MMEDATE CARE OF THE

NEWBORN
Mrs. Aurisita M. Delos Reyes, RN, MAN
Establish and maintain patency of the
airway
8uctioning
= duration- 5-10 sec or < 5 secs in preterm
= mouth before nose
W !ositioning
W = 8light trendelenburg
W = 8ide lying
W !urposes
W promotes drainage of secretions
W prevents increase C!
W R side lying- increase pressure L side of the heart
which favor the closure of Ductus Arteriosus and
Foramen Ovale
W !romotes gastric emptying thereby prevent reflux
of gastric contents and aspiration
W = 8upine {recommended for infants above 3 mos. _
W = !rone- { maybe a cause in 8D8 _
.
W Maintain appropriate
temperature
W = Temp of the NB at birth-
36.4- 37.2 o C
W = usually unstable and takes
6-8 hours to stabilize
Factors affecting
temperature of the NB
W 1. The thermoregulating center is
immature
W 2. 8hivering mechanism of the NB is
underdeveloped.
W 3. nadequate adipose tissues
{Brown fat_
W 4. Neonates are prone to heat loss
thru evaporation, radiation,
convection, and conduction.
NUR8NG MANAGEMENT:
W 1. DRY THE 8KN
W 2. WRA! THE NEWBORN
W 3. EX!O8E TO DRO!LGHT
W 4. CUDDLNG, HUGGNG,
EMBRACNG
complications
W 1. HY!OGLYCEMA results from
utilization of glucose in the form
of glycogen
W Normal blood sugar-
W 35 - 60 mg%
2. METABOLC ACDO88-
breakdown of fats- accumulation
of fatty acids
3. RE8!RATORY D8TRE88
.
W !romote adequate circulation
W Factors that influence
circulatory changes after
birth
W Lung expansion
W Cutting of the umbilical cord
LUNG EX!AN8ON=
W ncrease pressure in the LEFT
side Heart
W Closure of fetal structures
{Foramen ovale and Ductus
Arteriosus_
Nursing care:
W 1. stimulate to cry
W =except if !reterm { Conserve
energy_
W 2. proper position
W 3. administer NDOMETHACN
as ordered
Cutting of the umbilical
cord
W Decrease pressure in the RGHT
side of the Heart
W Closure of the DUCTU8
VENO8U8 and UMBLCAL
BLOOD VE888EL8
V.
W Bonding- a special mutual
relationship between mother
and infant. deally started on
the FR8T !EROD OF
REACTVTY.
METHOD8:
W 1. BREA8TFEEDNG
W = immediately after birth
W 2. EYE TO EYE CONTACT
W = Crede's !rophylaxis maybe
delayed for 2 hours
W 3. ROOMNG- N
W 4. HUGGNG, CUDDLNG, and
EMBRACNG
!UR!O8E8 OF
BREA8TFEEDNG
W 1. BONDNG
W 2. FACLTATE8 RELEA8E OF
COLO8TRUM AND BREA8T MLK
W 3.8TMULATE8 !RODUCTON OF
!ROLACTN AND OXYTOCN
W 4.8TMULATE8 GA8TROCOLC
REFLEX FACLTATNG EARLY and
MORE FREOUENT DEFECATON
THU8 !REVENT JAUNDCE
V.
W A88E88MENT TOOL8
W Apgar 8creening Test - authored by Dr.
Virginia Apgar
Done twice at 1 and 5 min. respectively
W !urposes:
W 1. To determine the
degree of acidosis and the need for
C!R
W 2. To evaluate ability of
the NB to ad]ust extrauterinely and
the prognosis
CRTERA
CRTERA:
W 0
W A!!EARANCE- BLUE
W !R- AB8ENT
W GRMACE- NO RE8!ON8E
W MU8CLE TONE- LM!
W RE8!RATON- AB8ENT
W ONE
W ACROCYANOTC
W < 100
W GRMACE
W 8OME FLEXON
W WEAK CRY
W TWO
W COM!LETELY !NK
W 100
W 8TRONG CRY,8NEEZE, COUGH
W ALL FLEXED
W 8TRONG CRY
NTER!RETATON
W 0-3=
W !OOR,8EROU8,8EVERELY
DE!RE88ED; C!R
W 4-6
W FAR,GUARDED, MODERATELY
DE!RE88ED
W NEED8 8UCTONNG & FURTHER
OB8ERVATON
W 7-10
W GOOD, HEALTHY
8LVERMANN AND
ANDER8ON
W !UR!O8E:
W TO DETERMNE THE DEGREE OF
RE8!RATORY D8TRE88
W HGH R8K BABE8
W A8 NECE88ARY
W CRTERA:
W NA8AL FLARNG
W U!!ER AND LOWER CHE8T
W X!HOD RETRACTON8
W EX!RATORY GRUNT
W NTER!RETATON:
W 0-3
W Good or healthy; no respiratory
distress
W 4-6
W Fair, Guarded with mild respiratory
distress
W 7-10
W !oor, serious with severe respiratory
distress
Dubowitz/Ballard Exam
for Gestational Age
W Neuromuscular
NeuromuscuIar
!HY8CAL MATURTY
W !REMATURE
W 8KN
W GELATNOU8, TRAN8!ARENT, V8BLE BLOOD
VE88EL8
W EAR CARTLAGE
W AB8ENT/ !LABLE
W BREA8T NODULE
W 1-2 mm
W GENTAL8
W MALE- TE8TE8- UNDE8CENDED
W 8CROTUM- LE88 8WOLLEN, FEW RUGAE
W FEMALE- CLTOR8 AND MNORA- !ROMNENT
W 8OLE CREA8E8- ANETROR TRAN8VER8E
W LANUGO
W ABUNDANT
TERM
W 8MOOTH, !NK,8U!ERFCAL
CRACKNG, LE88 V8BLE VEN8
W FORMED AND FRM WTH N8TANT
RECOL
W 3-5 mm
W !ARTALLY DE8CENDED
W MORE 8WOLLEN AND RUGAE
W !ARTALLY COVERED BY MAJORA
W 2/3 OF THE 8OLE WTH CREA8E8
W LE88 LANUGO
!O8T TERM
W !ARCHMENT,DEE! CRACKNG,
DE8OUAMATE8, NO V8BLE BV
W THCK CARTLAGE AND 8TFF
W 6 TO 10 mm
W FULLY DE8CENDED; !ENDULOU8
W MARKED 8WOLLEN; EXTEN8VE RUGAE
W MAJORA COM!LETELY COVER8 MNORA
and CLTOR8
W ENTRE 8OLE with CREA8E8
W NO LANUGO
MATURTY RATNG
8CALE
W TOTAL 8CORE AOG {weeks_
W -10 20 weeks Below 35= !RETERM
W - 5 22
W 0 24 35-45 = TERM
W 5 26
W 10 28 ABOVE 45= !O8TERM
W 15 30
W 20 32
W 25 34
W 30 36
W 35 38
W 40 40
W 45 42
W 50 44
V.
W DENTFCATON- preferably
in the presence of the parents
W = include: Double banding
W Finger and footprints
W Birthmarks-
HEMANGOMA
8TRAWBERRY MARK8
8TRAWBERRY MARK8-
{Nevus vasculosus_
W Elevated areas formed by
immature capillaries and
endothelial tissues
W !ORTWNE 8TAN8-{Nevus
Flammeus _
W a macular purple or dark red lesion
or patches
W Can be seen face, buttocks, thigh
and genitals
TELANGECTA88 NEV
W =flat , red areas of capillary
dilatation commonly seen at the
glabella, upper eyelid, and
upper lip
!ORTWNE
8TAN8{Nevus
Flammeus_
COMMON MARK8
{not to be use in D_
W MONGOLAN 8!OT8
Mongolian spot
W Bluish, greenish black, gray
patches
W = caused by accumulation of
melanocytes
W = seen at shoulder, upper arm,
back and buttocks
W = disappears at in a year { white
skinned _
W = pre-school { dark skinned _
MLA
MLA
W = white spots caused by
clogged sebaceous glands
W = disappears in 2 weeks
LANUGO
W = fine downy hair
W = seen upper arm, shoulder and
back
W = common characteristic of
premature babies
VERNX CA8EO8A
VERNX CA8EO8A
W = white cheesy substance seen
in areas like back, armpit,
inguinal, and buttocks
W = serves as protection from
infection and acts as insulator
NEWBORN
RA8H/FLEABTE RA8H {
Erythema Toxicum_
ERYTHEMA TOXCUM
W =pink papules with
superimposed vesicles
W =common at the face, back and
buttocks
W = self limiting
DE8OUAMATON
V. Care of the NB in
the nursery
W A. Recheck identification
W B. Check for anal patency
W nsert thermometer { 1 in._ per
anus
W C. 8pecial Care
W 1. nitial Bath
W A. H20 with non-alkaline based soap-
to prevent destruction of acid mantle
of the skin
W B. Oil- spread vernix caseosa
W C. Antimicrobial solution
2. Cord Dressing
W !ractice strict aseptic technique {
surgical asepsis_
W Apply sterile clamp- to prevent
OM!HALANGA
W Maybe remove after 24- 36 hours
W Apply antiseptic solutions
W Betadine- prevent Tetanus
Neonatorum
W Alcohol { 70 % _- keep dry and
prevent OM!HALT8
W EX!O8E { keep uncovered_
CREDE'8 !RO!HYLAX8
W Application of ophthalmic medication to
prevent O!HTHALMA NEONATORUM
W Medications:
W 1. 8ilver Nitrate-
W One percent
W 1 drop/eye
W Lower con]unctival sac
W 2.Ointments:
W Terramycin
W Gentamycin
W Erythromycin
W !enicillin
VTAMN K NJECTON
W TO !REVENT BLEEDNG
W DO8E =1 mg Term
W .5 mg !re term
W Route: M
W 8ite: Thigh muscles
W Vastus lateralis
W Rectus Femoris
ANTHRO!OMETRC
MEA8UREMENT8
W BRTHWEGHT- 2.5- 3.4 kg or 5.5-7.8
lbs
W BRTHLENGTH- 48-54 cm or 18-22
im
W HEAD CRCUMFERENCE- 33-35 cm
or 13-14 in
W CHE8T CRCUMFERENCE- 31-33 cm
or 12-13 in
W ABDOMNAL CRCUMFERENCE- 29-
31 cm or 11-12 in
X. VTAL 8GN8
W RR- 80 breaths/min at birth;
stabilize bet. 30-60 breaths/ min
W = rapid, irregular, with normal
physiologic apnea of <15 sec.
per min
W = shallow but quiet
W = abdominal and diaphragmatic
W !R- 180 beats per min
W = stabilizes between 120-160 bpm
W = rapid and irregular
W = usually increased when crying and
low if asleep
W = sites= Apical pulse
W Brachial
W Femoral- if weak or absent
suggest COA
W !edal
TEM!ERATURE
W BLOOD !RE88URE-
W = 80/46 mmHg at birth
W = at 10 days maybe 100/50
mmHg
W = higher in the LE and lower in
the UE
W = maybe by Doppler or Flush
methods
X. !HY8CAL
A88E88MENT
W HEAD
FONTANEL8
FONTANEL8
W TY!E8:
W 1. !ARED
W = ANTEROLATERAL {
8!HENOD _
W = !O8TEROLATERAL { MA8TOD
_
W 2. 8NGLE
W = ANTEROR { BREGMA _
W = !O8TEROR { LAMBDA _
CHARACTER8TC8:
W ANTEROR FONTANEL8
W = diamond shape
W = 3-4 cm long and 2-3 cm width
W = if 5cm maybe a sign of
HYDROCE!HALU8 and
CRETN8M
W = it closes 12 to 18 months
!osterior fontanel
W Characteristics
W Triangle in shape
W Located between lambdoidal and
sagittal sutures
W Measures 2 cm long and 1 cm
wide
W Closes between 2 to 3 mos
CA!UT 8UCCEDANEUM
CE!HALHEMATOMA
CA!UT 8UCCEDANEUM
W 8welling of the scalp
W Cause= prolong labor
W Characteristic= crosses the
suture line
W thereby affect both sides
W Disappears = 2 to 3 days
cephalhematoma
W =collection of blood caused by
rupture of periosteal capillaries
W Due to ncrease pressure of
birth
W =does not cross suture line
W =affects one side
W =disappears 3 to 4 weeks
craniotabes
W Localized softening of the
cranial bones
W Cause= early lightening {
descent of the presenting part
in the pelvic brim _
W Common to firstborn babies
W Disappears 6 weeks
MOLDNG
craniosynostosis or
craniostenosis
W !remature closure of the
fontanels and sutures
W Complications
W 1. NCREA8E C!
W 2. MENTAL RETARDATON
W 3. BRAN HERNATON
W 4. DEATH
B. Face
W Assess for symmetry
W =if absent BELL'8 !AL8Y or FACAL
NERVE !AL8Y
W =Caused by forceps delivery
W =disappears after 24 hours
W =8GN8 and 8YM!TOM8
W Asymmetrical face
W nability to open eye in the affected
side
W Drooling of saliva
W Uneven opening of the mouth
W Difficulty in sucking
management
W Feed baby with droppers and
syringe and connect to
artificial nipple
W RATONALE: TO !REVENT
!REMATURE D8A!!EARANCE
OF THE 8UCKNG REFLEX
EYE8
W =maybe slate blue or gray
W =pupils equal, round, reactive to light
and accomodation
W = if keyhole COLOBOMA
W = lacrimal duct= immature { tearless _
W TE8T x BLNDNE88
W 1. DOLL'8 EYE
W 2. GLABELLAR' TA! TE8T
W = best done first ten days
COLOBOMA
EXOTRO!A
8TRAB8MU8
E8OTRO!A
8TRAB8MU8
MANAGEMENT
W mmediate treatment for non
physiologic strabismus
W 1. Occlussion therapy
W 2 8urgery- 8OUNT Operation
W 3. Corrective Glasses
W 4. Laser therapy
EAR8 {!NNA _
A88E88MENT
W Note: if set lower- abnormal
W Chromosomal defects- Down
syndrome
W = !atau syndrome
W = Edward disease
W Kidney defects
W Craniofacial defects
DOWN
8YNDROME/TR8OMY 21
W Cause = unknown
W !redisposing factor=ADVANCE
!ARENTAL AGE
W Basic defect= presence of three { 3_
chromosome 21 { trisomy _
W Total no. 47
W Dx tests
W 1. Alpha feto protein = low
W 2. Chorionic villi sampling
W 3. Karyotyping
W LFE 8!AN= VARABLE
CHARACTER8TC8
W Microcephaly
W Low set ears
W 8addle nose
W 8mall mouth with large tongue {
macroglossia _
W 8hort neck
W 8hort and stubby digits with single
transverse line { 8MAN CREA8E _
W Hypotonic musculature
W !rotuberant abdomen
W 8mall penis with undescended testes {
Cryptoorchidism _
W MENTAL RETARDATON
COMMON !ROBLEM8
W 1. CARDAC DEFECT8
W 2. GT DEFECT8- E8O!HAGEAL
ATRE8A
W 3. GUT DEFECT8
CRANOFACAL DEFECT
NO8E
nose
W Assess nasal flaring/ respiratory
distress
W Causes
W 1. OB8TRUCTON
W A. secretions
W B. bone or membrane
W Commonly blocking the choana
or posterior nares CHOANAL
ATRE8A
W 2. LACK OF 8URFACTANT
RE8!RATORY D8TRE88
8YNDROME
=also known as HYALNE
MEMBRANE D8EA8E
cause: unknown
!redisposing factors:
1. !rematurity
2. LBW/ 8GA
3. Born C8
4. LGA
MANAGEMENT
W 1. C!A!/ C!!B{ Continues + a
W Airway !ressure_ aims to keep alveoli open thus prevent
atelectasis
W 2. O2 therapy- kept at 40 % to prevent blindness {
Retrolental Fibroplasia _ and Emphysema {
Bronchopulmonary Dysplasia _
3. NCUBATON= purposes
a. !rovide warm environment to conserve energy
= temp- 34.4oC and humidity 55-65%
b. !revent nfection thru Reverse solation
4. Medications:
a. 8teroid { Betamethasone _= promote surfactant
maturation
b. 8urfactant { Beractant _ given intratracheal
c. Na HCO3- correct acidosis
d. Gamma/ mmunoglobulin
W 4. MNMAL HANDLNG
W 5. TOUCH THERA!Y
W 6. Watch for Complications like
W a. ANEMA results from smaller mass of
RBC and frequent extraction of blood
W Management: BT with !RBC { 50 ML _
W b. HY!ERBLRUBNEMA managed by
phototherapy and exchange transfusion
W c. MALNUTRTON related to too much
utilization of Oxygen resulting to poor
growth and development
W Management:
W 1. T!N
W 2. Gavage
W 3. Breastfeeding
Factors affecting
prognosis
W 1. AGE
W 2. AVALABLTY OF
TREATMENT
W 3. RE8!ON8E TO TREATMENT
mouth
W assess
W 1. E!8TEN !EARL8
W White glistening epithelial cysts at the palate and
gums, caused be extra load of Calcium
W 2. TOOTH
W Needs extraction to prevent A8!RATON
W Caused by too much intake of vitamins
W 3. excessive drooling of saliva E8O!HAGEAL
ATRE8A
W 4. CLEFT L! AND !ALATE
W 5. ORAL CANDDA88
vomiting
W Non-pro]ectile- non obstructive
W 1. infection
W 2.chalasia or GERD
W !ROJECTLE- obstructive
W 1. pyloric stenosis
W 2. intussusception
W 3. hirchsprungs disease
neck
W 8hort
W THYROD GLAND- not palpable
W test for CRETN8M -T3 T4 det
W MENTAL RETARDATON
W Tx- 8YNTHROD
CONGENTAL
TORTCOLL8
W = also known as wry neck
W = contraction of the
sternocleidomastoid muscle
W = maybe treated by:
W EXERC8E
W A!!LCATON OF WARM !ACK8
OR COM!RE88
W TENOTOMY- surgical release of
contracted muscle
WTCH MLK
CHE8T
W A88E88 :
W 1. retractions
W 2. Witch milk- colorless or
transparent fluid caused by
maternal hormones
ABDOMEN
W DOME and CYLNDRCAL
W 8CA!HOD- DA!HRAGMATC
HERNA
W LVER= 2-3 cm BELOW RGHT
CO8TAL MARGN
W KDNEY8= 1-2 cm above
umbilicus
W 8!LEEN= left quadrant
Diaphragmatic Hernia
OM!HALOCELE
OM!HALOCELE
W !rotrusion of the abdominal
organs thru the umbilicus
W Usually contained in a sac
W !rone to infection
W Management:
W Cover the defect with sterile
saline dressing and preferably
change every two hours
GA8TRO8CH88
GA8TRO8CH88
W !rotrusion of abdominal organs
thru a defect or a hole in the
abdominal wall
W Very prone to nfection
W Management:
W 1. Reduction !rocess thru a
8ilastic 8ilo
W 2. Use overhead warming unit
W 3. !rophylactic antibiotic
W 2. 8urgery
ANOGENTAL
W THREE TY!E8 OF 8TOOL8
W MECONUM- green black ,
sticky, odorless, passed 4X per
day
W TRAN8TONAL- yellow-green,
slimy, 6X or more
W MLK
W a. Breast fed baby stool
W B. Bottle fed baby stool
BREA8T FED BABY
8TOOL
W Characterisitics:
W Golden yellow
W Mushy and soft
W 8weet odor
W !assed every after breastfeeding
BOTTLE FED BABY
8TOOL
W Characteristics:
W !ale yellow
W Hard and formed
W Offensive, foul odor
W !assed once/ day
M!ERFORATE ANU8
8igns and 8ymptoms
W absence of anal opening
W misplaced anal opening
W anal opening very near the
vaginal opening in the female
W no passage of first stool within
24 to 48 hours after birth
W stool passed by way of vagina,
base of penis or scrotum, or
urethra
W abdominal distention
Treatment: 8urgery
W 8tage : Colostomy { newborn_
W 8tage : !ull thru
W 8tage : Closure of colostomy
Voiding
W =expected to void 6 to 8x on 1
st
24 hours
W = failure may suggest
dehydration or absence of
urinary meatus
W =After 24 hrs= 12 to 20X/ day
W = failure means renal agenesis
GENTOURNARY
DEFECT8
W A88E88:
W 1. LOCATON OF THE URNARY
MEATU8, maybe
W A. Epispadias- urinary meatus
above or dorsal surface of the
penis
W B. Hypospadias- urinary meatus
located at ventral surface or under
penis
W management: MEATO!LA8TY
HY!O8!ADA8
CRY!TOORCHD8M
UNDE8CENDED TE8TE8
COM!LCATON8:
W 1. nguinal Hernia
W 2. Testicular cancer
W 3. 8terility
W Management:
W 1. Hormonal tx- HCG &
TE8TO8TERONE
W 2. ORCHO!EXYor
ORCHDO!EXY
HYDROCELE
ACCUMULATON OF
NTRAABDOMNAL FLUD
N THE 8CROTUM
W TY!E8:
W 1. NON- COMMUNCATNG
W 2. COMMUNCATNG needs
elective repair to prevent
HERNA
W NOTE: Trans illumination may
reveal fluid or loop of intestines
EXTREMTE8
W Assess for symmetrical
movements
W f absent suggests: weakness or
paralysis
W Note the following
abnormalities
W 1. Amelia- absence of entire
limb
W 2. !hocomelia- absence of arms
or legs
!HOCOMELA
ERB8 !AL8Y
ORTOLAN TE8T
ALL8/GALEAZZ
EOUNOVARU8
Management:
W 1. Exercise
W 2. Application of cast
W 3. Arthrodesis
W 4. Dennis Browne application
LEG CA8TNG
Back
W Flat and straight
W Lumbar curve forms at 6 months
W Note for tuft of hair, dimple or
mass
W May indicate 8!NA BFDA
8!NA BFDA
ncomplete closure of the
vertebrae
W Types:
W 1. OCCULTA- HDDEN; no protrusion
of 8pinal contents tho manifested by
tuft of hair, dimple and small mass
W 2. Cystica- with protrusion of the
spinal contents; maybe
W A. Meningocele- protrusion of
meninges and C8F
W B. Myelomeningocele- protrusion of
C8F, Nerve roots, Meninges, and
8pinal cord
W C. Rachischisis- protrusion of 8C and
Meninges
W 1. 8AC at the back
W Management:
W A. !rotect the sac from rupture thru
W = prone with hips abducted and head slightly
elevated
W = apply sterile donut ring
W = cover with sterile saline dressing and
change every two hours
W 2. ncrease C! related to Hydrocephalus w/c
include
W a. MACEWEN- cracked pot sound
W b. BO88NG- protuberant forehead
W c. 8UN8ET- iris lower than sclera
d. bulge and tense fontanel
W e. high pitch and shrill cry
W f. change in LOC
W g. change in V8
management
W 1. proper position
W 2. avoid straining
W 3. regulate flow rate of the V accurately
avoid over infusion
W 4. give drugs as ordered like:
W A. Mannitol- osmotic diuretic
W B. 8teroid- Dexamethasone
W C. Acetazolamide { Diamox _ decreases
production of C8F temporarily
5. f possible avoid L! due to Brain herniation
6. Use or apply protective devices
7. !assive ROM
8. ntermittent straight catheterization to empty
the bladder
9. Avoid constipation
surgery
1. Excision of the sac
2. 8hunting- divert C8F to decrease
and prevent increase C!
a. Ventriculoperitoneal
b. Ventriculo atrial
Note: observe for signs of shunt
malfunction
8HUNTNG
HYDROCE!HALU8
8KN
W Assess the color and marks:
W Note: !NK -{ruddy_ maybe due
to high
W 1. RBC- 4.4 to 7.5 million/mm3
W 2. HGB- 14.5 to 22.5 g/ dl
W 3. HCT- 45 to 65 %
W 4. WBC- 5,000 to 35,000 / mm3
Abnormal skin colors
W 1. BLUE- means HY!OXA
W 2. !ALLOR- means ANEMA
W = maybe due to:
W a. ABO and RH NCOM!ATBLTY
W b. BLEEDNG
W = maybe due to decrease synthesis of
Vit. K
W = deficiency or absence of clotting
factors
W = deficiency or lack of platelets
4. Jaundice
ABNORMAL
1
st
day
1 to 7 days
1 to 14 days
5 mg / day
12 mg
!hototherapy
Exchange
transfusion
NORMAL
2
nd
day
2 to 7 days
2 to 14 days
5 mg/day3
rd
day
8unlight
!hototherapy
REFLEXE8
W 1. MORO
W 2. TONC NECK REFLEX
W 3. GALLANT'8
W 4. 8TE!!NG
W 5. BABN8K
W 6. !LANTAR
W 7. DANCNG
W 8. GRA8!/ !ALMAR
W 9. !ARACHUTE
FEEDNG REFLEXE8
W 1. ROOTNG REFLEX
W 2. EXTRU8ON/ 8!T OUT/
!ROTRU8ON
W 3. 8UCKNG/ 8UCKLNG
W 4. 8WALLOWNG
!ROTECTVE REFLEX
W 1. GLABELLAR'8 / BLNK
W 2. GAG REFLEX
W 3. 8NEEZNG
W 4. COUGHNG
!EDATRC D8EA8E8
CADOVA8CULAR
D8EA8E8
ACYANOTC DEFECT8
VENTRCULAR 8E!TAL
DEFECT
!ATENT DUCTU8
ARTERO8U8
COARCTATON OF THE
AORTA
CYANOTC DEFECT8
DFFERENCE8
W ACYANOTC
W LEFT TO RGHT
W EFFECT8:
W 1. DECREA8E CO
W 2. CHF
W 3. LVH
W CYANOTC
W RGHT TO LEFT
W EFFECT8:
W 1. CYANO88
W 2. DEC. CEREBRAL
AND !ER!HERAL
!ERFU8ON
W 3. !OLYCYTHEMA
W 4. MULT ORGAN
MALFUNCTON
8GN8 AND 8YM!TOM8
W Tiring quickly
W DY8!NEA
W EDEMA
W DA!HORE88
W OLGURA
W GROWTH RETARDATON
W CYANO88 becomes severe with exertion
W 8YNCO!E
W HY!ERCYANOTC 8!ELL8 or TET 8!ELL8
W DAGNO8TC TE8T8
W = CHE8T X-RAY
W =2 D ECHO
W =ABG
W = CARDAC CATHETERZATON
management
W CLO8ED HEART O!ERATON
W O!EN HEART O!ERATON
operates on the principle of:
W 1. Hypothermia- decrease O2
consumption
W 2. Cardiopulmonary bypass-
bloodless field thereby prevent
bleeding and facilitates repair
palliative
W FOR TETRALOGY OF FALLOT
W 1. Blalock Taussig- anastomosis
between subclavian artery and
pulmonary artery
W 2. !otts procedure- anastomosis
between
W Aorta and !ulmonary artery
W 3. Brock- correction of !8 but not
V8D
TOGA {TRAN8!O8TON
OF GREAT ARTERE8_
W 1. BLALOCK HANLON- ENLARGE
W FORAMEN OVALE
W 2. RA8HKND !ROCEDURE-
NTERATRAL BALLOON
8E!TO8TOMY
W 3. !RO8TAGLANDN NFU8ON {
to maintain the Ductus
Arteriosus_
!RNC!LE8 N THE CARE
OF !ATENT WTH
CARDAC DEFECT8
W mprove the efficiency of
cardiac function thereby
increase the cardiac output
W Decrease the cardiac workload
W Decrease edema
W mprove tissue perfusion
GA8TRONTE8TNAL
D8ORDER8
CLEFT !ALATE
CHELO!LA8TY AND
!ALATO!LA8TY
genetic
Folic acid deficiency
8teroid
Exposure to TORCH
W Common problems:
W feeding difficulty
W infections- upper respiratory and ear
W speech defect { cleft palate _
W dental defect { nasal twang _
W altered normal body image
W respiratory distress
!re operative care
W !roper positioning especially during and
after feeding- Upright position
W Burp or bubble the NB more often
W Feed baby with the use of cross cut large
holed nipple or Breck feeder technique
W Observe for signs of complications- Otitis
media, etc
W For dental defects-m Orthodontic
exercise and surgery
W 8peech therapy
!ost operative care
W !roper positioning= !RONE x Cleft palate and
8U!NE or 8DE LYNG x Cleft lip
W Apply elbow restraint and release every 2
hours
W Give feeding with rubber tipped medicine
dropper after Cleft lip and paper cups and soup
spoon after cleft palate
W Cleanse the wound with hydrogen peroxide
W Give post operative meds which include
analgesic and antibiotic
W Avoid sucking, suctioning, blowing, pointed
and sharp ob]ects { spoon, fork, and straw _
W Make sure baby does not suck the LOGAN'8
BAR or BOW
E8O!HAGEAL ATRE8A
W failure of the esophagus to form a
continuous passage between the mouth and
the stomach
W = a congenital defect
W = often associated with other defects
W = assessment include VACTERL
W V- ertebral defects
W A- norectal defects
W C- ardiac like !DA { most common _
W T- rachea and
W E- sophagus
W R- enal defects
W L- imbs
W Cause: unknown but common in children
with Down 8yndrome
8igns and 8ymptoms
W excessive drooling of saliva
W choke after initial feeding
W resistance on NGT insertion
W respiratory distress
W abdominal distention
W cyanosis, tachypnea
W hx of hydramnios { antepartum _
Diagnostic tests: X-rays
W Treatment: 8urgery- depends on
the type of defect
W Creation of gastrostomy and
cervical esophagostomy
W Division of Fistula and
Esophageal Anastmosis
W Closure of the gastrostomy
Nursing care:
W !roper positioning- elevate
head at 20-30 degrees angle
W Regular suctioning
W Administer Oxygen if cyanotic
W Administer T!N- primary
source of nutrition
Total !arenteral
Nutrition or V
hyperalimentation
W = introduction of hypertonic
solution into the 8VC thru a
central line inserted in the
neck, arm, and groin veins
W = the solution contains sugar,
fats ,protein, minerals and
vitamins
ORAL MONLA88
/CANDDA88
NILIASIS/ CANDIDIASIS
W Acquired by the baby during
passage
W Cause: Candida Albicans
W Management:
W Antifungal { Nystatin _ spread with
gloved finger
Diaphragmatic Hernia
W a birth defect resulting to
crowding of the abdominal
organs in the chest cavity thus
leading to collapse of the lungs
W = Two types
W Left sided- BOCHDALEK HERNA
W Right sided-MORGAGN HERNA
8igns and 8ymptoms
W difficulty breathing
W fast breathing
W fast heart rate
W cyanosis {blue color of the skin_
W abnormal chest development, with one
side being larger than the other
W abdomen that appears caved in
{concave_
W A baby born with a Morgagni hernia
may or may not show any symptom
Treatment may include:
W neonatal intensive care
W Mechanical ventilator
W Extra corporeal membrane
oxygenator
W surgery
OM!HALOCELE
GA8TRO8CH88
OM!HALOCELE
W !rotrusion of the abdominal
organs thru the umbilicus
W Usually contained in a sac
W !rone to infection
W Management:
W Cover the defect with sterile
saline dressing and preferably
change every two hours
GA8TRO8CH88
W !rotrusion of abdominal organs
thru a defect or a hole in the
abdominal wall
W Very prone to nfection
W Management:
W 1. Reduction !rocess thru a
8ilastic 8ilo
W 2. Use overhead warming unit
W 3. !rophylactic antibiotic
W 2. 8urgery
!yloric 8tenosis
Narrowing of the pylorus
due to thickening of the
pyloric muscle
W 8igns and 8ymptoms
W 1. pro]ectile vomiting {
maybe bloody _
W 2. visible peristalsis
W 3. palpable olive shaped
mass
W 4. irritable and restless
NUR8NG CARE
W 1. Give thickened formula
W = Rice Cereal and Milk thru gavage
W 2. !revent and correct dehydration
W = V fluids
W 3. Measure and O
W 4. Monitor for Complications such as:
W a. Metabolic alkalosis and acidosis
W b. Dehydration
8urgical mgt
W FREDET RAM8TED !ROCEDURE
W { !YLOROMYOTOMY _
W = separation of the
hypertrophied muscle of the
pylorus without mucosal
incision
W LA!ARO8CO!Y
NTU88U8CE!TON
W = invagination or the telescoping of
the small bowel into the large bowel
W = may occur as early as 3 weeks old
manifested by
W abdominal pain
W pro]ectile vomiting with bile or
fecaloid
W sausage shaped mass
W passage of CURRANT ]elly- bloody
and mucoid stool
DX: LG8 or Barium Enema-
revels a Coiled 8pring or
8taircase sign
W TX: BARUM ENEMA
W 8URGERY: BOWEL RE8ECTON
with END to END ANA8TOMO88
W BOWEL MLKNG
HR8CH!RUNG8
D8EA8E
Hirchsprungs/
Aganglionic Megacolon
W Absence of ganglion nerve cells
resulting to the absence of
peristalsis in the affected
segment
W Accumulation of intestinal
materials leading to
W MEGACOLON
8igns and symptoms:
W non passage of meconium
W vomiting and abdominal
distention
W chronic constipation
W passage of ribbon-like or pellet
stool
W anorexia, shortness of breath
Diagnostic tests:
W Barium Enema
W Rectal exam
W Anorectal biopsy- most reliable
Treatment:8urgery
W Colostomy
W 8wenson and 8oave
W Closure of Colostomy
Nursing care: !re
operative
DaiIy enema- for retention oIive oiI or diIuted antibioti
i for non retention- isotonic saIine soIution
2SmaII but frequent meaIs of Iow residue
3easure abdominaI circumference daiIy
4!osition with head eIevated to ease breathing
5Administer drugs as ordered Ex StooI softeners
6raI hygiene
7!sychosociaI support
8igns and 8ymptoms
W absence of anal opening
W misplaced anal opening
W anal opening very near the
vaginal opening in the female
W no passage of first stool within
24 to 48 hours after birth
W stool passed by way of vagina,
base of penis or scrotum, or
urethra
W abdominal distention
M!ERFORATE ANU8
Treatment: 8urgery
W 8tage : Colostomy { newborn_
W 8tage : !ull thru
W 8tage : Closure of colostomy
MU8CULO8KELETAL
DEFECT8
BELL'8 !AL8Y { FACAL
NERVE !ARALY88 _
W 8GN8 AND 8YM!TOM8
W 1. Assymetrical face
W 2. inability to open eye in the
affected side
W 3. uneven opening of the mouth
W 4. drooling of saliva
CONGENTAL
TORTCOLL8
W = also known as wry neck
W = contraction of the
sternocleidomastoid muscle
W = maybe treated by:
W EXERC8E
W A!!LCATON OF WARM !ACK8
OR COM!RE88
W TENOTOMY- surgical release of
contracted muscle
ERB8 !AL8Y
8GN8 AND 8YM!TOM8
W 1. AB8ENCE OF MORO RERLEX
N THE AFFECTED 8DE
W 2. NCOM!LETE TONC NECK
REFLEX
W 3 DECREA8E 8EN8ORY AND
MOTOR FUNCTON
TREATMENT
W Abduction with external
rotation of the affected arm and
immobilize with FGURE EGHT
or AR!LANE 8!LNT
!HOCOMELA
Management:
W 1. EXERC8E
W 2. Application of LEG cast
W check the following:
W = Color
W = !ulse
W = Temperature
W = Capillary refill
EOUNOVARU8
EOUNOVARU8
W Characterized by:
W = plantar flexion { toes pointing
down _
W = inversion { toes pointing
inward _
W OTHER TY!E8:
W = eversion { toes pointing
outward _
W = calcaneus { toes pointing
upward _
Management:
W 1. Exercise
W 2. Application of cast
W 3. Arthrodesis
W 4. Dennis Browne application
LEG CA8TNG
H!
D8LOCATON/DY8!LA8
A
ORTOLAN TE8T
ALL8/GALEAZZ
!AVLK HARNE88
H! 8!CA CA8T
BRYANT'8 TRACTON
8COLO88
MLWAUKEE BRACE
!O8T HARRNGTON
ROD8 A!!LCATON
8!NA BFDA
ncomplete closure of the
vertebrae
W Types:
W 1. OCCULTA- HDDEN; no protrusion
of 8pinal contents tho manifested by
tuft of hair, dimple and small mass
W 2. Cystica- with protrusion of the
spinal contents; maybe
W A. Meningocele- protrusion of
meninges and C8F
W B. Myelomeningocele- protrusion of
C8F, Nerve roots, Meninges, and
8pinal cord
W C. Rachischisis- protrusion of 8C and
Meninges
HYDROCE!HALU8
W 1. 8AC at the back
W Management:
W A. !rotect the sac from rupture thru
W = prone with hips abducted and head slightly
elevated
W = apply sterile donut ring
W = cover with sterile saline dressing and
change every two hours
W 2. ncrease C! related to Hydrocephalus w/c
include
W a. MACEWEN- cracked pot sound
W b. BO88NG- protuberant forehead
W c. 8UN8ET- iris lower than sclera
d. bulge and tense fontanel
W e. high pitch and shrill cry
W f. change in LOC
W g. change in V8
management
W 1. proper position
W 2. avoid straining
W 3. regulate flow rate of the V accurately
avoid over infusion
W 4. give drugs as ordered like:
W A. Mannitol- osmotic diuretic
W B. 8teroid- Dexamethasone
W C. Acetazolamide { Diamox _ decreases
production of C8F temporarily
5. f possible avoid L! due to Brain herniation
6. Use or apply protective devices
7. !assive ROM
8. ntermittent straight catheterization to empty
the bladder
9. Avoid constipation
surgery
1. Excision of the sac
2. 8hunting- divert C8F to decrease
and prevent increase C!
a. Ventriculoperitoneal
b. Ventriculo atrial
Note: observe for signs of shunt
malfunction
8HUNTNG
prognosis
W Depends on:
W 1. location of the defect- the
lower the defect the better
chance
W 2. Availability of treatment
GENTOURNARY
DEFECT8
W A88E88:
W 1. LOCATON OF THE URNARY
MEATU8, maybe
W A. Epispadias- urinary meatus
above or dorsal surface of the
penis
W B. Hypospadias- urinary meatus
located at ventral surface or under
penis
W management: MEATO!LA8TY
HY!O8!ADA8
CRY!TOORCHD8M
UNDE8CENDED TE8TE8
COM!LCATON8:
W 1. nguinal Hernia
W 2. Testicular cancer
W 3. 8terility
W Management:
W 1. Hormonal tx- HCG &
TE8TO8TERONE
W 2. ORCHO!EXYor
ORCHDO!EXY
HYDROCELE
ACCUMULATON OF
NTRAABDOMNAL FLUD
N THE 8CROTUM
W TY!E8:
W 1. NON- COMMUNCATNG
W 2. COMMUNCATNG needs
elective repair to prevent
HERNA
W NOTE: Trans illumination may
reveal fluid or loop of intestines
NE!HROTC 8YNDROME
JAUNDCE