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Growth and Development

Growth- increase in physical size of a structure or whole.

-quantitative change.
Two parameters of Growth
1. weight- most sensitive measure of growth, especially low birth rate.
Wt doubles months
!" 1yr
#" $-$ % yrs
$. &eight- increase by 1'(mo during 1
- average increase in ht - 1
year ) *+,
stoppage of ht coincide with eruption of wisdom tooth.
Development- increase s-ills or capability to function
- qualitative
&ow to measure development
1. .bserve child doing specific tas-.
$. /ole description of child0s progress
!. 112T- 1enver development screening test.
3312T 45hil6 3etro 3anila 1evelopmental 2creening Test.
112T measures mental
# main rated categories of 112T
1. 7anguage communication
$. personal social-interaction
!. fine motor adaptive- ability to use hand movement
#. gross motor s-ills- large body movement
maturation- same with development 8readiness'
Cognitive development 9ability to learn and understand from e"perience to acquire and retain -nowledge.
To respond to a new situation and to solve problems.
:; test- test to determine cognitive development
3ental age " 1++ ) :;
<hronological age
=verage :; 9 >+-1++
Gifted child- ? 1!+ :;
@asic 1ivisions of 7ife
:. 5renatal stage from conception- birth
::. 5eriod of infancy
1. Aeonatal- 1
$B days or 1
# wee-s of life
$. Cormal infancy- $> day 9 1 year
:::. Darly childhood
1. Toddler 9 1-! yrs
$. 5re school #- years
:E. 3iddle childhood
1. 2chool age- F 9 1$ yrs
E.7ate childhood
1. 5re adolescent 11 9 1! yrs
$. =dolescent 1$ - 1B 9 $1
5rinciples of G G 1
1. GG1 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
5atterns of GG1
1. 6renal
digestive grows rapidly during childhood
$. 6Aeuromuscular tissue 4<A2, brain, 2. cord6
- grow rapidly 1-$ years of life
- brain achieved its adult proportion by * years.
!. 67ymphatic system- lymph nodes, spleen grows rapidly- infancy and childhood to provide protection
- tonsil adult proportion by * years
#. 6/epro organ- grows rapidly at puberty
/ates of GG1
1. fetal and infancy 9 most rapid GG1
$. adolescent- rapid GG1
!. toddler- slow G period
#. Toddler and preschool- alternating rapid and slow
*. school age- slower growth
fetal and infancy- prone to develop anemia
!. Dach child is unique
$ primary factors affecting GG1
=. &eredity - / 9 race
: 9 intelligence
2 9 se"
A - nationality
Cemales are born less in weight than males by 1 oz.
Cemales are born less in length than males by 1 inch
@. Dnvironment
; 9 quality of nutrition
2 9 socio eco. status
& 9 health
. 9 ordinal pos in family
5 9 parent child relationship
Dldest- s-illful in language and social s-ills
Hounger- toilet trained self
#.GG1 occurs in a regular direction reflecting a definitive and predictable patterns or trends.
1irectional 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 8head to tail'
- occurs along bodies long a"is in which control over head, mouth and eye movements and
precedes control over upper body torso and legs.
b. pro"imo- distal 8<entro distal'
- progressing form center of body to e"tremities.
c. 2ymmetrical- at side of body develop on same direction at same time at same rate.
d. 3ass specific 8differentiation'
- child learns form simple operations before comple" function of move from a broad general pattern
of behavior. To a bore refined pattern.
@. 2equential- involves a predictable sequence of GG1 to which the child no>rmally passes.
a. locomotion- creep than crawls, sit then stand.
b. socio and language s-ills- solitary games, parallel games
<. 2ecular- worldwide trend of maturing earlier and growing larger as compared to succeeding generations.
*.@ehavioral in the most compressive indicator of developmental status.
. universal language of child- play
F. great deal of s-ill and behavior is learned by practice. 5ractice ma-es perfect.
>. neonatal refle"es us must be lost before one can proceed.
-plantar refle" should disappear before baby can wal-
-moro refle" should disappear before baby can roll
persistent primitive infantile refle"es- case of cerebral palsy
Theories of GG1
1evelopmental tas-s- different form chronological age
-s-ill 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 tas-s.
1. Sigmund Freud 1B*-1>!> =ustrian neurologists. Counder of psychoanalysis
- offered personality development
5sychose"ual theory
a.6 Oral Phase 0-18 months
- mouths site of gratification
-activity of infant- biting, suc-ing crying.
-why do babies suc-I- enJoyment and release of tension.
-provide oral stimulation even if baby was placed on A5..
-never discourage thumb suc-ing.
b.6 AA!- 18 months-" #ears
-site of gratification- anus
-activity- elimination, retention or defecation of feces ma-e ta-e place
- principle of holding on or letting go.
-mother wins or child wins
-child wins- stubborn, hardheaded anti social. 4ana- pupu na, child holds pupu, child wins6
-mother wins- obedient, -ind, perfectionist, meticulous
.<-anal phase
-help child achieve bowel and bladder control even if child is hospitalized.
c.6 Phalli$- "-% #ears
site of gratification -genitals
activity- may show e"hibitionism
-increase -nowledge of a se"es
-accept child fondling his(her own genitalia as normal e"ploration
-answer <hilds question directly.
/ight age to introduce se"uality 9 preschool
d.6 !atent- &-12 #ears
-period of suppression- no obvious development.
-<hilds libido or energy is diverted to more concrete type of thin-ing
-helps child achieve 4K6 e"perience so ready to face conflict of adolescence
e.6 Genital- 12-18 #ears
-site of gratification -genitals
-achieve se"ual maturity
-learns to establish relationships with opposite se".
-give an opportunity to relate to opposite se".
'()C '()C*SO- psychoanalysis theory
- stresses important of culture and society to the development of ones personality
- environment
- culture
stages of psychosocial
a.6 trust vs mistrust + 0-18 months.
-foundations of all psychosocial tas-
-to give and receive is the psychosocial theme
--now to develop trust baby
1. satisfy needs on time
- breastfeed
$. care must be consistent and adequate
-both parents- 1
1 year of life
!.6 give an e"perience that will add to security- touch, eye to eye contact, soft music.
b.6 Autonom# vs shame and dou,t 18-" #ears --- independence (self gov0t
develop autonomy on toddler
1. give an opportunity of decision ma-ing li-e offer choices.
$. encourage to ma-e decision rather then Judge.
!. set limits
c. initiative vs guilt- --% #ears
-learns how to do basic things
-let e"plore new places and events
-activity recommended- modeling clay, finger painting will enhance imagination and creativity and
facilitate fine motor dev0t
d. industr# vs in/eriorit# &-12 #rs
-child learns how to do things well
-give short assignments and proJects
e. )dentit# vs role $on/usion or di//usion 12-18 #rs
- learns who he(she is or what -ind of person he( she will become by adJusting to new body image and
see-ing emancipation form parents
-freedom form parents.
f. )ntima$# vs isolation 20--0 #rs -loo-ing for a lifetime partner and career focus
g. generatively vs stagnation #+- +
#*-* yrs
h. ego integrity vs, despair +-*
0'A P)AG'1- 2wiss psychologists
-develop reasoning power
S1AG'S OF COG)1)2' D'2'!OP3'1
=-Sensor# motor 0-2 #rs
-8practical intelligence'- words and symbols not yet available baby communicates through senses and
4sub div.6
2chema =ge @ehavior
1.6 neonate refle" 1 month =ll refle"es
$.6 primary circular 1-# months -=ctivity related to body
-repetition of behavior
e". thumb suc-ing
!.6 secondary circular reaction #-B months -activity not related to body
-discover obJ and person0s permanence
-memory traces present
-anticipate familiar events.
<oordination of secondary reaction B-1$
-e"hibit goal directed behavior
-increase of separateness 4will search of lost toy,
-nows mom6
Tertiary circular reaction 1$-1B
-use trial and error to discover places and events
-8 invention of new means'
-capable of space and time perception
4hits for-, spoon on table or drops for-6
:nvention of new means there mental
-transitional phase to the pre operational thought
Preoperational thought 2-& #ears
2chema age @ehavior
5reconceptual $-#
-thin-ing basically complete literal and static
-egocentric- unable to view others interrupt
-concept of dying is only now
-concept of distance is only as fat as they can see.
-concept of amenism inanimate obJect is alive
-not aware of concept of r!eversibility- in every action theories an opposite
reaction or cause and effect
:nitiative #-F
@eginning of causation
Con$rete Operational thought &-12 #ears
1. able to find solution to everyday problems which systematic reasoning.
$. have concept of reversibility- cause and effect
!. have concept of longer uation 9 constancy despite of transformation.
#. #. activity recommended- collecting and classifying
*. 9stamps stationeries, dolls, rubber band mar-ers.
Formal Operational thought 12 and up.
1. <ognition achieved its final form
$. can deal with past present and future
!. have abstract and mature thoughts.
#. can find solutions to hypothetical problems with scientific reasoning.
*. activity ------- will sort out opinions and current events.
*O4!5'(G- recognized the theory of moral dev0t as considered to closely appro"imate cognitive stages
of dev0t
-sabay with cognitive devLt
Stages o/ 3oral dev6t
:nfancy 9 premoral, prereligious, amoral stage
=GD 2T=GD 1D2</:5T:.A
5re-conventional 7evel 1
$-! yrs 1 -5unishment( obedience oriented 4heteronymous morality6 child does
right cause a parent tells him or her to and to avoid punishment
#-F $ -:ndividualism. :nstrumental purpose and e"ch. <arries out action to
satisfy own needs rather than society.
-Will do something for another if that person does something for the
<onventional 7evel
F-1+ ! -.rientation to interpersonal relations of mutuality. <hild followers
rules cause of a need to be a 8good' person in own eyes and eyes of
1+-1$ # -3aintenance of social order fi"ed rules and authority. <hild finds ff.
rules satisfying. Collows rules of authority figures.
5ost-conventional 7evel :::
=bove 1$ yrs * -2ocial contract, utilitarian level ma-ing perspectives. Collowers
standards of society.
Mniversal ethical principle orientation. Collows internalized standards
of conduct.
D. 1DE0T 3:7D2T.AD2-maJor mar-ers of growth and dev0t
1. Period o/ in/an$#- universal language of child-pla#
a.6 Pla#- )n/an$#- solitar# pla#s
-solo, mom interactive
-facilitate motor and sensory dev0t
-safety- important age appropriate
solitary play- mobile, teeter, music bo", rattle
b.6 fear of infancy- stranger an"iety begin -F months pea- B months diminishes > months
1 month- dance refle" disappears loo-s at mobile
2 months- holds head up when in prone,
social smile,
baby coos 8doing sound'
cry with tears
-closure of frontal fontanel $-! months
head lag when pulled to sitting position.
" months- holds head and chest up when prone
follows obJ. past midline
grasp and tonic nec- refle" fading
hand regard 4loo-s at hand6
- months 9 turns form front to bac-
head control complete
needs space to turn
7augh aloud, bubbling sounds
7 months- turn both ways 8roll over'
-teething rings
-handles rattle well
-moro refle" disappears 4 #-* months6

% months- reaches out in anticipatory of being pic-ed up

-sits with support
-uses palmar grasp
-eruption o/ 1
temp teeth %-8 months 2 lower in$isors
-say vowel sounds 8ah', 8oh'
-handles bottle well
& months- transfer obJ. hand to hand
-li-es obJ that are good size
8 months- sits without support
-pea- of stranger an"iety
-planters refle" disappears B-> months in prep for wal-ing
8 months - creeps or crawls
-neat finger grasp refle"
- combine $ syllables 8mama' and 8papa'
- needs space for creeping
10 months 9 pull self to stand
-understands 8no'
-responds to own name
-pea- a boo, pat a ca-e
-can clap
11 months- cruisse
- stands with assistance
12 months- stand alone ta-e 1
-wal- with assistance
-drin- from cup, cooperate in dressing
-says $ words mama and dada
-pots and pans, pull tay, nursery rhymes
1oddler- parallel pla# - 2 toddlers pla#ing separatel#
-provide with similar toys
-squea-y frog to squeeze
waddling duc- to pull
truc-s to push-push pull toy
building bloc-s, pounding peg
toys to ride on
fear- separation an"iety
begin > months
pea- 1B months
! phases of separation an"iety 4in order6
1. 5- protect
$. d despair
!. d- denial
-don0t prolong goodbye
-say goodbye firmly to develop trust- say when ul be bac-
17 months 9 plateau stage
wal-s alone
lateness in wal-ing- mild mental retardation
-puts small pellets into small bowl
-holds spoon well
- seats self on chair
-creeps up stairs
- # - words
18 months- height of possessiveness
favorite word- 8mine'
bowel control achieved 4bowel 1
before bladder6
-no longer rotates spoon
-can run and Jump in place
wal-s up and down stairs holding railing or persons hand
-1-$+ words
-name, body part
-puts both feet on 1 step before advancing.
2- months- terrible two
-can open doors by turning door -nobs
-unscrew lids
-can wal- upstairs alone 9using both feet on same step at same time
-*+-$++ words 4 $ words sentences6
-daytime bladder control achieved 4 daytime 1
- ne"t nighttime bladder control6
"0 months or 2 9 #ears 9 ma-es simple lines or stro-e for crosses with a pencil
-can Jump down from chairs
--nows full name
- copy a circle
- holds up finger to show age
- temp teeth complete
post molar- last temp teeth to appear
how many deciduous teeth -$+
beginning of toothbrush 9 $-$ % yrs
tooth brushing with little assistance ! yrs
tooth brushing alone 9 yrs
right time to bring to dentist- when temp teeth complete
"% months or " #rs- trusting !
- unbutton buttons 4unbutton before learn to button6
-draw a K
- learns how to share
--nows full name and se" 4gender identity6
- spea-s fluently
-nighttime bladder control
-!++->++ words
-ride a tricycle
<haracteristic Traits of toddler
negativistic- 8A.N' -way to search for independence
9limit questions
9modify questions to a statement
$.6 rigid, ritualistic and stereotype
ritualism- for mastering
!.6Temper tantrums- head banging, screaming, stamping feet, holds breath
9ignore behavior
scaffoid abdominal-due to underdeveloped abdominal muscles
physiologic anore"ia- 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
<lues of toilet readinessO
1.6 can stand, squat wal- alone
$.6 can communicate toilet needs
!.6 can maintain dry for $ hours
Pre s$hoolers- associative or cooperative play
1.6 bahay-bahayan 9 play house
$.6 role playing
!.6 fear-body mutilation or castration
fear of dar- places witches
fear of thunder and lightning
fear of ghosts
-#ears old- furious # , noisy, aggressive, stormy
-can button buttons
-copy a square
-Jumps and s-ips
-laces shoes
-vocabulary 1,*++
--nows four basic colors
7 #ears old- frustrating *
-copy a triangle
-draw a part man
-imaginary playmates
-$,1++ words
<haracter Traits of 5re-schoolerO
1.6 curious, creative imaginative, imitative
$.6 $. favorite words- why and how
!.6 comple"es- word identification to parent of same se" and attachment to parent of
opposite se"
e". .edipal comple"- boy to mom
Dlectra comple"- girl to dad
<ause of incest marital discord
1eath-sleep only
@ehavior problems 5reschool
1. telling tall tales-over imagination
$. imaginary friend- to release tension and an"ieties
!. sibling rivalry- Jealousy to newly delivered baby.
#. regression- going bac- to early stage
-thumb suc-ing 4should be oral stage only6
-baby tal-
-bed wetting
-fetal position
*. masturbation- sign of boredom
-divert attention- offer a toy
S$hool Age
5lay- competitive play
D". Tug of war, trac- and field, bas-et ball
Cear. 1.6 school phobia
-orient to new environment
$.6 displacement from school
-teacher and peer of same se"
!. loss of privacy
-wants bra
#.6 fear of death
-F->yrs death is personified
-death- permanent loss of life
2ignificant 1evelopment
a. boys- prone to bone fracture
b. mature vision $+($+
% #ears- temp teeth begin to fall
perm teeth appear- 1
temp teeth- * months
perm teeth- yrs
-yr of constant motion
clensy mou0t
recognize all shapes
grade teacher becomes authority figure
-nail biting
-begin interest in God.
& #rs- assimilation age
-copy a diamond
-enJoys teasing and playing alone
-quieting down period
8 #rs- e:pansive age
-smoother mouth
-loves to collect obJects
-count bac-wards
8 #rs 9coordination improves
-tells time correctly
-hero worship
-stealing and lying are common
-ta-es care of body needs completely
-teacher finds this group difficult to handle
10 #rs- age o/ spe$ial talent
-writes legibly
-ready for competitive games
-more considerate and cooperative
-Joins orgs.
-well mannered with adult
-critical of adults
11-12 #rs + pre adoles$ents
-full of energy and constantly active
-secret language are common
-share with friends secrets
-sense of humor present
-social and cooperative
<haracter Traits 2chool =ge
1. industrious-
$. modest
!. can0t bear to lose- will cheat
#. love collections- stamps
Signs o/ se:ual maturit#
:-inc size breast and genitalia 4pelarche- 1
sign se"ual mat.
W- widening of hips
=- appearance a"illary, pubic 4 adrenarch6
3- menarche- last sign se"ual mat. Girls
=-appearance a"illary, pubic hair 4 1
sign se"ual mat6
1-deepening voice
1- development of muscles
:--inc in testes and penis size
5- prod of viable sperm 4 last sign se"ual maturity6
1. obesity
$. acne
!. homose"uality
#. death
*. replacement from friends
. significant person- opp se".
2ignificant dev0t
1. e"periences conflict bet his needs for se"ual satisfaction and societies e"pectation
$. change of body image and acceptance of opp(se"
!. nocturnal emission 9 wet dreams
#. distinctive odor- due to stimulation apocrine glands
*. sperm is viable by 1F yrs
. testes G scrotum increase until age 1F
F. breast and female genitalia increase until age 1B
5ersonality Traits =dolescents
1. idealistic
$. rebellious
!. reformers
#. conscious with body image
*. adventuresome
1. vehicular accident
$. smo-ing
!. alcoholism
#. drug addiction
*. pre marital se"
:33D1:=TD <=/D .C ADW@./A
days of life
1. initiation and maintenance of respiration
$. establishment of e"tra uterine circulation
!. control of body temp
#. inta-e of adequate nourishment
*. establishment of waste elimination
. prevention of infection
F. establishment of an infant parent relationship
B. dev0t care that balances rest and stimulation or mental dev0t
1.6 :nitiation and maintenance of respiration
stage of labor- initial airway
-initiation of a (w is a crucial adJustment
-most neonatal deaths with in $# h caused by inability to initiate a(w
-lung function begins after birth only
&ow to initiate a(w
a.6 remove secretions bulb syringe
@. <atheter 2uctioning
1.6 place head to side to facilitate drainage
$,6 suction mouth 1
before nose
-neonates are nasal breathers
!.6 period of time
-*-1+ sec suctioning, gentle and quic-
prolonged and deep suctioning can lead to hypo"ia, laryngo spasm, brady cardia due to
stimulation vagal nerve
#.6 evaluate for patency
-cover nostril and baby struggles there0s a need for additional suctioning
<. :f not effective, requires effective laryngoscopy to open a(w. =fter deep suctioning an endotracheal
tube can be inserted and o"ygen can be administered by an 4K6 pressure bag and mas- with 1++,
o"ygen at #+-+b(m.
Asg alertO
1. Ao smo-ing
$. =lways humidify to prevent drying of mucosa
!. .ver dosage of o"ygen can lead to scarring of retina leading to blindness 4 retro lentalfibrolasia or
retinopathy of prematurity6
#. When mecomium stained 4greenish6 never administer o"ygen with pressure 4 .$ pressure will
push mecomium inside6
$.6 Dstablishing e"tra uterine circulation
- circulation is initiated by lung e"pansion or pulmo ventilation and completed by cutting of cord.
F'1O P!AC'1A! C)(C;!A1)O
-5lacenta4simple diffusion6 9o"ygenated blood is carried by the umbilical vein- passes liver-ductus
venousus- :E<- /T atrium F+, blood is shunted to foramen ovale- 7T atrium mitral valve 9 7T ventricle-
aorta-lower e"tremities.
-/emaining !+,- tricuspid valve- /T ventricle- pulmonary arteries- lungs 4for nutrition6 4vasoconstriction
of lungs pushes blood to ductus arteriousus to aorta to supply upper e"tremities.
1uctus venosus- -shunts from liver to :EC
Coramen ovale- shunts bet $ atrias
1uctus arteriosus- from pulmonary artery to aorta
What will sustain 1
breath- decreased artery pressure
What will initiate lung circulation-lung e"pansion
What will complete circulation- cutting of cord
#.6 $ way to facilitate closure of foramen ovale
a.6 Tangential Cootstep- slap foot of baby
-never stimulate baby to cry if secretions not fully drained to prevent aspiration
-chec- characteristic of cry
normal cry- strong, vigorous and lusty cry
cri-du-chat syndrome-chromosomal obliteration cat li-e cry
b.6 proper position -right side lying pos.
-will increase pressure on left and foramen ovale will close
Coramen .vale and 1uctus arteriosus will begin to close within $#h
1ecrease 5.$, increase 5<.$ acidosis
Will cause 1
breath (cry of baby
1ecrease pulmo artery pressure
:ncrease 5.$ 1ecrease blood
:ncrease pressure to 7t
side of heart
<losure of
<losure of
ductus venosus
G =E=
<losure of foramen
.bliteration-complete closure
2tructure =ppropriate time of
2tructure remaining Cailure to close
C. .vale 1yr Cossa .valis =trial 2eptal 1efect
1 month 7igamentum =rteriosum 5atent ductus
1uctus Eenosus $ months 7igamentum venosum
$-! months 1.6 lateral umb. 7igament
$.6 interior iliac artery
Mmbilical vein $-! months -ligamentum teres 4 round ligament
of liver6
5osition of infant immediately after birthO
A21-trendelenberg( T position for drainage
contraindication of trendelenberg position - increase :<5
<2- supine or crib level position
Signs o/ in$reased )CP
1.< abnormally large head
2.< bulging and tense fontanel
".< increase @5 and widening pulse pressure P! G P# are Cushings triad of
-.< 1ecreased //, decreased 5/ )CP
7.< proJective vomiting- sure sign of cerebral irritation
%.< high deviation 9 diplopia 9 sign of :<5 older child
#- months- normal eye deviation
? months- lazy eyes
F.6 &igh pitch shrill cry-late sign of :<5
1emp (egulation
- goal in temp regulation is to maintain it not less than >F.F, C 4!.* <6
- maintenance of temp is crucial on preterm and 2G= 4small for gestational age6 - babies prone to
hypothermia or cold stress
=. factors leading to dev0t of &H5.T&D/3:=
1. preterms are born poi -ilo thermic- cold blooded
- babies easily adapt to temp of environment due to immaturity of thermo regulating system of
body. &ypothalamus
$. inadequate 2; tissue
!. baby is not capable of shivering
#. babies are born wet
5/.<D22 .C &D=T 7.22
1. evaporation- body to air 4T2@6
$. conduction- body to cold solid obJect 4cold compress6
!. convection- body to cooler surrounding air 4aircon6
#. radiation- body to cold obJect not in contact with body
earliest sign of hypothermia- increase in //
Dffects of &ypothermia 4 <old stress6
1.6 &ypoglycemia- #*-** mg(dl normal
*+- borderline
$.6 met acidosis- catabolism of brown fats 4best insulator of newborns body6
will form -etones
!.6 high ris- for -ernicterus- bilirubin in brain leading to cerebral palsy
#.6 additional fatigue to allergy stressful heart
To 5revent &ypothermia
1. dry and wrap baby
$. mechanical pressure 9 radiant warmer
i. pre-heated first isolette 4or square acrylic sided incubator6
!. prevent an necessary e"posure 9 cover baby
#. cover baby with tin foil or plastic
*. embrace the baby- -angaroo care
A. 'sta,lish Ade=uate utritional )nta>e
<2- breastfeeding after # hours
A21- breastfeeding asap
5hysiology breast mil- production
=s you deliver baby, decrease Dstrogen, decrease 5rogesterone- -=nterior 5osterior Gland 4=5G6 releases
prolactin 9 acts on
acinar cells 4or alveoli6 9 produce foremil- 9 stored in lactiferous tubules 4 or collecting tubules6
where breast mil- is produced 9 alveoli post-pit.gland
2uc-ing- 55G 9 o"ytocin 9 contraction of lactiferous tubules - mil- eJection refle"- let down refle".
Advantages o/ 5reast/eeding
1. Dconomical
$. =lways available
!. @reastfed babies have higher :; than bottle fed babies.
#. :t facilitates rapid involution
*. 1ecrease incidence of breast cancer.
. &as antibodies- :g=
F. &as lactobacillius bifidus- interferes with attac- of pathogenic bacteria in G:T
B. &as macrophages
2tore mil-- plastic storage container
2tore mil- 9 good for months from freezer- put rm temp. don0t heat
1. 5ossibility of transfer &D5 @, &:E, cytomegalo virus.
$. Ao iron
!. Cather can0t feed G bond as well
Stages o/ 5reastmil>?
1. <olostrum- $-# days present
contentO decrease fats, increase :g=, dec <&., dec <&.A, inc minerals,
inc fat soluble minerals
$. Transitional mil-- # 9 1# days
contentO inc lactose, inc water soluble vit., inc minerals
!. 3ature mil-- 1# G up
contentO inc fats 4linoleic acid6 9 resp for devt of brain G integrity of s-in
inc <&.- lactose 9 easily digested, baby not constipated.
- resp of sour mil- smelling odor of stool.
7actose intolerance- deficiency of enzyme 7=<T=2D that digest 7=<T.2D
1ecrease <&.A- lactalbumin
<ows mil- 9 inc fats-
1ec <&.
:nc <&.A 9 casing- has curd that0s hard to digest.
:nc minerals9traumatic effect on -idneys of babies. <an trigger stone formation.
:nc phosphorus
4ealth 1ea$hings?
1. 5roper hygiene- proper hand washing
<are of breast - cotton balls with lu-ewarm water
<a-ed colostrum- dry mil- on breast
$. @est position in breastfeeding 9 upright sitting -avoid tensionN
!. 2timulate G evaluate feeding refle"es
a.6 /ooting refle"- by touching the side of lips(chee-s then baby will turn to stimulus. 1isappear
by wee-s- by wee-s baby can focus. /efle" will be gone
- 5urpose rooting- to loo- for food.
b.6 2uc-ing 9 when you touch middle of lips then baby will suc-
- 1isappears by months
- When not stimulated suc-ing will stop.
c.6 2wallowing- when food touches posterior of tongue then it will be automatically swallowed
d.6 D"trusion( 5rotrusion refle"
-when food touches anterior portion of tongue then food will be e"truded.
5urposeO to prevent from poisoning
1isappear by # months G baby can already spit out by # months.
Criteria '//e$tive Su$>ing
a.6 @aby0s mouth is hi-ed up to areola
b.6 3om e"periences after pain.
c.6 .ther nipple is also flowing with mil-.
To prevent from crac- nipples G initiate proper production of o"ytocin.
- begin $-! min at Q breast 4 * 9 F min other authors6
to initiate production of o"ytocin
- increase 1 min( day 9 until reaching 1+ mins Q breast or $+ mins( feeding.
Cor proper emptying G continuous mil- production ( feeding
-feed baby on last breast that you feed her with, alternately 4 if not emptied - mastitis6
Pro,lems e:perien$ed in 5reast/eeding ?
day changes in breast post partum
a.6Dngorged- feeling of fullness G tension in breast.
- sometimes accompanied by fever -nown as 3:7R CDED/.
3gt? Warm compress- for breastfeeding mom
<old compress 9 for bottle feeding G wear supportive bra.
When is involution of breast- # wee-s
b.6 2ore nipple 9 crac-ed with painful nipple
3gtO 1.6 e"posure to air 9 remove bra G wear dress, if not, e"pose to $+ Watt bulb
avoid wearing plastic liner bra
- will create moisture, cotton only
c.6 3astitis- inflammation of breast O staphylococcus aureus
1. :mproper breast emptying
$. Mnhealthy se"ual practices
-contraindicated for breast feeding
- manually e"press inflamed breast
feed on unaffected breast
- give antibiotics 9 can still feed on unaffected breast
Contra )ndi$ations in 5reast Feeding?
3aternal <onditionsO
1. &:E <3E
&epa @ <oumadin
Aewborn <ondition - :nborn errors of metabolism
Drythrobastosis Cetalis 9 /h incompatibility
&ydrops Cetalis
Tay 2achs disease
*. Dstablish of waste elimination
=. 1iff stools
1. 3econium - physiologic stool
- blac- green, stic-y, tar li-e, odorless 42terile intestine6
will pass with in $# 9 ! hrs
failure to pass mecomium after $#h- G:T obstruction
e". &irschsprungs disease
imperforate anus
mecomium ileus 9 due to <ystic Cibrosis
$. Transitional stool -
- green loose G shiny, li-e diarrhea to the untrained eye
!. @reastfed stool - golden yellow, soft, mushy with sour mil- smell, frequently passed
- recur every feeding
#. @ottlefed stool 9
- pale yellow, formed hard with typical offensive odor, seldom passed, $9! "(day
- with food added -brown G odorous
Saundice baby 9 light stool
Mnder phototherapy 9 bright green
3ucus mi"ed with stool - mil- allergy
<lay colored stool 9 obstruction to bile duct
<hal- clay stool 9 after barium enema
@lac- stool 9 G:T bleeding 4melena6
@lood flec-ed stool - anal fissure.
<urrant Jelly stool 9 instussusection
/ibbon li-e stool 9 hirschsprung disease
2teatorrhea stool 9 fatty, bul-y foul smelling odor stool
- malabasorption syndrome 4 celiac disease or cystic fibrosis6
<ult blood 9 stool e"am
))) Assessment /or @ell+,eing
APGA( SCO(' 9 1r. Eirginia =pgar
2pecial <onsiderationsO 1
1 min 9 determine general condition of baby
Ae"t * min- determine baby0s capabilities to adJust e"tra uterinely
Ae"t 1* min 9 dependent on the * min
=- appearance- color 9 slightly cyanotic after 1
cry baby becomes pin-.
5- pulse rate 9 apical pulse 9 left lower nipple
G- grimace 9 refle" irritability- tangential foot slap, catheter insertion
= 9 activity 9 degree of fle"ion or muscle tone
/ 9 respiration
@aby cry 9 within !+ secs
Cailure to cry after !+ secs 9 asphy"ia near the neatorum
/esp. depression 9 due mom given 1emerol. =dminister Aalo"one

APGA( S$oring Chart?
+ 1 $
&/ -absent T1++ ?1++
/esp effort -absent - slow, irreg, wea- -good strong cry
3uscle tone - flaccid e"tremities - some fle"ion - well fle"ed
/efle" irritability
<atheter - no response - grimace - cough, sneeze
Tangential Cootslap - A/ - grimace - cry
<olor - blue(pale - acrocyanosis
4body- pin-
- pin-ish
APGA( result
+ 9 ! ) severely depressed, need <5/, admission A:<M
# 9 ) moderately depressed, needs add0l suctioning G .$
F - 1+ )good( healthy
<5/ 9 cardio pulmonary resuscitation or <5/
<ardio pulmonary cerebral resuscitation 4<5</6
* min no .$ 9 irreversible brain damage
1. sha-e, no resp, call for help
$. flat on head
!. head tilt chin lift maneuver e"cept spinal cord inJury over e"tension may occlude airway
@reathing 4 ventilating the lungs6
1. chec- for breathlessness
if breathless, give $ breaths- ambu bag
? 1 yr old- mouth to mouth, pinch nose
T 1 yr 9 mouth to nose
force 9 different between baby G child
infant 9 puff
<hec- for pulslessness Ocarotid- adult
@rachial 9 infants
<5/ 9 breathless(pulseless
<ompression 9 inf 9 1 finger breath below nipple line or $ finger breaths or thumb
<5/ inf 1O*
=dults $O1*
=ssessment tool determines respiration of baby
Silvermann Anderson )nde:
(espiration 'valuation 9 lowest score 9 best
<riteria + 1 $
<hest movement synchronized 7ag on respiration 2ee - saw
:ntercostal retraction Ao retraction Sust visible 3ar-ed
Uiphoid retraction Aone Sust visible 3ar-ed
Aares dilatation Aone 3inimal 3ar-ed
D"piratory grunt Aone &eard on stet
&eard on na-ed ear
:nterpretation resultO
+ -! 9 normal, no /12
# 9 9 moderate /12
F 9 1+ 9 severe /12
Assessment o/ Gestational Age
-5allards A Do,owitB
Cindings 7ess ! wee-s 45reterm6 !F - !B !> and up
2ole creases =nterior transverse crease
.ccasional creases $(!
<overed with creases
@reast nodules $mm #mm or !.* mm ? * or Fmm
2calp hair Cine G fuzzy Cine G fuzzy <oarse G sil-y
Dar lobe 5liable 2ome cartilage Thic- cartilage
Testes and
testes in lower canal
2crotum 9 small few rugae
2ome intermediate Testes pendulus
2crotum full e"tensive
Signs o/ Preterm 5a,ies
@orn after $+ wee-s, after !F wee-s
-frog leg or la"ed positon
-hypotonic muscle tone- prone resp problem
-scarf sign 9 elbow passes midline pos.
- square window wrist 9 >+ degree angle of wrist
- heal to ear sign-
abundant lanugo-
Signs o/ Post term ,a,ies?
? #$ wee-s
- classic sign 9 old man0s face
- desquamation 9 peeling of s-in
- long brittle finger nails
- wide G alert eyes
eonates in urser#
Asg responsibility upon receiving baby- proper identification
- foot printing, affi"ing mother thumb print
- ta-e anthropometic measurement
normal length- 1>.* 9 $1 inch or #F.* 9 *!.F*cm, average *+ cm
head circumference !!- !* cm or 1! 9 1# 8
&ydrocephalus - ?1#'
<hest !1 9 !! cm or 1$ 9 1!'
=bd !1 9 !! cm or 1$ 9 1!'
- oil bath 9 initial
- to cleanse baby G spread verni" caseosa
C" of verni" caseosa
1. insulator
$. bacterio- static
@abies of &:E K mom 9 immediately give full bath to lessen transmission of &:E
- 1! 9 !>, possibly of transmission of &:E
Cull bath 9 safely given when cord fall
1ressing the Mmbilical <ord 9 strict asepsis to prevent tetanus
" $leans in $ommunit#
1. clean hand
$. clean cord
!. clean surface
betadine or povidone iodine 9 to clean cord
chec- =E=, then draw ! vessel cord
:f $ vessel cord- suspect -idney malformation
- leave about 1' of cord
- if @T or :E infusion 9 leave B' of cord best access - no nerve
- chec- cord every 1* min for 1
hrs 9 bleeding .? !+ cc of blood
bleeding of cord 9 .mphalagia 9 suspect hemophilia
<ord turns blac- on !
day G fall F 9 1+ days
Caiture to fall after $ wee-s- Mmbilical granulation
3gtO silver nitrate or catheterization
- clean with normal saline solution not alcohol
- don0t use big-is 9 air
- persistent moisture-urine, suspect patent uracus 9 fistula bet bladder and normal umbilicus
d"O nitrazine paper test 9 yellow 9 urine
mgtO surgery
<redes 5rophyla"is 9 1r. <rede
-prevent opthalmia neonatorum or gonorrheal conJunctivitis
- how transmitted 9 mom with gonorrhea
drugO erythromycin ophthalmic ointment- inner to outer
silver nitrate 4used before6 9 $ drops lower conJunctiva 4not used now6
Eit-R 9 to prevent hemorrhage /(T physiologic hypoprothrombinemia
- =quamephyton, phytomenadione or -ona-ion
- .* 9 1.* ml :3, vastus lateral or lateral ant thigh
- * ml preterm baby
Eit R 9 synthesized by normal flora of intestine
Eit R 9 meds is synthetic due intestine is sterile
@eight? Aormal wt !.+++ 9 !#++ gms( ! 9 !.# -g ( .* - F.* lbs
=rbitrary lower limit $*++ gm
7ow birth wt baby delivered T $*++g
2mall for gestational age 42G=6 T 1+
, ran- or born small
7arge for gestational age ? >+
, ran- or macrosomia ?#+++ g
=ppropriate for G= 9 within $ standard deviation of mean
5hysiologic wt loss 9 * 9 1+, wt loss few days after birth
2mall G= T 4less6 1+
7arge G= ? 4more6 >+
Ph#si$al ':am and Deviations /r ormal
1. if client is new born, cover areas not being e"amined
$. if client is infant 9 the 1
yr of life - get E2 9 ta-e // 1

- begin fr least intrusive to the most intrusive area
!. if client is a toddler and preschool, let them handle an instrument li-eO
- play syringe or stet, security blan-et 9 favorite article. 7et baby hold it.
#. D"plain procedure and respect their modesty - school age and adolescent
TempO rectal- newborn 9 to rule out imperforate anus
- ta-e it once only, 1 inch insertion
:mperforate anus
1. atretic 9 no anal opening
$. agenetic 9 no anal opening
!. stenos 9 has opening
#. membranous 9 has opening
Darliest signO
1. no mecomium
$. abd destention
!. foul odor breath
#. vomitous of fecal matter
*. can aspirate 9 resp problem
2urgery with temporary colostomy
<ardiac rateO 1$+ 9 1+ bpm newborn
=pical pulse 9 left lower nipple
/adial pulse 9 normally absent. :f present 51=
Cemoral pulse 9 normal present. :f absent- <.= - coartation of aorta
Congenital 4eart Dse
<ommon in girls 9 51=, =21 atrial septal
<ommon in boys 9 T.G= 4 transportation of great arteries6
T= 9 tronchus arteriosus
T.C 9 tetralogy of fallot
1. familial
$. e"posure to rubella 9 1
!. failure of strucute to progress
acyanotic 7 to /
cyanotic / 9 7
A$#anoti$ heart de/e$ts 7 to /
1. ventricular septal defect - opening between $ ventricles
2G2" 1. systolic murmurs at lower border of sternum and no other significant sign
$. cardiac catheterization reveals increased o$ saturation Q / side of heart
!. D<G reveals hypertrophy of / side of heart
Asg <areO
<ardiac catheterizationO site 9 /t femoral vein
1. A5. hrs before procedure
$. protect site of catheterization. =void fle"ion of Joints pro"imal to site.
!. assess for complication 9 infection, thrombus formation 9 chec- pedal pulses
4 dorsalis pedis6
1.6 long term antibiotic 9 to prevent subacute bacterial endocarditis
$.6 open heart surgery-
$.< ASD 9 failure of foramen ovale to close
1. systolic murmur Q upper border of sternum
$. result of cardiac catheterization G D<G same with E21
3gtO open heart surgery
!.6 endo$ardial $ushion de/e$ts - atrium ventricular 4=E6 - affects both tricuspid and mitral valve
1" 9 confirmed by cardiac catheterization
3gtO - open heart surgery
=ntibiotics to prevent subacute bacterial endocarditis
#.6 51= - failure of ductus arteriosus to close
- should close within $# h -complete close 9 1 month
1. continuous machinery li-e murmurs
$. prominent radial pulse
!. D<G- hypertrophy 7eft ventricle
1. endomethazine 9 prostaglandin inhibitor - facilitate closing of 51=
$. ligation of 51= by !-# yo
!. thoracotomy procedure- na-adapa child
7.<Pulmunar# Stenosis- narrowing of valve of pulmo artery
2 G2"O 1.6 typical systolic eJection murmur
$. 2$ sound widely split
!. D<G- 7t ventricular hypertrophy
.6Aorti$ Stenosis 9 narrowing of valve of aorta
2 G 2"O 1. inactive, s" sme with angina
$. typical murmur
!. rough systolic sound and thrill
#. D<G- 7eft ventricular hypertrophy
cardiac catheterization-
3gt 5ulmo 2tenosis G =ortic 2tenosis
1.6 balloon stenostomy
$.6 surgery
1uplication of =ortic =rch- doubling of arch of aorta causing compression to trachea and esophagus
2G2" O 1. dysphagia $. dyspnea
!. left ventricular hypertrophy
3gtO - close heart surgery
B.6 Coartation o/ Aorta 9 narrowing of arch of aorta
outstanding 2" O absent femoral pulse
@5 increased on upper e"tremities and decreased on lower e"tremities
D<G 9 hypertrophy 7ft ventricle
3gtO close heart surgery
CCAO1)C 4'A(1 D'F'C1S ( to !
1. Transportation of Great =rteries 4T.G=6 - aorta arising from /t ventricle
pulmo artery arising form 7t ventricle
.utstanding 2"O
1. cyanosis after 1
cry 4due no e"ygenation6
$. polycythemia 9 increased /@< )compensatory due to .$ supply)viscous blood
)thrombus ) embolus ) stro-e
!. D<G 9 cardiomegaly
<ardiac cath 9 decreased .$ saturation
5alliative repair 9 rash-ind procedure
<omplete repair 9 mustard repair
$.6 1otal Anomalous Pulmonar#
venous return 9 pulmo vein instead of entering 7t atrium, enters /t atrium or 2E<
:ncreased pressure on /t so blood goes to 7ft
.utstanding 2"O .pen foramen ovale
3ild to moderate cyanosis
5olycythemia ) thrombus ) embolus ) stro-e
asplenia- absent spleen
3gtO restructuring of heart
!.6 1run$us Arteriousus- aorta G pulmo artery is arising fr 1 single vessel or common trun- with E21
2 G 2" 1. cyanosis
$. polycythemia 9 thrombus ) embolus ) stro-e
3gtO &eart transplant
#.6 4#poplasti$ !e/t heart s#ndrome 9 non f" 7eft ventricle
1. cynosis
$. polycythemia 9 throm, emb, stro-e
3gtO heart transplant
*.6 1ri$uspid atresia 9 failure of tricuspid valve to open
2G2UO open foramen ovale
4/ to 7 shunting 9 goes to 7t atrium6
cynosis, polycythemia
3gtO fontan procedure 9 open tricuspid valve
.6 1etralog# o/ Fallot
5 9 pulmonary stenosis
E 9 ventricular 21
. 9 overriding or de"troposition of aorta
/ 9 /t ventricular hypertrophy
2 G2"O
1. /t ventricular hypertrophy
$. high degree of cyanosis
!. polycythemia
#. severe dyspnea 9 squatting position 9 relief , inhibit venous return facilitate lung e"pansion.
*. growth retardation 9 due no .$
. tet spell or blue spells- short episodes of hypo"ia
F. syncope
B. clubbing of fingernails 9 due to chronic tissue hypo"ia
>. mental retardation 9 due decreased .$ in brain
1+. boot shaped heart 9 "-ray
1. .$
$. no valsalva maneuver , fiber diet la"ative
!. morphine 9 hypo"ia
#. propranolol 9 decrease heart spasms
*. palliative repair 9
@7T blaloc- taussig procedure
@roc- procedure 9 complete procedure
ACD;)('D 4'A(1 DS'
1. (4D (heumati$ 4eart Disease
- inflammation disease ff an infection acquired by group = @eta hemolytic strepto coccus
=ffected body 9 cardiac muscles and valves , musculos-eletal , <A2, :ntegumentary
2orethroat before /&1
=schoff 9 rounded nodules with nucleated cells and fibroblasts 9 stays and occludes mitral valve.
0ones Criteria
3aJor 3inor
1. polyarthritis 9 multi Joint pain 1. arthralgia 9 Joint pain
$. chorea 9 sydenhamms chores or
st. vetaus dance-purposeless involuntary hand and shoulder with
$. low grade fever
!. carditis 9 tachycardia
erythema marginatum - macular rashes
2; nodules
!. all lab results
increase antibody
8 < reactive protein
8 erythrocyte sedimentation
8 anti streptolysin
o titer 4=2.6
<riteriaO5resence of $ maJor, or 1 maJor and $ minor K history of sore throat will confirm the d".
Asg <areO
1. <@/
$. throat swab 9 culture and sensitivity
!. antibiotic mgt 9 to prevent recurrence
#. aspirin 9 anti-inflammatory. 7ow grade fever 9 don0t give aspirin.
2(D of aspirinO
- /eyes syndrome 9 encephalopathy- fatty infiltration of organs such as liver and brain
Aewborn resp 9 !+-+ cpm, irregular abd or diaphramatic with short period of apnea without cyanosis.
T 1* secs 9 normal apnea 9newborn
/esp <hec-
Aewborn 9 #+ 9 >+
1 yr - $+ 9 #+
$-!yr $+ 9 !+
* yrs $+ 9 $*
1+ yrs 1F 9 $$
1* G above 1$- $+
5('A14 SO;DS 4'A(D D;()G ASC;!1A1)O?
1.6 ED2:<M7=/ 9 soft, low pitched, heard over periphery of lungs, inspiration longer then e"piration
$.6 @/.A<&.ED2:<M7=/- soft, medium pitched, heard over maJor bronchi, inspiration equals e"p.
!.6 @/.A<&:=7 2.MA12- loud high pitched, heard over trachea, e"piration longer than inspiration.
#.6 /&.A<&: 9 snoring sound made by air moving through mucus in bronchi. Aormal
*.6 /=7D2-or crac-les 9 li-e cellophane 9 made by air moving through fluid in alveoli.
=bnormal- asthma, foreign body obstruction.
.6 W&DDV:AG- whistling on e"piration made by air being pushed through narrowed bronchi .=bnormal 9
asthma, foreign body obstruction
F.6 2T/:1./- crowing or ropster life sound 9 air being pulled through a constricted laryn". =bnormal 9
resp obstruction
=sthma- pathognomonic sign 9 e"piratory wheezing
5et 9 fish. 2port 9 swimming
1rugs 9 amynophylline 9 monitor bp, may lead to hypotension
7aryngo Tracheo @ronchitis 7T@
- inspiratory stridor 9 pathognomonic sign
/12 respiratory dist synd or hyaline membrane dis
<ause- lac- of surfactant 9 for lung e"pansion
&ypotonia, 5ost surgery, <ommon to preterm
Fi,rine h#aline
2" 9 definite with in 1
of life
:ncrease // with retraction
:nspiratory grunting 9 pathognomonic
F 9 1+ severe /12 4silvermenn =nderson inde"6
cyanosis due to atelectasis
1. surfactant replacement and rescue
$. pos- head elevated
!. proper suctioning
#. o$ with increase humidity- to prevent drying of mucosa
*. monitor E(2 s-in color , =@G
. <5=5- continuous K a(w pressure
F. 5DD5 - K end e"piratory pressure
5urpose of P-F- to maintain alveoli partially open and alveoli collapse
7T@ 9 most common Creup -viral infection of laryn", trachea G bronchi
outstanding s" - croupy cough or bar-ing
pathognomonic - stridor
- labored resp
- resp acidosis
- end stage 9 death
1. =@G
$. nec- and throat culture
!. d"- nec- "-ray to rule out epiglotitis
Asg 3gtO
1. bronchodilators
$.increase o$ with humidity
!. prepair tracheostomy set
5(OC4O!)1)S- :nflammation of bronchioles 9 tenatious mucus
<ausative agaent 9 /2E - /esp sincytial viruses
2"O flu li-e s"
:ncreased //
1rugO =ntiviral 9 /ibavirin
Dnd stage 9 epiglotitis
'P)G!O1)1)S - infl of epiglottis
- emer. <ondition of M/T:
2"O sudden onset
Tripod position 9 leaning forward with tongue protrusion
- never use tongue depressor
prepare tracheotomy set
T * yo 9 unable to cough out, put on mist tent 4humidifier o$6 or croupe tie
Asg <areO chec- edges tuc-ed on mist tent
5rovide washable plastic material
Ao toys with friction due .$ on
Ao hairy toys 9 due moist environment medium for bacterial growth
@5 9 B+(# mm&g newborn
@5 after 1+ days- 1++(*+
@5 ta-ing begins by ! yo
<.= 9 ta-e @5 on # e"tremities
1. 3ongolian spots 9 stale gray or bluish discoloration patches commonly seen across the sacrum or
buttoc-s due to accumulation of melanocytes. 1isappear by 1 yr old
$. 3:lla 9 plugged or unopened sebaceous gland . white pin point patches on nose, chin or chee-.
!. 7anugo 9 fine, downy hair 9 common preterm
#. 1esquamation 9 peeling of newborn, e"treme dryness that begin sole and palm.
*. 2tor- bites 4Talengeictasi nevi6 9 pin- patches nape of nec-
hair will grow as child grows old
. Drythema To"icum 9 4flea bite rash6- 1
self limiting rash appear sporadically G unpredictably as
to time G place.
F. &arlequin sign 9 dependent part is pin-, independent part is blue
4side lying 9 bottom part is dependent pin-6
B. <utis 3armorato 9 transitory mottling of neonates s-in when e"posed to cold.
>. &emangiomas 9 vascular tumors of the s-in
" t#pes 4emangiomas
a.6 Aevus Clammeus 9 port wine stain 9 macular purple or dar- red lesions seen on face or thigh. ADED/
disappear. <an be removed surgically
b.6 2trawberry hemangiomas 9 nevus vasculosus 9 dilated capillaries in the entire dermal or subdermal
area. Dnlarges, disappears at 1+ yo.
c.6 <avernous hemangiomas 9 communication networ- of venules in 2; tissue that never disappear with
age. - 3.2T 1=AGD/:.M2 9 intestinal hemorrhage
2-in color blue 9 cyanosis or hypo"ia
White 9 edema
Grey 9 inf
Hellow 9 Jaundice , carotene
Eerni" <aseosa 9 white cheese li-e for lubrication, insulator
@M/A T/=M3= 9 inJury to body tissue caused by e"cessive heat.

:AC=AT *-> yo
=ATD/:./ 5.2TD/:./ =nt 5ost
&ead >.* >.* .* .*
Aec- 1 1 1 1
Mpper arm $ $ $ $
7ower arm 1.* 1.* 1.* 1.*
&and 1! 1.$* 1.$* 1.$*
Trun- 1! 1!
@ac- 1! 1!
Genital 1 1
Q buttoc-s $.*Q $.* Q
Thigh $.F* $.F* # #
7eg $.* $.* ! !
foot 1.F* 1.F* 1.F* 1.F*
degree 9 partial thic-ness 9 superficial epidermis - erythema, dryness, 5=:A
-sunburn, heals by regeneration from 1 9 1+ days
degree 9 epidermis G dermis- erythema, blisters, moist, e"tremely painful
degree 9 full thic-ness- epidermis, dermis, adipose tissue, fascia, muscle G bone
lethargy, white or blac-, not painful 9 nerve endings destroyed
e". lava burns
1.6 1
aid a.6 put out flames by rolling child on blan-et
b.6 immerse burned part on cold &$o
c.6 remove burned clothing of with sterile material
d.6 cover burn with sterile dressing
$.6 a(w
a.6 suction 5/A, o$ with increased humidity
b.6 endotracheal intubation
c.6 tracheostomy
!.6 5reventiuon of shoc- G CGD imbalance
a. colloids to e"pand bld volume
b. isotonic saline to replace electrolytes
c. de"trose G &$o to provide calories
#.6 Tetanus to"oid booster
*.6 /elief of pain 9 :E analgesic 3./5&:AD 2.# 9 needed for $
degree 9 very painful
.6 1
defense of body 9 intact s-in
prevention of wound infection
a.6 cleaning G debriding of wound
b.6 open or close method of wound care
c.6 whirlpool therapy 9 drum with solution
F.6 s-in grafting 9 !
degree 9 thigh or buttoc-s 4autograft6, pigs( animals 9 "enograft
frozen cadaver 9 hallow graft
B,6 diet 9 increase <&.A, increase calories.
A1OP)C D'(3A1)1)S- infantile eczema 4galis6
5apulo vesicular erythematus lesions with weeping G crusting
<ause 9 food allergiesO mil-, citrus Juice, eggs, tomatoes, wheat
2"O - e"treme pruritus, linear e"coriation, weeping crustingL scaly shiny and white 9
Goal o/ $areO decrease pruritus 9 avoid food allergens
1ietO 5rosobi or :somil
&ydrate s-in, borow solution 1, hydrocortisone cream
5revent infection 9 proper handwahsing, trim nails
)3P'1)GO- s-in disease.
<ausative agent 9 grp = beta &emolytic streptococcus
- papulovesicular surrounded by localized erythema 9becomes purulent , oozes a honey colored
Pedi$ulosis$apitis 98RMT.'
- 3gtO proper hygiene 9 wash soap and &$o, oral penicillin 9 bactroban ointment
<an lead to acute glomerulonephritis =GA
AC'- adolescent problem
- self limiting infl dis 9 sebaceous gland comedones 9 sebum causing white heads
- sebum- lipids causing acne bulgaris
3gtO - proper hygiene- mild soap or sulfur soap- antibacterial retin = or tretinoi
1.6early cutting of cord 9 preterm 9 cut umb cord =2=5
fullterm 9 cut umb cord when pulsation stops
$.6 @leeding disorders 9 blood dyscrasias
4'3OP4)!)A 9 deficiency of clotting factor. U lin-ed recessive 9 inherited
:f mom 9 carrier, son 9 affected
:f father carrier- transmitted to daughter

&emophilia = 9 deficiency of coagulation component factor B
&emophilia @ 9or christmas disease, deficiency of clotting factor >
&emophilia < 9 deficiency of clotting factor 11
- umphalagia 9 earliest sign
- newborn receive maternal clotting factor
- newborn growing 9 sudden bruising on bump area- mar-s earliest sign
- continuous bleeding 9 hematrosis 9 damage or bleeding synovial membrane
1" test O
5TT. 5artial thromboplastin time 9 reveals deficiency in clotting factor
7ong Term Goal- prevention of inJury
Asg 1"- increase ris- of inJury
&TO avoid contact sport, swimming only, don0t stop immunization 9 Just change gauge of needle
Calls 9 immobilized , elevate affected part, apply pressure-not more then 1+ min
cold compress
-determine case before doing invasive procedure
!';*'3)A- grp of malignant disease
- rapid proliferation of immature W@<
- W@< 9 protection from infection, soldiers of body
<lassification O
1. !#mpho 9 affects lymphatic system
$. 3#elo 9 affects bone marrow
!. a$ute E ,lasti$- affects immature cells
#. $hroni$E $#sti$- affects mature cells
3OS1 CO33O CAC'( 9 4=776 9 =cute 7ymphocytic 7eu-emia
1. from invasion of bone marrow
signs of infection
a.6 fever
b.6 poor wound healing
c.6 bone wea-ness G causes fracture
signs of bleeding
a.6 petecchiae-small, round, flat, dar- red spot
b.6 epista"is
c.6 blood in urine( emesis
signs of anemia
a.6 pallor , body malaise , constipation
$. from invasion of body organ- hepato spenomegaly 9 abd pain ,
<A2 affectation, increase :<5
1" TestsO
1. 5@2- peripheral blood smear 9 determine immature /@<
$. <@< 9 determine anemia, leu-ocytosis, thrombocytopenia neutropenia
!. lumbar puncture 4756 9 determine <A2 involvement. @efore 75, fetal pos.- avoid fle"ion of nec-
9 will cause a(w obstruction.8<' position or shrimp position only.
#. bone marrow aspiration 9 determine blast cells,
- common site- iliac crest
- post @3= s(effect 9 bleeding
- apply pressure. 5ut pt on affected side to prevent hemorrhage
*. @one scan 9 determine bone involvement
. <T scan 9 determine organ involvement
Therapeutic 3gtO
1. surgery
$. irradiation
!. chemotheraphy
Cocus Asg <areO prevent infection
- !'2'!S OF C4'3O14'(AP4C
1. induction 9 goal of t"L to achieve remission
medsO :E vincristine
7- agpariginase
.ral predinisone
$. 2anctuary- treat leu-emic cells that invaded testes G <A2
giveO methotri"ate- adm intrathecally via <A2 or spine
cytocine, =rabinoside, steroids with irradiation
!. maintenance- to continue remission
giveO oral methotrisate 9 chec- W@<
-adm of methotrisate 9 do wee-ly W@< chec-
#. /einductin 9 treat leu-emic cells after relapse occurs. 3eds 9 same as induction
- give antigout agentsO allopurinol or Vyloprim- treat or prevent hyperurecemic nephropathy.
sg mgt? .utstanding nsg d"O alteration in nutrition less body requirement.
@ased on 3aslow0s heirarchy
SE'//e$t o/ Chemotherap#
1. A(E 9 adm antiemetic drugs !+ mins before chemo until 1 day after chemo
$. Mlcerations ( stomatitis ( abscess of oral mucosa- 4alteration nutrition less body req6
- oral care 9 alcohol free mouthwash , betadine mouthwash
- don0t brush 9 use cotton pledgets
- topical "ylocaine before meals
diet- soft, bland diet according to child0s preference
Temporary 2(D of chemoO
=lopecia 9 altered body image
&irsutism 9 hair
-give emotional support to parents
A5O in$ompati,ilit# 9
3ost common incompatibility 9 4 mom6 . 9 4 fetus6 =
3ost severe incompatibility 43om6 .9 4Cetus6 @
<an affect 1
4#drops 4h$+6 Fetalis 9 edematous on lethal state with pathologic Jaundice
Within $# h
1. initiate breastfeeding to get colostrum
$. Temp suspension of breastfeeding
- content breast mil- pregnanedioles 9 that delays action of glucoronil transferees
liver enzymes converts in direct bilirubin to become direct bilirubin
!. Aeeds phototherapy
#. needs e"change therapy
&yperbilirubinemia - ? 1$ mg(d7 of indirect bilirubin among full term
Aormal 9 +-! mg(d7
- bilirubin encephalopathy
- Remicterus - ? $+ mg(d7 among full term G
?1$ mg (dl of indirect 9 preterm
)can lead to cerebral palsy-
Ph#siologi$ Faundi$e 9 Jaundice within #B -F$ h 4$-! days6 e"pose morning sunlight
5athologic Saundice 9 within $#h. Saundice during delivery.
@reastfeeding Jaundice 9 caused by pregnanediole
=ssessment of Saudice O
1. @lanching neonates forehead, nose or sternum
- yellow s-in G sclera
- color of stool 9 light stool
- color of urine 9 dar- urine
3gtO 5hototheraphy 9 photo o"ygenation
Asg /espO
1. cover eyes 9 prevent retinal damage
$. cover genitals 9 prevent priapism 9 painful continuous erection
!. change position regularly 9 even e"posed to light
#. increase fld inta-e 9 due prone to dehydration
*. monitor :G. 9 weigh baby
. monitor E(2 9 avoid use of oil or lotion due- heat at phototherapy
) bronze baby syndrome-transient 2(D of phototherapy
weigh diaper 1gm ) 1cc
&ead 9 largest part of baby
W of its length
Craniostenosis or $raniosinustosis 9 premature closing of fontanel
&ydrocephalus 9 ant fontanel open after 1B mos
3icrocephaly 9 small growing brain due- alcohol G &:E mom
=nencepahly 9 absence of cerebral hemisphere
<raniotabes 9 localized softening cranial bone. <ommon 9 1
born child
-due early lightening 4$ wee-s prior to D116
/ic-ets of Eit @ deficiency 9 soft cranial bone in older children
<aput 2uccedaneum 9 edema of scalp due prolonged pressure at birth
1. present at birth
$. crosses suture lines
!. disappear after $-! days
Cephalhematoma- collection of blood due to rapture of pericostal capillaries
<har O
1. present after $# h
$. never cross suture line
!. disappear after #- wee-s
#. monitor for developing Jaundice
Se,orrhei$ Dermatitis 9 Xcraddle cap'
2caling, greasy appearing salmon colored patches 9 seen on scalp behind ears and umbilicus
<auseO - improper hygiene
1. proper hygiene
$. put oil night before shampoo
- baby oil
4#dro$ephalus 9 e"cessive accumulation of <2C
1. communicating 9 e"tra ventricular hydrocephalus
$. non-communicating- intraventricular hydrocephalus or obstructive hydrocephalus
due to tumor obstruction
2" 9 :<5 9 abnormally large head, bulging fontanel
- cushings triad
- high pitched cry
older child 9 diplopia 9 eye deviation, proJectile vomiting
- fontanel bossing 9 prominent forehead
- - prominent s-ull vein
- sunset eyes
3gtO position to lessen :<5 9 low semi-fowlers !+ degree angle
=dminister- osmotic diuretic 3annitol( .smitrol , 1iame"- =zetam
1ecrease <2C production
2hunting 9 =E shunt or Ep shunt 4ventriculoperitoneal shunt6
2have hair 9 in ./ 9 to prevent growth of micro org.
Asg <areO
1.6 post E5 shunt 9 side lying on non operated site - to prevent increase :<5
monitor for good drainage - sign 9 sun-en fontanel
bulging fontanel 9 bloc-ed shunt
change fontanel as child is growing
DHD2O =ssessment
1. chec- for symmetry
$. sclera 9 normal color 9 light blue then become dirty white
pupil 9 round- adult size
coloboma- part of iris is missing
signO -ey hole pupil
whiteness G opacity of lens congenital cataract
cornea 9 round G adult size
large 9 congenital glaucoma
1est /or ,lindness common tests
1. newborn 9 general appearance
- can only see 1+ 9 1$ 8
- visual acuity $+ ($++ to $+( B++
1oll0s eyes test- test for blindness
- done 1+
- pupil goes opposite to direction when head is moved
Globellars test 9 test for blin- refle". 5oints near nose 9 baby should blin-
$. :nfant G children
- appearance
- ability to follow obJect past midline
!. ! yrs 9 school age
- general appearance
=llen cards 9 test for visual acuity. 2how picture $+ ft away
:shiharas plates 9 test for color blindness
5rechool D chart - test for stereopsi of depth perception
<over testing test 9 cover 1 eye for 1+ 9 1* min. Then remove. Test for strabismus
#. 2chool age 9 adult
- general appearance
- snellens test
/etinobastoma 9 malignant tumor of retina
.utstanding sign O oat0s eye refle"-whitish glow of pupil
- red painful eye
- blindness
surgery 9 Dnucliation 9 removal of eyeball put artificial aye
1. flaring alenase 9 case of /12
$. cyanosis at rest 9 choanal atresia - post nares obstructed with bone or membrane
1. resistance during catheter insertion
$. emer. 2urgery within $# h
normal color nasal membrane 9 pin-ish
rhinitis 9 presence of creases G pale
chec- sense of smell 9 blindfold 9 smell
&air in nose 9 cilia
=dolescent no hair with ulceration of nasal mucosa suspect cocaine user
'pistasis 9 nosebleed
- sit upright, head slightly forward to facilitate drainage
- $old compress , apply gentle pressure, epinephrine
most developed sense of newborn 9 sense of touch
sense to develop G last to disappear 9 hearing
1. 5roperly aligned with outer cantus of eyes
low set ear 9 -idney malformation
e". /enal aginesis 9 absence of -idney
sign in uterus O oligohydramnios
sign in newbornO $ vessel cord
failure to void within $# h
3gtO -idney transplant
Chromosomal a,errations O -advance maternal age
1. non disJunction 9 uneven division
1risom# 21 - down syndrome - e"tra chromosome
#F"" K $1 - related to advance paternal age
3ongolian slant
@road flat nose
5rotruding nec-
5uppy0s nec-
&ypotonic 9 prone to resp problem
2imean crease 9 single transverse line on palm.
1risom# 18 9 8endvard syndrome'
1risom# 1"- patau syndrome
1urner 9 3onosomy of U synd.
- #*"+
- affected girls
- signs evident during puberty
- has poorly developed $dary se"ual char.
- 2terile
*line/elters S#ndrome- has male genitalia - #F UUH
- poorly devt secpndary se"ual characteristics
- no deepening of voice
-small testes, penis -sterile
Rlinefelter 9 <alvin Rline 9 male
Turner 9 Tina Turner 9 female
Otitis 3edia 9 inflammation of middle ear. <ommon children due to wider G shorter Dustachian tube
1.6 bottle propping
$.6 <left lip( cleft palate 9
2"O .titis
1. bulging tympanic membrane, color 9 pearly gray
$. absence light refle"
!. observe for passage of mil-y, purulent foul smelling odor discharge
#. observe for M/T:
Asg <areO
1. position side lying on affected aside 9 to facilitate drainage
$. supportive care- bedrest, increase fld inta-e
3ed 3gtO
1. 3assive dosage antibiotic
<omplication 9 bacterial meningitis
$. =pply ear ointment
2chool age 9 up and down
T ! yo 9 down G bac-
? ! yo 9 up G bac-
2mall child 9 down G bac- 4 no age6
surgery 4to prevent permanent hearing loss69 otitis media 9 myringotmy with tympanostomy tube
post surgery 9 position affected side for drainage
both 9 put ear plug
if tympanous tube falls 9 healed na
5ells Pals#- facial nerve PF paralysis /(T forcep delivery
1. <ontinuous drooling saliva
$. inability to open , eye G close either eye
/efer to 5T
TDC 4Tracheoesophageal Cistula6-TD=- no connection bet esophagus and stomach
.utstanding 2" 9 <oughing
<ontinuous drooling
Dmergency surgery
'pstein pearl 9 white glistering cyst at palate G gums related to hypercalcemia
Aatal tooth 9 tooth at birth. 3ove with gauze
Aeonatal tooth 9 tooth within $Bdays of life
3oniliasis 9 oral candidiasis
- white cheese li-e, curd li-e patches that coats tongue
- oral thrush
- Asg <are 9 don0t remove, wash with cold boiled &$o
3eds 9 nystatin ( 3ysnastatin 9 antifungal
*awasa>i Dse--strawberry tongue - originated in *orea
- 1r. Rawasa-i discovered it
- common in Sapan
- 8mucocutaneous 7ymphnode 2yndrome'
-persistent fever 9 * days
-strawberry tongue ,
-desquamation of palm G sole
- lymph adenopathy ? 1.* cm
1rugO aspirin
<an lead to 3:
!)PS- symmetrical
Cle/t lip 9 failure of median ma"illary nasal process to fuse by *-B w-s of pregnancy
- common to boys
- unilateral
Cle/t Palate- Cailed palate to fuse by > 9 1$ w-s of pregnancy
- common to girls
- unilateral or bilateral
1. evident at birth
$. mil- escapes to nostril during feeding
!. frequent colic G otitis media or M/T:
1. 2urgery
cleft lip repair 9 <heiloplasty )done 1-! months to save suc-ing refle" 4lost in months 6
<left 5alate- uranoplasty ) done #- months to save speech
Pre op $are
1. emotional support especially to mom
$. proper nutrition
!. prevent colic
feed 9 upright seating or prone pos
burp frequently $" at middle and after feeding-lower to upper tap
#. orient parents to type of feeding
rubber tipped syringe 9 cheiloplasty
paper cup( soup spoon( plastic cup 9 urano plasty
*. apply restraints 9 elbow restraints
so baby can adJust post op
<ondition that warrants suspension of operation
- colds G pharyngitis ) can lead to generalized infection 9 septicemia
Post Op sg Care ?
1. airway 9 positon post cheilopasty 9 side lying for drainage
post uranoplasty 4tonsillectomy6- prone
$. assess for /12 s" bleeding
!. assess for bleeding 9 freq swallowing. -F days after surgery 9 bleeding
#. proper nutrition
- clear liquids- 4 gelatin e"cept red or brown color due may mas- bleeding6
- 4 popsicle- not ice cream6
full liquid
soft diet
regular diet
*. 3aintain integrity of suture line such asO
7ogan bar 9 wash % strength &ydrogen 5ero"ide G saline solution- @ubbling effect
traps microorganism
- prevent baby form crying
for pain- analgesic
1.6 chec- symmetry
<ongenital torticolis- 8 wrynec-'-burn inJury of sternocleidomsstoid muscle during
delivery 9 due to e"cessive traction at cephalic delivery
3gtO passive stretching e"ercise , 2urgery
<omplication 9 scoliosis
14C(O)D gland 9 for basal metabolism
<ongenial cretinism 9 absence or non functioning thyroid glands
reasons for delaying d"O
1. Thyroid glands covered by sternocleidomastoid muscles in newborn
$. baby received maternal thyro"ine
!. baby sleeps 1 9 $+ h a day
earliest signO
1. change in crying
$. change in suc-ing
!. sleep e"cessively
#. constipation
*. edema 9 moon face
late sign
1. mental retardation
prognosis O mental retardation preventable when 1" is early
1. 55:-protein
$. radioimmunoassay test
!. radioactive iodine upta-e
3gtO synthroid 9 sodium 7evothyrosine -synthetic thyroid given lifetime
- chec- pulse rate before giving synthroid
- tachycardia 9 2" of hyperthyroidism
1. symmetry
$. breast - transparent fluid coming out from newborn related to hormonal changes-
!. chest has retroactive 9 /12
#. sternum sun-en 9 pectus e"cavation
A5DO3' 4in order6
1. inspection :
$. =uscultation =
!. percussion 5
#. 5alpation 5 ) Will change bowel sounds, so do last
Aormal contour of abd 9 slightly protruding
2un-en abd- diaphramatic hernia 9 protrusion of stomach content through a defective diaphragm due
to failure of puroperitoneal canal to close.
1. sun-en abd
$. 2" of /12
!. / to 7 shunting
Dmergency surgery within $#h
.mphalocele 9 protrusion of stomach contents in between Junction of abd wall and
3gt- very small surgery
:f large 9 suspension surgery
Asg 3gtO protect sac- sterile wet dressing
Gastro$hisis 9 absence of abd wall
Asg 3gtO sterile wet dressing
F: o/ G)1
1. assists in maintaining CGD G acid base balance
$. 5rocesses G absorbs nutrients to maintain metabolism G support G G 1
!. e"crete waste products from digestive process
/ecommended 1aily =llowance
<alories O 1$+ cal ( Rbw(day 4-ilo body wt6
!+ 9 !B+ cal( day
<&.AY $.$g (Rbw(day
Prin$iples in Supplementar# Feeding
2upplementary Ceeding usually 9 mos
2upplementary feeding given 9 # mos.
a.6 solid food offered to ff sequenceN
1. cereals 9 rich in iron
$. fruits
!. veg
#. meat
b.6 begin with small quantities
c,6 finger foods 9 offered months
d.6 soft table food 9 8modified family menu' given 1 yr
e.6 dilute fruit Juices 9 mos
f.6 never give half coo-ed eggs 9 usually causes of salmoneliosis
g.6 don0t give honey 9 infant botulism
h.6 offered new food one at a time 9 interval of # 9 Fdays or 1 wee- 9 determines food allergens
1otal 5od# Fluids- comprises * - B*, of body wt of infants G children
Where fluids are greater in infants
D"tracellular fld 9 prone to develop dehydration
=cid @ase @alance dependent on the ffO
a. chemical buffers
b. renal G resp system involvement
c. dilution of strong acids and bases in bld
/esp =cidosis 9 carbonic acid e"cess
- hypoventilation
- /12
- <.51
- 7aryngotracheobronchitis 47T@6
/esp =l-alosis 9 carbonic acid deficit
- hyperventilation
- fever
- encephalopathy
3et. =cidosis 9 base &<.! deficit
- diarrhea
- severe dehydration
- malnutrition
- ciliac crisis
3et =l-alosis 9 base &<.! e"cess
- uncontrolled vomiting
- AGT aspiration
- Gastric lavage
P(O5!'3S !'AD))G 1O FA' )35A!AC'
1. vomiting 9 forceful e"pulsion of stomach content
1. nausea
$. dizziness
!. facial flushing
#. abd cramping
assessO amt, freq, force
proJectile vomiting) increase :<5 or pyloric stenosis
3gtO @/=T diet - banana, rice 9 cereal, apple sauce, toast
2. Diarrhea 9 e"aggerated e"cretion of intestinal contents
=cute diarrhea 9 related to gastroenteritis, salmoneliosis
- dietary indiscretions
- antibiotic use
<hronic non specific diarrhea
1. food intolerance
$. e"cessive fld inta-e
!. <&., <&.A malabsorption
=ssessO freq, consistency, appearance of given colored stool.
@est criteria to determine diarrhea O consistency
<omplication ) dehydration
3ild dehydration *, wt loss
3oderate dehydration 1+, wt loss
2evere dehydration 1* , wt loss
'arliest s: o/ deh#dration
tachycardia increase temp weight loss
tachypnea sun-en fontanel G eyeballs scanty urine
hypotension absence of tears
Severe deh#dration?
.liguria , 5rolonged capillary refill time
=cute 9 A5. 4 rest the bowel 6
- with fluid replacement 9 :E
- prone to &ypo-alemia 9 give R chloride
before adm of R chloride 9 chec- if baby can void, if cant void 9 hypo-alemia
1rugO Aa &<.! 9 adm slowly to prevent cardiac overload
Gastric 3otility 1isorderO
4)(SC4P(;GS D)S'AS' 9 congenital aganglionic megacolon
=ganglionic 9 absence of ganglion cells needed for peristalis
Darliest sign
1. failure to pass mecomium after $#h
$. abd distension
!. vomitus of fecal material
early childhood 9 ribbon li-e stool
foul smelling stool
1. @arium enema 9 reveals narrowed portion of bowel
$. /ectal @iopsy 9 reveals absence of ganglionic cells
!. abd "-ray 9 reveals dilated loops on intestine
#. rectal manometry 9 revels failure of intestine sphincter to rela"
Therapeutic 3gt(Asg care
1. AGT feeding 9 measure tube fr nose to ear to midline of "yphoid G umbilicus
$. surgery
a.6 temp colostomy
b.6 anastomosis G pull through procedure
:ncrease <&.A, increase calories , decrease residue 9 pasta
G'(- Gastroesophageal (e/lu:
<halasia 9 presence of stomach contents to esophagus
Will lead to esophagitis complication 9 aspiration pneumonia
'sophageal $an$er
=ssessment O
1. chronic vomiting
$. faiture to thrive syndrome
!. organic 9 organ affected
#. melena or hematemesis 9 esophageal bleeding
1" procedure
1. barium esophogram 9 reveals reflu"
$. esophageal manometry 9 reveals lower esophageal sphincter pressure
!. intra esophageal p& content 9 reveals p& of distal esophagus.
3eds o/ G'(D
a.6 @etanicol 4 urecholine6 9 increase esophageal tone G peristaltic activity
b.6 3etachloporomide 4/eglam6 9 decrease esophageal pressure by rela"ing pyloric G duodenal
- increase peristalsis without stimulating secretions
c.6 &$ &istamine /eceptor =ntagonist 9 decrease gastric acidity G pepsin secretion
- Vimetidine, /anitidine 4Vantac6 9 ta-e !+ min before meals
d.6 antacid 9 neutralizes gastric acid between feedings - 3aalo"
2urgeryO Aissen funduplication O
<hronic vomiting 9
- thic-ened feeding with baby cereals - effective if without vomiting
- feed slowly, burp often every 1 ounce
- positioning
T > months 9 infant sit with infant supine
? > months 9 prone with head of mattress slightly elevated !+ degree angle
O5S1(;C1)2' D)SO(D'(S
=. 5H7./:< 2TDA.2:2 9 hypertrophy of muscles of pylorus causing narrowing G
1.6 outstanding 2"- proJectile vomiting
- vomiting is an initial s" of upper G: obstruction
- vomitus of upper G: can be blood tinged not bile strea-ed. 4with blood6
- vomitus of lower G: is bilous 4 with pupu6
- proJectile vomiting 9 increase :<5 or G: obstruction
- abd distension 9 maJor s" of lower G:T obst
$.6 met al-
!.6 failure to gain wt
#.6 olive shaped mass 9 on palpation
*.6serum electrolyte 9 increase Aa G R, decrease chloride
.6 ultrasound
F.6 " ray of upper abd with barium swallow reveal 8string sign'
1. 5yleromyotomy
$. Credet /amstedt procedure
)S1;SS;SC'P1)O- invagination or telescoping of position of bowel to another
<ommon site 9 ilio-secal Junction
5rone ptO person who eats fat
<omplication 9 peritonitis 9 emergency
1.6 persistent paro"ysmal abd pain
$.6 vomiting
!.6 currant Jelly stool- dye bleeding G inflammation
- palpate sausage shaped mass
1.6 &ydrostatic reduction with barium enema
$.6 =nastomosis G pull thru procedura
:nborn Drrors of 3etabolism- deficient liver enzymes
P4'C!*'1O;()A 45RM6 9 deficiency of liver enzymes 45&T6
5henylalaninehydro"ylase Transferase 9 liver enzyme that converts <&.A to amino acid
> amino acidsO
valine isolensine tryptophase
lysine phenylalanine
Thyronine 9 decrease malanine production
1.6 fair comple"ion
$.6 blond hair
!.6 blue eyes
Thyro"ine 9 decrease basal metabolism
- accumulation of 5henyl 5yruvic acid
#.6 =topic dermatitis
*.6 musty ( mousy odor urine
.6 seizure 9 mental retardation
Test 9 GMT&/:D TD2T 9 specimen 9 blood
- preparation increase <&.A inta-e
- test if <&.A will convert to amino acid
specimen and urine
mi"ed with pheric chloride, presence of green spots at diaper a sign of 5RM
7ow phenylalanine diet- food contraindicated- meats, chic-en, mil-, legumes, cheese, peanuts
Give 7ofenalac- mil- with synthetic protein
Gala$tosemia 9 deficiency of liver enzyme
- GM5T 9 Galactose Mrovil 5hosphatetranferase
- <onverts galactose to phosphate tranferace glucose
Galactose 9 will destroy brain cells if untreated 9 death within ! days
@eutler test 9 get blood -done after 1
presence of glucose in blood 9 sign of galactosemia
galactose free diet lifetime
neutramigen 9 mil- formula
C'!)AC D)S'AS' 9 gluten enteropathy
<ommon gluten foodO
:ntolerance to food with brow
@- barley
/- rye
.- oat
W- wheat
Darly 2"O
1. diarrhea 9 failure to gain wt ff diarrheal episodes
$. constipation
!. vomiting
7ate 2"O
1. abd pain 9 protruberant abd even if with muscle wasting
$. steatorrhea
<eliac <risis- e"aggerated vomiting with bowel inflammation
1. lab studies 9 stool analysis
$. serum antiglyadin 9 confirmatory of disease
gluten free diet 9 lifetime
all @/.W 9 not allowed
o- 9 rice G corn
1. vitamin supplements
$. mineral supplements
!. steroids
PO)SO)G- common in toddlers. 4falls- common to infant6
1. determine substance ta-en, assess 7.<
$. unless poison is corrosive, caustic 4strong al-ali such as lye6 or a hydrocarbon, vomiting is the
most effective way to remove poison.
- Give syrup 1 pecac to induce vomiting
!. 1 pecac 9 oral emetic
- 1* ml 9 adolescent, school age G pre school
- 1+ ml to infant
#. MA:ED/2=7 =AT:1.TD- charcoal, mil- of magnesia G burned toast
*. Aever adm charcoal before 1 pecac
Gluten 9 glutamine 4 normal absorption6
Gliadin 4 to"ic to epithelial cells of
villi of intestines, effects is
malabsorption syndrome6
Cats <&.A G <&.
peripheral edema G
Eit 1 calcium Eit R :ron folic acid
2teatorrhea .steomalasia
. antidote for acetaminophen poisoning 9 acetylsysterine 4 mucomyst6
F. caustic poisoning 4 muriatic acid 6 neutralize acid by giving vinegar . 1on0t vomit prepare
tracheostomy set
B. Gas- mineral oil will coat intestine
!ead poisoning
7ead ) 1estroy /@< functioning ) &ypochornic 3icrocytic =nemia ) 1estroy -idney functioning
=ccumulation of anemia ) Dncepalopathy
1. beginning s" of lethargy
$. impulsiveness, learning difficulties
!. as lead increases, severe encepalopathy with seizure and permanent mental retardation
1. @lood smear
$. abd " ray
!. long bones
1. remove child from source
$. if ? $+ ug(d7 9 need chelation therapy ) binds with led G e"creted by -idney
5seudomenstration slight bleeding on vagina related to hormonal changes
Tearing of fourchette with blood 9 rape( child abuse
/ape- /eport within #B h
2hape pubic hair in inverted triangle 4 female6
Mndescended testes 9 cyrptorchidism -common to preterm
surgery 9 orchidope"y
assess scrotum- warm room G hands
baby 9 pee within $# h
-chec- for arch of urination
'pispadias- urinary meatus located dorsal or above glans penis
4ypospadias- urinary meauts loc ventral or ,elow glans penis
&ypospadias with chordee- fibrous band causing penis to curb downward
5himosis- tight fores-in
@alanitis-infection of glands penis 9 due smegma
4#droseal 9 fld filled scrotum
Tst of 1"O
Transillumination with use of flashlight - glowing sign
2ari$oseal 9 enlarged vein of epididimis 4 girls- vulvular varicosities6
(enal Disorder Cause S: 1: SG CA('
infectious 1. =nasarca- gen
$. massive
!. microscopic or no
#. serum <&.A
*. serum lipid
. fatigue
F. normal or
decreased @5
Cocus of careO monitor
- weigh daily
:ncrease <&.A
:ncrease R- .S, beef
broth, banana
1ecrease Aa
=GA 4 acute
Grp A
Grp = beta
1. 45556 primary
periobital edema
$. moderate
!. gross hematuria
4 smo-ey urine6
#. serum R increased
*. fatigue
. increase @5
<omplication O
1. hypersensive
$. anemia
1. anti &5A
- hydralazine
or apresoline
$. iron
1. weigh daily
$. monitor @5 G
neurologiuc status
!. 1ietO decrease R,
decrease Aa
@=<R- chec- for flatness G symmetry
Open eural 1u,e De/e$t- decreased Colic =cid inta-e
25:A= @:C:1= .<<M7T=- failure of post laminae of vertebrae to fuse
2"O dimpling of bac- , =bnormal tufts of hair
25:A= @:C:1= <H2T:<=- failure of post laminae of vertebrae to fuse with a sac
1. 3eningocele 9 protrusion of <2C G 3eninges
$. 3yelomeningocele 9 protrusion of <2C G 3eninges G spinal cord 4 most dangerous6
!. Dncephalocele 4 <A2 complication 9 hydrocephalus6 9 cranial meningocele or
3ost common problem
- rupture of sac
- prone pos
- sterile wet dressing
3ost common complication - infection
3yelomeningocele 9 genitourinary complication- urinary G fecal incontinence
Asg careO always chec- diaper
.rthopedic complication 9 paralysis of lower e"tremities
2urgery to prevent infection
5ost op 9 prone position
SCO!)OS)S- lateral curvature of the spine
$ typesO
1. structural 9 rye nec-
$. postural 9 improper posture
1. uneven hemline
$. bend forward- 1 hip higher
1 shoulder blade more prominent
Asg careO
1. conservative 9 avoid obesity, e"ercise
$. preventive 9 3ilwau-ee brace - worn $! h a day
!. corrective surgery 9 insert &arrington rod
post op- how to move
log rolling- move client as 1 unit
chec- P of digits ) $+
1. syndactyly 9 webbing of digits
$. polydactyly 9 e"tra digits
!. olidactyly 9 lac- of digits
#. =melia 9 total absence of digits
*. pocoamelia- absence of distal part of e"tremities
'rD du$hennes 9 paralysis- brachial ple"us inJury or brachial palsy
- birth inJury caused by lateral G e"cessive traction during a breech inJury
1. unable to abduct arms from shoulders, rotate arm e"ternally or supinate forearm
$. absence or asymetrical moro refle"
1. abduct arm from shoulders with elbow fle".
COG')1A! 4)P D)S!OCA1)O 9 head of femur is outside acetabulum
1. sublu"ated 9 most common type
$. dislocated
1. shortening of affected leg
$. asymmetrical gluteal fold
!. limited movement 9 earliest s"
#. 4K6 ortolanis sign 9 abnormal clic-ing sound
*. when able to wal- 9 child limps 9 late s"- trendelenburg sign
Goal of 3gtO
Cacilitate abduction
1. triple diaper
$. carry baby astride
!. CreJ-a splint
#. 5avli- harness
*. &ip 2pica <ast
1A!)P'S 9 8clubfoot'
a.6 Dquinos 9 plantar fle"ion 9 horsefoot
b.6 <alcaneous 9 dorsifle"ion 9 heal lower that foot anterior posterior of foot fle"ed towards anterior
c.6 Earus- foot turns in
d.6 Ealgus- foot turns out
Dquino varus- most common
1. 2traighten legs G fle"ing them at midline pos
1. <orrective shoe- 1ennis brown shoe, spica cast
C"O of $ast 9
- to immobilize
- bone alignment
- prevent muscle spasm
lead pencil 9 mar- area to be amputated
cold &$+ 9 hasten setting process
hot &$+- slow setting process
=fter cast application 9 how to move ptO
- use open palm not fingers- fingers will cause indention
- dry cast 9 natural air not blower
- priority chec- O neurovascular chec-
<- circulation
3- motion 2- sensation
<ast 9 with bleeding
- mas- with ball pen edge of blood to -now if bleeding is on going
sign cast is dry ) resonant sound, cast cold to touch
do petaline 9 ma-ing rough surface of cast smooth
C"O To maintain balance
- To support wea-ened leg
Prin$iples in $rut$hes
- wt of body on palmN
- @rachial pulsing 9 if wt of body in a"ila
- 1o palm e"ercise- squeeze ball
Di//erent $rut$h Gaits?
1. 2wing Through
$. 2wing to
- no weight bearing are allowed into lower e"t
!. Three point Gait
- wt bearing is allowed in 1 e"t
#. Cour point gait
*. Two point Gait
- wt bearing allowed in $ lower e"t