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Cognitive development –ability to learn and understand from experience to acquire and retain knowledge.
To respond to a new situation and to solve problems.
Average IQ – 90-100
Gifted child- > 130 IQ
Principles of G & D
1. G&D is a continuous process
-begins form conception- ends in death
- womb to tomb principles
2. not all parts of the body grow at the same time or at same rate.
- asynchronism
Patterns of G&D
1. )renal
digestive grows rapidly during childhood
circulatory
musculoskeletal
3. )Lymphatic system- lymph nodes, spleen grows rapidly- infancy and childhood to provide
protection -infection
- tonsil adult proportion by 5 years
Rates of G&D
1. fetal and infancy – most rapid G&D
2. adolescent- rapid G&D
3. toddler- slow G period
4. Toddler and preschool- alternating rapid and slow
5. school age- slower growth
B. Environment
Q – quality of nutrition
S – socio eco. status
H – health
O – ordinal pos in family
P – parent child relationship
4.G&D occurs in a regular direction reflecting a definitive and predictable patterns or trends.
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Directional trends- occur in a regular direction reflecting the development of neuromuscular function.
These apply to physical, mental, social and emotional development and includes.
a. cephalo-caudal “head to tail”
- occurs along bodies long axis in which control over head, mouth and eye movements and
precedes control over upper body torso and legs.
b. proximo- distal “Centro distal”
- progressing form center of body to extremities.
c. Symmetrical- at side of body develop on same direction at same time at same rate.
d. Mass specific “differentiation”
- child learns form simple operations before complex function of move from a broad general pattern
of behavior. To a bore refined pattern.
B. Sequential- involves a predictable sequence of G&D to which the child no9rmally passes.
a. locomotion- creep than crawls, sit then stand.
b. socio and language skills- solitary games, parallel games
C. Secular- worldwide trend of maturing earlier and growing larger as compared to succeeding generations.
Theories of G&D
Developmental tasks- different form chronological age
-skill or growth responsibility arising at a particular time in the individuals life.
The successful achievement of which will ------- a foundation for the accomplishments of future tasks.
Theorists
1. Sigmund Freud 1856-1939 Austrian neurologists. Founder of psychoanalysis
- offered personality development
Psychosexual theory
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-answer Childs question directly.
Right age to introduce sexuality – preschool
stages of psychosocial
a.) trust vs mistrust – 0-18 months.
-foundations of all psychosocial task
-to give and receive is the psychosocial theme
-know to develop trust baby
1. satisfy needs on time
- breastfeed
2. care must be consistent and adequate
-both parents- 1st 1 year of life
3.) give an experience that will add to security- touch, eye to eye contact, soft music.
b.) Autonomy vs shame and doubt 18-3 years --- independence /self gov’t
develop autonomy on toddler
1. give an opportunity of decision making like offer choices.
2. encourage to make decision rather then judge.
3. set limits
f. Intimacy vs isolation 20-40 yrs -looking for a lifetime partner and career focus
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JEAN PIAGET- Swiss psychologists
-develop reasoning power
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KOHLBERG- recognized the theory of moral dev’t as considered to closely approximate cognitive stages
of dev’t
-sabay with cognitive dev;t
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-moro reflex disappears ( 4-5 months)
11 months- cruisse
- stands with assistance
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15 months – plateau stage
walks alone
lateness in walking- mild mental retardation
-puts small pellets into small bowl
-holds spoon well
- seats self on chair
-creeps up stairs
- 4 - 6 words
30 months or 2 ½ years – makes simple lines or stroke for crosses with a pencil
-can jump down from chairs
-knows full name
- copy a circle
- holds up finger to show age
- temp teeth complete
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scaffoid abdominal-due to underdeveloped abdominal muscles
physiologic anorexia- due to preoccupation with environment- food jag that last
for short period of time
loves rough and tumbling play
loves toilet training-
failure of toilet training- unreadiness
Milestones
4years old- furious 4 , noisy, aggressive, stormy
-can button buttons
-copy a square
-jumps and skips
-laces shoes
-vocabulary 1,500
-knows four basic colors
Death-sleep only
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School Age
Play- competitive play
Ex. Tug of war, track and field, basket ball
Significant Development
a. boys- prone to bone fracture
b. mature vision 20/20
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-sense of humor present
-social and cooperative
BOYS:
A-appearance axillary, pubic hair ( 1st sign sexual mat)
D-deepening voice
D- development of muscles
I--inc in testes and penis size
P- prod of viable sperm ( last sign sexual maturity)
Adolescent
Fear
1. obesity
2. acne
3. homosexuality
4. death
5. replacement from friends
6. significant person- opp sex.
Significant dev’t
1. experiences conflict bet his needs for sexual satisfaction and societies expectation
2. change of body image and acceptance of opp/sex
3. nocturnal emission – wet dreams
4. distinctive odor- due to stimulation apocrine glands
5. sperm is viable by 17 yrs
6. testes & scrotum increase until age 17
7. breast and female genitalia increase until age 18
Problems:
1. vehicular accident
2. smoking
3. alcoholism
4. drug addiction
5. pre marital sex
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IMMEDIATE CARE OF NEWBORN
1st days of life
B. Catheter Suctioning
1.) place head to side to facilitate drainage
2,) suction mouth 1st before nose
-neonates are nasal breathers
3.) period of time
-5-10 sec suctioning, gentle and quick
prolonged and deep suctioning can lead to hypoxia, laryngo spasm, brady cardia due to
stimulation vagal nerve
C. If not effective, requires effective laryngoscopy to open a/w. After deep suctioning an endotracheal
tube can be inserted and oxygen can be administered by an (+) pressure bag and mask with 100%
oxygen at 40-60b/m.
Nsg alert:
1. No smoking
2. Always humidify to prevent drying of mucosa
3. Over dosage of oxygen can lead to scarring of retina leading to blindness ( retro lentalfibrolasia or
retinopathy of prematurity)
4. When mecomium stained (greenish) never administer oxygen with pressure ( O2 pressure will
push mecomium inside)
-Remaining 30%- tricuspid valve- RT ventricle- pulmonary arteries- lungs (for nutrition) (vasoconstriction
of lungs pushes blood to ductus arteriousus to aorta to supply upper extremities.
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SHUNTS-shortcuts
Ductus venosus- -shunts from liver to IVF
Foramen ovale- shunts bet 2 atrias
Ductus arteriosus- from pulmonary artery to aorta
Closure of Closure of
Closure of foramen
ductus ductus venosus
ovale
arteriosus & AVA
st
What will
What will initiate
sustain 1lungbreath- decreased artery
circulation-lung pressure
expansion
What will complete circulation- cutting of cord
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Obliteration-complete closure
Temp Regulation
- goal in temp regulation is to maintain it not less than 97.7% F (36.5 C)
- maintenance of temp is crucial on preterm and SGA (small for gestational age) - babies prone to
hypothermia or cold stress
-
A. factors leading to dev’t of HYPOTHERMIA
1. preterms are born poi kilo thermic- cold blooded
- babies easily adapt to temp of environment due to immaturity of thermo regulating system of
body. Hypothalamus
2. inadequate SQ tissue
3. baby is not capable of shivering
4. babies are born wet
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To Prevent Hypothermia
1. dry and wrap baby
2. mechanical pressure – radiant warmer
i. pre-heated first isolette (or square acrylic sided incubator)
3. prevent an necessary exposure – cover baby
4. cover baby with tin foil or plastic
5. embrace the baby- kangaroo care
Sucking- PPG – oxytocin – contraction of lactiferous tubules - milk ejection reflex- let down reflex.
Advantages of Breastfeeding
1. Economical
2. Always available
3. Breastfed babies have higher IQ than bottle fed babies.
4. It facilitates rapid involution
5. Decrease incidence of breast cancer.
6. Has antibodies- IgA
7. Has lactobacillius bifidus- interferes with attack of pathogenic bacteria in GIT
8. Has macrophages
Store milk- plastic storage container
Store milk – good for 6 months from freezer- put rm temp. don’t heat
Disadvantages:
1. Possibility of transfer HEP B, HIV, cytomegalo virus.
2. No iron
3. Father can’t feed & bond as well
Stages of Breastmilk:
1. Colostrum- 2-4 days present
content: decrease fats, increase IgA, dec CHO, dec CHON, inc minerals,
inc fat soluble minerals
2. Transitional milk- 4 – 14 days
content: inc lactose, inc water soluble vit., inc minerals
3. Mature milk- 14 & up
content: inc fats (linoleic acid) – resp for devt of brain & integrity of skin
inc CHO- lactose – easily digested, baby not constipated.
- resp of sour milk smelling odor of stool.
Health Teachings:
1. Proper hygiene- proper hand washing
Care of breast - cotton balls with lukewarm water
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Caked colostrum- dry milk on breast
2. Best position in breastfeeding – upright sitting -avoid tension!
3. Stimulate & evaluate feeding reflexes
a.) Rooting reflex- by touching the side of lips/cheeks then baby will turn to stimulus. Disappear
by 6 weeks- by 6 weeks baby can focus. Reflex will be gone
- Purpose rooting- to look for food.
b.) Sucking – when you touch middle of lips then baby will suck
- Disappears by 6 months
- When not stimulated sucking will stop.
c.) Swallowing- when food touches posterior of tongue then it will be automatically swallowed
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Hydrops Fetalis
Phenylketonuria
Galactosemia
Tay Sachs disease
2. Transitional stool -
- green loose & shiny, like diarrhea to the untrained eye
3. Breastfed stool - golden yellow, soft, mushy with sour milk smell, frequently passed
- recur every feeding
4. Bottlefed stool –
- pale yellow, formed hard with typical offensive odor, seldom passed, 2–3 x/day
- with food added -brown & odorous
A- appearance- color – slightly cyanotic after 1st cry baby becomes pink.
P- pulse rate – apical pulse – left lower nipple
G- grimace – reflex irritability- tangential foot slap, catheter insertion
A – activity – degree of flexion or muscle tone
R – respiration
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APGAR Scoring Chart:
0 1 2
HR -absent <100 >100
Resp effort -absent - slow, irreg, weak -good strong cry
Muscle tone - flaccid extremities - some flexion - well flexed
Reflex irritability
Catheter - no response - grimace - cough, sneeze
Tangential Footslap - NR - grimace - cry
Color - blue/pale - acrocyanosis - pinkish
(body- pink
extremities-blue)
APGAR result
0 – 3 = severely depressed, need CPR, admission NICU
4 – 6 = moderately depressed, needs add’l suctioning & O2
7 - 10 =good/ healthy
Circulation
Check for pulslessness :carotid- adult
Brachial – infants
CPR – breathless/pulseless
Compression – inf – 1 finger breath below nipple line or 2 finger breaths or thumb
Interpretation result:
0 -3 – normal, no RDS
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4 – 6 – moderate RDS
7 – 10 – severe RDS
Neonates in Nursery
Nsg responsibility upon receiving baby- proper identification
- foot printing, affixing mother thumb print
- take anthropometic measurement
normal length- 19.5 – 21 inch or 47.5 – 53.75cm, average 50 cm
head circumference 33- 35 cm or 13 – 14 “
Hydrocephalus - >14”
Chest 31 – 33 cm or 12 – 13”
Abd 31 – 33 cm or 12 – 13”
Bathing
- oil bath – initial
- to cleanse baby & spread vernix caseosa
Fx of vernix caseosa
1. insulator
2. bacterio- static
Babies of HIV + mom – immediately give full bath to lessen transmission of HIV
- 13 – 39% possibly of transmission of HIV
3 cleans in community
1. clean hand
2. clean cord
3. clean surface
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betadine or povidone iodine – to clean cord
check AVA, then draw 3 vessel cord
silver nitrate (used before) – 2 drops lower conjunctiva (not used now)
V/S:
Temp: rectal- newborn – to rule out imperforate anus
- take it once only, 1 inch insertion
Imperforate anus
1. atretic – no anal opening
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2. agenetic – no anal opening
3. stenos – has opening
4. membranous – has opening
Earliest sign:
1. no mecomium
2. abd destention
3. foul odor breath
4. vomitous of fecal matter
5. can aspirate – resp problem
Mgt:
Surgery with temporary colostomy
Causes:
1. familial
2. exposure to rubella – 1st month
3. failure of strucute to progress
acyanotic L to R
cyanotic R – L
S&Sx 1. systolic murmurs at lower border of sternum and no other significant sign
2. cardiac catheterization reveals increased o2 saturation @ R side of heart
3. ECG reveals hypertrophy of R side of heart
Nsg Care:
Cardiac catheterization: site – Rt femoral vein
1. NPO 6 hrs before procedure
2. protect site of catheterization. Avoid flexion of joints proximal to site.
3. assess for complication – infection, thrombus formation – check pedal pulses
( dorsalis pedis)
Mgt.
1.) long term antibiotic – to prevent subacute bacterial endocarditis
2.) open heart surgery-
cardiac catheterization-
Mgt Pulmo Stenosis & Aortic Stenosis
1.) balloon stenostomy
2.) surgery
Duplication of Aortic Arch- doubling of arch of aorta causing compression to trachea and esophagus
S&Sx : 1. dysphagia 2. dyspnea
3. left ventricular hypertrophy
Mgt: - close heart surgery
Outstanding Sx:
1. cyanosis after 1st cry (due no exygenation)
2. polycythemia – increased RBC =compensatory due to O2 supply=viscous blood
=thrombus = embolus = stroke
3. ECG – cardiomegaly
Cardiac cath – decreased O2 saturation
Palliative repair – rashkind procedure
Complete repair – mustard repair
2.) Total Anomalous Pulmonary
venous return – pulmo vein instead of entering Lt atrium, enters Rt atrium or SVC
Increased pressure on Rt so blood goes to Lft
3.) Truncus Arteriousus- aorta & pulmo artery is arising fr 1 single vessel or common trunk with VSD
S & Sx 1. cyanosis
2. polycythemia – thrombus = embolus = stroke
Aschoff – rounded nodules with nucleated cells and fibroblasts – stays and occludes mitral valve.
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Jones Criteria
Major Minor
1. polyarthritis – multi joint pain 1. arthralgia – joint pain
2. chorea – sydenhamms chores or 2. low grade fever
st. vetaus dance-purposeless involuntary hand and shoulder with
grimace
3. carditis – tachycardia 3. all lab results
erythema marginatum - macular rashes increase antibody
SQ nodules “ C reactive protein
“ erythrocyte sedimentation
rate
“ anti streptolysin
o titer (ASO)
Criteria:Presence of 2 major, or 1 major and 2 minor + history of sore throat will confirm the dx.
Nsg Care:
1. CBR
2. throat swab – culture and sensitivity
3. antibiotic mgt – to prevent recurrence
4. aspirin – anti-inflammatory. Low grade fever – don’t give aspirin.
S/E of aspirin:
- Reyes syndrome – encephalopathy- fatty infiltration of organs such as liver and brain
Respiration
Newborn resp – 30-60 cpm, irregular abd or diaphramatic with short period of apnea without cyanosis.
< 15 secs – normal apnea –newborn
Resp Check
Newborn – 40 – 90
1 yr - 20 – 40
2-3yr 20 – 30
5 yrs 20 – 25
10 yrs 17 – 22
15 & above 12- 20
2.) BRONCHOVESICULAR- soft, medium pitched, heard over major bronchi, inspiration equals exp.
Normal
3.) BRONCHIAL SOUNDS- loud high pitched, heard over trachea, expiration longer than inspiration.
Normal
4.) RHONCHI – snoring sound made by air moving through mucus in bronchi. Normal
5.) RALES-or crackles – like cellophane – made by air moving through fluid in alveoli.
Abnormal- asthma, foreign body obstruction.
6.) WHEEZING- whistling on expiration made by air being pushed through narrowed bronchi .Abnormal –
asthma, foreign body obstruction
7.) STRIDOR- crowing or ropster life sound – air being pulled through a constricted larynx. Abnormal –
resp obstruction
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Asthma- pathognomonic sign – expiratory wheezing
Pet – fish. Sport – swimming
Drugs – amynophylline – monitor bp, may lead to hypotension
Fibrine hyaline
Sx – definite with in 1st of life
Increase RR with retraction
Inspiratory grunting – pathognomonic
7 – 10 severe RDS (silvermenn Anderson index)
cyanosis due to atelectasis
Mgt:
1. surfactant replacement and rescue
2. pos- head elevated
3. proper suctioning
4. o2 with increase humidity- to prevent drying of mucosa
5. monitor V/S skin color , ABG
LARYNGOTRACHEOBRONCHITIS
LTB – most common Creup -viral infection of larynx, trachea & bronchi
outstanding sx - croupy cough or barking
pathognomonic - stridor
- labored resp
- resp acidosis
- end stage – death
Lab:
1. ABG
2. neck and throat culture
3. dx- neck x-ray to rule out epiglotitis
Nsg Mgt:
1. bronchodilators
2.increase o2 with humidity
3. prepair tracheostomy set
SKIN:
Acrocyanosis
BIRTHMARKS:
1. Mongolian spots – stale gray or bluish discoloration patches commonly seen across the sacrum or
buttocks due to accumulation of melanocytes. Disappear by 1 yr old
2. MIlla – plugged or unopened sebaceous gland . white pin point patches on nose, chin or cheek.
3. Lanugo – fine, downy hair – common preterm
4. Desquamation – peeling of newborn, extreme dryness that begin sole and palm.
5. Stork bites (Talengeictasi nevi) – pink patches nape of neck
hair will grow as child grows old
6. Erythema Toxicum – (flea bite rash)- 1st self limiting rash appear sporadically & unpredictably as
to time & place.
7. Harlequin sign – dependent part is pink, independent part is blue
(side lying – bottom part is dependent pink)
8. Cutis Marmorato – transitory mottling of neonates skin when exposed to cold.
9. Hemangiomas – vascular tumors of the skin
3 types Hemangiomas
a.) Nevus Flammeus – port wine stain – macular purple or dark red lesions seen on face or thigh. NEVER
disappear. Can be removed surgically
b.) Strawberry hemangiomas – nevus vasculosus – dilated capillaries in the entire dermal or subdermal
area. Enlarges, disappears at 10 yo.
c.) Cavernous hemangiomas – communication network of venules in SQ tissue that never disappear with
age. - MOST DANGERIOUS – intestinal hemorrhage
Skin color blue – cyanosis or hypoxia
White – edema
Grey – inf
Yellow – jaundice , carotene
Vernix Caseosa – white cheese like for lubrication, insulator
INFANT 5-9 yo
ANTERIOR POSTERIOR Ant Post
Head 9.5 9.5 6.5 6.5
Neck 1 1 1 1
Upper arm 2 2 2 2
Lower arm 1.5 1.5 1.5 1.5
Hand 13 1.25 1.25 1.25
Trunk 13 13
Back 13 13
Genital 1 1
@ buttocks 2.5@ 2.5 @
Thigh 2.75 2.75 4 4
Leg 2.5 2.5 3 3
foot 1.75 1.75 1.75 1.75
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DEPTH
1st degree – partial thickness – superficial epidermis - erythema, dryness, PAIN
-sunburn, heals by regeneration from 1 – 10 days
2nd degree – epidermis & dermis- erythema, blisters, moist, extremely painful
scalds
3rd degree – full thickness- epidermis, dermis, adipose tissue, fascia, muscle & bone
lethargy, white or black, not painful – nerve endings destroyed
ex. lava burns
Mgt:
1.) 1st aid a.) put out flames by rolling child on blanket
b.) immerse burned part on cold H2o
c.) remove burned clothing of with sterile material
d.) cover burn with sterile dressing
2.) a/w
a.) suction PRN, o2 with increased humidity
b.) endotracheal intubation
c.) tracheostomy
3.) Preventiuon of shock & F&E imbalance
a. colloids to expand bld volume
b. isotonic saline to replace electrolytes
c. dextrose & H2o to provide calories
4.) Tetanus toxoid booster
5.) Relief of pain – IV analgesic MORPHINE SO4 – needed for 2nd degree – very painful
6.) 1st defense of body – intact skin
prevention of wound infection
a.) cleaning & debriding of wound
b.) open or close method of wound care
c.) whirlpool therapy – drum with solution
7.) skin grafting – 3rd degree – thigh or buttocks (autograft), pigs/ animals – xenograft
frozen cadaver – hallow graft
8,) diet – increase CHON, increase calories.
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ANEMIA-pallor
Causes:
1.)early cutting of cord – preterm – cut umb cord ASAP
fullterm – cut umb cord when pulsation stops
2.) Bleeding disorders – blood dyscrasias
Assessment:
- umphalagia – earliest sign
- newborn receive maternal clotting factor
- newborn growing – sudden bruising on bump area- marks earliest sign
- continuous bleeding – hematrosis – damage or bleeding synovial membrane
Dx test :
PTT. Partial thromboplastin time – reveals deficiency in clotting factor
Long Term Goal- prevention of injury
Nsg Dx- increase risk of injury
HT: avoid contact sport, swimming only, don’t stop immunization – just change gauge of needle
Falls – immobilized , elevate affected part, apply pressure-not more then 10 min
cold compress
-determine case before doing invasive procedure
Classification :
1. Lympho – affects lymphatic system
2. Myelo – affects bone marrow
3. acute / blastic- affects immature cells
4. chronic/ cystic- affects mature cells
MOST COMMON CANCER – (ALL) – Acute Lymphocytic Leukemia
S&Sx:
1. from invasion of bone marrow
signs of infection
a.) fever
b.) poor wound healing
c.) bone weakness & causes fracture
signs of bleeding
a.) petecchiae-small, round, flat, dark red spot
b.) epistaxis
c.) blood in urine/ emesis
signs of anemia
a.) pallor , body malaise , constipation
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2. CBC – determine anemia, leukocytosis, thrombocytopenia neutropenia
3. lumbar puncture (LP) – determine CNS involvement. Before LP, fetal pos.- avoid flexion of neck
– will cause a/w obstruction.“C” position or shrimp position only.
4. bone marrow aspiration – determine blast cells,
- common site- iliac crest
- post BMA s/effect – bleeding
- apply pressure. Put pt on affected side to prevent hemorrhage
5. Bone scan – determine bone involvement
6. CT scan – determine organ involvement
Therapeutic Mgt:
TRIAD:
1. surgery
2. irradiation
3. chemotheraphy
Focus Nsg Care: prevent infection
4 LEVELS OF CHEMOTHERAPHY
1. induction – goal of tx; to achieve remission
meds: IV vincristine
L- agpariginase
Oral predinisone
2. Sanctuary- treat leukemic cells that invaded testes & CNS
give: methotrixate- adm intrathecally via CNS or spine
cytocine, Arabinoside, steroids with irradiation
4. Reinductin – treat leukemic cells after relapse occurs. Meds – same as induction
Nsg mgt: Outstanding nsg dx: alteration in nutrition less body requirement.
Based on Maslow’s heirarchy
S/Effect of Chemotherapy
1. N/V – adm antiemetic drugs 30 mins before chemo until 1 day after chemo
2. Ulcerations / stomatitis / abscess of oral mucosa- (alteration nutrition less body req)
- oral care – alcohol free mouthwash , betadine mouthwash
- don’t brush – use cotton pledgets
- topical xylocaine before meals
diet- soft, bland diet according to child’s preference
ABO incompatibility –
Most common incompatibility – ( mom) O – ( fetus) A
Most severe incompatibility (Mom) O– (Fetus) B
Can affect 1st pregnancy
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Hydrops (h20) Fetalis – edematous on lethal state with pathologic jaundice
Within 24 h
Mgt:
1. initiate breastfeeding to get colostrum
2. Temp suspension of breastfeeding
- content breast milk pregnanedioles – that delays action of glucoronil transferees
liver enzymes converts in direct bilirubin to become direct bilirubin
3. Needs phototherapy
4. needs exchange therapy
Physiologic jaundice – jaundice within 48 -72 h (2-3 days) expose morning sunlight
Pathologic Jaundice – within 24h. Jaundice during delivery.
Assessment of Jaudice :
1. Blanching neonates forehead, nose or sternum
- yellow skin & sclera
- color of stool – light stool
- color of urine – dark urine
Nsg Resp:
1. cover eyes – prevent retinal damage
2. cover genitals – prevent priapism – painful continuous erection
3. change position regularly – even exposed to light
4. increase fld intake – due prone to dehydration
5. monitor I&O – weigh baby
6. monitor V/S – avoid use of oil or lotion due- heat at phototherapy
= bronze baby syndrome-transient S/E of phototherapy
weigh diaper 1gm = 1cc
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Cephalhematoma- collection of blood due to rapture of pericostal capillaries
Char :
1. present after 24 h
2. never cross suture line
3. disappear after 4-6 weeks
4. monitor for developing jaundice
Nsg Care:
1.) post VP shunt – side lying on non operated site - to prevent increase ICP
monitor for good drainage - sign – sunken fontanel
bulging fontanel – blocked shunt
change fontanel as child is growing
SENSES
EYES: Assessment
1. check for symmetry
2. sclera – normal color – light blue then become dirty white
pupil – round- adult size
coloboma- part of iris is missing
sign: key hole pupil
whiteness & opacity of lens congenital cataract
cornea – round & adult size
large – congenital glaucoma
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2. Infant & children
- appearance
- ability to follow object past midline
NOSE:
1. flaring alenase – case of RDS
2. cyanosis at rest – choanal atresia - post nares obstructed with bone or membrane
Sx:
1. resistance during catheter insertion
2. emer. Surgery within 24 h
normal color nasal membrane – pinkish
rhinitis – presence of creases & pale
check sense of smell – blindfold – smell
Epistasis – nosebleed
- sit upright, head slightly forward to facilitate drainage
- cold compress , apply gentle pressure, epinephrine
most developed sense of newborn – sense of touch
1st sense to develop & last to disappear – hearing
EARS:
1. Properly aligned with outer cantus of eyes
low set ear – kidney malformation
ex. Renal aginesis – absence of kidney
sign in uterus : oligohydramnios
sign in newborn: 2 vessel cord
failure to void within 24 h
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Chromosomal aberrations : -advance maternal age
1. non disjunction – uneven division
Otitis Media – inflammation of middle ear. Common children due to wider & shorter Eustachian tube
Causes
1.) bottle propping
2.) Cleft lip/ cleft palate –
Sx: Otitis
1. bulging tympanic membrane, color – pearly gray
2. absence light reflex
3. observe for passage of milky, purulent foul smelling odor discharge
4. observe for URTI
Nsg Care:
1. position side lying on affected aside – to facilitate drainage
2. supportive care- bedrest, increase fld intake
Med Mgt:
1. Massive dosage antibiotic
Complication – bacterial meningitis
2. Apply ear ointment
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Sx.
1. Continuous drooling saliva
2. inability to open , eye & close either eye
Mgt:
Refer to PT
TEF (Tracheoesophageal Fistula)-TEA- no connection bet esophagus and stomach
Outstanding Sx – Coughing
Choking
Continuous drooling
Cyanosis
Mgt:
Emergency surgery
Epstein pearl – white glistering cyst at palate & gums related to hypercalcemia
Hypervitaminosis
Natal tooth – tooth at birth. Move with gauze
Neonatal tooth – tooth within 28days of life
LIPS- symmetrical
Cleft lip – failure of median maxillary nasal process to fuse by 5-8 wks of pregnancy
- common to boys
- unilateral
Sx:
1. evident at birth
2. milk escapes to nostril during feeding
3. frequent colic & otitis media or URTI
Mgt:
1. Surgery
cleft lip repair – Cheiloplasty =done 1-3 months to save sucking reflex (lost in 6 months )
Cleft Palate- uranoplasty = done 4-6 months to save speech
Pre op care
1. emotional support especially to mom
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2. proper nutrition
3. prevent colic
feed – upright seating or prone pos
burp frequently 2x at middle and after feeding-lower to upper tap
4. orient parents to type of feeding
rubber tipped syringe – cheiloplasty
paper cup/ soup spoon/ plastic cup – urano plasty
5. apply restraints – elbow restraints
so baby can adjust post op
NECK-
1.) check symmetry
Congenital torticolis- “ wryneck”-burn injury of sternocleidomsstoid muscle during
delivery – due to excessive traction at cephalic delivery
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Mgt: synthroid – sodium Levothyrosine -synthetic thyroid given lifetime
- check pulse rate before giving synthroid
- tachycardia – Sx of hyperthyroidism
CHEST
1. symmetry
2. breast - transparent fluid coming out from newborn related to hormonal changes-
3. chest has retroactive – RDS
4. sternum sunken – pectus excavation
Fx of GIT
1. assists in maintaining F&E & acid base balance
2. Processes & absorbs nutrients to maintain metabolism & support G & D
3. excrete waste products from digestive process
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d.) soft table food – “modified family menu” given 1 yr
e.) dilute fruit juices – 6 mos
f.) never give half cooked eggs – usually causes of salmoneliosis
g.) don’t give honey – infant botulism
h.) offered new food one at a time – interval of 4 – 7days or 1 week – determines food allergens
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2. excessive fld intake
3. CHO, CHON malabsorption
Complication = dehydration
Mild dehydration 5% wt loss
Moderate dehydration 10% wt loss
Severe dehydration 15 % wt loss
Earliest sx of dehydration
tachycardia increase temp weight loss
tachypnea sunken fontanel & eyeballs scanty urine
hypotension absence of tears
Severe dehydration:
Oliguria , Prolonged capillary refill time
Mgt:
Acute – NPO ( rest the bowel )
- with fluid replacement – IV
- prone to Hypokalemia – give K chloride
before adm of K chloride – check if baby can void, if cant void – hypokalemia
Drug: Na HCO3 – adm slowly to prevent cardiac overload
Earliest sign
1. failure to pass mecomium after 24h
2. abd distension
3. vomitus of fecal material
early childhood – ribbon like stool
foul smelling stool
constipations
diarrhea
Dx:
1. Barium enema – reveals narrowed portion of bowel
2. Rectal Biopsy – reveals absence of ganglionic cells
3. abd x-ray – reveals dilated loops on intestine
4. rectal manometry – revels failure of intestine sphincter to relax
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Esophageal cancer
Assessment :
1. chronic vomiting
2. faiture to thrive syndrome
3. organic – organ affected
4. melena or hematemesis – esophageal bleeding
Dx procedure
1. barium esophogram – reveals reflux
2. esophageal manometry – reveals lower esophageal sphincter pressure
3. intra esophageal pH content – reveals pH of distal esophagus.
Meds of GERD
Anti-cholinergic
a.) Betanicol ( urecholine) – increase esophageal tone & peristaltic activity
b.) Metachloporomide (Reglam) – decrease esophageal pressure by relaxing pyloric & duodenal
segments
- increase peristalsis without stimulating secretions
c.) H2 Histamine Receptor Antagonist – decrease gastric acidity & pepsin secretion
- Zimetidine, Ranitidine (Zantac) – take 30 min before meals
d.) antacid – neutralizes gastric acid between feedings - Maalox
OBSTRUCTIVE DISORDERS
A. PYLORIC STENOSIS – hypertrophy of muscles of pylorus causing narrowing &
obstruction.
1.) outstanding Sx- projectile vomiting
- vomiting is an initial sx of upper GI obstruction
- vomitus of upper GI can be blood tinged not bile streaked. (with blood)
- vomitus of lower GI is bilous ( with pupu)
- projectile vomiting – increase ICP or GI obstruction
- abd distension – major sx of lower GIT obst
2.) met alk
3.) failure to gain wt
4.) olive shaped mass – on palpation
5.)serum electrolyte – increase Na & K, decrease chloride
6.) ultrasound
7.) x ray of upper abd with barium swallow reveal “string sign”
Mgt:
1. Pyleromyotomy
2. Fredet Ramstedt procedure
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- palpate sausage shaped mass
Mgt:
1.) Hydrostatic reduction with barium enema
2.) Anastomosis & pull thru procedura
9 amino acids:
valine isolensine tryptophase
lysine phenylalanine
Dx:
Beutler test – get blood -done after 1st feeding
presence of glucose in blood – sign of galactosemia
galactose free diet lifetime
neutramigen – milk formula
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Gluten – glutamine ( normal absorption)
Malabsorption
Fats CHON & CHO Vit D calcium Vit K Iron folic acid
peripheral edema &
malnutrition
Inadequate
blood
coagulation
Mgt:
1. vitamin supplements
2. mineral supplements
3. steroids
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6. antidote for acetaminophen poisoning – acetylsysterine ( mucomyst)
7. caustic poisoning ( muriatic acid ) neutralize acid by giving vinegar . Don’t vomit prepare
tracheostomy set
8. Gas- mineral oil will coat intestine
Lead poisoning
Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney functioning
Accumulation of anemia = Encepalopathy
Sx:
1. beginning sx of lethargy
2. impulsiveness, learning difficulties
3. as lead increases, severe encepalopathy with seizure and permanent mental retardation
Dx:
1. Blood smear
2. abd x ray
3. long bones
Mgt:
1. remove child from source
2. if > 20 ug/dL – need chelation therapy = binds with led & excreted by kidney
=nephrotoxic
Amogenital
Female:
Pseudomenstration slight bleeding on vagina related to hormonal changes
Male:
Undescended testes – cyrptorchidism -common to preterm
surgery – orchidopexy
assess scrotum- warm room & hands
Mgt:
Surgery
Mgt:
Circusicion
Tst of Dx:
Transillumination with use of flashlight - glowing sign
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Renal Disorder Cause Sx Tx NSG CARE
NEPHROTIC infectious 1. Anasarca- gen Prednisone Focus of care:
SYNDROME edema Diuretic monitor edema
2. massive - weigh
protenuria daily
3. microscopic or no Diet:
hematuria Increase CHON
4. serum CHON Increase K- OJ,
decreased beef broth, banana
5. serum lipid Decrease Na
increased
6. fatigue
7. normal or
decreased BP
AGN ( acute Autoimmune 1. (PPP) primary 1. anti HPN 1. weigh daily
Glomerulo Grp A beta peripheral drug 2. monitor BP &
Nephritis) hemolytic periobital edema - hydralazine neurologiuc status
streptococcus 2. moderate or apresoline 3. Diet: decrease K,
3A’s; protenuria 2. iron decrease Na
AGN, 3. gross hematuria
autoimmune, ( smokey urine)
Grp A 4. serum K increased
5. fatigue
6. increase BP
Complication :
1. hypersensive
encephalopathy
2. anemia
SPINA BIFIDA CYSTICA- failure of post laminae of vertebrae to fuse with a sac
Types:
1. Meningocele – protrusion of CSF & Meninges
2. Myelomeningocele – protrusion of CSF & Meninges & spinal cord ( most dangerous)
3. Encephalocele ( CNS complication – hydrocephalus) – cranial meningocele or
myelomeningocele
Most common problem
- rupture of sac
- prone pos
- sterile wet dressing
Most common complication - infection
Myelomeningocele – genitourinary complication- urinary & fecal incontinence
Nsg care: always check diaper
Orthopedic complication – paralysis of lower extremities
Surgery to prevent infection
Post op – prone position
EXTREMITIES:
check # of digits = 20
1. syndactyly – webbing of digits
2. polydactyly – extra digits
3. olidactyly – lack of digits
4. Amelia – total absence of digits
5. pocoamelia- absence of distal part of extremities
Goal of Mgt:
Facilitate abduction
Mgt.
1. triple diaper
2. carry baby astride
3. Frejka splint
4. Pavlik harness
5. Hip Spica Cast
TALIPES – “clubfoot”
a.) Equinos – plantar flexion – horsefoot
b.) Calcaneous – dorsiflexion – heal lower that foot anterior posterior of foot flexed towards anterior
leg
c.) Varus- foot turns in
d.) Valgus- foot turns out
Equino varus- most common
Assessment:
1. Straighten legs & flexing them at midline pos
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Mgt:
1. Corrective shoe- Dennis brown shoe, spica cast
Fx: of cast –
- to immobilize
- bone alignment
- prevent muscle spasm
lead pencil – mark area to be amputated
cold H20 – hasten setting process
hot H20- slow setting process
CRUTCHES
Fx: To maintain balance
- To support weakened leg
Principles in crutches
- wt of body on palm!
- Brachial pulsing – if wt of body in axila
- Do palm exercise- squeeze ball
Different crutch Gaits:
1. Swing Through
2. Swing to
- no weight bearing are allowed into lower ext
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