Finals Exam Ncm209

Care of Mother, Child at Risk or 04 L E C
08
with Problems (Acute & Chronic)
NCM 209 – Florence Puno
ORIENTATION AND INTRODUCTION
22 O1
OUTLINE
I Orientation
GRADING SYSTEM
A REFERENCES
II INTRODUCTION QUIZZES –Set A and Set B
III PROBLEMS RELATED TO MATURITY Missed quiz – inform CI
IV PRETERM NEWBORN
 Start at the time the CI said so, as well as end
V BALLAD SCORING
at the allotted time.
VI COMMON OR SPECIAL PROBLEM OF
 Late passers - deduction of points
PRETERM NEONATES
 Very particular with the time – time
A RDS management to answer the questions.
B HYPERBILIRUBINEMIA
C INFECTION CONNECTIVITY PROBLEMS – Within 3 hours in and out
D COLD STRESS sa zoom, send letter to the CI
E ANEMIA
VII POST TERM NEWBORN CONNECTIVITY PROBLEMS – no attendance within 3
VIII COMPLICATION OF POST MATURITY hours, send to the nursing coordinator.
A SGA  Attached ID, signature of parents and proof.
B IUGR
ATTENDANCE - may be done on quipper.
Concerns: inform the CI; just message the CI
responsible
ORIENTATION
 COURSE CODE and TITLE INTRODUCTION

 NCM 209: CARE OF MOTHER, CHILD AT RISK
Care of mother, child at risk or with or problems
OR WITH PROBLEMS (ACUTE AND CHRONIC)
(acute and chronic)
 COURSE DESCRIPTION:
 This course deals with concepts, PROBLEMS RELATED TO MATURITY
principles, theories and techniques in the  If there is complication, we need to have our
nursing care of at risk/high risk/sick clients quick decision making with regards to our nursing
during the child-bearing and the actions, what we can do, and what will be our
childbearing years toward health nursing care. There might be complications that
promotion, disease prevention, threaten the newborn babies that is why nursing
restoration and maintenance, and management is needed.
rehabilitation. The learners are expected
to provide safe, appropriate, and holistic
care to clients utilizing the nursing process
 REFERENCES:
BSN-2B TRANSCRIBED BY: GROUP # 1

Determine the weight
 The important marker of health is the birth
 Included in high risk- the complications that
weight
threatened human being

 Focus- the mother, child, high-risk pregnancy,
*Prematurity- the cause is unknown
and fetus. (In prenatal stage we could already
determine the problem inside.)
Maternal factors:
 The government has a program with regards
 Age of mother (if it is too young or too old)
to the mother and child.
 Mother is into smoking
Objective of the concept  Poor nutrition
 Described the high-risk newborn related to  Placental problem
maturity and gestational age  Preeclampsia (toxemia is common)
 Utilize assessment parameters to determine 
the health needs of the high-risk *If high-risk then complete bed rest
Assessment for:
o Newborn Fetal factors:
o Infant  Multiple pregnancy
o Toddler  Poor social economic status
 Distinguish appropriate nursing action with  Environmental exposure to harmful
different diagnostic exam for each high-risk substances
newborn 
 Formulate comprehensive plan management Placenta abruptio- placenta peels away from the
for each high-risk newborn. (NCP is universal) inner wall of the uterus before delivery so the baby
deprived of the oxygen and nutrients that will lead to
bleeding.
PRETERM NEWBORN Placenta previa- placenta is partially or totally cover
- Description- a neonate born before 37 weeks the cervix so there were sever vaginal bleeding
of gestation especially during pregnancy or delivery.
- Primary concern relates to immaturity of all
ASSESSMENT
body systems
- According to the experiences of the nurse and  Check the aspiration (preterm is irregular)
doctors:  Check body temperature
 6 and 8 months- still at high-risk o Usually below normal (Point kilo
 7 months- more strong turmeric- take on the temperature of
 9 months- organs are not fully developed the environment)
o Skin is thin with visible blood vessels,
minimal subcutaneous fat pads
 Check reflexes
o Suck poorly or swallowing reflexes
 Vowel sounds are diminished
 Assess extremities:
o Minimal creasing on the soles and
palms
o Extension of extremities does not
maintain flexion
o Abandons of lanugo
o Labia are narrow on girls
o Testes are undescended on boys
o Less muscle tone
BALLAD SCORING
Ballard scoring - technique of gestational age
assessment

Scarf Sign - this looks at how far the baby’s elbow can placenta, the amount and type of antibodies depends
move across the chest. (kung may resistant ba si baby on the mother's immunity and kung si mother hindi
or wala) naka receive ng mga vaccine and walang prenatal
Square window - trying to access the flexibility of the check up then it will affect the fetus.)
wrist of the baby.
Placenta abruptio - the placenta is away from the COLD STRESS
inner wall of the uterus, so there is no more oxygen or  Less subcutaneous tissue, poikilothermic
nutrients going to the fetus.
Placenta previa - can also lead to severe bleeding ANEMIA
(kumbaga ang placenta covers the cervix)  Less iron stores
 Assessment (of preterm) MANAGEMENT (PRETERM)

 Respirations are irregular with periods of
apnea  Improving respiratory function
 Body temperature is below normal  Oxygen therapy
 Skin is thin, with visible blood vessels and  Mechanical ventilator
minimal subcutaneous fat pads, may appear  Maintaining body temperature
jaundiced Isolette - maintains ideal temperature,
Poikilothermic - easily take on the temperature of the humidity and oxygen concentration isolates infant
environment from infection
 Poor sucking and swallowing reflexes (Unang yakap - skin to skin contact)
 Bowel sounds are diminished Kangaroo Care
 Extremities are thin, with minimal creasing on  Preventing infection
soles and palms.  Handwashing
 Extension of extremities and does not  Promoting nutrition
maintain flexion  Gavage feeding
 Abundance of lanugo hair  Milk feeding
 Labia are narrow in girls  Promoting sensory stimulation
 Testes are undescended in boys  Gentle touch, speaking gently and softly,
music box or low tuned radio
COMMON OR SPECIAL PROBLEM OF PRETERM
NEONATES Nursing Interventions
1. Monitor vitals signs every 2 to 4 hours
RESPIRATORY DISTRESS SYNDROME 2. Administer oxygen and humidification as
prescribed.
 Hyaline membrane disease 3. Monitor intake and output
 Due to lung immaturity 4. Monitor daily weight
 Deficient in surfactant 5. Maintain newborn in a warming device
 (The alveoli collapse, nada damage ang 6. Reposition every 1 to 2 hours, and handle
airway kaya mahirapan makahinga si baby)\ newborn carefully
7. Avoid exposure to infections
HYPERBILIRUBINEMIA 8. Provide newborn with appropriate
stimulation, such as touch
 High level of bilirubin in the blood, neonates 9. Suctioning of secretions as needed (as much
become jaundice. as possible do not suction, as needed lang lalo
 Due to immaturity of the liver na pag lead to respiratory problems)
 There is buildup of too much bilirubin in the 10. Monitor for signs of infection
blood kaya nagye yellow si baby. 11. Provide skin care
 Can travel through the brain (which is rare 12. Provide complete explanations for parents
pero once meron nagkakaroon ng seizure)
Kernicterus stains brain cells with bilirubin, causing POST-TERM NEWBORN
irreversible brain damage.
 Neonate born after 42 weeks of gestation
INFECTION  About 12% of all infants are post-term
 Not able to receive IgG globulins  Causes of delayed birth is unknown
(During the last 3months of pregnancy, antibodies  First pregnancies between the ages 15 to 19
from the mother are passed to the baby to the years and woman older than 35 years

 Multiparity grunting sound while breathing, check skin color)
 Fetal anomalies such as anencephaly
Assessment
 Depleted subcutaneous fat: old lookind “old
man facies”
 Parchment-like skin (dry, wrinkled and
cracked) without lanugo
 Fingernails long and extended over ends of
fingers
 Abundant scalp hair
 Long and thin body
 Sign of meconium staining nails and umbilical
cord (yellow to green)
COMPLICATIONS
Complications OF POST MATURITY
of Post Maturity PROBLEMS RELATED TO GESTATIONAL WEIGHT
 The placenta begins to age toward the end of
pregnancy, and may not function as efficiently - pag deliver ng baby, we are going to weigh the baby
as before.
 The failing placental function will place infants Small for Gestational
SMALL FORAgeGESTATIONAL AGE
at risk for intrauterine hypoxia during labor
and delivery. (Intrauterine hypoxia occurs o the fetus or the newborn is smaller than
when the fetus is deprived of adequate supply normal
of oxygen, maybe because of umbilical cord o SGA babies are those whose birth weight lies
collapse or placental infarction or maternal below the 10th percentile for that gestational
factors) age
o SGA babies may be:
Meconium Aspiration Syndrome (Occurs when there Premature (born before 37 weeks of
is a breathing problem on the newborn) gestation)
Hypoglycemia Full term (37 – 41 weeks)
 From nutritional deprivation and poor storage Post term (after 42 weeks of pregnancy)
of glycogen at birth
o what is important is the gestational age of the
Polycythemia
baby that starts on the first day of the
 Increase circulating rbc (hemoglobin is
mother’s last menstrual period
responsible, it will cause blood viscosity)
INTRAUTERINE
Intrauterine GROWTH (IUGR)
Growth Restriction RESTRICTION
MANAGEMENT
 Ultrasound is done to evaluate fetal o most common underlying condition leading to
movement, amount of amniotic fluids and the SGA newborn
placenta signs of aging o this condition appears physically,
 To reduce the chance of meconium aspiration, neurologically mature but smaller in size
upon delivery of newborn’s head and just o babies have birth weight below the 10%, so
before the baby takes his first breath they are smaller than normal babies of the
 Suctioning of the mouth and nose is done same gestational age
o the baby is weak and cannot tolerate large
Nursing Management
feeding
1. Closely monitor the newborn
o the baby is not receiving necessary nutrients
cardiopulmonary status
and oxygen
2. Administer supplemental oxygen therapy as
needed o Placental anomaly is the most common cause
3. Frequent monitoring of blood sugar; assess of IUGR
for sign of hypoglycemia Some factors that may contribute to SG are the
4. Provide thermoregulated environment
following:
 Use of isolette or radiant heat warmer
5. Monitor for signs of meconium aspiration Maternal factors:
syndrome (signs of meconium aspiration syndrome-
rapid breathing, note chest part kung may retraction,  high blood pressure
 chronic kidney disease

 advanced diabetes MATERNAL DIABETES
 heart or respiratory disease
- most widely known contributing factor
 malnutrition, anemia
- increase insulin acts as a fetal growth
 infection
hormone
 substance use (alcohol, drugs)
 cigarette smoking MACROSOMIA
Factors related to the fetus: - an unusually large newborn
- with birth weight of more than 4500 grams
 multiple gestation (twins)
 infection
ASSESSMENT FOR LARGE GESTATIONAL AGE
 chromosomal abnormality
 large, obese
Assessment
ASSESSMENTfor SGA
FOR SMALL GESTATIONAL AGE  lethargic and limp
 may feed poorly
 Respiratory distress – hypoxic episodes
 Loose and dry skin, little fat, little muscle mass Signs and symptoms of birth trauma
 Wasted appearance
 Small liver  bruising
 Head is larger compared to body  broken clavicle
 Wide skull sutures  evidence of molding
 Poor skin turgor  cephalhematoma
 Sunken abdomen  caput succedaneum
Problems of LGA babies
Babies with SGA may have problems at birth such as: o hypoglycemia (low blood sugar)
o respiratory distress
 Respiratory distress (asphyxia) o hyperbilirubinemia
 Meconium aspiration o potential complications related to the
 Hypoglycemia increase in body size
 Difficulty maintaining normal body o leading cause of breech position and shoulder
temperature dystocia
 Polycythemia (too many red blood cells) o fractured skull, clavicles, cervical or brachial
plexus injury and erb’s palsy
Interventions INTERVENTIONS
Generally, there is no treatment other than lifting the
o Observe for signs of respiratory distress
child gently to prevent discomfort. Occasionally, the
o Maintain body temperature
arm on the affect ted side may be immobilized.
o Monitor for infection and initiate measure to
prevent sepsis MANAGEMENT:
o Monitor blood glucose levels and for signs of
hypoglycemia Routine newborn care with special emphasis on the
o Initiate early feedings and monitor for signs of following:
aspiration o Monitor vital signs frequently, especially
o Provide stimulation such as touch and respiratory status
cuddling o Monitor blood glucose levels and for signs of
hypoglycemia
o Initiate early feedings
LARGE FORAge
Large for Gestational GESTATIONAL AGE o Note any signs of birth trauma or injury
o Monitor for infection and initiate measures to
o neonate who is plotted at or above the 90th
prevent sepsis
percentile on the intrauterine growth curve
o Provide stimulation such as touch and
o 2eigh more than 4,000 grams
cuddling
o the cause is unknown but sometimes genetic
factors and maternal conditions Common acute conditions of newborn:

RESPIRATORY DISTRESS SYNDROME (RDS) - Is the body’s way of trying to keep air in the
lungs so they will stay open
 Serious lung disorder caused by immaturity and - Tachypnea
inability to produce surfactant resulting in hypoxia - Nasal flaring
and acidosis - Retractions
 Surfactant – a biochemical compound that - Seesaw- like respirations (chest wall retracts
reduces surface tension inside the air sac and the abdomen protrudes)
 Decrease in surfactant results to lung - Decrease breath sounds
collapse, thus greatly reducing infant’s vital - Apnea
supply of oxygen - Pallor and cyanosis
 Damaged lung cells combines with other - Hypothermia
substance present in the lungs to form Seesaw-like respirations: as the patients, tries to
fibrous substance called hyaline membrane breathe the diaphragm descends causing the
(Hyaline membrane disease – this abdomen to lift and the chest to sink
membrane lines the alveoli and blocks gas
exchange in the alveoli)
Explanation:
 There is decrease pulmonary surfactant, so
MANAGEMENT:
definitely there will be increased surface tension
wherein the lungs will not expand well. Management: Oxygen Therapy
 Lack of the expansion of alveoli, this make it
impossible for the baby to breathe in after  When there is difficulty of breathing; consider
delivery, baby cannot breathe because of how may liters to administer because if there is
insufficient surfactant. too much then it can lead to: fibroplasia
 Lead to decrease alveolar ventilation, then there  Hood, nasal prong, mask, endotracheal tube
will be inadequate o2 and co2 exchange. (CPAP) Continuous Positive Airway Pressure, or
 Hypoxia – baby works harder and harder to PEEP (Positive-End-Expiratory Pressure) may be
breathe trying to reinflate the collapsed airways; used – different ways to deliver oxygen
baby’s lung function decreases so less oxygen is  CPAP – usually used (gray): CPAP machine blows
taken in and more co2 buildup in the blood that air at a prescribed pressure and a very effective
will lead to increase acid in the blood and lead to way to treat sleep apnea; this is ordered by the
acidosis. This will affect the body organ, so if there doctor.
is no treatment, this will lead to exhaustion of the  PEEP – used in NICU: maintaining the patient’s
baby to breathe. airway pressure
 Atelectasis – collapse of the lung tissue
ASSESSMENT:
ASSESSMENT MANAGEMENT:
Management: Surfactant Replacement therapy
Expiratory grunting – major symptoms (indicator of
 Attached to the newborn
RDS)
 ECMO – extracorporeal membrane oxygenation;
bypass heart and lungs; will allow the lungs to rest
–it will pump and oxygenate the patient’s blood

outside the body so it will allow the lungs and
heart to rest and you are connected to a machine
the blood through the tubing to an artificial lung;
so there is oxygen and takes out carbon dioxide;
blood is warm to body temperature and pump
back into your body.
 Muscle relaxants – Pancuronium (Pavulon)
 Reduces musclurar resistance
 Prevents pneumothorax
 Prepare Atropine – used to prevent the side
effect of Neostigmine; and Neostigmine
Methylsufate – given for the reversal of the
neuromuscular blocking agent
 Drugs in combination to prevent some
side effects
 Liquid Ventilation
 Uses perfluorocarbons – substances used in
industry to assess leaks
 Nitric Acid
 Causes pulmonary vasodilation – increases
blood flow to the alveoli
NURSING INTERVENTION
1. Monitor color, respiratory rate, and degree of
effort in breathing
2. Support respiration as prescribed
3. Monitor arterial blood gases and oxygen
saturation levels (arterial blood gases from
umbilical artery)
- Pulse oximeter to check o2 sat.
4. Suction every 2 hours or more often as
necessary; suction mouth and nose – only if
they are nose breathers.
5. Prepare to administer surfactant replacement
therapy (instilled into the endotracheal tube)
6. Administer respiratory therapy (percussion
and vibration
7. Provide nutrition
8. Support bonding
9. Encourage as much parental participation in
newborn’s care as condition follows

12
NCM 209 – Ms. Florence Puno
21 O2
OUTLINE HIGH RISK NEWBORN
I HIGH RISK NEWBORN
This birth weight is an important marker in regards to
II PRETERM NEWBORN
health. If may small 8 oz na bottle, ganun lang daw
III PLACENTAL ABRUPTIO
kaliit ang preterm.
IV PLACENTA PREVIA
COMMON OR SPECIAL PROBLEMS OF
Cause: unknown
NEONATES
Maternal factors: age, smoking, poor nutrition,
VI POSTERM NEWBORN
placental problem, preeclampsia/eclampsia
VII MECONIUM ASPIRATION SYNDROME
Fetal factors: multiple pregnancy, infection
VIII PROBLEMS RELATED TO GESTATIONAL
Other factors: poor socioeconomic status,
AGE
environmental exposure to harmful substance
IX LARGE GESTATIONAL AGE
X RESPIRATORY DISTRESS SYNDROME
If you are in the community and if tinanong mo si
XI HYPERBILIRUBENEMIA
mother then she said di siya nagapunta dun kay
XII SEPSIS
instead ipambili niya nalang ng bigas, we can tell her
XIII SIDS
na we have a program given by the government, sana
XIV KERNICTERUS
mag avail. Encourage the mother to seek for care dun.
XVI FAILURE TO THRIVE
XVII HYDROCEPHALUS
PLACENTAL ABRUPTIO
The placenta peels away from the inner wall before
RECAP: delivery. Sometimes partial, sometimes completely
Now the baby is depreived of nutrients, o2. And there
HIGH RISK NEWBORN would be bleeding.
Who among you are preterm?

They have sometimes complications that will threaten PLACENTA PREVIA
our newborn so definitely with our technology now, This condition occurs when the placenta covers the
there are early treatments or advances in our cervix. Common in early pregnancy. We call this as as
managements. Even in our doctors, there are doctors toxemia of pregnancy, now we term them as
who can handle high risk conditions. Na-aassess agad complication in pregnancy.
because of technology even if nasa loob pa ang baby.
Placenta accreta - Severe blood loss after delivery
Advanced technology would tell us how to manage
these high risk pregnancies for both the mother and Kaya minsan naga prepare ng blood incase
the fetus para magkaroon lang man ng positive magkaroon ng bleeding after delivery.
outcome.
ASSESSMENT
PRETERM NEWBORN  Respirations are irregular with periods of
apnea
Description:  Body temperature is below normal
A neonate born before 37 weeks of gestation  Skin is thin, with visible blood vessels and
minimal subcutaneous fat pads, may appear
Primary concern relates to immaturity of all body jaundiced
systems
May irregularities talaga sa respirations since not yet
Ito usually ang nakikita natin sa NICU. For survival mature ang organs ng preterm. Not the range and
talaga si 37 weeks. Note the weight. It is one of the also observe further the rise and fall of the chest.
indicators. Meron tayong gestational age to consider.

Poikilothermic-easily take on the temperature of the  due to lung immaturity; deficient in surfactant
environment So, the condition can cause the need to have extra o2
(baby). We need to help them breathe normaly.
Remember, the immaturity of the lungs might lack When there is not enough surfactant, our aveoli will
surfactant so dapat there is enough surfactant so collapse with each breath. Macollapse an gating
walang problem and walang flaring. lungs.
 poor sucking and swallowing reflex 2. Hyperbilirubinemia

 Bowel sounds are diminished  high level of bilirubin in the blood, neonate
 Extremities are thin, with minimal creasing on become jaundice
soles and palms.  due to immaturity of the liver
 Extension of extremities and does not
maintain flexion Kernicterus - staining of brain cells with bilirubin,
 Abundance of lanugo hair causing irreversible brain damage
 Labia are narrow in girls
 Testes are undescended in boys A rare kind of damage but preventable siya. It can
 Extension of extremities and does not happen with newborns with jaundice.
maintain flexion
May some babies nan aka straight lang ang Management: Phototherapy
extremities.
 Square window wrist

Assess the flexibility of the wrist. Try to note if there is Sometimes the pt would have brain problems. High
resistance also at the same time or if they could bilirubin would lead to brain damage.
extend or stretch. If ma straighten niya ba or may
resistant. Note also the degree angle. Once the bilirubin falls, we can turn off the
phototherapy and we must observe and refer.
3. Infection
 not able to receive IgG globulins
Alam naman natin diba kumukha si baby ng immunity
sa mother niya during the last 3 mos of the pregnancy.
But then here, kulang p kaya may infection.
 Scarf sign
Check the elbow. It is how the elbow can be moved
4. Cold stress
across the chest. Ang hint jan if malampas bas a chin.
 less subcutaneous tissue, poikilothermic
This is the major risk. Nakahubad pa naman an gating
newborn. We must avoid this kay naga adjust pa siya
sa environment niya.
5. Anemia
 less iron stores
Decreased hematocrit, decreased hemoglobin.
Decreased erythropoietin.
Common or special problem Management

Common or special problem 1.Improving respiratory function
of preterm neonates
of preterm neonates  Oxygen therapy
 Mechanical ventilator
1. Respiratory Distress Syndrome 2.Maintaining body temperature
 Hyaline membrane disease

Isolette - maintains ideal temperature, humidity and  Woman older than 35 years
oxygen concentration isolates infant from infection  Multiparity
 Fetal anomalies such as anencephaly
Kangaroo Care It’s either without the parts of the brain or parts of the
Method of holding the newborn. Skin-to-skin contact skull. Maybe the brain did not develop properly.
of baby and the mother. Portion of the baby’s brain is missing. Maybe the brain
tissue does not form properly. Maybe walang enough
3. Preventing infection skin to cover it.
 Handwashing Genetic and environmental factors can contribute to
To avoid infection anencephaly.
4. Promoting nutrition
 Gavage feeding Assessment
A way of providing milk directly to the baby’s stomach.  Depleted subcutaneuos fat: old looking "old
May tube na ginaplace sa nose ng baby and it carries man facies"
the breastmilk formula.  Parchment-like skin (dry, wrinkled and
 Milk feeding cracked) without lanugo
 Fingernails long and extended over ends of
5. Promoting Sensory stimulation fingers
Gentle touch, speaking gently and softly, music box or  Abundant scalp hair
low tuned radio  Long and thin body
 Sign of meconium staining
Nursing Interventions  nails and umbilical cord (vellow to green)
1. Monitor vital signs every 2 to 4 hours
2. Administer oxygen and humidification as COMPLICATIONS OF POST MATURITY
prescribed.  The placenta begins to aged toward the end
3. Monitor intake and output of pregnancy, and may not function as
Instructions should really be clear. efficiently as before.
4. Monitor daily weight.
So alam natin if enough ba ang nutrients. Or may  The failing placental function will place infant
weight problems. at risk for intrauterine hypoxia during labor
5. Maintain newborn in a warming device. and delivery.
6. Reposition every 1 to 2 hours, and handle newborn The fetus is derived of oxygen and nuteients
carefully. that’s why my hypoxia.
7. Avoid exposure to infections.
Do the handwashing and mag gloves since very risk sa
infections and newborn.
MECONIUM ASPIRATION SYNDROME
8. Provide newborn with appropriate stimulation, May breathing problem. The baby may pass
such as touch meconium into the amniotic fluid during labor or
9. Suctioning of secretions as needed delivery.
If di talaga maka breathe si newborn, then we could
suction.  HYPOGLYCEMIA
10. Monitor for signs of infection  FROM NUTRITIONAL DEPRIVATION AND
Skin color, temperature of the skin. POOR STORAGE OF GLYCOGEN AT BIRTH
11. Provide skin care May low blood sugar because the baby has too little
12. Provide complete explanations for parents glucoses na nastore.
Lalo na sa first time mothers. Ang anxiety level nila is  POLYCYTHEMIA
mataas.  increase circulating RBC
may problem sa hematocrit and hemoglobin.
POST-TERM NEWBORN
Management
Description: Neonate born after 42 weeks of gestation
 About 12% of all infants are post-term
 Ultrasound is done to evaluate fetal development,
amount of amniotic fluids and the placenta signs
Causes of delayed birth is unknown of aging to reduce the chance of meconium
 First pregnancies between the ages 15 to aspiration, upon delivery of newborn's head and
19years

just before the baby takes his first breath The fetus or infant is smaller or less-developed
suctioning of the mouth and nose is done than normal. We consider the sex, gender or
gestational age of the baby.
Nursing management
1. Closely monitor the newborn cardiopulmonary Gestational age – age of the fetus. Starts from
status Check VS. the mother’s last menstrual period.
2. Administer supplemental oxygen therapy as needed
3. Frequent monitoring of blood sugar; assess for sign SGA babies may be:
of hypoglycemia premature (born before 37 weeks of
4. Provide thermoregulated environment pregnancy),
 use of isolette or radiant heat warmer full term (37 to 41 weeks), or
to prevent cold stress. post term (after 42 weeks of pregnancy)
5. Monitor for signs of meconium aspiration syndrome
2. Intrauterine growth restriction (IUGR)
Differences Preterm Full Term  is the most common underlying
Posture “Relaxed More flexed condition leading to SGA newborn
attitude” limbs attitude Occurs usually when the fetus does not
more extended receive the proper nutrients or O2 that is
Ear Ear cartilages Well formed needed for the proper development of
are poorly cartilages organs and tissues.
developed, may
fold easily Early sign begins any time at pregnancy.
Sole Only fine Well and deeply But if may early onset, madetermine natin
wrinkles creased. through mga ultrasound and etc.
Female Clitoris is Clitoris is not as
Genitalia prominent; prominent; Birth weight is very important in the
labia majora labia assessment.
poorly majora fully
developed developed Some factors that may contribute to SGA are
Male Genitalia Scrotum is Scrotum is fully the following:
under developed,
developed and pendulous, Maternal factors:
not rugated  high blood pressure
pendulous, with  chronic kidney disease
minimal rugae lagi naga UTI, then need na ng IV meds.
Scarf sign Elbow is easily With resisting  advanced diabetes
brought across attempt when  heart or respiratory disease
the chest elbow  malnutrition, anemia
with little or no is brought to  Infection
resistance the midline of  substance use (alcohol, drugs)
the  cigarette smoking
chest
Grasp reflex Weak Strong, allowing Factors related to the fetus:
the infant to be  multiple gestation (twins)
lifted up from  infection
the mattress  chromosomal abnormality
note those chromosomal abnormalities in
regards sa SGA, when it is abnormal bcs it can
lead to health conditions sa body.
PROBLEMS
 RELATED
Placental TO GESTATIONAL
anomaly is the mostWEIGHT
1. Small for gestational age common cause of IUGR
 (SGA) babies are those whose birth
weight lies below the 10th percentile Assessment
for that gestational age  Respiratory distress - hypoxic
episodes

Hypoxic episodes. You have to know  Cephalhematoma
the rangeof RR. Other unusualities. Swelling of the head. There is a collection of bloody
Sounds. Adventitious sounds. fluid.
 Loose and dry skin ,little fat, little  Caput succedaneum
muscle mass Temporary swelling of the baby’s head.
 Wasted Appearance
 Small liver Problems of LGA babies
 Head is larger compared to body  Hypoglycemia (low blood sugar) of baby after
Syempre need to palpate. delivery
 Wide skull sutures  Respiratory distress
 poor skin turgor  Hyperbilirubinemia
o sunken abdomen
Potential complications related to increase in body
Babies with SGA may have problems at birth such as: size
 Respiratory distress (asphyxia) Leading cause of breech position and shoulder
 Meconium aspiration dystocia
 Hypoglycemia Fractured skull, clavicles, cervical or brachial plexus
 Difficulty maintaining normal body injury and erb's palsy
temperature Erb’s Palsy - Weakness or paralysis around the
 Polycythemia – too many red blood cells shoulder. May difficulty during delivery.
Interventions Generally, there is no treatment other than lifting

 Observe for signs of respiratory distress the child gently to prevent discomfort. Occasionally
 Maintain body temperature the arm on the affected side may be immobilized.
 Monitor for infection and initiate measures to
prevent sepsis
 Monitor blood glucose levels and for signs of
hypoglycemia
 Initiate early feedings and monitor for signs of
aspiration.
 Provide stimulation, such as touch and
cuddling
LARGE FOR GESTATIONAL AGE

Management
Description: Neonate who is plotted at Routine newborn care with special emphasis on the
or above the 90th percentile on following:
the intrauterine growth curve  Monitor vital signs frequently, especially
Weigh more than 4,000 grams respiratory status.
Cause - unknown  Monitor blood glucose levels and for signs of
genetic factors hypoglycemia
maternal conditions  Initiate early feedings
Maternal diabetes - is the most widely known  Note any signs of birth trauma or injury
contributing factor  Monitor for infection and initiate measures to
Increase insulin acts as a fetal growth hormone prevent sepsis
Macrosomia - an unusually large newborn  Provide stimulation, such as touch and
with birth weight of more than 4500grams cuddling.
Assessment
 large, obese
RESPIRATORY DISTRESS SYNDROME (RDS)
 Lethargic and limp
 May feed poorly Description: Serious lung disorder caused by
immaturity and inability to produce surfactant,
Sign and symptoms of birth trauma resulting in hypoxia and acidosis
 Bruising
 Broken clavicle Surfactant - a biochemical compound
 Evidence of molding that reduces surface tension inside the air sac

Decrease in surfactant results to lung collapse, thus
greatly reducing infant's vital supply of oxygen
Damaged lung cells combines with other substance

present in the lungs to form fibrous substance called
hyaline membrane (Hyaline membrane disease)
this membrane lines the alveoli and blocks gas

exchange in the alveoli
which means the pt has difficult getting air bcs there is
a blockage so mag compensate ang lungs sa blockage
na ‘yan so mag exert ng effort and mapagod. Management
PATHOPHYSIOLOGY a) Oxygen therapy
 hood, nasal prong, mask, endotracheal tube,
CPAP (Continuous Positive Airway Pressure),
or PEEP (Positive End -Expiratory Pressure)
may be used
CPAP machine blows air at a prescribed pressure
If the pt lacks surfactant, there would be surface

tension then lack expansion of alveoli, the tiny alveoli
collapse with each breath, it will further affect the
breathing ability of the baby. The more the baby will
breathe harder trying to reinflate that collapsed
airway, the baby’s lung function decreases, so there is
decreased oxygen (hypoxia). It will also lead to
increase acid in the blood (acidosis).
 Surfactant replacement therapy
Here, exhausted na ang lungs, so there would be  Extracorporeal membrane oxygenation
effusion of the alveoli and terminal bronchioles. And (ECMO)
hyaline-like membrane formation. And then the This will allow lungs to rest. They will pump and
collapsed of the lung tissue and that is the atelectasis. oxygenate the blood outside the body allowing the
heart and lungs to rest.
Assessment
 Expiratory grunting -major symptoms is the b) Muscle relaxants - Pancuronium (Pavulon)
body's way of trying to keep air in the lungs so • Reduces muscular resistance
they will stay open • Prevents pneumothorax
 Tachypnea • Prepare Atropine or Neostigmine Methylsulfate
 Nasal flaring
 Retractions c) Liquid Ventilation
 Seesaw - like respirations (chest wall retracts and • Uses perfluorocarbons - substances used in industry
the abdomen protrudes) to assess leaks
A type of paradoxical respiration
 Decreased breath sounds d) Nitric Acid
 Apnea • Causes pulmonary vasodilation - increases blood
 Pallor and cyanosis flow to the alveoli
 Hypothermia
Nursing Interventions
Seesaw - like respirations 1. Monitor color, respiratory rate, and degree of effort
in breathing.

2. Support respirations as prescribed  average increase of 2mg/dI; not exceeding
3. Monitor arterial blood gases and oxygen saturation 12mg/dI
levels (arterial blood gases from umbilical artery). So
that oxygen administered to the newborn is at the  Pathological Jaundice of Neonates
lowest possible Any of the following features characterizes
concentration necessary to maintain adequate arterial pathological jaundice:
oxygenation.  Clinical jaundice appearing in the first 24
4. Suction every 2 hours or more often as necessary. hours.
5. Prepare to administer surfactant replacement  Increases in the level of total bilirubin by more
therapy (instilled into the endotracheal tube) than 12 mg/dl
6.Administer respiratory therapy (percussion and
vibration Therapy is aimed at preventing Kernicterus, which
7. Provide nutrition results in permanent neurological damage resulting
8. Support bonding from the deposition of bilirubin in the brain cells.
9. Encourage as much parental participation in
newborn's care as condition allows. Causes
 Immaturity of the liver
RETINOPATHY OF PREMATURITY  Rh or ABO incompatibility
 vascular disorder involving gradual  Infections
replacement of retina by fibrous tissue and  Birth trauma
blood vessels  Maternal diabetes
 primarily caused by prematurity and use of  Medications
supplemental oxygen (longer than 30 days)
 Oxygen administration should never be more Assessment
than 40% unless hypoxia is documented  Jaundice
Kaya bantay sa pagbigay ng O2 kay baka  Dark concentrated urine
masobrahan. Paano makuha sa newborn?
That would put the baby at risk for becoming blind. Sometimes we use the condom catheter para sa bata
so para makacollect tayo and observe the urine.
Any premature newborn who required oxygen  Enlarged liver
support should be scheduled for an eye examination Usually jaundice happens when the liver does not
before discharge to assess for retinal damage. work well. So we must also check the liver. If it is
enlarged. Baka may mga infections. Remember the
Bronchopulmonary Dysplasia - over expanded lungs liver is part of the body that is most responsible where
prolonged use of 02 we can get rid of this high level of bilirubin. So once
So the breathing disorder occurs. Lalo na become may problem, the newborn can have high levels of
irritated na ang lungs. They do not develop normally. bilirubin.
 Poor muscle tone
Management:  Lethargy
a) Suction every 2 hours or more often as necessary.  Poor sucking reflex
b) Prepare to administer surfactant replacement
therapy (instilled into the endotracheal tube) Management
c) Administer respiratory therapy (percussion and 1. Phototherapy
vibration) - is use of intense florescent lights
d) Provide nutrition to reduce serum bilirubin levels
e) Support bonding - the use of blue lights overhead or in blanket -
f) Encourage as much parental participation in device wrapped around infant
newborn's care as condition allows.
HYPERBILIRUBINEMIA
Description: is an abnormally high level of Bilirubin in
the blood; results to jaundiced
TYPES:
 physiologic jaundice
 occurs on the second day to seventh day

- is use of intense flourescent lights to reduce 2. Cover the genital area, and monitor the
serum bilirubin levels in the newborn genital area for skin irritation or breakdown.
3. Cover the newborn's eyes with eye shields or
patches; make sure that eyelids are closed
when shields or patches are applied.
1. Note: hindi naman ganun ka galaw si
newborn but if infant malaki-laki na
so bantayan baka ma move ang cover
4. Remove the shields or patches at least once
per shift (during a feeding time) to inspect the
eyes for infection or irritation and to allow
eye contact and bonding with parents.
5. Monitor skin temperature closely.
1. Note: due to cold stress and changes
- Injury from treatment, such as: eye damage, of the skin color
dehydration, or sensory deprivation 6. Increase fluids to compensate for water loss.
7. Expect loose green stools and green urine.
8. Monitor the newborn's skin color (Jaundice,
pinkish (normal), pallor) with the fluorescent
light turned off, every 4 to 8 hours.
Note: do not hesitate to ask mother if ever gi
off ang light while on phototherapy, and tell
the mother ang tamang pag time ng
phototherapy and make sure to be confident
with your answers if may questions si mother;
Wallaby blanket tell the mother what was the ordered time;
 is simply a blanket which, when wrapped REMEMBER TO EXPLAIN THE PROCEDURE
around the infant's torso, delivers effective BEFORE STARTING THE PROCEDURE EVEN IF
therapy to jaundiced babies NA EXPLAIN NA NI DOCTOR, MAG
 no need to cover the baby’s eyes as all light ADDITIONAL KNOWLEDGE TAYO SA ATING
treatment is delivered through the blanket NURSING CARE KUNG MAG EXPLAIN NA
 Monitor the skin for bronze baby syndrome, a
grayish-brown discoloration of the skin.
Not only the skin, but also:
o Urine
o Serum
 Reposition newborn every 2 hours.
 Provide stimulation.
Bronze baby syndrome
Possible complication of phototherapy

 eye damage
 dehydration
 sensory deprivation
Note: maybe there is an intense discoloration of the
2. Exchange blood transfusion via umbilical catheter skin; especially for the premature bab
 for very severe cases After Treatment
 infants blood - remove = 5 / 10ml at a time
one of the treatments to correct anemia.  continue monitoring for signs of
hyperbilirubinemia, because rebound
Nursing Intervention elevations are normal after therapy is
discontinued.
1. Expose as much of the newborn's skin as
possible.  Turn off phototherapy lights before drawing
blood specimen for serum bilirubin levels

and avoid allowing blood specimen to  occurs when infants take meconium into their
remain uncovered under fluorescent lights lungs during or before delivery
(to prevent the breakdown of bilirubin in the  can lead to Respiratory distress in
blood specimen). newborn because they might aspirate
the meconium (present during/after
Jaundice birth) to the lungs
Note: even though fetuses does not eat their
 yellowing is associated with the accumulation intestine consist sterile substance that is
of bilirubin in the skin. meconium; Meconium is the first discharge
Most often caused by: oof the newborn: Meconium is a Green
o Liver disorder substance
o Gallbladder disorder  Occurs in term or post-term infants
 a symptom where skin and eyes becomes  During fetal distress there is increases
yellow intestinal peristalsis, relaxing the anal
sphincter and releasing meconium into the
amniotic fluid.
 Aspiration can occur in utero or with the first
breath.
 Meconium can block the airway partially or
completely and can irritate the newborn'
airway, causing respiratory distress
Note: anything that blocks the airway causes
respiratory distress
ASSESSMENT
Respiratory Distress is present at birth:

 Tachypnea,
NURSING INTERVENTIONS
 Cyanosis,
1. MONITOR FOR THE PRESENCE OF JAUNDICE;  Retractions,
ASSESS SKIN AND SCLERA FOR JAUNDICE.  Nasal flaring,
 Examine the newborn's skin color in  Grunting, (very common)
natural light.  Crackles, and rhonchi may be present (very
 Press finger over a bony prominence common)
or tip of the newborn's nose to press  Infant’s nails, skin, and umbilical cord may be
out capillary blood from the tissues. stained a yellow-green (meconium) color
 jaundice starts at the head first,
spreads to the chest, abdomen, and CAUSES AND RISK FACTORS
then the arms and legs, followed by
the hands and feet  Common to post mature
 Maternal history of diabetes
2. Keep newborn well hydrated to maintain
 Hypertension
blood volume.
 Difficult delivery
3. Facilitate early, frequent feeding to hasten
 Poor intrauterine growth
passage of meconium and encourage
excretion of bilirubin.
4. Report to the physician any signs of jaundice MANAGEMENT
in the first 24 hours of life and any abnormal  Suctioning must be done immediately after
S&S the head is delivered before the first breath is
5. Prepare for phototherapy, and monitor the taken (for secretions than blocks airway)
newborn closely during the treatment. Note: o2 can be administered for life support
1. Note: if not available it could be a kasi mahirap maghinga
problem because hindi lahat kompleto  Vocal cords should be viewed to see if the
ang facilities airway is clear before stimulation and crying
 Extracorporeal membrane oxygenation
Meconium aspiration syndrome (MAS) (ECMO)

 Cardiopulmonary bypass to support  Major common cause is group B beta-
gas exchange, allows the lungs to rest hemolytic streptococci (can breakdown RBCs)
 pump blood; pump outside of the - it can affect newborn and adults
body to the heart to remove the SEPTISIMIA (SEPSIS)
carbon dioxide and asses oxygen
blood back to the tissue; oxygenated
pag balik
CONTRIBUTING FACTORS
 Prolonged rupture of membranes

 Prolonged or difficult labor
 Maternal infection
 Cross contamination
 Aspiration (can be meconium aspiration)
ASSESSMENT
- often does not have specific sign of Illness

 Poor feeding
 Irritability
 Lethargy
 Pallor
 Tachypnea
 Tachycardia
 Abdominal distention
 Temperature instability - difficulty keeping
temperature within normal range
Note: due to infection; wala ng immunity
DIAGNOSING
 Blood, urine, and cerebrospinal fluid cultures
Focuses on:  Routine CBC, urinalysis, fecalysis
1. Observing neonates respiratory status closely  Radiographic test
2. Ensuring adequate oxygenation (as ordered)
3. Administration of antibiotic therapy (prevent MANAGEMENT
infection)
 Intensive antibiotic therapy
4. Maintain thermoregulation
 IV fluids (can be cloudy)
 Respiratory therapy
SEPSIS Routine newborn care with special emphasis on the

following
 Description: Generalized infection resulting 1. Monitor vital signs, assess for periods of
from the presence of bacteria in the blood apnea or irregular respirations.
Note: neonatal, usually may B categorized in 2. Administer oxygen as prescribed
the early onset; e.g. first few day na paglabas 3. Provide isolation as necessary.
(0-3 days) or late onset (after 4 days), the  Monitor and limit visitor (the patient
newborn will be assessed with the presence might get additional infection; especially
of bacteria. for premature babies because they have
If preterm it is very risky, mahirap mag adjust immature organs)
ang immunity level if may infection; onset are 4. Handwashing before and after handling
the very rapid sepsis for premature babies neonate

KERNICTERUS
SUDDEN INFANT DEATH SYNDROME (SIDS)
 Sudden death of any young child that is  If untreated, hyperbilirubinemia can result to
unexpected by history and which thorough kernicterus or the deposition of bilirubin in
postmortem examination fails to demonstrate the brain.
adequate cause of death  Usually occurs if the bilirubin levels are
 Usually occurs during sleep 25mg/di or higher in term infants
 Diagnosis is made after autopsy  Toxicity starts at 8-12 mg/dl in sick or low
 High incidence in preterm infants, infants with birth weights
abnormalities in respiration
 Unknown cause COMMON PROBLEM DURING INFANCY
FACTORS
 May be related to a brainstem abnormality

FAILURE TO THRIVE
in the neurological regulation of cardio- Common in South Africa and to some areas in our
respiratory control community.
 Sleep on their stomach or malpositioning  a condition in which a child fails to gain
 Obstruction of airway weight and is persistently less than the fifth
 Overheating while sleeping or too soft ang percentile on standard growth chart
surface nya or a toy can cause Malnutrition is being experienced; weight
 Mother or father smoking (secondhand problem
smoke)  Persistent deviation from established growth
 any maternal factor curve. sign of delayed weight development
 Baby is born late or no prenatal check up or  delay in physical growth and weight gain
premature might lead to cognitive impairment or even
 Have a sibling who died also of SIDS death
Weight is the most sensitive indicator of our
nutritional status; one of the problem of WHO
NURSING ROLE and DOH; then comes up feeding programsa
1. Care is directed at supporting parents/family and assessments of nutritionist of the health
2. Provide a room for the family to be alone center
(allow them to grieve)
3. Reinforce that death was not their fault 4 PRINCIPAL FACTORS FOR HUMAN GROWTH
4. Provide appropriate support referrals 1. Food
5. Explain how parents can receive autopsy 2. Rest and activity
results 3. Adequate secretions of hormones
4. Satisfactory relationship with caregiver
PREVENTION
Infants should be placed in the supine position Classified as:

for sleep. Organic (OFTT) - due to pathologic condition such as
 Soft moldable mattresses and bedding, such problem in absorption and hormonal dysfunction
as pillows or quilts, should not be used for  there might be other chronic disease that the
bedding. yung maka hinga siya ng maayos; child is experiencing that could interfere with
may proper ventilation and positioning and the nutrients intake or it could not be
allow proper circulation absorbed or problem with the metabolism or
 Stuffed animals should be removed from the excretion
crib while the infant is sleeping. might cause Nonorganic (NFTT) - due to psychosocial factor
suffocation and might cove baby’s face  disrupted maternal child relationship
 Discourage bed sharing (sleeping with an
adult). Idiopathic(IFTT) - Unexplained by the usual organic
 Home apnea monitor to infant with near miss and environmental etiologies but usually classified as
SIDS when you notice na walay rice and fall sa Nonorganic (NFTT)
abdomen or chest area during the baby is
asleep

 A thorough history is the best guide to 2. Provide sufficient nutrients.
establishing the etiology of the failure to 3. Make feeding a priority intervention.
thrive 4. Keep an accurate record of intake.
5. Weigh daily.
 Poverty is the greatest single risk factor
worldwide and in the United States
 Nutritional deficiency is the fundamental Introduce positive feeding environment
cause
 Establish a structured routine
ASSESSMENT FINDINGS  Hold the young child for feeding
 Maintain eye-to-eye contact (colorful AND
 Poor muscle tone, loss of subcutaneous fats, creative plating)
skin breakdown  Maintain a calm, even temperament
 Rumination - common characteristic,  Provide a quiet, nonstimulating environment
voluntary regurgitation  Talk to child giving appropriate directions and
 Lethargic- unresponsive praise for eating
 Positive delay in growth and development  Increase stimulation appropriate to the child's
 Signs of disturbed maternal - child interaction present developmental level.
 Diminished or nonexistent crying  Provide the parent an opportunity to talk.
 radar gaze - wide-eyed gaze and continual  When necessary, relieve the parent of
scan of environment childrearing responsibilities until able and
ready emotionally to support the child.
Characteristics of the individual providing care  Demonstrate proper infant care by example,
not lecturing.
 Difficulty perceiving and assessing the infant's  Supply the parent with emotional support
needs with fostering dependency.
 Frustrated and angered at the infant's  Promote the parent's self-respect and
dissatisfied response confidence by praising achievements with
 Frequently under stress and in crisis, with child.
emotional, social and financial problems
 All children with failure to thrive need additional HYDROCEPHALUS

calories for catch-up growth  An imbalance of cerebrospinal fluid (CSF)
absorption or production
TREATMENT (depends on the cause)  caused by: malformations, tumors,
 Medical disorder - specific treatment is given hemorrhage, infections, or trauma; Results in
 Parent-child relationship - Family counseling head enlargement and increased ICP
Psychosocial intervention
 Nutritious, high-calorie feedings
scheduled meals; feeding program every
week; offer solid before liquids pag kaya na;
Increase protein after 6 months if makakain
na
NURSING DIAGNOSIS
- Makita mo sa itsura ng bata; Makita mon a

imbalance nutrition TYPES
- Makita na less than body requirements; kulang ang COMMUNICATING
feeding  occurs as a result of impaired absorption
- Baka hindi naga feed si mother within the subarachnoid space.
- test skin integrity; baka mafeel mon a ang bone
-urinary elimination impapirment; constipation NONCOMMUNICATING
 blockage in the ventricular system that
NURSING INTERVENTIPN prevents CSF from entering the subarachnoid
1. Provide consistent caregiver. space

ASSESSMENT FINDINGS - treatment depends to cause
 Increased head circumference SURGICAL INTERVENTION

 Thin, widely separated bones of the head that
produce a cracked pot sound (Macewen's 1. GOAL: Prevent further SF accumulation by
sign) on percussion bypassing the blockage and draining the fluid
 Anterior fontanel tense, bulging, and from the ventricles to a location where it may
nonpulsating be reabsorbed
 Dilated scalp veins 2. Ventriculoperitoneal shunt
 Sunsetting eyes  the SF drains into the peritoneal
cavity
3. Atrioventricular shunt
 CSF drains into the right atrium of the
heart
Shunt - divert or by pass
MEDICATION
 Acetazolamide (diamox)
 promote the excretions of excess
fluids
PREOPERATIVE INTERVENTIONS
1. Give small frequent feedings as tolerated

until a preoperative PO status is prescribed.
2. Reposition head frequently and use an egg
crate mattress under the head to prevent
pressure sores.
3. Prepare the child and family for diagnostic
procedures and surgery
Instruct the parents on how to recognize shunt

infection or malfunction:
 Behavior changes, such as irritability and
lethargy
 In an infant
 Headache on awakening
 irritability, lethargy, and feeding poorly
 Nausea and vomiting
 In a toddler
 Ataxia- lack of coordination of muscle
 headache and a lack of appetite
movement
 Nystagmus- involuntary movement of the
 In older children,
eyes  an alteration in the child's level of
 Late signs: High, shrill cry and seizures. consciousness.
DIAGNOSTIC TEST
 CT scan
 MRI
 Skull X-ray
 Transillumination
 holding a bright light such as a
flashlight or specialized light (Chun
gun) against the skull in a darkened
room
 a skull filled with fluids rather than
solid brain substance
MANAGEMENT

12
22 O3
SPINA BIFIDA
OUTLINE
I Spina Bifida
Types:
II Meningitis
III Seizure 1. Spina bifida occulta
IV Otitis Media
V Cleft lip and palate ● posterior vertebral arches fail to close in the
lumbosacral area.
● Spinal cord and meninges remains in the
normal anatomic position defect may not be
visible dimble or a tuff of hair on the spine
Bony defect that occurs without soft tissues
Spina Bifida
involvement.
Description- A central nervous system defect results
● Asymptomatic may have slight neuromuscular
from failure of the neural tube to close during
deficits.
embryonic development generally in the lumbosacral
● No treatment if asymptomatic aimed at
region.
specific symptoms
2. Spina bifida cystica
So the defect is around that neural tube (Neural tube ● Protrusion of the spinal cord and/or its
defect) meninges with varying degrees of nervous
SPINA BIFIDA tissue involvement
It is a treatable spinal cord malformation that occurs
in varying degrees, depending on the severity.
● Meningocele
○ part of spinal protrudes through
Causes opening in the spinal canal.
○ Sac is covered with thin skin no nerve
Actual cause is unknown; multiple factors roots involved
● Genetic- if a sibling has had neural tube ○ No motor or sensory loss
defect ○ good prognosis after surgery- just
There is a higher than normal risk of having a watch out for signs of infection.
baby if there is a spina bifida already Bony defects that form a certain sac around
that area.
● Environmental factors
● Medications, viral infection and radiation ● Myelomeningocele (meningomyelocele)
Medications if may na take si mother during ○ With spinal nerves roots in the sac
pregnancy ○ Have sensory or motor deficit
○ Below site of the lesion
Taking folic acid decrease incidence of neural tube ○ 80% have multiple handicaps
defect There is a protrusion of the spinal cord in the
meninges with nerve roots na nandyan around
Folic acid is a water-soluble vitamin that is essential that wall of the cyst.
for cell-growth and production. If you have low folic-
acid intake, that will indicate also the occurrence of
spina bifida

● Myelogram- uses a special dye and an
x-ray (fluoroscopy) to provide a very
detailed picture of the spinal cord and
spinal column.
● Encephalogram
● Urinalysis, BUN, Creatinine clearance
Management
 Surgery
o Closure of sac within 48 hours
For the option of surgery, we will just remove
o Shunt
the sac then there is a closing of that skin,
o Orthopedic
then monitor the response of the patient with
 Drug Therapy
regards to the surgery, and how the child
o Antibiotic
adapts to the changes.
o Anticholinergic
Possibly there would be cognitive symptoms
Nursing management
and paralysis. Sometimes it would be
completely paralyzed, and with the cognitive 1. Prevent trauma to the sac
level naman because it occurs in the neural a. Cover with sterile, moist (normal
tube so the effect will lead on how the brain saline, non-adherent dressing
would develop. b. Change the dressing every 2 to 4
hours as prescribed, keep area free
from contamination
Assessment: c. Place in a prone position to minimize
tension on the sac
Depends on the spinal cord involvement d. Head is turned to one side for feeding
1. Visible spinal defect- makita mo nayan from e. Administer meds
head to toe 2. Prevent Complication
a. Use aseptic technique to prevent
2. Motor/sensory involvement infection
b. Assess the sac for redness, clear or
a. Flaccid paralysis of the legs
purulent drainage, abrasions,
b. Altered bladder and bowel function
irritation, and signs of infection
c. Hip and joint deformities
c. Clean intermittent catheterization
d. Hydrocephalus
d. Perform neurological assessment
Hindi naman lahat mag occur so need talaga
e. Assess for physical impairments such
frequent monitoring
as hip and joint deformities
3. Provide adequate nutrition
4. Provide sensory stimulation
Sometimes the patient will also experience 5. Provide emotional support to parents and
lack of strength. In the force routine family
newborn, there will be examinations to be 6. Provide discharge teachings
conducted for us to know the impairment in a. Wound care
the neurologic aspect. b. ROM, PT
c. Signs of complications
d. Medication regimen
Prenatal e. Positioning – feeding, diaper change
● Ultrasound Meningitis MENINGITIS
● Amniocentesis
- Inflammations of meninges of the brain and
spinal cord
Postnatal
- Cause by bacteria, viruses, other
● Xray of spine microorganism
● Ct scan

- As a primary disease or as a result of Diagnosis
complications of neurosurgery, trauma,
infection of the sinus or ears, or systemic
infections.  Lumbar Tap - CSF Testing obtained by lumbar
H Influenzae Menignitis – The most common form; puncture
between 6 to 12 months
Bacterial Meningitis
- Haemophilus influenza type B, Streptococcus
pneumoniae, or Neisseria meningitidis
- Viral Meningitis is associated with viruses
such as mumps, herpesvirus, and enterovirus

Assessment
Fever, chills, headache, high-pitched cry, irritability, Management
vomiting, poor feeding or anorexia, bulging anterior
fontanel in the infant Interventions:
 Provide isolation and maintain it for at
least 24 hours after antibiotics are
Signs of Meningeal Irritations initiated
 Nuchal rigidity – stiff neck  Administer antibiotics and
 Positive Kernig sign – severe stiffness antipyretics as prescribed
of the hamstring muscle causes an  Perform neurological assessment and
inability to tighten the leg when the monitor for seizures and
hip is flexed to 90 degrees. complications
 Opisthotonos  Assess for changes in level of
o Arching of the back consciousness and irritability
o Head and heels bent  Monitor intake and output
backward  Assess nutritional status
o And body arched forward  Determine close contacts of the child
 Brudzinski sign – Flexion at the hip in with meningitis because the contacts
response to forward flexion of the will need prophylactic treatment.
neck  Meningococcal vaccine is
recommended to protect against
meningitis
If a patient has meningitis, it is necessary to isolate
them.
Even if the sign of illness (fever) is minor, it should
never be taken for granted because it can become
severe in a matter of minutes or seconds.
Mastering drugs such as paracetamol, analgesics,
antipyretics, antibiotics, IV fluids, and pain relievers
since these are most commonly administered;
knowing their mode of transmission, indications, side-
effects, and responsibilities.
Bulging of the fontanel – because of the soft spot on Always remember when sponge baths can be given,
the top of the head or increased intracranial pressure when one can increase fluid intake, to check for good
or fluid in the brain ventilation, and give comfort to the patient since
these are somewhat part of the bed-side care.

A study in 2021 was conducted by The University of Non progressive does not generally result in brain
Copenhagen, where a new treatment for bacterial damage
meningitis, specifically of the pneumococcal
Seizure occur only when fever is rising
pathogen, was created where if a patient undergoes
through antibacterial therapy, then it may be possible - That is why we do not let the fever increase as
to reprogram or dissolve the neutrophil which is an much as possible
immune cell that fights of pneumococcal pathogens.
The study then seeks to try and dissolve these Commonly associated with high fever – 38.9 to 41.1
neutrophil nets because they block CFS in some parts Celsius
of the brain which would then cause edema. Once - Sponge bath kaagad tayu
there is an increase in WBC (neutrophils) then there is
a tendency that an infection is present. Some appear to have a low seizure threshold and
convulse when a fever of 37.8 to 39.8
A seizure is how the body responds to a problem, for
example if there is an increase in body temperature, Different classification of Febrile Seizure
then there is definitely a change in a cellular level
which would lead to the abnormal activity of the 1. Partial seizure
nerve endings. A. Simple- localized motor activity shaking of
arm or leg limited to one side of the body
B. Complex – psychomotor seizure memory
loss and staring non purposeful
SEIZURE
movement
Recurrent sudden changes in consciousness, behavior,
Seizure is classify as with respect the abnormal
sensation and or muscular activities beyond voluntary
neuronal activity
control caused by excess neuronal discharge.
Simple is affected the one side of the brain
There may be biochemical imbalances that can result
in seizures, or multiple seizures (repetition of And there is complex which alter the one side
electrical discharges, particularly in the nerve) consciousness
Normally the neuron sends out messages in electrical Aura – sensation that signals an attack
impulses periodically and the firing individual neuron
is regulated by an inhibitory feedback loop After – sleep or confuse; unaware of the
mechanism. seizure
If there are changes in motor-control, alterations with 2. Generalized

sensation in translation to muscular activities, this can A. Tonic – clonic, prodromal, AURA, tonic,
affect autonomic function. Febrile seizure is the most post ictal
common in this, where it is most common with - This begins in the both side of the brain but
children (6 months - 5 years), where in sometimes this can start at one side but mag spread lang siya
is associated with high fever with no intracranial - The aura is the warning sign
infections associated B. Absence - rarely 20 seconds stares
straight, does not fall
With seizure many more neurons than normal fire in a
synchronous fashion in a particular area of the brain; Status epilepticus - A seizure that lasts longer than 5
the energy generated overcomes the inhibitory minutes, or having more than 1 seizure within a 5
feedback mechanism minutes period, without returning to a normal level of
consciousness between episodes is called status
Febrile seizures is common in children between 6mon epilepticus.
- 3yrs old
Absence – abrupt lapses of consciousness lasting a
Febrile seizure are seizure that happened between few seconds
children with that age and I told you kanina na there is
high fever, there are no particular infection Atonic – abrupt, unexpected loss of muscle tone
Myoclonic – rapid short contractions of one or all
Febrile seizure
extremities
Common in 5% of population under 5 years old,
So this are the term to utilize on checking on your
familial
patients level of consciousness during the seizures

Contributing factors: seizure disorder -restless and repeatedly shakes the head,
frequently pulls or tugs at affected ear.
1. Intracranial infection
2. Space occupying lesion 2. irritability, cough, nasal congestion, fever.
3. CNS defect
3. Hearing impairment.
Assessment findings
4. Purulent discharges.
1. Restlessness / irritability
2. Body stiffens and loss of consciousness
3. Clonic movements – quick, jerking Diagnosis
movements of arm, legs, and facial muscle
 Examination of ear with otoscope.
Reveal bright red bulging eardrum.
Treatment Diagnostic test
 Culture and sensitivity of ear discharge.
1. Drug Blood studies
a. Diazepam - To rule out lead
b. Phenobarbital poisoning Possible complication
c. Dilantin - Hypoglycemia
- Infection  Permanent hearing loss mastoiditis.
- Electrolytes imbalance
Management
EEG – this is to detect abnormal wave
1. Antibiotics, analgesics
2. Surgery Tumor hematoma 2. Myringotomy incision into the tympanic
membrane to relieve pressure and drain the
INTERVENTION
fluid with / without tube.
 Reduce fever with antipyretics
 Give prescribed medication
 Generalized seizure precautions Postoperative interventions
 Do not restrain; pad crib rails; do not use tongue
blade  Wear earplugs while bathing, shampooing,
and swimming.
 Observe and record the time of seizure,
 Diving and submerging underwater are not
duration, and body parts involved.
allowed.
 Suction and administrator oxygen after the
 Child should not blow his or her nose for 7 to
seizure as required.
10 days after surgery.
 Observe the degree of consciousness and
behavior after seizure
 Provide rest after the seizure
Interventions
 Encourage fluid intake.
OTITIS MEDIA  Teach the parents to feed infants in upright
position, to prevent reflux.
- Inflammation of the ear particularly in the  Instruct the child to avoid chewing as much as
middle part possible during the acute period because
Why does the middle part of the ear get chewing increases pain.
infection? it is a bacterial or a viral infection of  Provide local heat and have the child lie with
the middle ear. the affected ear down.
 Instruct the parents in the appropriate
- Common in infants and preschoolers. procedure to clean drainage from the ear with
- Eustachian is shorter, wider, and straighter. sterile cotton swabs.
- Thereby, allowing nasopharyngeal ear more
easily. Instruct the parents
 Administration of analgesics or
antipyretics.
Assessment findings  Administration of the prescribed
1. Behavior that would indicate pain. antibiotics, emphasizing that the 10-to-

14-day period is necessary to eradicate 3. Ear infection
infective organisms. 4. Speech defect, dental malformation
 Screening for hearing loss may be 5. Body image
necessary.
Management (Rule of Ten)
Administering ear medications
1. Surgical correction
 Younger than age 3, pull the lobe down and
back. Cheiloplasty – correction of cleft done – 2 months old
 Older than 3 years, pull the pinna up and Palatoplasty – cleft palate surgery done – before
back. speech development allow for palatal changes that
take place with in 12-18 months
CLEFT LIP AND PALETE
Can’t Management
 Non union of the tissue and bone of the upper
lip and hard / soft palate during embryonic 2. Team approach therapy
development.
 Failure of the maxillary and premaxillary Dentist and orthodontist, Audiologist, Speech
process to fuse during fetal development. therapist, Pediatrician.
Etiology – primarily genetic environmental factors

Viral infection exposure to radiation Folic acid Nursing Intervention – Pre op cleft lip
deficiency teratogenic factors  Feed in upright position in small frequent
Assessment findings: feedings
 Burp frequently
1. Facial abnormality  Use large-holed nipples
2. Difficulty sucking and swallowing  Use rubber-tipped syringe – if unable to suck
3. Milk escapes through nose  Gavage feeding as ordered
 Finish feeding with water
 Provide emotional support for parents and
family
Nursing Intervention – Post op cleft lip

 Maintain patent airway
 Assess color; monitor for frequent swallowing
 Do not place in prone position
 Avoid straining suture lines
 Use elbow restraints
 Resume feedings as ordered
Assessment
Nursing Intervention – Pre op cleft palate
Cleft lip
 Prepare parents to care for child after surgery
 Can range from a slight notch to a complete
 Instruct concerning feeding methods and
separation from the floor of the nose.
positioning
Cleft palate
Nursing Intervention post operative – cleft palate
 Nasal distortion
 Suction mucus and saliva gently and do not
 Midline or bilateral cleft
touch the sutures
 Variable extension from the uvula and soft
 Incision care
and hard palate.
 Clean suture with sterile cotton swab with
Associated problems half strength hydrogen peroxide followed by
saline.
1. Feeding problems  Apply antibiotic ointment
2. URTI  Do not displace Logan bar

 Do not place in prone position, Place in side
lying position
 Keep spoons, pacifier, straws, away from
child’s mouth for 7 to 10 days post op
 Elbow restrains
 Special feeder – syringe with rubber tubing
into side of mouth, Breck feeder

19
NCM 209 – Puno,
22 O1
TOPIC TITLE HERE
OUTLINE
I. BURNS CLASSIFICATION ACCORDING TO DEPTH
II. CEREBRAL PALSY
III. POISONING 1. PARTIAL THICKNESS
IV. CHILD ABUSE a. Superficial partial thickness
V. IRON DEFICIENCY ANAEMIA  Epidermis
VI.  painful erythema, No vesicles
BURNS
 Is an injury to body tissue caused by excessive

heat
 It is the most severe form of trauma to the

integumentary system.
 Once you have burns it really disrupts the skin

which leads to the increase of fluid loss and
b. Deep Partial Thickness
sometimes lead to infection.
 Epidermis / dermis
 We have also scarring which can lead to impaired  very painful
skin integrity and the immunity is also  fluid filled vesicles
compromised that’s why most of the patient are  Red, shiny, wet
placed in a private room to be isolate because - To prevent blister apply cold packs
they are high risk for infection.
 Changes in the functioning the appearance the

body image it depends also how severe is the
burn.
BASIC TYPES
a. Thermal - Caused by flames, flash, scalding
(hot liquid), contact to hot metal, grease
b. Chemical - Inhalation or ingestions of acids,
alkalines, or vesicant
c. Smoke inhalation - Fire, gases, superheated
air-smoke causes respiratory tissue damage
d. Electrical burn - Damage of nerves and vessels 2. FULL THICKNESS
due to electric current  All skin layers and nerve endings, may involve the
- We need also to determine how the muscles, tendons, and bones
patient responds on percentage
 Little or no pain
based on the area of burning total
body surface area.  Eschar-the tough, leathery scab that form over
 Local response - do not exceed with twenty moderate or severe burn area
percent
 Wound is dry, white leathery, or hard
 Systemic response - exceeds Twenty percent

Phases/Stages of Burns
1. EMERGENT PHASE - this is the onset of the burn

injury and last until the completion of that fluid
resuscitation or a period about first 24 hours since the
emergent.
- Our Priority is to maintain airway
- We’re going to treat the client for burn shock prevent
burn shock to happen.
A. Remove the person from the source of burn
- Before you remove you should check area first if it is

safe
 Thermal - smother burn beginning with the

head
 Smoke inhalation - ensure patent airway
 Chemicals - remove clothing
 Electrical - maintain airway, identify entry
and exit route
B. Wrap in dry, clean sheet
C. Assess how and when burn occurred
D. Provide IV route if possible
E. Transport immediately
2. SHOCK PHASE
First degree burn - affect only the outer layer of skin,
- Fluid shift from plasma to interstitial causing
the epidermis. The burn site is red, painful, dry, and
hypovolemia
with no blisters. Mild sunburn is an example. Long-
- Low level of fluids
term tissue damage is rare and often consists of an
increase or decrease in the skin color. Assessment findings: Sign of dehydration, BP,
tachycardia, urine output, thirst
Second degree burn - affects both the epidermis and
the second layer of skin (dermis). It may cause  Hypovolemia this is the immediate consequence
swelling and red, white or splotchy skin. Blisters may once there is a fluid loss because of the decreased
develop, and pain can be severe. Deep second-degree perfusion or oxygen delivery.
burns can cause scarring.  Cardiac output might be decreased before any
significant change with regards to the fluid
Third degree burn - are deep, severe burns that
volume which is very evident.
completely damage the skin. Causes can include
 Sometimes the patient would also experience
exposure to flames, explosions, or strong chemicals.
rapid edema after burn injury.
People with third degree burns need immediate
 Your circulation should also be assessed to keep it
medical attention from a special burn unit. This can tachycardia because of the blood volume also
help prevent serious complications such as infection decreases you usually during the burn shock.
or shock.
- After burns there is increased vasoconstriction in Diagnostic test - hyponatremia, hypoproteinemia,

response to the substance that was released by the hyperkalemia
injured cells active hormones are released that will
increase the capillary permeability.

 Hyperkalemia - this immediately happen Major
after burn injury would result because of o partial thickness
massive cell destruction o greater than 25% of body surface
 Hypothermia - loss of skin results to inability o Full thickness greater than or equal to 10%
to regulate the body temperature.
o You check the temperature also of
your patient because of that loss of
skin portion.
3. DIURETIC PHASE / FLUID REMOBILIZATION

- Interstitial fluids returns to the vascular space
Assessment findings: Elevated BP, increase urine

output
4. CONVALESCENT - Wound healing
Assessment Focus:
1. EXTENT OF INJURY
 Rule of nines - This method divides the body's
surface area into percentages. The front and
back of the head and neck equal 9% of the
body's surface area. The front and back of
each arm and hand equal 9% of the body's
surface area.
 Lund and Browder - is commonly used to

assess the burned body surface area. Different
percentages are used in paediatrics because
the surface area of the head and neck relative
to the surface area of the limbs is typically
larger in children than adults
2. SEVERITY OF BURN CLASSIFICATION
Minor
o partial thickness (1st/2nd degree) less than 10-
15% of body surface
o full thickness (3rd degree) less than 2% of body
surface
o No burn on area of face, feet, hands or
genitalia
Moderate
o partial thickness (2nd degree) between 15-25%
of body surface
o full thickness less than 10%
o Smoke inhalation

 CATHETERIZATION
- Parameters such as vital signs (heart
rate), urine output, adequacy of
capillary filling, and sensorium status
determine adequacy of fluid
resuscitation.
2. Wound care
o open or closed burn therapy, hydrotherapy
3. Drug therapy
o Topical antibiotic - Silver sulfadiazine
o Systemic antibiotics
o Tetanus Toxoid / HTIG - to prevent further
BASIC BURN TREATMENT infection
o Analgesic - morphine sulfate
A. Minor burns:
o Antibiotic 4. Physical therapy
o analgesic o to prevent disability caused by scarring,
o ointment contracture
o Gauze bandage
5. Surgery
B. Moderate burns: o Escharotomy (an incision made into
o Do not rupture blisters - it will start an constricting eschar to restore peripheral bld.
infection and much more painful Circulation)
o analgesia/antipyretic ointment o Debridement
o Warm water and mild soap
o Burn dressing - bulky dressing - depends on the o Skin grafting
doctors order
C. SEVERE BURN
1. Supportive therapy: fluid management

- Our very goal here is to decrease the
fluid losses
- We have to prevent infection
- We have to control pain and to have
supportive measure
 Crystalloid solutions: lactated Ringer
 COLLOID SOLUTIONS SUCH FFP

- FFP(Fresh Frozen Plasma) is a blood
product it is a form of liquid portion of
full blood we're going to treat uh this is
used to treat condition in which if
there are low blood clotting factor
lower levels of your blood protein
solutions

NURSING INTERVENTIONS
FORMULA
1. Provide relief or control of pain
2. Monitor alterations in fluid and electrolytes

- check the results of your electrolytes imbalances
some other diagnostic tests.
3 Promote maximum nutritional status

- promote maximum or nutritional status for fast
healing.
4 Prevent wound infection
5 Prevent Gl complications
6. Provide health teachings
PARKLAND FORMULA
o Parkland formula this is used to calculate fluid
resuscitation for critical burn patient.
o very useful specifically for patients who sustain
large deep partial thickness, full
o Thickness burn.
o These are the formula that we're going to use
when we have our fluid resuscitation to our
patient.
• LR - Lactated Ringer
BSA - Body Surface Area
4cc X wt in kg X total BSA% (deliver ½ over first 8hrs,

then other ½ over the next 16hrs)
• FFP fresh frozen plasma

- determine the coagulation factor
0.5cc x wt in kg x total BSA% (deliver over the next

four hours following fluids)
• MAINTENANCE (D5W)
1cc X wt in kg X total BSA%

CEREBRAL PALSY
Types of Cerebral Palsy
Description:
- Neuromuscular disorder characterized by

impaired movement and posture resulting
from an abnormality in the extrapyramidal or
pyramidal motor system (pathway connecting
to the structure of your brain)
Neurological condition that damages the motor

system, responsible for movement
- CP is a chronic nonprogressive motor

dysfunction caused by damage to the motor
control centers of the developing brain and
can occur during:  SPASTIC
o Pregnancy - about 75% o tense, contracted muscles (most
o Childbirth – 5% common type of CP
o After birth – 15% up to about age  ATHETOID
three o Constant, uncontrolled motion of
limbs, head, and eyes
Etiology
a. Prenatal – genetic, mother with rubella, Involuntary movement, slow
accidents, PIH  RIGIDITY
b. Perinatal - drugs at delivery, precipitate o Tight muscles that resist effort to
delivery, breech deliveries make them move
c. Postnatal – kernicterus, head trauma (falls
out of crib, car accidents) Resistant to flexion and extension
The most common cause of CP is premature birth of  TREMOR

low birth weight o Uncontrollable shaking, interfering
with coordination
Also watch out baka may lacking supply of oxygen
going to the brain Repeated rhythmic involuntary contraction
early separation of placenta – maybe kulang pa ang  ATAXIC

nutrients na nakuha ng fetus o Poor sense of balance, often causing
falls and stumbles
Ataxic or ataxia is disturbances in the equillibrium

There’s compression in the cord or bleeding
Avoid infection because these infections may cause CP
Eat nutritious food – avoid nutritional deficiency

(affects brain, growth and development of child)
Kernicterus – causes brain damage

Characteristic according to Body’s Topographic
Response
Age Normal Cerebral palsy

development
By 3 months Lies straight on Still legs, cannot
Arm and Leg on one side (Hemiplegic) stomach, holds lift head, cannot
head up well, push up (on
- Arm bent, hand spastic or floppy, often of pushes up arms, arms)
little use lies on back, Pushes back
- She walks on tiptoe or outside of foot on brings two head to one
affected side. hands together side, one arm
- This side(unaffected) completely or almost and leg bent,
normal the other arm
and leg straight,
Both legs only (Paraplegic) or with slight involvement cannot bring
elsewhere (Diplegic) hands together
By 6 months Sits leaning on Cannot lift
- Upper body usually normal or with very minor
hands, takes head, round
signs weight on feet back, stiff arms
- Child may develop contractures of ankles and when held in and fisted
feet standing hands.
Both arms and both legs (Quadriplegic) Head falls back
when he is
- When he walks, his harms, head and even his pulled to sitting.
mouth may twist strangely. Tiptoe standing,
- Children with all 4 limbs affected often have arms pull back,
such severe brain damage that they never are stiff legs which
able to walk. are crossed like
scissors.
- The knees pressed together
By 9 months Sits alone, Round back,
- Legs and feet turned inward
reaches out, poor use of
supports self hands for play,
when placed stiff legs,
standing pointed toes.
Does not take
weight on legs,
poor head lifting

muscles. This reduces muscle spasm or improve
muscle tone.
Clinical manifestation
1. Alteration in muscle tone: abnormal posturing
and movement, continued primitive reflex
response
2. Delay in gross motor skills like sitting crawling,
walking
3. Fine motor coordination may be affected
(self-feeding and dressing)
4. Other deficits: poor vision, Strabismus or
nystagmus, hearing loss, cognitive
By 12 months Pulls to stand Difficulty pulling impairments, speech/language delay, seizure,
holding to stand, still growth problems (FTT-failure to thrive)
something, legs, pointed
Diagnosis: Based on clinical findings
crawls well toes.
Cannot crawl, Treatment: There is no cure for CP
uses only one
side of the body - Intervention enable the infant and child to
or drags self by achieve the best movement, locomotion and
only using… communication skills as possible and
By 18 months Stands and One arm stiff encourage self-sufficiency
walks alone, and bent, tiptoe
moves into and walking on one Patient care management
out of sitting, side, poor - Promotion of optimal rehabilitation in the
sits straight, standing areas of locomotion, communication, and the
uses both hands balance. activities of daily living
Uses mostly one
- Correction of associated disabilities
hand to play,
one leg may be Medical Management
stiff, sits with
weight to one Drug Therapy
side
- Antianxiety
- Skeletal muscle relaxants
Common problems are: - Local nerve block (administration of
anesthesia that causes numbness)
- Visual defects (strabismus, nystagmus,
refractory errors) Speech/ audiotherapy
- Strabismus – eyes do not properly alaign
Physical/ Occupational Therapy
while looking on one object
- Nystagmus – eyes make repetitive Surgical interventions are reserved for the child who
uncontrollable movement does not respond to more conservative measures or
- Refractory – shape of eye does not bend light for the child whose spasticity causes progressive
correctly (eg. Myopia- near sightedness, deformity (orthopaedic surgery – help correct
hyperopia- farsightedness) deformities)
- Hearing loss
- Speech or language delay Nursing Interventions
- Seizures The goal of management is early recognition and
- Mental retardation interventions to maximize the child’s abilities
Dorsal root rhizotomy - a procedure where surgeons A multidisciplinary team approach
locate and sever overactivated nerves that control leg
- Assess the child’s developmental level and
intelligence

- Encourage early intervention and that we can manage the poisoning, mas
participation in school programs better. But if it will take time to look for that
- Prepare for using mobilizing devices (assist in item or object, then do not. We have to rush.
movement) If di expert sa induce vomiting, then do not
- Encourage communication and interaction induce vomiting. Tendency talaga is ilabas
with the child on his or her developmental niya. If di sanay, then rush the patient to the
level rather than chronological age level. nearest hospital for proper management. (GI
disturbances: Naka-NPO si patient, we do not
- Provide a safe environment
introduce anything by mouth. We have to
- Assist in ADL
assess first the area
- Provide safe appropriate toys for the child’s
age and developmental level 2. Respiratory/circulatory disturbances:
- Position the child upright after meals collapse, shock, unexplained cyanosis
- Administer medications as prescribed to (Note if the patient collapsed, note for signs of
decrease spasticity. shock, discoloration, circulation) Check
- therapy everything from head to toes
possible clinical diagnoses: 3. CNS manifestation
- Risk for injuries (seizure) o Confusion
- Impaired physical mobility o Disorientation
- Deficit knowledge o Sudden loss of consciousness
o Convulsion
INGESTION OF POISONS
DIAGNOSIS: Check the blood, urine, toxicology
screening, check electrolytes, AVG testing, electrolyte
POISONING
testing, check the vomitus, and the presence of
poison
• POISON – Any substance that is harmful to the body
o Ingestion of toxic substance TREATMENT AND INTERVENTIONS
GENERAL MEDICAL TREATMENT
Common agent in childhood – Soaps, cosmetics,
detergents or cleaners and plants o Elimination of poisons
o Antidote administration
(There are some toxic plants, but sometimes it’s o General supportive measures
difficult for us to identify which one is toxic or not. If
you are able to identify, keep it away from children) GENERAL INTERVENTIONS
Modes of exposure: 1. Stabilize child’s condition
o Ingestion - Patent airway
o Inhalation
o Spray 2. Prevent absorption (Do not instill or painom
anything to prevent absorption. Magmatter
(Common in toddlers, this is their way to find out din yan anong nainom nya, acid ba, alkaline
about the environment, exploration. With adolescents, ba.)
baka suicide. Sa sobrang depressed, they tend to a. Determine type of substance ingested
isolate, then the next step could be suicidal b. Induced emesis – Except caustic material
tendencies. It is already common to adolescents, ingestion, comatose, active seizure or
remove anything that they can use, especially in a lacking gag reflex
major depressive state.) - Syrup of ipecac (Meron kasi itong
SIGNS AND SYMPTOMS combination, preparation, si ipecac. If you
do not know anything, then do not. What
1. GI disturbances: vomiting, abdominal pain, is this ipecac? It is used for emergency
anorexia, distinctive odor – kung pwede mo treatment of certain kinds of poisoning. It
ma-locate sa area or somebody brought that is used to cause vomiting.)
patient, yun ang nakita niya doon na may na c. Gastric lavage (Para makuha yung
spill or something for proper identification so napasok. Gastric irrigation: there is gastric

irritation. The process of cleaning out the 2. Acetaminophen poisoning = commonly used
contents of the stomach) analgesic
o RISK – liver damage
d. Activated charcoal (Common pa ito dati o Antidote – mucomyst (N-Acetylcysteine)
as one of the emergency treatments for o S/S – vomiting, liver tenderness,
certain kinds of poisoning. It also prevents abdominal pain
poison from being absorbed, para di fully
ma absorb yung poison sa stomach. (Acetaminophen cannot be used together with
e. Cathartic (Laxatives, increase motility of activated charcoal: do not use activated if the doctor
the intestine, increase the bulk of feces, will order acetaminophen.)
mailabas through feces.)
3. Provide treatment and prevention 3. Lead poisoning PLUMBISM
information to parents o Toddlers/preschoolers
o Lead interferes with red blood cell function
4. Incorporate anticipatory guidance related to Lead value of 15ug/dl – health hazard
the developmental stage of the child Symptoms appear when lead level is 70ug/dl
5. Discuss general first aid measures with
parents (in case poisoning will happen again THE MOST SERIOUS EFFECT IS LEAD ENCEPHALITIS
or about poisoning.)
Air, soil, water, houses, ceramic cookware, solder
used in metal cans and pipes
METHODS OF PREVENTION (It is very hard for children less than 7 years old. Lead
will really interfere with normal cell functioning.
1. Child proofing the environment Watch out for CNS function.)
2. Educating parents and child (You always have
to check the surroundings, check if meron S/S: Abdominal complaints- colicky pain,
bang something poisonous diyan na pwede constipation, and vomiting
magalaw ng ating toddler, educate parents if (Colicky pain: Occurs when there is obstruction in your
there is lack of knowledge regarding internal body. In your hollow internal organs like
poisoning) intestine, gallbladder, kidney, and ureters. We have
3. Anticipatory guidance different types of pain, describe the pain further. Is it
4. Understanding and applying the principles of throbbing pain? Radiating pain? Colicky pain? If
G/D nandoon sa intestine/s, sometimes colick.)
SPECIFIC POISONING o Pallor
1. Salicylate poisoning = aspirin, oils of o Irritability
wintergreen o Loss of coordination
o Toxicity begins at doses of 150-200mg/kg. o Encephalopathy
o S/S: CNS depression, vomiting, respiratory o + lead in the blood
failure o (Encephalopathy: There is a disease that
affects your brain)
(With regards to this aspirin, the peak effect is 2-
4hours if tablet. Effect would last 8 hours more or less. NURSING ACTION
Ingestion may be accidental or therapeutic
overdosing. When administering medication, we 1. Administer chelating agents
always have to check baka hindi natin alam if nag Dimercaprol (BAL in oil)
overdose na tayo. Di intended na ipoison si patient but o Not given if allergic to peanuts (prepared in
it led to this one. Lalo na sa bata, because you are peanut oil solution)
going to do computation here, mas matagal Edetate calcium disodium (calcium EDTA)
makabigay ng gamot sa pedia kay magcompute pa 2. Provide nutritional counseling
how many milligrams, consider weight and age. It 3. Aid in eliminating environmental conditions
would lead to hyperventilation, and loss of that led to lead ingestion
consciousness.) (Chelating *KEE-lay-ting* agents: Chemical
compounds in the form of complexes in regards to
metal ions bound to the drug na pwede ma-excrete

safely. Metal ion ito pareho *referring to dimercaprol (Paint chips: Kana ganing mangapaksit sa wall?
and edetate calcium disodium*) Crayons are for coloring, pero sa kanila asan na
mapunta? Pottery contains lead also.)
INGESTION OF POISONS: LEAD
4. Caustic poisoning: Ingestion of strong alkali
o When lead enters the body, it affects the May cause burns and tissue necrosis in the
erythrocytes, bones and teeth, organs and mouth, esophagus, and stomach
tissues, including the brain and nervous May result in significant injury to the entire
system; the most serious consequences are GI.
the effects on the central nervous system. Pharyngeal edema may cause airway
o Chelation therapy: removes lead from the obstruction: intubation might be necessary.
circulating blood and from some organs and (Strong alkali would really result to significant
tissues. (Chemical compounds in the form of injury to your GI. Most significantly, sa upper
complexes by binding those metal ions.) tract. Pagpasok palang, pag-ingest pa lang,
o EDTA – injected into the blood stream, to oropharyngeal, around your larynx,
remove heavy metal and minerals from the esophagus, then the mouth.
body. Pharyngeal edema: abnormal accumulation of
fluid leading to the swelling around the
pharynx.) CHILD ABUSE
- involves emotional or physical abuse or
neglect, as well as sexual exploitation or
molestation by caretakers or other
individuals
- Problem – related to parents limited
ability to cope or relate to the child
- Also victims of abuse
o Parents who were experienced child
abuse handed down to the child
- Physical, Mental, Verbal
EMOTIONAL ABUSE
- Speech disorders
- Habit disorders such as sucking, biting
BLOOD LEAD LEVEL TEST and rocking
Used for screening and diagnosis - Psychoneurotic reactions
o Neurosis – class of functional mental
disorder that involves distress pero
walang delusion, walang hallucination
o The behavior is not outside socially
acceptable norms also known as
Psychoneurosis or Neurotic Disorder
o Example: there’s anxiety when the child
is trying hard and still struggle with
specific skills over time
- Learning disorders
- Suicide attempts
SEXUAL ABUSE
- Torn, stained, or bloody underclothing

- Pain, swelling, or itching of the genitals
- Bruises, bleeding, or lacerations in the
genital or anal area

- Difficulty walking or sitting
- Unwillingness to change clothes or
unwillingness to participate in gym INTERVENTIONS
activities b.
- Poor peer relations o Support the child during a thorough physical
assessment
PHYSICAL ABUSE
o Assess injuries
- Unexplained bruises, burns, or fractures o Report case of suspected abuse; nurses are
- Bald spots on the scalps legally required to report all cases of
- Apprehensive child suspected abuse to the appropriate
- Extreme aggressiveness or withdrawal local/state agency
- Fear of parents o Place the child in an environment that is safe,
- Lack of crying (older infant, toddler, or thereby preventing a further injury
young preschool child) when o Document information related to the
approached by a stranger suspected abuse in an objective manner
o Assess parents’ strengths and weaknesses,
PHYSICAL NEGLECT
normal coping mechanisms, and presence or
- Inadequate weight gain absence of support systems
- Poor hygiene o Assist the family in identifying stressors,
- Consistent hunger support systems, and resources
- Inconsistent school attendance o Refer the family to appropriate support
- Constant fatigue groups
- Reports of lack of child supervision o If shaken baby syndrome is suspected,
- Delinquency monitor the infant’s level of consciousness
IRON DEFICIENCY ANEMIA

GOAL OF CARE
• IRON sotres are depleted, resulting in a decreased
1. Client will be safe supply of iron for the manufacture of hemoglobin in
a. See to it that the environment is not RBC.
safe. You really need to provide
safety; assess further. CAUSES:
2. Child will participate with nurse for emotional - Blood loss
support - Increased metabolic demands
3. Parents will participate in therapy - Syndromes of GI malabsorption
- Dietary inadequacy
NURSING INTERVENTION More common in:

- -Child bearing women
1. Attend to the needs of the child - -Poor iron intake
2. Report suspected child abuse case to - -Infants and children in rapid growth
appropriate agency - -Pregnant/ Lactating mothers
3. Provide role models for parents
4. Encourage parents to be involved in child’s ASSESSMENT
care
5. Encourage parents to express their feelings
- Compensatory tachycardia
6. Provide family education
- Pallor
7. Initiate referrals for long term follow-up
- Weakness, fatigue, irritability
a. If di na deal ang traumatic event na
- Lab results
nangyari sa child, it will lead to certain
disorder if di na manage earlier and
we call that as PTSD – Post Traumatic
Stress Disorder
ETIOLOGY

TWOFOLD
 Decreased production of RBCs 1. Correction of the underlying problem

- IDA responsible or iron deficiency
- Aplastic anemia 2. Replacement of depleted iron stores
 INCREASE DESTRUCTION OF RBCs
- sickle cell anemia MANAGEMENT:
- Thalassemia
- Food choices: meats, dark green & leafy
 Blood loss
vegetables, egg yolks, liver, kidney beans,
- IDA
iron-enriched formula & cereal
- Administer iron supplements as prescribed
MOST COMMON CAUSE OF IDA - Teach parents to administer iron
supplements:
o Inadequate intake of dietary iron in the first o Between meals
few years of life and adolescence. o Give with Vitamin C
o Blood school age o Do not give with antacids or milk
o In third world country - hookworms o Oral care
o Side effects
DIAGNOSIS Monitor signs and symptoms of bleeding
Adequate rest periods
Based on history, clinical presentation, and laboratory Explaination of all diagnostic test
data.
SIGN AND SYMPTOM OF ANEMIA ACCORDING TO CYSTIC FIBROSIS

SEVERITY
- This is a chronic multisystem disorder
1. MILD ANEMIA characterized by exocrine gland dysfunction.
- The Mucus produced by the exocrine glands is
- generally asymptomatic
abnormally thick,tenacious, and copious,
- may experience symptoms of moderate
causing obstruction of the small passageways
anemia during exertion.
of the affected organs, particularly in the
2. MODERATE ANEMIA respiratory,gastrointestinal, and reproductive
systems.
 Effects of compensatory mechanism - Cystic Fibrosis is a fatal genetic disorder and
- Shortness of breath respiratory failure is the most common cause
- Rapid, pounding heart beat of death.
- Dizziness, fainting, lethargy, irritability - There is also marked electrolytes change in the
3. SEVERE ANEMIA secretion of sweat glands.
 Effects of compensatory mechanism The most common symptoms are pancreatic enzyme
- Cardiac murmurs deficiency.
- Congestive heart failure - Caused by duct blockage
- Progressive chronic lung disease
EFFECTS OF TISSUE HYPOXIA - associated with infection, and sweat gland
- Pale skin, mucus membranes, lips, nail beds & dysfunction resulting in increased sodium and
conjunctiva chloride sweat concentrations.
- Impaired healing and loss of skin elasticity
- Thinning and early greying of the hair
- Abdominal pain, , n/v, anorexia
- Low grade fever
TREATMENT

ORGANS AFFECTED:
Airways, Liver, Pancreas. Small intestine, reproductive

tract, skin


18 a fistula
O5
The esophagus terminates before it reaches the
with Problems (Acute & Chronic) stomach, ending in a blind pouch, and/or
22
OUTLINE COMMON HEALTH PROBLEMS DURING INFANCY
I. ESOPHAGEAL ATRESIA
II. HYPERTROPHIC PYLORIC STENOSIS is present that forms an unnatural connection
III. HIRSCHSPRUNG'S DISEASE with the trachea.
IV. INTUSSUSCEPTION  Present lang ang EA when the upper portion of
V. IMPERFORATED ANUS the esophagus fails to connect to the lower
VI. DISPLACED URETHRAL OPENINGS esophagus and the stomach.
VII. DOWN SYNDROME  Mostly talaga mag appear sila together EA and
VIII. AUTISM TEF.
IX. ATTENTION DEFICIT HYPERACTIVITY  Atresia- absence of the normal opening
DISORDER  Fistula – abnormal passage between two internal
organs.
o Type I/ A- lower segments of the esophagus
are blind. Only your esophageal atresia is
present.
Type II/B- upper end of esophagus opens into
the trachea: blind lower segment. Rare type
 Where do our food enters? Esophagus. Here is of EA, the bottom part of the esophagus is
may problem sa connection. Malalaman ito earlier closed. The top section attaches to the
pag mag submit si mother sa prenatal check-up trachea.
because this is one of the congenital concerns. o Type III/C- upper end blind; lower and
 Normally, the esophagus and the trachea is connects into trachea. Most common.
normally separated. TEF occurs with related o Type D is esophageal atresia with both a
condition, marelate sya sa esophageal Atresia proximal and distal TEF, it is rare at 3%.
(EA). Kaya naka-slash yan sya. TEF means trachea o Type E esophageal atresia is just an isolated
esophageal fistula. tracheoesophageal fistula without associated
 EA is the esophagus does not connect to the esophageal atresia. Esophagus is intact here
stomach. TEF, esophagus and traches do not and connects normally to the stomach.
connect correctly. If happens, the food will be
ESOPHAGEAL ATRESIA
aspirated. Ma-inhale natin into our lungs.
 Feeding into the stomach directly could lead to
reflux (aspiration sa food or acid).
 It could also be one or more fistula may be
present between the malformed esophagus.
 EA – they cannot effectively swallow the amniotic
fluid. o With regards with our EA and TEF, this results
 Both resulting to abnormal development before from defective lateral separation between
birth, meron na dun problem with the tube that the esophagus and trachea that form
carries food from the mouth to the stomach. secondary to the defect.
 Early development of esophagus and trachea  Clinical Manifestation:
begins in a single tube that normally divides (4-8 1. Excessive amount of secretions constant
weeks after conception). If this separation does drooling large secretion from the nose
not occur separately this will lead to EA. No cause 2. Intermittent/unexplained cyanosis
known but there are contributing factors to 3. Coughs and chokes
consider. 4. Fluids returns through nose and mouth
5. Regurgitation & vomiting
6. Abdominal distention

7. Inability to pass a small catheter through 8. 2. Maintain patent airway; continued use of
The mouth or nose into the stomach. incubator
 Diagnostic Evaluation: 3. Suction as needed, change position
1. X-ray of abdomen and Chest X-ray frequently; avoid hyperextension of neck
2. X-ray with radiopaque catheter 4. Maintain IV fluids, antibiotics, and parenteral
3. Insertion of a catheter nutrition as prescribed.
 Management: 5. Maintain adequate nutrition-gastrostomy
o Includes maintenance of: 6. Monitor strict intake and output.
 a patent airway 7. Monitor daily weight.
 prevention of aspiration pneumonia 8. Inspect the surgical site for signs and
 gastric or blind pouch decompression. symptoms of infection.
 supportive therapy 9. Monitor for anastomotic leaks as evidenced
 surgical repair by purulent drainage from the chest tube,
1. Drug Therapy increased temperature, and increased white
 Antibiotics for respiratory infection blood cell count.
2. Surgery 10. Observe for signs of stricture at the
 Primary repair - esophageal anastomosis anastomosis site (e.g. poor/refusal to feed,
 Gastrostomy- feeding dysphagia, drooling, regurgitated undigested
 Esophagostomy- drain secretions food).
 Gastrotomy Tube Placement
The prognosis of EA is treated successfully. However,
after the surgery, some infants cannot eat a week
after surgery so they are more on fluids. Kanina may
reflux kasi one complication of EA is Gerd. There is scar
tissue that can cause long term issues that with
regards to EA. Iwasan natin na mag lead to Gerd.
so with babies with EA it needs to have a continuous

 if there EA/TEF, gastronomy may be treatment including those medications kung wala pa
an option. nag proceed with surgery, so mag didiscuss na naman
 Sometimes, laparotomy. yan. You have to make sure na may healthy breathing,
 When the baby is ventilated with healthy eating ang patient. So the problem in EA is
high pressure, gastronomy offer a the connectivity of the esophagus and trachea. How
route to decrease the resistance. will the baby adjust with this condition, kailan maka
 Pre-operative Interventions: kain, and always consider na surgical signs kasi prone
1. The infant may be placed in an incubator or with infection.
radiant warmer with high humidity
(intubation and mechanical ventilation may  Orogastric Tube
be necessary if respiratory distress occurs).
2. Upright position.
3. Maintain an NPO status. - kaysa naman mag
vomit
4. Regular suctioning- if there is difficulty
breathing
5. Maintain IV fluids or hyperalimentation as HYPERTROPHIC PYLORIC STENOSIS
prescribed.  One of the most common GI disorders in early
6. Observe closely for: infancy
 vital signs; respiratory behavior  Common GI obstruction
 amount of secretions  Congenital hypertrophy of the circular muscles of
 abdominal distention (baka may the pylorus in the stomach; the muscle becomes
maraming fluids) progressively thickened and elongated with
 skin color (cyanosis) narrowing of the pyloric canal.
 Post-operative Interventions
1. Monitor respiratory status.

 The PYLORIC STENOSIS HYPERTROPHY is a circular  When you say elongated pylorus with
muscle fiber of the pylorus, there is narrowing narrow lumen, we term that string sign.
along the lumen. 5. Olive-shaped mass is in the epigastrium just
 There is a narrowing of the lumen and the pylorus right of the umbilicus.
thickens and there is this consistency resembling 6. On barium enema, string sign can be seen
the cartilage already.  Barium Enema- abnormal retention of
 There is an obstruction when there is a narrowing the barium in the stomach and there is
of the distal canal of the stomach on the end part increased peristalsis
and becomes dilated. 7. Dehydration and malnutrition can occur.
8. Electrolyte imbalances can occur.
 Sometimes, yellowish skin color or
jaundice may occur
Also, watch out for that mass if it is

 The stenosis usually develops in the first few palpable. If it is palpable, it is firm non-
weeks of life, causing projectile vomiting, tender, medjo magalaw pero matigas.
dehydration, metabolic alkalosis, and failure to  Assess through ultrasound, lab tests,
thrive. electrolytes, pH level, BUN, creatinine to
There’s obstruction so ang tendency, pataas sha note if there is pyloric stenosis. Also,
insted of pababa radiography and xray
 Management
 Assessment o Fredet-Ramstedt Pyloromyotomy
1. Vomiting that progresses from mild  splits the hypertrophic pyloric muscle
regurgitation to forceful and projectile down to the submucusa ,allowing
vomiting pylorus to expand so that food may pass
 projectile vomiting- is when the baby o Some also will give IV with atropine.
brings up the stomach content in a  Nursing Interventions
forceful way 1. Monitor vital signs.
2. Vomitus contains gastric contents such as milk 2. Monitor strict intake and output.
or formula, may contain mucus, may be blood 3. Obtain daily weights.
tinged, and does not usually contain bile. 4. Monitor for signs of dehydration and
 Do not just note vomitus. You have to electrolyte imbalances.
describe that vomitus and those 5. Feed by gavage
stomach content na nalabas.  Thickened feedings
3. Exhibits hunger and irritability.  Slowly upright
 Burp frequently
6. Prepare the child and parents for surgery if
prescribed.
 Pyloromyotomy
 Pre op
- Monitor hydration status
- Correct F/E imbalances
- NPO (if di na NPO, they can
4. Peristaltic waves are visible from left to right
have small frequent feeding)
across the epigastrium during or immediately
- Monitor character of stools
following a feeding.

-
NGT (pag magpa ngt check the
peristaltic movement, check
ang tube)
 Post operative
- Monitor intake and output Start
SFF (para di mabigla si patient)
- Feed slowly, upright (para di ma
choke)
- Monitor for abdominal
distention (minsan bakai di na The disease may be a familial congenital defect or
side effect ng antibiotic kasi may be associated with other anomalies such as Down
sometimes, mahina ang syndrome and genitourinary abnormalities.
metabolism ) 4 methods,
inspect, palpate, auscultate, The affected colon becomes dilated because it is filled
percuss with feces and gas.
- Monitor for signs of infection
- Instruct parents on wound care
and feeding
 NSG Dx
o Imbalance nutrition less than body
requirement
o Deficit fluid volume
o Impaired oral mucous membrane
o Family coping
HIRSCHSPRUNG'S DISEASE (AGANGLIONIC

MEGACOLON)
 Absence of ganglion cells in a portion of the large
intestine
o nerve cell leads to Delayed meconium passage
 Is a parasympathetic nerve cells that regulates
so pag di ka makatae ng ilang araw what will
peristalsis in the intestine
happen? Edi na constipated ka later
 The absence of the ganglion cells would result to
o ito pa naman ang problem.ng ating mga
absence peristalsis and affected colon becomes
infant, ng mga baby, constipated sila,
dilated and filled with feces and gas (Hindi nalabas
karamihan sa kanila but it doesn't mean na
ang feces kasi walang peristalsis which lose their
lahat sila may Hirschsprung's disease
ability to move stool to the intestine.)
o Kailangan natin ma-assess kung gano katagal
 The disease may be a familial congenital defect or
ang kaniyang constipation
may be associated with other anomalies.
o Sometimes concerning our infant, newborn,
 such as Down syndrome and genitourinary
and even out toddlers, they experience
abnormalities.
constipation
AGANGLIONIC- A means absence of ganglion cells in o So if there is constipation it will sometimes
the portion of the large intestine. It is a Birth defect, a lead to Intermittent progressive abdominal
developmental disorder characterized by the absence distention
of ganglion cells in the colon that could result in  so andoon lang kain ka tapos di na ilabas
functional obstruction in the area  watch your superficial veins due to thin
abdominal wall which leads to
respiratory distress
o paglumabas na accumulated na so large fecal
masses, the infant mahirapan siya maglabas
so iyak ng iyak
 Di natin alam na there could be
sometimes na dahil naliit ang butas ng

anus or anal area so ang tendency baka abdominal distension there might be varying signs and
magbleed or bleeding symptoms from one person to another but the
 with this one may absence of ganglions response can occur as an isolated problem or as part
that would really push or magmove sa of that disorder that affects multiple organ systems
feces respiratory.
 so when certain nerve cells in the wall of
what do you assess? failure to pass, meconium stool,
the colon do not form in the right way
when the fetus is goin in congenital refusal to suck maybe because of this one abdominal
 If person does not have Hirschsprung's distension, vomitus
disease, large muscles move gas and  Diagnostic Studies
stool to that colon o Rectal
 The nerve cells is the one helping to  to determine what is inside
move those stools  small instrument minsan nga iniinsert
 Foul odor of breath and stools, syempre lang doon sa rectum para makakuha
pag hindi na nailabas tayo ngsample tissue to check if there is
o gas and stool get back up and this can cause a presence of nerve cells
partial or pagnandoon si stool sa loob total o biopsy.
bowel obstruction. They have problem passing  a sample can be collected using the
that gas and stools. almost all children will suction device to examine under the
Hirschsprung's option nila is surgery kaya lang microscope to determine whether the
hindi kaagad nila masurgery kasi nga iyong nerve cells are missing
child very young so hintayin pa nila lumaki
whether the child is really experiencing this  Management
kind of problem already. o Surgery
o can be one of birth defect because of the  remove the disease section of the
absence of your nerve cells intestine
o There may be a varying signs and symptoms  ano iyong nangyari sa intestine ng child,
from one person to another but hischsprung's ano iyonh involved
can occur as a isolated problem or part of a  mininal invasive technique
disorder that affects multiple organ system  Temporary colostomy
 Assessment Findings  A portion of the large intestine is
o Newborn brought through the abdominal
 Failure to pass meconium stool wall to carry stool out of the body
 Refusal to suck  Colostomy bag doon ang labasan ng
 syempre kasi feeling niya busog stool
siya pero actually hindi  monitor every shift ang colostomy
bag kung ano iyong content
 Abdominal distention  Bowel repair
 Bile-stained vomitus  Dissection and removal of the
meconium is the dark sticky substance present in the affected section with anastomosis
of intestine
intestine at birth, first bowel movememt after birth.
 Abdominal-perineal pull through
Problem with Hirschsprung is failure to pass first stool
 Nursing Management
(observe for the 1st 24 hrs to 48 hrs paghindi baka
1. Administer enema as ordered with Isotonic
hirschsprung)
solution only
2. Do not treat loose stools - child is constipated
o Children 3. Administer TPN (Total Parenteral Nutrition)
 Failure to gain weight and delayed 4. Instruct parents on colostomy care, correct
growth diet
 Abdominal distention o follow proper diet
 Vomiting o di mag sige pakain
 Constipation alternating with diarrhea o ang mga bata drink little water
 Ribbon-like and foul-smelling stools

opagumiyak ng grabe nahirapan siya  Cause is unknown
magpass ng stool
 Management
o Isotonic enema
 solution that has the same salt
concentration with the cells in the blood
 Salt Solution: 0.9 NaCl (Sodium chloride)
 Physiologic salt solution o Notice ito ating colon
 check osmotic pressure ng isotonic o pag may madetect sa Ultrasound o may
solutions makita
 di pwede maraming tubig dapat tama o Though polyps are benign kahit na benign
tama lang you still need to let it remove kasi baka
 we cannot drink beyond 8 glasses, has magdevelop into malignant
limitation kay usually pagmaginom ka ng o the obstruction could cause swelling leads
tubig mafull imong abdomen kaya to intestinal injury
becareful with this iso solution o most cases could be because of a virus
o Drug Therapy which leads to swelling on the lining of the
 Antibiotic intestine
 stool softners  Factors
 common ang stool softener sa mga 1. Hyperperistalsis and unusual mobility of
bata kaya di ito nawawala cecum and ileum (part of large intestine)
 lalo na pagka 3rd day wala pa 2. Lesion such as polyp and tumor
nakalibang si Infant  It is considered a surgical abdominal
 you noticed that even at home emergency in children
some children take stool softener  Mechanical Bowel Obstruction Occurs:
(2-3 days)  intestinal walls press against each
 should be as ordered other causing inflammation, edema
o Diet Therapy and decreased blood flow
 Low residue diet  May progress to necrosis, perforation
 Prescribed in Inflammatory bowel and peritonitis.
diseases  if not treated it may progress
 may mga infection  Gangrene of the bowel
 Clinical Presentation.
INTUSSUSCEPTION 1. Sudden onset of abdominal pain (in a
healthy baby)
 one part of intestine slides inside another
 bigla magreklamo ng pain
 patient experiences painful disorder
2. Infant cries out sharply and draws knees up
 most common abdominal emergency that affects
to abdomen
young infant usually 2 yrs old
 knee-chest position
 could be mixed of blood mucus sa stool niya
3. Vomiting occurs and increases overtime (Bile
parang jelly type
stained vomitus)
 This telescopic action often blocks food or fluid
4. Currant jelly stool
from passing through that area
 because of the mucus and the blood
 naka cut off ang blood supply dahil may blockage,
5. Signs of shock
affecting intestine and may lead to tear in the
6. (+) for Occult blood in stools
bowel and if may tear sa bowel may infection or
7. Sausage-shaped mass in RLQ
perforated na ang area then maglead to death of
bowel tissue dahil nga wala ng blood supply note: main symptom is severe abdominal pain,
 Invagination or telescoping of a portion of the crampimg, painful episodes (10-15 minutes or minsan
small intestine into a more distal segment of the matagal pa) magwala tas magbalik
intestine
 3 times more likely in boys than girls and the
common cause of intestinal obstruction in
childhood.

8. 6. blood in the feces that is not visibly
apparent unlike other blood in stool (hidden
blood in the stool)
 Diagnosis
o Often based on history and physical
examination alone
o Barlum enema
 Is definitive (in 75% of cases)
 It is therapeutic and curative in most o is a surgery that removes any part of the
cases with less than 24-hour duration bowel so that includes your small intestine,
 Certain xray exam that tells us any your large intestine, or the rectum. it's used
abnormalities in the large intestine or to treat diseases and then it's also used with
colon. anyone who's blockage of the large intestine
 Enema - that is there is injection of or blockage little around that colon.
that liquid into your rectum  Nursing Management
o Digital rectal exam 1. Provide routine pre- and post-operative care
 reveals mucous, blood for (monitor VS, assessment, intake and
 May makapa ba tayo diyan. May Makita output) abdominal surgery (care for
ba tayo na mucous or blood sa digital abdomen. Kayo mag assess on that area)
rectal exam 2. Monitor fluid and electrolyte status- monitor
 Kaya if masakit ang tiyan, baka hindi lang fluid and electrolyte
siya gutom baka ito na yung problem 3. Maintain nutrition and hydration
 It is assessment in the lower rectum. 4. Resume feedings 24 hours post operative-
Check if may mga blockage or may mga kapag may bowel movement you can ask the
problem diyan or prostate problem. Could patient “naka utot naka maam?”, “naka ihi
be benign or it could be a prostate cancer naka maam?” or kapag hindi pa makagalaw
no need to give resume eating food. Soft diet
lang.
IMPERFORATED ANUS
 Congenital malformation in which there is no anal
opening or there is stricture of the anus
 Etiology is unknown
 Immediate Treatment.  An arrest in embryonic development on 7th to 8th
o IV fluids week of intrauterine life
o NPO status  Pag imperforated meaning may blockage diyan.
o Diagnostic barium enema  A membrane remains and blocks the union
 Surgery between the rectum and the anus
o manual reduction of invagination  Rectum and the anus and in pouch do not connect
o resection with anastomosis with the colon. By rectum and among opening to
o possible colostomy (gangrenous) other.
o we need to determine the segments of the  there is a stenosis of the anus kaya ditto close
intestines. we need to imaginate into the  Blind rectal pouch with normal anus
adjoining intestinal lumen kasi baka doon
nag cause ng blockage. Pag hindi nakaya ng
IV fluids, NPO ipa surgery nalang talaga
because of that obstruction.
 Bowel Resection and colostomy
 Clinical Presentation
1. No stool passage with in 24 hours after birth

2. Meconium stool from other orifice DISPLACED URETHRAL OPENINGS
3. Only a dimple indicates the site of the anus
 Normally orifice is place at the tip of glans penis
4. Inability to insert thermometer
(male) and clitoris (female) pero here na displaced
 Diagnosis - Digital rectal exam
siya
o Ultrasound
 HYPOSPADIAS
o Abdominal X-rays
o Males: urethra opens on the lower surface of
o Wangesteen-rice method - is a method to
the penis Females: urethra opens into the
determine the relationship of our perennial
vagina
skin
 EPISPADIAS
 Management NPO, NGT
o Only in males
o Manual dilatation
o Urethra opens on the dorsal surface of the
o Surgery
penis
 Anoplasty – construction of the anus to
o Congenital absence of the upper wall of the
correct the anal stenosis which is
urethra
narrowing of the canal that cause a
o If may ganitong condition gina delay muna
painful bowel movement. Mag anoplasty
ang circumcision (first skin is used to cover
sila to open and drain the stool
the meatus
 Temporary colostomy
o Present at birth. A rare congenital
o Antibiotics
abnormality that involves the opening of the
urethra
o Dito yung urethra, the tube that urine exits.
o The urethra opens in the top of the penis
rather than the tip this is a tip that's on the
top opening
 Procreation may be interfered with in severe
 Management: cases
1. If suspected, do not take rectal temperature-  Increased risk of urinary tract infection
Baka mabutas sa kaka insert mo  MANAGEMENT:
2. Pre-operative care 1. Circumcision is delayed until surgical repair
 Monitor for the presence of stool in the 2. Surgical repair
urine and vagina (indicates a fistula) and  Meatotomy (is done because meatus is
report immediately. too narrow )
 Administer IV fluids as prescribed
 Prepare the child and parents for the
surgical procedures, including the
potential for colostomy. Mag colostomy
muna sila before surgery
3. Post-operative Care
 Expose perineum to air
 Check bowel sounds
 NGT for gastric decompression- if you're
going to apply this one you're going first
to remove the contents of the stomach to
the use of the NGT. Clear muna natin ang
tiyan
 Change position frequently
 Oral feeding started gradually as soon as
peristalsis function returned
 Instruct DOWN SYNDROME
the parents to use only a water-
soluble lubricant and to insert the dilator  Chromosomal disorder caused by the presence of
no more than 1 to 2cm all or part of an extra 21st chromosome.
 Pag naka NPO, IV fluid si baby

 It can affect person’s cognitive ability, physical
growth, moderate developmental issues.
Presence of higher risk of some health condition.
 like what all cells in the body contain the genes
that are grouped along chromosomes. So dito
there are normally 46 chromosomal cells so 23
inhabited from the mother 23 from the father.
 It is named after John Langdon Down, the British
doctor who described the syndrome in 1866.
 The disorder was identified as a chromosome 21
trisomy  flattened nose and face upwards slanting
 it may really be associated with the physical eyes
condition, the physical growth is delayed there  intellectual and developmental problems
might be a mild to moderate intellectual disability, may be mild, moderate, or severe
sometimes we could see also facial features  some of them are healthy some are not.
 the average IQ of this young adult usually with they have significant health problems, and
down syndromes is 50% equivalent to the mental they have some serious health condition
ability of eight years old or nine years old  soft skin
 cognitive developmental profile should really be
assessed, suggestive to mild to moderate
intellectual disability however cognitive
development and intellectual ability are
sometimes highly variable.
 Might have an error in cell division due to
chromosomal defect (extra chromosome)
 have physical, mild to moderate (can be severe)
cognitive impairment, IQ = 50-69% (or 8-9 yo),
moderate developmental issues
 23F + 23M = 46
 Assessment Findings:
1. Small head, flat facial profile
2. Low-set ears
3. Simian creases
4. 40% congenital heart defects
5. With moderate retardation
they are different in certain degree or not at all certain

physical characteristics. some of them have this low Brushfield spots = kerotoconus or thin cone shape
muscle tone (hypotonia) cornea dt inc pressure (refractive error)
6. Wide space between 1-2nd toes 8. defective motor skills

 Management:
they don't develop motor skills in the same way the
1. Prevent respiratory infections
typical developing child does. You can know motor
 Clearing the nose
functional motor skills
 Cool mist vaporizer
7. Lax muscle tone- low muscle tone of  Chest physiotherapy
hypotonia  Handwashing and avoiding exposure to
infection.
2. When feeding infants and young children, use
a small, straight-handled spoon to push food
to the side and back of the mouth. (Short but
fat tongue)
3. Encourage fluids and foods rich in fiber.

4. Constipation results from decreased muscle 3. Obvious limited activities/interest
tone, which affects gastric motility.  Clinical presentation
5. Provide good skin care because the skin is dry 1. Infant not responsive to cuddling
and prone to infection. 2. No eye contact or facial responsiveness
6. Family education 3. Impaired/no verbal communication
 Counseling 4. Echolalia
 developmental progress  Mimic verbalization or parroting all your
7. better language skills and ability to words to the extent that is already
communicate exasperating.
 E.g. mimicking peppa pigtypical behavior
AUTISM of autism
 Severe mental disorder beginning in infancy or 5. Inability to tolerate change
toddlerhood 6. Fascination with movement
 Pervasive developmental disorder  Attention is easily caught by movements
 Disorder apparent to the parents before the child 7. Labile moods
is 3 years old  Prolonged temper tantrums
 Characterized by:  Assessment
o Severe deficit in language. 1. Bizzare responses to the environment
o perceptual and motor development  Intense reaction to minor changes
o Defective reality testing  Attachment to objects
o Inability to function in social setting  Intensely preoccupied to moving object
 The cause is unknown, and the prognosis may be 2. Self-absorbed and unable to relate to others.
poor.  Solitary play
 Possible causes:  Preoccupied with their interest
o cause is unknown and prognosis may be poor 3. Repetitive hand movement, rocking, and
1. Unsatisfactory mother-child relationship rhythmic body movement
 Most common  Fidgety or masyadong magalaw na parang
 Can still be corrected if the parent is ‘di mapakali
aware and if they are willing to help the 4. Hitting, head banging, and biting
child  These manifestations are rather severe
 Busy parents, less interaction with child 5. Music often holds a special interest for them
2. CNS abnormalities 6. No delusions, hallucinations, or incoherence
 Pathologic problem  Autism is a mental problem but not
 Diagnosis is established based on symptoms and associated to these.
the use of specialized autism assessment tools. 7. Excellent long-term memory
 tests need for ASD or Asperger’s syndrome  Depending on the interested subject.
 social, communication, behavioral challenges  E.g they are interested to planets, they
 learning and problem solving skills can range to can memorize all the planets. They are
gifted to severely challenged smart this way.
 may be genetically traced, race, socioeconomics 8. May play happily alone for hours but have
 more common in males temper tantrums if interrupted.
 complicated lifelong neurobiological development  Nursing intervention
disorder 1. Provide parents /family with support and
 usually appear in first 2 years information about the disorder
 Characterized by 2. Assist child with ADL
o Severe deficit in language, perceptual and 3. Promote reality testing
motor development  Promote effective communication
o Defective reality testing  Talk at their own level of understanding
o Inability to function in social setting 4. Encourage the child to develop relationship
o Cannot establish eye-to-eye contact with another person
 Categories 5. Maintain regular schedule of activities
1. Inability to relate with others  Involve primary caregiver
2. Inability to communicate 6. Provide constant routine for child

7. Protect from self injury 8. Engaging in physically dangerous activities
8. Provide safe environment without considering the possible
9. Provide seizure precaution consequences
 If cause of autism is CNS problem  Because of impulsivity
 Prone to accidents
Additional Notes:
 Therapeutic Management
 Physical findings: same manifestation o Environment
because of chromosomal disorder  construction of stable environment
 strict instruction, strict activities
ATTENTION DEFICIT HYPERACTIVITY DISORDER  treatment should be fair (dili
 Developmental disorder characterized by bunalan) since the child cannot
inappropriate degrees of inattention, overactivity, understand why they have the
and impulsivity disorder
o usually appears together, but may appear  guide the child to help control their
solo impulsivity
o inattention = short attention span  lengthen, improve attention span
o impulsivity = interrupting others, cannot wait  decrease distractions
o constant motion, difficulty remain in the seat  stimulate health control hyperactive
o cannot be prevented or cures, but can be impulsive behavior
manages sx by mgmt., referral  special instruction free from distractions
 One of the most common reasons for referral of  fair but firm and set consistent limits
children to mental health services o Medications
 Childhood problems include:  controls excessive activity
o Lowered intellectual development  lengthening the attention span
o Some minor physical abnormalities  decreasing the distractibility
o Sleeping disturbances  Interventions
o Behavioral or emotional disorders 1. Provide environmental and physical safety
o Difficulty in social relationships. measures.
 Diagnosis 2. Encourage support groups for parents.
o Established on: 3. Administer prescribed medication; some
 parent and teachers reports commonly prescribed medications that
 psychological assessments (Only arise if include:
parents report and if there is teacher  methylphenidate hydrochloride (Ritalin).
referral)  pemoline (Cylert), and
o Diagnosable by 36 months  dextroamphetamine sulfate (Dexedrine).
 During toddlerhood - start of 4. Inform the child and parents that positive
socialization effects of the medication may be seen within
o 3 major characteristics revealed before 7 1 to 2 weeks
years of age
 Assessment
1. Fidgets with hands or feet or squirms in the REFERENCES
seat
 restless “PROF’S PPT ON QUIPPER AND LECTURE”
 Because of the impulsivity
2. Easily distracted with external or internal
stimuli
3. Difficulty with following through on
instructions
4. Poor attention span
5. Shifting from one uncompleted activity to
another
6. Talking excessively
7. Interrupting or intruding on others

18
22 O5
OUTLINE COMMON HEALTH PROBLEMSisDURING
present INFANCY
that forms an unnatural connection
with the trachea.
X. ESOPHAGEAL ATRESIA  Present lang ang EA when the upper portion of
XI. HYPERTROPHIC PYLORIC STENOSIS the esophagus fails to connect to the lower
XII. HIRSCHSPRUNG'S DISEASE esophagus and the stomach.
XIII. INTUSSUSCEPTION  Mostly talaga mag appear sila together EA and
XIV. IMPERFORATED ANUS TEF.
XV. DISPLACED URETHRAL OPENINGS  Atresia- absence of the normal opening
XVI. DOWN SYNDROME  Fistula – abnormal passage between two internal
XVII. AUTISM organs.
XVIII. ATTENTION DEFICIT HYPERACTIVITY o Type I/ A- lower segments of the esophagus
DISORDER are blind. Only your esophageal atresia is
present.
Type II/B- upper end of esophagus opens into
the trachea: blind lower segment. Rare type
ESOPHAGEAL ATRESIA
of EA, the bottom part of the esophagus is
 Where do our food enters? Esophagus. Here is closed. The top section attaches to the
may problem sa connection. Malalaman ito earlier trachea.
pag mag submit si mother sa prenatal check-up o Type III/C- upper end blind; lower and
because this is one of the congenital concerns. connects into trachea. Most common.
 Normally, the esophagus and the trachea is o Type D is esophageal atresia with both a
normally separated. TEF occurs with related proximal and distal TEF, it is rare at 3%.
condition, marelate sya sa esophageal Atresia o Type E esophageal atresia is just an isolated
(EA). Kaya naka-slash yan sya. TEF means trachea tracheoesophageal fistula without associated
esophageal fistula. esophageal atresia. Esophagus is intact here
 EA is the esophagus does not connect to the and connects normally to the stomach.
stomach. TEF, esophagus and traches do not
connect correctly. If happens, the food will be
aspirated. Ma-inhale natin into our lungs.
 Feeding into the stomach directly could lead to
reflux (aspiration sa food or acid).
 It could also be one or more fistula may be
present between the malformed esophagus. o With regards with our EA and TEF, this results
 EA – they cannot effectively swallow the amniotic from defective lateral separation between
fluid. the esophagus and trachea that form
 Both resulting to abnormal development before secondary to the defect.
birth, meron na dun problem with the tube that  Clinical Manifestation:
carries food from the mouth to the stomach. 8. Excessive amount of secretions constant
 Early development of esophagus and trachea drooling large secretion from the nose
begins in a single tube that normally divides (4-8 9. Intermittent/unexplained cyanosis
weeks after conception). If this separation does 10. Coughs and chokes
not occur separately this will lead to EA. No cause 11. Fluids returns through nose and mouth
known but there are contributing factors to 12. Regurgitation & vomiting
consider. 13. Abdominal distention
 The esophagus terminates before it reaches the 14. Inability to pass a small catheter through 8.
stomach, ending in a blind pouch, and/or a fistula The mouth or nose into the stomach.
 Diagnostic Evaluation:

4. X-ray of abdomen and Chest X-ray 13. Suction as needed, change position
5. X-ray with radiopaque catheter frequently; avoid hyperextension of neck
6. Insertion of a catheter 14. Maintain IV fluids, antibiotics, and parenteral
 Management: nutrition as prescribed.
o Includes maintenance of: 15. Maintain adequate nutrition-gastrostomy
 a patent airway 16. Monitor strict intake and output.
 prevention of aspiration pneumonia 17. Monitor daily weight.
 gastric or blind pouch decompression. 18. Inspect the surgical site for signs and
 supportive therapy symptoms of infection.
 surgical repair 19. Monitor for anastomotic leaks as evidenced
3. Drug Therapy by purulent drainage from the chest tube,
 Antibiotics for respiratory infection increased temperature, and increased white
4. Surgery blood cell count.
 Primary repair - esophageal anastomosis 20. Observe for signs of stricture at the
 Gastrostomy- feeding anastomosis site (e.g. poor/refusal to feed,
 Esophagostomy- drain secretions dysphagia, drooling, regurgitated undigested
 Gastrotomy Tube Placement food).
The prognosis of EA is treated successfully. However,

after the surgery, some infants cannot eat a week
after surgery so they are more on fluids. Kanina may
reflux kasi one complication of EA is Gerd. There is scar
tissue that can cause long term issues that with
regards to EA. Iwasan natin na mag lead to Gerd.
 if there EA/TEF, gastronomy may be so with babies with EA it needs to have a continuous
an option. treatment including those medications kung wala pa
 Sometimes, laparotomy. nag proceed with surgery, so mag didiscuss na naman
 When the baby is ventilated with yan. You have to make sure na may healthy breathing,
high pressure, gastronomy offer a healthy eating ang patient. So the problem in EA is
route to decrease the resistance. the connectivity of the esophagus and trachea. How
 Pre-operative Interventions: will the baby adjust with this condition, kailan maka
7. The infant may be placed in an incubator or kain, and always consider na surgical signs kasi prone
radiant warmer with high humidity with infection.
(intubation and mechanical ventilation may
be necessary if respiratory distress occurs).  Orogastric Tube
8. Upright position.
9. Maintain an NPO status. - kaysa naman mag
vomit
10. Regular suctioning- if there is difficulty
breathing
11. Maintain IV fluids or hyperalimentation as
prescribed. HYPERTROPHIC PYLORIC STENOSIS
12. Observe closely for:  One of the most common GI disorders in early
 vital signs; respiratory behavior infancy
 amount of secretions  Common GI obstruction
 abdominal distention (baka may  Congenital hypertrophy of the circular muscles of
maraming fluids) the pylorus in the stomach; the muscle becomes
 skin color (cyanosis) progressively thickened and elongated with
 Post-operative Interventions narrowing of the pyloric canal.
11. Monitor respiratory status.  The PYLORIC STENOSIS HYPERTROPHY is a circular
12. Maintain patent airway; continued use of muscle fiber of the pylorus, there is narrowing
incubator along the lumen.

 There is a narrowing of the lumen and the pylorus 14. On barium enema, string sign can be seen
thickens and there is this consistency resembling  Barium Enema- abnormal retention of
the cartilage already. the barium in the stomach and there is
 There is an obstruction when there is a narrowing increased peristalsis
of the distal canal of the stomach on the end part 15. Dehydration and malnutrition can occur.
and becomes dilated. 16. Electrolyte imbalances can occur.
 Sometimes, yellowish skin color or
jaundice may occur
 Also, watch out for that mass if it is

palpable. If it is palpable, it is firm non-
 The stenosis usually develops in the first few tender, medjo magalaw pero matigas.
weeks of life, causing projectile vomiting,  Assess through ultrasound, lab tests,
dehydration, metabolic alkalosis, and failure to electrolytes, pH level, BUN, creatinine to
thrive. note if there is pyloric stenosis. Also,
There’s obstruction so ang tendency, pataas sha radiography and xray
insted of pababa  Management
o Fredet-Ramstedt Pyloromyotomy
 Assessment  splits the hypertrophic pyloric muscle
9. Vomiting that progresses from mild down to the submucusa ,allowing
regurgitation to forceful and projectile pylorus to expand so that food may pass
vomiting o Some also will give IV with atropine.
 projectile vomiting- is when the baby  Nursing Interventions
brings up the stomach content in a 7. Monitor vital signs.
forceful way 8. Monitor strict intake and output.
10. Vomitus contains gastric contents such as milk 9. Obtain daily weights.
or formula, may contain mucus, may be blood 10. Monitor for signs of dehydration and
tinged, and does not usually contain bile. electrolyte imbalances.
 Do not just note vomitus. You have to 11. Feed by gavage
describe that vomitus and those  Thickened feedings
stomach content na nalabas.  Slowly upright
11. Exhibits hunger and irritability.  Burp frequently
12. Prepare the child and parents for surgery if
prescribed.
 Pyloromyotomy
 Pre op
- Monitor hydration status
- Correct F/E imbalances
- NPO (if di na NPO, they can
have small frequent feeding)
12. Peristaltic waves are visible from left to right
- Monitor character of stools
across the epigastrium during or immediately
- NGT (pag magpa ngt check the
following a feeding.
peristaltic movement, check
 When you say elongated pylorus with
ang tube)
narrow lumen, we term that string sign.
 Post operative
13. Olive-shaped mass is in the epigastrium just
right of the umbilicus.

- Monitor intake and output Start The disease may be a familial congenital defect or
SFF (para di mabigla si patient) may be associated with other anomalies such as Down
- Feed slowly, upright (para di ma syndrome and genitourinary abnormalities.
choke)
The affected colon becomes dilated because it is filled
- Monitor for abdominal
with feces and gas.
distention (minsan bakai di na
side effect ng antibiotic kasi
sometimes, mahina ang
metabolism ) 4 methods,
inspect, palpate, auscultate,
percuss
- Monitor for signs of infection
- Instruct parents on wound care
and feeding
 NSG Dx
o Imbalance nutrition less than body
requirement
o Deficit fluid volume
o Impaired oral mucous membrane
o Family coping
o nerve cell leads to Delayed meconium passage
HIRSCHSPRUNG'S DISEASE (AGANGLIONIC so pag di ka makatae ng ilang araw what will
MEGACOLON) happen? Edi na constipated ka later
o ito pa naman ang problem.ng ating mga
 Absence of ganglion cells in a portion of the large
infant, ng mga baby, constipated sila,
intestine
karamihan sa kanila but it doesn't mean na
 Is a parasympathetic nerve cells that regulates
lahat sila may Hirschsprung's disease
peristalsis in the intestine
o Kailangan natin ma-assess kung gano katagal
 The absence of the ganglion cells would result to
ang kaniyang constipation
absence peristalsis and affected colon becomes
o Sometimes concerning our infant, newborn,
dilated and filled with feces and gas (Hindi nalabas
and even out toddlers, they experience
ang feces kasi walang peristalsis which lose their
constipation
ability to move stool to the intestine.)
o So if there is constipation it will sometimes
 The disease may be a familial congenital defect or
lead to Intermittent progressive abdominal
may be associated with other anomalies.
distention
 such as Down syndrome and genitourinary
 so andoon lang kain ka tapos di na ilabas
abnormalities.
 watch your superficial veins due to thin
AGANGLIONIC- A means absence of ganglion cells in abdominal wall which leads to
the portion of the large intestine. It is a Birth defect, a respiratory distress
developmental disorder characterized by the absence o paglumabas na accumulated na so large fecal
of ganglion cells in the colon that could result in masses, the infant mahirapan siya maglabas
functional obstruction in the area so iyak ng iyak
 Di natin alam na there could be
sometimes na dahil naliit ang butas ng
anus or anal area so ang tendency baka
magbleed or bleeding
 with this one may absence of ganglions
that would really push or magmove sa
feces
 so when certain nerve cells in the wall of
the colon do not form in the right way
when the fetus is goin in congenital

 If person does not have Hirschsprung's what do you assess? failure to pass, meconium stool,
disease, large muscles move gas and refusal to suck maybe because of this one abdominal
stool to that colon distension, vomitus
 The nerve cells is the one helping to
 Diagnostic Studies
move those stools
o Rectal
 Foul odor of breath and stools, syempre
 to determine what is inside
pag hindi na nailabas
 small instrument minsan nga iniinsert
o gas and stool get back up and this can cause
lang doon sa rectum para makakuha
partial or pagnandoon si stool sa loob total
tayo ngsample tissue to check if there is
bowel obstruction. They have problem passing
a presence of nerve cells
that gas and stools. almost all children will
o biopsy.
Hirschsprung's option nila is surgery kaya lang
 a sample can be collected using the
hindi kaagad nila masurgery kasi nga iyong
suction device to examine under the
child very young so hintayin pa nila lumaki
microscope to determine whether the
whether the child is really experiencing this
nerve cells are missing
kind of problem already.
o can be one of birth defect because of the
 Management
absence of your nerve cells
o Surgery
o There may be a varying signs and symptoms
 remove the disease section of the
from one person to another but hischsprung's
intestine
can occur as a isolated problem or part of a
 ano iyong nangyari sa intestine ng child,
disorder that affects multiple organ system
ano iyonh involved
 Assessment Findings
 mininal invasive technique
o Newborn
 Temporary colostomy
 Failure to pass meconium stool
 A portion of the large intestine is
 Refusal to suck
brought through the abdominal
 syempre kasi feeling niya busog
wall to carry stool out of the body
siya pero actually hindi
 Colostomy bag doon ang labasan ng
stool
 Abdominal distention
 monitor every shift ang colostomy
 Bile-stained vomitus
bag kung ano iyong content
meconium is the dark sticky substance present in the  Bowel repair
intestine at birth, first bowel movememt after birth.  Dissection and removal of the
Problem with Hirschsprung is failure to pass first stool affected section with anastomosis
(observe for the 1st 24 hrs to 48 hrs paghindi baka of intestine
hirschsprung)  Abdominal-perineal pull through
 Nursing Management
5. Administer enema as ordered with Isotonic
o Children solution only
 Failure to gain weight and delayed 6. Do not treat loose stools - child is constipated
growth 7. Administer TPN (Total Parenteral Nutrition)
 Abdominal distention 8. Instruct parents on colostomy care, correct
 Vomiting diet
 Constipation alternating with diarrhea o follow proper diet
 Ribbon-like and foul-smelling stools o di mag sige pakain
abdominal distension there might be varying signs and o ang mga bata drink little water
symptoms from one person to another but the o pagumiyak ng grabe nahirapan siya
response can occur as an isolated problem or as part magpass ng stool
of that disorder that affects multiple organ systems  Management
respiratory. o Isotonic enema
 solution that has the same salt
concentration with the cells in the blood
 Salt Solution: 0.9 NaCl (Sodium chloride)

 Physiologic salt solution o Notice ito ating colon
 check osmotic pressure ng isotonic o pag may madetect sa Ultrasound o may
solutions makita
 di pwede maraming tubig dapat tama o Though polyps are benign kahit na benign
tama lang you still need to let it remove kasi baka
 we cannot drink beyond 8 glasses, has magdevelop into malignant
limitation kay usually pagmaginom ka ng o the obstruction could cause swelling leads
tubig mafull imong abdomen kaya to intestinal injury
becareful with this iso solution o most cases could be because of a virus
o Drug Therapy which leads to swelling on the lining of the
 Antibiotic intestine
 stool softners  Factors
 common ang stool softener sa mga 3. Hyperperistalsis and unusual mobility of
bata kaya di ito nawawala cecum and ileum (part of large intestine)
 lalo na pagka 3rd day wala pa 4. Lesion such as polyp and tumor
nakalibang si Infant  It is considered a surgical abdominal
 you noticed that even at home emergency in children
some children take stool softener  Mechanical Bowel Obstruction Occurs:
(2-3 days)  intestinal walls press against each
 should be as ordered other causing inflammation, edema
o Diet Therapy and decreased blood flow
 Low residue diet  May progress to necrosis, perforation
 Prescribed in Inflammatory bowel and peritonitis.
diseases  if not treated it may progress
 may mga infection  Gangrene of the bowel
 Clinical Presentation.
INTUSSUSCEPTION 9. Sudden onset of abdominal pain (in a
 one part of intestine slides inside another healthy baby)
 patient experiences painful disorder  bigla magreklamo ng pain
 most common abdominal emergency that affects 10. Infant cries out sharply and draws knees up
young infant usually 2 yrs old to abdomen
 could be mixed of blood mucus sa stool niya  knee-chest position
parang jelly type 11. Vomiting occurs and increases overtime (Bile
 This telescopic action often blocks food or fluid stained vomitus)
from passing through that area 12. Currant jelly stool
 naka cut off ang blood supply dahil may blockage,  because of the mucus and the blood
affecting intestine and may lead to tear in the 13. Signs of shock
bowel and if may tear sa bowel may infection or 14. (+) for Occult blood in stools
perforated na ang area then maglead to death of 15. Sausage-shaped mass in RLQ
bowel tissue dahil nga wala ng blood supply
note: main symptom is severe abdominal pain,
 Invagination or telescoping of a portion of the
crampimg, painful episodes (10-15 minutes or minsan
small intestine into a more distal segment of the
matagal pa) magwala tas magbalik
intestine
 3 times more likely in boys than girls and the
common cause of intestinal obstruction in
16. 6. blood in the feces that is not visibly
childhood.
apparent unlike other blood in stool (hidden
 Cause is unknown
blood in the stool)
 Diagnosis
o Often based on history and physical
examination alone
o Barlum enema
 Is definitive (in 75% of cases)

 It is therapeutic and curative in most to treat diseases and then it's also used with
cases with less than 24-hour duration anyone who's blockage of the large intestine
 Certain xray exam that tells us any or blockage little around that colon.
abnormalities in the large intestine or  Nursing Management
colon. 5. Provide routine pre- and post-operative care
 Enema - that is there is injection of for (monitor VS, assessment, intake and
that liquid into your rectum output) abdominal surgery (care for
o Digital rectal exam abdomen. Kayo mag assess on that area)
 reveals mucous, blood 6. Monitor fluid and electrolyte status- monitor
 May makapa ba tayo diyan. May Makita fluid and electrolyte
ba tayo na mucous or blood sa digital 7. Maintain nutrition and hydration
rectal exam 8. Resume feedings 24 hours post operative-
 Kaya if masakit ang tiyan, baka hindi lang kapag may bowel movement you can ask the
siya gutom baka ito na yung problem patient “naka utot naka maam?”, “naka ihi
 It is assessment in the lower rectum. naka maam?” or kapag hindi pa makagalaw
Check if may mga blockage or may mga no need to give resume eating food. Soft diet
problem diyan or prostate problem. Could lang.
be benign or it could be a prostate cancer
IMPERFORATED ANUS
 Congenital malformation in which there is no anal
opening or there is stricture of the anus
 Etiology is unknown
 An arrest in embryonic development on 7th to 8th
week of intrauterine life
 Pag imperforated meaning may blockage diyan.
 A membrane remains and blocks the union
 Immediate Treatment.
between the rectum and the anus
o IV fluids
 Rectum and the anus and in pouch do not connect
o NPO status
with the colon. By rectum and among opening to
o Diagnostic barium enema
other.
 Surgery
 there is a stenosis of the anus kaya ditto close
o manual reduction of invagination
 Blind rectal pouch with normal anus
o resection with anastomosis
o possible colostomy (gangrenous)
o we need to determine the segments of the
intestines. we need to imaginate into the
adjoining intestinal lumen kasi baka doon
nag cause ng blockage. Pag hindi nakaya ng
IV fluids, NPO ipa surgery nalang talaga
because of that obstruction.
 Clinical Presentation
 Bowel Resection and colostomy 5. No stool passage with in 24 hours after birth
6. Meconium stool from other orifice
7. Only a dimple indicates the site of the anus
8. Inability to insert thermometer
 Diagnosis - Digital rectal exam
o Ultrasound
o Abdominal X-rays
o Wangesteen-rice method - is a method to
determine the relationship of our perennial
skin
o is a surgery that removes any part of the  Management NPO, NGT
bowel so that includes your small intestine, o Manual dilatation
your large intestine, or the rectum. it's used o Surgery

 Anoplasty – construction of the anus to o Urethra opens on the dorsal surface of the
correct the anal stenosis which is penis
narrowing of the canal that cause a o Congenital absence of the upper wall of the
painful bowel movement. Mag anoplasty urethra
sila to open and drain the stool o If may ganitong condition gina delay muna
 Temporary colostomy ang circumcision (first skin is used to cover
o Antibiotics the meatus
o Present at birth. A rare congenital
abnormality that involves the opening of the
urethra
o Dito yung urethra, the tube that urine exits.
o The urethra opens in the top of the penis
rather than the tip this is a tip that's on the
top opening
 Management:  Procreation may be interfered with in severe
4. If suspected, do not take rectal temperature- cases
Baka mabutas sa kaka insert mo  Increased risk of urinary tract infection
5. Pre-operative care  MANAGEMENT:
 Monitor for the presence of stool in the 3. Circumcision is delayed until surgical repair
urine and vagina (indicates a fistula) and 4. Surgical repair
report immediately.  Meatotomy (is done because meatus is
 Administer IV fluids as prescribed too narrow )
 Prepare the child and parents for the
surgical procedures, including the
potential for colostomy. Mag colostomy
muna sila before surgery
6. Post-operative Care
 Expose perineum to air
 Check bowel sounds
 NGT for gastric decompression- if you're
going to apply this one you're going first
to remove the contents of the stomach to
the use of the NGT. Clear muna natin ang
tiyan
 Change position frequently
 Oral feeding started gradually as soon as
peristalsis function returned
 Instruct the parents to use only a water-
solubleDOWN
lubricant and to insert the dilator
SYNDROME
no more than 1 to 2cm
 Chromosomal disorder caused by the presence of
 Pag naka NPO, IV fluid si baby
all or part of an extra 21st chromosome.
 It can affect person’s
DISPLACED cognitiveOPENINGS
URETHRAL ability, physical
growth, moderate developmental issues.
 Normally orifice is place at the tip of glans penis Presence of higher risk of some health condition.
(male) and clitoris (female) pero here na displaced  like what all cells in the body contain the genes
siya that are grouped along chromosomes. So dito
 HYPOSPADIAS there are normally 46 chromosomal cells so 23
o Males: urethra opens on the lower surface of inhabited from the mother 23 from the father.
the penis Females: urethra opens into the  It is named after John Langdon Down, the British
vagina doctor who described the syndrome in 1866.
 EPISPADIAS  The disorder was identified as a chromosome 21
o Only in males trisomy

 it may really be associated with the physical
condition, the physical growth is delayed there
might be a mild to moderate intellectual disability,
sometimes we could see also facial features
 the average IQ of this young adult usually with
down syndromes is 50% equivalent to the mental
ability of eight years old or nine years old
 cognitive developmental profile should really be
assessed, suggestive to mild to moderate
intellectual disability however cognitive
development and intellectual ability are
sometimes highly variable.
 Might have an error in cell division due to
chromosomal defect (extra chromosome)
 have physical, mild to moderate (can be severe)
cognitive impairment, IQ = 50-69% (or 8-9 yo),
moderate developmental issues
 23F + 23M = 46
 Assessment Findings:
9. Small head, flat facial profile Brushfield spots = kerotoconus or thin cone shape
10. Low-set ears cornea dt inc pressure (refractive error)
11. Simian creases 16. defective motor skills
12. 40% congenital heart defects  Management:
13. With moderate retardation 8. Prevent respiratory infections
they are different in certain degree or not at all certain  Clearing the nose
physical characteristics. some of them have this low  Cool mist vaporizer
muscle tone (hypotonia)  Chest physiotherapy
 Handwashing and avoiding exposure to
14. Wide space between 1-2nd toes infection.
9. When feeding infants and young children, use
they don't develop motor skills in the same way the
a small, straight-handled spoon to push food
typical developing child does. You can know motor
to the side and back of the mouth. (Short but
functional motor skills
fat tongue)
15. Lax muscle tone- low muscle tone of 10. Encourage fluids and foods rich in fiber.
hypotonia 11. Constipation results from decreased muscle
tone, which affects gastric motility.
12. Provide good skin care because the skin is dry
and prone to infection.
13. Family education
 Counseling
 developmental progress
14. better language skills and ability to
communicate
AUTISM
 flattened nose and face upwards slanting  Severe mental disorder beginning in infancy or
eyes toddlerhood
 intellectual and developmental problems  Pervasive developmental disorder
may be mild, moderate, or severe  Disorder apparent to the parents before the child
 some of them are healthy some are not. is 3 years old
they have significant health problems, and  Characterized by:
they have some serious health condition o Severe deficit in language.
 soft skin o perceptual and motor development

o Defective reality testing  Attachment to objects
o Inability to function in social setting  Intensely preoccupied to moving object
 The cause is unknown, and the prognosis may be 10. Self-absorbed and unable to relate to others.
poor.  Solitary play
 Possible causes:  Preoccupied with their interest
o cause is unknown and prognosis may be poor 11. Repetitive hand movement, rocking, and
3. Unsatisfactory mother-child relationship rhythmic body movement
 Most common  Fidgety or masyadong magalaw na parang
 Can still be corrected if the parent is ‘di mapakali
aware and if they are willing to help the 12. Hitting, head banging, and biting
child  These manifestations are rather severe
 Busy parents, less interaction with child 13. Music often holds a special interest for them
4. CNS abnormalities 14. No delusions, hallucinations, or incoherence
 Pathologic problem  Autism is a mental problem but not
 Diagnosis is established based on symptoms and associated to these.
the use of specialized autism assessment tools. 15. Excellent long-term memory
 tests need for ASD or Asperger’s syndrome  Depending on the interested subject.
 social, communication, behavioral challenges  E.g they are interested to planets, they
 learning and problem solving skills can range to can memorize all the planets. They are
gifted to severely challenged smart this way.
 may be genetically traced, race, socioeconomics 16. May play happily alone for hours but have
 more common in males temper tantrums if interrupted.
 complicated lifelong neurobiological development  Nursing intervention
disorder 10. Provide parents /family with support and
 usually appear in first 2 years information about the disorder
 Characterized by 11. Assist child with ADL
o Severe deficit in language, perceptual and 12. Promote reality testing
motor development  Promote effective communication
o Defective reality testing  Talk at their own level of understanding
o Inability to function in social setting 13. Encourage the child to develop relationship
o Cannot establish eye-to-eye contact with another person
 Categories 14. Maintain regular schedule of activities
4. Inability to relate with others  Involve primary caregiver
5. Inability to communicate 15. Provide constant routine for child
6. Obvious limited activities/interest 16. Protect from self injury
 Clinical presentation 17. Provide safe environment
8. Infant not responsive to cuddling 18. Provide seizure precaution
9. No eye contact or facial responsiveness  If cause of autism is CNS problem
10. Impaired/no verbal communication
Additional Notes:
11. Echolalia
 Mimic verbalization or parroting all your  Physical findings: same manifestation
words to the extent that is already because of chromosomal disorder
exasperating.
 E.g. mimicking peppa pigtypical behavior ATTENTION DEFICIT HYPERACTIVITY DISORDER
of autism  Developmental disorder characterized by
12. Inability to tolerate change inappropriate degrees of inattention, overactivity,
13. Fascination with movement and impulsivity
 Attention is easily caught by movements o usually appears together, but may appear
14. Labile moods solo
 Prolonged temper tantrums o inattention = short attention span
 Assessment o impulsivity = interrupting others, cannot wait
9. Bizzare responses to the environment o constant motion, difficulty remain in the seat
 Intense reaction to minor changes

o cannot be prevented or cures, but can be  stimulate health control hyperactive
manages sx by mgmt., referral impulsive behavior
 One of the most common reasons for referral of  special instruction free from distractions
children to mental health services  fair but firm and set consistent limits
 Childhood problems include: o Medications
o Lowered intellectual development  controls excessive activity
o Some minor physical abnormalities  lengthening the attention span
o Sleeping disturbances  decreasing the distractibility
o Behavioral or emotional disorders  Interventions
o Difficulty in social relationships. 5. Provide environmental and physical safety
 Diagnosis measures.
o Established on: 6. Encourage support groups for parents.
 parent and teachers reports 7. Administer prescribed medication; some
 psychological assessments (Only arise if commonly prescribed medications that
parents report and if there is teacher include:
referral)  methylphenidate hydrochloride (Ritalin).
o Diagnosable by 36 months  pemoline (Cylert), and
 During toddlerhood - start of  dextroamphetamine sulfate (Dexedrine).
socialization 8. Inform the child and parents that positive
o 3 major characteristics revealed before 7 effects of the medication may be seen within
years of age 1 to 2 weeks
 Assessment
9. Fidgets with hands or feet or squirms in the
seat
 restless
 Because of the impulsivity
10. Easily distracted with external or internal
stimuli
11. Difficulty with following through on
instructions
12. Poor attention span
13. Shifting from one uncompleted activity to
another
14. Talking excessively
15. Interrupting or intruding on others
16. Engaging in physically dangerous activities
without considering the possible
consequences
 Because of impulsivity
 Prone to accidents
 Therapeutic Management
o Environment
 construction of stable environment
 strict instruction, strict activities
 treatment should be fair (dili
bunalan) since the child cannot
understand why they have the
disorder
 guide the child to help control their
impulsivity
 lengthen, improve attention span
 decrease distractions

Care of Mother, Child at Risk or 04 LEC
25
NCM 209 – Florence Puno
22 O6
CYSTIC FIBROSIS (INFANT) – KAWAZAKI DISEASE (PREE-SCHOOL)
OUTLINE  need to manage this one since there

are many organs involved. Pulmonary
I CYSTIC FIBRORIS involvement, mostly bigger
II CELIAC DISEASE percentage with these kind of
III COMMON HEALTH PROBLEM IN paintings. Sometimes the prognosis is
PRESCHOOL AGE
end stage lung disease which is the
IV BRONCHIAL ASTHMA
cause of death.
V WILM’S TUMOR
VI UTI  Somehow the problem now is not
VII GLOMERULONEPHRITIS only the pancreas but then the lung
VIII AZOTEMIA disease because that is the end stage
IX NEPHROTIC SYNDORME that gets involved with cystic fibrosis
X LUKEMIA
FOUR SYMPTOMS SAME WITH CELIAC DISEASE:
XI TONSILLITIS AND ADENOIDITIS
XII KAWASAKI DISEASE  Malnutrition
 Very hereditary ang cystic fibrosis, both the
lungs and digestive are affected
 protuberant abdomen – the abdomen sticks out
farther than the usual. There is excess
CYSTIS FIBROSIS subcutaneous fats and there is also loss of muscle
tone-assess and auscultate the abdomen to hear
 This is a chronic multisystem disorder
some muscle tone. Try to know why it is
(autosomal recessive trait disorder)
protruding maybe there is a build-up of some
characterized by exocrine gland dysfunction.
substances.
 The mucus produced by the exocrine glands is
 Steatorrhea
abnormally thick, tenacious, and copious,
 fat-soluble vitamin deficiency
causing obstruction of the small passageways
of the affected organs, particularly in the
RESPIRATORY SYMPTOMS:
respiratory, gastrointestinal, and reproductive
systems.
 Wheezing and dry nonproductive cough
 CF is a fatal genetic disorder and respiratory
 Dyspnea
failure is the most common cause of death.
 Cyanosis
 There is also a marked electrolytes change in
the secretion of sweat glands  Clubbing of the fingers and toes
MOST COMMON SYMPTOMS:
 pancreatic enzyme deficiency – caused by

duct blockage; associated with some
diseases/complications such as chronic
lung disease
 progressive chronic lung disease-
associated with infection, and sweat
gland dysfunction resulting in increased
sodium and chloride sweat concentration
 need to test this one
 It can indicate some disorder with clubbing

 There is a possibility of low oxygen level seen  Mostly men in CF, their tube (the one that
in capilliary refill carries the sperm to the penis is the vas
 Could be in patient cyanotic heart disease: deferens), if it will not fully develop that will
indication of low oxygen lead to bilateral abcess on the vas deferens.
 Barrel chest – anterior chest wall is bigger; usually DIAGNOSTIC TESTS:
seen in lung conditions
 Repeated episodes of bronchitis and pneumonia  Quantitative sweat chloride test (most reliable
 Common in children, but some are test) - the most reliable diagnostic test; measure
diagnoses especially in community they the concentration of chloride being excreted in
are not diagnosed. sweat, also used as a screening test for CF
 If there is defective chloride channel, the
GASTROINTESTINAL SYSTEM: concentration of chloride in cells are elevated
 Pilocarpine – a cholinergic drug that stimulate
 Meconium ileus in the neonate – thicker than production of sweat
normal meconium; it will create blockage in  the sweat is collected, and the sweat
intestine this would lead to cystic fibrosis electrolytes are measured
 Intestinal obstruction ( pain, abdominal  Normal - if sweat chloride concentration is 20
distention, nausea, and vomiting) meq/L or lower than 40mEq/L.
 Steatorrhea (frothy, foul-smelling stools) –  Chloride concentrations of 50 to 60 mEq/L are
observe when using diaper; there might be highly suggestive of cystic fibrosis and require
presence of excess fats in the feces; it cannot be a repeat test
flushed since it is bulky, it is oily in appearance  A chloride concentration higher than 60
 easy bruising and anemia mEq/L is a positive test result.
 Malnutrition and failure to thrive  Notes: chloride is the standard test for cystic
 Generalized edema ( due to hypoalbuminemia) fibrosis
 Rectal prolapse (due large, bulky stools and lack of  Chest x-ray film - reveals atelectasis
the supportive fat pads around the rectum) –  Atelectasis - (collapse of the lungs and loss of
there is loss of normal attachement inside the volume) and obstructive emphysema;
body; sometimes they scope out through the anus difficulty of breath leading to respiratory
and turn to side. failure. Sometimes patients are
asymptomatic – complain with chest pain
INTEGUMENTARY SYSTEM:  Emphysema – long term progressive disease,
chronic, primarily causes shortness of breath
 Abnormally high concentrations of sodium and due to too much air in the lungs or the over
chloride in sweat – does not allow chloride to be inflation of air sacs and alveoli commonly in
reabsorbed to the sweat cells; the more sodium adults. Lung tissues are involved there is
stays in the draft , the more fluoride remains in problem with the exchange of o2 and CO2. So
the sweat if there is emphysema there will be impaired
 Parents reporting that the infant tastes “salty” exchange of oxygen and carbon dioxide.
when kissed – the concentration of fluoride in the  Pulmonary function tests - provide evidence of
sweat are elevated with cystic abnormal small airway function.
 Dehydration and electrolyte imbalances,  Stool, fat, enzyme analysis: A 72-hour stool
especially during hyperthermic conditions – high sample is collected to check the fat and/or
temperature enzyme (trypsin – enzyme that digest our protein)
content (food intake is recorded during the
REPRODUCTIVE SYSTEM: collection).
 Duodenal analysis – nasogastric tube is inserted to
 Delay puberty in girls – cause blockage aspirate duodenal secretions
 Infertility (highly viscous cervical secretions) –
Therapeutic management
cause blockage
 Sterility (caused by the blockage of the vas
 Respiratory system- Goals of treatment
deferens by abnormal secretions or by failure of
include preventing and treating pulmonary
normal development of duct structures.

infection by improving aeration, removing 1. Instruct the child and family about the
secretions, and administering antimicrobial prescribed treatment measures and their
medications. importance.
 Chest physiotherapy – common; deep 2. Instruct the parents and caregivers to be
breathing exercises and chest tapping to sure immunizations are up to date.
loosen thr secretion in the lungs and 3. Inform the parents and caregivers that
mobilize to not cause obstruction and to the child should be vaccinated yearly for
drain influenza; pneumococcus vaccine may
 Aerosol Therapy also be prescribed.
 Bronchodilator
CELIAC DISEASE
 Antimicrobial
 Mucolytic Incidence and etiology:
 Use of a Flutter Mucus Clearance Device
(a small, hand-held plastic pipe with a  Genetic disorder that occurs in all races but
stainless steel ball on the inside) most common in Caucasians
 Use of a ThAIRapy vest device that  This disease is caused by permanent
provides high-frequency chest wall intolerance of gluten
oscillation to help loosen secretions  Gluten – a protein component of wheat,
rice, oats or barley
 Gluten-intolerance
 Incidence varies in different regions and more
 Gastrointestinal system
common in Europe
 The goal of treatment for pancreatic
insufficiency is to replace pancreatic CELIAC DISEASE
enzymes; pancreas is not able to produce
enough enzyme – there can be bloating,  Gluten-Induced Enteropathy/Gluten-sensitive
steatorhea enteropathy (GI tract disease - there is
 The amount of pancreatic enzymes interference in the absorption of the nutrients
administered is adjusted to achieve  Malabsorption Syndrome
normal growth and a decrease in the  Is a sensitivity or immunologic response to
number of stools to two or three daily. protein, particularly the gluten factor of protein
 Enteric-coated pancreatic enzymes should found in grains of wheat, barley, rye, and oats
not be crushed or chewed.  results in the accumulation of the amino acid -
 Pancreatic enzymes should not be given if glutamine, which is toxic to intestinal mucosal
the child is NPO. cells.
 Encourage a well-balanced, high-protein,  Intestinal villi (absorbs the product of digestion,
high-calorie diet; multivitamins and so if it is injured, they could properly absorbed
vitamins A, D, E, and K are also nutrients) atrophy (shortening of size) occurs,
administered. which affects absorption of ingested nutrients.
 Assess weight and monitor for failure to
thrive.
 Monitor for constipation and intestinal
obstruction.
 Ensure adequate salt intake and fluids
that provide an adequate supply of
electrolytes during extremely hot weather
and if the child has a fever.; cannot be too
much or lack salt because it is still needed
by the body.
 Home care
Celiac disease

 is a inherited condition that prevents the  Intensive therapy to replace fluids and
small intestine from absorbing nutrients, electrolytes is required
causing malnutrition.
INTERVENTIONS
What happens
 gluten, a protein found in some grains,  Maintain a gluten-free diet, substituting corn,
stimulates immune system antibodies. rice, and millet as grain sources.
Symptoms  Instruct parents and child about lifelong
 Diarrhea, malnutrition, weight loss, skin rash; elimination of gluten sources such as wheat,
some people have no symptoms rye, oats, and barley.
Microvilli  Administer mineral and vitamin supplements,
 Absorb nutrients in food including iron, folic acid, and fat-soluble
Normal intestine villi supplements A, D, E, and K
 Tiny projections on inside wall of intestine  Teach the child and parents about a gluten-
Endothelial cells free diet and about reading food labels
 Cover surface of villi carefully for hidden sources of gluten
 Instruct the parents in measures to prevent
Antibodies attack, damage lining of small intestine. celiac crisis.
 Basics of a Gluten-Free Diet
Celiac disease endothelial cells, villi, microvilli  FOODS ALLOWED
damaged by body’s reaction to gluten  Meat such as beef, pork, and poultry and
fish, eggs, milk and dairy products,
Diagnosis: vegetables, fruits, rice, corn, gluten-free
 Small Bowel Biopsy – tells if there is atrophy in wheat flour, puffed rice, cornflakes,
the villi cornmeal, and precooked gluten-free
 Serologic Test – detect antigliadin (one of the cereals
types of the gluten)  FOODS PROHIBITED
 Laboratory Test  Commercially prepared ice cream, malted
milk, prepared puddings, grains, including
Treatment anything made from wheat, rye, oats, or
 Lifelong adherence to GLUTENE FREE diet barley, such as breads, rolls, cookies,
o Education about diet cakes, crackers, cereal, spaghetti,
o Nutritional supplement may be use macaroni noodles& beer
(iron, folate, calcium, fat soluble
Basic of a Gluten-Free Diet
vitamins)
 Foods allowed
Assessment
 Meat such as beef, pork, and poultry and
 Acute or insidious diarrhea
fish, eggs, milk and dairy products,
 Steatorrhea
vegetables, fruits, rice, corn, gluten-free
 Anorexia
wheat flour, puffed rice, cornflakes,
 Abdominal pain and distention
cornmeal, and precooked gluten-free
 Muscle wasting, particularly in the
cereals
buttocks and extremities
 Foods prohibited
 Vomiting
 Commercially prepared ice cream, malted
 Anemia
milk, prepared puddings, grains, including
 Irritability
anything made from wheat, rye, oats, or
CELIAC CRISIS barley, such as breads, rolls, cookies,
cakes, crackers, cereal, spaghetti,
 Precipitated by infection, fasting, ingestion of macaroni noodles and beer
gluten
 Extreme and acute profuse watery diarrhea and
vomiting occurs
 Can lead to electrolyte imbalance, rapid
dehydration, severe acidosis

PROGNOSIS  Expiratory wheeze
 Cough
 Dietary avoidance of gluten results in  Thick tenacious
improvement of symptoms in 70% of patients  Barrel chest – if chronic
within 2 weeks Severe attack
 Serologic antibody titers decrease on a gluten-  Shortness of breath
free diet  Use of accessory muscles
 After 3-6 months antibody levels may  Retractions
become detectable  Nasal flaring
 Complete histological resolution of small  Irritability (earliest sign hypoxia)
bowel inflammation may take up to 2  Diaphoresis
years
COMMON HEALTH PROBLEMS IN Diagnosis

PRESCHOOL AGE  Assessment findings
 ABG – respiratory acidosis
Learning Objectives  Peak flow meter – an object way to measure
At the end of the lecture, the students will be able to: airway obstruction
 Describe the health problems presented by a  The most reliable early sign of an asthma attack is
preschooler; a drop in the child peak expiratory flow rate
 Organize manner of assessing preschool
Picometer
 With specific healthy conditions;
 Discriminate the different signs and  measure the air movement out of the lungs
symptoms of each specific  prevent asthma attack
conditions/illnesses common in preschool;
 Distinguish appropriate nursing actions with Spirometer
corresponding diagnostic tests that could
confirm the specific condition of preschool;  lung function test to measure how patients
 Outline safety measures in all aspects of capacity for breathing or how well they
breathe
preschool’s care
 assess lung function or how much air they
 Formulate a comprehensive plan of
inhale/exhale
management for a given condition of a  measures the amount and rate of air a person
preschool breathes in order to diagnose illness or
BRONCHIAL ASTHMA (common) determine progress in treatment
 It is an obstructive disease of the lower Medical Management

respiratory tract (the airways is associated
with hyper responsive that leads to episodes 1. Drug Therapy
of wheezing, breathlessness, chest tightness) A. Bronchodilators
 Often cause by an allergic reaction to an i. Beta-2-agonist bronchodilator
environmental allergen ii. xanthine derivative
 relax the muscle that tightens the
 Allergic reaction results in histamine release- -
airway
airways responses
 clear mucus na nandun sa lungs
Allergic reaction results to 3 main airway responses
B. Antiasthma
a) Edema of mucous membrane i. Corticosteroids
b) Spasm of the smooth muscle ii. Mast cell stabilizer
c) Accumulation of secretions (due to the iii. leukotriene inhibitors
swelling) C. Antibiotics
Risk Factor
1. Family history of allergies and asthma 2. Hyposensitization
2. Client history of eczema
 this would aim the allergic patient tolerance
 ano ba ang respond ni patient dun sa allergin
Clinical manifestations

3. Exercise a. stage V: bilateral renal involvement
 aimed to increase expiratory function Management

 using an incentive spirometer daily
 post a visible sign “NO ABDOMINAL
Nursing Interventions PALPATION”
1. Surgery - nephrectomy
1. Place client in high fowler’s position 2. Radiation therapy
2. Administer oxygen as ordered 3. Chemotherapy
3. Administer medications as ordered
4. Provide good hydration Nursing Intervention
5. Provide chest physiotherapy
6. Promote energy conservation Pre operative
7. Monitor respiratory function
8. Provide family health teachings 1. Do not palpate the abdomen
9. Proper ventilation 2. Handle the child carefully
3. Monitor BP, intake and output
Wilm’s Tumor / Nephroblastoma
WILM’S TUMOR/NEPHROBLASTOMA 4. Provide routine preoperative care
The kidneys are responsible for removing wastes from Post operative
the body, regulating electrolyte balance and blood
pressure, and stimulating red blood cell production. 1. assess the respiratory, circulatory, fluid and
electrolytes status
 A large malignant tumor that develops in the 2. monitor patency and adequacy of urinary
renal parenchyma output
 arises from bits of embryonic tissue that 3. Observe for any postoperative complications
remains after birth 4. Provide care for child receiving radiation and
 Rare kidney cancer and highly treatable, chemotherapy
usually develops on one kidney
 It accounts for 20% of solid tumors in Urinary Tract Infection
URINARY TRACT INFECTION (UTI)
childhood
 Tumor is rarely discovered until it is large  It is a bacterial invasion of the kidneys or
enough to be palpated bladder
 slightly less frequent in boys than girls  E. Coli accounts for about 80% of acute
episodes
Assessment
Predisposing factors
 Palpable mass
 Hematuria 1. poor hygiene
 Hypertension 2. irritation from bubble
 Anemia
Assessment findings
 Low grade fever
1. low grade fever
Diagnostic Test
2. abdominal pain - lower region
 Sonogram 3. burning pain upon urination
 CT scan 4. hematuria
 IVP = intravenous pyelogram - common, 5. Foul-smelling
imaging of renal pelvis 6. urinary frequency
7. Enuresis - common sign for pre-schooler
Staging of Nephroblastoma
Diagnostic Test
1. stage I : limited to kidney
2. stage II : tumor extends beyond kidney but 1. Urinalysis - presence of pus cells
completely encapsulated
Treatment
3. stage III : tumor confined to abdomen
4. stage IV: tumor has metastasized to lung,
 antibiotic
liver, bone or brain
 analgesic and antipasmodic

 increase fluid intake - helps you flush those  Cloudy, smoky, brown-colored urine (hematuria)
bacterias out  mL per hour must be collected
 note the color as well
Nursing Intervention  Pallor, irritability, lethargy
 In the older child, headaches, abdominal, or flank
1. Administer antibiotics as ordered pan, dysuria
2. Provide warm baths and allow water  Proteinuria that produces a persistent and
3. Force fluids excessive foam in the urine
4. Encourage measures to acidify urine
5. Provide health teaching
 avoidance of tub bath Azotemia AZOTEMIA
 avoidance of bubble bath
 For girls wipe perineum from front to back - A form of blood poisoning that accumulates in the
 void at least every 2 to 3 hours, try to empty blood
bladder - Increased blood urea nitrogen and creatinine levels
- Increased antistreptolysin O titer (used to diagnose
(hygiene is very important in UTI) disorders caused by streptococcal infections)
- Measures the antibodies
Glomerulonephritis
GLOMERULONEPHRITIS
refers to a group of kidney disorders characterized by
an inflammatory injury in the glomerulus, most of
which are caused by an immunological reaction.
 Affect more males
 structures in your kidney that is made up of

blood vessels
 Blood vessels - help filter blood, remove
excess fluid
 If glomeruli is damaged, your kidney will stop
working properly
Assessment/Diagnostic findings
Causes
 Urinalysis (specific gravity of urine)
1. immunological diseases
 Streptozyme tests
2. Autoimmune diseases
 Blood and tissue cultures
3. Antecedent group A beta-hemolytic
 Initial blood tests
streptococcal infection of the pharynx or skin
4. History of pharyngitis or tonsillitis 2 to 3
Treatment
weeks before symptoms
 Antibiotics
Note the common infections that cause acute GN (ex:  Loop diuretics (to increase plasma volume, to
streptococci) decreaset edema)
 Vasodilators (reduce vascular resistance and
Types improve that cardiac output)
 Calcium channel blockers (the movement of
 Acute: occurs 2 to 3 weeks after a calcium iron will inhibit)
streptococcal infection
 Chronic: can occur after the acute phase or Interventions
slowly over time
 Monitor vital signs, weight, intake and output,
Assessment and the characteristics of urine
 Limit activity; provide safety measures
 Periorbital and facial edema that is more  Provide high-quality nutrient foods
prominent in the morning  Restrictions depends on the stage and severity
 Anorexia, hypertension of the disease, especially the extent of the
 Decrease urinary output edema

 In uncomplicated cases: Regular diet is Interventions
permitted but sodium is restricted to a “no
added salt to foods” diet.  Monitor vital signs, intake and output, and daily
 Moderate sodium restriction: Hypertension or weights.
edema  Monitor urine for specific gravity and albumin.
 Foods high in potassium are restricted during  Monitor for edema.
periods of oliguria  Nutrition: A regular diet without added salt is
 Protein is restricted if the child has severe prescribed if the child is in remission; sodium is
azotemia resulting from prolonged oliguria restricted during periods of massive edema.
 Monitor for complications  Corticosteroid therapy is prescribed as soon as
 Administer diuretics, antihypertensives, the diagnosis has been determined; monitor the
antibiotics as prescribed. child closely for signs and infection.
 Instruct the parents to report signs of bloody  Immunosuppressant therapy (reduce the relapse
urine, headache, or edema. rate and induce long-term remission)
 Instruct the parents that the child needs to  Diuretics may be prescribed to reduce edema.
obtain appropriate adequate treatment for  Plasma expanders such as salt-poor human
infections, specifically infections. albumin may be prescribed for the severely
edematous child.
NEPHROTIC SYNDROME  Instruct the parents regarding the signs of
infection and the need to avoid contact with
 Nephrotic syndrome is a kidney disorder other children who may be infectious
characterized by massive proteinuria,
hypoalbuminemia (hypoproteinemia), and
edema.
 Autoimmune process
 The primary objective of therapeutic
management is to reduce the excretion of
urinary protein and maintain protein-free urine
(to check the presence of albumin in the urine)
WHY IS THERE A NEPHROTIC SYNDROME?

 The plasma enters the renal tubes and
excretes in the urine. The protein will cause
altered pressure and the patieng will
experience swelling.
Assessment
 Periorbital and facial edema is most prominent

in the morning
 Leg, ankle, labial, and scrotal edema occurs
 Urine output decreases; urine is dark and froth
(might be infectious if too dark) LUKEMIA
 Ascites (fluid in the abdominal cavity)
 Blood pressure is normal or slightly decreased.
 Massive proteinuria is seen.  refers to cancers of the white blood cells
 Decrease serum protein  Proliferation of abnormal white blood cells
that do not mature beyond the blast phase
 In the bone marrow, blast cell crowd out
healthy white blood cells, red blood cells, and
platelets, leading to bone marrow depression.
 White blood cells fight infection
 Blast cells also infiltrates other organs most
commonly the liver, spleen, kidneys, and
lymph tissue
 Lukemia can be seen in the bone marrow as
well as in the blood.

 If there are no white blood cells, it will not  Aims to eliminate completely any
help you fight infection remaining leukemic cells; or maintaining
 In general, lukemias are classified into acute remission
(rapidly developing, especially if there is no  Intensifies the assault against leukemic
chemotherapy yet) and chronic (slowly cells using chemotherapy
developing) forms.  Given for 2-3 years
 In children, about 98% of lukemia are acute
Two additional phases are instituted for children
Types of Leukemia who experience relapse
1. Acute Lymphocytic Leukemia 1. Reinduction

 Primarily strikes children and young adults  Administration of the drugs previously
(80-85% of childhood leukemia used plus additional drugs
 the malignant cell involved is the
lymphoblast) 2. Bone marrow transplant
2. Acute Myeloid Lekemia
 Also known as—Acute nonlymphocytic  Usually recommended after the second
lukemia remission in children
 Cells involved is the granulocytes
Nursing intervention
Types of Leukemia
 Preventing infection
 Chronic Lymphocytic Leukemia (CLL)  Reducing pain
 Chronic Myelogenous Leukemia (CML)  Promoting energy conservation and relieving
anxiety
Assessment Findings  Promoting normal growth and development
 Promoting a positive body image
1. Anemia (weakness, pallor, dyspnea)  Promoting family coping
2. Bleeding (petechiae, bruise)
3. Infection (fever, chills, malaise) TONSILLITISTONSILLITIS
AND ADENOIDITIS
AND ADENOIDITIS
4. Enlarged lymph nodes
5. Enlarged spleen and liver (splenomegaly and Nursing intervention
hepatomegaly)
6. Abdominal pain  Preventing infection
7. Bone and Joint pain  Reducing pain
 Promoting energy conservation and relieving
Diagnosis anxiety
 Promoting normal growth and development
Blood studies b  Promoting a positive body image
One marrow aspiration  Promoting family coping
Lumbar tap
Xray of bone TONSILLITIS AND ADENOIDITIS
Management  Tonsillitis refers to inflammation and infection

of the tonsils
Goal of care: complete cure
 the most common bacteria causing
Chemotherapy tonsillitis is Streptococcus pyogenes (the
bacterium that causes strep throat)
Treatment phase:
 Adenoiditis refers to inflammation and
1. Induction—achieving complete remission or infection of the adenoids
absence of leukemic cells
2. Consolidation/Sanctuary
 Preventing leukemic cells from invading or
growing in the CNS
3. Maintenance

 Do not give the child any straws, forks, or
sharp objects that can be put into the mouth
 Administer acetaminophen (Tylenol) for sore
throat as prescribed
 Instruct the parents to notify the physician if
bleeding, persistent earache, or fever occurs.
 Instruct the parents to keep the child away
from crowds until healing has occurred
KAWASAKI DISEASE
 Kawasaki disease is known as mucocutaneous

lymph node syndrome and is an acute
systemic inflammatory illness
 The cause is unknown but may be associated
Assessment
with an infection from an organism or toxin
 Persistent or recurrent sore throat  Cardiac involvement is the most serious
 Enlarged, bright red tonsils that may be complication; aneurysms (abnormal swelling
covered with white exudate in the wall of blood vessels) can develop.
 Difficulty in swallowing  Etiology is unknown
 Mouth breathing and an unpleasant mouth
Assessment
odor
 Fever
Acute stage
 Cough
 Enlarged adenoids may cause nasal quality of  Fever
speech, mouth breathing, hearing difficulty,  Conjunctival hyperemia
snoring, and/or obstructive sleep apnea  Red throat
 Swollen hands, rash, and enlargement of the
Pre-operative interventions
cervical lymph nodes
 Assess for signs of active infection
Subacute stage
 Assess bleeding and clotting studies because
the throat is vascular  Cracking lips and fissures
 Prepare the child for a sore throat  Desquamation of the skin on the tips of the
postoperatively, and inform the child that he fingers and toes
or she will need to drink liquids.  Joint pain
 Assess for any loose teeth to decrease the risk  Cardiac manifestations
of aspiration during surgery  Thrombocytosis
Interventions postoperatively Convalescent stage
 Position the child prone or side-lying to  Child appears normal but signs of
facilitate drainage inflammation may be present
 Have suction equipment available but do not
suction unless there is an airway obstruction
 Monitor for signs of hemorrhage (frequent
swallowing may indicate hemorrhage); if
hemorrhage occurs, turn the child to the side
and notify the physician.
 Discourage coughing or clearing the throat
 Provide clear, cool, noncitrus, and
noncarbonated fluids
 Avoid milk products initially because they will
coat the throat
 Avoid red liquids, which simulate the
appearance of blood if the child vomits

Medication
 IVIG
 aspirin
 steroids
Parent education
 Follow-up care is essential to recovery

 The signs and symptoms of Kawasaki disease
include the following:
1. Irritability may last up for up
to 2 months after the onset of
symptoms
2. Peeling of the hands and feet
may occur
3. Pain in the joints may persist
for several weeks
4. Stiffness in the morning, after
naps, and in cold
temperatures may occur.
 Record the temperature until child has been
afebrile for several days
 Notify the physician if the temperature is 101F
or higher
 Salicylates such acetylsalicylic acid (aspirin)
may be given
 Signs of aspirin toxicity include tinnitus,
headache, vertigo, bruising; do not administer
aspirin or aspirin-containing products if the
child has been exposed to chickenpox or the
flu.
 S/sx of bleeding: epistaxis, hemoptysis,
hematemesis, hematuria, melena, and bruises
on body
 S/sx of cardiac complications chest pain or
tightness (older children), cool and pale
Diagnosis extremities, abdominal pain, nausea and
vomiting, irritability, restlessness, and
fever x ⅗ days + ⅘ diagnostic criteria uncontrollable crying.
 Children should avoid contact sports, if age
1. erythema
appropriate, if taking aspirin or
2. rash on trunk
anticoagulants.
3. swelling of hands or feet
 Avoid administration of MMR or varicella
4. red eyes
vaccine to the child for 11 months post-
5. swollen lymph nodes
intravenous immune globulin therapy, if
appropriate.
Interventions
VIDEO LINK: https://youtu.be/jIzARfWbqv8
 Monitor temperature frequently
 Assess heart sounds, rate, and rhythm
 Assess extremities for edema, redness, and
desquamation
 Examine eyes for conjunctivitis
 Monitor mucous membranes for
inflammation
 Monitor strict intake and output

26
NCM 209 – MRS. PUNO
21 O8
COMMON HEALTH PROBLEMS IN ADOLESCENT
→ Lordosis - inward curve of the spine
OUTLINE
I SCOLIOSIS → Kyphosis - outward curve
II BONE TUMOR
 ASSESSMENT FINDINGS
o Uneven shoulders (could be left or

SCOLIOSIS right)
o Uneven hips
─ a lateral curvature of the spine
o Asymmetry of rib cage
─ five times more common in girls and has peak
o Unequal length of bra strap (for
incidence at 8 to 15yrs
females)
─ Majority (75%) - idiopathic (unknown cause)
o Bump or rib hump on one side of the
has a familial pattern (30% of children with
spine
scoliosis); wala siyang genetic factor but
shows familial pattern
─ associated with other neuromuscular
disorders (because of lateral curvature
nagkakaroon ng impairment with
neuromuscular functions)
 Etiology: unknown
 Theories postulated:
o Malfunctioning of the vestibular
balancing system
o Genetic patterns
o Muscular weakness
o Collagen metabolism
 Cause is unknown called idiopathic scoliosis
 FORMS:
 DIAGNOSIS
o Structural / Progressive form
 “S” curve of the spine
1. Forward bend test / Adam’s bend test
 usually idiopathic
 does not disappear with
position changes
 needs more aggressive
treatment
o Functional/ Postural/Non structural
 “C” curve of the spine
 caused by poor posture,
muscle spasm due to trauma,
or unequal length of legs
 disappears when child lies
down can be treated with
posture exercise. The earlier
that is detected, more better
the management, the better
prognosis. Kasi di pa matigas
ang mga buto.

 a test used most often in
schools and doctor's offices to
screen for scoliosis
2. Scoliometer – a commercial device used

to document the extent of spinal curve
1. Ask the child to slowly bend
forward until the shoulders are
level with the hips
2. Adjust the bending position
height so the deformity of the
spine is most pronounced
3. Gently lay the scoliometer across
the deformity at right angles to
the body, with the marking
centered over the curve
 Milwaukee brace
4. General meter: refer to a
─ 23 hours/day for 3 years para ma-
physician with a scoliometer
correct talaga yung curvature.
reading of seven degrees or
─ Very hassle
greater
 If 7 degrees or greater, refer to a
 Boston brace
physician for further evaluation.
─ A scoliosis brace is usually worn under
The greater the degree of
clothing and is one method used to
curvature, the greater the
try to improve the exaggerated
severity
curvature of the spine as seen in
scoliosis
3. Radiograph (X-ray)
 Traction
 assess the angle of the curve ─ Halo-pelvic traction (sa ulo ilagay)
and determine extent of ─ Halo-femoral traction
deformity ─ Electric rotating bed - stimulates
 Cobb angle standard method positioning of the patient
for assessing the curvature
quantitatively
 MANAGEMENT
- Depends on the maturity of the skeleton
and on the degree of curvature
o Spinal curve of less 20 degree

 no therapy, pede pa siya ma-
correct
 observation until 18years of
age
o Spinal curve greater than 20 degree
 conservative, nonsurgical
approach
 Braces - init, magkaka rashes,  Harrington rod (Steel rod)
kapoyon siya
 Traction
 Plaster jacket cast
o Spinal curve of more than 40 degrees
surgery (very risky)
 Spinal fusion with insertion of
Harrington rod

b. Use of incentive spirometry -
promotes lung expansion and
prevents pneumonia
c. Log roll - turn the patient as a
unit/whole para ma maintain;
do not raise the bed
2. Stress correct body mechanics
3. Promoting mobility, positive body

image and compliance with therapy
4. Preventing injury
 Some rescuers kahit walang
cervical fracture, gina stabilize
parin yung head kasi it would
case permanent disability
o Electrical stimulation 5. Preventing skin irritation
 Use as an alternative for
braces
 Electrodes are applied to the
skin or surgically implanted BONE TUMORS
 Electrical stimulation is
usually employed at night, - Ibat iba ang name sa tumor depende sa lugar
during sleeping hours 1. Sarcoma - tumors arising from connective
 To stimulate muscle to tissue, such bones and cartilage, muscle,
contract to straighten the blood vessels or lymphoid tissue
spine common neoplasm in adolescent
 Stretching exercises of the  Arise during adolescent
spine for non-structural because of rapid bone growth
changes ─ Common in adolescence. Happens at the end
 NURSING INTERVENTION of the long bone; found around the knee,
thigh bone, tibia, fibula, humerus
1. Provide care for child with brace ─ Tumor that occurs in the growth metaphysis
1. Teach the child to wear it constantly, ─ Trauma brings malignancy
except when bathing ─ Cause: unknown
2. wear over a t-shirt to protect the skin ─ Children with hereditary form of
3. report if there is rubbing (mag sweat retinoblastoma (eye tumor) have an increased
tas mangatol) risk
4. encourage exercise as prescribed ─ Osteosarcoma
5. Provide cast or traction care
a. Frequent cleansing on the pin
sites
b. Provide diversional activities
(nababagot sila kasi naka stay
put lagi)
c. Monitor for signs of
complications
6. Provide preoperative and post-
operative nursing care
a. Deep breathing exercise (kasi
naka lie lang lagi and it will
generate mucus sa lungs like
pneumonia)

TWO MOST FREQUENTLY OCCURING TYPES OF BONE
CANCER:
1. Osteogenic Sarcoma
 A malignant tumor of long bone involving

rapidly growing bone tissue
(mesenchymal matrix forming cells)
 Characterized by formation of osteoid
(immature bones)
o Bones are not strong
 Common sites of occurrence
o distal femur – 50% 2. Ct scan
o Proximal tibia – 20% 3. Bone scan
o Proximal humerus – 10 to 15%
 High incidence in children expose MANAGEMENT
to radiation and with
retinoblastoma 1. Surgery (orthopedic ward)
 Lungs – common site of - May be done to save the leg/arm
metastasis a. Limb salvage procedures (kung kaya pa
 Cancer cells (metastasis) ma-save) kaya need early detection
b. Bone or skin grafts
2. Ewing's sarcoma c. Amputation (if dili na masave) - BKA, AKA
d. Reconstructions - e.g. lagay ng steels,
ASSESSMENT kneecaps Resections of metastases
(tanggalin ang area kung saan na
1. Pain metastasize ang tumor)
2. Swelling, redness
3. Tender mass, warm to touch 2. Radiation therapy
4. Limitation of movement Chemotherapy - any group of drugs used in
5. Pathologic fracture - has a certain cause combination to treat a certain condition; dili
(medical cause). Due to sarcoma,naga develop tanan chemotherapy kay cancer imong itreat
ug fracture.
 Shrinking of the tumor
DIAGNOSIS
 Done in certain cycles
1. Bone Biopsy - pag may tumor, gina check ang
growth ng tissues. If mag reveal ng malignacy 3. Rehabilitation (giputol na ang limbs)
or benign. If malignancy > cancer If asa ang i. physical and occupational therapy
area na naay sarcoma, dyan insertan ng ii. psychosocial adapting (include family
syringe members)
iii. prosthesis fitting and training - Eg.
Artificial legs

NURSING MANAGEMENT  Lungs is the most frequent site of
metastasis (eg. Respiratory
Provide routine preoperative care (NPO, IVF, complication tas namatay)
VS) Eg. Amputation
CLINICAL FINDINGS
 need pa mag counseling before putulin
and counsel din after. Refer sa mga a. Pain and swelling on affected part
guidance counselors, nurses, doctors.
b. Palpable mass (very typical due to presence
b. Offer support or encouragement and accept of tumor)
client’s response of anger and grief
c. Tender (if i-palpate tas sakit) and warm to
 "out of all people ngano ako man jud?" touch (due to swelling)
c. Discuss to patient and family (pre-op) d. 15- 35% of clients have metastasis (nag
invade sa other parts of body) at time of diagnosis
1. rehabilitation program and use of
prosthesis  If may erwing's > poor prognosis kasi
usually meron ng metastasis
2. crutch walking (kay need pa mag heal
sng siter b4 mag prosthetic) MANAGEMENT
3. phantom limb sensation as normal o High doses of radiation therapy (aggressive
recurrence (most especially if a body ang treatment kasi poor ang prognosis,
part is amputated. Feeling nila andun meron ng metastasis sa other organs)
parin ang leg tas mafeel nila ang pain)
o Chemotherapy - shrink the tumor
- common struggle in patients with
amputation o Surgery
4. Prevent hip and knee contractures DIAGNOSIS
prone position several times a day
(unless otherwise ordered) o X-ray
5. Provide stump care (post surgical site o Bone scan

and mga gitahi na part tas gipang
stump > prone for infection) o Biopsy
o Bone marrow aspiration (kasi naga start sa

bone marror)
d. Ewing’s Sarcoma
o Caution adolescent to continue to be careful

and avoid activities that may cause added
stress to affected limb such as football and
weight lifting
o (kasi sa femur usually ang ma-affect > fragile

ang bones > pathologic fracture) so iwasan
mag play ng bodily contact activities
 Dr Ewing described the tumor

 Malignant (cancerous) tumor arising
most often in the bone marrow of the
diaphysis area (midshaft) of long bones
o Develop in flat bones
 The diaphyses of the femur are the
most common sites, followed by the
tibia and the humerus

17
22 O9
High Risk Adolescent
OUTLINE
FORM
I High Risk Adolescent
II Menstrual Dysfunction or Disorder 1. Structural/Progressive form “S” curve of the
III Scoliosis spine
IV Bone Cancer
Does not disappear with position changes needs
more aggressive treatment
High Risk Adolescent
Common health problem in adolescent

Scoliosis
A lateral curvature of the spine
2. Functional/ Postural/Non Structural “C” curve
Five times more common in girls and has peak of the spine
incidence at 8 to 15yrs Causes by poor posture, muscle spasm due to trauma,
Majority (75%) – idiopathic or unequal length of legs
Has a familial pattern
(30% of children with scoliosis)
Associated with other neuromuscular disorders
Etiology: Unknown
- Theories postulated:
- Malfunctioning of the vestibular balancing
system Disappears when child lies down can be treated with
 Genetic Patterns posture exercise
 Muscular weakness
 Collagen Metabolism
Causes is unknown called idiopathic scoliosis Assessment findings
1. Uneven shoulders
CONDITION TO CAUSE SPINAL DEFORMITY 2. Uneven hips
- CONGENITAL SPINAL COLUMN 3. Asymmetry of rib cage
ABNORMALITIES 4. Unequal length of bra strap
- MEUROMUSCULAR DISORDER (CP, SPINA 5. Bump or rib hump on one side of the spin
BIFIDA), MUSCULAR DYSTROPHY)
- RADIATION THERAPY

Spinal curve of less 20 degree no therapy observation
until 18 years of age
Spinal curve greater than 20 degree conservative,

nonsurgical approach
Braces
Traction
Plaster jacket cast
Spinal curve of more than 40 degree surgery
Spinal fusion with insertion of Harrington rod
Diagnosis
Forward bend test/ Adam’s bend test
A test used most often in schools & doctor’s offices to
screen for scoliosis
Scoliometer – a commercial device used to document

the extent of spinal curve
Cobb angle – standard method for assessing the
curvature quantitatively
Radiograph (x-ray) - assess the angle of the curve and
determine extent of deformity
Using a scoliometer
1. Ask the child to slowly bend forward until the
shoulders are level with the hips
2. Adjust the bending position health so the
deformity of the spine is most pronounce
3. Gently lay the scolimeter across the deformity
at right angles to the body, with thee marking
centered ever the curve
Steel rods help support the fusion of the vertebrae
GENERAL RULE:
Bone graft are place to grow into the bone and fuse
Refer to a physician with a scoliometer reading of
the vertebrae
seven degreed or greater
Management depends on the maturity of the skeleton

and on the degree of curvature

Use as an alternative for braces
Electrodes are applied to the skin or surgically
implanted
Electrical stimulation is usually employed at night,
during sleeping hours
To stimulate muscle to contract to straighten the spin
Stretching exercises of the spine for nonstructural
changes
Provide care for child with brace

Teach the child to wear it constantly, except when
bathing
Wear over a t-shirt to protect the skin
Report if there is rubbing
Encourage exercise as prescribed
Provide cast or traction care
Frequent cleansing on the pin sites
Provide diversional activities
Monitor sign of complications
Provide preoperative and post-operative nursing care

Deep breathing exercise
Use of incentive spirometry log roll; do not raise the
head of the bed
Stress correct body mechanics
Promoting mobility, positive body image and
compliance with therapy
Preventing injury and preventing skin irritation
Bone tumors
Sarcoma – tumors arising from connective tissue, such
bones and cartilage, muscle, blood vessels or
lymphoid tissue
= common neoplasm in adolescent
=Arise during adolescent because of rapid bone
Electrical stimulation growth

Two most frequently occurring types of bone cancer High incidence in children expos to radiation and with
- Osteogenic Sarcoma retinoblastoma
- Ewing’s Sarcoma Lungs – common site metastasis
 Osteogenic SARCOM/ osteosarcoma Assessment

 Tumor that occurs in the growth metaphysis Pain
 Trauma brings the malignancy Swelling, redness
 Most common in children Tender mass, warm to touch
 Cause Unknown Limitation of movement
 Children with hereditary form of Pathological fracture
retinoblastoma (eye tumor) have an increased

risk Diagnosis
Bon Biopsy
Ct scan
Bone scan
Management
Surgery
- Limb salvage procedures
- Bone or skin grafts amputation
- Reconstructions
- Resections od metastases
- Radiation therapy
- Chemotherapy
Rehabilitation
- Physical and occupational therapy
Osteogenic Sarcoma
- Psychosocial adapting
A malignant tumor of long bone involving rapidly
- Prosthesis fitting and training
growing bone tissue (mesenchymal matrix forming
cells)
Nursing management
= characterized by formation of osteoid (immature
1. Provide routine preoperative care
bones)
2. Offer support or encouragement and accepts
Common sites of occurrence
clients response of anger and grief
Distal femur – 50%
3. Discuss to patient and family rehabilitation
Proximal tibia – 20%
program and use of prosthesis crutch walking
Proximal humerus – 10 to 15%
phantom link sensation as normal recurrence

4. Prevent hip and knee contractures prone
position several times a day (unless otherwise Nursing Intervention
ordered)
5. Provide stump care Caution adolescent that may cause added stress
to affected limb such as football and weight lifting
Ewing‘s Sarcoma
Malignant tumor arising most often in the bone
Menstrual Dysfunction or Disorder
marrow of the diaphyseal area (midshaft) of lone
bones
High Risk Problem of Adolescence

The diaphyseal of the femur are the most common
MENSTRUAL DYSFUNCTION OR DISORDER
sites, followed by the tibia and the hemerus
Sexually Transmitted Disorders – are those disease
Lung is the most frequent site of metastasis spread through sexual contact
A. Gonorrhea
Causative agent Neisseria
Gonorrhea
Signs & symptoms: often asymptomatic in

females purulent yellow-green vaginal
discharge may cause ophthalmia neonatorum
and sepsis to newborn.
Clinical findings
1. Pain and swelling on affected part Treatment:
2. Palpable mass
3. Tender and warm to touch
4. 15-35% of clients have metastasis @ time of
diagnosis
Management
1. High doses of radiation therapy
2. Chemotherapy
3. Surgery
- Penicillin
Diagnosis
- Erythromycin
X-ray
- Ceftriaxone
Bone scan
- Doxycycline
Biopsy
Bone marrow Aspiration All sexual contacts must be treated

Sign & Symptoms:
Thin, irritating, frothy gray- green discharge
B. Chlamydia
strong odor, itching to genitalia
Chlamydia trachomatis
Most common STD
Treatment: metronidazole douche with weak
vinegar solution to reduce pruritus.
Signs & symptoms: watery, gray-white vaginal
discharge vulvar itching
May causes ophthalmia neonatorum, sterility
in female or male, tubal pregnancy
Drug: doxycycline or tetracycline,
azithromycin.
E. Candidiasis
C. Syphilis
Candida Albicans – fungus
Treponema pallium (spirochete)
Caused by a yeast transmitted from GI tract to
Crosses placenta after 16 weeks of pregnancy
vagina
Sign & Symptoms – thick, white cheese-like
Manifestation
vaginal discharges vulvar reddening and
Primary
pruritus.
Cardinal sign – CHANCRE – a hard red painless
lesion at the point of infection site disappear
Treatment: topical application or
without treatment in 4-6 weeks
suppositories of antifungal drug such as:
clotrimazole, nystatin, miconazole, Diflucan,
Secondary – rash, malaise, alopecia
gentian violet
Tertiary – effect any organ system –
cardiovascular, neurovascular system
Bathing with diluted sodium bicarbonate
solution to reduce pruritus.
Treatment: penicillin or erythromycin
D. Trichomoniasis
Trichomonas vaginalis – a single-cell
protozoan

Anorexia nervosa - Anemia
A disorder Characterized by to maintain a - Depression. social withdrawal and poor
body weight because Of a disturbance in of individual coping
the Size or appearance of the body.
an eating disorder characterized by extremely Management

low body weight, body image distortion andan
obsessive fear of gaining weight. Nutritional therapy
Total parenteral nutrition
May be manifested as severe weight Enteral tube feeding
restriction controlled by:
- Limiting food intake Behavior modification
- Excessive exercise
- Binge eating / purging Medication - antidepressant
Counselling
Clinical findings and diagnosis
 Individual therapy
 Group therapy
 Family therapy
The American Psychiatric Association Criteria for Bulimia Nervosa
Diagnosis Bulimia — refers to recurrent and episodes
body mass index — less than 85% of expected weight binge eating and purging
 Extreme weight loss accompanied by an awareness that eating pattern is
 intense fear of getting fat or gaining weight abnormal but not being able to stop
even though underweight

 severely distorted body image Bulimic person is of normal of weight or slightly
 refusal to acknowledge seriousness of weight overnight or underweight may abuse purgative.
loss laxatives and diuretic to aid in weight control
 amenorrhea
Etiology: Unknown
Manifestation
- Almost Skeleton-like appearance
Clinical manifestation and Diagnosis
- Sexually immature
- Dry skin, brittle nails
Dental caries and erosion
- Presence of lanugo
- Constipation, hypothermia, bradycardia,
Throat irritation
low blood pressure

Obesity
Electrolytes imbalance- hypokalemia An excessive of fat increases body weight by 20% or
more
Behavior problem
 Drug abuse Obesity is now among the most widespread medical
 Alcoholism problems affecting children and adolescents living in
 Stealing the United States and other developed countries.
 Impulsive activities
American Psychiatric Association the criteria Obesity increases the child's risk of serious
for bulimia are: health problems such as heart disease,
DM type 2 and stroke
Recurrent episodes of binge eating
It also can create emotional and social problems
A feeling of lack of control over behavior
during binges often feels isolated from the peer group embarrassed
to participate in sports
Self-induced purging use of laxatives, diuretics,
enemas Adolescents may have difficulty achieving a sense of
identity if they are always excluded from group and if
Average of at least two binge-eating episodes they don't like their image in a mirror
a week during 3 months period
Obsessiveness regarding body weight and shape BMI - most accurate method of assessment indicates
relationship between height and weight
Management
Pharmacology — antidepressant
Psychotherapy
- Monitor vital signs
- Monitor intake and output
- Record food intake Causes
- Encourage client to express feelings Many different factors contribute to this imbalance
- Help client to set realistic goal for self between calorie intake & consumption
- Help client identify interest and positive
aspect of self Genetic factors
Obesity tends to run in families

Dietary habits Cause/Reasons: a means of relieving the tension and
Fast food, processed snacked foods, and sugary pressure of their lives
drinks.
Use food as means of satisfying emotional needs in Adolescent
late — night eating  a desire to feel Confident and mature due to
peer pressure
Physical inactivity  A form of rebellion
The popularity of television. computers, and games
results into an increasingly sedentary lifestyle Children at greatest risk
1. have family in which alcohol or drug abuse is
Management present
Lifestyle modification, 2. Suffer from abuse, neglect
Physical activity, 3. Have behavior problems — and excessively
Nutrition, rebellious
4. Slow learners
Ways to manage obesity in children and adolescent 5. Have problems with depression and low-self
include: esteem
1. Start a program
2. Change eating habits (eat slowly, develop a Stages of substance abuse
routine) Stage O: Pre-abuse or Curiosity Stage
3. Plan meals and make better selections describes the adolescent with an increased potential
4. Increase physical activity and have a more for substance abuse need for peer acceptance; anger
active lifestyle and boredom
5. Know what your child eats school
6. Do not use food as a reward Stage l: Experimental Stage (Learning the Euphoria)
7. Limit Snacks Adolescents have already made a decision to "try
8. Attend a group (e.g. Overeaters Anonymous) drugs" and begun learning the drug induced mood
swing or euphoria.
Substance Abuse
is the misuse of an addictive that changes the user’s drug use is confined to social situations
mental state there are few behavioral changes other than "lying:
Refers to the use of chemical to improve a mental Stage 2, Early Regular Use (Seeking the Euphoria)
state or induce euphoria The adolescent now actively seeks the drug-induced
mood swing
Commonly abuse substance — alcohol, tobacco and
illicit drugs use drugs to seeks relief from everyday stress

Changes in dress, decline in personal hygiene, Prevention is the most effective and least expensive
deterioration in school performance, loss of previous treatment for substance abuse
interest in extracurricular activities adolescent
exhibits more mood swings, engage in regular lying. Medication -nicotine patches and methadone
Rehabilitation -counseling, social support. family
support
Stage 3 Late Regular Use (Preoccupation the
Euphoria) Suicide
Is a deliberate self- injury with the intent to end life.
Dependent on substance abuse
successful suicide occurs more frequently in male
Dependence - compulsive need to use a substance than females
satisfying effect
- deterioration of behavior such as fighting, lying, third cause of cause of death
stealing, prostitution often depressed, suicidal between 1 5 — 19 years of age
ideation, self-destructive and risk-taking behavior.
Suicide as viable solution to life problems
Stage 4 End Stage or "Burn Out"
Adolescent needs drug just to feel normal and to Risk Factors
avoid the profound and nearly constant dysphoria. Previous suicide attempts
Close family member who has committed suicide.
Depression guilt, shame and other remorse may be
overwhelming and suicidal ideation becomes more past psychiatric hospitalization
common
Recent losses: death of a relative, o family divorce or
Paranoia, angry outbursts and aggression are a
common. breakup with a girlfriend
Social isolation
Common Assessment findings
I. Failure to complete assignments in school Drug or alcohol abuse
2. Demonstration of poor reasoning ability Exposure to violence in the home or the social
3. Decreased school attendance environment
4. Frequent mood swings
5. Deteriorating physical appearance
6. Recent change in peer group Warning Signs for Suicide
7. Expressed negative perceptions of parents Suicidal talk
Preoccupation With death and dying
Treatment

Signs of depression Scoliosis
Behavioral Changes
Giving away special possessions and making
arrangements to take care of unfinished business Several things to look for when screening a scoliosis
include:
Difficulty with appetite and sleep  Head appears off centered between the hips
Taking excessive risks  One shoulder appears higher than the other
Increased drug use
 One shoulder blade is more prominent than
Loss of interest in usual activities
the other
 Trunk and ribcage appear shifted to one side
Tips for parents  Waist appears asymmetrical
 One hip appears lower than the other
Know the warning signs!  Clothing hangs unevenly
Adam’s Forward Bend Test

Do not be afraid to talk to Child.
The message is. "Suicide option help is available". - As your spinal curve develops and the spine twists,
asymmetry of the ribcage or waist is created
Suicide-proof your home.

Make the knives. pills and firearms inaccessible.
Scoliometer
Utilize school and community resources. - Is used to measure the amount of rotation
School psychologist, crisis intervention
- Trunk rotation is determined with a forward bent at
the waist and is a reflection of the severity of scoliosis
Take immediate action. If your child indicates
contemplating suicide - A rotation of greater than five to seven degrees
suggests scoliosis may be present
Do not leave Child alone

Bone Cancer
Seek professional
Listen to your child's friends.  Everything in our bodies begins with. Our cells
Be open. Ask questions. divide to create new ones, our cells continue
to divide until they are too old and tired to
duplicate, when a cell is too old to duplicate it
dies, though cancer cells are different.
 A cancer cell makes new copies of itself but
doesn't know when to stop. Before a cell can
divide it goes through a series of checks to see

if it is healthy. If there is a problem with the
cell it is disposed of.
 A cancer cell cheats. The cancer cell grows
and changes, if the cancer changes a little it's
called a benign tumor. Benign tumors can be
destroyed easily or removed with the help of
doctors.
 If the cancer cell changes too much it can
damage the area around it, this is called a
malignant tumor. Some cancer cells move to
other parts of the body where they grow into
other tumors, this spreading of cancer cells is
called metatarsus.If the malignant tumor is
big enough they can be shrunk by medical
treatments, removed or zapped by doctors.
 The outcome of cancer treatment depends on
many factors such as type of cancer, its
location, and speed of diagnosis. With the
help of medical research and development,
cancer treatments are seeking to better
manage symptoms and prolong life

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Care of Mother, Child at Risk or 04 L E C

 COURSE CODE and TITLE INTRODUCTION

BSN-2B TRANSCRIBED BY: GROUP # 1

BSN-2B TRANSCRIBED BY: GROUP # 2

 Assessment (of preterm) MANAGEMENT (PRETERM)

BSN-2B TRANSCRIBED BY: GROUP # 3

BSN-2B TRANSCRIBED BY: GROUP # 4

Problems of LGA babies

BSN-2B TRANSCRIBED BY: GROUP # 5

BSN-2B TRANSCRIBED BY: GROUP # 6

BSN-2B TRANSCRIBED BY: GROUP # 7

Who among you are preterm?

BSN-2B TRANSCRIBED BY: GROUP # 8

 poor sucking and swallowing reflex 2. Hyperbilirubinemia

 Square window wrist

Common or special problem Management

BSN-2B TRANSCRIBED BY: GROUP # 9

BSN-2B TRANSCRIBED BY: GROUP # 10

BSN-2B TRANSCRIBED BY: GROUP # 11

Interventions Generally, there is no treatment other than lifting

LARGE FOR GESTATIONAL AGE

BSN-2B TRANSCRIBED BY: GROUP # 12

Damaged lung cells combines with other substance

this membrane lines the alveoli and blocks gas

CPAP machine blows air at a prescribed pressure

If the pt lacks surfactant, there would be surface

BSN-2B TRANSCRIBED BY: GROUP # 13

BSN-2B TRANSCRIBED BY: GROUP # 14

Possible complication of phototherapy

BSN-2B TRANSCRIBED BY: GROUP # 15

Respiratory Distress is present at birth:

BSN-2B TRANSCRIBED BY: GROUP # 16

 Prolonged rupture of membranes

- often does not have specific sign of Illness

SEPSIS Routine newborn care with special emphasis on the

BSN-2B TRANSCRIBED BY: GROUP # 17

 May be related to a brainstem abnormality

Infants should be placed in the supine position Classified as:

BSN-2B TRANSCRIBED BY: GROUP # 18

 All children with failure to thrive need additional HYDROCEPHALUS

- Makita mo sa itsura ng bata; Makita mon a

BSN-2B TRANSCRIBED BY: GROUP # 19

 Increased head circumference SURGICAL INTERVENTION

1. Give small frequent feedings as tolerated

Instruct the parents on how to recognize shunt

BSN-2B TRANSCRIBED BY: GROUP # 20

BSN-2B TRANSCRIBED BY: GROUP # 21

BSN-2B TRANSCRIBED BY: GROUP # 22

BSN-2B TRANSCRIBED BY: GROUP # 23

If there are changes in motor-control, alterations with 2. Generalized

BSN-2B TRANSCRIBED BY: GROUP # 24

BSN-2B TRANSCRIBED BY: GROUP # 25

Etiology – primarily genetic environmental factors

Nursing Intervention – Post op cleft lip

BSN-2B TRANSCRIBED BY: GROUP # 26

BSN-2B TRANSCRIBED BY: GROUP # 27

 Is an injury to body tissue caused by excessive

 It is the most severe form of trauma to the

 Once you have burns it really disrupts the skin

 Changes in the functioning the appearance the