Inspiratory stridor, fever.
-may lead to LARYNGOSPASM
Mx (Supportive care)
-prevent coughing causing laryngospasm and
respiratory distress
-Avoid respiratory irritants and sudden
temperature changes
-feed and hydrate (aspiration precaution)
-administer high humidity with MIST THERAPY
during attacks by using a cool mist vaporizer.
-You can also bring the child in a steamy
bathroom at home
-“TUOB or SUOB” paano ginagawa? Bring hot
water to boil then use a towel para hindi mag
escape ang steam.
>BRONCHIAL ASTHMA
-allergologists- one who treats asthma in
children
-Chicken and chocolates and other food with
preservatives are common cause of asthma in
children.
Mx for asthma
1. allergen control- skin testing followed
by hypo sensitization for 3 years.
Mx during exacerbation for asthma
1. Administer ventolin (salbutamol)- this should
be inhaled orally
-best done kapag umiiyak ang bata
IVF drugs (aminophylline, steroids)
3. Orthopneic position
4. Allay anxiety
5. Avoid milk and vitamin C (yung milk
pwede magpalapot ng mucous while yung
vitamin C ay allergen)
6. Purse-lip breathing (spin wheel)
7. Swimming
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Hematologic Disorders in Pedia
“Nutritional anemia is the most common
type of anemia in children”
>IRON DEFICIENCY ANEMIA
-more common to 6 months and older
children. Iron from mother has been used-
up and due to overfeeding of milk.
Mx
-complementary feeding is done at 6
months (one at a time only to rule-out
allergy)
-In one week dapat iisang potahe muna
yung papakainin mo bago mag introduce ng
ibang potahe

Iron-rich foods:
-cereals
-egg yolk (wag yung egg white until they are
toddlers)
-dark green leafy vegetables
-dark meat (organ meat)
-Supplemental iron preparation (NOTE
THAT THIS IS IN LIQUID PREAPARATION.
Mag toothbrush siya after kasi pwede itong
mag cause ng yellow stains sa teeth. Paano
malalaman kung na absorbed ito?? Kapag
naging black ang stool.

>HEMOPHILIA- deficient in factor 8 (anti-

hemophilic factor)
-transmitted as x-linked from carrier mom
to affected son.

-daughter gets it as a train from carrier

mom.
-Hemarthrosis- bleeding in between the ball
joints (pain and swelling)
-intracranial hemorrhage (most dangerous)

Mx
-transfusion of factor 8, cryoprecipitate and
platelet concentrate
-prevent bleeding (avoid trauma)

REMEMBER PRICES!
Protect
Rest
Ice
Elevate above the heart
Support