PEDIATRIC NURSING

I. A. GROWTH AND DEVELOPMENT

Definition of Terms:
Growth increase in physical size of a structure or whole quantitative structure
2 Parameters of Growth
1. Weight
- Most sensitive especially in low birth weight
- eight !oubles by " months
- Triples by 1 year
- #ua!ruples by $ % year
$. Height
- &ncrease by 1 inch per month !uring first " months
- 'n! % inch per month from ( 1$ months
Deveo!me"t increase in the s)ills or capacity to function qualitative change
How to Meas#re Deveo!me"t$
1. by simply observing a chil! !oing specific tas)
$. by noting parent*s !escription of the chil!*s progress
+. by DD,T -Denver Developmental ,creening Test./ MMD,T -Metro Manila Developmental
,creening Test.
% Mai" Rate& 'ategories
1. La"g#age for communication
$. Perso"a (o)ia
+. *i"e Motor A&a!tive pre tensile ability -ability to use han! movement.
0. Gross Motor (+is ability to use large bo!y movement
Mat#ratio" synonymous with !evelopment -rea!iness.
'og"itive Deveo!me"t is the ability to learn an! un!erstan! from e1perience/ to acquire an!
retain )nowle!ge to respon! to a new situation an! to solve problems
I. ,. ,A(I' DIVI(ION O* LI*E
1. Pre-Nata begins at conception an! en!s at birth
$. Perio& of I"fa").
- 2eonatal -first $3 !ays or first 0 wee)s.
- 4ormal &nfancy -from $5
th
!ay to 1 year.
+. Ear. 'hi&hoo&
- To!!ler -1 + years.
- 6re-,chool -0 " years.
0. Mi&&e 'hi&hoo& school age ( 1$ years
7. Perio& of A&oes)e"t
- 6re-'!olescent89ate chil!hoo! -11 1+ years.
- '!olescent -1$ $1 years.
I. '. PRIN'IPLE O* GROWTH AND DEVELOPMENT
/. Growth a"& Deveo!me"t is a )o"ti"#o#s !ro)ess that 0egi"s from )o")e!tio" a"&
e"&s with &eath.
Pri")i!e1 womb to tomb
2. Not a !arts of the 0o&. grow at the same time or at the same rate.
Patter"s of Growth a"& Deveo!me"t
1. :enal/ !igestive/ circulatory/ Musculo-s)eletal -chil!hoo!.
$. Ne#roogi) Tiss#e
- ;rows rapi!ly !uring 1 $ years of life
- <rain -achieve to its a!ult proportion by 7 years.
- =entral 2ervous ,ystem
- ,=
+. L.m!hati) (.stem
- 9ymph no!es/ ,pleen/ Thymus
- ;rows rapi!ly !uring infancy an! chil!hoo! -to provi!e protection against inf1n.
- Tonsils is achieve! in 7 years
0. Re!ro&#)tive Orga" grows rapi!ly !uring puberty
2. Ea)h )hi& is #"i3#e
2 Primar. fa)tors affe)ti"g Growth a"& Deveo!me"t
A. Here&it.
Race
Intelligence
(e1
Nationality
,. E"viro"me"t
4uality of nutrition
(ocio->conomic status
Health
Or!inal position in family
Parent-=hil! relationship
%. Growth a"& Deveo!me"t o))#rs i" a reg#ar &ire)tio" refe)ti"g a &efi"ite a"&
!re&i)ta0e !atter"s or tre"&s
'. Dire)tio"a Tre"&s occurs in a regular !irection reflecting the !evelopment of
neuromuscular functions: these apply to physical/ mental/ social an! emotional
!evelopments an! inclu!es:
a. 'e!hao - )a#&a -hea! to tail.
- &t occurs along bo!ies* long a1is in which control over hea!/ mouth an! eye
movements an! prece!es control over upper bo!y torso an! legs.
b. Pro5imo 6 &ista -centro !istal.
- 6rogressing from the center of the bo!y to the e1tremeties
c. (.mmetri)a
- >ach si!e of the bo!y !evelop on the same !irection at the same time at the
same rate
!. Mass 6 s!e)ifi) -!ifferentiation.
- &n which the chil! learns from simple operations before comple1 function or
move from a broa! general pattern of behavior to a more refine! pattern.
<. (e3#e"tia involves a pre!ictable sequence of growth an! !evelopment to which the
chil! normally passes.
a. 9ocomotion
b. 9anguage an! ,ocial s)ills
=. (e)#ar refers to the worl!wi!e tren! of maturing earlier an! growing larger as
compare! to succee!ing generations.
7. ,ehavior is a most )om!rehe"sive i"&i)ator of &eveo!me"ta stat#s
8. Pa. is the #"iversa a"g#age of a )hi&
9. A great &ea of s+i a"& 0ehavior is ea"e& 0. !ra)ti)e
:. There is a" o!tim#m time for i"itiatio" of e5!erie")e or ear"i"g
;. Neo"ata refe5es m#st 0e ost first 0efore &eveo!me"t )a" !ro)ee&
6ersistent 6rimitive &nfantile :efle1 -suspect =erebral 6alsy.
I. D. THEORIE( O* DEVELOPMENT
Deveo!me"t Tas+s is a s)ill or growth responsibility arising at a particular time in the
in!ivi!ual*s life. The successful achievement of which will provi!e a foun!ation for the
accomplishments of the future tas)s.
THEORI(T(
/. (igm#"& *re#& </:78-/;2;= an 'ustrian neurologist/ 4oun!er of psychoanalysis
PHA(E O* P(>'HO(E?@AL THEOR>
a. Ora Phase <A 6 /: mo"ths=
- Mouth is the site of gratification
- <iting/ crying or suc)ing for en?oyment an! to release tension
- 6rovi!e oral stimulation even the baby is 26@/ offer pacifier
- 2ever !iscourage thumb suc)ing
0. A"a Phase </: mo"ths 6 2 .ears=
- 'nus
- May show toilet training
- >limination/ !efecation
- 6rinciple of
- Aol!ing on -chil! wins/ har! hea!e!/ anti social an! stubborn.
- 9etting ;o
- Mother wins -)in!/ perfectionist/ obe!ient/ obsessive compulsive.
). Phai) Phase <% 6 8 .ears=
- ;enitals
- May show e1hibitionism
- 'ccept the chil! fon!ling his own genital area as the normal area of e1ploration
- 'nswer the chil!*s question early

&. Late"t Phase <9 6 /2 .ears=
- 6erio! of suppression
- <ecause there is no obvious !evelopment
- =hil!*s energy or libi!o is !iverte! to more concrete type of thin)ing
- Aelp chil! achieve positive e1periences
e. Ge"ita Phase </2 6 /: .ears=
- 'chieve! se1ual maturity
- 9earn to establish satisfactory relationship with opposite se1
- ;ive an opportunity to relate with opposite se1
2. Eri) Eri)+so"
- Traine! in psychoanalysis theory
- Transits the importance of culture an! society to their !evelopment of ones society
(TAGE( O* P(>'HO(O'IAL THEOR>
Tr#st vs. Mistr#st <A 6 /: mo"ths=
- Trust is the foun!ation of all psychosocial tas)
- To give an! to receive is the psychosocial theme
- How tr#st is &eveo!e&1
- ,atisfy nee!s on time
- =are must be consistent an! a!equate
- ;ive an! e1perience that will a!! to security -touch/ hugs an! )isses/ eye to eye
contact/ soft music
A#to"om. vs. (hame a"& Do#0t </: mo"ths 6 2 .ears=
- 'utonomy is in!epen!ence or self governance
- How a#to"om. is &eveo!e&
- ;ive an opportunity for !ecision ma)ing such as offering choices
- >ncourage the chil! to ma)e !ecisions rather than ?u!ge
I"itiative vs. G#it <% 6 8 .ears=
- 9earns to !o basic things
- 'ctivity recommen!e! are mo!eling clay/ finger painting
- Develop creativity an! imagination to facilitate fine motor !evelopment
- How i"itiative is &eveo!e&1
- ;ive an opportunity of e1ploring new places an! events
I"&#str. vs. I"feriorit. <9 6 /2 .ears=
- 9earn how to !o things well
- How i"&#str. is &eveo!e&1
- ;ive an opportunity no short assignment an! pro?ects
I&e"tit. vs. Roe 'o"f#sio" </2 6 2A .ears=
- 9earn how he8she is or what )in! of person he8she will become by a!?usting to new bo!y image
- ,ee)ing emancipation or free!om from parents
I"tima). vs. Isoatio" <2A 6 %A .ears=
- 4ocus on career or loo)ing for lifetime partners
Ge"erativit. vs. (tag"atio" <%A 6 8A .ears=
Ego I"tegrit. vs. Des!air <87 a"& a0ove=
2. Bea" Piaget 6 a ,wiss psychologist
(TAGE( O* 'OGNITIVE DEVELOPMENT
A. (e"sorimotor <A 6 2 .ears=
- 6ractical intelligence because wor!s an! symbols are not applicable
- <abies are communicating through sense an! refle1
('HEMA AGE ,EHAVIOR
2eonatal :efle1
6rimary =ircular :eaction
,econ!ary =ircular :eaction
=oor!ination of ,econ!ary
Tertiary =ircular :eaction
&nvention of new means thru
mental combination
,. Preo!eratio"a Tho#ght
('HEMA
6re-conceptual
&ntuitive
1 month
1 0 months
0 3 months
3 1$ months
1$ 13 months -1 1 % year.
13 $0 months
2 6 9 .ears o&
AGE
$- 0 years
0 ( years
- 'll refle1es
- 'ctivities relate! to bo!ies
repetition of behavior -thumb
suc)ing.
- 'ctivity not relate! to bo!y
- Discover ob?ect or persons co!e
an! co!e memory arises
- 'nticipate familiar events
- >1hibit goal !irecte! behavior
- &ncrease sense of separateness
- Bse trial an! error to !iscover
change of places an! events
- =o!e an! =o!e invention of new
means
- =apable of space an! time
perception
- Transitional phase to operational
perio!
,EHAVIOR
- >gocentric -unable to view
another point of view.
- Their thin)ing is basically
concrete an! static
- Their concept of time is only now
an! their concept of !istance is
only as far as they can see
- 2ot yet aware of the concept of
reversibility
- =oncept of animism -inanimate
ob?ect is alive.
'. 'o")rete O!eratio"a <9 6 /2 .ears=
- =an fin! solutions to every!ay problems with systemic reasoning
- They have concept of reversibility
- 'ctivity recommen!e! is collecting an! classifying
D. *orma O!eratio"a </2 a"& a0ove=
- 6erio! when cognition has achieve! its final form
- They are capable
- =an fin! scientific reasoning -can !eal with the past/ present an! future.
- =apable of abstract an! mature thought
- Do abstraction by tal) time that will sort
%. Coh0erg </;:%= 6 recognize! the theory of moral !evelopment as consi!ere! closely to appro1imate
cognitive stages of !evelopment
(TAGE( O* MORAL DEVELOPMENT
IN*AN'>
Age <>ear=
Pre)o"ve"tio"a
$ - +
0 - (
(tage
<Leve I=
1
$
Des)ri!tio"
6unishment8obe!ie
nce orientation
-Cheteronomous
moralityD.. =hil!
!oes right because a parent tells him8her to an! to
avoi! punishment.
&n!ivi!ualism. &nstrumental purpose an! e1change.
=arries out action to satisfy own nee!s rather than
society. ill !o something for another if that person
!o something for the chil!
'o"ve"tio"a
(-1E
1E-$
<Leve II=
+
0
@rientation to interpersonal relations
of mutuality. =hil! follows rules because of a nee!
to be a Cgoo!D person in own eyes an! the eyes of
others.
Maintenance of social or!er/ fi1e! rules an!
authority. =hil!s fin!s following rules satisfying.
4ollows rules of 'uthority figures as well as parents
in an effort to )eep the CsystemD wor)ing
Post)o"ve"tio"a
@l!er than 1$
<Leve III=
7
"
,ocial contract/ utilitarian law-ma)ing perspectives.
4ollows stan!ar!s of society for the goo! of all
people
Bniversal ethical 6rinciple orientation. 4ollows
internalize! stan!ar!s of con!uct.
I. E. DEVELOPMENTAL MILE(TONE
PERIOD O* IN*AN'>
a. Pa.
- ,olitary play
- 2on interactive
- 6riority is safety
- 'ge who appreciate te!!y bears
- Attit#&e1 proper hygiene
0. *ear
- ,tranger an1iety
- <egin at " ( months
- 6ea) at 3 months
- Diminish by 5 months
). Miesto"es
E.I Neo"ate
- 9argely refle1
- =omplete hea! lag
- Aan!s fiste!
- =ry without tears -!ue to immature larcrimal !uct.
- Fisual fi1ation of human face
/ MONTH
- Dance refle1 !isappears
- 9oo)s at mobile ob?ects
2 MONTH(
- Aol!s hea! up when in prone
- ,ocial smile
- <aby CcoosD
- =ry with tears
- =losure of posterior fontanel by $ + months
- Aea! lag when pulle! to a sitting position
2 MONTH(
- Aol!s hea! an! chest when in prone
- 4ollow ob?ect past mi!line
- ;rasp an! tonic nec) refle1 are fa!ing
- Aan! regar!s -+ months.
% MONTH(
- Turns from front to bac)
- Aea! control complete
- <ubbling soun!s
- 2ee!s space to turn
- 9augh alou!
7 MONTH(
- :oll over
- Turn both ways
- Teething rings
- Aan!les rattle well
- Moro refle1 !isappear by 0 7 months
8 MONTH(
- :eaches outs in anticipation of being pic)e! up
- Aan!le bottle well
- ,its with support
- Bses palmar grasp by " months
- >ruption of first temporary teeth -$ lower incisors.
- ,ays vowel soun!s C'h/ ahD
9 MONTH(
- Transfer ob?ects han! to han!
- <eginning fear of stranger
- 9i)es ob?ects that are goo! size!
: MONTH(
- ,its with support
- 6ea) of stranger an1iety
- 6lantar refle1 !isappear
; MONTH(
- =reeps8crawl
- 2ee!s space for creeping
- 6incer grasp refle1
- =ombine two syllables C6apa/ MamaD
- Priorit.1 safety
/A MONTH(
- 6ull self to stan!
- Bn!erstan! wor! C2oD
- :espon! to own name
- 6ea) a boo
- 6at a ca)e since they can clap
// MONTH(
- =ruises
- ,tan! with assistance
/2 MONTH(
- ,tan! alone
- Ta)e first step
- al) with assistance
- Drin) from a cup
- =ooperate in !ressing
- ,ays the $ wor!s CMama/ 6apaD
- Toys: pots an! pans/ pull toy an! learn nursery rhymes
E.2. TODDLER
a. Pa.
- 6arallel -$ to!!lers playing separately.
- 6rovi!e two similar toys -squaw)y squeeze toy.
- a!!ling !uc) to pull/ pull truc)/ buil!ing bloc) an! poun!ing peg
0. *ear
- ,eparation an1iety
- Do not prolong goo!bye/ say goo!bye firmly
- + 6hases of separation an1iety
a. 6rotest
b. Despair
c. Denial
). Miesto"es
/7 mo"ths
- 6lateau stage
- al)s alone -!elay in wal)ing maybe a sign of mental retar!ation.
- 6uts small pellets into small bottle
- ,cribbles voluntarily with pencil
- Aol!s a spoon well
- ,eat self on chair
- =reep upstairs
- ,pea)s 0 " wor!s

/: mo"ths
- Ai!e of possessiveness
- <owel control achieve!
- 2o longer rotates a spoon
- :un an! ?ump in place
- al) up an! !own stairs hol!ing on -typically places both feet on one step before a!vancing.
- 'ble to name bo!y part
- ,pea)s ( $E wor!s
2% mo"ths
- =an open !oors by turning !oor)nobs
- Bnscrew li!s
- al) upstairs alone by still using both feet on the same step at same time
- Daytime bla!!er control
- ,pea) 7E $EE wor!s
2A mo"ths
- + year ol! !o tooth brushing with little supervision
- $ + year ol! is the right time to bring to the !entist
- Temporary teeth complete an! last temporary teeth to appear is the posterior molars
- $E !eci!uous teeth by age $ % years
- =an ma)e simple lines or stro)e for crosses with a pencil
- =an ?ump !own from the stairs
- Gnows full name
- =opy a circle
- Aol!s up fingers
28 mo"ths
- Trusting three
- 'ble to unbutton
- Draw a cross
- 9earns how to share
- 4ull name an! se1
- spea) fluently
- :ight time for bla!!er control -night time control.
- 'ble to ri!e a tricycle
- ,pea) +EE 0EE wor!s
- '#es for toiet trai"i"g
a. =an stan!/ squat an! wal) alone
b. =an communicate toilet nee!s
c. =an maintain himself !ry with interval of $ hours
&. 'hara)ter Traits
- 2egativistic li)es to say no -it is their way to search in!epen!ence.
- 9imit questions an! offer options
- Temper tantrums -stomping feet an! screaming.
- &gnore the behavior
- :igi! ritualistic: stereotype
- =ause: mastering
- 6rotru!e! ab!omen
- =ause:
- Bn!er !evelopment of ab!omen
- Bnstea!y gait
- 6hysiologic anore1ia -give foo!s that last for a short perio! of time.
E.2. PRE-('HOOL
a. Pa.
- 'ssociative play/ =ooperative play
- 6lay house
- :ole playing
0. *ear
- <o!y mutilation or castration fear
- Dar) places an! witches
- Thun!er an! lighting
). Miesto"e
% .ears
- 4urious four -noisy an! aggressive.
- 'ble to button
- =opy a square
- 9ace shoes
- Gnow the 0 basic colors
- Focabulary of 17EE wor!s
7 .ears
- 4rustrating five
- =opy a triangle
- Draw a " part
- &maginary playmates
- $1EE wor!s
&. 'hara)ter Traits
- =urious
- =reative
- &maginative
- &mitative
- hy an! Aow
e. ,ehavior Pro0ems
- Telling tall tales -over imagination.
- &maginary frien!s -purpose: release their an1iety an! tension.
- ,ibling rivalry -?ealousy to a newly !elivere! baby.
- <e! wetting
- <aby tal)
- 4etal position
- Masturbation is a sign of bore!om an! shoul! !ivert their attention
E.%. ('HOOL AGE <9 >EAR(=
a. Pa.
- =ompetitive play
- Tug o war
0. *ear
- ,chool phobia
- To prevent phobia orient chil! to new environment
- Displacement from school
- ,ignificant person is the teacher an! peer of the same se1
- 9oss of privacy
- 4ear of !eath
). (ig"ifi)a"t Deveo!me"t
- 6rone to bone fracture -green stic) fracture.
- Mature vision
&. Miesto"es
8 .ears
- Temporary teeth begins to fall
- 6ermanent teeth begins to appear -first molar.
- Hear of constant motion
- =lumsy movement
- :ecognizes all shapes
- Teacher becomes authority figure that may result to nail biting
- <eginning interest with ;o!
9 .ears
- 'ge of assimilation
- =opy a !iamon!
- >n?oys teasing an! play alone
- #uieting !own perio!
: .ears
- >1pansive age
- ,moother movement
- 2ormal homose1ual
- 9ove to collect ob?ects
- =ount bac)war!s
; .ears
- =oor!ination improves
- Tells time correctly
- Aero worship
- ,tealing an! lying are common
- Ta)es care of bo!y nee!s completely
- Teacher fin! this group !ifficult to han!le
/A .ears
- 'ge of special talents
- rites legibly
- :ea!y for competitive sports
- More consi!erate an! cooperative
- Ioins organization
- ell mannere! with a!ults
- =ritical of a!ults
//-/2 .ears
- 6re a!olescent
- 4ull of energy an! constantly active
- ,ecret language are common
- ,hare with frien!s about their secrets
- ,ense of humor present
- ,ocial an! cooperative
e. 'hara)ter Traits
- &n!ustrious
- 9ove to collect ob?ects
- =ant bear to loose they will cheat
- They are mo!est
(IGN( O* (E?@AL MAT@RIT>
Girs ,o.s
Increase size of breast an! genetalia
Wi!ening of hips
Appearance of a1illary an! pubic hair
Menarch -last sign.
- telarch is the 1
st
sign of se1ual maturity
Appearance of a1illary an! pubic hair
Deepening of voice
Development of muscles
Increase in size of testes an! scrotum -1
st
sign.
Pro!uction of viable sperm -last sign.
E.7. ADOLE('ENT PERIOD
- They have !istinctive o!or because of the stimulation of apocrine glan!
- They have nocturnal emission -wet !reams. the hallmar) for a!olescent
- Testes an! scrotum increase in size until age 1(
- ,perm also viable
- <reast an! female genetalia increase until age 13
a. *ear
- 'cne
- @besity
- Aomose1uality
- Death
- :eplacement from frien!s
0. (ig"ifi)a"t Perso"
- 6eer of opposite se1
). (ig"ifi)a"t Deveo!me"t
- >1periences conflict between his nee!s for se1ual satisfaction an! societies e1pectations
- =ore concern is change of bo!y image an! acceptance from the opposite se1

&. Perso"ait. Trait
- &!ealistic -parent-chil! conflict begins.
- :ebellious
- Fery conscious with bo!y image
- :eformer
- '!venturesome
e. Pro0ems
- Fehicular acci!ent
- ,mo)ing
- 'lcoholism
- Drug a!!iction
- 6re marital se1
IMMEDIATE 'ARE O* THE NEW,ORN
A. THE : PRIORITIE( O* THE NEW,ORN IN THE *IR(T DA> O* LI*E THE : PRIORITIE( O* THE NEW,ORN IN THE *IR(T DA> O* LI*E
1. &nitiation an! Maintenance of respiration
$. >stablishment of e1tra uterine circulation
+. =ontrol of bo!y temperature
0. &nta)e of a!equate nourishment
7. >stablishment of waste elimination
". 6revention of infection
(. >stablishment of an infant-parent relationship
3. Development care that balances rest an! stimulation for mental !evelopment
/. I"itiatio" a"& Mai"te"a")e of res!iratio"
Aerts
- ,econ! stage of labor initiate airway
- &nitiation of airway is a crucial a!?ustment among newborn
- Most neonatal !eaths with in the first $0 03 hours is primarily the inability to initiate airway
- 9ung function begins only after birth
How
A. :emoval of secretions by proper suctioning
,. 6roper ,uctioning of catheter
- 6lace baby*s hea! to si!e to facilitate !rainage
- ,uction nose first because neonates are nasal obligates
- ,uction for 7 1E secon!s an! shoul! be gentle an! quic) because prolong !eep suctioning
may result to hypo1ia/ bra!ycar!ia -cause! by vagal nerve stimulation. an! laryngospasm

'. &f not effective/ requires effective laryngoscopy to open the airway. 'fter !eep suctioning/ an
en!otracheal tube can be inserte! an! o1ygen can be a!ministere! by a positive pressure bag
an! mas) with 1EEJ o1ygen at 0E "E b8min.
N#rsi"g Aerts1
- 2o smo)ing sign to prevent combustion
- 'lways humi!ify to prevent !rying of mucosa
- Mas) shoul! cover nose an! mouth
- @ver!osage of o1ygen may lea! to scaring of retina which may lea! to blin!ness calle!
RETROLENTAL *I,ROPLA(IA( -retinopathy of prematurity.
- hen meconium staine! never a!minister o1ygen because pressure will force meconium to the
alveolar sac an! cause atelectasis
2. Esta0ishi"g e5tra#teri"e )ir)#atio"
Aerts1 circulation is initiate! by pulmonary ventilation an! is complete! by cutting of cor!
THE *ETO-PLA'ENTAL 'IR'@LATION
6lacenta -via simple !iffusion. o1ygenate! bloo! is carrie! by the vein liver D#)t#s
ve"os#s
&nferior vena cava right atrium 9AD sh#"te& to *orame" ovae - left atrium mitral valve
left ventricle aorta lower e1tremities.
The remaining +EJ - tricuspi! valve right ventricle pulmonary artery lungs -for nutrition.
vasoconstriction of the lungs pushes the bloo! to the D#)t#s arterios#s to aorta to supply the
e1tremities. The two arteries carry the uno1ygenate! bloo! bac) to the placenta for
reo1ygenation.
Aerts1 &ncrease pressure on the left si!e of heart causes closure of foramen ovale
(H@NT(
1. D#)t#s Ve"os#s shunt from umbilical vein to inferior vena cava
$. *orame" Ovae shunt between $ atria -begin to close within $0 hours.
+. D#)t#s Arterios#s shunt from pulmonary artery to aorta -begin to close within $0 hours.
A. 2 Way to facilitate Closure-of Foramen-ovale
/. Ta"ge"tia foot sa!
- ,o baby will cry to e1pan! lungs
- 2ever stimulate baby to cry when not yet properly suctione!
- =hec) characteristics of cry -strong vigorous an! lusty cry.
- =ri !u chat -meow cry.
2. Pro!er Positio"i"g
- Right side lying
(TR@'T@RE APPROPRIATE TIME
O* O,LITERATION
(TR@'T@RE
REMAINING
*AIL@RE TO 'LO(E
4oramen @vale
Ductus 'rteriosus
Ductus Fenosus
Bmbilical 'rteries
Bmbilical Fein
$0 hours complete by 1
year
$0 hours complete by 1
month
$ months
$ + months
$ + months
4ossa @valis
9igamentum 'rteriosum
9igamentum Fenosum
9ateral Bmbilical
9igament
&nferior &liac 'rtery
9ateral Bmbilical
9igament
&nferior &liac 'rtery
9igamentum Teres
-roun! ligament of liver.
'trial ,eptal Defect
6atent Ductus 'rteriosus
,. ,est !ositio" imme&iate. after 0irth1
2,D tren!elen!berg
=, supine or crib level position
(ig"s of i")rease I'P
1. 'bnormally large hea!
$. <ulging an! tense fontanel
+. 6ro?ectile vomiting -surest sign of cerebral irritation.
0. &ncrease bloo! pressure but wi!ening pulse pressure
7. Decrease respiratory rate
". Decrease pulse rate
(. Aigh pitch shrill cry -late sign.
3. Diplopia -sign of &=6 from " months 1 year.
2. Tem!erat#re Reg#atio"
Aerts1
- The goal in temperature regulation is to maintain it not less than 5(.(
o
4 +".7
o
=
- Maintenance of temperature is important for preterm an! ,;' because it may lea! to
hypothermia or col! stress
A. *a)tors Lea&i"g to the &eveo!me"t of H.!othermia
1. 6reterm are born !oi+iothermi) -col! bloo!e!. they easily a!apt to temperature of
environment !ue to immaturity of thermo regulating system of bo!y
$. &na!equate subcutaneous tissue
+. 2ewborns are not yet capable of shivering -increase basal metabolism.
0. <abies are born wet
,. Pro)ess of Heat Loss
1. >vaporation bo!y to air
$. =on!uction bo!y to col! soli! ob?ect
+. =onvection bo!y to cooler surroun!ing air
0. :a!iation bo!y to col! ob?ect not in contact with bo!y
'. Effe)ts of H.!othermia <'o& (tress=
1. Aypoglycemia !ue to utilization of glucose -0E 07 gm8!l is the normal bloo! sugar of a
newborn.
$. Metabolic 'ci!osis !ue to catabolism of brown fats -best insulator of a newborn.
+. Aigh ris) for CERNI'TER@( -bilirubin in brain.
0. '!!itional fatigue to alrea!y stressful heart
D. Preve"tio" of 'o& (tress
1. Dry an! wrappe! newborns
$. Mechanical measures
- :a!iant warmer
- &solette -square acrylic si!e! incubator/ must be pre heate! first.
+. 6revent unnecessary e1posure cover areas not being e1amine!
0. Bse tin foil in absence of electricity
7. >mbrace baby -calle! )angaroo care.
%. Esta0ish A&e3#ate N#tritio"a I"ta+e
Aerts1 <reastfee! imme!iately for 2,D an! after 0 hours for =, -=olostrum is present on the +
r!
trimester.
A. Ph.sioog. of ,reast mi+ Pro&#)tio"
- De)rease in level of estroge" an! !rogesti"/ stim#ates the a"terior !it#itar. ga"&/ that
stim#ates the !roa)ti" of the a)i"ar )es -alveoli. to !ro&#)e the foremi+ store& i"
a)tifero#s t#0#es
,. A&va"tage of ,reastfee&i"g
- Fery economical
- 'lways available
- 6romotes bon!ing
- Aelps in rapi! involution
- Decrease inci!ence of breast cancer
- <reast fe! babies has higher &#
- &t contains anti bo!y -&g'. lactobacillus bifi!us that interfere attac) of pathogenic bacteria in ;&T
- =ontains macrophages -store in plastic container/ goo! for " months when store! in freezer.
- Disa&va"tages of 0reast mi+ a"& )owEs mi+
- <oth has no iron
- 6ossibility of transfer of A&F/ Aepatitis <
- 4ather cannot fee! or bon! as well
'. (tages of ,reastmi+
1. 'oostr#m available $ 0 !ays after !elivery
=ontents:
- 9ow fats
- 9ow carbohy!rates
- Aigh protein
- Aigh immunoglobulin
- Aigh minerals
- Aigh fat-soluble vitamins
$. Tra"sitio"a covering 0 10 !ays
=ontents:
- Aigh lactose
- Aigh minerals
- Aigh water soluble vitamins
+. Mat#re mi+ 10 !ays an! above
=ontents:
- Aigh fats -linoleic aci! responsible for integrity of s)in an! !evelopment of s)in.
- Aigh carbohy!rates -lactose/ easily !igeste!/ responsible for sour mil) smelling o!or of stool.
- 9ow protein -lactalbumin.
D. 'owEs mi+
=ontents:
- Aigh fats
- 9ow carbohy!rates -a!! sugar.
- Aigh protein -casein. has a cur! that is har! to !igest
- Aigh minerals/ has traumatic effect on )i!neys of baby
- Aigh phosphorus that may cause inverse proportion with calcium
E. Heath Tea)hi"gs
1. Pro!er H.gie"e
- &mportance of han! washing
- :emoval of ca)e! colostrum
$. Positio"
- Bpright sitting avoi! tension to properly empty breast mil)
+. (tim#ate a"& eva#ate fee&i"g refe5es
a. Rooti"g
- touch si!e of lips or chee) an! baby will turn to the stimulus
- !#r!ose1 to loo) for foo!
- !isappear at " wee)s because baby can alrea!y focus
b. (#)+i"g
- by touching the mi!!le of lips then baby will suc)
- !#r!ose1 ta)e in foo!
- !isappear at " months
- easi. &isa!!ear whe" "ot stim#ate&
c. (waowi"g
- foo! touches posterior portion of tongue automatically swallowe!
- never !isappear cough/ gag/ sneeze
!. E5tr#sio"FProtr#sio" refe5
- foo! touches anterior portion of tongue an! tongue automatically e1tru!e!8protru!e!
- !#r!ose1 prevent from poisoning
- !isappear by 0 months because baby can alrea!y spit out
0. The )riteria of effe)tive s#)+i"g
a. baby*s mouth is hi)e well up to areola
b. mother e1periences after pain
c. other nipple is flowing with mil)
7. To !reve"t from )ra)+ "i!!es a"& i"itiate !ro!er !ro&#)tio" of o5.to)i"
- begin $ + minutes per breast
- increase 1 minute per !ay each breast until you reach 1E minutes each breast or $E minutes per
fee!ing
". *or !ro!er em!t.i"g a"& )o"ti"#o#s mi+ !ro&#)tio" !er fee&i"g
- fee! baby on the last breast that you fe! him
PRO,LEM( E?PERIEN'ED IN ,REA(T*EEDING
a. E"gorgeme"t
- soft an! non ten!er -1 !ay.
- feeling of tension an! fullness of breast
- while fee!ing warm compress
- bottle fee!ing col! compress an! wear supportive bra
0. (ore "i!!e
- crac)e!/ wet an! painful nipple
- e1posure to air is the management or $E watt bulb
- avoi! wearing plastic liner bra/ instea! wear cotton bra
). Mastitis
- inflammation of breast
- )a#sative fa)tor1 staphylococcus aureus
- improper breast emptying
- unhealthy se1ual practices
- breast fee! on unaffecte! breast
- e1press your breast on affecte! si!e
- ta)e antibiotic
- increase 7EE calories when breastfee!ing
- involution of breast is 0 wee)s
'ONTRAINDI'ATION( IN ,REA(T*EEDING
Maternal Conditions
- A&F/ Aepatitis </ =MF/ coma!in8warfarin sulfate inta)e
Newborn Conditions
- erythroblastosis fetalis
- hy!rops fetalis
- phenyl)etonuria -6GB.
- galactosemia
- tay-sachs !isease
7. Esta0ishme"t of waste-eimi"atio"
A. Differe"t stoos
1. Me)o"i#m
- 6hysiologic stool
- <lac)ish green
- ,tic)y
- Tar li)e
- @!orless -because of sterile intestines.
- 2o bacteria
- 6asse! with in $0 +" hours
- 4ailure to pass meconium suspect ;&T obstruction
a. hirschsprung
b. imperforate anus
c. meconium ileu -cystic fibrosis.
$. Tra"sitio"a
- <ecome green/ loose an! slimy that may appear to be a slight !iarrhea to the untraine! eye
+. ,reastfe& stoo
- ;ol!en yellow/ soft/ mushy with sour mil) smelling o!or frequently passe! occurring almost
nearly every fee!ing
0. ,otte-fe& stoo
- 9ight yellow/ forme!/ har! with a typical offensive o!or sel!om passe! $ + times a !ay
7. With s#!!eme"tar. foo&s a&&e&
- <rown an! o!orous
,. I"&i)atio" of (too 'ha"ges
- 9ight stool: ?aun!ice baby
- <right green: phototherapy
- Mucous mi1e! with stool: allergy
- =lay colore!: obstruction to bile !uct
- =hal) clay8whitish clay: barium enema
- <lac) stool: ;&T hemorrhage
- <loo! flec)e!: anal fissure
- =urant ?elly: intususeption
- :ibbon li)e: hirschsprung
- ,teatorrhea: fatty/ bul)y/ foul smelling suspect malabsorption a case of ).sti) fi0rosis or
)eia) &isease
A((E((MENT *OR WELL-,EING
A. APGAR ('ORING
(!e)ia 'o"si&eratio"s
- Ta)en on first 1 minute/ shows the general con!ition of baby
- 17 minutes is optional
- Ta)en again after 7 minutes/ to !etermine baby*s capability to a!apt8 a!?ust e1trauterinely
'om!o"e"ts
Appearance
- =olor: slightly cyanotic/ after first cry baby becomes pin)ish
Pulse rate
- 'pical pulse -left lower nipple.
Grimace
- :efle1 irritability -foot slap/ catheter insertion.
Activity
- Degree of fle1ion -muscle tone.
Respiration
APGAR ('ORING 'HART
()ore
'riteria A / 2
Aeart rate 'bsent 9ess than 1EE More than 1EE
:espiratory effort 'bsent ,low irregular wea) cry ;oo! strong cry
Muscle tone 4lacci! e1tremities ,ome fle1ion ell fle1e!
Refe5 irrita0iit.
=atheter 2o response ;rimace =ough or sneeze
Tangential 4ootslap 2o response ;rimace =ry
=olor <lue86ale 'crocyanosis
-bo!y an! e1tremities
blue.
6in)
I"ter!retatio" of APGAR Res#t
A-2: severely !epresse!/ nee! =6:/ a!mission to 2&=B
%-8: mo!erately !epresse!/ a!!itional suction an! o1ygen a!ministration
9-/A: goo!8healthy
'ARDIO P@LMONAR>-RE(@('ITATION
Airwa. <'ear Airwa.=
1. ,ha)e/ no response call for help
$. 6lace flat on be!
+. Aea! tilt chin lift maneuver
- =ontrain!icate! to spinal cor! in?ury
- @ver e1tension may occlu!e airway
,reathi"g <Ve"tiati"g the #"gs=
0. =hec) for breathlessness
7. '!minister $ rescue breaths
=irculation -by car!iac compression.
". =hec) for pulselessness
(. Do =6: -when breathless an! pulse less.
,. RE(PIRATION EVAL@ATION
(ILVERMAN ANDER(ON INDE? 'HART
()ore
'riteria A / 2
=hest movement ,ynchronize! 9ag on respiration ,ee saw
&ntercostal retraction 2o retractions Iust visible Mar)e!
Kiphoi! retraction 2one Iust visible Mar)e!
2ares !ilation 2one Minimal Mar)e!
>1piratory grunt 2one ,tethoscope 2a)e! ear
I"ter!retatio" of Res#t
A 6 2: 2ormal no respiratory !istress syn!rome
% 6 8: Mo!erate :D,
9 6 /A: ,evere :D,
'. A((E((MENT O* GE(TATIONAL AGE
,ALLARD AND DO,OWITG 'LINI'AL 'RITERIA
Gestatio"a Age <Wee+s=
*i"&i"gs Less THAN 28 29-2: 2; a"& #!
,ole creases 'nterior transverse
crease only
@ccasional creases in
$8+
,ole covere! with
creases
<reast no!ule -!m.. $ mm 0mm or + 7 mm ( mm (.7 mm
,calp hair 4ine an! fuzzy 4ine an! fuzzy =oarse an! sil)y
>ar 9obe 6liable ,ome Thic)
Testes ,crotum Testes an! scrotum in
lower canal/ scrotum is
small with few rugae
&nterme!iate Testes pen!ulous/
scrotum full with
e1tensive rugae
PRE TERM ,A,IE(
- $3 +$ wee)s
- 4rog leg or la1 position
- Aypotonic muscle tone
- ,carf sign -elbow passes the mi!line.
- ,quare win!ow wrist -5E
o
angle.
- Aeel to ear sign
- 'bun!ant lanugo
- 6rominent labia minora an! clitoris
PO(T TERM ,A,IE(
- More than 0$ wee)s
- @l! mans face -classic sign.
- Desquamation -peeling of neonate s)in characterize! by e1treme !ryness than begin from sole
an! palm within $0 hours
D. Neo"ate i" the N#rser.
L,pecial an! &mme!iate &nterventions
/. @!o" re)eivi"g
- 6roper i!entification -foot print with mothers thumb print.
- Ta)e antropometric measurement
2. The" ta+e a"thro!ometri) meas#reme"ts
a. 9ength M 15.7 $1 inches80(.7 7+.(7 cm average of 7E cm
b. Aea! =ircumference M ++ +7 cm average of +0 cm81+ 10 inches
c. =hest =ircumference M +1 ++ cm average of +$ cm81$ 1+ inches
!. 'b!ominal =ircumference M +1 ++ cm average of +$ cm81$ 1+ inches
2. ,athi"g ,a0.
- 2ormal oil bath
- =leanse an! sprea! verni1
- <abies of A&F positive mothers are given full bath to lessen transmission of infection
- &nsulator
- <acteriostatic
- 4ull bath is safely given when cor! falls
%. Dressi"g the #m0ii)a )or&
- 4ollow strict asepsis to prevent infection8tetanus
- Bse 6ovi!one io!ine
- =hec) for + vessels -$ arteries an! 1 vein.
- 'F' -$ vessel cor! suspect )i!ney malformation.
- 9eave about 1 inch of cor!
- 3 inches if anticipating &F or <T
- =hec) for the cor! q 17 minutes for the first " hours
- *or 0ee&i"g1
- +E cc is blee!ing to newborn
- Aemophilia is e1cessive blee!ing
- Om!aagia is blee!ing of the cor!
- =or! turns blac) on the thir! !ay
- 4alls by (
th
1E
th
!ay
- 4ailure to fall is umbilical granulation -silver nitrate.
- Bse saline to clean
7. 're&es Pro!h.a5is
- P#r!ose1 prevent opthalmia neonatorum -use erythromycine ophthalmic ointment.
8. A&mi"istratio" of Vitami" C
- A)tio"1 prevent hemorrhage
- :elate! to physiologic hypoprothrombinemia
- ;ive 'quamephyton/ phytomena!ione/ )ona)oib -.7 1.7 mg/ &M.
9. Weight-ta+i"g
2ormal eight: +EEE +0EE grams8+ +.0 )g8".7 (.7 lbs
'rbitrary 9ower 9imit: $7EE grams
9ow <irth eight: below $7EE grams
,mall for ;estational 'ge: less 1E percentile ran)
9arge for ;estational 'ge: more than 5E percentile ran)
'ppropriate for ;estational 'ge: within the $ stan!ar! !eviation of the mean
6hysiological eight 9oss: 7 1E percent occurs a few !ays after birth
E. PH>(I'AL E?AMINATION AND DEVIATION( *ROM THE NORMAL
A. Im!orta"t 'o"si&eratio"s
a. &f the client is new born/ cover areas that is not being e1amine!
b. &f the client is infant/ the first vital sign to ta)e is :: -!ue to fear of stranger.
- <egin at east intrusive to the most intrusive
c. &f the client is to!!ler an! preschool/ let them han!le an instrument play syringe/ stethoscope/
!. &f the client is school age an! a!olescent e1plain proce!ure
'OMPONENT(1
1. Vita sig"s
- Tem!erat#re is ta)en rectally to rule out imperforate anus an! thermometer is inserte! 1 inch
- Don*t force insertion because it may lea! to pruritus
- T.!es of im!erforate a"#s
a. Atreti) no anal opening/ causing failure to pass meconium
0. Age"eti)
- no anal opening/ causing failure to pass meconium
- ab!ominal !istention
- foul smelling stool
- vomitus of fecal materials
- respiratory problems
- Ma"ageme"t1 surgery with temporary colostomy
). Mem0ra"o#s
'ARDIA' RATE 'ARDIA' RATE 1$E-1"E8min
- &rregular
- :a!ial pulse is absent/ if present suspect 6D'
'ONGENITAL HEART DI(EA(E( 'ONGENITAL HEART DI(EA(E(
L'ommo" i" girs: 6D'/ ',D
L'ommo" i" 0o.s: T@;' -transposition of great arteries./ Truncus 'rteriosus
L=auses: T@4
1. 4amilial
$. >1posure to rubella -1
st
month for mother.
+. 4ailure of heart structure to progress
TWO MAJOR TYPES
A. A'>ANOTI' HEART DE*E'T(
Left to right sh#"ti"g
WITH IN'REA(ED P@LMONAR> ,LOOD *LOW
/. Ve"tri)#ar (e!ta Defe)t
- @pening between $ ventricles
(ig"s a"& (.m!toms
1. ,ystolic murmur at lower bor!er of sternum an! no other significant signs
$. =ar!iac catheter reveals o1ygen saturation at right si!e of heart
+. >=; reveals hypertrophy of right si!e of heart
Ma"ageme"t
1. 9ong term antibiotic therapy to prevent !evelopment of sub acute bacterial en!ocar!itis
$. @pen heart surgery

2. Atria (e!ta Defe)t
- 4ailure of foramen ovale to close
(ig"s a"& (.m!toms
1. ,ystolic murmur at upper bor!er of sternum an! no other significant signs
$. =ar!iac catheter reveals increase o1ygen saturation at right si!e of heart
+. >=; reveals hypertrophy of right si!e of heart
2. E"&o)ar&ia '#shio" Defe)ts
- 'F canal affecting both tricuspi! an! mitral valve
(ig"s a"& (.m!toms
1. @nly confirme! by car!iac catheter
Ma"ageme"t
- @pen heart surgery
%. Pate"t D#)t#s Arterio#s
- 4ailure of !uctus arteriosus to close
(ig"s a"& (.m!toms
1. =ontinuous machine li)e murmur
$. 6rominent ra!ial pulse
+. Aypertrophy of left ventricle upon >=;
Ma"ageme"t
1. INDOMETHA'IN -prostaglan!in inhibitor that facilitate closure of 6D'.
$. 9igation of 6D' by + 0 years ol!
WITH DE'REA(ED P@LMONAR> ,LOOD *LOW
/. P#mo"ar. (te"osis
- 2arrowing of valve of pulmonary artery
(ig"s a"& (.m!toms
1. Typical systolic e?ection murmur
$. >=; reveals hypertrophy of right ventricle
+. ,$ soun! is wi!ely split
2. Aorti) (te"osis
- 2arrowing of valve of aorta
(ig"s a"& (.m!toms
1. 9eft ventricular hypertrophy
$. Typical murmur
Ma"ageme"t
1. <alloon stenotomy
$. ,urgery -last resort.

2. D#!i)atio" of aorti) ar)h
- Doubling of arch of aorta causing compression to trachea an! esophagus
(ig"s a"& (.m!toms
1. Dysphagia
$. Dyspnea
Ma"ageme"t
1. =lose heart surgery
%. 'oar)tatio" of the Aorta
- 2arrowing of arch of aorta
(ig"s a"& (.m!toms
1. <loo! pressure in upper e1tremities is increase!
$. <loo! pressure in lower e1tremities is !ecrease!
+. @utstan!ing sign is a0se"t femora !#se
Ma"ageme"t
1. Ta)e bloo! pressure in 0 e1tremities
$. =lose heart surgery
,. '>ANOTI' HEART DE*E'T(
Right to eft sh#"ti"g
WITH IN'REA(E P@LMONAR> ,LOOD *LOW
/. Tra"s!ositio" of Great Arteries
- ,ituation where aorta is arising from the right ventricle an! pulmonary artery of the left ventricle
(ig"s a"& (.m!toms
1. =yanosis after 1
st
cry -outstan!ing sign.
$. 6olycythemia -compensatory mechanism to !ecrease o1ygen supply
+. 6rone to thrombus lea!ing to embolism resulting to stro)e -complications.
Ma"ageme"t
1. 6alliative repair )ash)in! proce!ure
$. =omplete repair mustar! proce!ure
2. Tota A"omao#s P#mo"ar. Ve"o#s Ret#r"
- 6ulmonary vein enters the right atrium or superior vena cava
(ig"s a"& (.m!toms
1. Mi1e! bloo! supplying the bo!y -o1ygenate! an! uno1ygenate!.
$. @pen foramen ovale
+. As!ee"ia -absent spleen.
0. Mil! to mo!erate cyanosis
Ma"ageme"t
1. :estructuring of the heart
2. Tr#")#s Arterios#s
- 6ulmonary artery an! aorta is arising from one common trun) or single vessel with F,D
Ma"ageme"t
1. 6ositive cyanosis an! polycythemia
$. :estructuring of the heart
%. H.!o!asti) Left Heart (."&rome
- 2on functioning left ventricle
(ig"s a"& (.m!toms
1. =yanosis
$. 6olycythemia
Ma"ageme"t
1. Aeart transplant
WITH DE'REA(E P@LMONAR> ,LOOD *LOW
/. Tri)#s!i& atresia
- 4ailure of tricuspi! valve to open
(ig"s a"& (.m!toms
1. @pen foramen ovale
$. =yanosis
Ma"ageme"t
1. 4ontan proce!ure
2. Tetraog. *aot
- 0 'nomalies 6resent
Pulmonary stenosis
V,D
Overri!ing aorta
Right ventricular hypertrophy
(ig"s a"& (.m!toms
1. Aigh !egree of cyanosis
$. 6olycythemia
- &ncrease re! bloo!
- Thrombus/ embolus/ stro)e
- Mental retar!ation
- =lubbing of fingernails -chronic tissue hypo1ia. late sign
- K-ray reveals 0oot sha!e heart
+. ,evere !yspnea
- :elieve! by squatting position
0. ;rowth retar!ation
7. Tet ,pells
- <lue spells/ short episo!e of hypo1ia
Ma"ageme"t
1. Morphine for hypo1ic episo!e
$. 6ropranolol -&n!eral. !ecrease heart spasm
+. 6alliative :epair ,LALO'C TA@((IG PRO'ED@RE
0. =omplete :epair ,RO'C PRO'ED@RE
A'4@IRED HEART DI(EA(E A'4@IRED HEART DI(EA(E
Rhe#mati) heart Disease
- &nflammatory !isease following an infection cause! by ;roup-' beta hemolytic streptococcus
-thrives in aerobic environment.
Affe)te& ,o&. Parts
- Musculos)eletal car!iac muscles an! valves
- &ntegumentary
- =2,
- 'schoff bo!ies
- :oun!e! no!ules containing of multi nucleate! cells an! fibroblasts that stays in mineral valve
(ig"s a"& (.m!toms
MABOR MINOR
6olyarthritis -multi ?oint pain.
=horea -s.&e"ha""s )horea. St. Vitus
dance/ purposeless8involuntary han! an!
shoul!er movement accompanie! by
grimace
=ar!itis
>rrythema marginatum -macular rash.
- ,ubcutaneous no!ules
'rthralgia -?oint pain.
9ow gra!e fever
&ncrease !iagnostic tests
a. 'ntibo!y
b. =-reactive protein
c. >rythrocyte ,e!imentation :ate
!. 'nti-streptolysin @ titer -',@.
Ma"ageme"t
- =<: -avoi! contact sports.
- =ulture an! sensitivity -throat swab.
- 'ntibiotic management -to prevent recurrence.
- 'spirin -anti inflammatory.
- (i&e Effe)ts1 :eye*s ,yn!rome
- 2on recurring encephalopathy accompanie! by fatty infiltration of organs such as liver an! brain
RE(PIRATION RE(PIRATION
- 'bnormal8!iaphragmatic
- ,hort perio! of apnea without cyanosis
- 2ormal apnea of newborn is less than 17 secon!s
Res!iratio" 'he)+
New0or" %A-;A
/ .ear 2A-%A
2-2 .ears 2A-2A
7 .ears 2A-27
/A .ears /9-22
/7 a"& a0ove /2-2A
,reath (o#"&s Hear& o" A#s)#tatio"
RE(PIRATOR> DI(TRE(( (>NDROME
- Ayaline membrane !isease
- 'a#se1 lac) of surfactant
- =ommon in preterm infants
- Aypo1ic
- 4ormation of hyaline
- =ausing atelectasis
(ig"s a"& (.m!toms
- Definite within 0 hours of life
1. &ncrease :: with retractions -early sign.
$. >1piratory grunting -ma?or sign.
+. 4laring alae nassi
0. Kiphoi! retractions
7. &ntercoastal retractions
". :espiratory aci!osis
Ma"ageme"t
1. Geep hea! elevate!
$. 6roper suctioning
- @1ygen a!ministration
- 6lace on continuous positive airway pressure
- 6ositive en! e1piratory pressure -maintain alveoli partially open an! prevent collapse.
+. Monitor s)in color/ vital signs/ '<;
0. ,urfactant replacement an! rescue
LAR>NGOTRA'HEO,RON'HITI(
- &nfection of laryn1/ trachea an! bronchi
(o#"& 'hara)teristi)s
VE(I'@LAR
,RON'HOVE(I'@LAR
,RON'HIAL
RHON'HI
RALE(
WHEEGING
(TRIDOR
RE(ONAN'E
H>PERRE(ONAN'E
,oft/ low pitche!/ hear! over periphery of lungs/ inspiration longer than
e1piration/ "orma.
,oft/ me!ium-pitche!/ hear! over ma?or bronchi/ inspiration equals
e1piration/ "orma.
9ou!/ high-pitche!/ hear! over trachea/ e1piration longer than inspiration/
"orma.
,noring soun! ma!e by air moving through mucus in bronchi/ "orma.
=rac)les -li)e cellophane. ma!e by air moving through flui! in alveoli.
A0"ormaN !enotes pneumonia or pulmonary e!ema which is flui! in alveoli.
histling on e1piration ma!e by air being pushe! through narrowe! bronchi.
A0"ormaN seen on chil!ren with asthma or foreign-bo!y obstruction.
=rowing or rooster li)e soun! ma!e by air being pulle! through a constricte!
laryn1/ A0"orma/ seen in infants with respiratory obstruction.
9ou!/ low tone/ percussion soun! over normal lung tissue.
9ou!er/ lower soun! than resonance/ a percussion soun! over hyperinflate!
lung issue.
Assessme"t
- <ar)ing cough8croupy cough
- :espiratory aci!osis
La0orator. (t#&ies
a. '<;
b. Throat culture
c. =<=
Diag"osti) (t#&ies
a. =hest an! nec) 1-ray -to rule out epiglotitis.
Ma"ageme"t
a. <roncho!ilators
b. @1ygen with increase humi!ity
c. 6repare tracheostomy set when necessary
,ro")hoitis
- &nflammation of bronchioles characterize! by pro!uction of thic) tenacious mucous
(ig"s a"& (.m!toms
- =ol! li)e8flu li)e symptoms
- 'a#sative age"t1 respiratory syncitial virus
- Dr#g1 :ibavirin -anti viral !rug.
- >n! stage epiglotitis -emergency con!ition or B:T&./ su!!en onset
Ma"ageme"t
- Tripo! position -leaning forwar! with tongue protrusion.
- 2ever use tongue !epressor
- 6repare tracheostomy set
- >ncircle age
- Mist tent Ccroup tentD/ croupette
- N#rsi"g ma"ageme"t
a. =hec) e!ges if properly tuc)e!
b. ashable plastic material
c. 'voi! toys that cause friction an! hairy an! furry materials
,LOOD PRE((@RE ,LOOD PRE((@RE
- 3E80" mmAg after 1E !ays 1EE87E
- 2ormal bloo! pressure ta)ing begins by + years ol!
Aerts
- <6 cuff must cover 7E (7J -$8+. of upper arm
- To large cuff results to false low <6
- To small cuff results to false high <6
(CIN (CIN
- 'crocyanosis -bo!y pin) e1tremities blue.
- ;eneralize! mottling !ue to the immaturity of the circulatory system
,IRTHMARC(
1. Mo"goia" (!ots slate-gray-or-bluish !iscoloration8patches commonly seen across he
sacrum or buttoc)s
- Due to increase melanocytes
- =ommon in asian newborn
- Disappear by 1 year/ preschool/ 7 years ol!
$. Miia plugge! unopene! sebaceous glan! usually seen as white pinpoint patches on nose/
chin an! chee)/ !isappears by $ 0 wee)s
+. La"#go fine !owny hair
0. Des3#amatio" peeling of the newborn s)in within $0 hours/ common among post term
7. (tor+ 0ites <tee"gie)tasis "evi= pin) patches at the nape of the nec)
- 2ever !isappear but is covere! by hair
". Er.thema To5i)#m <fea 0ite rash= first self limiting rash to appear spora!ically an!
unpre!ictably as to time an! place.
(. Hare3#i" sig" !epen!ent part is pin)/ in!epen!ent part is blue -:<= settles !own.
3. '#tis marmorata transitory motling of neonates s)in when e1pose! to col!
5. Hema"giomas vascular tumors of the s)in
2 T>PE(
a. Nev#s *amme#s macular purple or !ar) re! lesions usually seen on the face or
thigh
- Portwi"e stai": never !isappear but can be remove! surgically
b. (traw0err. hema"giomas <"ev#s vas)#os#s=6 !ilate! capillaries in the entire
!ermal or sub!ermal area continuing to enlarge but !isappear after 1E years ol!.
c. 'aver"o#s hema"giomas 6 =onsist of communicating networ) of venules in the
subcutaneous tissue that never !isappear with age.
- Dangerous type may lea! to internal hemorrhage
1E. Ver"i5 'aseosa white cheese li)e substance for lubricationN =olor of verni1 is same as
amniotic flui!
(CIN 'OLOR AND THEIR (IGNI*I'AN'E
,#e cyanosis8 hypo1ia
White e!ema
Gra. infection
>eowish ?aun!ice8 carotinemia -increase carotin.
Pae anemia
(CIN DI(ORDER( (CIN DI(ORDER(
,@RN TRA@MA ,@RN TRA@MA
- &s in?ury to bo!y tissue cause by e1cessive heat
Assessme"t
De!th
/
st
<!artia thi)+"ess=
>1. ,unburn
&nvolves only the superficial epi!ermis characterize! by erythema/ !ryness an! pain
Aeals 1 -1E !ays
2
"&
<!artia thi)+"ess=
>1. ,cal!s
&nvolves the entire epi!ermis/ an! portion of !ermis characterize! by erythema/ blistere! an!
moist from e1u!ates which is e1tremely painful.
2
r&
<f# thi)+"ess=
&nvolves both s)in layers/ epi!ermis an! !ermis8may involve a!ipose tissue/ fascia/ muscle an!
bone. &t appears leathery/ white or blac) an! not sensitive to pain since nerve en!ing ha! been
!estroye!.
Ma"ageme"t
1. *irst Ai&
a. 6ut out flames by rolling the chil! on a blan)et
b. &mmerse the burne! part on col! water
c. :emove burne! clothing
!. =over burn with sterile !ressing
$. Mai"te"a")e of a !ate"t airwa.
a. ,uction as nee!e!
b. @1ygen a!ministration
c. >T tube
!. Tracheostomy
+. Preve"tio" of (ho)+ a"& *#i& a"& Ee)tro.te ,aa")e
a. =olloi!s to e1pan! bloo! volume
b. &sotonic saline to replace electrolytes
c. De1trose an! water provi!e calories
0. A 0ooster &ose of teta"#s to5oi&
7. Reief of !ai" s#)h as IV a"agesi) -morphine sulfate.
". Preve"tio" of wo#"& i"fe)tio"
a. =leaning an! !ebri!ing of woun!
b. @pen8close metho! of woun! care
c. hirlpool therapy
(. (+i" grafti"g
a. <ig s)in 1enograft
b. Ta)en from ca!aver
3. Diet
a. Aigh protein
b. high calorie
ATOPI' DERMATITI( ATOPI' DERMATITI(
- &nfantile eczema
- ,)in !isease characterize! by maculo vesicular errythematous lesion with weeping an! crusting
- 'a#se1 allergens -main./ mil)/ eggs/ citrus ?uices/ tomatoes an! wheat
- =haracterize! by e1treme pruritus
- (ig"1 linear e1coriation/ i)he"ifie& scaling
Ma"ageme"t
- Treat main cause
- 6rosorbbee or &somil -mil).
- Ay!rate s)in with burrow*s solution
- 6revent infection
- =ut short the nails
IMPETIGO IMPETIGO
- 'a#se1 group ' beta hemolytic streptococcus
- =haracterize! by populo vesicular surroun!e! by localize! errythema becoming purulent an!
ooze forming a honey colore! crust
- 6e!iculosis capitis -)uto.
- ;ive oral penicillin
- ';2 complication
A'NE A'NE
- ,elf limiting inflammatory !isease affects sebaceous glan!s common in a!olescence
- (ig"s1 =ome!ones -sebum causing white hea!s.
- ,ebum is compose! of lipi!s
Ma"ageme"t
- 6roper hygiene
- ash face with soap an! water
- Bse sulfur soap or mil! soap
- :etin '
HEMATOLOGI' DI(ORDER( HEMATOLOGI' DI(ORDER(
PALLOR-ANEMIA PALLOR-ANEMIA
Possi0e )a#se of A"emia
1. >arly cutting of cor!
$. <lee!ing Disor!er8bloo! !yscracia
HEMOPHILIA HEMOPHILIA
- Deficient clotting factor
- K lin) recessive inheritance
- ,e1 lin)
- >1cessive blee!ing upon cutting of cor! or circumcision
- =arrier mother passe! to son/ when son becomes a father he will pass it to his !aughter
Hemo!hiia A <)assi)= !eficiency of the coagulation component -4actor F&&&.
Hemo!hiia , <'hristmas &isease= !eficiency in clotting factor &K
Hemo!hiia ' !eficiency in clotting factor K&
Assessme"t
- 2ewly !elivere! baby receive maternal clotting factor
- ,u!!en bruising of bumpe! area
- =ontinuous blee!ing to hemarthrosis
- <lee!ing or !amage of synovial membrane
Diag"osti) Test
- Aigh ris) for in?ury -prevent in?ury.
- 6artial thromboplastin time
Ma"ageme"t
- 'voi! contact sports
- (ig"ifi)a")e1 !etermine case before !oing any invasive proce!ure
- 2o aspirin
- &mmobilize an! elevate upon in?ury
- 'pply gentle pressure
- =ol! compress
- ,oo& tra"sf#sio"1 cryoprecipitate/ fresh frozen plasma
LE@CEMIA LE@CEMIA
- ;roup of malignant !isease characterize! by rapi! proliferation of immature <=
- <= -sol!iers of bo!y.
- Ratio1 7AA R,'1/W,'
'assifi)atio" <&e!e"&s o" affe)te& !art=
L.m!ho lymphatic system
TRIAD
M.eo bone marrow
A)#teF,asti) immature cells
'hro"i)F).sti) mature cells
A)#te .m!ho).ti) common among chil!ren
(ig"s a"& (.m!toms
1. *rom the i"vasio" of 0o"e marrow
- 'nemia -pallor/ fatigue/ constipation.
- <lee!ing -bruising/ petechiae/ epista1is/ blee!ing in urine/ emesis.
- &nfection
- 4ever
- 6oor woun! healing
- <one wea)ens an! causes fracture
$. *rom the i"vasio" of orga"s
- Aepatosplenomegaly
- =2, affectation -hea!ache an! signs of increase &=6.
Diag"osti) Tests a"& (t#&ies
1. P,( <!eri!hera 0oo& smear= !etermine immature <=
$. ',' anemia/ neutropenia/ thrombocytopenia
+. L#m0ar P#")t#re place in fetal position without fle1ion of nec)/ = position or shrimp position
0. ,o"e Marrow As!iratio"
- ,ite for aspiration is the iliac crest
- 6ut pressure after aspiration
- 6lace on affecte! si!e
7. ,o"e ()a" !etermine bone involvement
". 'T s)a" !etermine organ involvement
(#rger.
Irra&iatio" 'hemothera!.
Thera!e#ti) Ma"ageme"t
1. Me!ications
% Leves of 'hemothera!.
*or I"&#)tio" achieve remission -main goal.
a. &F Fincristine
b. 9aspariginase
c. @ral pre!nisone
*or (a")t#ar. treat leu)emic cells that has inva!e! testes an! =2,
a. Methothre1ate -i"trathe)a. via 'N(Fs!i"e.
b. =ytocin
c. 'rabinosi!e
!. >1tra irra!iation
*or Mai"te"a")e continue remission
a. @ral Methothre1ate
b. @ral " mercaptopurine
c. =ytarrabine
*or Rei"&#)tio" treat leu)emic cells after relapse occurs
a. &F Fincristine
b. 9aspariginase
c. @ral pre!nisone
A"tigo#t Age"ts treat8prevent hyperuricemic nephropathy
a. 'llopurinol -Oyloprim.
b. &ncrease flui! inta)e
N#rsi"g Ma"ageme"t
- 'ssess for common si!e effects
- 2ausea an! vomiting
- '!ministration of anti emetics +E minutes before chemo an! continue until 1 !ay after
- =hec) for stomatitis/ ulcerations an! abscess of oral mucosa
- @ral care -alcohol free mouthwash. no toothbrush
- Diet -soft an! blan!. accor!ing to chil!*s preference
- 'lopecia -temporary si!e effects.
- Airsutism
- To parents -always repeat instruction.
HEMOL>TI' DI(ORDER HEMOL>TI' DI(ORDER
a. Rh I")om!ati0iit.
- Mother negative/ fetus positive
- 0
th
baby affecte!
- Mother negative/ no antigen -no protein factor.
- >rythroblastosis fetalis: hemolysis lea!ing to !ecrease o1ygen carrying capacity with pathologic
?aun!ice within $0 hours
- Test1 =omb*s Test
- Va))i"e1 :hogam
- ;iven to :A negative mother within first ($ hours to !estroy fetal :<= therefore preventing
antibo!y formation
0. A,O I")om!ati0iit.
- Mother is type @/ fetus is type '/ </ '<
- Most common is @/ an! '
- ,evere @ an! <
- 4irst pregnancy can be affecte!
Assessme"t
- =ommon is Ay!rops fetalis/ e!ematous on lethal state with pathologic ?aun!ice within $0 hours
Ma"ageme"t
1. &nitiation of fee!ing/ temporary suspension of breast fee!ing to prevent )erni)terus
$. Preg"a"&ioe !elays action of g#)oro". tra"sfera)e -liver enzyme that converts in!irect
bilirubin to !irect bilirubin.
+. Bse of 6hototherapy
0. >1change Transfusion of :h or '<@ affectations that ten! to cause continuous !ecrease in
hemoglobin !uring the first " months because bone marrow fails to pro!uce erythrocytes in
response to continuing hemolysis.
>eow 6 Ba#"&i)e
H.!er0iir#0i"emia
- 2ormal: in!irect bilirubin E + mg8!l
- More than 1$ mg8!l of in!irect bilirubin in fullterm
Cer"i)ter#s
- <ilirubin encephalopathy more than $E mg8!l in!irect bilirubin in fullterm
- 9ess than 1$ mg8!l in preterm because of immature liver
Ph.sioogi)a Ba#"&i)e
- &cterus neonatorum
- 03 ($ hours
- >1pose to sunlight
Pathoogi)a Ba#"&i)e
- &cterus gravis neonatorum
- =linical ?aun!ice within $0 hours
,reastfee&i"g Ba#"&i)e
- 6regnan!iole
- " to ( !ays
Assessme"t
- <lanching the neonates forehea! / nose or sternum
- Hellow s)in an! sclera
- 9ight stool
- Dar) urine
Ma"ageme"t
Photothera!.
- 6hoto o1i!ation
- Aeight of 13 $E inches away from baby
N#rsi"g Res!o"si0iities
1. =over the eyes prevent retinal !amage
$. =over genitals prevent priapism -painful continuous erection.
+. =hange position for even e1posure to light
0. &ncrease flui! inta)e to prevent !ehy!ration
7. Monitor & P @ weigh baby 1 gram:1 cc
". Monitor Fital ,igns
- 'voi! use of lotion or oil because it may result to bronze baby syn!rome
HEAD HEAD
(tr#)t#res
,utures: +
4ontanels: 1$ 13 months close
A"terior fo"ta"e
- =raniostenosis8 craniosinostosis -premature closure of anterior fontanel.
Posterior fo"ta"e
- 1 1 1 cm
- =loses by $ + months
Mi)ro)e!ha.
- ,mall8slow growing brain
- 4etal alcohol an! A&F positive
A"e")e!ha.
- 'bsence of cerebral hemisphere
Noti)ea0e (tr#)t#re of the hea&
/. 'ra"iota0es
- 9ocalize! softening of cranial bones to 1
st
born chil! !ue to early lightening
- :ic)etts in ol!er chil!ren
2. 'a!#t (#))e&a"e#m
- >!ema of scalp !ue to prolonge! pressure at birth
- 'hara)teristi)s
- 6resent at birth
- =rosses the suture line
- Disappear after $ + !ays
2. 'e!hahematoma
- =ollection of bloo! !ue to rupture of periostial capillaries
- 'hara)teristi)s
- 6resent after $0 hours
- 2ever cross the suture line
- Disappear after 0 " wee)s
%. (e0orrhei) Dermatitis
- =ra!le cap
- ,caling/ greasy appearing salmon colore! patches usually seen on scalp/ behin! ears an!
umbilicus
- Primar. )a#se1 improper hygiene
- Ma"ageme"t1 proper hygiene/ apply oil the night before shampooing -use baby oil or coconut
oil.
7. H.&ro)e!ha#s
- =ollection of =,4
2 t.!es
a. =ommunicating e1tra ventricular hy!rocephalus
b. 2on communicating intra ventricular hy!rocephalus also calle! o0str#)tive
(ig"s a"& (.m!toms
- ,ign of increase &=6
- ,ign of frontal bossing -prominent forehea!.
- 6rominent scalp vein
- ,unset eyes
Thera!e#ti) Ma"ageme"t
- 6lace client in low semi fowlers position -+E
o
.
- @smotic !iuretic
- Diamo1 -'cetazolami!e. to !ecrease =,4 pro!uction
- ,eizure precaution
- ,urgery -'F shunt/ F6 shunt.
- ,have ?ust before surgery
- 6lace in si!e lying position on non operate! si!e
- Monitor for goo! !rainage
- ,un)en fontanel is a goo! sign
- Mental retar!ation !epen! on e1tent of hy!rocephalus
(EN(E( (EN(E(
a. (e"se of (ight <E.es=
()era light blue becomes !irty white
P#!is roun! an! a!ult size
a. =oloboma part of iris is missing
b. =ongenital cataract whiteness an! opacity -cause! by german measles.
'or"ea roun! an! a!ult size/ larger in congenital glaucoma
Test of 0i"&"ess
AGE 'OMMON TE(T
1. 2ewborn
$. &nfant an! chil!ren
+. +yr school age
0. ,chool 'ge '!ult
- ;eneral appearance
- ,ee 1E 1$ inches
- DoEs e.e test !one on 1E
th
!ay
- Ga0ears test blin) refle1
- ;eneral appearance
- 'bility to follow ob?ect past mi!line
- 6re school
- E )hart test for stereosis or !epth of perception
- Ae" )ar&s for visual acuity
- Ishiharas !ates for color blin!ness
- 'over testi"g for strabismus/ eye !eviation
- ("ee"Es test
RETINO,LA(TOMA
- Malignant tumor of retina
- :e! painful eye often accompanie! by glaucoma -!athog"omo"i) sig"1 )atEs e.e refe5.
- Ma"ageme"t1 enucleation
0. (e"ses of (me <Nose=
- 4laring or alae nasi -:D,.
- 6ale with creases nasal membrane/ chronic rhinitis
- I"fame&1 i"fe)tio"
- 'o)ai"e a0#se1
- 2o hair
- Blceration with abscess at the nasal mucosa
- 6erforation of nasal septum
- E!ista5is1
- 2ose blee!
- ,it upright with hea! tilte! forwar!
- =ol! compress
- 'pply pressure
- ;ive epinephrine
). (e"se of Heari"g <Ears=
- 4irst to !evelop an! last sense to !isappear
- 6roperly aligne! to outer canthus of eye
/. Ci&"e. Maformatio"
- 9ow set ears
- :enal agenesis
- Bnilateral8bilateral
- @ligohy!ramnios -sign of renal agenesis in utero.
- 4ailure to fa!e $0 hours
- Gi!ney transplant
2. 'hromosoma A0erratio"s
- More than +7 years
A. No"&isH#")tio"
/. Trisom. 2/
- Down syn!rome
- >1tra chromosome $1
- 0( KK Q $1 or 0( KH Q $1
- 'a#se1 a!vance paternal age
- Mongolian slant in eyes
- 9ow set ears
- <roa! flat nose
- 6rotru!ing tongue
- 6uppy*s nec)
- Aypotonic -respiratory problem unable to cough out.
- (imia" )rease <si"ge tra"sverse i"e of !am=
- >!ucable
2. Trisom. /:
2. Trisom. /2
%. T#r"ers
7. Ci"efiters (."&rome
,. Deetio" A0"ormaities
1. =ri-!u-chat ,yn!rome
$. 4ragile K ,yn!rome
'. Tra"so)atio" A0"ormaities
1. <alance Translocation =arrier
$. Bnbalance! Translocation ,yn!rome
D. Others
1. Mosaicism a situation wherein the non!is?unction of chromosomes occurs !uring the mitotic
cell !ivision after fertilization resulting to !ifferent cells contains !ifferent numbers of
chromosomes.
$. &sochromosomes a situation wherein the chromosomes instea! of !ivi!ing vertically it !ivi!es
horizontally resulting to chromosomal mismatch.
OTITI( MEDIA OTITI( MEDIA
- &nflammation of mi!!le ear/ common in chil!ren !ue to wi!er an! shorter eustachian tube
- =ommon with cleft lip an! palate
- <ottle propping/ may also result to !ental caries
- @toscopic: bulging tympanic membrane an! absence of light refle1
- @bserve for passage of mil)y/ purulent an! foul smelling o!or !ischarge
- @bserve for B:T&
Ma"ageme"t
- ,i!e lying on affecte! si!e to facilitate !rainage
- ,upportive care -T,</ antipyretic.
- Massive !osage of antibiotic -may lea! to bacterial meningitis.
- 'pply ear ointment
a. below + years !own an! bac)
b. above + years up an! bac)
- Mucolytics to shrin) mucous
- M.ri"gotom.1 surgical proce!ure !one by ma)ing a slight incision of the tympanic membrane
- 6lace client on the operate! si!e
- To prevent permanent hearing loss
MO@TH AND TONG@E MO@TH AND TONG@E
a. ,es Pas.
- 4acial nerve paralysis
- F&& cranial nerve in?ury
- :elate! to forcep !elivery
(ig"s a"& (.m!toms
- =ontinuous !rooling of saliva
- &nability to open 1 eye an! close other eye
Ma"ageme"t
- 'rtificial tears
- :efer to 6T -self limiting.
0. TE*FTEA
- Tracheo >sophageal 4istula. Tracheo >sophageal 'tresia
- 2o connection between esophagus an! stomach
- % 'Es1 coughing/ cho)ing/ cyanosis/ continuous !rooling
- >mergency surgery
). E!stei" Pears
- hite glistening cyst usually seen on palate or gums relate! to hypercalcemia
&. Nata Tooth
- Tooth at moment of birth relate! to hypervitaminosis -rootless.
e. Neo"ata Tooth
- Tooth within $3 !ays
f. Ora Thr#sh
- @ral moniliasis/ white cheese8cur! li)e patches that coats mouth an! tongue
- Treat with anti fungal -2istatin8Mycostatin.
g. A"o&o"tia
- 2o eruption of temporary teeth
CAWA(ACI DI(EA(E CAWA(ACI DI(EA(E
- =ommon in Iapan
- Mucocutaneous lymph no!e syn!rome
- Dr#g of )hoi)e1 'spirin/ ,alicylates
'riteria for &iag"osis of Cawasa+i Disease
1. 4ever lasting more than 7 !ays
$. <ilateral =on?unctivitis
+. =hange of lips an! oral cavity
a. Dry/ re!/ fissure lips
b. ,trawberry tongue
c. Diffuse erythema of mucous membrane
0. =hanges of peripheral e1tremities
a. >rythema of the palms an! sole
b. &n!urative e!ema of the han!s an! feet
c. Membranous !esquamation from fingertips
7. 6olymorphous rash -primarily on trun).
". 'cute nonpurulent swelling of cervical lymph no!e to R 1.7 cm in !iameter
'LE*T LIP 'LE*T LIP
- 4ailure of the me!ian ma1illary nasal processes to fuse by 7 3 wee)s of pregnancy
- =ommon in boys
- =an be unilateral or bilateral
'LE*T PALATE 'LE*T PALATE
- 4ailure of the palate to fuse by 5 1$ wee)s of pregnancy
- =ommon in girls
(ig"s a"& (.m!toms
a. >vi!ent at birth
b. Bltrasoun!8+ !imensional BTO
c. Mil) escape to the nostril
!. =ommon B:T& -otitis/ cholic.
Thera!e#ti) Ma"ageme"t
- ,urgery
- =left lip: cheiloplasty !one as early as 1 + months to save suc)ing refle1
- =left palate: uranoplasty !one 0 " months to save speech
N#rsi"g Res!o"si0iit.
<Pre O!=
- >motional support
- 6roper nutrition
- Bse :ubber tippe! me!icine !ropper
- 6revention of cholic
a. 4ee! upright position
b. <urp twice
c. 6rone position8on ab!omen
- @rient parents to fee!ing technique
'eft Li!
- Bse rubber tippe! syringe
'eft Paate
- Bse paper cup/ plastic cup/ soup spoon
- Bse elbow restraints -pre op.
- ,o baby can easily a!?ust post op
<Post O!=
- Maintenance of airway
- ,i!e lying -cheiloplasty.
- 6rone -uranoplasty.
- 4acilitate !rainage
- Monitor for !eveloping :D,
- 6roper nutrition
- 26@ 0 hours post op
- =hec) for col!s or nasopharyngitis
- May cause septicemia
- <egin with clear liqui!
- @bserve for signs of hemorrhage -frequent swallowing.
- Bsually happens " ( !ays post op
- 6rotect site of operation
- Maintain integrity of oga" 0ar
a. Aalf strength hy!rogen pero1i!e an! saline
b. 6revent baby from crying
c. 6revent cholic
!. =hec) for wet !iaper
NE'C NE'C
- =hec) for symmetry
a. 'o"ge"ita Torti)ois
- ry nec)
- <irth in?ury of sternoclei!omastoi! muscle !ue to e1cessive traction !uring cephalic !elivery
- Ma"ageme"t1
- 6assive stretching e1ercises !aily
- ,urgery -last.
- =omplication is scoliosis
0. 'o"ge"ita 'reti"ism <)o"ge"ita h.!oth.roi&ism= absence or non-functioning th.roi&
glan!s
(ig"s a"& (.m!toms
1. =hange in suc)ing -early sign.
$. =hange in crying
+. ,leep e1cessively !ue to !ecrease metabolism
0. =onstipation
7. Moon face baby
". Mental retar!ation -late sign.
Diag"osti) E5am
- :a!io active io!ine upta)e
- 6rotein boun! io!ine
- ra!io immuno assay test
Reasons for delayed diagnosis
- Thyroi! glan!s are covere! by sternoclei!omastoi!
- <aby receive maternal thyro1ine
- ,leep 1" $E hours a !ay
Ma"ageme"t
- ,ynthroi! -synthetic thyroi!.
- ,o!ium 9evothyro1ine -given lifetime.
'HE(T 'HE(T
- =hec) for symmetry
- <reast pro!uces wit)h mi+ a transparent flui! relate! to hormone changes
A,DOMEN A,DOMEN
- &nspection/ 'uscultation/ 6alpation/ 6ercussion
A. Dia!hragmati) her"ia
- 6rotrusion of stomach contents through a !efect in the !iaphragm !ue to failure of
pleuroperitoneal canal to close
(ig"s a"& (.m!toms
1. ,un)en ab!omen
$. ,igns of :D,
+. :elate! to shunting
Ma"ageme"t
- =6'6 -continuous positive airway pressure.
- Diaphragmatic repair within $0 hours
,. Om!ao)ee
- 6rotrusion of stomach contents between ?unction of ab!ominal wall an! umbilicus
- ,mall: surgery
- 9arge:
- ,uspension of surgery
- rap with sterile wet !ressing
- 'pply silver sulfa!iazine ointment to prevent infection
GA(TROINTE(TINAL (>(TEM
/. *@N'TION(
a. 'ssists in maintaining flui! an! electrolyte an! aci!8base balance
b. 6rocesses an! absorbs nutrients to maintain metabolism an! support growth an!
!evelopment
c. >1crete waste pro!ucts from the !igestive system
2. RE'OMMENDED DAIL> ALLOWAN'E
a. =alories: 1$E calories per )ilo bo!y weight per !ay -+"E +3E calories.
b. 4lui!s: 1" $E cc per )ilo bo!y weight
c. 6rotein: $.$ grams per )ilo bo!y weight
2. (@PPLEMENTAR> *EEDING 0 " months
Pri")i!es
a. ,oli! foo! is offere! to the following sequence
- =ereals: rich in iron -because at " months iron is completely catabolize!.
- 4ruits
- Fegetables
- Meat
b. <egin with small quantities
c. 4inger foo! is !eferre! by " months
!. ,oft table foo!8mo!ifie! family menu by 1 year
e. Dilute fruit ?uices -" months.
- Ratio1 1 oz. fruit to 0 oz. water
- 2ever give half coo)e! egg/ may cause gastroenteritis8salmoneliosis !iarrhea
- 'voi! giving honey cause infant botulism
- @ffer new foo! 1 at a time with interval of 0 ( !ays to !etermine foo! allergies
%. MABOR 'ON'EPT( O* *L@ID AND ELE'TROL>TE ,ALAN'E
Distribution of bo!y flui!
- Total bo!y flui!s comprises of "7 37J bo!y weight among infants an! chil!ren
- 4lui!s are greater >=4 compartment among infants an! chil!ren -prone to !ehy!ration.
7. A'ID-,A(E ,ALAN'E
Depen!ent on the following
a. =hemical buffers
b. :enal an! respiratory system involvement
c. Dilution of strong aci!s an! bases on bloo!
Im0aa")e of a)i&
a. Res!irator. a)i&osis
- =arbonic aci! e1cess
- Aypoventilation
- 'sthma
- 6neumonia
- >mphysema
- 9aryngo tracheo bronchitis
- :D,
0. Res!irator. a+aosis
- =arbonic aci! !eficit
- Ayperventilation
- 4ever
- >ncephalitis
). Meta0oi) a)i&osis
- =arbonate !eficit
- Diarrhea
- ,evere malnutrition
- Dehy!ration
- =eliac crisis
&. Meta0oi) a+aosis
- =arbonate e1cess
- Bncontrolle! vomiting
- ;astric lavage
- 2;T aspiration
- 6yloric stenosis
8. 'ONDITION( THAT PROD@'E *L@ID( AND ELE'TROL>TE( IM,ALAN'E
A. Vomiti"g
- 4orceful e1pulsion of stomach contents
(ig"s a"& (.m!toms
a. 2ausea
b. Dizziness
c. 'b!ominal cramping
!. 4lushing of face
e. Teary eyes
Assessme"t
- 'mount
- 4requency
- 4orce -pro?ectile:&=/ pyloric stenosis.
Ma"ageme"t
,anana
Rice/ cereal
Apple sauce
Toast
,. Diarrhea
- >1aggerate! e1cretion of intestinal content
1. A)#te &iarrhea are asso)iate& with the foowi"g
a. ;astroenteritis/ cause! by salmoneliosis -half coo)e! egg.
b. 'ntibiotic use
c. Dietary in!escretions
$. 'N(D <'hro"i) No" (!e)ifi) Diarrhea=
a. 4oo! intolerance
b. =arbohy!rates an! 6rotein malabsorption
c. >1cessive flui! inta)e
Assessme"t
- 4requency
- =onsistency
- 'ppearance of green color stool
'om!i)atio"s
Deh.&ratio"
1. Mil! 7J weight loss
$. Mo!erate 1EJ weight loss
+. ,evere 17J weight loss
(ig"s of &eh.&ratio"
1. Tachycar!ia
$. Tachypnea
+. Aypotension
0. &ncrease temperature
7. ,un)en fontanel an! eyeballs
". 6oor s)in turgor8!ry s)in an! mucous membrane
(. 'bsence of tears
3. ,canty urine -mar) oliguria sign of severe !ehy!ration.
5. eight loss
1E. 6rolonge! capillary refill time
Ma"ageme"t
1. 'cute 26@ to rest bowel/ &F infusion
$. 6otassium =hlori!e chec) if baby can voi! because it can lea! to hyper)alemia lea!ing to
car!iac arrest
+. ,o!ium <icarbonate metabolic aci!osis/ a!ministere! slowly to prevent car!iac arrest
9. GA(TRI' MOTILIT> DI(ORDER
HIR('HPR@NG( DI(EA(E
- =ongenital gagnlionic mega colon
- 'bsence of gagliion cells for peristalsis
Assessme"t
1. Neo"ata Perio&
- 4ailure to pass meconium after $0 hours
$. Ear. 'hi&hoo&
a. :ibbon li)e stool
b. =onstipation
c. Diarrhea
!. 4oul smelling stool
(ig"s a"& (.m!toms
- 4oul o!or breath with stool
- Fomitus of fecal materials
Ma"ageme"t
- 2;T fee!ing
- ,urgery
a. Temporary colostomy -at $ -+ months.
b. 'nastomosis an! pull through proce!ure
- Diet1 high calorie an! low resi!ue -spaghetti an! chic)en.
Diag"osti) Pro)e&#res
1. <arium >nema reveals the narrowe! portion of the bowel
$. :ectal <iopsy
+. 'b!ominal 1-ray reveals !ilate! loops on intestine
0. :ectal manometry reveals failure of intestinal sphincter to rela1
Therapeutic Management an! 2ursing =are
GA(TROE(OHAGEAL RE*L@? <GER=
- 'haasia presence of stomach contents in esophagus
Assessme"t *i"&i"gs
a. =hronic vomiting
b. 4ailure to thrive syn!rome -organic.
c. >sophageal blee!ing manifeste! by
Effe)ts a"& )om!i)atio"
- >sophagitis
- 'spiration
- =arcinoma
Diag"osti) !ro)e&#res
1. <arium >sophogram
$. >sophageal Manometry reveals lower esophageal sphincter pressure
+. &ntraesophageal pA content reveals pA of !istal esophagus
Me&i)atio"s
1. =holinergics
a. ,eta"i)oe <@re)hoi"e= - to increase esophageal tone an! peristaltic activity
b. Meto)ho!romi&e <Rega"= to !ecrease esophageal pressure by rela1ing pyloric
an! !uo!enal segments increasing peristalsis without stimulating secretion
c. Histami"e re)e!tor a"tago"ist <Ra"iti&i"eFGa"ta)= to !ecrease gastric aci!ity an!
pepsin secretion
!. A"ta)i& <Maao5= to neutralize gastric aci! between fee!ings
Ma"ageme"t
1. '!ministration of thic)ene! fee!ing with cereal to prevent vomiting
$. 4ee! slowly
+. <urp often every 1 oz.
0. Positio"1 below 5 months place in prone with hea! of mattress slightly elevate! on a +E
@
angle
7. (#rger.1 fun!oplication
:. O,(TR@'TIVE DI(ORDER(
P>LORI' (TENO(I(
- Aypertrophy of pylorus muscle causing narrowing an! obstruction
Assessme"t
/. ProHe)tie vomiti"g
N#rsi"g Aerts1
- Fomiting is an initial symptom of upper ;& obstruction
- Fomitus of upper ;& can be bloo! tinge! not bile strea)e!
- Fomitus of lower ;& is bilous
- 6ro?ectile vomiting is either a sign of &=6 or ;& obstruction
- 'b!ominal !istention is the ma?or symptom of lower ;&T obstruction
2. *ai#re to gai" weight
2. Pa!ate oive sha!e mass
%. Peristati) wave visi0e from eft to right a)ross e!igastri#m
Diag"osti) Pro)e&#res
1. '<; metabolic al)alosis
$. ,erum electrolyte: increase 2a an! G/ !ecrease chlori!e
+. Bltrasoun!
0. K-ray of upper ab!omen with barium swallow reveals string sign
Thera!e#ti) Ma"ageme"t
- (#rger.1 pyloromyotomy
INT@((@('EPTION
- Telescoping of one portion of the bowel to another
- =omplication of peritonitis
(ig"s a"& (.m!toms
- 'cute paro1ysmal ab!ominal pain
- Fomiting
- =urant ?elly stool
- ,ausage shape mass
Diag"osti) test
- K-ray with barium enema reveal staircase sign
Ma"ageme"t
- Aypostatic re!uction with barium enema
;. IN,ORN ERROR( O* META,OLI(M
- Deficient liver enzyme
PHEN>LCETON@RIA
- Deficiency of liver 6AT -6henylalanine Ay!roylase Transferase.
- 2o tyrosine/ melanin/ tyro1ine basal metabolism
(ig"s a"& (.m!toms
- 4air s)in
- <lon!e hair
- <lue eyes
- 'ccumulation of phenyl pyrobic aci! in the bloo!
- Musty or mousy o!or urine
- 'topic !ermatitis
- ,eizure
- Mental retar!ation
Diag"osti) Tests
a. G#thrie test
Ma"ageme"t
- 9ow phenylalanine in!efinitely
- 2o foo! rich in protein -chic)en/ eggs/ meat/ legumes/ peanut.
- Lofe"aa)
'ELIA' DI(EA(E
- ;luten >nteropathy
- &ntolerance to foo!s containing barley/ rye/ oats/ wheat -normally converte! to gluten.
- ith celiac !isease gluten is converte! to gia&i" -to1ic to the epithelial cells of villi lea!ing to
malabsorption of:
- 4ats -steatorrhea./ 6rotein an! =arbohy!rates -malnutrition./ =alcium -osteomalacia./ Fitamin G
-blee!ing./ Fitamin <1$ -anemia.
Assessme"t
1. Ear. sig"s
a. DiarrheaN failure to regain weight ff !iarrheal episo!es
b. =onstipation
c. Fomiting
!. 'b!ominal 6ain
e. ,teatorrhea
$. Late sig"s
a. <ehavioral changes: irritability an! apathy
b. Muscle wasting an! loss of subconscious fats -protuberant ab!omen.
+. 'eia) 'risis
a. >1aggerate! form of vomiting -emergency con!ition.
Diag"osti) Pro)e&#res
1. 9aboratory ,tu!ies: ,tool 'nalysis
$. ,erum antiglia!in an! antireticulin antibo!ies presence in!icates !isor!er
+. ,weat test to rule out cystic fibrosis
Thera!e#ti) Ma"ageme"t
1. Fitamin supplements
$. Mineral supplements
+. ,teroi!s
//. POI(ONING
- =ommon among to!!lers
Pri")i!es
1. Determine the substance ta)en/ assess 9@=
$. Bnless the poison was corrosive/ caustic -strong al)ali such as 9H>. or a hy!rocarbon/
vomiting is the most effective way to remove the poison from the bo!y
+. (.r#! of i!e)a) oral emetic to cause vomiting after !rug over !ose or poisoning
a. 17 ml to a!olescent/ school age an! pre school
b. 1E ml to infant
0. @"iversa a"ti&ote charcoal/ mil) of magnesia/ an! burne! toast
7. 2ever a!minister the )har)oa before i!e)a)
". 'nti!ote for 'cetaminophen poisoning. 'cetylsysteine -Mucomyst.
(. 4or caustic poison
a. 6repare tracheostomy set
b. Gerosine -use mineral oil to coat the intestine to prevent absorption.
c. ;ive vinegar to neutralize aci! -for muriatic aci! ingestion.
LEAD POI(ONING
- Destroy :<= functioning
- :esulting to hypochromic mycrocytic anemia
- 9ea!ing to )i!ney !estruction
- That lea!s to accumulation of amonia
- Then encephalitis
Assessme"t
a. <eginning symptoms of lethargy
b. &mpulsive an!
c. 's lea! increases/ severe encephalophaty with seizures an! permanent mental retar!ation
Diag"osti) Pro)e&#re
a. <loo! ,mear
b. 'b!ominal K-ray
c. 9ong bones
Ma"ageme"t
- :emove from source
- &f higher than $E mg8!l last management is )heati"g age"t -balance !immer parol/ ='>DT'.
less si!e effects
- <in!s with lea! an! e1crete! slowly via )i!ney
- (i&e Effe)ts1 nephroto1icity
ANOGENITAL ANOGENITAL
Aerts
*emae
- 6seu!o menstruation
- ,light blee!ing related to hormonal changes
- Ra!e
- Tearing of forchet
- =oncerne! with chil!*s care
- oun! follow !ifferent stages of healing
- &!entical woun!
- :eport to authorities within 03 hours -barangay captain/ bantay bata.
- ,hape of pubic hair is inverte! triangle
Mae
- =hec) testes -un!escen!e!.
- =ryptorchi!ism common in preterms an! management is or)hi&o!e5.
- arm room an! han!
- =hec) for arch of urine
- H.&ro)ee1 flui! fille! scrotum -translumination reveal a glowing sign.
- Phimosis1 tight fores)in -balanitis infection of glans penis.
- Vari)o)ee1 veins in scrotum is increase!
EPI(PADIA( meatus is locate! !orsal -above glans penis.
H>PO(PADIA( meatus is locate! ventral -below glans penis.
'HORDEE fibrous ban! causing penis to curve !ownwar!
Re"a Disor&er 'a#ses Assessme"t *i"&i"gs Treatme"t N#rsi"g 'are
1. 2ephrotic
,yn!rome
$. ';2
- &nfectious
- 'utoimmune
;rp. ' beta
hemolytic
streptococcus
- 'nasarca -general
bo!y e!ema.
- Massive proteinuria
- 2o hematuria
- ,erum lipi! increase
- 4atigue
- 2ormal or low <6
- 6rimary peripheral
periorbital e!ema
- Mo!erate proteinuria
- ;ross hematuria
-smo)y urine.
- ,erum potassium
increase!
- 4atigue
- &ncrease <6
- ,teroi!
-6re!nisone.
- Diuretics -9asi1.
- 'nti hypertensive
hy!ralasine
-appresoline.
- Aypertensive
encephalopathy
-complication
anemia.
- &ron infusion
- Monitor hy!ration
status -weight
every!ay with
same clothing.
- Decrease so!ium/
normal protein
- &ncrease
potassium inta)e
-beef broth.
- Monitor weight
- Monitor <6
- 2eurologic status
- &ncrease iron
- Decrease
potassium
- Decrease so!ium
,A'C ,A'C
- =hec) for symmetry an! flatness
(!i"a 0ifi&a O))#ta
- 4ailure of posterior laminae of vertebrae to fuse
- (ig"s a"& (.m!toms1 !impling at lower bac)
- 'bnormal tuffs of hair
(!i"a 0ifi&a '.sti)a
- ith sac
T.!es
/. Me"i"go)ee protrusion of =,4 an! meninges
2. M.eome"i"go)ee protrusion of =,4/ meninges an! spinal cor!
2. E")e!hao)ee cranial meningocele or myelomeningocele
'ommo" 'om!i)atio"
- =ommon problem is rupture of sac -place wet sterile !ressing an! place in prone position.
- &nfection
- Brinary an! fecal incontinence
- 6aralysis of lower e1tremities
- Ay!rocephalus -=2, complication.
- 'lways chec) for a wet !iaper
Treatme"t
- ,urgery to prevent infection
('OLIO(I(
- 9ateral curvature of spine common in school age an! a!olescent
- Bneven hemline
- , shape bac)
- hen ben!ing 1 hip is higher an! 1 shoul!er prominent
Ma"ageme"t
1. 'o"servative
a. >1ercise
b. 'voi! obesity
$. Preve"tive
a. Milwau)ee brace worn $+ hours a !ay
+. 'orre)tive
a. ,urgery insertion of Aarrington ro! -post op !o log rolling or move as 1 unit.
E?TREMITIE( E?TREMITIE(
I. Digits
a. (."&a)t.. webbing of !igits -ginger li)e foot. congenital
b. Po.&a)t.. e1tra !igit
c. Oi&a)t.. lac)ing !igit
Ameia total absence of e1tremities
Po)omeia absence of !istal part of e1tremities
,oth are )a#se& 0. THALIDOMIDE
II. Er0-&#)he""es !ara.sisF,ra)hia Pe5#s i"H#r.F,ra)hia !as.
- <irth in?ury !ue to lateral an! e1cessive traction !uring a breech !elivery
(ig"s a"& (.m!toms
- &nability to ab!uct arm from shoul!er/ rotate arm e1ternally an! supinate forearm
- 'bsence8asymmetrical moro refle1
Ma"ageme"t
- 'b!uct from shoul!er with elbow fle1e!
III. 'o"ge"ita Hi! Diso)atio"
- The hea! of femur is outsi!e acetabulum
T.!es
/. (#0#5ate& most common type
2. Diso)ate&
(ig"s a"& (.m!toms
1. ,hortening of the affecte! leg
$. As.mmetri)a g#tea fo&
+. Limite& moveme"t <ear. sig"=
0. <I= Ortoa"iEs sig" clic)ing soun! !uring ab!uction
7. hen able to wal) the chil! limps <ate sig"=
Ma"ageme"t
1. Triple the !iaper
$. =arry a stri!e
+. 4re?)a ,plint
0. 6avli) Aarness
7. Aip ,pica =ast
IV. Tai!es
- =lub foot
T.!es
a. E3#i"os plantar fle1ion -horse foot.
b. 'a)a"eo#s or Dorsifle1ion the heel is hel! lower than the foot8the anterior portion of foot is
fle1e! towar!s the anterior leg
c. Var#s foot turns in
!. Vag#s foot turns out
=ommon combination is TALIPE( E4@INO VAR@( an! TALIPE( 'AL'ANEO
VALG@(
Assessme"t
- Ma)e a habit of straightening legs an! fle1ing to improve to mi!line position
Ma"ageme"t
- =orrective shoes -De""is 0row" (PLINT=
- ,pica cast
'A(T 'A(T
P#r!ose1
- Maintain bone alignment
- 6revent muscle spasm
- &mmobilization
- Bse open palm
- ,upport with soft pillow an! !ry naturally
N#rsi"g 'are to Patie"t with 'ast
- =irculation/ motion/ sensation -neurovascular chec).
(ig"s of 'ir)#ator. Im!airme"t
,lueness or col!ness
Lac) of peripheral pulse
E!ema not correcte! with elevation
Pain on the caste! e1tremity
Tingling sensation -notify !octor because it is a sign of neurological impairment.
- Petai"g1 ma)ing the rough surface of cast smooth
- Mar) cast with ballpen if there is blee!ing
'R@T'HE( 'R@T'HE(
- To maintain balance/ support wea)ene! leg
- 6lace bo!y on palm
- Do palm e1ercises -squeeze ball.
Differe"t 'r#t)h Gaits
1. (wi"g Thro#gh
Pro)e&#re1
1. '!vance both crutches
$. 9ift both feet8swing forwar!8lan! feet in front of crutches
+. '!vance both crutches
0. 9ift both feet8swing forwar!8lan! feet in front of crutches
$. (wi"g To
Pro)e&#re1
1. '!vance both crutches
$. 9ift both feet8 swing forwar!8lan! feet ne1t to crutches
+. '!vance both crutches
0. 9ift both feet8 swing forwar!8lan! feet ne1t to crutches
- / a"& 2 is i"&i)ate& if weight 0eari"g is "ot aowe& i" 0oth ower e5tremities
+. Three Poi"t Gait
- &n!icate! if weight bearing is not allowe! on lower e1tremities
Pro)e&#re1
1. '!vance left foot an! both crutches
$. '!vance right foot
+. '!vance left foot an! both crutches
0. '!vance right foot
0. *o#r Poi"t Gai
Pro)e&#re
1. '!vance right crutch
$. '!vance left foot
+. '!vance left crutch
0. '!vance right foot
7. Two Poi"t Gai
Pro)e&#re
1. '!vance left foot an! right crutch
$. '!vance right foot an! left crutch
+. '!vance left foot an! right crutch
0. '!vance right foot an! left crutch
- % a"& 7 is i"&i)ate& if weight 0eari"g is "ot aowe& o" 0oth ower e5tremities
Other 'r#t)h-Ma"e#veri"g Te)h"i3#es
To (it Dow"
1. ;rasp the crutches at the han! pieces for control
$. <en! forwar! slightly while assuming a sitting position
+. 6lace the affecte! leg forwar! to prevent weight-bearing an! fle1ion
To (ta"& @!
1. Move forwar! to the e!ge of the chair with the strong leg slightly un!er the sit
$. 6lace both crutches in the han! on the si!e of the affecte! e1tremity
+. 6ush !own on the han! piece while raising the bo!y to a stan!ing position
To Go Dow" (tairs
1. al) forwar! as far as possible on the step
$. '!vance the crutches to the lower step. The wea)er leg is a!vance! first an! then the stronger
one. &n this way the stronger e1tremity shares the wor) of raising an! lowering the bo!y weight
with the patient*s arms.
To Go @! (tairs
1. '!vance the stronger leg first up to the ne1t step
$. Then a!vance the crutches an! the wea)er e1tremity -,trong leg goes up first an! comes
!own last.. ' memory !evice for the patients is Cup with the goo!/ !own with the ba!.D
WALCER WALCER
- ' wal)er provi!es more support than a cane or crutches
The !atie"t is ta#ght to am0#ate with the wa+er as foows1
1. 6atient must hol! the wal)er on the han! grips for stability
$. 9ift the wal)er/ placing it in front of you while leaning your bo!y slightly forwar!
+. al) into the wal)er/ support your bo!y weight on your han!s when a!vancing your wea)er
leg permitting partial weight-bearing or non-weight-bearing leg as prescribe!
0. <alance yourself on your feet
7. 9ift the wal)er an! place it in front of you again. =ontinue this pattern of wal)ing
'ANE 'ANE
- ' cane is use! to help the patient wal) with greater balance an! support an! to relieve
pressure on weight-bearing ?oints by re!istributing the weight. #ua! canes -four-foote! canes..
The cane is hel! in the han! opposite to the affecte! e1tremity
Metho&s of tra"sferri"g the !atie"t from the 0e& to a whee)hair
a. eight-bearing transfer from be! to chair. The patient stan!s up/ pivots his bac) is
opposite to the new seat/ an! sits !own
b. -9eft. 2on-weight-bearing transfer from be! to chair. -:ight. ith legs brace!
c. -9eft. 2on-weight-bearing transfer/ combine! metho!. -:ight. 2on-weight-bearing
transfer/ pull-up metho!
Thera!e#ti) E5er)ises
E5er)ise Des)ri!tio" P#r!ose A)tio"
Passive
A)tive assista")e
A)tive
Resistive
Isometri) or m#s)e
setti"g
'n e1ercise carrie! out
by the therapist or the
nurse without assistance
from the patient
'n e1ercise carrie! out
by the patient with the
assistance of the
therapist or the nurse
'n e1ercise
accomplishe! by the
patient without
assistance/ activities
inclu!e turning from si!e
to si!e an! from bac) to
ab!omen an! moving up
an! !own in be!.
'n active e1ercise
carrie! out by the patient
wor)ing against
resistance pro!uce! by
either manual or
mechanical means.
'lternately contracting
an! rela1ing a muscle
while )eeping the part in
a fi1e! positionN this
e1ercise is performe! by
the patient
To retain as much ?oint
range of motion as
possible to maintain
circulation
To encourage normal
muscle function
To increase muscle
strength.
To provi!e resistance to
increase muscle power.
To maintain strength
when a ?oint is
immobilize!
,tabilize the pro1imal
?oint an! support the
!istal part. Move the ?oint
smoothly/ slowly/ an!
gently through its full
range of motion. 'voi!
pro!ucing pain.
,upport the !istal part/
an! encourage the
patient to ta)e the ?oint
actively through its range
of motion. ;ive no more
assistance than is
necessary to accomplish
the action. ,hort perio!s
of activity shoul! be
followe! by a!equate
rest perio!s.
hen possible/ active
e1ercise shoul! be
performe! against
gravity. The ?oint is
move! through full range
of motion without
assistance. -Ma)e sure
that the patient !oes not
substitute another ?oint
movement for the one
inten!e!..
The patient moves the
?oint through its range of
motion while the
therapist resists slightly
at first an! then with
progressively increasing
resistance. ,an!bags
an! weights can be use!
an! are applie! at the
!istal point of the
involve! ?oint the
movement shoul! be
performe! smoothly.
=ontract or tighten the
muscle as much as
possible without moving
the ?oint/ hol! for several
secon!s/ then let go an!
rela1. <reathe !eeply.
TRA'TION TRA'TION
- Bse to re!uce !islocation an! immobilize fractures
Pri")i!es of Tra)tio"
1. The client shoul! be in !orsal or supine position
$. 4or every traction there is always a counter traction
+. 9ine of pull shoul! be in line with !eformity
0. 4or traction to be effective it must continuous
T.!es
(traight Tra)tio"
- eight of bo!y serves as counter pull
(+i" Tra)tio"
- 'pplie! !irectly to s)in
a. ,r.a"tEs tra)tio"
- Bse to immobilize ages below + years ol!
- 5E
@
angle with butto)s off be!
b. ,#)+Es e5te"sio"
- &mmobilize fracture ages more than + years ol!
c. (+eeta
- 'pplie! !irectly to bone
!. Hao tra)tio"
- &mmobilize spine
(+eeta Tra)tio"
2ursing responsibility
1. 'ssess for circulatory an! neurologic impairment
$. &t can lea! to hypertension
+. <e careful in carrying out nursing functions by not moving the weights
A@TOIMM@NE (>(TEM A@TOIMM@NE (>(TEM
T.!es of imm#"it.
a. 6assive 2atural maternal antibo!ies through placenta or breast mil)
b. 'ctive 2atural contract !isease an! pro!uce memory cells
c. 6assive 'rtificial receive anti serum with anti bo!ies from another host -Aepa <.
!. 'ctive 'rtificial receive vaccination an! pro!uce memory cell
Imm#"it. from mother <ast for ; 6 /2 mo"ths=
- Diptheria
- 6olio
- 6ertusis
- Tetanus
- Measles
NE@ROM@('@LAR (>(TEM1 NE@ROM@('@LAR (>(TEM1
Refe5es
a. ,i"+ refe5 6 rapi! eyeli! closure when strong light is shown
b. Pamar gras! refe5 soli! ob?ect is place! on palm an! baby grasp ob?ect
- P#r!ose1 cling to mother for safety -!isappear by " wee)s $ months.
c. (te! i"FWa+-i" Pa)e Refe5 6 neonate place! on a vertical position with their face
touching a har! surface will ta)e few quic)/ alternating steps.
- Pa)i"g Refe5: almost the same with step in place refle1 only that you are touching
anterior surface of a newborn*s leg.
!. Pa"tar gras! refe5 when an ob?ect touches the sole of a newborn*s foot at the
base of toes/ the toes grasp in the same manner as fingers !o - &isa!!ear 0. : 6 ;
mo"ths i" !re!aratio" for wa+i"g.
e. To"i)-"e)+-refe5 when newborns lie on their bac)s/ their hea!s usually turn to one
si!e or the other. The arm an! the leg on the si!e to which the hea! turns e1ten!/ an!
the opposite arm an! leg contract.
f. Moro refe5 test for neurological integrity -?arring crib/ lou! voice. assume a letter =
position -&isa!!ear 0. % 6 7 mo"ths=
g. Mag"et refe5 when there is pressure at the sole of the foot he pushes bac) against
the pressure.
h. 'rosse& e5te"sio" refe5 when the sole of foot is stimulate! by a sharp ob?ect/ it
causes the foot to rise an! the other foot e1ten! -test for s!i"a )or& i"tegrit..
i. Tr#)+ I")#rvatio" refe5 while in prone position an! the paravertical area is
stimulate!/ it causes fle1ion of the trun) an! swing his pelvis towar! the touch.
?. La"&a# refe5 6 while prone position an! the trun) is being supporte!/ the baby e1hibit
some muscle tone -test for m#s)e to"e a"& !rese"t 0. 8 6 ; mo"ths.
). Para)h#te rea)tio" while on ventral suspension with the su!!en change of
equilibrium/ it causes e1tension of the han!s an! legs -!rese"t 0. 8 6 ; mo"ths=
l. ,a0i"s+i refe5 when the sole of foot is stimulate! by an inverte! CID/ it causes
fanning of toes -&isa!!ear 0. 2 mo"ths 0#t ma. !ersist #! to 2 .ears.