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4 months
- Activity not related to body - Discover object or persons code and code memory arises - Anticipate familiar events - Exhibit goal directed behavior - Increase sense of separateness - Use trial and error to discover change of places and events - Code and Code invention of new means- Capable of space and time perceptionTransitional phase to operational period BEHAVIOR -Egocentric (unable to view another point of view) - Their thinking is basically concrete and static - Their concept of time is only now and their concept of distance is only as far as they can see - Not yet aware of the concept of reversibility - Concept of
Invention of new means thru mental combination B. Preoperational Thought SCHEMA Preconceptual
18-24 months
C. Concrete Operational (7 12 years) - Can find solutions to everyday problems with systemic reasoning - They have concept of reversibility - Activity recommended is collecting and classifying D. Formal Operational (12 and above) - Period when cognition has achieved its final form - They are capable - Can find scientific reasoning (can deal with the past, present and future) - Capable of abstract and mature thought- Do abstraction by talk time that will sort 4. Kohlberg (1984) recognized the theory of moral development as considered closely to approximate cognitive stages of development STAGES OF MORAL DEVELOPMENT INFANCY AGE (YEAR) Preconventional 23 STAGE LEVEL I 1 DESCRIPTION
DEVELOPMENTAL MILESTONEPERIOD OF INFANCY a. Play - Solitary play - Non interactive - Priority is safety - Age who appreciate teddy bearsAttitude: proper hygiene b. Fear - Stranger anxiety - Begin at 6 7 months - Peak at 8 months - Diminish by 9 months c. Milestones Neonate
Punishment/obedience orientation (heteronomous morality). Child does right because a parent tells him/her to and to avoid punishment. Individualism. Instrumental purpose and exchange. Carries out action to satisfy own needs rather than society. Will do something for another if that person do something for the child
4-7
- Largely reflex - Complete head lag - Hands fisted - Cry without tears (due to immature larcrimal duct) - Visual fixation of human face 1 MONTH - Dance reflex disappears - Looks at mobile objects 2 MONTHS - Holds head up when in prone - Social smile - Baby coos - Cry with tears - Closure of posterior fontanel by 2 3 months - Head lag when pulled to a sitting position 3 MONTHS - Holds head and chest when in prone - Follow object past midline- Grasp and tonic neck reflex are fading - Hand regards (3 months) 4 MONTHS - Turns from front to back - Head control complete - Bubbling sounds - Needs space to turn - Laugh aloud 5 MONTHS - Roll over - Turn both ways - Teething rings - Handles rattle well - Moro reflex disappear by 4 5 months
Conventional 7-10
LEVEL II
Orientation to interpersonal relations of mutuality. Child follows rules because of a need to be a good person in own eyes and the eyes of others. -Maintenance of social order, fixed rules and authority. Childs finds following rules satisfying. -Follows rules of Authority figures as well as parents in an effort to keep the system working
10-2
LEVEL III 5
6 MONTHS
ADOLESCENT PERIOD - They have distinctive odor because of the stimulation of apocrine gland - They have nocturnal emission (wet dreams) the hallmark for adolescent - Testes and scrotum increase in size until age 17 - Sperm also viable - Breast and female genetalia increase until age 18
d. Extrusion/Protrusion reflex - food touches anterior portion of tongue and tongue automatically extruded/protruded -purpose: prevent from poisoning - disappear by 4 months because baby can already spit out 4. The criteria of effective sucking a. babys mouth is hike well up to areola b. mother experiences after pain c. other nipple is flowing with milk
CRITERIA HEART RATE RESPIRATORY EFFORT MUSCLE TONE REFLEX IRRITABILITY CATHETHER TANGENTIAL FOOTSLAP COLOR
Interpretation of APGAR Result 0-3: severely depressed, need CPR, admission to NICU
CARDIO PULMONARY-RESUSCITATION Airway (Clear Airway) 1. Shake, no response call for help 2. Place flat on bed 3. Head tilt chin lift maneuver - Contraindicated to spinal cord injury - Over extension may occlude airway Breathing (Ventilating the lungs) 4. Check for breathlessness 5. Administer 2 rescue breaths Circulation (by cardiac compression) 6. Check for pulselessness 7. Do CPR (when breathless and pulse less) B. RESPIRATION EVALUATION SILVERMAN ANDERSON INDEX CHART SCORE
POST TERM BABIES - More than 42 weeks - Old mans face (classic sign) - Desquamation (peeling of neonate skin characterized by extreme dryness than begin from sole and palm within 24 hours D. Neonate in the Nursery *Special and Immediate Interventions 1. Upon receiving - Proper identification (foot print with mothers thumb print) - Take antropometric measurement 2. Then take anthropometric measurements a. Length = 19.5 21 inches/47.5 53.75 cm average of 50 cm b. Head Circumference = 33 35 cm average of 34 cm/13 14 inches c. Chest Circumference = 31 33 cm average of 32 cm/12 13 inches d. Abdominal Circumference = 31 33 cm average of 32 cm/12 13 inches 3. Bathing Baby - Normal oil bath - Cleanse and spread vernix - Babies of HIV positive mothers are given full bath to lessen transmission of infection - Insulator - Bacteriostatic - Full bath is safely given when cord falls 4. Dressing the umbilical cord - Follow strict asepsis to prevent infection/tetanus - Use Povidone iodine - Check for 3 vessels (2 arteries and 1 vein) - AVA (2 vessel cord suspect kidney malformation) - Leave about 1 inch of cord - 8 inches if anticipating IV or BT- Check for the cord q 15 minutes for the first 6 hours -For bleeding: - 30 cc is bleeding to newborn - Hemophilia is excessive bleeding - Ompalagia is bleeding of the cord - Cord turns black on the third day- Falls by 7th 10th day - Failure to fall is umbilical granulation (silver nitrate) - Use saline to clean 5. Credes Prophylaxis -Purpose: prevent opthalmia neonatorum (use erythromycine ophthalmic ointment)
CRITERIA Chest movement Intercostal retraction Xiphoid retraction Nares dilation Expiratory grunt
Interpretation of Result 0 3: Normal no respiratory distress syndrome 4 6: Moderate RDS 7 10: Severe RDS C. ASSESSMENT OF GESTATIONAL AGE BALLARD AND DOBOWITZ CLINICAL CRITERIA FINDINGS GESTATIONAL AGE (WEEKS) 39 and up LESS 37-38 THAN 36 Sole creases Anterior Occasion Sole covered transverse creases in with creases crease only 2/3 Breast 2 mm 4mm or 37mm-7.5mm nodule (dm) 5mm Scalp hair Fine and Fine and Coarse and fuzzy fuzzy silky Ear lobe pliable some thick Testes Testes and Intermediate Testes scrotum scrotum in pendulous, lower canal, scrotum full scrotum is with
2. Atrial Septal Defect - Failure of foramen ovale to close Signs and Symptoms 1. Systolic murmur at upper border of sternum and no other significant signs 2. Cardiac catheter reveals increase oxygen saturation at right side of heart 3. ECG reveals hypertrophy of right side of heart 3. Endocardial Cushion Defects - AV canal affecting both tricuspid and mitral valve Signs and Symptoms 1. Only confirmed by cardiac catheter Management - Open heart surgery 4. Patent Ductus Arterious - Failure of ductus arteriosus to close Signs and Symptoms 1. Continuous machine like murmur 2. Prominent radial pulse 3. Hypertrophy of left ventricle upon ECG Management 1.INDOMETHACIN (prostaglandin inhibitor that facilitate closure of PDA) 2. Ligation of PDA by 3 4 years old
B. CYANOTIC HEART DEFECTS Right to left shunting WITH INCREASE PULMONARY BLOOD FLOW 1. Transposition of Great Arteries - Situation where aorta is arising from the right ventricle and pulmonary artery of the left ventricle Signs and Symptoms 1. Cyanosis after 1st cry (outstanding sign) 2. Polycythemia (compensatory mechanism to decrease oxygen supply 3. Prone to thrombus leading to embolism resulting to stroke (complications) Management 1. Palliative repair kashkind procedure 2. Complete repair mustard procedure 2. Total Anomalous Pulmonary Venous Return - Pulmonary vein enters the right atrium or superior vena cava Signs and Symptoms 1. Mixed blood supplying the body (oxygenated and unoxygenated) 2. Open foramen ovale 3.Aspleenia (absent spleen) 4. Mild to moderate cyanosis Management 1. Restructuring of the heart 3. Truncus Arteriosus - Pulmonary artery and aorta is arising from one common trunk or single vessel with VSD Management 1. Positive cyanosis and polycythemia 2. Restructuring of the heart 4. Hypoplastic Left Heart Syndrome - Non functioning left ventricle Signs and Symptoms 1. Cyanosis 2. Polycythemia Management 1. Heart transplant
Management - CBR (avoid contact sports) - Culture and sensitivity (throat swab) - Antibiotic management (to prevent recurrence) - Aspirin (anti inflammatory)Side Effects: Reyes Syndrome - Non recurring encephalopathy accompanied by fatty infiltration of organs such a sliver and brain
RESPIRATION
- Abnormal/diaphragmatic - Short period of apnea without cyanosis
SOUND VESICULAR
CHARACTERISTICS Soft, low pitched, heard over periphery of lungs, inspiration longer than expiration, normal. Soft, medium-pitched, heard over major bronchi, inspiration equals expiration, normal. Loud, high-pitched, heard over trachea, expiration longer than inspiration, normal. Snoring sound made by air moving through mucus in bronchi, normal. Crackles (like cellophane) made by air moving through fluid in alveoli. Abnormal; denotes pneumonia or pulmonary edema which is fluid in alveoli. Whistling on expiration made by air being pushed through narrowed bronchi. Abnormal; seen on children with asthma or foreign-body obstruction. Crowing or rooster like sound made by air being pulled through a constricted larynx, Abnormal, seen in infants with respiratory obstruction. Loud, low tone, percussion sound over normal lung tissue. Louder, lower sound than resonance, a percussion sound over hyperinflated lung issue.
BRONCHOVESICULAR
WHEEZING
STRIDOR
RESONANCE HYPERRESONANCE
SKIN
- Acrocyanosis (body pink extremities blue) - Generalized mottling due to the immaturity of the circulatory system BIRTHMARKS 1. Mongolian Spots slate-gray-or bluish discoloration/patches commonly seen across he sacrum or buttocks - Due to increase melanocytes - Common in asian newborn - Disappear by 1 year, preschool, 5 years old 2. Milia plugged unopened sebaceous gland usually seen as white pinpoint patches on nose, chin and cheek, disappears by 2 4 weeks 3. Lanugo fine downy hair 4. Desquamation peeling of the newborn skin within 24 hours, common among post term 5. Stork bites (telengiectasis nevi) pink patches at the nape of the neck- Never disappear but is covered by hair
RESPIRATORY DISTRESS SYNDROME - Hyaline membrane disease -Cause: lack of surfactant - Common in preterm infants - Hypoxic - Formation of hyaline- Causing atelectasis Signs and Symptoms - Definite within 4 hours of life 1. Increase RR with retractions (early sign) 2. Expiratory grunting (major sign) 3. Flaring alae nassi 4. Xiphoid retractions 5. Intercoastal retractions6. Respiratory acidosis Management 1. Keep head elevated 2. Proper suctioning- Oxygen administration- Place on continuous positive airway pressure- Positive end expiratory
ACNE
Self limiting inflammatory disease affects sebaceous glands common inadolescenceSigns: Comedones (sebum causing white heads)- Sebum is composed of lipids Management - Proper hygiene - Wash face with soap and water - Use sulfur soap or mild soap - Retin A
HEMATOLOGIC DISORDERS
PALLOR-ANEMIA Possible cause of Anemia 1. Early cutting of cord 2. Bleeding Disorder/blood dyscracia HEMOPHILIAHEMOPHILIA - Deficient clotting factor - X link recessive inheritance - Sex link - Excessive bleeding upon cutting of cord or circumcision - Carrier mother passed to son, when son becomes a father he will pass it to his daughter Hemophilia A (classic) deficiency of the coagulation component (Factor VIII)
LEUKEMIALEUKEMIA
- Group of malignant disease characterized by rapid proliferation of immature WBC - WBC (soldiers of body) -Ratio: 500 RBC:1WBC Classification (depends on affected part) Lympho lymphatic system Myelo bone marrow Acute/Blastic immature cells Chronic/cystic mature cells Acute lymphocytic common among children Signs and Symptoms 1. From the invasion of bone marrow - Anemia (pallor, fatigue, constipation) - Bleeding (bruising, petechiae, epistaxis, bleeding in urine, emesis) - Infection - Fever - Poor wound healing - Bone weakens and causes fracture 2. From the invasion of organs - Hepatosplenomegaly - CNS affectation (headache and signs of increase ICP) Diagnostic Tests and Studies 1. PBS (peripheral blood smear) determine immature WBC 2. CBC anemia, neutropenia, thrombocytopenia 3. Lumbar Puncture place in fetal position without flexion of neck, C position or shrimp position 4. Bone Marrow Aspiration- Site for aspiration is the iliac crest - Put pressure after aspiration - Place on affected side 5. Bone Scan determine bone involvement 6. CT scan determine organ involvement Therapeutic Management 1. Medications 4 Levels of Chemotherapy For Induction achieve remission (main goal) a.IV Vincristine
SENSES
a. Sense of Sight (Eyes) Sclera light blue becomes dirty white Pupils round and adult size a. Coloboma part of iris is missing b. Congenital cataract whiteness and opacity (caused by german measles) Cornea round and adult size, larger in congenital glaucoma RETINOBLASTOMA - Malignant tumor of retina - Red painful eye often accompanied by glaucoma (pathognomonic sign: cats eye reflex) - Management: enucleation b. Senses of Smell (Nose) - Flaring or alae nasi (RDS) - Pale with creases nasal membrane, chronic rhinitis - Inflamed: infection - Cocaine abuse: - No hair - Ulceration with abscess at the nasal mucosa - Perforation of nasal septum - Epistaxis: - Nose bleed - Sit upright with head tilted forward - Cold compress - Apply pressure - Give epinephrine c. Sense of Hearing (Ears)
HEAD
Sutures: 3 Fontanels: 12 18 months close Anterior fontanel - Craniostenosis/ craniosinostosis (premature closure of anterior fontanel) Posterior fontanel - 1 x 1 cm - Closes by 2 3 months Microcephaly - Small/slow growing brain - Fetal alcohol and HIV positive Anencephaly - Absence of cerebral hemisphere Noticeable Structure of the head 1. Craniotabes - Localized softening of cranial bones to 1st born child due to early lightening- Ricketts in older children 2. Caput Succedaneum - Edema of scalp due to prolonged pressure at birth -Characteristics - Present at birth - Crosses the suture line - Disappear after 2 3 days 3.Cephalhematoma - Collection of blood due to rupture of periostial capillaries -Characteristics
2. Chromosomal Aberrations - More than 35 years A. Nondisjunction 1. Trisomy 21 - Down syndrome - Extra chromosome 21 - 47 XX + 21 or 47 XY + 21 - Cause: advance paternal age - Mongolian slant in eyes - Low set ears - Broad flat nose - Protruding tongue - Puppys neck - Hypotonic (respiratory problem unable to cough out) - Simian crease (single transverse line of palm) - Educable 2. Trisomy 18 3. Trisomy 13 4. Turners 5. Klinefilters Syndrome B. Deletion Abnormalities 1. Cri-du-chat Syndrome 2. Fragile X Syndrome C. Translocation Abnormalities 1. Balance Translocation Carrier 2. Unbalanced Translocation Syndrome D. Others 1. Mosaicism a situation wherein the non disjunction of chromosomes occurs during the mitotic cell division after fertilization resulting to different cells contains different numbers of chromosomes. 2. Isochromosomes a situation wherein the chromosomes instead of dividing vertically it divides horizontally resulting to chromosomal mismatch.
MOUTH AND TONGUE a. Bels Palsy - Facial nerve paralysis - VII cranial nerve injury - Related to forcep delivery Signs and Symptoms - Continuous drooling of saliva - Inability to open 1 eye and close other eye Management - Artificial tears - Refer to PT (self limiting) b. TEF/TEA - Tracheo Esophageal Fistula. Tracheo Esophageal Atresia - No connection between esophagus and stomach - 4 Cs: coughing, choking, cyanosis, continuous drooling - Emergency surgery c. Epstein Pearls - White glistening cyst usually seen on palate or gums related to hypercalcemia d. Natal Tooth - Tooth at moment of birth related to hypervitaminosis (rootless) e. Neonatal Tooth - Tooth within 28 days f. Oral Thrush - Oral moniliasis, white cheese/curd like patches that coats mouth and tongue - Treat with anti fungal (Nistatin/Mycostatin) g. Anodontia - No eruption of temporary teeth
KAWASAKI DISEASE
- Common in Japan - Mucocutaneous lymph node syndrome - Drug of choice: Aspirin, Salicylates Criteria for diagnosis of Kawasaki Disease 1. Fever lasting more than 5 days 2. Bilateral Conjunctivitis 3. Change of lips and oral cavity a. Dry, red, fissure lips b. Strawberry tongue c. Diffuse erythema of mucous membrane 4. Changes of peripheral extremities a. Erythema of the palms and sole b. Indurative edema of the hands and feet c. Membranous desquamation from fingertips
OTITIS MEDIA
- Inflammation of middle ear, common in children due to wider and shorter eustachian tube - Common with cleft lip and palate - Bottle propping, may also result to dental caries - Otoscopic: bulging tympanic membrane and absence of light reflex - Observe for passage of milky, purulent and foul smelling odor discharge - Observe for URTI Management - Side lying on affected side to facilitate drainage - Supportive care (TSB, antipyretic)
CHEST
- Check for symmetry - Breast produces witch milk a transparent fluid related to hormone changes
ABDOMEN
- Inspection, Auscultation, Palpation, Percussion A. Diaphragmatic hernia - Protrusion of stomach contents through a defect in the diaphragm due to failure of pleuroperitoneal canal to close Signs and Symptoms 1. Sunken abdomen 2. Signs of RDS 3. Related to shunting Management - CPAP (continuous positive airway pressure) - Diaphragmatic repair within 24 hours B. Ompalocele - Protrusion of stomach contents between junction of abdominal wall and umbilicus - Small: surgery - Large: - Suspension of surgery - Wrap with sterile wet dressing - Apply silver sulfadiazine ointment to prevent infection
GASTROINTESTINAL SYSTEM
1. FUNCTIONS a. Assists in maintaining fluid and electrolyte and acid/base balance b. Processes and absorbs nutrients to maintain metabolism and support growth and development c. Excrete waste products from the digestive system 2. RECOMMENDED DAILY ALLOWANCE a. Calories: 120 calories per kilo body weight per day (360 380 calories) b. Fluids: 16 20 cc per kilo body weight c. Protein: 2.2 grams per kilo body weight 3. SUPPLEMENTARY FEEDING 4 6 months
NECK
- Check for symmetry a. Congenital Torticolis - Wry neck - Birth injury of sternocleidomastoid muscle due to excessive traction during cephalic delivery - Management:
Management Banana Rice, cereal Apple sauce Toast B. Diarrhea - Exaggerated excretion of intestinal content 1. Acute diarrhea are associated with the following a. Gastroenteritis, caused by salmoneliosis (half cooked egg) b. Antibiotic use c. Dietary indescretions 2. CNSD (Chronic Non Specific Diarrhea) a. Food intolerance b. Carbohydrates and Protein malabsorption c. Excessive fluid intake Assessment - Frequency - Consistency - Appearance of green color stool Complications Dehydration 1. Mild 5% weight loss 2. Moderate 10% weight loss 3. Severe 15% weight loss Signs of dehydration 1. Tachycardia 2. Tachypnea 3. Hypotension 4. Increase temperature 5. Sunken fontanel and eyeballs 6. Poor skin turgor/dry skin and mucous membrane 7. Absence of tears 8. Scanty urine (mark oliguria sign of severe dehydration) 9. Weight loss 10. Prolonged capillary refill time Management 1. Acute NPO to rest bowel, IV infusion 2. Potassium Chloride check if baby can void because it can lead to hyperkalemia leading to cardiac arrest 3. Sodium Bicarbonate metabolic acidosis, administered slowly to prevent cardiac arrest 7. GASTRIC MOTILITY DISORDER HIRSCHPRUNGS DISEASE - Congenital gagnlionic mega colon - Absence of gagliion cells for peristalsis Assessment 1. Neonatal Period - Failure to pass meconium after 24 hours
PYLORIC STENOSIS
- Hypertrophy of pylorus muscle causing narrowing and obstruction Assessment 1. Projectile vomiting Nursing Alerts: - Vomiting is an initial symptom of upper GI obstruction - Vomitus of upper GI can be blood tinged not bile streaked - Vomitus of lower GI is bilous - Projectile vomiting is either a sign of ICP or GI obstruction - Abdominal distention is the major symptom of lower GIT obstruction 2. Failure to gain weight 3. Palpate olive shape mass 4. Peristaltic wave visible from left to right across epigastrium Diagnostic Procedures 1. ABG metabolic alkalosis 2. Serum electrolyte: increase Na and K, decrease chloride 3. Ultrasound 4. X-ray of upper abdomen with barium swallow reveals string sign Therapeutic Management - Surgery: pyloromyotomy
Management - NGT feeding - Surgery a. Temporary colostomy (at 2 -3 months) b. Anastomosis and pull through procedure - Diet: high calorie and low residue (spaghetti and chicken) Diagnostic Procedures 1. Barium Enema reveals the narrowed portion of the bowel 2. Rectal Biopsy 3. Abdominal x-ray reveals dilated loops on intestine 4. Rectal manometry reveals failure of intestinal sphincter to relax Therapeutic Management and Nursing Care
INTUSSUSCEPTION
- Telescoping of one portion of the bowel to another - Complication of peritonitis Signs and Symptoms - Acute paroxysmal abdominal pain - Vomiting - Curant jelly stool - Sausage shape mass Diagnostic test - X-ray with barium enema reveal staircase sign Management - Hypostatic reduction with barium enema 9. INBORN ERRORS OF METABOLISM - Deficient liver enzyme
PHENYLKETONURIA
- Deficiency of liver PHT (Phenylalanine Hydroylase Transferase) - No tyrosine, melanin, tyroxine basal metabolism Signs and Symptoms - Fair skin - Blonde hair - Blue eyes - Accumulation of phenyl pyrobic acid in the blood - Musty or mousy odor urine - Atopic dermatitis - Seizure - Mental retardation Diagnostic Tests a. Guthrie test Management - Low phenylalanine indefinitely
CELIAC DISEASE
- Gluten Enteropathy - Intolerance to foods containing barley, rye, oats, wheat (normally converted to gluten) - With celiac disease gluten is converted to gliadin (toxic to the epithelial cells of villi leading to malabsorption of: - Fats (steatorrhea), Protein and Carbohydrates (malnutrition), Calcium (osteomalacia), Vitamin K (bleeding), Vitamin B12 (anemia) Assessment 1. Early signs a. Diarrhea; failure to regain weight ff diarrheal episodes b. Constipation c. Vomiting d. Abdominal Pain e. Steatorrhea 2. Late signs a. Behavioral changes: irritability and apathy b. Muscle wasting and loss of subconscious fats (protuberant abdomen) 3. Celiac Crisis a. Exaggerated form of vomiting (emergency condition) Diagnostic Procedures 1. Laboratory Studies: Stool Analysis 2. Serum antigliadin and antireticulin antibodies presence indicates disorder 3. Sweat test to rule out cystic fibrosis Therapeutic Management 1. Vitamin supplements 2. Mineral supplements 3. Steroids
11. POISONING
- Common among toddlers Principles 1. Determine the substance taken, assess LOC 2. Unless the poison was corrosive, caustic (strong alkali such as LYE) or a hydrocarbon, vomiting is the most effective way to remove the poison from the body 3. Syrup of ipecac oral emetic to cause vomiting after drug over dose or poisoning a. 15 ml to adolescent, school age and pre school b. 10 ml to infant 4. Universal antidote charcoal, milk of magnesia, and burned toast 5. Never administer the charcoal before ipecac 6. Antidote for Acetaminophen poisoning. Acetylsysteine (Mucomyst) 7. For caustic poison a. Prepare tracheostomy set b. Kerosine (use mineral oil to coat the intestine to prevent absorption) c. Give vinegar to neutralize acid (for muriatic acid ingestion)
BACK
- Check for symmetry and flatness Spina bifida Occulta - Failure of posterior laminae of vertebrae to fuse - Signs and Symptoms: dimpling at lower back - Abnormal tuffs of hair Spina bifida Cystica - With sac Types 1. Meningocele protrusion of CSF and meninges 2. Myelomeningocele protrusion of CSF, meninges and spinal cord 3. Encephalocele cranial meningocele or myelomeningocele
LEAD POISONING
- Destroy RBC functioning - Resulting to hypochromic mycrocytic anemia - Leading to kidney destruction - That leads to accumulation of amonia
SCOLIOSIS
- Lateral curvature of spine common in school age and adolescent - Uneven hemline - S shape back - When bending 1 hip is higher and 1 shoulder prominent Management 1. Conservative a. Exercise b. Avoid obesity 2. Preventive a. Milwaukee brace worn 23 hours a day 3. Corrective a. Surgery insertion of Harrington rod (post op do log rolling or move as 1 unit)
Types a. Equinos plantar flexion (horse foot) b. Calcaneous or Dorsiflexion the heel is held lower than the foot/the anterior portion of foot is flexed towards the anterior leg c. Varus foot turns in d. Valgus foot turns out Common combination is TALIPES EQUINO VARUS and TALIPES CALCANEO VALGUS Assessment - Make a habit of straightening legs and flexing to improve to midline position Management - Corrective shoes (Dennis brown SPLINT) - Spica cast CAST Purpose: - Maintain bone alignment - Prevent muscle spasm - Immobilization - Use open palm - Support with soft pillow and dry naturally Nursing Care to Patient with Cast - Circulation, motion, sensation (neurovascular check) Signs of Circulatory Impairment Blueness or coldness Lack of peripheral pulse Edema not corrected with elevation Pain on the casted extremity Tingling sensation (notify doctor because it is a sign of neurological impairment) - Petaling: making the rough surface of cast smooth - Mark cast with ballpen if there is bleeding
EXTREMITIES
I. Digits a. Syndactyly webbing of digits (ginger like foot) congenital b. Polydactyly extra digit c. Olidactyly lacking digit Amelia total absence of extremities Pocomelia absence of distal part of extremities Both are caused by THALIDOMIDE II. Erb-duchennes paralysis/Brachial Plexus injury/Brachial palsy - Birth injury due to lateral and excessive traction during a breech delivery Signs and Symptoms - Inability to abduct arm from shoulder, rotate arm externally and supinate forearm - Absence/asymmetrical moro reflex Management - Abduct from shoulder with elbow flexed III. Congenital Hip Dislocation - The head of femur is outside acetabulum Types 1. Subluxated most common type 2. Dislocated Signs and Symptoms 1. Shortening of the affected leg 2. Asymmetrical gluteal fold 3. Limited movement (early sign) 4. (+) Ortolanis sign clicking sound during abduction 5. When able to walk the child limps (late sign) Management 1. Triple the diaper
CRUTCHES
- To maintain balance, support weakened leg - Place body on palm - Do palm exercises (squeeze ball) Different Crutch Gaits 1. Swing Through Procedure: 1. Advance both crutches 2. Lift both feet/swing forward/land feet in front of crutches 3. Advance both crutches 4. Lift both feet/swing forward/land feet in front of crutches 2. Swing To Procedure: 1. Advance both crutches 2. Lift both feet/ swing forward/land feet next to crutches 3. Advance both crutches 4. Lift both feet/ swing forward/land feet next to crutches - 1 and 2 is indicated if weight bearing is not allowed in both lower extremities
CANE
- A cane is used to help the patient walk with greater balance and support and to relieve pressure on weightbearing joints by redistributing the weight. Quad canes (four-footed canes.) The cane is held in the hand opposite to the affected extremity Methods of transferring the patient from the bed to a wheelchair a. Weight-bearing transfer from bed to chair. The patient stands up, pivots his back is opposite to the new seat, and sits down b. (Left) Non-weight-bearing transfer from bed to chair. (Right) With legs braced c. (Left) Non-weight-bearing transfer, combined method. (Right) Non-weight-bearing transfer, pull-up method
TRACTION
- Use to reduce dislocation and immobilize fractures Principles of Traction 1. The client should be in dorsal or supine position 2. For every traction there is always a counter traction 3. Line of pull should be in line with deformity 4. For traction to be effective it must continuous Types Straight Traction - Weight of body serves as counter pull Skin Traction - Applied directly to skin a. Bryants traction - Use to immobilize ages below 3 years old - 90O angle with buttoks off bed b. Bucks extension - Immobilize fracture ages more than 3 years old c. Skeletal - Applied directly to bone d. Halo traction - Immobilize spine Skeletal Traction Nursing responsibility 1. Assess for circulatory and neurologic impairment 2. It can lead to hypertension 3. Be careful in carrying out nursing functions by not moving the weights
AUTOIMMUNE SYSTEM
Types of immunity a. Passive Natural maternal antibodies through placenta or breast milk b. Active Natural contract disease and produce memory cells c. Passive Artificial receive anti serum with anti bodies from another host (Hepa B) d. Active Artificial receive vaccination and produce memory cell Immunity from mother (last for 9 12 months) - Diptheria - Polio - Pertusis - Tetanus - Measles
WALKER
- A walker provides more support than a cane or crutches The patient is taught to ambulate with the walker as follows: 1. Patient must hold the walker on the hand grips for stability 2. Lift the walker, placing it in front of you while leaning your body slightly forward 3. Walk into the walker, support your body weight on your hands when advancing your weaker leg permitting partial weight-bearing or non-weight-bearing leg as prescribed 4. Balance yourself on your feet