Nle MCN Road To Success

COPYRIGHT: JONAS MARVIN ANAQUE , RM , RN
OBSTETRICS and GYNECOLOGY with ethics and Jurisprudence


Aggravating Circumstances
- increases liability
• Committed with plan, 1° higher
• advantage of public position
• abused of confidence
Republic Act 8981- "PRC Modernization Act Of 2000

• Note: that PRC fix the time and place of examination
Powers of the board

Quasi- legislative power –promulgates laws, rules and regulations
Quasi- judicial power –conducting a hearing or investigations
Ethics
– rules, principles that guide nursing decisions or conduct in terms of the rightness or wrongness of that
decisions or actions.
Serves the purpose of governing conduct to ensure the protection of individual’s rights.
 Epikia – There is always an exemption to the rule

 Autonomy—respect ,support of independent decision making.
 Beneficence- compassion; taking positive action to help others; desire to do good
 Nonmaleficence- avoidance of harm or hurt
 Fidelity- loyalty, fairness, truthfulness- agreement to keep our promises.
- concept of keeping a commitment.- word of honor
 Justice- refers to an equal and fair
 Paternalism – giving care like a good father/mother of a family (decision is made by the nurse in
behalf of the client)
 •Deontology- relationship between duty and the morality of human actions
 Utilitarianism- do the greatest good to greatest number
 Veracity - Honesty; credibility; truthfulness
 Temperance - moderation or self-restraint in action, practice of always controlling your
actions, thoughts, or feelings (self-control.)
 Two-fold effect - applied in elective abortion and ectopic pregnancy
– an act is foreseen to have both good and bad effects
• double effect
bioethical principle is involved when the nurse is faced with problem of whom to save the
mother or baby
 Logic
• Using awareness of correct decision in performing procedures to avoid complaints
 Negligence is a failure to exercise the care that a reasonably prudent person would exercise in
like circumstances.
- by carelessness, not intentional harm.
 Specific Examples of Negligence
Failure to report observations to attending physicians.
• Example: Administration of medicine without a doctor prescription
 Incorrect sponge counts
 burns: heating pads ,solutions & steam vaporizers
 failure to take & observe appropriate actions – forgetting to take vital signs to a newly post –
operative client.
 Falls: side rails left down, baby left unattended
 mistaken identity, wrong medicine, dose & route
 .
 Malpractice - “you do things beyond your scope of practice”
• Also denotes stepping beyond one’s authority with serious consequences.
 Incompetence - Is the lack of ability, legal qualifications or fitness to discharge the required
duty.
 The Doctrine of Res Ipsa Loquitor
“The thing speaks for itself.”
 Doctrine of Force Majeure
• irresistible force, one that is unforeseen or inevitable.
• “you cannot stop it from happening”
• circumstances such as floods, fire, earthquakes and accidents
 Doctrine of Respondeat Superior
*the liability is expanded to include the master as well as the employee and not a shift of
liability from the subordinate to the master
 Assault
- An attempt or threat to touch another person unjustifiably
 Battery
- Willful touching of a person, beating a person without consent or permission
 Invasion of Privacy
- intrusion into the client’s private domain
 Libel – defamation by means of print, writing or picture
Example:
o writing in the chart/nurse’s notes that doctor A is incompetent because he didn’t respond
immediately to a call
 Slander – defamation by the spoken word stating unprivileged (not legally protected) or false
word by which a reputation is damaged
 Subpoena– a writ/notice to an individual/ordering him to appear in court at a specific time
and date as witness.
 Subpoena Duces Tecum- notice given to a witness to appear in court to testify including all
important documents
 Summon – notice to a defendant/accused ordering him to appear in court to answer the
complaint against him
 Due Process
• 5. Parricide – (also Parenticide) the killing of one's mother or father or other close relative or
husband or wife killing.
 Adultery - is committed by any married woman who shall have sexual intercourse with a
man not her husband
• A. Jus soli – citizenship based on place of birth
 EO 51 – Milk Code
 RA. 9165 – Dangerous Drug Act.
 RA. 6972 – Day Care Center in every Barangay
 RA. 7600 – Rooming –In and Breast feeding Act of 1992 (30 mins after birth)
 RA. 7610 – Anti-Child Abuse Law (Special Protection of Children against Child abuse,
Exploitation & Discrimination)
RA 9288 – Newborn screening Act of 2004
 FSH RELEASE OF FOLLICLES and estrogen

 MELANOCYTE STIMULATING HORMONE – DARK PIGMENTATIONS OF SKIN LIKE
MELASMA AND LINEA NIGRA
 EDC computation
------LMP – Feb 29,2016, ---- August 12,2016 (May 19, 2017) -----june,27,2014----
 leopolds manever 1-fundic height assessment and AOG assessment
 LM2- Fetal heart tone assessment
 LM3- non movable hard mass- engaged baby
 LM4- facing the mother
 LM1- breech palpation is CEPHALIC
 LM2- palpation of the head or round hard mass is a Transverse lie
 Leopolds maneuver – mother must be in Dorsal Recumbent position
 LM1- (fundal grip) fetal presentation , Aog, fundic height
 *If nodular it angular parts is palpated in LM1 - baby is in shoulder presentation and
transverse lie
 Lm2 / umbilical grip - fetal back,lie,position
*grasp the side of abdomen.
 Lm3- (pawliks grip) fetal engagement/balottement,
*grasp lower abdomen
 Lm4(pelvic grip)- fetal descent , fetal attitude, fetal cephalic prominence and presenting
part.
* grasp inguinal region facing the feet of mother
 Heart burn- pyrosis – avoid acidic beverages or drinks like citrus juices, calamnsi, lemon
and alikes… avoid also ilk, tea and coffee, avoid odorous , fatty , greasy foods
 Ectopic – adnexal mass
 Ectopic – Sudden sharp stabbing lower quadrant abdominal pain radiating to shoulder
or neck
 Ectopic- spotting bleeding, mass in abdomen usually lower quadrant and nausea and
vomiting with diziness
 Lochia rubra – 1st 3 days only --- red more on erythrocyte or RBC
 Lochial serosa – 4-9 days present – pink to brown with leukocytes or plasma
 Lochia alba – Creamy white, from 10 days up to 6 WEEKS postpartum
 Lochia must be FREE or absent of FOUL odor, blood Clots and fever and chills –
Puerperal SEPSIS
 Recto vaginal fistula – abnormal opening or communication between rectum and vagina
 Kegels exercise – for strengthening of perineal muscles – 3x a day at least 10-15 times in
sitting, standing position
 Secretory phase - progesterone
 Proliferative phase - estrogen
 Iron source – LIVER products, kidney beans, lima or lentil beans
 Meconium – tarlike, odorless blackish first stool of the baby within 24 hours after
delivery
 Breast feeding , colostrums, antibodies, storage of breastmilk
 How to relieve backpain of the mother– pelvic rocking and squatting exercise
 MagS04 antidote – Calcium Gluconate
 Braxton hicks contraction. – intermittent, painless irregular or false or practice labor
contraction.....
 IUD – long term reversible method
 IUD – inserted during menstruation, or 1-4 days after delivery , inserted in the uterus\
 Presumptive sign of pregnancy - amenorrhea...morning sickness or nausea and vomiting
less than 12 weeks
 Uterine contraction - must be rhythmic and regular
 Vit. A IU postpartum mother – 200,000 IU..
 Vit. A for pregnant mother – not more than 10,000 IU at 4 months pregnancy 2x a week
only
 tetracycline – causes discoloration of the baby teeth and bones – permanent GREEN
Teeth
 DEPO PROVERA – 3 months injectables, assess weight gain
 HCG – for positive pregnancy test ,
 Diagnosed hmole – by ultrasound – round masses
 PROGESTERONE – pyrosis, pregnancy, ovulation
 Lordosis, back ache and waddling gait – Relaxin hormones

 PRETERM LABOR – labor before 37 weeks and after 20weeks
 Dexamethasone, betamethasone, celestone – drugs given in preterm labor to mature
fetal surfactants
 POSTPARTUM.HEMORRHAGE within 6 days bleeding or more suggest RETAINED
FRAGMENTS OF CONCEPTION
 ECTOPIC PREGNANCY – sharp sudden stablike pain in lower quadrant of abdomen,
spotting bleeding
 PSEUDOCYESIS – false pregnancy
 CERVIX - squamo columnar cells
 QUICKENING – first fetal movement 16-20 weeks
GERM LAYERS...
 ECTO - sense organs and brain
 ENDODERM- lining of G. I and also liver
 Mesoderm – uterus, ovaries and blood cells, and the heart
 PARTOGRAPH – not assed in partograph are, input and output, RR, Weight and Height
 Assesed in partograph – fetal wellbeing, maternal wellbeing, progress of labor
 Central feature of partograph– cervical dilation
 IE is done every – 4 hours
 Active phase begins at 4 cm
 POSTPARTUM HEMORRHAGE 500- 100ml of blood loss
 POSTPARTUM BLUES- common normal 2-3 days postpartum,
 Oxytocin- rhythmic uterine contraction, given after 3rd stage of labor
 Methergine- check vital sign esp. Bp - hypertension
 THREATENED ABORTION- closed cervix, mild bleeding or spotting, mild cramping
 SEPTIC ABORTION – fever and chills abdominal cramping, foul discharges and abortion
 HBMR – is a tool used to render prenatal care consisting the risk factors and danger
signs of pregnancy
 PANEL 2 of HBMR – contains the risk factor and danger signs of pregnancy
 CATEGORY1 - NO RESTRICTION....NO CONDITION WHICH CONTRADICTS THE USE OF THE
METHOD...
 CATEGORY 3 –Use of method not usually recommended unless other more appropriate
methods are not available or not acceptable No (Do not use the method)
A condition where the theoretical or proven risks usually outweigh the advantages of
using the method
 CATEGORY 4--- Method not to be used- A condition which represents an unacceptable
health risk if the contraceptive method is used
 Pneumococcal conjugate vaccine (PCV) – safe for mother and baby
 Tetracycline: permanent green teeth staining of baby if used by pregnancy
 heat lamp – perineal heat therapy - 18-24 INCHES ( 25 watts – 12 -18 inches; 40 watts
bulb – 18-24 inches)
 Cramps in pregnancy – CALCIUM DEFICIENCY, DORSIFLEX FOOT EXTEND KNEE

 Leg cramps – vit. B, D, Calcium supplementation
 H-mole - sago like discharges and a liver fossicles discharges or grapelike
 In Hmole – No FHT or Fetal movement
 Auscultation fhb @20wks.
 site of BBT assessment – AXILLARY TEMPERATURE
 Symphisispubis – 12 weeks
 Xyphoid process or beast bone - 36 weeks (wks in aog)
 Level of navel – 20 weeks
 Iodine- cretinism...iron
 TETANUS toxoid- with chorionic gonadotrophin content
2 primary doses tt1&2
3 booster doses Tt3-4-5
IM -0.5ml right deltoid.... 90 degree angle injection....
Protects the mother against tetanus... and the baby against tetanus neonatarum
 1st pregnancy give TT1&2
2nd pregnancy give Tt3
3rd- Tt4
Succeeding pregnancies- TT5
 TT1- ASAP/20wks-**no protection (0% and 0 year)

 TTT2- 4 Wks or 1 month after TT1- 80%-**3years protection
 TT3- **6 mos. After TT2- 95% - 5 yrs protection
 TT4- 1 Year after TT3-99%- **10years protection
 TT5- 1 Year after TT4-99%- **lifetime protection
 BTL – permanent IRREVERSIBLE – laparoscopic (incision near the navel of abdomen)
 Vasectomy - permanent IRREVERSIBLE (incisions in the scrotum. One incision in the
middle of the scrotum or two incisions (one on each side) )
 lack of calcium- leg cramps....dorsiflex...
 Endometrial cancer s/s – abnormal vaginal bleeding or menorrhagia
 Crown heel length/CRL – 25 cm below is an abortus
 Cardinal movements – EXTENSION - crowning occurs ( cardinal movement that
precedes restitution or external rotation)
 RESTITUTION – external rotation to follow extension
 Unang yakap- dry the baby
 ISchial spine / levels (-1 is 1 cm above ischial spine)
 Sation 0 - Engaged
 +3 sation is Crowning or 3 cm below ischial spine
 Molding – overlapping or overrinding of skull bones
 BOW- check FHT
 Cheesy discharges and pruritus vulva – candidiasis, moniliasis
 Itchy genitalia or vagina is Vulvovaginitis

 Cauliflower cells – condylomata accuminata – HPV
 Clue cells by pap smear – bacterial vaginosis
 Foul fishy thin gray discharges by Whiffs test– bacterial vaginosis
 Strawberry cervix by pap smear – trichominasis
 FROTHY DISCHARGES – TRICHOMONIASIS
 PID – CAUSED BY GONORRHEA AND CHLAMYDIA
 HIV – attacks CD4 cells
 HIV/AIDS .– attacks immune sytem
- 52yrs old menopaused for 2yrs then nag pnta s clinic with signs of bleeding?- refer
for further examination or to a gynecologist or doctor for endometrial biopsy maybe a
sign of endometrial cancer or myoma and polyps
 VIT.D- RICKETS – risk for CPD
 Rigid like abdomen painful – abruption
 T cu 380 – 10 YEARS PROTECTION
 SPOTTING in the use of iud must be reported
 Coc – COMBINED ORAL CONTRACEPTIVES – NO to obesity, heavy smokers and DM
patient.
 Coc – REPORT IF HEADACHE AND MIGRANE IS EXPERIENCED
 CRETINISM –IODINE
 BREASTFEEDING – the 3 E (Early, Exclusive, Extended)
 Oxytocin is given after placental delivery for rhythmic or regular uterine contaction
 Breech in LM1- cephalic presentation (lm1)
 Shoulder dystocia- mc roBerTs maneuver
 Not to suture- anal and rectal sphinter muscles (3&4) – pubococcygeous
 Occipito mental preseting diameter- chin
 Tt that protects.pregnant mother -TT2
 Tt to.2nd pregnancy mother (Gravida 2) – TT3
 Transverse diameter - not less than 8 cm - Narrowest outlet
 OB conjugate – narrowest and smalles APD or anteroposterior of pelvis
 6 days postpartum bleeding – retention of fragments
 Ritgens maneuver used to control fetal head delivery..
 Involution- return of uterus to prepregnant state
 Too thin, too young, too sick woman must avoid getting pregnant
 33 weeks onward pregnancy check up is every week....
 Mother with risk factors check up just be As frequent as needed
 Abruptio placenta- boardlike rigid abdomen (painful, extreme or severe and tender)
 Placenta previa- abnormal implantation to lower uterus ( painless bright red )
 MDG target- reduction of maternal mortality by 80/100,000 live births (mdg5)
 2/3- reduction of child mortality rate (mdg4)
 Spacing of pregnancy - 3-5 years
 High risk pregnancy- below 18 years old and above 35 y.o PRIMIGRAVIDAS
 Pituitary gland - produces FSH,LH,

 Rectovaginafistula - opening or communication of vagina and rectum
 LOA - occiput facing left side of maternal pelvis towards the front or symphisis pubis
 Menstrual cycle -32days ovulation day is 18
 28 days ovulation day is 14)
 Moniliasis - white, cheesy,patches with itchiness or pruritus vulva
 Fetal back- LM2 or umbilical grip
 Clitoris - landmark of catheterization, erectile tissue with genital corpuscles
 Magnesium sulfate - anti seizure, anti convulsant
 Ferrous sulfate- take with vitamin c.... avoid coffee, milk, cheese and calcium
 feso4- 1 gram per singleton pregnancy- start at 5 months to 2 months postpartum
 Eclampsia - SEIZURE UP TO 72 HOURS – danger of seizure end at 48 hours
 Corpus luteum - SECRETORY PHASE - PROGESTERONE PRODUCE
 Appearance of pubic hair- androgen like testosterone in men and androgen in wome
 HIP AND BREAST DEVELOPMENT* ESTROGENPROLIFERATIVE AND FOLLICULAR PHASE-
ESTROGEN
 SECRETORY.& LUTEAL PHASE * PROGESTERONE
 Pituitary gland - produces FSH,LH,
 Voiding of a laboring women is every 2 hours
 Pulse and FHT every 30 mins
 Top left corner of partograph ----maternal info...
 Central feature - cervical dilatation
 Plot at left side of alert line marking X at the Active phase (4cm)
 PARTOGRAPH- not assessed is fluid intake and output...
 I.E every 4 hours
 Postpartum hemorrhage- criterion is blood loss more than 500 ml (500-1000ml)
 Postpartum hemorrhage- massage fundus and 10 iu oxytocin
 Effleurage- backrubbing during labor
 thickening of uterus- estrogen
 good for implantation- secretory
 secretion of endometrial lining - progesterone.
 Hcg- positive pregnancy test
 Hcg- morning sickness
 fsh - matures egg cell or prinordial to graafian follicle
 Melanocyte stimulating hormone- dark pigmentation of skin (linea nigra,chloasma)
 Pelvis- android (heart male)
 gynecoid-(for female,permit vaginal delivery,wide deep, apple shape)
 identifiable sex of fetus(4months or 16 weeks)
 FHT- (120 - 160) for breech take it Above umbilicus
 ECTOPIC PREGNANCY - lower abdominal sudden knifelike pain that radiates to shoulder
 PSEUDOCYESIS- false pregnancy - amenorrhea
CERVIX - SQUAMO COLUMNAR CELLS
 QUICKENING— 16(multi).& 20wks ( primi)

 GERM LAYERS.- ECTO (sense organs, hair, nail, skin, brain and nervous system) AND
 ENDODERM( GIT and respiratory lining, thyroid and parathyroid. Liver and internal
organs except uterus...
 Ritgens maneuver used to control fetal head delivery..
 Kegels strengthens the levator anii muscles.... pelvic floor muscles or perineal muscles....
and MOSTLY BENEFITED IS THE " " "Pubococcygeus Muscle"
 PROM- PREMATURE rupture of membrane for more than 20 hours mothers
temperature must be checked - RISK FOR INFECTION....
- I.E is every 4 hours
 Amenorrhea - presumptive sign..
 vit A/RETINOL food sources
-SQUASH,PAPAYA,YELLOW CAMOTE, EGG YOLK, RIPE GUAVA, RIPE MANGO, FORTIFIED
CEREALS, legumes and beans
 Iodine- prevents CRETINISM or MENTAL RETARDATION
- SOURCES- iodized salt, talaba oyster, anchovies or dilis, shells , clams, seaweeds
 Hot Sitz bath – 15-20 minutes
– is a procedure whereby patient’s perineal area is submerged to water with solutions
depending on the needs of the client.
- a bath in which only the pelvic area is immersed in warm fluid.(38-42 celcius)
idications : Hemorrhoids, Anal Fissures/Surgery, Episiotomy or laceration, Uterine
Cramps
 Contraindication : Pregancy , Menstruation
 afterpains, during the first few days after delivery is normal . These contractions —
which often resemble menstrual cramps — help prevent excessive bleeding by
compressing the blood vessels in the uterus. Common in breastfeeding primigravida
 iron- PREVENT ANEMIA OF PREGNANCY- LIVER PRODUCTS, RED MEAT AND INTERNAL
ORGANS, MONGGO, GREEN LEAFY VEGETABLES
 Vit.D for calcium absorption prevents RICKETS in children and osteomalasia in adult-
sources dairy products , fish, milk, cheese , anchovies, salmon, sardines
 Trichomonas vaginalis-trichomoniasis- trichomonas vaginalis protozoan * frothy creamy,
strawberry ( Drug : flagyl or metronidazole)
 Moniliasis, candidacies, - albicans.yeast infection - itchy, white cheesy, pruritus
vulva(vaginitis) ( High risk factor : Obesity and DM)
 KOH test or potassium hydroxide test for moiniliasis
 Hep b- nakukuha sa dugo o tusok ng karayom...at sex ( use one needle per patient)
 Syphilis - painless sores, ulcers,
 Hpv- condylomata- cauliflower CELLS
 POSTPARTUM BLUES- common normal
 Oxytocin- uterine contraction
 INEVITABLE ABORTION open cervix
 20 Weeks pregant(22 weeks after LMP):
 * The fetussleeps, awakes and can hear sound
 Menopause is climacteric or change of life

 Endometriosis- ectopic growth or growth of endometrial tissue outside uterus – most
common site - ovaries – Drug of choice : Danazol – methotrexate and hormonal therapy
– common to postmenopauseal…
 Accutane or tretinoin – anti acne contraindicated in pregnancy
 Penicillin and amoxicillin safest antibiotics of pregnancy
 Rubella vaccine is contraindicated in pregnancy
 Complication of streptomycin in pregnancy – deaf baby or abortion
 Complication of chloramphenicol in pregnancy – gray baby syndrome
 Complication of smoking in pregnancy is SGa or Low birth weight baby
 Complication of DM of mother is macrosomia and preterm baby
 Position of mother in IUD- lithotomy
 Position of mother in labor – Left side lying
 Position in mother for Leopolds- dorsal recumbent
 Position of mother with vaginal bleeding- trendelenburg
 Position of mother with ruptured BOW – knee chest or trendelenburg
 Position of mother with shock – trendelenburg
 Position of mother with cord prolapse - knee chest or trendelenburg
 Position for fetal distress – Left side lying
 Position of mother in BED PAN – sitting position
 Position for BSE- Supine lying
 Position for TSE of male- standing after warm bath
 Position of CS in Breast feeding- side lying
 Position of chatting mother in Breast feeding – sitting
 Position of mother in NSVD breastfeeding- Cradle hold
 Stored milk in room – 4-6 hours
 Stored milk in freezer – 6 months
 Mastitis – cold compress before feeding
 Engorgement – warm compress before feeding
 Avoid soap in breast
 Breastfeeding is immediately or within 30 minutes after birth and after 3-4 hours in CS
 EO – 51 is milk code – no pacifiers and prelacteal feeding like sugar waters and formula
 RA 7600 – Rooming in and breastfeeding act – June 2, 1992.
 Normal Spontaneous Deliveries. -
The following newborn infants be put to the breast of the
mother immediately after birth and forthwith
 roomed in within thirty (30) minutes:
 Republic Act 10028 or the “Expanded Breastfeeding Promotion Act of 2009”

Laugh out loud at 3 months
 Social preparation at 2 months
Treatment of Diaper rash

****Gently cleanse the diaper area with soap and water and pat dry.
 Creams and ointments containing zinc oxide or petroleum help to soothe skin and
protect it from moisture.
 QID – 4 x a day
 Vit K – to prevent hemorrhagic disease of newborn
 Source of Vit.A – yellow orange fruits and vegetables – papaya , squash
 BANANA- latondan for diarrhea
 RICE.am also rice water for diarrhea
Infancy is the period of time from 1 month to 1 year of age.
 2 months – social smile noted; cooing sounds
 3 months –laughs out loud
 4 months – grasp is voluntary
 5 months –roll over prone to supine
 6 months – sits with - rubber ring for teething
6- 7 months –*****beginning to fear strangers- CBQ
 8 months – sits without support,--- CBQ, peak of stranger anxiety is at this point-----
CBQ
 9 months – can creep or crawl----- CBQ, ,
and says first word (da-da)-------------CBQ
 10 months –uses pincer grasp----- CBQ
- patty-cake and peek-a-boo are the games -----------CBQ
 11 months – stand with support and tries to walks with support – cruises--------- CBQ
 12 months – stand alone,--- CBQ
can eat well with fingers and all kinds of table foods------ CBQ
- says two words plus ma-ma and da-da--------- CBQ
 Baby walks well alone at 15 months
 hernia is a protrusion of a loop of bowel from the abdomen
In babies the most common hernias are inguinal hernias and umbilical hernias.
 Sore/Cracked Nipples
- Make sure your baby is latching on correctly.
- Start feeding on the breast that is the least sore.
- expressed breast milk on your nipples to help them heal.
 *****Engorgement- breast fullness causes swollen, hard, painful breasts,
 Relieve engorgement by proper breat emptying
 Nurse or breastfeed frequently, 8 - 12 times a day.
- If the baby isn't nursing well or you still feel full after breastfeeding, use a breast pump
to help fully empty the breast.
- A proper latch and good positioning help the baby to breastfeed more efficiently and
remove more milk.
- Remove some milk before breastfeeding so the baby can latch on better. It is more
difficult to latch on to a hard, full breast.
 - Alternate warm and cold compresses.
- Gently massage the breasts.
- Allow warm water to run over your breasts in the shower.
- Try using green cabbage leaves. Rinse and refrigerate the leaves, then apply them to
your breasts for 15-20 minutes twice a day.
 Mastitis is swelling or inflammation of the breast tissue. Symptoms of mastitis include
redness or tenderness of the breast, flu like symptoms, and/or a fever. – staphylococcus
aureus is the bacteria
-Continue to breastfeed.
- Apply cold compresses.before feeding
 Thrush is a yeast infection t
 - Good hand washing is very important to prevent spreading the infection.
 -Burp the baby more often- sitting in lap or held in shoulder
 correct dose of Vit. K to be given to a neonate - 1 mg
 most appropriate food to be given early to baby - Mashed potato, mashe yellow camote,
Squash
 not a component of APGAR- BP, temperatue and weight
 sunken eyes, drinking eagerly, thirsty and skin pinch goes back slowly- some
dehydration
 BCG- produce a scar (0.05ml)
 primary critical observation for Apgar scoring - Heart rate
 otoscope to examine the ears of a 2 year-old c- Pull the pinna down and back
 Severe dehydration- a severe conditions DOES NOT always require urgent referral to a
hospital
 bathe the newborn- Before feeding
 small, whitish, pinpoint spots over the nose- Milia

 vitamin K injection to Vastuslateralis muscle
 blackish blue marks around his buttocks- Mongolian Spots
 Priority after birth is THE PATENCY OF AIRWAY
DIAPER RASH
 Wash the perineum with water, pat it, and dry.

 Reusable diapers are better for daytime use, and disposable diapers are better for
night time use.
 Change your baby's diaper every one to three hours and at least once a night
 Carefully clean his skin and apply a barrier cream with petroleum jelly or zinc-oxide after
each change
 Let your baby have plenty of 'bare-bum' time
 normal cry of the newborn – loud Lusty vigorous , frequent
 high pitch cry – neurological abnormalities- refer the baby

 10 steps - steps to a successful breastfeeding (criteria in the accreditation of a mother-

friendly hospital)
 Primary complex- communicable disease that affects the growth and development among
children
 Regurgitation- normal (Imperfect control of the cardiac sphincter and Pyloric sphincter is
not well developed)
 late sign of hunger for the babies- Crying
 cord be clamped after birth- cord pulsations stop
 caput succedaneum- edematous swelling of a portion of the fetal scalp ,swelling of tissue
over the presenting part of the presenting head
 diarrhea- abnormal condition that usually accompanied by teething
 Blink, cough, sneeze, gag, swallowing- newborn reflexes below are present at birth and
remain unchanged through adulthood
 a positive Babinski reflex - Immature central nervous system
 natural sedatives in milk –Tryptophan
 Staphylococcus aureus- most common organism causing mastitis
 should start feeding baby vegetables - 6 to 8 months
 a reddish stain on the diaper of a newborn- Uric acid crystals
 asymmetrical Moro reflex – brachial plexus
 anterior fontanelle close- At 12 to 18 months of age
 anterior fontanelle shape is diamond while posterior is triangle
 breast enlargement in neonates - Estrogen
 Drying the infant in a warm blanket – to prevent evaporation
 Jarring of bassinet will stimulate – moro reflex/startle
 Undress only the body area to be examined to prevent hypothermia
 Bililight or phototherapy distance – 12-30 inches
 Phototherapy baby stool is bright green or yellow green
 uncurling and fanning out of the toes when the lateral plantar surface - Babinski reflex
stoke by inverted J in the heel- sole
 epistaxis – nosebleeding
 measles – incubation – 7days-21 days
 nurse initial action should be to- Establish an airway for the baby after delivery
 treat oral thrush- Wipe the infant’s mouth with a clean, soft cloth wrapped around
her finger and dipped in salt water or NSS.
 sleeping newborn heart rate- 100 beats per minute
 crying- 180 bpm
 most important reflex - Moro
 normal weight loss in newborns - 5-10% of the birth weight
 cord falls off 7-10 days
 antibody present to a breast milk- IGA
 milk production influence by- Prolactin

 shampoo, the baby using the technique - Football hold
 losing of heat to the surrounding air - Convection
 first teeth that erupt- Lower central incisors
 positive Babinski reflex - Fanning of toes
 first word of the baby- dada
 4 month old baby- ability to reach toy
 partial bath correct sequence - Face and eyes, hair, trunk diaper area
 Solid foods are not given until this reflex disappears- Extrusion
 hormones influences milk let down reflex- Oxytocin
 Credes prophylaxis – prevents gonorrhea infection
 source for heat production in the neonate - Brown fat
 infant can be able to pick up small objects using pincer grasp - 10 mos.
 night blindness and white spots among infants and children is deficiency in- Vitamin
 Calcium and phosphorus for a proper development of the baby strong bones and teeth
 first micronutrient the baby received in supplementary feeding IRON
 First food received by the baby is Carbohydrates
 measles immunization is given9 mos.
 NOT a micronutrient- calcium
 club foot- deformities structure of bones of the foot inward or outward curvature of foot
 primary food of an 0-6 mos. Old – breast milk
 the v/s of an infant, which of the following is taken last- temperature and BP
 Measles vaccine is given by - subscutaneous route
 dizygotic twin - fraternal twin
 Birth weight of an infant is expected to increased double at 6 mos.
 Absence of Moro reflex – refer
 infant walks alone at 13-14 months (walks well at 15 months)
 cyanosis- most common danger sign of newborn
 head- biggest part of the baby’s body at birth
 practical way of reducing jaundice at home exposure to early morning sunlight
between 6-8am not after 9 am
 Vit. K is given intramuscularly mid- thigh
 task of infancy sense of trust
 sense of autonomy - toddler
 Crede’s prophylaxis- opthalmia neonatorum
 most highly developed of the special senses in a newborn at birth - touch
 first sense to appear and disappear- hearing
 cord 3 blood vessels, 2 arteries and 1 vein
 Competent nurse in apgar scoring – 7-10 score
 Incompetent nurse – 0-3 apgar score of baby

 cause of death of premature infant - immaturity
 primary goal in newborn - establish airway and spontaneous breathing respiration
 Rice cereal- food preferable to introduce first
 A child with HIV-positive blood should receive inactivated poliovirus vaccine
(IPV) rather than oral poliovirus vaccine (OPV) immunization.
 Infants subsisting on cow’s milk only don’t receive a sufficient amount of iron
(ferrous sulfate), which will eventually result in iron deficiency anemia.
 An infant usually triples his birth weight by the end of his first year.
 Clinical signs of a dehydrated infant include: lethargy, irritability, dry skin, decreased
urinary output, and increased pulse.
 Papules, vesicles, and crust are all present at the same time in the early phase of
chickenpox.
 A serving size of a food is usually one (1) tablespoon for each year of age.
 The characteristic of Fifth disease (erythema infectiosum) is erythema on the face,
primarily the cheeks, giving a “slapped face” appearance.
 A small-for-gestational age (SGA) infant is one whose length, weight, and head
circumference are below the 10th percentile
 Blood pressure in the arms and legs is essentially the same in infants.
 When bottle-feeding a newborn with a cleft palate, hold the infant’s head in an upright
position.
 Before feeding an infant any fluid that has been warmed, test a drop of the liquid on your
own skin to prevent scalding the infant.
 A newborn typically wets 6 to 10 diapers per day.
 microwaving food and fluids isn’t recommended for infants
 The most adequate diet for an infant in the first 6 months of life is breast milk.
 infant can usually chew food by 7 months, hold spoon by 9 months, and drink fluid from
a cup by one year of age.
 Choking from mechanical obstruction is the leading cause of death (by suffocation) for
infants younger than 1 year of age.
 In an infant, a bulging fontanel is the most significant sign of increasing intracranial
pressure.
 the second breast or last used breast should be used first at the next feeding to prevent
engorgement.
 Stress, dehydration, and fatigue may reduce a breastfeeding mother’s milk supply.
 To help a mother break the suction of her breastfeeding infant, the nurse should teach her
to insert a finger at the corner of the infant’s mouth.
 Cow’s milk shouldn’t be given to infants younger than age one (1) because it has a low
linoleic acid content and its protein casein is difficult for infants to digest.
 A woman who is breastfeeding should rub a mild emollient cream or a few drops of
breast milk (or colostrum) on the nipples after each feeding.
 let the breasts air-dry to prevent them from cracking.
 After feeding an infant with a cleft lip or palate, the nurse should rinse the infant’s mouth
with sterile water.
 Human immunodeficiency virus (HIV) has been cultured in breast milk and can be
transmitted by an HIV-positive mother who breast-feeds her infant.
 Colostrum, the precursor of milk, is the first secretion from the breasts after delivery.
 Most drugs that a breastfeeding mother takes appear in breast milk.
 Prolactin stimulates and sustains milk production.
 A mother who is HIV positive test result shouldn’t breastfeed her infant.
 Hot compresses can help to relieve breast tenderness after breastfeeding.
 The initial weight loss for a healthy neonate is 5% to 10% of birth weight.
 The normal hemoglobin value in neonates is 17 to 20 g/dl.
 The circumference of a neonate’s head is normally 2 to 3 cm greater than the
circumference of the chest.
 After delivery, the first action is to establish the neonate’s airway.
 During the first hour after birth (the period of reactivity), the neonate is alert and
awake.
 The neonatal period extends from birth to day 28.
 A low-birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth.
 A very-low-birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth.
 Administering high levels of oxygen to a premature neonate can cause blindness as a
result of retrolental fibroplasia.
 An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate
distress, and 0 to 3 indicates severe distress.
 To elicit Moro’s reflex, the nurse holds the neonate in both hands and suddenly, but
gently, drops the neonate’s head backward. Normally, the neonate abducts and extends
all extremities bilaterally and symmetrically, forms a C shape with the thumb and
forefinger, and first adducts and then flexes the extremities.
 An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate
distress, and 0 to 3 indicates severe distress.
 If jaundice is suspected in a neonate, the nurse should examine the infant under natural
window light. If natural light is unavailable, the nurse should examine the infant under a
white light.
 Vitamin K is administered to neonates to prevent hemorrhagic disorders because a
neonate’s intestine can’t synthesize vitamin K.
 The nurse should count a neonate’s respirations for one (1) full minute.
 In a premature neonate, signs of respiratory distress include nostril flaring, substernal
retractions, and inspiratory grunting.
 Respiratory distress syndrome (hyaline membrane disease) develops in premature
infants because their pulmonary alveoli lack surfactant.
 Whenever an infant is being put down to sleep, the parent or caregiver should position
the infant on the back avoid prone.
 The percentage of water in a neonate’s body is about 78% to 80%.
 When teaching parents to provide umbilical cord care, the nurse should teach them to
clean the umbilical area with a cotton ball saturated with alcohol after every diaper
change to prevent infection and promote drying.
 Cutis marmorata is mottling or purple discoloration of the skin. It’s a transient

vasomotor response that occurs primarily in the arms and legs of infants who are exposed
to cold.
 The first immunization for a neonate is the hepatitis B vaccine and BCG, which is
administered in the nurse shortly after birth.
 Down syndrome typically have marked hypotonia, floppiness, slanted eyes, excess skin
on the back of the neck, flattened bridge of the nose, flat facial features, spade-like hands,
short and broad feet, small male genitalia, absence of Moro’s reflex, and a simian crease
on the hands.
 erythromycin in a neonate’s eyes primarily to prevent blindness caused by
gonorrhea or chlamydia.
 Neonates who are delivered by cesarean birth have a higher incidence of respiratory
distress syndrome.
 phototherapy to a neonate, the nurse should cover the neonate’s eyes and genital
area.
 narcotic antagonist naloxone (Narcan) may be given to a neonate to correct respiratory
depression caused by narcotic administration to the mother during labor.
 In a neonate, symptoms of respiratory distress syndrome include expiratory grunting or
whining, sandpaper breath sounds, and seesaw retractions.
 In a neonate, long, brittle fingernails, absent lanugo with patches of skin desquamation
are a sign of postmaturity.
 Desquamation (skin peeling) is common in postmature neonates .
 first 24 hours Neonatal jaundice after birth is known as pathological jaundice and is
a sign of erythroblastosis fetalis.
 Lanugo covers the fetus’s body until about 20 weeks gestation. Then it begins to
disappear from the face, trunk, arms, and legs, in that order.
 Neonates typically need to consume 50 to 55 cal per pound of body weight daily.
 best technique for assessing jaundice in a neonate is to blanch the tip of the nose or
the area just above the umbilicus.
 Milia may occur as pinpoint spots over a neonate’s nose.
 Strabismus is a normal finding in a neonate.
 Respiratory distress syndrome develops in premature neonates because their alveoli lack
surfactant.
 Erythromycin is given at birth to prevent ophthalmia neonatorum.
 Hepatitis B vaccine is usually given within 48 hours of birth.
 hypospadias shouldn’t be circumcised at birth because the foreskin may be needed for
constructive surgery.
 Mongolian spots disappear by age 2 to 3 years.
 Vernix caseosa is a cheeselike substance that covers and protects the fetus’s skin in
utero..
 Caput succedaneum is edema that develops in and under the fetal scalp
during labor and delivery. It resolves spontaneously and presents no danger to the
neonate. The edema doesn’t cross the suture line.
 Nevus flammeus, or port-wine stain, is a diffuse pink to dark bluish red lesion on a
neonate’s face or neck.
 Guthrie test (a screening test for phenylketonuria) is most reliable if it’s done between
the second and sixth days after birth and is performed after the neonate has ingested
protein.
 Diaphragmatic hernia is one of the most urgent neonatal surgical emergencies.
 neonate, temperature normally ranges F (36.7° to 37.2° C),
 apical pulse rate averages 120 to 160 beats/minute
 respirations are 40 to 60 breaths/minute.
 The diamond-shaped anterior fontanel usually closes between ages 12 and 18 months.
 The triangular posterior fontanel usually closes by age 2 months.
 Meconium -neonate’s first feces, which are black and tarry.
 rooting reflex- the nurse touches a finger to the cheek or the corner of the mouth.
Normally, the neonate turns his head toward the stimulus, opens his mouth, and searches
for the stimulus.
 Harlequin sign is present when a neonate who is lying on his side appears red on the
dependent side and pale on the upper side.
 Acrocyanosis (blueness and coolness of the arms and legs) is normal in neonates
because of their immature peripheral circulatory system.
 When providing care, the nurse should expose only one part of an infant’s body at a time.
 prevent her from developing Rh antibodies, an Rh-negative primigravida should receive
Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate.
 Crowning is the appearance of the fetus’s head when its largest diameter is encircled by
the vulvovaginal ring.
CHILD HEALTH NURSING
Growth and Development
I. Growth – increase in physical size of the body (quantitative change)

Development – progression in skill and or ability to function (qualitative change)
II. Principles:
A continuous process
B ody systems don’t develop at the same rate
C ephalocaudal
D evelopment proceeds from proximal to distal
E levation from gross motor to refined skills
F or play is the universal language of children

G rowth rate varies
H as to follow a definite and predictable pattern of trends
I mportant indicator of development is the behaviour
J ust as each child is unique
III. Stages of Growth & Development
Basic Divisions of Childhood
Stage:
Neonate first 28 days of life
Infant 1 mo – 1 yr
Toddler 1 – 3 yr
Preschooler 3 – 5 yr
School Age 6 – 12 yr
Adolescent 13 – 20 yr
A. Infancy Period
 A rapid growth and development
 1 month until 1 year
 Erikson : Trust vs. Mistrust
 Freud : Oral (ID)
 Piaget’s : Sensorimotor stage (0-2 years old)
 1 month: neonatal reflex
 1-4 months: primary circular reaction (body is center of attention)
 4-8 months: secondary circular reaction (from body to environment)
 8-12 months: coordination of secondary reaction
 12-18 months: tertiary circular reaction (trial & error)
 Fear : Stranger Anxiety
 Play : Solitary
 Toys : mobile, rattle, teething rings, musical toys, crib, gym
B. Toddler
 Age 1 to 3 years
 Bow-legged
 Characterized by alternating rapid and slow rate of growth & development
 Erickson : Autonomy vs. Shame & doubt
 Freud : Anal (EGO)
 Piaget’s : Preconceptual / Preoperational stage (3-4 years old)
 A toddler draws conclusion only from the obvious facts that they see
 18-24 month: invention of new means through mental combinations
 Kohlberg : Level 1: Preconventional
 Stage 1: (2 -3 years old)
 Punishment/Obedience orientation
 Fear : Separation Anxiety

 Play : Parallel
 Toys : Push and pull
C. Pre school period

 Erickson : Initiative vs. Guilt
 Freud : Phallic
 Piaget’s : Intuitive stage (5-6 years old)
 A ssimilation
 B y magical thinking
 C entering
 D on’t aware of reversibility
 E gocentrism
 F antasy role
 Kohlberg : Level 1: Preconventional
 Stage 2: 4-7 years old
 Individualism
 Fear : Mutilation and castration
 Play : Associative & Imitation
 Toys : a simple jigsaw puzzle, dolls, coloring book, pencils, pens, crayons
D. School period
 By having a slow period of growth and development
 Erickson : Industry vs. Inferiority
 Freud : Latency
 Piaget’s : Concrete operations (7-12 years old)
 Aware of reversibility
 By inductive reasoning
 Conservation & Classification
 Development of Logical thought patterns
 Kohlberg : Level II: Conventional

 Orientation to interpersonal relations of mutuality
 Maintenance of social order
 Fear : Displacement from school
 Play : Cooperative & Collectibles
 Toys : Remote control games, game ball, table games
E. Adolescence
 Accelerated growth and maturation influenced by hormonal changes
 Characterized by growth spurt which begins early in girls, about 1-2 years ahead than boys
 Erickson : Identity vs. Role confusion
 Freud : Puberty/Genital
 Piaget’s : Formal stage (12 years old & above)
 Abstract thinking
 By deductive reasoning
 Kohlberg : Level III: Post-conventional
 Stage 5: 12 years and over
 Social contract (follows standards of society for the good of all
people)
 Stage 6: 12 years and over
 Universal ethical principle orientation
 Fear : Displacement from peers
 Play : Athletic & Sports
 Toys : Music gadgets etc.
IV. Maternal-Infant bonding

 A special mutual relationship between mother and infant
 B est initiated immediately after birth
 C an be achieved within the first 30 minutes or
 D uring the first period of reactivity
 E xhibited through: Breastfeeding
Rooming-in
Senses stimulation
V. Assessment
A. Initial care of the newborn
 Assessment
 observe or assist with initiation of respirations
 assess apgar score (pls see table below)
 monitor for nasal flaring, grunting, retractions & abnormal respirations
 obtain vital signs
 observe newborn for signs of hypothermia or hyperthermia
 assess gross anomalies
 Interventions
 Suction mouth, then nares with bulb syringe
 Dry newborn and stimulate crying by rubbing
 Maintain temperature stability; wrap newborn in warm blankets and place
stockinette cap on newborn’s head
 Keep newborn with mother to facilitate bonding
 Place newborn at mother’s breast if breastfeeding is planned, or place on mother’s
abdomen
 Place newborn in warmer
 Position newborn on side or abdomen or in modified Trendelenburg position to
facilitate drainange of mucus
 Ensure newborn’s proper identification
 Footprint newborn and fingerprint mother on identification sheets
 Place matching identification bracelets on mother & newborn
B. Apgar Screening test (by Dr. Virginia Apgar)

- Done twice at 1 and 5 minutes respectively
Criteria 0 1 2
HR: absent <100 >100
RR: absent weak cry vigorous cry
Reflex Irritability: no response grimace vigorous cry
Muscle tone: limp/flaccid minimal full flexion
Skin color: blue acrocyanosis pink
Scores: Interpretation
1-3 Poor - needs immediate CPR

4-6 Fair - needs further observation & stimulation
7-10 Good – healthy
C. Estimation of Age of Gestation by Dr. Ballard’s and Dubowitz

Criteria:
1. Physical characteristics
Pre-mature Term Full-term
Skin: very thin, gelatinous, smooth, thick, less visible parchment, leathery,
& visible blood vessels blood vessels cracked, wrinkled
Lanugo: Abundant thinning bald
Plantar creases: anterior transverse 2/3 with creases entire sole w/ creases
Breast: strippled areola raised areola full areola
Ear: flat & folded thin & soft thick & firm
Genital (M): undescended testes intermediate fully descended
Genital (FM): prominent labia & labia minora & clitoris completely covers minora
clitoris partly covered by labia & clitoris
majora
2. Neuromuscular characteristics
Pre-mature Full term
Posture: extension flexion
Square window: 90° angle 0° angle
Arm recoil: >90° angle <90° angle
Scarf sign: elbow passed midline not passed
Polpliteal angle: >90° angle <90° angle
Heel to ear: positive negative
3. Neurological assessment
Reflexes:
 Rooting: elicited when NB cheek is touched and turns towards the stimulus
 Extrusion: food placed on infant’s tongue is thrust forward and out of mouth
 Tonic neck: as head is turned to one side, arm & leg on that side extends with opposite
extremities in flexion
 Palmar grasp: elicited by placing finger in the NB palm

 Moro/Startle: newborn symmetrically abducts and extends arms
 Stepping: hold the NB in a vertical position allowing one foot to touch a table surface
 Babinski: dorsiflexion of big toe and fanning of all four toes as sole foot is stroked from
heel
VI. Profile of a Newborn

A. Birth weight: 2.5 to 3.4 kg (5.5 to 7.7 lbs)
BW: doubles at 6 months
triples at 12 months
quadruples at 2 ½ years
LBW: < 2,500 grams
Very LBW: <10th percentile
LGA >4,000 grams or >90th percentile
B. Birth length: 46 to 54 cm (18-22 inches)
C. Head Circumference: 34 to 35 cm (13.5-14 inches)
D. Chest Circumference: 32 to 33 cm (12-13.2 inches)
E. Vital Signs
 Temperature : 97.6 to 98.6°F (36.5 to 37 °C) axillary

 Heart rate : 120 to 140 bpm
 RR : 30 to 60 breaths per minute
 BP : 80/46 mmHg
VII. Physical Assessment
A. Head
1. Anterior fontanel: soft, flat diamond shaped, 3 to 4 cm wide by 2 to 3 cm long
- closes between 12-18 months
2. Posterior fontanel: triangular, 1 cm wide

- closes 2-3 months
3. Caput succedaneum: swelling of scalp caused by prolonged labor

- crosses over suture line
- gradually disappears at about third day of life
4. Cephalhematoma: collection of blood caused by increase pressure of birth

- caused by rupture of periosteal capillary
- absorbed within 3-6 weeks
5. Craniotables: localized softening of the cranial bones
- caused by pressure of the fetal skull against the mother’s pelvic bone in utero
- condition corrects itself without treatment in few months
B. Face: observe for symmetry
C. Eyes
A ssume permanent color between 3 & 12 months of age
B lue or gray irises
C ornea round
D ue until 4-6 months: strabismus
E rythromycin antibiotic ointment at birth
F or protection against chlamydia infection or ophthalmia neonatorum
G ets subconjunctival hemorrhage: a red spot on sclera on inner aspect of eye due to
pressure at birth (absorbed in 2-3 weeks)
D. Nose: nasal flaring indicates respiratory distress
E. Ears
The pinna normally align from inner to the outer canthus of the eye
The low set ears indicate:
1. Chromosomal disease
2. Kidney disease
3. Craniofacial lesions
Test newborn hearing by ringing a bell held 6 inches from each ear
F. Mouth
M oniliasis (Oral thrush)/Candidiasis – white cheesy patches in mucous membrane and tongue
O bserve for Cleft lip and palate
U sually blowing bubbles/mucus/drooling indicates tracheoesophageal fistula and esophageal

atresia
T ongue appears large and prominent
T eeth (Natal) – must be evaluated for stability, if loose, needs extraction to prevent
aspiration
H aving white glistening well circumscribed cyst commonly seen in palate caused by
extra load of maternal calcium – Epstein pearl
G. Neck
Short chubby with creased skin folds
Check for rigidity of neck – Congenital Torticollis/Meningitis
H. Chest
An engorged breast due to influence of maternal hormones
I. Abdomen
A bdominal contour slightly protruberant
B owel sounds occur 1 hour after birth
C heck for gastrochisis and omphalocele
D ue after an hour: umbilical cord stump appears white gelatinous, with red and blue streaks
E ncourage inspecting cord clamp for bleeding and:
1. 1st hour of life = cord is shrinked & dry, turns brown-like

2. 2nd to 3rd day = black
3. 6th to 10th day = breaks free
(leaves a granulated area that heals following a week)
F or presence of:
1. peristalsis and palpable olive shaped mass ( Pyloric stenosis)
2. palpable sausage shaped mass (Intussusception)
J. Imperforate anus
Types of stools:
1. Meconium – 1st stool passed by the newborn

 sticky, greenish black, or tar-like (odourless)
2. Transitional – passed by NB beginning 2nd or 3rd day of life
 greenish yellow & loose (odourless)
3. Milk stool
a) Breast-fed baby stool: light yellow and soft (sweet smelling)
b) Formula-fed baby stool: bright yellow and formed (noticeable odor)
K. Genital
1. Male genitalia
A genesis – absence of organ
B y urinary meatus of penis located:
a) Dorsal (above) – epispadias

b) Ventral (below) – hypospadias
C ryptorchidism – undescended testes, may lead to…
D’ following complications:
a) Inguinal hernia
b.) Sterility
c) Testicular cancer
E ctopic testes – inability of testes to enter scrotum due to closure of scrotal sac
2. Female genitalia
Swollen due to effect of maternal hormone
Pseudomenstruation
L. Extremities
A rms and legs appear short
B y clenched & fisted hands
C rease (simian) – associated with down syndrome
D igits (fingers & toes) assessment:
1. Syndactyly – webbing
2. Polydactyly – extra fingers & toes
3. Adactyly – absence of one or more digits
E xtra pad of fat in sole of foot – flat sole (normal)
F eet is plantar flexed – indicates clubfoot
G ets bowed & short NB legs (normal)
H ip dislocation or Dysplasia by Ortolani test
I n abducting the hips of the newborn:
both hips should abduct completely so they lie almost flat
against the mattress 180°
M. Back
A mass, tuft of hair, dimple (incomplete closure of vertebrae) – indicates Spina
Bifida
B y normally flat and straight
C urve of back usually develops at 5-6 months
N. Skin
Assessment:
A red pink skin (normal)
B lue hands and feet – acrocyanosis
C yanosis – hypoxia
D’ colors:
1. pallor – anemia
2. yellow – jaundice (within 24 hours = pathologic)
VIII. Major Developmental Milestone
2 months head lag
social smile
cooing
3 months lifts head & shoulders
4 months lifts chest
5 months roll over
6 months sit with support
palmar grasp
7 months transfer object hand to hand
8 months sit without support
9 months crawls
10 months pulls self to standing
11 months cruises (walks with support)
12 months stands alone
holds cup & spoon
15 months walks alone
18 months run & jump in place
24 months open doors by turning door knobs
30 months can jump down from chairs
Pediatric Disorders
I. Neurological Disorders
A. Hydrocephalus – excess of CSF in the ventricles or the subarachnoid space

> Communicating hydrocephalus or extraventricular hydrocephalus: fluid can reach the spinal cord
> Obstructive hydrocephalus or intraventricular hydrocephalus: with blockage on passage of fluid
- Causes of Excess CSF: Overproduction of fluid by choroid plexus in 1st or 2nd ventricle
Obstruction of the passage of fluid in the narrow aqueduct of sylvius
(most common)
Interference with the absorption of CSF from subarachnoid space
- S/Sx: A nterior fontanel bulging
B ones of the head are widely separated that produces a cracked-pot sound =Macewen’s sign
B row bulges (bossing)
C heck for sun-setting eyes
D’ increase in ICP
E rritability – shrill high pitched cry
- Management:
1) acetazolamide (Diamox): promote excretion of fluid
2) Ventriculoperitoneal shunt: fluid drains into the peritoneum
> headache & lack of appetite: earliest common signs of malfunction
- Nursing Diagnosis with Intervention/s:
1) Risk for Ineffective Cerebral Tissue Perfusion r/t  ICP
Flat on bed – prevent rapid drainage of CSF leading to rupture of cerebral arteries
Avoid lying on side w/ shunt – prevent pressure on valve
Carefully elevate 15 – 30 degrees if  ICP
2) Risk for Imbalance Nutrition, less than body requirements r/t  ICP
Support heads when feeding – hold head w/ whole palm to avoid puncture of the skull
Watch out for poor, ineffective sucking – sign of  ICP
B. Neural Tube Disorders
1) Spina Bifida Occulta – posterior laminae of vertebra fail to fuse during embryonic
development
S/Sx: Dimpling at the point of poor fusion
w/ abnormal tufts of hair or discolored skin on site
2) Meningocele – meninges covering the spinal cord herniate through unformed vertebrae
S/Sx: Protruding mass at the center of the back
Covered by a layer of skin or clear dura mater
3) Myelomeningocele – spinal cord & meninges protrude through the vertebrae
S/Sx: Flaccid & lack of sensation of the lower extremities
Loss of bladder and bowel control
- Causes: Lack of folic acid
Heredity
1) Risk for Infection r/t rupture or bacterial invasion of neural tube sac
Prone – keeps flow of feces & urine away from the disorder; put folded towel under
the abdomen to flex infant’s hips reducing pressure to sac
Side lying – put rolled blanket or diaper behind upper & separate one behind their
lower back (no pressure on the lesion)
- put folded diaper between the legs (prevents skin surface from
touching & rubbing)
Place a sturdy plastic wrap below the meningocele
Sterile, wet compress w/ NSS over the lesion – do not remove, just add fluid
2) Risk for Imbalance Nutrition: less than body requirements r/t difficulty assuming normal
feeding position
Ensure lesion is not pressed by supporting arm during feeding
When bubbling infant, advise not to pat back over the disorder
If lesion is large – prone or side lying when feeding w/ pillow or folded diaper under
the head
C. Meningitis - infectious process of the meninges due to bacteria, viruses, trauma & infections
- Dx: CSF analysis obtained by lumbar puncture
- S/Sx: A nuchal rigidity
B rudzinski’s
K ernig’s sign
- Nursing Intervention: Respiratory isolation within 24 hrs during antibiotic treatment
D. Cerebral Palsy - neuromuscular disability in which the voluntary muscles are poorly controlled
- Causes: Low birth weight
Birth injury
Premature birth
- S/Sx: P osture is abnormal, rigid & fixed
A rching of the back (Opisthotonus)
L imp or floppy body posture
S cissoring of legs
Y et crawls instead of walking
- Types:
1) Spastic – excessive tone in the voluntary muscles
2) Dyskinetic or Athetoid – involves abnormal involuntary movement
3) Ataxic – w/ awkward, wide based gait
4) Mixed – spastic + athetoid or ataxic + athetoid
- Nursing Interventions: S afety
S elf Esteem
S upport groups
II. Respiratory Disorders
A. Pharyngitis – infection and inflammation of the throat
1) Viral
–S/Sx: sore throat, fever & general malaise; enlarged regional lymph nodes, erythema in the
back of pharynx & palatine arch
- Management:
a) acetaminophen, ibuprofen
b) Warm heat to the external neck area for comfort
c) Gargle w/ warm water
2) Streptococcal – caused by GABHS
- S/Sx: eythema in the back of throat & palatine tonsils, enlarged tonsils, white exudates in
tonsillar crypts, petechiae on palate, high fever, extremely sore throat, difficulty
swallowing, overall lethargy, headache
- Management:
a) Full 10 days antibiotic treatment (Penicillin G or Clindamycin)

> advise parents to strictly follow the course to prevent hypersensitivity or autoimmune
reaction to group A strep causing rheumatic fever or glomerulonephritis
B. Tonsillitis - infection and inflammation of the palatine tonsils
-Causes:
in 3 y/o: viral
in school age: GABHS
- S/Sx: drooling, difficulty swallowing, high fever, lethargy, enlarged, bright red palatine
tonsils
-  ASO Titer
- Management:
1) Antipyretic, analgesic
2) Full 10 days antibiotic treatment (Penicillin or Amoxicillin)
3) Tonsillectomy (for chronic tonsillitis)
> done when organs aren’t infected
- Prone or side lying position: head lower than chest to drain blood
- Check signs of bleeding:  pulse & RR, frequent swallowing, throat clearing, feeling
of anxiety
- Restrict child’s activity (no gymnastics & swimming) until after 7 th day
> 1st day: clots form on area
> 5-7 days: clots lyse/dissolve)
- Offer sips of clear liquid, popsicles or ice chips
- Avoid acid & carbonated beverages
- Avoid red fluid such as Kool Aid
C. Croup or Laryngotracheobronchitis – inflammation of larynx, trachea & major bronchi

- Cause: 6 mos-3 y/o – parainfluenza virus
- S/Sx happens at night: C rackles/Wheezes
R uddy, brassy spasmodic cough
Retractions
O bstruction of airway
U sually a hoarse voice
P ersistent laryngospasm
- Management:
1) Run shower or hot water tap in bathroom: keep child in this warm, moist environment
2) Cool moist air w/ dexamethasone or racemic epinephrine
1) Ineffective Airway Clearance r/t edema & constriction of airway
Do not elicit a gag reflex
Keep child from crying
D. Epiglottitis – inflammation of the epiglottis
- Causes: pneumococci, streptococci, staphylococci
- S/Sx: 3D’s:
Drooling
Dyspnea
Dysphagia
- Management:
1) Never attempt to visualize the epiglottis directly w/ a tongue blade or obtain a throat
culture to prevent gagging and obstruction of glottis
2) Tripod position
3) Encourage HiB vaccine
4) O2 hood, Mist tent, Croupette, Cool O2
5) cephalosporin (Cefuroxime)
6) Prophylactic tracheostomy to prevent total obstruction
7) Prophylaxis for siblings
E. Asthma – chronic inflammatory disease of the airways
- S/Sx:
Difficulty exhaling Wheezing
Dyspnea Copious w/ white casts mucus
Long expiratory rate Dehydration
- Management:
1) Avoid cough suppressants
2) For mild but persistent asthma: inhaled anti-inflammatory corticosteroid (fluticasone)
Moderate persistent symptoms: long acting bronchodilator + fluticasone
Severe persistent: oral & inhaled corticosteroid + long acting bronchodilator + short
acting beta 2 agonist bronchodilator (albuterol or terbutaline)
3) Cromolyn sodium – mast cell stabilizer
> prevent bronchoconstriction thereby preventing symptoms of asthma
4) montelukast (Singulair) – leukotriene receptor antagonist
> used as prophylaxis & for chronic asthma
5) theophylline/aminophylline
> S/E: tachycardia
> A/E: hypotension

6) Increase fluid intake
> avoid milk & milk products (causes thick mucus & difficulty swallowing)
F. Pneumonia – infection & inflammation of alveoli
- Causes: Bacterial – pneumococcal, streptococcal, staphylococcal, chlamydial
Aspiration of lipid or hydrocarbon subs
Newborn born 24 hrs after rupture of membranes
Newborn who aspirated amniotic fluid & meconium
1) Pneumococcal – abrupt, follows an URTI
- S/Sx:
Blood tinged sputum b4 24 hrs Retractions Nasal flaring
Thick purulent sputum after 24-48 hrs Chest pain Dyspnea
High fever Chills Tachypnea
Dullness on percussion Crackles
- Management:
a) ampicillin or 3rd gen cephalosporin

b) amoxicillin-clavulanate (Augmentin) – for penicillin resistant organisms
c) Bed rest
d) Reposition child frequently – avoid pooling of secretions
e) Humidified O2 – alleviate labored breathing & hypoxemia
f) CPT – encourages movement of mucus
g) Encourage to cough
h) Small, frequent feedings
2) Chlamydial – common in newborns up to 12 weeks
- S/Sx:
Nasal congestion Tachypnea Rales

Sharp cough Wheezing
- Management
a) Macrolide antibiotic – erythromycin
3) Viral – RSV, myxovirus, adenovirus
- S/Sx:
Low grade fever Tachypnea
Non productive cough Diminished breath sounds
- Management:
a) Bed rest
b)Antipyretic
c) IVF
III. Cardiovascular Disorders
A. Congenital Heart Disorders
- Causes: Failure of heart to progress beyond embryonic development
Maternal rubella
Heredity
- 1st Classifications: (according to effect)
1) Acyanotic heart disease – has stricture to blood flow or shunt that moves blood from arterial
to venous system (oxygenated to unoxygenated or left to right shunts)
2) Cyanotic – venous to arterial (unoxygenated to oxygenated or right to left shunts)

- 2nd Classifications: (addresses the hemodynamic & blood flow patterns)
1) Disorders w/ increased pulmonary blood flow – left to right through abnormal opening or
connection between 2 systems/arteries
a) Ventricular Septal Defect – w/ opening in septum of 2 ventricles
> results to right ventricular hypertrophy &  pressure to pulmonary artery
- S/Sx: Easy fatigability
Loud, harsh pansystolic murmur
Palpable thrill/vibration
- Management:
1) Cardiac catheterization
2) Open heart surgery:  2 y/o to prevent pulmonary artery hypertension
> put Silastic or Dacron patch
> post op: be alert for arrhythmias
b) Atrial Septal Defect – abnormal communication between 2 atria
> results to right ventricular hypertrophy &  pressure to pulmonary artery
- S/Sx: Harsh systolic murmur
Fixed splitting – diagnostic of ASD
- Management:
1) Surgery – between 1-3 y/o
> put Silastic or Dacron patch
> post op: watch out for arrhythmias
2) Cardiac catheterization
c) Patent Ductus Arteriosus – blood shunt from aorta to pulmonary artery
> results to right ventricular hypertrophy
- S/Sx: Wide pulse pressure
Low diastolic pressure
Continuous machinery like murmur
- Management:
1) IV indomethacin – assess side effects (reduced glomerular filtration, impaired

platelet aggregation, diminished GI & cerebral blood flow)
2) ibuprofen – fewer side effects; prophylaxis for preterm infants
3) Cardiac catheterization – insert Dacron coated stainless steel coils (6 mos-1 y/o)
4) Ductal ligation
2) Disorders with obstruction to blood flow
a) Pulmonary Stenosis – narrowing of pulmonary valve or pulmonary artery
> results to right ventricular hypertrophy
- S/Sx: Cyanosis Thrill
Systolic ejection murmur Widely split 2nd heart sound
- Management:
1) Balloon angioplasty
b) Aortic Stenosis – stricture of aortic valve
> results to  pressure & hypertrophy of left ventricle & pulmonary edema
- S/Sx: Rough systolic murmur Chest pain

Thrill
If severe – faint pulses, hypotension, tachycardia, inability to suck
- Management:
1) Beta blocker or Ca channel blocker – for stabilization
2) Balloon valvuloplasty
3) Artificial valve replacement
c) Coarctation of the Aorta – narrowing of the aorta
- S/Sx:  BP in heart & upper body Moderately loud systolic murmur
Headache No palpable femoral pulses
Leg pain Nodules on ribs – enlarge collateral arteries
Vertigo
- Management:
1) Angiography by balloon catheter
2) Surgery – digoxin & diuretics b4 surgery to reduce CHF (done by 2 y/o)
3) Disorders with mixed blood flow
a) Transposition of Great Arteries – aorta arises from right ventricle instead of the left,
pulmonary artery arises from the left instead of the right
- S/Sx: Cyanotic birth
- Management:
1) PGE – prostaglandin
2) Balloon atrial septal pull through
3) Arterial switc: 1 wk -3 mos age

4) Disorders w/ decreased pulmonary blood flow
a) Tetralogy of Fallot – with pulmonary stenosis, VSD, overriding of the aorta & right
ventricular hypertrophy
- S/Sx: Polycythemia Clubbing of fingers
Severe dyspnea Squatting/knee-chest position when resting
Growth restriction Tet spells/hypoxic episodes
- Management:
1) Blalock-Taussig procedure – no BP & venipunctures on right arm after

procedure
2) Keep hypoxic episode to minimum – O2, squatting/knee-chest, morphine or

propanolol
3) Brock procedure – repair pulmonary stenosis, VSD & overriding aorta
B. Rheumatic Fever – autoimmune that occurs as a reaction to a GABHS infection
Signs & Symptoms (Jones Criteria)
Minor Major
Prolonged PR & QT interval Polyarthritis
Elevated sedimentation rate Erythema marginatum
C-reactive protein Carditis
Leukocytosis Chorea
Arthralgia Subcutaneous nodules
Fever
- Management:
1) penicillin – erythromycin
2) benzathine penicillin IM (Bicillin)
3) Corticosteroid: S/E: hirsutism, round moon face,  susceptibility to infection
4) Phenobarbital & diazepam: for chorea
1) Risk for nonadherance to drug therapy
Drug level must be maintained for 10-14 days
Prophylactic antibiotic therapy for atleast 5 yrs after initial attack
& when having dental or tonsillar surgery
C. Kawasaki Disease – mucocutaneous lymph node syndrome
> vasculitis is the principal & life threatening finding because it can lead to MI or aneurysm
Criteria for Diagnosis of Kawasaki Disease
1. Fever 5 days duration

2. Bilateral congestion of ocular conjunctivae
3. Changes of mucous membrane of URT (red pharynx, lips;
“strawberry tongue”)
4. Changes of peripheral extremities (peripheral erythema
& edema, desquamation of palms & soles)
5. Rash – truncal, polymorphous
6. Cervical lymph node swelling
- Management:
1) aspirin or ibuprofen
2) abciximab – platelet receptor inhibitor
3) IV Ig
4) Avoid steroids -  aneurysm formation
1) Risk for Ineffective Peripheral Tissue Perfusion
Observe for signs of heart failure – tachycardia, dyspnea, rales & edema
Inspect extremities for color & warmth
Check capillary refill
2) Pain r/t swelling of lymph nodes & inflammation of joints
Provide rocking & holding
Protect edematous areas from pressure
Keep child free from heavy blankets or clothing
Use a soft padded toothbrush for brushing
IV. Hematologic Disorders
A. Sickle Cell Anemia – presence of abnormally shaped RBCs
> autosomal recessive inherited disorder
- S/Sx: Fever Protruding abdomen Vomiting
Swelling of hands & feet Yellowed sclera Enlarged liver
Enlarged spleen Acute back pain
* Sickle Cell Crisis: sudden, severe onset of sickling
> occurs when dehydrated or w/ respiratory infection that results in lowered O2

exchange & low arterial O2 level or after extremely strenuous exercise
- Management:
1) Pain relief – acetaminophen
2) Adequate hydration
3) Oxygenation
4) Hydroxyurea
5) Exchange transfusion
1) Ineffective Tissue Perfusion r/t generalized infarcts due to sickling
O2 therapy
Bed rest
B. Thalassemia Major/Cooley’s anemia – autosomal recessive anemia associated with abnormal

beta chains of adult hemoglobin
Effects of Thalassemia Major
Body Organ or System Effect
Bone Marrow Increased facial mandibular growth
Skin Bronze colored
Spleen Splenomegaly
Liver & Gallbladder Cirrhosis & cholelithiasis
Pancreas Destruction of islet cells & DM
Heart Failure from circulatory overload
- Management:
1) digitalis, diuretics, low sodium diet
2) Transfusion of packed RBC
3) deferoxamine – remove excess Fe

C. Hemophilia
1) Hemophilia A – factor VIII deficiency
> sex linked recessive trait
- S/Sx: Extremely bruised lower extremities when bumped
Swollen & warm joints
- Management:
a) Fresh whole blood or frozen plasma
b) desmopressin
2) Von Willebrand’s Disease/Angiohemophilia – inherited autosomal dominant
> with factor VII defect (platelets unable to aggregate)
- S/Sx: epistaxis (major problem)
heavy menstrual flow
- Management:
a) arginine desmopressin
3) Christmas Disease – or Hemophilia B; factor IX deficiency
> sex linked recessive trait
4) Hemophilia C – factor XI deficiency
> or thromboplastin antecedent deficiency
> autosomal recessive
V. GastroIntestinal Disorders
A. Cleft Lip – fusion of maxillary and median nasal processes fail
> normal: fuse between 5-8 weeks intrauterine life
> more common among boys
Cleft Palate – closes at 9-12 weeks intrauterine life
> involves anterior hard palate and/or posterior soft palate
> more common among girls
- Management:
Cleft Lip: Cheiloplasty between 6-12 weeks
Cleft Palate: Uranoplasty between 1-2 y/o
1) Risk for Imbalance Nutrition, less than body requirements r/t feeding problems
*Cleft lip
Support baby in upright position and feed gently using commercial cleft lip
nipple (Breck feeder or Haberman)
Breastfeed 7-10 days after surgery
Bubble well the infant after feeding
Offer sips of fluid between feedings (keeps mucous membrane moist & prevents cracks
& fissures)
*Cleft palate
Commercial cleft palate nipple with rubber
Offer soft food (if surgery is delayed beyond 6 mos)
2) Risk for Ineffective Airway Clearance r/t oral surgery

Suction (be gentle, don’t touch suture lines)
3) Impaired Tissue Integrity at incision line r/t surgery
*Cleft lip
Turn infant lateral to the repair or on back (to prevent pressure on suture line)
Suture line is held by a Logan bar
Avoid infant crying as much as possible
*Cleft Palate
Keep elbow restraints
No spoon & straw during feeding
Keep on prone position
B. Tracheoesophageal Atresia & Fistula – trachea & esophagus are connected
Esophageal Atresia – obstruction of the esophagus
- Cause: Teratogens
- S/Sx: 3C’s
Coughing
Cyanosis
Choking
- Management:
1) Surgery – prevent pneumonia & dehydration
> close fistula & anastomose esophageal segments
> observe closely for 7-10 days to check for leaks

2) Gastrostomy – empty secretions & prevent reflux into the lungs
1) Risk for Imbalance Nutrition, less than body requirements
Gastrostomy feeding
 after feeding: keep the end of the tube elevated with covered sterile gauze
2) Risk for Infection r/t aspiration
PreOp: position in an upright position or on right side to prevent gastric juice from
entering the lungs
Frequent oropharyngeal suctioning
Keep infant from crying
Post Op: suction shallowly
Turn frequently
C. Gastroesophageal Reflux – called achalasia in infants
> cardiac sphincter & lower portion of the esophagus are lax & allow easy regurgitation
- S/Sx: Effortless vomiting
Irritable
Episodes of apnea
- Management:
1) Formula thickened rice cereal – 1 tbsp cereal/1 oz formula or breast milk
> hold infant in upright position & keep them upright in an infant chair for 1 hour
2) ranitidine or omeprazole
3) Tightening/suturing of esophageal sphincter

4) Fundoplication
5) Do not lie down 2 hrs after eating
D. Pyloric Stenosis – hypertrophy of the muscle surrounding the pyloric sphincter
- S/Sx: Projectile vomiting immediately after feeding - sour, no bile
Dehydration – lack of tears, dry mouth, sunken fontanels, fever,  urine output, poor
skin turgor, weight loss
Alkalosis
Hypopnea – slowed respiration
Olive shaped mass
- Dx: Barium Swallow
- Management:
1) Pyloromyotomy – electrolyte imbalance, dehydration & starvation must be corrected first
2) No oral feedings
1) Risk for Fluid Volume Deficit r/t inability to retain food
Monitor weight & urine output
E. Intussusception – invagination of one intestine to another
- Causes: Meckel’s diverticulum Hypertrophy of Peyer’s patches
Polyp Bowel tumors
- S/Sx: Sudden drawing up of legs & cry because of pain
Vomiting – with bile

Currant jelly stool
Abdominal distention
Sausage shaped mass (URQ)
- Management:
1) Surgery
2) Instillation of water soluble solution, barium enema or air (pneumatic insufflation)
- Nursing Diagnosis:
1) Pain r/t abnormal abdominal peristalsis
2) Risk for Fluid Volume Deficit r/t bowel obstruction
F. Celiac Disease – sensitivity or abnormal immunologic response to gluten found in BROW (barley,
rye, wheat & oat)
- S/Sx: Steatorrhea Abdominal distention
Vit ADEK deficiency Malnutrition
- Management:
1) Gluten free diet for life
2) Water soluble forms of Vit A & D
3) Fe & folate
1) Imbalanced Nutrition, less than body requirements r/t malabsorption of food
Record characteristics of stools
Read food labels carefully

Avoid spaghetti, pizza, hotdogs, cake, cookies
G. Hirschsprung’s Disease/Aganglionic megacolon
> absence of ganglionic innervation to the muscle of a section of the bowel
> no peristaltic waves
- S/Sx: Chronic constipation Abdominal distention
Ribbon like stools Failure to pass meconium by 24 hrs
1) Constipation r/t reduced bowel function
Normal saline for enemas: 2 tsp noniodized salt + 1 quart water
2) Imbalanced Nutrition, less than body requirements
No fried foods & highly seasoned foods
Post Op: assess for bowel sounds & passage of flatus
H. Imperforate Anus – stricture of the anus
- S/Sx: Abdominal Distention
Membrane filled w/ black meconium protruding from anus
Failure to pass meconium in the 1st 24 hrs after birth
Absent “wink” reflex
Stool in vagina or urine

1) Imbalance Nutrition, less than body requirements r/t bowel obstruction and inability for
oral intake
NGT to relieve vomiting & pressure to abdominal organs
Low residue diet (rice cereal, strained fruits & vegetables)
2) Impaired Tissue Integrity at rectum r/t surgical incision
Avoid rectal temperatures, enemas, suppositories
Clean suture lines with normal saline after bowel movements
Place diaper under, not on, the infant to cleanse at once the bowel movements
Place in side lying position to avoid tension in the perineal area
Rectal dilatation 1x or 2x/day
VI. Urinary Tract Disorders
A. Hypospadia – urethral opening is on the ventral (lower) aspect of the penis
Epispadia – opening is on the dorsal surface of the penis
- S/Sx: Cobra head appearance
Cryptorchidism
- Management:
1) No circumcision – portion of foreskin may be used during repair
2) Meatotomy
3) Injectable testosterone – for penis growth
B. Glomerulonephritis – inflammation of glomeruli that occurs as a immune complex disease after

GABHS infection
- S/Sx: Hematuria Reddish brown/Smoky urine Hypertension
Proteinuria Oliguria Abdominal pain
Fever Edema Prolonged PR interval
Vomiting Headache T wave inversion
Anorexia
- Management:
1) furosemide
2) Semi fowlers, digitalization & O2 – if w/ heart failure
3) Ca channel blockers
4) Kayexalate – for  K & Phosphate
5) Normal salt & protein diet
6) Weigh child daily
C. Nephrotic Syndrome – abnormal loss of protein from the urine due to altered glomerular
permeability
- Causes: Antigen-Antibody reaction
Autoimmune
T lymphocyte dysfunction
- S/Sx: Proteinuria Hypoalbuminemia
Edema Hyperlipidemia
- Management:
1) Corticosteroids – monitor protein loss
> can cause cushingoid appearance (moon face, extra fat at base of neck,  body hair)
> do not stop abruptly: can cause adrenal insufficiency
2) cyclophosphamide (Cytoxan)
3) Diuretics & K supplement
- Nursing Diagnosis with Intervention:
1) Imbalanced Nutrition, less than body requirements r/t poor appetite & protein loss
Good protein & potassium intake
Monitor fluid intake
Monitor weight daily (same clothing, time & scale)
Comparison of Features of AGN & Nephrotic Syndrome
Factor AGN Nephrotic Syndrome
Cause Immune reaction to GABHS Idiopathic; Hypersensitivity rxn
Onset Abrupt Insidious
Hematuria Profuse Rare
Edema Mild Extreme
Hypertension Marked Mild
Hyperlipidemia Rare or mild Marked
Peak age frequency 5-10 y/o 2-3 y/o
Interventions Limited activity; Corticosteroid; cyclophosphamide;

antihypertensives; symptomatic diuretics; K supplement
therapy for CHF
Diet Normal for age High protein, low sodium
Prevention Prevention or thorough tx of None known

GABHS infection
VII. Endocrine or Metabolic Disorders
A. PKU – autosomal recessive
> no phenylalanine hydroxylase:  phenylalanine in the blood
- Dx: Guthrie blood test
- S/Sx: Mousy odor Light blonde hair
Very fair skinned Blue eyes
- Management:
1) Lofenalac – low phenylalanine formula
2) Low protein diet
3) Avoid Nutrasweet – w/ aspartane
B. Cystic Fibrosis – w/ generalized dysfunction of the exocrine glands
> autosomal recessive trait
- Dx: Pilocarpine Iontophoresis: 60 mEq/L (+ Cystic Fibrosis)
- S/Sx: Tenacious secretions in pancreas & lungs
 Cl concentration of sweat – salty perspiration
Blocking of the vas deferens (tenacious seminal fluid)
Thick cervical secretions
Steatorrhea
Meconium ileus
Malnutrition
Fat soluble vitamin deficiencies
Respiratory acidosis
1) Risk for Imbalance Nutrition, less than body requirements r/t inability to digest fat
High calorie, high protein, moderate fat diet
Adequate salt intake
Water miscible Vit. A, D, E
Breastfeeding w/ supplemental formula – soybean formula for milk allergy or

Probana
Take synthetic pancreatic lipase (Cotazym or Pancrease) with meals or within 30 minutes
of eating
 add to a teaspoonful of food, no hot foods, don’t add to formula milk

Offer water frequently
Guard against overexertion or heat exposure
2) Ineffective Airway Clearance r/t inability to clear mucus
Nebulization or aerosol therapy then CPT
Humidified O2
Add acetylcysteine (Mucomyst) to mist
No cough suppressants
Frequent reposition
Bed rest – plan activities & rest period b4 meals

ESSENTIAL NEWBORN CARE

DESIGNED BY: DOH
FOLLOWING INTERNATIONAL STANDARDS OF: WHO
UNDER THE UMBRELLA: UNANG YAKAP
IMMEDIATE INTERVENTIONS/TIME BOUNDED
STEP ONE Immediate drying

Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back, arms and legs.
STEP TWO Uninterrupted skin-to-skin contact

Aside from the warmth and immediate bonding between mother and child, it has been found that early skin-to-
skin contact contributes to a host of medical benefits such as the overall success of breastfeeding/colostrum
feeding, stimulation of the mucosa—associated lymphoid tissue system, and colonization with maternal skin
flora that can protect the newborn from sepsis and other infectious disease and hypoglycemia.
STEP THREE Proper cord clamping and cutting

Waiting for up three minutes or until the pulsations stop is found to reduce to chances of anemia in full term
and pre-term babies. Evidence also shows that delaying cord clamping has no significant impact on the mother.
STEP FOUR Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-
in.
The earlier the baby breastfeeds, the lesser the risk of death. Keeping the baby latched on to the mother will
not only benefit the baby (see skin-to-skin contact) but will also prevent doing unnecessary procedures like
putting the newborn on a cold surface for examination (thereby exposing the baby to hypothermia),
administering glucose water or formula and foot printing (which increases risk of contamination from ink
pads) and washing (the WHO standard is to delay washing up to 6 hours; the vernix protects the newborn from
infection). On the other hand, necessary actions such as eye care, vitamin K administration must be timed. Eye
care must be done after the infant has located the mother’s breast.
NON-IMMEDIATE/NON-TIME BOUNDED
1. EYE CARE ( CREDES PROPHYLAXIS)

2. IMMUNIZATIONS (BCG/HEP B)
3. VITAMIN K ADMINISTRATION (IM/PO)
4. WEIGHING
5. WASHING

Nle MCN Road To Success

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COPYRIGHT: JONAS MARVIN ANAQUE , RM , RN

OBSTETRICS and GYNECOLOGY with ethics and Jurisprudence

Republic Act 8981- "PRC Modernization Act Of 2000

Powers of the board

 Epikia – There is always an exemption to the rule

 FSH RELEASE OF FOLLICLES and estrogen

 Lordosis, back ache and waddling gait – Relaxin hormones

 Cramps in pregnancy – CALCIUM DEFICIENCY, DORSIFLEX FOOT EXTEND KNEE

 TT1- ASAP/20wks-**no protection (0% and 0 year)

 Itchy genitalia or vagina is Vulvovaginitis

 Pituitary gland - produces FSH,LH,

 QUICKENING— 16(multi).& 20wks ( primi)

 Menopause is climacteric or change of life

Treatment of Diaper rash

 small, whitish, pinpoint spots over the nose- Milia

 Wash the perineum with water, pat it, and dry.

 normal cry of the newborn – loud Lusty vigorous , frequent

 high pitch cry – neurological abnormalities- refer the baby

 10 steps - steps to a successful breastfeeding (criteria in the accreditation of a mother-

 milk production influence by- Prolactin

 Incompetent nurse – 0-3 apgar score of baby

 Cutis marmorata is mottling or purple discoloration of the skin. It’s a transient

CHILD HEALTH NURSING

Growth and Development

I. Growth – increase in physical size of the body (quantitative change)

B ody systems don’t develop at the same rate

D evelopment proceeds from proximal to distal

E levation from gross motor to refined skills

F or play is the universal language of children

G rowth rate varies

H as to follow a definite and predictable pattern of trends

I mportant indicator of development is the behaviour

J ust as each child is unique

III. Stages of Growth & Development

Basic Divisions of Childhood

Neonate first 28 days of life

 Fear : Separation Anxiety

C. Pre school period

 Stage 3: 7-10 years old

IV. Maternal-Infant bonding

 assess gross anomalies

B. Apgar Screening test (by Dr. Virginia Apgar)

HR: absent <100 >100

RR: absent weak cry vigorous cry

Reflex Irritability: no response grimace vigorous cry

Muscle tone: limp/flaccid minimal full flexion

Skin color: blue acrocyanosis pink

1-3 Poor - needs immediate CPR

C. Estimation of Age of Gestation by Dr. Ballard’s and Dubowitz

Pre-mature Term Full-term

Lanugo: Abundant thinning bald

Breast: strippled areola raised areola full areola

Genital (M): undescended testes intermediate fully descended

Pre-mature Full term

Posture: extension flexion

Square window: 90° angle 0° angle

Arm recoil: >90° angle <90° angle

Scarf sign: elbow passed midline not passed

Polpliteal angle: >90° angle <90° angle

Heel to ear: positive negative

 Palmar grasp: elicited by placing finger in the NB palm

VI. Profile of a Newborn

BW: doubles at 6 months